May is Ehlers-Danlos Syndrome/Hypermobility Spectrum Disorder Awareness Month

Learning the basics starts with learning a few acronyms —

Generalized Joint Hypermobility (GJH)

Medically, GJH is defined by scoring above a certain threshold on a test called the Beighton Scale.  The Beighton Scale includes assessment of flexibility of the fingers, thumb/wrist, elbows, knees, and hips/back.  GJH often coincides with being considered very flexible or ‘double jointed’ (those with GJH don’t really have any extra joints, though!).  GJH can be related to a person’s genetics or it can be accumulated through experience or training (unintended stressors that lengthen tissues or training that increases flexibility like gymnastics or yoga).

Ehlers-Danlos Syndromes (EDS)

The Ehlers-Danlos Syndromes are a group of genetic disorders of the connective tissue.  As of 2017, there are 13 distinct types of Ehlers-Danlos Syndromes, each named for the most significant feature of the syndrome (vEDS for vascular EDS, etc).  Of those 13 syndromes, 11 are extremely rare (all except cEDS and hEDS) and 12 have molecular identifiers (can be confirmed with genetic testing).  The most common form, Hypermobile Ehlers-Danlos (hEDS), can not be confirmed with any medical test.  This form is currently diagnosed by meeting standardized criteria on a clinical exam while ruling out other testable disorders.  All forms of EDS include GJH as a characteristic.

Hypermobility Spectrum Disorders (HSD)

HSD can include GJH or even localized joint hypermobility with no symptoms on the milder end of the spectrum, while the severe end of the spectrum includes GJH with limiting symptoms in multiple body systems in addition to joint problems.  HSD is only diagnosed when a patient has symptoms related to joint hypermobility, but does not meet the criteria for other diagnosable disorders with similar symptoms (including the Ehlers-Danlos Syndromes).

Symptoms, Signs, & Associated Conditions of EDS/HSD

At first glance, symptoms of EDS/HSD can seem random and unrelated:

  • Joint pain
  • Fatigue, disruptive sleep
  • Brain fog, anxiety, depression
  • Dizziness
  • Difficulty standing
  • Digestive troubles
  • Sensitivities/atypical responses to medications and/or environmental triggers
  • Headaches/migraines

However, knowing that EDS/HSD are connective tissue disorders, the symptoms can all be connected by an understanding of the role of connective tissue in the body.  Connective tissue is found throughout the body.  In many areas it serves as the ‘wrapper’ of body structures (for example: internal organs, blood vessels, digestive tract, airway, muscles, nerves, brain and spinal cord).  In many other areas it connects body parts and holds them in place providing strength and elasticity (for example: skin, muscle, tendon, bone, organs).  In EDS/HSD the connective tissues are not standard-issue because the genes that make the connective tissue have mutations.  Depending on which genes are involved, the signs of altered connective tissue vary widely among the different EDS/HSD types and even among individuals with the same type of EDS/HSD.

Some of these signs include:

  • Stretchy and/or soft/velvety skin
  • Joint subluxations or dislocations during every day activities
  • Dental crowding with high/narrow palate
  • Prolonged time in orthodontia
  • Atypical scars; easy bruising; fragile skin
  • Striae (stretch marks) unrelated to weight gain/loss
  • Slower than expected healing of soft tissues after injury or surgery
  • Hernias and/or organ prolapse
  • GI dysmotility (food not moving through the digestive tract or into the blood stream as expected)
  • Dysautonomia (abnormal management of fight/flight vs. rest/digest/repair by the nervous system)
  • Mast cell activation disorder (abnormal immune system activity that is not allergy or autoimmune in nature)

The Basics of Care for EDS/HSD

At the present, there are no treatments or cures that can change the connect tissue of EDS/HSD to be more like standard-issue connective tissue.  However, there are treatments available for almost every symptom and associated condition related to EDS/HSD.  The most important factor is recognizing that individuals with EDS/HSD have special connective tissue that requires special care.

Lifestyle can have a much greater impact, positive or negative, on an individual with EDS/HSD.  Optimal fitness, exercise, activity, and nutrition are essential for management.  Unfortunately, determining ‘optimal’ is incredibly difficult to determine and usually requires guidance from skilled professionals experienced with EDS/HSD.  Medications can also be helpful for managing symptoms, signs and associated conditions.  Here again, it is important that these are prescribed by providers who understand EDS/HSD to avoid triggering additional problems.

  • Care can and should be basic, but for many, it is not!

One of the most challenging aspects of having EDS/HSD is finding a provider who can deliver appropriate care.  Here at Foothills Orthopedic and Sport Therapy, we understand EDS/HSD.  Not only do we do our best to provide optimal physical therapy in a supportive environment, we also work hard to connect our patients to necessary providers and resources.  Our goal for people with EDS/HSD is to live their best life in the body they have!

Links to more information:

www.ehlers-danlos.com

* I especially recommend this EDS Society web site  and this site for patients, loved ones and friends to learn more about EDS

* This comprehensive article may be appropriate for your primary medical provider: Hypermobile Ehlers-Danlos Syndrome

* Sign up for this FREE virtual training at Project ECHO

Safe Hiking This Spring

Image result for hallett peak rocky mountain national park

 

The weather is getting warmer, the days are getting longer, and the mountains are calling. Before you hit the trails this spring, keep the following tips in mind to ensure a good start to your hiking season.

Physical Preparation

  • It’s a good idea to perform a few weeks of pre-season exercise to get ready for hiking. This could include walking, bicycling, swimming, elliptical, or any combination of aerobic activities to build your endurance.
  • Treadmill walking on an incline, especially with a light backpack, can be very helpful. This activity most closely simulates hiking and will give you the most specific adaptations.
  • Choose an easy to moderate trail for your first hike of the season and use good judgement when you decide how long to hike for the first time. If you haven’t hiked for six months, then don’t hike 10 miles your first time out for the season!

Trail Safety

  • It’s best to start your hikes earlier in the day to avoid hot afternoon temperatures. Additionally, if you are hiking at higher altitudes, it’s a good idea to get off the mountain by early afternoon in order to avoid thunderstorms.
  • Watch for wildlife and give animals plenty of room. Talk with a park ranger or volunteer about the types of animals you may encounter on the trail and how to behave if you do cross paths.
  • Be a good steward of our beautiful trail systems. Staying on marked trails not only preserves the landscape and prevents trail erosion, but it will keep you safe and prevent you from getting lost.
  • Always hike with a buddy!
  • Bring plenty of water, snacks, sunscreen, a map and/or compass, and light layers. Expect changes in weather conditions, especially if you are hiking at higher elevations.

Being prepared will keep you safe, healthy and injury-free. Most importantly, it will help you have fun! If you have any concerns about your fitness for the upcoming hiking season, please contact us. Our skilled therapists will perform a comprehensive examination and help you to develop a tailored exercise program to get you ready to explore our great outdoors!

Dancing and Your Brain

 

Image result for older couple dancing

We all know that exercise is important for maintaining our physical health and function as we age. But did you know that certain types of exercise also help maintain your brain? This month we will look at some of the cognitive benefits of dancing. Get ready to kick up your heels!

The Brain Changes With Age

Aging is associated with gradual changes in our memory and attention. It is important to preserve these abilities so that we can live safely and independently into our old age. Dancing has been shown to help maintain these functions. Exercise (such as dancing) causes the release of growth factors in the brain. These chemicals help to nourish the connections between nerve cells (1).

The Effects of an Enriched Environment

Enriched environments are stimulating to the brain. They provide the brain with lots of interesting information to work with. This keeps the brain active and using its numerous connections. Research has shown that animals living in enriched environments have delayed changes in their brains (1). Attending a dance is an example of being in an enriched environment. Dancing includes being physically active, moving in rhythmic ways, using memory and recall of dancing patterns, and balance reactions. Dancing also involves social interactions, emotions, and music. All of these factors add up to powerful stimulation for the brain.

 

So get out there and dance to keep your brain young!

 

1) Kattenstroth JC, Kolankowska I, Kalisch T, Dinse HR. Superior sensory, motor, and cognitive performance in elderly individuals with multi-year dancing activities. Front. Aging Neurosci., 21 July 2010. https://doi.org/10.3389/fnagi.2010.0003. 

Physical Therapy and Hip Osteoarthritis

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Osteoarthritis (OA) is a common condition that can affect many joints in the body. It is often seen on x-rays as narrowing of the joint space. Sometimes bone spurs are present. Often the lining of the joint is inflamed. This can cause significant pain and difficulty performing daily activities. If this condition is affecting your life, you may be wondering what your treatment options are. A recent article in the journal Physical Therapy discuses the most current evidence-based treatments for OA of the hip(1).

Conservative Care

The international community recommends conservative care first. This includes a combined approach using education, exercise and weight loss to manage hip pain and improve function. Exercise provides numerous benefits for hip OA including:

  • Improved muscle strength. When supporting muscles are strong they absorb impact forces so the hip joint doesn’t have to.
  • Increased joint range of motion. Good flexibility is important because it lessens the stress on joints.
  • Decreased joint pain.
  • Better physical function.

Secondary Recommendations

  • Pain medications. Over the counter medications are recommended first. These include non-steroidal anti-inflammatories, often called NSAIDs.
  • Joint replacement surgery. This option is reserved for people who have significant pain and limitations in daily activities and who have failed conservative treatments.

If you are suffering from hip pain and find yourself limited in the things you enjoy doing, contact our clinic for a physical therapy assessment. Our staff of trained therapists looks forward to helping you decrease your pain so you can get back to your normal daily routine.

 

 

  1. Poquet N, Williams M, Bennell KL. Exercise for osteoarthritis of the hip. Physical Therapy. 2016; Volume 96 (11): 1689-1694.

Wintertime Fall Prevention

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With the build-up of snow and ice on the roads and sidewalks, slipping and falling becomes a real concern for many people during the winter. Although we haven’t had much snow yet, it’s always a good idea to be prepared. Here are some ideas to get you thinking about fall prevention before the snow flies.

Walking Outdoors

  • If you go for walks outside, consider using equipment such as ski poles for better balance. You may also try crampons, metal spikes that can be attached to shoes/boots for better traction.
  • Expect the unexpected. Although the sidewalk may look clear, there could be black ice. Take small steps to keep your body weight balanced over your feet.
  • Have someone drop you off close to building entrances so you don’t have to walk across slippery parking lots.
  • Avoid walking outdoors at night if possible. It’s harder to see hazards in the dark!
  • Walk with someone else. In addition to the good company, you have someone to lean on if necessary.
  • Take your cell phone with you. If you do fall and injure yourself while out walking, then you will be able to call for help.

Walking With Pets

Taking your dog for a walk poses its own challenges during the winter. It’s important to understand your pet’s temperament and make accommodations. If you have an animal that likes to pull on the leash, then you need to be extra cautious when out walking.

  • Consider using a harness, gentle leader, or other equipment to help reign-in your dog’s energy.
  • Walk at a slower pace and take shorter steps to improve balance.
  • Know your pet’s triggers. If your dog is skittish around traffic, then walk in quieter areas and stay away from busy streets. If other dogs are problematic, try to modify your route to avoid walking past homes/yards with aggressive dogs.
  • Walk during the warmest part of the day when sidewalks are less likely to be icy.
  • Have a friend or family member take over the dog walking duties if you are concerned about falling.

 

Staying Active This Winter

Image result for winter conditions

As the days get shorter and the weather gets colder it’s normal to fall into hibernation mode. Many of us struggle to remain active during the winter months. Colder temperatures along with snow and ice can make outdoor exercise a dangerous undertaking. Still, we know that it is important to maintain physical fitness through all seasons of the year. Here are a few suggestions to help you stay active this winter.

Join a Gym

Purchasing a gym membership is one way to stay fit. Some gyms allow you to pay one month at a time. This is a good option if you want a convenient way to exercise in the winter, but then plan to get outside again in the spring when the weather improves. Gyms offer group classes, individual sessions with personal trainers, and a wide assortment of exercise machines. If you are not the “gym type” or a gym membership is not in your budget, then there are other options.

Go For a Walk Indoors

When the weather is bad and you can’t walk outside, try walking inside. Large stores can easily be used as an indoor track. Try walking up and down the aisles, or around the perimeter of the store. If you need to make a purchase, all the better. If you don’t have anything on your shopping list, then you can appear to be browsing for something and then leave without buying anything. Another option is walking inside a mall, recreation center, or school.

Exercise at Home

If you can’t leave the house, then there are plenty of things you can do at home without any special equipment. Consider some of the following exercises:

  • Walk laps around the house
  • Climb up and down the stairs (if available)
  • Step up and down on a step stool (if able to perform safely)
  • Do standing leg exercises such as leg raises, calf raises, or mini squats
  • Do arm exercises such as wall push-up

Every Little Bit Counts

The US Department of Health and Human Services recently revised their Physical Activity Guidelines for Americans.  In the past, they encouraged people to perform exercise in 10 minute intervals. However, this may not be possible for all people, especially those who are deconditioned or have chronic illnesses that makes exercise difficult. The new recommendations encourage everyone to sit less and move more. Adults should try to accumulate 150 minutes per week of moderate-to-vigorous physical activity in any increments, large or small. Doing exercise in any amount counts; it all adds up!

 

Foothills Orthopedic & Sport Therapy is here to help you with your fitness goals this winter. If you have specific concerns, or you would like to schedule an appointment to develop a personalized home-based program, we are here for you! Give us a call.

Ski Season in the Rockies

Image result for skiing

 

It’s time to get your skis, snowboards, boots and bindings tuned up! Dig out your favorite jacket and gloves because ski season is almost here! Your gear may be ready for the slopes, but what about you? Are YOU ready for the slopes? Are you having any issues with your knees, hips, feet, shoulders or spine? Pain in any of these areas could slow you down on the slopes this season.

Tips for Preventing Injuries on the Slopes

A few simple changes to your routine and some common sense go a long way toward preventing injuries.

  • Perform a warm-up program before getting on the ski lift.
  • Start with a few easier runs to get your body moving and to make sure your equipment is in good working order.
  • Stick to marked trails. Skiing and snowboarding in out-of-bounds areas poses additional risks that can increase the potential for injury.
  • Maintain your skill level and use proper technique. Most people take lessons when they are new to the sport, but lessons can also be helpful for proficient skiers who want to advance their skills to the next level.

Show Up Prepared for the Slopes

Make sure your body and your equipment are ready for the season. Prepare your body by participating in at least a few weeks of pre-season regular exercise including:

  • Aerobic conditioning such as cycling, running, rowing, swimming, or using an elliptical machine
  • Core strengthening such as planks
  • Leg strengthening such as squats or lunges

Remember to pack all important equipment.

  • Helmet
  • Wrist guards–recommended for snowboarding
  • Appropriately sized skis for your height, weight, skill level, and terrain

Pace yourself on the slopes.

  • Consider skiing a half-day on your first day out, or take rest breaks when needed. You are more likely to get injured when you are fatigued.
  • Don’t ski multiple days in a row for the first time out this season.
  • Limit alcohol consumption. Being active at high elevations leads to relative dehydration. Alcohol magnifies this dehydration which can increase the potential for injury. Who doesn’t love a mug of hot chocolate at the ski lodge? Just say no to the Bailey’s Irish Cream!

Pre-Season Physical Therapy

If you have any questions regarding your physical readiness to start skiing, or any other sport, please contact us at Foothills Orthopedic & Sport Therapy for a free consultation. We would be glad to assess your readiness to participate and provide guidance on appropriate exercises, as well as any treatment that might be needed to get you on the ski lift and ready to carve some powder!

 

 

National Physical Therapy Month

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October is National Physical Therapy Month

“My knee hurts when I go down stairs.” “I can’t reach behind my back without my shoulder hurting.” “I have constant back pain.” Do any of these statements apply to you? These are common problems that cause people to seek medical treatment. Pain can be debilitating and can cause people to turn to prescription pain medication. This October, the American Physical Therapy Association (www.apta.org) is raising awareness of physical therapy as a safe and effective alternative to opioids for treating chronic pain.

 

The Facts About Opioids

  • Opioid medications are prescribed at alarming rates.
    While there has been a decrease in opioid prescription in recent years, they are still prescribed at alarming rates. According to the CDC, in 2016 health care providers wrote 214 million prescriptions for opioids.
  • The risk for misusing prescription opioids is real.
    According to the CDC, every day over 1,000 people are treated in emergency departments for misusing prescription pain medications.
  • The risk for addiction is real.
    According to the CDC, as many as 1 in 4 people who receive prescription opioids struggles with addiction.
  • The risk for heroin use is real.
    According to the CDC, among new heroin users, about 3 out of 4 report abusing prescription pain medications before using heroin.
  • Physical therapy is a safe and effective alternative to opioids for long-term pain management.
    In March 2016 the CDC released guidelines urging non-opioid approaches for managing chronic pain. Physical therapy is a safe and effective non-opioid alternative.
  • There are some situations in which opioid therapy is appropriate.
    Opioids may be appropriate for cancer treatment, palliative care, end-of-life care, and certain acute situations. Still, the CDC guidelines suggest pairing drug therapy with non-drug therapy. In fact, the prescriber checklist recommends trying non-drug therapy first.
  • Patients have a choice about the kind of treatment they receive.
    Before accepting a prescription for opioids, patients should talk to their health care providers about related risks and safer alternatives.

The Facts About Physical Therapy

  • Physical therapy is not always prescribed. A study published in Spine found that between 1997 and 2010 only about 10% of doctor visits for low back pain resulted in a referral to a physical therapist. If your doctor doesn’t give you a referral to see a physical therapist, ask for one!
  • A wide range of conditions respond to physical therapy. Physical therapists are trained to work with conditions that affect all joints, muscles, tendons, and ligaments of the body. Some physical therapists have additional training in specific areas such as hand therapy or women’s health. There is likely a therapist out there with the skills to help your specific problem.

 

 

 

 

 

National Balance Awareness Month

By the Numbers

September is National Balance Awareness Month. Every year millions of older adults fall. In fact, more than one in four people over age 65 will fall every year. Less than 50% of those people will report falling to their doctors. Falls have a significant impact on the individual, their families and the entire community.

It’s Not Just Falling

Another important thing to remember is that not everyone who has difficulty with balance will actually fall. Some people describe tripping, stumbling, feeling dizzy, swaying, falling into objects, difficulty walking in a straight line or simply feeling “off”. You may feel like your balance is fine when you are standing still, but you may have more difficulty when waking and trying to do multiple things at the same time.

Balance relies on your vision, your inner ear, your muscular system, and your proprioception (your body’s ability to tell where it is in space). If one of these systems is not working correctly, it will result in difficulty with your balance.

Factors Affecting Balance

There are many different factors that can cause difficulty with your balance including:

  • Muscle weakness
  • Joint stiffness
  • Inner ear problems
  • Medications
  • Decreased activity levels
  • Some medical conditions
  • Fear of falling

Prevention is Key

Taking steps to prevent falls and improve your balance is essential to your health and wellness. Look around your house and make sure that you have proper lighting and clear pathways. Avoid excessive clutter. Visit your eye doctor regularly. Maintain your strength, balance, and endurance. If you have had a fall or you are having difficulty with balance, we would love to help. Contact our office today to schedule a balance assessment.

Common Jaw Exercises in the Treatment of TMJ Dysfunction

What is TMJ Dysfunction?

The temporomandibular joint, or TMJ, is formed by your jaw bone (mandible) and skull (temporal bone). Dysfunction of this joint is common and results in a variety of symptoms. People with TMJ dysfunction may experience: headaches, jaw pain, neck pain, earaches and/or ringing, and at times difficulty opening the mouth. Joint noise such as “clicking or grinding” may also occur.

 

The causes of TMJ dysfunction vary. Common factors include localized arthritis, injury, occlusal (bite) imbalance, and stress in the form of clenching and/or grinding. Exercises relax the jaw muscles, reduce strain to the TMJ, decrease clenching/grinding, restore normal motion, and increase joint stability (strength).

Specific Exercises for the TMJ

 

  1. Normal resting tongue position – Place your tongue against the roof of the mouth as if making a “clucking/clicking” sound. Ideally the front 1/3 of the tongue should rest upwards, just behind the front teeth. This is considered to be the best position for your tongue to help keep the jaw muscles more relaxed.

 

  1. Controlled Opening – Place your tongue towards the roof of the mouth (exercise #1 above). Open comfortably without pulling the tongue away from its upward position. This is intended to limit jaw movement and minimize excessive strain to the ligaments and muscles that support the TMJ. This also often helps to decrease joint noise.

 

  1. Mandibular Isometrics – This exercise has also been called rhythmic stabilization. The goal is to increase muscular control or strength by a series of contractions. Place the jaw in rest position with slight opening and then lightly push against the lower jaw in six different directions: open, close, right, left, backward, forward – without letting the lower jaw move. Keep the amount of resistance very light.

 

  1. Axial Extension of the Cervical Spine – This exercise is used to improve the relationship of the head to cervical spine (neck). It helps to decrease postural stress that could influence the jaw muscles. Tilt the head (eyes) down slightly, complete a gentle chin tuck, then finish with a tiny “nod” of the head without losing the chin tuck position.

If you are experiencing any symptoms associated with TMJ dysfunction, we may be able to help. Contact our clinic today to be evaluated by a TMJ specialist.