Sports Physical Therapy

The Achilles tendon is band of tissue that connects the calf muscles (gastroc and soleus) to the heel bone (calcaneus). The Achilles tendon can be injured in a few different ways, but the two most common injuries are Achilles tendonitis and Achilles tear. Achilles tendonitis is an overuse injury that occurs most often in runners who suddenly increase the duration or intensity of their runs, middle aged people who play sports on the weekends only, and dancers who repetitively jump from a deep squat position. Most cases of Achilles tendonitis can be treated with a course of sports physical therapy, but the more severe cases can lead to an Achilles tear or rupture, which may require surgical repair.

If surgery is needed to repair a torn Achilles tendon, you will most likely be required to walk with no weight on the operated foot for some time and then in a walking boot. The duration of non-weight bearing and immobilization will depend upon the severity of the tear that was repaired. After this period your ankle will most likely be stiff, all of the muscles in your leg will be weak, and your balance on that leg will be limited. This is where physical therapy comes into play. With specific manual therapy techniques, exercise instruction, and balance/gait training, a physical therapist will restore your previous function and help you get back to your sports and recreational activities.

The anterior cruciate ligament (ACL) is a very important ligament in the middle of the knee that connects the thigh bone (femur) to the shin bone (tibia) and prevents the tibia from sliding out in front of the femur. The ACL is a strong ligament but can be overstretched or torn in certain situations, such as knee hyperextension, a blow to the outside of the knee during something like a football tackle, or a foot plant/pivot after running or landing a jump. The ACL can be partially or completely torn. A partially torn ACL does not necessarily need to be surgically repaired and can respond well to a course of physical therapy to restore normal knee range of motion and leg strength.

A completely torn ACL, on the other hand, may require surgery, depending on your activity level and future goals. The most common procedure for a complete tear is called an ACL reconstruction. This is where the ACL is completely reconstructed using either a tendon from your own body or tissue from a cadaver. If the ACL is torn in such a way that it pulls a piece of the bone off either the femur or the tibia, an ACL repair will be required to reattach the bone fragment to the rest of the bone. After either an ACL reconstruction or ACL Repair, it is very important to go through a course of physical therapy to restore premorbid function. After a period of knee immobilization (wearing a brace) and partial weight bearing, the knee gets stiff and the leg muscles become weak. A physical therapist can restore normal range of motion and strength by using different manual techniques and exercise instruction, and eventually help you to return to your premorbid activity level and sport.

Frozen shoulder, also known as adhesive capsulitis, is stiffening of the shoulder due to scar tissue, which results in painful movement and loss of motion. The actual cause is unknown, but some research has shown frozen shoulders to result from reactions to injury, inflammation or prolonged immobilization, such as wearing a sling after surgery. Your therapist may use a combination of stretching and manual therapy techniques to increase your range of motion and design a home exercise program specifically to reduce loss of motion. Sometimes conservative treatment does not reduce the pain, therefore alternative suggestions may help to progress treatment such as an anti-inflammatory or pain-relieving medication in an injection. While these injections do not change the duration of therapy, they will help relieve pain during treatment sessions. Treatment duration of a frozen shoulder can vary depending on the stage of “freezing” or “thawing.” Typically, an individual can expect to be treated by a sports physical therapist for at least 2-3 months with a continuing home exercises lasting up to a year.

The shoulder and hip are ball and socket joints that are lined by a piece of cartilage called the labrum. The labrum lines the socket of the shoulder and hip and keeps the ball of the shoulder or hip from rubbing on the socket. Labral tears can be caused by an impact injury or dislocation of a joint, an overuse injury that involves repetitive activity, or structural abnormalities.

Patients with labral tears will usually complain of a non-specific deep pain in either the hip or shoulder. Many times they will feel a clunk or click, or decreased motion, and the inability to perform daily activates or sports because of pain in the joint. Conservative treatment of a labral tear focuses on regaining mobility, strength, and function. Surgery for labral tears may be necessary because the structure does not have a good blood supply in certain regions and many times will not heal on its own. Post-operative treatment will consist in restrictions of the joint range of motion for a period of time as well as decreased activity for a period of time while letting the structure heal. Sports physical therapy in this phase will also focus on increasing motion, strength, and function.

A torn meniscus is one of the most common knee injuries. Any activity that causes you to forcefully twist or rotate your knee, especially when bearing all of your weight on it, can lead to a torn meniscus. The meniscus is a C-shaped piece of cartilage that, along with chondral cartilage in each knee, acts as a cushion between the thigh bone and the shin bone. Meniscus tears can be very painful at first, but depending on the severity of the tear, you may be able to avoid surgery and return to your normal activity level without pain. A good course of physical therapy may be able to restore any loss of range of motion or muscle strength and to train you to return to your specific work functions and/or sports activities.

If the meniscus tear happens to be severe and you are not responding well to physical therapy, your doctor might consider surgery to either repair the tear (meniscus repair) or simply remove the torn piece of cartilage (meniscectomy). The latter is much more common and has a shorter recovery period, but a repair may be the only option. If you do have to have a meniscus repair, the doctor will most likely require some range of motion and weight bearing restrictions for the first 2-6 weeks, whereas after a simple meniscectomy you would have no restrictions. Following either surgery it is important to go through a course of physical therapy to recover the loss of knee motion or leg strength so that you can return to normal function and resume any athletic activities you love. You can expect a full recovery after either surgery if you’re motivated and diligent about doing everything that is asked of you by your doctor and your sports physical therapist.

Patellofemoral Syndrome/chondromalacia: Patellofemoral pain and chondromalacia are common knee problems that cause either pain under the knee cap or on the outside of the knee. Aside from meniscus tears, they are one of the most common physical therapy diagnoses. Patellofemoral pain by definition is pain under in the region of the knee cap and the lateral knee. This pain is typically caused by improper tracking of the patella. Chondromalacia refers to the wearing away of cartilage on the underneath of the kneecap which may be caused by patellofemoral (tracking) problems.

Both of these conditions are caused by muscle weakness, typically originating from the hip and gluteal complex. Tightness in structures such as the ITB may also cause some of the patellofemoral pain and chondromalacia. A course of exercises that focus on functional strength will help to correct the tracking issue as well as the pain under the knee cap.