What is a SLAP lesion and how is it treated?

Have you been diagnosed with a SLAP tear, or know someone who has a SLAP tear? Chances are you are probably reading this post because you do. So, what is a SLAP tear anyway? SLAP is the acronym for Superior Labrum Anterior-Posterior lesion, which is a tear in the superior posterior labrum of the shoulder.

The shoulder joint is a ball and socket joint, which can be depicted like a golf ball on a tee for comparable size ratio.

The lip of the tee is what keeps the golf ball on the tee and prevents outside forces like a gust of wind from knocking the ball off. The labrum in the shoulder is responsible for keeping the ball, or head of the humerus, in the socket. If there is a tear in the labrum, the ball can roll out of the socket. This is termed instability in the shoulder joint, which can be painful clicking with arm movement, decreased or apprehensive range of motion, and decreased function.

The superior portion of the labrum is naturally more prone to injury, due to the reduced blood supply to this section. Therefore as we age, there is a decreased potential for healing because our blood supply decreases overtime. Many SLAP tears are a result of wearing down of the labrum that occurs slowly over time. In patients over 40, tearing or fraying of the superior labrum can be seen as normal process of aging. Acute injury to the labrum can cause a tear resulting from a motor vehicle accident, a fall onto an outstretched arm, forceful pulling on the arm, such as when trying to catch a heavy object.  In overhead athletes such as throwers, swimmers, and tennis players, a SLAP lesion usually occurs as a result of a peel-back mechanism when the shoulder is in maximal external rotation.

Peel back mechanism occurs in the late cocking phase of a pitcher’s mechanics

SLAP lesions may occur in isolation or in conjunction with other injuries such as a rotator cuff tear. Research has shown that as much as 73% of baseball pitchers with SLAP lesions also have partial thickness tears of the rotator cuff. And 80-90% of baseball pitchers have some sort of labral pathology.

Common symptoms of a SLAP tear are similar to many other shoulder problems, which include

• A sensation of locking, popping, catching, or grinding
• Pain with movement of the shoulder or with holding the shoulder in specific positions
• Pain with lifting objects, especially overhead
• Decrease in shoulder strength
• A feeling that the shoulder is going to “pop out of joint”
• Decreased range of motion
• Pitchers may notice a decrease in their throw velocity, or the feeling of having a “dead arm” after pitching.

If these symptoms are affecting your everyday function or your ability to complete work tasks then a visit to the doctor will help identify the cause of your pain.

During your visit, your doctor will talk with you about your symptoms and ask about any work activities or sports that aggravate your shoulder. They will also check your range of motion, strength, and stability of your shoulder. The results of these tests will help your doctor decide if additional testing or imaging is necessary.

Imaging tests utilized to identify a possible SLAP lesion are x-rays and magnetic resonance imaging (MRI) scan with contrast. X-rays create a clear picture of dense structures, like bones. The labrum of the shoulder is made of soft tissue so it will not show up on an x-ray. However, your doctor may order x-rays to make sure there are no other problems in your shoulder, such as arthritis or fractures. The MRI with contrast will be able to clearly show any tear or dysfunction of the labrum.

Left: Normal Labrum, Right: SLAP Tear identified.
(MRI with contrast)

Once the dysfunction has been identified the SLAP tear is either treated with nonsurgical or surgical options. Nonsurgical options include non-steroidal anti-inflammatory medication (ie ibuprofen or naproxen) to reduce pain and swelling. Physical Therapy is another non-surgical option your doctor may provide to restore movement and strengthen your shoulder. If nonsurgical options do not improve your pain or function then surgery may be recommended to correct the labrum dysfunction. Based on the identified dysfunction, the SLAP tear is either repaired or debrided surgically.

SLAP repair vs. debridement have different rehabilitation protocols. In general, a debrided SLAP lesion is when the labrum has frayed edges and has been cleaned up (i.e. like you would cut the frayed ends off of a piece of fabric). A repaired SLAP lesion is one in which the labrum or lip, had to be tacked down to the “tee” again (i.e. like nailing down a loose shingle to your roof after a flap of it broke free in a recent storm.) A patient with a debrided labrum can be progressed much faster than one who has their labrum repaired, as there was no tissue that was surgically repaired. However, the debrided tissue may be irritated from the injury or from the surgery itself, and the patient should be progressed as tolerated. 

After a labral repair, it needs to be protected while the labrum heals. To keep your arm from moving you will most likely using a sling for 2 to 4 weeks after surgery. Once the initial pain and swelling has settled down, your doctor will start with physical therapy. The physical therapist will follow a protocol that includes gentle stretches, range of motion exercises, and eventually strengthening. Based on your rehabilitation, your doctor will discuss with you when it is safe to return to sports activity. In general, throwing athletes can return to early interval throwing 3 to 4 months after surgery.

After surgery the majority of patients report improved shoulder strength and less pain. Because patients have varied health conditions, complete recovery time is different for everyone. Although it can be a slow process, following your surgeon’s guidelines and physical therapists’ rehabilitation plan is vital to a successful outcome. Elite Sports Medicine and Physical Therapy’s therapists have experience with returning patients to their desired goals or athletes back to their sport of choice after the diagnosis of a SLAP lesion. Contact us to see how we can help you get back to the activities you love.

Do you suffer from Tension Headaches?

If so, then you are among the 30-80% of the U.S. adult population who suffers from occasional tension headaches. Approximately3% suffer from chronic daily tension headaches. Women are twice as likely to suffer from tension-type headaches as men. Mostpeople with episodic tension headaches have them no more than once or twice a month, but the headaches can occur more frequently. Chronic tension headache suffers can have headaches for more than 60-90 days.

So what causes Tension Headaches?

There is no single cause for tension headaches. This type of headache is not an inherited trait that runs in families. Tension headaches are usually triggered by some type of environmental or internal stress. The most common sources of stress include family, social relationships, friends, work, and school. In some cases, tension headaches are caused by tightened muscles in the back of the neck and scalp. This muscle tension may be caused by

• Inadequate rest
• Poor posture
• Emotional stress, including depression
• Anxiety
• Fatigue
• Overexertion

 Unlike migraine headaches, there are no associated neurological symptoms (muscle weakness or blurred vision) with tension headaches. In addition, severe sensitivity to light or noise, stomach pain, nausea, and vomiting are not symptoms usually associated with tension headaches.

 How are tension headaches treated?

The goals of treatment for tension headaches are to prevent further attacks and relieve any current pain. Your physician may prescribe medications such a pain relievers, muscle relaxants, or antidepressants. Medications do not cure headaches and over time, pain-relievers and other medication may lose their effectiveness. Identifying the stressors or factors that may be triggering your headaches is very important in alleviating your pain.  Physical Therapy is another option that your physician may perscribe or recommend.

 How can Elite Sports Medicine and Physical Therapy help?

Elite’s physical therapists will conduct a through examination that includes a review of your health history. The therapist will ask you questions and will perform tests to determine the most likely cause of your headaches. Listed below are some questions our therapist may ask to help identify causes.

• You will be asked :
  • To recall any pervious injuries to your neck, head and jaw
  • The location, nature, and behavior of your pain and other symptoms
  • To draw your areas of pain on a body diagram
  • Perform tests of muscle strength and sensation
  • Examine your posture with sitting, standing, and performing various activities
  • Measure the range of motion of your neck, shoulders, and other relevant parts of your body,
  • Use manual therapy to evaluate the mobility of the joints and muscles in your neck

 If it appears that you do have tension-type headaches, our physical therapists will work with you to design a plan of care to meet your goals. If the evaluation indicates that you may have a different type of headache—such as sinus, migraine, or cluster headache—the physical therapist will refer you to another health care professional for additional diagnostic tests and treatment.

 Elite Sports Medicine and Physical Therapy’s therapists will work with you to correct the problems that are causing your pain and will help you learn to prevent headaches through simple changes to your posture and lifestyle.

 Based on the identified problems your Plan of Care may include:

 Improve neck mobility: Our use specialized techniques called manual therapy and trigger point dry needling to increase movement and relieve pain and to stretch the muscles of the back of the neck.

 Improve your strength: We will teach you exercises to increase the strength of the muscles that help stabilize your upper back and neck to improve your posture and endurance and make it easier for you to sit or stand for longer periods of time without discomfort.

 Improve your posture: Elite’s therapists will teach you ways to improve your posture. Whether it is simply pushing your chest out or pulling your shoulders blades backwards and together, slight modifications to everyday living can make a vast improvement in posture.

 Modify your workstation or home office: Tips may include:

• Using a headset instead of a regular phone
• Adjusting your computer screen so that it is  no lower than the level of your eyes
• Finding an appropriate desk chair
• Adjusting the position of your computer mouse

See if Elite Sports Medicine and Physical Therapy can help you alleviate your headaches and provide you with the necessary tools to prevent them in the future.

Shin Splints slowing you down?

Since the weather has turned from grey gloomy skies of winter to the sunny blue skies of spring and summer, our desire to be outside and be active increases. Not to mention we are all trying to get ready for bathing suit season. Most of us put on our running shoes and hit the streets to burn those extra calories off, but how many of you have been put on hold because of shin splints? 

Shin splints are a common aliments among runners. This conditions is usually associated with an abrupt change in activity level. Like most of us during the winter months our activity level decreases and we become more sedentary and then the weather changes along with our activity level. BANG the perfect environment for shin splints to develop. 

Other common names for shin splints are soleus syndrome or tibial periostitis, but the proper medical terminology is medial tibial stress syndrome. As this name suggests, this condition involves the overload (stress) of the medial (inner border) part of the tibia (shin bone).

If the problem persists and does not resolve, it is recommended you seek an evaluation by a sports medicine professional to rule out other diagnoses such as a stress fracture, posterior tibial tendon disease, and exercise-induced exertional compartment syndrome.

The diagnosis is typically made by physical examination, with tenderness along the inside area of the leg. PlainX-rays usually do not show any changes. Advanced imaging, such as bone scan and MRI can sometimes be performed and help confirm the diagnosis, but is usually not necessary.

The mainstay of treatment is rest to allow the tibial bone to heal. Other treatments that may help include:

• Physical Therapy treatment

• Orthotics (specifically those with arch support)

• Non-steroidal anti-inflammatory medicine

• Ice

To help avoid shin splints, we recommend runners to be vigilant in allowing adequate time to increase training demands, as well as run in a properly-fitted, well-cushioned running shoe. Cross training is also another important aspect when allowing down time for the shins to heal. Elite Sports Medicine and Physical Therapy provides its runners with custom made orthotics to correct identified biomechanics that may be predisposing them to shin splints. We can help you keep on running and not let your shins slow you down. 

What is Dry Needling and how does it work?

Do you have knots in your muscles or aches and pains that just seem to hang around no mater how many stretches you do or massages you get?  If so, then you may want to look into dry needling. What is dry needling?  Is it acupuncture? And how does it work? These questions are the most frequently asked by patients, physicians, athletes, and physically active individuals. This post is going to describe what dry needling is and how it can alleviate trigger points or “knots” in muscles and the pain they produce.

Dry needling is a broad term for a manual therapeutic technique that involves multiple advances of a filament needle into the muscle region, which produces pain and typically contains a trigger point. Most patients are uneasy with the idea of a needle puncturing the skin, but most will not even feel the needle penetrate the skin. Once the needle is in the muscle, the feeling of discomfort can vary considerably from patient to patient. Usually a healthy muscle will produce very little discomfort with the insertion of the needle, however, if the muscle is sensitive and has an active trigger point the patient may feel the sensation of a muscle cramp. This response is commonly referred as a “twitch response”. Besides the muscle cramp sensation or an active twitch of the muscle, the patient may feel referral of pain or reproduction of the symptoms they are seeking to relive.

So how does dry needling differ from acupuncture? After reading the procedure of dry needling it does sounds like acupuncture. However, acupuncturists utilize needles to correct the energy flow of the body or “chi”, chronic health and neurological conditions through the guidance of meridian lines, tongue and pule examination, and acupuncture points. Dry needling addresses purely the dysfunction of the muscle through extensive palpation to identify the unhealthy muscle tissue.  So the only similarity is the use of needles, but the theory behind the treatments are very different. 

Dry needling is an effective treatment for acute and chronic pain, rehabilitation from injury, and even pain and injury prevention, with very few side effects. Most common side effect is muscle soreness 1-2 days after treatment, which can be alleviated by drinking plenty of fluids and the application of heat. Besides the treatment of dry needling the practitioner will provide corrective exercises. These corrective exercises are specifically designed to provide a positive environment to allow for correction of the unhealthy muscle tissue habits. This technique is unequaled in finding and eliminating muscular dysfunction that leads to pain and functional deficits. Typically positive results are apparent within 2-4 treatment sessions, but also depend on the severity of the condition, overall health of the patient, and the experience level of the practitioner.

So the next time you are finding lingering symptoms from knotted muscles and lack of results from a deep tissue massage or stretching. Maybe you should address the issue further through dry needling. Elite Sports Medicine and Physical Therapy will be providing this manual treatment technique when its doors open at the end of April. 

One step closer!!

As the old saying goes, good things come to those who wait. After signing the lease back in November, we finally have an occupancy date of April 26^th!  Since April is right around the corner, everything has been kicked into high gear. Construction has been underway for the past week and progressing quickly.

In the meantime, we have been given the task of picking out finishes for the space. After looking through all the options, we finally decided upon the final selections. We started the process by picking out a carpet to set the base color to play off.  Then the game of which one looks better rendered the wall colors, wall base color, door stain color, and counter top laminate selections.  Sounds like it went quickly, but really it took like three weeks to get this all completed then about a week of second-guessing the selections.  Either way the selections have been sent off to the contractor and ordered from the respected vendors. We wanted Elite to look crisp, clean and of course Elite! It will be nice to see it all come together in the end to see if our vision of the office is just how we wanted it.  Below are the pictures of the selections we made for the office.

Carpet then left to right wall base color, counter top laminate, and cabinet/door stain color

Crisp Linen for main wall color and then the blue above for accent wall color. Again carpet and wall base color

Stay tuned to hear more updates on Elite’s progression toward opening day. Don’t worry we will have pictures of everything as the construction progresses.

The build out process…one word…..UGH!

 

Above is the space for Elite. Currently, we are still at this stage because there are many untold details of the build out process. Since being let go from my job at the end of November, due to being a competitor. I have been left to worry through out this whole process of untold details.  First off, you have to agree upon plans that are submitted to the architect. Once these plans are approved by the architect they need to be sent off to the MEP, which is the mechanical, electrical, and plumbing. The MEP plans have to go through each individual department with their separate plans and details. After each department has put in their two cents about their part in the process the plans are collected by the project manager. See this first process sounds like it goes quickly, but in all honestly it took a month and a half. 

Now on to the submission of the plans to the county. When plans are submitted to Prince William County it automatically takes 3 weeks because it is considered a medical office. The plans go through the same process with each department reviewing the plans and chiming in with their comments. As of right now our first round of comments should be in on 2/12.

From this point their is job to fix any issues with the plans and resubmit. After they are resubmitted it is a 9 day turn around from the county for a response. So there goes another two weeks at the best. If all goes well with the correction then permits will be granted and we can start the build out process. Phew….remember we signed the lease for the space back in November. So as you can see their is a lot more that goes into this process then is described by the project manager, let alone giving you a estimated opening date. As of right now our estimated occupancy date is May 1st. 

In the meantime, I have kept myself busy with various tasks that need to be completed before opening the doors to a practice. We have worked with a graphic designer to design a logo and business cards. Opened a business account with the seed money necessary to get things going. Picked through various equipment catalogs to get together a bid for our physical therapy  and office equipment. Along with starting a Facebook page and now a blog. Everyday I try to figure out other tasks that can be completed in the meantime before our doors open. 

Well, as you can see the build out process is not something to taken lightly or underestimated. It has many nooks and crannies that are not reviled until you are going through the process. Even though we have made it thus far and are slowly inching toward that opening date. Positive thoughts and projects get me through this down time. 

It is weird being on the other side of the coin. I am your typical worker or I guess a-typical worker considering how things have changed in the working world. I never took time off and even came in if I was sick and able to work. Either way we are more forward and soon enough I am going to be so busy I can’t keep myself going. Honestly, I can’t wait! Continue to follow for more updates in the build out process. 

Welcome to Elite Sports Medicine and Physical Therapy’s Blog

Elite Sports Medicine and Physical Therapy would like to welcome you to our blog! We are a privately owned physical therapy clinic in Gainesville, Va. We currently are going through the build out process for the clinic space and tentatively looking to open the doors in Mid April. We wanted to start this blog for various reasons. First off to keep you updated on how the build out is progressing. Then once up and running we will use this blog to keep you updated on current physical therapy rehabilitation treatments, information on sports injuries and also how to improve sports performance. So please follow us as we start this journey as new business owners!