physiquality blog: how does physical therapy help after a cast comes off?

Despite my many injuries, I have been fortunate in that I have never had to wear a cast. (Immobilizer, yes; cast, no.) I don’t envy those that have had to wear one. I’ve heard they are itchy, and that your skin gets quite papery while encased in plaster.

While I’ve never had to adapt the movement of my arms every much, I do know what it’s like to go for weeks at a time without putting any weight on your leg. Your calf muscles will atrophy, and even driving can be a strain due to the loss of strength. Working with a physical therapist, both as the cast is placed and particularly after it comes off, can be a big help when recuperating and returning to your daily activity.

How does physical therapy help after a cast comes off?

The adult human body is made up of 206 bones. (We’re born with 270, but over time, as we grow, some fuse to give us 206 around the time we turn 30.) Unfortunately, many of those can break or fracture, leading to a cast in order to heal. So what happens after the cast is removed? What is necessary in order to return to normal activity?

A variety of factors will affect the length of time needed to heal, as well as how physical therapy will help you regain your pre-injury range of motion and level of activity.

The American Physical Therapy Association, or APTA, points out that there are several levels of bone fractures. The simplest is defined as a non-displaced fracture. This means that the bone may be broken, but the pieces are still properly aligned within the body.

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physiquality blog: how Pilates and PT help you stay active as you get older

While I’ve written many times about the importance of staying active as you age, I think this is the first time I’ve cited Isaac Newton when reminding others about the importance of activity.

How Pilates and PT help you stay active as you get older

with advice from Rachelle Hill, PT, MSPT, CSCS,
Kristina Holland, PTA,
Jessica Loncar, PT, MS, OCS, Cert. MDT,
and Mika Yoshida, CSCS, EP-C

As we grow older, our bodies change. While it may sound counterintuitive, staying active is the best solution when our joints start to ache and our energy starts to fade. (Isaac Newton probably had no idea he was also talking about the human body when he explained that a body at rest stays at rest, and a body in motion remains in motion.)

Two ways to remain in motion as we age are physical therapy and Pilates. As we’ve pointed out in the past, physical therapy helps maintain and improve your health as you age. “Therapy helps to promote an increased awareness of your body,” says physical therapist Rachelle Hill. At Moreau Physical Therapy (a Physiquality member in Louisiana), Rachelle and her fellow PTs apply therapy to improve posture and reduce back pain, evaluate gait to make walking more efficient and less painful, and improve balance to reduce the risk of falls, she explains.

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physiquality blog: injury prevention for dancers

As a dancer who has had multiple knee surgeries after 30+ years of training, this is a subject that is near and dear to my heart. I have spoken with physical therapists in the past about whether I would have tried some of these techniques to reduce my chance of injury, but thinking back to my 16-year-old self, I don’t know that I would have. And as my problems stemmed from a combination of nature and nurture — genetically misaligned knees that couldn’t handle the years of dance training with a turnout — there’s a part of me that doubts any additional exercises could have averted the surgical procedures.

But there are many other dancers that could avert serious injury by listening to their bodies and strengthening the muscles that oppose those used in dance. For more, read on for the advice from our physical therapist and trainers who work with dancers.

Injury prevention for dancers

with advice from Elisabeth Wheeler, PT, DPT
Ann Cowlin, MA, CSM, CCE,
Mark Salandra, CSCS,
and Wayne Seeto, OT, MSPT

Most dancers know that one of the challenges of the performing arts is to make it look easy, effortless – and painless. According to Elisabeth Wheeler, a physical therapist who works with dancers at Allegheny Chesapeake Physical Therapy in Pennsylvania, up to 90% of dancers will have an injury at some point during their training. So whether you are a professional dancer in a company, or one who takes classes for physical (and mental) activity, it is important to pay attention to your body in order to avoid injury.

Elisabeth notes that dancers can have a variety of injuries throughout the body:

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physiquality blog: carpal tunnel syndrome

I’m thankful that, despite my years of typing hunched over my desk, I have had tendonitis in my wrist over the years, but it has never developed into carpal tunnel syndrome. I have heard that it can be extraordinarily painful and never quite fully heals. To learn more from our expert about what causes CTS and how it can be avoided, read on…

Carpal tunnel syndrome

with advice from Susan Cupples, OTR/L, CHT, LAc

Carpal tunnel syndrome: It’s something we’ve all heard about, but do you know what it really is and what to do about it?

The carpal tunnel connects the underside of the wrist to the palm. It consists of several tendons and muscles, the median nerve, and a thick ligament which covers the entire area. When any of these tendons get irritated and swell, they place pressure on the median nerve, causing the pain known as carpal tunnel syndrome.

Carpal tunnel syndrome can present in a variety of ways, says Susan Cupples, an occupational therapist and certified hand therapist, who is the owner of El Cerrito and Oakland Hand Therapy and Acupuncture, a Physiquality network member in Northern California. According to Susan, any of the following symptoms could be signs of carpal tunnel syndrome:

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physiquality blog: how to treat shin splints

Given that dancers are listed as susceptible to shin splints, I’m fortunate that I have never dealt with them. As the pain can start mildly, it’s something that many often shrug off as a minor problem. However, if they are ignored, the problem can become much worse, so it’s best to see your physical therapist or healthcare provider sooner rather than later.

How to treat shin splints

with advice from Lisa Cox, ATC
and Medi-Dyne

Simply put, when you have pain in the shin bone or tibia (the front of your lower leg), you have shin splints. Most common in runners and dancers, shin splints can be caused by overuse or overtraining, or musculoskeletal issues like ankle instability or flat feet.

When you experience such pain, especially while exercising, it is best to back off from activity. If the pain continues, says Lisa Cox, “medical care should be sought sooner than later.” A certified athletic trainer at Clinton Physical Therapy Center (a Physiquality member in Tennessee), Lisa explains that those who wait 3 – 4 weeks to seek treatment often have longer recovery times than those who seek treatment sooner.

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physiquality blog: what every golfer should know about injuries

Some weeks it’s a struggle to get qualified information for my posts on health and wellness. And then there are weeks like this, where I had three highly-qualified experts contact me with pages of excellent information. While I don’t play golf myself, I understand the dangers of overuse and wanted to share as much advice as I could from these three PTs.

What every golfer should know about injuries

with advice from Brandon Brackeen, PT, DPT,
Marc Schoettle, PT, DPT
and Chris Wickel, PT, DPT, Cert. MDT

Whether you just started hitting the links or have been playing golf for years, understanding the variety of injuries that can result from playing golf will help your game, as well as your overall wellness.

For beginners, says Chris Wickel, a physical therapist at Conshohocken Physical Therapy (a Physiquality member in Pennsylvania), injuries can often happen because of poor body mechanics. While many people may think it’s simple to pick up a set of clubs and hit the links, a bad golf swing can lead to years of bad habits (and bad scores).

If you’re new to the sport, consider taking some lessons with a teaching pro — the PGA certifies teachers who can ensure that you learn the game with proper form. If you’ve tried playing and have felt pain during your swing, consider consulting with a physical therapist, whose musculoskeletal expertise can reduce pain and improve your game. As a Titleist Performance Institute Certified medical professional, Chris is an expert in evaluating a player’s golf swing and pinpointing where an error occurs in its mechanics.

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physiquality blog: what you should know about TMJ and TMD

The more I read (and wrote) about TMJ/TMD, the more I was thankful that I have never had this problem. And I have a feeling that those people our physical therapists treat are especially grateful for their specialized training and knowledge.

What you should know about TMJ and TMD

with advice from Renee Bailey, PTA
and Pressure Positive

Temporomandibular joint disorders or dysfunction, often referred to as TMJ or TMD, cover a wide variety of problems, most commonly pain and muscular tightness in the jaw. You’ve no doubt heard of this problem, but did you know that physical therapy is one of the solutions?

TMD can be a result of a variety of causes, explains Renee Bailey, a physical therapist assistant at Conshohocken Physical Therapy, a Physiquality member in Pennsylvania. “Symptoms can arise from something as simple as bad posture habits, or it can be a result of trauma to the joint, like a direct hit or impact, a whiplash injury, or even clenching or grinding your teeth,” she says.

The most widely reported symptom of TMD is pain, which can range from the jaw to the neck, ears and shoulders and can also present as a headache. Other symptoms noted by the National Institute of Dental and Craniofacial Research include stiffness in the jaw muscles and joint; limited movement or locking of the jaw; clicking, popping or grating in the jaw joint when opening/closing the mouth and while chewing; difficulty swallowing; and changes in how the upper and lower teeth fit together. Renee has also seen patients that experienced ringing in the ears (tinnitus) and dizziness.

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physiquality blog: buying the right shoe for whole-body health

This post actually came about as I’d asked one of our PTs about brands that offer comfortable yet stylish shoes. My mother has been having problems finding comfortable footwear and, like many women, didn’t like the looks of the shoes that doctors had recommended. Gini, at one time, had run a shoe store out of her PT clinic for this very reason — patients with foot and orthopedic problems were having a hard time finding stylish shoes that wouldn’t be bad for their health.

Once I had her advice for my mother in hand, I turned to our marketing director at Physiquality and suggested that more people would want to hear Gini’s advice, and he agreed.

Buying the right shoe for whole-body health

with advice from Virginia Davis, PT, MA

Buying the right shoe for your health

Whether you’re young or old, the wrong pair of shoes can lead to pain from (almost) your head to your toes. High heels can damage your back, knees and feet while increasing your risk for ankle sprains or breaks; they can also lead to arthritis, foot deformities, poor posture, plantar fasciitis and balance impairments. The lack of arch support and foot protection in flip-flops can lead to a number of issues, including tendinitis and stress fractures.

So how can you pick a pair of shoes that is good for your feet?

Look for flats or low wedges over high heels.Some women may not want to hear it, but the first step is to walk away from the high heels. Look for flats or low wedges; while a wedge helps to distribute the weight of your feet throughout the sole of the shoe, if its incline is more than an inch or two, it will still affect your body’s alignment, which can cause knee and back pain.

Both men and women should try to avoid thinking of comfortable or healthy shoes as orthopedic shoes. “The term ‘orthopedic shoes’ conjures up an image of a clunky, heavy and unattractive shoe to treat a medical condition,” says Brian Hoke, a physical therapist and a member of the Vasyli Medical Think Tank. This misperception is a big part of the problem in getting people into footwear that supports the natural anatomy and biomechanics of the foot. Brian notes that many manufacturers have embraced a much more fashion-forward approach to supportive footwear that blends fashion and function.

Physical therapist Gini Davis Agrees, asserting that it is possible to find footwear that is both stylish and comfortable. “Fashion does not have to go out the window because of foot pain, hard to fit feet, orthotics, or on-the-job comfort,” says Gini, owner of Crescent City Physical Therapy (a Physiquality member in New Orleans).

Aside from more widely-known brands like Taryn Rose (created by a podiatrist turned shoe designer) and Ecco, Gini recommends a variety of lesser-known brands that span a wide range of styles and prices:

  • Aravon by New Balance. Gini notes that these come in a variety of widths and are a great shoe in the mid-price range. “They have lots of styles, including some great walking shoes,” she adds.
  • Taos. The brand makes plenty of styles, but she recommends this brand, as well as La Plume and Comfort Club, for their sandals.
  • Image © Thierry RabotinMunro. Widely available at a variety of department stores, she advocates these because they come in several widths.
  • Naot. This brand out of Israel features engineered insoles and sturdy arch supports.
  • Thierry Rabotin. Made in Italy and the highest price point on her recommended list, these are her personal favorite. “If they are comfortable, they are worth the money,” says Gini, adding that they have lots of styles, including low heels and walking shoes.

If you’re trying on shoes at the local store and these brands aren’t available, Brian has a few tips to consider when selecting shoes:

  1. Look for a shoe with a solid heel counter (the insert used to reinforce the heel cup of a shoe and to increase support). Squeeze the heel region; if you can make the sides of the heel area touch, this is not a good counter.
  2. Check the natural flex point of the shoe. Put the shoe on end and push down to see where the shoe bends. It should not bend in the arch area, but it should have a natural bend at the ball of the foot.
  3. Look for a shoe with a removable insole. Some insoles are simply a layer of cheap foam, while others are contoured to fit the natural anatomy of the foot. If the person wears an orthotic (a prescription insole to better meet the person’s individual needs) the factory insole can be removed and the custom insole or orthotic can be placed into the shoe.

Gini advises that you should think about how your shoes will affect your health when considering your next footwear purchase. “Shoes are the most important item in your wardrobe,” she says. “When your feet hurt, everything else suffers.”


Virginia Davis, PT, MA, is a physical therapist and owner at Crescent City Physical Therapy, a Physiquality network member in New Orleans, Louisiana. A foot/ankle specialist with more than 35 years of experience, she is also a board member of PTPN, the nation’s premier network of rehabilitation therapists in independent practice, and the parent company of Physiquality.

Brian Hoke, PT, DPT, SCS, is the director and co-owner of Atlantic Physical Therapy in Virginia Beach, Virginia. Brian is a member of the Vasyli Medical Think Tank, a select group of medical professionals committed to educating clinicians in the role of biomechanics in injuries. Vasyli‘s U.S. distributor for PTs and other healthcare professionals is Patterson Medical, a vendor partner of Physiquality’s parent company, PTPN.

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For further reading, look through our selection of articles on health and wellness, in addition to the below links:

Schneider-Levy, Barbara. Foot therapy. WWD Marketplace, January 14, 2013.

Jacobs, Deborah L. How to find comfortable shoes that don’t compromise style., September 6, 2012.

Keep flip-flops from “going wild” this season. American Podiatric Medical Association, May 25, 2012.

physiquality blog: choosing a physical therapist that measures outcomes

Outcomes is becoming a more and more popular term in healthcare. While we often hear about using outcomes to reward high achieving providers, I think this post was a good reminder that measuring outcomes is beneficial for patients as well.

Choosing a physical therapist that measures outcomes

with advice from Mitch Kaye, PT
and Kristina Holland, PTA

If you don’t work in the healthcare industry, you may have heard the term “outcomes” but not understood what it meant. Why is measuring outcomes beneficial for both patients and healthcare providers?

First of all, what are outcomes? Simply put, measuring outcomes means measuring how successful a particular treatment is, whether in physical therapy or another field in healthcare. Kristina Holland, a physical therapist assistant at Clinton Physical Therapy Center (a Physiquality member in Tennessee), says, “When physical therapists measure their patients’ ‘outcomes,’ they are answering the question, ‘Has therapy helped my patient to function better?'” By collecting data on a variety of treatments over a period of time, physical therapists (and other healthcare providers) will have data that tells them what the most successful treatments are.

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physiquality blog: how to deal with ankle sprains

As someone who took six months to heal from a bad ankle sprain that happened six weeks after giving birth, I now know that sprains are no casual injury. Ever since my sprain, I’ve wanted to know more about how to decide when to see the doctor (Hint: Waiting six months is a bit too long) and what physical therapists can do for such an injury. Here’s what our experts had to say.

How to deal with ankle sprains

with advice from Kate Chewning, PT, DPT,
Maria Fermoile, PT, DPT, OCS
and Tenille Policastro, PT, DPT

Ankle sprains are a common injury. They can occur during strenuous activity, like playing a sport, or something as simple as missing a step down from a curb.

If you’ve injured your ankle, Kate Chewning, a physical therapist at Allegheny Chesapeake Physical Therapy (a Physiquality member in Pennsylvania) reminds you to R.I.C.E.:

  • Rest. Kate recommends trying to stay off your feet. She says, “Don’t walk or put too much weight on your affected ankle, as this will only increase the stress to your ligaments,” increasing the time it will take to heal.

  • Ice. Application of an ice bag, cold gel pack, or similar item will aid in decreasing inflammation while also helping with pain relief. Kate advises making your own ice massager by freezing water in a paper cup. Simply tear back the edges of the cup to apply the ice to the skin in a circular motion.

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