Is Toe-Walking an Early Sign of a Health Condition?

By Brian Rog with Contributions by: Annie Kender, PT, DPT, C/NDT of the ATI Grand Blanc, Mich., Clinic

Is Toe-Walking an Early Sign of a Health Condition?

When a child learns to walk, instinctively, he or she will begin walking with their feet flat on the ground. But because this is a skill that takes much practice, it’s not uncommon for them to transition on and off their tip toes as their walking abilities develop.

Some children begin walking on their toes for stability, others walk on their toes for sensory reasons – these children sometimes have difficulty tolerating pressure through their heels or they prefer the sensations (or proprioceptive input) they received from their joints locking out. Children may also walk on their toes due to range of motion restrictions in their calf muscles (gastrocs).

As your child’s coordination and muscles develop, they will begin walking with a heel-toe pattern; on average around 18 months of age. However, should those heels remain ascended beyond age 2-3 as your child’s only means of getting around, this may be an early sign of a neurological condition (Cerebral Palsy, Spina Bifida, Tethered cord, etc.). Conversely research reports 7-24 percent of children who walk on their tip-toes are idiopathic toe walkers, meaning they do not have a correlated disgnosis such as Cerebral Palsy.

When to see a specialist

Research supports the idea that heel strike in children begins around 22 weeks following initial onset of walking independently. For the majority of children, this occurs around 18 months of age. Toe walking is not considered a normal part of this early independent gait. As we mentioned, if by age 2, your child hasn’t outgrown toe walking, this may be an indication of neurological immaturity or muscle weakness.

To that, ATI Physical Therapy experts suggest consulting with your pediatrician, because if left untreated, toe-walking can put your child at further risk for contractures, foot deformities and balance deficits. And in severe cases, your child may require surgical interventions if deformities or contractures are advanced. Fortunately, physical therapy interventions are an effective way to help your child overcome this.

Long-term effects of toe walking, if left untreated

As you can imagine, toe-walking places a great load on the muscles and tendons. Many children who consistently walk on their tip-toes since establishing independent ambulation, may develop foot deformities as early as the age of four. These children may demonstrate ankle range of motion restrictions, impaired balance and poor postural alignment.

Physical therapy for toe walking

Therapeutic treatment such as physical therapy can assist your child in achieving a heel-toe gait pattern as well as correcting any range of motion restrictions, muscle imbalances and postural deformities.  After identifying the child’s origin for toe-walking, a plan of care is established to address the child’s deficits. Treatment methods typically include stretching, strengthening of lower extremities and core, balance retraining, sensory integration techniques, serial casting, orthotic training and a home exercise program.

After completing physical therapy, what’s next?

Once your child has successfully completed their PT treatment, you will receive a home exercise program to further continue their treatment plan at home.

For children with an established heel-to-toe pattern, who no longer demonstrate weakness or range of motion restrictions, their home program is minimal. For children with neurological conditions as an underlying source of their toe-walking, they may require intermittent services over their lifetime to maintain gains, usually around growth spurts.

Is your child toe-walking? ATI may be able to help

If you are concerned about your child’s toe-walking tendencies, we first suggest connecting with your pediatrician to determine the next course of action. Should physical therapy be required, please don’t hesitate to contact your your nearest ATI physical therapy clinic to see what pediatric therapy options are available for your child.

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Featured Body Part: Hip

Featured Body Part: Hip

By  Angela Bender and Cori Cameron for ATI Physical Therapy

The hip is one of the strongest, most secure, and stable joints in the body, but it is not indestructible. While the hip bone may look like one bone, it is made up of three bones that are completely fused – ilium, pubis, and ischium. Whether we’re walking, running, bending or sitting, the hip plays a critical role. When injured, it can cause every day tasks to be painful and difficult. As we get older, the risk of hip injury increase due to many different factors. Knowing more about common causes and conditions and ways prevent hip injuries will give us a better chance to avoid some of the risks of injury.

Common Causes
The hip bone has a cushion of cartilage that helps to prevent friction when the hip bone moves. Even though the hip bone is durable, arthritis, injuries and other problems can all cause hip pain.

  • Overuse Injuries – With age and use, the cartilage can wear down and the muscles and tendons can become damaged.
  • Sudden (Acute) Injuries  – During a fall or other injury, the hip bone can be fractured.
  • Pinched Nerves – Tightness in the outer hip muscles can place pressure on the nerves.

Common Conditions
Hip pain can be caused by any one of these common conditions:

  • Osteoarthritis – The most common disease affecting the hip is osteoarthritis. The cartilage in the hip joint gradually wears away, becoming frayed and rough, and the protective joint space between the bones decreases resulting in bone rubbing on bone.
  • Other Forms of Inflammatory Arthritis – Rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, psoriatic arthritis are all also common types of arthritis that cause hip pain.
  • Bone Fracture – A hip fracture is a break in the upper quarter of the femur (thigh) bone. Hip fractures most commonly occur from a fall or from a direct blow to the side of the hip.
  • Developmental Conditions – Usually present from birth, developmental conditions occur when there is an abnormality either in the shape of the head of the femur, the shape of the acetabulum or the supporting structures around them (e.g. dysplasia of the hip).

Injury Prevention
Paula Savino, PT, MPT, and Clinical Case Manager, gives us some tips to help prevent and rehabilitate hip injuries:

  • Stay Flexible – Make sure to stretch your quads, hamstrings, hip adductor and hip flexor muscles daily. Hold those stretches for at least 30 seconds and repeat 2-3 times.
  • Keep Your Legs Strong – Focus on all four planes of the hip. The hip can move in multiple directions so strengthen your hip abductors, adductors, flexors and extensors. Try some squats, lunges and lateral walks with resistance.
  • Avoid Overtraining – Make sure you vary your exercises and don’t always do the same thing. If you have pain after exercising, stop the activity, rest, ice and elevate your leg.

Rehabilitation
If you have pain in your hip that isn’t going away, rehabilitation is a great step to take to improve your functionality. During hip rehabilitation:

  • Be Prepared to Re-Educate Your Muscles – Focus is on strong gluteal, hip abductor and hip adductor muscles. This will help ensure good hip alignment with daily activities.
  • Be Balanced – Work on dynamic balance exercises to improve your proprioception and ability to stay upright.
  • Always Think Proper Posture – Maintaining your center of gravity over your feet will reduce undue stress and strain on your hip.
  • Be Strong through Your Core – Your core provides for better overall stability of the hip by providing a foundation for proper movement patterns.
  • Wear Proper Footwear – It is important to provide a good foundation for the hip.

When weighing your treatment options for hip pain and injuries, consider physical therapy. Physical therapy offers a wide variety of treatment options including strengthening, stretching, and sustainable home exercise programs. Stop in or call any ATI location for a complimentary injury screen or to learn more about how physical therapy can help you overcome your hip pain. Click here to schedule a complimentary injury screen.

Get hip with ATI!

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Why Aquatic Therapy Is a Great Choice for Treating Injuries

By Brian Rog, ATI Physical Therapy with Contributions by: Danielle Debulgado, Aquatic Therapist

Why Aquatic Therapy Is a Great Choice for Treating Injuries

In today’s age, the volume of physical therapy services available at our fingertips is unending. Because of this, finding one that fits your needs and allows you to effectively return to a healthy routine can be a challenge. We compare it to shoe shopping. With so many different styles and fits, finding the one shoe that’ll rocket you to the moon requires some effort.

Likewise, finding your ideal therapy provider requires the same amount of energy.  In most cases, our primary physicians can be a great starting point, but without the right questions and insight, you may end up back where you began. For this reason, it’s important to go a step further and connect with a local physical therapy provider like ATI to see what options are available to you.

When arriving at the rehabilitation phase of your recovery, the ultimate goal is to choose a no-risk therapy that’ll lessen recovery times, while still getting you back to an uninterrupted lifestyle. Typically, your rehabilitation options will range from a menu of traditional flat land therapies, which are still extremely effective injury recovery solutions. However, many people aren’t aware that their options don’t have to stop there.

Thanks to advancements in technologies and accessibility, a lesser-publicized therapy, known as aquatic therapy, is steadily becoming a highly endorsed secondary option for a range of injury cases. Given the countless mental and physical benefits provided through H2O, everyone from elite-level athletes, to stroke survivors are benefitting from this low-impact, high-return therapy.

Here at ATI, aquatic therapy is available at a handful of our locations, so we had the opportunity to catch up with one of our aquatic experts, Danielle Debulgado, from our Aurora, Ill., clinic to learn more about the benefits of this increasingly favored therapy option.

Can aquatic therapy still yield the same outcomes as traditional therapies?

Simply put, yes! The buoyancy property of the water tremendously helps decrease the degree of weight-bearing, which ultimately lessens stress placed on the joints. When we say ‘weight-bearing’, we are referring to the ability of the body to resist or support weight. For example, in chest-high water, the body is roughly 35 percent weight-bearing, meaning the body feels 65 percent-less weight than it would on land.

Aquatic therapy is also a great segue into land-based therapies, especially for back surgery patients who are restricted to wearing a Thoracic Lumbosacral Orthosis (TLSO) and limited in performance of land exercise. With the help of aquatic therapy, these patients are able to start with light aquatic exercise to prevent total deconditioning. Eventually, the aquatic exercise will allow patients to gain strength and range of motion, which can make the transition to land-based PT much easier.

Who benefits the most from aquatic therapy treatments?

While aquatic therapy can benefit just about anyone, we find that it is a favorable alternative therapy for individuals who are unable to tolerate traditional land-based exercises. It can also be beneficial for patients diagnosed with back and lower extremity ailments, fibromyalgia, gait and balance deficits and people dealing with weight-bearing restrictions.

Why are more physicians turning to aquatic therapy instead of traditional therapies?

For patients unable to achieve their goals in land-based therapies, whether it is due to high pain levels, low tolerance or severe restrictions, aquatic therapy is a second chance at a successful recovery. To that, post-surgical patients who would otherwise be restricted with land-based treatments can start with aquatic based therapies earlier in their recovery to prevent deconditioning and help transition them to land-based treatment – ultimately resulting in favored outcomes.

Aquatic therapy is said to speed up the recovery period faster than land-based therapies, why is this? 

Due to the decreased weight-bearing conditions of the aquatic environment, aquatic therapy allows patients to move with less restriction and less stress on their body. Because of this, a patient with severe Osteoarthritis may not be able to walk the stairs in their home; however, since their body weight decreases in the water, they may be able to perform step-ups

 in an aquatic environment. Consequently, this allows for increased activation of the proper muscles needed to improve the step-up motion, which ultimately can help improve the patient’s ability to perform stair negotiation in the home.

Also, as we mentioned, post- or pre-surgical patients that would otherwise be restricted in their ability to perform land-based therapy, are able to begin therapy sooner in the water. In doing this, water therapy helps increase the patient’s ability to start proper muscle recruitment and increase range of motion without increased pain.

What are some lesser-known benefits of aquatic therapy?

Few are aware, but aquatic therapy can be great for patients diagnosed with multiple sclerosis (MS). Typically, patients with MS would perform aquatic exercises in a colder temperature pool as opposed to a warmer therapeutic pool as warmer temperatures are not the most conducive environment for a patient with MS.

Aquatic therapy is also beneficial for patients with stress reactions/fractures, which are most common among athletes, especially runners. In fact, for injured athletes refusing to surrender their on-the-go freedoms, exercising in an aquatic environment enables a continuation of conditioning – you can even run in the water, without increasing stress.

And for patients experiencing weakness and pain from nerve damage in the hands and feet, often referred to as peripheral neuropathy, aquatic therapy can be a helpful remedy. The hydrostatic pressure property of the water helps to decrease the swelling in these areas and improve proprioceptive awareness (internal body awareness).

How long will a standard aquatic therapy session last? 

Depending on a patient’s tolerance, an aquatic therapy session can typically last anywhere from 25-75 minutes.

Are there any drawbacks to aquatic therapy?

The most recognizable drawback to any activity in the water is drowning, which is why supervision is necessary whenever you get in the water. It’s also important to remember that while the water allows us to perform exercises with ease given the lessened weight-bearing conditions, your body is still working and pushing. Doing too much, too fast can cause extreme muscle fatigue resulting in soreness. Adding to that, outside of the pool, your body is back experiencing full weight-bearing conditions, so you’ll need to engage in transitional recovery training to avoid negatively impacting your joints, muscles and bones.

Is aquatic therapy right for you?   

With any recovery effort, ultimately, the goal is to see results without the stress, and given the layers of physical and mental benefits afforded through aquatic therapy, it’s no surprise why more clinicians and patients are getting behind this treatment option. To find out if aquatic therapy can help you, contact your nearest ATI Physical Therapy clinic today!

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An Inside Look Into Flexor Tendon Injuries

By: Brian Rog and Julianne Lessard, OTR/L,CHT for ATI Physical Therapy

An Inside Look Into Flexor Tendon Injuries

Our hands and fingers are among the most important assets to our body, so an injury, specifically to the hand’s control center, the flexor tendon, can open the door to a lengthy and exhausting road to recovery. If you are not familiar with the flexor tendon system, it consists of strong cords of tissue that connect the muscles of the forearm, through the wrist, and across the palm to the tips of the fingers and thumb. All four fingers connect to one primary muscle, which is responsible for controlling the middle knuckles and another muscle that controls the fingertips.

Flexor tendons are essential in enabling movement in the fingers and allow us to engage in simple activities like writing, holding a coffee cup, holding hands and zipping a coat. Unfortunately, this often overlooked muscle group can be damaged in an instant, so it’s important not to discount its value and susceptability to injury.

Injuries to the flexor tendons can happen so quickly that the individual affected by it does not have time to comprehend the severity of the damage. It’s important to know that almost any injury to the palm-side of the hand will involve the flexors.

When an injury does occur, more often than not, the cause of the injury is traumatic and can be be caused by something as simple as a laceration from the tip of a knife while cutting a vegetable, or a bit more harrowing such as a major contact injury from a table saw.

There are also closed inuries such as jersey finger that can result when a player grabs another player’s jersey as they pull away. The affected area mostly involves the tip of the finger, which is prone to avulsions and laceration injuries to the tendons.

Another common closed injury involving the covering of the tendons called sheaths can also occur. These are caused by overuse or strain and are usually categorized as tendonitis. Symptoms here are more subtle with a deep ache and sometimes a triggered or locked finger. Hand Therapy and an orthosis or brace can often help reduce swelling, however, in some cases, an injection or surgery is needed.

The good news in all of this is that treatment for a hand injury can be effective, but here’s the caveat, as we mentioned, it’s a tiring process, which will most likely require a surgical procedure, followed by a recovery period that can extend for several months and on. So do yourself a favor and keep your hands out of harms way – we know, it’s easier said than done.

There’s no denying that minor accidents will occur from time to time, so the more you know, the better you can prepare. If you have sustained an injury to your hand and are unsure of the steps needed to get back to life before the injury, stopy by your nearest ATI Physical Therapy clinic and ask our team for a complimentary injury screening. Our team will assess your injury, provide next step suggestions in care and get you on your way!

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