Category: Physical Therapist: Rehabilitative Services
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The Expert: Columbus Community Hospital's Rehabilitative Services

The Gold Standard of Care for your Therapy Needs

Web site: www.columbushosp.org

Our physical therapy department provides treatment that prevents, identifies, corrects and alleviates the progression of conditions resulting from injury, disease and other causes. Our therapists implement a team approach with physicians and patients in order to reach each patient's maximum potential.

Our program is the only one in the area that can provide you with the expertise of a doctorate level and five master level therapists for your every physical therapy need. With a combined 52 years of experience, our physical therapists cover all age ranges from birth to senior citizen and encompass specialties for:

  • Development delays

  • Neurological conditions such as CP, MS, and Parkinson's

  • Hip and knee replacements

  • Stroke rehabilitation

  • Back and neck injuries

  • Hand injuries

  • Headache management

  • Urinary incontinence

  • Lymphedema

  • Neuromuscular massage therapy

  • Sports and work related injuries

  • Athletic enhancement

We have highly skilled therapists at three locations and encourage physicians and their patients to choose the location that best serves their needs.

Address:
Premier Physical Therapy,
US 30 Center Building
3100 23rd Street, Suite 16
Columbus, NE 68601
Phone: (402) 562-7346 		Address:
Columbus Community Hospital,
Third Floor Clinic,
4600 38th Street,
Columbus, NE 68601
Phone: (402) 562-3333 		Address:
Wiggles & Giggles Therapy for Kids,
2108 13th Street,
Columbus, NE 68601
Phone: (402) 562-3341


Most Recent Questions & Answers
My sister is recovering from a bad case of the flu. However, due to inactivity, she can now barely stand up. What kinds of exercises or therapy would help her regain strength?
Anonymous

Thank you for your question. The flu and other illnesses such as pneumonia can cause you to loose strength quickly. I have personally experienced this weakness after I had pneumonia four years ago. I was amazed at how weak I became after being on bed rest for about a week. After prolonged bed rest, your body will have difficulty working in an upright position. Sitting in an upright position will start to prepare your body for upright activity. Try increasing the amount of time you spend sitting upright. Then try standing up straight for increasing amounts of time. I like standing exercises such as short squats or marching in place to start to condition the lower extremity muscles for normal activity. Finally, a gradual walking program should be started. Walking for short distances three to four times a day initially increasing the distance and repetitions as you become stronger.

Randy Perault, DPT, CSCS,
Physical Therapist
Columbus Community Hospital Premier Physical Therapy

I had a AVM in '06 followed by left sided hemiplegia. I can walk but I used to be a competitive ice skater and really want to get back to it. I think my anterior tibialis and adductor are not working. Any ideas?
Anonymous

Thank you for the question. However, this is a very difficult question to answer online. First, an arteriovenous malformation (AVM) is an abnormal collection of blood vessels, usually in the brain. When these blood vessels become weak and break, they cause bleeding in the brain and oxygen deprivation to vital areas. Depending on the location, this bleeding and oxygen deprivation can cause a wide range of temporary or permanent neurological symptoms, including muscle weakness that you are describing. So the hemiplegia that you have is more neurological than just muscle weakness.

There are many variables that are involved in determining if you would be able to return to competitive ice skating. First of all, you stated that you have hemiplegia. How involved is the hemiplegia? Do you have limited range of motion? How limited is your strength, especially of the tibialis anterior and adductors? Do you have any abnormal tone as a result of the AVM? You also state that you are able to walk, but do you have a limp or abnormal walking pattern?

I think the best thing that would help you at this time would be to have an evaluation performed by a neurologist and a physical therapist. They would help answer all the questions stated above. It would be much easier to see you in person to watch you walk, check your stretch and range of motion, and determine any other limitations you may have. After the evaluation, they may be able to develop a treatment plan to work on your limitations and determine how likely it would be to return to competitive ice skating.

If you have any more questions, please feel free to contact one of our physical therapists at 402-562-3333.

Doug Peters, DPT, MTC, CSCS
Physical Therapist
Columbus Community Hospital

Hey what up? This is Tyler again, I don't know who is saying there me and asking u questions, but it's not me, and there lame, anyways have u ever heard of a sabot splint? well, I have had a saebo splint for about 1 month, and my occupational therapist tells me I can regain faction back into my affected hand, but it wont be 100%,that really frustrates me, so im very determined to prove everyone wrong, I have to have a functional hand, I have too, I really want to go back to doing hair again(that was my profession before my stroke)can u help me with any information on how I can regain my fine motor shills in fingers,(isn't that called dexterity?)now im 29 y/o now, I was 25 y/o when I had my stroke, can I recover from my stroke, and be honest, ill tell u right now, I have allot of tone, in my hand, and spasticity in my legit don't want to bore u guys, but I just really want to know, and I want u to be str8 with me, and be honest, thank you
Tyler (the one and only) M

Dear Tyler,
I am glad to hear that you have been working with an occupational therapist and that you have begun to use a saebo splint. I would recommend that you continue to pursue this treatment under the direction of this OT. To answer specific questions regarding function and dexterity, I would need to review your medical history, conduct a thorough evaluation and work with you for awhile in therapy. Losing function at any age is disheartening but when you are 25 years old, the change it brings to your life can be overwhelming. Your spirit and determination is admirable! I want you to know though, that Occupational Therapists are trained not only to restore function, but also to help people to learn to live well within their current level of function with adaptive techniques and equipment. I hope that you can find it in yourself to celebrate and maximize the function that you do have rather than putting all your efforts into grieving what has been lost. In my experience, I have helped many people return to leading a full life after rehab. In many cases, it has not been a return to the exact life they had before their accident/injury, but equal to or even better!
Many things are possible when the human spirit is focused. I encourage you to call Columbus Community Hospital at 562-3333 to schedule a time to visit with me in more detail about your situation, with the recommendation of your physician.
Sincerely,

Julie Bennett
Occupational Therapist
Columbus Community Hospital

I am 5'7 and weigh 255 lbs. I have been trying to walk more often to get exercise and lose weight but I have noticed the last month or so that after about 10 minutes of walking my lower back tightens up really bad and hurts. It feels like someone is pushing down on me(like pushing down on a slinky to squish it) It spasms so bad I have to stop and stretch and even that doesn't alleviate the pain, this has caused me to cut my walks shorter and shorter. I have even tried different pairs of athletic shoes for support. I wonder if it is just because of the weight I am carrying around or is there a possibility that I have a disc out of place, I am skeptical about going to a chiropractor.
Anonymous

Thank you for your question. Prior to beginning any sort of exercise regimen, it is advised to consult with your primary physician. If you did follow up with your physician and just recently began an exercise regimen, different modes of exercise may be more appropriate that do not require weight-bearing. Such modes include stationary cycling, recumbent cycling or possibly aquatic walking. It is also good to rotate shoes, but assure a proper fit and type of shoe that works best for you and your foot type. It would be interesting to know what types of stretching you are doing for the low back. Some people respond favorably to a direction, whether it is flexion (bending forward) or extension (bending backwards). For example, if you are performing a knee to chest stretch, which places the lumbar spine in flexion, and experiencing increased discomfort or no relief of your pain, it may be of benefit to try extending the spine. You can extend the spine in standing by placing your feet shoulder width apart, placing your hands on your hips and bending backwards while keeping your legs straight. Bend back as far as you comfortably can tolerate and hold for a count of two and then return to an upright standing position. Repeat this for 15-20 repetitions. If you remain concerned regarding your condition, I would consult with your physician, who may refer or recommend other options.

Jon Brezenski, DPT, PT, ATC
Physical Therapist and Athletic Trainer
Columbus Community Hospital

I am a 55 y/o male in good physical health. I am currently playing in a 3 on 3 basketball league for 50-59 y/o. I am conscientious about stretching before and after games. I carbo-load the day I play. I drink 8-10 glasses of water daily. One hour before the game I mix (home remedy) an 8 ounce glass with a teaspoon of sugar and just less than a 1/2 teaspoon of salt. I eat 1-2 bananas a day. All this precautions and yet I am proned to quadriceps strains (inner thigh mostly). I have played 4 games and 3 of the 4 I strained either or both legs quads. All Strains have occurred during the initial jump shot movement. I resort to RICE for day or 2 after the strains and by game time I feel little to no pain.
I think I sweat more than the average person. I become excited before games, probably not helpful due to increased body tension. I recall that I suffered from quad strains during my high school sports years. On a daily basis I take: 1/2 tablet of triamterene (dieuretic)for inner ear disorder; 10mg Crestor for slightly elevated cholesterol: 20mg of Citalophram for migraine disorder; 200mg of B-2 and 400mg of Magnesium also for migraine disorder; and fish oil caps, multivites and .81 aspirin. On the day I play I don't take the dieuretic (except for the last game that I forgot and took it). Any ideas what I can do, knowing about the above, which will help me keep from recurring strains?
Anonymous

Thank you for the question. It sounds like you take very good care of yourself from the nutritional standpoint which will help with your active lifestyle. A good, healthy diet will definitely help anyone with an injury to recover faster which provides the injured tissues with the nutrients they need to repair faster. However, even the best diet will not prevent injuries. For example, some of the best college and professional athletes have nutritionists to help them with their diet to become stronger, faster, and keep an edge over the competition. Yet, they still develop injuries, such as muscle strains.
A muscle strain is typically called a "pulled" or "torn" muscle. A strain occurs when a muscle has been worked beyond its normal capacity which then causes a muscle to stretch or tear. This can cause pain, swelling, limitation of movement and decreased strength.
You have been treating the injury properly with RICE (Rest, Ice, Compression, Elevation). Then you do not want to use that muscle again in strenuous activities until you are painfree. Once you are painfree, then give the muscle an extra few days to rest and then gradually work back up to your physical activities. If it is a severe strain, I personally recommend two weeks of very light activity with the muscle after the pain has subsided. This allows the muscle sufficient time to recover. Even if a muscle becomes painfree, it does not necessarily mean that the injury has healed. People frequently make the mistake of thinking that once they are painfree, they can return to the physical activities they enjoy. In the case of a muscle strain, the pain may be gone, but the muscle is still not completely healed. If you go back to playing basketball the next week and it is not completely healed, it becomes very easy to re-strain the muscles since the muscle is not strong enough to handle the extra loads and activities. In your case, it sounds like you are not allowing your muscles enough time to recover before you play more basketball.
My recommendation would be to take two weeks off of playing basketball once your pain has subsided. Once the pain has subsided, I would recommend that you perform some light activities that use your quad muscles, but do not increase the pain. Some exercises that may help include squats and sitting knee extensions, performing 25 repetitions with a very light weight (or no weight) 1-2 times per day. After the two weeks is up, start some "small" jumping activities, gradually increasing the height of the jump, to get your muscles accustomed to more aggressive jumping. If you don t have any problems with this, then you should be ready to return to the basketball court. Also, continue with your stretching routine before and after exercising and when playing basketball.
If you have any additional questions, please contact one of our physical therapists at 402-562-3333.

Doug Peters, DPT, MTC, CSCS
Physical Therapist
Premier Physical Therapy

I am a 34 yo female who has been experiencing quadricep atrophy mainly in my left knee. It is occurring at a fast rate. I am very active but have 2 young children and do not work out. I have been doing some SAQ's, quad sets and SLR's and not seeing much success. For the past year or so I have noticed crepitus under the patella and it pops everytime I squat or go to sit in a chair. I find myself compensating and using more hamstrings to sit than my quads. I have some discomfort around the patella but no significant pain. Now I am feeling the stability is decreasing and having a difficult time with steps or any activity that I have to use it and it is starting to fatigue quickly. I do have a history of JRA as a teenager but never have followed up with it and I do struggle with joint pain but take no prescriptions only an occasional NSAID. Any suggestions?
Amy

Quadriceps atrophy in an active 34 year old would be unusual. I would recommend a follow up with orthopedic or arthritis specialist to have your JRA and joints evaluated to see if there is medication or any type of updated management of your condition. The exercises you have been doing are good basic exercises, but may not be enough to strengthen your quadriceps. We generally progress to standing weight bearing exercises to further challenge the quadriceps. Weak quadriceps will lead to patella problems and would explain the pain you are having round your patella. I would be hesitant to start any type of aggressive strengthening until you are cleared by a specialist.

Randall Perault, MSPT,SCS, ATC
Physical Therapist
Premier Physical Therapy

I had an ankle fusion done when I was 9 years old, due to a shortened fibula (misdiagnosed fracture of my growth plate.) I am now 42 years old, and experiencing more pain in the muscles and support in my calf and arch area. What exercises can I do to increase strength and support for my fused ankle? Thank you so much!
Anonymous

Whenever a joint is fused the muscles that surround that joint will no longer be used normally. They cannot be stretched or strengthened because the there is no longer movement in the joint that they move. With a fused ankle, the muscles of your lower leg will no longer be used properly and it will be very difficult to stretch or strengthen them. The way to stretch the muscles of your lower leg will be to move your ankle up and down as far as you can and hold your ankle at that end range for 15 to 20 seconds. If you are experiencing arch pain, some type of orthotic or arch support may provide relief. Thank you for your question.

Randall Perault, MSPT,SCS, ATC
Physical Therapist
Premier Physical Therapy

Im a 24yr old man who plays football very regular, 3 years ago now i was diagnosed with an Avulsion of the Patella Tendon, which my specialist said he had not seen before in footballers, but had seen it in runners, eventually after cutting down the number of matches i played it begain to pass me by and within 5 months of rest I was back playing regular, however recently now that the season has come to an end I am getting an aching pain just under my left knee cap, (same place as Patella tendon) is there anything I can do to make this go away, excursuses or any advice for this.
Jamie

Thank you for the question. Your complaints appear to be related to possible inflammation of the patellar tendon. A combination of applying ice and rest should beneficial in helping to achieve discomfort. I would not be too concerned about performing exercises at this time, especially if you are experiencing the discomfort from a long season. Let the symptoms subside and then begin a low intensity strengthening and ROM regimen for the lower extremities. Some basic exercises include quad setting, short-arc quad strengthening and straight leg raises. It may be beneficial to discuss with your primary physician if physical therapy can be recommended and a course of treatment that may include anti-inflammatory modalities and instruction of the exercises above by a licensed physical therapist.

Jon Brezenski, DPT, PT, ATC
Premier Physical Therapy

i was told that deep brain stimulation does not actually work in people with post stroke,if this is the case,why is deep brain stimulation all over the internet telling people it does work,and its very sucessful,can u help me with this,and is there anything out there i can benefit from for my arm and hand?
Tyler M

Hello again, Tyler. Thank you for your recent questions. They are interesting questions because they open the realm of "experimental" treatments that are currently being researched.
Deep brain stimulation is an area of treatment beyond my scope of practice and your specific questions regarding it would be best answered by a neurologist.
In the past, therapy for post-stroke patients spent less time trying to regain function in the affected limb and more time focusing on how patients can compensate for the loss of function. This was based on the thought that the brain cannot regenerate itself and any damage to it is permanent.
New research has demonstrated that this is not entirely true. The brain has what is called  neuroplasticity , the ability to reorganize and re-wire itself as a result of repetitive actions. In other words, if one part of the brain is damaged another part can re-wire to take over the functions of the damaged part.
Constraint-induced movement therapy is based on  neuroplasticity and focuses on forcing patients to use the affected limb intensively for 3-6 hours per day for several weeks. This is accomplished by restraining the functional limb and not allowing the patient to compensate with it. This then encourages another part of the brain to "re-wire" to control the limb.
I applaud your continued search for effective treatment for your hand and arm, Tyler. It is obvious from your persistent quest for more information that you are extremely motivated to regain function. It is difficult to give you concrete information regarding what may work for you without knowing your full history. I encourage you to contact me or another occupational therapist directly in order to get more specific information.
Thank you again for your questions, Tyler.

Julie Bennett, Occupational Therapist
Columbus Community Hospital

I have a patient that is limping on the right side with trunk lean to the right. He fell off a rail-car while working at an elevator. His glut med strength is 4/5. With larger steps, limp is less observable but Pt usually takes smaller steps and deficit is noticeable. He has not had surgery. Poor hip rotation noted bilaterally. What exercises should I include in his program to eliminate his limp with gait. He doesn't want to use a cane since he is only 54. Thanks!
Anonymous

This patient needs strengthening of the hip musculature, most notably the hip abductors. There are 2 primary ways to strengthen these muscles, which essentially include the gluteus medius and minimus, as well as the tensor fascia latae muscles. These muscles are located in the buttocks and along the lateral aspect of the pelvis and hips. Exercise that involves "open-chain" strategies, in which the distal end of the leg being strengthened (i.e. foot) is free to move in space and is not fixed to the ground. An example of this would be standing or lying hip abduction. The second way to strengthen the hip abductors involves utilizing "closed-chained" strategies, in which the foot is fixed to the ground and the body moves in space. An example of this would be resisted lateral walking or sidestepping. This can be achieved using cable or theraband resistance. Closed-chain exercises may be the more beneficial of the two strategies as it incorporates more functional movements and can be used more effectively to eliminate the "limp" with gait, however, both are effective means of strengthening this muscle group. Incorporating some flexibility exercises for the hips, specifically to improve hip internal and external rotation, may also be beneficial. Thanks for the question.

Jay Pelan, PT, DPT, CSCS
Physical Therapist
Premier Physical Therapy

Can ACL surgery cause nerve damage? I am 6 months post-op (patella graft) and my surgeon referred me to get a neuro consult, EMG and NCS because of atrophy.
Anonymous

Sorry to hear about your problem. In 18 years of working with ACL repairs I have never experienced nerve damage that causes quadriceps atrophy. A common nerve problem following an ACL repair is numbness on the lateral aspect of the knee due to compression of the medial cutaneous branch of the femoral nerve. This is much different than quadriceps atrophy. Quadriceps atrophy is not uncommon following an ACL repair for a variety of reason. Without examining your knee it would be very hard to tell what might be the cause of your atrophy. I would follow up with your tests and see what they may reveal. There could be another reason for the atrophy besides for repair. I hope this is helpful.

Randall Perault, MSPT,SCS, ATC
Physical Therapist
Premier Physical Therapy

Can an affected arm and a hand be restored to its function again post stroke, and what can be done about this?
Tyler

Thank you for your recent question about restoring an affected arm after a stroke. Rehabilitation of your arm can have many aspects and the route a therapist may take will depend on the status of your arm now, your past medical history, the limitations that are present, and your ability to participate in treatment and home programs. An occupational therapist will initially evaluate your affected arm to determine range of motion, strength, function, and amount of spasticity in the muscles. Treatment may include manual stretching, exercises, activities to encourage functional movement, splinting, and possibly modalities. Treatment sessions will include constant repetition of the exercises and activities in order to reprogram your nervous tissue and brain to work together to achieve normal movement patterns. Splinting will most likely be a part of this and will require you to be able to mange these at home. Stretching the muscle groups over a long period of time will be of more benefit than quick, or brief stretches. Bilateral tasks will be utilized as it is another way to retrain your affected arm as to what normal movement is. Overall, I think the best way to get the information you are looking for is to speak with your physician and ask to see an occupational therapist. We have to treat every person individually and the only way this can take place is through a hands-on evaluation.
Thank you for using our site as a resource for information about your condition. I hope that I have been helpful in identifying where to start as you begin to research your condition.

Sincerely,
Julie Bennett, OTR/L
Occupational Therapist
Rehab Services, Columbus Community Hospital

My Dad has had arthroscopic surgery on both of his knees. The surgeons worked on his worn out meniscus discs (they trimmed cartilage and removed bone fragments). He also suffers from arthritis in both of his knees. He is 51 years old and 278 lbs. I am trying to help him get back into shape but I'm not sure what types of cardio, strength training, and flexibility exercises would be good for someone like him. I have told him to start with walking (30 minutes daily) and even that is causing him discomfort. He can't take pain medication (it thins his blood out too much) so I want to make sure any discomfort is minimal. What types of strength exercises would you suggest especially for lower body? What types of cardio? How would you strengthen the muscles around the knee joint? What types of flexibility exercises would you recommend?
Amanda

Amanda,
Trying to loose weight or exercise with bad knees is a challenge. For cardio, we recommend low impact exercise such as the NU Step. The NU Step will allow your father to use all the major muscle groups and the heart and lungs with minimal stress on the knees. Walking in a pool may be another option. The buoyancy of the water will take stress off of the knees. These two exercises are best started for 5-10 minutes and gradually increased. Strengthening exercises will also have to chosen carefully. I would start out with exercises laying on your back such a straight leg raises, short arc quads (placing a ball or bolster under the knee and straightening the knee against gravity) or bridging (laying on your back, bending your knees and lifting your buttocks off the table). These three exercises will strengthen the quadriceps with minimal force through the knee. The best flexibility exercise would also be done lying on your back and trying to slide the heel back by bending your knee as far is comfortable. Placing a belt around your foot and pulling back with your arms in a seated position is a way to increase the force of the stretching. Strengthening and stretching exercises are best performed in sets of 10 to start.
Trying to exercise with bad knees can be a frustrating experience. I hope these exercises help.

Randy Perault, MSPT,SCS, ATC
Physical Therapist
Premier Physical Therapy

What exercises would you prescribe for a 53 year old physical education teacher who had a quadriceps tendon rupture? I am walking 45 minutes a day and would like to strengthen my quadriceps. The doctor said to use light weight for leg extensions.
Tyler M

First of all, the quadriceps tendon is a large tendon that runs directly over the patella (kneecap) and anchors the quadriceps muscles of the front of the thigh. As you can imagine, these are very strong muscles and the quadriceps tendon must be able to withstand a lot of force in order for these muscles to be able to move the hip and knee joints. Therefore, it is important that the quadriceps muscles and tendon be strong enough to withstand all the forces that are placed on it on a daily basis. Some exercises that are recommended when recovering from a quadriceps tendon rupture would be the following:
1. Straight leg raise ( which involves laying supine and tightening the muscles around the knee to keep the leg straight, while at the same time the leg is raised straight up and down off the surface).
2. Leg extension - using light resistance and a shorter range of motion to begin with, progressing to full knee flexion range as tolerated.
3. Mini-squats or leg press - again beginning with shortened range of knee flexion and progressing to a full squat to 90 degrees of knee flexion as tolerated. These are three basic exercises that are effective at building the quadriceps muscles. Consult your physician or a physical therapist for further instruction in the rehabilitation of this injury. Thanks for the question.

Jay Pelan, DPT, CSCS
402-562-7346
jjpelan@columbushosp.org
Columbus Community Hospital Premier Physical Therapy

Hi, my name is Tyler, I have wrote this site before, my question is, is it possible to walk normal again post stroke, because sometimes I feel there is no hope for me, I was 25 y/o when I had my stroke, now I'm 29 y/o, is there anyway u guys can help me?? Thank you very much!!
Tyler M

Thanks for your interest and questions. It's apparent that you are very interested and motivated to achieve all you can achieve. That's what therapists like in a patient!
Three things that can help your situation we've mentioned in previous responses are unweighted gait training on a treadmill, aquatic gait training, and a Functional Electric Stimulation (FES) system designed for stroke gait improvement.
We offer two of them. Our Rehab Department, housed in Columbus Community Hospital, will have an unweighting/ unloading gait system that is also enhanced by a computerized gait analysis and training treadmill system. We a hoping to have it all up and running in 1-2 months. We are awaiting some modifications to our space to accommodate our new equipment.
Our affiliate, Premier Physical Therapy @ 30 Center Mall in Columbus, has a SwimEx therapy pool and underwater treadmill for gait training in the water.
The third option, an FES system, is available in Nebraska through Madonna Rehabilitation in Lincoln or Immanuel Rehabilitation in Omaha. You would need to contact either of them for an assessment whether that type of system would be beneficial for you.
In regard to whether there might be hope to walk "normal" again, we would need to assess you personally to be able to give you our professional opinion on your prognosis.
We would be happy to assist you in any way if you are interested and are in our area. Please contact us @ 402-562-3333 for more information.
Thank you again.

Doug Janssen, DPT
Columbus Community Hospital Rehab Services

I had an ankle fusion surgery and am in a non weight bearing cast. So far it has been almost a month and am told that after 2 more weeks I will be put in another cast for 6 weeks. I am already overweight and don't want to gain anymore weight. Is there an aerobic exercise that I can do that is non weight bearing?
Lori

Thank you for your question. While your options might seem somewhat limited right now, there might be two types of machines that would allow you to exercise while not putting weight through the affected ankle. One is the Schwinn Airdyne bicycle which has a peg on the front of the bike for you to rest that leg forward off the pedals to keep from putting weight on it. The exercise then would be stationary cycling using your other leg pedaling and both arms pushing through handles that move back and forth. The combination of upper and lower body resistance will help you to raise your heart rate for more calorie burning exercise. Another nice piece of equipment would be the NuStep machine which allows the same type of upper and lower body pushing and pedaling to achieve aerobic exercise for weight loss. Your affected foot could again be rested to the side to avoid weight bearing until your restriction is removed by your doctor. Hopefully you have access to an exercise facility that would have these devices as they are expensive for an individual to invest in for home use. I hope this information is helpful and best wishes!

Doug Janssen, DPT
Columbus Community Hospital Rehab Services

I have read about pool plyometrics and how they lessen the impact on joints. I am in my late, late twenties and I have congenital hip dysplasia that went untreated as an infant. A few years ago I was diagnosed with having hip arthritis due to the dysplasia. The doctor was pretty emphatic about putting off surgery until I absolutely needed it because the wear to my hip was minimal.
I have been pretty athletic throughout my life and would like to remain active. I know, based on research that heavy weight bearing exercises are not good for arthritic joints. However, there is a school of thought out there that if you build the muscles surrounded the effected joint that you can lessen the arthritis, is this completely accurate?
My question is if an exercise doesn't hurt does that mean then that it's not been affected or could wear and tear still be taking place? Also, would pool plyometrics be a good idea? Finally, diets play a role in arthritis?
Thank you
Anonymous

In response to your question about exercise and the arthritic hip, you are right in the fact that strengthening the muscles around the hip joint will lessen the wear and tear on that joint and can often assist in relieving some of the symptoms of arthritis. Since you have a history of congenital hip dysplasia, this may place you at a higher risk of developing arthritis in that joint. I would suggest that you participate in exercise that does not overly stress the hip joint, but still emphasizes strength and stability to the joint. Specific strength training exercises that I would recommend would be those that involve machine weights. Examples are leg press, leg curls, and leg extensions. These provide safe, controlled motion to the hip, knee, and ankle joints and can be easily adjusted for proper body alignment and resistance. I would also recommend exercises that can be performed in a standing position and involve working the hip joint through flexion (forward), abduction (lateral), and extension (backwards) motions. Plyometric (or jumping) exercises should be avoided on land, but performing these in the water that is at least waist depth will lessen the impact on the joints of the lower extremities and should be fine. Let pain be your guide to exercise. If an exercise consistently increases your pain in a particular joint then it would be a good idea to modify or completely eliminate the exercise from your routine. As far as diet is concerned, the most important way this comes into play is with controlling your weight. Overweight individuals put themselves at a higher risk of developing arthritis due to the excess wear and tear the extra weight has on the joints. Speak to your physician or registered dietician to determine what your optimal body weight should be and what the best way to achieve this is. Thanks for the question.

Jay Pelan, DPT, CSCS
Physical Therapist
Certified Strength and Conditioning Specialist
Columbus Community Hospital's Premier Physical Therapy

Good day,
I would appreciate any help in proving that my current physical issues were related to the accident and the continued work done without properly finishing treatment.
The company's lawyer is saying a chiropractor is not a real doctor for assessing my back and neck pain but that's where I had my rehab done from a work related fall is this false? if so how can I prove it in court?
Below is the basic situation in which I find myself.
I slipped and fell on my right shoulder and then onto my right hip, plus my right elbow hit the concrete floor. I was told at the time of the accident it was a strain/sprain of the right side of the neck, a lumbar strain, and a right elbow strain. I went though rehab from 3/29/05 until 8/05. I went 3 times a week initially, then down to 2 times a week, until Aug. 05. There was no light work given to me at work after the accident. I had to go without treatments for at least 90 days to see if I needed to continue the treatments or to be seen by a doctor. The machines broke down in Sept. 2005 - July 06. I had to assemble the automobile parts by hand insertion. I told the company safety director that when I fell and just stopped treatments, it hurt to do the work by hand. But I still stayed there trying to do my job which also meant lifting boxes ranging from 30 to 50lbs. or more. I was also pulling skids, operating a tow motor, lifting boxes from the floor level and boxes that were above my head. The pain in my neck and back was getting worse and I was not allowed to see a doctor. I dropped a box of parts at work in April 06 because my arms went numb. The first Emg or MRI on my neck only was allowed 5/06-7/06, a year later. The lumbar was not allowed, but was done in 12/06 as my insurance picked it up. The company put me off work Aug 06 because there was no light duty. The MRI results showed I have disc bulging at the L2-3 with annular tears, C3-4 disc bulge, left foraminal stenosis, C5-6 disc bulge, and central canal stenosis. My insurance did call me after the lumbar MRI was done because they know I have never been treated for anything like this before, and they asked about car-accident or work-related injury. The company's lawyer and their assessment doctors are saying that the findings from the MRI are not due to the fall on 3/29/05. They are saying I'm 46 year old woman and that it's part the natural aging process. But I never had the headaches everyday, pain in my neck and back, tingling in my arm, hands, legs and feet and difficulty swallowing food before the accident. How can I prove this is related when the MRI was done a year later so I can get treatment and medication for this? Thank you for any help.
Brenda

Due to the complicated issues associated with your injury and possible legal action that could be involved, our healthcare professionals have declined to comment.
We encourage you to discuss any healthcare concerns with your primary care physician.
Thank you,
Columbus Community Hospital

I have a problem with my hip, and it happened suddenly. I am not an athlete so it is not an injury from what I can figure. When I am sitting I am fine, but when I get up it is so painful to start walking. It feels like it is in the joint. The doctor diagnosed it as bursitis, but I don't know if that is correct. It is not painful to the touch at all. When I lay on the floor and try to do leg lifts of bend my leg towards my chest, it is so painful that I wince. Once I start walking it starts to feel a little better. At night, my leg is just starting to ache and sometimes when I'm just sitting. It seems to be getting worse. I have gone to physical therapy and they said that my leg is extremely weak and I can't push against them. I know I need extreme strengthening but am afraid it would make it worse. I am 45, I also have low back pain on the opposite side from a car accident. I have had x-rays of both and it is all muscular. What do you think I can do?
Anonymous

Thank you for your question. It is difficult to assess your pain without performing a thorough evaluation. After analyzing the information you provided me, I would assess your low back as a possible cause of your hip pain. A lumbar disk herniation could cause radiating pain into your hip. If it is a posterior disk herniation, activities such as getting up from a seated position and bringing your knees toward your chest would flex your low back and produce increased pain as you described. Conversely, activities where your low back is in an extended position, such as walking would help decrease your pain. Typically pain coming from the hip joint, such as bursitis or arthritis, will worsen with prolonged walking. You may want to try some low back extension exercises such as laying on your stomach and pressing up with your arms, while keeping your hips on the floor. If you notice any decrease in pain or increase in hip range of motion or strength following this exercise, it may be an indication that your pain is related to your back. Like I said before, it is hard for me to completely assess your pain without a complete evaluation and your pain could still be related to a hip pathology. If that is the case, continuing with your hip flexibility and strengthening exercises under the guidance of your physical therapist is probably your best option. If you have any further questions or if you would like any additional information, please feel free to contact me at 402-562-3333. Thank you.
Thank you,

Matt Wesch, DPT
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

I had a dislocated patella in my left knee and articular cartilage damage behind my patella last year. I had a lateral release surgery to correct the injury but want to know what exercises are safe now? I have been doing squats, deadlifts, etc. and only find that one-legged exercises seem to cause me soreness. However are parallel squats, deadlifts, going to cause me more rapid cartilage damage and/or arthritis? Should I use bodyweight exercises instead of weighted ones?
Anonymous

You will need to be careful with your exercise choices following a dislocated patella, articular cartilage damage and a lateral release. The lower you go with a squatting exercise, the more pressure you will place on the patella. We generally recommend not going to parallel on squats. A 45 to 60 degree bend of the knee is enough to strengthen the quadriceps with less stress placed on the patella. Body weight and gravity are excellent choices for resistance to these exercises. If you are not having pain or popping with weights, it is probably alright to continue with weights. Another option to challenge the quadriceps would be holding your squats for a longer period of time, say five to 10 seconds, versus the normal repetitions. If single leg squats cause pain, this is in indication that to much stress is being placed on the patella. You will need either decrease the weight or how far you are squatting or stick with double leg exercises.
Thank you,

Randy Perault, MSPT,SCS, ATC
Physical Therapist
Premier Physical Therapy

My 15 year old son recently pulled a quadracep (r) while playing indoor soccer. He heard a pop and could no longer run although he can walk with no pain. He says it hurts the most when he lifts his leg as in a kicking motion. What therapy should he do to get back to action as soon and safely as possible. Thanks.
Anonymous

Thank you for your question. The strained quadriceps in a common injury experienced in sports that involve the active kicking motion. Proper treatment includes a rest period to allow the muscles to heal properly. Along with rest, the application of ice to help reduce inflammation is recommended during the first 72 hours following injury. If the injury is greater than 72 hours, application of heat is appropriate. Prior to beginning strengthening exercises, your son should restore the full range of motion (ROM) available in the hip and knee without experiencing significant discomfort. When full ROM is restored, strengthening exercises and functional training exercises such as sprinting, jumping and kicking can begin within tolerance. Supervision of these activities by a licensed physical therapist or certified athletic trainer is recommended. When your son is able to complete functional sport activities without significant pain or discomfort, your son should be able to resume participation with his indoor soccer team.
Thank you,

Jon Brezenski, DPT, ATC
Premier Physical Therapy

Columbus Community Hospital's Rehabilitative Services

Had a spinal compression at c-3, c-3 that was fused. As time progressed, the quads have lost strength and mass. What can be done to correct this? I m waiting results from a Neurologist. He did find nerve damage in my left leg.
Anonymous

Thank you for the question. I assume in your initial sentence that you had a spinal compression fracture at L-3 and (maybe) L-4 that was fused. The "C" stands for the cervical spine which is the neck, and the "L" stands for the lumbar spine which is the low back. If you did have problems at C-3 and C-4, you would be having more problems in your hands and arms. Having a spinal compression fracture and fusion in the lumbar spine can cause pressure on nerves that extend into the legs.
There are a number of different things that can place pressure on the nerves from the low back that can result in loss of strength and muscle mass of the legs. In order to correct the loss of strength and mass, pressure needs to be removed from the nerves that are being pinched. Depending on where the nerves are affected and how severe, will depend on how this can be corrected. In some instances, physical therapy or even just exercises can help in relieving the pressure from the nerve. However, if the cause is degenerative or from an injury to the low back, surgery may be needed. You also stated that you have nerve damage in your left leg. Nerve damage will cause weakness and loss of muscle mass. Again, depending on the severity of the nerve damage will determine if you can get the strength and muscle mass back. If the nerve damage is severe enough, you may not get the strength and muscle mass to return. In some instances, the peripheral nerves can regenerate after damage and the strength and muscle mass can return (to some degree or another).
The best thing you could do now is to work on strengthening exercises for you legs. If you have nerve damage in you legs, you want to maximize the strength that you do have and prevent any additional loss of strength and muscle mass. Two basic exercises you could perform would be: 1) Mini-squats, going down as low as you could tolerate for 10 repetitions, and 2) Forward step-up, stepping up onto a step and back down for 10 repetitions.
It is difficult to inform you of what can be done to correct losing leg strength and muscle mass without performing a thorough evaluation and knowing where the problems are originating. It would be beneficial for you to continue talking with your Neurologist to find which nerves are being affected and where they are affected. This would help you find out more what could be done to correct the leg weakness and loss of muscle mass.
Thank you again for the question.

Douglas R. Peters, DPT, CSCS
Physical Therapist

Columbus Community Hospital's Rehabilitative Services

My husband had a total hip replacement last Feb. Three months after surgery he was fine and then started to limp again due to muscle weakness in his leg. Was diagnosed with S1, L5 herniated disc but has no pain. We don t believe weakness/limp is a result of disc problem. Any idea what could be causing continued muscle weakness/limp 11 months after surgery? He has continued to do strengthening exercises but really no improvement.
Anonymous

Thank you for the question. If your husband did not have any problems for three months after surgery before developing weakness and a limp, the problem may not be surgery related. If it is not surgery related, it may be due to nerve damage. This nerve damage may be from a herniated disc or nerve impingement (pinching) in the lumbar spine. When people have a herniated disc or nerve impingement, they may not have any pain, but may still have other symptoms, such as weakness.
However, if your husband favored his hip/leg too much after surgery, and/or was not performing his exercises correctly, the muscles of the hip/leg may have become weaker, eventually causing him to limp. Although he has continued to work on strengthening exercises for his hip but has not improved, I would question if he is doing his exercises correctly or maybe he needs to be advanced with new exercises.
Another possibility would be muscle or nerve damage in the hip from the surgery, but this would typically be seen within the first few days/weeks after surgery. A limp may also occur after surgery, depending on what type of procedure your doctor used to replace the hip.
It is difficult, in this instance, to give you a more precise answer without performing a thorough evaluation. In your situation, I would recommend talking with the orthopedic surgeon who performed the surgery and even talk with a neurologist to determine if your husband has any nerve damage, either from a herniated disc or from some other source. The presence of a limp may require your husband to use a cane until the hip is strong enough that he does not need it. This may also be an instance where your husband may need additional physical therapy, and needs to be advanced with new exercises.
Thanks again for the question,

Douglas R. Peters, DPT, CSCS
Physical Therapist

Columbus Community Hospital's Rehabilitative Services

I broke my ankle this summer. I wore a boot for 8 weeks, & an ankle brace for 3 weeks. The ankle has healed fine, but I have lost strength in my legs. I try to walk as much as possible, using a walker quite a bit. It seems to me that I should be able to walk without the walker by now. What kind of exercises can I do in order to strengthen my leg muscles? I am 68 years old. Thank you.
Anonymous

Thank you for the question. When a joint, such as your ankle in a boot, has been immobilized for several weeks, it will make several adaptations, including muscle weakness. It is weak because you have been unable to use the muscles around the ankle throughout their full range of motion. Once the boot is removed and you are able to use the ankle more, the ankle joint and the muscles surrounding the ankle are not going to function as normally as they used to. People will frequently not use their ankle as much after a cast or boot is removed just because it feels weaker and stiffer. Since they are not using it as much as they used to and are now "favoring" it, it is not going to get stronger as quickly as it should.
The best way to strengthen the ankle is to bear weight through your bad ankle while performing exercises. Try not to favor it. When you are walking, try not to limp. One exercise you can do to strengthen the ankle is a heel raise. Begin this exercise with both legs. Once this becomes easy, progress to performing the exercise with the affected leg. The exercise is performed by standing on one (or both) leg(s) and to raise up on your toes while keeping the knees straight. This exercise will strengthen the muscle below the back of the knee called the gastrocnemius, which is the muscle that typically becomes weak after being immobilized. You can also raise up on the heels while in the same position. Bear as much weight as you can through the bad ankle. Perform these two exercises three times per day, performing two sets of 10-15 repetitions. A third exercise is to try balancing on the bad ankle/leg. This works a lot of the small muscles around the ankle necessary for balance and walking. Perform this activity three times per day, performing two sets of 20-30 seconds. If you have difficulty pulling your ankle/toes up, then your Achilles tendon may be tight and may need to be stretched out. You can stretch it by taking a towel, place the middle of the towel on the ball of your foot, and then pulling the ankle/foot back with the towel while keeping the knee strait. Two other exercises to help strengthen the legs include marching in place and mini squats, which will help strengthen the hips and knees.
These are good exercises to improve leg and ankle strength so you won't need to use the walker. Also, walking without the walker for short distances in your home is a good way to start weaning yourself away from the walker. By trying to keep the weight evenly distributed between both legs and trying not to limp will help improve your ability to walk without a walker. If you continue to limp without the walker, you can use a cane in the opposite hand as your affected ankle. This is a good progression to eventually be able to ambulate without any assistive device.
Try these activities to improve your ankle and leg strength, as well as improving your ability to walk. Please contact one of our physical therapists at Columbus Community Hospital by calling 402-562-3333, if you have any additional questions.
Thanks again for the question,

Douglas R. Peters, DPT, CSCS
Physical Therapist

Columbus Community Hospital's Rehabilitative Services

I am in my late twenties, I have mild hip arthritis. I have done some research and I have come to learn that the hamstring, quadracep and lower back muscles are the ones I should strengthen. Also that I should stay away from low reps and focus on doing high reps. Are lunges and squats, romanian deadlifts ok? Can I increase strength in my muscles or is it more about maintaining functionality?
Steven

Thank you for the question. When you have arthritis, it is best to work on exercises with light weight that allows you to perform a high number of repetitions. This helps with blood flow and circulation through the joint, as well as causing less irritation and damage to the joint surfaces. When using heavy weights that only allow you to perform a low number of repetitions, it places more stress on the joint which may speed up the degenerative process of arthritis.
Weight bearing exercises like lunges, squats, and Romanian deadlifts also place more stress to the joint surfaces, possibly causing more pain and irritation to the hip joint (or any weight bearing joint). However, if you do not have pain with those exercises, you can continue to perform them, but it would be best if you used a light weight that allowed you to perform higher repetitions to minimize the irritation and stress to the joint surfaces. Strength will still improve performing the exercises in this manner, but not to the degree as if you were performing them using a heavy weight that only allows you to perform low repetitions. If you want to preserve the function of the hip joint, it would be more important to perform exercises with lighter weight than trying to strengthen the muscles and compromise damaging the joints with heavy weights.
Thanks again for the question,

Douglas R. Peters, DPT, CSCS
Physical Therapist

Columbus Community Hospital's Rehabilitative Services

The doctors diagnosed my innerknee pain and popping as muscle atrophy. I started physical therapy twice a week and it didn't seem effective to me. Part of my therapy was walking on a treadmill (which I have at home) and riding the bicycle (which I have one at home). I feel that I can do exercises at home as well as what I was getting there. The doctor seemed to think that this could be corrected. He said that my cartlidge and ligaments were in good shape. The P.T. didn't seem to think that it could be corrected. It, at times, is very painful. Can it be corrected and, if so, which exercises would be most useful?
Anonymous

It appears that there is obvious injury to your knee. The "pain and popping" that you are experiencing is not normal, and may be caused from a number of different things going on in your knee. You may have cartilage damage, meniscal damage, etc. From a rehab standpoint, the best thing you can do is to strengthen the muscles around your knee joint, particularly your quadriceps and hamstring muscles. Sometimes imbalance between these muscles can adversely affect the normal functioning of the knee joint, particularly the way the patella (knee cap) moves when you flex and extend the knee. In this case, muscle atrophy (weakness) may be a contributing factor.
I would suggest focusing your efforts on strengthening of the leg muscles. Leg extensions, curls, partial-squats, leg press, and lateral step-downs off of a 4 or 6 inch step are all examples of exercises that are effective at strengthening the leg. If your "pain and popping" continues to get worse and does not allow you to perform these exercises, then I would let your doctor know. Thanks for the question.
If you have any more questions, please contact one of our physical therapists at 402-562-3333.

Jay Pelan, DPT, CSCS
Physical Therapist
Certified Strength and Conditioning Specialist
Columbus Community Hospital's Rehabilitative Services

My son tore his acl 98%, he is almost 16 years old and a football/tennis player. What is the best technique to repair this. I have heard patella and hamstring allografts but what about a quadricep tendon transfer? What is this? Please e-mail me with the info. as I am seeing the doctor tomorrow and want to know what he is talking about!!! Thank you!!!
Anonymous

Thank you for the question. There are a few different ways to repair the ACL including: patellar tendon graft, hamstring graft, or receiving a graft from a cadaver. I have not heard of a quadriceps tendon transfer to repair the ACL, but some doctors refer to the patellar tendon as the quadriceps tendon. Therefore, when the doctor was talking about the quadriceps tendon transfer, he may have been referring to the patellar tendon graft. Each technique is sufficient to repair the ACL, but rehabilitation will be the key to the success of the ACL surgery. Also, each doctor prefers a certain technique that they feel is best to achieve optimal results.
If you have any more questions, please contact one of our physical therapists at 402-562-3333.

Doug Peters, DPT, CSCS
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

What type of squat is better for someone with mild hip arthritis, front squat or regular squat and does it matter if you do high or low reps?
Anonymous

Front squats (bar placed in front of shoulders with arms crossed over bar) and regular back squats (bar placed behind the head) are both very good strengthening exercises for the legs and back if performed with appropriate technique. The thing you have to be concerned about with arthritis is the effect these exercises have on the hip joint. The front squat isolates more of the quadriceps muscles where the back squat isolates more of the gluteus muscles. Both exercises involve multiple muscle activation of the legs and low back to both stabilize and move the weight against gravity.
Both of these exercises are safe to perform if you have mild arthritis as long as proper technique is maintained and you stay within your pain free range. In other words, do not squat very deep if this aggravates your symptoms. Performing more of a half-squat as opposed to a full-squat may be more appropriate. Also, use a lighter weight. One in which you can perform 12-15 reps with moderate effort. Avoid heavy weight and low reps because this may put too much stress on your already arthritic hip.
It would also be wise to incorporate other hip strengthening exercises in you program because the more support your muscles provide to the hip, the less wear and tear will occur. Examples are hip abduction and adduction exercises, as well as quadriceps and hamstring strengthening exercises. If you have any further questions, you can call me at the hospital (562-3333). We also offer an exercise consultation for $50 with one of our Certified Strength and Conditioning Specialists if you are interested in us helping you evaluate your exercise program and make recommendations for improving your workouts. To find out more call the above number.
Thanks for the questions.

Jay Pelan, DPT, CSCS
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

My 18 yr old daughter had ACL reconstruction 2 weeks ago. She is a basketball player and doing very well after surgery. Yesterday when she saw her orthopaedic surgeon, he prescribed therapy for once a week for 4 weeks. He also stated normal ACL protocol. I guess he figures she is very active, but isn't more therapy usually prescribed even at first?
Hannah's Mom

Most orthopedic surgeons have different protocols when it comes to post ACL reconstruction physical therapy. The rehabilitation process also depends on if there were any other injuries, such as a meniscus tear, along with the ACL repair. Some surgeons may limit the amount of knee flexion or weight bearing for a certain time frame, which may effect the amount of physical therapy indicated.

Most ACL protocols are fairly conservative for the first 4-6 weeks and focus mainly on range of motion and mild strengthening exercises. Most of these exercises can be performed at home, just as easy as at the Physical Therapy Clinic. If the orthopedic surgeon and the physical therapist feel your daughter is progressing well with these exercises and performing her exercises at home, one time per week physical therapy is probably appropriate. The doctor then may order additional physical therapy following those four weeks, if further rehabilitation is needed. Your daughter will also have to communicate her goals to the doctor and to the physical therapist if she would like to return to sports, such as basketball, so the rehabilitation process can be progressed accordingly.

Matt Wesch, DPT
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

Having mild hip arthritis, is ok to do jump sqauts on well padded gym mats?
Bill

If you have arthritis it is not a good idea to do impacting exercises such as jump squats. These exercises could be potentially irritating to the joint. The well padded gym mats would help to cushion the impact, but jumping in general still places a lot of forces on the lower extremity joints. If you already have the early stages of hip arthritis, your cartilage in your hip joint is starting to either wear away or degenerate. The degeneration process would occur faster with impact exercises and activities. Regular squats which are not deep (75 degrees of knee flexion or less) would be a good alternative for strengthening the hips and quadriceps without irritating the joint.

Donette Smejkal, MPT
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

I am 26 and have mild hip arthritis due congentive displaysia. A goal my of mine is to be able to dunk, although I don't or won't play basketball due to my arthritis, I would still like to be able to dunk. I do a jumping exercise where on land on a twelve inch bench softly but then instead of jumping off, I step down and repeat the exercise. Will this lesson the impact of the exercise and our their exercises you can recommend perhaps?
Anonymous

First of all, let me explain what congenital hip dysplasia is. It is a condition in which the hip develops abnormally, often during the first few weeks, months, and even years of life. The result is instability in the hip joint and increasing risk of dislocating the head of the femur (thigh bone) from its socket in the pelvis where it connects. This condition should be treated during early childhood. If it's not, a noticeable limp may be present into adulthood, as well as increasing pain.

It sounds like you are pretty active, so I will presume your condition has been treated to some degree, and you are able to function well in your daily activities. You mention that you have "mild arthritis." I would suggest that if you do have some pain in the hip, you would be wise to avoid any type of impacting force on the hip joint. This includes intense plyometric (jumping) training. However, your current routine of landing on top of a bench as opposed to on the ground does lessen the pressure of the impact. If you are able to tolerate this with no pain in the hip then this would be the best way to train.

The landing is what puts the most pressure on the hip, so if this force can be lessened in any way, it would allow you to train without complications. Do keep in mind though, your arthritis does indicate that you most likely have some level of degeneration in this joint. Based on your young age, you do not want it to get worse. Be cautious in your training and listen to your body. In other words, if it hurts, don't do it!

Another recommendation I have in your training is performing jumping exercises on a soft surface, such as a cushioned mat. This may allow you to tolerate a complete take-off and landing without aggravating the hip. I would avoid any single leg jumps where you put all your body weight on the affected hip, as this may invite injury and pain. Your goal is feasible, and I encourage you to continue with your current method of jumping exercises if it does not aggravate your hip. Thanks for the question!

Jay Pelan, DPT, CSCS
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

My husband had ACL surgery 2 weeks ago friday, started the stationary bike last week, was able to bend his knee 100 degrees 3 days after surgery adn was almost down to 0 degrees. He works in construction and was in great shape before surgery, when should he be able to return to work? He is walking with a slight limp. When can he begin to Mt. Bike again? (he had Allograft surgery)
Anonymous

Return to work after ACL surgery for a construction worker will generally be 2 to 9 months. While it sounds as if your husband is doing well, the graft needs time to heal and strengthen. Early return to work could interfere with this healing process. Allografts tend to be slightly more susceptible to failure than autografts. If he is able to return to a more sedentary job, his return could be as soon as possible. Mountain biking would fall into the same category. It is a very active sport and his knee will need time to heal before putting that much stress on it. There is always the temptation to push the return to work and activity, but this is a process that takes time to heal and to avoid having the repair fail and needing another surgery. . Your surgeon would be the best person to consult on these matters.

Randy Perault, MSPT,SCS, ATC
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

We were talking about anorexia in my biology class and it was brought up how your body will eventually eat your own muscle. Then we talked about how it is irreversable for the muscle to recover. Why is this? What has happened to the body that it cannot build that back up?
Gabrielle

Gabrielle, That is a very good question and one that often brings about many misconceptions. First of all, anorexia nervosa involves self-induced weight -loss, either by restricting the amount of food you eat, or eating large amounts of food (called "binge-eating")followed by self-induced vomiting (called "purging"). This disorder affects mostly young, white females.

You are correct in stating that once external nourishment (food, liquids, etc.) are used up by the body, it needs to find nourishment elsewhere. Proteins are the building blocks of the body. They maintain and promote organ and tissue (muscle) growth. Carbohydrates also give the body the energy it needs to perform daily activities. When proteins and carbs area not made available, the body looks to break down its own lean body mass, primarily excess fat and fat-derived fuels. Muscle tissue also falls victim. Since muscle is built and maintained by proteins, they are one of the first parts of the body that are affected by starvation.

Over time, excessive weight loss occurs, as well as decreased levels of energy and possibly increased incidence of sickness. The most noticeable signs will be the loss of the musculoskeletal system, including diminished muscle mass and bone integrity. In severe cases, the heart, lungs, liver, kidneys and hormones will be affected. This can permanently impair the bodies organs, leading to severe sickness and even death. In other words, if the organs of the body are deprived of nutrients for too long, permanent damage can be caused.

In acute cases, the results can be reversed if the problem is addressed quickly. It is important to notice early warning signs, including the following: 1. Comments regarding body weight, such as "Do you think I'm fat." 2. Dramatic weight loss for no medical reason. 3. Preoccupation with food, calories, and weight.

Thanks for the questions. If you have further questions, feel free to contact me at the hospital.

Jay Pelan, DPT, CSCS
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

I've been told that lying side leg raises were one of the best exercises for arthritis of the hip as they build strength in the hip. While I'm not in pain immediately after I do the exercise, the next day my hip is quite stiff, and feels inflamed. I have worked up to 24 raises with ankle weights. Coul I be overdoing it?
Anonymous

It is possible that you could be overdoing it. If you are performing the exercise with ankle weights and you are working hard or straining to get up to 24 repetitions, it is possible that you could be placing too much pressure on the joint, and irritating the joint more than helping it.
A couple of suggestions you may want to try. Start with performing the exercise without any weight and decrease the repetitions to 15. If this does not bother you the next day, then gradually increase the repetitions 2-3 each day, working up to 25 repetitions (as long as the hip does not bother you the next day). If you continue to feel stiffness the day after exercising, then you may want to back off a little bit until it does not bother you. Once you have reached 25 repetitions, with no problems in the hip, then you can gradually increase the weight.
You may also want to try performing additional exercises (if you are not already) that increase the strength of the entire hip and leg, using the same guidelines as mentioned above. If you would like additional exercises for your hip and leg, please call us at 402-562-3333.

Doug Peters, DPT, CSCS
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

How would you treat polymyositis?
Nichole

Polymyositis is an inflammatory muscle disease which affects many muscles, mainly the muscles of the trunk, shoulders, hips, and thighs. Varying degrees of weakness, decreased muscle power, and atrophy are present and the onset can be gradual or rapid. The loss of strength can be noticed with difficulty in getting up from chairs, climbing stairs, or lifting above shoulder height. Occasionally the muscles are tender to the touch and ache. People of polymyositis also feel generally unwell, fatigued, and may experience weight loss, and low-grade fever.

Physical Therapy is an important part of the treatment of polymyositis. Exercise will not "cure" polymyositis, but it can increase muscle strength, flexibility, cardiovascular, and psychological well being. Currently, it is questionable whether muscle can actually regenerate after it has been damaged by polymyositis, however, you can maintain and strengthen the muscle you have and prevent further loss of muscle tissue.

Before starting any exercise program, it is wise to check with your physician for obtaining approval. It is also recommended to consult with a physical therapist on exercise parameters, since a physical therapist brings extensive knowledge of the musculoskeletal system to an exercise plan. What is best for one person with myositis may be inappropriate for you. Therefore, an individualized program is ideal. The physical therapists at Columbus Community Hospital will design an individualized program for you which will best meet your needs. We will teach you how to do the exercises correctly to avoid harm and maximize benefits. We may also include certain modalities (Electrical stimulation or ultrasound) and/or provide soft tissue mobilization to relieve pain and inflammation in a particular area.

Some general guidelines to consider for exercise are:

  1. Do exercises that you enjoy. If you dread your exercise program, you will not follow through on it. If possible find a friend who will exercise with you.


  2. Start gradually. Don't jump into a full-fledged program. Ideally, you should eventually include aerobic activity 3 to 4 times per week for 20-30 minutes, plus strengthening exercises 2 to 3 times per week.


  3. Work on exercises which will a)increase flexibility (such as stretching); b) develop strength (working against resistance with either bands or light weights) and c) enhance endurance (such as walking or cycling).


  4. Always begin your workout with stretching exercises which are slow holding stretches for 20-30 seconds. Never bounce when you stretch.


  5. Listen to your body. It will probably tell you if you are doing too much. If something hurts, stop. Use pain as a warning sign to make you re-evaluate what movement it was that you were doing to cause pain? Too much weight? Too many repetitions? Poor body mechanics?


  6. Forget the "no pain, no gain" motto of exercise. While muscle fatigue and soreness are expected with any exercise program, whether for healthy or inflamed muscles, something may be wrong if there is pain. Stop the exercise and consult a physical therapist or physician.

Please contact Columbus Community Hospital Rehabiliative Services, at 562-3333 to schedule an evaluation appointment in order to individualize an exercise program and treatment plan which will best meet your needs.

Donette Smejkal, MPT,
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

I was non weight bearing for 12 weeks post pelvic fractures. I now have difficulty walking due to muscle loss and atrophy (Quads and gluts). Can you specify what exercises I should be doing?
Yvonne

Strengthening exercises targeting the quadriceps and gluteals are strongly recommended due to the involved muscle loss or atrophy in these muscle groups. The typical progression of exercises depends on how long it has been since your fracture and what the starting strength is of your muscles.

The typical progression of exercises would begin with active range of motion and isometric resistive exercises in the lying or seated positions. These exercises would include quad sets, gluteal sets, bridges, seated knee extensions, prone hip extensions, and supine or side lying hip abduction. You could then progress to standing exercises, such as hip abduction, hip extension, squats, step ups, and lunges.

Please feel free to call us at 562-3333 to obtain a handout of the recommended exercises or if you have any questions.

Donette Smejkal, MPT,
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

I have ptosis in my left eye, is there any physical therpy techniques that can train the levator muscle, keeping in mind that it is mild but apparentand it has developed three monthes ago.
Anonymous

Ptosis is the medical term for drooping eyelids. A person with ptosis is not able to lift one or both upper eyelids to uncover the eye completely . There are 2 different types of ptosis: Acquired Levator Dehiscence Ptsosis and Congenital Ptosis. Acquired Ptosis occurs when the tendon of the levator muscles loosen or detach. Congenital Ptosis usually results from a lack of development in the levator muscle.

Treatment for Ptosis is dependent on the cause. Surgery may be an option for congenital ptosis and neuromuscular electrical stimulation may be effective for acquired ptosis. Neuromuscular e-stim therapy stimulates and strengthens the levator nasi and levator labii muscles.

Your physician will determine the cause of your ptosis and what treatment is appropriate. Neuromuscular electrical stimulation for ptosis is very often provided by a speech-language pathologist because of their specialization in facial musculature.

Donette Smejkal, MPT,
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

I have arthritis in the hip. Basically, I am pain free except when I get up from sitting and take that very first step. The pain is severe then, but once I continue walking it disappears. Can you recommend any exercise that will help counter this?
Anonymous

There are several muscles that cross the front of the hip joint that could be contributing to your complaints. They are called hip flexors. When we sit they are put in a shortened position. When we move form sit to stand they are quickly brought into a stretched position which can cause pain until they get stretched put in the first few steps we take. Arthritis of the hip can contribute to the muscles losing flexibility.

The best way to stretch out the hip flexor muscle group is to extend the involved leg backwards and hold it feeling a gentle stretch across the front of the hip. This can be done by standing and bringing the involved leg backwards and resting it on step or placing your involved leg behind you while leaning backwards with your upper body. A gentle stretch should be felt and held for 15 to 30 seconds. This can be done several times a day.

There are more advanced stretching that can be done, but should be done with the help of a physical therapist.

Randall Perault, MSPT,SCS, ATC
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

Im a physical therapy student in my last year, my dad has a non prograssive myopathy in his hand, which resulted in the atrophy of the hand and the forearm muscles, it was like this for quite a while but now , weakness is developing in the shoulder due to disuse, i have tried manual strengthing because the mucsle grade is 3- and we seem to be getting no where, ide like is if u'de give treatment tips for this kind of situation.
Anonymous

In response to your question about the shoulder weakness following a non progressive myopathy of the hand: First off I feel it is important that your father has followed up with his doctors to insure that this weakness is because of the disuse and not the result of some other neurological condition related or unrelated to the myopathy.

There are many ways to assist your father with exercises, but because of the significant weakness, you will have to be creative to find ways to assist the muscles before attempting more active movements. Having him roll a rehab ball or smaller ball out in front of himself on a table and progress to different rolling it in different directions. Sitting next to a table, he can glide the hand and arm out in front of himself and even out to the side into flexion and abduction, assisting with his body. Keeping the shoulder joint stimulated is important and you can assist him in stabilizing the hand and arm out to his side while sitting on the bed and then leaning onto the arm to apply a gentle force into the joint. The hand and wrist may need to be splinted with a basic resting wrist splint to protect it, keep deformities from occurring and to give it some stability, especially when doing the exercises.

Don't forget that the joint needs to be moved through full range to limit adhesions. You can help him with passive range of motion and teach him to use his other arm to assist the affected arm through passive flexion in a seated or supine position. Being a physical therapy student, you should have access to different neuromuscular rehab literature and texts that can help you with even more specific activities for this type of condition.

I hope you find this information helpful. You are certainly welcome to call us at our clinic if you have any further questions.

Pam Perault, MSPT, SCS, ATC
Columbus Community Hospital's Rehabilitative Services

I have been diagnosed with hip arthritis. While I have soreness, I do not have pain except when I get up from a sitting position. I would like to continue doing squats, lunges and mild aerobics but worry that I may be causing more damage. Can you advise me?
Anonymous

Strengthening and flexibility exercises are strongly recommended for arthritic joints in order to maintain or improve the range of motion of the joint and to provide improved strength and support for the joint. The squats and lunges are good strengthening exercises which you can continue. I would advise that your mild aerobics should be the low impact type, such as walking, cycling, and use of stair stepping machines. Another excellent low impact type of aerobic activity would include exercises in the water, as the water helps to unload the stress off the joints but yet provides resistance. Make sure your aerobic exercise does not involve jumping or running activities as these are high impact and could cause extra stress and irritation to the arthritic hip joint. Thanks for the question.

Donette Smejkal, MPT
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

I had ACL surgery 6 weeks ago, and my knee still gives out unexpectedly sometimes. I dont know what to make of this. I also want to know what the normal weight gain or loss is after ACL surgery.
Anonymous

This is a fairly common complaint following ACL surgeries. There is a group of muscles on the front part of your thigh referred to as your quadriceps muscles. These muscles cause your knee to extend and help keep it stable during walking. The trauma of an ACL surgery along with inactivity can cause these muscles to become weak. The reason your knee gives out unexpectedly is probably due to quadriceps muscle weakness. Therefore, it is important for you to perform exercises in order to help strengthen these muscles and improve your stability with walking. It may take a little time to strengthen these muscles to 100%.

As to your second question, there is no necessary amount of expected weight gain or loss following an ACL surgery. The amount of weight gain or loss, like with any thing, is going to depend on your activity level following surgery and your diet.

Matt Wesch, DPT
Columbus Community Hospital's Rehabilitative Services

I had ACL arthroscopic surgery on my left knee in 6 months back. Tell me when can I jog normally. My Quadriceps (2 inch less) and gluteus is loose compared to right leg. Please tell me muscle atrophy after ACL surgery is 100% recoverable or not.
Anonymous

Following an ACL repair, muscle atrophy is common no matter what your age. The repair needs time to heal and your rehabilitation needs to be done in gradual steps to prevent interfering with this healing process. Jogging is usually initiated at 8 to 12 weeks, providing you have normal range of motion and no swelling of the knee with activity. At six months, you should be able to jog normally. The fact that you have quadricep and gluteus weakness indicates that you need to be performing some type of specific resistence exercise for these areas to strengthen them. Muscle atrophy following ACL surgery is 100% reversable providing you are doing resistive execise to the affected muscles. Your muscle strength will not recover on it's own with just normal daily activity.

Randall Perault, MSPT, SCS, ATC
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

Why is physical therapy not working for muscle atrophy?
Anonymous

First of all, let's define "muscle atrophy" for those readers who are not familiar with this term. Muscle atrophy occurs when a muscle, or group of muscles, remain inactive over a period of time. The result is loss of muscle tissue. This can occur rapidly if a muscle is not used frequently.

Physical therapy can be beneficial to preventing muscle atrophy if exercise is part of your treatment plan. For example, performing standing exercises, such as mini-squats or leg extensions (kick-outs) regularly will promote muscle hypertrophy, or growth, in the thigh muscles.

There may be other things going on that also cause muscle atrophy. For instance, nerve pathology, lack of nutrition, diabetes, etc. These are only a few of many other conditions that may alter the body's ability to prevent muscle atrophy.

Consult your physical therapist or doctor if you are performing a regular exercise program and are still noticing an increase in muscle atrophy. Otherwise, re-evaluate your exercise program as you may need to add more resistance exercises.

Thanks for the question.

Jay Pelan, DPT, CSCS
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

I have been lifting weights for a few years but have stopped for the last two months. Will this cause muscle atrophy and weight loss??
Anonymous

Yes, it can. Muscle atrophy (the loss of muscle mass or size) occurs from a decrease or lack of muscle use, and in this case, when lifting weights was stopped. As the muscle becomes smaller, it does not have as much mass or weight as it did while lifting weights, therefore you will lose muscle weight. You may even see a decrease in strength due to the muscle atrophy.

A good example of muscle atrophy and weight loss by stopping weight trainng is by looking at a college or professional football player who weighed 250 pounds during the time he played. Once his football career is over and he does not continue with intense workouts that includes lifting weights, his muscles will become relatively inactive compared to his playing days, and his muscles will atrophy, thus causing him to lose weight. Within a few months or years, this same football player may weigh only 200 pounds due to muscle atrophy.

However, your weight may increase after you stop lifting weights. This occurs because your metabolism also decreases as your muscles begin to atrophy. If you continue to eat as much as you did while you were lifting weights, and your metabolism decreases, your weight may begin to increase due to an increase in fat. If your weight stays the same, the amount of weight that was lost through muscle atrophy was regained by an increase in fat.

Douglas R.Peters, DPT, CSCS
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

What ways can massage and other hands-on bodywork techniques benifit a patient with Parkinson's disease?
Linda N.

Very good question. First of all, lets define Parkinson's Disease. PD is a chronic, progressive disorder that affects a specific part of the brain called the basal ganglia. A specific neurotransmitter (or chemical messenger) called "dopamine" is produced in this part of the brain. It's purpose is to allow the body to function in a normal, controlled manner. In PD, the production of dopamine is impaired. This results in the following clinical signs. Rigidity (or heaviness and stiffening of the limbs), tremors, slow movements, and sometimes difficulty walking (shuffling gait).

The most important way to offset the effects of PD, other then medication, is to remain active. A good exercise program will help maintain healthy joints and muscle flexibility. It will also help to maintain the normal, unrestricted movements associated with performing everyday activities.

Massage is an effective way to keep muscles "loose" and promote flexibility. Stretching is another form of exercise that is also very important to maintaining adequate muscle length. This will allow you to have full range of motion at all joints. Stretching and massage go hand in hand because they focus directly on the muscles of the body. PD affects primarily the musculoskeletal system. It would be wise to consult with an exercise specialist, such as a fitness or athletic trainer or therapist to learn the proper way to perform stretching and flexibility exercises. As always, check with your doctor or therapist before beginning any exercise program.

Thanks for the question!
Jay Pelan, DPT, CSCS
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

I recently tore my ACL and my doctor told me I will need physical therapy. How long and how many times a week is rehab recommended?
Karla

Depending upon what type of activity you are planning to return to, most ACL recovery time-spans range from 4 months with an accelerated protocol, to an average of 6 months. ACL rehabilitation protocols, (i.e. exercise and activity progression) vary depending upon the doctor who performs the surgery or the therapist performing the rehab. General goals with most protocols begin with restoring full knee active range of motion (flexion and extension), followed by strengthening exercises for quadriceps and hamstring muscles. Specific exercises are added to provide stability to the knee and regain a normal walking/running motion.

As far as frequency of therapy, you can expect 3x/week to begin. As you improve the range of motion, strength and stability in your knee, the frequency usually decreases to 2x/wk or even 1x/week. I usually see my ACL patients 3x/wk for the first 4-6 weeks and then re-evaluate them. If they are compliant with a home exercise program and are doing well with their rehab, then I decrease their frequency to 1-2x/wk.

Thanks for the question.
Jay Pelan, DPT, CSCS
Columbus Community Hospital's Rehabilitative Services

My mother fell on the floor and although she had a bump on her knee (all better now), the following evening she noticed that her inner upper arm was horribly black & blue from the shoulder-under arm area to the elbow. She is able to raise her arm from the shoulder, but unable to raise her lower arm from the elbow down? What's wrong?
Anonymous

Because your mother presents with what appears to be a significant amount of bruising along with a loss of function at the elbow, I would strongly recommend that she be examined by her doctor. The fact that she is unable to lift her forearm at the elbow is concerning because she may have ruptured a tendon or possibly injured something in the joint that is blocking its function. There is also the possibility that a nerve could have been injured from the fall, but this does not seem as likely. Without physically examining the injury, I can not give you any definite answers to your question based on the information given. However, again, I strongly encourage your mother to see her doctor.

Pam Perault, MSPT, ATC
Columbus Community Hospital's Rehabilitative Services

I would like information on the back pain method that you had in, Sunday's paper. My husband suffers with back pain all the time.
Anonymous

The McKenzie Method is a unique, comprehensive and logical step by step process to evaluate the patients problem quickly. This mechanical examination can classify most patient conditions by the level of pain or limitation that results from certain movements or positions. A McKenzie assessment can eliminate the need for expensive and/or invasive procedures. It was developed by Robin McKenzie, a physical therapist in New Zealand, in the 1950's. Research has shown that the initial McKenzie assessment procedures to be as reliable as MRI's and x-rays at determining the source of the problem and quickly indentify responders and non-responders. In my 15 years as a physical therapist, I have not found a more reliable way of evaluating and treating low back pain.

McKenzie treatment prescribes a series of individualized exercises. The emphasis is on active patient involvement, which minimzes the number of visits to the clinic. Ultimately, most patients can successfully treat themselves when provided with the proper knowledge and tools. For patients with more difficult mechanical problems, a McKenzie therapist ca provide advanced hands-on techniques until the patient can self administer there exercises. By learning how to self treat the problem, patients gain knowledge of how to minimize the risk of recurrence.

The thing I enjoy most about the McKenzie Method is the annual meetings. The McKenzie Institute is made up of health care professional from all areas of medicine looking for the best way to treat low back pain. It's not just physical therapists saying our way is the best. It is doctors, surgeons, radiologists and chiropractors comig together to discuss the Method and how to apply it

Randall Perault, MSPT, SCS, ATC
Physical Therapist
Columbus Community Hospital's Rehabilitative Services

What types of exercises are recommended or restricted, for my recent diagnosis of osteopenia?
JO

Osteopenia results from decreased calcification or decreased density of bone. Often associated with osteoporosis, osteopenia results from conditions that cause metabolic breakdown of bone and altered osteiod (bone) synthesis. Osteopenia is more common in women, mostly postmenopausal. This is mostly due to a reduction in female hormones associated with the aging process.

One of the best ways to treat osteopenia is through exercise. Weight-bearing exercises are beneficial because they put a mild stress on bones, thus causing them to grow stronger in order to adapt to this increased stress. The worst thing to do in this case is be immobile. Both aerobic and strength training exercises are beneficial if prescribed in the correct amounts. Some examples of safe exercises: walking, stationary bicycling, and light resistance exercises using free weights, rubber bands, or machines are a few examples.

As always, consult your physician before beginning any kind of exercise program. The frequency and amount of exercise will be different for everyone diagnosed with osteopenia, depending on the severity of the disease. Therefore, it would also be wise to consult someone with training in exercise prescription, such as a physical therapist, personal trainer, or exercise physiologist to assist with devising and exercise program.

Jay Pelan, DPT, CSCS
Physical Therapist
Columbus Community Hospital's Rehabilitative Services