Are you having trouble performing a full depth squat? Can’t keep your chest up or your heels are coming off the ground? We can help you reach your crossfit or gym session goals. A physical therapist is a musculoskeleton expert, examining how the body performs and functions. At Pacific Physical Therapy our physical therapists can evaluate your

First, we assess your mobility of the ankle, knee and hip 

Research shows that adequate ankle mobility for a full depth squat is between 20-30 degrees relative to a person’s height and structural proportions. Hip and knee flexion are approximately 125 respectively for a squat depth of at parallel or below.  

Are there asymmetries in range of motion at the hips and knees? Is hip external rotation the same bilaterally? The FABER test is a good way to assess hip external rotation differences. 

Second, we assess your neuromuscular control

Trial doing a squat with a light weight or kettle bell with arms outstretched – Better?  

Start doing squats with anterior counter weight and progress from arms outstretched to holding weight in at chest or front rack position. Perform squat in a slow and controlled manner with attention to form for appropriate muscle recruitment.  

Core stability is also important with maintaining appropriate pelvic positioning and reducing the “butt wink” effect at the bottom of the squat 

Finally, we look at stance 

A taller person will need a wider stance to allow a full depth squat with good body mechanics.  

Torso length affects the amount of lean as well, longer torso will have to lean farther forward to maintain center of gravity.  

The goal is to reduce the distance from the center of gravity, therefore the vectors of the legs and trunk from that point will need to be longer – meaning the width of a person’s stance will have to be wider.  

We can help you reach your full depth squat but customizing a treatment plan to address your mobility or muscular deficits. These treatment plans are individual to you to help you reach your goals.

Click here to request an appointment and one of our staff will reach out to you. 

Or give us a call at 360-329-7052 to reach our Port Orchard Office or 360-625-9161 to reach our Silverdale Office, both located in Kitsap County

Brianna Cook PT, DPT is a physical therapist specializing in orthopedic conditions.  

References –  

Endo Y, Miura M, Sakamoto M. The relationship between the deep squat movement and the hip, knee and ankle range of motion and muscle strength. J Phys Ther Sci. 2020;32(6):391-394. doi:10.1589/jpts.32.391 

Kim SH, Kwon OY, Park KN, Jeon IC, Weon JH. Lower extremity strength and the range of motion in relation to squat depth. J Hum Kinet. 2015;45:59-69. Published 2015 Apr 7. doi:10.1515/hukin- 2015-0007 

Neck Pain After a Car Accident 

Neck pain is unfortunately a common injury after a car accident. Depending on the severity of the accident, x-rays of the neck may be indicated. Clinicians will likely use the Canadian Cervical Spine Rule to determine if radiographic images are necessary. A dangerous mechanism of injury includes a fall from greater than 3 ft, axial load to the top of the head (diving), a high-speed car accident (>100 kph), rollover accident, ejection from a car, motorized recreational activities, or bicycle struck by a collision. In these cases of a dangerous accident, x-rays will be ordered. After fractures and any other serious, emergent conditions of the spine are ruled out, you may be referred to physical therapy. 

In 2017, a new clinical prediction guideline (CPG) was released by the American Physical Therapy Association (APTA). This guidelines suggested that there are three possible outcomes for those who are experiencing neck pain with a whiplash associated disorder. About 45% of people will have mild disability, 40% with moderate disability, and 15% with severe disability. The most recovery will occur in the first 6-12 weeks after the injury which is the critical window for healing and treatment.  

There are 5 risk factors that may indicate persistent problems after the injury. The first is a high pain intensity, defined as >6/10 on the Numeric Pain Rating Scale. Second is a high self-reported disability score based on the Neck Disability Index, specifically a score of >30% disability. The third risk factor is high pain catastrophizing. Based on the Pain Catastrophizing Scale, a score of > 20 is a risk factor. Fourth is high acute post-traumatic stress symptoms, and a score of > 33 on the Impact of Events Scale (revised) indicates higher risk for persistent symptoms. The final risk factor is cold hyperalgesia or pain induced with a cold temperature. 

Treatment 

Now let’s talk about various treatment options for those in the three categories of early recovery, prolonged recovery, and chronic symptoms. In the early recovery group, there is emphasis on staying active and performing pain free mobility. These patients will likely heal on their own with monitoring of symptoms from the therapist.  In those with a prolonged recovery, the therapist will emphasize active range of motion, low load strengthening, and manual therapy. It will be important for your therapist to supervise those exercises to ensure proper muscle activation, promote optimal coordination, and increase awareness of proper posture. In the group with more chronic symptoms, education will be emphasized based on the patient’s individual and realistic prognosis. Your therapist will also perform cervical mobilization and individualized progressive exercise.  

While there are a lot of specific details in this blog post, it is your therapist’s responsibility to best hypothesize the patient’s prognosis after a car accident. It is especially important to explain the mechanism of injury to the best of your ability and provide a timeline of your symptoms. Your therapist will review this information in addition to your initial paperwork to develop your individualized plan of care for physical therapy.  

If you have experienced a motor vehicle accident and need an evaluation, our clinics in Port Orchard and Silverdale will help you know what is the best way to address your injury.

Click here to request an appointment and one of our staff will reach out to you. 

Or give us a call at 360-329-7052 to reach our Port Orchard Office or 360-625-9161 to reach our Silverdale Office, both located in Kitsap County

Jill Hoffman PT, DPT is a physical therapist specializing in treating orthopedic conditions

References 

1. Blanpied, Peter R., et al. “Neck Pain: Revision 2017.” Journal of Orthopaedic & Sports Physical Therapy, vol. 47, no. 7, 2017, https://doi.org/10.2519/jospt.2017.0302. 

Experienced a knee injury? Physical Therapists are experts in musculoskeleton conditions and will be able to easily assess your knee injury. Pacific Physical Therapy located in Port Orchard and Silverdale in Kitsap County has those experts on hand.

Meniscus Injuries 

The meniscus serves as a cushion in your knee joint. Meniscus injuries are the most common knee injuries. They are commonly injured with the ACL and sometimes the MCL. There are two common types including traumatic tears and degenerative tears. Younger patients often injure the meniscus during a traumatic event such as playing a sport and twisting on a planted leg. Older patients often have chronic injuries that occur overtime rather than one specific incident. Females, older individuals, higher body mass index, lower physical activity are at higher risk for meniscus tears. In addition, those with increased age and delayed ACL reconstruction are at risk for developing a future meniscus tear.

Diagnosis and symptoms

Some signs of a meniscus tear include a twisting injury, tearing sensation at the time of injury, feeling a “catching” or “locking” sensation, or tenderness along the sides of your knee. One may experience delayed swelling in the knee that begins 6-24 hours after the injury. Your therapist may also perform some special tests in the clinic to determine a possible cause of your knee pain.

Treatment Plan for a Torn Meniscus

There are various treatment options for a torn meniscus including conservative management (physical therapy), partial meniscectomy, or total meniscectomy. The research has shown that patients who opt for nonoperative management, including physical therapy, have similar to better outcomes in terms of strength and perceived knee function in the short and intermediate term compared to those who have a partial meniscectomy.

Physical therapy treatment for a meniscus injury occurs in stages. Initially, it is important to promote progressive motion in the knee. Next, you want to be able to isolate contraction of all muscles surrounding the knee to provide increased stability. Eventually, you will progress gross strengthening of the legs in functional movement patterns such as squatting. Finally, your therapist will direct you in specific treatment and exercises for return to sport such as balance and agility. The specific course of treatment will depend on if you’ve had surgery or not and what kind of surgery is performed. Your therapist will work with you and your surgeon to follow specific protocols to get you back to your prior level of function without limitations.

If you have experienced a knee injury and need an evaluation, our clinics in Port Orchard and Silverdale do an injury screen to help you know what is the best way to address your injury.

Click here to request an appointment and one of our staff will reach out to you. 

Or give us a call at 360-329-7052 to reach our Port Orchard Office or 360-625-9161 to reach our Silverdale Office, both located in Kitsap County

Jill Hoffman PT, DPT is a physical therapist specializing in treating orthopedic conditions.

1. Logerstedt DS, Snyder-Mackler L, Ritter RC, Axe MJ; Orthopedic Section of the American Physical Therapy Association. Knee pain and mobility impairments: meniscal and articular cartilage lesions. J Orthop Sports Phys Ther. 2010 Jun;40(6):A1-A35. doi: 10.2519/jospt.2010.0304. Erratum in: J Orthop Sports Phys Ther. 2010 Sep;40(9):597. PMID: 20511698; PMCID: PMC3204363.

Most of us have heard the song, “Well, your toe bone connected to your foot bone. Your foot bone connected to your heel bone…” but how often do we stop to actually consider how the mechanics of one body part can affect the other.  I’ve already written a blog about how strengthening the hips is beneficial for reduction of knee pain. Today I want to talk about a joint even further from the hip that can be negatively impacted by hip weakness: The ankle.  

The foot-ankle complex is a high repetition machine and when functioning properly, it can accommodate thousands to tens of thousands of steps per day. When it is not functioning correctly however, it can make every single step very painful. If you’ve ever walked with a rock in your shoe, you can imagine what ankle tendinopathy (tendon dysfunction) feels like. One type of ankle tendinopathy is called posterior tibial tendon dysfunction and research 1&2 is now pointing to hip weakness as a correlation.  

If you are up for a little experiment, try standing up in a normal stance with feet spread shoulder width apart with your shoes off. Feel how much of the arch of your foot is contacting the floor. Now, without lifting your feet, pull your knees inward towards each other and feel the arches of your feet flatten further. In contrast, pull your knees outward without lifting your feet and you may feel yourself start to tighten your glutes as your arches start to lift upward. Imagine how important this is if you take 10,000 steps per day and how weakness in the hips and glutes can contribute to pain and dysfunction at the ankle. 

The Journal of Orthopaedic & Sports Physical Therapy published an article in 20111 which highlighted the correlation specifically in women. The study found that women with posterior tibial tendon dysfunction demonstrated both ankle and hip muscle weakness. Another research article in the same journal2 concluded that increased foot pronation (foot flat position) is hypothesized to place greater strain on the posterior tibialis muscle. If you participated in the experiment above, you can see the direct relationship between hip and overpronation. 

This specific type of dysfunction is often found in runners, but also in those who suddenly try to increase their walking distance. Here at Pacific Physical Therapy, we have therapists who look to address issues all along the chain to make sure you can return to an active lifestyle. We assess ankle strength, joint mobility, hip strength, hip mobility, balance, footwear and various factors that can contribute to pain and dysfunction. If you have been putting up with nagging arch and foot pain, now is the time to get physical therapy and have a skilled professional help create a plan tailored to treating and correcting your dysfunction.

Alicia Gilfoy, PT, MPT is a physical therapist who has been treating in the outpatient orthopedic setting since 2007. 

1. J Orthop Sports Phys Ther 2011;41(9):687-694. 
2. J Orthop Sports Phys Ther 2011;41(10):776-784 

Frozen Shoulder

What is Frozen Shoulder?

Frozen Shoulder also known as Adhesive Capsulitis is an idiopathic condition when the shoulder joint becomes inflamed. More specifically, it includes synovitis in the glenohumeral joint, thus the connective tissue within the shoulder becomes inflamed. The cause of adhesive capsulitis is unknown at this time. However, there are some populations when this condition is more common including individuals with diabetes mellitus or thyroid disease, those who are 45-60 years old, females, and individuals with a previous occurrence of frozen shoulder in the opposite arm. 

Prognosis

This condition often lasts for 12-18 months depending on each individual’s symptoms and pathological involvement. The progression of frozen shoulder is often broken down into four different stages including pre-adhesion, freezing, frozen, and thawing stages. The pre-adhesion phase can last 1-3 months. Individuals often describe pain at the end ranges of movement, achy pain at rest, and difficulty sleeping. Next, the freezing stage can last from 3-9 months, and individuals experience progressive loss of motion in all directions. The third stage, also known as the “frozen stage” is when there is continued pain and loss of motion. This can last from 9-15 months. The fourth and final stage known as the “thawing stage” is when pain begins to resolve but there is lasting stiffness in the joint which can persist from 15-24 months since the initial onset of the condition. Although this can be a lengthy process, physical therapy can help during the various stages of the condition.

How can PT help?

Your physical therapist can perform a thorough examination to help determine the diagnosis of adhesive capsulitis and the stage of the condition. Research has shown that the most effective intervention is corticosteroid injections in conjunction with shoulder mobility and stretching exercises to reduce pain. Physical therapy can also assist in providing different modalities including diathermy, ultrasound, or electrical stimulation to help reduce pain in the shoulder. During the thawing stage of the condition, therapists may perform joint mobilizations to progressively regain motion in the affected shoulder. There are various ways physical therapists may assist individuals in management of their pain and provide activity modification techniques to continue to participate in daily life.

Jill Hoffman, PT, DPT is a physical therapist specializing in treating orthopedic conditions. 

If you had physical therapy for neck pain 20 years ago, you might have pointed to the pain and had a therapist apply passive modalities such as ultrasound, heat or ice to the affected area. The field of Physical Therapy and the associated research has come a long way to help us understand what treatment techniques are more and less effective in today’s fast paced world. This article will address some treatment techniques that you may or may not be familiar with and that we offer at Pacific Physical Therapy. 

When a patient begins treatment for neck pain, a thorough history including the cause of the symptoms and positions/activities that reproduce symptoms or alleviate symptoms will be completed. The therapist would also most likely assess range of motion, muscle tenderness, joint mobility, neural tension (if complaints of symptoms radiating into the arms are present), muscle strength, posture, and proprioception. [Proprioception is the body’s ability to have internal knowledge of the position of a specific joint or muscle in relation to the rest of the body.] The answers to these tests and questions can direct a physical therapist to the treatment options most appropriate for the patient.  

Neck pain can be caused by a variety of dysfunctions, but generally it falls into two categories: Onset with an injury such as whiplash or onset without an injury, which is generally postural or degenerative. With whiplash type injuries, there is research that shows that “ability to reproduce a target position of the neck” does diminish.1 This is much like the way that balance/proprioception in an ankle may be limited after an ankle sprain. Other research indicates that proprioception can be trained and improved upon.2 Here at Pacific Physical Therapy, we use Motion Guidance for many of our patients to retrain the neck’s sense of positioning. This option is not only beneficial for pain reduction and neuro-muscular re-education, but it can also be fun! Using visual feedback while tracing lines and designs can help your brain sync the movement patterns and improve the sense of where the neck is in relation to the head and body. 

Another research-based treatment options for patients with neck pain is cranio-cervical flexion training – also known as deep neck flexor strengthening. This type of strengthening has been shown to be very effective at reducing neck pain, both in patients with whiplash who have reduced strength in this area and patients with postural dysfunction.4 This means it can be very beneficial for people who fall into both the injury and no injury categories. The way I typically like to describe this treatment method is that it is similar to strengthening the core to reduce low back pain. The deep neck flexors are basically the core for your cervical spine. It can be challenging to contract the correct muscles without a skilled therapist to guide you through the exercises initially, but the exercises can be done at home once the correct form and technique is learned. 

At Pacific Physical Therapy, we strive to ensure that each patient’s care is individualized with treatment options that help them achieve their goals. Part of our job is to use our skills and knowledge to help reduce pain through manual therapy skills such as muscle energy techniques, soft tissue mobilization, joint mobilizations. We may also utilize some of the “old fashioned” modalities if deemed appropriate. The way I see it though, the most important part of our job is to give our patients the knowledge and skills they need to return to living a lifestyle that includes the ability to participate in activities that give them joy.  

Alicia Gilfoy PT, MPT has been treating patients with vestibular conditions for 9 years and has taken additional coursework to ensure a comprehensive diagnosis and treatment plan for her patients.

1. Loudon JK, Ruhl M, Field E: Ability to Reproduce Head Position After Whiplash Injury. Spine. 1997, 22: 865-868.  
2. Izquierdo TG, Pecos-Martin D, Girbés EL: Comparison of Craion-Cervical Flexion Training Versus Cervical Proprioception Training in Patients with Chronic Neck Pain: A Randomized Controlled Clinical Trial. J Rehabil Med. 2016, 48: 48-55. 
3. G Jull, E Kristjansson, P Dall’Alba: Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients. Manual Therapy. 2004, 9: 89-94. 
4. Edmondston SJ, Wallumrød ME, MacLéid F, Kvamme LS, Joebges S, Brabham GC: Reliability of isometric muscle endurance tests in subjects with postural neck pain. J Manip Physiol Ther. 2008, 31: 348-354.