The Jackson Clinics

Sprained ankles may be common, but they can lead to long-term problems. A European study found that up to 75% of the sprains incurred by professional soccer players occurred in ankles with previous sprains or instability.

Another study reported that up to 40% of people who had previously sustained an acute ankle sprain were likely to experience chronic ankle instability. The most common ankle sprain is a lateral ankle sprain, where the foot rolls inward, stretching the ligaments on the lateral, or outside, part of the ankle. The ligaments most commonly involved are the anterior talofibular ligament, which keeps the ankle bones from slipping forward, and the calcaneofibular ligament, which keeps the ankle from rolling inward.

A grade I sprain causes the ligament to stretch, a grade II sprain results in a partial tearing of the ligament, while in a grade III sprain, the ligament suffers a complete tear, or rupture. Pain and swelling accompany all three types of sprain; in a grade III sprain, the ankle is quite painful, walking can be difficult and patients may complain of instability or a “giving way” sensation to the ankle joint.

As ligaments heal, the resulting scar tissue causes the ankle bones connected by the ligaments to be held together less tightly than before the injury. This laxity makes it easier to resprain the ankle.

If your ankle ligaments do not heal adequately following a sprain, your physician may suggest placing a lateral wedge in your footwear under the outer half of the heel to stabilize the ankle and keep it from rolling inward and being sprained again. Because the ankle joints are complex and subject to many stresses, the use of a heel wedge alone is unlikely to return the ankle to full function. Thus, your doctor will most likely recommend that you work with a physical therapist for two to four weeks.

Whether your goal is to walk the dog or return to sports, we can devise a complete program of rehabilitation exercises to help prevent you from injuring your ankle again. These exercises would allow you to achieve full range of motion of the ankle, strengthen the muscles along the outside of the leg and restore the proprioceptors, special nerve cells that send information about position and movement of the body, in this case, the ankle. We can design sports-specific exercises to help you safely return to your preinjury activities

The bodies of people with diabetes either do not produce enough of the hormone insulin or do not utilize it properly. A crucial compound, insulin regulates blood glucose , also called blood sugar, which is the body’s primary energy source.

While type 1 diabetes occurs mostly in children and young adults—the result of a biological glitch that does not allow their bodies to produce any insulin — type 2 diabetes occurs primarily in adults over the age of 45 and is linked to lifestyle factors . As Americans have become less active, more prone to weight gain and have increased their consumption of overprocessed foods, the incidence of type 2 diabetes has risen.

In the United States, type 2 diabetes affects almost 11% of the population over the age of 20, or 23.5 million people. If you have type 2 diabetes, your risk of death is twice that of a person your age who does not have the disease.

Complications from type 2 diabetes arise when glucose is produced but does not enter the body’s cells, lingering in the blood instead, affecting almost any system or body part from the kidneys, eyes and feet to the heart and brain. Type 2 diabetes can cause emotional stress and strain as well.

The good news is that with careful treatment and the following lifestyle modifications, type 2 diabetes can be managed and complications can be delayed or avoided altogether:

• Take your prescribed medications , both to control blood sugar and to treat concomitant conditions such as high blood pressure.
• Lose weight.
• Stop smoking.
• Adhere to a moderate exercise routine.
• Engage in positive social contact —reach out to friends and family who make you feel good.

Working with your physician, we can design an exercise program to address these lifestyle modifications. Call our office to schedule an appointment and help stave of type 2 diabetes or reduce its harmful effects.

To fix a broken bone internally into position and support it until it is able to bear weight, surgeons have turned to new materials such as stainless steel, cobalt and titanium, which are compatible with the body and rarely cause allergic reaction or implant failures. While metal screws made from these materials are widely used, they can cause complications, some of which may not be noticeable at first.

After the broken bones have been put back into place (reduced), screws are placed through the dense cortical bone of one bone into the dense cortical bone of the other. With this connection holding the broken bones together as they heal, patients usually enjoy a positive surgical outcome. Although the screws are often not removed after healing, they usually do not result in complications for most patients.

However, problems can arise. For instance, your doctor might be concerned that the hole created to sustain the screw can trigger weakness in the bone and surrounding area. Or a screw could shift to another position or even be noticeable at the skin’s surface. Even though most screws stay in place, these issues often mean that a screw must be removed.

Depending on the specific surgery, which can range from anterior cruciate ligament surgery of the knee to shoulder surgery,  physical therapy should begin as soon as possible. Taking into account any limitations you have, we can tailor a rehabilitation program to help reduce surgical complications, including those related to the screw.

Targeted exercises performed safely and under guidance can help to

• strengthen bone and surrounding tissues
• gently improve your mobility
• support flexibility and coordination
• regain muscle strength and range of motion

Further injury is also more likely to be prevented when physical therapy starts early, allowing your body to heal successfully. Talk to us about the best program to complement your surgery and reduce complications.

If you were athletic before your pregnancy, you can continue your “normal” workouts, as long as you use common sense. For women who were not particularly active before becoming pregnant, it is a great time to begin some gentle, easy workouts.

Engaging in some form of prenatal exercise has important benefits: less weight gain during pregnancy, a significantly shorter and less painful labor, a faster recuperation from the birth and a quicker return to your prepregnancy weight. And because exercise releases endorphins, it also helps alleviate emotional stress and potential depression.

However, some guidelines should be considered when exercising during your pregnancy:

• Keep your heart rate below 140 beats per minute. Because the fetal heart rate is affected by the mother’s, do not overexert yourself.
• Slow down. Your balance may be off, and you may tire more easily, especially during the later stages of pregnancy.
• Avoid overstretching. During pregnancy, a hormone that lubricates your joints and increases flexibility to help you during labor is released, so beware of your newfound suppleness.
• Continue to engage in weight training or abdominal exercise if you did so before becoming pregnant.
• Avoid jarring movements or sports with a high risk of injury, such as horseback riding, downhill skiing and contact sports. The best prenatal exercises are swimming, walking, prenatal yoga and stationary biking.
• Listen to your doctor’s recommendations, and do not let your desire to stay in shape jeopardize your (or your baby’s) health.

We can design an exercise regimen that will keep you in shape during your pregnancy. In addition, we can show you safe and effective ways to strengthen your arm, leg and abdominal muscles, which you will need once your baby arrives.

Do you experience knee pain when you return to the basketball court after a layoff of a few months? If your knee always aches—even if you cannot remember incurring a specific injury—you may be suffering from jumper’s knee (formally known as patellar tendinopathy). This progressive deterioration is especially common among adult male basketball and volleyball players.

In the knee, the quadriceps tendon attaches the heavy quadriceps muscle on the front of the thigh to the top of the kneecap (patella), and the patellar tendon attaches the bottom of the kneecap to the shin bone (tibia ). Repetitive stress overload on these tendons during jumping and especially on landing causes repeated microtears and collagen degradation in the tendon, resulting in gradual, aching knee pain.

Athletes with low strength, and poor hamstring and quadriceps flexibility are most likely to develop jumper’s knee. Overtraining, excessive playing on hard surfaces, and individual jumping and landing technique can worsen the problem.

For a definitive diagnosis, see a physician who specializes in sports medicine. If the doctor determines that you suffer from jumper’s knee, we can develop an exercise program to progressively improve the flexibility and strength of your hamstrings and quadriceps.

Eccentric exercise (when the muscle lengthens in response to external resistance) can especially benefit individuals with jumper’s knee by speeding up the rehabilitation of weak or injured tendons . We can show you how to perform specific eccentric exercises correctly using free weights, body weight exercise and nonhydraulic exercise machines so you can return pain-free to the basketball court. Importantly, this strengthening and stretching process takes time (10 to 12 weeks) to reach ultimate improvement. No quick fix is available! August 2010

Because recovery from surgery to repair flexor tendons (the tendons that control the movement of your fingers) can be challenging and slow, many people become frustrated after about two months. Why does it take so long to regain the ability to fully bend or straighten your finger?

For one thing, effective rehabilitation requires patience and diligence . Regaining a considerable amount of function and movement in your fingers will not happen overnight.

In addition, although flexor tendon injuries do not sound very serious, they can be difficult to repair. One part of the challenge is that the injury can become a psychological problem . Recovering motion in your fingers depends more on how well your brain adjusts to the situation than how well your fingers bend.

To aid in your recovery, you should take these simple precautions:

• Do not use the injured tendon until your physician gives you permission.
• Avoid lifting heavy objects.
• Do not let the tendon get stretched.
• Do not drive a car until your doctor says it is all right to do so.
• Keep bandages clean and dry at all times.
• If you have a cast, place a plastic bag over your hand when showering or bathing to keep the cast dry. A newspaper bag, a bread bag or a small trash bag can be sealed at the top with tape or a knot to prevent water from reaching the cast.
• Avoid the urge to push or lean on the cast for at least three months so you do not break it.

While complete recovery from flexor tendon repair may take as long as one year, you can regain a large percentage of your former range of motion if you are patient. We would be happy to work with your surgeon to design and implement an exercise program that targets your flexor tendon after surgery and restores flexibility to your finger.

Mononucleosis—often known simply as “mono”—has an incubation period of one to two months. Once symptoms appear, recovery can take an additional four to six weeks. Until your physician tells you it is safe to resume more strenuous workouts, avoid any but the mildest exercise (e.g., short walks).

In many mono patients, the spleen—a large blood-filtering gland located in the upper-left part of your abdomen—becomes enlarged. Participating in contact sports or simply moving around too much can put you at risk for a ruptured spleen, a rare but possible complication of mono. If, despite taking precautions, you experience sharp abdominal pain, confusion, dizziness, fainting or blurred vision, contact your physician immediately. The doctor will then determine if you need to go to the emergency room.

It is also important to avoid exercise because too much activity during the first weeks of mono can make symptoms linger longer and be more severe than they otherwise would. This is true whether you initially feel fatigued or not.

One more point: Stay hydrated. When you feel feverish and are coping with throat and neck discomfort, you may not be interested in eating or drinking. But taking in lots of fluid will help your body counteract the virus causing your illness. In fact, to help the recovery process, you should try to consume at least twice the amount of fluids you normally would.

Typically, a person with mono experiences fever and pain from swollen glands for a week or two, followed by up to three months of fatigue. During the later period, listen to your body. If you feel up to a short walk and do not experience fever or dizziness, go ahead. When your physician agrees it is time for more vigorous exercise (usually after two to three months), we can design a physical therapy program to help recondition your body so you can eventually resume your prior level of activity.

How much exercise is enough? There is no one answer. Age, sex and current fitness level, along with risk factors such as diabetes, heart disease, stroke and excessive weight, must be factored into the equation. All of these considerations may make it impractical to compare various fitness programs. But he following guidelines can help you reach your goals.

For healthy adults younger than 65 years of age who wish to maintain their heart health, the American College of Sports Medicine recommends moderate cardiovascular exercise 30 minutes a day, five days a week. Jogging, swimming and brisk walking are good examples of cardiovascular exercises, as are strenuous housework activities such as scrubbing floors.

In 2002, the National Academy of Sciences Institute of Medicine said that Americans should perform even more physical activity to control their weight . While 30 minutes a day can maintain good health, 60 minutes a day can help control your weight and 90 minutes a day may be necessary to produce and maintain weight loss.

Weight training can also produce significant changes to your physique. One of the most effective weight-training tools is the kettlebell, whose use combines functional strength development, body control and rigorous cardiovascular exercise. In addition, stretching enhances a strength program by increasing flexibility and helping to move more freely.

It is also important to maintain your target heart rate . You can find standard target heart rates, which vary by age, on several Web sites. To check your heart rate, stop exercising momentarily, take your pulse for 10 seconds and multiply this number by six to find the number of beats per minute. If you are just starting an exercise program, keep your heart rate at the lower end of your target heart rate zone. Women will find that newer tables set the target heart rate a bit lower than previously recommended.

Remember to undergo a thorough physical examination before beginning any physical fitness program. We will gladly design a program that can enable you to achieve your fitness goals. Call our office for a consultation.