The Jackson Clinics

Adecade ago, individuals who had osteoarthritis of the knee were limited in their options for treatment: anti-inflammatory medications, cortisone injections, reduced activity or surgery. Viscosupplementation, a relatively new treatment involving injections of a lubricating substance called hyaluronan, has become available for patients who suffer from this painful condition or who are unable to tolerate nonsteroidal anti-inflammatory drugs.

In a healthy knee, the bones smoothly glide over each other, thanks to shock-absorbing cartilage and lubricating synovial fluid. Patients who have osteoarthritis often have less synovial fluid than normal. When the cartilage breaks down and the gel-like synovial fluid deteriorates, you end up with the pain and stiffness of osteoarthritis.

In viscosupplementation, an injection of hyaluronic acid (a substance naturally present in that precious synovial fluid) can boost the production of synovial fluid , increase joint mobility , offer pain relief and reduce inflammation. These injections go by several brand names, including Synvisc, Orthovisc, Euflexza and Hyalgan.

While viscosupplementation is not a “cure” for osteoarthritis, some studies have found that these injections can reduce pain and improve function for up to 26 weeks. If you are trying to avoid knee surgery, and other treatments have not alleviated your pain, viscosupplementation might be worth a trial. In fact, a 2008 Canadian study suggested that these injections, together with a strong physical therapy program and additional medications, could treat the pain and stiffness of osteoarthritis just as effectively as knee surgery.

Viscosupplementation can certainly work hand in hand with your physical therapy. The injections may improve function and comfort in your knee, so that we can build strength and flexibility in the affected joint through exercise—which is a tried-and-true (not to mention a safe and natural) way to treat osteoarthritis.

In the past, breast cancer survivors were told not to lift anything even moderately heavy—not a bag of groceries, not a suitcase, not their children. They also were warned against using their arms strenuously— no scrubbing floors or raking leaves.

The thinking behind these prohibitions was that exercising the arms could increase the chance of developing or exacerbating lymphedema, a painful swelling caused by a buildup of lymph fluid . Most likely to occur in women who have had underarm lymph nodes removed or damaged by radiation as part of their cancer treatment, lymphedema can develop at any time—even years—after cancer treatment.

In 2009, Dr. Kathryn Schmitzled a study at the University of Pennsylvania that suggested such prohibitions may have been too restrictive. The authors looked at breast cancer survivors with stable lymphedema. Half the women were enrolled in a controlled weight lifting program that met twice a week for 13 weeks while the other half did not exercise at all. After one year, the women who lifted weights experienced significantly reduced symptoms of lymphedema, compared with those women who did not exercise. The weight lifters also gained upper body strength.

These results do not mean that breast cancer survivors should ignore what their doctors have told them about heavy lifting. The women in the study began by lifting only one to two pounds and added weight only under strict supervision . What the results do suggest is that controlled resistance exercise may help breast cancer survivors with lymphedema relieve the symptoms and prevent the condition from worsening.

However, Dr. Schmitz noted that weight lifting by breast cancer survivors is not a do-it-yourself proposition. It is essential, she said, for women to “work with a well-trained certified fitness professional to begin weight training. Do not try to start this kind of program on your own. Train with a physical therapist or a certified fitness professional who specializes in lymphedema or works with cancer patients.”

Our experienced staff will be happy to work with you and your doctor to develop an exercise program to improve your postcancer lifestyle, resume as much of your routine as possible and avoid the symptoms of lymphedema.

The Pelvic Girdle workshop is designed to teach treatment techniques that you can apply immediately in clinical situations for increased effectiveness.

Next course is scheduled for June 5th – 6th at the Sheraton Reston Hotel in Reston, VA.

Visit http://www.richardjacksonseminars.com/ to learn more.

Richard Jackson Seminars, taught by Richard Jackson, PT, OCS, offers unique physical therapy instruction emphasizing clinical relavance and advanced manual therapy training.

Suffering from back pain?

Join us for FREE

     Wednesday, May 19th
     7:00pm – 8:00pm
     The Jackson Clinics | Fairfax Office
     8550 Lee Highyway, Suite 450 

 - Learn Back Basics
 - Identify Core Stabilizer Muscles
 - Hands On Posture & Body Mechanics Lab 

Taught by: Laura Malnati, DPT, Kris Porter, DPT, OCS & Matthew Randall, DPT
Bring a friend and get BACK SAVVY.

Seating is limited, so call today! 703.208.1002

You probably remember learning how to ride a bike. But most likely, your six-year-old self had no clue just how benefecial this newly acquired skill could be to your overall health and wellness.

One of the most popular and enjoyable fitness activities, cycling was recently celebrated in the medical community for enhancing cardiac health, thanks to a 2009 study published by the Scandinavian Journal of Medicine and Science in Sports Physical therapists had embraced the bike long before this, however, for its role in post-surgical, post-injury rehabilitation.

Bike riding has s pecific advantages for people who suffer from back and knee problems. Cycling builds the large muscles in the hip, back and thigh. It specifically helps strengthen the muscles responsible for stabilizing individual vertebrae and nourishes discs as they heal.

Lower down the body, where a breakdown of cartilage is often responsible for knee pain, the action of pedaling a bike encourages nourishment of cartilage in a low-stress manner. Plus, the overall health benefits of cycling—enhanced cardiac health, improved circulation and better all-around strength and flexibility—can enhance any rehabilitation program.

Cycling is not without risk, however. To avoid stress injuries, you need to follow a few simple procedures. Here are a few tips to get you started:

• Find a seat that allows for an upright, balanced position. Many seats encourage a “forward bent,” which places stress on your back, neck, elbows and wrists. Sitting totally erect is the most ergonomically healthy way to ride.
• Employ a precycling workout that improves strength and flexibility in hamstrings and quadriceps.
• Take frequent breaks to stretch your neck, arms and shoulders when riding for long periods of time or at high intensity.

We can design an appropriate stretching and strengthening routine to ensure that your body is ready to ride, whether on the race track, in the mountains or on an indoor recumbent bike in the comfort of your living room. Soon, you will be riding your way to better overall health and physical well-being.

It is a glorious Saturday morning; you have put the stress of work behind you. All week long, you have been looking forward to playing golf. But when one of your foursome suggests walking the course, you suddenly become a little nervous. Yet riding in a golf cart robs you of much of the health benefits of golfing.

Golf can provide a terrific workout. In addition to exercising the muscles used to swing a club, golfers who walk the course frequently cover as much as four miles in 18 holes, a distance that passes quickly as you think about your game and talk with friends. And you gain even more health benefits when you carry your own clubs and burn more calories in the process. If the clubs are too heavy to carry, walk anyway and use a pull cart for your bag.

Technique is very important for more than just your score. Because the golf swing contorts the body, you can injure yourself. Therefore, you must warm up properly . Stretch several times a week to increase your flexibility, making it easier to swing your clubs. Strengthening your core muscles will give you a looseness in your backswing and follow-through, and help you hit longer drives.

Stretching and strength training will give you better body control and power, critical elements for a successful golf game. But they must be performed correctly for you to realize their benefits.

Realistically, your golf swing is a reflection of your physical attributes and limitations. We will be happy to work with you and analyze your needs, developing a program that will increase your flexibility and functional strength, give you better balance and the power to hit drives far down the fairway, and help you prevent injuries. Before your next tee time, call our offices or stop in to set up an appointment and see what we can do for you and your golf game.

Almost everyone has heard of total hip replacement and total knee replacement. But fewer people are familiar with total ankle replacement (also called total ankle arthroplasty).

Although the ankle looks like a simple hinge joint, it actually involves much more complex movement, absorbing forces up to five times body weight. Many conditions, such as severe osteoporosis, rheumatoid arthritis and post-traumatic arthritis, can cause degeneration of the ankle joint, leading to severe pain, swelling and immobility.

Until recently, the only choice to repair a degenerated ankle was to fuse the shin bone (tibia) to the top foot bone (talus), a procedure called ankle arthrodesis. This eliminated pain but left the ankle completely immobile.

When total ankle replacement (or TAR, for short) was first performed in the 1970s, the two-part prosthesis implanted was not very successful. Nowadays, ankle prostheses are made of three pieces of plastic and metal. While not perfect, they relieve pain and allow movement of the joint. These improvements have enabled TAR to become part of the treatment used to correct ankle arthritis.

Ideal candidates for TAR

• are older than 50 years of age
• have a degenerative ankle that has not responded to nonsurgical treatment
• are physically active but do participate in activities that put heavy stress on the ankle

People who undergo TAR need six to 12 weeks of rehabilitation to adjust to their new joint. Physical therapy can improve range of motion and strengthen the ankle while controlling pain. Because the ankle prosthesis does not move in quite the same way as a natural ankle, gait training, initially with an assistive device, is necessary. If you and your doctor decide that TAR is right for you, we will be glad to work with your surgeon to develop a postoperative rehabilitation program that will get you and your new pain-free ankle moving again.

Extensor tendons allow you to extend your wrist and open your hand. They run along the forearm to the wrist and then along the back of the hand. Because these tendons have little protection, they are quite vulnerable to injury. You could injure your extensor tendons in several ways:

• lacerations (for example, if your hand goes through a glass window)
• blunt trauma or crush injuries
• deep burns
• animal bites
• disease

In people with rheumatoid arthritis, these tendons can erode and rupture at the wrist. And someone with ruptured extensor tendons will lose movement in the fingers.

Most extensor tendon ruptures must be surgically repaired, but surgery alone will not restore the hand to the fullest function possible. To regain dexterity, it is essential that surgery be followed by several months of physical therapy . Because the wrist and hand are complex structures, each extensor tendon repair requires a slightly different approach to rehabilitation, depending on where the rupture occurred, how many tendons were injured and whether there are other surrounding injuries such as broken bones.

Physical therapy can prevent scar tissue from forming between the tendon and the bone so that the gliding motion of the tendon is restored. This allows the hand to open and close smoothly through its complete range of motion (ROM). But care must be taken to balance exercises that increase ROM against putting too much tension on the repair site before it is fully healed.

Only properly guided rehabilitation can return full use of your hand following extensor tendon surgery. We can work with your doctor to develop a physical therapy and home exercise program appropriate to your injury.