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| Ten Tips for a Healthy Holiday!!! |
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Eat Sensibly: Eat more fruits and vegetables. These are packed with powerful antioxidants which can help offset the effects of stress and possible late night get-togethers during this time of year. If you have a party at your house, put low-calorie and fat-free salad dressings on the menu. Pack the table with flavorful vegetable dishes, and make reduced-fat versions of your family's favorite traditional dishes.
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Stay Active: No matter what, try to follow a regular exercise routine to help regulate metabolism. Don't have an hour to spare? Try 10- or 15- minute brisk walks at intervals throughout the day - they all add up. Remember, after a holiday meal, to wait 60 to 90 minutes before taking your walk.
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Drink Water: Water is essential to keep all our systems functioning smoothly but it's also essential for rehydrating the body and recovering from a hangover. You should be drinking, on average, two liters of water each day and more if you are physically active.
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Don't Party on an Empty Stomach: Eat something at home before you go to the event or party. When you're hungry, you tend to overeat and are likely to choose foods that are less healthy. Have a healthy vegetable soup or grab a piece of fruit on the way out to the party to tide you over.
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Control your Alcohol:Make water or diet sodas your beverages of choice. If you do choose to drink alcohol, be sure to have something to eat along with it. Also, choose light beer and wine over mixed drinks. A holiday-sized mixed drink can have as many as 500 calories or more.
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Control your portion sizes: One of the most important rules to remember all through the holiday season is the law of energy balance, which states: To lose body fat, you must consume fewer calories than you burn up each day.
There are two corollaries to the law of energy balance:
Too much of ANYTHING gets stored as fat - even healthy food.
Small amounts of anything - even junk food - will probably NOT get stored as fat as long as you don't indulge too frequently.
There's no reason to deprive yourself of things you enjoy. Just make sure you don't overindulge. As long as you enjoy your favorite foods in moderation, and you keep working out, it probably won't end up around your waistline.
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Try to maintain your current weight: Don't try to diet during the holidays, instead try to maintain your present weight. In this way, you have a realistic goal. You allow yourself to indulge here and there, but you don't go over the edge.
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Relax and Breathe: Take some time out of your busy holiday schedule for a little R&R (rest and relaxation). Set aside at least 15 minutes each day to just sit and relax. Deep breathing exercises can help relieve stress and tension. Incorporating some meditation on a daily basis is also a good idea -- even if it's only for a few minutes a day it will help you remain centered. If you do so, the rest of your day will be more productive.
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Get some sleep!: Quality sleep is essential for a balanced life. During sleep, the body rests, cleanses, and purifies itself. It repairs, rebuilds, grows, and heals itself. During sleep, the stresses, strains, and tensions accumulated throughout the day are ideally released, and, in our dreams, to some degree resolved.
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Create a new Holiday tradition that builds connection amongst family and friends: Annual holiday traditions can be a source of great comfort, satisfaction, and connection between friends and family. But creating a new holiday tradition can be just as satisfying. Take a fresh look at your various holiday activities. If you discover that one or more of your current holiday traditions is in need of an overhaul, or that you yearn to supplement them, consider creating a new holiday tradition. Keep in mind that the best traditions may be the simplest ones that involve spending quality time together. Our new tradition- the CPAT holiday office decorating contest!
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Greetings!
Happy Holidays! We hope you all enjoyed a festive Thanksgiving! 2008 is almost over and the holiday season is upon us! In this newsletter, please enjoy an article on some tips for staying healthy this holiday season, as well as an extremely informative article on Shoulder Instability- a must read for those with shoulder pain, or anyone who participates in sports that place a large amount of stress on the shoulder joints. Swimmers, baseball, volleyball, tennis, football players, pay close attention. Prevention is obviously key for anyone participating in those sports, and it can be accomplished through a sport-specific strength and conditioning program. For more information, please contact your local CPAT office or favorite PT!
CPAT is also excited to announce our first annual office decorating contest, in which our offices will compete by adorning their office with the best holiday decorations that exemplify this year's theme- "Healthy Holidays." Feel free to stop by your nearest office to see how they have done! The winning office will receive $100 to help a person or people in need this holiday season! |
| Shoulder Instability |
Contributed by: Mary Naylor, MPT- Clinic Director, CPAT Bowie
Introduction
Shoulder instability means that the shoulder joint is too loose and is able to slide around excessively in the socket. In some cases, the unstable shoulder actually slips out of the socket. If the shoulder slips completely out of the socket, it has become dislocated. If not treated, instability can lead to arthritis of the shoulder joint, capsular injuries, tendon damage, and fractures.
Shoulder Anatomy
The shoulder complex is made up of three bones: the scapula (shoulder blade), the humerus (upper arm bone,) and the clavicle (collarbone).
The rotator cuff connects the humerus to the scapula. The rotator cuff is actually made up of the tendons of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis.
Tendons attach muscles to bones. Muscles move bones by pulling on tendons. The muscles of the rotator cuff also keep the humerus tightly held in the socket. A part of the scapula, called the glenoid, makes up the socket of the shoulder. The glenoid is very shallow and flat. A rim of soft tissue, called the labrum, surrounds the edge of the glenoid, making the socket more like a cup. The labrum turns the flat surface of the glenoid into a deeper socket that molds to fit the head of the humerus.
Surrounding the shoulder joint is a watertight sac called the joint capsule. The joint capsule holds fluids that lubricate the joint. The walls of the joint capsule are made up of ligaments. Ligaments are soft connective tissues that attach bones to bones. The joint capsule has a considerable amount of slack, loose tissue, so that the shoulder is unrestricted as it moves through its large range of motion. If the shoulder moves too far, the ligaments become tight and stop any further motion.
Dislocations happen when a force overcomes the strength of the rotator cuff muscles and the ligaments of the shoulder. Nearly all dislocations are anterior dislocations, meaning that the humerus slips out of the front of the glenoid. Only three percent of dislocations are posterior dislocations, or out the back.
Sometimes the shoulder does not come completely out of the socket. It slips only partially out and then returns to its normal position. This is called subluxation.
Causes
Shoulder instability often follows an injury that caused the shoulder to dislocate. This initial injury is usually fairly significant, and the shoulder must be reduced. To reduce a shoulder means it must be manually put back into the socket. The shoulder may seem to return to normal, but the joint often remains unstable. The ligaments that hold the shoulder in the socket, along with the labrum (the cartilage rim around the glenoid), may have become stretched or torn. This makes them too loose to keep the shoulder in the socket when it moves in certain positions. An unstable shoulder can result in repeated episodes of dislocation, even during normal activities. Instability can also follow less severe shoulder injuries.
In some cases, shoulder instability can happen without a previous dislocation. People who do repeated shoulder motions may gradually stretch out the joint capsule. This is especially common in athletes such as baseball pitchers, volleyball players, and swimmers. If the joint capsule gets stretched out and the shoulder muscles become weak, the ball of the humerus begins to slip around too much within the shoulder. Eventually this can cause irritation and pain in the shoulder.
A genetic problem with the connective tissues of the body can lead to ligaments that are too elastic. When ligaments stretch too easily, they may not be able to hold the joints in place. All the joints of the body may be too loose. Some joints, such as the shoulder, may be easily dislocated. People with this condition are sometimes referred to as double-jointed.
Symptoms
Chronic instability causes several symptoms. Frequent subluxation is one. In subluxation, the shoulder may slip (sublux) in certain positions, and the shoulder may actually feel loose. This commonly happens when the hand is raised above the head, for example while throwing. Subluxation of the shoulder usually causes a quick feeling of pain, like something is slipping or pinching in the shoulder. Over time, you may stop using the shoulder in ways that cause subluxation.
The shoulder may become so loose that it starts to dislocate frequently. This can be a real problem, especially if you can't get it back in the socket and must go to the emergency room every time. A shoulder dislocation is usually very obvious. The injury is very painful, and the shoulder looks abnormal. Any attempted shoulder movements cause extreme pain. A dislocated shoulder can damage the nerves around the shoulder joint.
If the nerves have been stretched, a numb spot may develop on the outside of the arm, just below the top point of the shoulder. Several of the shoulder muscles may become slightly weak until the nerve recovers. But the weakness is usually temporary.
Diagnosis
Your doctor will diagnose shoulder instability primarily through your medical history and physical exam. The medical history will include many questions about past shoulder injuries, your pain, and the ways your symptoms are affecting your activities.
In the physical exam, your doctor will feel and move your shoulder, checking it for strength and mobility. Your doctor will stress the shoulder to test the ligaments. When the shoulder is stretched in certain directions, you may get the feeling that the shoulder is going to dislocate. This is a very important sign of instability. It is called an apprehension sign. (Don't worry. Unless your shoulder is extremely loose, it will not dislocate.)
Your doctor may order an X-ray. X-rays can help confirm that your shoulder was dislocated or injured in the past. X-rays are usually done after the shoulder is put back into joint. This allows your doctor to make sure the joint is back in place.
If your doctor is unsure about the diagnosis, you may need to undergo further tests. A surgeon may need to examine your shoulder using an arthroscope while you are under general anesthesia, which puts you to sleep.
Treatment
Nonsurgical Treatment
Your doctor's first goal will be to help you control your pain and inflammation. Initial treatment to control pain is usually rest and anti-inflammatory medication, such as aspirin or ibuprofen. Your doctor may suggest a cortisone injection if you have trouble getting your pain under control. Cortisone is a strong anti-inflammatory medication.
Your doctor will probably have a physical therapist direct your rehabilitation program. At first, patients are shown ways to avoid positions and activities that put the shoulder at further risk of injury or dislocation. Overhand athletes may be issued a special shoulder strap or sleeve to stop the shoulder from moving in ways that strain it.
Your therapist may use heat or ice treatments to ease pain and inflammation. Hands-on treatments and various types of exercises are used to improve the range of motion in your shoulder and nearby joints and muscles. Later, you will do strengthening exercises to improve the strength and control of the rotator cuff and shoulder blade muscles. Your therapist will help you retrain these muscles to keep the ball of the humerus in the socket. This will improve the stability of the shoulder and help your shoulder joint move smoothly.
You may need therapy treatments for six to eight weeks. Most patients are able to get back to their activities with full use of their arm within this amount of time.
Surgery
If your therapy program doesn't stabilize your shoulder after a period of time, you may need surgery. There are many different types of shoulder operations that have been developed and used in the past to stabilize the shoulder. Almost all of these operations attempt to tighten the ligaments that are loose. The loose ligaments are usually along the front or bottom part of the shoulder capsule.
Bankart Repair
To perform the Bankart type repair using the arthroscope, several small incisions are made to insert the arthroscope and special instruments needed to complete the procedure. These incisions are small. It may be necessary to make three or four incisions around the shoulder to allow the arthroscope to be moved to different locations to see different areas of the shoulder.
There are many small instruments that have been specially designed to perform surgery in the joint. Some of these instruments are used to remove torn and degenerative tissue or nibble away bits of tissue and then vacuum them up from out of the joint. These instruments can remove any bone spurs rubbing on the tendons of the shoulder and smooth the under surface of the acromion and AC joint.
Once any degenerative tissue and bone spurs are removed, the torn ligaments that stabilize the shoulder are reattached to the bone around the socket of the shoulder, the glenoid. The ligaments are reattached with suture anchors.
Capsular Shift
Another surgery to tighten a loose shoulder joint is a procedure called a capsular shift. The lining of any joint is called the joint capsule. The joint capsule forms a pocket that is made up of the ligaments and connective tissue around the joint. The shoulder joint has a fairly large joint capsule that is necessary to allow the joint to move in such a wide range.
Sometimes the problem causing the shoulder instability is because the joint capsule is simply too large. This may cause shoulder instability in multiple directions. This is sometimes referred to as multi-directional instability. In order to fix this type of instability, the joint capsule needs to be made smaller and tightened.
This procedure also can be performed using the arthroscope. The surgeon pulls the flap of tissue over the front of the capsule and connects it together. Once the appropriate degree of tightness is achieved, the surgeon uses a combination of sutures and suture anchors to hold the joint capsule in this position until healing occurs.
Rehabilitation
Nonsurgical Rehabilitation
Even nonsurgical treatment for shoulder instability usually requires a rehabilitation program. The goal of therapy will be to strengthen the rotator cuff and shoulder blade muscles to make the shoulder more stable. At first you will do exercises with a therapist. Eventually you will be put on a home program of exercise to keep the muscles strong and flexible. This should help you avoid future problems.
After Surgery
Rehabilitation after surgery is more complex. You will likely wear a sling to support and protect the shoulder for one to four weeks. A physical therapist may direct your recovery program. Depending on the surgical procedure, you will probably need to attend therapy sessions for two to four months. You should expect full recovery to take up to six months.
The first few therapy treatments will focus on controlling the pain and swelling from surgery. Ice and electrical stimulation treatments may help. Your therapist may also use massage and other types of hands-on treatments to ease muscle spasm and pain.
Therapy after Bankart surgery proceeds slowly. Range-of-motion exercises begin soon after surgery, but therapists are cautious about doing stretches on the front part of the capsule for the first six to eight weeks. The program gradually works into active stretching and strengthening.
Therapy goes even slower after surgeries where the front shoulder muscles have been cut. Exercises begin with passive movements. During passive exercises, your shoulder joint is moved, but your muscles stay relaxed. Your therapist gently moves your joint and gradually stretches your arm. You may be taught how to do passive exercises at home.
Active therapy starts three to four weeks after surgery. You use your own muscle power in active range-of-motion exercises. You may begin with light isometric strengthening exercises. These exercises work the muscles without straining the healing tissues.
At about six weeks you start doing more active strengthening. Exercises focus on improving the strength and control of the rotator cuff muscles and the muscles around the shoulder blade. Your therapist will help you retrain these muscles to keep the ball of the humerus in the socket. This helps your shoulder move smoothly during all your activities.
By about the tenth week, you will start more active strengthening. These exercises focus on improving strength and control of the rotator cuff muscles. Strong rotator cuff muscles help hold the ball of the humerus tightly in the glenoid to improve shoulder stability.
Overhand athletes (such as those who throw baseballs or footballs) start gradually in their sport activity about three months after surgery. They can usually return to competition within four to six months.
Some of the exercises you'll do are designed to get your shoulder working in ways that are similar to your work tasks and sport activities. Your therapist will help you find ways to do your tasks that don't put too much stress on your shoulder. Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems.
To get more information or speak to a therapist about your specific shoulder issue, please contact your nearest CPAT office. |
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On behalf of everyone in the CPAT family- we would like to wish you and your family a very happy and healthy holiday season!
Sincerely,
Doug Rosener
Chesapeake Physical and Aquatic Therapy |
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