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!

From head to toe, swimmers must kick the injuries and pain to get to the top

By Julie Gardner for ATI Physical Therapy

From head to toe, swimmers must kick the injuries and pain to get to the top

While many probably consider swimming a relatively safe sport, injuries can still put these athletes in hot water.  Katie Varnado, ATC from the ATI Sports Medicine department knows about swimming injuries first hand from her work with these athletes.  Here’s what Katie has to say…

What injuries are common…

  • Swimmer’s Shoulder:  The shoulder is the joint most commonly injured, and may include rotator cuff impingement, biceps tendinitis and shoulder instability.  All can result from overuse, fatigue and weakness, especially when proper techniques are not used.
  • Swimmer’s Knee:  This injury occurs during the breaststroke because of the “whip kick,” which places all of the force of the kick on the outside of the knee. The inner ligament of the knee, called the medial collateral ligament, is put under stress.
  • Other Lower Body Injuries: Breaststrokers may experience pain from inflammation of the hip tendons. Lower back disk problems or spondylolisis, a stress fracture in the vertebrae of the spine, may be caused by the dolphin kick.


Katie recommends these tips to help prevent injury. In addition to stretching, there are specific things a diver can do to help ward off a repetitive injury:

  • Understand and focus on proper stroke techniques
  • Lessen repetitive strokes that are causing the  overuse injury
  • Perform core strengthening and cross-training exercises as part of pre and early season routines
  • Be sure to warm-up and cool down after activity and use periods of rest to recover
  • Focus efforts on rotator cuff and scapular strengthening for most shoulder injuries,  and pelvic and hip strengthening exercises for hip and knee injuries
  • Speak with a sports medicine professional or athletic trainer if you have questions  about injuries, exercises and  prevention

Soccer stretches to always incorporate into your pre-game warm up from ATI

By: Brian Rog and Jen Robbins, MS, ATC for ATI Physical Therapy

Soccer stretches to always incorporate into your pre-game warm up from ATI

We all aim to be that bigger, faster and more conditioned athlete on the soccer field, but getting there requires a disciplined level of strength and endurance to keep up with the rapid speed and agility loads. A large fraction of your success falls heavily on your pre-game routine, which tends to be one of the most neglected aspects for many.

Before hitting the field and to help meet the physical demands of the sport, it’s important to properly stretch to limber up and activate the necessary muscle groups needed to withstand the strains from gameplay. Through stretching, the risk of injury is minimized, while flexibility is maximized.

As a result, you may also notice gains in your endurance and levels of balance. In fact, increased bending and flexibility also play a pivotal role in bettering overall posture, which over time, will strengthen your core and keep your performance at a maximum. Pre-game stretches and warm ups are also crucial for increasing the heart rate so oxygen can be transported to those muscles where major nutrients are consumed.

Considerable research has proven that increased stretching harvests a powerful impact on performance outcomes during a physically-demanding activity. When deciding to focus on specific dynamic or static stretches before hitting the field – the experts at ATI Physical Therapy recommend (after loosening up) incorporating these varying levels of stretching techniques to help support your pre-game regimen.

Skipping with High Knees

Standing in an upright position, begin skipping forward, driving your knee up each time you jump as you swing your opposite arm up overhead. Be sure to keep your movements controlled and maintain your balance.

Single Leg Cross Jumps

Begin in a standing upright position, balancing on one foot, with a crossed line on the ground beside you. Jump into each section on the same foot in a crisscross pattern. While doing the exercise, do not let your knee collapse inward as you land from each jump, and keep your foot facing forward.


Standing in an upright position with your hands on your hips and feet positioned shoulder width apart, step forward and lower your body towards the ground, then in a controlled motion, carefully return to the starting position. While doing the exercise, do not let your knee collapse inward and keep your trunk steady.

Standing Quad Stretch

Standing in an upright position on one leg, reach back and pull the opposite foot up toward your body and push your hips forward until you feel a stretch in front of your thigh (to maintain balance, you may hold the wall or a chair). Be sure to keep your thighs aligned with each other and the bent leg in line with the hip. Repeat on the opposite side. To increase the stretch, keep your knees together and push your hips forward. This stretch should be held between 10 and 30 seconds.

Standing Calf Stretch

Face a wall and keep approximately a foot’s distance from it. Extend one leg straight behind you, keeping your heels flat on the ground and your rear knee straight. Begin to lean toward the wall until you feel tension in the calf muscle of the extended leg. Hold this stretch between 10 and 30 seconds. Repeat on the opposite leg.

Kneeling Hip Flexor Stretch

Kneel on the ground with one knee bent in front of your body and make sure the bottom of your foot is flat on the ground. Tighten your abdominals, tilt your pelvis backward and gently shift your weight forward until you feel a stretch in the front of your hip. Hold this stretch between 10 and 30 seconds. Repeat on the opposite side.

Butterfly Stretch

While in an upright seated position on the ground, bring the soles of your feet together to form a diamond shape and gently pull your heels towards you while also easing your knees to the ground. Be sure to sit upright and place your hands on the top of your feet. Hold this stretch between 10 and 30 seconds.

Lower Back Twist Stretch

Lay flat on the ground with your knees bent and feet resting on the ground. Extend both arms out to form a ‘T’ position. Keeping your back flat and shoulders on the ground, gently rotate your knees down towards the ground until you feel a stretch in your trunk. Hold this position for 10-30 seconds then return to the starting position. Repeat on the other side. When performing this stretch, be sure not to lift your shoulders off the ground when rotating your knees.

IT Band Stretch

Begin sitting on the ground with your legs bent to one side. Take your top leg and cross it over your opposite knee. Using your hands, hug your knee to your chest and hold this position. Hold this stretch between 10 and 30 seconds. Repeat on the opposite leg.

Seated Hamstring Stretch

While in a seated position, fully extend your legs keeping your feet together and bend forward at your hips until you feel a stretch in the back of your thighs and hold. Be sure to tuck your chin towards your chest and hold this stretch between 10 and 30 seconds.

These stretches should take no longer than 20 minutes, conditional to age and fitness levels. Remember, stretching is your last opportunity to prep your body before taking to the field, so incorporating these techniques into your pre-game warm up will get your body to the levels required to meet the demands of the sport and deliver that bomb between the sticks.

Lessening Knee Replacement Pain Through Dry Needling

By Brian Rog and Charles Matt Huey, PT, MPT, Cert. MDT, CMTPT for ATI Physical Therapy

Lessening Knee Replacement Pain Through Dry Needling

Often times, the inevitable postsurgical pain and discomfort following a procedure like a total knee arthroplasty (commonly known as a knee replacement) is a mystifying variable we cannot seem to escape – even with the inclusion of opioids. However, what if we told you, that this pain could be lessened considerably without medication, would you believe us?

Major advancements in technology have allowed the operational side of procedures to go as seamless as possible; however, the short- and long-term effects of post-surgery pain still appear to be unavoidable. Well, that was the original belief. Thanks to research, a lesser known, yet growing in popularity, practice called myofascial trigger point dry needling or dry needling, is playing a vital role in minimizing post-surgery pain when it is most severe. Data suggests that patients who undergo dry needling prior to a total knee replacement endure less pain after intervention as compared to those who do not.

Before we take a closer look into these findings, it is important to understand what exactly dry needling is, its role in helping to mediate knee injuries, how dry needling differs from acupuncture, and what conditions it is most appropriate for treating.

But first, let’s brush up on the origins of knee pain as this will help draw a better connection to dry needling and knee pain.

Trigger points and knee pain

Most patients undergoing knee replacement surgery have endured some form of pain through the process, or experience decreases in their functional abilities. Because of this, simple activities like walking or standing become troublesome, so people tend to do less of both thinking they will be better off. Unfortunately, this inactivity attributes to several physiology responses such as decreased endurance, stamina, weakness and loss of motion.  There may also be a change in gait pattern, which can cause the muscle fibers to shorten or over-lengthen, leading to trigger points.

Herein lies the problem. These trigger points then begin to harvest pain due to the sarcomeres (functional unit of striated muscle) moving closer together, causing a decrease in blood flow and oxygen saturation, which makes the muscle area very acidic. And when there is an acid build-up in the muscles, you’ll experience knots, fatigue and muscle burn.

Since most researchers’ efforts zero in on the causes of the pain, like bone-on-bone contact in the knee, these trigger points, which have a large role in the resurrection of pain, often go unnoticed. It is at this moment that we start to understand the value of techniques like dry needling.

What is dry needling?

Dry needling is a technique for the treatment of myofascial pain (contraction knots) and dysfunction in musculoskeletal areas where muscles are typically denser. Due to the sensitive nature with treating areas of deep tissue, dry needling helps target these areas without the discomfort or bruising commonly experienced through hands-on techniques. The goal of dry needling is to help the body relax and increase blood flow at locations of discomfort. By doing this, the muscles will contract, which will allow for improved functionality and decreased pain.

Some of the more common conditions dry needling helps to remedy deal with sprain/strain injuries, chronic pain conditions, chronic tension-type headaches, pressure build-up in the muscles, and nerve compression conditions.

Differences between dry needling and acupuncture

Like dry needling, acupuncture uses similar anatomically specific (non-injection) filiform needles to help reduce pain. However, the approach and ideologies of the procedures are where we start to see the similarities fade.

Dry needling involves the insertion of a needle into soft tissues with the aim of decreasing muscle tissue tension and improving musculoskeletal function.

Acupuncture, on the other hand, uses needles to manipulate the balance and flow of the body’s energy meridians. Doing this stimulates the body to produce its own pain-relieving endorphins, which help to promote healing and restore health.

Dry needling and post knee replacement surgery pain

Earlier in the story, we talked about a study that suggests dry needling can help lessen post-surgery pain in total knee replacements. Fascinating, right?

Here’s what we know, the study observed 40 patients undergoing a total knee replacement. The 40 subjects were unknowingly randomized to a ‘true’ dry needling group or to a ‘sham’ group where the procedure mimicked a dry needling intervention, but was not true dry needling. Each of the participants were examined for myofascial trigger points by an experienced physical therapist 4–5 hours before surgery. Immediately following anesthesiology and before surgery started, subjects in the ‘true’ group were dry needled in all previously diagnosed trigger points, while the ‘sham’ group received no treatment in their myofascial trigger points. This is where it gets good. The results concluded that subjects in the ‘true’ group had less pain after their surgery and showed significant differences in the need for immediate post-surgery opioids. So that begs the question, why isn’t dry needling more commonly recommended to individuals undergoing a total knee arthroplasty? The answer is simple. Awareness!

Muscles after surgery

Using knee replacement cases as our example, dry needling is beneficial as it helps to reduce trigger points that either developed prior to the surgery or afterwards.  During the surgery, tissue is pulled and moved around which can be traumatic to the tissue.  It will then respond by shortening and becoming painful. The patient may also not want to start moving again right after the surgery due to pain or other complications from the surgery. Again, lack of activity will cause decreased strength, shortening of the muscles, reduced endurance, etc., ultimately leading to trigger points.  The patient’s body mechanics may have changed as well causing the muscle to fire and move in incorrect patterns, which also lead to trigger points.

Dry needling and long-term opioid use

As compared to opioids, dry needling is a safe and effective alternative to controlling musculoskeletal pain especially in chronic pain patients. Opioids have a long list of side effects and can lead to spiraling dependencies. Opioids work by binding to receptors in the brain and body, however, there are limits to the number of receptors that can be utilized. Once every receptor has something bound to it, any additional increase in dosage has no effect. By steadily increasing the dosage level means that the medication is not working and other options need to be explored.

Studies have found longer relief of pain is best managed through dry needling as compared to wet needling (lidocaine injections) and medication. The use of dry needling is just one component in controlling pain. A skilled therapist will use needling to remove any painful trigger points but also direct the patient in a beneficial exercise program to continue to decrease and control pain.

Does ATI Physical Therapy offer dry needling treatment?

Dry needling is currently offered at select ATI Physical Therapy locations across our more than 750 clinics nationwide. To see if dry needling is available to your area, we recommend calling your nearest ATI clinic for more information.