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Physical therapists see many patients who have sustained orthopedic or athletic injuries and, with a good clinician, the results from rehabilitation are usually excellent.

At Pivotal Physical Therapy, the physical therapists are experts in both how to treat the immediate trauma and preventing future injury. Initially, we evaluate the injury and determine the most efficient method of recovery. Concurrently, we focus on the whole athlete, assessing their form and movement patterns. We can then determine if poor biomechanics contributed to the injury and retrain the athlete in more efficient movement patterns. A typical byproduct of the “new” movement patterns is a decrease in symptoms (or avoidance of future symptoms) and an increase in performance.

To address the immediate cause of the symptoms (i.e., swelling, stiffness, inflammation) we employ various modalities (e.g., heat, ice, ultrasound, electrical stimulation) as needed, as well as massage, stretching and joint mobilization. For the prevention of re-injury, the therapist employs sophisticated movement analysis and retraining techniques.

Typical Treatment

Total treatments: 12 Duration: 6 weeks Frequency: 2 times per week Protocol: Strengthening, stretching, muscle re-education, Home Exercise Program.

Case Study

History

44 year old male runner (15 miles per week) with a 3 month history of right heel pain. Originally the heel was only painful when running. Currently it is very painful with his first steps in the morning and, the end of the day (after wearing leather soled shoes). He has had to stop running because of the pain.

Assessment

During the initial evaluation the physical therapist noted:

1. Extreme tenderness of the right medial heel 2. Tightness of right calf muscles 3. Over-pronation of right foot 4. Significant weakness of R hip muscles. 5. Patient’s walking pattern indicated a poor heel strike (especially on right) and excessive medial rotation of right hip. 6. Running style assessment was deferred due to pain. The patient reported he ran primarily on his toes. 7. A soft gel heel insert was suggested to help decrease the pain with daily walking, and reduce stress upon heel strike. 8. The patient was educated regarding footwear for daily use and running.

Treatment

The first 4 sessions were dedicated to pain relief.

1. Ultrasound, ice were applied to the tender spot on his heel. 2. Massage, stretching to his R calf muscles 3. Hip strengthening exercises were taught to begin addressing the hip weakness.

Treatment 5 progress and results.

1. The right heel pain had decreased by 50%. 2. Right calf muscles were longer and more supple 3. The hip exercises had begun to feel easier. 4. Deep massage to the heel was performed which helped to alleviate another 20% of his pain.

Sessions 6-8 emphasized lower extremity aligntmentwhen standing and walking.

1. The patient would practice balancing on his right leg on various surfaces (e.g., wobble boards, trampoline, soft foam pads) with the exercises becoming progressively more challenging.

By the 8th session he had to squat on his right leg while standing on the foam pad and maintaining ideal lower extremity alignment.

Sessions 9-12 were dedicated to fine tuning his running style.

1. No R heel pain 2. Running style was assessed on the Treadmill and his heel strike had normalized on the R side while he had some residual excessive medial rotation of the right hip. 3. His balance exercises continued to become more difficult (because running, if you think about it, is really a single leg sport, you are never on both legs at the same time). 5. Continue to increase right hip strength.

Comment

At the time of discharge the patient had returned to running 10 miles per week at an increased pace (formerly 8 now 7 minutes per mile)and without pain.

The above case history represents our “typical” patient. Obviously results and duration of treatment can vary for each patient depending upon their age, severity of the condition, diagnosis, and compliance with their Home Exercise Program.

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