The spine is the most dynamic structure in our body as it allows for optimal stability and movement and maintains our posture. This highly integrated and dynamic structure is involved in all movement and is undergoing constant stress 24/7, so it should not be surprising to us when it shows wear and tear. Contributing factors to low back pain include poor body mechanics and work ergonomics, decreased strength, and muscular/structural imbalances. As the low back is subject to repetitive stresses of daily life and occasional injury, it may respond by showing signs and symptoms of wear and tear. These symptoms may manifest themselves as pain located around the waistline and/or lower extremities and, possibly, numbness and tingling to the lower extremities. If any of these symptoms persist or worsen, seek immediate medical attention.
Spondylolisthesis is a forward slipping of a vertebra over another. The individual may or may not present with pain and is usually the result of repetitive stress to the spine. A program emphasizing proper body mechanics, aerobic conditioning, lumbar stabilization, core strengthening, and patient education is key to eliminating and preventing low back pain. Individuals with low back pain are encouraged to take a proactive role in their recovery in conjunction with the guidance and supervision of your physician, physical therapist, and athletic trainer.
Low Back Strain:
Muscle strains may occur as a result of poor body mechanics with daily activities/work tasks or unexpected movement, i.e., lifting heavy objects, slipping on ice, or motor vehicle/sports accident. All of these can cause the muscles to contract beyond their normal limits placing stress on the spine. Ice and anti-inflammatories will help reduce pain and swelling. Consult our team of physician, physical therapist, and athletic trainer to get a team approach to your care.
Discs are located between the vertebrae of the spine to help minimize shock and help optimize movement. As we age, the discs lose their elasticity and may tear or bulge resulting in damage to your spinal nerves. This can produce extreme muscle spasms and pain to low back and legs and/or numbness and tingling to legs and toes.
De Quervain’s Syndrome:
This condition involves inflammation of the tendons of the thumb. Pain is very noticeable in the wrist and thumb during general thumb use and during gripping and pinching activities. Conservative management usually consists of splinting the wrist and thumb, along with the use of anti-inflammatories (oral and/or injection). Occupational therapy may also be introduced to restore flexibility to the wrist and thumb, evaluate causative factors, educate on the prevention of symptoms, and strengthen the wrist and thumb to regain function. Therapy may also be prescribed to use thermal or electrical modalities to control inflammation and pain.
Fractures to Hand or Wrist:
A common mechanism of injury is falling on an outstretched arm with the wrist hyper-extended. Proper alignment of the bone(s) is essential for normal healing and restoration of motion. In addition, because of important vessels and nerves surrounding these structures, it is very important to follow up with an orthopedic surgeon or a hand specialist. Treatment generally consists of casting or surgery to stabilize the fracture followed by therapy to regain range of motion of the joints.
Tendonitis, simply put, is inflammation of the tendon. A tendon is what connects muscles to bone, and it typically crosses a joint. Overuse of the joint or muscle causes inflammation of the tendon. Tendonitis is very common in the wrist and hand. Tendonitis of specific tendon(s) can have different names, i.e., De Quervain’s tenosynovitis, Intersection syndrome, finger tendonitis; but treatment is generally the same.
Tendonitis is generally treated with anti-inflammatories to reduce pain and swelling as well as by immobilizing the joints the tendon crosses. Occupational therapy may be prescribed to use thermal or electrical modalities to decrease pain and inflammation, for custom splint fabrication, to learn exercises and stretches to restore muscle and tendon flexibility, and to strengthen the wrist and hand to resume normal use. Your workstation and daily activities may need to be modified to prevent further injury and overuse.
Carpal Tunnel Syndrome:
The carpal tunnel is a narrow passageway in your wrist that allows nine tendons in the fingers and thumb as well as the median nerve to travel into the hand. Pressure inside the carpal tunnel may be increased by repetitive wrist motions, gripping, or sustained wrist and finger positions. This increased pressure on the nerve may cause wrist pain, numbness and tingling in the thumb and first two fingers, and eventual hand weakness.
Carpal Tunnel Syndrome may be managed with anti-inflammatories, with splinting to immobilize the wrist and decrease pressure in the carpal canal. A patient may be referred to an occupational therapist for splinting, nerve and tendon exercises, thermal or electrical modalities to decrease inflammation, and education on prevention of symptoms and activity modification. Our professional staff may also visit your worksite to adjust your workstation and fully optimize good technique to avoid future injury or recurrence. If conservative management is unsuccessful, surgery may be required to decompress the nerve.
There are many forms of arthritis with most forms being categorized as either Osteoarthritis or Rheumatoid Arthritis. Osteoarthritis generally occurs from “wear and tear” on the joints, while Rheumatoid arthritis is actually an autoimmune disorder that attacks the lining of the joints. Both forms of arthritis frequently occur in the wrist and hand. In addition to medical management, occupational therapy may be prescribed. Therapy goals are to decrease joint inflammation, improve joint range of motion, and provide education on joint protection techniques as well as to provide equipment to relieve strain on the affected joints during daily activities. Therapists may also fabricate rigid splints to rest and immobilize joints during a “flare-up” and recommend a variety of soft splints that support joints during hand use.
Trigger finger, also known as stenosing tenosynovitis, can occur in any of the fingers or thumb. It is caused by the swelling of one of the tendons that bend the finger or thumb. This tendon inflammation causes the finger to catch in a bent position. Straightening of the finger will then cause it to snap. Trigger finger can be associated with chronic inflammation (such as rheumatoid arthritis), overuse of the hand, or from using tools with hard or sharp edges. Conservative management may consist of anti-inflammatories or cortisone injections. Occupational therapy may be prescribed for splinting of the hand in order to rest the tendon and prevent triggering, for use of modalities to decrease inflammation, to provide exercises to maintain joint motion, and to provide ergonomic assessment and education.
Mallet finger is an injury to the fingertip. It commonly occurs when the tip of the finger is hit—usually while playing sports such as baseball and basketball. With this injury, the tendon that straightens the tip of the finger is disrupted, and the finger ends up in a bent position. Mallet finger can also be associated with a fracture of the fingertip. Your finger will be splinted or pinned in a straight position until the tendon heals (usually around 6 weeks). The tip of the finger is NOT allowed to bend during this time. You may need to see a specialist if there is a fracture or if the finger does not heal properly.
Tendon/Ligament Injuries to Fingers:
These types of injuries usually occur with direct contact to the fingers (“jammed finger”) or forceful gripping of an object that is moving. Pain may occur with movement, or in some cases, finger movement may not occur at all if a tendon is ruptured. Proper medical attention is necessary to avoid permanent deformity to the finger involved. Immobilization is usually done as required by the physician to allow proper healing of the damaged tissues. Once the splint is removed, occupational therapy will help restore proper motion to the fingers and facilitate the return to full function.
Guyon Canal Syndrome:
This condition involves the ulnar nerve and artery as they pass into the hand at the wrist (on the small-finger side of the hand). It is also known as “handlebar palsy”—named for pressure on the ulnar nerve in the hand from the handlebars of a bicycle during long-distance cycling. Pressure on this nerve causes numbness and tingling in the ring and small finger, pain on the small-finger side of the hand, and eventual hand weakness.
Treatment generally consists of conservative management with the use of anti-inflammatories and/or therapy. Therapy may include splinting of the wrist until the irritation of the nerve subsides, use of modalities to decrease inflammation, activity and tool modification to reduce pressure on the nerve, and strengthening of weak muscles.