Pickleball has been reported as one of the fastest-growing sports among the adult population in recent years. Whether its popularity stems from the exercise it offers, its resemblance to tennis, or the camaraderie it fosters during matches, many enthusiasts find it addictive. As expected, with the game’s increasing popularity, there has been a rise in the number of injuries associated with pickleball.

Lower extremity injuries, such as muscle strains, ligament sprains, and fractures, were among the top reported injuries leading to emergency room visits.¹ Slips, trips, and falls are identified as the primary causes of these injuries. While we don’t intend for this information to discourage you from enjoying this endearing game, we strongly recommend taking an active approach to injury prevention by following our three suggestions.

Firstly, prioritize enhancing your balance. Incorporate activities like balancing on one foot for 30 seconds into your daily routine, such as during tooth brushing, dishwashing, or commercial breaks. Once you’ve mastered this, challenge yourself by passing a small, weighted object (only 2-5 pounds) between your hands in various positions. Increase the difficulty by performing these exercises on an unstable surface like a carpet, yoga mat, or pillow. The objective is to refine your balance and minimize the risk of injury, so ensure you’re close to a wall or sturdy object for support if needed.

Secondly, engage in cross-training. This entails exercising in ways beyond just playing pickleball to prevent muscle imbalances. Incorporate fundamental exercises such as squats, lunges, and core strengthening exercises into your routine. Strengthening your legs and core can offer better support for the dynamic movements in pickleball, reducing the risk of lower extremity injuries. Additionally, include flexibility exercises, such as pre- and post-play stretching, to enhance joint mobility and decrease the likelihood of strains or sprains.

Third, focus on proper footwear. Many slips, trips, and falls in pickleball can be attributed to inadequate footwear. Ensure that you wear supportive, non-slip shoes with good traction on the court. Make sure your shoes fit well and provide stability for lateral movements, as pickleball involves quick side-to-side actions that can strain your ankles and feet.

It’s important to listen to your body and not push yourself too hard, especially if you’re new to the sport or returning after a break. Start with a proper warm-up, including light cardiovascular activity and dynamic stretching, to prepare your muscles for the demands of the game.

If you experience any discomfort or pain, don’t ignore it. Addressing minor issues early on can prevent them from becoming more serious injuries. Consider consulting with us at Rye Physical Therapy for personalized advice and exercises tailored to your specific needs!

References:

1. Casals M, Jimenez S, Caparros T, Martínez-Gallego R, Baiget E. Scoping review and quality of studies on the epidemiology of pickleball injuries. Apunts Sports Medicine. 2023;58(217):100403. doi:10.1016/j.apunsm.2023.100403

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We are very excited to announce the opening of Rye Physical Therapy! For years, many of our Hampton Physcial Therapy Rye patients have asked us to bring our services closer to make their rehab care more convenient. So, when we saw the opportunity to open at this fabuous location, we knew it would be ideal!  We finally pulled the trigger and opened our doors on November 1^st at Airfield Place, 6 Airfield Dr Rye, NH – off Rt 1 (formally the Rye Airfield Skate Park). This beautiful facility has been completely renovated to include many Health oriented businesses.

Rye Physical Therapy will be run and operated by Hampton PT’s very own Shane Johnston. Shane and Kate Serodio are co-owners in this new venture.  Shane has been treating and healing patients for over 4 years at Hampton PT and is very excited for this amazing opportunity.  Shane will continue to provide the same great services we have here at Hampton PT such as Manual therapy, Dry Needling, Graston Technique®, Spinal Manipulations, Vestibular Rehab, post operative rehab, balance and fall prevention training and much more.

The family of businesses at AIRFIELD PLACE include; FlightHouse Gym – a full-service gym (formally MaxEdge Fitness), New England Pickleball, Rinse Recovery Spa, Flow House, The Hanger, as well as Engrain Café.  Within these businesses you will have access to Pickleball; Group Fitness classes, Pilates, yoga; an open Gym, Childcare services; and The Hangar is a coworking space.  Rinse Recovery will give you access to the most recent recovery technology available!  They will have a contrast room featuring a large traditional sauna, 3 infrared, and two Morozko Forge Cold Plunges to maximize the benefits of heat therapy, cold therapy, and contrast therapy.  This space will also have other recovery tools such Red Light therapy panels, Therabody Massagers, PEMF mats, etc.

We could not imagine a better location for Rye PT!

Stop by or give us call to schedule your Free Discovery Visit!

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BY Dylan Chisholm, PT, DPT, cert. DN, cert. VRS

Many people will attain medical professionals, including physical therapists, for spinal manipulations for their acute or chronic lower back, neck or mid back pain in hopes of alleviating their ongoing pain or related dysfunction. These manipulations, or “adjustments”, often produce loud, cracking noises that allow for the body’s natural receptors to reset, giving better alignment and thus assisting in reducing overall pain in the spine. However, many are unaware that physical therapists are also capable of manipulating, or “cracking”, various other joints of the body, including the hips, wrists, elbows, knees and ankles. This is known as extremity manipulations with the goal of reducing pain and allowing you to get back to doing the activities you love. The purpose of this blog is to educate you on various diagnosis and pain patterns that extremity manipulations can assist with along with various other physical therapy interventions.

One of the most common diagnoses that physical therapists see daily is osteoarthritis (OA), often in the hip, knee and ankle. Osteoarthritis is generally a degenerative process of the joint which can be very debilitating and painful for many patients. Hip OA will often clinically show as pain that can be along the front of the hip as well as into the groin. This pain is commonly seen due to extra compression into the hip that produces a “bone on bone” effect over time. The hip manipulation is a technique used to quickly decompress the joint and allow for fluids inside of the hip to better flow in and out of the joint, which provides nutrients and healing properties that can alleviate pain and make your walking tolerance better.

Knee OA can present as having increased stiffness and achiness into your knee especially with walking long distances, stairs and getting out of the car. The cartilage and menisci of your knee that provide a “cushion” for the knee bones over time will break down, causing the dreaded “bone on bone” and thus leading to increased pain and difficulty performing daily activities. Performing a quick knee manipulation can allow for the receptors of your knee to reset, which can assist in reducing pain and improve Range of Motion (ROM) and balance at the joint.

Many patients will at some point sprain their ankle, which can cause significant instability, swelling and pain at the ankle and can be a long-term problem if ankle sprains occur frequently over time. Due to progressive ankle OA, our calf muscles will also become tighter, which reduces the ability for us to pull our foot off the ground and clear the toes when we are walking, which can cause trips and falls. A manipulation of the ankle can help to reduce pain and improve the ability for the joints to move, which can help with walking and most daily activities.

Extremity manipulations are an important aspect of physical therapy treatment that is often overlooked but can be a game changer when it comes to reducing pain and improving function. This technique along with various other interventions that physical therapists perform, including soft tissue mobility, functional strengthening, dry needling, joint mobilizations and balance training can improve your quality of life and get you back to doing the things you love.

If you experience daily pain into your hips, knees and ankles and wish to get back to walking more with less pain, give Rye Physical Therapy a call and schedule with one of our highly skilled and trained physical therapists today!

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Dry Needling. It sounds scary and a little intimidating. You may have heard of it and are wondering what it all entails and if you would benefit from it. Dry needling (DN) is a treatment option a DN certified Physical Therapist can perform for a wide range of musculoskeletal disorders. Although it sounds similar to acupuncture, DN and acupuncture have very different training and theory behind them. While acupuncture follows certain meridians for needle placement, DN places small monofilament needles at the exact location of pain. DN can target trigger points within muscles, as well as tendons and bone, if necessary, to improve pain levels and get you back to what you love to do!

DN first came to be in the 1940s after the use of “wet” needling in which corticosteroids, analgesics or saline are injected into muscles and trigger points for pain relief. Several years later, a study was performed which showed no major differences between injecting a substance into painful areas compared to “dry” needling in which no substance is injected. Since then, numerous studies were performed supporting the use of dry needling for musculoskeletal pain. DN is a much safer treatment as it omits the use of medication for pain control.

The main goal of DN is to treat the muscle tissue by decreasing trigger points and reducing pain and inflammation. What exactly is a trigger point you ask? A trigger point is a tight band of muscle fibers that can restrict range of motion and create pain/tenderness. Trigger points cause prolonged or poor contraction of the muscle fibers. They are no longer getting proper blood supply which inhibits the muscle from receiving the oxygen and nutrients it needs to return to its normal state. Additionally, nerves surrounding the trigger point become more sensitized causing the area to feel more sore and painful. Utilizing DN to treat trigger points helps to de-activate the trigger point, releasing the taught fibers. This allows for improved blood flow and can flush out the area to reduce tension. DN needling is also very beneficial for areas of chronic inflammation such as arthritic joints and tendinitis. DN will stimulate blood flow and many cells crucial to the healing progress to start the healing cascade. DN is typically not a stand-alone treatment so it is important to work with your physical therapist to address your other impairments that may be contributing to your pain.

There are several other conditions the therapists at Rye Physical Therapy commonly treat with DN and have very good success, one being tendinopathies. Tendinopathy is the failed healing of a tendon, usually resulting in degeneration of collagen proteins. This condition presents with pain and a reduction in range of motion and flexibility. Tendinopathy typically results from overuse or sudden stress on a tendon. Several tendons susceptible to overuse include the achilles tendon, medial and lateral epicondyle tendons, rotator cuff tendons and the plantar fascia. The best type of DN to address tendinopathy associated pain is known as the pistoning technique. To perform this technique, the therapist will insert the needle and move the needle in an up and down motion, repeatedly hitting the targeted tissue. This will cause a disruption in the chronic degenerative process due to increased bleeding and production of cells necessary to promote healing. Other conditions we see major success with include headaches, rotator cuff pathologies and temporomandibular joint dysfunction. It can even be utilized to treat pain associated with osteoarthritis as certain chemical reactions occur during the needling process causing pain inhibition.

So, you’ve opted to try DN and are wondering exactly what to expect. If you are a new patient, your physical therapist will perform a detailed evaluation and identify your specific impairments. For the procedure, you will be placed in a comfortable position in which the therapist can easily access the location they will be dry needling. The area will be sterilized, and the therapist may palpate to feel for trigger points before carefully inserting the needles into the proper area. At times, the needles may be uncomfortable to insert but once in you shouldn’t continue to feel any lasting pain. Although it may sound even more intimidating, electrical stimulation will typically be hooked up to the needles. Once the electrical stimulation unit is on you will feel a comfortable pulsing sensation. The electrical stimulation is used to further promote increased blood flow and pain relief, enhancing the benefits of the needles. The whole procedure will last for about 10-30 minutes and the needles will then be removed. Immediately following, you may feel some generalized soreness to the area which typically resolves within 24 hours. It’s important to note not everyone is a candidate for DN. Those with needle phobias, metal allergies, clotting or bleeding disorders, pregnancy or lymphedema should avoid DN. DN is a great treatment option so if you would like to give it a try, please don’t hesitate to reach out to us here at Rye Physical Therapy!

Citations
Dry Needling Institute. (2018). Dry Needling for Craniofacial, Cervicothoracic and Upper Extremity Conditions. Montgomery, AL: Dr James Dunning.https://www.footdoctorscolorado.com/library/dry-needling-targeting-your-trigger-points.cfm

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A breakdown of a potential injury that can occur in your elbow that can easily become debilitating if not addressed early.

By Michael Brezak, PT, DPT

Winter may be finally coming to an end with the appearance of grass and increase in wet puddles in the road and yard. At least we all hope so, but this being New England how can anyone truly tell what the weather will do in an instant. One minute it is snowing in the morning, then sunny with clearing skies and warming sun. Yet as the snow starts to melt, we all experience the change of seasons. I personally call this mud season up here, but spring would also suffice. And with spring comes the term we have all come to love and hate, spring cleaning. Whether it is yard work or cleaning out items in the house/condo/apartment what have you, that tends to mean a lot of carrying, raking, or picking up heavy items to dispose of. This can bring on a whole mess of problems, but today I am going to delve into pain along the inner aspect of your elbow and help you better understand the cause, symptoms, and management of a debilitating injury that is oftentimes ignored.

Pain is something that at one point in our lives we have all experienced in one form or another. Oftentimes it is in or joints whether it is the knee, hip, or shoulder, but the elbow is also a joint that can be injured just as well. Excessive overloading usually with carrying based activities or repetitive use at our wrist with twisting/grasping motions can have an effect at the elbow. Largely this type of action can cause lateral epicondylitis or tennis elbow, but there is also medial epicondylitis or golfer’s elbow (golfer’s pay attention now). These two conditions are the result of overloading the tendons at the elbow of the muscles in the forearm through the aforementioned methods. A simple test is to place 1-2 fingers just below the joint line and ‘pluck’ or ‘strum’ your fingers back and forth across the tendon. If pain or discomfort ensues, well then you could be experiencing some joint tendonitis. Typically, this is reported as no pain or a dull ache throughout the day until on use it becomes a sharp/stabbing often causing a release while holding or carrying items.

“Typical symptoms are pain along the origin of the common flexor tendon with repetitive wrist flexion, pronation, and valgus stress. Patients may complain of night pain and pain at rest.” Christina Brady, MD and Anil Dutta, MD

So then what does treatment look like for someone who is experiencing this condition? Medical management is fairly straightforward upon completion of a medical history including a description of events or factors that tend to flare up or calm down the symptoms. Therapists at Rye Physical Therapy use techniques and manual therapy applications that are evidence based to achieve optimal results in the shortest amount of time. The therapists upon completion of a medical history will determine the best course of action for you whether it includes the newest ultrasound guided dry needling, instrument assisted soft tissue, or neural mobilization to facilitate tendon healing and decrease the inflammatory response. Ultimately with the mindset and goal to return you to your prior level of function. Still unsure? Rye Physical Therapy offers Free Discovery Visits in which a therapist will go over your symptoms and determine with you if physical therapy can be beneficial.

References:
Dutta, C. B. and A. (n.d.). Medial epicondylitis and medial elbow pain syndrome: Current treatment strategies. ClinMed International Library. Retrieved February 25, 2022, from https://clinmedjournals.org/articles/jmdt/journal-of-musculoskeletal-disorders-and-treatmentjmdt-2-014.php?jid=jmdt

Javed, M., Mustafa, S., Boyle, S., & Scott, F. (2015, November). Elbow pain: A guide to assessment and management in Primary Care. The British journal of general practice : the journal of the Royal College of General Practitioners. Retrieved February 25, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617264/

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By NICOLE CARVILLE, DPT – Rye Physical Therapy South

Spinal stenosis is an extremely common diagnosis that I see patients with daily as a Physical Therapist. Some patients present with x-ray or MRI findings diagnosing “lumbar spinal stenosis” at a certain spinal level. Other patients schedule a direct access appointment – if their insurance does not require a referral – and I am able to evaluate if they present with signs and symptoms consistent with spinal stenosis.

So, what is spinal stenosis?

By definition, it is caused by a narrowing of space around the spinal cord and is part of the natural aging process. It is often caused by degenerative osteoarthritis of the spine and is most frequently found at L4-L5, L5-S1 and L3-L4. It can be graded as mild, moderate or severe depending on the degree of narrowing. Other risk factors for stenosis include family history and genetics. It is most commonly reported by individuals over the age of 60 years old. However, it is important to remember that an image of your spine that shows stenosis does not mean that you will have pain from stenosis. Many patients have this diagnosis and have no pain for years, and others come to physical therapy with pain and we work hard to decrease and eliminate pain as much as possible.

What can spinal stenosis feel like?

The severity of symptoms that people experience depends on the degree of narrowing and the location which can lead to pressure on the spinal cord and nerve roots. Majority of patients who have lumbar spinal stenosis will feel pain in their lower back. However, some patients will also experience symptoms of pain, fatigue, weakness or numbness in the legs. These symptoms in the leg can also progress into something called claudication pain where there is a significant cramping sensation. This occurs when the nerves that exit from the lumbar spine and go down the legs have a lack of blood flow or have mechanical compression. Claudication pain is often associated with change in posture where bending forward from the back decreases pain and extending the back, standing and/or walking increases pain.

If spinal stenosis is degenerative, what can you do for me?

For patients that have spinal stenosis and are symptomatic, our treatment focuses on reducing pain as well as restoring function. This treatment includes manual hands-on treatment, exercise and modalities as needed. The exercises we do are flexion based, otherwise known as forward bending of the back. These exercises include range of motion, stretching and strengthening of the core and hips. In addition, we provide patient education with tips on sleeping position, activity modifications and what to avoid. The biggest emphasis is on avoiding spinal flexion, otherwise known as backwards bending. At Rye Physical Therapy we are also trained in Dry Needling techniques that many patients with stenosis find to be extremely beneficial for pain management. The goal of all our treatment interventions is to reduce irritation of both the spinal cord and nerves thereby reducing your symptoms.

What other treatment options are there?

In addition to physical therapy, patients can pursue medical interventions including oral medication and/or corticosteroid injections as well as surgical intervention if needed. Oftentimes, patients are managed with a multimodal approach where we combine multiple interventions.

Have you been diagnosed with lumbar stenosis? Or are you experiencing symptoms similar to the ones described above? Please give us a call at Rye Physical Therapy for an evaluation to discuss what you are experiencing and talk about how we can help you achieve your goals!

References:

https://www.ncbi.nlm.nih.gov/books/NBK430872/

https://www.welcomebackclinic.com/blog/Lumbar-Spinal-Stenosis-and-Neurogenic-Claudication.htm

https://pubmed.ncbi.nlm.nih.gov/34978252/

 

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By Kate Dulac Serodio, DPT, OCS

Recently Powerhouse Sports reached out asking Rye Physical Therapy to partner with them in caring for their athletes.  They have a great Baseball/All athlete training program and work hard to provide the best care for their athletes.  They offer onsite Baseball pitching & hitting development programs and strength & conditioning programs for all sport athletes.  They take pride in the programs they offer and strive to make sure they’re offering the best programs and are practicing injury prevention. Injury prevention is a top priority for Powerhouse.  Mike Montville, owner of Powerhouse Sports who works directly with the Red Sox believes the only real difference in what he offers at his facility vs the Pro’s is the access to resources. Onsite manual arm care is one of those resources he believes can be game changing for the youth athletes.   Mike is pleased to now be able to offer Manual Arm Care with the onsite Partnership of Hampton PT!

What exactly is Arm Care? Unfortunately, if you don’t know, you’re actually in the majority.  If you or your child are not performing routine arm care in-season and off-season then you’re at risk of injury and decreased performance. Arm care is a simple group of exercises that typically should target the rotator cuff, scapula, and forearm muscles.  It is essential for baseball players from youth to the professionals to perform their arm care program.  According to Mike Reinold, owner of Champion PT and the go-to Physical Therapist for the Red Sox “An arm care program is one of the foundational pillars of any baseball player’s program, however, it is often one of the most neglected areas.”  Despite this knowledge many athletes neglect this part of their training.  Neglect from independent arm care will result in decreased performance and increased risk of injury.   If you want to be like the Pro’s, consider not only being compliant with your independent arm care but also making Manual arm care a part of your individual arm care program.

“An arm care program is one of the foundational pillars of any baseball player’s program, however, it is often one of the most neglected areas.” Mike Reinold, Champion PT

Why would I need Manual Arm Care? Unfortunately, even with a dedicated independent arm care program athletes will often require or simply benefit from hands on therapy.   The literature shows that the more you throw the tighter and more tired you get.   It is very important that you maintain your strength with your routine arm care program but the reduction in mobility may benefit quickly and significantly from manual arm care.   Repetitive throwing results in posterior cuff tightness which can immediately result in a 10-degree reduction of internal rotation.   Cumulatively not addressing this can not only affect performance but can result in injury.  Manual treatment would be beneficial to target the pec minor, teres major and subscapularis as these are all muscles that internally rotate the shoulder while throwing and may require stretching or soft tissue release.  Again, adding this to your routine could be game changing for performance and injury prevention.

What are the different Manual arm care treatments? Hampton PT therapists have numerous techniques/certifications to address pain, joint mobility restrictions, muscle restrictions. Treatment options are:

DRY NEEDLINGhttps://ryephysicaltherapy.com/treatments/dry-needling/

Graston Technique® https://ryephysicaltherapy.com/treatments/graston-iastm-technique/

MANUAL MANIPULATION https://ryephysicaltherapy.com/treatments/spinal-manipulation

CUPPING https://ryephysicaltherapy.com/treatments/cupping

Manual Treatments “Arm Care” https://ryephysicaltherapy.com/treatments/manual-arm-care

We look forward to not only partnering with Powerhouse Sports but also with you.  We are eager to help you achieve your performance goals with a goal of being injury free! Give Rye Physical Therapy a call to discuss your young athlete’s (or your) arm care treatment.

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At some point we start to notice things are not quite as easy as they used to be. Reactions feel slower, standing on one foot feels like an acrobatic trick, and changing positions requires a moment to regain our orientation. There are multiple reasons for these changes, and we have the opportunity to get ahead of them right now! Our body’s balance is determined by three systems, the vestibular system, the visual system, and somatosensory system. Throughout our lives our body relies on different systems to create stability. Here’s why.

From infancy to approximately 3-6 years of age, we depend highly on vision, as this system develops and matures first.1 Our eyes have the goal of staying in line with the horizon, and if our vision doesn’t show us this, we know something is “not right” and our body will physically try to correct to reorient the image.

Children learn and gain stability and strength in their environment by exploring, sometimes falling, and making mistakes. What may seem clumsy in young age between the ages of 4 and 7 is actually a developing proprioception system. 2 Proprioception is the feeling in your joints. They tell us if we are in alignment, if there is abnormal pressure, or if we are in need of stepping to regain our balance. By 7 years old this proprioceptive system is most dominantly relied upon.2 However, at this young age, if we are to challenge ourselves with uneven surfaces or a narrow base of support, vision is again depended upon.

The last component of our balance system, the vestibular system, matures between the ages of 15 and 16.3,4 Our vestibular system is made up of a series of small bones and organs in our inner ear that tells via the movement of fluid in the inner ear where we are in space with relation to gravity. The vestibular system is very important, as when we experience a conflict in information (such as when your car is not moving, but the car next to you starts pulling forward or backwards), this is the system that corrects our experience and tells us what movement is truly happening.

As we age, neurons in our brains used to communicate information about our body’s special position lose dendrites (communicating branches), myelin sheaths (nerve coating that increases signal speed) degrade, cilia in the ear become damaged, and different pathologies including diabetes, neuropathies, unilateral vestibular hypo function, etc. can exponentially negatively impact all 3 systems.

The good news is, we are not helpless in this scenario! Numerous studieshave demonstrated the benefits of staying physically active as we age to improve our central nervous system (brain and nerves) as well as our muscle spindle function. In fact, a study by Duke- NUS Medical demonstrated that a tailored physical therapy routine for balance and gait challenges reduced patients’ risk of falls by 50%.6 What we can learn from this is that YOU have control over your balance and safety, and physical therapy has been scientifically proven to help you achieve reduced fall risk and improved mobility.

If you are concerned about your balance, Rye Physical Therapy is here to help. Call for an evaluation. We can get you scheduled ASAP!

1. REFERENCES
2. 1 Lear S. Pediatric Balance Assessment. BA Audiology.org. https://www.baaudiology.org/files/2114/5796/1722/1430_Samantha_Lear.pdf. Accessed January 4, 2020.

2 Sá CDSCde, Boffino CC, Ramos RT, Tanaka C. Development of postural control and maturation of sensory systems in children of different ages a cross-sectional study. Brazilian journal of physical therapy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816079/. Published 2018. Accessed February 10, 2020.

3 Cherng RJ, Chen JJ, Su FC. Vestibular System in Performance of Standing Balance of Children and Young Adults under Altered Sensory Conditions – R. J. Cherng, J.J. Chen, F. C. Su, 2001. SAGE Journals. https://journals.sagepub.com/doi/10.2466/pms.2001.92.3c.1167. Accessed February 10, 2020

4 Ralli G. Maturation and evolution of the vestibular system. GiovanniRalli. https://giovanniralli.it/allegati/108/aging .compressed.pdf.

5 Ribeiro F, Oliveira J. Aging effects on joint proprioception: the role of physical activity in proprioception preservation. European Review of Aging and Physical Activity. 2007;4(2):71-76. doi:10.1007/s11556-007-0026-x.

6 Keeping the Elderly Safe. Science Daily. March 2017. https://www.sciencedaily.com/releases/2017/03/170316093025.htm.

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Rye Physical Therapy, with clinics in both Hampton and Seabrook, NH is proud to announce that all of their therapists have received certifications in Blood Flow Restriction “BFR” Training .

Blood flow restriction training is a method of strength training that involves restricting the blood flow to working muscles to trick the body into getting stronger by creating a metabolic stress response. It is achieved through the application of external pressure over the extremities. The goal is to enable patients to make greater strength gains while lifting lighter loads, thereby reducing the overall stress placed on the limb. Muscle hypertrophy, or muscle growth, requires either mechanical stress (lifting heavy loads) or metabolic stress (hormones and metabolites).

In the rehabilitation setting, achieving muscle loading at a threshold high enough to induce muscle hypertrophy is very difficult. BFR allows us to safely train muscles at very load loads, limit muscle and joint strain, while achieving the same results as heavy loading. We can now maximize strength gains safer and faster without the side effects of traditional load based training like delayed onset muscle soreness, joint stress, and micro tearing! We are excited to offer this service to our patients.

Patients no longer have to do max repetitions to achieve strength gain!

Blood flow restriction training is surprisingly comfortable. The pressure cuff induces muscle fatigue relatively quickly and with very little strain. A trained physical therapist, with the aid of a Doppler ultrasound, will determine individual blood pressure values and customize a protocol. The use of a Doppler and individualization of restriction pressure is vital to the safety and effectiveness of this technique. After the appropriate pressure is validated, a special restriction cuff is placed on 1-4 limbs during the duration of a prescribed exercise program. The exercise program can be aerobic, restive or a combination of the two. The exciting thing about BRF training is that the effect is systemic, therefore affecting the whole body. Using this method has total body benefit due to its action on hormones and growth factors that act on multiple systems.

“This is an ideal therapy for most orthopedic post-operative patients. BRF will allow you to build muscle sooner during the early phase of your rehab program. Most protocol’s are limiting early on in recovery in order to protect the joint or repair. BFR will now allow us to safely help you build muscle sooner!” says owner of Hampton PT, Kate Serodio

“We are very excited to be on the forefront of the latest rehabilitation and performance methods. As research uncovers safer, faster, and more effective treatments, we strive to be the first to offer these to our patients and clients. Additionally, we take great pride in the fact that our therapists are some of the best educated in the field. We strongly encourage our therapist to be over-educated!” says Pinnacle Rehabilitation Network Vice President Dan Fleury. Rye Physical Therapy is a Pinnacle Rehabilitation Network Partner.

Local Pinnacle Rehab network affiliated sites currently performing BFR: Rye Physical Therapy, Portsmouth Physical Therapy, and Somersworth Physical Therapy.

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By Michael Brezak, DPT – Rye Physical Therapy, Hampton NH Clinic –

There are many different types of joints in the human body. Some are more fixated while others tend to have higher mobility. This of course comes at a cost as the joint with higher degrees of mobility can also experience more traumatic injuries. The shoulder joint is one such highly mobile joint that often times experiences various injuries from falling, sport related activities, or from repeated motions. The shoulder is classified as a ball-and-socket joint with almost a full 360 degrees in a plane of motion. To support this joint, it is encapsulated in a fibrous band of connective tissue and deepened with a ring of connective tissue known as a labrum. The joint is then stabilized further by a system of four muscles that also are the basis for movement called a rotator cuff (Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis). When there is an excessive amount of force applied, the shoulder becomes displaced causing a dislocation either forwards or backwards that requires medical attention. This article aims to give insight on the three types of shoulder dislocations, treatment approach, and prognosis.

Anterior Shoulder Dislocation: This type of shoulder injury is whenever a blunt traumatic force is directed from behind the joint itself or from falling on an outstretched arm. This injury is usually the most common experienced resulting into upwards of 95% of shoulder dislocations. Determination is performed via X-ray diagnostics and presents with the individual holding their shoulder slightly away from their body.

Posterior Shoulder Dislocation: When a force is applied to the frontal aspect of shoulder, the ‘ball’ of the socket has a high chance to become displaced posteriorly. This type of dislocation is less common than an anterior dislocation, but can be more severe due to becoming lodged behind a bony prominence of the shoulder blade. This type of dislocation is usually the most common in the elderly.

Inferior Shoulder Dislocation: This type of dislocation is the least common of the various types. In this dislocation the joint is directed downward while the arm is rapidly forced upward. An example of this is falling from a height while the arm hits and object forcing it upward. While the least likely, this type of dislocation can be further complicated by compression of nerves and numerous blood vessels in the area.

What can physical therapy do?
Once you have received confirmation of your shoulder being dislocated, you may be placed into a shoulder sling to limit excessive movement and referred to physical therapy. Each patient receives patient focused goals based on their personal goals, but the aim is to restore functional, strength, and stability. Some initial exercises that can be performed at home without significant discomfort are found below:

Isometric pushes: Standing at a wall, place a soft pillow against the wall with your injured arm holding it in place. Your injured arm should be resting at your side with your elbow bent to 90 degrees. Push into the pillow with 50% intensity holding for 3 seconds, rest, repeat.

Scapular Squeezes: While standing or sitting, squeeze your shoulder blades together as if rowing a boat. Let your arms either hang at your side or have your elbows bent to 90 degrees simulating rowing a boat. Hold each squeeze for 3 seconds, rest, repeat.At Rye Physical Therapy we apply the latest in research-based interventions to get patients back to their previous level of function in the shortest amount of time. We create rehab goals based on the patient’s interests/desires while improving on your ability to return to those activities. We have two locations in both Hampton and Seabrook to provide you with a level of care and service needed to get you back where you want to be. If you still have questions feel free to call either location or sign up for a FREE Discovery Visit and speak with a therapist to learn how physical therapy can help you.

References:

1. 1. Shoulder Dislocation-Harvard Health. Harvard Health Publishing-https://www.health.harvard.edu/diseases-and-conditions/shoulder-dislocation-
2. 2. Edmiston, Julie PA-C , RT. Distinguishing three types of shoulder dislocations. Journal of the American Academy of PAs. May 2013. 26:5. p 60, 62-63.

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