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Active Care Rehab

Hallux Limitis

Hallux Limitis literally means limited big to motion. Hallux Limitis is a degenerative or arthritic condition in which the big toe becomes progressively stiffer ad more painful. While motion still exist in the  big toe with Halux Limitis, Hallux Rigidus is an extreme version of  Limitis where little to no motion is present.

Many people have Hallux Limitis and do not realize it. Pain generally does not occur until toe range of motion is less an 35-40 degrees. Hallux Limitis occurs more commonly in runners, especially those whose big toe is longer than their second toe. With this condition a bone spur begins to grow directly on top of the big toe “knuckle.”

Hallux Limitis can cause many biomechanical problems and needs to treated correctly. Techniques like Active Release and Graston can restore motion by 30 degrees and home exercises can help prevent the recurrence of ROM loss. General ankle mobility should be addressed and over-the-counter orthotics can help lessen pain. Click here for ankle mobility exercises.

 

Yours in health,

 

Dr. Justin Hildebrand

Active Care Rehab

IT Band Syndrome

IT-BandIliotibial (IT) Band syndrome or Runner’s Knee frequently occurs in runners, especially those upping their mileage. ITB is described as a burning pain in the outside of the knee and the pain is increased with activity. If left untreated and activity continues pain can begin to move upward from the knee, into the IT Band.

The IT Band is a fibrous, extremely strong structure that begins in the hip as the gluteus medius, maximus and tensor fasciae latae. It travels down the outside of the leg and attaches just below the knee. The pain associated with ITB is due to tension in the band due to the muscle pull in the hip.

Studies have shown that individuals with ITB Syndrome have greater inward rotation at the knee and an increase in hip drop on the side of pain. Lack of hip muscle flexibility can increase the risk for ITB Syndrome by increasing the strain placed on the band. The foot, although commonly ignored, plays a significant role in IT Band pain. Having a high arched or rigid foot has shown to cause ITB Syndrome. This means that the foot and the hip need to be treated for resolution and preventative treatment for IT Band Syndrome.

Click here to see exercises for IT Band Pain.

 

Yours in health,

 

Dr. Justin Hildebrand

Active Care Rehab

Patella Tendinopathy

indexPatella tendinitis or jumper’s knee is more accurately called patella tendinopathy. Tendinitis mean inflammation of the tendon but patella tendinopathy is a degenerative condition of the patella tendon. This condition is described as local tenderness of the patella tendon at the attachment on the patella.

Patella tendon injuries occur more commonly in distance runners, sprinters, and athletes that freqently jump. The increase is knee flexion or bending predispose these individuals to the injury because knee flexion increases the force and stress on the tendon. Excessive quad tightness or dominance may increase the risk for injury as well.

Treatment for patella tendinopathy consist of Active Release and Graston on the quad muscles as well as the tendon to decrease tightness and built up adhesions. These myofascial release techniques also start the rebuilding of the tendon by starting a controlled inflammatory response. Rehab exercises to strengthen and lengthen the  quad muscles help decrease longevity and recurrence of the injury.Interestingly, research has shown that resistance quad strengthening such as knee extension exercises has a negative effect on recovery.

 

Yours in health

 

Dr. Justin Hildebrand

Active Care Rehab

Knee Cap Pain

imagesPatellofermoral Pain Syndrome, also called retropatella pain,  is successfully treated in more than 2/3 of cases with conservative treatments including rehabilitation. The goal of these programs should be to reduce pain and restore function of the foot, knee, and hip. A classic sign of PFPS is pain in the knees while sitting for long periods of time and reduction of pain when standing.

The exact cause of patellafemormal pain syndrome is debated by many different specialists. Many believe that weakness in the VMO or medial/inside quad muscle causes abnormal movement of the knee cap and leads to pain and dysfunction. Exercises to strengthen the VMO are commonly preformed but these exercises only make the underlying dysfunction worse.

Current research shows that the true cause of PFPS is not the abnormal movement of the knee cap but the abnormal movement of the femur under the knee cap. This abnormal movement is caused by weakness in the hip muscles, which allow increased inward movement of the leg. Not only the hip but the foot can increase one’s risk of developing PFPS. Loss of motion of the ankle joint or major excessive pronation or supination of the foot can increase the stress on the knee and lead to pain under the knee cap.
Braces and straps can help decrease symptoms.

For PFPS exercises click here.

 

Yours in health,

 

Dr. Justin Hildebrand

Active Care Rehab

Meniscus Injury

meniscusA meniscus is a crescent shaped fibrocartilage that divides a joint. In the knee the menisci are C shaped and  provide structural integrity to the knee when it undergoes stress. The knee menisci are commonly injured during twisting activities and during collisions involving inward or outward movements of the knee.

The lateral meniscus is less commonly injured than the medial meniscus. Small tear in the meniscus can and should be treated conservatively. A lateral meniscus tear presents as pain in the outside of the knee that is worse with twisting and especially going down stairs.  Due to its connection to the lateral meniscus the popliteus muscle, located behind the knee, commonly causes posterior knee pain when the lateral meniscus is injured. A medial meniscus tear presents as pain in the inside of the knee that is worse with twisting and especially going up and down stairs.

Swelling and/or stiffness will appear in the knee when a tear is present. If the knee locks in extension or flexion and popping and clicking are present a more serious tear maybe present. An MRI with contrast maybe necessary to determine the extend of the tear.

Non-contact meniscus injuries occur due to lack of hip and ankle stability. When the foot and ankle can not control knee motion correctly increased stress is placed on the menisci. Eventually the stress overtakes the strength the joint and injury occurs.

Conservative treatment for meniscus injury starts with restoring proper joint motion loss whether flexion, extension or both. This can be accomplished with joint mobilization exercises and Active Release Technique. Once joint motion is restored and pain is under control, focus should begin on correcting the hip and/or ankle imbalances that predisposed the individual to the meniscus injury.

 

Yours in health,

 

Dr. Justin Hildebrand

Active Care Rehab

Carpal Tunnel Syndrome

ctsCarpal Tunnel Syndrome (CTS) is the entrapment of  the median nerve at the wrist and causes numbness, tingling, and pain in the hand. More specially the pain, numbness, and tingling occurs on the palm side in the thumb, index, middle, and occasionally the ring finger. These symptoms on the back side or in any other part of the hand is not true carpal tunnel syndrome. Pain, numbness, and tingling starting in the elbow area and includes the thumb and fingers mimics carpal tunnel but could be pronator teres syndrome.

The carpal tunnel is a narrow canal or passageway  located on the palm side of the wrist. A ligament, the transverse carpal ligament, covers the tunnel and the 9 tendons of the forearm/wrist muscles along with the median nerve pass through the tunnel. When the ligament shortens due to adhesion/scar tissue development median nerve compression occurs. This compression causes numbness, tingling and/or pain to occur in the hand and fingers. Overuse of the forearm muscle and tendons can cause crowding and adhesion development in the tunnel and also lead to nerve compression.

Standard medical treatment for carpal tunnel is wrist brace for 6 months
, NSAIDs,  and surgery if symptoms precede.  According to Mayo Clinic, “Fortunately, for most people who develop carpal tunnel syndrome, proper treatment usually can relieve the tingling and numbness and restore wrist and hand function.” Conservative treatment consist of nerve mobilization to free the nerve of compression, Graston to mobilze the soft tissue (ligaments/tendons, and rehab to decrease the factors that lead to CTS. According to research Graston has a 88% success rate for the treatment of CTS. Click here to see CTS exercises.

 

Yours in Health,

 

Dr. Justin Hildebrand

Active Care Rehab

Plantar Fasciitis

Plantar fasciitis affectPFs many people from the avid runner to the worker that stands most of the day.  In fact, it is one the most common causes of heel pain. Plantar fasciitis occurs due to a thickening of the soft tissue of the bottom of the foot. The fascia, after being stressed for many days or weeks, starts to break down and inflammation sets in. This process may involve no pain what so ever.

The fascia will start to thicken and possibly long with the little toe muscles, pull on the heel bone creating a heel spur. A sharp pain in the morning and after long periods of being ideal starts to occur. The pain is usually described as intense, sharp pain for the first couple of steps that gradually gets better with walking. If nothing is done than the pain can begin to occur more often and not dissipate as steps are taken.

This thickening can occur due to having an over-pronated foot or flatten arch as well as having an overly supinated foot or high arch. The symptoms are almost identical for the high and low arched foot but the treatment needs to be individualized and different for each person and their foot. the low arched individual generally has an over-stretched plantar fascia and loose joints in their feet. The high arched person generally have a tight, shortened fascia and a rigid, tight foot. The two different presentations need and should be treated very differently.

Medically, plantar fasciitis, caused by low  or high arches, are most commonly treated with rest, NSAIDs/cortisone injections and orthotics.  Surgery to remove stress on the fascia or to remove the spur associated with plantar fasciitis can also be performed. Conservatively, intrinsic foot muscle strengthening, joint mobilization, and myofascial release can successfully decrease symptoms and relieve plantar fasciitis.

 

Yours in health,

 

Dr. Justin Hildebrand

Active Care Rehab

Lessening Your Risk of Heart Disease

th (3)Heart disease is the number one killer of men and women in the United States, and most of these cases are preventable. I will repeat this statement, heart disease is the number of killer of all people in the United States, and most of these cases are preventable.  Many address heart disease with diet and exercise, while others treat it with medication, and some will treat it with a combination of both. A few unlucky individuals find out too late and will be unable to reverse the effects of heart disease.

LDL or bad cholesterol has long been known to be the culprit of heart disease. Although lifestyle factors do play a role in high cholesterol, some individuals have a genetic predisposition to an increased risk of heart disease. For those concerned because of family history, an increase risk due to lifestyle, or are just looking to prevent heart disease, nutritional supplementation may be beneficial.

CoQ10 is an enzyme found in mitochondria, the energy producing structures in all cells. This enzyme is required to make the body’s engine run, as it works as an antioxidant to protect DNA from damage, helps provide energy needed to heal and has been linked to helping control cholesterol levels. A low level of CoQ10 has been seen in individuals with cardiac failure.

If you have heart disease, you know that statins are the medications of choice and you may know that muscle pain and weakening are common side effects of these drugs. Researchers believe that taking CoQ10 may reduce the risk of serious muscle damage due to statins and it may reduce the muscle and joint pain that results from taking statin medications. Statins, along with aging, reduce the amount of CoQ10 that the body produces. Decreased CoQ10 causes decreased heart muscle repair and decreased energy.

CoQ10 enzyme is found primarily in organ meats such as heart and liver, though not many of us had beef heart for dinner last night. Fruits and vegetables are not a good source of CoQ10; consequently, supplementation is thebest bet for receiving adequate amounts. Adults under 40 should take a supplement containing 100 mg/day.Adults over 40, as well as people taking a statin, need 200mg a day and studies have shown up to 300mg a day can be taken without side effects.

Diet and exercise changes are still the best choice for reducing or preventing the risk for heart disease, but adding CoQ10 can also be a great benefit. Other supplements that can help reduce heart disease risk are garlic, red yeast rice, and vitamin E. Heart disease maybe the number one killer, but remember heart disease is also preventable.

Yours in Health,

Dr. Justin Hildebrand