Week 11 – Dallas Goedert

At a Glance –
Player: Dallas Goedert
Position: Tight End
Team: Philadelphia Eagles
Injury: Unspecified Shoulder Injury
Projected Recovery Time: 4-8 weeks

The Philadelphia Eagles have certainly been making a run this season. However, after their game versus the Washington Commanders, their aspirations for a perfect season have come to an end, and a controversial facemask call has led to an injury of one of their key players, Dallas Goedert. Goedert has been placed on the IR for an unspecified shoulder injury, but reports confirm that he should be able to return to play before the end of the regular season.

The shoulder is a very complex part of the body, composed of 4 different joints, meaning an unspecified shoulder injury could be anything. Sprains of ligaments that range from mild to severe can take a few weeks to months, and the more severe ligament sprains can require surgery to correct. Muscle strains usually heal quicker than injuries involving ligaments. Because Goedert is likely to return by the end of the season, whatever the injury may be, he likely does not require a major surgery, as recovery after ligament or muscle repairs usually takes several months rather than several weeks. Regardless of the muscle/joint involved, Goedert is without a doubt participating in physical therapy. For shoulder injuries, the major goal is maintaining mobility and promoting stability. The shoulder joint requires a lot of motion, and if it’s lacking it in one place, it will compensate in others, leading to greater risk of injury in the future. For strength and stability, focus will be on building up the muscles of the rotator cuff muscles throughout the shoulder’s range of motion to prevent re-injury upon return. Strength gains typically take about 6-8 weeks to see meaningful improvements so it may take several weeks for Goedert to be back, but it is likely that he will return in time for the Birds to make their playoff run!

In this video, the 3DPT demonstrates a few exercises that could be incorporated into a rehab program for a shoulder injury.

Early Stage: Prone swimmers

Late Stage: Single arm KB snatch

Return to Sport: Medicine ball chest pass

Source: https://dknation.draftkings.com/2022/11/14/23459526/dallas-goedert-injury-updates-week-10-eagles-vs-commanders-how-long-out-fantasy-football-depth-chart

What is Dry Needling?

By: Dr. Ryan McDevitt, PT, DPT

Trigger point dry needling is a physical therapy technique that decreases pain in your muscles. Our goal, as PTs and musculoskeletal specialists, is to restore normal muscle and joint function. The dry needling technique is used in conjunction with a comprehensive evaluation that complements other treatment techniques to decrease pain and restore function.

Dry needling physical therapy uses a solid filament needle to treat muscle trigger points. These points are a highly localized, hyper-irritable spot in a taught band of skeletal muscle fibers. Many people know them by their more common name—the infamous “knot.” These muscle trigger points play a role in producing and maintaining the pain cycle. They can alter muscle performance, as well as generate pain along common referral patterns. These points develop in muscle for various reasons, including referred or local pain, inflammation, athletic injury or other causes.

How Does Dry Needling work?

The intramuscular stimulation produces a local twitch response or rapid depolarization of muscle fibers. After this process, the muscle activity dramatically reduces, which results in relaxation and decreased pain and dysfunction. This decrease in pain is related to the removal of muscular compression on your joint, nerve, and vascular tissue. Sometimes, the insertion of the needle also reproduces “referred pain” symptoms. This is a positive sign confirming the trigger point as the source of the pain. Dry needling is highly effective for chronic muscle and repetitive sport injuries.

What type of problems can be treated with dry needling?

Dry needling can be used for a variety of musculoskeletal problems. Muscles are thought to be a primary contributing factor to the symptoms. Such conditions include, but are not limited to: 

• neck/back/shoulder pain

• tennis elbow

• carpal tunnel

• golfer’s elbow

• tension headaches and migraines

• jaw pain

• sciatica

• hamstrings strains

• calf tightness/spasms

Is the procedure painful?

Most patients do not feel the insertion of the needle. The local twitch response elicits a very brief painful response. Some patients describe this as a little electrical shock; others feel it more like a cramping sensation. Again, the therapeutic response occurs with the elicitation of local twitch responses and that is a good and desirable reaction.

What is the difference between dry needling and acupuncture?

The dry needling technique uses the same size needle that acupuncture uses, but with a different theoretical purpose. Traditional Chinese medicine practitioners use the holistic treatment of acupuncture to normalize energy, or Chi, in the body to cure syndromes. Although an acupuncture needle is used in dry needling, dry needling is based on traditional reasoning of Western medicine. The sites for the needle insertion are located in specific myofascial trigger points in skeletal muscle, which can differ from acupuncture.

http://ptpluslouisville.com/dry-needling/

How is Dry Needling Different from Trigger Point Injection?

Trigger point dry needling does not deliver any medication, hence the term “dry”. Therefore, the treatments can be done more frequently with no adverse side effects. Traditional trigger point injections use a hollow, hypodermic needle to inject substances such as saline, Botox or corticosteroids. The theory suggests that the “needling effect” is the most important part of the process rather than the chemicals injected. This does not mean that certain patients will not have greater benefits with injections rather than dry needling and vice-versa.

Why is my doctor not familiar with dry needling?

In the US, dry needling is a relatively new method for treating myofascial pain and not everyone is already aware of this effective modality. Feel free to inform your doctor about this treatment option. It is upon all of us to educate others about new and innovative ways to treat pain.

Ryan McDevitt, PT, DPT

3 Dimensional Physical Therapy

rmcdevitt@3dpt.com

Week 10 – Tremaine Edmunds

At a Glance –
Player: Tremaine Edmunds
Position: Linebacker
Team: Buffalo Bills
Injury: Adductor injury
Projected Recovery Time: 2-8 weeks

The Bills played in what many have been calling the “Game of the Year” this past weekend against the Minnesota Vikings. The Bills defense was key in the first half of the game, holding the Vikings to 10 points. However, the Bills offense made some key errors that changed the outcome of the game, and the Bills lost a key player on the defensive end, Tremaine Edmunds, to an adductor injury. It has not yet been disclosed as to what the extent of the injury was, nor has Edmunds’ return to play been discussed.

Injury to the muscles of the groin, also known as the adductors, is common in sports that require running and jumping. This type of injury often occurs due to tightness and over-stressing of the adductor muscle group, leading to a good bit of pain when walking or running. Sample’s return will be likely dependent on the grade of the strain, which can be mild (Grade I) to severe (Grade III). If the strain is less than a grade 3, which is a complete tear to the muscle or tendon, Edmunds will likely be ready to play in the upcoming game vs the Browns. However, he will be putting the time in with his physical therapist to ensure that he is ready (and safe) to return. Edmunds’s treatment plan will focus on addressing strength and flexibility impairments so he can return to sport with minimal risk of re-injury, as recurrence rates are high, and manual therapy and other modalities will be used to improve pain level so he can make a quicker return. Typical exercises to “bulletproof” the adductor muscles are slider lunges, adductor stretches, and adductor lifts. Edmunds may be able to return as early as this week to football, but he is going to continue rehabbing those adductors for the remainder of the season. The Bills’ Defense could use him in the upcoming game against the Browns.

In this video, the 3DPT demonstrates a few exercises that could be incorporated into a rehab program for an adductor injury.

Early Stage: Lateral Slider lunge

Late Stage: Copenhagen Plank

Return to Sport: Carioca shuffle with hip drive

Source: https://sports.yahoo.com/bills-lb-tremaine-edmunds-injury-230044269.html?src=rss

Week 9 – Josh Allen

At a Glance –
Player: Josh Allen
Position: Quarterback
Team: Buffalo Bills
Injury: UCL sprain
Projected Recovery Time: 6-12 weeks (if non-op), 6-12 months (if operative) 

Josh Allen has been a very popular and consistent Fantasy QB this year. Unfortunately, Allen’s ability to play has been called into question after suffering an elbow injury during this past week’s loss against the New York Jets. During the final drive of the game, Allen got hit as he attempted to make a pass, and he had significant pain in his elbow when attempting to throw after. Reports suggest a potential UCL injury but have not confirmed the extent of such injury.

The UCL (ulnar collateral ligament) is a major stabilizer of the elbow. It limits the elbow when it is under valgus stresses, and it stabilizes during the throwing motion. UCL injuries are very common in throwers, and injury to the UCL, in which the UCL is completely torn, typically requires surgery as that stability is essential for throwing. With a UCL repair, recovery from surgery typically takes 6-12 months, depending on a person’s progress. If the UCL is not completely torn, conservative management is possible. Regardless of severity, Allen will be participating in PT. Focus of sessions will be in building up both forearm and shoulder strength

to better protect the UCL and stabilize the elbow, and efforts will eventually focus on that throwing motion and ensuring the UCL can withstand the stresses that throwing puts on it. Elbow range of motion will also be addressed, as full straightening and bending of the elbow can be lost, leading to difficulty with not only throwing but everyday tasks. Towards the end of rehab, there will be an emphasis on perturbation training to continue to promote stability and improve Allen’s ability to react to unexpected movements during play. If Allen is able to avoid surgery with a mild to moderate sprain, he may play on a week to week basis. However, recovery after surgery takes 6 months minimum, meaning someone else will have to lead the

Bills to playoffs. Bills’ fans have had enough heartache – hopefully Josh will be cleared to play after further imaging is performed this week.

In this video, the 3DPT demonstrates a few exercises that could be incorporated into a rehab program for UCL sprain.

Early Stage: Eccentric Biceps and Hammer curls with Kettlebell

Late Stage: Repeated weighted ball throws @90* of abduction 

Return to Sport: Eccentric Weighted Ball Throws

Source: https://billswire.usatoday.com/2022/11/06/buffalo-bills-josh-allen-slight-pain-arm-injury-jets/

Week 8 – Nick Williams

At a Glance –
Player: Nick Williams
Position: Defensive Lineman
Team: New York Giants
Injury: Bicep strain
Projected Recovery Time: 1-8 weeks  

The Giants have been consistently surprising the NFC, with a winning record as we approach the halfway mark of the season. This team has seen a string of injuries this season, and this week, they have seen the loss of a defensive player this week, Nick Williams.

Williams is dealing with a bicep strain, which can pose an issue with any activity requiring elbow bending and wrist turning, which, as you can imagine, is very prominent on the defensive side of the ball. Muscle strains require varying times of recovery, depending on the extent of the damage. It is likely that Williams sustained a grade I or II strain, in which there is mild to moderate tissue damage, since he is out on a week by week basis. If it were a grade III strain, Williams would likely be out for the season since that type of strain is a complete tear of the tissue fibers. Regardless of the degree of strain, Williams is likely already working with his rehab team. The biceps brachii (or more commonly referred to as just the biceps) works at the elbow and the shoulder, so rehab will engage most of the upper extremity. William’s rehab team will take care to ensure his biceps is ready to return to play to avoid re-aggravation or worsening of injury, such as sustaining a complete biceps tear, which requires surgical correction and a much longer time in rehab. Low grade strains can take anywhere from 1 to 8 weeks to resolve, so it is unclear when Williams will be back, but hopefully in the next few weeks, he will return to help the Giants to continue to make their run.

In this video, the 3DPT demonstrates a few exercises that could be incorporated into a rehab program for bicep strain.

Early Stage: weighted pronation/supination

Late Stage: single arm eccentric TRX curl

Return to Sport: BOSU push-ups with lacrosse ball balance

Source: https://www.bigblueview.com/2022/10/30/23431692/2022-week-8-ny-giants-injury-news-nick-williams-out-biceps-news

Week 7 – JC Jackson

At a Glance –
Player: JC Jackson
Position: Cornerback
Team: Los Angeles Chargers
Injury: Patellar (kneecap) dislocation
Projected Recovery Time: 6-8 months

The Chargers have had a bit of a lackluster season compared to last year’s. Injury has not helped this situation, and the Chargers saw the loss of a valuable defensive player this week. During the second quarter of the Chargers vs Seahawks, a key divisional game, cornerback JC Jackson suffered a non-contact knee injury and did not return to play. Reports confirm he is dealing with a dislocated kneecap, and this injury is season-ending. Jackson will likely be undergoing surgery to repair the damaged tissue, likely the MPFL, in the upcoming weeks.

The medial patellofemoral ligament (MPFL) connects the kneecap to the femur, and it is a primary stabilizer of the kneecap. With patellar dislocations, the MPFL can be damaged, even torn completely, which often requires surgery to correct if a person does higher level activities such as running and jumping. A person can expect to spend several months in rehab before he or she can return to normal activities. Whether the person is a high-level athlete or someone who just wants to walk normally again, there is a protocol that limits bending and weight-bearing post-op to allow the ligament to heal. Knee bending will be gradually introduced in the first 6 weeks post-op, and traditional strengthening will become the focus of treatment

sessions at ~7 weeks post-op. The quad muscle itself will be much weaker from the initial trauma to the knee, as well as the surgery, and early efforts will focus on building the quad strength up to assist with functional activities, such as walking, as well as to avoid asymmetry between sides which can contribute to re-injury down the line. Jackson will have plenty of time to work on agility and higher level tasks, as his position requires quick changes of direction, which put the stability of the kneecap at risk, but he should be ready for next season. The Chargers have a tough road ahead – hopefully, they will be able to make some roster moves to fill Jackson’s position.

In this video, the 3DPT demonstrates a few exercises that could be incorporated into a rehab program for patellar (kneecap) dislocation.

Early Stage: long arc quad with ankle weight and band

Late Stage: box step up with terminal knee extension

Return to Sport: single leg hops with foot elevated

Source: https://profootballtalk.nbcsports.com/2022/10/23/chargers-j-c-jackson-suffers-dislocated-kneecap-brandon-staley-calls-injury-significant/

Week 6 – Kendrick Bourne

At a Glance –
Player: Kendrick Bourne
Position: Wide receiver
Team: New England Patriots
Injury: Turf Toe
Projected Recovery Time: 1-4 weeks

The Pats have had a bit of a slow start this year, struggling in their division and suffering losses in some close games. Their offense was able to get something going yesterday with their win over the Browns, but one of their more notable playmakers, Kendrick Bourne, left the game after a few snaps. Reports confirmed Bourne sustained “turf toe”, an injury to the ligaments of the toe joint caused by hyperextension of the big toe during push off. This injury got its name because of its increase in frequency as artificial turf became more popular and preferable to typical grass fields, and it is very common in the NFL. Turf toe can develop gradually or result from a sudden injury, and symptoms include limited toe range of motion, joint swelling, and pain. The ligaments are essential for weight transfer on your foot, allowing you to propel yourself forward during walking, running, and jumping. The severity of the ligament sprains dictates a person’s activity levels, and a complete rupture often requires surgical correction.

Details have not been released on the severity of Bourne’s injury, though it does not seem to be severe. It is likely he sustained a Grade I or II injury, meaning mild to moderate ligament damage, and does not require surgery. Bourne’s PT team will be working closely with him to monitor his symptoms and help him return to play without reaggravating his symptoms. Bourne will likely have high pain levels immediately after injury, and he will follow POLICE guidelines (Protect, Optimal Loading, Ice, Compression, and Elevation) to help decrease those pain levels. Symptoms can easily be re-aggravated so great care will be taken to offload Bourne’s foot with proper footwear; more flexible shoes put more stress on the ligaments vs

rigid shoes that do not allow for as much movement at the toe joint. Higher level exercises will be held to allow for the injury to heal and to protect the joint, and ice, compression, and elevation will help with inflammation and pain control. After symptoms improve, Bourne will work with his PT team to improve toe joint range of motion. If the joint itself is stiff, it has to sustain greater stress as there is less range for a force to disperse through, and correcting that limitation will help prevent re-injury. Lower leg and foot muscle strengthening will also help offload the toe joint. It is unclear whether Bourne will be able to play this upcoming week – the Pats are playing under Monday’s lights, so he has one extra day to get ready.

In this video, the 3DPT demonstrates a few exercises that could be incorporated into a rehab program for turf toe.

Early Stage: Resisted Plantar flexion with Big Toe Flexion 

Late Stage: Eccentric squat on toes

Return to Sport: Resisted Running

Source: https://985thesportshub.com/listicle/kendrick-bourne-injury-situation-comes-into-focus-with-new-report/

Week 5 – Darren Waller

At a Glance –
Player: Darren Waller
Position: Tight End
Team: Las Vegas Raiders
Injury: Hamstring Strain
Projected Recovery Time: 1-6 weeks

The Raiders put up an impressive first half against the Kansas City Chiefs during Monday night’s game. However, they ran into a bit of a tight end issue, as their starting tight end, Darren Waller, left the game after the first play. Waller remained questionable for most of the game with a hamstring injury. Unfortunately for the Raiders, Waller did not return for the game, and unfortunately for Waller, hamstring strains tend to be very nagging injuries, and he may be dealing with this injury for several weeks, depending on the grade of strain. Low-grade strains are classified as mild, with minor damage to individual muscle fibers but preservation of the muscle as a whole. Strength and flexibility may be impacted but minimally, whereas with higher grade strains, you can expect to have significant loss of function. 

Regardless of the severity, hamstring strains have high recurrence rates, meaning that re-injury is likely. Wallers’s ability to return, especially without having a re-aggravation of that injury, will be largely dependent on his work with his physical therapy team. His treatment plan will focus on addressing strength and flexibility impairments so he can return to sport with minimal risk of re-injury, and manual therapy and other modalities will be used to improve pain level so he can make a quicker return. Emphasis of his program will be on improving eccentric hamstring strength, which is essential for his position as a tight end. Waller is running during the majority of his time on the field, and running requires a LOT of eccentric hamstring strength as your hamstring is used to control your leg as you swing it forward. The recovering hamstring muscle will be put to the test constantly during Waller’s routes so it is crucial for him to work with his rehab team to avoid being sidelined by this injury again. Typical exercises to “bulletproof” the hamstrings include hamstring bridges, hamstring curls, and nordic leg curls. Waller may be able to return as early as this week to football, but he is going to continue rehabbing that hamstring for much (if not the remainder) of the season. Hopefully he’s back sooner rather than later –the Raiders could certainly use him!

In this video, the 3DPT demonstrates a few exercises that could be incorporated into a rehab program for a hamstring strain.

Early Stage: Single leg bridge with foot elevated 

Late Stage: Eccentric nordic hamstring curl

Return to Sport: Barbell RDL into a hang clean

Source: https://justblogbaby.com/2021/05/30/raiders-darren-waller-best-te-nfl-2021/

My MRI showed…

Patients are often discouraged by the findings of an MRI, and we often hear patients say something along the lines of  “The MRI showed I have a herniated disc and the only way to fix it is surgery, but my doctor wanted me to try Physical Therapy first” or “my insurance company will not cover the surgery unless I do Physical Therapy first”.  As Physical Therapists we actually love to hear this because that means we have the opportunity to change the way this person thinks about their condition and about Physical Therapy. There is nothing more satisfying than seeing that same person walk out the door pain free and fully functional without the need to have surgery. 

Diagnostic imaging such as MRI’s, CT-Scans, and X-rays can be extremely useful in identifying anatomical abnormalities. They can show us broken bones, torn ligaments and tendons, herniated discs, degenerative joint disease, arthritis, spinal stenosis, spondylolysis, spondylolisthesis, and a host of other conditions. But, do these imaging studies tell us the cause of your pain or what treatment you will respond best to? The answer may surprise you……

In order to answer that question, let’s look at the MRIs, X-Rays and CT-Scans of people who do NOT have low back pain and see what we find. Fortunately, there are several academic journal articles that have answered this question for us. (1,2,3)

These researchers took MRIs, CT-Scans and X-rays of people who are not in pain and found that “degenerative joint disease, disk bulging, disk protrusion, disk herniation, foraminal stenosis are common MRI findings in people WITHOUT back problems”. Additionally, as we age the percentage of people with these conditions increases.

This might not sound like good news, but it is!  This means that a lot of people have herniated discs, bulging discs, degenerative disc disease and a host of other conditions without having pain or dysfunction. The body has an amazing ability to compensate for deficits.  

So, do imaging studies tell us the cause of pain? Well, an imaging study, on its own, will not necessarily tell us the cause of pain. Will an MRI tell us if we need surgery? Well, again, not always. Sometimes people will present with a pattern of pain or disability and display signs and symptoms that are consistent with anatomical findings on MRIs, CT-Scans or X-rays, and sometimes they don’t. This is where a thorough physical exam comes into play.

In Physical Therapy, we cannot “un-herniate” or “un-bulge” a disc, we cannot reverse osteoarthritis or foraminal stenosis. But what Physical Therapists are expert at is improving function and reducing pain. We have a specialized skill set that allows us to help you improve your mobility, strength, endurance, and function while reducing disability and pain through a patient centered approach, and we are very good at it.

Diagnostic imaging can be extremely valuable, but don’t let the results alone discourage you, or make you feel like there is nothing you can do. Be an active participant in your recovery. With very few exceptions, you can improve your strength, mobility, endurance, and functional tolerance while reducing disability and pain.

Sources:

• Boden S. et. al, Journal of Bone Joint Surgery Am. 1990 March;72(3):403-408
• Boden S. et. al, Journal of Bone Joint Surgery Am. 1990 September;72(8):1178-1184
• Jensen M. et. al, New England Journal of Medicine. 1994 July 14;331)2):69-73

Week 4 – Sterling Shepard

At a Glance –
Player: Sterling Shepard
Position: Wide Receiver
Team: New York Giants
Injury: ACL tear
Projected Recovery Time: 6-12+ months (out for the season)

The Giants have been somewhat surprising this season, and though it’s only week 4, a winning record is a winning record. The Giants did suffer a big loss during last week’s game against Dallas, and I don’t just mean losing against the Cowboys. During the last minutes of the game, the Giants wideout, Sterling Shepard, was running down the field and then was suddenly on the ground – without any clear mechanism of injury. Reports later confirmed that Shepard suffered a non-contact ACL tear, meaning he is facing another season-ending injury. He will be getting surgery in the upcoming weeks. ACL tears are very common among football players, resulting from rotational stresses, sudden changes of direction, and/or poor landing mechanics, and the recovery requires surgery and months of physical therapy. The ACL, or anterior cruciate ligament, is a key stabilizing structure in the knee that limits the forward movement of the tibia on the femur, and without the ACL, it is much more difficult for the surrounding structures to maintain knee stability, especially in weight bearing. NFL players are elite athletes that have to be able to withstand crazy physical stresses on the body, meaning knee stability is essential to perform well and avoid further injury, and for this reason, most NFL players opt to get ACL reconstruction surgery. This surgery, however, takes months to recover from (and a lot of rehab), meaning the Giants will have to make do without Shepard.

During the ACL reconstruction surgery, tissue is taken from the tendon of the quadriceps, hamstrings, or patella and anchored to the tibia and femur, providing similar stability as the original ACL. However, it takes up to two years for the new “ligament”, or graft, to fully resemble a normal ACL. Physical therapy starts just days after surgery. The first few weeks of rehab will focus on improving pain levels, decreasing swelling, and recovering range of motion and quad muscle strength, and around the 3-month mark, a person can finally be cleared to run. Strengthening of the quad, glutes, and hamstrings will be prioritized during sessions to improve lower body control and eliminate any muscle imbalances that may have contributed to the initial injury. The later phases of rehab will focus on proper technique with cutting, pivoting, and single-leg activities, with an emphasis on proper landing mechanics and dynamic balance. Protection of the graft is the biggest priority throughout rehab, as well as decreasing the risk of re-injury, which unfortunately can be common after the initial injury. Though NFL players are outstanding athletes, recovery after ACL reconstruction will take at least 6 months because the healing and remodeling of the graft will follow that 2-year timeline despite any strengthening or balance training efforts. Therefore, if Shepard has no complications post-op, he will likely be ready to participate on a limited basis in OTAs and camp in anticipation of the 2023 season. Oftentimes, ACL tears are accompanied by damage to other structures in the knee that may not be reported, and if this is the case, recovery will be prolonged. Whether he is back in 6 or even 12 months, it is clear that the 2022 season is finished for him, and he will spend a good amount of time with his PT to get back on the field. In the meantime, the Giants can continue their efforts in maintaining this winning record, which might be a little tough with the Eagles being in their division.

In this video, the 3DPT demonstrates a few exercises that could be incorporated into a rehab program for an ACL tear.

Early Stage: Standing terminal knee extension with alternating leg extension 

Late Stage: Single leg assisted pistol squat

Return to Sport: T-test Drill

Source: https://profootballtalk.nbcsports.com/2022/09/27/sterling-shepard-tore-his-acl/

Week 3 – Tua Tagovailoa

At a Glance –
Player: Tua Tagovailoa
Position: Quarterback
Team: Miami Dolphins
Injury: Possible Concussion, head injury
Projected Recovery Time: 2-4 weeks

The Dolphins had an impressive win over the Buffalo Bill on Sunday, but not without controversy. At the end of the first half, the Dolphin’s quarterback, Tua, left the game after suffering an apparent head injury. To the surprise of many, especially after a pretty scary sway from Tua after getting up, Tua returned to finish the game. Because of the severity of the hit, many speculated that Tua had a concussion that was potentially mishandled, and there is now an official investigation into the apparent head injury to determine if Tua was wrongly cleared to return to the game. It is unclear whether Tua will be ready to play on Thursday, when the Dolphins face the Bengals.

Concussions are a difficult injury to treat as people present differently, depending on the severity of the concussion, but Tua will likely be working with a PT regardless of the severity of his injury. The biggest goal of Tua’s physical therapy program will be to re-introduce activities gradually. The concern of Tua being cleared despite having a concussion is completely justified -If someone returns to higher level activities too quickly, a brain bleed can develop from excessive swelling, or a person may develop post-concussive syndrome, in which symptoms last for several months. It is imperative that Tua be sidelined and treated by his healthcare team if he has symptoms. Typical symptoms include headaches, dizziness, and “feeling foggy”, and early interventions in Tua’s PT program will help him improve his tolerance to moving his head,standing, and performing daily activities. Tua will also work on strengthening key muscle groups in the neck, as well as addressing vestibular impairments, which are very common with concussions. Vestibular (or inner ear) problems interfere with balance and coordination, and PTs have a variety of exercises to help Tua improve his stability. As he progresses, the exercises will become more difficult to ensure he can tolerate the demands of professional football. There is even a formal treadmill program that measures heart rate and symptoms that Tua will likely participate in to make sure he can return to football safely. His PTs will know the signs of a poor response to exercise to make sure he isn’t doing too much, and hopefully in the next 2-4 weeks, he will be able to make a full recovery and return to football when appropriate.

Take a look at this video to see the 3DPT team demonstrating some of the exercises that Tua may see in early, mid and late-stages of his rehab

Early Phase: 3 gaze stabilization exercises while standing on foam:

• Pencil pushups
• Saccades
• VOR

Mid-Phase: Tennis ball reaction drill on terracore

Late Phase / Return to sport: box agility with blaze pods

Source: https://www.cnn.com/2022/09/26/sport/tua-tagovailoa-miami-dolphins-buffalo-bills-spt-intl/index.html

Week 2 – Trey Lance

At a Glance –
Player: Trey Lance
Position: Quarterback
Team: San Francisco 49ers
Injury:  Fibular fracture, ligament disruption
Projected Recovery Time: 6-9 months (out for the season)

Since this past offseason, Trey Lance has been the guy for the 49ers QB position, despite the 49ers still having Jimmy G on the roster. Many speculated that Jimmy G would have gone to a different team since he lost the starting position, but after Sunday’s game against the Seahawks, Garoppolo won’t be going anywhere. Lance left the game after suffering a severe ankle injury, and reports confirm he won’t be back this season. Lance has already undergone surgery to address a fractured fibula and ligament disruption in his ankle, and he has released a statement that he intends to be back in time for the 2023 season. In the meantime, he has a lot of rehab to do.

Immediately after surgery, Lance will go through a phase of limited-to-no-weight bearing to allow the damaged tissues to heal. Ligament healing typically means the period of immobilization can last even longer. During this time, Lance will be working regularly with his PT to work on strength and mobility of the unaffected joints of the affected leg, as well as to help manage pain and swelling post-op. After about 4-6 weeks, Lance will finally start some weight bearing activity. During these early healing phases, Lance will likely be utilizing blood flow restriction training (BFRT), as this training technique allows him to gain more strength without breaking weightbearing or strength training restrictions. BFRT works by partially occluding blood flow to an extremity, which triggers specific pathways that cause the body to build muscle faster. Essentially, you feel like you did a high intensity workout without having to use much weight at all! It won’t be until 12 weeks or more that Lance will be able to start football-related drills, and this will only happen once he has minimal pain and regained full strength and flexibility. Balance and stability will also be emphasized in his rehab journey, as ligament involvement can often lead to an unsteady ankle, and targeting balance and stability can help Lance avoid re-injury down the line. As unfortunate as this injury is, Lance has plenty of time to get back on his feet and prepare for the 2023 season. In the meantime, the 49ers are lucky that they still have a quality backup in Jimmy G. 

Take a look at this video to see the 3DPT team demonstrating some of the exercises that Lance may see in early, mid and late-stages of his rehab

Early Phase: Banded dorsiflexion mobilization

Mid-Phase: Single leg calf raise

Late Phase / Return to sport: Single leg landing with lateral hop

Source: https://www.espn.com/nfl/story/_/id/34625493/san-francisco-49ers-qb-trey-lance-surgery-repair-two-injuries-ankle

Week 1 – TJ Watt

At a Glance –
Player: TJ Watt
Position: Defensive End
Team: Pittsburgh Steelers
Injury:  Pec Muscle Strain (full extent unknown)
Projected Recovery Time: 6 weeks – 4+ months

The Pittsburgh Steelers had an electrifying divisional win against the Bengals during Week 1 of the NFL season. This unexpected victory had much to do with the Steelers’ defense, who kept Joe Burrow in check with 4 picks during the game, but during the 4^th quarter, this unit lost a key player: TJ Watt. Watt, who had both a sack and interception, exited the game with a pec injury. Following tests confirmed a torn pec, but the severity of the tear is yet to be known, as Watt is seeking second and third opinions from specialists. The fact that Watt has not been ruled out for the season yet is promising – there may be a chance that this injury may not be so severe that it requires surgical correction. If the injury can be managed conservatively, Watt will still miss time on the field, but he may make it back with plenty of the season left.

Regardless of whether or not Watt requires surgery, he will certainly be working with his physical therapy team. The pectoralis major muscle, a huge muscle on either side of the chest that provides dynamic shoulder stability, and strength and flexibility of this muscle is absolutely essential to perform the demands of professional football. In conservative treatment, early efforts will be dedicated to reducing pain and irritability of the involved muscle. Ice and gentle passive motion will be utilized often. Isometric exercises, in which the muscle activates but the joint itself does not move, will be utilized to slowly restore strength and prevent further atrophy. As time goes on, concentric movement (strengthening with joint movement) will be added into his strength program, and when Watt has that essential stability, he will progress to football-related exercise to ensure that he will not re-injure that muscle when he goes to tackle the quarterback or braces himself when hitting the ground.  

Take a look at this video to see the 3DPT team demonstrate a few of the moves that could be incorporated into Watt’s rehab program for a pec muscle strain.

If TJ undergoes surgery, his recovery and rehab process will be delayed by time spent with immobilization, to allow the repaired tendon to heal, and progress is generally slower to protect that healing tendon. Undergoing surgery also means a missed season. The verdict has yet to be delivered regarding whether TJ Watt will return this season, but if you took the Steelers D for your fantasy team, there’s still hope.

Source: https://www.sportingnews.com/us/nfl/news/tj-watt-injury-update-steelers-pec-injury-bengals/s8qktqi5glkbwcgog6qwekho

Get to know 3DPT Tabernacle’s Dr. Katy Loughran!

My journey with 3DPT started in December of 2019. I was already working as a physical therapist at the time and I first heard about 3DPT from other PTs in the area. Early on after joining the team, I noticed that 3DPT was a PT company like no other I had worked for before. The employees were so welcoming and the patients were a joy to work with. I knew within a week that 3DPT was a perfect fit for me!

When I first started in 2019, I worked in the 3DPT Medford office, but within a few months I transitioned to the new 3DPT Tabernacle office when the clinic opened in early 2020. Little did anyone know that 2020 would be a year like no other! After being closed for a short time that year due to COVID restrictions, we were able to open our doors again and also started doing telehealth visits, which  allowed me to work with patients in a whole new way!

I also took some time in 2020 to earn a few new certifications that would help me as a PT.  First, I obtained a Clinical Strength and Conditioning Specialist (CSCS) certification, which allows me to apply scientific knowledge to train athletes and adults to improve their athletic performance, and I also got certified as a nutrition coach.

I have loved my time at 3DPT so far and have had the opportunity to work with amazing patients, athletes and colleagues. Recently, Carlie (Strazzullo) asked if I would take over as the clinic director of the Tabernacle office while she is out on maternity leave. Of course the answer was yes!  I am excited to take on the role as clinical director of the Tabernacle office and very fortunate to work with the best employees and patients!

Outside of work, I have also been pretty busy, as I am currently planning my wedding! I am getting married this October to my partner of 9 years, DJ. My fiancé is also a Physical Therapist – we met in PT school at Thomas Jefferson!

For fun, I enjoy going to baseball games, watching sports, and going to the beach. I am a big Philadelphia sports fan and you can catch me wearing my sports shirt in the office on Fridays.

I grew up in a small town located in Delaware County, PA so I am still learning all of the Jersey towns. I went to Strath Haven High School before transitioning to the University of Delaware for college. At Delaware, I studied Health Sciences and ran cross country for 2 years. I had to stop running due to injuries but my injuries led me to the field of PT! Although I missed running, I was happy that my injuries introduced me to my passion of being a PT.

I feel incredibly blessed to be doing a job that I love and helping 3DPT patients move and feel better everyday!

One of 3DPT’s first employees now the newest 3DPT clinic owner!

My journey with 3DPT actually started before 3D even existed! I was a high school student trying to figure out what career path I was going to choose. My mom was going to physical therapy at the time and thought I would really like her PT (who was Ken Guzzardo!), and that I should reach out to shadow him. I did end up shadowing Ken over the summer until he left that company to start up his own that would be called 3 Dimensional Physical Therapy.

Fast forward to 2012, I was a sophomore at Northeastern University in the 6-year Doctorate of Physical Therapy Program.  I was ready to start my first co-op experience and I found my way back to 3DPT. At the time Ken and Jeff had just opened in Medford and I would be their 2nd employee to work the front desk and aide. Then in 2014 I did another co-op rotation with 3DPT because I truly felt like I learned the most from being there.

Following graduation I lived in Arizona, New York City, and Michigan treating in various outpatient and inpatient facilities before settling back in NJ with my husband. Over the countless jobs I had worked, nothing was quite like 3DPT and I was lucky enough to come on board at 3D full time starting in 2018. Now I’m about to start a new PT adventure – becoming an owner of 3DPT Hainesport – and in just a few weeks!

Those early co-op experiences at 3DPT really shaped who I am today as a physical therapist. I learned a solid foundation of the way people and employees should experience physical therapy! Those core values (posted on our walls at every 3D clinic!) have become important to me as a clinician and now as a business owner. From being an aide at 19 years old, to getting married at the same time as a few of my coworkers in 2019, and then having a baby in 2021, some of my life’s biggest moments have happened at 3DPT, alongside the people who are now like family.

I’m so excited to continue 3DPT’s commitment to excellent physical therapy and patient care in Hainesport and its local communities!

If I’m not at 3D, you can find me spending time with my husband Gary, our 1 year old son Baker, and 2 dogs Birdie and Rory. We love to travel and all things Disney! Becoming a mom has really given me an appreciation for the human body and its incredible abilities. This new adventure has challenged me in the best ways and has certainly kept me on my toes this past year and I’m looking forward to all the new challenges of toddler life!

Onward and Upward! These 3DPT employees are heading to grad school!

Over the years, we have had numerous 3DPT employees who worked as aides or at the front desk get accepted into graduate school for physical therapy and other healthcare graduate programs.  It is rewarding to be able to act as a stepping stone for all of these employees as they work their way towards their end goal of becoming licensed healthcare providers.  We have 6 current employees that have been accepted into graduate school and will be leaving us over the next few months. We want to take this chance to recognize them and wish them all the best!

Alina Olesky, front desk at 3DPT Haddon Heights

I will be attending Arcadia University for Physical Therapy this upcoming August. After having graduated from Rowan University and taking a year off from school, I am eager to start this next chapter of my life! I’ve always known that I wanted to be a physical therapist since high school, and after working at 3DPT for the past 3 years, it’s made me more excited for this next step. The time I’ve spent working at 3DPT has been such an unforgettable experience for me. Being surrounded by coworkers and patients that care about you, support your goals, and push you to grow is a great feeling. Whenever I needed advice on interview questions, application processes with PTCAS, or personal experiences with PT school, I always knew that I could ask any of the PT’s for help. I have to thank 3DPT for all they’ve done for me these past few years. Once these next two years at Arcadia University fly by, I am looking forward to starting my career as a physical therapist. I aspire to continue growing as a PT in both personal education and leadership positions. I am grateful to have had the opportunity to work with 3DPT, and I can’t thank everyone enough!

Seth Csaszar, aide 3DPT Medford

I was first acquainted with 3 Dimensional Physical Therapy as a patient in 2020.  I had recently left active-duty military to go back to school and start my journey of becoming a Physical Therapist. At 3DPT I was instantly set up for success with a great PT, Jeff Sallade. I can remember in my first session with Jeff asking if I could come in and shadow him for PT school observation hours. Jeff said, “Of course! but first let’s get you taken care of.”  It was that instant feeling of acceptance and security that I loved most about 3D, and from that point on, they welcomed me into their family. Fast forward a couple years, I went on to complete an Exercise Science internship that led into a job with 3DPT.  Throughout my time at 3D, I was fortunate to be able to work alongside exceptional therapists and colleagues that continuously showed me how their passion and continuation of expertise sets the standard for care and workplace atmosphere. I also have to mention the patients at 3D who always inspire me! I am thankful to get to know the coolest, most extraordinary people, to help them out, and to learn about their personal journey and progress.

From patient, to intern, from letters of recommendations to the daily interactions with co-workers, 3D has had the biggest professional influence on me. Their leadership and care have been invaluable to learn from and experience.

I am excited to say that in the Fall I will be a Drexel Dragon and begin my last leg of accomplishing my goal of becoming a PT. In the future, I would love to specialize in sports therapy, but I have a lot of interest in working with older populations and veterans. Maybe one day, I can combine all of them and come back to work at the place where it all started. I can’t say thank you enough to ALL my 3D family!

Alexa Brown, aide 3DPT Medford and Tabernacle

I am excited to be starting my PT school journey this fall at Drexel University! I am so thankful for my time as both a patient and employee at 3DPT and could not have gotten to where I am today without them. Being a patient, I developed a love for physical therapy. I always looked forward to my appointments because of the environment the staff at 3D created. I always knew I wanted to work in healthcare, but seeing the way that physical therapy can have an impact on so many different individuals and diagnoses solidified my career choice. As an employee at 3DPT both in the Medford and Tabernacle offices, I gained so much knowledge and experience in the field and felt constantly supported by all of the physical therapists and staff I worked with. They were always willing to take the time to explain to me what they were doing and why, and offered support and advice during my application process to PT school. I could never thank all of them enough!

Mana Patel, front desk 3DPT Cherry Hill

I just graduated from Rowan University in May with a Bachelors in Health and Exercise Science and a minor in Sport and Exercise Psychology. I will be attending Thomas Jefferson University for Physical Therapy School this fall. I would like to one day specialize in pelvic floor physical therapy and hope to eventually earn my OCS and SCS board certifications.

Working at 3DPT has given me the opportunity to learn more about my future career. It has not only reinforced my dream to become a physical therapist but it has allowed me to build a network of people whom I can rely on.

Lily Ngo, aide at 3DPT Cherry Hill

I recently graduated from Rowan University and am so excited to have been accepted into the Physical Therapy Doctorate program at Thomas Jefferson University!

My time at 3DPT has helped me so much along my journey to becoming a PT. Everyone at 3DPT truly embodies our core values. The one that stand out for me is Accountability – that is the core value that I will carry with me to graduate school. Working at 3D, I saw that patients were more than just a statistic, and the more I worked at 3D, the more I saw myself grow as an aide and develop a love for physical therapy. Not only was I gaining experience in patient care in preparation for graduate school, but I was developing relationships with both my patients and coworkers. The word accountability means responsibility, or obligation. However, during my time here at 3D, I’ve come to realize a different definition of accountability. Patients here are not seen as just an obligation. Accountability, to me, is the privilege of being able to help them feel 100% in all dimensions of their life. This is the value I will take with me to graduate school, and this is the value that I will forever thank 3D for giving me. As a bonus, I also met my very best friend while working here, Samantha Gardner!

Megan Glenn, aide 3DPT Tabernacle 

After completing my Bachelors of Science in Health Sciences, I will be continuing my education at Stockton University to receive my Master of Science in Communication Disorders. Although I will have only worked at 3DPT for a year before moving on to graduate school, I can confidently say that I have gained so many great qualities from working with the amazing people in this company. I feel that I am now much more confident and prepared to work in a clinical healthcare setting. After graduate school, I plan to be a speech-language pathologist in the outpatient or medical setting, in hopes to open my own swallowing clinic one day!

March is National Athletic Training Month

March is National Athletic Training Month! 

National Athletic Training Month is held every March in order to spread awareness about the important work of athletic trainers. This year’s slogan is “Providing Health Care Everywhere”, and I’m going to explain a little bit about what that means. With all of the different healthcare providers out there, it can be a little confusing to know who does what and where you can find them. A large majority of athletic trainers work at high schools and colleges to provide sports medicine to athlete; however, that is not the only place you will find athletic trainers!

First, let’s talk about who athletic trainers are. Athletic trainers are healthcare professionals who collaborate with physicians to provide preventative services, emergency care, clinical diagnosis, therapeutic intervention, and rehabilitation of injuries and medical conditions. Athletic trainers function as an integral member of the healthcare team in clinics, secondary schools, colleges and universities, professional sports programs, and other athletic healthcare settings. A few other places you may find athletic trainers include physicians’ offices, industrial settings, professional sports such as NASCAR or Rodeo, performing arts, health clubs, law enforcements, the military, and even NASA! The role of an athletic trainer varies based on the setting they work in, but their most important job is prevention of injuries.

Now that we know who athletic trainers are, what distinguishes them from physical therapists? Although physical injury is the focus for both athletic trainers and physical therapists, athletic trainers work specifically with physically active people and are under the direct supervision of a physician. Physical therapists on the other hand may work independently with any patient who has been injured or is dealing with an illness that impacts their physical wellbeing. Another key difference is that athletic trainers work to primarily prevent future injury and are on the field or court during an injury to provide immediate medical care whereas physical therapists are focused on recovery and may not be with a patient during their initial injury.

As an athletic trainer and a physical therapist myself, I love when these two healthcare professionals can work hand in hand to help a patient from the time of injury to returning back to function.  With good communication and a network of health professionals, patients can have an easier, more fluid recovery process and have more fun along the way!

Sarah Obuchowski – PT, Professor and now Clinic Director!

My career with 3DPT began in 2019, when I was placed at the West Berlin clinic for my final clinical rotation of PT school. After my first week there, I told my family, “this is where I’m going to work.” I wasn’t sure if there was an opening for a PT at that time, or even what life would look like after graduation, but I was adamant that 3DPT West Berlin would be the place my career started. Luckily, everything worked out the way I had hoped, and I was hired after graduating in January 2020.

My time with 3DPT so far has been incomparable (including my first official day as a PT –  the day New Jersey shut down because of the pandemic!) I have grown as a clinician, formed connections with patients that have made a positive impact on my life, and made memories with the best coworkers imaginable. Practicing as a PT in this clinic has given me the opportunity to hone my skills as a clinician and determine what type of injuries I treat best.  In the past few years, I really have excelled at treating patients coming in with lower extremity injuries, especially post-op knee or ankle surgeries, and those coming in for anything running related. It has been the best experience getting to know my patients and to work with them to achieve their goals; I just love what I do! An added bonus of my job is how close the people in my office are with each other – my coworkers have been my biggest supporters from the minute I started. I look forward to being around them and learning from them every week.

After being at 3DPT for about a year and a half, my boss, Ryan McDevitt (aka the “Best Boss” according to the Best of South Jersey poll!), offered me the opportunity of a lifetime: to manage the clinic that has given me my start. I knew that I hadn’t been in the field for very long, but I also knew that I could do the job, and do it well. It was an easy, resounding “yes”. So as of January 1, 2022, I am officially the clinic director of 3DPT West Berlin!

Filling this role has been challenging, but it has also given me great joy. We’ve had a busy year already – we’ve expanded the clinic, installed a turf section for athletes, and welcomed a new PT, my first student, Alyssa. Ryan is the best mentor to teach me the ropes and am doing my best to serve our patients and local community. Though I can’t speak for everyone, I’d say it’s going pretty well! I’m excited to continue to grow as a leader in the company and my field.

My life outside of 3DPT has been just as busy. I finished my first marathon this past November, which has been a goal of mine since rehabbing my knee, and marathon #2 set for later this year. Running is a major love of mine so being able to finally tackle those 26.2 miles was so special.

I also got engaged to my best friend, Nick, who I met in PT school, and we just bought a house! We also adopted 2 dogs, who are crazy and misbehave often but make us laugh just as much. Another exciting thing I am doing currently is teaching as an adjunct at Arcadia University, my alma mater (and favorite place), where I get to help instruct in their new anatomy lab. I enjoy every minute that I’m there, and I feel so lucky to be part of their esteemed program. So yes, I’ve been busy, but as my mom likes to tell me, “all good things.”

A lot of things have changed since starting as a student at 3D in 2019, but my original thoughts on 3DPT remain unchanged. This company is special, so are the people I work with, and so are the patients. I couldn’t have asked for a better start to my career, and I know it is only going to get better from here. Reflecting on my time at 3DPT West Berlin, I have a lot of thoughts, but the one that stands out most is:

I am so grateful to have been placed here.

To learn more about Sarah and the entire 3DPT team, click here.

Allison Korn – Physical Therapist, Performer, Clinic Director!

Time flies when you’re having fun! It’s still hard to believe that it’s been 4 years since I started my journey at 3DPT back in 2017 as a student in West Berlin. My time there was amazing and I knew 3DPT was where I wanted to be after I graduated PT school.  Working as a student in Berlin gave me a start as a PT but also helped me to explore one of passions – working with dancers and performing artists! I have been dancing and performing since I was a little girl and my love for dance and appreciation for the body’s movement led me to this profession in Physical Therapy!

When I started full time at 3DPT, I moved to our Haddon Township location and have been there ever since.  Now I’m excited to announce that I am the Clinic Director there!  When our new Haddon Heights office opened in November, I moved into the director role and I am so excited to take on this new challenge of running the day-to-day operations and getting to work with an AMAZING team to keep creating positive change for our patients. It has been great getting started, settling in, and I am excited to keep growing the office both within our walls here and out in our community!

Over my time at 3DPT I have loved working with all of my patients and getting to be a part of the Haddon Township communities.  I am still an active part of the performing arts community and am a proud troupe member (a re-occuring actor) with Masquerade Theatre who has its home in Riverside, NJ and I perform with them regularly! Dance and theater are a huge part of what makes me unique as a clinician and a human and it keeps my body and brain healthy and inspired for my patients in the clinic.

A few years now into my career, I’ve also discovered a new path and treatment passion. I love educating patients on the importance of the core and how the core is affected by the pelvic floor. I have had the opportunity to work with a lot of new mothers and was looking to progress myself professionally when I decided to take the first pelvic floor course with the APTA. After taking my first class I was hooked! I was so inspired by the fabulous women I was learning from and that was really when Pelvic Health at 3DPT started to come to life. I am proud to be able to treat women post partum for varying conditions such as urinary incontinence, pelvic organ prolapse, pelvic pain, diastasis recti, bowel dysfunction, and more.

When I started here at 3DPT, it was hard to imagine being in this exciting position, as a new grad with the world at her fingertips. I am appreciative of my journey so far and am looking forward to an exciting future!

Allison grew up in Laurel Springs, NJ and currently lives in Haddon Township herself with her boyfriend Andrew and their two cats Flynn and Belle!

To learn more about Allison and the entire 3DPT team, click here.

Pointe Shoe Readiness Assessment

According to the Harkness Center for Dance Injuries, 66% of dance injuries occur at the foot and ankle, and these injuries associated with introduction to pointe shoe wear, can be reduced with appropriate screening of students by instructors and medical professionals such as physical therapists and physicians.

The Harkness Center for Dance Injury criteria for transition to pointe work includes a detailed assessment of the following: stage of physical development; the quality of her (or his) trunk, abdominal and pelvic control (“core” stability); the alignment of her legs (hip-knee-ankle-foot); the strength and flexibility of her feet and ankles; and the duration and frequency of her dance training.  It is noted that pointe shoe work creates a force on the foot that is up to 12x the ballerina’s body weight, which can be damaging to growth plates and overall typical physical development in young dancers. With this in mind, the typical time to begin is around 12-13 years of age, which is considered to be a generalized maturation point for many young girls. In addition to age as an indicator of maturity, dancers can also be screened for physical readiness based on a series of tests for balance, foot/ankle strength, as well as hip and core strength.

Criteria for Physical Readiness:

Foot and Ankle

• Range of Motion:
  • Dancers should present with greater than or equal to 90 degrees of plantar flexion range of motion (aka the position of a fully pointed foot) pointe shoe work.
    • 90 degrees is the minimal requirement for demi pointe (flat shoe work)
    • Elite dancers (per the Harkness Center for Dance Injuries) often present with approximately: 113 degrees of plantar flexion and  0 (neutral foot placement)-10 degrees of dorsiflexion (the fully flexed position of the foot)
    • Inadequate plantar flexion can result in posterior bony or soft tissue impingement
• Strength:
  • Student must pass the plantar flexion strength assessment (manual muscle test) with 4/5 or 5/5 (see below table)
    

• Single leg stance:
  • Students should be able to hold SLS for at least 30 seconds with eyes closed without compensation with flat foot
  • Students should also be able to maintain releve in passe for at least 5 seconds without foot/ankle or core compensations such as arching of the back or loss of full releve
• Single leg jump and landing:
  • Students should be able to perform single leg sautes or comparable jump with good form with both take-off and landing for at least 10 repetitions

Hip and Knee 

• Range of Motion:
  • Students should present with full hip and knee range of motion with no compensation
• Strength:
  • No evidence of genu valgum (knock knees) or hip drop with the following functional tests to indicate adequate hip and knee strength:
    • Lateral step down test (bilaterally)
    • Functional squat
    • Single leg squat (bilaterally)
  • Perform RDL (Russian Deadlift) and/or airplane test with good form and minimal compensation bilaterally
  • Passing a strength assessment from a medical professional (i.e. physical therapist/physician) if further assessment feels necessary or wanted by student, family, or instructor

Core

• Strength:
  • Achieve level 4 or 5 on Sahrmann Scale of Core Strength and Stability
    
  • Maintain a plank on elbows for >30 seconds with good form and no compensations
  • Be able to maintain good form with bird-dogs or other comparable anti-rotation activity
    

Are you ready to dance en pointe? Call 3DPT and we can help you determine if your body can handle the stresses of dance and dancing en pointe.

Conference Championship: Tyler Higbee

At a Glance –
Player: Tyler Higbee
Position: Tight End
Team: Los Angeles Rams
Injury: Knee Injury (Unspecified)
Projected Recovery Time: 2-8 weeks

The LA Rams are going to the Super Bowl! The NFC champions punched their ticket to the game on February 13th after narrowly defeating the San Francisco 49ers, and now the Rams have the opportunity to win the Lombardi, at home, in Los Angeles! The Rams did, however, lose a key player to an injury during the first half of Sunday’s game.

Tyler Higbee, the Rams’ tight end, missed most of the conference championship due to a knee injury. Most feared the worst, that Higbee sustained a ligament injury, but recent reports state that the injury was not too severe and that Higbee may be able to play in the Super Bowl. The chances are slim but not nonexistent.

Higbee’s knee injury is unspecified, but since there is a chance he can be back in 2 weeks, he is without a doubt working with his physical therapist. With acute knee injuries, the focus of a rehab plan is often on decreasing inflammation, modulating pain, and restoring range-of-motion, strength and balance. After an injury, inflammation (in the joint, known as effusion, or around the joint, known as swelling) are common, and effort will be taken to reduce this inflammation, as it can increase pain levels, decrease range-of-motion, and reduce muscle firing and efficiency. Elevation and compression sleeves will be key in the next few days, as well as targeted stretching and strengthening to address any impairments.

Trauma to the knee can cause voluntary firing of the quadriceps to be reduced, and electrical stimulation will be used to help regain neuromuscular control of that muscle. It can take a few days for inflammation to go away, and even longer to regain strength, range of motion, and balance, so Higbee will be evaluated on a day-by-day basis to determine if he will be ready to return for the last game of the season. Even though it is the Super Bowl, Higbee doesn’t want to return if he isn’t ready as premature return to play can lead to increased risk of injury when the person isn’t ready. That being said, Higbee has one job the next two weeks: rehabbing to be cleared for one of the biggest games of his life. We’ll see how he does!

Watch this video to see the team demonstrate a few of the exercises Higbee may be doing for his knee injury

Source:
https://theramswire.usatoday.com/2022/01/31/rams-injuries-tyler-higbee-taylor-rapp-sean-mcvay/

Divisional Round: Cameron Sample

At a Glance –
Player: Cameron Sample
Position: Defensive End
Team: Cincinnati Bengals
Injury: Adductor (Groin) Strain
Projected Recovery Time: 2-8 weeks

The Cincinnati Bengals have been very impressive this season, and this past weekend was no exception. After defeating the Titans in the Divisional Round, the Bengals are heading to the conference championship, but not without injury. During Saturday’s game, Cameron Sample, a rookie Defensive End, exited the game and did not return due to a groin injury. Reports have not confirmed whether Sample will be ready to play in the Conference Championship, but with the nature of this sort of injury, his ability to play will likely be a game-time decision.

Injury to the muscles of the groin, also known as the adductors, is common in sports that require running and jumping. This type of injury often occurs due to tightness and over-stressing of the adductor muscle group, leading to a good bit of pain when walking or running. Sample’s return will be likely dependent on the grade of the strain, which can be mild (Grade I) to severe (Grade III). If the strain is less than a grade 3, which is a complete tear to the muscle or tendon, Sample will likely be ready to play in the upcoming game vs the Chiefs. However, he will be putting the time in with his physical therapist to ensure that he is ready (and safe) to return. Sample’s treatment plan will focus on addressing strength and flexibility impairments so he can return to sport with minimal risk of re-injury, as recurrence rates are high, and manual therapy and other modalities will be used to improve pain level so he can make a quicker return. Typical exercises to “bulletproof” the adductor muscles are slider lunges, adductor stretches, and adductor lifts. Sample may be able to return as early as this week to football, but he is going to continue rehabbing those adductors in the offseason. If last weekend’s game is any indication of how the conference championship will play out, the Bengals will need to play close to perfect to stop the Chiefs from making it back to the Super Bowl.

Watch this video to see the team demonstrate a few exercises that address strength and flexibility impairments associated with this injury.

Source:
https://stripehype.com/2021/08/22/bengals-rookie-defensive-ends/

Wild Card Weekend: Nick Bosa

At a Glance –
Player: Nick Bosa
Position: Defensive End
Team: San Francisco 49ers
Injury: Concussion
Projected Recovery Time: 2 weeks – 2+ months

The San Francisco 49ers are making a surprising run in this year’s playoffs, eliminating the Dallas Cowboys. They did lose a notable player to concussion: Nick Bosa. Bosa, who returned this year after rehabbing a torn ACL, exited the game prior to haltime after colliding with his own teammate. He will likely need physical therapy intervention to help him return to the field safely. Concussions are mild traumatic brain injuries, caused by a blow or jolt to the head, that may leave a person with behavioral, cognitive, or physical symptoms for weeks to months. They are serious injuries that can disrupt the brain’s chemistry and function, and it is important to diagnose the injury and allow the brain to heal. Physical therapists are trained to identify and understand symptoms to ensure a person safely returns to activity, and Bosa’s PT will definitely have a role in determining his return to the field. His return for the Divisional Round is up in the air.

Concussions are a difficult injury to treat as people present differently, depending on the severity of the concussion, but the biggest goal of Bosa’s physical therapy program will be to re-introduce activities gradually. If someone returns to higher level activities too quickly, a brain bleed can develop from excessive swelling, or a person may develop post-concussive syndrome, in which symptoms last for several months. One of the best ways to treat concussions is exercise, surprisingly enough. Studies have shown that exercise improves blood flow to the brain and strengthens the brain’s communication pathways, and by returning to exercise gradually, a person can start returning to daily activities. Typical symptoms include headaches, dizziness, and “feeling foggy”, and early interventions in Bosa’s PT program will help him improve his tolerance to moving his head, standing, and performing daily activities. Bosa will also work on strengthening key muscle groups in the neck, as well as addressing vestibular impairments, which are very common with concussions. Vestibular (or inner ear) problems interfere with balance and coordination, and PTs have a variety of exercises to help Bosa improve his stability. As he progresses, the exercises will become more difficult to ensure he can tolerate the demands of professional football. There are even formal treadmill programs that measure heart rate and symptoms that Bosa will likely participate in to make sure he can return to football safely. During one test, known as the Buffalo Concussion Treadmill Test, the person walks at 3.3 mph, increasing the incline by 1 every minute. The test is terminated when the person’s symptoms increase by >3 on a 10-point scale or if they reach their max heart rate. The cardio exercise prescription following is based on 60-80% of the max heart rate that was achieved during this test, which is done ~5 days per week for 20 minutes. This test and subsequent interventions ensure that the person has a good tolerance to exercise and is not returning to activity prematurely. His PTs will know the signs of a poor response to exercise to make sure he isn’t doing too much, and hopefully in the next 1-2 weeks, he will be able to make a full recovery and return to football, just in time for the Niners to make their push.

In this video, you’ll see Drs. Barbie Barron and Dan Dietz demonstrate some exercises that would be done in the early stages of rehab for a concussion. At the end, Dr. Sarah Obuchowski demonstrats the Buffalo Concussion Treadmill Test.

Sources:
https://cdn-links.lww.com/permalink/jsm/a/jsm_2020_01_28_haider_19-313_sdc1.pdf

Week 18: Cam Akers

At a Glance –
Player: Cam Akers
Position: Running back
Team: Los Angeles Rams
Injury: Achilles Repair (after tearing it during preseason)
Projected Recovery Time: 6-12 months

The LA Rams saw the shocking return of Cam Akers, an exceptional running back who tore his Achilles … during 2021 … in July. Many thought Akers would not return for the 2021-2022 season due to the nature of this injury, which is typically slow-going and limited by tissue healing timeline. Akers, being the exceptional athlete that he is, defied the odds with an incredible return to the Rams just in the nick of time for Wild Card Weekend. Because this recovery time is almost unheard of, Akers is the focus of this week’s injury report.

Achilles tendon ruptures require surgical intervention if a person wants to return to higher level function. It is one of the hardest lower body injuries to rehab. Soon after surgery, in which the tendon is reattached to the insertion site at the heel, physical therapy is incorporated to maintain knee and hip strength, as well to slowly build up ankle strength and flexibility. During the early phases of rehab, calf stretching and active use are restricted, but gentle exercises that avoid calf muscle use and tension can be incorporated to prevent atrophy and tightness in unaffected ankle musculature.

Akers was likely immobilized in a boot for the first 6-8 weeks post-op to protect the repair, and his PT helped him wean off the boot and normalize his walking. Significant focus will be on building calf strength once it is safe to activate the calf muscles, and it can take 6+ months for him to perform a single leg heel raise that is comparable to the unaffected side for most people. Aker’s return to play in that timeframe is so impressive because, by the time most people are able to finally perform a heel raise, Akers was back at practice. Plyometrics and football drills usually are not initiated until 6 months out to protect the repair, but Aker’s strength, flexibility, and balance were adequate enough to return to sport early. He may be back on the field, but Aker’s work in the PT clinic is far from finished, and he is without a doubt still putting the necessary hours into his rehab so that he can continue to play and avoid injury, as well as problem-solve with his PT if certain activities give him trouble. Since total recovery from this injury can take 9 or more months, Aker’s return is an incredible feat and may be just what the Rams need to take on the Cardinals this weekend.

In this video, the 3DPT team demonstrates a Plantar-Flexion progression with progressive loading (exercises that build on each other and progressively get harder with more weight, throughout the recovery process.)

Week 17: Lucas Niang

At a Glance –
Player: Lucas Niang
Position: Right Tackle
Team: Kansas City Chiefs
Injury: Patellar Tendon Tear
Projected Recovery Time: 6-8 months

The Kansas City Chiefs have certainly turned a corner during the second half of this season. Though they were on the losing end of their game against the Bengals this weekend, the Chiefs were exciting to watch, and with the first-round bye of playoffs on the line, next week’s game will likely be just as exciting. However, the Chiefs will have to rework their offensive line, as both tackles were lost to injury during this week’s game. One of the tackles, Lucas Niang, will be out for the rest of the season due to a patellar tendon rupture. He may be back at the start of the 2022 season, but it all depends on his progress with physical therapy.

The patellar tendon connects the kneecap to the tibia, and it is essential to perform any activity that requires the use of the quad, such as running, jumping, and walking. When the patellar tendon is torn, surgery is often required to repair the tendon, and a person can expect to spend several months in rehab before he or she can return to normal activities. Whether the person is a high-level athlete or someone who just wants to walk normally again, there is a protocol that limits bending and weight bearing post-op to allow the tendon to heal. A person is not able to bear weight through the lower extremity until 4 weeks, and full bending of the knee is expected by week 20. The goals of the protocol are to avoid too much tension on the patellar tendon, which is stressed by knee flexion. The quad muscle itself will be much weaker from the initial trauma to the knee, as well as the surgery, and early efforts will focus on building the quad strength up to assist with functional activities, such as walking, as well as to avoid asymmetry between sides which can contribute to re-injury down the line. Niang has a long journey ahead of him with his physical therapist, and around months 4-8, focus will be on building up strength, agility, and speed to help him return to football. The tackle position requires a lot of power to ward off the opposing players, and Niang will have to demonstrate exception lower extremity strength to be cleared to play to ensure his knee and the repair can tolerate that particular stress. Until then, he is on the sideline, wondering like the rest of us if the Chiefs have what it takes to bring that Lombardi home again.

In this video, the team demonstrates a few exercises that would be included in a rehab program for a patellar tendon rupture.

Sources:
https://www.sanfordhealth.org/-/media/org/files/medical-professionals/resources-and-education/5-patellar-tendon-repair-rehabilitation-guideline.pdf

Week 16: Clyde Edwards-Helaire

At a Glance –
Player: Clyde Edwards-Helaire
Position: Running Back
Team: Kansas City Chiefs
Injury: Collar bone injury
Projected Recovery Time: 2-6 weeks

The Kansas City Chiefs have been on a hot streak, winning each of their last 8 games played. They without a doubt will be a force to reckon with come playoffs, but after this week’s game against the Pittsburgh Steelers, it seemed they may have to go without their running back, Clyde Edwards-Helaire. Edwards-Helaire suffered an injury to his collarbone during the game and was ruled out for further testing and imaging, and many feared the worst: that Edwards-Helaire would have to go on the IR and miss the rest of the season. However, recent reports confirm that there is no structural damage to the collarbone, meaning that Edwards-Helaire will likely be back for playoffs and Chiefs fans everywhere can collectively breathe a sigh of relief. He is week-to-week, and his return will largely depend on his progress with physical therapy.

The collarbone, also referred to as the clavicle, forms the connection between the arm and the trunk. The collarbone itself is susceptible to fracture, but there are also ligaments and tendons that connect to the collarbone that can be involved with trauma to the area. Luckily, Edwards-Helaire avoided significant injury to his shoulder and collarbone, but he is dealing with tenderness and swelling of the area. During the first couple of days after Edwards-Helaire’s injury, focus will be on decreasing the inflammation of the area and avoiding putting excessive stresses on the collarbone. Once Edwards-Helaire’s pain levels decrease, focus will be on restoring mobility and strength of the area. Increased focus will be on building shoulder stability to ensure that when Edwards-Helaire returns to play, he will be able to avoid further injury, especially when tackled. If stability and strength of the upper extremity are not restored, the clavicle could be fractured or there could be ligament damage, both of which would mean a much longer recovery. Edwards-Helaire is week-to-week, meaning he could be ready to play by the time the Chiefs play the Bengals during Week 17. His clearance to return will largely be dictated by his gains in strength, stability, and mobility, as well as reduction in pain levels. Even if he’s not ready to play by the end of the regular season, he will have plenty of opportunity when the Chiefs make their run during the post-season.

Take a look at some exercises that could be incorporated into a rehab program for an injured collarbone.

Sources:
https://www.nfl.com/news/2021-nfl-season-notable-injuries-news-sunday-week-16-games

Week 15: Chris Godwin

At a Glance –
Player: Chris Godwin
Position: Wide Receiver
Team: Tampa Bay Buccaneers
Injury: ACL and MCL sprain
Projected Recovery Time: 9-12 months

The reigning Super Bowl champions are once again heavy favorites in the NFC. However, in Sunday night’s performance versus the Saints, the Tampa Bay Bucs looked a little lackluster. Tom Brady got shut out for the first time since 2006, so you know the Bucs had a bad game. A large part of this story is that Brady’s offensive weapons left the game to significant injury. One of those key players was wide receiver Chris Godwin. Godwin, a favorite target of Brady, suffered a knee injury and was ruled out for the rest of the game. Recent reports confirm both an ACL and MCL injury, meaning that Godwin will miss the rest of the 2021 season. He will likely undergo surgery in the next month, while participating in physical therapy before and after to get him ready for the 2022 season.

This injury is a pretty severe one. The ACL and MCL are essential for restricting certain motions and providing stability. ACL injuries are all too common in the NFL, and adding an MCL sprain to the mix adds another level of complexity to both surgery and rehab, extending the recovery. The MCL provides stability against valgus forces, which push the knee inward and predispose a person to a lower extremity injury, and an injury to the MCL is essential to address to avoid re-injury when returning to higher level sports. Godwin will likely undergo surgery within the next month, reconstructing both the ACL and MCL. After surgery, Godwin will spend a lot of time with his physical therapy team. He will not be able to bear weight through his leg for 4 weeks but will be doing plenty of strengthening and stretching exercises until he is cleared to walk on his affected leg. After a traumatic injury and surgery to the knee, the quadricep muscle has difficulty functioning correctly, and focus of early treatment sessions will be on improving the quad’s ability to fire on command so that when Burrow can start higher level activities, he will be prepared. As was mentioned, ACL and MCL re-tears are associated with the valgus position so a huge focus on Godwin’s rehab program will be injury prevention. Strengthening the hips by doing variations of bridges and hip abduction exercises helps a person maintain a healthier knee position to avoid that valgus, and a lot of time will be dedicated to Godwin maintaining that healthy knee position while performing dynamic activities. Studies have shown that ACL tears have greater re-tear rates when returning to play before 9 months, no matter how strong or prepared a person is, because the new graft has not fully remodeled so it is very important that Godwin is patient and returns when his body is ready. He will be doing plenty of sprints and plyometrics to put his knee to the test before he is cleared to practice with the team and will likely not be ready to play when the 2022 season starts. This injury falls right before Godwin enters free agency, which will be all the motivation he needs to be ready to go for next year.

Watch this video to see the team demonstrate a few examples of exercises for this type of injury – in both the early stage and later stages of rehab.

Sources:
https://tcomn.com/wp-content/uploads/2014/08/ACL-and-MCL-Rehab-2-13-13.pdf

Week 14: Randall Cobb

At a Glance –
Player: Randall Cobb
Position: Wide Receiver
Team: Green Bay Packers
Injury: Core Injury with subsequent surgery
Projected Recovery Time: 4-8 wks

The Green Bay Packers have had a very successful 2021 season. Though the Packers administration has not done the best job in providing Aaron Rodgers offensive weapons, Devante Adams and Randall Cobb have done more than enough to help Green Bay have a winning season. This week, however, the Packers did have to make do without Cobb, who, although he isn’t wide receiver #1, has had pretty impressive stats this year. Cobb has apparently sustained a core injury that is serious enough to warrant surgery and has actually undergone surgery in the past week. The Packers are hoping he can return in the post-season.

Though physical therapy can treat minor to moderate core injuries, surgery is indicated when there are tears in the muscles and ligaments (as well as their attachment sites to the bones) that significantly limit the ability to perform even daily tasks. There are several muscles that make up the core so a “core injury” does not tell us exactly which muscle(s) are involved, but treatment post-op is somewhat similar. After surgery, Cobb will be spending a good deal of time resting for at least 2 weeks to heal. During that time, he will be put on a walking program to promote good circulation and reduce the risk of complications from surgery. There will also be stretches he can perform to maintain mobility of the trunk after surgery. He will not be permitted to lift, push or pull objects within those first 2 weeks. Around week 3, he will be cleared to perform light exercises and core strengthening, but there will still be a limit on how much he can lift to minimize the risk of re-injuring the healing musculature. Focus during that time will be on establishing core stability via participating in a neutral spine program, which starts with lower level exercises but gets increasingly difficult as time goes on. During the earlier weeks of this program, Cobb will work on strengthening his transverse abdominus and pelvic floor muscles, both of which are essential for upholding core stability and reducing the risk of re-injury. These muscles function to support the trunk by maintaining tension within the abdominal wall and continue to do so even with upper and lower body movement, leading to less stress on surrounding structures, including the other abdominal muscles. As time goes on, more dynamic movement will be incorporated to simulate the sport, but the goal remains the same: keeping the core active with movement, no matter how strenuous. Cobb’s return depends on his progress with his physical therapist, as well as his pain levels, and he will not be back for at least 4 weeks. However, with there being 18 weeks this year, it is likely he may make an appearance in the post-season, depending on how deep of a run the Packers make. After watching Sunday night’s game against the Bears, though, there’s a good chance we’ll see Cobb on our screens early in 2022.

This video demonstrates 2 early stage rehab exercises as well as 2 later stage rehab exercises for a core injury.

Source:
https://www.performancehealth.com/articles/6-post-operative-abdominal-rehabilitation-exercises

Week 13: Christian McCaffrey (#2)

At a Glance –
Player: Christian McCaffrey
Position: Running back
Team: Carolina Panthers
Injury: Ankle Injury
Projected Recovery Time: 2-6 months

The Panthers have experienced a whirlwind of a season, after starting off hot and now being 5-7, and injuries to their star player has only made matters worse. If you’ve been following our injury reports, you might have seen Christian McCaffrey (CMC) featured for our Week 3 article. After rehabbing his hamstring and returning to play, CMC found himself on the IR again after sustaining a serious ankle injury during the Week 12 Panthers vs Dolphins game. He reportedly rolled his ankle, and MRI imaging confirmed enough tissue damage to cause CMC to miss the conclusion of the season (since it is rather unlikely that the Panthers will make the playoffs). Though specifics about his injury have not been disclosed, it is likely that CMC sustained a significant ankle sprain. CMC’s absence from the field is unfortunately nothing new, as he has only played in 10 out of 33 games in the past 2 seasons. His focus during the upcoming weeks will be on avoiding surgery with the help of his rehab team and physical therapist.

The good news is that CMC does not necessarily have to get surgery as long as his rehab goes well and should be back and ready to go by the 2022 season. After the Dolphins game, CMC was seen walking in a boot and will likely continue walking in the boot for the next 2-4 weeks. The goal of this immobilization is to decrease the stress on the ankle and its ligaments to allow for healing, as well as provide protection from any further tissue damage. This protection in the early weeks is essential since once you sprain your ankle, regardless of the severity, you are at greater risk to sprain it again, which is known as sustaining “chronic ankle sprains”. Chronic ankle sprains occur when the ankle’s strength and proprioception (the body’s ability to determine where it is in space) are not restored after the initial ankle sprain and can even warrant surgery if the ankle is unstable enough. Rehab is essential to prevent repeated ankle sprains and ankle stabilization surgery, which is why CMC’s prognosis depends on how he does in PT. CMC is likely participating in PT already despite being in the boot, and early efforts will be on building ankle strength and proprioception so that when he returns to the field, he will automatically avoid putting his ankle in positions that put too much stress on the ligaments. Later efforts will really hone in on building CMC’s proprioceptive response. Exercises will include maintaining balance on unsteady surfaces, on one leg, and with eyes closed. Additionally, landing and running mechanics will be refined to ensure that even during the game, CMC’s ankle will stay in that safe position. Recovery all depends on CMC’s progress, as well as the extent of the sprain. Since CMC is out but does not necessarily need surgery, it is likely he sustained a Grade II ankle sprain, which means a portion of the ligament tissue is torn but not completely through. Recovery for this is ~6-8 weeks. Though the hopes of Panther’s fans are certainly dashed this season, having their star running back return, healthy, will be a great start to the 2022 season.

To see some of the exercises McCaffrey will likely be doing throughout his rehab for the ankle sprain, watch the team demonstrate a few in this video!

Sources:
https://www.panthers.com/news/christian-mccaffrey-placed-on-injured-reserve

Week 11: Chris Carson

At a Glance –
Player: Chris Carson
Position: Running Back
Team: Seattle Seahawks
Injury: Unspecified neck injury with subsequent surgery
Projected Recovery Time: 16-24 weeks

The Seattle Seahawks have had a disappointing season in 2021, largely at the hand of injuries. Though Russell Wilson has finally returned to the field after having finger surgery, the Seahawks are missing another piece on their offense: Chris Carson. Carson is an excellent running back whose absence has been felt deeply on the team, and though there were hopes he could return during Week 10, he was reinstated on IR this past week with confirmation that he will be undergoing surgery. Carson will not be ready to return until the 2022 season.

Though the specifics have not been disclosed on the nature of Carson’s injury, it is likely that his issue involves the disc in the cervical spine. Intervertebral discs separate vertebrae (bones) in the neck and back, and they provide cushioning and shock absorption to the structures around them. Sharp turns or compressive forces, as well as age, can lead to a disc becoming herniated, which means the disc juts out. If the disc protrudes in a certain direction, it may compress a spinal nerve which can be painful and lead to both muscle and sensory symptoms. People often complain of numbness, tingling, and weakness that travels down their leg or arm. Herniated discs can cause symptoms that limit a person’s ability to function, and when symptoms are severe enough that the person does not respond to conservative treatment, surgery is warranted. Carson’s pain levels and disability caused him to fall into this category. Although it was not disclosed just what type of surgery he had to address this issue, he likely underwent a discectomy, in which the part of the disc that is causing his symptoms is removed. Physical therapy will be key to help him return next season. Herniated discs are an injury that physical therapists treat very often, even if a person does get surgery. For herniation of discs in the cervical spine, as is the case with Hunter, focus of treatment is on building strength in the neck, upper back, and shoulders. Discs often become damaged due to instability from muscle weakness, and strengthening key muscle groups helps with injury prevention. The hits that are part of football can easily re-aggravate Carson’s pain so he will work closely with his rehab team to build that stability up. Endurance is equally as important for Carson as he has to play the full 60 minutes, and there are specific exercises we have up our sleeves to help. A basic exercise Carson will do is a chin tuck, which looks kind of like a double chin but requires use of muscles that are essential for neck stability, and his program will incorporate exercises that require Carson to hold that position to build up endurance and stability. He will be able to start game-like exercises at about 16 weeks post-op and will have plenty of time to get ready for OTAs in the spring. Though the Seahawks may not be doing too hot this year, they have the return of their star RB to look forward to during the off-season.

To see a few exercises that would be included in a PT program for post-neck surgery, view this video:

Source:
https://www.fieldgulls.com/2021/11/19/22792237/seattle-seahawks-news-chris-carson-out-for-the-season-neck-injury

Week 10: Dallas Goedert

At a Glance –
Player: Dallas Goedert
Position: Tight End
Team: Philadelphia Eagles
Injury: Concussion
Projected Recovery Time: 2 weeks – 2+ months

In Detail:

The Philadelphia Eagles are certainly not out of playoff contention, especially with their victory against the Broncos this week. However, the Eagles lost their tight end, Dallas Goedert, only 10 minutes into the game after Goedert suffered a helmet-to-helmet hit while being tackled. Goedert was quickly ruled out for the game and is currently participating in the NFL’s concussion protocol. He will likely need physical therapy intervention to help him return to the field safely. Concussions are mild traumatic brain injuries, caused by a blow or jolt to the head, that may leave a person with behavioral, cognitive, or physical symptoms for weeks to months. They are serious injuries that can disrupt the brain’s chemistry and function, and it is important to diagnose the injury and allow the brain to heal. Physical therapists are trained to identify and understand symptoms to ensure a person safely returns to activity, and Goedert’s PT will definitely have a role in determining his return to the field.

Concussions are a difficult injury to treat as people present differently, depending on the severity of the concussion, but the biggest goal of Goedert’s physical therapy program will be to re-introduce activities gradually. If someone returns to higher level activities too quickly, a brain bleed can develop from excessive swelling, or a person may develop post-concussive syndrome, in which symptoms last for several months. One of the best ways to treat concussions is exercise, surprisingly enough. Studies have shown that exercise improves blood flow to the brain and strengthens the brain’s communication pathways, and by returning to exercise gradually, a person can start returning to daily activities. Typical symptoms include headaches, dizziness, and “feeling foggy”, and early interventions in Goedert’s PT program will help him improve his tolerance to moving his head, standing, and performing daily activities. Goedert will also work on strengthening key muscle groups in the neck, as well as addressing vestibular impairments, which are very common with concussions. Vestibular (or inner ear) problems interfere with balance and coordination, and PTs have a variety of exercises to help Goedert improve his stability. As he progresses, the exercises will become more difficult to ensure he can tolerate the demands of professional football. There is even a formal treadmill program that measures heartrate and symptoms that Goedert will likely participate in to make sure he can return to football safely. His PTs will know the signs of a poor response to exercise to make sure he isn’t doing too much, and hopefully in the next 2-4 weeks, he will be able to make a full recovery and return to football, just in time for the Eagles to make their playoff run.

Wondering what PT for a concussion might look like?
Take a look at this video to see a few activities that would be included in the early and late stages of rehab for a concussion.

Sources:
https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-concussion

From Student to Owner- Haddon Heights Here I Come!

In June of 2014 I started my last 6th month clinical rotation as a Student Physical Therapist at 3DPT. That first day as a student I was nervous but also excited to be at such a great company and to have the opportunity to learn from two great mentors; Jeff and Ken. It is hard to believe 7 years later I am now partnering with 3DPT and opening up my very own office in Haddon Heights! I never initially thought I would go into ownership, I knew that out of school I wanted to focus on advancing my skills as a clinician and learning new techniques to better serve my patients. I focused on earning two advanced board certifications in orthopedics and sports and hands-on treating skills of which I am Full Body Certified in Active Release Technique (ART). I thought after all of these courses I would feel satisfied, but I found myself wondering, “what’s next?”

I had the opportunity to work alongside Chuck Bachi in the Haddon Township Office. If you know Chuck, you know he is very goal oriented. He helped me focus my goals and gave me the opportunity to develop my leadership and business skills through managing the Haddon Township Office.

The Haddon Township office is thriving and when it became apparent that in order for 3DPT to continue to be able to serve more and more people in this area we would need another location, it was a no brainer for me to jump at the chance. I am excited to be able to offer the same great care that all of our 3DPT clinics offer to the Haddon Heights and surrounding communities!

Jessica currently lives in Marlton and when not treating likes to run and exercise and spend time with her husband, Damon, and their Dog and Cat, Palmer and Thor.

3DPT Haddon Heights will be open this November! We’re located at

500 Grove Street, Suite 100
Haddon Heights, NJ 08035
856-617-0175

To make an appointment now, call us at 856-617-0175 or visit our website.

Week 9: Mike McGlinchey

At a Glance –
Player:  Mike McGlinchey
Position: Right Tackle
Team: San Francisco 49ers
Injury: Torn Quadriceps Tendon
Projected Recovery Time: 4-6 months

In Detail:

The 49ers have seen their fair share of injuries this season, especially those involving the knee. During this week’s game versus the Cardinals, the 49ers lost a notable player, Mike McGlinchey, to a torn quadricep. Though it has not been disclosed if it was the tendon or muscle itself that was torn, this injury comes as a particular blow to the 49ers because McGlinchey was having his best season in the NFL. However, this injury is severe enough to cut that standout season short. McGlinchey will likely be undergoing surgery in the upcoming weeks to re-attach/repair the damaged muscle or tendon, and he will be spending a lot of time with his physical therapist to prepare for next season.

The quad is made up of four muscles that come together to attach to the kneecap via the quad tendon, and these muscles are primarily responsible for knee extension and hip flexion. The quads are some of the most prominent muscles involved in running and squatting, and a complete tear in the quad, whether it was through the tendon or muscles themselves, is a disabling injury. Surgery is almost always necessary to help a person return to full function, and McGlinchey will have to put in the work with his rehab team to be back in 2022. After surgery, McGlinchey will be immobilized in a knee brace, limited to walking with crutches for up to 8 weeks.

During these earlier phases, focus will be on ensuring his knee reaches neutral for extension and to gradually introduce knee flexion. Around 8 weeks, gradual weight bearing activities can start, and McGlinchey will be able to trial mini squats, step ups, and other functional movements that are quad dominant. Around 11 weeks, he will be able to start single leg activities, which will be key in restoring balance and movement patterns to ensure McGlinchey will be strong enough to return to play. Later phases of rehab focus on the quad’s ability to withstand higher level stresses, especially in single leg stance, and that the quad muscles maintain their flexibility, as quad inflexibility is predictive to further injury upon return.

Players that play the right tackle position are specifically known for being the best run blockers on the offensive line, which means McGlinchey needs a lot of lower body stability to counteract and block opposing players, and the sudden impact he will have to match could potentially cause another quad tear if he is not strong enough. Luckily, McGlinchey is known for his work ethic and will undoubtedly put in the time for his comeback season. For now, the 49ers will have to rely on a rookie or two to try to take his place.

To see what McGlinchey’s PT program for a quad tear might include, take a look at the video to see the team demonstrate a few exercises.

Source:
https://www.espn.com/nfl/story/_/id/32584934/source-san-francisco-49ers-rt-mike-mcglinchey-season-torn-quadriceps

Week 8: Dak Prescott

At a Glance –
Player:  Dak Prescott
Position: Quarterback
Team: Dallas Cowboys
Injury: calf strain
Projected Recovery Time: 2-6 wks

In Detail: 

The Cowboys have been on a roll this year, whether we like it or not, and that is largely because of their quarterback, Dak Prescott. Dak has made an incredible comeback after suffering a very ugly injury to his right ankle during last season, which took surgery and months of physical therapy to rehab. Unfortunately, it is to this particular ankle that he suffered a calf strain while playing against the Patriots during Week 6. Because of Dak’s extensive injury history, it is difficult to determine how long he may be out; his return largely depends on the extent of the calf strain. Since Dak is week-to-week, it is likely he suffered a Grade I or II calf strain, in which there is mild to moderate damage to the muscle fibers but not a full thickness tear (known as a Grade III strain), which often requires surgical intervention. Dak’s return will largely depend on the strength, flexibility, and pain of the injured calf, which means he will be working very closely with his physical therapist to try to play against the Broncos in Week 9.

The calf itself is made up of two muscles: the soleus and gastrocnemius. These muscles are largely responsible for propulsion with running, and Dak needs them to be fully functioning if he wants to be a mobile quarterback. In the earlier phases of rehab, focus will be on strengthening in non-weight bearing positions to avoid putting too much stress on the healing calf. Following Dak’s injury, it may be likely that his ankle lacks some flexibility, meaning there is increased strain on the two muscles. His therapist can perform ankle mobilizations to promote improved range-of-motion of the ankle, and coupled with targeted gastroc/soleus stretch, Dak will see improved ankle excursion that will help him avoid re-aggravation of the strain. As the healing process progresses, his PT will design a program to allow him to gradually load the muscle and tendon to prevent both atrophy and overuse, as both of those outcomes can delay his recovery even more. This program will include several single leg exercises, specifically focusing on single leg calf activation via heel raises and single leg jumps, to ensure that Dak will be able to perform all required of him during the game. Once Dak can participate in treatment sessions and practice without limitations or pain, he will be able to return to play. Regardless, Dak should make it back in time for playoffs, and with how the Cowboys have been playing, it is pretty likely he will still be needed.

Take a look at this video of the West Berlin team demonstrating a few exercises for a calf strain injury during the various stages of rehab.

Source:
https://dknation.draftkings.com/2021/10/31/22752803/dak-prescott-injury-status-update-news-fantasy-football-week-8-cowboys-vs-vikings-backup-cooper-rush

Week 7: Baker Mayfield

At a Glance –
Player:  Baker Mayfield
Position: Quarterback
Team: Cleveland browns
Injury: fractured humerus, labrum tear, shoulder dislocation (of non-throwing arm)
Projected Recovery Time: 6-24 weeks, though may be able to return at 4 weeks

In Detail: 

The Browns have been one of the most exciting teams to watch in recent years, largely due to the addition of their star QB, Baker Mayfield. Baker has helped the Browns make greater strides towards the postseason since he was drafted, but the Browns will have to make do without him for a few weeks at least due to a shoulder injury to his non-throwing arm. He has been dealing with a shoulder problem since the beginning of the season, when he reportedly dislocated his shoulder playing against the Texans during Week 2, and since then has been dealing with shoulder instability and multiple dislocations. It has been disclosed that Baker has been dealing with a torn labrum, but recent reports also state that Baker has sustained a fracture to his humerus, specifically the greater tubercle, where portions of the rotator cuff attach, meaning his injury has become more difficult to treat he still is to remain active on the roster. During this past week’s Thursday game, Baker did not play, but it has not yet been disclosed how many games he may be missing.

Baker certainly has a lot going on with his shoulder, but the humerus fracture coupled with the shoulder dislocation is concerning. If he returns prematurely to play, Baker may sustain further injury as he is unable to protect himself if he falls or gets hit. The fractured humerus especially could worsen if Baker’s shoulder dislocates again and will largely dictate whether he needs surgery or not. Two major muscles of the rotator cuff, the supraspinatus and infraspinatus, attach to the greater tuberosity, meaning the rotator cuff is unable to fully stabilize the shoulder with activity. Baker may not even be permitted to use those muscles to allow time for the bone to heal. Typical bone healing takes 6-8 weeks as long as everything goes as planned, and this timeline does not account for the torn labrum Baker is also dealing with, which takes about 4-6 months to rehab. Fans are hoping he is able to delay the surgery until the offseason, which could jeopardize his start for the 2022 season, not to mention jeopardize his shoulder if he sustains any additional injury during this season. His healthcare team is closely monitoring the situation and have released a statement that Baker won’t be cleared to play unless safe to do so. Regardless, physical therapy has a huge role in Baker’s return. For both fracture and labrum repair, the focus of his rehab will be stability, especially of the rotator cuff musculature, to prevent any further dislocation. In early sessions, Baker will be restricted to isometric sets (muscle fires but arm doesn’t move), allowing early muscle activation without compromising the involved sites. As time goes on, Baker will be introduced to higher level strengthening, such as weight bearing, which is an excellent way to promote strength and stability. Perturbation training (unpredictable movements applied to the arm) will also be key to ensure Baker can utilize the scapular stabilizers and maintain proper positioning of his arm, even in unexpected situations, to ensure he is able to react and protect the shoulder during games. If surgery does occur, Baker is looking at a 4-6 month recovery, which is not ideal but necessary to ensure his shoulder heals. For now, it’s up to Case Keenum to help the Browns to postseason, and if his previous experience is any indication, the Browns seem to be in capable hands.

Take a look at this video to see what a PT program for all of Mayfield’s injuries could include at the various stages of rehab.

Source:
https://sports.yahoo.com/baker-mayfield-report-offseason-surgery-152018306.html

Week 6: Antonio Gibson

At a Glance –
Player:  Antonio Gibson
Position: Running back
Team: The Washington Football Team
Injury: Stress fracture in shin
Projected Recovery Time: 6-8 weeks, though may be able to return at 2-4 weeks

In Detail: 

The Washington Football Team has seen its fair share of injuries so far this season, and during this week, one of their biggest playmakers (not to mention, a staple to several Fantasy rosters) made an early exit from the game against the Chiefs. Antonio Gibson, a standout in his sophomore year in the NFL, has been dealing with a stress fracture to his shin for the past several weeks, and though he has been able to manage the stress fracture with limited reps during practice, he suffered worsening pain in his leg during the game that sidelined him after only 10 carries. Gibson has recently undergone an MRI, and though reports have not yet been released about his current status, it is likely he may miss some time. Stress fractures are overuse injuries, often resulting from repetitive forces to bones, and often require prolonged rest from higher level activities to heal.

A stress fracture is a small crack typically occurring in a weight bearing bone, and this injury doesn’t simply develop overnight. Sudden increases in physical activity and inadequate training are often the culprits that cause a stress fracture, and this type of injury is often seen in runners and athletes in high-impact sports. As a running back, Gibson is exposed to plenty of activities that involve impact, and he likely did too much too quickly at the start of the season. When bone is overloaded too quickly with activity, the body breaks down older bone faster than it is able to replace it, leading to small fractures in the areas most affected by the impact. If left unaddressed, this injury can even progress to a full fracture through the bone, leading to greater complications and often long-term issues. The greatest treatment for this injury is to refrain from impact activities and gradually return with the assistance of physical therapy, meaning that, unfortunately, Gibson might be out for some time to allow his stress fracture to heal. Working with his physical therapist will help Gibson return in a safe manner, and the earlier phases of rehab will focus on building lower body strength in a manner that does not put excessive stress on the affected site. Efforts during early treatment sessions will focus on correcting any lower body muscle weakness and poor movement patterns that may have contributed to increased stress on the bone. Gibson may even have to be immobilized in a boot depending on the severity of the fracture, again with the intention to offload the bone and allow it time to remodel and heal. His physical therapist will gradually reintroduce weightbearing and then impact activities to allow the bone to remodel in a safe manner, and Gibson’s symptoms will help guide his progress. If he starts feeling that chief complaint discomfort, his PT will know to step back to prevent a recurrence or setback. Stress fractures take 6-8 weeks to fully resolve, but Gibson may be able to return earlier to games if his reps are limited and he has minimal pain. Radiographs (x-rays) may not always detect stress fractures or be able to track healing, but MRIs can help with determining if the bone is responding well to therapy sessions and activity modifications. Though it may be tough for the Washington Football Team to go without another one of their key playmakers, it is essential for Gibson to address this injury before it worsens so he can be 100% when the WFT plays its divisional rivals during the second half of the season.

Check out this video to see the team demonstrate a few exercises that may be included in all stages of a rehab program for a stress fracture of the tibia.

Sources:
https://www.cbssports.com/nfl/players/playerpage/2960976/antonio-gibson

Family first: My journey to 3DPT Deptford

It’s hard to believe that in just a couple of weeks, one of my life’s goals will be coming true – I will officially be opening a new 3DPT clinic in Deptford, NJ!  Opening a new office for 3DPT has actually been a goal of mine since even before joining the team.  Back in 2011, while I was still in my undergraduate studies at the University of Pittsburgh, Ken Guzzardo (my brother-in-law) partnered with Jeff Sallade to open 3 Dimensional Physical Therapy. Once I graduated and began my Doctorate in Physical Therapy at Drexel University in 2013, I immediately sought out mentorship from Ken. After earning my DPT degree in 2016, I spent a few years practicing in Philadelphia, and during that time was able to grow as a clinician, but in the back of my mind I knew my career was missing something…family. In January 2020 I had the opportunity to join 3DPT’s Medford clinic and that “empty” feeling went away – because 3DPT isn’t just any regular workplace, it’s a part of my family.

Having spent almost 2 years at 3DPT Medford and now planning for 3DPT Deptford, I’m excited to continue to contribute to 3DPT’s mission:

To raise the standard for the healthcare and workplace experience to best serve our community. 

I’ve witnessed firsthand that this is exactly what 3DPT truly does. Everything we do has one goal in mind – to provide a great experience for every patient, every single visit. I have been incredibly fortunate to have spent the past 2 years learning and growing from Jeff, Ken, each partner and manager in our offices, my fellow PTs, our entire staff and our amazing patients. I’m extremely honored and excited to bring our 3DPT family to the Deptford community!

Zach currently lives in Oaklyn and when he is not at 3DPT you can find him spending time with his wife, Nicki, and their 2 dogs Leo and Luna.

He’s a diehard Eagles fan (Go Birds!) and University of Pittsburgh football and basketball fan regardless of their record.

3DPT Deptford will be open this November! We’re located at:

The Court at Deptford
1500 Almonesson Road, Suite 7
Deptford, NJ 08096

To make an appointment now, email us at deptford3dpt@gmail.com.

Here’s a first look at the 3DPT Deptford clinic!
 

Week 5: Russell Wilson

At a Glance –
Player:  Russell Wilson
Position: Quarterback
Team: Seattle Seahawks
Injury: Mallet finger, finger fracture
Projected Recovery Time: 4-12 weeks

In Detail:

Thursday night’s game was Russell Wilson’s 165th consecutive start as a QB.

Russell Wilson is one of those quarterbacks that is always fun to watch, and everyone knows when he’s on the field, that the Seattle Seahawks always have a chance to win. Wilson is also known as one of the most reliable players in football, as he has never missed one game in his career in the NFL (which began in 2012!!!). That is, until this week, when Russ suffered an injury to his throwing hand during the Seahawks vs Rams on Thursday night. During a throw in the third quarter, Russ hit his hand on D-tackle Aaron Donald and was unable to play after the following possession. Russ was unable to finish out the second half, and after a few days, it was confirmed that Russ suffered 2 pretty serious finger injuries – a finger joint fracture and, even worse, a ruptured finger extensor tendon (which is known as mallet finger). The ruptured tendon typically requires surgery to help a person return to sports, and Russ has already undergone surgery to start his recovery process. He will hopefully be ready to return around Week 8 at the earliest.

Russ will start working with his physical therapist within the first few days post-op. There are specially trained PTs who treat hand injuries specifically, known as Certified Hand Therapists, and a Hand Therapist will likely be the one in charge of Russ’ care. Recovery from mallet finger requires several weeks of immobilization of the hand via a protective orthosis, which his therapist will fabricate for him personally, and Russ will be wearing this for most hours of the day for the first 8-10 weeks post-op, especially with sleeping. For tendon repairs, active finger extension (straightening) and passive finger flexion (bending) are off-limits for the first 8 weeks as there is often a second surgery during that time frame to remove the pin that fixates the healing bone/tendon, and early goals of rehab will revolve around maintaining strength and mobility of the uninvolved fingers, as well as preserving range-of-motion of the joints of the finger involved. It will take ~6-8 weeks for the involved joint to heal from the fracture as well. As the weeks progress and Russ has less limitations in motion, he will be able to initiate strengthening, and a major focus of treatment will then transition to building grip strength, which is a major impairment from this injury. As you can imagine, grip strength is extremely important to hold and then throw a football, and Russ will spend plenty of time practicing throwing with his PT to make sure his form and comfort levels are similar to pre-injury. In a normal patient population, recovery takes 12+ weeks, but elite athletes are always the exception, and Russ may return in as little as 4 weeks if everything goes smoothly. Until then, Geno Smith will take over as starting QB, hopefully keeping the Seahawks in the competition until Russ can have his spot back.

Russell Wilson’s physical therapy program will likely be with a hand specialist and may include some of the exercises you can see in this video.

Sources:
https://www.orthoillinois.com/wp-content/uploads/2016/12/ExtensorTendonISurgeryMalletFinger2017.pdf
https://www.seattletimes.com/sports/seahawks/russell-wilsons-injury-leaves-the-seahawks-at-a-bleak-crossroads-could-it-portend-the-end-of-an-era/

Week 4: Isaac Seumalo

At a Glance –
Player:  Isaac Seumalo
Position: Guard
Team: Philadelphia Eagles
Injury: Lisfranc
Projected Recovery Time: 6-9 months

In Detail: 

Not the offensive line again!

The Eagles suffered yet another hit to their offensive line during Monday night’s game against Dallas. Isaac Seumalo became the third O-lineman to be injured this season already, and his particular injury to the foot, known as a Lisfranc injury, means he will be out for more than this past week’s loss against the Chiefs – this injury is season-ending.

The Lisfranc injury occurs when there is an insult to the Lisfranc ligament, which runs from the 2nd metatarsal (long bone of 2nd toe) and medial cuneiform (a bone on the inner part of your foot). If there is disruption of this ligament, the bones in the foot can become misaligned and a person may experience feelings of instability at the midfoot joints. Additionally, with this type of injury, fractures of surrounding bone and damage to connective tissue are common. If the injury consists of bone fractures, cartilage damage, and/or midfoot misalignment, conservative treatment is not enough, and surgery must be utilized to correct the injury. Though the extent of Seumalo’s injury has not been disclosed, it is clear that there is significant damage to his foot as he is indeed undergoing surgery in the upcoming weeks for his Lisfranc injury.

Surgery typically involves re-aligning the base of the 2nd metatarsal to the medial cuneiform bones and stabilizing them via plates and screws. Immediately after surgery, progress is typically slow-going, as Seumalo will be under non-weightbearing restrictions for up to 6 weeks to allow the foot to heal. Around the 6-week mark, he will get the “ok” to walk in a boot and start working with his physical therapist, and the goal of this early phase is to start to address range-of-motion and foot strength impairments. He will progress to full weightbearing around the 8-week mark and be able to progress to more dynamic strengthening and balance training. Around the 16-week mark, he will be able to progress to lower level dynamic activities, meaning at this point he will be able to start his return to running process if he has adequate calf strength and ankle range-of-motion, as well as low pain levels. At this phase, patients typically struggle with calf strength and balance, which are both essential for the guard position as it requires a lot of calf power and lower body stability, and a major focus of Seumalo’s rehab sessions as this time will focus on those two components to ensure that he will be able to return to football without risk of re-injury. It can take up to 9 months for him to be fully ready to return to games, which gives him plenty of time to prepare for the 2022 season. As for the Eagles, hopefully their lineman problems stop here so they can recover and refocus their efforts on beating the Panthers this Sunday.

Sources:
https://www.inquirer.com/newsletters/eagles/eagles-isaac-seumalo-kvon-wallace-20210929.html
https://www.orthovirginia.com/UserFiles/File/microsites/Eastwood/Eastwood-Lis-Franc-Protocol.pdf

To see some of the things Seumalo will likely be doing once he does start PT, take a look at the video below to see the team demonstrate a few early stage and late stage rehab exercises for a lisfranc injury.

Week 3: Christian McCaffrey

At a Glance –
Player:  Christian McCaffrey
Position: Running back
Team: Carolina Panthers
Injury: Hamstring Strain
Projected Recovery Time: 2-8 weeks

In Detail:

Hamstring strains are already too common this 2021 season, and the latest victim to this injury is a key player on the Carolina Panthers (and probably your Fantasy League’s #1 draft pick).  Christian McCaffrey, known as one of the best running backs in the league, left the game against Houston on Thursday during the third quarter. After being evaluated in the injury tent McCaffrey ended up heading to the locker room for the remainder of the game and left the fate of the Panthers in his teammates’ hands. Luckily, the Panthers got the win, but on the down side, it has been confirmed that McCaffrey sustained a hamstring strain and it’s unknown at this point when McCaffrey will return. Hamstring strains tend to be very nagging injuries, however recent reports confirm that McCaffrey’s strain is likely low-grade and not as severe as originally thought and he is expected to return sooner rather than later. Low-grade strains are classified as mild, with minor damage to individual muscle fibers but preservation of the muscle as a whole. Strength and flexibility may be impacted but minimally, whereas with higher grade strains, you can expect to have significant loss of function.

Regardless of the severity, hamstring strains have high recurrence rates, meaning that re-injury is likely. McCaffrey’s ability to return, especially without having a re-aggravation of that injury, will be largely dependent on his work with his physical therapy team. McCaffrey’s treatment plan will focus on addressing strength and flexibility impairments so he can return to sport with minimal risk of re-injury, and manual therapy and other modalities will be used to improve pain level so he can make a quicker return. Emphasis of his program will be on improving eccentric hamstring strength, which is essential for his position as a running back. CMC is sprinting during the majority of his time on the field, and running requires a LOT of eccentric hamstring strength as your hamstring is used to control your leg as you swing it forward. The recovering hamstring muscle will be put to the test constantly during McCaffrey’s routes and carries so it is crucial for him to work with his rehab team to avoid being sidelined by this injury again. Typical exercises to “bulletproof” the hamstrings include hamstring bridges, hamstring curls, and nordic leg curls. CMC may be able to return as early as this week to football, but he is going to continue rehabbing that hamstring for the remainder of the season. Hopefully he’s back sooner rather than later – the 3-0 Panthers seem to be on a run!

To see what CMS’s rehab might include, take a look at this video to see the team demonstrate a few exercises that would be included in both early stage and late stage rehab for a hamstring injury.

Source:
https://www.panthers.com/news/christian-mccaffrey-placed-on-injured-reserve

Week 2: Ryan Fitzpatrick

At a Glance –
Player:  Ryan Fitzpatrick
Position: Quarterback
Team: Washington Football Team
Injury: Subluxed Hip
Projected Recovery Time: 6-8 weeks

In Detail: 

The Washington Football Team has lost a legend (for at least 6 weeks) during their opening game to the LA Chargers. Ryan Fitzpatrick, a seasoned veteran in the NFL, suffered a subluxed hip from a hit during the second quarter and didn’t return for the duration of the game. He was placed on the IR shortly after, with reports confirming the extent of the injury and the potential for Fitzpatrick to have to undergo surgery in the upcoming week. However, after consulting multiple physicians, Fitzpatrick decided to treat his injury conservatively, meaning he opted not to have surgery and participate in rehabilitation instead, and he is hoping to be back to play after the bye week in Week 9. This return date will be determined by the severity of Fitzpatrick’s injury, as well as how well Fitzpatrick responds to physical therapy.

A hip subluxation is a partially dislocated hip, in which the femur is partially forced out of the hip socket. The hip is a particularly stable joint, meaning that this sort of injury takes a lot of force to occur. The severity of the injury depends on damage to the surrounding connective tissue, as well as if there was any damage to the femur itself. Oftentimes, if there is a femur fracture, surgery is required to reduce the femur (or put it back) into place. Connective tissue damage can equally warrant surgery, especially if the labrum, which provides essential stability for the hip, is damaged, which can really prolong the recovery. However, since Fitz is able to avoid surgery for now, it seems that the extent of soft/bony tissue damage is minimal, meaning he can aim to be back sooner rather than later. His ability to return safely, though, is largely determined by how his rehab goes. Physical therapy is going to be a huge part of Fitzpatrick’s routine in the upcoming weeks. During the course of rehab, focus will be on increasing muscle strength, as well as restoring hip movement, in a safe and graded way. The earlier phases of hip rehab will emphasize lower level strengthening, including isometrics (strengthening muscles without movement), and care will be taken to avoid motions that may aggravate the hip or elicit symptoms of instability. As Fitzpatrick gains his strength, he will be able to progress to single leg activities and plyometrics. It won’t be until the later phase of rehab that he will be cleared to participate in practice without limitation. Since meaningful improvements in muscle strength take at least 6 weeks to see, Fitz won’t be ready to go until Week 8 at the earliest, though a more realistic timeframe is Week 10, as long as Fitz doesn’t see any setbacks during his recovery. Until then, The Football Team will have to rely on Taylor Heinicke, who had an impressive showing against the Bucs during playoffs last season. From the looks of Week 2, the Football Team seems to be in capable hands.

Watch this video to see a few demonstrations of exercises that may be included in the rehab of a hip subluxation – 2 for early stage rehab and 2 for late stage rehab.

Source:
https://profootballtalk.nbcsports.com/2021/09/16/ryan-fitzpatrick-not-having-surgery-on-hip-injury/

Saving Private Practice Physical Therapy: IPTA

Over the last decade, the healthcare industry has gone and is still going through some big changes. Some changes, with advances in technology, have made our lives easier like the ability to see your doctor over the computer (telehealth), online scheduling of appointments, prescriptions automatically sent to the pharmacy, etc. On the other hand, other changes aren’t so great. Maybe your favorite doctor’s office changed ownership or you’ve had to change your doctor or prescription because of changes in insurance coverage.  With large hospital systems merging and private equity companies acquiring as many healthcare facilities as possible, we see less and less smaller practices, who are now being forced to make a decision to sell to a larger entity or try to ride it out themselves.

So what’s a small business to do in this changing environment? As Lou Holtz said, “In this world, you’re either growing or you’re dying. So get in motion and grow.”  At 3DPT, we believe strongly in our ability to provide a great healthcare experience for our clients in an environment that our co-workers genuinely want to come and work in each and every day. We have no plans to change this!  We are committed to growth and so we’ve created Independent Physical Therapy Associates, or the IPTA.

IPTA is a group of independent physical therapy companies that will come together under one tax ID number for billing, Human Resources, and compliance, all while each company retains its name, ownership, and community recognition, as a division of the IPTA. Joining together as one group will help to ensure that private practices do not have to make the decision to increase patients per hour, to cut corners to save costs, or sell to a larger entity. And that in-network private practice represents why we all wanted to be a Physical Therapist in the first place – to help people regain their lives!

The mission of the IPTA is to save private practice Physical Therapy. We believe our clients should be able to use their insurance that they pay a lot for in their premiums to have access to high quality clinicians who care about their goals without having to add multiple patients per hour or hand off care to a PT aide. We believe in growing by having the right people in place who can provide this care and ensure the quality remains at the forefront of their minds. And we believe in not growing too large too quickly or else you dilute what has allowed us to flourish over the last 10 years.

What does IPTA mean for 3DPT patients?

It means that you can be confident that you will get the great care and experience that 3DPT has always been committed to!  By forming the IPTA and combining with other private practices who believe in the same quality of care that we believe in, we are allowing our patients a third option. Instead of choosing a larger health system where you may be seen along with many other patients per hour, or having to go out of network or cash based for one-on-one care, we are ensuring that our patients can continue to use their health insurance while seeing an IPTA division.

3 Dimensional Physical Therapy is still 3 Dimensional Physical Therapy, but now a division of IPTA. We’re proud to be leading this initiative to save private practice Physical Therapy!

Click here to learn more.

Week 1: J.K. Dobbins, Gus Edwards, Marcus Peters

At a Glance –
Player(s):  J.K. Dobbins, Gus Edwards, Marcus Peters
Position: Running back, Running back, Corner (Respectively)
Team: Baltimore Ravens
Injury: Torn ACL
Projected Recovery Time: 6-10 months

Although several teams have lost players to injury during the pre-season, the Baltimore Ravens have been bitten pretty significantly by the injury bug, just days before the regular season kicked off.  J.K. Dobbins, Gus Edwards, and Marcus Peters all sustained the same season-ending knee injury during practice –  the dreaded ACL tear – leaving the Ravens organization scrambling to fill the running back position.

ACL tears are very common among football players, resulting from rotational stresses, sudden changes of direction, and/or poor landing mechanics, and the recovery requires surgery and months of physical therapy. The ACL, or anterior cruciate ligament, is a key stabilizing structure in the knee that limits the forward movement of the tibia on the femur, and without the ACL, it is much more difficult for the surrounding structures to maintain knee stability, especially in weight bearing. NFL players are elite athletes that have to be able to withstand crazy physical stresses on the body, meaning knee stability is essential to perform well and avoid further injury, and for this reason, most NFL players opt to get ACL reconstruction surgery. This surgery, however, takes months to recover from (and a lot of rehab), meaning the Ravens will have to make do without these three players.

During the ACL reconstruction surgery, tissue is taken from the tendon of the quadriceps, hamstrings, or patella and anchored to the tibia and femur, providing similar stability as the original ACL. However, it takes up to two years for the new “ligament”, or graft, to fully resemble a normal ACL. Physical therapy starts just days after surgery. The first few weeks of rehab will focus on improving pain levels, decreasing swelling, and recovering range of motion and quad muscle strength, and around the 3-month mark, a person can finally be cleared to run. Strengthening of the quad, glutes, and hamstrings will be prioritized during sessions to improve lower body control and eliminate any muscle imbalances that may have contributed to the initial injury. The later phases of rehab will focus on proper technique with cutting, pivoting, and single-leg activities, with an emphasis on proper landing mechanics and dynamic balance. Protection of the graft is the biggest priority throughout rehab, as well as decreasing the risk of re-injury, which unfortunately can be common after the initial injury.

Though NFL players are outstanding athletes, recovery after ACL reconstruction will take at least 6 months because the healing and remodeling of the graft will follow that 2-year timeline despite any strengthening or balance training efforts. Therefore, if the Ravens players have no complications post-op, they will likely be ready to participate on a limited basis in OTAs and camp in anticipation of the 2022 season. Oftentimes, ACL tears are accompanied by damage to other structures in the knee that may not be reported, and if this is the case, recovery will be prolonged. Whether these players are back in 6 or even 10 months, it is clear that the 2021 season is finished for them, and they will spend the rest of the year with their PT team preparing for their comeback season. In the meantime, the Ravens will have to do their best to put these injuries behind them in their pursuit of the elusive Lombardi trophy. From the looks of Week 1, they’re off to a great start.

After ACL reconstruction surgery, Physical Therapy is essential to helping regain strength, mobility, flexibility and flexion for everyone.

Here are few examples of exercises that could be a part of an ACL rehab program. The first 2 moves would be applicable in Early Stage rehab, right after surgery and the second 2 moves would be applied in late stage rehab.

Source:
https://www.cbssports.com/nfl/news/ravens-rb-j-k-dobbins-vows-to-return-better-than-ever-following-season-ending-acl-injury/

3DPT celebrates 10 years!

On August 18, 2021 3DPT officially turns 10!  It’s crazy to believe how fast 10 years have gone by. Sometimes the days and the weeks are slow, but 10 years in business really has gone by fast.

Parents often talk about how quickly it seems their kids grow up and it’s true! My kids are now 9 and 11 (Ken and I started 3DPT in the middle of them being born!) and whenever I see pictures of them as babies or toddlers, it makes me a little sad that they have grown out of that stage and I can no longer scoop them up and hold them like I used to.

But unlike with my kids, it doesn’t make me sad at all to think about 3DPT back in the first few years that we were open. Like all small business owners, Ken and I were working crazy hours, doing everything we could think of in order to get the business going. Our biggest worry in the early days was having enough people to treat in order to keep the doors open. Now we have grown more than we could have ever imagined – 5 offices with 2 more coming soon.

Just the other day I ran into a former patient who came into 3DPT in our first year of being open. As we were talking, she asked how 3DPT was doing and I told her that we were celebrating our 10 year anniversary this month. Her response was “10 years! Has it already been 10 years?” She was also blown away at how fast those 10 years had gone by.

And so are Ken and I!  3DPT has defied the odds, as only 30% of small businesses make it to the 10 year mark. So when I think back to the early days of 3DPT I get a feeling of pride and I get excited to think about what will happen with 3DPT in the next 10 years.

So how did 3DPT get to our 10th year?  There are a few reasons that come to mind. First, we wanted 3DPT to be the type of  place where we would want to work and where we’d want our own families to want to go for physical therapy. Keeping that and our Core Values top of mind has helped guide every decision from who we hire to how we work with our patients. (Click here to learn more about our core values!)

Second, Ken and I were smart enough to realize that the two of us alone did not have enough hours in the day to grow the company. We prioritized hiring really great people to help us with our growth. I am proud to say that we now have 6 other partners in 3DPT and over 60 phenomenal employees who all play a role in our success.

We also realized the importance of being involved in the communities where our clinics are located. I think most people appreciate small businesses and want to support them. All of our clinics look to develop great relationships with patients, physicians and partners in our communities and strive to be recognized as leaders.

10 years in business also warrants a “thank you” to a wide array of people, so I am going to list the 3 most important right here:

• Our family – especially our wives who are understanding of the time commitment it takes to run a business
• Our patients – we are honored you have chosen 3DPT to help you achieve better health!
• Our 3DPT family (employees) – we are grateful for your hard work every day and know none of this is possible without you!

Knowing how fast our first 10 years have gone, we’re looking forward to celebrating lots more over the next 10 years!

Click here for a message from 3DPT’s other co-founder, Ken Guzzardo.

PS To celebrate our 10 anniversary, we are throwing a big party & inviting our partners, communities and friends to help us celebrate.

On September 2nd from 5-8 pm at Medford’s Freedom Park, join us and other local businesses for a Small Business Community Block Party!

Get to know the businesses & neighbors that make our communities amazing AND stay for the live music food trucks, an inflatable obstacle course, prizes, games like pop-a-shot bball, speed pitch and soccer darts and more

Click here for more information.

Hip, Hip (not so) Hooray…yet!

It is amazing how quickly one year flies by. We have all experienced this – those of us with kids feel like the last day of school creeps up on us and it seems like the kids were just getting on the bus for their first day of school (well, maybe not this year, but you know what I mean).

This week marks one year since I had my other hip replaced. That’s right – I am 46 years old and I have had both of my hips replaced (the other one was 3 years ago). Call it bad genetics coupled with too many marathons – not a great combination. There are a bunch of people both inside and outside of 3DPT that know my situation and so I constantly get asked “How is your recovery going?” I usually spout off a quick answer of “Yeah, it is going pretty good” and since I am back to work and moving around normally, most people are pretty satisfied with that answer and the conversation moves on.

The reality is that this past year was hard. My recovery did not go as well as I wanted it to – mostly self-inflicted. I was a good patient for about a month, and then I stopped doing the things that I needed to do to continue my progress.

Crazy, right? I am a physical therapist so I should know better, but we often are the worst patients. After a few months of not feeling good and limping around the clinic (and my wife basically ordering me to get my act together), I decided to commit myself to the things I needed to do. The problem is, I really don’t like doing strength training, mobility training and yoga-type activities. I know it is what I need, but I would rather be out on my bike for 3 hours out in the Pinelands or hang with my friends on our 8-mile Sunday morning run from the Bagel Shop.

I struggled with being consistent in doing those “rehab” things and my recovery has taken longer than expected. The days where I do a yoga session or combine strength and mobility training, I feel like a new person. If I go for a 2- or 3-mile run, it usually takes me a day of feeling pretty crappy before I recover. I am starting to learn my lesson. If I eventually want to be able to go for that long run, I need to be more committed to doing the stuff that I despise doing.

I’m getting there and my mindset is slowly changing, but it is still hard. My triathlon friends are talking about doing an Ironman in Florida next year. I want to do all of the training and be there at the starting line with them and cross one more finish line. That is one of the greatest feelings I have experienced.  I guess I will have to endure a few more yoga classes and early morning strength training sessions to make it happen. Let’s hope these hips can get me there.

Here’s a video of Jeff talking about his experience as a patient and doing the exercises he likes the least!

Get to know 3DPT: Student Edition

Over the years, every 3DPT clinic has had the opportunity to work with numerous students who have done a clinical rotation with us for school. We have relationships with many of the physical therapy programs in the area (Stockton, Arcadia, Drexel, Widener and more) so that their students have the opportunity to spend time in an outpatient PT setting and can work with (amazing!) patients before jumping into their career as a therapist.  This is helpful for the students AND for us – not only is it rewarding to be able to act as a stepping stone for these students as they work their way towards becoming PTs, but on quite a few occasions some of the students have become 3DPT employees!

In this issue of “Get to know 3DPT” we thought it’d be great to “get to know” the student PTs that are currently with us – why they want to become physical therapists and a little bit more about themselves.  Matt Wolfe from Drexel is in our Haddon Township clinic and Carly Egrie is in our Medford clinic.  And Nate Fullam, who just finished up his time at 3DPT Cherry Hill, shared a little bit about how he feels about his time at 3DPT.

Matthew Wolfe, Drexel University
My name is Matthew Wolfe, a 3rd year PT student from Drexel University in my last rotation before I graduate in June. I am interested in outpatient physical therapy because of the wide array of people and diagnoses we see and the impact it can make on people’s lives. While I have not needed PT myself, my parents are mostly the reason I went into this field. They have had their fair share of physical therapy ranging from acute care to outpatient, with me and my siblings helping them out along the way and the rest is history. Since then, my goal has been to help people get back to their prior level of function and resume their normal daily lives.

Now a little bit about myself:  I played soccer all my life growing up with a few other sports sprinkled in. Outside of sports, I try my hand at as many hobbies as I can. Right now, I am an amateur video editor, car mechanic, computer geek, and furniture maker. I am always open to trying new things, even if it does not turn out well, I appreciate the experience. In June, I am moving to Port St. Lucie, FL, taking the boards in July, and finding a job. I am enjoying my time at 3DPT and learning a lot along the way. I hope to eventually work for a company with the same environment in the future.

Carly Egrie, Stockton University
Growing up, my dad had a close family friend that was a PT and his knowledge about the body fascinated me. He always had an answer on how to fix our ailments. Whenever we came to him with a complaint of pain, such as “it hurts when I do (fill in the blank)”, he always responded with his famous one liner of “well then don’t do that!” and followed it up with a solution on how to make us feel better. I decided at 14 that I wanted to follow his career path and started looking into how I could become a PT. I knew that PT was a perfect career, where I could combine my love for exercise/sports with my love of helping others. When I sustained a shoulder injury from swimming in high school, my journey to recovery further solidified my love for the profession. I remember taking notes on explanations from the PT who was treating me so that I could remember his knowledge when I had my own patients.

My desire to become a PT continued throughout my undergraduate studies at the University of Rhode Island. I studied Kinesiology and Exercise Science and further fell in love with how the human body works and how movement can be used as medicine. My adventurous spirit and hunger for knowledge led me to Australia my Junior year, where I completed a hybrid study abroad/internship program. I studied Sports Science for a semester and worked as an Athletic Trainer for a semi-professional Australian Rules Football Team. The team physiotherapists quickly become sources of inspiration for me, and I found myself digging deeper for more opportunities to learn. I ended up taking a full-time internship position in Australia and stayed for a second semester where I worked side-by-side with the team physiotherapists as an Athletic Trainer and aide. This experience was so enriching, and I showed up every day eager to gain as much as I could from my time working with the Football players and in the clinic. After I returned home to the US, I began my application process to PT school. I decided to stay locally and complete my Doctorate in Physical Therapy at Stockton University.

Throughout my studies at Stockton, I have continued to fall more in love with the PT profession. I completed my first clinical rotation at a Wellness Center where I had the opportunity to see how PT can be utilized holistically and in conjunction with other professions like acupuncturists, massage therapists, and personal trainers. I really enjoyed combining my love of holistic medicine with PT, making my first clinical a wonderful learning experience. My love for sports and working with athletes inspired me to search for clinics that treat active individuals. After asking friends and fellow PT’s, I came across 3DPT and knew it’d be an awesome fit for me. Throughout my journey here, I’ve learned that athletes love us as much as we love treating them. I’ve also loved the opportunity to work with a variety of patient cases and diagnoses to further expand my PT knowledge. The 3DPT community has truly made an impact on me and made me feel like family right away. I’m so thankful for the opportunity to learn and grow as a PT from all of the PT’s and patients at 3DPT!

Fun Facts

Favorite meal
Sushi, hands down

Favorite vacation spot:
My favorite place I’ve ever visited is a close tie between Australia and Thailand. But in terms of closer vacation spots, Ft. Lauderdale holds a special place in my heart!

Favorite movie:
All of the Star Wars movies (I’m a proud nerd)

Favorite sport to watch or play:
To watch = football (Go Birds! ☺), to “play” = dance (I’ve danced since I was 2 years old and was on a professional dance team!

Nate Fullam, Widener University
My time with 3DPT was nothing short of great. 3DPT helped me to grow and develop my skills as a rising clinician and I couldn’t be more thankful. This team is welcoming and they show that they truly care for each patient. I am proud that I was able to join this team and help them in their mission to help this community

Click here to check out a series of videos on Nerve glides to instruct viewers on ways to ease nerve pain

While the time we have with our students is short, we hope that the time they have at 3DPT and with our patients stays with them as doctors of physical therapy!

Commitment to Excellence

We are what we repeatedly do. Excellence, then, is not an act but a habit. This quote is attributed to Aristotle from all the way back in the 4th century, but is still so applicable today! Excellence is usually not something that is simply a “one and done” act but something that is continually strived for.  This is certainly true for us at 3DPT, and so much so that we made our Commitment to Excellence one of the 5 Core Values that define who we are. Excellence – or truly being the best – is what we as a company aim for everyday for our employees, our patients and our communities.

Excellence can be defined differently by everybody.  For an athlete, excellence could be a gold medal, a championship ring or a world record. Most people would agree that Michael Jordan was an excellent basketball player – he’s certainly got the championship rings to prove it! But besides the championships he’s known for, Michael Jordan’s commitment to being the best –  his work ethic – is just as well known. Excellence takes vision of what “the best” looks like, determination to get there and most importantly, actually doing the things that make you better.

So what does Commitment to Excellence mean for us at 3DPT?

Our definition of excellence is providing the best physical therapy care and customer service to our patients and communities.  We work toward that each day and here’s how we do it:

1. Hiring the best employees!
   Being the best takes teamwork and we are pretty sure we have the best team around! This isn’t by accident of course. We take a lot of time and consideration when hiring every employee – from aides to front desk employees to physical therapists.  We want to make sure that each potential employee aligns with our core values and can commit to providing excellent care.
2. Ongoing education and learning
   We hope you agree that our physical therapists are great at what they do! They all have a great combination of clinical expertise and compassion and care for our patients.  But it doesn’t stop there… our physical therapists are committed to continuous improvement and learning.  Every 3DPT employee participates in continuing education and certification courses throughout the year so that they can stay up-to-date on the latest and greatest practices, technologies and tools to help patients.
   (3DPT often hosts these classes so that all PTs in the south jersey area have access to great education!)
   
    
   Additionally, Did you know that 5 of our PTs are double Board certified in Orthopedics and Sports? And 1 PT is Board certified in Pediatrics?
   (PS there are less than 10 double board-certified PTs in South Jersey and 5 work at 3DPT!)

   To become Board Certified, a Physical Therapist completes a one year residency program, or completes 2,000 hours of work in that specialty before taking a board examination. This is after completing both a four year Bachelor’s degree program and a three year Doctor of Physical Therapy (DPT) program. To maintain this certification, Physical Therapists need to stay up to date on the latest breakthroughs and treatment approaches.

3. Continuous improvement of how we do things
   Great PTs provide wonderful care but a patient’s overall experience with 3DPT is more than the physical therapy program.  Your experience starts on your first call to make an appointment!  From the friendly person you talk to, the ability to get an appointment quickly and at a time that’s convenient for you, to the verification of your insurance coverage and copays, it’s important that every step of the way is the best it can be. Our Operations Director, Jeanine, is always evaluating our processes and systems to see where we can improve. The insurance verifications and billing teams continuously stay up-to-date on policies and procedures of insurance companies (which isn’t an easy task!) so that patients don’t have to wonder about coverage. And our wonderful front desk team makes sure patients are scheduled, temperatures taken and pretty much everything else in the clinic runs smoothly!
4. A team of leaders that wants the best
   Last but not least, 3DPT has a wonderful team of leaders that truly want to be the best for our employees and patients! Owners Ken Guzzardo and Jeff Sallade had a vision 10 years ago to start a physical therapy company that was different. A company that set the bar, not just for physical therapy clinics, but for the way patients and employees should be treated by all healthcare companies.  Now, 5 clinics later, that vision is still the motivation of all 3DPT managers. The leadership team leads by example when it comes to their commitment to excellence – still learning & taking classes, still delivering the best care and always looking for ways to make the patient experience better.  And even ways to make the physical therapy field better…Ken was just elected to be a Director on the NJ American Physical Therapy Association (APTA) Board!

As mentioned earlier, Excellence takes vision, determination and action. But it also requires one more thing – a reason to want to be the best.  For us, that’s the easy part – it’s our wonderful employees, patients and communities that let us be a part of their lives! We may not have a gold medal or championship ring, but we have the best patients around 🙂

Community Cares

For us at 3DPT, one of the best parts of being a small business is being a part of awesome communities alongside our patients, friends and other partner businesses.  We truly value the opportunities we get to take part in community events and to support local organizations. It’s been almost 10 years since we opened 3DPT and our commitment to the communities we’re a part of continues to be one of the most important things to us.  In fact, a few years ago when we formalized our Core Values, Community was at the top of our list!

What does that mean exactly?
It means we want to actively bring value to our communities and to support our towns, neighbors and partner businesses however we can.  We do this by hosting annual blood drives at each of our clinics, Toys for Tots collections and donations to various organizations throughout the year, sponsoring local sports teams & school events and getting involved in and supporting community events. And for the 9th year in a row, we are offering scholarships to graduating seniors of our local high schools!

This past year of quarantining and canceled events made getting together harder to do, but being a good neighbor is still as important to us as ever!  Here are a few ways each of our clinics were recently able to take part in our communities:

• 3DPT Medford has been busy organizing collection drives for a few great organizations!  Earlier this year we partnered with New Covenant Ministry to collect food and clothing items for those in need in Camden and Philadelphia, and right now, until May 1, we’re partnering with Medford Brownie Troop 20134 to collect shoes for Soles4Souls and Zappos for Good for those in need (feel free to drop off any new and lightly used shoes at our Medford office!)
  
• 3DPT West Berlin just finished up their donation drive of pet items to support Voorhees Animal Orphanage!  They were able to donate $450 and LOTS of items to help our furry friends!
  
• You may have seen us share about 3DPT Haddon Township’s flower sale, organized to raise money for a local family in need of a new van for their special needs children (the family adopted 4 children, 2 of which use wheelchairs.)  3DPT and our wonderful patients were able to donate $266 to support their fundraising efforts to purchase a new van with a built in ramp!
  
• If you’re around town in Cherry Hill, you may see that 3DPT Cherry Hill is a sponsor of a few local sports teams, including the Cherry Hill Soccer Club.  We also got to participate in CHYAA baseball’s opening day celebration. Check out this video!

https://youtu.be/y6iZFfod7dY

• 3DPT Tabernacle is located in NJ’s Pine Barrens and we recently got the opportunity to participate in a Wharton Forest clean up day. It was a great day with local friends and businesses and we were able to fill up 2 trucks with trash!
  

We’re grateful for the wonderful communities we’re a part of and we’re looking forward to being out and about with everyone again as events and opportunities continue to open up.

Thank you for being the best neighbors of all and for YOUR support of 3DPT!

Get to know 3DPT’s Dr. Lauren Vranich!

One of the most common questions I am asked on a daily basis is why did I become a physical therapist. The honest answer is that I could not imagine being anything else.

I grew up being very active in a whole bunch of sports. Soccer, softball, lacrosse, basketball, cross country, track… you name it, I probably tried it. I was most competitive with soccer, playing on various clubs teams and traveling all over the east coast. In high school, I stuck with soccer, basketball, and lacrosse where we won a few division championships and group titles and I made some of my best friends. In college, I retired to intramural sports and developed more of an interest in fitness at the gym.

When it came to academics, I always had more of an interest in my science classes. The human body is truly an amazing thing. I could never get enough of learning about how it worked from the most basic cellular level to larger muscle movements. This led to me choosing Biology as my major at Stockton University.

When I started to consider what would be an ideal career path that would combine my interests in sports and fitness with biology, it seemed like a no brainer to explore physical therapy. I came home for my first winter break as a college freshman and decided to volunteer at a local outpatient PT clinic to see what the profession was all about. I immediately loved it. I observed physical therapists interacting with a variety of people on a daily basis and helping them physically improve and achieve their personal goals. I decided this occupation was perfect for me. I returned to that clinic each winter and summer break throughout my undergraduate career to work as an aide and learn as much as I could in preparation of PT school.

I ultimately continued my education at Stockton University with their physical therapy program. On my third and final clinical rotation, I was placed at 3 Dimensional Physical Therapy in the Haddon Township office. This rotation ended up being a major milestone in my career path, in that I fell in love with the atmosphere and what the company stood for, to the point where I began my professional career in the same office and continue to work here today!

Over the past year and a half, I have had the opportunity to work with patients with a variety of diagnoses and injuries. It is truly so rewarding to be able to help people each day work toward their goals and return to activities they love doing. And that is why, when I look back at the road that led me to physical therapy, I can honestly say that I could not imagine myself in any other field!

Get to know 3DPT’s Barbie Barron!

When I first started applying to colleges, like many other high school students, I wasn’t exactly sure what I wanted to do for the rest of my life and what I would major in.  I always knew that I wanted to help people in some way but wasn’t sure exactly how. The only thing that I was sure about was that wherever I was going to attend college, they needed to have a softball program!

I have been involved in sports for as long as I can remember. Whether it was doing ladder drills or homemade obstacle courses in the garage or playing in a recreation league, I was always doing something.  I tried almost any sport you could think of from the age of 5 to middle school, but I realized that softball was my favorite by far. From then on I decided to devote all my time to working out and practicing so I could make my dream of playing in college a reality.

In high school, I played for Washington Township (where we won the state championship my senior year!) as well as for multiple travel teams around the south jersey area. During my high school and travel career, I knew that my goal was to play softball in college, but that I would also need to choose a school where I would get a great education as well. While I didn’t know exactly what I wanted to do long term, I began to lean towards a career in the health and medical field. My junior year anatomy class gave me the push I needed to really hone in on my interests and find something that could combine my love of science with my sports background.

After learning about how the body works and the complexities of movement I began thinking about how many injuries I had seen throughout my sports career and how many could have been prevented or healed faster if my teammates had this knowledge. While there are many careers that deal with sports injuries, many of them felt like a pit stop along the process and I wanted to be able to see it through to the end.

At the same time, my dad had been attending physical therapy for a frozen shoulder. I had the chance to shadow a few of his appointments and became very interested in the process. Then, a few weeks later one of my batting instructors told me about a small school in Philadelphia called The University of the Sciences where they were very big into science and other “nerdy things” that he thought I’d be interested in.  A quick google search, and then later a tour of the campus, and a meeting with the softball coach, I had learned that they had both a physical therapy program and a softball team. I was sold.

Throughout my time on the USciences softball team, I had a few minor injuries including a quadriceps strain and bicep tendonitis. Both times, I was lucky enough to be able to work with a physical therapist (who had previously been a USciences student) who was able to help me back on the field and return stronger than when I had left. I knew that I was interested in physical therapy when I started my undergrad but getting that firsthand experience made me even more excited to continue to the graduate program and eventually graduate with my Doctorate of Physical Therapy.

I have been with 3DPT for a little over a year and have already had the chance to work with so many amazing patients. With my experience as a collegiate softball player and having a few injuries myself, I can definitely relate to my patients who are athletes.  I know firsthand that athletes are anxious to get back to their sport as soon as possible after an injury, but now with my knowledge as a PT, I reassure my patients that it is better to rest and rehab rather than rush back and risk potential re-injury!

I am lucky to get to work with a lot of softball and baseball players at 3DPT West Berlin and I recently had the opportunity to help lead an injury prevention program with a high level softball team during their off season!  I’m excited to continue to meet more people and work with them to achieve their goals on and off the field!

From Aide to future Doctors of PT

If you have been to one of our PT clinics, you have likely had the chance to interact with our physical therapy aides. The PT aides at 3 Dimensional Physical Therapy assist the physical therapists with providing the best experience possible for all of our patients. They help to keep the clinic looking great, provide patients with heat or ice, and help patients get set up with exercises to keep their session moving along efficiently.

At 3DPT, we have been lucky to hire outstanding people as our PT aides. We prefer to hire people who have an interest in the healthcare field – someone who plans to move forward in a healthcare profession.  Over the years, we have had numerous employees who worked as PT aides get accepted into graduate school for physical therapy as well as programs for occupational therapy, nursing, athletic training and physician assistant.  It is rewarding to be able to act as a stepping stone for all of these employees as they work their way towards their end goal of becoming licensed healthcare providers.

We have 3 current employees who have recently been accepted into Graduate school for Physical therapy and will be leaving us over the next few months. Pat Fryer and Dominic Bilello, both PT aides in our Medford office, and Zach Bille, aide in our Haddon Township office will all soon be Doctors of Physical Therapy!

Pat and Dom have been some of the best aides 3DPT Medford has had the pleasure of working with. They always go above and beyond what they were required to do and exhibit all of the 3DPT core values.  They truly care about all of our patients and we often receive comments about how respectful and great they are. We are so proud of them for getting into school and we know they are going to be excellent physical therapists.

Zach has been working at 3DPT Haddon Township since his high school years. He has gone from helping the therapists a few hours a week after his soccer practices, to being our Lead Aide. He has shown that he is versatile in any role and any task we have given him. He has been in charge of ordering supplies, has learned the front desk duties and even does marketing tasks for us. Patients are always commenting at what a nice young man Zach is and how easy he is to talk to. Zach is known for getting patients water while they ice and engaging them in conversations. He has shown true interest in pursuing Physical Therapy as his career by asking to sit in on evaluations and ask questions about what patients are doing.  We are so excited and proud of him for getting into PT school!

Fun Fact:  Zach has been a willing participant in MANY of our YouTube videos demonstrating PT exercises!

Here’s what all 3 guys had to say about their time at 3DPT and their next steps:

Pat
I will be attending George Washington University for Physical Therapy starting August of this year. I could not be more excited for this opportunity to pursue a career I’m so passionate about. George Washington is located in Washington DC with countless opportunities nearby to explore the many different fields within physical therapy. I can’t wait to start this new journey, but it will definitely be sad leaving 3 Dimensional Physical Therapy. I’ve been working as a physical therapy aide here for almost 3 years now and I can confidently say that it has been the best job I’ve ever had. The people I work with, the patients I’ve connected with and the everyday environment of the clinic are unmatched. These are just a few of the many things I’ll miss about 3D when I go off to PT school. I can’t thank everyone at 3DPT enough for the opportunity they presented me with, I know that I wouldn’t be here without the help of everyone along the way. Although the Physical Therapy program spans 3 years it’s never too early to start looking ahead! I hope to one day have my own clinic and have the same impact on my patients and community that 3D has on the communities around South Jersey. I know that there’s a long road ahead of me, but I’m ready for it. Thank you again to everyone at 3DPT

Dom
After graduating from West Chester University, I wanted to work in a PT clinic during my gap year to gain more knowledge about the field and develop skills to apply in PT school. Working at 3DPT has definitely checked these boxes and exceeded what I thought I would learn as an aide. After observing the therapists at 3DPT each day, I’ve determined that after PT school I want to work in a similar outpatient setting that provides therapy for a variety of different populations. In my opinion, treating all different types of patients is not only more exciting, but also creates a more skillful professional. Because I work closely with a diverse group of patients, I’m now familiar with how to correctly demonstrate and teach an array of therapeutic exercises to patients. I’ve also learned how a PT would progress a patient’s exercise, why they might modify a treatment, and why they would choose one exercise over another. All of these skills will be extremely useful in a DPT program.  I’m thrilled to have started working at 3D during the beginning of my PT school application process because the guidance I received from every therapist during the entire process was pivotal to me being accepted into DPT programs. I’m incredibly thankful for all the times a therapist at 3D went out of their way to tell me about their application experiences, helped me prepare for interview questions, and provided insight on what factors to weigh when choosing between different DPT programs. I’m excited to say that I’ve chosen to undergo Widener’s DPT program beginning this summer. Thank you 3D for being such a big part of this journey and for all the help along the way!

Zach
Following the completion of my Bachelor’s degree at Rowan University I will be attending Stockton University’s Doctorate of Physical Therapy program. Getting to this position would have largely been an uphill battle if it were not for the help of those at 3DPT. The therapists who work for the company are very knowledgeable and have greatly helped me navigate this difficult process. After my time at Stockton is finished I am looking to become an established physical therapist and eventually own a clinic myself, maybe even as a part of 3D! I am very grateful for the time I’ve been able to spend learning under the guidance of those at 3D and I am looking forward to my future with the company.

Acting in Virtual Environmental

Insider Tips on How to Stay Safe Before, During, and After Online Performance

Many events are going “Virtual” these days, including stage and dance performances!  3DPT’s Performing Arts specialist, Dr. Allison Korn, PT, DPT is a dancer and actor herself and as a physical therapist and a performing artist, she has some great tips for those performing virtually.

Allison will be playing a lead role in an upcoming performance with Masquerade Theater, called Wit. Click here for ticket information!
 

1. 1. Save your eyes.
      Since the creation and increase in popularity for virtual performance during the pandemic, long periods of time in front of items such as ring lights, device screens, accessory cameras, as well as their placement in the performance/rehearsal space, are placing increased strain on the eyes.
      • Blue light glasses can be a great option to reduce strain on the eyes and assist with the eye’s accommodation from screen to script and back into the “stage light”.
      • If eye pain persists and causes additional symptoms like headache, eye fatigue, difficulty focusing on objects and/or reading, consider reaching out to a physical therapist for eye training to reduce these symptoms.

       

   2. Set up your rehearsal and performance space to allow for good body mechanics.

       
      For rehearsals:

      • • Ensure proper sitting posture (see picture below). Good sitting posture will prevent strain on the cervical muscles in the back of the neck, reduce over elongating the scapular retractors (muscles that naturally pull your shoulder blades together ex. rhomboids and middle trapezius), and tightening of the pectoral muscles and thoracic spine.
           
          
           
        • Keep your script or music directly in front of you in order to reduce the amount of accessory turning/twisting during text work/vocal rehearsal
        • Do not lean over your mic for vocal or radio/audio only performance. Allow your body to sit upright and supported, or stand with the mic placed to support your mic’s technical specifications/type of microphone. (Though typically placing the mic about a foot away from your face, at head level either seated or standing should be a good starting place). Work with your technical director to set up your mic or computer to best support your body mechanics and produce optimal sound.

       
      For performance:
       

      • Think about the best way to arrange props and costumes to allow for optimal, unrestricted movement in your space. This is often challenging if you are managing a backdrop, set piece(s), props and costumes in a small space, but entirely worth the effort in order to protect your body and clear your headspace to focus on your performance.

       

   3. Consider cord management.
      In order to create the best looking product, technical and lighting directors may require several different types of accessory equipment such as external microphones, webcams, ring lights, overhead light for effects, and ethernet cables.With so much equipment and the need to move in and out of your space quickly and quietly, cord management is key to avoid tripping over wires or overextending your reach. Zipties, twist ties, power strips, or rubber bands can be an easy solution to make your space more efficient.

    

   4. Prepare for prolonged standing/sitting.
      Many shows in the virtual environment are being performed seated due to the confines of the camera. You can  prevent pain in the low and middle back brought on by prolonged seated posture by working on your thoracic mobility, or in other words, how the middle section of your spine moves. This area can often stiffen up and cause pain in both seated and standing, which naturally can be distracting mid performance.See THIS video below for a few key exercises to add.In addition to addressing your mobility, you can support your seated posture by modeling it after the picture above for your personal body mechanics and addressing deficits in core strength.   Having good core strength and stability will allow you to sit upright while using less energy. See the video(s) below that match your comfort level for a few good core exercises to best support your posture.
       
      Beginner/Intermediate
      Advanced:
      • • • No equipment core exercises
          • 8-minute abs

         

      Additionally, wear shoes that you can stand in for prolonged periods since the audience usually cannot see your feet.  Unless otherwise directed by your director or costumer, consider comfortable shoes to support being on your feet and moving in and around your space safely. Though tempting to wear socks or go barefoot, shoe-wear is often a better choice to support your foot and ankle.

      • If you are experiencing pain in the feet and ankles, check out Dr. Allison Korn’s VIDEO on Toe Yoga, or these series of exercises to strengthen the ankle musculature.

       

   5. Warm-Up! 
      Just because you are not onstage where lots of movement and physicality is required, you should still warm up your body in preparation for the show.  A good warm-up will alert your muscles that it is time to be engaged and best support you no matter what the performance set-up. Click here for an active warm-up to try!!

Groin Strains in Hockey Players

Groin strains are one of the most common injuries sustained in ice hockey. With the high speed nature of the sport and demand for quick changes of direction, the muscles on the inside of the leg are at a high risk of injury. Fortunately there is a lot you can do to decrease your risk of injury.

Groin strains can include one of several muscles that surround your hip. Their primary function is to assist with stability of the leg you are standing on or to bring your leg closer to the opposite side. In hockey specifically these muscles go from being stretched to quickly contracted when skating with powerful strides. The two main risk factors for injury are lack of hip motion or strength of the inside hip muscles. We will address those two factors with the exercises below, but remember these are to decrease the risk of a healthy athlete developing an injury. If you are injured it is important to see a Physical Therapist or health professional who can assess the injury further.

Copenhagen plank
This is a challenging exercise that targets the hip adductors. It is important to perform with a flat back to prevent any compensations. This will help incorporate core strength with adductor strength. There are several variations in the video above so start with the easiest and work up as able.

Single leg landing
This exercise will help with stability. All the muscles of the hip will be recruited to help with balance and stability which will help with pushing off and changing direction effectively. Be sure to watch the video to perform with proper form.

Hip abduction stretch
This is an important stretch to include in a strength and conditioning program. The less resistance there is bringing your legs wide will decrease the risk of a muscle strain. Try to allow at least 10 minutes per day for full lower body stretching.

Get to know 3DPT’s Denise Grazioli!

We may be (just a little) biased, but we are pretty sure we have the best team here at 3DPT!  Our PTs are experts in sports and orthopedic physical therapy of course, but more importantly every 3DPT employee truly cares about our patients and delivering the best PT experience you can have – our PTs, our billing and authorizations team and of course, our front desk staff!  From your first call to the first friendly faces you see when you come to 3DPT, our front desk crew helps make sure our patients are taken care of!  From checking in patients & taking temperatures, answering the phones, making sure patients get appointments at the best time and SO MUCH MORE – our front desk team does it all!

One friendly face you’ll see at TWO 3DPT clinics is Denise Grazioli.  Denise helps hold down the fort at both 3DPT Medford and 3DPT Tabernacle.  She’s a local lady and when she’s not working, she’s with her adorable grandkids and her family.

After 25 years of working in the medical field with her previous employer, Denise decided to make a huge life change!  She quit her job to look for a job closer to home so she could spend more time with her husband, kids, grandkids and dogs. She saw an opening at 3DPT and answered the call, and we couldn’t be more glad she did! Denise says, “It’s the best move I’ve ever made! From the very start, I was treated and felt like family. I don’t know why I waited so long to move on! I would like to thank Jeff, Ken, and Carlie for the opportunity to work at 3DPT!”

Here are some other fun facts about Denise: 

Favorite Food:
Chicken Parm

Favorite Sport:
Softball (played for 6 years as a shortstop)

Favorite Thing To Do:
Spend time with my family, friends and pets

Favorite Color: 
Pink

Favorite vacation spot: 
Antigua

If you’ve been thinking about coming in for Physical Therapy, give us a call – our front desk team will take care of you!

Week 20 – Semifinals Edition: Eric Fisher

At a Glance –
Player: Eric Fisher
Position: Left Tackle
Team: Kansas City Chiefs
Injury: Torn Achilles
Projected Recovery Time: 9-12 months

The Kansas City Chiefs dominated against the Buffalo Bills in the week’s semifinal matchup, securing the AFC championship for the second straight year. Though the repeat AFC Champs have much to celebrate this week, they also (once again) have to shuffle players on the offensive line due to a major loss of Left Tackle, Eric Fisher. Fisher, who has protected Mahomes’ blindside throughout this season and was an important contribution to the Chief’s formidable offense, was injured during the fourth quarter of the AFC championship. He was ruled out of the rest of the game with an ankle injury, which has since been identified as an achilles tendon rupture. Unfortunately, Fisher will miss one of the most important games of his career: Super Bowl LV. The Chiefs will have to face Tom Brady and the Buccaneers without one of the most important players on the team on February 7th, and he may not return to practice with them until October – at the absolute earliest.

Achilles tendon ruptures require surgical intervention if a person wants to return to higher level function. It is one of the hardest lower body injuries to rehab. Soon after surgery, in which the tendon is reattached to the insertion site at the heel, physical therapy is incorporated to maintain knee and hip strength, as well to slowly build up ankle strength and flexibility. During the early phases of rehab, calf stretching and active use are restricted, but gentle exercises that avoid calf muscle use and tension can be incorporated to prevent atrophy and tightness in unaffected ankle musculature. Fisher will be immobilized in a boot for the first 6-8 weeks post-op to protect the repair, and his PT team will help him wean off the boot and normalize his walking. He won’t be able to formally perform a heel raise until ~3 months out, and it can take 6+ months for him to perform a single leg heel raise that is comparable to the unaffected side. Plyometrics and football drills won’t be initiated until 6 months out to protect the repair. A large focus of Fisher’s rehabilitation will be on restoring power to the Achilles so that he can return to left tackle, a position that requires lower body agility and strength to block and protect the quarterback. This process can take 9 months or longer, and any asymmetry between legs predisposes Fisher for re-injury. Unfortunately, the Chiefs will have to face the Buccaneers, who have one of the best edge rushing defenses in the league, a few weeks from now without one of their best linemen. We will have to wait and see if this injury impacts Mahomes and the outcome of the game, but one thing we do know for certain is that we’re in for a great game on February 7th.

Sources:
https://www.cbssports.com/nfl/news/chiefs-eric-fisher-will-miss-2021-super-bowl-after-tearing-achilles-in-afc-championship-game-per-report/

Get to know 3DPT’s Maryann Maloney!

At 3DPT, our goal is to help our patients feel great – in every way we can!  That means a customized physical therapy plan and hands-on care from a PT, but it also means helping to alleviate the burden of figuring out insurance coverage for your visits with us.

That’s where our Authorizations team comes in! They work everyday to ensure that 3DPT patients can focus on their physical therapy without having to worry about co-pays and coverage. The Authorizations team plays a huge part in helping us deliver the best overall experience to our patients, and one of the stars of the team is Maryann Maloney!  In fact, as a patient of 3DPT, you may have met Maryann even before you met your PT.

Maryann verifies all of our new patients’ benefits prior to them starting treatment by calling their insurance company to check physical therapy benefits and accumulations.  She then calls the patient to let them know their patient cost-sharing responsibility and other applicable requirements (pre-auth/referrals, etc.) – all before the first appointment!  She’s the super kind voice you only hear over the phone and never get to meet in person!

Maryann’s role helps set the tone for the patient experience at 3DPT before you even walk in the door at any of the clinics. As you can imagine, Maryann is very busy since she is responsible for all of our 5 locations and all of the new patient appointments.

Here’s a little bit about Maryann:

Maryann Maloney grew up in Delaware County, PA but has been living in Medford for 23 years with her husband and three children who are 22, 19 and 18 years old.  The family enjoys spending time together in the winter, skiing and in the summer, they love going to the beach. (They’re looking forward to a fun, relaxing trip to the Outer Banks this July!)

Some other fun facts: Maryann’s favorite food is Lobster Mac n’ Cheese from Braddock’s Tavern and her favorite movie is The Notebook!

Prior to working at 3DPT, Maryann worked at IBM for 17 years on the Astrazeneca Pharmaceuticals contract as a project manager.  When she left IBM, Maryann worked part time for a pharmaceutical company, then joined the 3DPT team in July of 2019 in the Authorizations department and so far, so great!  She really enjoys her job and being in a company that cares about their employees, and we couldn’t be happier that she’s a part of the team! Maryann and the entire Billing and Authorizations team are truly heroes at 3DPT!

Rotational Stress

Now that we are all familiar with the susceptibility of ACL tears or ruptures in all forms of sport, let’s dive into one of the less understood duties of the ACL, rotational stress. As far as non-contact ACL injuries go we have looked at the common mechanisms such as hyper-extension of the knee or that knock-knee or valgus position. But what about when we go to cut on the field or court? Or a quick change in direction creating a large amount of force? The knee will rotate while the foot is fixed on the ground and the ACL is tasked to prevent excessive movement in that type of closed chain rotation (the femur rotating on the tibia while the foot is fixed to the ground). A quick change of direction or plant and cut maneuver can place our knee in a provocative position, especially if we have not gone through a thorough ACL prevention program. The pairing of excessive knee valgus with the foot planted (causing excessive rotation within the knee) places an astronomical amount of stress on the ACL.

So what can we add into our ACL prevention programs to optimize our sport specific movements while reducing rotations stress? Fox (2018) correlates a landing and cut pattern with reduced ACL stress with a forefoot land (on the ball of your foot) and trunk rotation and slight lateral flexion which optimizes base of support and allows for an explosive movement into the new direction. The trunk movement over the plant knee allows for improved force absorption through the entire body and ultimately allows us to exert a larger amount of force against the ground for a quick and explosive directional change (see photo).

ACL prevention programs are quickly becoming a popular standard for athletes, but the program needs to be fully inclusive. Glute, hamstring, quadricep, and hip strength is of extreme importance, but we need to ensure we are not leaving out the sport specific tasks like change of direction. Drills such as the T-Test or partnered change of direction exercises should be paramount in any program. ACL prevention programs are not only there to reduce the possibilities of ACL injuries in practices or competitions, but they are there to develop better athletes and performance.

Resources:

1. Fox, A. S. (2018). Change-of-direction biomechanics: is what’s best for anterior cruciate ligament injury prevention also best for performance?. Sports Medicine, 48(8), 1799-1807.
2. Ferretti, A., Monaco, E., & Vadala, A. (2014). Rotatory instability of the knee after ACL tear and reconstruction.Journal of Orthopaedics and Traumatology, 15(2), 75-79.
3. https://www.physio-pedia.com/Anterior_Cruciate_Ligament_(ACL)

Week 19 – Playoff Edition: Patrick Mahomes

At a Glance –
Player: Patrick Mahomes II
Position: Quarterback
Team: Kansas City Chiefs
Injury: Nerve Injury
Projected Recovery Time: 1-4 wks

All eyes are on the Chiefs this week as we wait anxiously to see if America’s favorite quarterback will be able to play against the Bills in the AFC Championship on Sunday. Patrick Mahomes, Superbowl MVP last year, suffered a scary neck injury during this past week’s game vs the Browns and was unable to return, leaving it up to a backup quarterback to lead the Chiefs past the Browns. The Chiefs managed to emerge victoriously, despite the Browns’ comeback in the second half, but their chances of another victory against a formidable Bills team are slim without Mahomes at the helm. Reports have emerged early this week on Mahomes’ condition, and the consensus is positive, stating that there is a good chance that Mahomes will be back as he passed all concussion tests without issue. It turns out the source of Mahomes pain and limitations is his neck, as he is dealing with a nerve injury. Though reports have not confirmed specifics, it is likely Mahomes tweaked or compressed a nerve with the hit he sustained during the game, and his return is dependent on the severity of the injury and his functional limitations, as well as his pain levels. Currently, Mahomes is still progressing through the rest of the NFL’s concussion protocol but is expected to practice this week.

Recovery from a nerve injury is dependent on the severity of the injury. Nerves can simply be compressed or tugged on, in which symptoms improve quickly, or they can be significantly damaged, which interferes with the nerve’s ability to communicate to the muscle it innervates (or supplies) and sometimes requires surgical intervention. Since Mahomes is expected to return so quickly, it is unlikely any long-term damage was sustained, but he will be working closely with his physical therapy team to ensure he is ready to go on Sunday. Mahomes took a pretty hard hit that put a lot of strain on his head and neck so he will be performing specific exercises to help strengthen affected muscles in his neck. By working on specific musculature in the neck called the Deep Neck Flexors (DNFs), he will be able to improve neck stability to avoid aggravating any symptoms and prevent re-injury. Exercises you could expect for Mahomes to perform are neck isometrics, in which he activates his neck muscles in response to external forces to keep his head steady, and chin tucks, which strengthens the DNFs (and looks like he’s giving himself a double chin). The muscles affected by the nerve injury will also be the focus of sessions to improve their ability to respond, as reaction times can be delayed post-injury. As long as Mahomes doesn’t experience any setbacks, he should be ready to play on Sunday, which means we’re all in for an exciting matchup to decide who’s heading to the Super Bowl.

Sources:
https://www.sportingnews.com/us/nfl/news/patrick-mahomes-injury-update-concussion/zk4x3ag3vy0g15aluxn8byz2w

Week 18 – Wildcard Weekend: John Wolford

At a Glance –
Player: John Wolford
Position: Quarterback
Team: LA Rams
Injury: Stinger
Projected Recovery Time: 1-4 wks

The Rams put on an impressive display during Wildcard Weekend, defeating the Seahawks despite problems at the quarterback position. Jared Goff, the Rams’ starter, suffered a thumb dislocation and underwent subsequent surgery during Week 16; this past weekend, he was the backup, not ready just yet to play a full game, until Wolford, the backup-turned-starter, suffered a nasty hit to the head and neck and had to leave the game. Goff had to step in, despite his injury, and led his team to a well-deserved victory. The hit Wolford sustained was worrisome, as his head collided with Jamal Adams’ shoulder pad, but he was able to walk off the field despite appearing to be in significant pain. Wolford’s condition was unknown for the remainder of the game, but it was released that he was taken to the hospital shortly after leaving the field. Reports surfaced this week that this hospital trip was merely precautionary and that Wolford simply suffered a stinger injury, which means he may be able to play in the upcoming Divisional Round, should the Rams need him.

A stinger is a nerve injury, and it is very common in football. This type of injury most commonly occurs when the neck and head are forced back or to the opposite side, putting tension on a bundle of nerves known as the brachial plexus, which is located in the neck. This tension causes what most describe as “electric-shock pain” to radiate down the arm for a very short period of time (around 10 seconds or less). Afterward, though that sharp pain is gone, a person’s function continues to be impacted as the nerves that break off of the brachial plexus and travel down the arm are irritated and unable to function normally. A large complaint from people who experience this injury is decreased ability to move or use the upper extremity, which would make it pretty difficult to throw a football. The rate of recovery largely depends on how severe the injury is, as well as if a person participates in physical therapy. Wolford will likely start working with his physical therapist as soon as he can to alleviate symptoms and recover function sooner. Rehab for stingers include strengthening upper extremity muscles affected by the stinger, as well as addressing neck muscle weakness, to help a person avoid further injury when returning to higher level activity. Another major component of rehab is addressing aggravated nerves. When using the upper extremity, tension is applied to the nerves, and after a stinger injury, nerves are much more sensitive to any tugging. There are specific nerve stretches and mobilizations a physical therapist can do with Wolford to help Wolford’s nerve develop a better tolerance to being moved again, allowing him to return to football without reaggravating symptoms. Stingers vary in terms of recovery time, but Wolford can return as early as this week if his symptoms are mild enough. The Rams face a heavily favored Packers team this upcoming weekend, and Head Coach Sean McVay hasn’t named a starter yet, so Wolford is certainly in the mix… for now.

Sources:
https://www.sports-health.com/sports-injuries/head-and-neck-injuries/stinger-injuries-what-know
https://theramswire.usatoday.com/2021/01/10/rams-starting-quarterback-playoffs-goff-wolford/

5 S Formula For Reaching Goals

Tips for Achieving Goals

We set goals all the time! These goals could be related to fitness, sports, nutrition, work, and/or school. Setting goals keeps us driven and motivated on a daily basis. Many of us are great at setting goals. At the start of the new year, we may brainstorm 5, 10, or even 15 goals to achieve throughout the new year. New year, new you! These goals are set within the first week of January…… then it takes us a few weeks to get focused and put together a plan to achieve these goals…. Well then it’s Superbowl Sunday, a birthday party or two, spring break, social outings, other distractions… you get the point. It’s easy to set goals, but harder to put in the work to achieve the goals. Unfortunately, there are tons of distractions and excuses that prevent us from staying focused on our personal objectives!

The 5 -S Formula is an effective strategy we all can implement to improve our success rate in reaching our goals. This formula helps identify what might be appropriate and successful skills, practices, and actions to assist us on our road to success! The 5 pieces of the formula break down how to implement smaller and logical steps while progressing towards the end objective. Let’s look into what this formula entails and how it can be applied to your individual goals:

The 5 S’s:

1. 1. Strategic
      When working towards a goal, each action must be connected to the goal. Linking each tasks to the goal will improve your focus and efficiency in making the goal a reality. For example, lets say running a 5k in 4 months is your goal. Will running 1x/month and playing tennis 3x/week get you to your goal? Or will creating a weekly running plan for 4 months progress you to your goal? Next, removing limiting factors standing in the way of your goals and filling in any gaps preventing you from making the goal a reality are also important actions in the strategic planning phase. In addition, write down your strengths and build off them! What are you good at? What actions works best with your lifestyle? Building off your strengths to create goal-oriented actions that will assist you in reaching the goals faster! Implementing specific activities tied to your goal will help you efficiently and affectively succeed.

    

   2. Segmental
      Break down the steps you need to complete to get you your goal. The practices and actions you put into place must be a smaller piece of a larger whole. For example, a clean, which is a common Olympic lift and movement performed in crossfit classes, involves a complex sequence of movements necessary for lifting the weighted bar from the floor to chest level. To properly learn the movement, one must break down the entire movement into smaller parts. Practicing and mastering the smaller parts is crucial for executing the exercise safely and correctly when performed as a whole. When working towards your goal, make sure you break down the plan into smaller, achievable segments. This will help make the goal seem attainable and less overwhelming!

    

   3. Sequential
      This step may seem simple, yet we are all guilty of completing step 1 of a task then jumping to step 10. Once at step 10, we realize we are lost or something is too challenging and then backtracking to prior steps. Performing your actions in a logical order that matches your own pace and skill level is key for success. Don’t jump ahead to try and complete the task faster! Skipping over crucial steps usually leads to increased stress and frustration. Lay out a step by step plan that progresses in a reasonable, attainable order. Steps 2-9 are there for a reason!

    

   4. Simple
      When an action or tasks is too complex, many of us shut down. We either avoid what needs to be done, make excuses not to continue, and/or scrap the task completely. The practices or actions you set in place to get you to your goal must be easy to understand and fit your lifestyle. For example, let’s say your goal is to eat out for dinner less and cook dinner 6 days per week. You could look up 6 new recipes, with 20 or more ingredients and over 2 hours of prep time. However, what are the chances 2 hours of prep and cooking will take place after a long day of work? Instead, plan your meals ahead of time with food you know and love! Make pre portioned meals on Sunday or prep all the ingredients Sunday so you can quickly and easily whip together dinners each night. KEEP IT SIMPLE!

    

   5. Supported 
      Sometimes we need to ask for help, ask for support, in order to keep us focused and working towards our goals. This is NOT a sign of weakness. Sometimes we hesitate asking our loved ones for help and try to achieve everything on our own! However, we need to understand its ok to ask for extra support. That’s what friends and loved ones are for! There will be days where you feel off track, your goal seems impossible, your tired and want to give up. It is those situations when we need to reach out to our support systems to lift us up and keep us going. Each step toward your goal will require some type of teaching, coaching, mentorship, and accountability from an outside source.

   Take a second to evaluate your goals. Are you making progress to achieve that goal? Have you lost sight of the goal? Is it taking you too long to achieve the final step? Maybe you are skipping crucial steps along the way. Maybe the actions you are trying to complete are too complicated. Use the 5-S Formula above to evaluate your goals and game plan for reaching each goal. Make the changes you need get back on track and let’s make each goal happen!

Week 17: Mike Evans

At a Glance –
Player: Mike Evans
Position: Wide Receiver
Team: Tampa Bay Buccaneers
Injury: Hyperextended knee
Projected Recovery Time: 1-6 wks

It’s finally the best time of the year – playoff season! Surprisingly, the NFL made it through to all 17 weeks without cancelling or missing a game despite COVID-19 and the multitude of injuries that plagued the league this year. Playoffs are a particularly stressful time for teams that are lucky to still be playing as injuries can largely determine how far a team goes. The Tampa Bay Buccaneers are currently dealing with a big hit to their team this week with the injury to their star wide receiver, Mike Evans, who went down with a knee injury during the Week 16 game against the Falcons. Knee injuries are especially worrying because recovery can be up to a full year, making a return the following week impossible, but MRI imaging found no structural damage in Evans’ knee. Considering the Buccaneers have an important game against the Washington football team January 9th, this news is best-case scenario. Head coach Bruce Arians confirmed that Evans practiced at half-speed on Tuesday, but whether he is ready to play in a high stakes game remains to be seen.

Evans’ physical therapist will have a huge role in Evan’s recovery, whether he is able to return this week or not. Though he sustained no structural damage, Evans still suffered a pretty serious and painful injury. A knee hyperextension injury means that the knee straightened too far, putting stress on critical ligaments such as the ACL, and extreme hyperextension can lead to ligament compromise. Luckily, Evans avoided significant ligament damage but is likely to be experiencing symptoms that will make his return this Saturday difficult. Common symptoms after this type of injury include pain, swelling, restricted motion, and instability, all of which are unlikely to resolve in the next few days. Evans’ PT’s job is to help him manage those symptoms and return to play safely. For managing pain and swelling, ice, elevation and protecting the joint (with bracing, compression, etc.) are pivotal. Instability and restricted motion are a little trickier to amend in such a short amount of time, but a lot of time will be dedicated to working on Evans’ balance and reaction, as well as restoring full motion, during treatment sessions. A knee hyperextension injury may make full knee extension painful, which can lead to difficulty with running as full extension is needed during weight acceptance and pushing off, so if Evans cannot obtain full extension, he may not be able to perform to his full capacity as a wide receiver. Instability is another issue altogether as this symptom predisposes Evans to greater injury due to the inability to avoid knee positions that may compromise structures in the knee. His return so early is a risk, but Evans will work closely with his PT to decrease his risk of re-injury with multiple sessions throughout the week to work on remaining balance and strength deficits, even if the Buccaneers lose during the Wild Card round. Hopefully, Evans will be ready to go on Saturday – his presence on the field will only boost their odds for a win.

Sources:
https://www.buccaneers.com/news/washington-buccaneers-injury-report-jan-5-wild-card-playoffs-mike-evans-2020
https://www.healthline.com/health/fitness-exercise/hyperextended-knee#symptoms

Week 16: Jared Goff

At a Glance –
Player: Jared Goff
Position: Quarterback
Team: Los Angeles Rams
Injury: Broken and dislocated thumb
Projected Recovery Time: 2-8 wks

This next week is pivotal for the Los Angeles Rams to finalize their spot in the playoffs. If they win, they’re in, but they have to beat the Arizona Cardinals and Kyler Murray without their QB Jared Goff, who hasn’t missed a game since 2018. During this past week against the Seattle Seahawks, Goff sustained a pretty serious injury, dislocating his thumb. However, after reducing the dislocation himself, Goff finished out the game, which is pretty impressive despite the loss. Reports have since surfaced that Goff dislocated and fractured his thumb, which requires surgical correction, with the hopes that he can return if the Rams make the playoffs. Though the Rams control their destiny, they are putting a lot of faith in their backup QB, John Wolford, who has never thrown a pass in an NFL game.

Though it was not disclosed specifically what damage Goff sustained to his thumb, he likely injured ligaments since he needed surgery to return to play. For this sort of injury, it typically takes 6-8 weeks to recover. However, Goff aims to be back around the weekend of January 9-10th, meaning he will have less than 2 weeks to work back to playing shape. He will be spending a lot of time with his physical therapist to help manage pain, swelling, and other bothersome symptoms that people deal with post-op. Because he is returning to football, Goff will likely wear some form of a brace to limit motion and protect the joint. If there is ligament damage, the brace will definitely restrict thumb motion to some degree which may make playing quarterback difficult. The thumb is absolutely essential for gripping and throwing a football so the brace will likely feel awkward and cumbersome for Goff – going through exercises and drills to help Goff acclimate to his new accessory will ensure he can return to the game confidently. Even if Goff is able to make that impressive return in 2 weeks, he will work with his physical therapist for the following weeks, even into the offseason, to ensure his motion and strength returns to normal to prevent re-injury. Goff’s return is contingent on the Rams making the playoffs, however, so it is unclear if he will have the opportunity to play in the post-season at all. The fate of the Rams rests on Wolford’s shoulders, and the rest of us will be watching to see if the Rams will make a playoff appearance after narrowly missing last year.

Sources:
https://bleacherreport.com/articles/2924517-rams-jared-goff-to-have-surgery-on-thumb-injury-hopes-to-be-back-for-playoffs

Week 15: Michael Gallup

At a Glance –
Player: Michael Gallup
Position: Wide Receiver
Team: Dallas Cowboys
Injury: Hip Pointer Injury
Projected Recovery Time: 1-3 wks

The Dallas Cowboys’ offense has had a rough year with injuries, and Week 15 has resulted in another loss, Michael Gallup, right before an important match up with divisional rival Philadelphia. During the game against the 49ers, Gallup was ruled out for an apparent hip injury, which was later identified as a hip pointer injury. Though he was unable to return to the game on Sunday, he has not been ruled out for this week’s matchup against the Eagles. His ability to play depends on the extent of his hip pointer injury, as well as the severity of his symptoms.

Hip pointer injuries occur from trauma to the iliac crest, or the large bone on the outside of the hip, and is common with falls and contact sports. Typically, a deep bruise occurs that is pretty painful, though symptoms can range from mild to moderate. Mild symptoms include pain and tenderness, but more severe symptoms can limit hip movement and even cause weakness in the hip, which would make it pretty difficult to return to play football. The more severe symptoms can occur when a muscle that attaches close to that site, called the sartorius, is involved, which will lead to difficulty in actively flexing and rotating the leg. It has not been disclosed just how significant the hip pointer injury is for Gallup, but reports have stated that he has not been ruled out for this week’s game – yet. In order for Gallup to return to play, he will be working diligently with his rehab team to manage symptoms and improve any strength or range of motion limitations. Ice and elevation will be a big part of helping with the increased pain, and his PT will be able to perform gentle mobilizations that can address any hip flexibility limitations, improving his range of motion without increasing his baseline pain. Even if Gallup does return this week, which is possible, considering the stakes of the game, he will continue working with his PT to ensure his full motion and strength return. If he does not return to his prior level of function when playing, Gallup will be at risk for re-injury due to the asymmetry between sides. However, with the proper treatment, Gallup should be playing without restrictions in the next few weeks. The Cowboys could use him back on the field; after all, they’re not technically out of the playoff hunt yet.

Source:
https://www.upmc.com/services/sports-medicine/conditions/hip-pointer#symptomsdiagnosis
https://www.cbssports.com/fantasy/football/news/cowboys-michael-gallup-sustains-hip-injury/

Get to know 3DPT’s Dr. Katie O’Rourke!

They say the first-born child tends to be reliable, caring and are achievers (The good stuff, at least!).  That is all certainly true of 3DPT’s newest physical therapist, Dr. Katie O’Rourke, who is the oldest of 5 siblings! She’s also a competitive tennis player, so Katie is used to hard work and being a great team player.  Katie loves that physical therapy gives her the opportunity to care for patients and help them work hard to achieve the PT goals!

Click here to learn more about Katie and keep reading for some more fun facts about our newest PT.

COLLEGE(S) ATTENDED:
Thomas Jefferson University for my Doctorate in Physical Therapy and Fairleigh Dickinson University for my Bachelors of Science in Biology

HIGH SCHOOL:
Sacred Heart High School (My class was the last graduating class there – the school is now closed!)

TELL US THE INJURY/CONDITION YOU LIKE TREATING THE MOST:
I really like helping individuals with balance disorders and adolescent sports injuries.

WHY IS 3DPT LUCKY TO HAVE YOU:
I am very motivated and determined and I’m looking forward to continuing to grow and learn here!  I am also organized, attentive to detail, responsible, caring, and trustworthy.

FAVORITE MOVIE OF ALL TIME:
Mamma Mia

FAVORITE DISH AT A RESTAURANT:
Anything pasta!

MOST DARING THING YOU’VE DONE:
I am the least daring person you may ever meet!

Week 14: Mike Williams

At a Glance –
Player: Mike Williams
Position: Wide Receiver
Team: Los Angeles Chargers
Injury: Back Pain
Projected Recovery Time: 1-4 wks

Although the LA Chargers are last in the AFC West, they have had an exciting season with rookie Justin Herbert at the helm. The offense of this team has shown glimpses of promise throughout the season, and Chargers fans are hopeful that the future is bright. The rest of the season, however, may be a different story, especially with the potential loss of wide receiver Mike Williams. During the Week 14 game against the Atlanta Falcons, Williams suffered a hit early, not returning to the game. It is unclear the severity of the injury, or whether he will be back soon, but it has been disclosed that it was a back injury that sidelined Williams. Williams had a previous back injury in 2017, suffering a herniated disc, and also was dealing with muscle spasms in 2019. It is likely that Williams could have aggravated old injuries during the Chargers’ most recent game – his recovery and return depend on the extent of the injury.

Whether he has a disc issue or muscle spasms, Williams will definitely be working closely with his physical therapy team. Manual therapy will be a major component to help Williams manage his injury, and techniques physical therapists specialize in can help Williams manage pain and stiffness. Disc issues specifically can linger if they go untreated, but luckily, movement can be the best form of treatment for pain from a disc. Discs act as shock absorbers between vertebrae, and oftentimes, people believe that a herniated disc, in which the disc protrudes abnormally, is a permanent condition, but in reality, a disc can be influenced by directional movements and positions. Certain manual techniques can “influence” these discs, and the addition of these techniques to an exercise program can help a person maintain the positive changes and relieve low back symptoms. Symptoms include pain, typically in the low back, and radiating symptoms, such as numbness, weakness, and pain, that indicate the disc is intruding on a nerve as it exits the low back. A positive response to treatment means improvements in that radiating pain, and the goal is to eliminate that radiating pain and the pain in the spine. Establishing a neutral spine program will be crucial for Williams. This program puts an emphasis on core strength, as the group of abdominal muscles is essential for stabilizing the spine and decreasing the amount of stress put on the vertebrae and discs. Common exercises include bird dogs, posterior pelvic tilts, and planks, all of which utilize the trans abdominis muscle, or the core muscle that is a great spinal stabilizer. It can take several weeks to improve core strength so it is likely Williams will continue his work with his PT after being cleared to return to play. As long as the aggravated symptoms are mild, Williams can return in as little as one week. However, since the Chargers have no playoff implications, there may not be a rush for him to return.

Source:
https://dknation.draftkings.com/2020/12/14/22175141/keenan-allen-mike-williams-injury-game-status-week-15-fantasy-football-chargers-vs-raiders

Week 13: Antonio Gibson

At a Glance –
Player: Antonio Gibson
Position: Running back
Team: Washington Football Team
Injury: Turf Toe
Projected Recovery Time: 1-4 wks

The Washington Football Team put on an impressive display this week, making a statement in the league with their victory over the undefeated Steelers. What was even more impressive, however, was that they were able to do so without their rookie running back, Antonio Gibson, who has had a great start to his NFL career. Gibson suffered a toe injury during an early carry in the game and did not return to play. Reports confirmed Gibson sustained “turf toe”, an injury to the ligaments of the toe joint caused by hyperextension of the big toe during push off. This injury got its name because of its increase in frequency as artificial turf became more popular and preferable to typical grass fields, and it is very common in the NFL.  (Davante Adams suffered the same injury in the 2019 season).  Turf toe can develop gradually or result from a sudden injury, and symptoms include limited toe range of motion, joint swelling, and pain. The ligaments are essential for weight transfer on your foot, allowing you to propel yourself forward during walking, running, and jumping. The severity of the ligament sprains dictates a person’s activity levels, and a complete rupture often requires surgical correction.

Details have not been released on the severity of Gibson’s injury. It is likely he sustained a Grade I or II injury, meaning mild to moderate ligament damage, and does not require surgery. Gibson’s PT team will be working closely with him to monitor his symptoms and help him return to play without reaggravating his symptoms. Gibson will likely have high pain levels immediately after injury, and he will follow POLICE guidelines (Protect, Optimal Loading, Ice, Compression, and Elevation) to help decrease those pain levels. Symptoms can easily be re-aggravated so great care will be taken to offload Gibson’s foot with proper footwear; more flexible shoes put more stress on the ligaments vs rigid shoes that do not allow for as much movement at the toe joint. Higher level exercises will be held to allow for the injury to heal and to protect the joint, and ice, compression, and elevation will help with inflammation and pain control. After symptoms improve, Gibson will work with his PT team to improve toe joint range of motion. If the joint itself is stiff, it has to sustain greater stress as there is less range for a force to disperse through, and correcting that limitation will help prevent re-injury. Lower leg and foot muscle strengthening will also help offload the toe joint. Gibson may return to play in as little as a week, while still participating in rehab to manage any flare-ups and continue with injury prevention. The Football Team isn’t out of the running for clinching their division so they could certainly use Gibson sooner than later in their final push to make their first playoff appearance since 2015.

Sources:
https://www.espn.com/nfl/story/_/id/30472167/washington-football-team-loses-antonio-gibson-toe-injury
https://www.webmd.com/fitness-exercise/turf-toe-symptoms-causes-and-treatments#1

Week 12: Todd Gurley

At a Glance –
Player: Todd Gurley
Position: Running back
Team: Atlanta Falcons
Injury: Knee Injury (Unspecified)
Projected Recovery Time: 1-4 wks

The Atlanta Falcons had a dominant presence this week against the Vegas Raiders. The win was ever more impressive since they were missing one of their key playmakers: Todd Gurley. Gurley, who has been one of the most impressive running backs in the league over the years, was ruled out of the game due to an unspecified knee injury. The severity of the injury was also not clarified, but reports indicate that he may return to face the Saints this week, meaning he may have aggravated an older injury. In 2014, Gurley tore his ACL while playing at the University of Georgia. Since then, Gurley has been managing knee pain that has impacted his career in the NFL, causing him to miss time and even preventing him from getting re-signed by the LA Rams, a team he helped bring to the Super Bowl in the 2018-2019 season. Sources have reported that though Gurley underwent successful ACL rehab, he is now suffering from knee osteoarthritis, a direct and common consequence of the injury. Osteoarthritis is an irreversible condition, and Gurley will be dealing with this pain for the rest of his career and beyond.

Osteoarthritis is a condition in which there is gradual degeneration of cartilage in a joint, as well as underlying bone, often associated with aging, previous injury, and increased stress on a joint. Cartilage is a type of connective tissue that lines the joints and acts to absorb shock and promote smooth gliding between bones. When an injury occurs that causes trauma and damage to the cartilage, the process of joint breakdown can occur, and this cycle may continue even after the injury is resolved. This scenario is the case for Gurley, who is now dealing with an arthritic knee at a young age due to a previous traumatic injury. Research has found a significant association between ACL tears and osteoarthritis, even if a person gets reconstructive surgery, and signs of arthritis are evident shortly after this sort of injury occurs. With the frequency of ACL tears in the league, this evidence is alarming and indicates that most players will be dealing with arthritis pains, which include pain, stiffness, swelling, and other symptoms, sooner or later. Luckily, there are ways to manage these symptoms, and physical therapy is one of the best treatment options! Though exercise can’t reverse joint damage, it can help improve muscle bulk and strength around the joint so the muscle can better absorb shock, meaning that less stress will go through the joint. Gurley is likely working with his rehab team to address this most recent flare-up of pain, working on the strength of his quad, hamstring, and hip muscles, addressing inflexibility in his lower body, and helping him with activity modification. A flare-up of arthritic symptoms can occur from overuse, which wouldn’t be surprising in Gurley’s case due to the high demand of his position, and his PT Team will design a program that will allow him to return to football with a graded approach to avoid exacerbating his symptoms again. Gurley will likely take less reps and spend less time on the field upon his return, but he will likely be able to make it back in the upcoming weeks so long as his symptoms can be managed. The Falcons aren’t technically eliminated from playoff contention yet so who knows… maybe they’ll make a run!

Sources:
https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925#:~:text=Osteoarthritis%20is%20the%20most%20common,%2C%20knees%2C%20hips%20and%20spine
https://www.sandiegouniontribune.com/sports/profootballdoc/sd-sp-pfd-todd-gurley-arthritis-knee-rams-0302-story.html#:~:text=Rams%20running%20back%20Todd%20Gurley,knee%2C%20according%20to%20a%20source.&text=In%202014%20at%20Georgia%2C%20Gurley,arthritis%20is%20not%20a%20shock

Week 11: Joe Burrow

At a Glance –
Player: Joe Burrow
Position: Quarterback
Team: Cincinnati Bengals
Injury: Torn ACL, MCL, “other structural issues”
Projected Recovery Time: 9-12 months

Joe Burrow’s debut in the NFL was one of the most anticipated this year. The beloved Louisiana quarterback, who won the Heisman in 2019, was expected to make great changes when he was drafted No. 1 overall in the 2020 draft. He was on pace to be Rookie of the Year this season, but his impact was brought to a standstill when he sustained a pretty serious injury in his game vs The Washington Football Team. During the second half of the game, Burrow was taken down while attempting to make a third-and-two pass, and he was clearly in a lot of pain. He was ruled out of the game and tweeted, “See ya next year,” minutes later. Sources confirmed that Burrow tore both his ACL and MCL, as well as sustained “other structural issues,” meaning he will not return until 2021.

The ACL and MCL are essential for restricting certain motions and providing stability. ACL injuries have sidelined an astonishing number of players this year (for more information on ACL tears specifically, see Week 2’s article on Saquon Barkley), and adding an MCL tear to the mix adds another level of complexity to both surgery and rehab, extending the recovery. The MCL provides stability against valgus forces, which push the knee inward and predispose a person to a lower extremity injury, and an injury to the MCL is essential to address to avoid re-injury when returning to higher level sports. Burrow will likely undergo surgery within the next month, reconstructing both the ACL and MCL. Reports stated there were other structural issues involved, which could delay his surgery if there is increased swelling. Though the reports were nonspecific, Burrow could have sustained a bone contusion (or bone bruise) from the injury if his tibia struck his femur with enough force, which can take a number of weeks to heal completely.

After surgery, Burrow will spend a lot of time with his physical therapy team. He will not be able to bear weight through his leg for 4 weeks but will be doing plenty of strengthening and stretching exercises until he is cleared to walk on his affected leg. After a traumatic injury and surgery to the knee, the quadricep muscle has difficulty functioning correctly, and focus of early treatment sessions will be on improving the quad’s ability to fire on command so that when Burrow can start higher level activities, he will be prepared. As was mentioned, ACL and MCL re-tears are associated with the valgus position so a huge focus on Burrow’s rehab program will be injury prevention. Strengthening the hips by doing variations of bridges and hip abduction exercises helps a person maintain a healthier knee position to avoid that valgus, and a lot of time will be dedicated to Joe maintaining that healthy knee position while performing dynamic activities. Studies have shown that ACL tears have greater re-tear rates when returning to play before 9 months, no matter how strong or prepared a person is, because the new graft has not fully remodeled so it is very important that Burrow is patient and returns when his body is ready. He will be doing plenty of sprints and plyometrics to put his knee to the test before he is cleared to practice with the team and will likely not be ready to play when the 2021 season starts. Though it may take up to 12 months, he has his team and fans fully behind him, eagerly awaiting the return of their MVP.

Sources:
https://tcomn.com/wp-content/uploads/2014/08/ACL-and-MCL-Rehab-2-13-13.pdf
https://www.espn.com/nfl/story/_/id/30374069/torn-acl-mcl-plus-more-knee-damage-cincinnati-bengals-qb-joe-burrow-sources-say

Happy Thanksgiving 2020

Thanksgiving is here and despite the challenges of this year, there are lots of things we are grateful for!  Our #1 will ALWAYS be our wonderful patients!  Thank you, Thank you, Thank you to everyone who continues to support 3DPT – we wouldn’t be who we are without each of you!  

What else are we grateful for?

3DPT owners, Ken Guzzardo and Jeff Sallade give us the top 5 things they’re especially grateful for this year.

Jeff’s top 5:

1. A great group of people to work with that made it possible for 2020 to be an even better year than 2019 despite all of the challenges. Everyone stepped up this year and we learned how valuable our employees and partners are to the success of the practice. As a result of our great employees, we were able to maintain our entire team because our downturn was short lived.
2. The fact that physical therapy was deemed ESSENTIAL and we were able to continue to help all of our patients in many different forms (telehealth, home visits and in-clinic visits). This also allowed me to come to work every day and have some normalcy at a time where very little was normal.
3. A brand new right hip in June courtesy of Dr. Greg Klingenstein to match my new left hip I received 2 years ago. I am on the road to being active again with my wife and kids and look forward to another Ironman in 2022!
4. My kids sports for the most part were normal from July up until now. It gave them a chance to continue to compete and play on their teams with their friends and gave my wife and I the chance to watch them and hang out with the other parents on the sidelines – this was our much needed social outlet.
5. No matter how far from normal we are, I still have my health and an awesome wife and kids to come home to every day. I have probably thrown a million football passes to my kids, juggled the soccer ball with them in the yard for countless hours and played over one hundred games of Monopoly as a family (why do they have to pick the game that never ends?). I am confident I will look back on this and in some ways be thankful for the extra time we all had together.

Ken’s top 5:

1. Health – personally, my family, my co-workers, my friends, and my patients.
2. Family – Spending this much time with my wife and kids has really been a great experience. I wish it had been for different reasons, but we’re trying to build the best memories that we can in the current environment. Even though we haven’t been in person as much with my parents, siblings, aunts/uncles, grandmoms, and in-laws, I’m thankful for all of the phone calls, zooms, and outdoor gatherings we have been able to do.
3. Co-workers – There is nothing to test relationships and personalities like dealing with a crisis situation. My co-workers have stepped up in so many different ways to continue to raise the standard for the workplace and healthcare experience for our clients.
4. My Partners – Having a lot of smart and caring people to bounce ideas around really helps ensure we were making the best decisions that we could. From so many late nights on calls, to debating about the best course of action, my partners and I went through a lot this year. And I’m thankful for each and every one of them.
5. Clients – We are in an industry where we work with our clients in close environments. Our clients trusted us to continue to help them and keep them safe in the middle of a pandemic, and I’m forever grateful for their confidence in us. I’m thankful for every telehealth client during the initial lock down phase, and thankful for every person who comes through our doors who entrusts us now not only with their recovery but also their safety and health.

“Gratitude is the best medicine. It heals your mind, your body and your spirit. And attracts more things to be grateful for.”

We wish you all a very Happy Thanksgiving and hope that even through the challenges you also have lots of great people and things to be thankful for!

Week 10: Drew Brees

At a Glance –
Player: Drew Brees
Position: Quarterback
Team: New Orleans Saints
Injury: Rib Fractures, Punctured Lung
Projected Recovery Time: 3-8 weeks

The New Orleans Saints’ seem to be Super Bowl contenders every year. With Drew Brees at the helm, this team is virtually unstoppable. However, Brees suffered some pretty serious injuries over the past 2 weeks that will put the rest of this team’s talent to the test. During his Week 9 win over the Buccaneers, Brees apparently sustained rib fractures that went undiagnosed despite pain and discomfort that he felt while playing. This injury became more severe when he was hit during the first half of the Saints vs 49ers. Brees reportedly had chest pain and difficulty breathing that was significant enough to pull himself out of the game, and he did not return in the second half. Reports confirmed Brees sustained at least 5 total rib fractures, as well as a punctured right lung. He is out indefinitely and consulting multiple medical professionals to determine when the best (and safest) time is to return.

Fractured ribs are very common but dangerous injuries in contact sports. They are difficult to diagnose as symptoms typically present as chest pain, or even difficulty breathing. One of the biggest risks of fractured ribs going undetected is that they can cause a lung to be punctured, which then may lead to a collapsed lung. This particular scenario unfolded for Brees during this week’s matchup against the 49ers as he suffered a punctured lung (also known as a traumatic pneumothorax) from his fractured ribs, and the upcoming weeks will be focused on allowing the rib fractures and lung to heal. Fractured ribs typically heal on their own, with pain being managed by ice, but treatment for a punctured lung depends on the severity of the damage to the lung. A smaller pneumothorax can sometimes heal on its own, but a larger pneumothorax typically requires the placement of a chest tube to help keep the lung inflated while draining air from areas it shouldn’t be in the chest cavity. One of the biggest complications after suffering a pneumothorax is experiencing another one, which is why it is imperative that Brees fully heals before returning to the field. It takes about 6-8 weeks for both fractured ribs and a pneumothorax to heal, and with there being only 7 weeks left until the post-season, Brees will definitely feel some pressure to return to the field. His medical team will be closely monitoring how his injuries are healing to ensure he does not return prematurely. In the meantime, Brees will be taking some time to rest to allow his injuries to recover.

Drew’s physical therapy team will likely play a role during his recuperation as well to ensure that Brees minimizes his risk of complications associated with his injury. In the early phases after a pneumothorax, the risk of pneumonia is high, so his physical therapist can prescribe breathing exercises and even a lower intensity exercise program to allow the lungs to expand and expel any extra fluid that may be trapped in the respiratory tract. As he continues to recover, his PTs will prepare him for his return to football, gradually introducing him to activities to ensure he can tolerate the stress. Their biggest concern will be his respiratory response to exercise, and they will monitor his body’s response through vitals to confirm he can tolerate the higher demand of football when he is cleared to play. Whether Jameis Winston is up to the task of carrying this team to the post-season during this time, however, is yet to be determined.

Sources:
https://www.uofmhealth.org/health-library/zt1003spec#:~:text=A%20fractured%20rib%20usually%20takes,ice%20on%20the%20injured%20area
https://www.healthline.com/health/punctured-lung#complications

Week 9: Josh Lambo

At a Glance –
Player: Josh Lambo
Position: Kicker
Team: Jacksonville Jaguars
Injury: Glute Med Strain
Projected Recovery Time: 8-14 weeks

Josh Lambo has always been a reliable choice for Fantasy Football players. Rated as one of the best kickers prior to the 2020, Lambo was anticipated to have another productive season on the Jags. However, after being activated off the IR, Lambo re-aggravated a hip injury that will sideline him for the rest of the season. This injury came late during the Jags vs Texans when Lambo took an onside kick and was more severe than the initial hip injury from earlier in the season. Reports indicate that Lambo injured his left gluteus medius (glute med) muscle, and as a kicker, this injury is particularly debilitating. The glute med muscle is essential for single leg activities as one of its main functions is to maintain a level pelvis, and damage to this muscle makes activities like running and climbing stairs very difficult. Injury to this muscle leads to outer hip pain and also increases risk for general lower extremity injury, as studies have shown that poor control and strength of this muscle predisposes people to sustain knee and ankle injuries. It makes sense that someone whose position depends on having stability and power on one leg would be unable to finish out the season if the injury was severe enough.

Though the specifics have not been reported on Lambo’s injury, the fact that he is reportedly out for the season indicates he sustained more than just a minor strain. Whether the tendon or the muscle itself has the injury, treatment will look very similar, and Lambo will work very closely with his rehab team to help him prepare for next season. If Lambo suffered what is called a Grade 2 muscle strain or sprain, in which fibers of the muscle or tendon are significantly damaged but there is not a complete rupture, he can undergo conservative treatment with physical therapy to allow the affected structures to heal. As the healing process progresses, his PT team will design a program to allow him to gradually load the muscle and tendon to prevent both atrophy and overuse, as both of those outcomes can delay his recovery even more. Early phases will focus on pain management and simple activation and control of the glute med, but as time goes on, increased focus will be on single leg activity. When Lambo kicks during a game, he drives his right leg forward to kick the football, and he relies a TON on that planted left leg to provide power and stability when his right foot leaves the ground. Treatment sessions will thus put emphasis on a variety of balance exercises to ensure that when Lambo returns in 2021, he will have the stability necessary for those 55 yarders. Even if the injury is more severe and there is a full-thickness muscle or tendon rupture, Lambo will still participate in PT after he undergoes surgery, though the recovery process will be longer. These types of injuries tend to be very nagging so his PTs will teach Lambo strategies to prevent injury recurrence. With the Jags record this year, they could really use a reliable kicker and are going to have to try their luck with someone else (and if you still have Lambo on your roster, you better try your luck elsewhere, too).

Sources:
https://sports.yahoo.com/report-josh-lambo-headed-back-172412215.html

Get to know 3DPT’s Dr. Dan Deitz!

Dr. Dan Deitz recently graduated with his Doctorate in Physical Therapy from Acadia University and prior to starting at 3DPT, he spent time at Magee Rehab hospital working with patients with spinal cord injuries and neurological conditions.

Fun Fact: Dan always knew he wanted a career in healthcare but realized he had a phobia of blood. He found his perfect fit in Physical Therapy and hasn’t looked back since!

Dan’s already loving working with 3DPT patients.  PT gives him the opportunity to meet new people, and collaborate with his patients to create a pt program that will help them meet their goals!

Click here to learn more about Dan and keep reading for some fun facts:

COLLEGE(S) ATTENDED:
Arcadia University

HIGH SCHOOL:
Eastern Regional HIgh School

CRAZIEST INJURY YOU EVER TREATED:
A rotator cuff repair on an individual with a C8 level spinal cord injury.

TELL US THE INJURY/CONDITION YOU LIKE TREATING THE MOST:
I love working with all patients, but I’m most interested in working with patients with injuries pertaining to the lower extremity.

TELL US WHAT MAKES YOUR DAY GREAT AT 3DPT:
Seeing make progress to their goals and the endless jams being played over the speaker.

WHY IS 3DPT LUCKY TO HAVE YOU:
I’m extremely friendly and I love strategizing with patients to make meaningful and impactful changes in their lives.

FAVORITE MOVIE OF ALL TIME:
Goodfellas

LAST BOOK YOU READ:
The Kite Runner

FAVORITE DISH AT A RESTAURANT:
Bacon Brulee Benedict from the PopShop

MOST DARING THING YOU’VE DONE:
Drive solo to Tennessee to sell dumplings out of a food truck.

Week 8: Danielle Hunter

At a Glance –
Player: Danielle Hunter
Position: Defensive End
Team: Minnesota Vikings
Injury: Herniated Disc with subsequent surgery
Projected Recovery Time: 16-24 weeks

The Minnesota Vikings have had a disappointing season in 2020. Despite the impressive showing against Green Bay that resulted in a win at Lambeau this past week, the Vikings have had one lackluster performance after another. Their defense is very young, and though their rookies have shown promising improvements in defending the passing and rushing game, they are missing their star defensive end on that field. Danielle Hunter, a 2x pro-bowler and major playmaker, has not seen a snap so far this year, and recent reports indicate he won’t make it on the field at all this season. Rumors of an injury began in August during training camp, but it seemed that Danielle would return quickly as Coach Mike Zimmer dismissed the neck injury as a “tweak.” However, as weeks went on, it became clear that Hunter’s injury was more complicated as he was never activated from the IR. There wasn’t much information about his recovery until this week, when it was disclosed the Hunter actually underwent neck surgery to address a herniated disc. He released a statement that he is recovering well and will be ready to play in 2021.

Intervertebral discs separate vertebrae (bones) in the neck and back, and they provide cushioning and shock absorption to the structures around them. Sharp turns or compressive forces, as well as age, can lead to a disc becoming herniated, which means the disc juts out. If the disc protrudes in a certain direction, it may compress a spinal nerve which can be painful and lead to both muscle and sensory symptoms. People often complain of numbness, tingling, and weakness that travels down their leg or arm. Herniated discs can cause symptoms that limit a person’s ability to function, and when symptoms are severe enough that the person does not respond to conservative treatment, surgery is warranted. Hunter’s pain levels and disability caused him to fall into this category. Although it was not disclosed just what type of surgery he had to address this issue, he likely underwent a discectomy, in which the part of the disc that is causing his symptoms is removed. He has already started physical therapy to help him get ready for the 2021 season. Herniated discs are an injury that physical therapists treat very often, even if a person does get surgery. For herniation of discs in the cervical spine, as is the case with Hunter, focus of treatment is on building strength in the neck, upper back, and shoulders. Discs often become damaged due to instability from muscle weakness, and strengthening key muscle groups helps with injury prevention. The hits that are part of football can easily re-aggravate Hunter’s pain so he will work closely with his rehab team to build that stability up. Endurance is equally as important for Hunter as he has to play the full 60 minutes, and there are specific exercises we have up our sleeves to help. A basic exercise Hunter will do is a chin tuck, which looks kind of like a double chin but requires use of muscles that are essential for neck stability, and his program will incorporate exercises that require Hunter to hold that position to build up endurance and stability. He will be able to start game-like exercises at about 16 weeks post-op and will have plenty of time to get ready for OTAs in the spring. Though the Vikings may not be doing too hot this year, they have the return of their pro-bowler to look forward to during the off-season.

Sources:
https://www.si.com/nfl/vikings/news/vikings-de-danielle-hunter-successful-surgery-herniated-disc-neck
https://www.tmisportsmed.com/pdf/tmi-anterior-cervical-disectomy-and-fusion-protocol-3-15.pdf

Week 7: Ron Rivera

At a Glance –
Player: Ron Rivera, aka “Riverboat Ron”
Position: Head Coach
Team: The Washington Football Team
Injury: Squamous Cell Carcinoma (Skin Cancer)
Projected Recovery Time: Treatment completed, with follow-ups in the future

The month of October is dedicated to Cancer Awareness in the NFL. If you’ve watched any games this month, you may have noticed the “Crucial Catch” slogan on the colorful gear that both players and staff have worn, calling awareness to a very common and often life-altering disease. The NFL is using this month to promote the importance of screening and early detection of cancer, as well as ways to reduce the risk of developing cancer. Although this article is typically reserved for injuries sustained to players, one very influential coach in the NFL celebrated an important milestone this week, and it seemed fitting to highlight his battle with cancer during the last week of the NFL’s Crucial Catch campaign. Ron Rivera, the head coach of The Washington Football Team, was diagnosed with Squamous Cell Carcinoma (SCC), a type of skin cancer, in August of this year. Cancer is characterized by abnormal and accelerated growth of cells, and with SCC, skin cells are the cells dividing uncontrollably. This type of cancer is caused by exposure to UV radiation and can be deadly if left undetected. Luckily, Riverboat Ron had a yearly check-up that allowed his doctors to catch the cancer in its early stages, which means the disease is very treatable. Footage was released this week containing the very best news: Ron Rivera completed his last round of cancer treatments after 7 weeks.

If you know anyone who has undergone cancer treatment, you know that the side effects of the disease and its treatments can be very harsh. The number one symptom that people will complain of is Cancer-Related Fatigue, which is exhaustion related to cancer and its treatments that interferes with a person’s ability to function. This fatigue is very difficult to alleviate, but there are some actions a person can take to decrease its effects, and participating in physical therapy has been shown to be one of those effective treatments. When a person with a cancer diagnosis comes in for treatment, his or her PT team will design a program that will help the patient preserve energy and function more normally. Parts of treatment will focus on targeting musculoskeletal problems, such as muscle inflexibility and weakness, that may interfere with a person’s function, as well as addressing deconditioning (or lack of energy with normal activities) by helping patients improve their endurance gradually so that they can perform their daily activities more easily. Additionally, PTs can offer tips on how to perform daily tasks while exerting less effort. It has not been disclosed if Rivera has been participating in PT during this time, but he has been very vocal about his fatigue, and it is likely that he has been staying as active as possible to lessen the effects of that exhaustion. He will continue to go through follow-ups for years to keep an eye on his progress, but going through that final round of treatment is a great reason to celebrate. His battle and success against cancer confirms just how important screening and early detection is to treat and beat this disease. We can’t be happier for Riverboat Ron!

Check out the link below to learn more about screenings and early detection from the American Cancer Society:
https://www.cancer.org/healthy/find-cancer-early/cancer-screening-guidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html

Sources:
https://www.espn.com/nfl/story/_/id/30197801/washington-coach-ron-rivera-cheered-hospital-cancer-treatments-finish
https://www.skincancer.org/skin-cancer-information/squamous-cell-carcinoma/
https://www.cancer.org/healthy/find-cancer-early/cancer-screening-guidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html

Week 6: CJ Board

At a Glance –
Player: CJ Board
Position: Wide Receiver
Team: New York Giants
Injury: Concussion, Neck Strain
Projected Recovery Time: 3 weeks – 2+ months

The NFC East is still wide open, despite the fact that the division is 5-18-1 in games played this year. Injuries have been rampant in this particular division, as every team has lost at least 1 key player this season. During a divisional game this past week, another injury occurred – again to the Giants – and this one was particularly concerning. When attempting to make a catch, CJ Board was hit and knocked unconscious, hitting his head on the ground when he landed. Luckily, the Giants’ head coach reported that Board was responsive on the field and had sensation and movement in all extremities. Though Board was quickly immobilized and transported after the injury, it has been confirmed that he has been ruled out with a concussion and neck sprain. He will need to participate in physical therapy to heal, rebuild strength, and address vestibular deficits. Concussions are mild traumatic brain injuries, caused by a blow or jolt to the head, that may leave a person with behavioral, cognitive, or physical symptoms for weeks to months. They are serious injuries that can disrupt the brain’s chemistry and function, and it is important to diagnose the injury and allow the brain to heal. Physical therapists are trained to identify and understand symptoms to ensure a person safely returns to activity.

Concussions are a difficult injury to treat as people present differently, depending on the severity of the concussion, but the biggest goal of Board’s physical therapy program will be to re-introduce activities gradually. If someone returns to higher level activities too quickly, a brain bleed can develop from excessive swelling, or a person may develop post-concussive syndrome, in which symptoms last for several months. One of the best ways to treat concussions is exercise, surprisingly enough. Studies have shown that exercise improves blood flow to the brain and strengthens the brain’s communication pathways, and by returning to exercise gradually, a person can start returning to daily activities. Typical symptoms include headaches, dizziness, and “feeling foggy”, and early interventions in Board’s PT program will help him improve his tolerance to moving his head, standing, and performing daily activities. The injury report states he has a “neck strain”, which is a little ambiguous but indicates Board may have had whiplash from his injury. A whiplash injury puts strain on the tendons, ligaments, and nerves in your neck, causing pain and headaches, among other things; Board will work on strengthening key muscle groups in the neck, as well as addressing vestibular impairments, which are very common with both concussions and whiplash. Vestibular (or inner ear) problems interfere with balance and coordination, and PTs have a variety of exercises to help Board improve his stability. As he progresses, the exercises will become more difficult to ensure he can tolerate the demands of professional football. There is even a formal treadmill program that measures heart rate and symptoms that Board will likely participate in to make sure he can return to football safely. His PTs will know the signs of a poor response to exercise to make sure he isn’t doing too much, and hopefully in the next 3-4 weeks, he will be able to make a full recovery and return to football, just in time for the second half of the season.

Sources:
https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-concussion
https://giantswire.usatoday.com/2020/10/19/new-york-giants-offering-encouraging-news-cj-board-terrifying-injury/

Week 5: Dak Prescott

At a Glance –
Player: Dak Prescott
Position: Quarterback
Team: Dallas Cowboys
Injury: Compound Ankle Fracture, Ankle Dislocation
Projected Recovery Time: 5-9 months

The NFC East saw one of the greatest comebacks this week with the return of Washington’s QB Alex Smith, who suffered a gruesome leg injury in 2018. Smith battled through several life-threatening infections, muscle and nerve damage, as well as an intense physical therapy program, to make it back to the NFL, and his dedication and grit is truly impressive to everyone, no matter what team they support. Unfortunately, this division also lost one talented QB the same day another returned: Dak Prescott. Dak, who is in his contract year, suffered a gruesome ankle injury during a divisional game against the NY Giants when he was tackled during the third quarter. You could tell by the look on his face when he was carted off the field that something was seriously wrong. It was confirmed Monday that Dak indeed suffered a compound lower leg fracture, as well as dislocation of that same ankle. Dak underwent surgery Sunday night and is undoubtedly out for the rest of the 2020 season. The severity of Dak’s injury makes it difficult to predict his recovery timeline, but the greatest concern is ensuring his leg does not get infected. A compound fracture means that there is a break in the skin, which can allow germs and other infection-causing agents into the wound, and risk of infection is higher. The surgery stabilizes the displaced ankle bones, but the surgical team will also thoroughly clean out the wound to reduce the risk of infection as much as possible.

After surgery, Dak will go through a phase of limited-to-no-weight bearing to allow the damaged tissues to heal. If there is ligament involvement, which news has not been released as of yet but is very likely, this immobility phase will last even longer. After about 4-6 weeks, Dak can finally start some weight bearing activity, although he likely would have started physical therapy already. Many injured athletes (including Alex Smith!) are now utilizing blood flow restriction training (BFR) early in their recovery, as this process allows you to gain more strength without breaking weightbearing or strength training restrictions. BFR works by partially occluding blood flow to an extremity, which triggers specific pathways that cause the body to build muscle faster. Essentially, you feel like you did a high intensity workout without having to use much weight at all! Dak will likely use BFR often during the earlier phases to regain strength to accelerate his recovery time. It won’t be until 12 weeks or more that he will be able to start football-related drills, however – he has to have minimal pain and regain full strength and flexibility before starting those activities. Eventually, after Dak passes his Return to Sport Testing that puts his balance and strength to the test, he will be able to finally return to practice and games, 5 to 9 months later.

Though he has a long road ahead of him, Dak has proven to be a resilient player and person and will be back, ready, to play for his contract in 2021.

For more information on BFR, as well as how we use it at 3DPT, check out this link: https://3dpt.com/blood-flow-restriction/

Sources:
https://www.espn.com/nfl/story/_/id/30094698/dak-prescott-dallas-cowboys-carted-field-ankle-injury
http://nwomedicine.com/wp-content/uploads/2014/09/ProtocolAnkleORIF.pdf

Get to know 3DPT’s Pat Fryer!

By: Pat Fryer
If you have been to one of our PT clinics, you have likely had the chance to interact with our physical therapy aides. The PT aides at 3 Dimensional Physical Therapy assist the physical therapists with providing the best experience possible for all of our patients. They help to keep the clinic looking great, provide patients with heat or ice, and help patients get set up with exercises to keep their session moving along efficiently.

At 3DPT, we have been lucky enough to hire outstanding people as our PT aides!  This is not by accident – we prefer to hire people we’ve had a chance to get to know and who have an interest in moving forward in a healthcare profession.  This is exactly how Pat Fryer came to work at 3DPT!  Pat was originally a patient here, but has been a great member of the team at 3DPT Medford since 2013.  He’s always going above and beyond to help our patients and PTs.  Keep reading to hear Pat tell his 3DPT story!

My 3DPT journey started back in 2013 when I was playing football in high school. I was a center and long snapper at Shawnee High School. During one of our games, a defender pushed into my knee and I went down immediately. Thankfully the injury ended up being minor and I was diagnosed with patellar tendinitis. After the season I began physical therapy at 3DPT with Jeff and was back to new within a couple of months, which was great!  But even better, after going through physical therapy at 3D I knew that I wanted my career to focus on an area that incorporated sports and the rehab of injuries.

Two years later I started college at Penn State University as an Athletic Training major. I had the amazing opportunity to work with the Men’s Ice Hockey team, the men’s & women’s gymnastics teams and the men’s & women’s fencing teams. I loved being immersed in these sports, but I felt something was missing. While working with certain sports teams I was only seeing a limited number of certain injuries and age groups. That’s when I made the switch to Kinesiology as my major.  Soon after I came to 3DPT to speak with Jeff about spending time at the clinic to shadow the PTs. I shadowed Jeff once a week during the summer of 2017 and knew that this was where I belonged. After my junior year of college I inquired about becoming an aide at 3DPT and Jeff hired me for the summer.

During 2018 and 2019 I worked as an aide during the summers while I was still attending Penn State. I graduated in December of 2019 and since then I have been working at our Medford office and occasionally at our new Tabernacle office. I couldn’t ask for a better workplace or coworkers and I couldn’t imagine working anywhere else. This past summer I applied to Physical Therapy schools and am now waiting to hear back about admissions decisions. (Fingers crossed!)

Thank you to Jeff, Ken and everyone at 3DPT because without them none of this would be possible!

Fun Facts

Favorite Food:
Buffalo wings, the spicier the better

Favorite Activity:
Playing sports and hanging out with my friends, preferably while watching sports

Favorite Sport: Football:
I’m a huge fan of Penn State and the Packers

Week 4: Ziggy Ansah

At a Glance –
Player: Ezekiel “Ziggy” Ansah
Position: Defensive End
Team: San Francisco 49ers
Injury: Bicep Tendon Tear
Projected Recovery Time: 3-7 months

The San Francisco 49ers need to replace yet another pass rusher after Week 4. After losing pro-bowler Nick Bosa to an ACL tear earlier this season, the Niners defensive line was missing a significant piece, and Ziggy Ansah was given the chance to fill that role. This opportunity was short-lived as Ansah left the game on Sunday vs the Birds after suffering an arm injury, ruled-out from play at halftime. An MRI on Monday confirmed a tear of the bicep tendon, meaning that Ansah will likely undergo surgery to repair the tear within the next week. It is unlikely that he will return to play in 2020. Bicep tendon ruptures typically occur when a strong force is applied to a bent elbow that the muscle cannot counteract, and the torn tendon can be at the level of the elbow or shoulder.  The bicep muscle is one of the main muscles responsible for elbow flexion (bending) and supination (rotating your arm so your palm faces up), and a complete tear at either tendon leads to significant loss of strength and function in the arm. Regardless of the location of the tear, physical therapy is a major portion of a person’s recovery of function and return to normal activities.

After Ansah undergoes surgery to repair the bicep, surgical precautions will be in place, stabilizing his elbow and preventing him from actively using the muscle. Typically, a person is not able to contract his or her bicep for 8 full weeks post-op so focus of early programs are on maintaining wrist and shoulder strength, as both can be affected by arm immobilization. A major part of the earlier program is making sure Ansah doesn’t contract his bicep muscle or put too much tension on the repair by straightening the elbow too much. After he completes this “protective phase” of his program, he can start working on restoring normal motion and strength. His physical therapist’s job is to design a program that gradually loads the bicep to ensure Ansah does not over-stress the repaired tendon. The last few weeks of rehab will focus on restoring power, or the ability to exert a lot of force quickly, which is essential for his position. Defensive Ends push other players aside to get to the QB, and if he does not have adequate power or strength, the repaired tendon will be at risk and may get re-injured. Upper body stability is a key component for injury prevention, and many exercises in Ansah’s later program will incorporate weight bearing positions to challenge his ability to support himself with his upper body. He will have to go through Return to Sport Testing to make sure he is ready to return to the field. Unfortunately, it takes about 3-7 months to be cleared so his chances of returning during the regular season are slim. However, if the Niners make a post-season appearance, Ziggy Ansah may be back to help them in their hunt for the Lombardi Trophy.

Sources:
https://www.gundersenhealth.org/app/files/public/1463/Sports-Medicine-Protocol-Distal-Biceps-Tendon-Repair-Tanner
https://www.espn.com/nfl/story/_/id/30049584/san-francisco-49ers-ziggy-ansah-kwaun-williams-latest-head-ir

Week 3: Julio Jones

At a Glance –
Player: Julio Jones
Position: Wide Receiver
Team: Atlanta Falcons
Injury: Left Hamstring Strain (Low Grade)
Projected Recovery Time: 2-4 weeks

Hamstring strains have been a common theme during this 2020 NFL season. The Atlanta Falcons organization is no exemption, and this specific injury sidelined an integral piece of the Falcon’s offense: Julio Jones. Julio, a key playmaker and veteran on the team, was ruled out minutes before the Falcons’ contest against the Bears this past Sunday after re-aggravating a hamstring injury during the Falcons-Cowboys game during Week 2. It is unknown at this point if he will be cleared for the upcoming game against the Packers because, unfortunately, hamstring strains tend to be very nagging injuries. Julio initially injured his hamstring during the 2020 offseason but was able to play the first few weeks with few limitations, indicating that it was likely a low-grade strain. Low-grade strains are classified as mild, with minor damage to individual muscle fibers but preservation of the muscle as a whole. Strength and flexibility may be impacted but minimally, whereas with higher grade strains, you can expect to have significant loss of function.

Regardless of the severity, hamstring strains have high recurrence rates, meaning that re-injury is likely. Julio is currently dealing with the nagging nature of this injury, and it is unknown at this time if he will be ready to return in time for Monday Night Football. He will be working closely with his rehab team to try to make that deadline. Julio’s treatment plan will focus on addressing strength and flexibility impairments so he can return to sport with minimal risk of re-injury, and manual therapy and other modalities will be used to improve pain level so he can make a quicker return. Emphasis of his program will be on improving eccentric hamstring strength, which is essential for his position as a wideout. Julio is sprinting during the majority of his time on the field, and running requires a LOT of eccentric hamstring strength as your hamstring is used to control your leg as you swing it forward. The recovering hamstring muscle will be put to the test constantly during Julio’s routes so it is crucial for Julio to work with his rehab team to avoid being sidelined by this injury again. Typical exercises to “bulletproof” the hamstrings include hamstring bridges, hamstring curls, and nordic leg curls.

Click here to read more about hamstring strains and see some of the exercises that can be used to help prevent injuries

Julio may be able to return as early as this week to football, but he is going to continue rehabbing that hamstring for the remainder of the season. Hopefully he’s back sooner rather than later – the Falcons (and your fantasy team) could really use him!

Week 2: Saquon Barkley

At a Glance –
Player: Saquon Barkley
Position: Running back
Team: New York Giants
Injury: Torn ACL
Projected Recovery Time: 6-10 months

In Greater Detail –
If you had to name the top 5 running backs in the NFL, Saquon Barkley is without a doubt on your list. This first-round draft pick had an impressive debut in 2018, setting multiple league and franchise records, and though he suffered a high ankle sprain last year, he was expected to have another standout season in 2020. Unfortunately, those hopes fell short as Saquon sustained one of the most dreaded injuries in sports: the ACL tear. This injury is far too common (7 NFL players suffered torn ACLs just this past weekend!) and results from rotational stresses, sudden changes of direction, and/or poor landing mechanics. The ACL (anterior cruciate ligament) limits forward translation of the tibia on the femur, providing stability for the knee joint in multiple planes. This ligament can rupture if excessive forces are placed on it, and if the tear is complete, surgery is often warranted if someone is returning to a higher level of play. The NFL is certainly classified as such, and thus Saquon will undergo surgery to reconstruct the ACL in the upcoming couple of weeks.

During this surgery, tissue is taken from the tendon of the quadriceps, hamstring, or patella and anchored to the tibia and femur, providing similar stability as the original ACL. However, it takes up to two years for the new “ligament”, or graft, to fully resemble a normal ACL. Physical therapy is a major part of a person’s recovery, and an elite athlete like Saquon will likely start PT within a few days of having surgery. The first few weeks of rehab will focus on improving pain levels, decreasing swelling, and recovering quad muscle strength, and around the 3-month mark, a person can finally be cleared to run. Strengthening of the quad, glutes, and hamstrings will be prioritized during sessions to improve lower body control and eliminate any muscle imbalances that may have contributed to the initial injury. The later phases of rehab will focus on proper technique with cutting, pivoting, and single-leg activities, with an emphasis on proper landing mechanics and dynamic balance. Protection of the graft is the biggest priority throughout rehab.

Though NFL players are outstanding athletes, recovery after ACL reconstruction will take at least 6 months because the healing and remodeling of the graft will follow that 2-year timeline despite any strengthening or balance training efforts. Therefore, if Saquon has no complications post-op, he will likely be ready to participate in OTAs and camp in anticipation of the 2021 season. Oftentimes, ACL tears are accompanied by damage to other structures in the knee that may not be reported, and if this is the case for Saquon, his recovery will be prolonged. Whether Saquon is back in 6 or even 10 months, it is clear his 2020 season is finished, and he will spend the rest of the year with his PT team preparing for his return to MetLife in 2021. Saquon is one of the most exciting players to watch, and this injury hit hard across the entire NFL. We can’t wait for his comeback season!

At 3DPT we work with lots of patients with ACL injuries, but we also work with athletes to strengthen and prepare their bodies so that injuries can be prevented!  To read about an ACL injury prevention program we led with the elite soccer players of REAL Jersey FC click here.

Get to know 3DPT’s Olesky Sisters!

We consider ourselves like a family here at 3DPT – we spend lots of time together, we really like each other, and we’re always here to support one another.

This is especially true for Alina and Liz Olesky, two of the smiling faces you’ll see working at the front desk at 3DPT Haddonfield and…actual sisters!

Alina and Liz fit in perfectly in the 3DPT family too – both have a love for community and helping others. In fact, Alina has taken on the role of 3DPT Haddo’s Community liaison and Liz is studying to be an ASL interpreter to help those in the deaf community (check out her video below)

Alina Olesky:

Some of you may know Alina Olesky from the front desk at our Haddonfield location, but she is now one of our community service liaisons too! Alina is a senior at Rowan University, and soon she will be graduating and applying for PT school. Since high school, Alina has known that she’s wanted to become a physical therapist. She’s always been interested in human biology and fitness, and being able to combine those two interests was a no brainer. As a community liaison, Alina will be helping 3DPT find opportunities to give back to our community. In fact, this September, Alina has signed up Haddonfield to partake in STEPtember, fundraising to support cerebral palsy research.

Liz Olesky:

Liz works at the front desk in the Haddonfield and Cherry Hill locations! After receiving a BS from Stockton University in Health Sciences, Liz just started her final year in the American Sign Language interpreting program at Ocean County College.  If anyone is in need of PT and an ASL interpreter, Liz can help!

Just like every family, 3DPT’s family has some amazing people!  Click here to learn more about our entire team.

Week 1: Vonn Miller

At a Glance –
Player: Von Miller
Position: Linebacker
Team: Denver Broncos
Injury: Subluxed Peroneal Tendon(s)
Projected Recovery Time: 12-24 weeks

Denver fans have high hopes for this season, and rightfully so, with the signing of Drew Lock as their QB, as well as the promise of a formidable defense due to many standout players on the opposite side of the ball. This impressive defense, however, is unfortunately a man down before the team’s season even started. Von Miller, a veteran linebacker on the Broncos, suffered from a subluxation, or dislocation, of the peroneal tendons at practice on Sept. 8, undergoing surgery just 3 days later. This type of injury is rather unusual and results from damage and/or tearing of the connective tissue that surrounds the two muscles located on the outside of the ankle. These muscles are responsible for eversion, which allows the foot to turn towards the outside; and without the stabilization offered by the connective tissue, these tendons can roll out of the groove that contains them, causing malfunction and further damage.

You can see in the pictures below how disruption of that connective tissue can lead to muscle displacement. Surgery is warranted when the injury is severe enough, and thus Von Miller was placed on the IR soon after an MRI confirmed the diagnosis.

Following the surgery that repairs and tightens the connective tissue, a person can expect to have a non-weightbearing restriction for 4-6 weeks. There is another period of immobilization using a cast that then progresses to the rehab phase, which is a major part of a person’s recovery. It is during this phase that the person will work on gaining motion, strength, and stability with a physical therapist. For Von Miller, an emphasis will be placed on the later phases of rehab to ensure he is ready to return to play while minimizing risk of re-injury.

PT is key for avoiding re-injury for people affected by peroneal subluxation as there tends to be significant balance and strength impairments post-op!! Football is a tough sport to return to due to the high degree of contact, and Von Miller will undoubtedly focus on game-like exercises during the later phases of his rehab so he is prepared. For typical people, recovery takes at least 18 weeks, but this timeline is likely shorter for Von Miller (he is an elite athlete, after all) so he may not miss the entire season. The best-case scenario is that he makes an appearance in December, but again, it depends on Von Miller’s progress with PT. Hopefully, the Bronco’s D can hold it together so he can be back just in time for the playoffs.

Sources:  

http://www.indianafootandanklecenters.com/common-disorders/peroneal-tendon-dislocation

https://www.sportingnews.com/us/nfl/news/von-miller-injury-update-timeline-return-date/1vsdrskqznkce1ecg402vpgxs5

Get to know 3DPT’s Dr. Anthony Perrone!

When I am asked why I became a physical therapist, the short answer I give is that I was exposed to the profession as an injured athlete in high school and college. During this time I learned a lot about the rehabilitation process and how physical therapists can play a crucial role in improving a person’s quality of life.  I loved how the profession requires a combination of anatomy, science, exercising and always getting to meet new people and having the privilege to make a difference in their lives.   As I enter the 10th year of my PT career, I reflect on the determination and desire I still have to reach my goals in providing an exceptional level of care, help push our profession forward and to help young therapists reach their goals.  The drive and commitment I have everyday to reach these goals began senior year of high school in 2003, when my career path turned in an unexpected direction.

That year,  I felt as if everything in my baseball career was falling in place.   This was my 3rd season as a starting varsity outfielder and I was being scouted by numerous colleges and professional teams the prior year.  I had worked tremendously hard in the offseason in the weight room, becoming a better fielder and hitter.  The only concept I understood at that young age was to train, train and train as hard as I could.  It didn’t matter what I was doing, as long as I did it at 120% effort then it would be serving a purpose.  My dream of playing professional baseball one day was becoming more of a goal for me.  Training, practicing and playing was never work, it was always fun and I loved the team aspect of the game.  I had never suffered a serious injury that kept me out of the game and I was in the best shape of my life that year, or so I had thought.

It was a very hot and humid morning in Florida during our high school baseball spring trip.  Our team was playing our 7th game of the season, and I remember being off to a tremendous start of the season.  During my first at-bat, we had runners on 1st & 2nd with 1 out. The count went to 2-0 and I knew the pitcher was going to have to put something over the plate on the next pitch.  What I did not know was the next pitch was going to be one of my last of my high school career.  The pitcher wound up and delivered a hanging slider over the plate and I crushed it to right center field.  As I was headed to first base, I could see that the ball was sailing over the right fielder’s head and I would no doubt have a chance at a triple.  Once any hitter gets this feeling after they hit a ball, they turn it up to 5th gear on the base path.  As I reached 2nd base, I pushed off the base with my right foot as I turned towards 3rd base. As soon as I pushed off I felt and heard a “pop” in my right hamstring.  I limped to third base and managed to belly flop into third base with a triple.  I remember rolling over on my back and feeling the stabbing pain in my upper hamstring.  The next moments are a blur, but I remember seeing my 2 teammates Matt and Nick (pictured) standing over me. They picked me up and carried me off the field.  Swelling and bruising would follow and it was a few days before I could bear any weight on the leg.   The next series of events would lead my career in a completely different direction.

I would end up retearing my hamstring multiple times over the next month trying to get back on the field too quickly and not going through the comprehensive rehabilitation process required for such an extensive injury.  My senior year and summer baseball season were lost, most opportunities to play at the next level were lost and the ability I had to sprint the way I could was lost.   My first year at Seton Hall University I walked on the baseball team, or as I like to say, “limped on” and made the team. I played there for 2 years but was still never physically the same. It was extremely frustrating knowing I could compete on this level, but my chronic hamstring injuries would not allow me.   I decided to transfer to William Paterson to start focusing more on school while still giving baseball another shot, because the passion I had for the sport was still strong and the program and coaching staff was top notch.  However, it would be another disappointing and injury plagued season during my 3rd year of college.

At this point, I was heartbroken and completely mentally and emotionally drained from what I went through during the previous 4 years.  I never wanted to play again and felt resentment towards the game.  Instead  I wanted to focus on becoming a physical therapist and help people overcome physical limitations that are not allowing them to do the things they love to do in life. It was already cemented in my mind that any athletes who would be coming into my office for PT would receive every ounce of effort I could give to make sure they get back into sport and they do not have to endure what many athletes like myself did.  As I was volunteering at multiple PT clinics during my 4th year of college, I spent time at a PT clinic with therapists who approached PT on a different level. They were more focused on the source of the problem, not just treating the symptoms. It was a completely different kind of PT that I was used to.  I remember thinking to myself, man… where were these guys when I was struggling trying to stay healthy playing baseball.

When I found out I got into PT school later that year, I was ecstatic and felt accomplished.  I was set to start my career next fall as a PT student, but deep down I knew I was not ready to quit on baseball yet.  I knew I had one year of eligibility left to play baseball that spring as a 5th year senior, and quitting the game that I loved since I was 3 years old so much because of injuries, would be something that I would think about everyday of my life. I decided to give it another try but this time with a different approach.  To prepare myself for that season,  I decided to train at that same PT clinic I had volunteered at with their PT’s and strength and conditioning staff.   I trained not only hard, but much smarter this time, and addressed specific physical limitations that could increase the risk of getting hurt again.  Now… I felt I was in the best shape of my life.

Sure enough, that year I started every game but one and did not miss a game due to injury.  It was an incredible season; getting to compete in every game, the friendships that I still have today from teammates and playing the game at the level I wanted to. Seasons like this stay with an athlete for life.  I truly understood during that season how addressing your physical conditions can have a significant impact on your overall well being and quality of life.   Now as a PT helping others work through their physical limitations, I feel spoiled in a sense that I have the privilege of watching a patient’s overall well being and quality of life improve as they get back to doing the things they love.  I am grateful for that privilege everyday.  Physical therapy not only helped give me that last season in college, but also gives me a purpose and an opportunity to make a difference each and everyday.

Happy birthday 3DPT Cherry Hill

On August 1, 2019, 3 Dimensional Physical Therapy officially opened our 4th clinic in Cherry Hill, NJ.!  Our first year in Cherry Hill has flown by and has been filled with lots of great people, events and of course physical therapy!

We started off with a Grand Opening celebration in September and even had Cherry Hill’s mayor-to-be cut the inaugural ribbon. We’ve hosted events like a blood drive, a couple pop-up Barre classes with Barre3, injury prevention seminars and had the chance to participate in a few community events.  We’ve hosted 2 students working toward their doctorates – first Brooke from the University of the Sciences and now Kristen from Arcadia.  And best of all, we’ve gotten to work with some amazing patients throughout the year!

When Chuck and Anthony first met in graduate school, working together in their own clinic was just a dream. You can read that story here!  Now the dream is a reality and they get to work alongside each other and a great team every day – Jen and Sam who welcome everyone with a smile at the front desk, Justin who helps patients during their sessions and even Jetty, our furriest employee 🙂

We’re extremely grateful for the opportunity to help patients in the Cherry Hill community everyday and are looking forward to many more years in Cherry Hill!

Click here to see a video highlighting Cherry Hill’s first year!

How to choose YOUR best care

Did you know that you don’t need a prescription to see a Physical Therapist? Most insurance companies allow you to see a licensed Physical Therapist for up to 30 days without a prescription. This is helpful especially in cases of vertigo or low back pain where early PT has been shown to not only get you better more quickly, but also save you and the healthcare industry time and money by avoiding unnecessary procedures.

If you have already seen a physician and have a prescription, here are some questions that you can ask to ensure you’re in the right Physical Therapy office for you:

1. How many patients do your therapists see per hour?
   Some companies will require their Physical Therapists to see 4-5 people per hour. This will limit both the amount of hands-on care you will receive, as well as limit the personal attention from the PT. Some people do not mind a higher volume clinic, but this is a great question to ask off the bat so that you understand the treatment that you will receive.

 

2. Will I be working with the same Physical Therapist each visit, and will they be providing the treatment?
   This comes down to personal preference. Some people will feel more comfortable with the same clinician each visit, and some won’t mind rotating based on schedules. Some companies do a great job with communication between staff members so that everyone is on the same page with treatment progression. Some people will want to work with just 1 PT during their session, and some will not mind who follows them through exercises.

 

3. Can you tell me upfront what my cost will be?
   Transparency of healthcare pricing and billing practices is a hot topic right now. Did you know that an independent outpatient clinic will charge (and be reimbursed) less per visit than a corporate or hospital clinic? This could impact you if you have a large deductible plan or a high percentage copay. A company should be able to tell you before your visit what your financial responsibility will be in an honest and transparent way to allow you to make the best decision for you.

 

4. Do you have a specialist for my condition?
   Physical Therapy school does a great job preparing PTs for practicing. We all come out of school a generalist, but start to specialize or at least have an area of interest based on our continuing education courses (New Jersey requires a minimum of 30 hours every two years), home study of research articles, and professional experience. There are also advanced certifications that may further specialize a PT perfectly for your condition. Getting you matched with the best person for your condition or goals could be invaluable to your care. For instance, a PT who is a runner or lifts weights would understand the goals and challenges of returning to those hobbies.

You are trading your time and money (copay or deductible) to entrust the clinician to help achieve your goals. You are not going to Physical Therapy because your shoulder hurts, you are choosing PT because you can’t lift your child or put on a coat without pain. The relationship with your Physical Therapist is different than with other healthcare providers. We get to be your PT but also your coach, friend, and sometimes your cheerleader, along your recovery process. If there are issues or frustrations, please talk with your PT to see if there is a simple miscommunication or a way to improve your experience. Here are some questions that you can ask yourself to ensure you have chosen the right clinic:

Does the company live up to the promises made above?
The answers that you got to the questions above should be what you see in the clinic. If you were told 2 patients per hour, and your therapist is seeing 4 people each time you are in, then you should question that. Or if you have a PT aide running you through entire programs and weren’t told that initially, you should have a conversation with your therapist.

Is my Physical Therapist listening to me?
Your PT should be hearing what you are saying, and adjusting treatment or explaining accordingly. There are some exercises or treatments that will hurt. These should be explained. Most should not hurt, so if something does bother you then the therapist should modify that treatment. PT should not mean pain and torture like it used to. PTs are better educated with pain science and are learning to improve tissue quality and function rather than just irritating or inflaming it. Your therapist should also not get defensive if you ask them questions, rather they should take that as a sign that you are interested and invested in your recovery!

Am I making the progress that I want?
Your Physical Therapist should be communicating with you throughout your course of PT about how your progress is going from their standpoint. You should be communicating with them about how your progress is going from your standpoint. If you think you’re doing terrible and they think you’re ready for discharge then there is a problem. This should be a regular conversation with your PT to make sure you are both on the same path towards recovery.

Does my Physical Therapist care about me?
This may sound corny, but this is also the most important item in this list. Your PT should be invested in your recovery! If you get the feeling that you are a number or another body, then your recovery probably will not go the way it should. This is the part that separates PTs from other healthcare professionals – we get to care about you and your recovery while being there with you multiple days per week for weeks and sometimes months of treatment.

Now that you know what to look for and the questions to ask for physical therapy , you can make the best decision possible for your recovery and rehabilitation choice. Don’t be afraid to ask and question your PT, the front desk during your initial appointment, or your physician if you are directed to go to a specific clinic for your PT. What works for others may not be the best choice for you. In today’s healthcare industry, you are your best advocate. When it comes to choosing your Physical Therapist, you do what is best for you!

Get to Know 3DPT’s Gina!

Gina came to 3DPT first as a Mom seeking PT for her son, then as a patient herself, and then was hired as a Front Desk administrator! The journey took 8 years to get her behind the desk at 3DPT in Tabernacle, but it was worth the wait and she is so happy to finally be part of the 3DPT family! A Philly girl at heart she’s been in Tabernacle, NJ for the past 19 years with her husband Scott and two sons (Nick and Nate). And her very energetic doodle, Kimmo!

My Journey to 3DPT
My 3DPT journey began in 2012 when my son (in high school then) tore his ACL and needed physical therapy.  At that time Ken (Guzzardo) and Jeff (Sallade), 3DPT’s owners were just starting out and renting space inside the Pinelands Indoor Soccer Facility in Southampton. The space was small – just a room with 2 tables and two very motivated physical therapists! I popped my head inside this little room where I met Ken and I asked, “Are you guys physical therapists?” After a short conversation I knew we were with good, knowledgeable and caring therapists. And so, began my son’s ACL therapy. He healed strong and went on to play ice hockey his Senior year and all 4 years of college. And he is still playing hockey, softball and golf with no knee issues! Thank you, Ken!

Two years later (2014), I needed Physical Therapy for a shoulder issue. I called 3DPT to make an appointment and found out they had relocated from their little room to a beautiful new office in Medford. I started my shoulder therapy with Joey Strazzullo twice a week. I was greeted with a friendly and happy front desk staff that made me feel like we were old friends. As my weeks of therapy progressed, I got to know Joey better. He quickly became one of my favorite people! The staff made me feel so welcomed and I remember thinking “If I ever need a job in the future, I’d really like to work here. This is a happy place”! Within 3 months my shoulder was healed, and I was discharged. Thanks Joey!I was a little bit sad to end mytherapy and leave this great group of people.

Two years later (2016), I found myself in need of a job. I stopped by the office and had a quick chat with Ken. Ken asked me to check back in a few weeks as there were a lot of wheels in motion with the possibility of a new office opening in Berlin. How exciting…a 2nd location! I interviewed with a few companies and accepted a front desk position with a Beauty company in Mt. Laurel. Two months after I started my new job, Ken called me. He was ready to hire me. UGHHH! I didn’t want to leave my new job after only 8 weeks. I just couldn’t do that. I had to decline. We were both disappointed. The timing just wasn’t right. But I’m a true believer in the motto “All things work out for a reason”.

Over the next 3 years 3DPT opened new offices in Berlin, Haddonfield and Cherry Hill. With each new clinic I felt genuinely happy for the success of 3DPT and the people who make it tick!  From humble beginnings in a tiny rented room to four locations! That is quite an accomplishment! Meanwhile, a little part of me felt like I missed out on a possible job opportunity…again.  It is now 2019 and 3DPT is getting ready to open its 5th office… in Tabernacle, my hometown!

Surely this must be a sign? Right? This time I listened to that little voice in my head and after some soul searching and a few phone calls, 3DPT brought me onboard to train for a front desk position in Tabernacle! Located just 3 minutes from my home, I was excited to begin my new job at a brand-new clinic. The Owner of the Tabernacle clinic grew up in Tabernacle… Carlie Strazzullo, wife of my favorite PT, Joey Strazzullo! This was meant to be! Things are coming “full circle” so to speak. I trained at the Medford clinic for 5 months and in February 2020 the Tabernacle office opened its doors!

The community has welcomed us, and we are so grateful for the support of great patients, friends and family! It took 8 years, but I am finally “HOME”! Come visit us!

FUN FACTS:
Favorite Activity:
Live Theater (Broadway and local)! I was a Communications/Theater major and after college I performed at the Dutch Apple Dinner Theater (Lancaster, PA) for a few years. So much FUN!

Favorite Dish at a Restaurant:
Chicken Parmesan! Mangia!

Favorite Sport:
Ice Hockey. Let’s Go Flyers!

Oddest Job:
Route Auditor for Waste Management. I rode in the garbage truck (cab) and tracked the addresses of all the trash we picked up. Note: Trucks roll out at 4am!

Balanced Nutrition for a Healthy lifestyle

Maintaining Nutritional Balance
Life is busy! We are trying to manage jobs, school, kids, sports, family, fitness, and so much more on a daily basis. Food gives us fuel  to get us from one task to another. However, it can be hard maintaining a balanced diet with such busy schedules. How much protein should I eat day? Did I eat enough carbs today? Did my meal include enough fat? Nutrition can be complicated but there are strategies we can use to make eating a healthy diet a bit simpler. Let’s discuss one easy strategy anyone can use to help portion and balance each meal

Counting calories, tracking macros, and weighing food are common tools individuals use to track daily meals.  It can be challenging to monitor whether we are eating enough or too much each meal. However, our own hand is a great tool for portioning and balancing our meals. Each meal contains an assortment of macronutrients, nutrients we use in large amounts. These nutrients are better known as carbohydrates, proteins and fats. The food we eat supports our internal systems and in turn affects our body composition, performance, recovery and overall well being. Fats, proteins, and carbs are all necessary for fueling our bodies and keeping us running inside and out! Now let’s look into how we can use our hands to estimate serving sizes and promote balanced meals.

The picture shows how we can use different parts of our hand to portion our food each meal. A serving of protein, such as chicken or steak, should be roughly the size of your palm. The recommended serving size for non-starchy vegetables, such as carrots, broccoli, zucchini, is equivalent to the size of your fist. The area of a cupped hand is the recommended serving size for carb sources, such as bread, rice, and quinoa. Finally, the size of your thumb is a good indicator of a proper serving of fat, such as nut butters, oils, butter. It is recommended each meal contain roughly 1-2 palms of protein, 1-2 fists of non-starchy vegetables, 1-2 cupped handfuls of carbs, and 1-2 thumbs of fat

What are some healthy options for each category? Here are some quality food sources for each category to help fill up your plate:

Carbs: white and brown rice, quinoa, buckwheat, oats, potatoes, beans and legumes, noodles, pasta

Fat: avocado, nuts, nut butters, coconut oil, olive oil, cheese, butter, cream, whole eggs, fatty fish (salmon, herring), fattier cuts of beef and pork

Protein: chicken, turkey, beef, bison, fish, eggs, dairy (Greek yogurt, cottage cheese), beans and legumes, tofu

The above list is just a start and there are tons of great options for each category at the store and local market. Remember—always looked for fresh, minimally processed foods when possible. This will help maximize your nutrient intake!

Using hand measurements is one simple way to balance carbs, protein and fats each meal. However, keep in mind we are all unique individuals with different lifestyles, nutritional needs, and diet preferences. Age, sex, activity level, and health status will impact your daily energy requirements. For example, the recommended portions will differ between a high school athlete training daily and a 65-year-old male exercising 3x/week and working a sedentary job. Finally, it’s important to find a system that works for you. One way of eating may work for you but not your best friend! If using your hand as a tool for portion control and balance keeps you energized, awesome!! If tracking macros gets you to your health and fitness goals, go for it!! No matter what, it still comes down to making sure each meal contains a variety of all the macronutrients necessary for fueling and energizing your body each day

Injury Prevention at 3DPT

For athletes nothing could be worse than missing playing time due to an injury… except maybe being forced to miss playing time due to a quarantine!  The first half of 2020 has certainly been different for everyone, including athletes of all ages. From young athletes to professionals, pretty much everyone has been sidelined from playing their favorite sports.  Players may be anxious to get back to playing, but jumping right back into their high level of sport can be risky after months of no action.  So what does an athlete do?  The best thing an athlete can do is to train and prepare for upcoming play – not just practicing skills, but strengthening their bodies to handle the stresses of play.  This type of training can reduce the risk, or help prevent, injuries from occurring once playing starts up again.  An athlete playing a contact sport is always introducing their bodies to forces that are difficult to control, and the risk of injury is always present. However studies have shown that injury prevention training can significantly MINIMIZE the risk of injury!

At 3DPT that’s exactly what we’ve been helping a few sports teams and athletes do! Our PTs have developed an injury prevention program designed to help strengthen and prepare players for high level play while they’ve been home.  Normally we’d do this in person with players (check out the ACL prevention program we did with REAL Jersey Football Club back in the winter by reading our blog here). But with social distancing guidelines in place, we’ve adapted our injury prevention program to be done virtually via teleconference software!

Here are 3 teams that we’ve done injury prevention training with over the last few months:

REAL Jersey Football Club
Expanding on our ACL injury prevention program from the winter working with just 2 REAL Jersey women’s teams, 3DPT now is helping train ALL of REAL Jersey Football Club’s players – about 150 – via Zoom sessions. The athletes were unable to hold regular practices while in quarantine so the teams’ coaches, athletes and 3DPT therapists joined together virtually for weekly conditioning sessions. The goal of these sessions was to help prepare the players and reduce their risk for injury once they returned to the field. Each meeting, 3DPT Physical Therapists guided REAL FC through various strength, stability, balance, impact and conditioning programs. It is important for the athletes to incorporate a strength program into their training schedule to maintain conditioning and balanced strength throughout the body. This will keep athletes strong on the field and reduce risk of injury! The players did great and the therapist loved working with these higher level athletes each week. Soon they will be back on the field and we hope the hard work they put in has helped prepare their bodies for the high demands of their sport!

Here’s what Martin Wood of REAL had to say about 3DPT’s program: ​

“The injury prevention training that 3DPT provided to my girls’ teams this winter and spring was invaluable – the girls were made to work hard in areas that they aren’t used to but also had a lot of fun with it. I know the parents thought it was necessary as well and we look forward to continuing with 3DPT in the future.”

Seneca HS sports teams
Carlie Strazzullo of 3DPT Tabernacle has worked with various Seneca High School athletes over the years, providing injury prevention tips and information during preseasons to ensure that the athletes are well equipped to reduce the risk of injury during season! So over the quarantine, Carlie and fellow 3DPT Tabernacle PT, Katy Loughran decided that they would make it their mission to keep these athletes involved and strong! They were able to take Seneca athletes from varying sports through an 8-week program focused on strengthening, landing, balance, and agility!

Mount Laurel STORM Softball
3DPT Physical Therapists have been working with Mount Laurel Storm’s 12U softball team, guiding their players on the best strengthening exercises and correct form to help keep them injury-free!  We started off with weekly virtual Zoom sessions, and soon will be moving to the field for in-person training!  This team won their age group National Championship last year, so they’re doing all they can to stay in top condition and bring in another title!

At 3DPT we love working with athletes to help them get back to their sport if an injury does occur, but the best injury is the one that never happens!  It’s been rewarding to help these athletes correct muscle imbalances, improve agility and jumping mechanics, and neuromuscular control through proper exercises and training, all helping to minimize the risk of injury.

For more information about injury prevention and strength training programs at 3DPT, contact your local 3DPT clinic here!

Yoga for Low Back Pain

When you think of yoga the image that pops into most heads is a picture of someone in an intricate pose that seems impossible to replicate. If you have been on the internet or social media lately, chances are your feed has been bombarded with the latest yoga workout trends and “quick fixes” that promise to improve fitness or relieve pain instantly. Due to the advanced postures that exist and social media’s influence, many people may write yoga off and consider it a “fad” that does not work and will quickly pass. But the truth is that yoga is a practice that dates back to 2700 BC and can be great for fitness, strengthening, stretching and relieving pain!

What is yoga?
Although you may not consider yourself a master on your first try, anyone who practices yoga can be considered a yogi. Practicing yoga combines not only performing the physical poses, but also the use of breathing techniques and mindfulness. In yoga, the intent of the action is just as important as performing the action. Because so many people only think of yoga as the physical postures lets define some basic definitions:

Yoga: harmonizing oneself with the universe. It is a pragmatic science that has evolved over thousands of years that deals with the physical, moral, mental and spiritual well-being of people as a whole.

Medical yoga: the use of yoga practices for the prevention and medical treatment of medical conditions.

Hatha Yoga: the physical practice of yoga

Physical Benefits of Yoga
Besides becoming stronger and more flexible, yoga has shown to have many other physical benefits including:

• Decrease in symptoms (pain) related to the low back and arthritis
• Decrease in heart rate
• Decrease in blood pressure
• Decrease in respiratory rate
• Decreased depression, impulsivity, and anxiety
• Decrease in chronic inflammation
• Lower risk of cardiovascular episodes

In this video, Barbie demonstrates a yoga flow that you can do for low back pain and below are images of these moves.

Child’s Pose
Hold for 5-10 breaths

Cat/Cow
Inhale during “cat”
Exhale during “cow”
Repeat 5-10 breaths

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[one_half_last]

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Thread and Needle
Hold for 5-10 breaths
Repeat on both sides

Supine Pigeon
Hold for 5-10 breaths

Supine Twist
Hold for 5-10 breaths
Repeat on both sides

Sphinx
Hold for 5-10 breaths

Upward Facing Dog
Hold for 5-10 breaths

If you are experiencing low back pain, talk to your healthcare team about incorporating these yoga stretches into your therapy.  And call your  3DPT office to schedule an appointment with a physical therapist.  We can work with you to create a personalized plan to address your back pain!

Sources

1. Basavaraddi IV. Yoga: Its Origin, History and Development. Ministry of External Affairs, Government of India. http://www.mea.gov.in/in-focus-article.htm?25096/Yoga Its Origin History and Development. Published April 23, 2015.
2. Stephens I. Medical Yoga Therapy. McClafferty H, ed. Children. 2017;4(2):12. doi:10.3390/children4020012.
3. Yoga for Arthritis : Benefits of Yoga for the Arthritis Patient. Arthritis Information. https://www.hopkinsarthritis.org/patient-corner/disease-management/yoga-for-arthritis/#intro. Published September 25, 2015. Accessed January 2, 2018.
4. Moonaz S, Bingham CO, Wissow L, Bartlett SJ. YOGA IN SEDENTARY ADULTS WITH ARTHRITIS: EFFECTS OF A RANDOMIZED CONTROLLED PRAGMATIC TRIAL. The Journal of rheumatology. 2015;42(7):1194-1202. doi:10.3899/jrheum.141129.
5. Williams K, Abildso C, Steinberg L, et al. Evaluation of the Effectiveness and Efficacy of Iyengar Yoga Therapy on Chronic Low Back Pain. Spine. 2009;34(19):2066-2076. doi:10.1097/BRS.0b013e3181b315cc.

How to Strengthen your Post-Baby Core

Pregnancy… one of the most exciting, rewarding, and exhausting times of your life. Your body is changing on a daily level to nurture and grow your baby. Fast forward 9 months; you have just given birth to your new beautiful child. The body that once housed a tiny human slowly starts adjusting back to “normal.”  As time progresses, you are starting to see some real changes. You are starting to feel more like yourself and at 6 weeks postpartum you’ve been cleared to start exercising by your OBGYN, but something doesn’t feel right. Your body just went through monumental changes in less than a year and you are struggling with transitioning back to physical activity. You feel weak and your back is aching from hours of caring for your baby. So, where do you start? What does safe exercise look like now?

What is Diastasis Recti and How Does It Occur?
Diastasis Rectus Abdominis (DRA) occurs when the membrane joining the two sides of the rectus abdominis muscle, “six-pack muscle,” stretches, causing the muscle to separate. This can happen when the uterus increases in size during pregnancy. Expansion of the uterus can result in pressure on the abdominal muscles, especially the rectus abdominis. The tissue connecting the rectus abdominis is called the “linea alba.” When this tissue stretches due to increased pressure, it can result in diastasis recti.

What Does Diastasis Recti Feel Like? What Symptoms Can Occur?

• A separation of the rectus abdominis muscle that is visible or palpable
• A soft or “flabby” sensation in abdominal region
• Hip, pelvic, or lower back pain
• Difficulty maintaining correct posture
• Weakness in middle or lower abdominal region
• Dysfunction in the pelvic floor muscles

What Is Involved In A Diagnosis?

• A full and detailed subjective history
• Gentle abdominal palpation to assess level of separation (DRA)
• Assessment of posture
• Assessment of core and hip strength
• Assessment of overall range of motion
• Assessment of mobility

How Is Physical Therapy Helpful?
After a thorough evaluation and examination, a physical therapist will prescribe interventions based on the impairments that are currently present. The program that is implemented will be individualized and personalized to tailor your needs. The main goal of physical therapy is to return you to your prior level of function while monitoring and improving symptoms.

Some potential avenues of treatment: 

• Postural awareness and control
• Stretching and flexibility exercises
• Bracing activities – gently engaging lower abdominal muscles
• Deep diaphragmatic breathing exercises
• Manual therapy techniques
• Education regarding the most appropriate exercises to perform while rehabbing from diastasis rectus abdominis

In this video, Dr. Parker demonstrates a few core exercises for diastasis rectus abdominis

Whether you are new to the mom game or you are a seasoned veteran, you deserve to feel your best after pregnancy. If you feel that you may be suffering from any of the symptoms of diastasis recti, don’t hesitate to contact a physical therapist skilled in women’s health to schedule an evaluation and begin your journey back to feeling like yourself again.

References:
Physical Therapy Guide to Diastasis Rectus Abdominis. (2019, December 27). Retrieved April 22, 2020, from https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-diastasis-rectus-abdominis#HowIsItDiagnosed

Get to know 3DPT’s newest PT, Dr. Sarah Obuchowski

My first day as an official 3D physical therapist is one I’ll never forget. I remember how excited I was to finally start – the years dedicated to school and hours spent studying were finally paying off! I had been preparing for this moment for years, and the fact that I finally made it was surreal. As I pulled into the parking lot that day, thoughts were already racing through my head about where I wanted to go with my career and what I wanted to accomplish. When I walked into 3DPT West Berlin, though, those plans came to a screeching halt because my first day of work quickly became the day New Jersey shut down entirely because of COVID-19.

Clearly, none of my plans accounted for this sort of situation. The following days were filled with uncertainty and nerves, and all I knew was that this situation was not what I had imagined it would be. I knew I wanted to be a PT since high school after several sports-related injuries required rehab for me to continue playing. My PTs helped me find the confidence to return to the field when I wasn’t so sure I could, and since then, I wanted to be that person for other people. My experiences in high school set the stage for the following 7 years – I chose a small college in PA with a castle and great PT program to begin my career, had an amazing undergrad experience where I was lucky to play collegiate lacrosse, and enrolled in a challenging but enriching program where I learned who I wanted to be as a clinician. After graduating this past January and passing my Boards shortly after, I was as ready as ever to start at 3DPT, a company I had come to love after finishing my last clinical rotation as a student there. Everything was coming together perfectly, but then New Jersey closed, and I wasn’t so sure where that left my plans or me.

Two months later, after having to adapt to the new normal, I can definitely say things did in fact fall into place, even if they didn’t land in the most traditional fashion. I have had the opportunity to work alongside talented and compassionate colleagues who are always willing to help me learn and grow, and I have seen how our company has risen to meet the challenges of this situation to put our patients first. I understand more than ever the value of patience and humor after seeing us all struggle with current events. And you can bet that I have realized that plans are far from certain, and what’s important is to remain resilient and surround yourself with people who make you better, even in the middle of a pandemic. I’m happy to report that I have found those people at 3DPT.

In June, it will be a year since I joined 3D as a student. I knew after my first week that this company was special, and I feel incredibly lucky that I get to stay. My “3D journey” has not always been a straightforward one, but it sure has been a memorable one. I’m grateful for the opportunity to work with the 3D family, and I’m excited to see where my career with 3DPT takes me. If my first official day is any indication of how things will go, there’s no doubt that this experience will be unforgettable.

Fun Facts about Sarah:

FAVORITE MOVIE OF ALL TIME:
Little Women (the 1949 one)

FAVORITE DISH AT A RESTAURANT: I
’m a huge fan of various diner omelets with extra cheddar cheese and a side of fries

MOST DARING THING SHE’S DONE:
Climbed up a 4 story fire tower on top of Bald Mountain in VT (on a very windy day) to check out the views on a hike

CRAZIEST INJURY SHE’S EVER TREATED:
During one of my rotations, I was placed on a surgical floor and worked with someone who had several fractures and pressure sores and was diagnosed with rhabdomyolysis after a bad fall. We worked together to help him walk again so he could be discharged to his home

3DPT Alumni – Up and Onward!

Over the years, we have had the opportunity to work with numerous students who either did a clinical rotation with us for school or worked as PT aides. Many get accepted into graduate school for physical therapy as well as programs for occupational therapy, nursing, athletic training and physician assistant. It is rewarding to be able to act as a stepping stone for all of these employees as they work their way towards their end goal of becoming licensed healthcare providers. Currently we are celebrating with 9 current or former employees that have recently graduated or are moving onto graduate school.

Here’s what they’re up to:

Brooke Chisholm:  Brooke is graduating from the University of the Sciences Doctorate of Physical Therapy Program on May 20th. She completed her final clinical with 3DPT and says it was a great experience that provided her with invaluable skills and knowledge. She plans to take her boards on May 30th. Throughout her coursework she also coached as the graduate assistant of the university’s softball team and has been an assistant coach of an 18U travel softball team for five years. Brooke is passionate about treating older adults, especially those with neurological diagnoses such as Parkinson’s Disease and Multiple Sclerosis. She’s excited to start her career and continue to learn from those around her.

Dan Crawford: Dan spent time at 3DPT in Haddonfield for his last clinical rotation this past spring.  Dan has interest in undergoing an orthopedic and/or sports residency program in the near future. While his main focus will be outpatient orthopedics, he also would enjoy treating in an acute care hospital. Dan also plans to coach at the high-school level and assist with local community non-profit programs.

Rachel Einhorn: Rachel worked as an aide at 3DPT Haddonfield in 2018. She graduated from Stockton University with a Bachelors in Health Sciences in December 2019, and will be attending Rutgers University’s Doctorate of Physical Therapy South program. She aspires to work in pediatrics and education after graduating.

Dan Gorelik:  Dan worked as an aide at 3DPT Haddonfield.  He recently committed to Rutger’s DPT South program class of 2023. In his spare time he enjoys hiking, reading, crossfit, and Olympic weightlifting.

Courtney Hutchins:  Courtney Hutchins ( you might remember her as Courtney Janusz) graduated in May from Belmont University, in Nashville, TN, with a doctorate in occupational therapy. She got married in April, and she and her husband will be headed to the Virginia Beach area this summer so he can start graduate school.  Courtney will begin as an OT, hopefully in an outpatient clinic similar to 3DPT!

Morgan Tyson:  Morgan  just graduated from Temple University with a Doctorate in Physical Therapy.  She has an interest in orthopedics outpatient, Sports, and inpatient rehab. She’s so excited to officially enter the field and start helping people in the best way she knows how!

Anthony Walsh:  Anthony is graduating and receiving his Doctorate in Physical Therapy from Rutgers University- South. Anthony will be pursuing his career in the New York, northern New Jersey area. Anthony’s career interests include orthopedics, sports, and  neurology. Anthony doesn’t want to just rehabilitate injuries, but help individuals live a healthy, active lifestyle proactively before injuries occur.

Brooke Wasco:  Brooke just graduated Summa Cum Laude from Stockton University with a BS in Health Science. This fall, she will return to Stockton as a student in the DPT program. 3DPT is a main reason why she chose PT for her career and she’d love to join our team after graduation!

Justin Wigley: Justin, commonly referred to as “Wigs” is currently a PT Aide at 3DPT Medford. He’s a graduate of Shawnee High school and Gettysburg College and will be attending the Monmouth University Masters of Physician Assistant Studies program this fall.  Has a smile that lights up the clinic and loves working with athletes especially soccer players and runners.

Congratulations to all of our graduates and best of luck to those moving on to graduate programs!

We’re extremely proud of all of you and know you’ll accomplish amazing things moving forward!

Have You Been Struggling With Your Weight?

By: Know It All Nutrition, LLC

Struggling with the “Quarantine 15”?  Being at home with a supply of snacks within reach and changes to your normal routine (not to mention stress!) may have led to a few extra pounds…

Our friends from Know It All Nutrition are experts when it comes to this stuff and gave us a few questions to ask ourselves about weight gain and some tips to prevent it!

Start out by asking yourself a few simple questions that will help to give you a better idea of what might be preventing you from losing weight.

1.  How do your clothes fit? This is the best gauge of what’s going on in your body even more so then the number on the scale. If your clothes are loose, that means you’re losing fat and if they are tight, you are gaining fat.

Take away: FOCUS on your body composition and not the number on the scale as many factors can affect that number such as water retention from high sodium intake.

2.  Do you really know what you’re eating each day? Being accountable and mindful of your intake can help you see big changes in your weight. People who use food logging apps on a regular basis lose more weight than people who are not accountable for their food intake. If you are eating too many calories or too little calories each day and you don’t know it, this could be why you are not seeing changes in your weight.

Take away: Weighing, measuring and tracking your food intake if even for a short period of time can help you figure out the truth about what’s going into your mouth each day.

3. Are you eating too many carbohydrates? Carbohydrates are easily broken down and don’t hold you for long. Focus on eating protein first at meals. Protein takes longer to digest and keeps you feeling full and satisfied.

Take away: Eat 25-30% of your calories/day from lean protein sources such as beans, chicken breast, egg whites etc.

4. How much water are you drinking every day? Water can help you to lose weight and flush out the fat. Not only is hydrating but it fights fatigue, aids in digestion and prevents constipation. How much you need is very individual and depends on several factors such as your weight, activity and how much you sweat.

Take away: Start increasing your intake slowly and if you are thirsty, this is a sign you might already be dehydrated. Drink up!

5. Empty Calories? What are they? Foods that have no nutritional value that will slow or stop weight loss efforts. Some examples include: cake, cookies, pastries, icecream, chips, candy, soda, alcohol and coffee drinks etc.

Take away: Limit your empty calorie intake to 150-200 per day.

Know it All Nutrition is now offering telemedicine sessions for nutrition counseling which most insurances are now covering. Plus they’re offering a 10% discount for all “non insurance clients”!  Give them a call at 856.626.0040 or visit their website at www.knowitallnutrition.com for personalized nutrition counseling for help with weight loss or healthy meal planning.

What to Expect after Hip Replacement surgery

Hip replacement surgery can be a big decision but a necessary one for someone in pain or with limited mobility.  Knowing what to expect after any surgery and preparing for recovery is important to make sure you have the best results possible.  Some information about what you can expect following your hip replacement surgery is outlined below.  Physical therapy can play a crucial role in recovery after surgery and you can even better prepare for surgery with Prehabilitaiton – Physical therapy before surgery!

What can you expect in a Prehabilitation program before surgery?
Research shows many advantages of pre-habilitation programs like improvements in length of hospital stay, postoperative pain, postoperative complications, physical function, and quality of life. Ultimately, patients are more likely to recovery faster post-operatively when participating in a thorough physical therapy program before surgery.  Physical therapy prior to surgery typically lasts 4-8 weeks and focuses on an individual’s specific strengthening needs leading into surgery.  Prehab typically includes strengthening by performing exercises you’d likely do in a post-operative PT program (some are listed below).

What happens Immediately after my Surgery?
Immediately after your surgery you will be placed in recovery at the hospital. You will be evaluated by a Physical Therapist and asked to walk and perform certain movements to ensure you are ready to go home. Most patients tend to stay one day or less in the hospital after their joint replacement. The primary concern for discharge to home is safety. This is what the PT in the hospital will evaluate you for. Oftentimes people still feel the effects of the anesthesia from surgery and do not have pain until later once they have gone home. This is normal and should not be a concern unless pain levels are escalated very high and you show other signs of infection.

What are Signs of Infection?
Signs of infection include:

• Heat/warmth at incision or in leg. Some amount of warmth is normal.
• Redness/streaking
• High pain levels that are not altered by position
• Fever
• Drainage from incision
• Chills/Sweat
• Shortness of Breath

When can I drive?
Most surgeons recommend allowing at least 2 weeks before driving if it is your Right Hip that is being replaced. Criteria also include being off pain medications and being in a safe state of mind to drive. You will need to make sure you follow your hip precautions if you were given any from your surgeon while driving.

What about my Incision?
Most incisions will be closed with absorbable sutures. Occasionally sutures or staples will be used that require removal 1-2 weeks after Surgery. You should not use any lotions or get your incision wet for at least 4 weeks. You will want to contact your surgeon if you have any discharge from your incision. Scar/incision mobility will be an important part of your therapy once it is healed.

How Long do I have to Follow Hip Precautions?
The stability of your joint is checked immediately after surgery. A critical period of at least 6 weeks is necessary to follow the hip precautions and sometimes longer. Your surgeon will inform you if they think you should follow this for longer. While most of the acute recovery occurs in 6-8 weeks, the progression of return to function strength and mobility occurs from 6-12 months post surgery.

When Can I Return to Sports?
This is an important topic to discuss with your surgeon prior to surgery. The answer to this can depend on the extent of damage in the hip joint and how things go in the surgery. You want to ask your surgeon what they anticipate your outlook to be based on your age, weight, exercise level, xray and bone stock. Typically, most surgeons allow their patients to participate in low impact sports around 3 months after surgery. These include (but are not limited to) swimming, doubles tennis, golf, hiking, cycling, low-impact aerobics, and rowing.

Other sports like downhill skiing, cross-country skiing, weightlifting, ice skating, rollerblading, Pilates and yoga involve more impact and an increased risk for falls. Oftentimes balance is affected after having a hip replacement.  It is advised that you be cleared or discuss with your surgeon before participating in these activities.

It is highly recommended that high-impact sports with high fall risk and possible contact be avoided after a total hip replacement. These include any sports involving running, jumping, and repetitive high impact on the hip, specifically racquetball, squash, basketball, soccer, football, softball, snowboarding, and high-impact aerobics. This is why it is important to discuss expectations for your surgery with your surgeon prior to the operation

When do I start Physical Therapy?
Patients are often seen as soon as the next day or within the same week. Some patients may start PT at their home if they are unable to attend a clinic until they are able to drive themselves.

What will I be doing in Physical Therapy?
Initial exercises will focus on decreasing swelling, pain and inflammation. Promoting normal Range of motion and flexibility in your hip is also important. Strengthening exercises will be performed to help improve stability of your joint and because swelling and surgical irritation can cause our muscles to get weaker. As you get stronger you will begin to work towards functional movements such as going up and down stairs, squatting, and walking on all surfaces. Below are some examples of exercises you may do during Physical Therapy both before surgery as part of your pre-hab and after.

Heel Slides

Quadricep Set

Bridge Bridges

Sit to Stand Exercise

How do I set up My Pre-Hab appointment?
Visit our website at www.3dpt.com and schedule online or call one of our offices close to you!

Functional Endurance Rehab

Functional Endurance Rehabilitation is an exercise program that is established and monitored by a licensed physical therapist for those who fatigue quickly or have decreased endurance making daily activities difficult. Each program will consist of various endurance and strengthening activities that are specific to each patient’s individual needs. If you experience symptoms of fatigue or reduced endurance related to diagnoses like COPD, asthma, pneumonia, scoliosis, Parkinson’s, COVID-19, and general deconditioning, you may benefit from functional endurance rehab. Read below to learn more about each of these conditions and why they would benefit from a program like Functional Endurance Rehab (FER).

Chronic Obstructive Pulmonary Disease (COPD) is a group of chronic inflammatory lung diseases, including chronic bronchitis and emphysema, that obstruct airflow out of the lungs. Chronic bronchitis is characterized by coughing, shortness of breath, and the presence of mucus that lingers for 3 months to 2 years consecutively. With chronic bronchitis, the amount of cilia (hair-like projections that work to keep airways clear) in your lungs is reduced, which makes it more difficult to get rid of mucus. Emphysema results from damage to your alveoli (tiny sacs of air in your lungs that allow for gas exchange). This ultimately causes your lungs to stretch out and lose their elasticity, resulting in air getting trapped in your lungs, making it difficult to exhale, and causing shortness of breath. Symptoms that are typically related to COPD include

• Shortness of breath
• Wheezing
• Chronic coughing.

A functional endurance rehab program will provide strength and resistance training for these patients who may experience muscle wasting and weakness due to poor nutrition and/or long term use of corticosteroids.

Asthma is a respiratory condition in which the airways become inflamed, narrow, swell, and produce extra mucus, making breathing difficult. Symptoms range from mild to severe and include:

• Difficulty breathing
• Chest pain
• Coughing
• Wheezing

Functional endurance rehab can help these patients to improve their endurance and activity tolerance as well as learn various techniques to improve respiratory muscle function.

Pneumonia is an infection in one or both lungs that causes inflammation of the alveoli. The alveoli fill with fluid or pus, making it difficult to breathe. Symptoms include

• Shortness of breath
• Cough
• Chest pain
• Fatigue.

Functional endurance rehab will help patients diagnosed with pneumonia learn various techniques and body positions to help clear their airways and improve respiratory muscle function.

Scoliosis is a condition involving a lateral curvature of your spine. This curve, depending on how significant, may result in physiologic changes that ultimately affect your breathing. Some of these physiologic changes include

• Decreased lung volumes
• Displaced intrathoracic organs
• Restricted rib movement
• Altered mechanics of respiratory muscles.

A functional endurance rehab program will help these individuals by incorporating exercises to stretch muscles that have become tight and strengthen muscles that have become weak due to scoliosis, providing postural training, and enhancing respiratory muscle function.

Parkinson’s disease is a disorder of the central nervous system that affects movement, most commonly associated with tremors. Another side effect that may be developed during this disease process is dysphagia. Dysphagia is a difficulty with swallowing that often leads to coughing, choking, and aspiration of foods and liquids, which can lead to pneumonia or a life threatening chest infection. Expiratory muscle training, a component of functional endurance rehab, can result in improved ability to swallow or increased cough production in the event that there is a swallowing issue. Parkinson’s disease is also known to result in decreased respiratory muscle strength as well as chest wall rigidity, both of which could benefit from a functional endurance rehab program with a focus on respiratory muscle strength as well as flexibility of those muscles.

Functional endurance rehab can help individuals recovering from COVID-19 by addressing the various respiratory conditions that may result from a COVID-19 diagnosis, including pneumonia, bronchitis, or ARDS (acute respiratory distress syndrome). This type of program can also help to address general deconditioning that may occur following the period of prolonged rest while recovering from COVID-19.

General deconditioning is a physical and/or psychological decline in function that may occur following a period of prolonged bed rest and inactivity. This may occur following an injury, in the case of a chronic disease, and even following a diagnosis of COVID-19. This will ultimately affect all systems of the body. Individuals who have become deconditioned will benefit from a functional endurance rehab program to improve heart and lung function, build muscle and strength, increase general endurance, and improve flexibility.

A Functional Endurance Rehab program may be extremely beneficial to those diagnosed with the above stated conditions or those experiencing symptoms similar to those highlighted above. Schedule an appointment here (link to schedule an appointment) or call us for more information on how to get started today!

Why is shoulder pain common in swimmers?

Shoulder pain is a common problem for swimmers and one of the most common musculoskeletal complaints, with some research indicating a prevalence between 40-91% in swimmers. Let’s dive in and take a deeper look as to why swimmers are at an increased risk for shoulder pain and injury.

Swimming is a full body exercise involving repetitive motion at multiple joints. Each stroke – freestyle, backstroke, butterfly, and breaststroke – involves a complex set of shoulder movements that assist the athlete in propelling through the water. For example, freestyle requires scapular protraction and retraction and humeral motion in all planes during the recovery, pull-through, and power stroke portion of the stroke. Some sources say competitive swimmers swim up to 6-9 miles/day, 6-7 days a week, which correlates to 2500-4000 shoulder rotations per day!

What predisposes swimmers to shoulder pain and injury? Repetitive motions performed through a large range of motion make the joint more prone to injury. Other factors such as improper stroke mechanics, shoulder, core, and hip muscle weakness, overtraining, insufficient recovery, poor motor control, and deficits elsewhere in the body can contribute to shoulder discomfort.

Posture is another factor that can contribute to shoulder pain in swimmers. Individuals presenting with a forward head and rounded shoulder posture may be more inclined to shoulder discomfort when participating sports requiring repetitive overhead motion. Soft tissue restrictions, such as tight anterior shoulder musculature, tight posterior shoulder capsule, and weak scapular stabilizers are common findings with posture abnormalities that can contribute to shoulder discomfort while swimming

Finally, issues involving the length and tension of the shoulder capsule and surrounding musculature can contribute to discomfort in and out of the water. It is common for swimmers to present with posterior capsule tightness and anterior shoulder laxity. However, there still needs to be a healthy balance between the muscle tension and joint mobility to ensure the shoulder is supported and not predisposing the athlete to pain in and out of the water.

There are plenty of ways athletes and recreational swimmers can keep their shoulders healthy! Ensuring optimal shoulder and scapular strength is one key piece to building efficient and pain free shoulders. The shoulder is an inherently unstable joint since it has the ability to move in all directions. For this reason, strong muscles surrounding the joint are critical for maintaining stability, proper motion, and painless function

Check out this video to see  3 exercises, prone (on your stomach) row, shoulder extension, and shoulder abduction, that help address scapular muscle strength, stability, and motor control. Perform these exercises with or without weight off a bed, couch, or padded table. Strong and healthy shoulder will reduce the risk of injury and pain in swimmers of all ages.

Physical therapy can help keep your shoulders strong and healthy or help address any fault in the system that may be contributing to shoulder pain. Rehab may include stretching, mobility work, scapular strengthening and more!! Reach out to one of the members of the 3DPT team today for an assessment. We will provide you with a program which will get you ready for excelling in the water!!

Click here to read about 3DPT aide, Gabby’s experience as a swimmer and how she managed shoulder injuries throughout her swimming career.

My Experience with Swimming

Swimming was a sport I was involved in my entire life. From summer swimming, high school swimming, club swimming and college swimming, this sport took up the majority of my time. I swam for Rowan University the past 4 years and was very dedicated to the sport. 

We had practice Monday-Saturday for 6 months out of the year. While swimming came with commitment and dedication, it also came with injury. My main events were the 100 and 200 Butterfly which caused excessive stress on my shoulders. Each year, swimmers are affected by shoulder injuries due to overuse, fatigue of the muscles, shoulder laxity, instability and the type of stroke. 91% of swimmers have experienced one instance of shoulder pain in their swimming career. Us swimmers tend to call this “Swimmer shoulder” which basically means shoulder pain due to overuse.

Competitive athletes may swim up to 9 miles per day and this equates to 2,500 shoulder revolutions per day. Some common injuries of the shoulder from swimming can include irritation/inflammation in the shoulders, rotator cuff tears or tendonitis, shoulder impingement syndrome, tears in cartilage around the shoulder socket and bicep tendonitis. Over the years, swimmers tend to lack flexibility of anterior shoulder muscles and lack stability of posterior shoulder muscles due to repetitive range of motion. In the sport of swimming the shoulders and upper extremities represent up to 90% of power in the 4 strokes. The 4 strokes in swimming are freestyle, butterfly, breaststroke and backstroke. Depending on the stroke can depend on the overuse of your shoulder.

The most common stroke is the freestyle and no matter the person, this stroke puts stress on your shoulders. In all of the strokes, the Subscapularis and Serratus Anterior are active during the pull through phase which is likely going to cause fatigue and can lead to impingement. The pull through phase in a stroke is the part when your hand enters the water to the time it exits the water. The shoulder range of motion in swimming is very similar to overhead athletes which is why shoulder injuries are so common.

Breast stroke is the one stroke that doesn’t cause as much stress on your shoulders as the other strokes. Since I was a butterflier my entire 4 years and would practice the stroke everyday, this stroke put the most stress on my shoulders which led to repetitive injury and therapy. If you are swimming, you are doing repetitive motions by bringing your arms around a full range of motion. Over time you bring your arm up and over, your shoulder will impinge your tendon. If your shoulders are healthy, there will be enough gap between your tendon and shoulder that it wont start to wear away the tendon. With time and fatigue you may develop inflammation which can rub and cause shoulder pain from overuse. The mechanics of swimming can be very challenging and with poor technique, this can cause impingement quicker on someone’s shoulder. Poor mechanics is bad for swimmers all around because not only does it slow you down and make your stroke look sloppy, it will start to rub on your tendons more which leads to injury and pain.

Some ways you can avoid shoulder injuries would be to learn and use proper technique, stretch before every swim workout and strengthen your shoulders with specific exercises to build power and strength. Check out this article on shoulder pain in swimmers to learn more and see a few strengthening exercises to try.

Here’s a video of me swimming (Lane 3, 3rd from left), with a first place win!

https://youtu.be/ks7VJ-ADx0U

Get to know… Dr Joe Strazzullo

My “3DPT story” is one of fate and love.  It may sound dramatic, but my job at 3DPT has changed my life forever – for the better!

My journey started when I was in PT school at Drexel.  Around the time I had to pick where I wanted to do my final internship, I was first introduced to Ken Guzzardo.  He was a Teaching Assistant in my Kinesiology class, and his clinical knowledge and respect for all of the students resonated with me. When he spoke about 3DPT, the practice he just opened, I could tell that he was in it for the right reasons and his values aligned with mine. So when it came time to choose my internship, 3DPT was at the top of my list. I didn’t know it at the time but that decision would ultimately turn into one of the biggest decisions both professionally and personally that I ever made.

After I interviewed with Jeff Sallade, I was introduced to Janine Fitzpatrick, our lead front desk for the past 7 years. She was so welcoming and friendly and gave me even more confidence that this was the place I wanted to be. I spent the next 3 months working alongside Jeff as he passed down clinical skills that he had learned since starting as a PT. This knowledge would ultimately become the foundation of my clinical skills and helped shape my philosophy on patient care. Another invaluable lesson I took away from being at 3D during those first 3 months, is the type of culture that allows for the best work environment and patient experience.

Several weeks after my internship ended I got a phone call from Jeff asking me if I would like to become part of the 3DPT team! I instantly jumped at the opportunity and after I passed my boards, I officially became the 3rd physical therapist hired at 3DPT. I couldn’t have been more excited to have the opportunity to work with a company that shared so many of my values and truly put patient care above everything else. At that point I had had plenty of clinicals and experiences at other practices where this was not the case and it did not result in better care for the patient. For those of you that have experienced 3DPT and other facilities, I hope you feel the same!

Just when I thought things couldn’t get better, I met a new PT Aide, Carlie Flake, during my first week at work.  For those of you that know Carlie, it is easy to see why so many people gravitate towards her – she is so thoughtful and caring and the most beautiful girl I’ve ever met. 3 years later, on May 18th 2019, Carlie became my wife! She has since opened up the 5th 3DPT office in Tabernacle, NJ where she grew up and I am so proud of her!

My journey with 3DPT so far has been filled with great experiences and memories and has allowed me the opportunity to create so many relationships with my patients. I have had the pleasure of being the clinical director in our Medford office for 3 years now and I look forward to continuing to grow with the company. What I thought was a simple decision when I was in PT school, has led me to my beautiful wife and an amazing work family where I can fulfill my aspirations as a PT!

Fun Facts about Joe:

• I enjoy playing almost every sport, but my true passion is playing hockey. I am also an avid Flyers, Eagles, Phillies, and Sixers fan.
• I love to travel and have been to many places, including California, Colorado, Vermont, North and South Carolina, Canada, Jamaica, Greece and St. Lucia. My goal is to visit all 50 states and someday travel to Switzerland.
• My favorite place to be is the beach. I love being in the ocean and playing sports on the beach.

Patellofemoral Pain Syndrome

Patellofemoral Pain (PFP) is one of the most common injuries runners experience. In fact, it is one of the most common conditions we see in outpatient physical therapy! So, if you’re experiencing generalized knee pain, participating in a running program (shout out to our #RunStrong participants), or are just curious about the underlying issues associated with a very prevalent condition, look no further!

PFP is typically described as knee pain in the front of the knee that involves the patella (knee cap). Women typically experience PFP more often than men, and common symptoms include pain that is felt with activities that load your patellofemoral joint, such as climbing stairs, squatting, and jogging. Although this description may seem simple, or even a little vague, PFP can be very complicated to treat because the exact cause of it is not completely understood. A lot of research has been dedicated to understanding this condition more, and though we don’t know exactly why PFP arises, we do have a better understanding of how to treat it.

The best evidence and research out there suggest there are a few key things to address in treating PFPS: 1. glute and quad strength, 2. lower body control, and 3. activity frequency/quantity.

Glute and quadriceps strength are very important to address if you’re experiencing PFP. Studies have shown that people with PFPS have significant hip abduction, hip external rotation, and knee extension strength deficits. It is unknown whether these deficits are the cause of PFP or a product of PFP (chicken vs. egg??).  However, we do know that by strengthening the muscles that perform those actions, ie, your quads and glutes, you’ll see an improvement in pain levels and function over time. If you’re experiencing PFP, or even want to work on injury prevention, check out the strengthening exercises in the video about PFP below!

Lower body control is another key aspect to work on. Whether it’s habit, or the weak muscles I just mentioned, many runners and well-trained people struggle to keep their knees in the best position. The less favorable position, otherwise known as “knee valgus”, predisposes you to injury and even contributes to developing PFP! Research has shown that as the amount of valgus increases, the amount of stress on your patellofemoral joint increases, which can cause increased irritation in that area. Practicing activities with good form (see photo below) and lots of repetition can help you form better habits and strength so that when you’re doing dynamic activities, you keep your knee in a better position and put less of a load through your patellofemoral joint. Try some of the exercises below and see how you do!!

Last on our list: activity frequency and quantity. PFP is often described as an overuse syndrome, meaning ramping up your mileage or activity too fast and putting more stress on the body than your tissues can tolerate at that moment. There are a few things you can do if you think you’re overdoing it. Adjusting your run program is a good place to start. Add a few more rest days, decrease your mileage if you can and do some fun cross-training instead, target strength deficits that can be contributing to your pain. A rule of thumb that I live by is the 10% rule: don’t increase your weekly mileage by more than 10% from one week to the next. If you follow a guideline that helps you control your training, you put yourself at less of a risk for overuse injuries by making sure your body is able to tolerate the repetitive stresses you’re putting on it. The more you know!!

As I’ve mentioned, PFP is a pretty complicated condition; these key components are just a few adjustments among many that can be made. If you’re feeling some pain in your knee and these symptoms ring a bell, or you want to work on prevention, reach out to your favorite 3DPT physical therapist!! We can break down your movement and analyze your training schedule to help you figure out just what you need to do to beat that PFP. You got this, and happy running!!

Citation:

Barton CJ, Lack S, Hemmings S, et al. The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning. British Journal of Sports Medicine 2015; 49:923-934.

5 Most Common Soccer Injuries

Soccer is one of the most popular sports in the world and its popularity is only increasing!  The US women’s national team has been dominating the competition for several years now and young kids, both boys and girls are being motivated to be part of the success.  But as with all sports, soccer comes with the risk for injury. Here are 5 of the most common injuries that can happen with soccer and ways to decrease your risk.

Overuse injuries

Overuse injuries are becoming more prevalent as more kids have increased the level of their soccer training and game play. These injuries include shin splints and patellafemoral pain.  Shin splints are associated with pain usually on the outside of your shin bone and is brought on with running and jumping. This is due to small tears in the fibers in the shin. When you experience this pain, it is important to get treated quickly to prevent a stress fracture from developing. A shin splint can be treated in just a couple weeks, but a stress fracture often means 6 weeks without activity.

Patellafemoral pain is the fancy name for pain at the front of the knee. The pain is due to more stress on the tendon that attaches the kneecap to the shin bone than it is prepared for. Common causes are running, jumping and kicking. This is another injury that is important to be treated early so it does not progress. There are typically muscle imbalances that need to be corrected to prevent future pain.

Sprains

The next big category of soccer injuries is sprains. This can occur in any ligament in the body, but often happens in the ankle and knee of soccer players. Ankle sprains are especially concerning in the young athlete, because if not treated properly they can linger and cause long term issues. Knee sprains can range from mild MCL/LCL strains to full ACL tears. The treatment varies with each but all are important to get checked out. Physical therapy can help retrain your muscles around the joint to better support them if the ligaments are stretched out.

Strains

We have covered muscle strains in several articles so be sure to check them out for a full breakdown. Common muscle strains in soccer players include the hamstrings, quadriceps, calf and hip flexors. There are varying degrees of injury with each so it is important to have your injury assessed by a trained professional. Strengthening muscles is a key way to decrease injury risk. If you are new to a sport, schedule a free consultation with a physical therapist to gauge your injury risk.

Concussions

Concussions are another big category of injury in soccer players. These have become more common particularly because testing has improved. Between heading the ball and collisions between players, the head is at risk to various degrees of stress. There is much more research out today showing the impact concussions can have on life so concussions are not to be taken lightly. There are several physical therapists who are trained specially to deal with concussions and its side effects. In the past we were told rest was the only way to recover, but we now know there is a lot that can be done to speed up recovery and minimize the impact a concussion will have on your daily life.

Fractures

Broken bones are not as common as the above injuries in soccer, but they still happen. Unfortunately, there is not as much you can do to prepare for this type of injury. Balance training can help decrease your risk of falls and strengthening will help provide some cushion to any blow you may face, but sometimes bad luck happens. A fracture typically requires a period of immobilization before resuming light activity. It is important during the stage to work with a PT to safely build your strength back up before getting on the field.

Soccer is a great game, but like most sports there is always a risk for injury. If you are just beginning, or resuming a season after a long time off, set up a free consultation with one of our physical therapists to ensure you are at your best.

Ankle Sprains

Ankle sprains are a common injury, not just for athletes but in daily life. Legos, curbs, potholes, etc all have been accused of causing an ankle sprain. Regardless of how it happens, the effects are still the same – the ligaments around the ankle are either stretched or torn, and the ankle swells and becomes painful to walk on. We will cover the typical steps following an ankle sprain, but remember recovery varies person to person so it is important to see a health professional to ensure you take the correct steps.

Immediately following an ankle sprain there is typically pain and swelling. This is your body’s way of reacting and sending healing nutrients to the site. Inflammation is a part of recovery in the early stages. New research has shown that icing an ankle sprain can actually delay healing due to the need for the blood flow. Ice would only be beneficial if pain is too severe to manage daily activities. In the early stages the most important thing to do is rest to protect the ankle from further damage. Crutches are not always necessary, but slower walking may be needed.

In the beginning after a sprain a physical therapist can assess the damage and which ligaments are affected as well as making sure no red flags are present such as a fracture to one of the bones that make up the ankle joint. Once pain has diminished, we can start slowly building up the strength around the joint. Ligaments are different from muscles and tendons in that their length is not designed to change. They are supposed to hold bones in place, while the muscles move around them. If the ligament has been stretched with a sprain, the bone may move more than it should. That is why it is important to retrain the muscles around the joint to better stabilize and support the ligaments.

There are many tools and techniques we can use as physical therapists to assist with this. Single leg balance is a key component to ensuring long term health of the ankle. Progressing from stable to unstable surfaces and eventually to eyes closed allows the body to further stabilize the ankle joint. Strengthening will include calf raises and various other moves to allow the muscles to support the joint as well for long term health. Most people can fully recover without any long term issues, but without taking the proper steps chronic inflammation and arthritis can develop. Speak with your physical therapist if you have any questions or concerns.

This video shows Andrew a high school basketball player recovering from a severe ankle sprain.  These are a few of the agility exercises that we could incorporate into PT.

Hamstring Strains – Rehab and Prevention

Many athletes have experienced a hamstring strain at some point in their career. Sports that require a high level of sprinting including soccer, football and track are more vulnerable than others, and  without proper rehab, the risk of a second hamstring injury is even greater. Here are some tips on what to do to get back to sport quickly while minimizing the risk of further injury and ways to prevent hamstring injuries.

Rehab after hamstring strain

The first important thing to do is to see a Physical Therapist to assess the severity of the situation. There are 3 grades of hamstring muscle injury.  Grade 1 is a strain of some of the muscle fibers, but usually no tears. This can heal with a couple days of rest and protection. A grade 2 is slightly more severe with a possibility of a few muscle fibers torn. Depending on the extent of injury you may be out for a couple weeks. A grade 3 injury is the most intense and is when there is a full tear of the muscle. This can happen anywhere along the muscle – for the hamstring that is on the back of the leg from the knee to your pelvis. A grade 3 injury requires a longer period of rest and protection to allow the muscle to heal back together. When this happens it is helpful to work with a physical therapist to decrease pain level and help bring more blood flow to the area to assist with healing.

It is common when someone strains a muscle to be told to stretch more, but often that is not a helpful strategy initially. If you had a string that was partially torn would you want to stretch it more or protect it from stretching and try to strengthen it? Muscles are living tissue that can regenerate, but it is important to protect them to allow them to heal properly. Once you can fully straighten your leg without pain, it is time to start strengthening to prevent this from happening again. There is a gradual progression that must take place to allow the muscles time to build up force and your physical therapist is educated to take you along that road.

Tips to prevent a pulled hamstring

The good news is that strengthening your muscles and hamstrings before intensive activity can help prevent injuries.  There is a lot you can do with limited equipment to decrease your risk of injury. The hamstrings are more vulnerable to strains due to their position in the body. They are on the back of the leg and they cross the hip and knee joint. When you are running or kicking, the hamstrings have to go from a stretched position to a flexed position very quickly. Imagine a muscle as a rubber band connecting to points. The thicker the rubber band is, the less it will be affected by stretching and it will be able to generate more force. That is why hamstring strengthening is so important for long term athletic health. As you strengthen the muscle it is able to grow in size, becoming thicker and less prone to stretching injuries. Below are several exercises to try to maintain strength and to prepare your body.

Core strengthening is also critical for preventing hamstring strains. Since your hamstrings attach to your pelvis, it is important to have solid strength through the core and hip muscles so that the hamstrings have a solid base to pull from. Below are several core exercises that help prepare the body for all the forces that come with athletic events.

Here is Dr. Matt Vassalotti demonstrating a few:

Contact 3DPT if you have any questions about how to rehabilitate or prevent a hamstring strain.

Pre-habilitation: What is it and why is it effective?

Physical therapy plays a crucial role in recovery after surgery. Individuals will undergo weeks or months of physical therapy in order to reach his or her goals and return to a preoperative level of function. What if there was a way to maximize recovery after surgery? Pre-habilitation, or physical therapy prior to surgery, is an effective but underutilized treatment approach for maximizing postoperative outcomes.

Pre-habilitation programs can be utilized for a wide range of orthopedic procedures, such as rotator cuff repairs, joint replacements, and ACL reconstructions, and beneficial for all age groups. Fitness levels, especially prior to surgery, can powerfully predict objective and functional outcomes associated with surgery. Studies show that patients with higher functional capabilities will better tolerate a surgical intervention. Enhancing a patient’s functional capacity before surgery is the main focus of rehab physical therapy and is highly correlated to successful recovery after surgery. Physical therapy prior to surgery typically lasts 4-8 weeks and focuses on the patient’s individual deficits leading into surgery

Research highlights the many advantages of pre-habilitation programs. For example, improving physical function prior to surgery has shown improvements in length of hospital stay, postoperative pain, postoperative complications, physical function, and quality of life. It has also been noted in research that patients who received treatment before surgery returned to work and sport sooner than patients who did not undergo pre surgery treatment. Ultimately, patients are more likely to recovery faster post-operatively when participating in a thorough physical therapy program before surgery

Have questions regarding treatment options prior to surgery? Reach out to the team at 3DPT! Our therapist would be more than happy to discuss any questions you may have regarding a pre-habilitation program

Common Running Injuries – Iliotibial Band Syndrome (ITBS)

Iliotibial Band Syndrome (ITBS) is a common overuse injury in which symptoms are felt on the lateral part of your knee, especially during repetitive physical activity. Your IT band is a thick piece of connective tissue formed by 2 muscles in your hip (your glute max and tensor fasciae latae) that travels down the outside of your thigh and attaches just below your knee. ITBS is an overuse syndrome in which excessive tension in your IT band causes your IT band to rub against your femur, which causes discomfort and pain. If you’re experiencing pain in that area that worsens with activity, as well as other symptoms, like snapping or cracking in that area, you may be experiencing ITBS.

There are several steps you can take to resolve ITBS. The first step is activity modification. If you are doing a repetitive physical activity, such as running, you may want to reduce your mileage or frequency. Being a runner myself, I know it can be tough to modify your regimen, especially if you’re training for a race, but it may be a good idea to adjust your running program at least until your symptoms calm down. You also want to take a look at your running route. If you run on the same side of the street, try to switch it up so that one leg isn’t on the crown of the road the entire time, which can put excessive tension on your IT band too.

Hip strengthening is also a very important component in resolving ITBS. People with ITBS are found to have hip musculature weakness that causes your knee to cave in into valgus (see picture below). This position predisposes you to injury and it also puts tension on that IT band. For strengthening exercises, check out our videos for lower extremity strengthening and pay attention to exercises like side steps, side-lying hip abduction, clamshells, and stepdowns.

Stretching and foam rolling have also been found to relieve symptoms of ITBS. Like I mentioned earlier, your IT band is very thick so it’s unlikely you’re lengthening it with these stretches or techniques. However, these methods do help desensitize the area so that when you go to run or do physical activity, you feel less pain. If you’re feeling pain on the outside of your knee, try massaging the area with a roller stick, foam roller, tennis ball, or even a rolling pin! You can also give these IT band stretches (see video below)! Make sure when you do them, you hold for 15-20s and perform 4-5 reps. Make sure you feel a stretch in your outer thigh. These techniques are great to do before going out for your run!

As always, contact your favorite 3D physical therapist with any questions. Happy Running, everyone!

Physical Therapists – First Line Responders For Musculoskeletal Concerns

Most of us have a usual routine of what to do when we are experiencing pain that is interfering with day to day function. When that pain in your shoulder, or your back, hip, knee, or any part of the body is too much to handle on your own you pick up the phone to dial into your primary care physician or an orthopedist. Maybe you get an appointment within a week or a month and you just continue to deal with this nagging issue that interferes with your day to day life. But what if we were to tell you that you don’t have to wait that long to see a professional about your pain? That’s right, you can see your local physical therapist at 3 Dimensional Physical Therapy, without ever seeing or getting a referral from a physician!

Direct Access for Physical Therapy is a law that allows our Physical Therapists at 3D to evaluate, develop a plan of care, and treat an individual for 30 days without a referral from a physician. PTs undergo extensive training during their graduate curriculum and continuing education, which is part of license renewal, learning proper screening tools to make referrals to the appropriate health or medical professional, if necessary. Once these screens are completed and give the PT the “green light” to proceed, a thorough musculoskeletal assessment will be completed.

We like to take things a further step when possible and incorporate your primary care physician, orthopedist, or any medical professional that you would like in the loop during your course of care with us. We will consistently be sending your physicians faxes of your evaluation and re-evaluations. Keeping your physicians up to date with your physical therapy progress and functional improvement is paramount. This way if you are scheduled for an appointment in the future they are aware of the proactive measures taken which can assist them in their decision making process of what the appropriate next step(s) could or would be.

Our Physical Therapists at 3DPT are experts when it comes to the human body and will work diligently to find the root cause of your musculoskeletal issue. You will be constantly re-evaluated to ensure that your individualized plan of care is addressing and alleviating your personal concerns regarding your function. We look forward to providing you with the best care around and faster than you ever would have thought. It’s time to focus on your physical needs and start moving the way that you want to. So give us a call at any of our offices, we’re excited to see your progress.

Why posture can cause shoulder pain

Why Posture Can Cause Shoulder Pain

For most of our lives we have been hearing, “Stand up straight! You’re slouching!” So naturally we take a deep breath in, squeeze our shoulders back and maybe up toward our ears, feel some nice relief and let out a long sigh. Then 30 seconds later we return to our slouched posture. So why are we comfortable with a slouched posture? If it doesn’t hurt, then why does that put us at risk for other musculoskeletal issues? Many of us spend time sitting at work, school, or spend countless hours looking down at our various electronics. According to the CDC 25% of Americans sit for at least 8 hours a day and this number continues to grow. Without educating ourselves of the importance of proper posture then we are leading ourselves down a potential path to a multitude of musculoskeletal impairments, especially in the shoulder.

Diving into the anatomy of posture we begin at the head, neck, shoulder, and mid back region. Our head and neck should be in a slightly extended position or what is known as a lordosis. This will transition into our mid back or our thoracic spine which has a natural flexed position or what is known as a kyphosis. Our shoulders should be extended back with our shoulder blades slightly pinched and resting on our ribcage.  With prolonged sitting or electronic use we tend to let gravity win which will then increase the thoracic kyphosis in our mid back, our head will begin to shift forward, and our shoulders will become rounded. Over time this can cause muscle imbalances which can be seen below: tight shoulder/neck/chest muscles, weakened muscles in the front of the neck and mid back region near the shoulder blades.

So how do these anatomical compensations lead to various injuries in the shoulder? These posture changes ultimately change the way our muscles can function and over time can change the physical bone structure of our shoulder. When our head is shifted forward, shoulders rounded, and shoulder blades tilted forward similar to the picture above we close down the amount of space the upper arm bone, the humerus, can freely move. The shoulder is a ball and socket joint which means it is a very mobile joint and moves in every plane of motion. With the above postural changes the shoulder has a reduced amount of space to move because the shoulder blade and collarbone are now in the way preventing the humerus from freely moving. Despite this we still accomplish all of the motion we require but we do so via compensation patterns through our upper neck and shoulder muscles such as the upper trapezius and levator scapulae. Over time you may start to feel stiffness or burning in your neck and shoulders – your first sign of this anatomical and physiological change. This discomfort can become unrelenting and a literal pain to your day to day function.

Another common injury that may result from this posture change are rotator cuff injuries. Now that the space between the humerus, collarbone, and shoulder blade are reduced we are more likely to irritate the rotator cuff tendons as this is exactly where those tendons pass. Every single time we raise our arms overhead with this type of posture we could be rubbing against those rotator cuff tendons which are intended to be contained within a frictionless environment. As you could imagine if you add friction to this over and over and over again then it is only a matter of time before we start getting aches, pains, tendinopathies, or potentially worse, a rotator cuff tear.

Posture is key for proper shoulder movement and is something we should focus on with every rehabilitation and strength training program. The primary areas that need to be addressed are reducing the work and stress placed on the upper trapezius, levator scapulae, and pectoral muscles, and recruit the middle and lower trapezius as well as the serratus anterior muscles so they can join the party in our day to day tasks that involve the shoulder and neck. When we are better able to recruit the middle and lower trapezius and serratus anterior we can optimize the space between our shoulder blade, collarbone, and humerus to successfully move with reduced friction in the region and take that stress off of the rotator cuff and the overactive upper trapezius and levator scapulae. Give us a call at 3 Dimensional Physical Therapy for your posture screen and learn some stellar exercises to help engage those under active muscles. We want to provide you with tools that will help you for a lifetime!

And remember, in New Jersey you do not need a referral from a physician to make an appointment with our Physical Therapists. Direct Access allows us to evaluate and treat you without a physician’s referral so give any of our offices a call to make an appointment today!

Check out this video to see 3 exercises that can help strengthen your shoulders to prevent bad posture!

Resources:
https://time.com/5459319/americans-sit-too-much/

The Heart of 3DPT

The Heart of 3DPT

Elvis Presley once said “Values are like fingerprints.  Nobody’s are the same but you leave them on everything you do.”   A few years ago, we sat down to sum up all of the things important to us as a company – the things we wanted 3DPT to stand for and what we wanted to leave with every patient that comes to 3DPT.  Our core values. We came up with 5 values that summarized the things most important to 3DPT. You may have seen them listed on the wall in the reception areas of our offices, because we want these values to be front and center for every employee to remember and every patient to see.   Here they are:

• Community – We feel fortunate to be a part of great communities!  We want to actively bring value to our communities and to support our towns, neighbors and partner businesses.  We love taking part in events so you will probably run into us!
• Honesty/Integrity – We want to earn the trust of every patient that chooses 3DPT.  That means we will be honest in every situation and honor our commitment to providing the service and care we promise.
• Accountability – We promise to do our part for each patient – as a business and as a caregiver. Our promises include:  Spending the necessary time and care with each patient by not scheduling more than 2 patients/hour, working to ensure patients do not have to wait for appointments and can work with the same therapist each visit, provide transparent billing,  and most of all we promise to always provide the best customer service and care to every person that comes to 3DPT!
• Stepping Up – PT can be uncomfortable and recovery can be a long road.  We want our patients to know that we will be there for them by stepping up to challenges and staying committed to see them succeed.  We work with our patients to develop a customized treatment plan that meets their goals, not a standard set of exercises or stretches for everyone.
• Commitment to Excellence – Each 3DPT employee is committed to providing the BEST – excellent – customer service and physical therapy care to our patients.

To sum it up, everything we do has one goal in mind – to provide a great experience for every patient, every visit.  These 5 values are more than just decals on the wall, they are truly the heart of 3DPT! Keeping these values top of mind helps us to ensure we’re delivering a great patient experience.

We hope that as someone who has been a patient or has encountered 3DPT, you see us reflecting these values (and if not, let us know!).  We want our customers to be confident that despite an injury or pain or any chaos that might be going on around us, you never have to question 3DPT’s commitment to you and your health!  If you have any questions about 3DPT, our core values or anything else, please call us or drop us a line. You can always find our core values on our website, www.3dpt.com!

Virtual Couch to 5K 8-week schedule

Virtual Couch to 5K 8-week schedule

Dynamic Warm up: 

Stretching:  

Agility

Agility, in relation to sports, is defined as “the rapid whole body movement with change of velocity or direction in response to a stimulus.” Or in other words, the ability to react quickly with speed or direction changes when you need to.  Agility is an important skill for athletes, especially in many of the sports that involve a high rate of ACL injuries (Sheppard & Young, 2005), making agility training an important aspect to incorporate in an ACL injury prevention program.

Agility training incorporates many components and combinations of motor skills that are essential in many high risk sports. These motor skills can include but not limited to acceleration, deceleration, accuracy of direction, position of center of gravity, speed, and coordination training (Padua et al., 2018) Several studies have looked into agility training and its ability to improve aspects in ACL prevention such as hamstring strength, landing mechanics, and neuromuscular control of the lower extremities. In a 2009 study (Wilderman et al.), thirty females were put through a 6-week agility program that resulted in improved medial hamstring activity during a side-step pivot which can help prevent an ACL sprain. Other studies of ACL injury prevention (as Nessler et al. in 2017 and Gokeler et al. 2018) recommend agility training as part of a comprehensive program for ACL prevention to prepare athletes for unanticipated events, improve neuromuscular control, and to improve limb symmetry.

Although lower body strengthening, core strengthening, and balance training are all important aspects of ACL prevention, these do not not replicate positions or situations that many athletes will be involved in during their sports. Comparably, agility exercises contain more dynamic and sport-specific movements than balance training and strength training, making them an essential part of an ACL prevention program.

In week 6 of 3DPT’s ACL Prevention program with REAL Jersey Football Club, Drs Anthony Nguyen and Kaitlin Ley introduced players to a few exercises to improve agility.  Check out the video to see the exercises (and some extra footage!) of their moves. You’ll see agility training can be fun!

References:
Gokeler, A., Seil, R., Kerkhoffs, G., & Verhagen, E. (2018). A novel approach to enhance ACL injury prevention programs. Journal of Experimental Orthopaedics, 5(1). doi: 10.1186/s40634-018-0137-5
Makhlouf, I., Chaouachi, A., Chaouachi, M., Othman, A. B., Granacher, U., & Behm, D. G. (2018). Combination of Agility and Plyometric Training Provides Similar Training Benefits as Combined Balance and Plyometric Training in Young Soccer Players. Frontiers in Physiology, 9. doi: 10.3389/fphys.2018.01611
Nessler, T., Denney, L., & Sampley, J. (2017). ACL Injury Prevention: What Does Research Tell Us? Current Reviews in Musculoskeletal Medicine, 10(3), 281–288. doi: 10.1007/s12178-017-9416-5
Padua, D. A., Distefano, L. J., Hewett, T. E., Garrett, W. E., Marshall, S. W., Golden, G. M., … Sigward, S. M. (2018). National Athletic Trainers Association Position Statement: Prevention of Anterior Cruciate Ligament Injury. Journal of Athletic Training, 53(1), 5–19. doi: 10.4085/1062-6050-99-16

Core

When it comes to ACL injuries, you might not think about poor core strength as a contributing factor.  Similar to glute strength, core strength helps stabilize the knee with daily and sporting activities. The Clinical Practice Guidelines published by the Journal of Orthopaedic and Sports Physical Therapy states that exercise-based injury prevention programs for the knee that include trunk/core strengthening may help lower ACL injury rates.

Photo credit:https://www.stack.com/a/soccer-agility-lateral-strength-exercises

Core and hip strength and stability can influence knee control during single limb and cutting motions which are commonly seen in lacrosse, soccer, and basketball.  Core control is important for handling contact and perturbation during sports, and when weakness is present, athletes may have less control over how body’s response to stimuli. Athletes with decreased core strength, demonstrate larger lateral trunk movement with sudden movements and this can increase the risk of knee injuries.

Core stability improves an athlete’s ability to prevent buckling of joints and to return the body to equilibrium after perturbation. For example, a soccer player with optimal core control can prepare the body for cutting quickly to shoot on an open net. Weakness would impact the athletes ability to control quick movements and possibly place the ankle, knee and hip in undesirable positions.

Research suggests deficient core muscles may increase the risk of lower extremity injury. The good news is that additional studies show that core training can improve single-limb stability and neuromuscular control. There are a variety of core exercises that are beneficial and most do not require gym equipment. Plank and single leg bridges are two core exercises you can start today to help strengthen proximal muscles.  Adding resistance, hip movement, and instability are easy ways to make planks more challenging as well.

In our ACL injury prevention program with REAL Jersey Football Club teams, we challenged our players to a Plank challenge to see who could hold a plank – in correct form – the longest!  For the 2007 team, the longest plank was 3 minutes and 30 seconds and for the 2005 team, the longest plank was held for 4 minutes and 15 seconds! Check out the photos!

Sources:

1) ACL Injury Prevention: What Does Research Tell Us? Nessler et al 2017
2) Core Stability and Its Relationship to Lower Extremity Function and Injury, Wilson et al 2005
3) Mechanisms, Prediction, and Prevention of ACL Injuries: Cut Risk WithThree Sharpened and Validated Tools, Hewett et al 2016
4) Exercise-Based Knee and Anterior Cruciate Ligament  Injury Prevention, Arundale, et al 2018

Balance & Stability

When preparing for an upcoming athletic season, it is important to maintain a good off-season workout routine to get your body in shape for the season. Depending on the sport, it is typical for an off-season program to include cardiovascular endurance training as well as strength training. These are crucial components, but one piece that often gets overlooked is balance training.

Your body is designed with several systems that help control balance in the structure of the body, and 3 separate systems that help maintain your balance from a brain control aspect. In the body we have passive, active and neural control subsystems for balance. The passive subsystem includes bones and ligaments. You don’t have to think about these tissues to maintain your balance, they are just there to hold you in place. The active subsystem includes the muscles and tendons that attach to the bones. When you contract the muscles, this will affect how the body reacts to the various elements you encounter. The neural subsystem blends the structures of the body with the brain component. There are joint receptors throughout the body that can sense how the body is moving and use that information to maintain balance and upright posture. Higher level athletes have a better feel for how their body is moving in space due to these joint receptors.

When discussing balance from a brain control function you have the visual, vestibular and somatosensory systems. Somatosensory is what we discussed with the neural control above with the joint receptors. The visual system is just what you see and is typically what we rely most on. Try balancing on one foot with your eyes closed and you can see how important this is. Finally there is the vestibular system. This includes 3 canals in your ear with fluid inside that sense the position of your head in relation to gravity. If these canals are affected you can develop vertigo or dizziness.

So why is balance training important to prevent an ACL tear? It is reported that 70% of ACL tears are non-contact. This is typically due to making a sharp cut and the leg sliding out, twisting over a fixed foot or landing with poor mechanics causing the knee to cave in. If your muscles are not prepared to handle the forces, the stress shifts to the ligaments which is when a tear occurs. Training your balance can greatly decrease your risk of this happening.

In physical therapy we work on neuromuscular re-education. This is the concept of training your muscles to react to an outside stimulus. If you are running and go to make a sharp cut, your joint receptors have to sense the movements of your ankle, knee and hip as well as their position related to your trunk. Your muscles have to respond to this stimulus and contract appropriately to maintain balance and control. All of this has to happen in a split second and would be impossible to think about as it is happening. That is why it is important to have your muscles ready to react on cue. There are many exercises and balance tasks available to train so if you have any questions give us a call to set up a consultation.

Week 4 of our ACL Prevention program with REAL Jersey FC,  focused on the players working on these balance and stability activities.  Check out the video to see some of their moves.

Sources:

https://www.bettermovement.org/blog/2013/what-is-your-movement-style
https://www.sciencedirect.com/science/article/pii/S0306987713000789
https://www.ncbi.nlm.nih.gov/pubmed/10874221

Impact and Landing Training

It is estimated that 350,000 Anterior Cruciate Ligament (ACL) reconstructions are performed annually in the United States! (Nesseler et al., 2017) Athletes that participate in high-risk sports – sports that involve a lot of jumping, cutting, and landing – are usually at an increased risk for injury, AND female athletes are generally at a greater risk than males for ACL tears (due to anatomical differences at the hip/knee and differences in biomechanics have been the most cited in the current literature). It is reported that female athletes are “2-8 times more likely to sustain an ACL injury than male athletes,” and the incidence of female to male ACL tears in high-risk sports may be significantly greater at 3.5x greater in basketball and 2.8x greater in soccer (Journal of Orthopaedics, 2016).  The good news is that a comprehensive ACL injury prevention program, like 3DPT’s ACL prevention with REAL Jersey Football Club teams, can train athletes proper form and strengthening to help minimize these risks!

Since injury to the ACL “occurs during dynamic activities that primarily involve cutting and pivoting and can occur during landing after a jump,” it is important that landing and impact activities, through plyometric and agility training, are incorporated into an ACL injury prevention program (Nesseler et al., 2017).   Athletes can be taught how to reduce stress on the ACL ligament through proper biomechanics and proper control while landing in various ways, including increased knee flexion angle at initial contact, increased valgus forces at the knee, decreased rotational stress, and proper trunk control, etc. An ACL prevention program can teach athletes how to compensate and adjust for problematic movement patterns (hyperextension, excessive valgus, or abduction moments attributed to ACL stress, etc.) that may reduce in ACL injury.  Additionally, with improvements in biomechanical control, proper active muscle contraction, and precise neuromuscular timing, an ACL prevention program could assist with knee stability during running, jumping, and cutting or pivoting maneuvers and decrease stress on the ACL.

In week 3 of 3DPT’s ACL Injury Prevention program with REAL Jersey Football club’s 2005 and 2007 girls teams, Drs. Anthony Nguyen and Matt Vassolotti demonstrated and instructed the athletes on correct form for landing after jumps, emphasizing the position of the hips and knees.  Take a look at this video of our athletes trying out some of these moves!

References: 

1. Nessler, T., Denney, L., & Sampley, J. (2017). ACL Injury Prevention: What Does Research Tell Us? Current Reviews in Musculoskeletal Medicine, 10(3), 281–288. doi: 10.1007/s12178-017-9416-5
2. Padua, D. A., Distefano, L. J., Hewett, T. E., Garrett, W. E., Marshall, S. W., Golden, G. M., … Sigward, S. M. (2018). National Athletic Trainers Association Position Statement: Prevention of Anterior Cruciate Ligament Injury. Journal of Athletic Training, 53(1), 5–19. doi: 10.4085/1062-6050-99-16
3. The female ACL: Why is it more prone to injury? (2016). Journal of Orthopaedics, 13(2). doi: 10.1016/s0972-978x(16)00023-4

Clinician Highlight – Chuck Bachi, PT, DPT, OCS, SCS

NAME:
Chuck Bachi

COLLEGE(S) ATTENDED:
The College of New Jersey (TCNJ) B.S. Health and Exercise Science 2008
University of Medicine and Dentistry of New Jersey (UMDNJ) Doctorate of Physical Therapy DPT 2011

HIGH SCHOOL:
Scotch Plains-Fanwood High School 2004

CRAZIEST INJURY YOU EVER TREATED:
I was seeing a young man who suffered a gunshot wound to the head while being mugged. He was lucky to be alive, but lost function of the right side of his body. After Months of Physical Therapy he was able to walk out the door without using an assistive device. Very rewarding.

TELL US THE INJURY/CONDITION YOU LIKE TREATING THE MOST:
I fell in love with Physical Therapy after suffering sports injuries and I love helping athletes of all kinds get back to their sport, but I also love to help people gain more independence. The cases where people are unable to walk, climb stairs or put on a shirt by themselves the 1st day they come in and are completely independent when they finish with Physical Therapy.

TELL US WHAT MAKES YOUR DAY GREAT AT 3DPT: 
When I hear “I can’t believe how good I feel”

WHY IS 3DPT LUCKY TO HAVE YOU:
I love helping people reach their goals.

FAVORITE MOVIE OF ALL TIME:
Forrest Gump

FAVORITE DISH AT A RESTAURANT:
Surf N Turf

MOST DARING THING YOU’VE DONE:
Paraglide in the Swiss Alps.

You are the company you keep

Our long awaited opening of the 3DPT Tabernacle office finally occurred last week. We are excited for our partner Carlie Strazzullo (formerly Flake) to get in there and serve the people in that area. Carlie has wanted to do this for a long time and we are happy that she now has her chance!

Carlie has been working at 3DPT in our Medford office since 2014. She just had her last day of work in Medford last Monday and part of me was sad to see her walk out of the Medford office as an employee there for the last time. A bigger part of me was happy for her and the opportunity she earned through her hard work. The situation made me think about how lucky Ken and I have been in regards to the help we have had through the years and how it has contributed to our success.

When we opened the original 3DPT in Medford in 2012, we really had no idea what our long term plan was – we were just hoping that a few people walked in the door for treatment and we could pay our bills. We didn’t even think about paying ourselves.  As we started to grow, we realized we needed to hire some people to help us out – we could no longer do everything by ourselves. This was a crucial crossroads in the history of our practice as Ken and I were going to no longer be in complete control. We were entrusting some of the success of the practice to other people.

We figured out that who we chose to help us out was a really important decision. We put a great deal of effort into making sure we hire the right people. Our interview process is not easy – we often have employees come in for multiple interviews and they always spend time in the clinic interacting with patients and staff before they are hired – we want to see what they are like in a real life situation. The most valuable lesson I have learned is this: get to know a potential employee as a person during the interview process. Find out what their core values are, what matters most to them and figure out if that aligns with 3DPT’s core values. If you have a good match, you likely have a good hire.

Take Carlie, for instance. Carlie walked into our Medford office in 2014 and asked about a position in the company. She was referred to us by a friend of mine so I figured I owed it to Carlie to hear her out when she showed up unexpectedly and I just happened to be near the front door. I could tell by talking to her that she was someone who would fit in great at 3DPT so I ended up hiring her the next day. She went on to PT school and worked for us in many different capacities while she was in school. We hired her as a PT right after she graduated and now she has just opened her own office as a partner of Ken and I. Pretty cool story – I love telling it.

We have been fortunate to have made many great hires since we started the practice. Now as the company grows, we are able to provide growth opportunities for our employees and watch them move into better positions. All of the offices that we have subsequently opened are run by therapists who originally worked as a PT in our Medford office. All of them have earned the chance to have ownership in their offices and become a partner of the practice. We provide mentorship and guidance to them while we learn from them every day as well. (Here is a secret – they are all smarter than me!)

Our growth as a company will only be limited by the amount of quality people that we can find and hire. One day Ken and I hope to be able to pass the business along to the great people we have hired (me sooner than Ken since I am way older than him). It is a great feeling knowing that whenever this happens, 3DPT will be in good hands because of the incredible people we have surrounded ourselves with. The old saying is right in our case – you are the company you keep.

Hip and Glute strengthening

The knee, and more specifically, the ACL, is one part of the body highly susceptible to injury, especially in young women.  Female athletes commonly tear their ACLs in sports such as basketball and soccer. There is an abundance of research suggesting various factors predispose athletes, specifically females, to ACL injuries. Hip strength is one factor highlighted throughout research as a possible contributor to these injuries.

The hip plays a major role in controlling knee stability.  The hip and knee joints work to support each other during daily and sporting activities, and some studies suggest knee injuries are associated with hip muscle weakness. In addition, muscle fatigue in the core and glutes can negatively impact body mechanics and predispose athletes to injury. How do poor strength and fatigue contribute to ACL injuries?  Hip and knee internal rotation increases with weakness and fatigue, which then causes a valgus force in the knees, or the knees diving in toward each other (see photo).

Knees excessively diving in can be related to diminished hip muscle strength, especially in the glutes, and is one of the most common factors associated with ACL tears. Additionally inadequate core and hip strength and endurance often cause athletes to use incorrect form and excessive movement in certain areas of the body, increasing the risk of injury.

So when it comes to reducing the risk of ACL injury, what can be done?  Strengthening the core, hips and glutes! For example, the glute max muscles helps provide 3 dimensional stability of the hip. The glute med muscles help to stabilize the femur and pelvis with side to side motions as needed during dynamic cutting. By strengthening and engaging hip muscles during activity, athletes can reduce the amount of knee diving and inherently reduce the risk of ACL injury.

In week 2 of our 3DPT’s Guide to ACL Prevention with REAL Jersey Football Club, the players learned these 3 key exercises that help to strengthen the hip and glutes –  Clamshells, single leg bridges and lateral band walks,.

Here are examples of each.  Try 2 sets of 10 reps to start working those glute muscles!

Articles:

1) ACL Injury Prevention: What Does Research Tell Us?
Trent Nessler  et 2017
2) The Influence of Abnormal  Hip Mechanics on Knee Injury: A Biomechanical Perspective
Christopher M Powers, 2010
3) The female ACL: Why is it more prone to injury?
Journal of Orthopaedics 2016
4) Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female Athletes
Timothy E. Hewet et al 2005

Assessment and Dynamic warm up

Among athletes, no matter the sport, the words “ACL tear” are probably among the most dreaded.  The ACL, or Anterior Cruciate Ligament, is a ligament that provides stability to the knee. A tear to the ACL can happen to anyone, but in many cases, tears occur in athletes of sports that require explosive movement, like football, soccer, lacrosse and dance.  Surprisingly 70% of ACL injuries are non-contact related!

At 3DPT we treat A LOT of patients with ACL injuries! And the great news is there is a (sports) life after an ACL tear!  With surgery (and in some cases without) and a good PT program, most athletes are able to return to activities and high level sports without issue.

In fact, some of your favorite athletes may have had multiple ACL injuries.   Megan Rapinoe of the Women’s National Soccer team tore her ACL 3 times and then went on to help her team win the World Cup last summer.  And Rapinoe is not alone – her teammate, Alex Morgan also tore her ACL. Women are 3x more likely to tear their ACLs than men and among high schoolers, girls account for a significant proportion of ACL injuries, particularly girls who play soccer, since most ACL injuries come from repetitive strain or twisting, rather than being hit or tackled by another player.

Unfortunately, the incidence of ACL injuries among young athletes has dramatically increased over the last 10 years.  A recently published article cites a clinic in Philadelphia saw a 400% increase in ACL surgeries in teens since 2009! (click here to read the article)

So what can athletes do to protect themselves from injury?  Preventative Training!

And that’s exactly the proactive approach that 2 teams of the REAL Jersey Football Club have taken to protect their players.  REAL Football Club is an elite soccer program based in South Jersey and one of the best youth soccer programs nationwide.  3DPT has partnered with the 2005 and 2007 girls REAL JFC teams to provide an 8 week hands-on injury prevention program to teach the players the best exercises and correct form to help minimize the risk of injury.  And as part of the 3DPT’s Guide to ACL Prevention we’ll be sharing tips, information and excerpts of the program with you!

So let’s get started!

Week 1 of the REAL injury prevention program focused on assessment and warming up.

Often, young female athletes demonstrate poor knee control during jumping activities where the knees tend to dive in towards each other, increasing stress on the ligaments.  So in our first session with REAL we evaluated each player’s jumping mechanics and knee control in a series of exercises. We’ll be measuring their performance in these areas as the program progresses!

Additionally, we taught the players a Dynamic Warm Up that they can use to start each practice and game to get their bodies ready to handle the stresses of high level athletics.   A good warm up includes dynamic stretching, agility, plyometrics, and muscle activation.

Click here to see Dr. Carlie Strazzullo demonstrate a dynamic warm up appropriate to get ready for any sporting activity:

Here is a video of the players giving it a try themselves:

Check in with us every week for 3DPT’s Guide to ACL Prevention to see more recommendations to stay injury free!

10 Important Tips to Prevent Injury & Enhance your Running Program

Many people will get back into running this time of year after taking some time off during the holidays.  Even more will get outside and start running as the weather warms up in the upcoming months. There are many running-related injuries that can often be prevented, such as plantar fasciitis, IT-Band Syndrome, runner’s knee and Achilles tendinitis.  The following tips are based off the current research and recommendations from our running experts at 3 Dimensional Physical Therapy.

1) Do not increase your total weekly mileage by more than 5-8% If you have a history of a lower extremity injury, high body mass or poor running experience.

2) Do not increase total weekly mileage greater than 10-15% if you are an experienced runner.

3) Those who run only 1x per week have a higher likelihood of injury. Instead of one big weekly run, break it up into 2 to 3 smaller runs.

4) Avoid running everyday, mix in rest days and cross training days (bike, elliptical, rowing etc)

5) Shoes are rarely the cause of pain, usually it’s training errors and lack of strength, stability, flexibility, etc. Shoes should simply fit well and be comfortable.

6) Do not change too many variables all at once (i.e. Hills, terrain, speed, distance)

7) Keep track of step cadence. Those whose steps per minute fall below 160 may be more prone to injury. Try to stay above 165 to 170  throughout your run.

8) Don’t forget to incorporate hip/quad strengthening, balance work and core stability into your program.

9) If you took weeks or months off from running, do not start up at the distance you were doing before you stopped. Give your body a chance to progress back into it.

10) If you have running pain that persists, do not continue to run through the pain.

Running can be great exercise and easy way to start moving more.

Give us a call at 3 Dimensional Physical Therapy if you’re experiencing any pain as you get started or back into your running routine.

Call to make an appointment today!
Medford~WestBerlin~Haddonfield 

Non-surgical treatment for ACL tears: Are you a Coper?

The ACL (Anterior Cruciate Ligament) provides stability to the knee. Tearing the ACL can cause giving way during sports or buckling while walking down the street. Nonsurgical treatment focuses on restorating knee joint mobility, increasing quadriceps strength and endurance, agility training, protective bracing and active modification. Success with this treatment is most common in sedentary individuals or those willing to modify their sporting activities. Some people achieve higher levels of function with nonoperative management of an ACL injury, and it is possible for someone to compensate for the absence of the ACL by stabilizing the knee with muscle activation. These individuals have been termed copers, indicating that they can cope with the knee laxity that exists after ACL injury.

Copers:

1. ACL only (No meniscus, PLC, MCL, LCL injury)
2. Full pain free ROM
3. No Joint Effusion
4. Quadriceps Strength >70% (Injured/Healthy)
5. Able to perform single leg hopping on injured leg

Screening:

1. Single Leg Hop Testing: Single, crossover, triple and timed hop tests (>80%) (https://youtu.be/VUauqk9qLQA)
2. Episodes of “giving-way” since injury (<2  since injury)
3. Knee Outcome Survey (>80%)
4. Global rating of Knee function (>60%)

There is an established screening process to determine if a person is a candidate for non-surgical rehabilitation following an ACL tear. Eastlack, et al. developed the following screening process. To participate in the screening process, the patient must have an isolated tear of the ACL (ie, non repairable meniscal injury and and no other concomitant ligamentous damage), full pain-free knee ROM and no knee joint effusion. These patients injured leg’s strength must equal at least 70% of the uninjured knee. Once this milestone is achieved, the patient must be able to tolerate single-leg hopping on the involved leg without pain. The screen is typically administered within two months of the injury. Some patients can reach these milestones within two days after injury, while others take much longer to achieve these goals.

If impairments, such as effusion or quadriceps weakness, are present, the patient will participate in a rehabilitation program until the deficits are resolved prior to initiation of the screening process. The screening includes 4 tests: (1) single, crossover, triple and timed hop tests. (2) Report of the number of giving-way episodes from the time of the injury to the time of testing. (3) the KOS ADLs scale and sports activity scale; and (4) a global rating of knee function, in which the patient self rates his level of function on a scale from 0 to 100, with 100 being full preinjury knee function. In the authors’ clinic, a functional knee brace is worn by all patients during the hop tests. Rehabilitation candidates are defined as patients who meet all 4 of the following criteria: (1) no more than one episode of giving way since injury, (2) score on the hop test of > 80%, (3) KOS ADLs scale score of >80%, and (4) global rating score of >60%.

If a patient is a candidate for non-operative ACL rehab they will go through weeks or months of Physical Therapy treatment with a focus on perturbation- training. Perturbation training consists of applying “destabilizing forces to the patients’ involved limb while the patient stands on tilt boards or roller boards” as previously discussed coupled with typical agility and strengthening program of the lower extremity. At the completion of Physical Therapy, patients must resume full participation in high level sporting activities for a full year to be considered true “copers”. Level I sports are defined as those that encompass jumping, cutting and pivoting types of maneuvers for 50 hours or more per year (soccer, football, basketball). Level II sports are those that involve lateral motion (skiing). Patients who are not considered rehabilitation candidates due to an inability to meet the threshold on any one of the 4 criteria are considered “noncopers” and are referred back to their orthopedic surgeon. Currently, there is no evidence for effective rehab of this group long term. In the United States today, patients who play to continue high intensity participation in Level I and II sports most often opt for surgical stabilization usually on the advice of their physician.

Click here to see videos demonstrating Physical Therapy for copers:

Perturbation training videos:

Citation
Manal, Tara Jo, et al. The Knee: Physical Therapy Patient Management Utilizing Current Evidence. Orthopaedic Section, APTA, Inc., 2011.

SUPER BOWL EDITION – Jimmy Garoppolo ACL tear

This is it – the last game of the NFL season, the SUPER BOWL!!!

Our 3DPT’s NFL Injury Review covered a lot of players and injuries this season, including the star quarterback of one the Super Bowl teams – Patrick Mahomes.  So it’s only fitting that our last edition highlight a major injury that the 49ers quarterback, Jimmy Garoppolo, came back from last season.

The last time Jimmy Garoppolo and the 49ers faced the Chiefs, the quarterback went down with an ACL tear that ended his season and ended the 49ers hopes of a rebound year. Fortunately both Garoppolo and the 49ers have been able to recover leading them for a rematch on the biggest stage. We covered an ACL sprain earlier in Week 14, but the implications of a full ACL tear are different and demonstrate how impressive Garoppolo’s recovery has been.

One of the biggest issues immediately after ACL reconstruction surgery is the pain and swelling. This can cause the quadriceps muscle to lose its function, making walking difficult and why crutches are often prescribed. The early stages of rehab can be the toughest for an athlete because they are used to performing at such a high level and now are confined to much simpler activities. One of the things that helped Garoppolo was that his teammate, Jerrick Mckinnon had just gone through the same surgery a few weeks before. This allowed Jimmy the opportunity to see what was in store for the recovery and have someone to go through it with.

As the recovery progresses following an ACL surgery, there are small milestones the athlete will try to hit. Garoppolo talked about how it was important to celebrate these small victories. At 3DPT we love seeing the patient succeed from performing a straight leg raise with no quad lag to performing a smooth jump and landing. It is important for the physical therapist to not only coach the patient how to perform tasks but give them the confidence to do everything they need. For Garoppolo he had to have the confidence to get back in the pocket with people trying to take him down. Squats and lunges will not be enough to feel confident in your ability to evade danger at the last second.

To get to the Super Bowl, Garoppolo had to trust in his rehab team. His counterpart, Patrick Mahomes had his own knee issues which we covered earlier this year, in Week 7. He too has been able to get back to top form as they prepare for the biggest game of their young careers. These players highlight the importance of having a good rehab team you can trust. Even if you aren’t trying to get back to playing NFL games, you should be given the confidence to do everything you want and we here at 3DPT are ready to help however we can.

Now that the NFL season is over, our 3DPT’s NFL Injury Review will be too!  But don’t worry, we’ve got more great information to share! Over the next few weeks we’ll be starting a new series, digging deeper into the ACL injury, and more importantly how to prevent one.  Check in with us next week to learn more!

Carlie Strazzullo – hometown girl to hometown business owner!

Carlie Flake (now Strazzullo!) has a love a few important things – her husband, Joey ♥, her family, Physical therapy and her hometown of Tabernacle!  Like her parents, Carlie was born and raised in Tabernacle and loves everything about her community. She grew up participating in Girl Scout’s, sports, and academic-related groups at Tabernacle Elementary School, Olson Middle School and Seneca High School and next month will come full circle by opening her own physical therapy clinic in Tabernacle!  Carlie couldn’t be more excited and happy to see this dream come true – combining her two passions, physical therapy and her community!

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Carlie has been with 3DPT since right after graduating from college and she’s done pretty much everything here – work at the front desk, help as a physical therapy aide and even verify insurance benefits. (Many of you reading this can remember Carlie from then!)  This time helped her earn the hours she needed to apply to physical therapy programs! Soon after, Carlie accepted admittance to Stockton University’s Doctor of Physical Therapy program, and spent the next 3 years studying to become a physical therapist. Lucky for us, she was able to spend her final 12 week clinical rotation at 3DPT Haddonfield with Chuck and Jess as her clinical instructors!

Once she was an official Doctor of Physical Therapy, Carlie knew she had a home at 3DPT.  She loved everything 3DPT stood for (and still does!) – the commitment to patient care and to the communities we’re a part of.   It didn’t take long for Carlie to express her interest in opening an office in her hometown of Tabernacle to Jeff and Ken, and together they decided that this would be their next venture!  After all, it was in Tabernacle, during her time at Seneca, that she made the decision to become a PT! During her Junior year soccer season, while running down the soccer field to accept a pass, Carlie tore her ACL, an injury that required surgery and months and months of physical therapy to follow. It was then that Carlie’s interest in physical therapy started.

After graduating from Seneca, Carlie went to Stockton University to earn her Bachelor’s of Biology  (Fun Fact: she’s also responsible for starting the women’s lacrosse team there! She met with administrators to start an intramural team which quickly grew into the school’s first NCAA DIII Women’s Lacrosse team. Carlie was able to play 1 season at Stockton, that brought her much success and allowed her interest in sports and the human body to grow!)

And the rest is history… or really just the beginning!

We’re so excited for Carlie to realize her dream and know that with her passion for physical therapy and her community, Tabernacle will love having their hometown girl back as a business owner!

Carlie’s Journey to 3DPT Tabernacle:

• Both of Carlie’s parents, Ernie and Christine Flake, grew up in the area and met at Shawnee High School
• Carlie lived in Tabernacle throughout her entire childhood, going to Tabernacle Elementary School, Olson Middle School and Seneca High School.
• At Seneca High School, she played both soccer and lacrosse.
• In the pre-season of her Junior soccer season, Carlie tore her ACL. Although this injury prohibited her from playing soccer that season and delayed her return to lacrosse, this injury led her to the world of physical therapy.
• Carlie went to the then Richard Stockton College of New Jersey where she earned her Bachelors of Science in Biology (2014).
• During her undergraduate education she helped start a club lacrosse team which was soon recognized as an NCAA Division III sport, in which she was able to play 1 season and be named NJAC Rookie of the Year, NJAC 1st All-Conference Team, and IWLCA All-Boardwalk Region Second Team.
• Following graduation from Stockton for her undergraduate education, Carlie was looking for a job as a physical therapist aide to accumulate observation hours and experience in the field as she waited for responses from PT school applications.
• She was hired at 3DPT where she spent a year as an aide and at the front desk.
• She went onto the Doctor of Physical Therapy program at Stockton University where she spent 3 years studying to be a PT.
• Her last clinical rotation was completed in the 3DPT Haddonfield office with Chuck and Jess as her clinical instructors
• Was soon after hired at 3DPT Medford as a physical therapist.
• With a goal to be a business owner and open her own practice, she was afforded the opportunity to partner with Jeff Sallade and Ken Guzzardo, the founders of 3 Dimensional Physical Therapy, to open an office in her hometown, Tabernacle.

Neck Pain in Dancers

When we see a Broadway show, go to the ballet, or watch other dance performances, we are so invested in the performance that it is easy to miss the risk that dancers take every time they step out on stage. Professional and amateur dancers alike are placing their bodies under increased stress and strain in order to create the most beautiful line, nail difficult tricks and dance steps, and add to the progression of the story being told on stage with their movement. Some of the more common injuries that come to mind for dancers are foot/ankle pain, knee pain, and low back pain; however, neck pain is another injury that should be considered and taken seriously. Around 7-12% of all dancers will experience a neck injury in their career, with 9% of that group being ballerinas and 27% being modern, jazz, and contemporary performers. This percentage difference is due to the different challenges of each technique and the forces placed on the body of each discipline.

So what puts dancers at risk for a neck injury? Dancers in general are predisposed to thoracic hypomobility and neck pain as a result due to their tendency to be in excess extension (aka “dancer posture”, sometimes defined by constant upright posture, with retracted shoulders). This tendency for excessive extension leads to a loss of the normal curves of the spine and when the natural cervical lordosis is lost, it leads to stiffness and pain in the thoracic region. Often when evaluating neck pain, physical therapists typically notice deficits such as decreased range of motion in the upper back and mid back, hypomobility of spinal segments and ribs at their attachments on the spine, and an increase to any pain in the cervical spine. Other symptoms associated with neck pain that are reported by both dancers and general population could be headaches or shoulder pain due to compensations, which in dancers further limits mobility and movement patterns. Unfortunately, due to the fact that one injury can change a dancers movement, it places them at an even higher risk of injury if they continue to work in pain.

Besides the everyday risks associated with their high-level physical movement, dancers also need to consider a variety of special factors that could cause a neck injury. Listed below are factors that are often out of the performer’s control, but add to the production for the sake of creativity and overall visual appeal of a performance. Some of those factors include:

• Heavy mic packs (large battery back with mic cord and ending in microphone receiver) that are often worn in the mid thoracic region or on the back of the head underneath their wig, which is most often done for female performers.
   
  

  

• Moving big, heavy set pieces (which professional performers are encouraged to do, as they are compensated accordingly for the risk of moving the set piece)
   
  

  

• Costumes, wigs, and head-dresses, especially those that are bulky, tall, or have ornaments (hats, hanging components, etc.)
  

In conclusion, dancers take a big risk with their body as a whole while performing. Safe performance/rehearsal conditions, good body technique, mechanics, and awareness are crucial to preventing serious injuries for performers. Physical therapists are  traditionally a great resource for dancers to utilize in preventing injury, rehabilitating injury, and advocating for safe work conditions.

If you or another performer is interested in learning more about Performing Arts Rehabilitation, schedule an appointment with Dr. Allison Korn, 3DPT’s performing arts specialist, at our Haddonfield Location.

Clinician Highlight – Welcome Zach Friedman, PT, DPT, CSCS!

What better way to ring in the new year than with a new team member?

We’re excited to welcome Zach Friedman, PT, DPT, CSCS to the 3DPT Medford team!  

Zach has been a PT for a few years and loves spending time getting to know his patients while helping them get back to feeling great and doing what they love.

The love of Physical therapy actually runs in his family – his sister, Leah, and brother-in-law, Ken Guzzardo, are already in the 3DPT family!

Learn more about Zach below

NAME:
Zach Friedman, PT, DPT, CSCS

COLLEGE(S) ATTENDED:
I attended The University of Pittsburgh for my Undergraduate degree and Drexel University for my Doctorate in Physical Therapy

HIGH SCHOOL:
Robbinsville High School in Robbinsville, NJ

CRAZIEST INJURY YOU EVER TREATED:
It’s really a combination of injuries… I worked with someone who has had over 20 surgeries and helped him rehabilitate from 2 knee surgeries, shoulder surgery, and back surgery.

TELL US THE INJURY/CONDITION YOU LIKE TREATING THE MOST:
Any and all shoulders, post-concussion, and post-operative knee like ACL rehabilitation

TELL US WHAT MAKES YOUR DAY GREAT AS A PT:
Working in an environment where everyone truly loves what they do, are having fun, and helping everyone achieve their goals in the process.

WHY IS 3DPT LUCKY TO HAVE YOU:
I’m lucky to be a part of a team like 3DPT where everyone brings passion, creativity, evidence based practice, and a positive and fun attitude day-in and day-out. These are hallmarks to bring everyday to the office and I’m excited to join in on it.

FAVORITE MOVIE OF ALL TIME:
Goodfellas

LAST BOOK YOU READ:
Defending Jacob by William Landay

FAVORITE DISH AT A RESTAURANT:
At the moment it might be Soup Dumplings. But I also love a good cheeseburger with bacon and an over-easy egg.

MOST DARING THING YOU HAVE DONE:
Hiking up a very active volcano in Bali with my wife during our honeymoon.

Welcome, Zach!

 Click here to learn more about Zach and our entire team at 3DPT!

Week 17: Shoulder Separation – Brandon Brooks

The regular season ended for the Eagles in pretty much the same way most of their games have – with a high profile injury.  Brandon Brooks, arguably one of the best offensive linemen in the NFL, made our 3DPT NFL Injury Review list again this time with a physical injury.  Brooks left last Sunday’s game against the NY Giants after injuring his shoulder during an extra point attempt.  The update out of Philly is that Brooks suffered a shoulder separation that will end his season, adding him to the list of Eagles players on injury reserve.

The shoulder is a complex joint.  We’ve covered two other injuries involving the shoulder in earlier articles – a shoulder dislocation and a clavicle fracture. A shoulder separation is different from a dislocation. A dislocation involves the humerus sliding out of its place on the shoulder blade, while a separation impacts the joint where the shoulder blade attaches to the clavicle. This is called the acromioclavicular joint or AC joint. There are 2 main ligaments that hold these bones together and the grade of the tear is based off of how many of the ligaments are damaged.

Treatment is determined based off the grade with grades 1-3 often being treated with a sling and rest before starting physical therapy. Grades 4-6 typically require surgery to stabilize the joint with PT afterwards to work on motion. Physical therapy for an AC tear involves strengthening the muscles around the joint to help stabilize. The rotator cuff muscles play an integral role with shoulder stabilization and are a key focus early on.

An NFL lineman has to produce much more force through the shoulder compared to the average person. Brooks requires surgery for his injury and healing could take 6-8 months, including the PT needed to help strengthen the muscles following the period of immobilization. Brooks season ended last year with an Achilles injury so he is used to the offseason recovery. It will be critical for him to get a good rehab team to get him back to 100%.

The Eagles have gotten this far with players from their practice squad, so hopefully Brooks’ replacement will work out for the team in this week’s game against the Seahawks.

Week 16: Fractured rib – Zach Ertz

With just one week left in the regular NFL season, injuries abounded across the league, including more for the Eagles!  The team has taken a big hit this season with all the injuries and many players that are still in the game, have had to step up!  One of the team’s key players, Zach Ertz, has been a powerhouse for the Eagles but in the game against Dallas this week, the team had a scare when Ertz had to leave the game after a big hit.   While Ertz’s arms were extended, a Cowboys defender made contact with his side and the initial word out of the locker room is Ertz suffered a fractured rib. While he was able to get back into the game, it’s still unknown if he will be playing in this week’s playoff-deciding game against the Giants.

A fractured rib can be a painful injury, depending on the extent of damage, as the ribs move with each breath. Players have played through this injury in the past, but again it depends on the severity. Carson Wentz and Ben Roesthlisberge of the Steelers have each had their issues with rib injuries and were able to play with some extra protection, but as quarterbacks, they also have less risk of high speed injury compared to an outfield player like Ertz. The difficulty with rib injuries is not only the pain, but also complications if there is an impact to the damaged area. The main function of the ribs is to protect the chest wall including the lungs and blood vessels coming from the heart. Severe damage to the ribs can puncture the lungs causing many more issues.

Patrice Bergeron from hockey’s Boston Bruins played through broken ribs in the Stanley Cup Final a few years ago and was able to avoid any further damage, but it is a risk nonetheless. Hopefully the Eagles do not need Ertz to seal the division title against the Giants if he is sidelined, but we will see how he is able to perform moving forward after that.

Week 15: Lisfranc Injury – Alshon Jeffery

Week 15 of the NFL brought some drama and excitement – at least in the NFC East – with the Eagles still holding on to playoff hopes. Some of the team’s younger players, like Miles Sanders and Greg Ward Jr. stepped up this week in the absence of the (many) veterans out with injuries – Jackson, Agholor and Jeffery.  Eagles fans had high hopes for another Super Bowl this season but injuries have sidelined many of the team’s top players. The Eagles finally announced that Alshon Jeffery has been out with a Lisfranc injury that requires surgery. This can be a tough injury to rehab from and the initial word is Alshon may be out for 9 months and could even miss part of the 2020 season.

Lisfranc injuries involve the bones in the middle of the foot. These bones take a great deal of force with each step transferring the force from the ground up into the ankle. The ligaments of the foot typically hold the bones in place, but when the force is high enough, damage can occur. Just as with other ligaments, the lisfranc ligament can be sprained. This is a less severe injury, but typically still requires a period of decreased weight bearing to allow it to heal. Jeffery is scheduled to have surgery on his foot which is likely due to the ligament being fully torn with the potential for a fracture in one of the bones of the foot.

Recovery can be lengthy because of the need to maintain decreased weight bearing in the early stages. However, resting also causes all the supporting muscles and ligaments to become weakened. Once the surgeons confirm full healing, physical therapy can begin to rehab the motion as well as gradually increasing force through the joint. Regaining motion can be difficult depending on the severity of the injury. Some patients may require having their bones fused to prevent further injury through the midfoot which will place added stress through other areas of the foot and ankle. This is why recovery can be lengthy as it is important to give the body time to adjust to the forces.

Jeffery is getting older and is already more injury prone than other receivers. This injury is one that will take a lot of work to recover from, but hopefully he can get back to full health to help out next season.

Week 14: ACL Sprain – Cedrick Wilson

Week 14 of the NFL season ended with the Eagles and Cowboys somehow tied for first place in the NFC East, both with a record of 6-7!  There were plenty more injuries for the Eagles in their Monday night game against the Giants, but the Cowboys also lost a receiver during their game on Thursday against the Bears.

Cedrick Wilson is not a household name, but his injury was worth analyzing due to how it happened. He injured his ACL reaching for a ball causing his knee to hyperextend (See video).

[embedyt] https://www.youtube.com/watch?v=0Nl8MAObeOQ[/embedyt]

With the force of his body weight combined with the speed he was traveling, his femur was forced forward on his tibia below. Normally the ACL is designed to prevent this exact motion, but for Wilson the force was more than the ligament could handle. Fortunately for him though, he did not fully tear the ACL, an injury which is commonly seen in NFL athletes.

An MRI revealed Wilson’s knee injury is just an ACL sprain and no surgery is needed. This is better news for him however it leaves the knee vulnerable to further damage in the short term while everything heals. Physical therapy is crucial for an injury of this nature to assist with knee control around the joint. In a healthy individual, the ligaments provide support for the knee while you walk, run, jump or any other knee motion. When a ligament is damaged, it is up to the surrounding muscles to take up the slack to provide the stability. A physical therapist can help design exercises that will help train the body to understand how the knee joint is positioned in order to best stabilize it.

With an injury like this, an athlete’s recovery time is typically 4-6 weeks, and Wilson is likely to be out for the rest of the season.  With an Eagles/Cowboys matchup in a few weeks, Eagles fans can be assured that Wilson will not be in the game.

Clinician Highlight – Welcome Katy Loughran!

Welcome, Katy Loughran, PT, DPT, to 3DPT Medford!

Katy Loughran loves being a physical therapist!  Of course helping patients get back to being their best physically is rewarding in itself, but Katy also enjoys having the opportunity to spend time getting to know each patient and their specific goals for PT!  We’re excited to have Katy join our team and know 3DPT patients will love her as much as we do!

Learn more about Katy below

NAME:
Katy Loughran, PT, DPT

COLLEGE(S) ATTENDED:
I attended The University of Delaware for my Undergraduate degree, Thomas Jefferson University for my Doctorate in Physical Therapy and Arcadia University for a post-doctoral residency!

HIGH SCHOOL:
Strath Haven High School in Delaware County, PA

CRAZIEST INJURY YOU EVER TREATED:
I once treated a patient recovering from a gunshot wound!

TELL US THE INJURY/CONDITION YOU LIKE TREATING THE MOST:
I enjoy treating all patients and working on general conditioning, as well as with athletes and runners.  I especially enjoy rehabbing ankle and foot injuries

TELL US WHAT MAKES YOUR DAY GREAT AS A PT:
Seeing patients laughing and having fun while they are working hard to improve and get back to full function!  And being around great co-workers to share ideas and fun with!

WHY IS 3DPT LUCKY TO HAVE YOU:
I am excited to work with the team and new patients! Connecting with patients on a personal level is very important to me. I want all my patients to feel comfortable under my care and know I want to get to know the individual beyond his/her injury. I love learning about patients, their families, and daily interests.

FAVORITE MOVIE OF ALL TIME:
Bridesmaids or Remember the Titans

LAST BOOK YOU READ:
The 4 Agreements by Don Miguel Ruiz

FAVORITE DISH AT A RESTAURANT:
French toast or anything Buffalo chicken

MOST DARING THING YOU HAVE DONE:
I’m not a very daring person ha ha!

Welcome, Katy!

 Click here to learn more about Katy and our entire team at 3DPT!

Week 13: Stinger – Jordan Howard

Week 13 brought another embarrassing performance from the Philadelphia Eagles.  Injuries have plagued the team this year and this week Jordan Howard was out for his fourth week.  He was injured in week 9’s win against the Bears, with what the team is calling a “stinger”. This is a relatively common injury in contact sports, but the name is not suggestive of anything specific.

A stinger, also called a “burner”, is a nerve injury to one or multiple nerves in the neck and/or shoulder that causes a burning or stinging type pain. All of the nerves in the arm originate in the neck. These nerves combine to form the brachial plexus, which is found mostly in the space between your neck and shoulders (see photo).  If a football player like Jordan Howard were make a tackle or block with his shoulder, there can be shearing or compressive force through the brachial plexus which causes the injury. Typically this injury lasts only a few minutes or sometimes hours, but it appears Howard sustained a more severe injury.

Similar to muscle/tendon injuries, nerves have 3 grades of injuries. Instead of “grade 1, 2 or 3,” the injuries are called neurapraxia, axonotmesis and neurotmesis. Neurapraxia is the least intense injury and occurs when the small nerve fibers are compressed but are not permanently damaged. A stinger would fit into this category.  It is similar to hitting your “funny bone,” which is actually compressing your ulnar nerve at your elbow. The symptoms typically don’t last long, but can take longer to heal depending on damage. Axonotmesis is more intense with the peripheral nerves being affected, but the deeper axons remain intact. Neurotmesis is the most severe which happens when the nerve is severed at any point along the path.

Nerves regenerate much slower than soft tissue or bone injuries. On average they heal around 1 inch per month, so the extent of nerve injured will determine the length of recovery. The issue with Howard is associated with not only pain but also weakness, so it would be difficult for him to perform at his full capacity with limited motion or feeling in his arm. He is approaching his 4th week of injury this week, so hopefully he can return soon.

Week 12: Anxiety

In week 12 of the NFL season, there were no high profile injuries in to note, however Eagles player, Brandon Brooks did miss the team’s game against the Seahawks this week for another reason. Brooks has openly spoken about anxiety he faces before most games.  On Twitter he mentioned how nausea and throwing up before games are normal for him and how he has been dealing with anxiety for several years since signing a long term contract with the Eagles. The feelings of nausea are something he has gotten used to, but this past Sunday, his anxiety got the better of him and he was unable to push through to play. It may seem odd to see someone as accomplished as Brooks to miss a game because of mental issues, but anxiety can be as intense as a physical injury but hard to spot from afar.

Most people can relate to some degree of feeling anxious.   Whether it is nerves before a public speaking event or even just going out to new places, anxiety can affect anyone.  Yet while most people experience it, talking about anxiety is not as common. There is a stigma in our culture associated with anxiety that is only now starting to change.   Brandon Brooks is not alone when it comes to his anxiety disorder. Over the past couple of years many professional athletes, particularly in the NFL and NBA, have opened up about their anxiety.  Additionally, many Olympic athletes struggle with anxiety. Since most Olympic events are individual sports, the athlete is the center of attention, and with high expectations of performance, which can be difficult for anyone especially for someone who does not want to be in the spotlight.  3DPT’s Ken Guzzardo spent time at the Olympic training facility in Colorado and noted that the training center has four sports psychologists and counselors on site to help athletes perform under immense internal and external pressure.

In physical therapy, it is common for patients to be anxious not only about their treatment, but throughout the recovery process. People in PT are experiencing pain that may be affecting their life and it is not something that goes away overnight. There have been studies done on patients with low back pain and various other conditions showing that even when the site of injury has fully healed, the patient still feels pain due to the brain tissue being affected. A good physical therapist will focus not only on the tissue affected, but help with the mind recovery as well.

Mental health is important in the recovery process.  David Leibovitz of Hopewell Springs Counseling Center says, “It doesn’t take a psychologist to know that your body and mind are very closely linked. Often times when people are dealing with an injury or illness, it affects many facets of their lives including their emotional functioning.  Many professionals in our field believe that people who actively cope with physical injuries report faster recovery and lower levels of both physical pain and emotional suffering.”

Anxiety is as real as any physical issue that an athlete faces.  Just as physical therapy helps to get athletes back on track physically, the right support system can help athletes with anxiety handle the pressure of performing at their best level.

Special College Edition – Week 11: Hip dislocation – Tua Tagovailoa

While there were plenty more injuries in the NFL in Week 11, this week’s most traumatic injury came from college football, so we’re doing a special “College football edition of 3DPT’s Injury Review!”

On Saturday, the University of Alabama’s star quarterback, Tua Tagovailoa was tackled by 2 defenders in the game against Mississippi State. The impact of the fall of Mississippi’s defenders on top of Tua, caused his hip to become dislocated. This is a serious injury and one that can have long term complications, so let’s look at this in more detail.

The hip is similar to the shoulder in that it is the joint that connects the limb to the trunk, however shoulders dislocate much more often than hips. One of the main reasons for this is the stability due to bony support. While the shoulder is set up like a golf ball on a tee, the hip has much more overlap from the pelvis, similar to a fist inside a palm. This creates more stability which is needed due to the high forces experienced with movement. All this stability is great, but when something goes wrong it tends to be pretty serious.

90% of hip dislocations happen posteriorly, the same that Tua experienced Saturday. This is when the knee or leg is driven backwards. Falling off a ladder or the impact from the knees on a dashboard in a car accident are common causes. The reason this injury is such a big deal is due to the blood vessels and nerves that can be compromised. When the hip is dislocated these structures are stretched and in severe cases can be torn. This can lead to nerve damage which causes pain and weakness throughout the leg. If blood vessels are torn it can affect the blood supply to the top of the leg bone. When this happens, the bone will die which requires a hip replacement. For the average patient, this is not the worst thing due to how advanced hip replacement surgeries are, but for the athlete it can be career ending.

Fortunately the initial news is that the surgery went well and Tua’s prognosis is for a full recovery. There is always a risk for complications during the recovery but it is good news to start. The recovery for the average person is typically 3-4 months but for an athlete can be upwards of 1 year. Initially the patient will have to be non-weight bearing to allow the bone to heal. Regaining hip range of motion and strength will take time after that before he can begin running followed by cutting and higher impact activities. Hopefully we can see Tua back in action next year with the eventual goal of the NFL as long as all goes well.

Clinician Highlight – Welcome Barbie Barron!

3DPT is happy to welcome our newest Physical Therapist, Barbie Barron, to our West Berlin clinic!

Barbie recently received her doctorate from The University of the Sciences Physical Therapy program and is excited to start her career at 3DPT!

She loves working with her patients to create a treatment program that is not only going to help them get back to feeling great but is also fun and rewarding!

We’re excited to have Barbie as part of the 3DPT team!

Get to know more about Barbie

NAME:
Barbie Barron, PT, DPT

COLLEGE(S) ATTENDED:
I attended The University of the Sciences for both my Doctorate in Physical Therapy and Bachelors of Science in Exercise Science

HIGH SCHOOL:
Washington Township High School in Washington Township, NJ

CRAZIEST INJURY YOU EVER TREATED:
I treated a patient who had a bi-lateral Transfemoral Amputation (both legs amputated above the knee)

TELL US THE INJURY/CONDITION YOU LIKE TREATING THE MOST:
I enjoy treating sports-related injuries, especially those having to do with the shoulders

TELL US WHAT MAKES YOUR DAY GREAT AT 3DPT:
Starting the day with a coffee and being able to laugh and have fun while helping people improve and feel better

WHY IS 3DPT LUCKY TO HAVE YOU:
I am passionate about helping others and love to continue to learn and try new things.

FAVORITE MOVIE OF ALL TIME:
The Lion King

LAST BOOK YOU READ:
Big Little Lies by Liane Moriarty

FAVORITE DISH AT A RESTAURANT:
Gnocci in pesto sauce

MOST DARING THING YOU HAVE DONE:
I planned a trip to Greece in less than 2 weeks!

Week 10: MCL injury – Jacoby Brissett

Week 10 finished with a few big upsets throughout the league! One of the more surprising upsets was the 1-7 Dolphins beating the Colts!  A big factor contributing to the loss was the Colts’ quarterback, Jacoby Brissett, missing the game due to an MCL injury he experienced in Week 9’s game.  In that game, one of the Colts’ offensive linemen first stepped on his ankle, then fell back further onto his knee, bending it inwards. Brissett was unable to finish the game and was held out of this week’s game as he his was not fully ready to go.

The MCL is one of the main stabilizing structures of the knee. It is on the inside of the knee so when the knee is bent inwards it can be stretched or torn if there is enough force. The MCL is also often compromised when there is an ACL tear. When the MCL is torn there is less static stability of the knee joint requiring more muscle activity to control the joint movement. This can put more stress on the meniscus, so it is important to rest and allow full healing to prevent further damage.

An MCL sprain follows the same frame as all ligament injuries with 3 grades of injury. Brisset likely suffered a grade 1 sprain as he was able to walk around the sidelines after the injury, although he was unable to return to the game. He was also able to practice, but was not fully ready for the impact of game play. Grade 2 injuries typically take several weeks to fully heal, while grade 3 injuries can be upwards of 6-8 weeks for full healing.  There is a lot of blood supply to the MCL, so for most injuries, recovery can be non-operative. However it is important to properly rehabilitate to prevent complications.

With how Brisset is progressing, it is looking like he may be able to return to game play this week, so we will keep an eye on his recovery to see how things go.

Week 9: Turf Toe – Davante Adams

Week 9 was an unfortunate one for the Philadelphia Eagles and Desean Jackson!  Jackson only played for a few minutes of the game last week and unfortunately re-aggravated his core muscle injury – an injury we discussed last week. This highlights the importance of proper rehab and ensuring full recovery prior to returning to sport, as now he will have to have surgery and will be out for another 6 weeks!

This week we will be highlighting an injury called “turf toe.” Davante Adams of the Green Bay Packers has been dealing with this injury for much of the early part of the season and was finally able to return to game play this week. It may seem odd to be out for a long period due to a toe injury, but this can be a painful one with a lot of force going through the joint with each step.

Turf toe was originally described in 1976 coinciding with the emergence of more sports being played on artificial grass surfaces. This combined with new shoes being more flexible puts increased force through the joints of the feet. The big toe takes a lot of stress with each step which can lead to a tear of the ligaments on the bottom of the toe. These ligaments are there to support the big toe and prevent it from moving into too much extension. As with any ligament injury there are 3 grades of injury. A grade 1 typically requires just rest with no impact through the joint. This can heal within a week or 2 of proper treatment. A grade 2 is a little more severe and can require a change in footwear to a more stable sole which will decrease joint impact with each step. A grade 3 is the most severe and can require some form of bracing to allow the ligament to heal before working on stretching and returning normal range of motion. It is important to wait until the pain is gone to return to activity level.

For an NFL athlete recovery can be longer due to the intensity of the sport and the forces they experience when running and cutting. Davante Adams missed 4 games waiting for his turf toe to heal and was able to return to action last week. Afterwards he said it didn’t feel 100%, but he was still able to play through it. With millions on the line though, NFL players often push through more pain than would be recommended. If you suspect you may have turf toe, talk to your doctor or physical therapist to prevent risk of further injury.

Week 8: Core Muscle Injury – Desean Jackson/Marcell Dareus

Week 9 of the NFL season is coming up and we still have not seen the Philadelphia Eagles’ star Wide Receiver, Desean Jackson, in a game since week 1 when he left the team’s first game early with an injury.  Initially his injury was reported as a groin strain, but is now being considered a core muscle injury. What exactly does that mean?

A core muscle injury  is a common injury that is known a few different things, such as sports hernia or athletic pubalgia. A hernia suggests part of the abdominal contents has protruded through the abdominal wall, which is not the case with a core muscle injury.  With a core muscle injury there are small tears in the muscles or tendons that are attached to the hip. It has been shown that prior injuries to any of the hip or abdominal muscles can leave scarring in the muscle leading to more force through the tendon attachment. There are 21 muscles that cross the hip joint. Whenever there is an imbalance in either strength or flexibility between those muscles, forces can be increased on specific muscles causing them to tear. Desean’s injury happened early in the season highlighting the importance of a solid offseason regimen to prepare the body for the intensity of the NFL season.

Depending on the severity of the a core muscle injury the first treatment is rest to allow the muscles to heal. At this stage, PT can help to stretch or loosen tight muscles using manual therapy. This can help alleviate any imbalances that may have been created over the years. Once the pain level is minima,l light strengthening of the hip and abdominal muscles can begin to further stabilize the pelvis. Surgery is occasionally required to fix more severe issues.  Last week, in a game agains the Cincinnati Bengals, the Jaguars’ defensive tackle, Marcell Dareus, also had a core muscle injury but his muscle fully detached from his hip, leading him to have surgery.

Whether it is surgery or conservative treatment, athletes are typically able to recover in 4-6 weeks, but occasional pain can linger signalling prolonged tissue damage. It is important to be aware of how the body is feeling to prevent further injury. Everybody heals differently.  It appears Desean is back to practicing with the team so if he is able to play this weekend, he will fall into the 7 week timeframe. If you suspect you have developed a core muscle injury be sure to talk to your physical therapist or doctor with any concerns.

Week 7: Patellar Dislocation – Patrick Mahomes

Patrick Mahomes has had a great start to his NFL career.  In just two years he’s already made a name for himself as a star quarterback – already named the NFL MVP in 2018 and even made the cover of the popular video game Madden 20 – a sure sign of NFL stardom!  So any fan of the NLF was sure to hear the news when Mahomes was injured during last week’s Thursday Night Football game. Mahomes went down early in the showdown between his Kansas City Chiefs and the Denver Broncos, as he was attempting a QB sneak for the first down.  While reaching forward, his knee collided with a defender’s knee and the impact drove Mahomes knee inward with his knee cap being forced to the outside of the joint. This is known as a dislocated patella or kneecap. A patellar dislocation can be a gruesome looking injury, but it appeared Mahomes was able to adjust his knee cap on the field and relocate it. He had an x-ray and was ruled out for the remainder of the game with a subsequent MRI the next morning. The news is the MRI results were best case scenario, but let’s check out what that could mean for him moving forward.

The kneecap is an important structure in the knee as it allows the quadriceps muscle to function properly. As you straighten your leg, the kneecap slides up which provides your leg with greater strength potential due to the physics of the movement. There are several ligaments that hold the kneecap in place along with the bony stability of the knee. The main ligament is the medial patellofemoral ligament. This is the one most likely damaged with a lateral dislocation, as was seen with Mahomes. From the MRI results we could assume the ligament was not torn, but it was still loosened from the impact of the injury. This leads to an increased risk of re-injury as the kneecap now has more available motion then it originally had. Along with more motion, less impact is needed to dislocate it – even just changing directions puts force on the ligaments of the knee.

The role of physical therapy with a dislocated knee cap is to regain range of motion of the knee as well as strength and proprioception. Often the knee will need to be immobilized for several weeks to allow the ligaments to heal in the correct position. Once this is completed your PT will begin increasing how much your knee can bend while ensuring the knee cap stays in position throughout the motion. For the average person, return to sporting activities usually takes several months. The immobilization period decreases the strength of the leg muscles so it is important to regain that strength before returning to the field. Balance and single leg stability is also important to retrain as that is an important part of most sports.

The outlook for Mahomes appears to be optimistic as they are saying it could be as soon as 3 weeks for him to return. There is still a risk of re-injury so I would imagine the Chiefs would not want to rush him back to action as his long term future is more important than a couple of November games. If he is your fantasy quarterback I would try to find a solid backup in case he is out for more than the estimated 3 weeks.

Jessica Jennings – from student, to star PT, to clinic director

Jessica Jennings is a bit of a star here at 3DPT!  Not only is she a really great Physical Therapist and co-worker, she’s a mentor to new PT students – both as an adjunct professor for Arcadia’s DPT program and coordinator of all the student clinical rotations here at 3DPT!  And fun fact…she’s known as “3DPT’s Minister of Fun,” because she organizes all our company get-togethers 🙂

All this and still manages to train for marathons in her spare time!

Jess started her 3DPT career as a student from Arcadia’s DPT program in 2014, working on a 6 month clinical rotation. She and 3 other classmates interviewed with Jeff to get a spot here but even then Jess stood out and made such a great impression that 3DPT offered her the position and was excited to have her as part of the team!  When her rotation started, Jess hit the ground running and was pretty much managing a full caseload from the start – 3DPT had recently gone through some staffing changes and it was very busy in the clinic! Jess held her own and her 6 months as a student flew by. After graduation, 3DPT offered her a job!

But that wasn’t an excuse to slow down for Jess – she knew right away she wanted to pursue further knowledge in orthopedics and sports.  Immediately after she graduated with her Doctorate in Physical Therapy she began an Orthopedic Residency which she completed while working at 3DPT. This prepared her to sit for her Board Certification in Orthopedics which she obtained in 2017. That same year she started studying for her sports certification, which also included shadowing Athletic Trainers and obtaining her Emergency Medical Responder certification. She earned her Board Certification in Sports in 2018.  (Jess is one of only 6 Physical Therapists Board certified in both Orthopedics AND Sports in South Jersey – 5 of them work at 3DPT!)  

During this time, Jess became very interested in ART – Active Release Techniques – and started working towards earning her ART certifications. She became full body certified earlier this year!

In just 5 years, Jess has accomplished so much and has been an integral part of 3DPT’s team.  Now Jess is taking on a new role – as the Clinic Director of 3DPT Haddon Township! We know that Jess will continue to use her passion for physical therapy and patient care to help 3DPT continue to grow.  It’s been an amazing journey SO FAR and we can’t wait to see what the future holds for Jess at 3 Dimensional Physical Therapy!

Click here to learn more about Jessica.

Week 6: Achilles tear – Seahawks, Will Dissly

Week 6 of the NFL season did not disappoint in terms of more player injuries..!

One injury that stands out is the Achilles tendon tear of the Seahawks, Will Dissly.  Dissly went down with the injury after making a quick cut for a reception. Quick pivoting and sudden acceleration are common causes of Achilles tears as the tendon gets overstretched.  Dissly had a season ending injury last year as well, so hopefully he will have a better recovery this time around. An Achilles tear can be a tough injury to recover from. Fans of the Eagles know the impact an Achilles tear can have after watching Sidney Jones get beat plenty more times on Sunday. He tore his Achilles 2 years ago and from the looks of it still has not fully recovered.   Let’s look into more detail about what goes on with an Achilles tear.

Earlier in the season we covered calf strains (click here to read about that) and the impact they can have on an athlete.  An Achilles tear affects the tendon that attaches the calf muscle to the heel bone. The Achilles is the strongest tendon in the body, withstanding forces up to 7 times bodyweight with running activities but if there are issues in the muscle or the tendon itself, it can be vulnerable to a full tear. Besides elite athletes, Achilles tears are common in the weekend warrior – the middle-aged person who works all week then does strenuous workouts on the weekend. Frequently the feeling that accompanies an Achilles tear is like being kicked in the calf with a burning pain following.

It is important to get medical treatment quickly after this injury to prevent the tendon from rolling up. Depending on the tear and healing potential, surgery can be avoided, but the treatment times are much longer. Surgery has demonstrated good results and can be relatively non-invasive depending on the extent of tear. Rehab following an Achilles tear is a slow progression to prevent damaging either the tendon itself or the surgical repair. Since the tendon has to accept the body weight with each step it is important to allow proper healing. Regaining motion through the tendon takes time which is also at the expense of muscle strength. The normal patient will usually be back to regular activities after 4-6 months assuming no complications. For the NFL athlete they need to rehab up to explosive strength or else they end up 5 steps behind as we have seen with Sidney Jones. Dissly is a young player and had been having a good year prior to the injury so hopefully he is motivated to get back to full strength for the start of next season.

How to tell if I am running with good form?

As part of your Physical Therapy treatment a running analysis is essential for us to know if you are demonstrating symmetry and good body mechanics. While it is not always appropriate to perform a running analysis on the first session or right after an injury, a short video of one’s typical running pattern can give us a lot of information!  Some aspects can be changed simply by strengthening or stretching while other components take a little more finesse to change. Just because you were injured does not mean you need a change to your running mechanics, nor does one need to change if they have never been injured. However, certain key elements can be adjusted if other conservative options have failed or not achieved 100% of one’s goals to return to running.

Here are some of the items that we look for when performing a video running analysis on someone:

• Footstrike/ Sound
• Step Rate/ Stride Length
• Pelvic drop
• Trunk /arm movements

FootStrike
This is a controversial topic amongst runners so let’s just talk about the evidenced based facts. We can break down your footstrike into either forefoot, midfoot or heel strike patterns. Forefoot running has gotten a lot of buzz along with the barefoot running craze. If we look at the science behind it, we know that landing on the forefoot can help to decrease forces and use of the muscles in the front of the lower leg which may be helpful for those suffering from shin splints or medial tibial stress syndrome. Conversely, landing with a heel strike can help reduces Achilles tendon force which may be helpful for those suffering from Achilles tendonitis/tendonopathy. Altering one’s footstrike does not always need to be done just because they were injured. However, it can be something to adjust if needed to reduce force on certain muscles.

Step Rate
Step rate or “cadence” is considered the number of steps one takes per a given speed. It is a simple calculation of speed= Step rate x stride length. Research has shown that by increasing ones “step rate’ by as little as 5-10% above their preferred, can decrease loading forces on the hip, knee, and Achilles. In order to do this, one typically has to decrease their stride length. These are parameters that may help to alter if you are prone to injury.

Pelvic Drop
When one strikes the ground we often look at the individuals pelvis or “belt line”. If we see one or both pelvis drop below a neutral horizontal line this could indicate hip weakness. The hips are the steering wheel for the knee and if your pelvis drops, your hips rotate inward toward your midline. This then causes your knee to dive in toward your midline and can also cause your foot to pronate or roll inward as well. Weakness in the hips or lack of good mechanics at the hips can also predispose one to injury.

Trunk/Arm Movement
Often overlooked, the position of your trunk and arms can affect your ability to propel forward. If you are not bringing your hands back far enough, it could create unnecessary rotational side to side movement rather than helping to drive your hips backward. If you lack movement in your thoracic spine or your mid back you may have an uneven arm swing, which can be seen during observation of running.

By now you have probably realized that it takes a lot of different body parts to be moving correctly to have good running form! Research shows that most people who think they have an idea of how their running form is, are actually incorrect. Let us at 3DPT help you take a look at what is actually happening when you run and get you back to your best training yet!

Week 5: Concussion – Mason Rudolph

The NFL saw plenty more injuries in week 5 of football season, but none were as noteworthy as Pittsburgh Steelers quarterback Mason Rudolph’s injury.  While Rudolph was attempting to pass, a Ravens defender dove in for the tackle and the top of his helmet landed on the bottom of Rudolph’s face mask. The hit was a similar blow that a boxer might experience taking a hook to the jaw!  The result was a concussion and Rudolph immediately went limp with his head hitting the ground with full impact. The medical staff rushed out to attend to Rudolph and he was taken to the hospital. The word out of Pittsburgh is that he has returned home from the hospital, which is good news, but the effects of a concussion can still last a while. Let’s look into more detail what happens with a concussion.

Concussions have gained a lot of attention over the years as we are learning more about the long term effects. The injury, which was once not considered as serious, is now considered a mild traumatic brain injury. The brain is made of soft material which is protected by fluid within the skull, so as you move throughout the day no damage occurs. If there is a strong enough force to the skull or body however, the brain can hit the inside of the skull causing bruising or damage to the brain tissues or blood vessels, resulting in a concussion. There are many symptoms that can accompany a concussion. The following is a list of symptoms developed by the American Association of Neurological Surgeons1.

• Prolonged headache
• Vision disturbances
• Dizziness
• Nausea or vomiting
• Impaired balance
• Confusion
• Memory loss
• Ringing ears
• Difficulty concentrating
• Sensitivity to light
• Loss of smell or taste

People may experience different symptoms with a concussion, but the good news is that the symptoms can be treated. Following an initial period of rest, there are several exercises to focus on to assist with recovery.  At 3DPT, many of our therapists are specially trained to help with the management of concussions and can determine which techniques are best.

The NFL has its own protocol each player has to go through in order to return to sports activity. While each player progresses through the stages at a different speed depending on recovery, it is important to fully recover prior to returning to the field as a second concussion soon after the first one can have serious, even fatal effects. For the most part, players fully recover with proper treatment but it is always important to try to decrease your risk of future injury.

There is a test that has been developed to assist with identifying concussions, called ImPACT tests, that are becoming more popular, especially in youth sports to help with concussion testing and management. The test is completed before the season starts to get a baseline measurement, and is designed to be taken following a concussion to assess impact. We do ImPACT testing here at 3DPT.  Contact us with any questions or to set up an appointment, click here: https://3dpt.com/impact-testing-form/

Week 4: Shoulder Dislocation – Mitch Trubisky

There were plenty more injuries to check out in week 4 of the NFL season, but one of the most noticeable was Chicago Bears quarterback Mitch Trubisky going down with a dislocated shoulder. He was tackled by a Vikings defender and fumbled on the play. As Trubisky was going down, he reached for the ball with his left hand, landing on a fully outstretched left arm. The word out of Chicago is that the damage is not as severe as it could have been and Trubisky likely will not miss the whole year but will be out for some time. Let’s look more into what happens with a shoulder dislocation.

The way Trubisky fell is one of the classic causes of a shoulder dislocation. We call it a FOOSH, or Fall On OutStretched Hand. The shoulder isdesigned like a golf ball on a tee with the end of the arm bone being the golf ball and a piece of the shoulder blade,  the tee. As you fall with the arm out, that “golf ball” is separated from the tee and with enough force it can be pushed off completely. This can happen whether you slip while walking your dog, falling on ice, even sliding into a base while playing baseball.

There are muscles and ligaments that normally hold these bones together, but when you dislocate your shoulder there is a risk of loosening these tissues leading to an increased risk of future dislocations. The shoulder joint is also supported by a fibrous ring called the labrum. To use the same golf ball analogy, this goes around the edge of the tee providing more contact area. Many times with a dislocation, part of the labrum is torn which leads to decreased support at that area.

It is important to seek care for a shoulder dislocation quickly to ensure no nerve or blood vessel damage has occurred as this can lead to more severe effects. According to the reports, Trubisky did not have any issues after his shoulder was relocated. Physical therapy for a dislocation usually begins quickly with the main goal being to strengthen the muscles around the shoulder joint and providing proprioception training which helps the muscles better maintain the shoulders position. Rehab generally takes about 6 weeks for the average person. Trubisky will likely have multiple sessions per day and since it was his non-throwing arm affected he may be able to return sooner than that, but the risk of it popping out again with a sack will still be there.

Week 3: High Ankle Sprain – Saquon Barkley

In Week 3 of the 2019 NFL season, thankfully the Philadelphia Eagles did not experience any big injuries… But we don’t have to look far for a big impact injury. Penn State grad and NY Giants superstar running back, Saquon Barkley, went down early in the game against Tampa Bay with his ankle bending awkwardly. Barkley was helped off the field by trainers and was later seen on the sidelines using crutches, unable to put any weight on his injured ankle. The initial diagnosis for Saquon’s injury is a high ankle sprain, which could be bad news for the Giants.

A high ankle sprain is typically worse than the more common lateral ankle sprain, due to more tissues involved. The ankle joint is shaped like an arch with a dome (talus bone) underneath.

In a high ankle sprain that dome is forced upwards and with the rotation component seen with Barkley’s injury, the bones forming the arch are forced apart. Those bones, the fibula and tibia, are held together by ligaments and the interosseous membrane (see photo). The extent of ligament damage varies with each injury. There is also a risk of fracturing the fibula with this injury, but fortunately the preliminary x-rays for Barkley were negative for a fracture.

The initial stage of recovery following a high ankle sprain involves protecting the ligaments to prevent further damage and trying to control pain and swelling. The patient may be non-weight bearing (on crutches) for several days to allow healing, but will progress to weight bearing as pain allows. Early treatment following the initial stage focuses on regaining motion through the joint and strengthening the muscles around to better protect the damaged structures. Ankle stability is especially important for an athlete like Saquon and since the ligaments are affected, it is important to train the muscle to better stabilize the ankle. Balance is also a key component to work on as the ankle assists with maintaining balance. Once the patient is pain free and demonstrating improved stability, they can begin working towards more advanced drills to return to sport.

Recovery generally takes 4-6 weeks for a high ankle sprain and can be up to 8 weeks depending on severity of damage and demands of the sport. Barkley apparently experienced a similar injury his freshman year of college and only missed 2 weeks, but that is not common. This injury may not affect the outcome of the Giants season, but the Eagles will probably have to face Barkley back at full strength when they teams meet December.

Do Stem Cell Injections Help with Knee pain?

Osteoarthritis is the degeneration of joint cartilage and the underlying bone, which ultimately causes pain and stiffness of the involved joint. Current treatment strategies that are most popular for treating this condition include medication (i.e NSAIDs, opioids), intra-articular injections, physical therapy, and surgery.

Stem cell injection therapy is considered a new effort in regenerative medicine proposed to have potential benefits in treating a variety of conditions. The current research regarding this treatment method is largely based in individuals with osteoarthritis, especially of the knee.

Stem cells are a special type of human cells that have the potential to develop into many different cell types. The type of cell they develop into depends on the environment in which they are injected. This is what provides their unique potential to help treat disorders like arthritis, because they have the ability to differentiate into cartilage or bone. The most common locations from which stem cells may be derived to be used in this procedure include the patient’s own adipose tissue, bone marrow, and the umbilical cord.

When considering stem cell injection therapy as compared to joint replacement in the treatment of osteoarthritis, stem cell injections have demonstrated a few advantages. Overall, the process is less invasive than that of surgical intervention, therefore is associated with fewer potential risks. Adverse effects that have been reported with stem cell injection therapy include pain and swelling following the procedure.

Current research regarding the effectiveness of stem cell injection therapy for treating knee osteoarthritis and establishing an effective rehabilitation program shows that stem cell treatment improved knee pain and self-reported functional ability with physical activities. Further, it has been demonstrated that physical therapy played a significant role in improving self-reported physical function scores in patients who had received stem cell injections.

Physical therapy treatment would typically begin 2 weeks following a stem cell injection, allowing time for the stem cells to transform into the new, regenerated cartilage. Then, physical therapy is key to incorporate appropriate rest, biomechanical loading, tissue mobilization, and procedure-specific protocols in order to optimize outcomes following this type of procedure.

While the effectiveness of stem cell injection therapy has been demonstrated in research, it is important to note that pure stem cells are not currently available for treatment in the U.S. at this time outside of clinical research studies.

Calf Strains – Dallas Goedert and Alshon Jeffrey

Week 2 was a rough one for injuries especially if you were an offensive player for the Philadelphia Eagles. Not only did Carson Wentz have to leave the game for a bit, most of his top targets were knocked out early. Two players specifically went down with calf injuries, Dallas Goedert in warmups and Alshon Jeffery early in the game. Calf strains are a common injury in sports, but can have varying recovery times. Let’s look into more detail…

Muscle strains in general are common in sports requiring explosive movements, such as football. These movements require a great deal of force transferred through the muscle and if the muscle is not strong enough to handle the force, it can be strained. The calf, along with the hamstring and quad, are muscles commonly injured in this way because they cross 2 joints. The calf, specifically the gastrocnemius, crosses the ankle and the knee. As the knee bends, such as in sprinting, the calf is unable to produce maximal force and is more vulnerable to injury.

There are 3 grades of calf strains based on the severity of the injury. A grade 1 is the least severe with very few muscle fibers involved. Returning to activity usually is possible between 10-12 days depending on the sport and overall healing. A grade 2 calf strain involves a greater degree of muscle fibers and can take up to 3 weeks to recover. A grade 3 injury is a complete tear of the muscle and requires 6 months of healing time following surgery.

Proper recovery is important to prevent further injury as the risk of recurrence is high. Dallas Goedert is proof of this – his calf strain this week was actually a re-injury he suffered in preseason. Fans of the NBA also know how important this can be after seeing Kevin Durant go down with a torn achilles, the same game he returned from a calf injury. Not to say the calf injury specifically led to the achilles tear, but if the calf muscle is not fully healed, it will put added stress on the tendon.

The first step of the recovery is to rest the muscle and remove any unnecessary stress which could include crutches, depending on the extent of the injury. Once pain-free motion through the ankle has been achieved, the athlete can begin strengthening the muscle. This is a crucial stage because the calf muscle requires power to push off, but it also needs to support the weight of the body to control the descent when jumping and slowing down from a sprint. There are many steps to complete before returning to sports activities so it is important to work with an expert to ensure full recovery.

At this time we don’t yet know the extent of the injuries to Jeffery and Goedert, but hopefully we can see them suit up and be back to action in the next several weeks.

Nick Foles’ Clavicle Fracture

Week 1 – Nick Foles’ Clavicle Fracture

This week was the first week of games for the NFL and Eagles fans were happy to be celebrating their win against the Redskins.  But one injury that occurred in a completely different game was almost just as heartbreaking for Eagles fans as if it happened on our own team!  Philly’s own Super Bowl hero, Nick Foles, early in his first game as a Jaguar against the Chiefs, was tackled after making a long throw for a touchdown. The Chief’s defender landed on him and the combined force of them hitting the ground together caused Nick’s clavicle to break.

The clavicle, or collar bone as it is more commonly referred to, is one of the more common bones to break in the human body as it has little protection in the event of a fall. Situated at the top of the chest on either side of the neck, your collarbone can be easily felt and one can imagine how falling directly onto the bone can cause it to break. Sports are common causes for injuries to this bone, but it can also happen with a fall in any setting, especially for those with weaker bones like the elderly.

The main symptom of a clavicle fracture is pain. This bone is the only link between the arms and the rest of the body. The constant pull from gravity on the bone can make the pain worse, which is why many fractures are treated with a sling for several weeks while healing takes place. It is important to limit motion through the affected arm to allow the bone to heal normally. Occasionally surgery will be required to stabilize the bone depending on the site of the fracture.

How can a physical therapist help with a clavicle fracture?
In the initial stages of healing it is important to focus on decreasing pain and swelling using any medication recommended by your doctor and icing several times throughout the day. After a few weeks your therapist will begin gently moving your arm to focus on regaining motion safely. Once you have pain free motion, usually around 6 weeks, you can begin strengthening the muscles around the bone but healing times will vary. Treatment is typically effective in regaining full strength and motion with very few long term complications.

Fortunately for Foles, his fracture occurred on the side of his non throwing arm, but with the impact NFL quarterbacks are subject to, he will most likely not be rushed back into action. If Foles is on your fantasy team you will want to look elsewhere for the next 6-8 weeks!

Stay tuned for next week’s injury review!

Clinician Highlight – Lauren Vranich, PT, DPT

We are excited to welcome (back!) our newest Physical Therapist, Lauren Vranich, to 3DPT Haddon Township!

Earlier this year, Lauren Vranich spent 3 months with 3DPT while she was finishing up her Physical Therapy doctorate at Stockton University. We liked having Lauren with us so much that we asked to her to come back for good and we couldn’t be happier to have her as part of the team!

Get to know more about Lauren:

NAME:
Lauren Vranich, PT, DPT

COLLEGE(S) ATTENDED:
Stockton University for my Doctorate in Physical Therapy and
Bachelors of Science in Biology

HIGH SCHOOL:
Cinnaminson High School

TELL US THE INJURY/CONDITION YOU LIKE TREATING THE MOST:
I really enjoy treating any orthopedic or sports-related injuries.

WHAT MAKES YOUR DAY GREAT AT 3DPT
Working with patients who are eager to get better and report noted improvements with their rehab, as well as working in a friendly and supportive environment with awesome co-workers.

WHY IS 3DPT LUCKY TO HAVE YOU?
I am truly passionate about providing the best quality of care for each patient as well as bringing a positive attitude into the work place each day

FAVORITE MOVIE OF ALL TIME:
Rocky

LAST BOOK YOU READ:
The Art of Racing in the Rain

FAVORITE DISH AT A RESTAURANT:
Sushi

MOST DARING THING YOU HAVE DONE:
Zip lining in Saint Thomas

Welcome, Lauren!

Click here to learn more about the entire physical therapist team at 3DPT

Clinician Highlight – Rachel Parker

3DPT West Berlin’s Rachel Parker’s love of running began in 2011 when she completed her first half marathon in Ocean City, NJ.  Fast forward 8 years, and her passion for running has only grown – in her own life and for helping her patients achieve their running goals.

Rachel recently completed an Advanced Running Assessment and Treatment course. Along with her personal experience as a runner, the information from this course will help Rachel better diagnose specific running injuries and design treatment plans to rehabilitate and recover the athletes she treats!  

 “It was being a runner that mattered, not how fast or how far I could run. The joy was in the act of running and in the journey, not in the destination.”  – John Bingham

Get to know more about Rachel:

NAME:
Rachel Parker, PT, DPT

COLLEGE(S) ATTENDED:
Stockton University for my Doctorate in Physical Therapy and Bachelors
Burlington County College for my Associates of Science

HIGH SCHOOL:
I was homeschooled until age 16, then attended Baptist Regional School

MOST REWARDING EXPERIENCE AS A THERAPIST:
Each injury is unique and rewarding in its own way. This is one of the reasons I love being a physical therapist. One of the injuries that I found most rewarding to treat was a patient who underwent a partial knee replacement (UKA) with the goal of completing an Ironman. This incredible individual not only rocked his therapy, but went on to achieve his goal one and a half years later and successfully completed an Ironman Triathlon

TELL US THE INJURY/CONDITION YOU LIKE TREATING THE MOST:
Running-related injuries and Post-concussive syndrome

WHY IS 3DPT LUCKY TO HAVE YOU:
I am very invested in my patients and devoted to compassionate and individualized care

FAVORITE MOVIE OF ALL TIME:
The Holiday

FAVORITE DISH AT A RESTAURANT:
Anything Gluten free!

MOST DARING THING YOU HAVE DONE:
Jumped off a 25-foot cliff in Maine!

Did you know that quite a few 3DPT physical therapists are avid runners?  Distance runners, track athletes and even an Ironman competitor!
Click here to learn more about the 3DPT team!

Can Physical Therapy get rid of my Headaches?

Did you know your 3DPT physical therapist can help you decrease or eliminate headache pain? A trained physical therapist can help to decrease pain caused from musculoskeletal headaches, which are headaches caused by muscle tension, joint dysfunction, or irritation to the nerves in your neck.  Some of the muscles that can cause headaches include your upper trapezius, suboccipitals, and sternocleidomastoid, to name a few! 

As with any first visit at 3DPT, your physical therapist will do a thorough evaluation with you – obtaining a history of your headaches and other information, along with evaluating your movement and strength.

From there we will create a personalized treatment plan involving muscular releases and joint mobilizations, followed by stretching and strengthening to eliminate the muscle imbalance that can cause headaches.

In this video, Liz demonstrates what a treatment for headaches might look like.  It’s amazing that muscles and joints that may not have been bothering you could be the cause of headache pain!

As experts in how our bodies work, physical therapists can help determine underlying causes of pain, such as headaches.  If you’ve been suffering from headaches, call one of our offices to make an appointment!

And follow us on Facebook and Instagram to see updates and regular posts on physical therapy and health information!

Cherry Hill… Here we come!

3DPT Cherry Hill is opening August 1st!!!

You may have heard by now that 3DPT is growing! Over the next few months our 3 locations will become 5 – with new clinics in Cherry Hill and Tabernacle.  We’re so grateful and excited for the opportunity to help more people by providing excellent physical therapy!

Our newest office in Cherry Hill be opening next week on August 1st!
Chuck Bachi, who heads up our Haddon Township office and Anthony Perrone, in our Medford office, will be joining forces to lead 3DPT Cherry Hill.  Incredibly, this collaboration has been 11 years in the making!  Anthony and Chuck met on the first day of graduate school at Rutgers University in Newark in August 2008.  Anthony and Chuck became great friends, frequently studying together, pushing each other to be better students and clinicians and helping each other with complicated patient cases during clinical affiliations.  They are both passionate about helping people through Physical Therapy and had aspirations to own a physical therapy practice together at some point in their careers.

After graduation, Anthony and Chuck worked in outpatient Physical Therapy practices in North Jersey to begin their careers.  From the start, they both had patients tell them about the differences they experienced with their treatment – how at other PT places they had felt like a number, didn’t get hands-on treatment and would be left alone while doing exercises.  Chuck and Anthony shared a different approach – no one is treated like a number, each patient has an individualized physical therapy plan of care specific to their needs and gets one-on-one, hands-on treatment.

After 4 years, Chuck moved to South Jersey and started working at 3DPT in Medford, a company that matched his physical therapy approach of personalized care.  In 2016, 3DPT’s owners Ken Guzzardo and Jeff Sallade offered Chuck a unique opportunity to partner with them to open our Haddon Township office!

Even though Anthony and Chuck lived quite a distance apart, they remained close friends. They traveled to and presented at national physical therapy conferences together over the years. Additionally, they spent time studying together to become board certified clinical specialists in sports and orthopedic physical therapy.  Physical therapists who are dual board-certified specialists are rare so it was rewarding to achieve their certifications together!

In 2019, as luck would have it, Anthony ended up relocating to South Jersey when his girlfriend began her pediatric residence at Cooper Hospital. Of course, Chuck recruited Anthony to work at 3DPT as soon as possible, knowing that Anthony’s philosophy of treatment aligned with 3DPT’s commitment to excellence in patient care.   Around the same time, 3DPT was approached with an opportunity to expand into a newly constructed, 6,000 square foot clinic in Cherry Hill –  a space already designed for a Physical Therapy Practice!  Jeff, Ken, Chuck and Anthony saw this as a great opportunity for 3DPT to grow and Chuck and Anthony’s vision to be PT partners became a reality!

Officially Partners!

3DPT Cherry Hill opens its doors on August 1, 2019!  Chuck will be treating in both Cherry Hill and Haddon Township and Anthony will be in the new office full time.  Be sure to follow us on Facebook and Instagram for ongoing updates and news from Cherry Hill!

We are excited to share the excellent physical therapy and patient care that all 3 Dimensional Physical Therapy clinics offer to new patients!  To schedule an appointment at the Cherry Hill office, call us at 856-438-5633.

3DPT Cherry Hill
496 Kings Highway North, Suite 110
Cherry Hill, NJ 08034
856-438-5633

Did we mention, Chuck and Anthony both have birthdays in August? What better way to celebrate!

Clinician Highlight – Allison Korn, PT, DPT

3DPT’s Allison Korn has been dancing and performing since she was a little girl.  Her love for dance and appreciation for the body’s movement made a profession in Physical Therapy and easy choice! 

As an avid dancer and performer, Allison is familiar with the physical demands of the performing arts.  She is trained in ballet, modern, contemporary, and musical theatre dance and plans to begin voice training soon! As both a physical therapist and performer, Allison uses her experience to tailor the care of the performers she sees at 3DPT to their specific needs. Most dancers and performers are practicing and performing for several hours, several days a week putting considerable stress and strain on their bodies. PT is essential for performers to stay healthy and maintain a high level of performance for every audience that comes to see them!  Physical therapy helps these people to decrease pain, improve their range of motion and strength, and learn about how to keep their bodies safe as they are auditioning, rehearsing, and performing. Physical therapy can even help keep actors injury-free as they move around complicated sets, have to wear heavy or cumbersome costume pieces and hair pieces, and keep them injury-free with stunt work or onstage combat. Some physical therapists can even address these deficits mid-show (usually seen with Broadway and off-Broadway performances)!

Allison is actively involved in theatre at Haddonfield Plays and Players.  Her most recent show is a production of All Shook Up, running from July 11 – August 3, 2019, as both the choreographer for the show and a member of the ensemble!  This is Allison’s second production with Haddonfield Plays and Players, first appearing in their production of High Fidelity in October 2018.  Performing locally allows her not only to hone her skills as a performer, but she is able to use her experiences to stay current in the performance world for her patients.

For more information on All Shook Up or to purchase tickets, visit the Haddonfield Plays and Players website here.

If you or someone you know is in need of a performing arts physical therapist, call our Haddonfield office to schedule an appointment with Allison. To learn more about Allison, click here or to check out the videos Allison has compiled for dancers, click here.

Get to know more about Allison:

NAME:
Allison Korn, PT, DPT

COLLEGE(S) ATTENDED:
University of the Sciences (undergraduate and graduate education)

HIGH SCHOOL:
Sterling High School, Magnolia, NJ

CRAZIEST INJURY YOU EVER TREATED:
I worked with an amazing kid who sustained a spinal cord injury after a dirt bike accident and was paralyzed from the waist down. It was wonderful to see him walk, drive, and start to participate in sporting activities after months of hard rehab.

TELL US THE INJURY/CONDITION YOU LIKE TREATING THE MOST:
I love working with dancers! Dance is really unique in both technique and performance mentality, and my dance background allows me to connect on a deeper level with these patients. I am able to incorporate dance technique and use dancing itself as an intervention to rehab injuries

TELL US WHAT MAKES YOUR DAY GREAT AT 3DPT:
My co-workers really make my day great at 3DPT! They are kind, supportive, and create a great environment for learning so I can be the best therapist for my patients. Their positive energy brightens my day!

WHY IS 3DPT LUCKY TO HAVE YOU:
I am able to treat performing arts injuries more specifically as I am still actively involved in dance and theatre.

FAVORITE MOVIE OF ALL TIME:
Beauty and the Beast – I am a shameless Disney fan.

LAST BOOK YOU READ:
The Couple Next Door

FAVORITE DISH AT A RESTAURANT:
Pretty much any crepe at La Café Creperie in Haddonfield.

MOST DARING THING YOU HAVE DONE:
Besides performing on stage in front of large audiences, the most daring thing I have done is complete a Tough Mudder race. The race was challenging and a little painful, but I was proud of my ability to push myself mentally and physically to complete it!

Learn more about our entire team of physical therapists or call any of our locations to make an appointment!

LOVE IS IN THE AIR AT 3DPT!

If you’ve been to 3DPT in the last few months, you may have heard wedding bells ringing!  In May and June, we got to celebrate 3 weddings involving 5 of our Physical Therapists.  Kaitlin and her long-time love, Gary, Joey and Carlie and Sean and Liz all tied the knot and we couldn’t be happier for them!

Kaitlin Hartnett (PT in Medford) was the first of our newlyweds. She married her now husband Gary on May 10th in a beautiful ceremony just outside of Philadelphia. No bride wants to see a drop of rain on her wedding day – even more so for an outdoor ceremony!  But while it poured almost all day, right before Kaitlin and Gary said “I do”, the rain stopped, the ceremony went on as planned outside and it couldn’t have been more perfect!

Our second wedding took place just a week later on May 18th.  Carlie Flake and Joey Strazzullo (both PTs in Medford) had the first ever wedding at Russo’s Farm in Tabernacle.  With friends and family there to celebrate, the wedding was an amazing time in a beautiful setting.  3DPT can take credit for playing a role in Joey and Carlie’s marriage as they met in our Medford office when Joey had just started out as a therapist and Carlie was a PT aide just over 5 years ago!

Last but definitely not least was the wedding of Liz Young (PT in Medford) and Sean King (PT in Berlin) on June 15th.  Sean and Liz met in undergraduate school years before becoming physical therapists but they both started their first PT jobs at 3DPT!  June 15th just happened to be the perfect day for a wedding and Liz said her day “was the absolute, without a doubt, by far, best day of her life.”

We are ecstatic to have had the chance to celebrate in the marriage of great employees and great people. We know this is just the beginning of a lifetime of happiness for Kaitlin & Gary, Joey & Carlie and Sean & Liz.

What is Blood Flow restriction?

Call to make an appointment today!
Medford~WestBerlin~Haddonfield 

My first meeting with Blood Flow Restriction
As many of you know, I am a physical therapist and a sports fanatic! I love to treat athletes and watching them get back to what they love to do, while teaching them some valuable lessons along the way. I have focused my continuing education courses around the latest research and treatment options that help optimize an athlete’s recovery. A few years ago I was watching ESPN and saw an Outside the Lines special on BFR – Blood Flow Restriction – training and how many professional teams were adopting this technology and utilizing it with their players. (See the ESPN clip here https://www.espn.com/video/clip/_/id/15175951 & https://www.espn.com/video/clip/_/id/15162497)  I looked into some of the research but at the time, the practice was relatively new and not many studies had been performed. Fast forward 3 years, and now there is a ton of research showing that BFR works in many different ways and is safe.

Recently, a few surgeons who 3DPT works with, reached out to me to see if I started using BFR for any of our physical therapy patients yet. At 3DPT, we are committed to provide the best possible care for our patients and with the research that was now available and surgeons in the area looking for it, I knew I had to get certified in Blood Flow Restriction.  In May, I took the ORS (owensrecoveryscience.com) BFR course in Maryland and I was blown away. At the course they presented so much research on the reasons why BFR works and what happens in the body when it is applied. Below I will discuss some of the science behind it and why it is useful in physical therapy, improving athletic performance and preventing injury.

A quick anatomy lesson
Without getting too scientific, a quick anatomy lesson would be helpful to understand the mechanisms behind BFR.

Our bodies have two general types of skeletal muscle fibers: slow-twitch (type I) and fast-twitch (type II).

1. Slow-twitch/Type 1
   a. Require oxygen as fuel
   b. Produce less force
   c. Able to maintain longer-term contractions
   d. Key for stabilization and postural control
2. Fast-twitch/Type 2
   a. Do not require oxygen
   b. Produce high levels of force
   c. Fatigue quickly
   d. Used in powerful bursts of movements like sprinting

During normal activities, where oxygen in our blood stream is plentiful, we are using slow-twitch, or type 1, muscle fibers. However when we exercise, especially at very high intensity levels, the oxygen in our blood and muscles gets used up quickly, leading us to use of the fast-twitch/type 2 fibers. If we continue to perform the high intensity activity, our body continues to recruit more and more of these type 2 fibers until all fibers have been recruited, leading to muscle failure. It sounds complicated but just think about when lifting weights.  Your muscles progressively become more tired and eventually “fail” due to the body not being able to recruit more (consider all this the local response). When this is occurring we are also breaking down muscle tissue and the muscle releases a signal (essentially a cry for help) for the central nervous system (brain and spinal cord) to come to the rescue (systemic/full body response).  If you have worked out intensely you know this means increasing heart rate, ventilation and sweating. Hormones that help in the repair and rebuilding processes of the muscle are also released throughout your body during and following high intensity exercise. The most abundant being human growth hormone (HGH) and insulin-like growth factor (IGF).

For the body to truly build bigger and stronger muscles we need to have more muscle protein- building then muscle protein-breakdown.

SO…What if there was a way we could recruit and fatigue these fast-twitch/type 2 fibers and cause those muscle building hormones to be released, without having to break them down with high intensity exercises and heavy loads???? Or what if there was a way to truly strengthen and build our muscles right after surgery or injury, when we are unable to lift heavy loads?

DRUM ROLL PLEASE…. Introducing BFR, or Blood Flow Restriction

What is BFR?
BFR is a rehab intervention and performance enhancing tool that uses the body’s natural systems of stress and recovery that we talked about above. Trained healthcare professionals use an FDA-approved tourniquet on a specific part of the body to restrict 50-80% of venous blood flow. By reducing blood flow, we can create positive effects that will allow for increased muscle growth and strength that you would traditionally need a heavy load to achieve. Research on traditional resistance training requirements for muscle growth suggests loads heavier than 65% of an individual’s one rep max (1rm) must be used to create hypertrophy gains. So to keep it simple, a person who can squat 100lbs 1 time must squat more than 65lbs to create muscle growth and improve strength. With BFR, working out at just 20% of this 1 rep max (20lbs in the example above) allows for the same growth in muscle mass!! SO, performing exercises with BFR will allow you to rehabilitate more aggressively and decrease muscle atrophy (weakness), even when you have weight bearing restrictions, following a surgery or injury. Because little damage is done to the muscles by avoiding heavy weight lifting, improvements in strength and endurance can come quicker = faster recovery!

BFR and Physical Therapy
There is more and more evidence supporting the use of BFR in physical therapy, especially for those too elderly, frail or injured to engage in traditional strength training exercises. Injured individuals often cannot put too much weight on a muscle or joint but need to build bigger and stronger muscles. BFR solves this problem and because of those great hormone responses discussed above, we’ve seen rapid changes in many injuries such as tennis elbow, patellar tendonitis, and muscle strains. Even after surgery, during periods of non-weight bearing, BFR has been shown to be highly effective at minimizing the loss of strength and muscle mass. When post-surgical patients cannot perform exercises with heavy weight, BFR solves the strength problem, without using any exercises outside the surgeon’s protocol. Now those low level “strength” moves you are limited to during early rehab can actually create strength and muscle mass gains.

Here is a quick example of a study that showed the incredible impact that BFR can have on general exercise:
(Clarkson et al 2017)
In this study, sedentary, elderly adults (men and women in their 60s & 70s) walked with and without BFR for 6 weeks (4 walks per week, 24 total walks).  The study measured common functional measures of strength, mobility, balance and endurance (the timed-up and go test, the 6-minute walk test, the 30 second sit-stand test, and the modified Queens College Step Test)   at the start of the program, at 3-weeks and at 6-weeks.

The BFR walking group saw a 2.5 to 4.5 times greater improvement in their measures of physical function compared to the non-BFR walking group.  That’s 250% to 450% greater gains in strength, endurance, balance and mobility just by adding Blood Flow Restriction to the walking.  That. Is. Amazing.

BFR Beyond PT
Evidence also shows the benefits of using BFR to:

1. Prevent injury- due to release of growth hormone discussed above which will strengthen tendons and improve muscle structure.
2. Recovery- Improve muscle recovery after sporting events or after long races for the endurance athlete
3. Improve Endurance- Improved VO2 max with use of BFR

All of the benefits above could potentially help athletes, weight lifters, runners, cyclists, crossfit athletes and many others, improve performance and prevent injury.

How does it feel?
While at my certification course, I was able to try the cuffs out on myself. The set up is easy – the cuff was velcroed tightly to my upper thigh and the machine pretty much does the rest. It is equipped with a doppler to measure blood flow and the pressure increases to determine how much is required to restrict 100% blood flow and quickly backs down to 80%. This is where the magic happens! I completed straight leg raises (locking the leg straight and then lifting it while keeping it straight) in a series of repetitions, 30/15/15/15 with 30 second breaks in between each set. The first set wasn’t too hard but I did feel more tired than anticipated. Each set following became progressively harder and the muscle burn in my quad and hip flexor became more intense like I was performing heavy squats! I took a 5 min rest and then performed knee extensions sitting off the edge of the table (sitting and kicking the leg straight) and again the burn in my quad was intense. I woke up the next day with sore legs, like I had completed a full workout, when in reality I had only performed 2 easy exercises that are typically used at the very beginning of a knee strengthening program, proving that the muscles really was working and being built!

We are excited to be offering this game changing technology and rehab tool to 3DPT and believe it will benefit many patients.  If you are interested in learning more about Blood Flow Restriction, call to make an appointment today!

Call to make an appointment today!

Congratulations to the 2019 3DPT Scholarship recipients!

For the past six years, 3 Dimensional Physical Therapy has had the privilege of  awarding an annual scholarship to local graduating high school seniors.  In 2012, we had just one scholarship recipient and this year in 2019, we’re awarding 5 scholarships to college-bound seniors!

Earlier this year applicants from select schools were asked to tell us about their experience with Physical Therapy – either a time throughout their high school career when they recovered from an injury through physical therapy or why they’d like to pursue physical therapy as a career.

Here are the 2019 3DPT Scholarship recipients and where each will be headed for college next year!

From our Medford Office:

Maggie Hamilton (Lenape Regional High School District) – Wagner College

From our Berlin office:

Ethan Shacket (Eastern Regional High School) – Ohio State University

From our Haddon Twp. Office:

Gabby Barranger (Haddonfield High School) – University of Hartford

Julia Saia (Haddon Township High School) – Liberty University

Cole Maher (Collingswood High School) – University of Central Florida

At 3 Dimensional Physical Therapy we feel lucky to be a part of our amazing communities and the remarkable people we get to meet and serve each day in our clinics.  We are proud to help support these amazing students and we know they will go far!

Call to make an appointment today!
Medford~WestBerlin~Haddonfield 

What is E-Stim?

It may sound technical, or even a little scary, but NMES is just another tool that 3DPT Physical Therapists use to help get patients the best results from their physical therapy program…

NeuroMuscular Electronic Stimulation, or NMES, uses electrical impulses to help increase strength and range of motion especially for muscles that can’t be used due to injury. It is often used to “re-train” a muscle to function and to build strength before or after a surgery.

For example, often times after a major knee injury or surgery, the quadricep (thigh muscle) becomes inhibited and does not function well. By using this form of electrical stimulation we will help “wake up” the quad muscle and get it firing.

In this video, Ryan demonstrates NMES on field hockey player, Kara Heck, who will be undergoing ACL surgery next week. The goal is to get her quadricep muscle firing as strong as possible so she goes into her surgery with a quad muscle that is strong and functioning well. The twitching of the muscle that you see in the video is done by the electric stimulation.

To learn more about NMES or any of the services we offer, call one of our offices to schedule an appointment with a physical therapist.

Call to make an appointment today!
Medford~WestBerlin~Haddonfield 

What to do when you get shin splints?

The weather is finally nice (and rain free!) and you start getting back into your old running routine, everything is going great until you start feeling that aching/burning pain in the front of your leg. Shin splints are a common running injury and sideline runners for quite some time. What is the actual cause of this pain and how do you treat it?

Shin splint pain can be muscular related pain or it can be bone related which is also called medial tibial stress syndrome. What happens is that the impact from landing on your feet with running can cause your bone and muscle tissue to break down and start to swell and become inflamed. If you continue to run when your shins are hurting, over time this will cause further break down and this is when people may develop a stress reaction or fracture. Bone injuries take longer to heal, so if you are having shin pain start physical therapy right away!

Overtraining/ overuse injuries like shin splints occur when you increase your intensity, duration or frequency of impact exercise such as running too quickly. It is important to have a good training program that is gradual. There are some other causes for shin splints and your physical therapist can help you identify what these are. A few of these are listed below:

Causes:

• Running mechanics
  • Foot posture/shoe wear
  • Ankle/Hip weakness
• Training errors
  • Increase intensity/ frequency
  • Hill training early in season/ in training
  • Running on cement or hard surfaces
• Bone Mineral Density
  • Nutrition

Treatment can include a variety of options. Often times soft tissue work helps to improve the healing process. Check out this video on ART or Active Release Technique for shin splints.

Your therapist may work on some of the muscles involved and also have you stretch and or foam/roll. During your initial exam we will identify specific areas of weakness. As a runner, it is important to have strong core, hips, quads and foot muscles. Check out this video by Dr. Korn on foot intrinsic strengthening. Working these muscles can help if one of the causes of your shin splints is flat feet.

Lastly, taking some rest time may be needed. During this time performing biking, swimming or elliptical can keep you moving while being less impact on your joints. Performing strength training is also very important!

Want to be evaluated by a therapist for some of the above causes?

Call to make an appointment today!
Medford~WestBerlin~Haddonfield 

3DPT Aides Moving on up!

by: Jeff Sallade
If you have been to one of our PT clinics, you have likely had the chance to interact with our physical therapy aides. The PT aides at 3 Dimensional Physical Therapy assist the physical therapists with providing the best experience possible for all of our patients. They help to keep the clinic looking great, provide patients with heat or ice, and help patients get set up with exercises to keep their session moving along efficiently.

At 3DPT, we have been lucky enough to hire outstanding people as our PT aides. This is not by accident – we prefer to hire people who have an interest in the healthcare field, someone who may have an interest in moving forward in the healthcare profession.  And now because of this, are starting to see some of our PT aides make their way back to 3DPT as Physical Therapists as they have finished or are finishing up graduate school.   One example is Carlie Flake (now Strazzullo). Carlie walked into our Medford clinic in 2014 and we hired her immediately as a PT aide. Soon after, Carlie was accepted into PT graduate school at Stockton. Carlie worked for us when she could during her 3 years of PT grad school.  She now works for us as a physical therapist (we made sure we hired her because we knew how great she was) and will be opening a 3DPT clinic in Tabernacle this fall!

Over the years, we have had numerous employees who worked as PT aides for us get accepted into graduate school for physical therapy as well as programs for occupational therapy, nursing, athletic training and physician assistant.  It is rewarding to be able to act as a stepping stone for all of these employees as they work their way towards their end goal of becoming licensed healthcare providers.  We have 3 current employees that have been accepted into graduate school and will be leaving us over the next few months. We want to take this chance to recognize them and wish them all the best.

Erica Day – accepted into Temple University Athletic Training program

Gina Bischof – accepted into Salus University Occupational Therapy program

Shane Morales  – accepted into Rutgers University Physical Therapy program

Erica, Gina and Shane have been great members of the 3DPT team and we know they will be amazing Healthcare Professionals too.  Thank you for all you have done for 3DPT and we hope to cross paths again a few years down the road!  New PT Aides will be joining the 3DPT family and we look forward to seeing where their experience with us will take them.

Call to make an appointment today!
Medford~WestBerlin~Haddonfield 

Clinician Highlight – Liz Young

Liz Young started as a Physical Therapist at 3DPT just about two years ago and she’s been keeping busy ever since.  From finishing her first marathon in November, teaching spin classes 1-2 times a week at a local gym, to now just weeks away from getting married, Liz has a lot going on! 

But that hasn’t stopped Liz from taking time to continue to learn about new PT best practices and treatments and how to best serve her patients.  As one of the Pediatric Specialists at 3DPT, Liz loves working with our youngest patients and is always learning more about how to best help them.

Learn about what it means to be a Pediatric Specialist and get to know more about Liz!

As a Pediatric specialist PT, what special training have you had?
In PT school, every doctorate student participates in clinicals, or 3 month rotations in physical therapy settings, to get hands-on experience.  My last clinical rotation was at the Weisman Pediatrics facility, where I got to work specifically with children needing physical therapy.  Also my parents own a preschool, so growing up I had a lot of opportunity to work with kids.  Now I get to work with kids, helping them rehabilitate with physical therapy!

What areas have you had training in that are especially important for pediatric patients?
I recently earned my ImPACT certification (Immediate Post-Concussion Assessment and Cognitive Testing) so that I can better treat patients who have had a concussion.  Post-concussion rehabilitation is crucial for everyone and especially for young patients, whose brains are still developing.

I also recently took continuing education courses in Neuro-Developmental Treatment (NDT), pediatric kinesio-taping as well as Torticollis.  Torticollis is a common condition in which babies have a tilted head or trouble turning their necks.

If you’re a Pediatric Specialist Physical Therapist, do you only work with kids? 
Not at all!  I enjoy working with all patients at 3DPT and treat all conditions.  Being a Pediatric Specialist just means that if a child does come into 3DPT needing physical therapy, I am able and trained to work with them specifically.

Some fun facts about Liz:

COLLEGE(S) ATTENDED: 
I earned my Doctorate in Physical Therapy from Drexel University in Philadelphia, PA and my Bachelors in Health and Exercise Science from Rowan University in Glassboro, NJ.

HIGH SCHOOL:
Cherokee High School in Marlton, NJ

CRAZIEST INJURY YOU EVER TREATED:
I treated someone that had paralysis from West Nile Virus. He got the infection from a mosquito bite while gardening in his backyard in NJ.

TELL US WHAT MAKES YOUR DAY GREAT AT 3DPT: 
Working with amazing people – both the staff and patients!

WHY IS 3DPT LUCKY TO HAVE YOU: 
Because I treat every patient like they’re a family member.

FAVORITE MOVIE OF ALL TIME:  
Despicable Me

LAST BOOK YOU READ:
How to treat your own neck – I needed to read it before I recommend it to patients!

FAVORITE DISH AT A RESTAURANT:  
The dessert after the meal!

MOST DARING THING YOU HAVE DONE:  
Either hiking Angels Landing in Zion National Park in Utah or cliff jumping in the Adirondacks.

Learn more about our entire team of physical therapists or call any of our locations to make an appointment!

The Start of Something Good – how 3DPT came to be

by: Jeff Sallade
This week is “National Small Business Week”. There are all kinds of statistics that illustrate the difficulty in owning a successful small business – less than 50% of small businesses survive beyond 5 years. As 3DPT gets close to completing its 8th year in business, I wanted to tell you the story of how 3DPT came about and why I think we have been able beat the odds and get well beyond that 5-year mark.

I had always had the desire to own my own physical therapy business as I worked for different companies throughout my PT career. But I also always had an excuse as to why it wasn’t a good time in my life to go ahead and do it – I was getting married, I was moving, I didn’t have enough money, etc… The fact of the matter was that I just was not ready to take the risk.

I met my current business partner, Ken Guzzardo, at a previous job and learned that he also had the same idea of wanting to start his own PT practice. Ken was persistent with me and kept telling me that we could partner up and do great things. Ken did a great job convincing me and in August 2011, 3DPT was formed.

***Cool 3DPT fact: The very first “treatment session” actually occurred in my living room – we didn’t have an office space so we made do with what was available. ***

Almost 8 years later, we now have 3 offices with at least one more in the works set to open this summer. If you ask me what has allowed us to surpass the 5-year mark that many small businesses can’t get past, I would sum it up this way: Everything we do has one goal in mind – to provide a great experience for every patient, every visit. This is how we do it:

• We have hired great therapists that truly care about our patients’ well being and helping them improve their quality of life.
• We have taken on partners who care about the success of the business as much as we do to run our offices in Berlin and Haddon Township.
• Our front desk and aide staff really know how to make a patient feel welcome and important.
• Our billing and insurance group deftly handles the sometime perilous world of financial responsibility and health care bills.
• We now have a marketing employee that ensures you are kept updated on what is going on at 3DPT even if you’re not a current patient.

A few years ago, we sat down and summed up the most important things to 3DPT – our core values.  You may have seen them on the wall in the reception areas of our offices because we want these values to be front and center for every employee to remember and every patient to see.

Community · Honesty/Integrity · Accountability · Stepping Up · Commitment to Excellence

Keeping these values top of mind helps us to ensure we’re delivering a great patient experience.  As a private practice, 3DPT is not guaranteed referrals from physicians or hospitals.  We rely on patients telling others about their good experience at 3DPT through referrals to friends and family and positive reviews for others to see.

So here’s a chance for you to help us continue to grow!  If you have had a great experience at 3DPT,  and would like to share about your experience as a patient, we would love for you to leave a review so others can learn about what to expect from their PT here.  Anyone that leaves a review by May 17th will get recognized with a reward!

Here are direct links to leave a Google review:

• For our Medford office, click here
• For our Berlin office, click here
• For our Haddon Township office, click here

Or Like us on Facebook and leave a review for us on our Facebook page!

Even with all of the hard work, sacrifice and hours invested in opening and operating 3DPT, we have never once regretted our decision to open this business. The reward of getting to help people on a daily basis as well as being able to provide a place of employment for close to 50 people has made owning a small business worth it. We hope 3DPT is around for many years to come and look forward to continuing to provide the best PT and service to our customers!

Call to make an appointment today!
Medford~WestBerlin~Haddonfield 

Physical Therapy Near Me – what to consider when choosing a PT practice

by: Ken Guzzardo
Did your doctor tell you to go to a physical therapy clinic and you are not sure if you should go there? Are you unhappy or not seeing improvements with your current physical therapist? Are you looking for a physical therapy clinic and not sure what to expect?

Most people will search the internet for “physical therapy clinics near me” and numerous physical therapy clinics will show up making it difficulty to decide which clinic to select.   In today’s era of overcrowded  and “factory-like” clinics,  there are important factors you should consider when choosing a physical therapy clinic.

When going to any medical appointment, you are trading your time and money (copay or deductible) in the belief that the interaction will help you to get better. Whether you have pain, an illness, or loss of function, the medical appointment should lead you down the right path towards recovery. Below are 6 key questions to ask when scheduling your first Physical Therapy visit and to think about on each follow up visit to make sure that you are trading your time and your money for the best services to get you back to full function.

1.  How many visits do your Physical Therapists see per hour?

Many Physical Therapy visits will overlap with another patient’s session. When therapists treat more than two patients per hour, the PT is not able to effectively watch your form during exercise and make recommendations to improve the effectiveness of the exercise. She or he is not able to provide the hands-on joint mobilizations, Graston, Active release, or other manual techniques that are important to improving the tightness in muscles and joints to make the exercises effective. When you ask this question, the answer should not be more than two patients per hour. If you begin treatment and notice that the visits per hour is more than you were initially told, question your PT for a different time of day that may work better, or consider changing companies entirely.

2.  Will I work with the same PT each visit?

Your physical therapy experience should be about your relationship with the therapist and their knowledge about how the body works. All graduating Physical Therapists have a Doctorate degree now. This requires an undergraduate degree in addition to 2-3 years of schooling to obtain their Doctorate.

When you see a physician, you make a connection with that physician. You believe that physician will get you better, and you see the same physician on follow up visits because she or he knows you, your case, and what they have tried before that has worked or not worked. This relationship is even more important with your Physical Therapist. You will see your PT anywhere from 1-3 times per week, and they should be doing some kind of hands on intervention at each session. It is imperative that they know you and you know them since it is a more intimate relationship than you will have with the physician. If you are seeing a different PT each visit, the hands-on technique may be different, the treatment philosophy may be different, and your recovery may take longer because the person doesn’t know you. There is a difference between the PT knowing your diagnosis and knowing you as an individual. It matters for your recovery if the therapist knows your goal is to lift your grandchildren, run a 5K, or sit at work without pain. The same PT will get to you know and the “why” we are working with you.

3.  Will my session be with a PT or with an assistant or aide?

Physical Therapists know the body and movement inside and out, and they design your treatment plan after performing your initial evaluation. When you are doing your exercises in the treatment sessions, the movements that the PT selected are for a reason. They are designed to improve strength, flexibility, control, etc. It really matters if your arm is at a 90-degree angle versus a 70-degree angle for activities, and you want a Doctor of Physical Therapy or other movement expert to be the one supervising your exercises to make sure the exercise is being performed the correct way. Physical Therapist Assistants work closely with the PT and are also experts in exercises and hands on interventions. There are excellent teams of PTs and PTAs who work hand in hand to get their patients better.

In the State of New Jersey, a Physical Therapy aide is not permitted to make recommendations on correcting form and/or instructing patients in how to do an exercise. You are trading your time and money for a PT visit, and you should ask that a movement specialist is the one making sure you are maximizing your session.

4.  What continuing education has my Therapist taken?

Physical Therapists are required to complete 30 hours of continuing education courses every two years. Some PTs take the minimum just to remain licensed, and others shatter the required amount year after year because of their thirst for knowledge. PTs can specialize in treating different conditions based on their continuing education. You want someone working with you who has completed advanced coursework or certifications in a treatment that will help you, not someone who passed their licensure exam years ago, and now just takes the minimum to get by.

5.  Is my treatment progressing towards my goals?

Every patient is different. Two people with the same diagnosis may be trying to achieve two different things and therefore should be treated two different ways. Every treatment session should be making progress towards achieving YOUR goals with an individualized home exercise program that you can perform in between sessions. If you are performing the same exercises day in and day out for few weeks and are not seeing progress, then you should question the PT on taking a different approach to YOUR particular rehabilitation. It doesn’t take long to know that a round peg will not fit into a square hole, and your PT should be able to recommend different treatment options for you.

6.  Is my Physical Therapist teaching me?

The ultimate goal of PT is to instruct and empower you, the patient. You will learn about your condition as well as learn what exercises and/or stretches should be performed after your graduation from PT to reduce the risk of the condition returning. You should ask your PT why they are selecting certain exercises and what their hands-on interventions are trying to accomplish. This allows you to understand the rationale behind treating your particular condition and helps with reinforcing the importance of the home exercises they issued you.

There are a lot of excellent Physical Therapists and PT clinics out there, and there are some that may not be able to offer you the care that you need. You have every right to make sure you are with the right Physical Therapist, in the right environment and setting to get you better. Your physician may recommend a company that they like or refer to often or are financially vested in, but make sure that the office works for you and will not load you into an overcrowded office where you are working exclusively with an aide or a different PT each session.  When searching for “Physical Therapy near you,” consider the questions above, read patient reviews and choose the PT clinic that best meets YOUR needs.  Having the right team of physician and PT, you will get better, faster, and with less of a risk of reinjury.

Call to make an appointment today!
Medford~WestBerlin~Haddonfield~Cherry Hill~Tabernacle

Clinician Highlight

3DPT is excited to welcome new Physical Therapist, Anthony Perrone, to our Medford office!

Anthony has been a Physical Therapist for over 8 years and is a Certified Sports and Orthopedic Specialist.
As a former PT patient himself, he is passionate about helping people heal and get back to doing the things they love!
Get to know more about Anthony

NAME:
Anthony Perrone, PT, DPT, OCS, SCS

COLLEGE(S) ATTENDED: 
William Paterson & Seton Hall University for my undergraduate degree and Rutgers-Newark for my Graduate program.

HIGH SCHOOL: 
Bergen Catholic High School

CRAZIEST INJURY YOU EVER TREATED:
A patient I treated for nearly one year had a rare form of Guillain-Barre Syndrome (a rare neurological disorder caused by the immune system attacking healthy nerve cells that can make patients feel numbness or tingling in their arms and legs and can proceed to gradual paralysis).  I actually presented this case at an annual PT conference. The patient was my sister and she worked tremendously hard to regain full function.

TELL US THE INJURY/CONDITION YOU LIKE TREATING THE MOST:
Athletes of all levels – ranging from an elderly patient trying to get more mobile, to the weekend warrior and the high-level competitive athlete

WHAT MAKES YOUR DAY GREAT AT 3DPT:
Working hard, having fun and taking pride in being part of a great staff and profession.

WHY IS 3DPT LUCKY TO HAVE YOU?:
I work hard for my patients and I care about them because I was once in their shoes. I can relate to how it feels to not be able to do the things you love to do. It is a privilege to be in a profession that gives you the opportunity to help people in this manner.

FAVORITE MOVIE OF ALL TIME: 
Ace Ventura 1

LAST BOOK YOU READ: 
Casino Healthcare

MOST DARING THING YOU HAVE DONE:
Jet Skiing with one of my best friends from Lavallette to Atlantic City, NJ.

Welcome Anthony!
Learn more about our entire team of physical therapists or call any of our locations to make an appointment!

Low Back Pain and Sciatica Seminar

On March 23th, 3 Dimensional Physical Therapy hosted a free seminar on Low Back Pain and Sciatica at our Medford office.  We had a great, interactive audience who participated and asked lots of questions!

Jeff Sallade, co-owner of 3DPT, presented on:

• The 3 main causes of Low Back Pain and Sciatica
• The biggest mistake people make when it comes to low back pain
• How to heal back pain for good without medication, injections or surgery.

The entire seminar was captured on video, so if you weren’t able to attend, click on the link below to hear the presentation.  Also you can view the slides from Jeff’s presentation to follow along with.

If you are experiencing back pain, call one of our offices to make an appointment with a therapist to see how physical therapy can help alleviate your pain!

Take Me Out to the Ball game!

by: Ken Guzzardo
For as long as I can remember, I have loved baseball. I’ve enjoyed playing the game, keeping score while watching games, and traveling around the country with my dad and brother visiting different stadiums. So far, we have been to 11 of the pro teams, so there’s still some work to do! Before my wife and I were dating, we went to the first night game at Citizen’s Bank Park with the Thomas Jefferson PT program. When Jim Thome came to the plate, I bet her a date that he would hit a home run. After she agreed to the bet, he sent the next pitch flying into the stands which got me date number 1! Baseball really is the best game!

Whether it was my 130 pound frame in high school or the fact that I couldn’t hit to save my life, I realized early on that my professional baseball career probably wasn’t going to happen. So I chose the next best thing – working with baseball players!  Part of the reason I chose to study Physical Therapy was to have the opportunity to work with people of all abilities, including athletes.

Over my career, I have had the opportunity to work with many baseball players.  I volunteered with the Camden Riversharks for several seasons and have worked with a number of youth, high school, collegiate, and professional baseball players. Currently, I’m even leading a research study to determine the predictors of injury in high school and college baseball players! I’ve worked with a lot of great athletes and great families, and have seen many of my patients move through their baseball careers. There are many days that I get to have a catch with my patients during their return to throwing programs. Who is lucky enough to have a catch at work?

Baseball is very demanding on the body. There is so much rotation, stress on the shoulder and elbow, and overall fatigue throughout a long season that it begins to take a toll physically on the athlete. I really enjoy the challenge of diagnosing not only the injury, but really taking a step back and figuring out which stress is causing the injury in the first place. A lot of times, by strengthening the athlete’s legs, we can maximize their efficiency and help improve shoulder or elbow pain. One of the most rewarding parts of my job is when I see my athletes playing not only pain-free, but also throwing and hitting harder than ever because their bodies are that much stronger.

Thanks to baseball, I not only tricked my wife into a date, but also developed great family memories growing up and with my daughters today. The fact that I get to work with baseball and softball players as a part of my job makes it that much more fun to come to work. Thank you, baseball, for all you have done for me personally.  I’m so thankful for the opportunity to give back and help athletes of all ages enjoy playing without injury!

Muffin Madness! – WINNER

On Monday, March 11th, 3DPT hosted our 3rd annual Muffin Madness contest!  We invited employees, patients and friends to stop by and submit 6 of their best muffin creations to be judged on taste, appearance, texture and creativity.  Judges tasted every recipe and muffins were also made available for purchase for a charitable donation.

After many taste tests (yum!) and deliberation, the winner was determined to be…
3DPT’s own Jeff Sallade!! Jeff’s banana, chocolate & peanut butter chip muffin topped with a banana cream cheese icing glaze was the crowd favorite this year.  The presentation was spectacular and the taste was even better.  With all the donations and funds raised by muffin sales, we were able to raise $191, which was matched by 3DPT, for a total of a $382 donation to Jeff’s charities of choice:  The Fellowship Alliance Chapel Benevolent fund and the Perinatal bereavement program through the Virtua Foundation!

Below is the recipe for the winning Muffin.  Our friend and registered dietician, Lynne Nugent from Know it All Nutrition (www.knowitallnutrition.com) suggested a few simple healthy substitutions to cut down on calories and fat (healthy substitutions are in red). Enjoy!

Banana, Chocolate and PB Chip Muffin
with Cream Cheese Icing

Makes 24 muffins; serving size 1 muffin
Calories:  472  (396 without icing)
Fat:  20 grams (17 grams without icing)

Ingredients:
Healthy substitutions are shown in RED

• 1 Stick of butter (1/2 stick, or 4 tbsp of butter)
• 1 ¼ cups sugar (3/4 cups of sugar)
• 2 large eggs (4 egg whites)
• 4-5 extremely ripe bananas, mashed so there are no big chunks (the riper the better!) (3 bananas)
• 1 tablespoon of vanilla (1 tsp vanilla)
• ½ cup of buttermilk (you have to use buttermilk!)
• 2 ½ cups of flour (1 ¼ cup of all purpose white flour and 1 ¼ cup of wheat flour)
• 1 tsp each of salt and baking soda
• ¾ cup applesauce
• 1 ½ tsp cinnamon
• 3 cups of chocolate chips (1 cup of choc chips)
• 1 ½ cups of peanut butter chips (1/2 cup of PB chips)

Using healthy substitutions:
Calories:  222
Fat:  6 grams

For the icing:
(Instead of adding icing, sprinkle powdered sugar on top of muffins!)

• 8 oz cream cheese
• 1/8 cup of sour cream
• 2 tbsp butter
• 1 tsp vanilla
• 1 mashed ripe banana
• 2 cups powdered sugar
• Pinch each of nutmeg and cinnamon

Directions:
Mix butter and sugar in a Kitchen Aid Mixer.  Add eggs one at a time until blended.  Add bananas, vanilla and buttermilk and blend.

Combine flour, salt, baking soda and cinnamon, then add 1 cup at a time until well blended.  Add chocolate and peanut butter chips and mix gently.   Bake at 365 degrees for 25-30 minutes, depending on your oven.  Insert a toothpick and when it comes out clean, they are done.

For the icing:
Combine cream cheese, sour cream and butter until smooth.  Add remaining ingredients and mix vigorously until smooth.  Spread onto cooled muffins.

I Can’t Eat Whatever I Want?

by: Jeff Sallade
I have spent much of the past 15 years training for and competing in endurance races such as marathons and Ironman triathlons. One of the perks of doing this was that I was pretty much able to eat as much food as I wanted. I love food – this was one of my main motivations for doing these races in the first place. It meant I really didn’t have to worry too much about gaining weight.   If I put on a few pounds I could quickly make them go away by training for another race.

I have weighed pretty much the same since I was 18 years old (plus or minus a few pounds). After I finished my last Ironman race in October 2017 though this started to change. I remember driving home from the race in Louisville and stopping at a Pirmanti Brothers Restaurant and ordering a sandwich with kielbasa, perogies, roast beef, fried eggs and cheese, in addition to the fries they pile on top (best sandwich I ever ate!).  I could still eat whatever I wanted with no repercussions, right?  Over the next year however, I slowly put on weight because of my eating habits. To complicate matters, I had to get my left hip replaced in August 2018 because of all these crazy races I had done (click here for that story). My activity level drastically diminished and I knew I needed to do something to stop gaining weight.

In November 2018, I got in touch with dietitian, Lynne Nugent from Know It All Nutrition and asked for her help. When I stepped on the scale at our first session it was an eye opener – I was 20 pounds heavier than what I weighed a year earlier when I raced my last Ironman. Lynne helped me realize what I already knew – I was going to have to change my eating habits if I was going to take off some of the weight I had put on.

Lynne wanted me to start recording everything I ate during the day.  At first I thought there was no way I was going to be able to pull it off – I am not the type of person who is super organized and it would be a big challenge for me to commit to doing something like that. But I took Lynne’s advice and decided I was ”all in” and started recording everything I ate. I used to just devour whatever I wanted without much regard to fat, carbs, and protein and never gave any thought to portion size – I literally just ate as much as I wanted. When I began recording all of my food intake, it made me think about what I was eating and why I was eating it. I had a daily calorie goal and I viewed it as a competition to try to not to go over that number.

Getting into the habit of recording my food turned into no big deal – I kept up with it and became really interested in learning the number of calories and the macro breakdown of the foods I commonly ate. Here are the main things I realized just a week into caring about my nutrition:

1. The aches and pains that I had accepted as normal suddenly began to disappear as I cleaned up the foods I ate.
2. My energy levels picked up throughout the day – I no longer had times of the day where I felt sluggish and wanted to just lay down and take a nap.
3. Portion size became really important to me – I was really surprised at how small most suggested portions are.
4. I still had times during the day where I felt hungry, but instead of eating junk food and empty calories, I learned to choose to eat something that would satisfy me and not make me feel awful afterwards.
5. Vegetables pretty much have no calories – you can eat as much of them as you want. No one becomes overweight from eating too many vegetables! (too bad they don’t taste like pizza)

Four weeks after my first consultation with Lynne, we met again for the dreaded weigh-in. I was down over 5 pounds from our first visit! It was a big win for me to see that progress. My goal is to lose the 20 pounds I gained and I feel pretty confident that I will make that happen. I have seen the importance of giving consideration to the food I put in my body and the effect it has on how I feel.

I am excited to continue working with Lynne.  The biggest benefit of working with a registered dietitian is that I feel accountable to her. I think it is always easier to accomplish goals when someone else is involved and has an interest in you reaching those goals. I experienced that with my years of training and racing with my friends in my running/triathlon group.

If you can identify with anything that I touched on in this article I would encourage you to seek out the help of a registered dietitian. I never knew my health insurance covered their services, so that was a nice surprise. Below are the names and contact information of 2 registered dietitians that 3DPT knows and trusts (including the one I am using) and would encourage you to reach out and begin the process of learning how you can achieve better health!

Lynne Nugent, RDN
Know It All Nutrition, LLC
Making YOU The Expert

1 Eves Drive, Ste. 122
Marlton, NJ 08053
856-626-0040

www.knowitallnutrition.com

Jessica Cahill, RD, CSCS
Success By Lifestyle
Haddon Township, New Jersey
609-472-1339

www.successbylifestyle.com

My experience at the United States Olympic Training Center

by Ken Guzzardo
This past fall, I was able to cross a professional goal off of my list when I had the opportunity to volunteer at the Olympic Training Center (OTC) in Colorado Springs, Colorado. I enjoy working with all populations and injuries, but athletes have always been fun and presented the biggest challenge. Between coordinating practices and games, to progressing through return to play protocols, to loading the Physical Therapy visits with exercises specific to their sport, the athlete requires me to think ahead and make sure we are on the same page with goals. When I met with a physician for USA wrestling, he recommended that I look into volunteering with the USOC, so I sent off my resume that evening. A year later, I was asked to come out to Colorado Springs, and after getting my wife’s blessing (since she was going to be home with my two young daughters) and discussing with my partners at 3D, I booked my flights.

The OTC is home to men’s and women’s wrestling, boxing, and shooting, men’s gymnastics and numerous Paralympians. As a volunteer, I worked side by side with the full time staff with a schedule of my own. My schedule was 8-6 Monday through Friday and 12-2 Saturday, with some on-call hours a few nights each week, so it was definitely not a relaxing vacation!

At the OTC, medical disciplines all work closely together. I could collaborate on treatment or a diagnosis with a chiropractor, athletic trainer, physician, physical therapist, or an orthopedic surgeon. This was a great practice to work in, because it really was focused on the patient. Our goal each and every session was to get the athlete relief and progress exercises to allow him or her to practice and return to their sport as quickly as possible. For most of these athletes, there is a window of years when they are eligible for the Olympics, so they could theoretically miss their shot because they were injured at the wrong time.

Some athletes live at the OTC year round, and others come in for camps or training sessions. The week that I was there in September happened to be the week that men’s gymnastics was having their World Team trials, and men’s and women’s wrestling and boxing were practicing before their international competitions. Not only did I get to work with some amazing athletes during this week, but I also got to watch the World Team selection.

I also had the opportunity to work with numerous Paralympians during my time in Colorado. Snowboarders and skiers who had amputations or spinal cord injuries and blind swimmers were just some of the amazing athletes with whom I was able to rehab. It was a fun challenge to not only think about the requirements of their sport, but also think about how they have to compensate or move differently depending on their disability. These athletes were inspiring!

In addition to working in the Sports Medicine clinic, I was also able to observe and cover practices for gymnastics and wrestling, brainstorm with strength and conditioning, transport athletes for medical testing (if there is an injury, it needs to be diagnosed ASAP so MRIs and other testing is very quick!), and observe diagnostic ultrasounds.

During the second week I stayed in Colorado, I was lucky enough to have my wife, two daughters, and mother-in-law join me at the end of the trip. I was able to show them the Olympic training center, and we even explored the area. We hiked at the Garden of the Gods and enjoyed some beautiful sights!

Two of my biggest take homes from this experience are:

• Healthcare professionals need to collaborate. I consider myself lucky because I get to work with some amazing Physical Therapists each day who I can bounce ideas off of. I also have a good network of personal trainers, athletic trainers, chiropractors, physicians, and surgeons who I can refer out to or discuss cases to get the best for our mutual patient or client.

• It takes A LOT to be an athlete of this caliber! Not only do you need to be blessed with the physical gifts of being an athlete, but they have a mental toughness that is unbelievable. Some of the athletes would eat breakfast, come in for treatment, go to practice, eat lunch, come in for treatment a second time, go to strength and conditioning, use the recovery room (hot tub, sauna, cold tub, massage), eat dinner, go to bed, and then wake up and do it again. 5-6 days a week! And the Olympics are two years away still! The mental fortitude and dedication requires all when your reward of the Olympics is years and years down the road was amazing to me.

Now that I have completed my training rotation, I am eligible for coverage for national or international events. I hope to cover some national events, and at some point be able to go to the Olympic games as a Physical Therapist with Team USA. Who knows when that will be, but this was an awesome first step that would not have happened without the support from my wife, kids, and my co-workers who were able to cover for me while I was gone for two weeks. Go USA!!!

When the Therapist Becomes the Patient

by: Jeff Sallade
Over the past year or so, I have had a ton of patients in the clinic ask me “Why are you limping?” or “What is wrong with you and why are you walking like that?”. My fellow therapists and co-workers stopped asking since they had grown used to me walking around like an old man.

A combination of poor alignment (I was born with this) and years of soccer and running marathons had led me to develop severe arthritis in both of my hips. I learned how bad it was about 4 years ago when I got an XRay of my hips for something unrelated – my doctor (Dr. Katie Gollotto) came into the room and asked me if I knew how bad the arthritis was in my hips. I had no idea – I had never really had any pain in my hips – I just noticed that they were pretty tight and I was never the most flexible person in the room.

I continued to be able to do all of the running and triathlons over the next few years with minimal pain in my hips – I kept thinking to myself, “Maybe my hips will never actually hurt even though I have a ton of arthritis.”

My luck of being mostly pain free ran out as I started having pain in my hips about a year and a half ago while I was training for an Ironman race. I had to modify my training and even had to rely on some injections into my hips to get me through my training and my race. (I was able to finish the Louisville Ironman in October 2017)

This past winter and spring I finally realized that running was no longer a good idea – I would be really banged up after I went out for a run. I also coach my kids’ sports teams, and I was having a hard time running around the fields with them. My low point was when my then 5 year old son could legitimately beat me in soccer because he could just blow by me and there was nothing I could do. (except try to trip him – which I did)

That was tough for me to accept, so I started considering getting my hips replaced. I have treated plenty of people who had gone through the surgery and they all seemed to do pretty well. I met with Dr. Greg Klingenstein of Reconstructive Orthopedics (I am fortunate enough to have seen his patients he had done surgery on so I knew he was a great surgeon) and decided to go for it.

On August 1st,  at the ripe old age of 44,  I received my new left hip and began my own physical therapy right away. I was amazed that my pain from the arthritis was gone pretty much right away. I definitely had some soreness from the surgery, but I was able to walk without a cane just a few days out. I had to learn to not go too crazy with activity for the first month – I would pay the price if I did too much by being really sore.

It has been a learning experience to be on the receiving end of physical therapy. It has opened my eyes to some things that I never appreciated as a therapist. For example, I learned that if I got lazy with some of the mobility and stretching exercises for my hip, I became stiff and didn’t see the progress that I wanted and expected. It has also allowed me to experience treatment first hand from most of our therapists and realize just how good all of our therapists are.

I am now 2 months out of surgery and I am amazed at how much more mobility I have in my left hip. The biggest wins for me so far are being able to put socks on pretty easily and not having my kids have to pick up the ball out of the hole for me when we go miniature golfing.

I am likely getting my other hip done in December – I figure I might as well fix it all so I can be done with it and move forward. I know plenty of people who have gotten new hips and went on to run again. I want to be one of those people. I know I need to commit to things like yoga and strength training that I never made a priority before my surgery in order to increase my chances of success. I am willing to commit to that if it will help me be able to run.

It might even help me beat my son at soccer – he is only going to get better as he gets older.

Why you NEED to have your Child ImPACT Tested

ImPACT TESTING

You might have heard about the necessity to get your child ImPACT tested prior to the start of their sport season. So what is this test and what is its purpose? ImPACT testing is a neurocognitive test that helps to determine if an Athlete is ready to return to their sport after they have suffered a concussion

A concussion is a type of traumatic brain injury in which there is a short term disruption of neurological function that can cause a variety of symptoms such as confusion, dizziness, headaches, memory deficits, balance impairments and nausea to name a few. Concussions are considered a “functional” brain injury vs a “pathological” one. This means that it does actually affect the brain but the injury is usually more temporary. However, rest is required both mentally and physically for the brain to heal.

How do we measure if the brain is healed? The international conference on concussion has established 6 Domains affected by Concussion: Vestibular, Ocular, Cognitive, Cervical, Emotional and Physical/Exertion.  Some of these domains are easy for us to measure with different tests, eye movements, neck movements, and exercise. The cognitive component can be a little harder to objectify. This is where ImPACT testing comes in. ImPACT stands for Immediate Post-Concussion Assessment and Cognitive Testing.  The ImPACT test is a series of computer based cognitive skills such as visual processing, attention, memory, and reaction time. By having your child take a baseline ImPACT test while they are healthy and non concussed, we can then compare their baseline scores to their scores when they take the ImPACT test when they have a suspected concussion. We can then assess how their current cognitive function is compared to their baseline or non injured function. We can also compare their cognitive function to normative data from their age group.

Why is it so important we do not return to sport too soon? Sometimes a child may feel symptom free after they have had a concussion, but symptoms arise when they go back to full game play. If the brain is not fully healed they may not perform at their best level which puts them at risk for any type of injury or worse another Concussion. An additional concussion can cause Second Impact Syndrome which is when a second concussion occurs before a first one has fully healed. This can cause rapid swelling in the brain and more permanent and disabling injury. ImPACT testing is considered part of the standard for assessing ability to return to play and sport safely without risk of further brain injury.Don’t delay, get tested today!

Schedule your child to get their baseline ImPACT test as soon as possible. Call now! 609-714-3378

5 Tips to Prevent Injury For Dancers

No matter the dance style, the dance class is an integral part of every young dancer’s education. It is the time that dancers are pushed to their limits and train hard in order to improve their skills for their upcoming shows. Due to the intensity of course work or seasonal dance programs, injury and illness rates are at an all time high.

Since dancers are so in-tune with their own bodies, it is crucial for dancers or parents of dancers to be aware of injury prevention techniques in order to make the most of their classwork. Listed below are the top 5 tips for injury and illness prevention, which are summed up by the acronym D.A.N.C.E.

D: Dynamic Warm-up
A: Advocate for Your Health
N: Nourish Your Body
C: Cross-Train
E: Energy Conservation

1. 1. Dynamic Warm-Up
      • Dancers often choose static stretching before class in the hopes of warming up the muscles before barre. While static stretching is good to increase flexibility and muscle length, static stretching can be ineffective for creating heat within the muscles which safely prepare the body to move in all planes of movement. This problem is easily solved with an active warm-up before the barre. Watch the video below for an example warm-up!
        

1. 1. Advocate for Your Health
      • Dancers are known for being extra aware of their body and how it feels in a variety of strenuous situations. This awareness can play a big role in the prevention of injury, if the dancer is willing to speak up about pain and illness. During intense training, a good rule of thumb to use to protect the body is “If you feel something, say something”. This motto will help dancers and their instructors to adjust training accordingly and take steps to prevent further injury. It is also important for dancers to remember that resting is an option when they are hurt, even if it feels like the wrong choice. Reporting injuries right away and thus receiving the care you need, decreases injury/illness severity, decreases time away from class long term, and can return you to class a stronger, healthier dancer.

1. 1. Nourish Your Body
      • Eating well is key to building strong muscles and a strong immune system that will keep a dancer in class and injury free all summer. It is important to get plenty of protein, greens, calcium, and other essential nutrients throughout your training day. Be sure to consult a nutritionist if you are unsure of how to structure a safe and healthy eating plan that is not only effective, but also sustainable.

1. 1. Cross-Train
      • Dancers are strong athletes as well as expressive artists and should be treating their bodies as such. Most dancers miss several strength training exercises that will build their bodies safely and reveal the true athlete within. Cross training muscle groups such as the glute and hip musculature, core, and upper body will help a dancer to become a better, stronger dancer, who is less prone to injury. See the videos below to practice some of the exercise that most dancers miss while training.
        
        
        

1. Energy Conservation
   • Decreasing fatigue outside of the studio is important because an overworked body is at increased risk for injury. Try to limit extra cardio activity such as running, cardio classes, or other strenuous activity. Rest time is just as important as time spent in the studio.
     According to the National Sleep Foundation, teenagers aged around 14-17 require 8-10 hours of sleep and young adults aged 18-25 years old require 7-9 hours of sleep. As an athlete it is important to reach these sleep goals each night in order to provide your body with adequate time for rest and repair.

Torticollis: What is it and how can Physical Therapy Help?

Congenital Muscular Torticollis is an adaptive muscle shortening disorder that ranks as one of the most common deformities in the infant population. This muscle shortening can take place before birth in utero or be acquired anytime after birth. The congenital form tends to be more common with twin pregnancy, forceps delivery, vacuum extraction, or breech positioning. The acquired form of torticollis can be a result of impaired vision, tonsillitis, breastfeeding or bottle feeding to one side, gastric reflux, and prolonged periods of time spent in car seats, bouncers, strollers. More specifically, torticollis is a result of a shortened sternocleidomastoid muscle which is responsible for bending the neck to one side and turning the head to the opposite side. When this muscle imbalance occurs, there are a few key signs and symptoms to be aware of in your new baby.

Torticollis Signs:

• Tilted neck appearance
• Upward chin tilt
• Use of one hand/arm
• Looking to one side only
• Difficulty turning the head
• One-sided shoulder hike
• Lump in the neck musculature
• Plagiocephaly/head flattening

If you notice these signs in your baby,  it is important to get your child checked by your pediatrician and to be sure to speak with your physician on the benefits of physical therapy for the treatment of torticollis. A Physical Therapist will work with you and your child to correct muscle imbalances with a focus on stretching the affected muscles, strengthening weak musculature, and emphasizing typical motor development to ensure the acquisition of important developmental milestones. Your physical therapist will also teach you techniques to supplement treatment at home to ensure the best results for your child.

Contact 3 Dimensional Physical Therapy to schedule with one of our PEDIATRIC therapists in our Haddonfield, Berlin or Medford offices!

Movin’ on Up to the Big Field

Moving from 8th to 9th grade is a huge step in a student’s life. Not only does one have to get used to being a high schooler and adjusting to new classes, but for the baseball player, there is another big adjustment to be made – transitioning to the “big field”. Bases stretch from 60 feet up to 90 feet, and the pitcher’s mound increases from 46 feet to 60 feet, 6 inches. There is a lot that these young baseball players can work on to not only avoid injury during this transition, but also perform better. In this article, we will discuss some of these concepts. Stay tuned for future posts which will outline exercises to help.

What worked on the little league field doesn’t always work on the big field

At the little league level, some athletes are much bigger than others. We are all familiar with the Little League World Series when one team has a 6’4, 220 pound 12 year old playing against “typical” 12 year olds. That athlete has a distinct advantage because they are bigger and stronger. This size advantage makes it easier for the player to muscle the ball to the plate faster and swing harder. When the field dimensions change, these athletes often have a tough time adjusting to using their entire body and struggle to make that transition. Athletes who learn to use their entire body will adapt much easier to this transition.

What is the kinetic chain

When a player throws or hits, most people think about the ball moving forward or the bat swinging. These motions have several components to them:

• The athlete must initiate the movement from their back leg
• The core and trunk must rotate in the right order, allowing the arms to come through and throw or swing
• The core and lead leg must decelerate the motion.

If there is a breakdown along this chain, stress will be placed on the shoulder, elbow, back, or any area along the chain that is trying to over-produce. This is why the 6’4 12 year old dominates at one level but struggles at the next. Most likely, he never learned to initiate and decelerate the throwing or swinging motion correctly, and his shoulder or elbow breaks down at the next level because he is trying to throw hard. If an athlete develops a good core and leg program, he will throw harder at this level and use his body properly, without over-throwing.

What can you do this summer?

This is a key summer to get adjusted to the larger dimensions of the big field. There are key exercise professionals who can help with learning the proper way to use your body to throw and hit.

Personal trainers – Those who are experienced in baseball will develop a program that will build strength and proper movements

Yoga – There is no better exercise program to enable flexibility and, most importantly, to control those movements. The baseball players who have longer stride lengths and can rotate better will maximize their velocity and minimize their risk of injury

Physical Therapists – You don’t always have to see a PT until after you are already injured. A lot of Physical Therapists who are trained in baseball will be able to develop a treatment program to improve mobility and strength in baseball specific movements. This pre-hab is, at times, done in conjunction with personal training.  It is important for these professionals to have a good relationship to optimize communication.

Chiropractors – Adjustments can help with spinal alignment and mobility, and some sports chiropractors will also incorporate stretching and strengthening programs into their treatment regimen

Coaches – Pitching and hitting coaches can work with mechanics and maximize both hitting and throwing technique

This summer is an important time for athletes adjusting from little league dimensions to the big league fields. There are exercises that are important to learn to facilitate proper mechanics. The ultimate pay off will be improved hitting and throwing with decreased risk for injury. Many fitness and medical professionals can help these athletes with this transition. Please stay tuned for our next post which will highlight a few key exercises to begin immediately.

Ken Guzzardo, PT, DPT, OCS, SCS
3 Dimensional Physical Therapy
Medford, West Berlin, Haddonfield
www.3dpt.com
Please email any questions to kguzzardo@3dpt.com

Bio-Feedback Training

You have probably heard time and time again posture is important. What happens if your body has “forgotten” what normal posture is? This can happen for a variety of reasons such as whiplash after a car accident, acute back pain and and inflexibility. Pain can cause muscles to “turn off” and not work the way they should. Certain muscles  that maintain our posture all day long might end up being “turned off”. Pain can also make us guard our muscles or hold our bodies in different positions to avoid pain. Even when the pain is gone we might continue to have an altered position sense or a change in our posture from these injuries or painful episodes. This can then lead to compensations, pain and dysfunction in the future.

A good example of this is in the case of whiplash to the neck. During a car accident there is an acceleration/deceleration response at the neck. This can cause strain, pain and dysfunction to the muscles in our neck that help hold it upright and provide us with posture all day long. IN this video below, Dr. Charles Bachi demonstrates a few exercises using a Laser to work on posture and joint position sense.

This second video demonstrates how using the laser at our core/pelvis can help with low back pain and achieving a Neutral spine. Check out PT student Extraordinaire Jamie Kinkler educating on Laser use for Low back.

A third way we use the laser in treatment is due to poor mechanics in squatting, lifting and jumping. Using the laser as an external cue to focus on can help individuals work on improving their mechanics to avoid injury and work the proper muscles! Dr. Charles Bachi Educates on Laser use for joint mechanics

Laser cues during exercise can help with a multitude of problems such as headaches, concussions, chronic or acute neck and back pain, herniated discs, spinal stenosis, knee pain, running injuries and much more!

Call us at 3 Dimensional Physical Therapy to schedule an Appointment today!
Medford- Berlin- Haddonfield
609-714-3378

Pediatric Physical Therapy

Physical therapists have a strong knowledge base of anatomy and movement. They perform assessments to recognize dysfunctions in almost every system of the body and provide interventions to promote optimal physical function and health. Often times, physical therapists will specialize in a specific area of physical therapy (for example, Orthopedics, Neuro, Pediatrics). Pediatric physical therapists specialize in working with children – newborns to young adults, and everything in between. In the pediatric setting, physical therapists use clinical reasoning and evidence based practice to improve independence, facilitate motor and developmental skills, increase strength and flexibility, improve endurance and fitness, and increase participation in age appropriate gross motor activities. Pediatric physical therapists collaborate closely with families to develop individualized treatment programs centered around the wants and needs of the child.

A common misconception is that physical therapy is physical therapy. PT is so diverse! With this in mind, it is very important to seek out a pediatric physical therapist for your child. Even better, you can go on the American Physical Therapy Association website and find a board certified Pediatric Physical Therapist in your area (http://www.abpts.org/FindaSpecialist/).

The services a pediatric physical therapist can offer include:

• Assessment of developmental and gross motor skills – to help make sure your child is reaching milestones on time
• Upper/lower extremity and spine evaluation – to make sure things are moving the way they should be
• Assessment of balance, gait, and mobility – to make sure your child is walking, running, and hopping the way he or she should be
• Assessment for brace or orthotic needs – to help make sure your child has good alignment from head to toe
• Assistive device and equipment assessment – to help promote independent mobility, no matter your child’s skill set

Pediatric PT’s work with children with a range of diagnoses, including, but not limited to:

• Cerebral Palsy
• Connective tissue diseases (such as Ehlers-Danlos Syndrome)
• Coordination or balance disorders
• Developmental delay
• Gross motor delays
• Hypertonia
• Hypotonia
• Juvenille Rheumatoid Arthritis/Juvenile Idiopathic Arthritis
• Muscular dystrophy
• Myelomeningocele
• Neuromuscular disorders ( such as Charcot-Marie-Tooth)
• Torticollis
• Traumatic Brain Injury
• Trisomy 21

3 Keys to a Positive Outcome in Physical Therapy

When it comes to optimizing the ability to have a positive outcome in physical therapy, 3 areas must be examined. These areas include attitude about an injury, therapeutic alliance, and compliance.

A patient’s attitude about their injury can greatly affect the results they have in physical therapy. Thoughts and beliefs about an injury will lead to one’s attitude which in turn translates to their motivation. For example, if someone believes that their injury is too severe and there is no hope that they will ever get better, they will be less likely to have the drive that is needed to complete the steps and exercises required to achieve their goals.

On October 16, 2010, Eric LeGrand of Rutgers University suffered a severe spinal cord injury while making a tackle. A fractured C3 and C4 vertebrae left him paralyzed from the neck down. LeGrand was put on a respirator right away to help him breathe, and doctors informed his mother that he would more than likely need the aid of the machine to continue breathing for the rest of his life. Doctors also informed Karen LeGrand that her son had a suspected 0–5% chance of walking for the rest of his life. The next day when LeGrand woke up, he managed to mouth the words; “I’ll be back,” to his mother. Due to his drive to get better and his positive attitude he instilled throughout his recovery, even in the face of doubt from his doctors, Eric proceeded to practice breathing without the use of medical equipment, and was independently breathing by the following Thanksgiving. He has also since regained movement in his shoulders and sensation throughout his body and in July of 2011 he was standing straight up with the help of a specialized metal frame. Eric continues to defy odds through his hard work and dedication to get better and his unwillingness to ever give up. If Eric would have started out with the belief that he was not going to breathe or move independently ever again, he may not have had the right attitude or motivation necessary to get him where he is today.

Therapeutic alliance refers to the sense of collaboration, warmth, and support between the patient and therapist. The 3 main components of the therapeutic alliance construct have been determined as being: (1) the therapist-patient agreement on goals, (2) the therapist-patient agreement on interventions, and (3) the affective bond between patient and therapist. These aspects are particularly important and have been shown to predict outcomes in therapy.

A study in 2013 by Ferreira et al. demonstrated that higher levels of therapeutic alliance (more positive interactions) were associated with greater improvements in perceived effect of treatment, function, and reductions in pain and disability in patients with low back pain. It is important that a physical therapist listens to their patients and develops a plan of care that is based around their goals, personalize interventions to meet their goals, and to develop trust in their patients through education and showing compassion for their injury.

It is essential for patients to stop performing the poor, compensatory strategies, such as poor lifting techniques or squatting mechanics, and work on the proper movements or mechanics that are taught to them while in therapy. Otherwise, they could be continually feeding into a problem and counteracting what is trying to be accomplished in physical therapy. For optimal outcomes in physical therapy, individuals need to realize that what they are doing and learning at physical therapy is what they need to continue with throughout the day. It is also important to maintain the exercises given as a home exercise program (HEP) and to follow the reps and sets set forth by the program. Typically, patients are only in physical therapy 1-3 hours a week, so what is being done outside of PT for the other 165 hours of the week is an important and crucial aspect to how well their recovery will go. All of this falls under compliance and is one of the most important aspects that are often over looked as a key to a successful physical therapy experience.

All three of these components; attitude, therapeutic alliance, and compliance are extremely important to successful outcomes and are most certainly connected to each other. A positive therapeutic alliance can impact ones attitude about their injury which can impact their motivation to do their exercises and remain compliant. Experiencing these 3 components can make all the difference in having a good experience and a positive outcome in physical therapy.

References:
Hall AM, Ferreira PH, Maher CG, et al. The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: a systematic review. PhysTher.2010;90:1099–1110

Ferreira PH, Ferreira ML, Maher CG, et al. The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain. Phys Ther. 2013;93:470–478.

Tendinopathy

What is Tendinopathy?

Tendinopathy is the broad term used to describe pain at or along the insertion of muscle into the bone. Tendons are what connect our muscles to the bone and often times we can strain or injure the tendons. When injury occurs to the tendon we call this a tendinitis with the suffix “itis” referring to inflammation in the tendon. Without proper care and healing this injury can turn into a more serious problem termed tendinopathy. When an injury to a tendon lasts longer than 4-6 weeks and starts drifting towards over 3 months this becomes a chronic issue and is harder to treat. This is where the research starts to lack sufficient evidence as to why pain and injury linger. It is theorized to result from mechanical overuse with inflammation during the acute stage and degeneration in the chronic stage¹.

The problem with treating tendinopathy is that when researchers look at the quality of the tissue at the tendon injury, inflammatory cells are not always present. Often times the tendon may appear darkened or thickened. Our bodies attempt to heal the injury but instead of laying down parallel collagen fibers a matrix that is thicker and weaker with more water, more immature cartilage and less organization is seen under microscope². Small blood vessels and nerve endings can often be seen in this new matrix of weakened fibers that may be part of the cause for continued pain throughout this process.

Here is an example of normal tendon on the left(A) and injured tendon on the right(B):

What are the symptoms?

Symptoms may include but are not limited to:

• Pain and stiffness in muscle/tendon which may be worse morning or night
• Muscle or tendon may be tender or present with swelling
• Weakness or stiffness associated with using the muscle/tendon

What do we know?

• The muscle and tendon have changes in the structure of their collagen
• Muscle and tendon are weakened from the structural changes
• Pain is present due to weakness, growth of nerve endings and central nervous system

What do we do?

• • IASTM has shown promising evidence in helping to remodel the collagen fibers to their original parallel configuration and strength
  • Eccentric exercise/ specific exercise can be used to help re-inforce the remodeling collagen

Pain can be controlled through various therapeutic modalities

• Modification of activity is sometimes necessary and should be guided by health care professional

1.Eckenrode B, Stackhouse S. Improved Pressure Pain thresholds and Function Following Noxious Electrical Stimulation on a Runner with Chronic Achilles Tendinopathy: A Case Report. Int J Sports Phys Ther. June 2015; 10(3): 354-362.
2. Xu, Yinghua; Murrell, George. The Basic Science of Tendinopathy. Clin Orthop Relat res. July 2008; 466 (7)

Fultz injury

How bad is the Fultz injury?

Markelle Fultz is the latest Sixers rookie to be injured before ever playing a game for the team. If anyone else was watching the summer league to see what the #1 overall pick looked like, you probably saw and gasped when he landed on another player’s foot and his ankle rolled. Luckily the x-rays were negative for a fracture, but it was scary seeing him being helped off the court unable to put any weight through his leg. What does a grade 1 ankle sprain mean, and what will his rehab look like?

The injury and anatomy:

When someone “rolls” their ankle, they usually suffer an injury to the outside of the ankle. There are three main ligaments (connection of bone to bone) on the outside of the ankle that keep stability. When someone has a grade 1 sprain, it is usually an injury to the anterior talofibular ligament, or ATFL. A sprain is a tear, and a tear is a sprain. So this means that Markelle Fultz has a partial tear of the ATFL. Sounds scary, but it isn’t in the grand scheme of things.

Rehab:

The Athletic Trainers (ATCs), Physical Therapists, and strength coaches will work with Markelle to maintain ankle mobility as the body heals from the injury. They will also strengthen the muscles on the outside of the leg called the peroneals to support and stabilize when he is jumping, running, or cutting. Proprioception, or balance, will be another key component to his rehab. The ATCs will also tape and provide proper support for Markelle’s ankle to provide as much stability as possible. Between the functional strength of the peroneals, improved proprioception, and taping/shoewear support, Markelle will be just as good as ever when the season starts!
#TTP (Trust the Proprioception)

Stay Tuned for our next article, which will show some common ankle exercises along with basketball-specific drills that will help with an injury like this.

5 secrets to sitting without pain

People are sitting now more than ever. Study after study are showing that prolonged sitting and desk work are causing multiple health problems. There is increased pressure on the spine, overuse injuries causing carpal tunnel, sciatica, pinched nerves, headaches and low back pain to name a few. Short of switching careers there are some measures you can take to prevent these injuries. The secrets to sitting without pain

1. Chair
   1. Elbows Should be at 90* and relaxed, Armrest can often help with this
   2. Feet should be flat on ground not dangling
   3. Hips, knees, ankles all at 90* angles
   4. Lumbar support/pillow to reinforce natural curvatures of spine
2. Computer
   1. Screen should be no more than 18-24 in from face
   2. Screen should be at eye level
   3. Screen should be centered and not off to the right or left
3. Keyboard and mouse
   1. Ensure that your wrist is neutral: not up or down or off to the side to type
   2. Mouse should be close to the chair. One should not have to extend elbow to reach for mouse
4. Phone/ files/etc
   1. Phone should be in reach, avoid using the head to shoulder technique to hold the phone up. If you are on the phone a lot, head set may help you avoid neck issues
   2. Constant turning to a file, cabinet, calendar etc should be avoided. Keep what you use the most close in front of you and when necessary turn whole body and not just your head
5. Hints
   1. Standing desks can be utilized to prevent sustained sitting. Standing is important because sitting can increase pressure on the spine. Some employers may even help to pay for improved chairs or standing desks.
   2. Take frequent breaks at least once an hour where you stand up, stretch or walk for a bit
   3. Use sticky notes at your computer or set alarms on your phone to remind you to stand or change positions every hour

http://www.versatables.com/discover/ergonomics/the-equation/ergonomic-equation-part-one-neutral-position/

The Top 5 Tips for Better Posture

These are the top 5 Tips for Better Posture:

1. Embrace your curves!

1. Spine has normal curvatures that help to maximize your muscles ability to stabilize and position your spine in the least shearing or compressive positions. Using something like a Lumbar Pillow can help maintain your normal Lordotic curve at your low back.
   Copyright: http://i162.photobucket.com/albums/t271/Mom2nat_2007/SpineCurves.jpg

2. Eyes up here!

1. We all do it, we are constantly looking down at our phone, computer etc. Try lifting your head up so your eyes are level and tuck your chin back towards you slightly. This should be your normal resting positions. Adjust your mirrors in your car for this posture. Adjust your computer to be at eye level in this posture. Every inch of , “forward head” can increase the weight on your neck by an additional 10lbs!!!*

3. Stretch it out!

1. 1. Our chest muscles and the muscles in the back of our head and neck tend to get tight when we have a forward head posture. Ask your therapist to help you learn to stretch these muscles!

1. 1. Check out these Stretches for your neck as explained by PT Chuck Bachi

Copyright: http://www.forwardheadposturefix.com/

4.Get Moving!

1. Staying in one positions for too long is bad all around. If you sit all day make it a point to stand for 10 min every hour. If you stand all day, try to sit for a few minutes or perform a few simple stretches to mix up your stance.

5. Stronger, Better, Faster

1. Regular strengthening to your postural muscles includes your shoulder and shoulder blade muscles. The deep neck muscles in the front of your neck should also be worked. Ask your therapist about how to work these muscles groups!

Check out these postural strengthening exercises as explained by PT Jessica Jennings

What is Active Release Technique?

Active Release Technique (ART) is a movement based massage technique which has shown to have great effect in conditions involving strains/ sprains and overuse conditions such as tendinopathy. ART is performed by professionals who have undergone extensive training and have superior knowledge of anatomy. ART is unique from other types of massage in that it has an active component.

What can I expect?
After learning from you about your injury or pain, you will be assessed through hands on palpation which involves looking for abnormalities in tissue texture, movement and function. This allows your therapist to find what specific tissue or movement reproduces your discomfort and is the source of your pain. Specific protocols are then used along with very specific tensioning of the tissue based on the anatomy to affect the tissue.

What is happening to the Tissue?
Through the hands on assessment abnormalities in tissue are found. Abnormalities may include scar tissue or adhesions which creates a lack of oxygen flow to the tendon/muscle/tissue. Lack of oxygen can create poor movement and function of the tissue. Adhesions may also cause nerves to become pinched. ART is used to eliminate and prevent these adhesions from causing impairments to the soft tissue.

ART is used in conjunction with other hands on techniques and with specific exercises to retrain soft tissue to function appropriately and return you to your normal activities or sports.

ART is good for: Patellar and Achilles tendinopathy, muscle strains (quad, hamstring etc), plantar fasciitis, sciatica, IT band syndrome, shin splints, and more! Check out the following videos:

Physical Therapy Perspective on Ankle Dislocations in Athletes

Within the last week, the Eagles’ number one corner, Ronald Darby, and the Phillies’ outfielder, Pedro Florimón, both suffered an ankle dislocation. The most obvious concern of a die-hard sports fan is how long these players will be out of action, and from a physical therapy prospective, the answer, of course, is “it depends”.

An ankle dislocation is a rare traumatic injury with only 1% of reported dislocations involving the ankle joint. As such, there is limited evidence on prognosis and clinical management for ankle dislocations. This injury is most common in falls, motor vehicle accidents, and, sports. It usually involves a fracture to the bony structures of the joint, as well as ligamentous, neurovascular (nerves/vessels) and skin involvement. Medial displacement of the foot (foot rolling inward) is most common with this type of injury, as is the case of both Darby and Florimón.

In sports, an ankle displacement is likely to occur when an athlete is in a plantar flexed (foot pointing down) position, which is also the position that many ankle sprains occur in. You can see here that both athletes have their foot pointed down while loading the heel, as well as being overextended in their step, which places them in a more vulnerable position for this type of injury to occur.

The amount of time and the recovery of function after experiencing a dislocation depend on multiple factors, including neurovascular compromise; the joint(s) involved, and associated fracture(s). The two sports injuries mentioned in this article are examples of each extreme in terms of timelines of recovery. Darby is projected to be out for six weeks, whereas Pedro’s season has ended. Regardless of the timeline of recovery, physical therapy management remains focused on minimizing loss of function and graded return to activity.

If we imagine an uncomplicated ankle dislocation, such as is the case for Darby, physical rehabilitation goal number one is to reduce pain, and throughout the course of rehab, the athlete is going to let pain guide the treatment. With this in mind, as soon as the athlete enters the clinic, the PT is likely to begin with passive, non-weight-bearing mobilizations to the ankle in order to regain some lost motion that is likely after a period of casting. This will be followed by a progression to active motion and strength exercises for the ankle and foot, as well as motion and strength exercises for the trunk and upper extremity. Weight-bearing will be graded throughout the process, which is partially determined by the athlete’s ability to tolerate it.

Once the athlete is cleared to bear his/her full weight, rehabilitation can then begin to focus on more sport-specific exercises. These will likely target ankle stability, core stability, functional strength, and the ability to control movement (motor control). One might wonder, why is Ronald Darby returning to play so fast? From a physical therapy perspective, tissue healing occurs no more quickly for an athlete than for an average person. However, he is able to dedicate more time to his rehab, which ultimately improves recovery time. An important goal in tissue healing is to optimize the athlete’s environment so that healing can occur properly, and that is precisely what early and frequent rehab can do for a high-performance athlete.

Another worry from a fan’s perspective is whether the athlete will suffer a drop-off in performance or get re-injured. If rehabilitation is not executed properly, the athlete is at risk for both of these. Proper rehab must be consistent and, therefore, must include a continuum of care involving a system that tracks the athlete over time through a comprehensive array of health services. As such, physical therapists must communicate well with both the surgeons and athletic trainers.

Ideally, an athlete will not return to his/her sport until they can meet certain performance criteria. This should be extensive, not just a few simple tests, when determining if the athlete is ready. Physical therapists and the athletic trainer will play a big role in this decision-making. For more information on physical therapy treatments, please contact us at 3DPT.

Top Exercises To Prevent Dance Injuries

Core Strength

Dancers are notorious for having strong bodies and core. Many dancers practice for several hours a day on top of other activities such as school and work. Due to the high demands and the high level of endurance needed to dance all day, dancers need a stronger core than the average person. Many dance positions call for elongation of the spine. It is important to strengthen the muscles the way they would function in dance rather than static positions or typical flexion based core strengthening such as a crunch. When we refer to the core we are not just talking about your abdomen but rather a combination of muscles that form a cylinder at your trunk and consist of your abdomen, back, pelvic floor and diaphragm. Proper function and breathing is required for optimization of movement. Check out these videos on Dance Specific Core Strength!

Foot Intrinsic Strength

Footwork is crucial to a dancer. Many dance positions require end range contractions for long periods of time such as pointework. Dancers need to develop pushoff from their toes and feet to create jumps. Dexterity and strength can be improved with specific training. Check out these videos on Strengthening The Foot Intrinsics!

Often time injuries or lack of control at our feet can come from higher up in our body. Hip strength can be a contributor to stability at our knees and feet…..

Hip Mobility and Stability

Dancers are notoriously known for being very flexible. Turnout refers to the amount of external rotation required at the hips to achieve the core foot positions. To maximize turnout, dancers may end up compensating by tilting their pelvis forward (anterior pelvic tilt), arching their back (lordosis) and letting their feet cave in (pronate). These compensations may make a dancer susceptible to back and foot injuries. Along with core strength, hamstring and glute strength is vital to be able to maximize turnout while avoiding compensation that may lead to injury. Check out these videos on Hamstrings and Glute Strength for Dancers!

Shoulder Pain As It Relates to Baseball

Overhead activities such as throwing a baseball, is one of the most strenuous motions you can perform at your shoulder and elbow. No other exercise or activity can quite reproduce the stress on the joint and ligaments quite like throwing a ball. Baseball players are at risk for several injuries due to the high repetitions of throws they have to perform in games and practices. One typical injury we see is having pain in the anterior or front portion of the shoulder while throwing. This is called anterior instability and can be tested by performing an apprehension test which Dr. Chuck Bachi describes in this video. By placing the arm in the cocked position it causes the head of the humerus bone to slide forward and stress the front of the shoulder. When he pushes down on the head of the humerus to “ relocate” it, the pain is gone. This is a positive test for anterior Instability. So how do we treat it?

Stretching

Stretching to the back of the shoulder or posterior capsule of the shoulder is important. When the capsule and muscles in the back of the shoulder are tight, they may contribute to pushing the head of the humerus bone forward. This is called secondary impingement and can end up creating issues with your rotator cuff tendons. In the video above, Dr. Chuck demonstrates joint mobilizations performed by a Physical Therapist to improve elasticity in posterior capsule. He also performs manual stretching and Instrument Assisted Soft Tissue Mobilization to improve the flexibility and motion at the back of the shoulder. At the end of the video, John demonstrates a stretch that he can perform on his own to maintain the motion he has gained.

Strengthen

After you have improved your motion through stretching you want to prevent this from reoccurring. Key areas to strengthen are your scapular muscles and your posterior rotator cuff muscles. Your scapula provides the stable base for your shoulder to move. Check out these videos on Y’s and T’s to help stabilize your scapula. The other important area to strengthen is your posterior rotator cuff muscles. These muscles help you to decelerate the ball when you throw. They need to be extra strong to prevent your posterior capsule from tightening up and to handle the high demands repetitive throwing results in. Check out this video of John performing a posterior cuff strengthening exercise.

Not all pain in the front of the shoulder is from instability. If you are having shoulder pain of any kind, you want to be evaluated by your Physical Therapist to personalize your exercise and treatment program.

Call today to schedule your appointment! 609-714-3378

How to Improve Joint Range of Motion When Stretching Isn’t Enough

One of the toughest parts of having an injury or an operation is when you struggle to get the motion back into your joint. Often times, surgeries require you to be immobilized for a certain period of time such as in an ACL tear or a Rotator Cuff tear. This is needed to allow the repairs to heal. Sometimes your joint may get stiff because there was significant trauma and swelling creating scar tissue in the joint such as after an ankle sprain or a total knee replacement. Limited motion in our joints can cause us to compensate in our walking or in our ability to do our every day activities. Limited motion in the joint will also decrease the strength of the muscles surrounding the joint. Stretching and mobility exercises can help but are more effective on muscle and tendons. To stretch the capsule of the joint which is what is causing the stiffness, the most effective method is through Low Load, Prolonged Duration(LLPD) stretching. LLPD is sometimes called TERT which means Total End Range Time. The concept is that you are applying a low load or stretch for a long period of time at the end of the joints current range of motion.

The best way to understand is through this video. Dan had a severe injury to his knee and had to keep his leg straight in a brace for several months. Due to high amounts of scar tissue and stiffness in his joint capsule, his knee will not bend more than 51 degrees. Chuck explains that the best evidenced way to improve joint movement is through performing this Low Load, Prolonged Duration stretch for at least 60 minutes a day. This does not have to be done all at once but can be broken up into several times a day.

Another demonstration of a type of LLPD is in this 90/90 Hip stretch demonstrated by Chuck. This stretch helps to improve hip Internal and external rotation motion. Basically how much your hip can turn in or out. Hip mobility is really important for certain sports such as golf, baseball and running. Limited hip mobility may also be the cause of low back pain and should be assessed by your physical therapist.

If you never regained all of your motion after an injury you may benefit from this type of stretching. Talk with your Physical Therapist to make sure this stretching will be safe and effective for you!

Call to make an appointment today!
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