Physical Therapy Terms
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What is an ACL?
The anterior cruciate ligament (ACL) is one of four ligaments that form the knee joint. Ligaments are fibrous connective tissues that connect bones to other bones, and the four knee ligaments support the knee joint.
The ACL is located within the center of the knee joint and attaches to the knee at the bottom back of the femur and crosses diagonally through the knee joint to attach at the upper part of the tibia. The posterior cruciate ligament (PCL) crosses the knee joint in the opposite direction, forming an X shape.
The ACL works with the PCL to stabilize the knee joint. The ACL specifically controls the rotation and forward movement of the shin bone.
ACL Injury
The ACL is one of the most commonly injured ligaments in the human body, especially in sports injuries. ACL injuries usually occur suddenly and without warning. Tears and other injuries occur when the ligament is stretched or torn during a sudden twisting motion.
High-impact sports are the most common cause of ACL injuries, but they can also occur due to trauma, such as a car accident or missing a step on a staircase.
The symptoms of an ACL injury include pain, swelling, and knee instability. Treatment for ACL tears often requires surgery to repair the ligament and extensive physical therapy rehab.
What is the Acromioclavicular Joint?
The acromioclavicular (AC) joint is one of the four joints that make up the shoulder complex. It is located at the tip of the shoulder where the clavicle (collarbone) and the scapula (shoulder blade) meet, providing stability and motion to the shoulder complex.
The AC is a plane synovial joint, also called a gliding joint, which enables bones to “glide” past one another in any direction along the plane of the joint. In the case of the acromioclavicular joint, it enables us to raise our arms above our heads.
Because the AC joint attaches the scapula to the thorax, it also helps with the movement of the scapula to provide a greater degree of arm rotation, such as shoulder abduction and flexion.
Acromioclavicular Joint Structure
The AC joint consists of an articulating surface, a joint capsule, and ligaments.
There is an articulation between the lateral end of the clavicle and the acromion of the scapula. The articular facets are incongruent, which means they vary in their configuration.
The AC joint is enclosed by a fibrous capsule. The inner surface is lined with a synovial membrane and is externally supported by ligaments:
- The coracoclavicular ligament is the primary supporting ligament.
- The acromioclavicular ligament reinforces the joint capsule and is the primary restraint to posterior translation and posterior axial rotation at the AC joint.
Acromioclavicular Joint Injury
While the AC joint is strong, it is prone to injury. Acromioclavicular joint injuries are particularly common in contact sports.
The most common type of injury is a separated shoulder, also known as acromioclavicular joint injury. These types of injuries occur after a fall onto the front and upper part of the shoulder when the arm is by the side.
Acromioclavicular joint injury symptoms include non-radiating pain, swelling or bruising, and a deformity in the shoulder (depending on the severity of dislocation).
What are Activities of Daily Living?
Activities of Daily Living (ADLs) is a term that describes the fundamental skills needed to independently care for oneself. ADLs are used to indicate an individual’s function status; difficulties with these activities often correspond to what level of help, supervision, and hands-on care a person needs. Limitations may be temporary due to an injury or surgery, or they may chronic.
Basic Activities of Daily Living
The Basic Activities of Daily Living (BADLs) are basic self-care tasks we are taught as children.
These activities may include the following:
- Ambulating: the ability to walk independently
- Feeding: the ability to feed oneself
- Dressing: the ability to select clothes and dress oneself
- Continence: the ability to control bladder and bowel movements
- Personal hygiene: the ability to bathe and groom oneself and maintain hygiene
- Transferring: the ability to move body positions
- Toileting: the ability to get to and from the toilet
Instrumental Activities of Daily Living
In addition to Basic Activities of Daily Living, there are also Instrumental Activities of Daily Living (IADLs). These self-care tasks require more complex thinking and are things people learn as teenagers/young adults.
Examples of IADLs include the following:
- Managing finances: paying bills
- Shopping: shopping for clothes and other necessary items
- Meal preparation: everything involved with putting a meal on the table
- Housecleaning/home maintenance: keeping up with house chores and maintaining living conditions
- Managing transportation: driving, organizing public transport, etc
- Managing communications: cell phone, mail, email, etc.
- Managing medications: obtaining medications and taking them as directed
ADLS and Physical Therapy
Individuals who have suffered a debilitating accident, illness, or injury may lose their ability to perform simple daily tasks. In these instances, individuals must regain these basic skills and abilities quickly with the help of physical therapy, occupational therapy, and other concurrent programs.
A physical therapist will assess the Activities of Daily Living in patients to determine their functional status and determine a proper course of action. Doctors often recommend physical therapy regimens that improve joint strength and flexibility. Exercises that increase grip strength, gait, and balance can significantly improve overall ADL performance.
Physical therapists can also assist patients to improve tasks that are of specific importance. This includes advanced ADLs such as writing, homecare, and work and meaningful ADLS like sports and hobbies.
Rehabilitative therapy is especially important for stroke patients. A stroke can be emotionally and physically challenging; physical therapy can help a patient regain movement, improve communication, and overall increase quality of life.
What is Ambulation?
Ambulation refers to the ability to walk or move from place to place independently. Various factors can impede a person’s ability to walk, such as injury, surgery, chronic health conditions, and old age. Ambulation is most often used to describe patients post-surgery and those enrolled in physical therapy.
The Importance of Early Ambulation
Patients need to begin moving as soon as possible after surgery, especially older adults. This process is called early ambulation and involves moving patients out of bed as soon as it is medically safe.
Ambulatory activities are light-duty and may include sitting, standing, and walking, with or without assistive devices. Early ambulation is important because movement can prevent postoperative complications.
Moving improves blood flow, which, in turn, can speed up the healing process. Other benefits of early ambulation after surgery include
- Improvements in the gastrointestinal, genitourinary, pulmonary, and urinary tract functions
- Increases in muscle tone and strength
- Shorter hospital stays
If patients remain sedentary after surgery, they can be susceptible to many more complications. These are some problems associated with lack of ambulation:
- Bed sores
- Muscle weakness
- More susceptible to urinary incontinence and infection
- Increased risk of deep vein thrombosis (DVT)
- Increased risk of pneumonia
Ambulatory Devices
Physicians and physical therapists encourage patients unable to ambulate independently to move as much as possible. Sometimes, an ambulatory assistive device is needed.
Ambulatory assistive devices include
- Wheelchairs
- Crutches
- Canes
- Walkers
- Motorized scooters
Sometimes, an ambulatory device may only be required short-term until the patient recovers. In other instances, these devices may be part of a long-term plan.
Physical Therapy and Ambulation
Ambulation exercises are a common goal in physical therapy and rehabilitation. Gait training is a type of physical therapy to improve walking. Gait training is beneficial for restoring ambulation in individuals with the following injuries or events:
- Stroke
- Balance disorders
- Spinal cord injury/paralysis
- Hip or knee replacement
- Leg amputation
- Musculoskeletal disorders
Your physical therapist will recommend exercises and techniques that are specific to your condition, strength, and ability. Length of treatment and use of ambulatory devices will depend upon how quickly you progress.
Ankle Foot Orthosis
Ankle foot orthoses (AFOs) are external biomechanical devices used to treat various walking disorders caused by either neurological or musculoskeletal disorders. AFO devices offer support and control the position and motion of the ankle, compensate for weakness, or correct deformities for the wearer. AFOs can also be used to control foot drop, the inability to lift the front part of the foot.
Who Can Benefit from an Ankle Foot Orthosis?
Individuals who have suffered a stroke or have been diagnosed with multiple sclerosis (MS) and difficulty walking may benefit from an ankle foot orthosis brace. Other common pathologies that can result in drop foot syndrome and require ankle foot orthosis include the following:
- Diabetes
- Peripheral nerve trauma
- Poliomyelitis
- Spinal Stenosis
- Traumatic brain injury
- Neuromuscular atrophy
- Peroneal paralysis
Types of Ankle Foot Orthoses
A typical ankle foot orthosis brace creates an L-shaped frame around the foot and ankle and extends from just below the knee to the metatarsal heads of the foot (balls of the foot).
There are several types of AFOs, including articulated AFOs, Rigid AFOs, and Graphite AFOs. These braces are typically made from plastic, carbon fiber, or metals; rigidity varies depending on the wearer’s needs.
Traditional Plastic AFOs
- Accommodate a wide variety of needs
- Easy to apply
- Plastic is heat-moldable for a more custom fit
- Economical
- Ideal for short-term use
Carbon Fiber AFOs
- Semi-flexible and lightweight
- Open heel design helps avoid contact with pressure points
- Lateral support controls medial instability, ankle pronation, and eversion
- Promotes natural gait pattern
Swedish AFOs
- Lower profile than traditional plastic
- Easy fit and customizable via heat-molding
- Provide moderate lateral stability
- Suitable for moderately active people
Ankle Foot Orthosis Evaluation
Acquiring a prescription for a suitable AFO may require collaboration between different members of your healthcare team, including an orthotist, physical therapist, and referring physician. An AFO evaluation requires an overall assessment of your health, strength, and mobility.
Your physical therapist will pay close attention to your walking pattern and take any underlying diseases into consideration when selecting the appropriate AFO to meet your needs.
Learn more about foot and ankle pain physical therapy and the other ailments we treat on our website or by calling Mid-County Physical Therapy at 703-763-3922.
Physical Therapy Assessment
If you have been referred to a physical therapist for rehabilitation therapy post-surgery or are seeking a non-invasive solution to relieve pain or an injury, your initial visit will begin with an assessment or evaluation. Following the initial assessment, your physical therapist will then be able to diagnose then treat your condition.
During the physical therapy assessment, your physical therapist will ask specific questions about your health and history and perform a physical examination for injury and illness. Using this information, your physical therapist can devise an individualized plan to recover your strength and flexibility and heal you quickly.
At Mid-County Physical Therapy in Woodbridge, VA, we develop specific exercise and rehabilitation programs exclusively for your recovery. We will adjust and modify your individualized treatment program regularly to account for your progress.
What is Included in a Physical Therapy Assessment?
Your physical therapist will begin their assessment with a discussion about your condition. They will ask specific questions during the physical therapy evaluation, and it is important to answer honestly to ensure your plan of care will be the most effective.
Detailed Health History
Here are some of the questions you can expect during your physical therapy assessment:
- Where are you feeling pain?
- What is your level of pain on a scale from 1-10?
- What is your health history (including any preexisting conditions, injuries, medications, etc.)?
- What was your previous level of function before this condition?
- How is your current condition affecting your mobility and quality of life?
With honest answers to these questions, we can help understand your condition and goals for recovery.
Mobility Assessment
In addition to our questionnaire, our physical therapy evaluation will also include a physical examination.
During your physical therapy mobility assessment, you will be evaluated for the following:
- Strength
- Range of motion
- Mobility
- Flexibility
- Posture
- Balance
- Coordination
- Muscle function
- Skin integrity
Post-Assessment Diagnosis and Treatment Plan
Following your physical therapy assessment, your physical therapist will discuss the results of your evaluation and give you their diagnosis. They will work with you and, based on your needs and preferences, devise a treatment plan.
Depending on their findings and diagnosis, they may recommend exercise therapy to improve your strength, mobility, balance, and coordination. They might also recommend dry needling to treat myofascial pain, laser therapy to treat sports injuries, or BioQpulse & Red Light Therapy for back problems.
At Mid-County Physical Therapy, we treat a wide variety of ailments with high-quality customer service and patient care.
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What is a Bone Fracture?
A bone fracture is a medical condition where a break, either complete or partial, occurs in the structure of a bone. In some cases, the break may be two clean pieces. In other cases, there are multiple fragments that can complicate the healing process.
Here are some of the most common types of fractures:
- Closed fractures: a fracture where all fragments are contained within the limb
- Open/compound fractures: fractures where the bone is protruding from the flesh. In some cases, they may need to be realigned within the flesh before they can be set.
- Comminuted fractures: fractures where the bone has splintered into multiple pieces.
Compound fractures have the highest potential to be severe.
Bone Fracture Causes and Prevention
The most common cause of bone fractures is physical trauma, either low or high energy. The most common high-energy trauma fracture cause is a vehicle crash injury. The most common type of low-energy trauma fracture cause is at-home falls.
Consuming vitamin D and calcium greatly lowers the risk of fractures, especially in older adults. The best preventative measures for fractures include reducing distractions while driving, keeping cords out of high-traffic areas in the home, and keeping stairways well-lit.
Bone Fracture Treatment
The first stage of any bone fracture treatment is immobilization, usually with a cast or splint. Once the bone has regained load-bearing strength, the next stage of treatment is physical therapy.
The longer the bone remains isolated, the harder it will be to regain the full usefulness it had prior to the break. Physical therapy for a bone fracture will involve regaining full motion of the affected area and strength training to get it back to full capacity.
For adults, it takes about 3 months for a fracture to heal to the point where the bone can bear 80% of its original weight. Depending on the location of the fracture, complications such as turning of the bone prior to healing can result in non-union (the bone remaining permanently unhealed) or malunion (the bone healing improperly).
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What is a Herniated Disc?
A herniated disc, or Spinal Disc Herniation, is an injury to the tissue that cushions the vertebrae, in which the tissue weakens or is destroyed. Characteristic herniated disc symptoms include back pain, a burning sensation or numbness in the legs and feet, and weakening of bladder or bowel control.
Herniated Disc Causes
Here are some of the most common causes of a herniated disc:
- Regular stress on the vertebrae
- Spinal trauma
- The worsening of a disc protrusion
Minor herniation typically heals in weeks to months, whereas major herniation may never heal without surgery or other intervention.
Herniated Disc Treatment
Most herniated disc treatments can be done without surgery or invasive practice. If the disc is a Lumbar disc, non-surgical methods will be attempted first. Surgery will be considered if the disc is causing significant leg pain, weakness, or loss of bowel control.
Typically, other less invasive methods will be attempted as the risk-reward ratio of a possible surgery is weighed. If there is no other option, patients may be prescribed painkillers to begin exercising and stretching to prepare for the surgery.
Physical therapy can be beneficial for anyone suffering from a herniated disc. A physical therapist can provide education on proper body mechanics, such as posture, to maintain the healing effects and prevent another disc herniation. Physical therapy for disc herniation includes improving posture and sleeping position, as well as upright exercises such as jogging to regain lost strength and increase range of movement.
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Lumbar Pain
The lower back, or lumbar region, is the area that starts just below the ribcage. Lumbar pain is a common condition affecting about 10% of the population at any given time. Severity is classified by how long the lower back pain lasts; acute pain lasts less than 6 weeks, sub-chronic pain lasts between 6 and 12 weeks, and chronic lower back pain is pain lasting more than 12 weeks.
Lumbar Pain Causes and Prevention
Lower back pain is usually the result of a sprain or strain on the lumbar vertebrae. However, it rarely has a single cause and is usually the result of several factors at once.
Common factors that increase the likelihood of lumbar pain include obesity, smoking, unexpected weight gain (such as during pregnancy), poor health, stress, or improper sleeping position. Poor, hunched posture over a long period of time is also a causal factor.
The best way to prevent lower back pain is to exercise regularly; recurring lower back pain is often the result of the weakening of the muscles that support the spine over time. Understanding proper lifting techniques (for example, lifting heavy objects with the legs instead of the back) is also an important preventative measure.
Lumbar Treatment
The most common form of treatment for lower back pain is physical therapy. Typically, your physical therapists will recommend exercises to increase the strength of the muscles that support the lumbar spine. During physical therapy, patients will also be educated on good posture and sleeping position to improve and maintain spinal health.
In cases of severe chronic pain, medications such as acetaminophen or skeletal muscle relaxants may be prescribed. Most patients suffering from lumbar pain recover within 6 weeks.
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What is a Rotator Cuff?
The rotator cuff refers to a group of muscles and tendons within your shoulder that protects your shoulder joint. The rotator cuff keeps the ball of the humerus (upper arm) in the shoulder socket. The rotator cuff has two main functions: it protects your shoulder joint and allows you to move your arm over your head.
There are four rotator cuff muscles: Supraspinatus, Infraspinatus, Teres minor, and Subscapularis. Each of these muscles plays a role in various upper extremity movements, including flexion, abduction, internal rotation, and external rotation. They are also vital to shoulder movement and function.
Rotator Cuff Injury
Rotator cuff injuries are common among certain athletes and can occur from daily wear and tear and overuse. Partial rotator cuff tears are among the most common types of rotator cuff injury. They are more likely to occur among tennis and basketball players or in occupations that require repetitive arm movement, such as as a painter.
Other common rotator cuff injuries and disorders include rotator cuff tendinopathy (formerly called tendinitis), bursitis, calcific tendinitis, and impingement.
Rotator Cuff Injury Treatment
Treating a rotator cuff injury rarely requires surgery. The most common treatment options for rotator cuff injury include rest, NSAIDs, physical therapy, corticosteroid injections, and dry needling.
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Thoracic Back Pain
Thoracic spine pain, commonly called middle back pain, is pain radiating from the thoracic vertebrae, located between the lumbar vertebrae and the cervical vertebrae.
Middle back pain is much less common than lower back pain, as the middle back is strong and holds up much less weight than the lower back. Occasionally, persistent middle back pain can be indicative of a more serious underlying issue, such as cancer.
Thoracic Back Pain Causes and Prevention
It is difficult to pinpoint the exact cause of most thoracic pain cases, as they often heal before the cause is identified. Some of the typical causes for middle back pain include low upper body strength, bad posture, high-energy trauma (like a car accident), or overuse of the muscle group. Loss of bladder control or leg strength should be treated cautiously, as it could indicate a more serious illness.
There are only a few preventative measures or practices to help prevent middle back pain. If you sleep on your back, changing your sleeping position may help. Additionally, correcting posture while sitting or standing can also help to prevent thoracic back pain.
Thoracic Back Pain Treatment
There are several treatment options for middle back pain, such as massage therapy, hot/cold therapy, or analgesics. Physical therapy in the form of thoracic spine mobility exercises is also necessary to return the middle back muscles to their previous strength and maintain mobility during the healing process. Thoracic physical therapy consists of exercises such as rolled towel extensions, wall rotations, and side-lying rotations.
What is a Total Knee Replacement?
Total knee replacement, or knee arthroplasty, is a surgical procedure to replace the damaged surfaces of the knee joint with artificial components.
During the surgery, a surgeon removes damaged cartilage and bone from your knee joint and replaces them with a man-made plastic cup and metal support. The artificial joint is designed to provide pain relief, improve function and mobility, and reduce the risk of developing arthritis in the future.
Total knee replacement surgery is most commonly performed on people who have severe arthritis that causes pain while walking or participating in daily activities, who have had several years of nonsurgical treatments (such as physical therapy) that haven’t helped relieve their symptoms, or who have developed complications from other treatments.
Total Knee Replacement Recovery
While total knee replacement surgery is a common surgery, it is a major operation. The recovery process will vary from person to person, but you should be able to return home after one or two nights in the hospital. Carefully following your surgeon’s instructions will get you the best results and the shortest recovery time.
The recovery process includes several stages of healing and post-op rehabilitation. After surgery, swelling and pain are common. You may need help getting around on crutches for about six weeks after your surgery. After that, physical therapy is needed to help you regain strength and range of motion in your new knee joint. This can take several months or more, depending on how active you were before having surgery.
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