Rehab FAQ

Runner's Clinic | Orthotic Management | Falls & Balance | Pelvic Floor Dysfunction | Modified Barium Swallow Study

Runner's Clinic

Why do I get knee pain when I run? I never have it any other time.

This can occur for any number of reasons.  Running is much different than normal walking and much more stressful for your joints. When your foot hits the ground while running, within milliseconds your knee is loaded with up to three times your body weight, and it is the knee's job to absorb all the shock that isn't dispelled by the foot and ankle. Any weakness or malalignment in the kinetic chain (foot/ankle, knee/hip) will make you susceptible to pain in any or all of these joints.

What are "shin splints," and what causes them?

The term “shin splints” is a global term that encompasses a number of different lower leg disorders. Among these are medial tibial stress syndrome (periostitis), deep posterior compartment syndrome, tibial stress fractures, and exertional compartment syndrome. Most runners incur leg pain as a result of localized repetitive trauma to the musculoskeletal structures of the lower leg. The most common diagnosis in this population is that of Medial Tibial Stress Syndrome. Most cases of shin splints are due to over training or increasing running time too quickly. Some cases are caused by the shock of running on a hard surface such as asphalt or hard ground. Still others may be biomechanically related to over- or under-pronation.

How can I get rid of my shin splints?

First, what is causing the shin splints has to be determined by a physician or a physical therapist. If it is over-training, a curtailment of the exacerbating exercise would be a good start. Then begin anti-inflammatory modalities both topically (ice) and internally (ibuprofen, naproxen, etc.) as directed by your physician. If it is being caused by shock, sometimes just a shoe change or foot orthotics are needed to help mitigate road shock and/or control foot motion.

How do I know if I'm a pronator or a supinator?

First of all, pronation and supination are both normal foot motions. It is only when we have too much or too little of these motions that it becomes problematic. Usually, if you are an over-pronator, you will begin to experience some sort of lower extremity pain which onsets somewhere along the inside aspect of the foot/ankle or knee. Some people over-pronate but experience no pain. If you are an over-supinator, pain usually occurs along the outside aspect of the foot/ankle, leg or knee. This is caused by poor shock absorption since the foot cannot absorb it properly in this position. Most over-supinators experience problems early in their running careers and need special shoes and/or orthotics.

Orthotic Management

If I wear foot orthotics, will my bunions go away?

No, orthotics cannot correct pre-existing bony malalignments. They are, however, effective in preventing bunions or arresting their further development.

Do I have to wear my orthotics all the time?

That depends on the condition for which you are being treated. Some conditions are only problematic during high impact or prolonged activities. If this is the case, your therapist may only requrie that you wear your orthotics during these types of activities. Other conditions require you to wear your orthotics for most all weightbearing activities. Most people can get away with occasional wear of dress shoes (e.g. going to church, going out to dinner, etc.) if they are diligent about wearing their orthotics at all other times.

Can I wear my orthotics in all types of shoes?

No, probably not. In order for orthotics to be effective, they must be worn in very supportive shoes. The last or form of the shoe is very important since it provides the base of support for the orthotic. Shoes that are straight or board-lasted are best.

What type of foot ailments can be treated by the use of foot orthotics?

We treat a wide range of foot problems with foot orthotics. Remember, some type of pathology is causing the problem and if the problem can be traced to one of a biomechanical origin, we will try custom orthotics to correct the problem. Conditions like plantar fasciitis (heel pain), tarsal tunnel syndrome, fallen arches, metatarsalgia (ball of foot pain), bunion pain, great toe pain, ankle soreness, etc. are all included.

Can orthotics help my back and knee pain?

Sometimes knee and back pain are caused or exacerbated by lower extremity malalignments. If flat or high arched feet are causing these malalignments, foot orthotics can sometimes be effective in relieving the pain by realigning the lower extremities into a more functional position.

Will my insurance pay for the cost of the orthotics?

Typically, insurance companies do not pay for the orthotic devices. Most insurance companies, however, will pay for the exam. Whether your particular insurance will or will not pay for the devices can only be determined by calling them and inquiring.

Falls & Balance

I tend to avoid doing things I used to enjoy because I am afraid that I will lose my balance and fall. Is there something wrong with me or is it just old age?

The answer to both of those questions is no. There are a lot of older people who feel this way and it is not abnormal. As we age, we lose neurons (brain cells) that are responsible for allowing us to maintain our balance. By age 60, almost 50% of these neurons are lost. Along with this, we tend to lose some of our flexibility and reaction time. These factors all cause a decrease in balance and confidence in our ability to react to perturbations to our balance. With added safety awareness and an active lifestyle, some of these factors can be eased enough to allow some individuals to be more confident in their daily activities. Others may need to seek professional help like the Human Performance Lab to overcome their confidence problems and be given advice as to what they need to resume their normal lives.

If my doctor sends me to the Human Performance Lab for a balance/fall risk assessment, what should I expect?

Typically, this assessment takes approximately 75-90 minutes to complete. It involves a complete medical history, physical exam, balance screening and, if then deemed appropriate, an equilibrium evaluation in the Smart Balance Master.

What is the Smart Balance Master?

The Smart Balance Master is a computerized device that through a series of tests can determine in what system or systems of balance your deficit lays. Humans have three systems of balance: somatosensory (gravitational pull on the body), visual, and vestibular (inner ear). When any of these three systems are compromised, a balance problem ensues. The Balance Master also has a treatment mode that can be programmed to a specific patient's needs.

What are some of the common risk factors for falls?

Clinicians categorize fall risk factors as either intrinsic (factors that are due to our bodies) or extrinsic (factors that have to do with our environment). Intrinsic factors would include: loss of flexibility and coordination, muscle weakness, balance deficits, vision impairment, medications, gait anomalies, and decreased cognition. Some Extrinsic factors would be: insufficient lighting, loose or plush rugs, small pets, stairs, bathrooms without handrails and debris in the walkways.

My doctor told me I should us a cane while walking. I walk just fine around my house; why do I need one?

You may be fine when you are at home in familiar surroundings, but that is much different than when you are out on uneven terrain or without something to grab on to if you lose your balance. Your physician knows how much of an inconvenience it is to carry a cane, so if he or she orders one, it is necessary.

Pelvic Floor Dysfunction

How do I talk to my healthcare provider about my problem?

When you bring the subject up, be honest. Tell him or her that you are embarrassed about the topic, but you really want help. Tell your provider that you are having pain or problems doing things you used to be able to do. This includes sexual relations. There is no need to be shy about talking about something that is a normal part of life.
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What is a “Kegel” exercise?

Kegel exercises are named after the first physician to describe this contraction. A Kegel is a contraction of your pelvic floor muscles (often referred to in the media as the PC, or pubococcygeus muscle) and is more accurately called a “pelvic muscle contraction” or a “pelvic muscle exercise”.
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What should I expect on my first visit for Urinary Incontinence?

At your first visit, a physical therapist trained in pelvic floor muscle dysfunction will do an in-depth evaluation. This will include a general medical history, a history related to your current condition, and questions about your eating, drinking, and voiding habits.
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What is Pelvic Pain?

Pelvic pain is described as pain in the lower abdomen, pelvis, or perineum and is considered to be chronic when symptoms have been present for more than six months. The pain may be described as aching or burning in the area of the perineum or abdomen.
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What is Urinary Incontinence?

There are several types of urinary incontinence, but in general incontinence refers to the leakage of urine at inappropriate times:

  • Stress incontinence is leakage of small amounts of urine when there is increased pressure on the bladder. This can happen with exercise or with sneezing, coughing, lifting or other activities.
  • Urge incontinence is the leakage of medium to large amounts of urine when a person feels a sudden strong urge to urinate.
  • Mixed Incontinence includes symptoms of both stress and urge incontinence.
  • Functional Incontinence is urine leakage that occurs when a person can not get to the toilet in time.
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What kinds of prenatal and postpartum issues can physical therapy help with?

Physical therapists are skilled in evaluating and providing patient centered treatment of musculoskeletal problems. Physical therapists trained in the area of women’s health have further knowledge about issues directly related to women as they move through different stages of life, from childbearing years to the post menopausal period. Physical therapists can provide hands on treatment to address spinal and pelvic joint dysfunction, instruct in exercises to address muscle weakness and imbalance, and provide guidance and instruction related to modifications of activities of daily living that may be difficult during the prenatal and postpartum phases.
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Modified Barium Swallow Study (MBSS)

What is a Modified Barium Swallow Study (MBSS)?

When you have a swallowing test in the speech language pathologist's (SLP's) office or in your hospital room, the SLP can't see what is happening inside of your mouth and throat. The MBSS lets the SLP see:

  • If food is going into your airway instead of your stomach, call aspiration
  • Which parts of your mouth and throat may not be working well
  • What kinds of food are safest for you to swallow
  • If certain positions or strategies help you swallow better

Babies and young children can also have this test done. Your SLP can tell you more about what to expect for your child.

What should I expect at my Modified Barium Swallow Study (MBSS)?

This study is done in the radiology, or X-ray department. You will meet the speech-language pathologist (SLP) there. There may also be a doctor there, called a radiologist. A radiology technician will be there to help you get ready and set up the equipment.

You will sit or stand next to an X-ray machine. Your SLP will give you different foods and drinks mixed with barium. The barium makes the food and liquid show up on the X-ray. Barium is not harmful and won't stay in your body for too long. The X-ray machine is only turned on while you swallow so you don't get too much radiation.

The SLP will ask you to do different things during the test. You may try soft foods and hard foods, and thin liquids and thick liquids. You may take small amounts and large amounts. You may be asked to move your head in different positions. You may also try things like swallowing hard. The test may be recorded so it can be watched again later.

If your child is having as MBSS, you may be asked to hold him/her in your lap. You will be given protection from X-rays, like lead vests and cover ups. You may feed your baby from a bottle if that is how he/she eats. Barium is not dangerous for babies or young children. You may see it in the baby's diaper for few days after the study.

You should not have this test done if you think you may be pregnant. It is not safe to have X-rays while pregnant.

What happens after the study?

Your speech-language pathologist (SLP) and doctor will talk about what they saw during the study. You and your family will be told the results. The SLP may show you the video of the test so you can see what happens yourself.

Your SLP will use the test results to decide what treatment will help your swallowing. You and the SLP will discuss what foods and liquids are safest, and how to eat them. You may start swallowing therapy soon after the study.
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