Achilles is a common overuse injury that occurs in people of all fitness levels.  The causes can be variable, but one factor that seems to be consistent with all cases is stress to the gastroc and soleus muscles in the calf region with irritation and loading at the tendon insertion at the heel bone.  This stress may be a result of continued forces placed through the tendon structure from activities ranging from standing, walking, exercise, to recreational activity or sport.

History

The athlete with overuse tendinopathy not ices a gradual development of symptoms and typically complains of pain and morning stiffness after increasing activity level. Pain diminishes with walking about or applying heat (e.g. a hot shower). In most cases, pain diminishes during training, only to recur several hours afterwards.

The onset of pain is usually more sudden in a partial tear of the Achilles tendon. In this uncommon condition, pain may be more disabling in the short term. As the histological abnormality in a partial tear and in overuse tendinopathy are identical. We do not emphasize the distinction other than to suggest that time to recovery may be longer in cases of partial tear. A history of a sudden, severe pain in the Achilles region with marked disability suggests a complete rupture.

Types of Achilles

Midportion Achilles tendinopathy

It is important to distinguish between midportion and insertional Achilles tendinopathy as they differ in their prognosis and response to treatment. We briefly review the pathology of Achilles tendinopathy, list expert opinion of the factors that pre dispose to injury, and summarize the clinical features of the condition. The subsequent section details the treatment of midportion tendinopathy.

Treatment of Midportion Archillies

Archillies tendinopathy Level 2 evidence -based treatments for Achilles tendinopathy include heel-drop exercises, nitric oxide donor therapy (glyceryl trinitrate [GTN] patches), sclerosing injections and micro current therapy (see below), In addition, experienced clinicians begin conservative treatment by identifying and correcting possible etiological factors. This may include relative rest, orthotic treatment (heel lift, change of shoes, corrections of malalignment) and stretching of tight muscles. Whether these ‘commonsense’ interventions contribute to outcome is unlikely to be tested. The sequence of management options may need to vary in special cases such as the elite athlete, the person with acute tendon pain unable to fully bear weight, or the elderly patient who may be unable to complete the heel-drops. As always, the clinician should respond to individual patient needs and modify the sequence appropriately.

Insertional Achilles tendinopathy, retrocalcaneal bursitis and Haglund’s disease

These three ‘diagnoses’ are discussed together as they are intimately related in pathogenesis and clinical presentation.

Relevant anatomy and pathogenesis

The Achilles tendon insertion, the fibro cartilaginous walls of the retrocalcaneal bursa that extend into the tendon and the adjacent calcaneum form an ‘enthesis organ’. The key concept is at this site the tendon insertion, the bursa and the bone are so intimately related that a prominence of the calcaneum will greatly predispose to mechanical irritation of the burs a and the tendon. Also, there is significant strain on the tendon insertion on the posterior aspect of the tendon. This then leads to a change in the nature of those tissues, consistent with the biological process of mechanotransduction.

Treatment

Treatment must consider the enthesis organ as a unit, isolated treatment of insertional Tendinopathy is generally unsuccessful. For example, Alfredson’s pain, full heel-drop protocol (very effective in midportion, tendinopathy) only achieved good clinical results in approximately 30%ofcases of insertional tendinopathy. Patients with more than two years of chronic insertional tendinopathy, sclerosing of local neo vessels with polidocanol cured eight patients at eight -month follow-up.

Other Causes of pain in the Achilles region

Achilles bursitis is generally caused by excessive friction, such as by heel tabs, or by wearing shoes that are too tight or too large. Various types of rather stiff boots (e.g. in skating, cricket bowling) can cause such friction, and the pressure can often be relieved by using a punch to widen the heel of the boot and providing ‘donut’ protection to the area of bursitis as it resolves. Referred pain to this region from the lumbar spine or associated neural structures is unusual and always warrants consideration in challenging cases.

Clinical perspective

Acute tendon rupture is most common among men aged 30- 50 years (mean age, 40 years); it causes sudden severe disability. Overuse Achilles tendon injuries-tendinopathy may arise with increased training volume or intensity but may also arise insidiously. Because the prognosis for midportion Achilles tendinopathy is much better than for insertion tendinopathy, these conditions should be distinguished clinically. Most textbooks suggest that rupturelim its active plantar flexion of the affected leg- but beware, the patient can often plantarflex using an intact plantar is and the long toe flexors. The condition that was previously called ‘Achilles tendinitis’ is not truly an inflammatory condition and, thus, should be referred to as ‘Achilles tendinopathy” pathology that underlies the common tendinopathy.

Whether you treat an Achilles tendon rupture with surgery or use a cast, splint, brace, walking boot, or other device to keep your lower leg from moving (immobilizing your leg), after treatment it’s important to follow the rehabilitation program prescribed by your doctor and physical therapist. This program helps your tendon heal and prevents further injury. http://www.alliancephysicaltherapyva.com/

Our elbow joint is made up of bone, cartilage, ligaments and fluid. Muscles and tendons help the elbow joint move. When any of these structures is hurt or diseased, you have elbow problems.Our elbow joint is made up of bone, cartilage, ligaments and fluid. Muscles and tendons help the elbow joint move. When any of these structures is hurt or diseased, you have elbow problems.

Many things can make your elbow hurt. A common cause is tendinitis, an inflammation or injury to the tendons that attach muscle to bone. Tendinitis of the elbow is a sports injury, often from playing tennis or golf. You may also get tendinitis from overuse of the elbow

The injuries around the elbow will be described under the following heads:

• Fractures of the distal end of the humerus
• Dislocation of the elbow
• Fractures of the proximal ends of the radius and ulna.

• The closed manipulation fails,
• The brachial artery is injured and needs exploration, and
• There is an associated nerve palsy which needs exploration.
• After open reduction the fracture fragments are fixed internally with Kirschner wires-(commonly called K-wires)

Injuries Around the Ankle Joint…

Ankle sprain is an extremely common complaint with many causes. An ankle sprain occurs when the ligaments surrounding the ankle joint are stretched or torn as the ankle joint and foot is turned, twisted or forced beyond it’s normal range of motion. The most common cause of an ankle pain in athletes is a missed step or a missed landing from a jump or fall. Ankle sprains vary in severity and are classified by the degree of severity.

History

The usual mechanism of injury to the ankle joint is a rotational violence in which the body swings around a trapped foot. Depending on the quantum of force, there may be ligamentous injury or bony injury around the ankle. The exact position of the foot at the time of injury is elicited. Ankle injuries are usually classified by the direction of the force and the position of the foot at the time of injury. Following a tibial plateau fracture or talar fracture, the ankle and subtalar joint may go in for secondary degenerative arthritis, which can present as chronic pain and recurrent effusions of the ankle joint. Presence of knee pain and hip pain should be asked for as the foot and ankle disorders can alter the biomechanics of the limb predisposing the knee and hip to degenerative osteoarthritis.

Examination

Inspection

The foot, ankle and the leg are completely exposed. The position of the foot in relation to the leg is determined. The foot may be displaced anteriorly, posteriorly or sideways depending on the type of injury. The foot is usually displaced laterally in external rotation injuries. It may be displaced medially in adduction injuries and displaced upwards and laterally in vertical compression injuries. In vertical compression injuries with diastasis of inferior tibiofibular joint, the ankle may appear broadened. In fracture dislocation of the talus, the displaced fragment may stretch the skin of the dorsum of the ankle and may impend rupture of the skin.

Palpation

The bony points palpated are:

Lower end of tibia and fibula including the malleoli:

As these bones are subcutaneous, it is easy to find out any fractures, irregularity abnormal mobility. In ligamentous injuries around the ankle, the insertion sites of these ligaments such as anterior talofibular ligament, deltoid ligament may be tender to palpation. To demonstrate the ligamentous injury further, the ankle joint is stressed by giving valgus and varus forces to it. Any abnormal opening out can be demonstrated both clinically and radiologically.

Tarsal bones:

The calcaneum is palpated bidigitally on either side to demonstrate tenderness or thickening or irregularity. In chronic degenerative arthritis of subtalar joint, tenderness and restriction of movements of subtalar joint will be present.

Metatarsal bones:

In Jones fractures the base of the Vth metatarsal is avulsed due to the pull of the peroneus brevis muscle. Fractures of the shaft of the metatarsals are demonstrated by eliciting tenderness on axial pressure over the metatarsal head. Diffuse swelling over the tarsometatarsal joints may be seen in Lanfranc’s fracture dislocation. In ‘march fracture’, there will be diffuse swelling over the neck of lInd metatarsal with pain.

Muscular compartment:

Tendo-Achilles which gets inserted in the calcaneum is frequently injured resulting in loss of active plantar flexion.

Thompson’s test:

Squeezing the calf muscle will cause plantar flexion of the ankle joint. When there is a discontinuity in the tendon, this manoeuvre will not cause plantar flexion.

Movements:

In acute injuries, active movements may not be possible.

Measurement

The leg segment is measured from the medial joint line to the malleolus.The vertical height of the heel is measured from the tip of the medial malleolus to the floor in a standing patient. In fractures of the talus and calcaneum, this height may be decreased. The longitudinal measurement of the foot from the tip of the heel to the tip of great toe and then to the tip of the little toe are measured. Circumferential measurement of the foot at the level of the ankle joint, at the level of maximum arch and at the level of the metatarsal heads are measured and compared with the normal side.

Neurovascular examination

Ankle injuries may rarely be associated with posterior tibial artery and nerve injuries. In Lanfranc’s fracture dislocation, the digital arteries and nerves may get damaged and careful animation is needed to diagnose this. The chronically disabled group usually suffers from the sequelae of old trauma or inflammatory infective or degenerative or neoplastic causes. These patients need to be examined by proper history, detailed examination of the individual bone and joints. After eliciting a detailed history, the examiner should arrive at a provisional differential diagnosis based from the history and then proceed to physical examination. This will help in finding the subtle signs of the disease.

Clinical Features

The Patient typically present with a twisting injury of the foot following which they complain of inability to bear weight, pain around the ankle and very often swelling around the ankle. Clinically the stability of the ankle joint must be tested by valgus and varus stress under anaesthesia, Associated injury to the tendons and the neurovascular bundles, which run in close vicinity to the joint, has to be ruled out. The state of skin must be checked. The skin over the deformed ankle may get unduly stretched, resulting into necrosis, if not reduced immediately.

Physical therapy modalities (such as ultrasound) and manual therapy modalities (such as friction massage) are often used when the acute phase is over.A Physical Therapistis a specialist trained to work with you to restore your activity, strength and motion following an injury or surgery. Physical therapists can teach specific exercises, stretches and techniques and use specialized equipment to address problems that cannot be managed without this specialized physical therapy training.

Injuries around the hip constitute one of the most difficult injuries to treat and predict the outcome. But the best way to treat your pain is by Physical Therapy without any Burn and Injury. In dashboard injuries, the impact is driven to the knee of the patient which passes on the energy of hip joint causing posterior dislocation of hip.

Examination
Inspection
Attitude: The examination of attitude in a hip joint injury is very useful. In posterior dislocation of hip, the hip will be in flexion, adduction and internal rotation. In intracapsular fracture neck of femur, the lower limb lies in external rotation and minimal shortening. In trochanteric fractures, the lower limb lies in complete external rotation and the limb appears shortened. In anterior dislocation of hip, there will be flexion, abduction and external rotation deformity.

Swelling: In dislocation of hip, the femoral head may be felt either in the gluteal region or in the perineal region or iliac region. In trochanteric fracture, there will be diffuse swelling around the hip and thigh.
Palpation
The bony landmarks to be palpated are:
1.Greater trochanter: The position of greater trochanter helps us in the diagnosis of fractures around the hip. The greater trochanter, anterior superior iliac spine (ASIS) and ischial tuberosity have a constant relationship to each other which will be altered in affections of hip joint and proximal femur. Bryant’s triangle is formed by a line connecting ASIS and greater trochanter, line dropped from the ASIS perpendicular to the floor and the line connecting the greater trochanter and the perpendicular line. The base of the Bryant’s triangle is measured and compared with opposite side. In fractures of the neck and dislocations of hip, the base will decrease to the proximal migration of the trochanter. In posterior dislocations of hip, the greater trochanter will be more anteriorly felt near the ASIS. In anterior dislocations, it will be felt more posteriorly. It should be palpated for tenderness, thickening or irregularity. In subtrochanteric fractures, Bryant’s triangle will not be altered but there will be loss of transmitted movements between the proximal and distal femur.
2.Head of femur: Normally, the femoral arterial pulsation is felt against the head of femur. In dislocations, this resistance is lost thereby altering the intensity of pulsation. The femoral head may be felt posteriorly or anteriorly depending on the type of dislocation. A smooth round bony hard mass which moves with rotational movements of the shaft of femur is nothing but the head of femur. The medial surface of the medial femoral condyle is in the same direction as that of the head of femur. This gives a rough guidance to locate the head in an intact femur.

Neurological examination
In posterior dislocations of hip, the nerve to be commonly affected is the sciatic nerve. The common peroneal part of the sciatic nerve is most often involved than the tibial part manifesting as foot drop.
So Treat your problem of Hip Joint with Physical Therapy at Alliance Physical Therapy which is located in eight prime locations in Northern VA and DC region.http://www.alliancephysicaltherapyva.com/

SPONDYLOLYSIS AND SPONDYLOLISTIES

These linked conditions generally affect your lower back but may occur in may part of your spine.Spondylolysis occurs when a defect or weakness in a vertebrae develops into a fracture. The vertebra is then at risk of slipping out of line with the vertebrae adjacent to it, leading to spondylolosthesis, which can be debilitating and painful, or may be painless and go unnoticed.

CAUSES
Spondylolysis may start with a minor crack the narrow arch of bone in a vertebra,known as the usually it is the result of a fall or due to strain and overuse .some sports such as cricket and soccer repeatedly put stress on the arches of the vertebrae ,which can lead to minor cracks or breaks.Spondylolisthesis generally develops from spondylolysis ,with the crack widening to a complete break due to further stresses and strains .This break allows the damaged vertebra to slip out of line, which can irritate the linked facet joints and ligaments and possibly trap a nerve.

SYMPTOMS AND DIAGNOSIS
The pain from a displaced vertebra due to spondylolisthesis depends on the degree of slippage. A slight slip may cause little or no pain, while a greater degree of slippage can lead to more intense pain because of the irritation to the spinal joints and ligaments .If your nerve is trapped, there may be some pain numbness, or “pins and needless” in one or both of your legs. Your doctor will make a diagnosis through a physical examination and testing including on X-ray, MRI scan and myelogram.

RISKS AND RECOVERY
Back strengthening exercises can help stabilize your posture, but where vertebrae have severely slipped, nerve entrapment can develop that may require surgery. Young people diagnosed with spondylolisthesis should avoid contact sports and activities with a high risk of back injury .A young person who is still growing should be monitored every six months, using X-rays to detect further movements and shift in the spinal column. Once growth stops, the vertebrae are unlikely to slip any farther.

Sandwiched between each of the vertebrae in your spinal column is a disk of cartilage that acts as a shock-absorbing pad. These disks have a soft, jellylike center and a tough, fibrous outer layer. A tear in this outer layer will allow some of the soft center to bulge out. This bulge on the nerve roots emerging from the spine in the region of the damaged disk.

CAUSES
Any activity that puts increased pressure on the disks of your spine can lead to a disk hemlation.This can occur in the cervical spine, or, more commonly in the lower back. He general gear and tear that comes with age can also contribute, making middle-aged people susceptible to if they bend suddenly or lift an awkward weight.

SYMPTOMS AND DIAGNOSIS
Depending on the location of the herniated disk, symptoms can vary, but there is usually severe pain and restriction of movement. In the lower back, the pain tends to be a deep unrelenting ache, which may radiate out to your hips; groin buttocks and legs. You may also develop sciatica-a sharp pain, radiating down one leg accompanied by numbness or tingling. Herniated disks can also occur in the neck, causing severe pain that may spread into your shoulders, arms and hands, making it difficult to turn your head or move it backward or forward. You will usually feel pain in only one side of your body. Your doctor will make a diagnosis by performing a physical examination; if your symptoms persist, he may order further tests, such as an MRI or CT scan.

RISK AND DISCOVERY
Recovery from a slipped disk usually takes 4-6 weeks .However if a disk herniated protrudes fully into the spinal curial; it can compress the caudal equine and damage the nerves leading to your legs, bladder and Bowles. This may result weakness and numbness in both legs and the lower part of your body, loss of bladder and bowel control, and even impotence. Although this rarely happens, it is an emergency and you should seek immediate medical help.

Literally, many elder people have arthritis, but today it’s not just a problem of the old. Some forms of arthritis affect kids still in diapers, while thousands of people are suffering in the prime of their lives. The general denominator for this condition is joint and musculoskeletal pain, which are grouped together as ‘arthritis.’ Often that pain is a result of swelling of the joint lining. Arthritis is the most common cause of inability in the USA.

Types of Arthritis:

Arthritis is of two types. One is Osteoarthritis Arthritis and other on is Rheumatoid Arthritis.

Osteoarthritis Arthritis is local or generalized degeneration of the articular cartilage and the formation of “lips and spurs” at the edges of Joints. An exaggeration of the normal aging process.

Rheumatoid Arthritis is an inflammatory disease involving the synovial membranes and the particular structures.

Symptoms:

The main symptoms of Osteoarthritis are:
• Progressive pain
• Joint enlargement
• -lived stiffness in morning
• Difficulty moving
• A grating or crackling sound or sensation in your joints

The main symptoms of Rheumatoid Arthritis are:
• Joint swells with redness and tenderness
• Symmetrical joint involvement is common
• Migrate from joint to joint
• Inflammation around the joints and in other areas

Causes:

Arthritis is cleanly defined as swelling in the joints. There are different types of arthritis, but the two most common types are rheumatoid arthritis and osteoarthritis. Joint stiffness and joint pain are the two most common symptoms of arthritis. Those with arthritis may experience more than one inflamed joint. Main Causes are:
• Main Cause of this disease is Inflammation of synovial membrane tissue. This tissue lining the joints in human body and when this tissue becomes swollen, it results to severe pain and stiffness in that body part.
• Being inflexible, unwilling to change, fear, anxiety, depression, deep shock all these are Arthritis Psychological Causes.
• Poor digestion, Hyperacidity, Enzyme deficiency, Poor Skin, Kidney, Gallbladder and Liver activity, spinal imbalance causing reflex conditions as above leading t accumulated toxins which cause an inflammation reaction.
• Excessive use of Meat, soda drinks, coffee, salt, excess refined carbohydrates, sweets, raw vegetable deficiency all these cause arthritis.
• Fatigue can enhance the feeling of pain and more fatigue increase in arthritis pain.

Treatment:

• Raw Vegetable and Juice fasting is the fastest method of attaining result. Fasting period depends upon the patients and conditions and may range from 7-21 days.
• Take Raw Non Citrus Vegetarian diet and avoid coffee, tea, alcohol, sweets etc.
• And one of the best treatment for this is Physical therapy and Hydrotherapy like Hot and cold showers to stimulate general circulation and act as general tonic, Hot compress, Cabinet Bath, Sauna bath, Paraffin bath etc.
• Daily Massage with olive and peanut oil.
• Or sometimes Joint replacement surgery may be required in eroding forms of arthritis.

Best treatment for arthritis is Physical exercise. Low impact aerobic exercise is best. Talk to your medical professional regarding which types of exercises are ideal for you. And people who are suffering from Arthritis due to Physiological cause they must laugh, shed their stress, loose weight, and have more intimacy with outer world. And do regular exercise.