“I fell and landed on my shoulder,” a patient once told me. He expressed himself with a concerned look on his face. He was worried about his daughter’s birthday party. In two days, all of her friends would be over and he felt as though he was not contributing as much as he should have been in order to prepare for the event. He told me that for some reason his arm was not moving as it normally would.
What Is Frozen Shoulder?
As this story is told, one may begin ask what could possibly be causing the gentleman’s problem. One answer is Adhesive Capsulitis, also known as Frozen Shoulder. Do you know someone who has received this diagnosis? If so, what you may not have known is that this diagnosis does not have a standard definition or classification. What it is does have are similar characteristics between the varying diagnosing parties.
What are the Characteristics of Frozen Shoulder?
What is known for certain is that there is a progressive loss of range of motion and that the pathology progresses through different stages. Let’s begin with identifying the commonly accepted three phases of Frozen Shoulder: freezing, frozen, and thawing phase. Each of these has different pain levels associated with them. Each phase is also associated with a varying range of motion that may improve or worsen, depending on what phase the person is in.
Photo via Mayo Clinic
In general, Frozen Shoulder can take around two years to resolve naturally. So, can you imagine presenting that news to the gentleman we were discussing before?
Not being able to complete his normal life activities for two years would be hard to hear. The good news is that there are various interventions one can use to help manage the symptoms of Frozen Shoulder throughout the various phases. Two potential options are a passive range of motion of the glenohumeral joint (avoiding the painful range) and scapular mobilization, which are both examples of physical therapy interventions. Some physicians may choose to do a manipulation under anesthesia.
Get Assistance with Frozen Shoulder
If you want to learn more about skilled interventions to treat Frozen Shoulder, we are here to serve you. We aim to provide evidence-based interventions and help you along your rehabilitative care. The team at Rehab At Work provides expert knowledge and patient-first care. If you’d like to schedule a consultation, contact us today.
With the onset of middle age, many of us may start reducing the frequency of the activities that kept us challenged physically in our younger years. We no longer get onto or off of the floor or ground to play with our children, to play with our dogs, or to the garden. As we downsize our living situations we are no longer carrying laundry baskets up and downstairs and we begin to pay to have someone else paint, hang drapes and wash our windows. As a result of this progression into a simpler and more leisurely middle age, we will rarely have the need or opportunity to get on/off of the floor, reach or work overhead, carry moderate weights up and down stairs or walk on challenging unlevel terrain. Unfortunately, we lose what we don’t use!
Without regular challenges to our balance, over time we run the risk of losing the ability to maintain our balance when it matters most. Falls increase as we age for that exact reason and falls can result in hip fractures, concussions, or worse. Falls are the number one cause of injuries and death from injuries among older Americans. In fact, according to a report from the Centers for Disease Control and Prevention, an older adult falls every single second of each day in the United States. Nearly any activity that keeps you on your feet and moving, such as walking, can help you to maintain a good balance. But specific exercises designed to enhance your balance are beneficial to include in your daily routine as they can help improve your stability. Below is a list of 12 exercises that you can do at home to improve your balance and reduce the risk of injury due to falls. Also included are several exercises that will help improve your leg strength so that if you do find yourself on the ground you will be able to get yourself back up again! If you have severe balance problems or symptoms of dizziness or vertigo, you should be evaluated by a physician or physical therapist before attempting to engage in balance exercises. Dizziness is not the same as balance. Dizziness is a sense of spinning or disequilibrium that can cause balance deficits but it needs to be fully evaluated as to its cause prior to engaging in any type of balance retraining.
1). SINGLE LEG STANDING ON LEVEL SURFACE (Goal is 30 continuous seconds)
2). SINGLE LEG STANDING WITH LEG SWING OR REACH OUT
To challenge yourself when performing your single-leg standing reach out with one leg either forward or out to the side. Repeat 10 times. As an alternative, swing your leg back and forth quickly either front to back or side to side
3) SINGLE LEG STANDING WITH ARM SWING OR REACH OVERHEAD
To challenge yourself when performing your single-leg standing reach up over the head with either arm. Repeat 10 times. Move slowly or quickly to vary the challenge.
4) SINGLE LEG STANDING ON AN UNLEVEL SURFACE (PILLOW) Once you can safely manage 30 continuous seconds on a level surface, challenge yourself by attempting an unlevel surface such as a pillow. Work up to 30 continuous seconds of single-leg standing.
5) TANDEM STANDING (STAND HEEL TO TOE) Stand with one foot in front of the other as above. Maintain your balance for 30 seconds then switch, placing the other foot in front, and repeat.
6) TANDEM STANDING WHILE TOSSING AND CATCHING A BALL To challenge yourself, toss a ball with a family member or friend (or against the wall to yourself!) while attempting to maintain your balance for 30 seconds. Switch and place the other foot in front and repeat
7) TWO-LEG STAND, EYES CLOSED Perform this activity in a safe location (the corner of a room, next to the kitchen counter). Begin with feet comfortably apart and close your eyes. Maintain your balance. When you can safely manage 30 continuous seconds progress yourself by moving your feet closer together and then, eventually, to standing on a pillow/uneven surface.
8) SINGLE LEG STAND ON UNLEVEL SURFACE WHILE TOSSING A BALL
9) HEEL TO TOE WALKING FORWARD AND BACKWARD Perform this activity in the kitchen with your hand lightly touching or hovering above the counter in case you lose your balance. Walk heel to toe forward. Walking the length of the counter and then walk heel to toe backward. Repeat several times.
10) SIT TO STAND FROM A CHAIR WITHOUT USING HANDS/ARMS To increase your leg strength for getting up off of the floor, practice standing up from a chair without using your arms to assist you. If this proves too difficult at first, place a pillow or two in the chair when you first get started and then remove the pillows as you get stronger.
11) WALL SITS (WALL SQUATS) Perform this activity against a sturdy wall. With your feet away from the wall, slide your back down the wall to end up in what appears to be a sitting position. Hold this position for 3-5 seconds and then push with your legs to slide yourself back up the wall to a standing position.
12) BRIDGES
Wall Sits Start PositionWall Sits End Position
(start position) (end position)
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Article by Nancy David, PT, Frederick Clinic Manager
What is it about pain that makes it so difficult to cure in certain cases?
Normal Pain
Normal pain is helpful. It is protective. By causing an unpleasant feeling, normal pain changes our behavior. It teaches us how to avoid things that lead to injury or illness. It motivates us to avoid using an injured body part, to give it enough time to heal. Normal pain can be intense at the onset and should gradually decline over time, as healing occurs and we can gradually get back to normal life again.
Sometimes pain is not helpful. Phantom limb pain is a perfect example. This type of pain is sometimes experienced after an amputation. Intense pain is felt in an area of the body that is not even there anymore.
Why does this happen? Why does the body produce pain in this way?
Pain is very complicated. Top researchers are just starting to understand it. Pain involves complicated biochemistry and a very complex nervous system.
Abnormal Pain
Abnormal pain evolves due to over-sensitivity of our nervous system. There is a long list of reasons for this sensitization. Generally, the longer we have pain, the more likely it will cause nervous system sensitization. 3-months is typically the limit of what is considered normal or acute pain, after that, it is considered Chronic Pain. In this stage, pain becomes more of a problem than the actual physical injury itself. The pain is very real, but it does not have as much of a useful purpose and it becomes very stubborn and difficult to treat.
Living with abnormal or chronic pain can cause things to spiral. Pain will discourage you from moving and this may prevent you from participating in normal family life, work and social activities. Your experience with normal pain tells you that it will fade away with healing. This may not be the case with chronic pain. So, while you wait for your pain to go away, the stress keeps adding up. Your friends and family start getting frustrated with you. Your doctor may run out of ideas to treat your pain when normal treatments don’t work. The typical medications for pain aren’t working because this is Abnormal Pain and it doesn’t respond to the typical medication the way that normal pain does. You may feel there is no option other than surgery or you may have already had surgery with limited or no benefit. You might become convinced there must be something else wrong with you that just hasn’t been discovered yet.
The good news is that research is improving our understanding of how abnormal pain works and how to manage it.
Get moving: When movement hurts, it becomes hard to get motivated to move. Even when you do get motivated, you may start too fast or do the wrong exercises and cause a setback, making it even harder to get motivated to move. This is when you really need professional guidance. Physical therapists and Occupational therapists are well suited to guide you through this difficult process.
Guided Imagery: In the beginning, you may not be in a proper condition for movement. Therapists, in extreme cases, may decide to start you with Guided Imagery to prepare your brain and nervous system for movement.
Measured Exercise: In less extreme cases, therapists will guide you through a very closely monitored and measured amount of very specific types of exercise. Once your brain starts to experience movement again without the associated pain, the nervous system will start to turn down the sensitivity. By using measured exercise, you can set and achieve specific movement goals. Achieving goals has a positive effect on your nervous system and causes the release of Dopamine, a reward and feel-good chemical working in your nervous system. This in-turn allows for further movement to occur. Again, this must be carefully measured to avoid painful setbacks. By taking small steps like this and achieving small goals in a progressive manner, you can get back to moving without pain.
Get sleep: Chronic pain causes disturbance in your sleep patterns, which winds-up the nervous system, making it more sensitive. Movement causes the release of neurochemicals that aid in sleep. Getting better sleep soothes the nervous system.
Get good nutrition: A very large topic for a future discussion. Just know that certain food types are inflammatory and others have the opposite effect, reducing inflammation in the body. Stay tuned for future discussions on this topic.
Cognitive Behavioral Therapy: Pain causes negative thoughts and emotions. These negative thoughts have a negative effect on your nervous system and increase nerve sensitivity. With guidance, you can learn to recognize these negative thoughts when they occur and develop new strategies to reverse them.
This whole process takes time and requires guidance along the way.
Work Conditioning: For injured workers, this is a program that goes beyond traditional therapy, giving you more time and more guidance to deal with your chronic pain. Work Conditioning gives you 2-3 hours for 3-4 days per week, giving you more time to get moving than traditional physical therapy visits. If you do well with this, you can keep it going by progressing toWork Hardening which progresses even further and focuses on getting you prepared to return to work.
Teenager girl studying online at home looking at teacher giving lesson at laptop screen at quarantine isolation period. Home schooling. Social distancing. Online school test.
During these unprecedented times, many schools in the US and worldwide are closed, forcing students and teachers to adapt to virtual learning. But, this can be very dangerous to a child’s health in general. Most of the schools that adopt this approach have provided families with laptops and (in some cases) tablets. As mentioned in our previous blogs, problems can arise from prolonged use of technology such as neck pain, back pain, elbow pain, or carpal tunnel syndrome. These same issues could affect children, depending on how much screen time they spend doing virtual learning. There could be long term implications on a child’s physical and mental wellbeing; for example, a poor computer set-up can lead to tendinitis (inflammation of tendons) along the wrist, forearm, and elbow. Poor posture can also lead to back pain and neck pain. A previous blog, “Home office Ergonomics,” mentioned the importance of setting up a proper workstation to work from home. A well-designed work station, paired with stretching and rest breaks, can help prevent neck pain and tendinitis in adults and kids.
Parents/caretakers are doing their best to assist their children with virtual learning. Still, many are unconsciously ignoring the importance of creating a safe and comfortable digital workstation for their children. However, setting up a workstation for kids can be slightly more difficult due to their smaller size.
Here are some quick tips to help make sitting in front of a computer more comfortable:
• Keep your monitor at eye level, and place your keyboard close to your body.
• Sit in a chair with back support to avoid slumping.
• Make sure your feet are firmly planted on the ground, or use a footstool if your feet don’t reach the ground.
Items to consider purchasing if your child is working with a laptop:
• Laptop Kickstand.
• Computer mouse and keyboard.
• Headset.
One should take this approach when setting up a child’s workstation for virtual learning. Don’t be afraid to get creative and use seat boosters and props. Yoga blocks make for an easy, non-permanent work station modification. But most importantly, remember that they are kids, and movement is by far the most important tip for your child. Taking regular rest periods away from the screen is essential for their health. Provide your child with active options during those rest periods. For example, jumping jacks, hula hoop, jump rope, going up and downstairs, or simply just walking. Try to add the fun factor to a routine and recognize their hard work.
REHAB AT WORK staff are ready to assist you and answer any questions in setting up a safe workstation for you and your child(ren). Or if you are experiencing any of the symptoms mentioned above, then contact one of our offices and schedule an appointment so we can help you feel better.
On October 14th at 11AM, we welcome you to join a virtual session on managing and anxiety with Mark Karolkowski, OT. This session is available to the public.
