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ACL- Incidence and Prevention

The Anterior Cruciate Ligament (ACL) is one of four major ligaments (ligaments connect bone to bone) of the knee joint that coordinate function and promote stability of the knee joint. The anterior cruciate ligament (ACL) is the most commonly injured knee ligament. In the United States there are between 100,000 and 200,000 ACL ruptures per year, with an annual incidence in the general population of approximately 1 in 3500, although the actual incidence may be higher. These numbers are steadily on the rise from year to year.

Sports that are more at risk for ACL tears are Soccer, lacrosse, volleyball, and basketball. Females are more likely than males. An estimated 70% of ACL injuries are sustained through non-contact mechanisms, while the remaining 30% result from direct contact. The classic ACL injury occurs during a non-contact event usually when decelerating, stopping suddenly, twisting, cutting, or jumping. Stretching, strengthening, agility work, and PEP programs are all preventative measures to decrease your risk of this injury.

There are many advantages to seeking help and guidance to prevent such a significant injury from occurring. At BREAKTHRU, we have developed a team of skilled Rehabilitation specialists and personal trainers to fit the needs of the individual client to decrease the risk of injury. We make sure that the patient has exceptional biomechanics and functional movement patterns to not only decrease the likelihood of injury, but to enhance the client’s athletic ability. We have a strong relationship between therapy and fitness that enhances the quality of treatment and provides an aspect of health and wellness you do not find at other facilities.

The staff here at BREAKTHRU provides a winning combination to get you back on the field and keep you at the top of your game!

Dr. Kyle Hadden PT, DPT, Cert. MDT, OCS

 

Summer Shape Up


Go ahead, Show Off THIS Summer! 

Breakthru has just released our newest training program that is sure to get you in shape and CRUSHING your goals!

 

This Program is being offered in Medford Taunton Forge only and runs June 19 – August 4

 

Meet the Trainer:  Tim has 26 years of experience as a personal trainer, training athletes, and ‘everyday athletes.”  He is a Nationally Certified Strength and Conditioning Specialists through the National Strength & Conditioning Association (NSCA).  He is Shawnee’s Strength and Conditioning coach and has led Shawnee football and baseball teams to multiple state championships as Assistant Coach.

 

Have Tim and the Breakthru Team help you

achieve your goals WHILE having fun!

 

Attention All Youth Athletes!

Gain Power, Go Faster, Get Stronger, Be BETTER!

Prepare for the upcoming season and stand out amongst the crowd.  

Reach your fullest athletic potential by improving your agility and endurance.  

 

Become a BETTER Athlete!

15 ONE HOUR small group training sessions ONLY $25 each

*restrictions apply, call or stop by for details.

 

 

Meet Tim Welsh: 

Tim is a 1989 Graduate of Gettysburg College with a BA in Health and Physical Education.  He is a nationally Certified Specialist through the National Strength and Conditioning Association (NSCA).
Additionally, he us the Strength and Conditioning coach for the baseball and football teams at Shawnee High School and has coached and trained athletes at all levels from the youth programs to NCAA Division 1 elite athletes.
  • Level 1: 2nd-8th graders
  • Level 2: 9th-12th graders
  • Level 3: Collegiate Level 

Our Summer Program runs from June 19 to August 4. 

Meniscus Injuries: Surgery vs. Physical Therapy

To have surgery or not to have surgery… that is the question? At some point in most of our lives, we will be faced with this difficult decision regarding some injury, ache, or pain we are experiencing. Making informed decisions could be the difference between a pain-free existence or a potentially worse outcome. As physical therapists, we are frequently asked if “surgery is the right option for me?” In my experience, there is no instance where I hear this question more than with knee injuries, specifically, meniscus injuries.

You may be wondering, what the heck is a meniscus?  At its core, your meniscus is a thickened cartilaginous pad between the two joints formed by the femur (the thigh bone) and the tibia (the shin bone), also known as your knee! The meniscus acts as a smooth surface for the joint to move on, serving as a shock absorber, a lubricant, and a joint protector all at once. The anatomical position and make up the meniscus make it a relatively avascular structure, meaning it receives very little blood flow. Why is that important? Well, should you be unfortunate enough to injure or tear your meniscus, it will not simply heal on it’s own, medical intervention will be warranted to help manage your pain and dysfunction.

 

What are my options? Most Orthopedics Physicians will give you two: Arthroscopic Surgery (a Partial Meniscectomy/the removal the damaged tissue) or Physical Therapy. For some of you the answer may seem straightforward… if surgery is an option, why wouldn’t I just have it done? For a few reasons…outside of the cliched “no surgery is a minor surgery” answer. The risks involved with even “minor surgeries” can be significant. Knee surgery specifically has proven to be a catalyst for more problems in the future. Invasive procedures can accelerate the development of Osteoarthritis and degrade the integrity of the knee joint, ultimately increasing chances of future knee pain and even more surgical intervention. Avoiding surgery could extend the life and health of your joint! But don’t fret…more and more evidence has emerged suggesting that the rush to invasive procedures may not necessarily yield better results.

In a recent randomized controlled trial involving nearly 200 symptomatic participants, (>45 years old), it was found that at 6 and 12 month evaluations, pain scores and reports of improvement between a surgical intervention only group and a physical therapy only group were nearly identical. The study additionally reported that nearly 30% of the group eventually classified as a“crossover group,” receiving both surgery and PT. This group showed markedly better improvement when compared to the surgery only group as well. According to their findings, the researchers concluded that attempting a prolonged bout of physical therapy prior to exploring surgical interventions was shown to be equally as effective as immediately opting for surgery. Meaning surgical intervention and PT yielded similar results with PT presenting a fraction of the risks, making it the more highly recommended option.  

Studies like this exist throughout the literature and the evidence continues to remain consistent… physical therapy is the BEST FIRST option with meniscus injuries. The risks of surgery and possible consequences of invasive interventions simply outweigh the reward. Physical therapy presents a low-risk, high-reward option that has been repeatedly proven to be as effective as surgery with a fraction of risk and trauma involved. If bouts of PT are at first ineffective, it may then be time to consider secondary options.

If you take anything from this post, let it be this: Should you ever find yourself in this type situation, take the time to get informed! Ask your physician about your options or consult a physical therapist to see how they can help. It is a decision that could save you from the trauma of surgical intervention while  prolonging the health and integrity of your joints!

 

Make a SPLASH into Recovery

Spring is around the corner! With it comes the opportunity to participate in all of the exciting activities the season affords. Unfortunately, many individuals are unable to take full advantage of this warm weather due to chronic pain or other injuries that causes difficulty with movement and activity.  Being unable to engage in hobbies or activities you are accustomed to can lead to a decreased quality of life.

Thankfully, it is not too late to get back to performing the activities you, or someone you know, once loved. Aquatic Physical Therapy can aid in improving movement, decreasing pain, and restoring function for all daily activities. In this article, we will discuss how there is no better time to dip your toe in and try aquatic therapy at BREAKTHRU.

  • What is Aquatic Physical Therapy? 

Many individuals feel as if they have exhausted all options including physical therapy and must live with their pain.  This is simply not true. Aquatic physical therapy is distinctly different from land based physical therapy. In the water, buoyant forces push the body upwards, effectively causing you to “weigh” less. This results in less impact during activity and a decreased load on the joints, muscles, and bones.  Movement is easier and less painful than on land, and patients are able to perform exercises not possible out of the pool. Additionally, our pools have multiple massaging jets and are kept at a warm 90°F which provides relief to tight muscles, spasms, as well as decreasing pain.  

At BREAKTHRU, exercise programs are constructed individually for each patient to ensure the highest levels of success. The exercise program will be challenging, but manageable for you, and will work specifically to increase your endurance, strength, and flexibility. Most exercises that are performed on land can also be performed in the pool. Our aquatics facility has a plethora of water based exercise equipment including use of dumb bells and flotation devices.

Most notably, we uniquely offer an underwater treadmill that can be remotely controlled to reach the perfect, most comfortable speed for you. The treadmill allows individuals to walk, jog, or run in the water where they “weigh less.” Additionally, we also have the ability to provide gentle resistance through water based currents in the pool.  

At BREAKTHRU, our goal is to provide the highest quality care to patient’s during their path to recovery and fitness. To us, this means one-on-one care with a Doctor of Physical Therapy (DPT) is the utmost importance.  

You will be scheduled with the same PT at every visit which will allow him or her to get to know you and your health condition personally. The entire staff will make sure you are performing exercises correctly with proper form at the right dosage (reps, sets, and durations), as well as taking recommended breaks throughout.  

  • How can I get started?

FREE Screen: If you are unsure if aquatic therapy is right for you, it all starts with your FREE consultation with a Doctor of Physical Therapy. You can set up this FREE meeting at our Mt. Laurel location (Near the Whole Foods and LA Fitness) by calling (856) 722-1044 OR our Medford Fitness location by calling (609) 451-6582

Initial Evaluation: If you or someone you know could benefit from decreasing pain and moving better, you can see a Doctor of Physical Therapy by scheduling an initial evaluation. At the evaluation, your PT will take a detailed history of your condition by asking questions and listening to your story. He or she will then take a look at what impairments you may have (strength, flexibility, pain, motor control).  The process typically takes between 30-45 minute.  You will then meet the friendly staff, be given a tour of the facility, and scheduled for the first session.  

First session: will consist of becoming familiar with the pool, getting to know your physical therapist, and beginning your exercise program. A typical treatment session is around 1 hour in length and allows time for warm up on our underwater treadmill or massaging jets, as well as your exercise program and a cool-down.  At following sessions, your exercise program will be progressed appropriately in accordance with your plan of care and include more exercises that will benefit you.  

  • Who can benefit from skilled aquatic physical therapy?

Arthritis:Arthritis of the hip and knee are one of the most common diagnoses seen for aquatic therapy at BREAKTHRU.  Our patients are able to walk for longer distances on the underwater treadmill without pain. Additionally, physical therapy will strengthen the muscles of the lower leg, thigh, and glutes in order to decrease pain and improve strength. This will help take some of the stress off of your arthritic joint by allowing the muscles to stabilize and absorb force. Osteoarthritis is the most common form seen at our clinic, however water based therapy will improve function in RA as well.

Low Back Pain: Low back pain is the most common diagnosis seen in physical therapy and can cause patient’s difficulty in walking, bending, and lifting items. Additionally, some low back pain may even be felt in the legs and feet.  In the pool, the water can relax the low back muscles and the jets can help de-sensitize an area by providing gentle stimulus to the nerves.  Stretching can be performed in the pool. Additionally, we will work to strengthen the core in the water which will act as a “natural back brace” to strengthen your spine’s support.

 

 

Post Joint Replacement: A large amount of evidence exists through research studies supporting using pool based therapy following total knee arthroplasty (TKA) or total hip arthroplasty (THA). These patients can benefit from water based therapy when cleared by a surgeon. Walking can be performed for longer periods of time with less rests. Most exercises can be performed with decreased pain in the pool, which can provide relief to patient’s looking to get moving sooner. These patients will eventually progressed to land based exercises.

Sports related surgeries:  Athletes who suffer ACL, PCL, or Meniscal injuries requiring surgery are often braced for several weeks. Afterwards, they typically follow a protocol in place by a physician in order to return them to sport safely. Many protocols recommend water based jogging in order to begin loading the joint before beginning these activities on land, however most physical therapy centers do not have access to pools. At BREAKTHRU, we can begin jogging activities early in the pool, which allows the athlete to return to running and sport sooner. Additionally, jogging in the pool will keep the athlete at a high level of conditioning during their recovery.

 

General Deconditioning: The pool is a great way to begin physical therapy for individuals who lack strength or endurance in their legs or core.  These individuals may report getting tired with walking after a short distance, having difficulty going up or down stairs, or feel “weak” in the legs. Exercises can be initiated in the pool and progressed to improve strength. Water-safe weights can be incorporated into programs to challenge the patient. Once the patient has gained sufficient strength, physical therapy can begin on land. This is a great “stepping stone” to begin land-based physical therapy.

References:Waller B, Ogonowska-Slodownik A, Vitor M, et al. Effect of Therapeutic Aquatic Exercise on Symptoms and Function Associated With Lower Limb Osteoarthritis: Systematic Review With Meta-Analysis. Physical Therapy. 2014;94(10):1383-1395. doi:10.2522/ptj.20130417.
Barker A, Talevski J, Morello R, Brand C, Rahmann A, Urquhart D. Effectiveness of aquatic exercise for musculoskeletal conditions: a meta-analysis. Physiotherapy. 2015;101. doi:10.1016/j.physio.2015.03.250.
Prins J, Cutner D. Aquatic Therapy In The Rehabilitation Of Athletic Injuries. Clinics in Sports Medicine. 1999;18(2):447-461. doi:10.1016/s0278-5919(05)70158-7.
Schonewill A, Rogers K, Spear A, Weinberg D, Pitt R. Combined Effects of Aquatic and Land-Based Rehabilitation in Female Soccer Players Post ACL Reconstruction: An Overview of Current Evidence. Journal of Physical Therapy and Health Promotion. 2015;3(2):11-19. doi:10.18005/pthp0302001.
Villalta EM, Peiris CL. Early Aquatic Physical Therapy Improves Function and Does Not Increase Risk of Wound-Related Adverse Events for Adults After Orthopedic Surgery: A Systematic Review and Meta-Analysis. Archives of Physical Medicine and Rehabilitation. 2013;94(1):138-148. doi:10.1016/j.apmr.2012.07.020.

Spring Off the Treadmill

The transition from winter to spring can be a difficult time of year to get out of the house for a run. Rainy, cold days can lead us to opt for a run on the treadmill rather than braving the elements for a long run outside. The question becomes how different is running on a treadmill versus running over ground? Today we are going to be discussing a recent research article looking at different forces through the knee and ankle when running on treadmill versus running over ground.
Knee pain, specifically patellofemoral pain, and achilles tendon injuries are two of the most common injuries sustained by runners. Patellofemoral pain occurs due to an increased load between your kneecap and your femur. This can cause pain with prolonged sitting, climbing stairs, or standing up from a seated position. Achilles tendon injuries are often associated with overuse, and can be painful with push off while running/walking or going up a hill. These injuries can be lingering issues for runners, and if left untreated, can be very painful, often resulting in an inability to run. This study evaluated the different stresses placed on these two areas between running on a treadmill and overground.
Previous studies have shown that when running on a treadmill, runners tend to adopt a 1 to 5 percent shorter step rate compared to their selected step rate on ground. An increase in step rate has also been shown to decrease patellofemoral stress while running. This helps to limit stride length, decreasing the tendency to overstride. The research showed no difference between patellofemoral stress on the treadmill versus overground running. This was not the case for the achilles tendon loads. Running on a treadmill produced a higher loads sustained through the tendon, meaning that the calf muscles are working much harder when running on a treadmill. Further studies are needed to determine how this may impact injury rates for those who prefer to run on treadmills, and how this information can be utilized for returning from injury.
As April showers turn into May flowers, it is good to get out on the road and leave the treadmill behind. For those runners who have been experiencing pain in their achilles, or even knee pain, please contact your local Breakthru Physical Therapist to help you get back to running pain free.
-Dr. Dan Pinto PT, DPT
Williy R. et al. Patellofemoral Joint and Achilles Tendon Loads During Overground and Treadmill Running. JOSPT 2016. 46:8.

Acute Management of Lateral Ankle Sprains

Ouch! You rolled your ankle running pick-up basketball this weekend with your friends. Frustrating….we know.

Lateral ankle sprains are injuries that pose a major inconvenience. They limit your ability to walk, move, sleep, and perform your typical self-selected physical activities… plus your friends will be short a player next weekend. Don’t lose hope, we are here to help teach you how to properly manage these injuries and provide advice and strategies for the most effective and efficient rehabilitation.
Lateral Ankle Sprains account for nearly 25% of all musculoskeletal injuries and nearly 10% of all admissions to emergency rooms. However this rush to the emergency room is often unnecessary. The gold standard in the diagnosis of acute lateral ligament injury is the delayed physical examination. Research has shown that, barring the complete inability to bear any weight through the injured ankle, you should be waiting 4-5 days before seeking medical attention. Rushing to the doctor during this acute phase of injury has been shown to result in unreliable diagnosis of the injury. Because of the diffuse location of the pain and swelling, the examiner cannot differentiate the pain or instability you are feeling, leaving you without a true answer or diagnosis.

So what should you do? Remember what your parents always said… ice it! Well how about RICE it.

Well how about RICE it. The combination of Rest, Ice, Compression, and Elevation during that first 4-5 day period has been shown to very effectively reduce pain and swelling. Following this initial period, researchers can tend to disagree. However a majority feel that a brief period of immobilization (5-7 days via air-cast/walking boot) should follow. But don’t baby it! Prolonged use of immobilization (>10 days) can have a detrimental impact on muscles, ligaments and other joint surfaces, resulting in inferior outcomes post-injury. Instead, switch over to a less-rigid support, i.e. compression wraps, lace-up braces, tape.
Finally, at the 7-10 day period, it is now time for a structured, individualized rehabilitation program. Structured physical therapy, from a Certified Doctor of Physical Therapy, focusing on pain relief, swelling reduction, dynamic stability, mechanical analysis/correction of movement, and progressive strengthening of surrounding musculature, has been shown to significantly accelerate the healing process. Not only can therapy help rehabilitate an old injury, it can help prevent a new one. Did you know that the #1 risk factor for a lateral ankle sprain is a previous lateral ankle sprain? With a skilled, trained professional guiding your care, not only will your current injury improve, you will be preparing your body for a safer and more efficient return to activity with an eye towards preventing another injury in the future.
Ankle injuries can be a nuisance. They are painful and difficult to manage. However, utilizing the strategies and guidelines laid out above, you are now equipped with a well rounded approach on how you can help address your injury. By taking the proper steps and seeking the proper care at the appropriate times, you have the tools to turn this potentially chronic issue into an afterthought and before you know it, you will be that mighty weekend warrior once again!

-Dr. Dave Pasi, PT, DPT

Source:
Van den Bekerom, M., Kerkhoffs, G., McCollum, G., Calder, J., Niek, C. (2012). Management of acute lateral ankle ligament injury in the athlete. Knee Surgery Sports Traumatology Arthroscopy, 21, 1390-1395

Complimentary Seminar 4/6/17 on: The Female Runner: Maximizing Health to Improve Performance

Join Breakthru Physical Therapy +Fitness at our Medford Taunton Forge Location  for an evening discussion featuring Coach Jason Kilderry and our very own, Dr. Kevin Schnitzer!  Coach Jason will be discussing training, nutritional, and recovery considerations for female endurance athletes that aid in improved performance, less injuries, and most importantly, improved health, based on the latest scientific literature.  Coach Jason has an extensive background in exercise physiology and kinesiology and is able to break down popular claims about these topics and deliver real answers in a fun, applicable, interactive and easy to understand manner.

When:  Thursday, April 6, 2017
Registration: 6:30pm-7:00pm
Presenters: Coach Jason Kilderry
                          Dr. Kevin Schnitzer, DPT, PT 
-Differences in the female athlete with focus on anatomical, biomechanical, and neuromuscular differences
-Clinical significance of differences and relationship to injury and rehab
-Injury rate trends in female runners: as in patellofemoral, ITB, shin splints plantar fasciitis etc
-Rehab/neuromuscular correction
-Research: findings and faults
Q&A: 7:50pm-8:00pm

Food and beverages will be served!

 

Breakthru to Injury-Free Running!

In 2015, a total of 17 million runners completed a road race. With frequency of running injuries reported by literature being 19 to 92% of runners, how can we maximize your ability to run without pain?1
A study was performed in 2014 where runners were asked why they believe they are getting injured so frequently. The most common factors that runners believed were the cause of injuries were not stretching, training errors, wearing the wrong running shoe, running technique, and lack of strength.2  All of these factors seem to be a huge piece for remaining healthy as a runner, however one is more important than them all, can you guess which one?
If you skipped over lack of flexibility, or not stretching as being a reason why runners get injured, you get the fortune to guess again. A recent systematic review of randomized controlled trials has shown that there is no correlation in stretching being an activity that protects runners from injury. 2
Running technique is another very popular topic in the sport, especially when it comes to how we land. Should we be landing on our rear-foot, our mid-foot, or our fore-foot? Different landing patterns stress muscles differently, overusing some while underusing others, however this aspect of running is not the greatest reason that runners are getting injured.
Choice of running shoe is one of the most popular topics when talking in the running community. This will be covered in further discussion, so for the time being, this is not the greatest cause of injury in runners.
Various studies have shown that the most common way a runner gets injured is due to making errors in training. Runners that are doing too much, too soon, or running too fast from week to week, are putting themselves at great risk for injury. In a study of 873 runners, 202 runners sustained an injury when progressing their weekly mileage greater than 30% over a two week period.2
Some of the most common injuries that can be experienced when increasing your pace are achilles tendinopathy, hamstring strains, iliopsoas strains, stress fractures, and plantar fasciitis. Some common injuries that are experienced when increasing distance too quickly are patellofemoral syndrome, iliotibial band syndrome, patellar tendinopathy, medial tibial stress syndrome, and gluteus medius strain. 3
If you have been experiencing any pain with running or after running, it is important to meet with your physical therapist. Please continue to look out for future information regarding the current literature behind what keeps us running.

-Dr. Dan Pinto PT, DPT

 

References:
Van Gent et al. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. British Journal of Sports Medicine 2007; 41(8) Saragiotto B Yamato T, Dias Lopes A, What Do Recreational Runners Think About Risk Factors for Running Injuries? A Descriptive Study of Their Beliefs and Opinions. JOSPT 2014 44(10)Nielsen et al. Classifying Running-Related Injuries Based Upon Etiology, With Emphasis on Volume and Pace. IJSPT 2013 8(2).

Baker’s Dozen Training Special

BAKER’S DOZEN SPECIAL

Get 13 for the price of 12!

Make a commitment for the year and let us help you make 2017 your BEST and HEALTHIEST year ever!

 

Offer 1:

Get a Complimentary Training Session with the purchase of a Package of 12 Sessions

  • Semi-Private, 30-minute Personal Training sessions   $360     [hc-hmw snippet=”Bakers-Dozen-SPT-30-min”]

 

  • Semi-Private, 60-minute Personal Training sessions   $600     [hc-hmw snippet=”Bakers-Dozen-SPT-60-min”]

 

  • Private, 30-minute Personal Training sessions   $480     [hc-hmw snippet=”Bakers-Dozen-PPT-30-min”]

 

  • Private, 60-minute Personal Training sessions   $840     [hc-hmw snippet=”Bakers-Dozen-PPT-60-min”]

Offer 2:

Get a Complimentary Month with a Series Training 12-Month Contract

Available options include 30-minute, 60-minute, Private, and Semi-Private training sessions

Call to purchase your Series Training Package

 

 Only available until January 31, 2017

* ALL clients (old & new) are eligible for this special promotion

** Exclusively offered at our Medford Taunton Forge and Voorhees locations

*** Certain restrictions may apply.  Please call for details.