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Welcome to Advance Physical Therapy, Inc. Newsletter

"I alone cannot change the world, but I can cast a stone across the waters to create many ripples.”
Mother Teresa

The mid point of 2015 finds us going through exciting transitions at Advance Physical Therapy, Inc. We added an additional therapist, Dr. Shannon Chen, DPT to our team. While some of our staff is preparing for physical therapy school admissions, we've also added additional physical therapy aides, a personal trainer and front office administrator to our APT team.

We like to create positive ripples in your lives and the team that we have assembled is committed to your wellness. We strive to provide you with the best care physical therapy has to offer.

To your health,
Advance Physical Therapy, Inc.
“Left foot, Left foot
Right foot, Right.
Feet in the morning.
Feet at night.....
Dr. Seuss

Which area of the body contains one quarter of all the bones in the human body?  The ankle and foot! For the next two months, we will inform you about ankle anatomy and common ankle and foot injuries and conditions.
 
So what is the difference between the ankle and foot anyway?  Simply put, the ankle is closer to the heel. The heel bone, or calcaneus, however, contrary to what many believe, does not officially form the ankle joint. That distinction goes to a deep bone just in front of the calcaneus, called the talus. The primary ankle joint is called the talocrural joint, the joining of the talus with the bottom of the major leg bone, the tibia.  It has a “hinge-like” motion that allows you to bring your foot up and down, and walk in a heel-toe manner.  There is also a less mobile joint on the outside of our ankle, called the distal tibiofibular joint. Although it is inherently much stiffer than the talocrural joint, its mobility is important, too. The neighboring calcaneus is a key area of muscle attachment for ankle motion.  (See diagram).

Units 18 and 19 the Knee, foot, and ankle

A very common injury involving the leg, talus and calcaneus is the inversion ankle sprain. Almost all land-based athletes have experienced tearing of the ligaments that attach the talus to the lateral leg bone, or fibula. Those who participate in jumping and landing sports, like basketball, are particularly prone to ankle sprains. As well, having a frequent history of ankle sprains, or “ankle instability” predisposes us to an ankle sprain.

Inversion (Lateral) Ankle Sprain: Structures, Injury, Rehab, Repair

The foot is more complicated than the ankle. Besides muscle attachment, the calcaneus serves with its neighbor, the talus, to allow the side to side motions of the foot. This joint is called the subtalar joint. Since we are designed to traverse any type of terrain, we need our foot to conform to slanted or uneven surfaces. The subtalar joint is actually a conjoining of the talus and calcaneus in three different places, to assist our foot in conforming to a myriad of surface challenges, whether you’re on the golf course, or tredding the cobblestone streets in Europe.
A particularly persistent foot problem is plantar fasciitis. The plantar fascia is a thick fibrous band of tissue that attaches the heel to the base of the toes. Exercising or spending lots of time on your feet, especially in high heels, having tight calves, and being overweight are some of the risk factors for this diagnosis.

Besides the subtalar joint, we have the navicular, cuboid, the first, second and third cuneiforms, the metatarsals and the tarsal bones (See diagram). These bones serve as important muscle attachment sites for the muscles that control the hinge action of the ankle, the side to side movements of the foot and motion of the toes.

feet anatomy feet bones anatomy foot bones anatomy of the bones of the ...

Generally speaking, the tibia is one of the strongest bones in our body, and transmits our weight in standing to the ground via the talus. A very common athletic injury that involves the back side of the tibia is Achilles tendinopathy, sometimes called Achilles Tendonitis. The Achilles tendon is a strong thick tendon formed from the two powerful calf muscles on the back of the leg. It attaches to the back of the heel, and when it is overused, a painful tendinopathy can develop.  Sometimes, this condition is painless, and a rupture of the tendon can occur.

Disease: Achilles tendon rupture

Next month, we will focus on effective treatment methods for these common ankle and foot problem which we often see in physical therapy.

If we can answer any questions or field any topics of interest regarding  physical therapy, health and wellness or about our programs, please contact us. We'd love to hear from you.
info@advanceptinc.com
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Differentiating Tendonitis vs Tendonosis?

Critical Difference in Distinguishing Joint Pain

Tendinosis, the degenerative condition in a tendon, is far more severe and much less diagnosed than its cousin tendinitis, an inflammatory condition. Although tendinosis diagnoses are less common, the condition is actually more prevalent, especially among athletes. The more alarming fact is that popular treatments for tendonitis can actually have little-to-no success when treating tendinosis, which could delay or even terminate an athlete's career.

Patellar tendinosis is often referred to as "jumper's knee" or "runner's knee." It occurs mostly with athletes whose knees, specifically the tendon, are making rapid movements in multiple directions and being overused, like those in sports such as volleyball and basketball, or with strenuous activities like running and hiking.

Differentiating Tendinopathies

"The majority of athletes with patellar tendinopathies usually fall into two categories: high school basketball players, and runners of any age coming in at a close second.

This injury is most certainly not limited to athletes of sports that mainly require movements like jumping. It's like tennis elbow; only about 10 percent of people who have tennis elbow actually play tennis. However, patellar tendinosis specifically is found quite often in the athletic population, especially among basketball and volleyball athletes.

So, why is tendinosis in general more common yet less diagnosed than tendonitis? For starters, it's not always noted as being a different condition than tendonitis. People in general have a tendency to let things go. The medical community in general is not as well educated on the differences as they should be.

There are medical practitioners and physical therapists that see patients who are coming in with anterior knee pain, and get a diagnosis from a medical doctor or their family physician that says 'patellar tendonitis' and they treat it as such. They treat it with ice massage, rest, and other tendonitis treatments.

It's crucial for therapists to delve into the causes behind the symptoms of these conditions, rather than just going off what they think the patient has.

Therapists should be using a process of elimination when it comes to figuring out whether their patient has degeneration or inflammation. Since the patellar tendon is so close to the skin, they should be looking for obvious, visible symptoms of tendonitis to rule out tendinosis.

What you should see with tendonitis patients are the hallmark signs of inflammation, like swelling, redness, or palpable amounts of fluid in or around the tendon. And if you don't see these signs, the pain the patient is experiencing is most likely caused by the degenerative condition rather than the inflammatory. In the absence of those symptoms, the likelihood is that people don't have tendonitis -- but they have tendinosis, and this condition must be managed in a different way.

Role of Eccentric Training

Treatments for tendonitis are vastly different from those of tendinosis, and there is no room for overlap. In fact, tendonitis treatments can worsen the condition of a patient who actually has tendinosis.

It could worsen the condition if you're talking using anti-inflammatories, icing and resting with no physical activity. The most important thing is to understand the mechanism of tendonitis and tendinosis, and the pathomechanics happening in the tendon. Rest and modification of activity and increasing inflammation is the opposite of what you want to do in a tendinosis condition.

So what are the right ways to be treating this condition? Eccentric training has been studied and shown to be a positive and effective treatment for tendinosis patients for multiple parts of the body. Research is clear that eccentric activity and eccentric training are going to be the best way to treat tendinosis. It's been shown not only in the knee, but also the hamstring, Achilles, elbow, shoulder -- all over the body.

In fact, eccentric loading and training should be the preferred, primary treatment for any PT to utilize before considering an alternative like surgery, which comes with its own risks and recovery time. In a 2006 study published by The Journal of Bone and Joint Surgery, authors performed a randomized controlled trial in which one group with patellar tendinosis received a 12-week eccentric training program, while the other group with the same condition went in for an open tenotomy, followed by an exercise regimen slowly leading to eccentric training.

The authors concluded that there was no particular advantage to open tenotomy surgery over an eccentric training intervention period. They recommend any tendinosis patient receive a 12-week rehabilitation program with eccentric training before considering surgical operations.

There's no question that if we are not fully versed in the difference in conditions and treatments, we could be setting up our patients for long-term disability and re-injury.

If you are experiencing any of these types of injuries, please let us know how we can be of assistance in providing you a thorough PT evaluation.


Locations
2944 Broadway Street                         1208 E. Arques Avenue Suite #105
Redwood City, CA 94062                     Sunnyvale, CA 94085

(W) 650.261.0330                                 (W) 408.720.8225
(F) 650.261.0331                                   (F) 408.720.8755


Our website is: www.advanceptinc.com
Our e-mail address is: info@advanceptinc.com
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