ChristopherJohnson

Chris completed his undergraduate studies at the University of Delaware, where he earned a bachelor of science with distinction while completing a senior thesis in the physical therapy department under Dr. Lynn Snyder-Mackler.  Chris was a member of the varsity men’s tennis team, scholar athlete, captain in 2000, and recipient of the Lee J Hyncik award for excellence in athletics and academics.  He remained at the University of Delaware to earn a degree in physical therapy (2003) while completing an orthopedic/sports graduate fellowship under Dr. Michael J. Axe. Following graduation, he relocated to New York City to work at the Nicholas Institute of Sports Medicine and Athletic Trauma of Lenox Hill Hospital as a physical therapist and researcher. Chris also assumed the role of managing therapist at NY Orthopedics PT (2009-10) before deciding to further pursue his work as a physical therapist and clinical educator. Chris currently works at New York Sports Med and Physical Therapy and is one of the founding members of the PT Project Continuing Education Series. He is also a competitive triathlete and recently qualified for the Half Ironman World Championships in Clearwater. Chris has completed triathlons at all distances and is preparing to qualify for the Hawaii Ironman World Championships. Recently, Chris became certified as a triathlon coach (ITCA), to compliment his work as a physical therapist, especially when providing rehabilitation to individuals who participate in endurance-based sports.

Sound communication between the orthopedic surgeon and physical therapist is of the utmost importance when managing the care of a patient following surgery. This is particularly the case for patients who have undergone rotator cuff repairs given the delicate nature of the procedure coupled with the fact that there is a relatively high incidence of retears on second look MRIs and ultrasounds. In order to protect the repair from deleterious forces while restoring function, a therapist should obtain as much information about the surgery as possible. This will undoubtedly improve his or her clinical decision making when it comes to advancing a patient through the rehabilitation process. While several protocols exist for rotator cuff repairs, therapists must exercise caution in strictly adhering to them because any experienced PT knows that they serve as a framework rather than a step by step program. After working closely with the orthopedic surgeons at the Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT) of Lenox Hill Hospital for the past several years, I have learned that there are three important questions to ask an orthopedist when they refer a patient to you following a rotator cuff repair.

1. What was the size of the tear?

2. What was the quality of the tissue?

3. How confident are you in the repair?

Ascertaining this information will not only engender a successful outcome for your patients, but will also convey a sophisticated level of understanding to the referring orthopedist.  Never let your patients be victimized by ill communication.

ChristopherJohnson

Ted Corbitt, considered by many to be the “father of American distance running,” was once quoted as saying that “you are only as good as your last injury.” While this is a profound statement, it requires one caveat. I tell people that “you are only as good as your last injury” and the extent to which it was properly rehabilitated. Too often, we witness elite athletes rush back to their respective sports before they are completely rehabbed only to sustain a more catastrophic injury.

Note: I would also like to mention that Ted Corbitt completed 199 marathons and ultramarathons during his lifetime and received the lifetime achievement award from Runner’s World. Of particular relevance to the physical therapy community, Ted was the chief physical therapist at the International Center for the Disabled on East 24th St in Manhattan. I hope you take the time to learn more about this amazing individual in terms of his life and athletic achievements.

ChristopherJohnson

There are several exercises, which people commonly perform, that may predispose the body to injury. As a physical therapist, who provides care for many patients presenting with cervical spine pathology (neck problems), one such exercise is that of neck circles. While the neck may afford one the ability to complete a full circle, it should not be performed given the risky nature of this movement. When one combines extension, rotation, and sidebending (all motions involved with part of the circular motion), hyperextension and compression of the cervical spine may occur. This may subsequently result in unwanted foraminal closure and nerve root compression. This movement is also very similar to the Spurling’s maneuver, which is an orthopedic examination technique used to assesses for a cervical radiculopathy. So if you suffer from neck pain and/or experience tingling and numbness in the arm, please don’t resort to neck circles, but rather, seek medical consultation from an orthopedist or reputable physical therapist. And always remember what Wu Tang says…you best “Protect Ya Neck.”

ChristopherJohnson

Have you recently been diagnosed with a rotator cuff tear involving the supraspinatus? Are you worried that once you are cleared to return to your prior activities without restriction that you will not be able to return to the gym and more specifically perform the bench press. Don’t fret but rather just simply modify your hand position so you are using an undergrip, which is just the opposite of the one shown here. By using an undergrip, the lifter is clearing the supraspinatus tendon from the undersurface of the acromion thereby minimizing the risk of shoulder impingement. I would also encourage the lifter to first become acquainted with the new hand position, use less weight to start, position the hands at a width of ~ 1.5 times the biacromial width, and always get a lift off.  Hope this is helpful…long live the shoulders. For additional information please read the article by Fees M, Decker T, Snyder-Mackler L, and Axe M entitled “Upper extremity weight-training modifications for the injured athlete. A clinical perspective.” This was published in AJSM (1998).

ChristopherJohnson

Before I left the clinic today, a colleague asked me if I had read the recent exhanges between physical therapists and chiropractors on The PT Project. While I have not read all of the comments related to this matter, it is a bit disconcerting that such tensions exist between these two different yet similar disciplines. Being a physical therapist, I would like to get something off my chest and say that I work closely with several talented chiropractors as I do physical therapists. Just like any field, there are practitioners who are excellent at their trade just as there are practitioners, who are less than mediocre. The important thing is that regardless of our approaches and philosophies, our ultimate goal comes down to one thing and that is helping patients, and we are both in a great position to do so. In closing, the only thing that I would like to say to practitioners in either field, who are interested in advancing medicine and helping people, is that “I got nothing but love” for you.

ChristopherJohnson

As a physical therapist and researcher, I always marvel at the abilities of breakdancers and often wonder what injury patterns exist among this population of athletes. In a recent study by Kauther et al. in AJSM (2009) entitled “Breakdance Injuries and Overuse Syndromes in Amateurs and Professionals,” the authors provided me with just such information.  Since I live in Brooklyn and work in New York City, I frequently find myself watching breakdancing performances, and felt it was my duty to highlight the results of this study. In this retrospective analysis, 144 breakdancers (40 professionals and 104 amateurs) were surveyed from the “Battle of the Year World Final” which is held in Braunschweig, Germany.  All participants completed a 4-page questionnaire pertaining to general info as well as info related to previous breakdancing injuries.  The major findings of this study are as follows:

ChristopherJohnson

Are physical therapists putting too much faith in the reliability of goniometric measurements? A recent study by Mullaney et al. (http://www.ncbi.nlm.nih.gov/pubmed/20557263) out of the Nicholas Institute of Sports Medicine and Athletic Trauma addressed this very issue. In the case of intra-tester reliability of shoulder ROM measurements (flexion, external rotation, and internal rotation), a change of 6-11 degrees is necessary to be sure that a true change has occurred. For comparison of measures made by two different therapists (inter-tester), a change of 15 degrees is required to be certain a true change has occurred. As a co-author of this study, I was alarmed by these findings because oftentimes my patients are denied visits by insurance companies solely based on such measurements.

ChristopherJohnson

Iliotibial band (ITB) syndrome is a debilitating condition that affects lower extremity function and is commonly associated with pain at the level of the distal lateral thigh and knee. The ITB is a superficial thickening of tissue that is an extension of the gluteus maximus, gluteus medius, and tensor fascia latae (TFL). It inserts onto the lateral aspect of the patella by way of the lateral patellar retinaculum as well as Gerdy’s tubercle and the fibular head. In the event one seeks medical consultation for ITB syndrome by a physical therapist, chances are that they will be introduced to the foam roller. A foam roller is to the ITB as a steam roller is to pavement. More specifically, a foam roller will function to break down any trigger points and tissue inconsistencies in the structures of the lateral thigh (vastus lateralis, biceps femoris, ITB) and desensitize the region. Unfortunately, physical therapists oftentimes substitute foam rolling for proper stretching of the ITB. If the Ober’s test, which is used to assess for ITB tightness, remains positive after foam rolling then the therapist should focus more of their treatment on stretching the ITB and related structures. While I appreciate the “role” of foam rollers in treating ITB syndrome and encourage their use, especially as part of a home program, make sure to understand that foam rolling does not equate to stretching.

ChristopherJohnson

Nearly everyone is familiar with rotator cuff tears (RCTs) these days. The prevalence of RCTs is not surprising given the fact that people tend to fall into deleterious postures throughout the day, consistently overload their arms while performing routine activities, and often assume harmful overhead positions for an extended period of time while sleeping. Furthermore, most people, who engage in a strength training regimen, tend to perform high risk exercises with too much resistance and improper form while lacking adequate stability at the scapulothoracic articulation (where the shoulder blade interfaces with the rib cage). The cumulative effect of these forces and positions is rotator cuff pathology. As a physical therapist, I often use metaphors to teach physical therapy interns and patients to help them better understand rotator cuff injuries. In the case of rotator cuff disease, I liken the rotator cuff tendons to a piece of rope that has started to fray. The last thing that the tendons or rope want to see is repetitive motion, especially when coupled with external resistance. The rotator cuff tendons would more appropriately benefit from a greater balance in the surrounding elements, proper mechanics at the joints of the spine and shoulder girdle complex, and more fluid motion. So how does this affect the rehabilitation process? Rather than jump to prescribe shoulder exercises involving 3 sets of 10 repetitions, first identify the major impairments that may be contributing to the problem. For example, is the thoracic spine able to adequately extend and are the ribs able to externally torsion on the side of the involved shoulder? Is the scapula able to posteriorly tip or tilt as the arm elevates? Is there posterior shoulder tightness that may cause anterosuperior migration of the humeral head, which alters the arthrokinematics of the glenohumeral joint. Is there adequate scapulothoracic stability that will afford the arm a stable base to move from? Are there altered length tension relationships in the surrounding soft tissue, which may predispose one to subacromial impingement. Do the periscapular muscles possess adequate strength? Are there postural considerations such as forward head and/or rounded shoulders that need to be corrected? By addressing such impairments, an ideal environment for healing will be created for the damaged rotator cuff tendon(s) and patients will most likely enjoy improved function of this vital muscle group. Lastly, remember that the rotator cuff is a group of precision muscles that are best trained from a resistance standpoint of 40-60% of one’s maximum voluntary contraction (MVC) so make sure not to excessively overload them as it will only add insult to injury. I should also reminder readers that not all rotator cuff tears are amenable to conservative management and sometimes surgery is indicated. Long live in the shoulder!

ChristopherJohnson

Anytime orthopedists and physical therapists get on the topic of shoulder dysfunction, posterior capsular tightness is inevitably mentioned. A tight posterior capsule causes antero-superior migration of the humeral head relative to a a shoulder with normal capsular relationships. In the context of more extensive amounts of posterior capsular tightness, a postero-superior shift of the humeral head occurs. An association between posterior capsule tightness and loss of internal rotation range of motion (@ 90 degrees of abduction) has also been documented and has been noted to affect the dominant arm to a greater extent than the nondominant arm. Clinically, posterior capsule tightness can be qualitatively assessed by performing a posterior glide of the glenohumeral joint at 0, 45, and 90 degrees of abduction. On the other hand, internal rotation ROM is measured with the patient supine and the shoulder abducted 90 degrees with the scapula stabilized. In addition to these assessment techniqes, clinicians should also be aware of the Tyler test developed by Tim Tyler from the Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT). This test assesses the limitation in cross-arm adduction and is thought to measure tightness in the posterior shoulder elements to include the posterior capsule and the musculotendious units of the posterior shoulder musculature. To perform this test, follow the steps outlined below:

1. Position the patient in sidelying with the nontested extremity under the patient’s head

2. Have the patient flex their hips and knees to 45 and 90 degrees, respectively to stabilized the body

3. Align the acromion of the tested extremity perpendicular to the plinth

4. The examiner shoulder face the patient and grasp their elbow at the epicondyles or their forearm

5. Passively abduct the shoulder to 90 degrees while maintaining neutral rotation

6. Stabilize the scapula into a position of retraction with the free hand

7. While maintaining the scapula, lower the shoulder into horizontal adduction maintaining neutral rotation

8. Lower the humerus until motion ceases or rotation of the humerus occurs

9. Record the distance from the top of the plinth to the medial epicondyle

It should also be mentioned that there is high intratester reliability (0.92-0.95) and intertester reliability (0.80) for this assessment technique.

I encourage clinicians to become aquainted with this test as it yields meaningful information that will help to guide one’s treatment plan when working with patients presenting with shoulder dysfunction.

References:

1. Clinical Examination of the Shoulder by Todd Ellenbecker 2004 Elsevier Saunders

2. Tyler et al. Quantification of posterior capsule tightness and motion loss in patients with shoulder impingement AJSM 2000

3. Tyler et al. Reliability and validity of a new method of measuring posterior shoulder tightness JOSPT 1999.

ChristopherJohnson

1. Servers Lost Data! – Please re-register
2. A Brief Review
3. Shape-Ups: Do they shape up or down?
4. Wii-hab Increasing Rehab Potential
5. Managing a Hyperkyphotic Spine. . .