Ligaments connect bone to bone and help provide stability within a joint. There are different levels of sprains to a ligament and if the injury is significant a tear may result. Some ligament tears may require surgery. It is possible to damage more than one ligament in the same incident. Ligament Injuries commonly occur in the shoulder, knee, and ankle. The most common ligament injuries in the knee include the anterior cruciate ligament (ACL), medical collateral ligament (MCL), and less commonly the lateral collateral ligament (LCL), and the posterior cruciate ligament (PCL). Physical therapy can help patients with ligamentous injuries to help strengthen structures surrounding the joint. Patients will also benefit from physical therapy post surgery to help ensure a quick and complete recovery.

Neck Pain

What causes neck pain?

Neck pain can be caused by many different things. The most common reason in the general population is because of poor posture while working on a computer (laptops especially because poor posture) and looking at our cell phones. This can change the position of the bones of the neck (cervical spine) and pull and tighten the muscles around the area. Not only can the muscles of the neck become tight or weak (or both), but muscles of the shoulder and chest often overlap and can be affected by posture, adding to the neck pain.

The more forward your head is, the heavier it becomes for the muscles to hold up. Think about holding a gallon of milk: if you hold it close to your body it feels much lighter than when you hold it out in front of you with your arm straight. It is heavier when it is more in front of you. Similarly, your head is heavier when it is more in front of you. Physics!

Being in this posture throughout the day as we work at our computers and look at our cellphones, many (or all) days of the week, all the time, leads to the muscles adapting to this posture. This can cause tightness and weakness in muscles in the area and this can worsen the pain over time.

There can be other reasons for neck pain and they are often worsened by this posture many of us have.

Other causes of neck pain include: whiplash from a car accident or fall, joint stiffness between the spines of the neck, arthritis, disc herniation. These can also cause tightness and weakness  in the area as well.

Treatment

The most important treatment for neck pain is to work on your posture. Posture is most often the underlying reason for neck pain, and even if it is caused by an actual injury, posture often contributes to the pain or slows down the healing process. Since we spend a lot of time at work, and many of us work a lot on computers, your desk ergonomics are a great place to make your first change. Sit-stand desks are a great way to help with this, however, the set up of each is still important. You can find many resources for this online, or your physical therapist can assist with work station set up.

There are also hands on treatments to decrease tightness, joint stiffness, and strengthening exercises that a physical therapist can help with. Sometimes using tape to help calm down muscles and assist you in using the right muscles is a treatment that may be used.

Surgery is something we often try to avoid for neck pain, but may be something that is needed after trying strengthening, stretching, and changing postural habit. This would be something to discuss in physical therapy and with your doctor. Healthcare providers often recommend trying physical therapy first, before considering surgery, depending on what is causing the neck pain.

Patient Resources

Online search for desk ergonomics

Gross AR, Goldsmith C, Hoving JL. Conservative management of mechanical neck disorders: a systematic review. J Rheumatol. 2007;34(5):1083-1102.

 

Miller J, Gross A, Sylva J. Manual therapy and exercise for neck pain: a systematic review. Man Ther. 2010;15(4):334-354.

 

Falla D, Jull G, Russell T, Vicenzino B, Hodges P. Effect of neck exercise on sitting posture in patients with chronic neck pain. Phys Ther. 2007;87(4):408-417.

 

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Joint pain is also called arthralgia. Joint pain can affect one or more joints and may be caused by many types of injuries or conditions. Rheumatoid arthritis causes stiff and painful joints. Osteoarthritis may involve degeneration of cartilage and growth of bone spurs. Joint pain may also be caused by bursitis-inflammation of the fluid filled sacs that help cushion bones. Physical Therapy can help with joint pain to provide protection tips and exercises to strengthen/stretch muscles around joints.

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Joint dislocation occurs when a joint separates or dislocates abnormally disrupting the normal alignment of a joint. Joints may also sublux and this occurs when the joint begins to dislocate but has not yet lost contact on two sides of the joint. Dislocations occur commonly in the shoulder and finger joints. Physical Therapy can help identify tight and weakened muscles around the joint and design exercises to help promote balance and teach joint protection strategies and proper posture.

As we age, flexibility may be reduced if we fail to stay active and/or work on flexibility. Muscles can tighten and range of motion can become limited. This may affect your every day activity as well as your active lifestyle. Everyone can stretch and work on flexibility despite you age, size, or body type. Physical Therapy can help identify your tightness and tailor exercises to increase your flexibility and help you maintain flexibility, prevent injury with exercise, promote circulation and range of motion and relax you.

Heel spurs are often associated with plantar fasciitis. A hook of bone forms on the heel bone (calcaneous) and this is known as a heel spur. Upon x-ray, this hook of bone is seen protruding from the bottom of the foot often where the plantar fascia is attached to the heel bone. Physical therapy can help with heel spurs to assess proper gait mechanics, shoes and muscle and flexibility imbalances.

Hand injuries can vary from minor cuts and bruises to serious lacerations or broken bones. Injury to underlying structures of the hand has a potential for serious handicap. A good medical evaluation and rehabilitation can reduce this risk. The hand/wrist contains 27 bones and includes arteries, veins, muscles, tendons, ligaments, nerve and cartilage. After a thorough evaluation, a physical therapist will design an individualized treatment program which may include exercises to improve range of motion, strength and flexibility, manual therapy to improve joint and soft tissue mobility, and education in ergonomics and joint protection strategies.

Lordosis is an excessive inward curvature of the spine. There is normally a natural inward curve in the cervical and lumbar spine but an excessive curve (especially in the low back) may lead to swayback. Increased or decreased lordosis (flat back) can affect the spine by decreasing shock absorption which decreases the distribution of mechanical stress. Physical therapy can help through education in proper posture, exercises to strengthen muscles and address other contributing factors.

Kyphosis is a forward curvature of the upper spine. Some rounding is normal but kyphosis generally refers to an increased rounding of 40 to 45 degrees or more. This condition is often called hunch back. Kyphosis may be due to degenerative diseases, osteoporosis with compression fractures of the vertebrae, developmental problems or trauma to the spine. This condition can affect all ages, cause few problems in mild cases but also be so severe it can affect your breathing/lungs, nerves, organs, etc. Physical Therapy can help with postural education, strengthening and stretching exercises and ergonomic tips to prevent the condition from worsening.

The knee joint is designed to bend and straighten. The knee may be injured by a direct blow but more commonly twisting or stretching it through a greater range of motion. Types of knee injuries may include ligament tears or sprains, meniscus or cartilage tears, strains of muscles and tendons around the knee joint and inflammation of the bursa of the knee secondary to direct blows or chronic use. Physical Therapy can help with knee injuries to help stretch and strengthen the joint and weakened structures to promote more balance, educate in proper gait and joint protection strategies as well as supervise a more structured rehabilitation regime following surgery to endure maximum range of motion and strength gains to normalize function.