BACK PAIN

Low back pain is one of the most common diagnosis seen in many physical therapy clinics, and it affects nearly 85-90% of Americans at one time or another. It is the second leading cause of visits to a doctor, and the leading cause of lost time at work.

The most common causes of low back pain are:

• Muscle strain or ligament sprain: This injury results in microscopic tears of varying degrees in muscles, tendons and/or ligaments. It is considered one of the most common causes of low back pain. The injury can occur because of overuse, improper use, or trauma.
• Bulging, herniated or ruptured discs: Discs act as cushions between the individual bones (vertebrae) in your spine. Sometimes, the soft material inside a disc may bulge out of place or rupture and press on a nerve.
• Degenerative Disc Disease (DDD): Refers to the changes in the spinal discs as the result of chronic wear and tear, injury, or simply aging. When the discs between the vertebrae begin to break down, the damaged discs lose their water content, lose their height, and bring the vertebrae closer together. When this happens, the discs don't absorb the shocks as well, particularly when you are walking, running or jumping.
• Osteoarthritis: It is a condition in which the protective cartilage that cushions the bones of the spine (vertebrae) wears down. This causes pain and swelling. It may also cause the development of osteophytes, or bone spurs. In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord (spinal stenosis). Physical therapy & exercise can do wonders to relieve arthritic pain!
• Stenosis: A narrowing of the vertebral canal. Characterized by stiffness/lack of motion in the spine. Physical therapy can help reduce the pain that may be associated with stenosis. PT also helps to keep the vertebrae moving well and avoid further stiffening.
• Spondylosis: A degeneration of the spine. This is a completely normal part of aging. Discs between the vertebrae get smaller and the vertebrae may show bony changes like spurs. Usually there are no symptoms but if there are, Physical therapy is the best course of treatment to relieve them.
• Ankylosing Spondylitis (AS): A condition where the vertebrae gradually become fused together. Physical therapy is the best course of treatment to releive the symptoms and lessen the progress of the vertebrae fusing.
• Spondylolisthesis: A defect that allows one vertebra to slide over another. When this happens, bones can press on the spinal nerves and cause lower back pain.
• Spinal Deformities: Curvature problems such as scoliosis or kyphosis. Manual treatment and corrective exercises in physical therapy can help reduce the symptoms and severity of these conditions.
• Vertebral Fractures: Caused by a high degree of force, such as an auto/bicycle accident, a direct blow to the spine, or compressing the spine by a fall onto the buttocks or head.

Physical therapists are highly educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility without surgery.

Current research recommends that in most cases of lumbar degenerative disc disease, the most effective treatment is physical therapy. There is substantial evidence supporting the benefits of physical therapy and exercise for the treatment of low back pain and after back surgery. The strength and stability that physical therapy provides can reduce back pain, improve function, and significantly shorten a patient's recovery time after surgery.

SHOULDER

The shoulder complex has the most range of motion of any joints in the body. It therefore can be subject to a variety of conditions, nearly all of which can be treated successfully with physical therapy.

Some of these conditions/symptoms include:

• Pain with reaching overhead and/or back:
• Shoulder Impingement/Subacromial Pain Syndrome A general term for pain that occurs just under the bony prominence at the end of your shoulder (acromion). This is very common and can nearly always be corrected with physical therapy.
• Rotator Cuff: The rotator cuff is a group of 4 muscles around the shoulder. These are often involved in shoulder pain, especially at the front of the shoulder. Usually it is an irritated tendon. If one of these muscles has a tear, research shows that even FULL-thickness tears can return to full pain-free function & sports with physical therapy!
• Labrum: The labrum is a cartilaginous tissue that increses the surface area of the joint and promotes smoother function. A tear in the labrum does not neccessitate surgery. Most of thees can be successfully rehabbed with physical therapy. Many people have tears in their labrum and don't even know it!
• Instability: A condition where the shoulder tends to come out of the joint easily, either partially (subluxation) or completely (dislocation). Your ProCare PT will give you specific exercises to strengthen and stabilize the joint for this condition. Nearly all cases are rehabbed with physical therapy, only extreme cases may require a surgery.
• Tenidinitis/Tendinosis/Tendinopathy: These conditions are microtears in tendons which can become very painful. Tendons are the tissue that connects muscle to bone. It is very common for these tissues to get irritated from a trauma (such as fall or auto accident) or overuse from repitition or force. This can affect any tendon in the body. Initially ice the area if it starts to feel sore and many times it will be better in a couple of days. If it will not resolve on it's own, Physical Therapy is the best method to take care of it. The combination of manual treatment and specific exercises can resolve nearly all tendinopathy issues.

ELBOW

The elbow is where three bones of the arm come together. The humerus of the upper arm and the ulna and radius of hte forearm. The elbow is most often injured via a fall, throwing or racquet sports, or extended use of the hands/wrists. Some of the more common elbow issues that Physical Therapy will help are:

• Medial or Lateral Epicondylitis: AKA Golfer's elbow or tennis elbow. Many of the muscles that move the wrist back and forth attach at the inside (medial) or outside (lateral) of the elbow. Repetitive use of these can cause mild to severe pain in the area. Your ProCare PT will work with you to determine the cause. They will treat to get rid of the pain and help you modify to keep it away.
• Nerve Entrapment/Irritation: Several nerves pass around/through the elbow. They can become compressed which can cause pain into the upper arm, forearm, wrist, or often in the hand/fingers. Your PT can help determine the cause and provide treatments and methods to resolve the issue.
• Ligament Sprains: The ligaments (which attach bone-to-bone) can often be damaged with overuse via repetition or force. The most common is the Ulnar Collateral Ligament to be sprained with excessive throwing (such as a baseball pitcher).

HAND & WRIST

We use our hands for virtually everything.

• Carpal Tunnel Syndrome: A type of nerve entrapment of the median nerve. It is often caused by overuse of the hands, such as someone who works all day manipulating things with their hands. Symptoms are often numbness, pain, and/or tingling in the fingers. Physical therapy can resolve most cases and should be your first course of action.
• Arthritis: Arthritis is a condition of inflammation or degeneration of the joints. There are many types of arthritis but osteoarthritis is the most common. It is not unusual for arthritis to first appear in the fingers. This can cause pain with holding, gripping, or manipulating anything with your fingers. Physical therapy can do wonders to relieve the pain of arthritis and help you maintain full function in your hands.

HIP

The hip is a very stable joint that connects the leg to the torso. Hip pain may be caused by many things. Your PT will perform a full evaluation to determine the cause of your pain. Some of the common issues that cause hip pain and can be treated with PT are:

• Arthritis: Arthritis is a condition of inflammation or degeneration of the joints. There are many types of arthritis but osteoarthritis is the most common cause of pain in the hip. MANY, MANY STUDIES SHOW THAT EXERCISE IS THE SINGLE BEST TREATMENT FOR ARTHRITIS! Your PT can provide manual treatment to help relieve pain and give you specific exercises to strengthen around the joint. These can greatly help reduce pain and maintain a pain-free joint.
• Bursitis: A bursa is a fluid-filled sac designed to cushion and protect area of the body. When these get irritated, they can be severly painful. The bursa on the outside of the hip bone is a very common one to get irritated. Initially try to ice the are and see if it will calm down on it's own. If not, physical therapy can get rid of that pain for you.
• Labrum: The labrum is a cartilaginous tissue that increses the surface area of the joint and promotes smoother function. A tear in the labrum does not neccessitate surgery. Most of these can be successfully rehabilitated with physical therapy. Many people have tears in their labrum and don't even know it!

KNEE

We put our knees under a lot of stress. There are many causes of knee pain. Many may be exacerbated with climbing up/down stairs, squatting, kneeling... The cause of your pain can be determined through a thorough PT evaluation. Some of the more common causes of knee pain are:

• Ligament Sprains: There are multiple ligaments around the knee, all of which can be injured. A sprain is a varying degree of tears in the ligamentous tissue. Most of these are rehabilitated successfully with physical therapy. The most common to be injured is the Anterior Cruciate Ligament (ACL). It is often sprained with cutting or jumping activities. They may require surgery but recent studies have shown that many full ACL tears can be rehabbed and return to full sport with PT (no surgery).
• Arthritis: Arthritis is a condition of inflammation or degeneration of the joints. Osteoarthritis (OA) of the knee is a very common cause of pain. Do NOT let arthritis or xrays that reveal "bone on bone" scare you. Just because your are "bone-on-bone" does not mean that you should have pain. Even severe pain from arthritis can be helped with physical therapy. MANY, MANY STUDIES SHOW THAT EXERCISE IS THE SINGLE BEST TREATMENT FOR ARTHRITIS! Weight loss can also greatly help knee OA pain as every pound of body weight is about 4 lbs of force on your knee when just walking (think about how much with jumping!). Your PT can provide treatments to help relieve pain and give you specific exercises to strengthen around the joint. These can greatly help reduce pain and maintain a well functioning joint.
• Patellofemoral Pain: AKA Anterior Knee Pain Syndrome. A broad term describing pain around the patella (kneecap). May be caused by any of the tissues in/around the patella. A physical therapy evaluation can best determine the specific course of action for this pain.
• Patellar Tendinitis: AKA "Jumper's Knee". The main symptom being pain the the tendon from the patella (kneecap) to the tibia (lower leg). Often caused by overuse, especially jumping. Physical therapy treatment and specific exercises can alleviate the pain and prevent it from reoccuring.
• Post Surgical Rehab: After a surgery, it is vital to properly rehabilitate. We will guide and progress rehab based on the procedure performed to safely get to desired activity level. Proper rehab will include getting you to a point where you have a much reduced risk of future injury.

ANKLE & FOOT

There are a lot of bones, ligaments, nerves, muscles, and tendons in the ankle and foot. Any of these can be a cause of pain and most can be helped with physical therapy. Some of the most common issues are:

• Ligament Sprain: There are multiple ligaments around the ankle, all of which can be injured. A sprain is a varying degree of tears in the ligamentous tissue. Most of these are rehabilitated successfully with physical therapy. The most common mechanism of ankle injury is inversion (often called "twisting") where the foot goes too far inward, stretching the ligaments on the outside of the ankle. It is important to rehab following an ankle sprain to avoid re-spraining.
  Most people do not seek treatment, they just let the swelling subside and return to normal activities. If you've ever sprained an ankle in this way, you may have noticed that it seemed easier to re-sprain it after that. That is because people do not work on their proprioception (how your body tells you joints position). Rehabbing a sprained ankle is very important to work on proprioception so if your ankle starts to evert, you are able to respond quickly to avoid a bad sprain.
• Plantar Fasciitis: The plantar fascia is a tough, fibrous tissue running along the bottom of the foot from the balls of the toes to the heel. This can be very painful, even to just walk. It is ofter signified by painful first steps after sleeping. Initially, try to wear supportive shoes anytime you are on your feet. If it does not subside, physical therapy can help you to be rid of that pain and prevent it from re-occuring.

HEADACHES/DIZZINESS/VESTIBULAR/BALANCE

HEADACHES: Many people are unaware that Physical Therapy can significantly help with many types of headaches, including debilitationg migraines.

VESTIBULAR DISORDERS & DIZZINESS: Dizziness can have a multitude of causes, many can be helped with physical therapy. Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. BPPV usually creates a sensation of the head or surroundings spinning. They are often associated with head movement or bending over. It is caused by improper location of crystals in the inner ear. These can be relocated with PT. ProCare Physical Therapists can help you with dizziness through vestibular rehab. An evaluation from your PT will determine how we can help resolve your dizziness.

BALANCE: Maintaing good balance is important for everything, and especially important as we age. Falling can result in severe, even fatal injuries. Balance is achieved via three systems; vision, vestibular, and proprioception. We tend to get vision dependent for balance. ProCare Physical Therapists can help you retrain all of these systems to improve balance and reduce fall risk.

SPORTS PERFORMANCE & INJURIES

We are fortunate to live in the wonderfully active, outdoorsy, healthy state of Colorado. Exercise and being active is the single best medicine we have! PT can help you reduce risk of injury or return from injury to do the things you love.

• Injury Prevention: There is considerable evidence that an appropriate injury prevention program can significantly reduce the risk of injury. A good injury prevention program will include specific exercises to strengthening and maintain muscle balance. It will activate neurologic systems to operate at prime condition. Your ProCare PT can get you on the appropriate program for your specific sport/activity to keep you injury-free.
• Injury Rehabilitation: If you are unfortunate enough to experience an injury, rehabbing it is vitally important to return to full strength and prevent further injury. Your ProCare PT is the expert to guide your progression safely from injury recover to return to sport.
• Sports Performance: Supervised training is vital to perform at your highest level. The keen eye of our PTs can help you correct and fine-tune movement patterns and muscle imbalances to get you to peak performance. They will work with you to develop a custom program to help you achieve your goals.

DRY NEEDLING

Dry needling is a safe, minimally discomforting technique for patients with certain musculoskeletal presentations. Dry needling is a treatment performed by skilled, trained physical therapists, who must be certified in the procedure. A thin filiform needle is used to penetrate the skin and stimulate underlying muscular, nervous, and connective tissues for the management of neuromusculoskeletal pain and movement impairments. Dry needling (DN) is rarely used stand-alone but rather in conjunction with other physical therapy treatments.

ProCare has physical therapists who are certified in dry needling. They will determine, through a thorough evaluation, what treatments will be most beneficial to you. Contact us if you would like more information.

WORKER'S COMP

According to the Economic Policy Institute, on average, there are 23,000 on-the-job injuries in the United States every day. Annually, this adds up to 8.5 million injuries and a huge cost to workers, their families, and our economy.
The top 10 Most Common Workplace Injuries (according to CompSource, The Work Experts) are:

• Overexertion: This includes injuries related to pulling, lifting, pushing, holding, carrying, and throwing activities at work.
• Fall on Same Level Surfaces: This pertains to falls and slips on wet and slippery office floors, snow covered pathways, or on their way to work.
• Fall to Lower Level Surfaces: This type of fall happens from an elevated area such as roofs, ladders, and stairways.
• Bodily Reaction: These are injuries caused by slipping and tripping without falling.
• Struck by Object: Objects that fall from shelves or dropped by another person.
• Struck Against an Object: This happens when a person accidentally runs into objects such as walls, doors, cabinets, glass windows, tables, chairs, etc.
• Highway Incident: Transportation used for business purposes such as trucks and cars may be involved in an automobile accident just like any regular traveler.
• Caught In/Compressed By: This type of injury usually occurs in a factory where large and dangerous machinery is used.
• Repetitive Motion: This type of workplace injury is one of those less obvious, but definitely harmful ones in the long run.
Repetitive motions such as typing and using the computer can strain muscles and tendons, causing back pain, vision problems, and carpal tunnel syndrome.
• Assaults and Violent Acts: Attacks caused by office politics and other arguments have led to serious physical injuries.

As you can tell from the top 10 list, all employees have a risk of injury at their job. The physical and massage therapists at ProCare Physical Therapy can help with getting you back to health and back to work as soon as possible by addressing your pain and dysfunction. Physical Therapists can also help with injury prevention in the workplace by teaching proper lifting techniques and ergonomic changes to improve postures and repetitive motion strains. Most worker's compensation policies cover physical and massage therapy. We would be happy to check with your benefits department to see what services are covered if you are injured at work.

AUTO INJURY

Motor vehicle accidents often result in a variety of complex injuries and symptoms. Some of the more common auto accident injuries that we see and treat include:

• Whiplash: A neck injury that can occur during rear-end automobile collisions, when your head suddenly moves backward and then forward. This sudden, abnormal motion can cause damage to the soft tissues (muscles, tendons & ligaments), and/or stretching/irritation of the nerves and spinal cord. The most common symptoms related to whiplash include headaches, neck pain and stiffness, dizziness, shoulder pain, arm pain/weakness/tingling, and back pain. Recent studies have shown that physical therapy may be the best choice to decrease pain, improve mobility, and minimize lost productivity as a direct result of whiplash associated disorders.
• Back Injury: In a car accident, your low back or mid back can be injured. From herniated discs to fractures, our physical therapists can work with you to determine the best treatment plan to alleviate any pain and prevent future problems with your back.
• Shoulder & Arm Injury: Shoulder pain and injury are very common with car accidents. Some of the more common shoulder injuries seen in auto accidents are rotator cuff tears, sprains/strains, impingement syndrome, separations/dislocations, and labral tears.
• Knee & Hip Injury: Knees can get forced into the dashboard or back of the seat in an auto accident. If the force is great enough, then this can also cause hip pain/injury.
• Muscle Injury: Injury to a variety of muscles, tendons, and ligaments are extremely common in auto accidents.

Often, individuals experience little or no symptoms initially following a car accident but subsequently suffer from a variety of symptoms, including pain and decreased function & mobility. The trauma associated with these types of injuries may take days and sometimes weeks to manifest. It is important to receive immediate and appropriate treatment following an auto accident. The longer you delay treatment, the more prolonged the recovery process is likely to be. The clinicians at ProCare are experts in treating motor vehicle related injuries. Physical therapy is used in conjunction with massage therapy to provide the quickest path to recovery from an automobile accident.

THERAPEUTIC MEDICAL MASSAGE

ProCare has a dedicated massage therapist who will target your medical needs specifically. This may be covered by your insurance. Massage Therapy is beneficial for all of the conditions listed below and more. Massage can:

• Relax and soften injured, tired, and overused muscles.
• Reduce spasms and cramping.
• Pump oxygen and nutrients into tissues and vital organs, improving circulation.
• Reduce postsurgery adhesions and swelling.
• Exercise and stretch weak, tight, or atrophied muscles.
• Enhance immunity by stimulating lymph flow-the body's natural defense system.
• Promote tissue regeneration, reducing scar tissue and stretch marks.
• Alleviate low-back pain and improve range of motion.
• Ease medication dependence.
• Improve the condition of the body's largest organ-the skin.
• Increase joint flexibility.
• Lessen depression and anxiety.
• Release endorphins-amino acids that work as the body's natural painkiller.
• Relieve migraine pain.
• Help athletes of any level prepare for, and recover from, strenuous workouts.
• Assist with shorter, easier labor for expectant mothers and shorten maternity hospital stays.