Did you watch the super bowl? Did you hear the announcers say “ACL”?

Joe Burrow, the starting quarterback for the Cincinnati Bengals tore his ACL two years ago, and during the game, former New York Giants wide receiver (currently on the LA Rams) Odell Beckham Jr. tore his!
ACL stands for Anterior Cruciate Ligament. 

What is it?

It’s one of the primary ligaments in the knee, along with the Posterior Cruciate Ligament (PCL) Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL)
So how does an ACL tear?

The majority of ACL tears come from non-contact injuries - when a person themselves places great force or movement on their knee to cause injury. They can also tear with contact injuries which is when there is a valgus force (force from the side) on the knee from the force of another person. 

In field sports a big culprit of non-contact ACL tears is from what we call the “turf monster”. This is when the turf catches the person’s foot while they’re running or trying to come to a stop on the field. Which is how Odell Beckham Jr. tore his ACL.

There is also an increase in ACL tears among women, most likely due to the Q Angle  (The angle between the hip and knee) - something that we will touch on in more depth on another Five Minute Friday episode.
Rehab for an ACL tear typically involves surgery as there is poor blood supply to this ligament. Therefore, it’s unlikely to re-heal itself. ACL tears are generally replaced by a graft of another tendon, such as:
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• Patellar tendon (most common)
• Hamstring tendon
• Allograft - tendons from a cadaver 
• Gracilis tendon (least common)

Generally a return to sports is a 9 month timeline, obviously there are always outliers (Adrian Peterson) but 9 months is a framework that most protocols revolve around. 

We will go more in depth of return to sport on another episode of 5 Minute Friday. Stay tuned!

Thanks for reading!


By: Dr. Tony Tanzi, PT, DPT, CSCS and Dr. Kyle Ioos, PT, DPT

You're fresh out of surgery and you arrive to physical therapy in your sling. You're not allowed to move your arm but your physical therapist is... 

This is what we call manual therapy.

It's when a physical therapist is doing any skilled intervention (treatment) with their hands.

There are 3 main reasons to do manual therapy:

Reduce Pain
Improve tissue tension
Improve mobility / range of motion

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These are all great to do at the early stages of treatment, meaning in your first few visits due to the higher level of pain you are experiencing. As your pain decreased we will transition you off of manual therapy and onto more functional based exercises. We broke down manual therapy into six different types:

1. Passive Range of Motion:
This is when a Physical Therapist is moving your limb through a motion and you are
totally relaxed, letting the therapist do all the work.

2. Joint Mobilization
This is when the Therapist will try to loosen a specific joint capsule, again with you the
patient being totally relaxed

3. STM or MFR
Soft tissue massage or Myofacial release are two types of “massages” to relieve tissue
tension.

4. Transverse friction massage
This is usually performed across a healed scar or over scar tissue in a “transverse”
direction to aid in breaking up scar tissue.

5. Strapping
A massage is done on a muscle while there is movement.

6. Effleurage
Primarily used to decrease swelling of the limbs in post surgical patients. This type of
manual therapy gently attempts to circulate the swelling back into the system.

Manual therapy is NOT what we would call instrument assisted therapy (IASTM). This type of therapy is when a Therapist uses tools (graston tools, cupping tools etc) to assist with the manual techniques.
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It is important to note that manual therapy is best used at the early stages of your treatment. As you progress it is vital to transition to more functional based activities and exercises. This helps you the patient regain independence and get back to living an active lifestyle!

By: Dr. Kyle Ioos, PT, DPT and Dr. Tony Tanzi, PT, DPT, CSCS

“I have pain that starts in my low back and goes down my leg, what is it?

Ah, yes, good old - SCIATICA!

What is sciatica you ask?

Sciatica is nerve pain in your lower back that radiates down your leg and is caused by an
irritation, inflammation or pinching of a nerve in the lower back. The most common cause is a herniated disc or slipped disc.

Did you know?

The sciatic nerve is the longest and thickest nerve in the body.

What does Sciatic pain feel like?

Sharp, shooting, jolt, burning, electric or even jabbing pain that travels anywhere from your buttock down to your toes.

But I have pain in both legs, is that Sciatica?

Although it is unlikely to be affecting both legs, it CAN happen.

Does sciatica happen suddenly or slowly over time?

Both - Sciatica can come on suddenly or gradually. It all depends on the cause. A disk
herniation will cause sudden pain where arthritis in the spine will develop slowly.

Who is at risk for sciatica?

- Anyone with a previous back injury - any injury to your lower back puts you at risk.
Overweight - Increased weight or load on your spine can lead to back strains and pains
Lack of core muscles - the core is what protects your spine and gives you support.
Manual labor or active jobs - heavy lifting / bending puts you at high risk
Have osteoarthritis - any damage to your spine will compromise the nerves
Inactive lifestyle - prolonged sitting or not being active can make your muscles stiff can increase your risk
Pregnant women - certain hormones of pregnancy cause loosening of ligaments making the spine less stable

What are the common causes of Sciatica?

Herniated or slipped disc
Degenerative disk disease (natural wear down of the discs between the vertebrae of the spine)
Spinal stenosis (narrowing of the spinal canal)

How do you diagnose Sciatica?

PTs use what's called a Straight Leg Raise Test

MDs can use:
X-rays
MRIs
Nerve Conduction Velocity test
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How is Sciatica Treated?

Various manual techniques, stretches and exercises all go into a proper sciatica plan of care.

If you or someone you know are suffering from Sciatica pain or discomfort, text
BACKPAIN to (845) 225-2000 and I will send you a video with 3 simple exercises to help
alleviate or reduce your pain!

Don’t wait, text BACKPAIN to our number (8452252000) and you can get started in
reducing your discomfort!

We get this all the time:

“On my script it has ultrasound checked off. I just want to know what is ultrasound and what is it used for?”

There are two types of ultrasound: Diagnostic and Therapeutic.

Diagnostic: Sound waves are used to create a real time image
Therapeutic: (What we use) To put it simply, the ultrasound machine produces an electrical current that is converted into acoustic energy through the transducer.

In order for this acoustic energy to be absorbed into the body, we use a coupling agent. This is where the blue gel comes into play. This gel decreases acoustical impedance by eliminating as much air as possible. This allows us to more effectively direct this energy to our target area

Why do we use it?

Therapeutic ultrasound is considered a deep heating agent, so unlike moist heat and hot pads, ultrasound can increase tissue temperature at a depth of 5 cm. This allows us to more effectively treat deep structures like muscle. Ultrasound has the potential to decrease pain, muscle spasms and joint stiffness as well as help facilitate tissue repair.
We personally like to use ultrasound early on in a patient's rehabilitation when movement and exercise is contraindicated or not well tolerated. 

​With that said, ultrasound is not indicated for everyone and their are contraindications that your therapist must screen for prior to providing treatment
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Isn’t soup the best? Especially this time of the year - who doesn’t love a cup of hot, healthy goodness? They’re also so easy to make and require very little clean-up (most of the time). 
I find myself gravitating to creamy vegetable soups most of the time and I hardly ever follow a recipe. I throw 3-4 different veggies into a large pot, add desired spices, boil them in broth/water until tender, then add in a can or two of light coconut milk (depending on how much I’ve made) and blend it all together with an immersion blender. I also love serving it over some rice - which makes it much more filling.
    If I am following a recipe (or using one for a frame of reference), the first two recipes below are my go to. The third soup is one I haven’t made yet but it definitely on my Soups-To-Make list:


1. Vegan Broccoli Cheddar Soup

• 3 potatoes, chopped
• 2 cups broccoli
• 1/2 cup nutritional yeast
• 1 tsp garlic powder
• 2 cups water 
• Instructions: In your instant pot combine all of your ingredients except the nutritional yeast. Cook on sealed/high pressure for 15 minutes. Once done add in your nutritional yeast and lightly blend with an immersion blender. Add salt to taste. Serve over rice with additional nutritional yeast.

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2. Split Pea Soup

• 1 cup dry split peas *soaked overnight
• 2 large carrots, chopped
• 2 stalks celery, diced
• 1/2 a large onion, diced
• 1.5lbs of potatoes, chopped (about 8 small or 3-4 large)
• 5 cups water
• 2 tbsp Italian seasoning
• 1 tsp salt (plus more to taste)
• Instructions: On the stovetop add in your peas, onions and salt with 5 cups of water and bring to a low boil. Cover this and let it cook while you prep all your other ingredients. I like to cook the peas a bit by themself so that the veggies don't get super overcooked but this also is not necessary. Add in the rest of your ingredients, bring the soup back to a low boil, cover and cook for about 40 minutes. Once the soup is done I like to lightly blend it with an immersion blender. If you let it cool a bit it will thicken a lot! Then adjust the seasonings adding more salt to taste or black pepper and serve alone or over rice.

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 3. Knoephla Soup

Soup:

• 3 tablespoons unsalted butter
• 2 large carrots, chopped
• 2 celery stalks, chopped
• 1 large onion, chopped
• Kosher salt and pepper
• 2 garlic cloves, minced
• ½ teaspoon ground nutmeg
• 10 cups chicken or vegetable broth
• ½ teaspoon dried thyme, chopped
• 4 springs fresh dill, chopped
• 2 bay leaves
• 1 ½ pounds red potatoes, chopped into ½-inch pieces
• ½ cup heavy cream​

Knoephla:

• 3 ¼ cups all-purpose flour, plus more for dusting
• 1 ½ teaspoons baking powder
• 1 ¼ teaspoons kosher salt
• Freshly group black pepper
• ⅛ teaspoon group nutmeg
• 1 large egg 

Instructions: For the soup: Melt the butter in a large pot over medium-high heat. Add the carrots, celery, onions, a good pinch of salt and a few turns of pepper and cook, stirring often, until the vegetables soften, about 10 minutes. Add the garlic and nutmeg and cook, stirring, until fragrant, 2 more minutes. Stir in the stock, herbs, bay leaves and potatoes. Increase the heat to high and bring to a boil. Reduce the heat to a simmer, then cover and cook for 40 minutes.

​For the knoephla: Meanwhile, whisk together the flour, baking powder, salt, a few turns of pepper and the nutmeg in a medium bowl. Stir in 1 cup (236 grams) water and the egg and mix to form a shaggy dough. Turn it out onto a clean work surface and knead it for a few minutes, adding flour as needed, until you have a smooth and stiff dough. Roll it into a 1/2-inch-thick blob, then cut into 1/2- to 3/4-inch squares, dusting with flour so they don't stick together.When the soup has 20 minutes left of simmer time, add the knoephla directly to the soup and continue to simmer.
Stir in the cream. Taste and adjust the seasonings as desired. Remove the bay leaves before serving. 
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If you try one of these recipes, be sure to let me know the next time you stop into the clinic! 

By: Chloe, Patient Success Coordinator 

Squats:
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Stand with feet shoulder width apart and toes pointed forward to slightly turned out. Bend knees and lower buttock towards floor keeping your back straight and bending at your hips. Perform 3 sets of 10 to 15 repetitions. 

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​By: Dr. Josh Hammond, PT, DPT