September 2008
Fenton
Physical
Therapy
Linden
Physical
Therapy
Milford
Physical
Therapy
400 Rounds Drive
Fenton, MI 48430
(810) 750-1996
319 S. Bridge Street
Linden, MI 48451
(810) 735-0010
135 S. Milford Rd
Milford, MI 48381
(248) 685-7272
Fracture Factors
Know Your Risk Factors For Hip Fracture
It was Sunday,
and
Helen
was
getting ready
for church.
She was in
her kitchen
preparing
breakfast
when her left
leg
“just
gave
out”,
and she was on the floor. Her husband called an
ambulance and she was transported to the hospital.
The next day, she had a surgical repair of the fracture in her left femur. Two weeks later, she was in
therapy working on recovering the mobility and
strength in her leg. Helen was upset about the injury because she went to the doctor regularly and
had always had a normal bone density score. She
was amazed that her hip could fracture so easily,
and that it would take months to fully recover. What
Helen did not know was that a low score on a density test is only one of many red flags for fracture.
hip fracture, regardless of bone density score. If
your bodyweight is less than your weight at age
twenty-five, your risk for hip fracture doubles. Being
taller, drinking lots of caffeine, and spending less
than four hours a day on your feet, all increase the
risk of hip fracture.
While bone density score is an important risk factor
for hip fracture, it is not the only risk factor to consider. Research studies have identified several
other important factors in hip fracture. Knowing
these risk factors allows you to assess your risk for
a hip fracture and make informed choices on actions
to prevent bone loss.
Some risk factors can be managed, such as more
activity and less caffeine, but most are out of your
control—you can’t get shorter. Multiple long term
studies have shown exercise to be an effective
method of preventing hip fracture. Knowing your
risk profile can be valuable when discussing screening for osteoporosis and medical treatment to help
prevent hip fracture. Exercise is the only long term
therapy that produces nothing but beneficial side
effects.
If your mother had a hip fracture before the age of
80, you have nearly three times the risk of suffering
a hip fracture, regardless of whether you have high
or low bone density score. Fracturing any bone after the age of fifty signals a higher risk for a future
From these studies, it appears that having a combination of these risk factors makes a woman more
prone to hip fracture. Individuals with low bone density scores and no more than one other risk factor
had a 2.6% annual risk for hip fracture. Women with
normal bone density and four or more of the other
risk factors had a 9% annual risk for hip fracture.
Helen’s mother fractured her hip at age 70. Helen
broke her right wrist at the age of 50. Helen was
five feet nine inches tall and stated she weighed
about ten pounds less than she did at 25. Helen
drank two or three cups of coffee and had one or
two cola drinks a day. She was a self-confessed
“couch potato” and rarely participated in any physical activity. Helen, and most hip fracture patients,
have all or most of the risk factors.
Michael S. O’Hara, P.T., O.C.S., C.S.C.S.
Fenton Physical Therapy
Linden Physical Therapy
Milford Physical Therapy
Bone Loss And Medications
Many of the drugs we must take to manage chronic medical problems have an unwanted side effect. They
tend to make your bones weaker and more susceptible to fracture. Women who use any of the drugs listed
below on a regular basis are at higher risk of a hip fracture. You probably cannot alter the medications you
are taking, but you can take proactive steps such as exercise and modification of diet to help maintain bone
mass. The medications below can weaken bone:
-Thyroid hormones.
-Steroid medications such as cortisone and prednisone.
-Long term use of steroidal inhalers has been linked to
bone loss.
-Chronic use of antacids that contain aluminum.
-Long term use of the blood thinner heparin.
-Aromatase inhibitors used to suppress estrogen.
-Chemotherapy treatment for cancer.
-Protease inhibitors used in the treatment of AIDS.
-Long term use of proton pump inhibitors to treat reflux or
GERD.
-Methotrexate used to treat cancer, psoriasis, arthritis and
immune disorders.
-Barbiturates and anticonvulsants used to treat epilepsy.
Barb O’Hara, R.Ph.
The Happy Hunter
Randy injured his shoulder playing softball in June of 2008. He had pain
with almost all shoulder motions for six weeks. Randy was initially treated
with rest, medications, and gentle range of motion exercises. After two
months, he was able to return to almost all of his prior activities; but he still
could not pull back on his hunting bow. Randy was an avid bow hunter, and
he had never missed an opening day of deer season. He tried performing
exercise to strengthen the shoulder; but after a month, the pain persisted.
Randy was referred to our office to see if we could abolish the pain and get
him back to the woods with his bow.
On initial evaluation, we had Randy bring in his bow. He had pain in the
back of the shoulder with the last six inches of pulling the bow back. Pain in
the shoulder intensified the longer he held the bow in the fully drawn position. His shoulder mobility appeared normal and was pain free. He had normal strength with all motions except protraction (moving forward) of the
shoulder blade. Manual compression of the shoulder blade against the posterior rib cage created the same pain he had with pulling back the bow. Randy also reported the pain when
lying on the floor on his right side. Randy was treated with a home program of positioning the shoulder in a
passively elevated position three times a day for ten minutes. We manually mobilized the muscles that hold
the scapula on the rib cage to create greater motion. Randy stopped all activities that compressed the scapula against the rib cage, such as bench pressing. He was progressed in a series of standing shoulder girdle
stability drills. After two weeks, Randy was able to fire his bow accurately and pain free.
Fenton Physical Therapy
Linden Physical Therapy
Milford Physical Therapy
09/08
Ask The P.T......Michael O’Hara, P.T.
Q: My right hip is very arthritic, and the only recourse I have is a hip replacement. I am only 52 years old
and want to put off the surgery as long as possible because the replacements only last fifteen years. What
can I do to put off the inevitable surgery?
A: If your hip has progressed to the point that the joint has been anatomically altered and your hip motion is restricted by the arthritis, then
there is probably nothing physical therapy can do to improve your motion or decrease your pain. We can usually find some pain-free
strengthening activities to improve muscle function around the hip in
the remaining range of motion your hip still possesses. This can enhance hip stability and get the hip ready for your eventual surgery. I
am not sure that putting off the hip replacement “as long as possible” is
a good idea. Your hip is your lower back and knees best friend. If your
hip is unable to extend and rotate properly, your body will find a way to
take you through space and overload the knee and lumbar spine. The
excessive wear and tear on the knee and lower lumbar spine can lead
to early degenerative changes in these joints. You end up with a damaged knee and lumbar spine as well as a bad hip. Most hip replacements, in individuals of normal weight, last a long time. Revisions are a
commonly performed surgery that most people recovery from quickly.
Over the last twenty years, advancements in orthopedics have been
amazing. They might have something even more incredible than today’s hip replacements by the time you need your revision.
Kat Wood
Physical Therapist, Athletic Trainer, and Orthopedic Specialist
Physical Therapist and Athletic Trainer, Kathryn
Wood, recently passed the American Physical
Therapy Association’s Board examination as a
Certified Clinical Specialist in Orthopedics. Kat
joins our other physical therapists Rodger Evans
(2006) and Michael O’Hara (1997) in passing
the OCS examination. Kat graduated from Alma
College in 2000, received her physical therapy
degree from Indianapolis University in 2002, and
recently completed her DPT at Indianapolis University. She has been part of our team at Fenton Physical Therapy for the last four years.
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Hours
Mon-Thur: 5:30am-10pm
Friday: 5:30am-9:00pm
Saturday 8am-5pm
Sunday 8am-2pm
404 Rounds Drive
Fenton, MI 48430
810-750-0351
Beat The Clock
The Best Training Tool Is A Stopwatch
When performing an exercise
program, many
variables can
be altered to
produce a desired training
effect.
The
most
commonly modified
variables are
the number of
sets and repetitions of a
specific exercise. For example, you plan out three sets of eight
repetitions on the leg press, and then two sets of
ten repetitions in the leg curl. The load, or the
amount of weight, used on the machine, barbell, or
dumbbell can be heavier or lighter. Loads are commonly increased in a pyramid fashion as multiple
sets of an exercise are performed. Even the speed
that you perform the movement can be changed to
stimulate different muscle fiber types and create
optimal neural recruitment. Successful exercise
programming requires frequent alteration of variables to ensure the client continues to make progress. One of the least used, but most valuable
training variables you can modify is that of time.
Using time as a training variable has many advantages. It will speed up your workouts and shorten
the time required to stay fit. If you are easily distracted, time based training will improve your focus
and make your training more efficient. Timed training teaches your body how to efficiently recover
between exercise bouts. The capacity of your cardiovascular system to slow back down after a chal-
lenge is one of the important factors your cardiologist measures on a stress test. How much work
you are able to perform in a specific period of time
is one of the best measurements of fitness.
Greater “Work Capacity” is the most sought after
goal in athletic strength and conditioning. The
hockey, basketball, soccer, or tennis player who
can continue to play while others fatigue will be the
winner. Listed below are some of the best ways to
control the time variable in your training.
Time Between Sets
The simplest method is to alter the duration you
rest between sets of a strength training exercise.
Three sets of twenty push ups with 40 seconds of
rest between sets will feel dramatically different
than three sets with 120 seconds of rest between
sets.
Total Number of Repetitions/Period of Time
How many push ups, pull ups, box jumps, or kettlebell swings can you perform in a specific period of
time? Pick an exercise and load, set a timer for five
minutes and start counting. This is the idea behind
Charles Staleys’ Escalating Density Training system. Keep track of your repetition totals and try to
create a new record at your next session.
Time To Completion
Set up a circuit of three or four exercises for a specific number of repetitions at each exercise. Start
the timer and see how long it takes to complete
three or four cycles. Scale the exercises to your
fitness level and push to achieve better times.
Having a specific time goal can greatly increase
your exercise intensity.
Michael S. O’Hara, P.T., O.C.S., C.S.C.S.
Fenton Physical Therapy
Linden Physical Therapy
Milford Physical Therapy
08/08
Diver Down
Vacation Injury Recovers With ASTYM
Donna was on vacation in the Bahamas when she struck her left thigh on the side of a boat during a diving
trip. She had left hip pain that caused her to limp for the next four weeks. The pain with walking resolved
after five weeks, but when she attempted to return to her exercise classes the pain returned. Diagnostic imaging tests were normal ,and she was prescribed Motrin and daily stretches for her hip. She stated the treatment with stretching and Motrin did not produce any changes in her pain. Three months after the injury,
Donna was referred to our office for physical therapy treatment by her physician.
Donna reported pain in the front and outside of the left hip with walking up stairs, running, and tennis. The
pain was recreated with resisted hip abduction and with squatting. Donna was unable to fully flex the left
thigh or sit cross legged on the floor. The outside of the upper thigh was tender to palpation. Her initial treatment consisted of augmented soft tissue mobilization (ASTYM) of the left leg and a daily home program of
stretches for the hip. As her pain decreased, she was progressed to strengthening drills. After five sessions ,Donna was able to return to her exercise class and remained pain free. Her left hip range of motion
was normal after her eighth and final session. Donna spoke with us a month later and reported she remained
pain free.
Dear Doctor:
At our facilities, the initial evaluation, consistent reevaluations, exercise instruction and manual therapy are
always and only performed by a Physical Therapist on each and every visit. Excellent service and treatment
standards can only be maintained when the highest level of professional care is provided. We are also able
to treat your patients within a day or two of referral. Our extended evening hours allow convenient scheduling times for your patients. They are seen when they need it most, without an extensive waiting period.