Contemplating a total joint replacement? Hopefully, I can help in your decision. After teaching joint replacement classes, the pre and post op, I've made several observations while doing so, but I would like to start by saying that pain will change your decision making and some tolerate it better than others. Sometimes, it will drive you into the quickest pain reducing decision which is understandable. I think we can all agree that keeping your original "parts" is always the best option and exhausting all of the conservative treatments prior to surgery should be recommended by your physician. One of those treatments should be physical therapy. I've spoken about mechanics in the past and how they influence the wear and tear on your joints like the tires on your car. If they are not balanced properly, you will get less life out of them. The hip musculature is often overlooked in knee rehab and is crucial in knee health because it controls the rotational forces at the knee. Ever stand up from a chair and feel like your knees want to move inward? That's glute weakness - yes, your butt is weak! Your knees, of course, do not want to move in that direction and it will cause stress on the structures surrounding the knee. Strength of the lower extremity will also help to distract the knee joint providing increased joint space. Just because your x-ray shows decreased joint space, that does not mean it is the source of your pain. If I had a dollar for everyone who said they had "bone on bone" in their joints, I would have my student loans paid off! You could x-ray the entire population of those over 55 and find poor joint space on x-ray, but it does make a good selling point. In health care, we need to start treating the patient first and not the imaging. There are several structures that surround the hip and knee joints that can mimic your pain and believe it or not, your physical therapist is trained to figure that out! I'm not here to discourage you from having a joint replacement, I just want to educate you on your options. You have to go through the extensive rehab after and you will benefit greatly from doing some strengthening before, so why not try therapy and possibly avoid the surgery altogether?!
Thank you for reading and please share so that we can all BeneFIT!!!

www.ScottRusin.com

It is pretty often that I see people rub their shoulder while they are at the gym working out. They appear healthy and most often have no mechanism of injury, meaning that nothing traumatic has happened to the shoulder to create the pain. It is what us physical therapists call, insidious onset. Well, guess what? Your gym routine is probably the cause of the pain. How? Most gym routines focus on the big movers, the muscle groups that are the largest and are the so called, "show muscles" (pecs, lats, deltoids).  These large muscle groups are big internal rotators of the shoulders and therefore, turn the shoulders inward or round out your posture. This is a problem for the shoulder because it causes impingement symptoms, which is the pinching sensation you get when you lift your arm. It is your body's way of telling you that the muscles that do the opposite motion, external rotation, are not doing their job. They be can strengthened easily through exercise and I will provide a sample of exercises. 
Another problem that seems to have emerged is the repetitive use of kettle bells when lifting overhead. The unnatural movement of the wrist forces the shoulder to impinge on the soft tissue in the shoulder, most commonly in those who have not developed the proper rotator cuff strength. The muscles of the posterior (back) shoulder are very important in shoulder health and often neglected in workouts. They help to open the space between the bone on the top of the shoulder, the acromium, and the head of the humerus, the ball and socket joint. In therapy, we often stretch the large muscle groups and combine that with scapular strengthening (muscles of the upper back). The muscles of the rotator cuff are small and delicate, requiring low resistance and high repetitions to strengthen. You don't want to train these muscles like the pecs and lats because they can tear.  Also note that during any lat exercise, try and squeeze with the shoulder blades to encourage the upper back to engage.

I often include the door stretch for periods of longer than 30 seconds, multiple times. This is effective in stretching the pecs which may become dominant from too much bench press.

I also like to include external rotation exercises like the one here. It doesn't have to be this exercise because there are several that you can benefit from, but these therabands seem to be in most gyms. High repetitions, low resistance. Make sure you keep the shoulder from lifting up during the exercise. Keep both shoulder level at all times and make the shoulder blade move the arm instead of the arm moving without the shoulder blade.

These are just two exercises to get you started. Please share so everyone can BeneFIT! Any questions, please ask in the comment section or email me at [email protected].

While working as director of the rehab department for Twin Cities Hospital 2 years ago, I did a talk for a group of city workers that performed some labor intensive work. My topic was low back health, something that I had already spent a lot of time teaching to new employees at the hospital. I raised the question, "how many of you have low back pain?". There was well over 60 people in front of me and to my surprise, 90% of them raised their hands. So, my curiosity led me to my next question, "What do you do for it?". I had two responses, chiropractor and pain pills! I'm not here to pick a fight with chiropractors, but I will with pain pills! Lets get something straight, most low back pain is simple mechanics, muscular balance, and a little strength. The sooner you address it, the easier it typically is to fix. Pain pills will help you deal with the symptoms, but the pain is most likely to return because the underlying cause of the pain is not addressed. Often, what we find in older, chronic low back pain is tightness in the front of the hips from a lifestyle that encourages extensive sitting combined with weakness of the glutes (butt muscles) from a lack of activities that target these muscles. I cannot say this for all backs as each individual is different, but generally speaking that is something I see very often. Upon initiation of treatment by a physical therapist you should see progress within the first couple of visits and not have to sign up for 6 months. Refer also to my trigger point blog because there are also trigger points deep within the hip rotators that can mimic sciatic pain. You can crack and pop a joint all that you want, but once again, the mechanics have to be addressed at some point. In physical therapy, we incorporate soft tissue work in the form of myofascial release, massage, trigger point release etc., combined with stretching of the musculature or joint mobilizations to assist restricted joints. We follow that up with exercise to re-educate the musculature to do its job properly. Who else legally does that? We have progressed as a profession into movement specialists and continue to advance. The most recent research is starting to prove that physical therapy is more effective than surgery in some instances. 

Please feel free to contact me if you have questions regarding back pain. My email is [email protected] or set up an appointment at Sandestin Physical Therapy Services (850)267-6755.
Please share so that we can all BeneFIT! 
“You have not lived today until you have done something for someone who can never repay you.” 
- John Bunyan

If you didn't notice, I'm a physical therapist and truly believe in what our profession does in the grand scheme of health care. Sometimes, I feel that we are on the low end of the totem pole, but have the potential to save the health care system large amounts of the green stuff. People tend to fear us because of the mantra "no pain, no gain" or "physical terrorist", but I think our profession has really progressed over the past several years into more of a biomechanics specialty or movement specialist with emphasis in manual therapy techniques (massage, mobilizing stiff joints, stretching, etc.) allowing us to treat much more effectively. So, what better way to kick off this BeneFIT blog than to explain how us physical therapists can help. 
I spend a lot of time educating potential clients on how correcting muscular imbalances can greatly relieve tension and pain. I like to think of your joints as tires on your car. If they're balanced properly, you get more life out of the tire. Joints act the same way. When you lack symmetry between one side and the other because of tightness or weakness, you may create torsion on the back creating pain, for example. Before you have surgery, I strongly encourage you to try a conservative approach and go see a physical therapist to assess your mechanics while attempting to correct them. "A recent study from Finland asserts that when it comes to treatment of nontraumatic rotator cuff tears, physical therapy alone produces results equal to those produced by arthroscopic surgery and open surgical repair. According to the study's authors, follow-ups of 167 shoulders treated show that "conservative treatment should be considered as the primary treatment for this condition."