Low back pain is an extremely common condition that affects individuals worldwide.  It is estimated that 80% of the population will experience a significant bout of low back pain at some time during the life span, and approximately 25% of adults in the United States will likely have had one entire day of low back pain in the last three months.  Low back pain is the most common disorder managed in outpatient physical therapy, accounting for 50% of all referrals. A common question asked by patients with low back pain is, “do I need an X-ray or MRI of my low back?”

A common concern of patients coming to outpatient physical therapy is whether the condition they are receiving treatment for will require surgery.  Patients presenting with lateral hip pain, or pain located at the outer portion of the hip, are often concerned whether arthritis is causing their pain, and worry that they may require a total hip replacement.  The good news is that lateral hip pain is usually not a result of arthritis, but more likely a condition involving the soft tissues of the lateral hip.

Has your child complained of pain in their feet or ankles during or after sports activity?  In the past, parents and medical providers have been quick to brush these complaints off as “growing pains”.  However, if your child or adolescent is experiencing pain at the posterior side of the heel bone, they may be experiencing a condition known as calcaneal apophysitis, or Sever’s Disease.

Sever’s Disease is a condition in which the growth plate (apophysis) of the heel bone becomes inflamed, typically as a result of repetitive traction forces applied through the calf musculature (gastrocnemius/soleus) and Achilles’ tendon.  Prevalence is greater in those individuals participating in sports or activities involving repetitive or heavier impact loading through the lower extremities, such as soccer, basketball or gymnastics. Ages nine through fifteen are most affected, as the growth plate remains open during this time frame.  Incidence of Sever’s Disease abates as the calcaneal growth plate closes.

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Anterior knee pain, also known as patellofemoral pain syndrome (PFPS), is one of the most common conditions affecting active individuals. It is estimated that 2.5 million runners are diagnosed with PFPS each year, with females being at greater risk. Studies have also shown that PFPS can be very stubborn, with the majority of cases affecting function for at least 5 years, and a very large percentage of individuals suffering more than one episode of pain.

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Frequently, individuals experience shoulder pain without any specific cause or trauma. As most people think, the smart thing to do in this situation would be to stop using the shoulder – avoiding any movement that would cause further pain. In the case of frozen shoulder, or adhesive capsulitis – conventional wisdom in this case is not so wise!

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Recent articles in this series have discussed various conditions affecting the lower leg and foot, specifically Achilles’ tendon injuries, ankle sprains and plantar fasciitis. All of these conditions manifest as pain in different areas of the lower extremity, yet they all have a common link. The shared common factor among these conditions is limited ankle dorsiflexion, or the ability of the distal foot to move upward toward the shin (“toes to nose”). Limited dorsiflexion is commonly seen following ankle sprains and fractures, especially when a period of immobilization follows trauma. This limited mobility can also set the stage for dysfunction (and pain) in other areas of the body, as the body functions as a “kinetic chain”, or an interconnected series of levers and joints. However, limited ankle dorsiflexion is not the only “guilty party” that has a tendency to affect other regions. Limited joint mobility, weakness of specific muscles, or excessive mobility can all have negative effects inother areas of the body.

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Most people have heard of plantar fasciitis and know that it is a fairly common affliction of the foot. But many fewer individuals know what plantar fasciitis is (and how in the world “fasciitis” is actually pronounced!). Plantar fasciitis (“fash-ee-itis”) is a condition that affects the plantar fascia, a band of dense connective tissue (“fascia”) located at the bottom, or “plantar” surface of the foot, typically at the area of the heel bone (calcaneus).  One of the most common foot problems addressed by health care professionals, plantar fasciitis is thought to affect upwards of 2 million Americans per year, and is estimated to affect one in ten individuals during their lifetime.

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Tendon injuries are among the most common injury types affecting the lower extremity, with involvement of the Achilles’ tendon being especially prevalent. Achilles’ pain can affect young and middle age athletes, as well as the less active and older individual. Achilles’ injuries vary in the type of tissue damage involved, and treatment of these injuries can vary dramatically, depending on the state of the tendon. Damage to the Achilles’ can vary from an acute inflammation (“tendinitis”), to a chronic degenerative state (“tendinosis” or “tendinopathy”), to complete tearing or rupture of the tendon.   All three of these conditions generally involve a problem with loading of the tendon, yet each one demands a significantly different treatment approach.

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Ankle sprains are the most common injury of the lower extremity, affecting a large percentage of the sporting population, especially those participating in contact and collision sports such as basketball, football and soccer. Ankle sprains are especially prevalent in younger athletes, with the greatest incidence of injury occurring duringthe mid to late teen years. Ankle sprains are commonly underestimated regarding the functional restrictions that take place and the long-term negative effects that can occur among those affected. Recurrence of ankle sprains is estimated to be as high as 40-70%, especially among individuals participating in higher risk sports. Long-term negative effects can include need for surgical repair of damaged ligaments, and cartilage damage, also known as osteoarthritis. Clearly, the mindset of an ankle injury as “just a sprain” needs to be reconsidered.

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Physical Therapy Intervention to Provide For Safe Return To Activity

As discussed in the previous article on this topic, ACL injury is a very common and debilitating condition. ACL injuries are four to six times more common in female athletes competing in the same sports activities as males. Treatment of ACL injuries can be costly from an economic standpoint – conservative estimates for a single episode of surgery and post-operative treatment range between $17,000-25,000 – as well as have other significant detrimental long-term effects, including decreased academic performance and a 105 times greater risk for radiographically diagnosed osteoarthritis.

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