Keep your eye on the ball, Charlie Brown

We have all seen the video and laughed at the misfortune of Charlie Brown.  His concerning lack of a balance righting response brought him straight down on his back and head.  What we didn’t see was the aftermath of this incident, and what it took to put Charlie Brown back together again.

Injury 1 – Grade 1 Hamstring strain –
How - Lack of warm up and over extension of the right leg after missing the ball
Recovery - Physical Therapy focused on myofascial release, static and dynamic stretching along with open and closed chain strengthening

Injury 2 – Sacral contusion –
How -  Landing on the sacrum and the tailbone (coccyx) from a double-your-height height hurts even more. 
Recovery - Physical Therapy was required to improve sacral alignment as well as decrease pain and tightness in the surrounding hip flexors, low back muscles, and glutes.  Charlie then required extensive core stabilization and body mechanics training to avoid bad movement patterns that his body learned after this injury.  He had to sit on a donut for several weeks due to pain

Injury 3 – Concussion –
How - Landing on the back of his head caused temporary loss of consciousness and vision problems.  
Diagnosis -  He took an IMPACT test that helped the physician diagnose a concussion. 
Recovery - Physical Therapy focused on improving tightness of the neck muscles, especially the area where the head and the neck meet, as well as improve vision and vestibular problems.  He was kept out of gym class for several months to decrease the risk of being hit in the head and suffering second impact syndrome.

 

Injury 4 – Distrust of girls – Physical Therapy could not help this.  It was a long time before Charlie was able to trust girls again, and he and Lucy have recently been able to talk without resentment and anger.

Ken Guzzardo, PT, DPT, OCS, SCS

WTH is MRSA

Raymond James Stadium, Tampa Bay, FL

What the heck is Methicillin-resistant Staphylococcus aureus?  If you follow sports or work in the medical field, you have heard the term MRSA before.  As we get ready for Sunday’s Eagles game, there is debate of the cleanliness of Tampa Bay’s facilities since three of their players have contracted this infection.  This blog post will look at what exactly MRSA is, how it could be contracted, and how it is treated.

Staph (Staphylococcus Aureus) infection

A staph infection is a bacterial infection that can cause a number of diseases depending on the area and tissue of the body that is infected.  People who have a weakened immune system, surgical incision, damage to the skin, or chronic conditions such as diabetes, cancer, or vascular disease are at an increased risk of infection.  Infection of the skin typically presents as a red, swollen, and painful area and may have an abscess or boil.  If Staph has infected the blood stream, fevers and chills are common.  Staph is commonly treated with antibiotics, but surgery is sometimes required depending on the location and extent of the infection.

MRSA

This is not really what MRSA looks like

Methicillin-resistant Staphylococcus aureus is a type of a Staph infection that is resistant to the class of antibiotics commonly used to treat the infection.  This “Superbug” requires a different cocktail of antibiotics to treat, and sometimes necessitates IV delivery of the antibiotics to eliminate the infection.  Treatment can last weeks to several months.  Lawrence Tynes, who would have been the kicker for the Bucs, was diagnosed with MRSA over the summer and has yet to play for Tampa Bay this season.   

His wife tweeted this picture in August of Lawrence taking antibiotics through a PICC line.

Amanda Tynes (via Twitter)

Concern with the training room

As we said before, individuals who have damage to the skin, including scrapes or cuts, could be susceptible to Staph infections if exposed.  According to an article by Neely and Maley¹, MRSA can live from at least 1 day up to over 90 days on fabric surfaces.  There are products out there that can clean and kill MRSA, such as this one, but it must come into contact with the disease to be effective.  Athletes sustain scrapes and small cuts all of the time, which can make them more susceptible to picking up an infection.  This is especially important when they are in close contact with each other in a common area such as the athletic training room.  According to this article in the Washington Post, the Tampa Bay Bucs already treated their facility earlier this season after both Lawrence Tynes and Carl Nicks were diagnosed with MRSA.  After the facility was cleaned, Nicks had a recurrence of his infection, and a third Buc, Jonathan Banks, was just diagnosed with the disease.  This is not the first time a team has had to deal with a MRSA outbreak in their complex.  The 2003 St. Louis Rams had 8 players with the infection, and players like LeCharles Bentley have had their careers cut short by post-operative MRSA.

At the time of this blog, the Bucs brought an independent assessment team to determine the safety of the facilities for both Eagles and Tampa Bay players.  If additional measures are needed, the team will shut down their training room and locker room for an intense cleaning to disinfect all surfaces or potential sources of contamination.

Ken Guzzardo, PT, DPT, OCS, SCS

3 Dimensional Physical Therapy

kguzzardo@3dpt.com

Lit cited

Neely, A, Maley, M; “Survival of Enterococci and Staphylococi on Hospital Fabrics and Plastic”; Journal of Clinical Microbiology; 2000 February; 38(2); pp 724-726.

The meniscus surgery conumdrum

In the United States there are approximately 850,000 people undergoing meniscal surgeries every year.  Are you—or somebody you know—on the fence and unsure of where to turn?  We at 3DPT are here to help you decide.

                                                              

                                                          

                                                        Meniscus Structure and Function

Let’s back up a little.  First, what exactly a meniscus is may be a key factor in your decision.  The meniscus is located in the knee joint.  It is made up of 2 cartilage-like discs that act as functional extensions of the normal cartilage found within the knee.  It acts to increase the contact area between the relatively round end of the femur (thigh bone) and the relatively flat end of the tibia (shin bone) therefore decreasing the amount of stress on the knee cartilage.  This larger contact area is essential to normal function of the knee, as its absence would cause undue stress on the normal cartilage found within the knee eventually causing arthritis.

My MRI says I have a torn meniscus.  What are the options?

So you were running or walking along a sidewalk one day and landed on a funny uneven surface and tweaked your knee.  Actually, that tweak probably felt more like an explosion.  Now you’re in the doctor’s office and you’re told that imaging studies show your ACL is fine (phew!), but that you have a torn meniscus.  There are a few routes that people typically go from here and why you should choose one from another depends on a number of factors.  The typical options are meniscectomy (take out the damaged part of meniscus), meniscal repair (reattach the torn meniscus), and/or physical therapy.

                                                Which route is best for me?

This question is very difficult as the answer depends on many different factors specific to every individual.  Here is the type information we feel that you should know in order to make an informed decision for yourself.

Meniscectomies are surgeries performed to remove a piece of torn meniscus.  Why take out a piece of meniscus you ask?  Two thirds of a normal meniscus essentially has no blood supply, making it nearly impossible to heal.  Also, sometimes a piece of the meniscus can get stuck in a bad position making it difficult to move the knee correctly.  Therefore a logical option is to simply take out the damaged bit.  Unfortunately, studies have shown that this can cause even worse repercussions down the road.  One study¹ published in 2008 by Mills and colleagues showed that knee cartilage defects are much more prevalent in people who had undergone meniscectomies than in healthy control subjects  (77% vs 42%) after just 3-5 years after surgery.  This suggests that people who have a piece of their meniscus taken out are more prone to knee arthritis.  Why is this?  That meniscus is such an important player in the cushioning and distribution of stresses on knee cartilage that when even a piece of it is taken out the cartilage takes too much of the load and rapidly breaks down.

Meniscal repairs are surgeries that began to be performed in response to the knowledge of this problem with meniscectomies.  Surgeons basically tie down the torn part of the meniscus to prevent it from flapping back up and promote healing.  For tears in the small region of the meniscus that has blood supply this may be a better option.  This surgery allows for the contact area of the knee joint surfaces to stay roughly the same as before.  The only down side here is that you will still have to undergo surgery.  Not only is surgery in general a scary thought, but it can also be detrimental to long term function.  Multiple studies^2,3 have shown low participation in usual functions and strength in people undergoing meniscus surgery as far as 4 years out.

Physical therapy is the conservative approach to treating meniscus tears.  As much as I would like to tell you that physical therapy can heal your meniscus, that region of very little blood supply will likely not heal via any method.  Physical therapy will focus on stretching, strengthening, and improving the way your body moves in order to decrease the amount of stress that your knee takes.  Perhaps the real beauty of physical therapy with meniscus injury is that the meniscus stays in the knee where it was meant to be.  The thought is that even a damaged meniscus is better than no meniscus.  Earlier this year a study published in the New England Journal of Medicine showed essentially no difference in outcomes for people who participated in physical therapy rather than surgery⁴ after 6 and 12 months.  For physical therapy as a profession this was huge.  We can have the same affects on knee recovery as surgery, without the negative effects of cutting into you or the arthritis down the road.

Jamie Rosenberg, SPT

1)   Mills PM et al. Tibio-femoral cartilage defects 3-5 years following athroscopic partial medial meniscectomy. Osteoathritis and Cartilage. 2008; 16: 1526-1531     

2) Muscle strength, functional performance, and self-reported outcomes four years after arthroscopic partial meniscectomy in middle-aged patients.  Arthritis & Reuhmatism. 2006; 55 (6): 946-952

3) Roos EM et al.  Substanstial disability 3 months after arthroscopic partial meniscectomy: a prospective study of patient-relevant outcomes.  Jour of Arthro and related surg. 2000; 16 (6): 619-626.   

4) Katz JN et al. Surgery versus Physical Therapy for a Meniscal tear and osteoarthritis.  The New Eng Jour of Med. 2013; 368 (18): 1675-1684.