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What is frozen shoulder?

A common diagnosis for shoulder pain and decreased function is “frozen shoulder.”  But what is this disorder?  Technically, the condition is known as “adhesive capsulitis.”  This condition occurs when the tissue around the shoulder joint (known as the capsule) stiffens.  It may occur after a minor injury but often develops without any clear reason.  There is a possibility it can be linked to other health issues such as diabetes or thyroid disease, but no clear origin of the disorder has been defined. 

This disorder affects 2-5% percent of the population.  It usually affects people between 40 and 65 years of age.  The problem usually lasts 1-2 years.  Frozen shoulder is generally characterized into three stages: 1) “freezing,” which is a progressive loss of motion, decreased function, and pain; 2) “frozen,” where the shoulder is stiff and painful; and 3) “thawing,” which is a gradual return of range of motion and function.  During the freezing and frozen stages, the pain and decreased range of motion may impact daily activities such as getting dressed, brushing one’s hair, reaching into a cabinet, and sleeping on the affected side.

What treatments are available for frozen shoulder?

A physician is the only person capable of diagnosing frozen shoulder.  But if it is diagnosed, there are a number of recommendations and treatment options available.  First of all, experts urge that a person who has been diagnosed with frozen shoulder continue their daily activities as normally as possible. Continuing to use the affected arm will help to loosen it. A physician may recommend a cortisone injection to the shoulder or oral anti-inflammatories.  Finally, physical therapy is a key portion of the treatment for frozen shoulder.

What can physical therapists do for frozen shoulder?

Physical therapists can perform a number of treatments for frozen shoulder.  This includes heat to the shoulder to loosen it, followed by joint mobilizations and stretching.  Patient education and a home program are critical components that a PT can provide.  Your physical therapist can help you understand the condition, and customize a treatment program for you to perform at home to decrease the pain and stiffness associated with frozen shoulder.  This is in conjunction with those treatments performed in the clinic on a regular basis.

For more information, please visit your physician or a physical therapist that specializes in musculoskeletal disorders.

E. Dan Syrett, DPT

What should you expect at your first Physical Therapy visit?

A lot of people are nervous when they arrive at their first physical therapy session. You might have heard rumors about PT being "Pain and Torture" and have a false sense of what to expect. Here are some tips to make your first PT session go smoothly.

1.  Your first visit is the initial evaluation.  The therapist will talk to you about your symptoms, when they began, and how you are feeling now.  If you have had surgery, they will ask about your recovery so far.  At this visit, the therapist spends time getting to know you and your personal goals for recovery.  Take the time to talk about what you are feeling and what you would like to get back to doing. 

2.  Dress comfortably.  Wear clothes you can move around in without restriction.  If you are coming for knee pain, they will need to see your knee. Pants will be fine as long as you can pull them up and expose the knee.  For your shoulder, a short sleeve or sleeveless shirt should be fine.   If you are coming for your back or neck, loose and comfortable clothes might be fine or you might be asked to change into a gown.

3.  Remember, you are in control.  The therapist’s job is to evaluate your symptoms, develop a plan of care, and use the appropriate treatment techniques.  Treatment techniques can include manual therapy (using their hands to mobilize and stretch) and exercise therapy.  It is important to remember that you are in control.  Be sure to communicate what you are feeling and let your therapist know if an exercise is causing you pain.

Physical therapy is a collaborative effort between the therapist and the patient.  You will work together to set reasonable and personal goals so that you can get back to life with as little “Pain and Torture” as possible.

Cynthia York King, DPT

Physical Therapist

OrthoVirginia/West End Orthopaedic Clinic

Good Posture

Having good posture is one of those things that many people know they should focus on but few people do.  Simply put, posture is the way you hold your body in an upright position while you are sitting, standing, laying down, etc.  Having good posture is important even when you are perfectly healthy, but in patients that have pain from sitting or standing for too long, posture has an even greater impact.  Staying in a poor position stresses your muscles and can irritate muscles that are already tight or weak.

Consider your posture when you are sitting, particularly if you are at a desk or driving for much of the day.  Many people tend to slouch the longer they are sitting, which straightens the normal curves in the neck and back.  Sit with the shoulders straight and the head over your body.  You may need a roll at the curve of your back for proper back support and to avoid slouching.  Your knees should be bent, and your arms can rest comfortably on your desk or armrests at about a 90 degree angle.  Sit so that your feet can rest on the floor (or a stool if your chair is too tall for you).  When driving, you want to adjust the seat position in the car so that you are not leaning or reaching to use the wheel or pedals, but the knees can still bend comfortably.

Standing with upright posture can also require retraining your old habits.  If standing up straight is challenging for you, try standing with your back against a wall or a door, and try to let the back of your head, shoulders, and butt touch the wall.  If you need to stand for a long period of time, shifting your weight from one side to the other can help you tolerate standing with less discomfort.  Other suggestions to keep in mind include: not locking the knees when you stand, keeping the feet slightly apart, and keeping the chin tucked a little to keep the head level and avoid the head being too far forward on your body.

While most people will not be consciously aware of their posture while they are asleep, having good posture while lying down can make sleep more comfortable.  Use pillows or rolled up towels to position the body in as neutral a position as possible.  Support your neck and make sure your pillow is under your head and not your shoulders.  If lying on your side, folding a flat pillow between your knees or rolling a towel under your waist may allow the back and legs to remain in good alignment while you sleep.  Use a firm mattress for appropriate support, although the level of firmness that works best for you can change depending upon a person’s preference.

Even if your posture is perfect, you will need to change positions every so often.  The human body was not designed to sit or stand all day, but to keep moving.

“Posture for a Healthy Back.” http://my.clevelandclinic.org/healthy_living/back_health/hic_posture_for_a_healthy_back.aspx

 “Guidelines to Improve Posture.”   http://www.spine-health.com/wellness/ergonomics/guidelines-improve-posture

Alicia Dettmer, DPT

Running Feet

Running Feet

Runners typically experience foot pain for a variety of reasons.  People often assume their problem is that they “pronate”.  However,   during each step it is normal to both supinate and pronate.  A problem may arise if the timing between pronation and supination is incorrect or if there is an imbalance between the amount pronation and supination.

As a runner you want and need your foot to both absorb body forces and provide a stable lever to propel you forward.  As we supinate the joints become stable and our foot/ankle is efficient at propelling us forward.  As we pronate our arch drops and our foot/ankle is more efficient at absorbing body forces.

If you are experiencing foot/ankle pain a physical therapist can evaluate your feet and how it relates to the rest of your body.  Your physical therapist can help determine specific exercises to correct for muscle imbalances and weakness, or if inserts or a different type of shoe may be beneficial to get you back on the road.

Rob Lehner, DPT

The Kitchen - Don't make it an ergonomic disaster!

The Kitchen – an Ergonomics Disaster!

Several of the activities we do in the kitchen are easy and painless, until you have a back problem.  By developing healthy habits in the kitchen and around the house you can help prevent poor posture and help relieve or prevent future problems.

• Try to avoid leaning forward over the kitchen sink.  Instead, try opening a cabinet door under the sink and resting your foot on the shelf to give your back more stability.  Also, try to tighten your lower abdominal muscles as you are standing and moving.
• When reaching into lower cabinets to get those pesky plastic containers and pots/pans, squat from your knees and avoid bending forward from your hips.  This allows your back to stay in a more neutral position and uses your leg muscles, instead of straining your back muscles.
• If you are going to be doing something where you are standing at the counter for a prolonged period of time, take a break and pinch shoulder blades back for 5 seconds a couple times. 
• Be mindful of how your body feels.  If you start to feel aching in your neck or back, change positions or stop and switch to a different activity.
• If you experience pain, contact your physical therapist or physician.

Shannon L. Lasowitz, DPT

Physical Therapist 

An Ergonomic Workspace is Important for Good Posture

When resting or sitting at a desk, not many people think about their posture.  However, this is very important.  While you may think that your body is resting, there are actually many muscles working to keep you upright.  Prolonged positioning in awkward or incorrect postures can potentially contribute to neck pain, upper back pain, and headaches.  This may be especially prevalent in people who work in sedentary or desk jobs.
            A good question to ask is how is your environment set up?  Think about your job.  Are you sitting at a desk all day?  If so, then the computer monitor should be straight ahead at eye level.  You should not have to turn your head to look at your monitor.  The keyboard should be sitting at a height that allows your elbows to be bent and resting comfortably.  You should have a good chair with good back support and feet fully on the floor.  Do you answer the phone all day?  If you do, do you have to turn your head or body repeatedly to reach it?  Do you cradle the phone between your ear and shoulder? Any of these motions can contribute to neck or back pain.  A hands-free headset can eliminate some of these problems.  If any of the above aspects are off, then that may predispose you to incorrect posture.
Also be sure to think about home life and how you sit when looking at the computer/TV or reading.  Any prolonged postures can potentially contribute to neck or back pain.  It is always a good idea to periodically check how you are positioned to make sure that your posture is good.  A good rule of thumb for correct posture is to overexaggerate good posture and then relax.  To do this, sit fully straight with your shoulders back and head in line with your trunk.  Then relax about 10 percent.  This should be about the position that is appropriate for your body.

            There are many other aspects that can contribute to neck pain, headaches, and back pain.  If you have any further questions, our physical therapists will be glad to help.  We are able to screen where your pain is coming from, assess your posture, help correct it, and talk through your work/home environment to see if any changes are necessary.

Is Physical Therapy Painful?

No pain no gain is an exercise motto that promises greater rewards for the price of hard and even painful work. As a physical therapist, I hear this motto almost on a daily basis and unfortunately it does not always apply to the work that needs to be done during physical therapy treatment.

Pain is a subjective unpleasant sensory experience associated with actual or perceived damage to tissue. Individuals receiving physical therapy are there as a result of damaged tissues. As a result, therapy revolves around healing of those tissues. In physical therapy there is a certain amount of “pain” depending on the stage of recovery. Normal pain sensations could be either associated with stretching tightened tissues or strengthening weakened muscles. In other cases, therapy will focus on decreasing swelling or inflammation of an injured area. During this stage, pain should be avoid due to the risk of increasing swelling or inflammation ultimately slowing down the healing process

Due to the subjectivity of pain varying from person to person it is important to report any sensations of pain to your therapist when receiving treatment. They will be able to distinguish whether the pain you are experiencing is a normal sensation or pain that should be avoided.  As physical therapists, part of our job is to monitor the pain elicited carefully and on an individual basis in regards to the patient’s diagnosis.

Remember no pain no gain does not always apply to physical therapy despite popular opinion!