Join us in welcoming Will Nutt, a first-year physical therapy student at Elon University. Will is completing an eight-week clinical rotation at DOAR Central under the instruction of James Turner, DPT. A native of Ohio, Will received an undergraduate degree in Exercise Science from Concord University, where he also played football.
Archives for January 2011
Do you experience vertigo that causes you to have nausea, a fear of falling, or reluctancy to go out in public because these symptoms might occur? Vertigo can be a very debilitating condition which can affect many aspects of a person’s life. Vertigo is defined as the illusion of movement or the illusion that the world around you is moving. Most commonly, vertigo is associated with benign paroxysmal positional vertigo, acute vestibular neuritis, and menieres syndrome. Benign paroxysmal positional vertigo or BPPV is a common cause of vertigo that can be treated by physical therapists. Benign means that there is no malignancy, paroxysmal means that the symptoms are sudden and intense, position means that the symptoms are related to a specific position, and the main symptom is vertigo.
The inner ear is made up of three canals; a posterior, horizontal, and anterior canal. BPPV occurs when the free floating calcium carbonate crystals, called otoconia, in the canals of the inner ear are displaced and send false signals to the brain about the relation of your body in space. Vertigo is the main symptom of BPPV which is often associated with nausea. Typically, symptom-provoking positions will include rolling over in bed, looking up, washing hair, turning your head to look to the side, and reaching for an object on the floor. Episodes of vertigo tend to last for less than one minute with BPPV.
There are tests that physical therapists can use to determine if you have BPPV, which will guide the treatment. The tests for BPPV will often bring on your symptoms of vertigo and nausea that may last for up to several minutes. During the test, the physical therapist will be examining both eyes for nystagmus. Nystagmus is involuntary rapid eye movements that will give the physical therapist information about which canal of the inner ear may be affected. If the test is positive for BPPV, the treatment can be implemented to relocate the otoconia to their correct location using the Canalith Repositioning Maneuver, also known as the Epley maneuver. If the patient does in fact have BPPV, their symptoms should be significantly decreased or resolved after treatment. There are also maneuvers that the physical therapist can teach patients to do at home that will help resolve the symptoms associated with BPPV.
In a study from the Journal of Neurology, Neurosurgery, and Psychiatry, it was found that in a group of 35 patients that had posterior canal BPPV, 28 of the 35 patients did not have symptoms of positional vertigo or nystagmus 24 hours after the treatment.1 The long-term outcomes of BPPV using a Kaplan-Meier estimation were that 18% had reoccurrence at 12 months, 30% at 36 months, and 37% at 60 months.2 Your physical therapist will instruct you on what to do if you experience a reoccurrence of BPPV. The therapist will also assess a patient’s balance and balance training exercises may also be indicated. Patients that are being evaluated for vestibular disorders should have someone to drive them home and need to sit in an upright chair for 20 minutes after the treatment. Some therapists may also recommend that patients sleep in a recliner at a 45-degree angle for one night after treatment. BPPV is just one of many causes of vertigo; if you are experiencing any of these symptoms, discuss them with your physician to determine if physical therapy is appropriate for you.
Please join us in welcoming Tiffany DeLoatch, DPT to the team at Danville Orthopedic & Athletic Rehab. Tiffany earned a Doctorate of Physical Therapy degree from Elon University in December 2010. She will see patients at DOAR Central and Martinsville Physical Therapy.
A native of Martinsville, Tiffany attended Averett University in Danville, where she earned a Bachelor of Science in Sports Medicine/Wellness. While a student at Averett, Tiffany was captain of the women’s basketball team and a member of the women’s lacrosse team.
While attending Elon, Tiffany completed clinical rotations at Maria Parham Center for Rehabilitation in Henderson, North Carolina; St. John Health System in Tulsa, Oklahoma; and TheraSport Physical Therapy in Eden, North Carolina. She completed a 6-month clinical internship at Alamance Regional Medical Center in Burlington, North Carolina.
Aquatic physical therapy, as the name implies involves utilizing water to achieve physical therapy goals. Water can be excellent environment for patients who have difficulty with weight bearing activities due to arthritis, recent fracture, sprain/strains, or excessive weight. There is no other method of exercising available that creates a near zero gravity setting. For instance, a 200 lb person would only weight 100lbs in waist deep water and if you increase the water dept to shoulder level that same person would only weigh 20 lbs, a mere 10% of their weight on land.
Aquatic therapy can facilitate healing to the site of the injury. By exercising in water, vasodilation of blood vessels occurs. This will increase blood flow to the injury site, which results in increased oxygen and nutrient delivery as well as waste product removal. All of which will promote the healing process.
The hydrostatic pressure exerted by water is yet another reason aquatic therapy can be beneficial. When patients are almost completely submerged in water, blood circulation improves drastically. This can facilitate decreased swelling in the lower extremities of the body.
A rather obvious benefit of aquatic therapy is the added resistance that the patient experiences while in the pool for therapy. Air resistance is much less than water resistance, so patients in water use many more muscles and have stronger muscle contractions than they would by exercising on land. I am quite sure most people, even if they cannot swim, have experienced this phenomenon, if not try and walk as fast as you can in chest deep water and see how fast you become fatigued.
Temperature can also have a beneficial effect. Aquatic therapy is performed in a heated pool with temperatures normally between 92 and 96 degrees. The heated water helps aching muscles and joints to relax and improve blood circulation. Patients suffering from back pain and muscle spasms really benefit the most from the heat.
Other beneficial attributes associated with water physical therapy include, increased range of motion, improved balance and coordination, normalization of muscle tone, protection of joints during exercise, and reduction of stress.
As a physical therapist at Danville Orthopedic & Athletic Rehab, I incorporate aquatic therapy whenever it would be beneficial to the patient. After injury or surgery, patients receive individualized exercise programs that help patients re-learn skills of daily life activities in a reduced gravitational setting in a pool, then incorporate these skills back to land where gravity is reintroduced. By utilizing both water and land therapy concurrently patients achieve incredible results in improved functional ability and accelerated recovery time. Our combined therapy emphasizes correct movement patterns with proper posture and total body fitness, which not only increases functional ability, but also reduces the possibility of re-injury.
Although tendonitis can result from an acute injury, it is usually the result of a repetitive muscle force, placing persistent strain on a tendon. Some of the more common forms of tendonitis include laterl/medial epicondylitis, patellar tendonitis achilles tendonitis, rotator cuff tendonitis and plantar fasciitis.
So now that we know what we are dealing with, how do we treat the symptoms? Initially, the individuals can do two things to treat themselves: 1) identify the aggravating factor and stop doing it, and 2) ice, ice and more ice (10-15 min at a time or until “numb”).
However, most people, including fellow healthcare workers, tend to ignore the initial symptoms and push onward. After all, no one wants to stop a favorite hobby or take a sick day from work. So tendonitits usually progresses to a more chronic issue, an these indivudals become patients. Physician-prescribed teratemnts often begin with anti-inflammatory medications and possibliy injections to the involve region. If these are no sufficient, patients may be referred to physical therapy.
As a physical therapist, my plan of care for tendonitis usually involves treating the symptoms and again, identifying and modifying the aggravating factor(s). Adaptations may include ergonomic changes, body mechanics re-training, or an unloading brace. Referencing the tendonitis protocol, I use continuous ultrasound to penetrate and heat the tendon restrictions followed by cross friction massage to release these adhesions. We then reinforce the proper tendon gliding by stretching the involved soft tissues and initiating gentle strengthening with isometrics and/or eccentrics.
Once symptoms decline, I usually add isotonic strengthening and develop an individualized home program of stretching and strengthening to minimize the risk of recurrence. If you have questions or concerns about this or any related topics, please contact one of our physical therapists.