Overactive bladder and involuntary loss of bladder control affect more than 25 million Americans—men and women alike, young or old. Individuals who experience these conditions often feel ashamed, depressed and socially isolated.

A bladder that leaks involuntarily is not a normal process of aging and is sometimes caused by other medical factors. While many treatment modalities, such as drug therapy, electrostimulation, medical devices, injectable bulking agents and local estrogen therapy, can help people control their bladders, a 2008 study published in the Annals of Internal Medicine reported that physical therapy can help control, alleviate and often eliminate the embarrassing symptoms of this condition in women.

Prior to designing an exercise program specific to your needs, we can evaluate and determine the type of incontinence (stress, urge or both) and then focus on the degree of problems you have experienced. We will then work with you to perform exercises, including the Kegel exercise, to strengthen the pelvic floor. You will be advised to stop the ow of urine midstream and then focus on contracting the muscles that accomplish that task. The Kegel exercise should be performed several times each day, with a gradual increase to 10 repetitions each time. You should evaluate your technique when doing the exercise because improper technique can result in poor results for incontinence patients, and evaluation differs for men and women.

We can also help you retrain your bladder by keeping a journal indicating when urination occurred, when the need to urinate was felt and when accidents happened. You will develop a schedule to visit the bathroom at timed intervals throughout the day, triggering a stimulus to help to train the leakage.

Diet also plays an important role in controlling incontinence. For instance, alcohol and caffeinated beverages, chocolate and acidic fruits stimulate the bladder, causing it to release more urine. We may recommend changes in your diet, depending on the type of incontinence, its severity, and your age and health status.

We will be glad to evaluate your incontinence problems and develop a program to help manage your symptoms. We can also provide you with instructions to properly perform all exercises to recondition your bladder. Our professional guidance can help you to reduce and control this vexing problem and improve your quality of life.

Jake Johnson was an avid tennis player before pain from a degenerative hip joint took him o the courts. When his doctor said that he needed total hip replacement surgery, he thought his tennis playing days were over. But were they?

In the past, most surgeons recommended against playing tennis after a hip replacement. Today, artificial hip construction has been improved to withstand more stress. Hip replacement is also being performed on younger people with less joint damage. Changes such as these have caused doctors to rethink some of their advice about playing tennis after a hip replacement.

After your surgery, be aware that your physician is not going to give you the go-ahead to play competitive tennis. Even singles social tennis is strongly discouraged, but it may be possible for you to play a set or two of social doubles on a regular basis.

The greatest risks to playing tennis with an artificial hip include causing excessive wear on the new joint surface, dislocating or fracturing the hip, and possibly loosening the joint. These risks must be evaluated on an individual basis.

If and when you can return to the courts depends on

• the degree to which the hip joint had degenerated before surgery
• your overall bone health
• whether you received a cemented or uncemented replacement joint
• your dedication and response to an appropriate rehabilitation program

Before you return to tennis, golf or any other sport, we can develop a progressive, realistic and manageable physical therapy program that will strengthen appropriate muscles and help minimize risk. Gradually, you hopefully will experience a successful recovery for your hip and reach the point where you may be able to get back on the court for a friendly set of social doubles.

Heel pain can be a complex problem, but many times it results just from overuse of the foot. Heel pain can also result from running, especially with poor form, shoes with insufficient support, a sudden injury to the heel, and physical conditions, such as Achilles tendonitis, plantar fasciitis, a pinched nerve at the back of the foot, heel spurs or stress fractures. The best way to treat your heel pain usually involves an integrative physical therapy program that uses both stretching and manual techniques.

Before prescribing such a program, we will examine your knees, hips, ankles and feet to assess impairment and restrictions. We can teach you to use exercises to help relieve pain and swelling while improving your mobility. These include stretching exercises focused on the calves, which then stretch the heel cord, and grabbing the base of your toes and pulling them toward your shin to stretch the foot. We can also ascertain whether you are a candidate for hands-on therapy involving trigger-point soft-tissue techniques applied to the calf.

You can take some steps to alleviate the pain in your heel. The following home care tips can make a
difference:

• Ice the affected area at least twice a day for 10 to 15 minutes, more often for the first few days.
• Rest the foot for at least a week to allow the inflammation to “cool” down.
• Take an over-the-counter agent such as ibuprofen or naproxen to reduce pain and inflammation if recommended by your physician.
• Obtain and wear proper-fitting shoes with good arch support and cushioning.
• Use a heel cup, felt pads in the heel area or a shoe insert in your existing footwear.

Improving muscular strength and balance can protect you from a recurrence of injury and pain. Should your heel pain require surgical intervention, we can design an exercise program to complement your recovery. Following a personalized exercise program will encourage heel pain healing, avert any future injuries and keep your feet in healthy, active condition.

The ACL—anterior cruciate ligament— provides stability to the knee by keeping the tibia (shinbone) from sliding in front of the femur (thighbone). About 250,000 ACL reconstructions are performed annually in the United States on individuals who experience the condition. ACL tears are not usually sutured together because the repairs do not fare well over time. Instead, the damaged ACL is reconstructed with a tendon graft.

One choice, taking a tendon—usually the patellar tendon—from the knee opposite that of the injured ACL, allows for a more symmetrical and hopefully easier, quicker and less painful rehabilitation process. Surgeons who prefer this method say that regaining overall strength and range of motion can be easier than when only one knee is affected.

The surgeon can also use a tendon, called an allograft, taken from a cadaver, which can reduce pain, surgical time, and the number and depth of incisions. However, this choice introduces a certain risk of infection, no matter how eective the screening procedures may be.

In the third scenario, the surgeon takes a patellar, hamstring or quadriceps tendon from the leg with the injured ACL, depending on surgical preference and on the patient’s anatomy and injury. The subsequent “trauma” in the area from which the graft is taken needs to be addressed in recovery and rehabilitation.

We can evaluate the unique circumstances related to your ACL injury and work with your surgeon to determine the best approach related to your care—and whether it includes the reconstructive surgery. Regardless of treatment choice, we can help you restore muscle strength, endurance and coordination, and modify your physical activity to put less stress on your knee.

We can help you before and after surgery by tailoring your program to optimize the recovery process. Working together as a team will help assure a successful outcome and get you back on your feet to carry out daily activities and participate in sports stronger than before.

Back pain is a common complaint, with about 25% of people in the United States reporting low back pain within the previous three months. Back pain often occurs after surgery for a back injury. Other causes include a ruptured disc, osteoporosis, arthritis, lumbar muscle strain and sciatica. A sedentary lifestyle, pregnancy, obesity, smoking and depression are risk factors for back pain. Occupational triggers include
workplace stress, poor posture, inadequate seating or heavy lifting with bad form. Much of the time, however, the causes of back pain are unknown, and the symptoms resolve by themselves.

While there are many treatments for this ailment, a person with back pain often benefits from exercise and physical therapy. For instance, in recent years, Pilates exercises have been promoted to alleviate back pain. While this particular system has advantages, the key is to restore mobility and reduce pain, which means that many other forms of exercise can be just as effective.

Regardless of the initial causes, our first focus will be to reduce the swelling and inflammation, and relieve the pain. Techniques to accomplish this may involve

• heat, ice or ultrasound application
• transcutaneous electric nerve stimulation
• flexibility and strengthening exercises
• instructions and exercises to improve your posture

Because all back pain is not the same, we will create a customized program for you, taking into account the cause, your lifestyle, and your health, fitness and wellness goals. In addition to teaching you specific exercises to get moving and educating you to take care of your back in the future, we may recommend particular sports in which you can participate. This is important because ongoing exercise is very valuable and lessens the likelihood of the return of low back pain.

For almost 90% of people, back pain resolves within weeks, provided you follow your exercise program. We can show you safe and effective ways to improve function, reduce pain, and strengthen and maintain a healthy back—for life.

The seven cervical (neck) vertebrae are separated by tough, flexible disks that absorb shock from movement. These bones have a large hole in the center through which the spinal cord passes and several smaller holes that allow nerves coming o the spinal cord to enter the body. Any condition that injures the nerve root where it emerges from the spinal column is called a radiculopathy.

In younger people, radiculopathy usually results from a herniated or bulging disk that causes pain by pressing on the nerve root. In older people, the cause is often a change in bone structure that narrows the hole through which the nerve passes.

Initial treatment with physical therapy usually involves rest, ice, and stretching and strengthening exercises, as well as correcting any improper sports techniques. A soft collar worn for a short period of time rests the neck muscles and limits neck motion.

We can help you properly align your spine and improve your posture while sitting at home or on the job if your neck pain is the result of a bulging disk. In addition, we can show you how to use your stabilizing muscles such as the serratus anterior, middle and lower trapezius, rhomboids and latissimus dorsi. To further improve posture while alleviating pain, an easily learned technique called cervical retraction can be performed
at home 20 to 30 times each day, either all at once but more often divided into five to eight repetitions four to ve times during the day.

For ultimate success in treating your cervical radiculopathy and elbow pain, we can work with your physician and you to design an exercise program of stretching and strengthening to help ease your pain and restore your function.