As we age, the natural loss of muscle makes it harder for our bodies to handle daily activities, such as bending, walking and picking up heavy objects. This loss of muscle tone contributes to back problems, knee injuries and a myriad of other body ailments. No matter how limber you may be, the cardinal rule for muscle is “use it or lose it.” Strength training not only helps maintain muscle but it can also

• reduce the risk of osteoporosis by increasing bone density
• help you maintain a healthy weight—lean muscle mass burns more calories than fat
• protect your joints and ligaments, helping you to avoid future injuries
• improve balance and overall well-being

It is important to engage in the right kind of stretching, as well. Some studies have suggested that the traditional static stretching (stretching a muscle or muscle group to its farthest point and then holding that position)—often a part of stretch and tone classes—is not ideal when used alone before exercise. Instead, the dynamic stretching (slow, controlled leg and arm swings or torso twists) often used by athletic teams to warm-up or a combination of the two (gentle general exercise to warm up and gentle dynamic stretching after exercise) may be more helpful. A 2008 study by the U.S. Centers for Disease Control and Prevention found that engaging in both static and dynamic workouts reduced the risk of knee injury in female soccer players by half.

To truly improve your physical health, heal from injury and prevent future chronic ailments, a good overall fitness plan is needed. We can design an individualized plan that incorporates the right kind of stretching, strength training and aerobic exercise to turn your body into a well-oiled machine.

Meniscus tears are common injuries. However, the approach to these injuries has changed dramatically in the past decade. Surgeons used to favor “partial meniscectomy,” where they would simply cut out the damaged portion of the meniscus cartilage. In severe cases, they would remove the entire meniscus altogether.

Patients tended to do quite well in the short-term with this approach but would suffer early and intense onset of arthritic symptoms. This brought to light the importance of the protective nature of the meniscus, which provides stability and lubrication to the joint and minimizes the load exerted on the knee from the daily grind of standing and walking.

Nowadays, most surgeons prefer to fix the tear whenever possible. The rehabilitation process for this procedure is long and arduous, but it is quite effective when performed properly. After surgery, you will be asked to wear a brace (which will lock your knee in place) for at least a month.

Most of the time, physical therapy can begin shortly after surgery. In the initial weeks, it will focus on gentle mobilization to encourage healing of the soft tissues and ensure that you do not compensate by putting too much stress on the other side of your body, which can lead to further problems in the future.

After about eight weeks, a more intensive strengthening and stretching rehabilitation program will ensure that knee flexion is equal to that of the uninjured knee. By three to four months, you will be able to resume normal activities and forgo knee protection. A return to sports will be slower, but a properly healed meniscus means that you will no longer have restrictions on motion and will not be required to wear a brace when competing.

Whether or not your torn meniscus requires surgery, a well-designed rehabilitation program can make a return to normal life and sports smooth and successful. We will be happy to work with you and your physician to devise an individualized program appropriate to your age, health status and activity level.

This damage could result from nerve damage, nervous system diseases, swelling, nerve compression or tiny bundles called neuromas. Diabetes is a common cause of neuropathic pain. Pain following an outbreak of shingles—called postherpetic neuralgia—is  a serious neuropathic pain problem, especially in the elderly. For as many as 30% of cases, however, the cause is unknown.

The pain related to nerves is very specific. It can be sharp, burning or stabbing. It may occur primarily around a dysfunctional area or it can travel through the nerve to various parts of the body (referred pain). In addition to the pain, a person can also experience tingling, numbness, weakness and pain from a simple light touch to the skin.

Clearly, neuropathic pain can be very debilitating to sufferers and, if left untreated, can lead to depression. Medications used to treat neuropathic pain include adjuvant drugs (antidepressants and antiseizure medicines), nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, corticosteroids and nerve blocks.

Seeing a physical therapist soon after your pain is diagnosed  is vital to learning how to manage the pain and function in your daily activities. We can work with your physician to complement any medication you may already be taking. Treatment incorporates a broad range of tools, such as strengthening exercises, psychological support and techniques to improve range of motion. For those with significant pain, even light exercises and stretching can provide improved function and reduced pain. Manual therapies and therapeutic massage, along with electrical stimulation where appropriate, may be added to your customized program to alleviate painful muscle spasms.

Neuropathic pain, especially when chronic, can be a major challenge. A regular physical therapy program that we can devise may help you to successfully cope and feel more like yourself again.

The hip is a ball and socket joint. The ball, or head of the femur, fits into a socket called the acetabulum. Both ball and socket are lined with cartilage so that the joint can move smoothly. Any abnormality in the shape of the femur or the acetabulum can wear away the cartilage, creating a painful condition in the hip called femoroacetabular impingement (FAI).

There are two types of FAI.

• Cam impingement occurs if the head of the femur is not completely round. As the joint moves, irregularities in the femur head bite into the labrum or lining of the acetabulum, wearing it away.
• Pincer impingement occurs if the front edge of the acetabulum extends too far.
  When the hip moves, the labrum is crushed against the neck of the femur.

FAI can be difficult to diagnose because other muscles and joints attempt to compensate for damage to the hip joint. As a result, pain may appear to come from the lower back, groin or gluteal muscles.

People are born with the bone abnormalities that cause FAI. Nonathletes usually will not develop impingement symptoms until middle age or older. But athletes who perform repeated movements and put high loads on the hip can develop pain from FAI in their teens and 20s.

Surgery is the most frequent treatment for FAI, and it is usually successful. Some studies have shown that more than 75% of competitive athletes who have arthroscopic surgery for FAI are able to return to their sport.

Following surgery, physical therapy is essential to prevent scar tissue formation, restore range of motion and develop strength in the hip. When you plan surgery for FAI, our experienced physical therapists can work with your surgeon to develop a rehabilitation program aimed at getting you back to athletic competition.

Given the limited daylight and unpredictable weather, it might be a good time to think about joining a fitness facility for a few months. This opens up a world of exercise opportunities, including access to

• full-body strength training with free weights and machines
• cardiovascular equipment, such as the treadmill or elliptical trainer
• fitness classes

On your own, you can walk the mall, wear a pedometer to count the steps you take each day, rent an exercise DVD or borrow one from the library, engage in active housework or join an indoor sports league (basketball, indoor soccer, volleyball or swimming). If you prefer not to join a gym, have limited time during the day or do better with a specific program, we can suggest alternative forms of exercise you can perform at home:

• strength training with handheld dumbbells, barbells, olympic plates or kettlebells, or weights strapped onto your ankle or wrist
• elastic bands that increase resistance as you continue through your range of motion
• running up and down the stairs for 10 minutes several times a day
• investing in one piece of equipment for total body conditioning

With festive holidays and shorter days, it can be all too easy to eat more and exercise less. Our support can keep you motivated and on track each week. For those who plan to continue with outdoor running or sports, we can ensure that you do so safely.

Once the milder spring months come along, we can assess your progress in terms of fitness. Then, we can revamp your program to incorporate outdoor activities and other forms of exercise to ensure that you continue to achieve your fitness goals.

In the knee, the femur (thighbone) of the upper leg meets the tibia (shinbone) of the lower leg. Cartilage covering these bones allows them to slide smoothly when the knee is moved. In some people, unequal tibial alignment means that additional pressure is exerted on either the inner (medial) or outer (lateral) compartment of the knee. As a result, cartilage in the area of greater pressure wears away faster, leading to pain and reduced joint function.

The type of tibial osteotomy performed depends on which side of the knee is damaged.

• In a closing wedge osteotomy, the surgeon removes a wedge of bone from the lateral side of the tibia and pins the cut sides of the tibia together.
• In an opening wedge osteotomy, the surgeon cuts a wedge out of the medial side of the tibia and grafts bone from the pelvis to push the cut edges of the tibia apart.

With surgical adjustment of the tibia, pressure is shifted to the area of the knee where cartilage is still intact. This prolongs the life of the joint and delays the need for total knee replacement.

Successful recovery from tibial osteotomy requires long-term physical therapy to achieve a normal gait and regain strength and joint flexibility. A 2011 study conducted at the University of Western Ontario suggests that strength training begun 12 weeks before surgery can result in improved knee-related quality of life, less pain and a greater ability to participate in sports after surgery.

If you are considering tibial osteotomy, are physically active and want to return to sports after surgery, we can work with you and your surgeon to design an exercise program that increases the knee’s range of motion, prevents muscle loss, rebuilds muscle strength and prevents stiffness. With our assistance, you may return to your previous level of activity with less pain and better mobility than you had before surgery.