what are some of the common causes for shoulder injuries in climbers?
With the growing popularity of climbing, both indoors and out, there are a growing number individuals developing overuse injuries associated with this activity. As many front range climbers know all too well, training has become a huge part of this once fringe activity. With the popularity of climbing gyms, newer climbers are getting stronger and progressing faster. In addition, many weekend warriors are now training multiple days in the gym in addition to their outdoor climbing. This quick progression and increased volume of climbing can lead to many overuse injuries.
One of the most common overuse injuries I’ve seen amongst climbers is shoulder impingement. So what is shoulder impingement? In simple terms, shoulder impingement is a condition that occurs when the bone of the upper arm, the humerus, compresses the rotator cuff against the top of the shoulder blade, at the acromion process. This condition is termed subacromial impingement. With repetitive overhead motions, this compression creates irritation and inflammation in the muscle being compressed leading to pain, loss of function, and possible tearing of the muscle if left untreated.
common symptoms of shoulder impingement include:
so why are climbers susceptible to shoulder impingement?
With the repetitive nature of overhead reaching and pulling, climbers have a high likelihood of overdevelopment of large muscle groups such as the latissimus dorsi, rounded shoulder posture due to tight pectoral muscles and weak scapular stabilizers, and weakness in the small stabilizers muscles of the shoulder. These imbalances are also common with newer climbers utilizing improper techniques with hang board training, poor engagement of the scapular muscles when hanging from the arms, and quick progression into high volume and high intensity climbing.
so what should you do if you have pain similar to that described above?
An important first step is rest and activity modification. While no climber, myself included, wants to be told to take rest days, continued climbing through pain can leading to further pain, inflammation, and loss of function. If symptoms are minor and your are continuing to climb, some aggravating positions to avoid can include:
In order to speed up the recovery process, proper evaluation by a physical therapist will help to identify the condition, its cause, and provide the guidance necessary to create an effective treatment plan. Physical therapists can utilized techniques including soft tissue and joint mobilization, cupping, dry needling, and develop appropriate corrective exercise routines to normalize the mechanics of the shoulder. These techniques can help to speed the recovery process and avoid long term issues that can develop from chronic shoulder impingement.
In the event of minor shoulder pain that has recently develop and resolves quickly after completion of activity, some simple mobility and strengthening exercises may be an effective self treatment. Some good starting points are:
As most climbers know, the only thing better than climbing is more climbing. With this basic understanding of what that annoying shoulder pain may be, the proper individuals to see for assessment and treatment, and simple self care exercises that can also be used to help prevent muscle imbalances means less time in pain and more time enjoying the amazing climbing the front range has to offer.
You may have noticed some of the publicity surrounding these mysterious dark bruises on some of the Olympic athletes or even on some of your own friends around town. You might have heard about “cupping” or seen videos on the internet involving Chinese ceramic or glass cups and fire. If you’ve ever wondered about trying it or if it could help you in your injury recovery or sports performance, read on!
What's the difference between "MFD" and cupping:
While cupping has been an important part of Eastern medicine practices for thousands of years, in the PT clinic we do Myofascial Decompression (MFD). Myo = muscle, Fascia = the connective tissue surrounding and supporting the muscles. We have adapted these tools used in Eastern Medicine for its “negative pressure” (decompressive) properties for our use within Western Medicine and combined it with our deep knowledge and understanding of musculoskeletal anatomy and tissue physiology. In traditional Eastern medicine practices, the cups are placed deliberately on Chi energy meridians.
With MFD, we first perform movement assessments and determine restrictions in range of motion, muscle imbalance, and movement inefficiencies. We place the cups deliberately on targeted myofascial points, much like is done during other massage and manual therapy, and we can control the amount of vacuum with a handheld pneumatic pump (no fire!). We may also ask you to make specific movements during treatment to target these muscular and fascial issues. So in our PT clinic, we don’t do “cupping” in the traditional sense.
What's the science?
Studies have shown that the individual cups and the negative pressure generated within them can induce biomechanical stresses on soft tissue in a different direction from other manual techniques commonly used in therapy. If you think about foam rolling or massage, most of these stresses are compressive, while the cups create decompression, or “lifting/separation” of the tissue layers. These stresses can then stimulate physiologic changes in the tissue; in cases of myofascial restrictions where collagen cross bonding and scarring has occurred, it makes sense to use decompression to create space and separation of tissue for improved nutrient and fluid exchange. Recent MRI studies have shown that we can even affect fairly deep muscles with the vacuum generated within the cups, and that these changes actually last over time (not just temporary), especially when reinforced with PT exercises!
What about afterwards?
Make sure to hydrate! Recovery is much like after a deep tissue or targeted sports massage; let yourself heal. It’s important to train your muscles to move correctly in their new range, so make sure to keep up with your exercises as instructed by your PT!
Cellulitis is a common bacterial skin infection that if goes untreated, can lead to serious health issues. A bacterial skin infection is when bacteria enters the body (usually through hair follicles or tears/cuts in the skin). A common cause for these infections such as cellulitis is following surgery (due to an open wound). Having some general knowledge on what to look for when it comes to cellulitis may help prevent getting it, or allow you to get early intervention so that it does not become serious.
Risk factors for bacterial infections
Below are some risk factors that increase the possibility of getting bacterial infections such as cellulitis. If you have some of the risk factors it does not mean that you will get a skin infection but it does put you at a higher risk. So if that is the case you should make sure to take extra precautions when it comes to good wound management (see below) and performing weekly skin checks.
Signs/Symptoms of Cellulitis
emergent care may be necessary if any of the below symptoms are present:
Signs and symptoms of cellulitis can often appear like other skin infections so it is always important to reach out to your Doctor and or surgeon. Especially these days when pictures can be easily sent and assessed it is better to be safe than sorry.
Treatment of Cellulitis
The current treatment for cellulitis is IV antibiotics. So the sooner it can be assessed by a medical professional and diagnosed the quicker they can get medications on board. Other things that may help in the treatment of cellulitis include:
How to Prevent Cellulitis
While there is no vaccine or true prevention of cellulitis there are measures that you can take to significantly decrease the risk of the infection. The first and most important is to wash your hands often with soap and or alcohol based hand rub, especially before dealing with any open cuts on the body. Clean all minor cuts and injuries that break the skin with soap and water. Clean and cover all open wounds with clean, and dry bandages until they are fully healed. If you have an open wound or active infection, avoid submerging the area in any bodies of water (pool, river, hot tub, etc.)
If you recently had surgery make sure to follow good wound care practice in order to limit the risk of infection (more info on good wound care can be found here.
If you have any questions or concerns it is always best to contact your physician or surgeon immediately so they can decide the next steps to take.
David Simmons, PT, DPT
We all get bruises. Sometimes we know where they come from and sometimes we don’t even realize we’ve gotten them. So what is a bruise and what do the phases of colors they go through mean?
The most common type of bruise involves an injury to the small blood vessels below the skin’s surface. Blood pools below the skin and you are able to see the color of that blood showing through the skin. You can also get bruises to bones, muscles, etc. in the case of deeper injuries or surgeries. Most bruises will heal within 2 weeks although some may take longer depending on the size.
What is the rainbow of colors the bruise will go through?
How can you treat a bruise?
After the first 2-3 days, you can gently massage the affected area to encourage blood flow. Gentle movement of the affected body part can also encourage blood flow and healing. If the bruise is painful, taking an over-the-counter medication such as Tylenol or Advil can help relieve symptoms.
When should you seeek out medical attention associated with a bruise?
If it affects the function of the related body part
If it worsens rather than healing within the first 2 weeks
If the bruise is significant and has no identifiable cause
If there is a suspected fracture
If the size of the bruise increases notably
Elana Gordon, PT, DPT
Not to scare you but this is NOT a comfortable surgery to recover from. I frequently tell my patients who are planning this surgery to expect to be miserable for 1-3 weeks. Miserable is a very strong word yet very few of my patients say it wasn't as bad as they thought it was going to be. What surprises many of my patients is how long the knee remains uncomfortable after surgery, many of them think "I am tough" or "I am in good shape going into surgery" so it shouldn't be that bad. Unfortunately this is basically carpentry of the body and it hurts. Toughing it out for a few days isn't enough because it still hurts after week one and two. With that said, the outcomes are EXCELLENT and almost everyone is glad they had their surgery and often wish they had it sooner.
Fortunately the pain gradually subsides and the new complaint is STIFFNESS. If you leave your knee straight too long it hurts and if you leave it bent too long it hurts. Stationary bikes are really helpful at keeping the knee from getting too stiff and it is quite rewarding the first time you make a full revolution on the bike. Most of my patients will struggle to get knee extension (straightening) OR knee flexion (bending), rarely do patients have trouble getting both directions. Knee extension is the priority as it allows you to stand and walk properly. If you are fortunate enough to have your range of motion come back easily, your rehab is much more comfortable. The stiffer you are, the harder/longer it needs to be pushed on by the patient or therapist.
A total knee replacement or total knee arthroplasty is exactly what it sounds like. You are getting a "new" joint. Many patients have two "bad" knees by the time they are thinking about joint replacements. It isn't uncommon that the knee that looks worse on x-ray isn't the more painful knee. Most patients choose to have the more painful knee done first and it isn't long after surgery before your "bad" knee becomes your "good" knee. Your new knee will NOT look like your old knee, not only will you have a nice scar down the front of your knee, the knee itself will appear wider than your non-surgical knee, many of my patients think this is swelling that will subside and are disappointed when I tell them it is actually just the shape of their new knee. If you have both your knees replaced, you will then have a matching set! Swelling and bruising are common and frequently not a concern, if you have concerns about how your incision looks please contact your surgeon or PT. Your knee/leg often aren't too pretty in that first week but will improve quickly.
A Good Outcome
Orthopedic surgeons that specialize in joint replacements do a lot of them, some average 8 or more a day. That high volume allows the surgeon and their entire surgical team to be very good at them. The outcomes are generally EXCELLENT.
Total knee replacements are the most common surgery I see here at Altitude Physical Therapy and myself and our other therapists are very confident in treating patients afterwards. Some of those treated before surgery are able to delay surgery or eliminate the need entirely. Please don't hesitate to reach out to any of the Altitude clinics if you have further questions or concerns of what to expect.
Drew Sowyrda, PT, DPT
Total knee replacements -- or total knee arthroplasties (TKA) have become one of the most performed orthopedic surgeries in the world. According to the Agency for Healthcare Research and Quality, in 2017, more than 754,000 knee replacements were performed in the United States. In the PT clinic I treat as many patients after total knee replacements as any other orthopedic surgery. In orthopedic healthcare, total knee replacements are widely regarded as one of the most successful surgeries. The AAOS notes that over 90 percent of replacement knees are still functioning after 15 years.
Knee replacements are most often done when a person’s knee joint develops severe arthritis. This is when the cartilage in the knee joint -- at the bottom of the femur (“thigh bone”) and the top of the tibia (“shin bone”) -- degrades and the joint becomes painful and usually inflamed. Cartilage acts as padding in the knee joint and to decrease friction as the knee moves. When a person loses most of the cartilage in the knee this can be described as “bone on bone” arthritis and can require a TKA. Most of the time this loss of cartilage is due to wear and tear and is described as osteoarthritis. In some cases this can be caused by an inflammatory condition called rheumatoid arthritis or trauma like a motor vehicle accident.
Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Recently more and more surgeons are utilizing robotic guided surgical techniques and generally with excellent outcomes.
In a traditional TKA the surgeon uses preoperative x-rays, intraoperative anatomical landmarks, and manually positioned alignment jigs to guide bone cutting and implant positioning. These handheld techniques can lead to less reliable alignment-guide positioning, inadvertent sawblade injury to the knee muscles and ligaments, and limited ability to fine-tune the implant positioning. Suboptimal implant positioning may lead to poor functional recovery and reduced implant survivorship. (At this point I should note that I work with many surgeons who have done hundreds or thousands of these traditional TKAs with great clinical outcomes.)
Robotic TKA uses computer software to convert anatomical information into a virtual patient-specific 3D reconstruction of the knee joint. The surgeon uses this virtual model to plan optimal bone cutting and implant positioning based on the patient’s unique anatomy. An intraoperative robotic device helps to execute this preoperative patient-specific plan with a high level of accuracy. The action of the sawblade is confined to the preoperative surgical plan which limits soft-tissue injury and bone trauma.
A 2019 systematic review about robotic total knee replacement found the following:
If you are considering getting a TKA there is clearly a lot of evidence that robotic TKA are effective and in some ways superior to a traditional TKA. That being said, there are many other factors to consider when looking for a surgeon to do your TKA including:
Once you've made your decision don't forget the importance of rehab! All of our physical therapists are experts in both pre and post op knee replacement rehab. For more information about what to do once you've made this big decision, check out this informational page and reach out to one of our clinics to set up an appointment!
Eric Hanyak, PT, DPT
There's a term we use in physical therapy called "respect the healing process." I've decided to shed a little more light on what we mean by this. Ultimately, the body is supposed to go through certain processes after an injury. These phases are inflammation, proliferation, and remodeling. Each phase has its frustration with respect to our patients. Contrary to popular belief, physical therapy will not make any of these phases go FASTER.
The inflammation phase is the immediate response to an injury. It is the swelling and the PAIN! Physical therapy works to help manage this phase through soft tissue work, light joint mobilizations, TENS units, exercise for facilitation and activation of surrounding musculature, gradual return of range of motion and more. The goal of getting into physical therapy this early is so that we can be prepared to move into the next phase: proliferation.
The proliferation phase is when most of the scar tissue will form. Scar tissue is a key component to healing. Whatever tissue we injured NEEDS scar tissue to heal. It reinforces the injured tissue. During this phase, physical therapy targets progressive loading of muscle and tendon structures through exercise. These techniques coupled with hands on work will help reduce excessive scar tissue formation. These treatments help prepare us for the last phase: remodeling.
The remodeling phase is when we restructure the scar tissue to align appropriately with the component it is trying to heal as well as increase exercise demand and tolerance for the surrounding areas. For example, if the achilles tendon was injured or slightly torn, we will emphasize exercise and hands on work to promote the vertical nature of the fiber alignment in the achilles tendon. This is also achieved with select tissue loading that is usually more weightbearing and functional.
This is the phase where physical therapy transitions to a routine more targeting your goals. If you want to get back to hiking, we will start lunges and squats. If you want to get back to running, we would start light plyometric and speedwork. These exercises are built upon the exercises you've been doing in the proliferation phase. As you can see from the chart above, this is the longest phase of healing. I always like to tell my patients that once you injure a structure or tissue once, you are at a greater risk of injuring it again. Physical therapy will give you all the keys and exercises necessary to reduce this risk as much as possible!
The phases of healing are overlapping in nature but never to be rushed. Physical therapy guides each patient individually through inflammation, proliferation and remodeling to ensure the best recovery and reduce your risk of re injury. A key component during your physical therapy experience at Altitude is that we will identify how you injured yourself in the first place which I have found is the best approach to not letting it happen again! Remember, you can start physical therapy even BEFORE you get injured, too! :-)
For more detailed description of the phases of healing, please see the image above or visit: https://www.physio-pedia.com/Soft_Tissue_Healing
Lisa Corken, PT, DPT
ANSWER: It depends
Yoga is a group of physical, mental, and spiritual practices or disciplines which originated in ancient India. Yoga is one of the six orthodox schools of Hindu philosophical traditions. There is a broad variety of yoga schools, practices, and goals in Hinduism, Buddhism, and Jainism. The term "yoga" in the Western world often denotes a modern form of Hatha yoga, yoga as exercise, consisting largely of the postures called asanas.
Is Yoga safe?
In order to teach Yoga you have to study five areas:
Studies have found the incidence of pain in Yoga practitioners caused by Yoga is more than 10% per year - which is comparable to the rate of all sports injuries combined among the physically active population.
There is some evidence that regular Yoga practice is beneficial for people with high blood pressure, heart disease, aches and pains - including lower back pain - depression and stress.
The National Center for Complementary and Integrative Health (part of the NIH) suggests the above findings, however they note "Although there has been a lot of research on the health effects of yoga, many studies have included only small numbers of people and haven't been of high quality. Therefore, in most instances, we can only say that yoga has shown promise for particular health uses, not that it has been proven to help".
Created by Joseph Pilates in the 19302, Pilates was first called Contrology and inspired during WWI while held in camp for four years. Joseph was a nurse-physiotherapist and his goal was to create lifelong sustainable exercise at a low cost. Pilates recognized that the brain controls mobility and stability of the body. Specific muscles are used in a functional sequence at controlled speeds - emphasizing quality, precision and control of movement. Complex movements are broken down step-by-step to internalize the pattern.
Regular practice should lead to:
Yoga and Pilates compared
Similarities: strength, flexibility, fitness, importance of breath
Differences: Pilates emphasizes core strength while yoga emphasizes flexibility
So should I do yoga or Pilates?
Depending on classification it may make sense for you to do one or the other, or both, or possibly neither!
How do I know my low back pain classification?
See an expert at Altitude! All our physical therapists are experts in identifying movement patterns and dysfunctions as well as classifying the best way to treat your low back pain!
Caitlin Barritt, PT, DPT, OCS
One of the things I absolutely love about the physical therapy profession is our ability to teach our patients how to take care of themselves. We are so fortunate to have the education and knowledge to help our patients prevent further injury to the best of our ability.
The answer that any business-minded physical therapist will tell you is that you should ALWAYS come see us! But that’s not always feasible for everybody… I will tell you that I firmly believe you should seek guidance whenever you start a new workout or exercise routine to ensure proper form and reduce your risk of injury. As human movement experts, physical therapists are more than qualified to help smoothly transition and initiate new exercise regimens.
In my 8 years of working as a physical therapist, I’ve learned a lot about what someone’s body can tolerate in terms of exercise and physical activity. Here’s a pretty unpopular opinion: body aches and pains are normal! Of course everyone wants to be pain-free all the time, but that’s just not reality. In fact, it’s why the phrases like “it hurts so good,” and “feel the burn,” even exist! Working out and exercising pushes our body beyond its limits so it can continue to strengthen and improve.
Back to the question at hand: self care versus physical therapy. As I mentioned above, always seek advice and instruction prior to initiating any new workout or physical activity to avoid injury. That being said, my advice, which may differ from other physical therapists, is to evaluate your pain/discomfort on three aspects:
If your pain is piercingly sharp, my recommendation is to seek physical therapy right away. If the pain lasts longer than 48 hours, I recommend getting it checked out. Lastly, if the pain is super consistent - for example every single time you step downstairs it hurts in exactly the same way - having someone fully evaluate it is the best way to go.
Our body will have aches and pains here and there when we transition into a new workout routine, or go skiing for the first time in the season, or initiate a running program after sitting on the couch for months. These are expected and relatively normal. However, if you notice that the pains become sharp, last a long time, and are consistent - give us a call! To get you started with your new routine or evaluate your pain, we can utilize our telemedicine platform! This allows us to gather a full history of your pain/injury and complete a movement screen. Then we can get you started on your road to recovery as quickly as possible through exercise and advice - and ultimately avoid serious injury!
Lisa Corken, PT, DPT
If you’ve ever had pain in your jaw (or currently have pain in your jaw) you’re not alone! According to the National Institute of Dental and Craniofacial Research, the prevalence of jaw pain is about 5-12% of the population. It is more common among individuals aged 20-40 years and is about twice as common in women as men. Jaw pain can range from a mild annoyance to something which is so severe that it limits an individual’s ability to talk, eat, and brush their teeth. Many providers - physicians and dentists alike - don’t quite know the best way to address their patients’ jaw pain, and many people have no idea that physical therapy can be so helpful in treating this condition. Before I tell you how physical therapy can help, let’s get a little better understanding of the anatomy of the jaw and the various things that can go wrong.
When we talk about jaw pain, we are usually referring to the temporomandibular joint, known as the TMJ for short. You can feel this joint just in front of your ears, try it! Place your fingers at the back part of your cheekbone just in front of your ear and open and close your jaw. That’s your TMJ! A fun fact is that you can also feel the TMJ move if you put your finger just inside the tragus of your ear, which is the little cartilage flap on the front of your ear. If you place your finger just on the inside of that and open and close your jaw, you can also feel your TMJ moving. The joint you’re feeling joins your mandible (jaw bone) to the temporal bone of your skull. There is an articular disk that separates the two joint surfaces.
When you come to physical therapy for jaw pain, you might be told that you have temporomandibular dysfunction (TMD for short.) This just means that something in that joint, or the structures surrounding that joint, isn’t functioning properly. Symptoms of this can be pain, clicking, popping, grinding, clenching, or tightness. It is important to note, though, that popping or clicking on their own don’t necessarily mean that something is wrong and that you need to seek treatment. In the absence of any other symptoms (such as pain or tightness,) clicking and popping can be just fine. Sometimes, you can also get symptoms which might not seem directly related to your jaw but can be associated with jaw dysfunction. These can include neck pain or stiffness, headaches, ringing in the ears, and even dizziness. These symptoms can be caused by dysfunction of the joint, the muscles around the joint, the articular disk, or any combination thereof. Your physical therapist will help narrow down which structures to focus on based on tests and measurements performed at your first visit, as well as from taking a thorough history to better understand how your symptoms began.
Treatment for TMJ pain often includes a combination of techniques including joint mobilizations, soft tissue techniques, home exercises, and even dry needling. Your therapist will tailor your exact treatment plan to you based on their findings at your initial evaluation. With this individualized treatment plan, physical therapy can be highly effective at treating any unpleasant jaw symptoms you might have!
Heather Shaughnessy, PT, DPT
Bob Cranny, PT