Workplace Wellness (via APTA)

Just wanted to share with you all the APTA's recommendation for workplace wellness.  Click HERE or read below for the same info. (This info is copied and pasted directly from the APTA website)


Working at a computer work station all day can take a toll on the body.  Repetitive activities and lack of mobility can contribute to aches, pains, and eventual injuries. 

Sitting at a desk while using the keyboard for hours on a day to day basis can result in poor circulation to joints and muscles, it can also create an imbalance in strength and flexibility of certain muscles, and muscle strain.  These issues can be easily remedied by taking frequent short breaks, or “micro breaks,” throughout your day.

• Get out of your chair several times a day and move around—even for 30 seconds 
• Roll your shoulders backwards
• Turn your head side to side
• Stretch out your forearms and your legs 

Additionally, specific guidelines for your work station can help maximize your comfort and safety. 

Your chair should have the following:

• Wheels (5 for better mobility)
• The ability to twist freely on its base
• Adjustable height
• Adjustable arm rests that will allow you to sit close to your desk
• Lumbar support
• Seat base that adjusts to a comfortable angle and allows you to sit up straight

The position of the keyboard is critical: 

• The keyboard should be at a height that allows you to have your forearms slightly below a horizontal line—or your elbows at slightly more than a 90 degree angle. 
• You should be able to slide your knees under the keyboard tray or desk. 
• Avoid reaching for the keyboard by extending your arms or raising your shoulders. 
• Try to avoid having the keyboard on top of your desk.  That is too high for almost everyone—-unless you can raise your seat.  The elbow angle is the best test of keyboard position. 

The position of your computer monitor is important:

• The monitor should be directly in front of you.   
• The top of the monitor should be at your eye level, and at a distance where you can see it clearly without squinting, or leaning forward or backward.
•  If you need glasses for reading, you may need to have a special pair for use at your computer to avoid tipping your head backward to see through bi-focals or other types of reading glasses.

 How can a physical therapist help?

Many physical therapists are experts at modifying work stations to increase efficiency and prevent or relieve pain.  Additionally, if you are experiencing pain that isn’t relieved by modifications to your work station, you should see a physical therapist who can help develop a treatment plan to relieve your pain and improve your mobility.

See a Physical Therapist Demonstrate Exercises for the Workplace

Buster Posey Injury Update Part 2

via MLB.com:


"Buster Posey underwent surgery Sunday to repair three torn ligaments in his left ankle and has been ruled out to return for the rest of the season, Giants head athletic trainer Dave Groeschner said.

Posey had two screws inserted into his leg, but should make a full recovery and be ready to participate in Spring Training next year, Groeschner said.

"It's a good prognosis," he said in a conference call with reporters in Milwaukee. "It's a long road from here. He just had a very devastating injury, had to have surgery and has a long rehab process to go."

In reference to our previous Buster Posey injury update, the scenario that seems to have played out is number 2 (complete tear of the ligaments/broken fibula).  The good news for Posey, is that the surgery performed was a relatively minor one, in comparison to some of the more complicated ORIFs, secondary to the way the fibula was treated.  If the fibular fracture had been more severe, they would have required additional hardware to be inserted into the ankle for stability.  Posey had two screws inserted into the ankle, which will be removed in about 8 weeks, and the fibula was left to heal on its own.  With this in mind, Posey is done for this season, but with a good rehabilitation program, he should hopefully be back at the beginning of next season.  

I apologize again for the delay in updates.  As the resort season has ended out in the California desert, the patient load has started to pick up.  Again, I will try to keep my updates coming every 2-3 weeks.  Expect to see a thorough post on barefoot running within the month.  I hope everyone is having a great day.  

-Dr. Joshua Cacho, PT, DPT

Buster Posey Injury Update!

Just a quick Thursday morning post, ESPN is reporting that Buster Posey's X-rays have come back positive for a broken ankle.  In addition, reports are now showing that he may have injuries to the ligaments of his left knee.  Pending an MRI, the severity of the break has yet to be announced, but we will discuss prognosis of a clean break versus one requiring an ORIF.  Needless to say, Buster is more than likely done for the season and the long-term potential of his career may be in jeopardy.

The results of the MRI will  more than likely determine the course of action that the orthopedic surgeon take to bring Buster back to playing health.  Here are a few scenarios that include potential prognosis for returning to play:

Scenario 1:  Fractured bone without additional ligamental injury;  Treatment:  CAM (walking) boot and physical therapy; Time out: 6-8 weeks;  Prognosis: Should return to full ability with no loss of function.

Scenario 2:  Complete fracture with ligamental injury.  Likely treatment:  ORIF (open reduction, internal fixation) and physical therapy;  Time out: 4-6 months; Prognosis:  Given age, should return to close to full strength with minimal limitations.

Here's a picture of the ORIF.  Note that hardware that is inserted will be a limitor of what he is able to gain back functionally.  The more hardware, the less movement he will be afforded.

Scenario 3:  Complicated fracture, in which the bone is completely shattered.  Likely treatment:  ORIF and physical therapy;  Time out: Out for the year;  Prognosis:  May not ever get back to original playing ability.  Given the severity of this injury, significant limitations may be present for the rest of his life.

Just a reminder, the these are only three possible scenarios of what may come about in the future with Buster's ankle.  The commentary provided is just what I have experienced in the clinic, and is in no way a definite answer to the question of how long he will be out.  Professional athletes do typically have a shorter recovery period than the normal lay-person, but given the money involved, the Giants will not rush him back into action.  As a medical professional, here's to hoping that his injury is not too severe and he will be able to play to the potential he has shown in his young career.

Have any questions or comments? Please feel free to email me at jcachodpt@gmail.com and I will get back to you as soon as possible.  

Knee Pain Continued: Patellofemoral Syndrome and Other Patellar Injuries

This week's topic: patellofemoral pain syndrome (PFPS).  For those of you who aren't familiar with this terminology, patellofemoral pain syndrome is characterized as pain originating from the areas underneath or around the patella (kneecap), due to abnormal forces being placed upon the patellofemoral joint. This can result in potential irritation to the underlying articular cartilage (chondromalacia), irritation/inflammation of the synovium, and finally damage to the bones themselves. Common signs and symptoms that accompany patellofemoral pain syndrome are anterior knee pain that occurs with activity, and is exacerbated with ascending/descending stairs/hills.

The question that may be running through your mind, is WHY DOES THIS HAPPEN?  As stated earlier, the probable cause for PFPS is abnormal forces acting upon the patellofemoral joint.  In my clinical experience, it seems as though muscle imbalances (tightness/weakness of certain muscles) seem to be one of the primary causes of this issue.  Weakness of the quadricpes/gluteal musculature and tight hip flexor musculature seem to be quite prevalent in my encounters in the clinic. 

Prior to jumping right into treatment, it's important that we use a special test to verify that the individual is suffering from PFPS.  For these purposes, we will use the eccentric step down test, which a study conducted by Nijs et al, determined that it's results are most likely to indicate PFPS.  The test can be completed as shown in the following video:             

Finally, let us examine treatment of patellofemoral pain syndrome.  Before we start, let me remind you that the information presented on this blog should not be used as a substitute in any manner for skilled services. In addition, I am in no way making diagnoses or providing treatment via the blog. This blog is solely intended to educate the readers in the area of injuries/rehabilitation. If feel as though you may need help, please see your physician or physical therapist (in direct access states) for a referral/evaluation.  As stated earlier, we will be focusing on fixing the muscle imbalances of the lower extremities.  Use the following stretches and exercises to help with your  PFPS:

Let me apologize for the lack of posts in the past couple weeks.  When I started the blog off, I was writing 1-2 articles per day and I got a bit burnt out.  Needless to say, from here on out, I am going to try to do a lengthier post every other week, and then post the sports stuff whenever something important comes up.  Tiger Woods' latest knee pain/achilles tendonitis will probably be my next professional sports subject, so keep an eye out for that one golf fans.  Thanks again for reading my blog! Keep checking it out for new updates!

Student Shoulder: I'm So Tense!!!

Have you ever reached the end of a long school and work day and felt an annoying tightness and soreness extending from the top of your shoulders and into the neck? Chances are you are dealing with what has been aptly described as "student shoulder" or in clinical terminology, soft tissue limitations of the upper trapezius, levator scapulae, and other shoulder girdle musculature.  When this happens, the typical response is to have a friend/family member/significant other come and massage the affected area for a bit...  The problem is that within a matter of time, the pain/tightness/soreness comes back.  This can be extremely aggravating, and potentially debilitating in certain situations.  


In order to address this issue in the best way possible, we must first separate ourselves into two categories.  Our first category is people with postural tightness of the upper trapezius secondary to a passive insufficiency of the scapular stabilizers (your back is weak), or the second group in which the upper trapezius is actually tight from excessive activity. For the purpose of this post, we will use a quick and easy screen to figure out which of the two categories you fit in.  Use the following picture and subsequent instructions to get through the test:

• Begin the screen by sitting in a relaxed slouched position like in figure A.
• Feel the muscles extending from your shoulder, up to the neck-record what your feel.
• Next, assume a nice, tall posture like the one in figure B.
• Once again feel the same muscles and record what it feels like.

Ok, now that our screen is completed, categorization of your type can be completed.  For the purpose of this blog, we will refer to postural tightness as Type 1 and overwork tightness as Type 2.

• You probably have TYPE 1 tightness if your muscles were tight in the slouched (figure A) posture, but relaxed in the tall posture (figure B).
• You probably have TYPE 2 tightness if your muscles were tight in both slouched and tall postures.

Treatment Options:

Depending on the severity of your issue, I would recommend consulting with a physician/physical therapist in the event skilled services are required.  If you are dealing with a minor affliction, here are some options you can try...

If you are dealing with Type 1 tightness, this is typically caused by a passive insufficiency of the posterior shoulder girdle musculature.  What this means is that because your posterior shoulder girdle muscles are weak, we assume the slouched posture as in figure A.  The shoulders have now been drawn forward to weakness of the back muscles and potential tightness of the anterior musculature.  This forward position pulls the upper trapezius on stretch, leading to that tight feeling.  Because the trapezius is already on stretch, there is no need to stretch it.  The key is to stretch the anterior musculature (pectorals) and strengthen the posterior musculature.  Here are a few examples of things you can do:

Ok on to Type 2, or overwork muscles of the upper trapezius.  In many individuals, the upper trapezius is a frequently overworked muscle.  This is typically due to weakness of the other back muscles, leaving the upper trapezius to do all the work.  For this scenario, the upper trapezius is actually tight and should be stretched in addition to strengthening of the posterior musculature.  In this case, skilled services from a PT may be necessary as the individual may have issues properly activating the right muscles. But here is a few options you can try out:

Alright, I believe that is all for this post.  Again, please consult with your physical/physical therapist prior to engaging if you are dealing with a specific injury.  Hope this can help ease some of your tension!!

Coming Soon!

Here's a list of what to look out for in the coming weeks:

• What's up with my kneecap? Patellofemoral injuries/pain
• Knee Explosion: Prognosis/Recovery for Ligament/Mensicus Injuries
• Why are My Shoulders So Tense?:  Tightness or Passive Insufficiency?
• SHOES.SHOES.SHOES:  What is right for YOU??

Carlos Boozer Injury Update: Turf Toe?

Per request from the great Cherine K., here is an update in regards to Carlos Boozer, PF for the Chicago Bulls.   I'm sure many of you may be wondering how Boozer ended up with turf toe, when clearly he plays a sport that is played on a wood surface.  Was Boozer participating in some drills on a turf surface when they occurred? Or is this yet another semi-shady incident like his early season hand fracture that required him to get surgery after tripping over his bag.  

Unfortunately for conspiracy theorists, turf toe is a rather common injury whose name arises from its association for sports played on rigid artificial turf surfaces such as football/soccer/rugby.  However, because this injury is common to these sports, does not mean that these injuries are specific to this surface.  

Turf toe occurs secondary to hyperextension of the 1st metatarsophalangeal joint (big toe), resulting in a sprain of the ligaments on both the dorsal and plantar surfaces.  Constant running, planting, and pushing off are all examples of possible methods of injury to obtain this diagnosis. In addition, flexibility of the sole and toe box of athletic shoes can increase the likelihood of injury. Therefore, it makes it easier to see how this injury could occur in a basketball player, just the same as a football player.  The prognosis of this injury is dependent on the severity of the sprain.  A grade I sprain would typically be 1-2 weeks recovery, a grade II sprain (mild/moderate ligament tearing) would mean a 4-6 week recovery, and a grade III sprain might potentially necessitate surgery to repair torn ligaments.  

What is concerning about the Boozer injury is that he "felt something pop" in his right foot, causing him to miss the last 18 minutes of their win against the Pacers. Even though he had a MRI confirming the diagnosis, no word has been released as to the severity of the sprain.  Clinically, normal turf toe would necessitate a 1-2 week recovery period, so it remains to be seen how he will be able to function over the course of a seven game series.  Much like the Derrick Rose injury, he will more than likely be given pain killing injections, but if there is severe tearing of the ligaments, the Bulls may be in some trouble.

I hope this post was educational and useful. I hope everyone is having a great and relaxing weekend.  Until next time!

-Dr. Joshua Cacho, DPT

Disclaimer:
The information, including opinions and recommendations, contained in this website is for educational purposes only. Such information is not intended to be a substitute for professional medical advice, diagnosis or treatment. No one should act upon any information provided in this website without first seeking medical advice from a physical/physical therapist.