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Lymphedema is unfortunately a disease that is often under recognized and therefore goes untreated. If left untreated, people are at increased risk for other complications and long-term disability.  
 

What is Lymphedema?  

    Lymphedema is chronic swelling that is caused by the build-up of fluid that occurs when the lymphatic system is either faulty or damaged. The lymphatic system is a network of tissues and organs that help rid the body of toxins, waste and other unwanted materials. The primary function of the lymphatic system is to transport lymph, a fluid containing infection-fighting white blood cells, throughout the body.*
 

What causes Lymphedema? 

   A lymphatic system can be abnormal at birth. When the system can no longer cope with the demand of lymphatic fluid, it can lead to what we call Primary Lymphedema.  

  Alternatively, someone can develop Secondary Lymphedema when the lymphatic system has been damaged from some sort of external source. This can be caused by cancer and its related treatments, trauma, surgery, obesity or chronic venous insufficiency.  
 

What are some of the signs and symptoms of Lymphedema?  

   Symptoms of Lymphedema include a feeling of fullness, tightness or heaviness in the affected arm or leg, achiness or discomfort in the affected arm or leg, poor fitting of clothing or shoes, indentations or pitting in the skin, and changes of the skin such as thickening of the skin.  
 

Is Lymphedema treatable?  

   Once you have been diagnosed with Lymphedema, it is a lifelong condition that will require continued management. Seeking the help of a physical therapist with provide you the tools necessary to continue self-management.  
 

How can physical therapy help?  

   Lymphedema treatment is known as complete decongestive therapy or CDT.  This would consist of manual massage to help stimulate the lymphatic vessels to improve flow of lymphatic fluid, compression therapy to decrease swelling, exercise, skin care and instructions in self-care.  
 

If you are dealing with uncontrollable swelling in an arm or leg, it is time to reach out to a physical therapist! It is best to find a certified lymphedema therapist (CLT). We can help you manage and control your swelling so you can return to all the activities you love to do! 

*https://www.livescience.com/26983-lymphatic-system.html

Cupping is a not-so-new treatment that has been popularized by Olympic athletes. What is cupping, why does it leave those marks, and what conditions are indicated for its use?

What is cupping?

Cupping is a myofascial release technique that utilizes negative (tension) pressure to reduce pain, promote healing, increase blood flow, improve range of motion, assist recovery, and reduce formation of scar tissue. Dry cupping, which the most utilized form of cupping and the type performed by PEAK Physical Therapists, uses silicone, plastic, or glass cups of various sizes that are placed on the target area and the air within the cup is removed with a pump. This method draws out toxins and cellular waste products from the muscle tissue and deep fascial layers.

When should I get cupping treatment and what does it entail?

Cupping can be a treatment method for a majority of musculoskeletal conditions including, but not limited to:

• Pre- or Post- Surgery

• Acute Injury

• Low Back Pain

• Sciatica

• Poor Circulation

• Headaches

• Trigger Points

• TMJ Pain or Dysfunction

• Chronic Pain

• Edema/Swelling

• Arthritis

For the treatment, a single cup or multiple cups may be applied at one time, with the therapist keeping the cup in place for a period of up to 4-5 minutes. The therapist can move the cups along the length of an area of tissue to achieve a greater release (external glide), or having the patient move the affected area with the cups applied (internal glide) to achieve greater self awareness, independence, and functional ability.

What are the marks left after cupping treatment?

The skin reactions left after the cup is removed are due to the movement of blood under the skin. The presentation of color depends on the individual, location of the treatment, and how much stagnation of blood and toxins are present under the tissue. In follow-up treatments the marks will become progressively lighter as the pathogens are systemically removed from the body. These marks often dissipate 1 day to 2 weeks following treatment depending on the technique utilized and are typically not painful to touch. Those who receive cupping treatment often feel an immediate sense of relief.

Next Steps?

Many providers at PEAK Physical Therapy utilize myofascial cupping with their patients as a tool in combination with other manual techniques and therapeutic exercise to elicit lasting changes and improve overall functional ability. If you are interested in trying cupping, please call any one of our convenient Denver locations today!

Plantar Fasciitis- How to Avoid It, and What You Can Do If It’s Already Developed 

 

What is the plantar fascia? 

Your plantar fascia is a thick, dense tissue that connects your heel bone to the base of your toes, and supports the arch of your foot. As you place more weight or pressure on your foot, this tissue is supposed to gently expand, allowing a shock absorption in the foot, and springing it back to it’s original shape once the weight is lifted.

What often gets forgotten is that it doesn’t act alone to ensure this motion can be repeated thousands of times throughout the day. The muscles within your foot, as well as the muscles of the calf, can contribute to a strong, pain-free arch.  

 

What is plantar fasciitis? 

Plantar fasciitis occurs when too much strain is placed on the plantar fascia, creating micro-traumas that are not healing as quickly as they are being produced. This causes long-term inflammation and pain.

The symptoms are most often a sharp pain at the heel near your arch, in the arch itself, or occasionally at the balls of the feet. The symptoms are most notable when the fascia has been tight for an extended time, such as first thing in the morning, or after a long period of sitting, especially AFTER being active prior to the rest.  

 

How can I prevent it? 

To understand prevention, we first have to look at causes. Some common causes are: 

• Increased activity- a runner who adds too many miles per week, or someone who is pretty sedintary at work all week, then takes on a big hike or house project 
• Abnormal foot structure- if you naturally have a fallen arch, or an abnormally tall arch, you are at higher risk  

• Weight gain- adding more weight to your body essentially adds more weight to every step, and in turn the plantar fascia  

The simplest, but also potentially hardest, way to combat the first and third causes there, is to maintain a consistent, active lifestyle, and to avoid any sudden changes in exercise habits. Adding activity is great, just be sure to do it gradually and slow down if pain starts to develop.

An abnormal foot structure can be more difficult to combat, especially if it has been present your entire life. In this case, a physical therapist can do an assessment to see if you would be appropriate for over-the-counter or custom foot orthotics.

If the “structural” issues have developed in recent years, however, it is likely that the cause is weakness in the supporting muscles of the foot and ankle that were mentioned earlier. In this case, strengthening of the internal foot muscles and ankle muscles is a great place to start.

There are loads of articles that can point you in the right direction on where to get started with this, or you could consult a physical therapist to put a preventative exercise program in place, especially if you plan to increase your activity in the near future and are between 40 and 60 years old (higher risk of developing plantar fasciitis).  

 

What if I’ve already got it? 

That’s OK!

Plantar fasciitis is generally very treatable with conservative treatment, with only severe cases requiring non-conservative care. Start out by reducing time on your feet for a few days as much as possible, icing the feet, and starting with some of the foot strengthening exercises that can be found online.

Next, use a night splint designed to keep your foot in a 90 degree or greater angle, in order to prevent the plantar fascia from excessively shortening overnight. Excess shortening leads to excess irritation and inflammation in the morning.

In addition to these, try rolling the arch of your foot on a golf ball or frozen water bottle in the mornings, to pre-stretch the fascia before placing your full weight on it. This will help prevent sharp pains, which can start the inflammation cycle over.

If these tips don’t significantly reduce your pain in 5-7 days, reach out to a physical therapist! The longer the symptoms last, the more difficult they are to eliminate, so make sure to be proactive, and ask for help if it is needed.
 

Stay active, stay safe.

Concussions are a hot topic now-a-days especially in sports. So what exactly are concussions, why is it important to treat concussions, and when should you seek additional help from a physical therapist?

What are concussions?

Concussions (now more commonly understood as mild traumatic brain injuries or mTBIs) are caused by a bump, blow, or jolt to the head, or even a hit to the body, that causes the brain to move quickly back and forth. 

What are the symptoms of a concussion?
Symptoms of a concussion include headaches, sensitivity to light, nausea/vomiting, dizziness, personality changes like aggression, difficulty concentrating, neck pain, difficulty with memory, and more. 
Things like physical activity, trying to use technology, driving, even reading can be difficult and worsen symptoms.

Are concussions common?

Concussions are actually very common. Between 1.7 and 3 million concussions happen every year due to sports and recreation.
That's not all! Even more occur from traumatic events like car accidents! About 50 percent of all concussions go unreported, which means that likely more than 50 percent go untreated.
Concussions typically go unreported in sports because athletes don’t want to stop playing but even if you're not an athlete the most common concussion comes from a fall.

What can I do if I suspect I have suffered a concussion and how long is recovery?

On average, the brain takes about 7 days to recover with adequate treatment. However, the worse the brain injury, the longer it takes to recover. Without any treatment at all, any concussion will take longer to recover. 

Initially after a concussion, you’ll want to rest. This means getting adequate sleep (7-10 hours at night) and short naps during the day (30 minutes). 

Minimizing stimulation is important as it allows the brain to rest and recover. This means reducing screen time on your phone/tv/computer, reading, listening to loud music, and minimizing rigorous activity. 

 

Next steps?
Once your symptoms have improved/resolved, slowly integrating those activities back while keeping your symptoms minimal will help your brain re-acclimate. This progression will be tolerable for many concussions. However, depending on the severity of the symptoms and type of symptoms, the symptoms won’t resolve on their own. This is the best time to seek more help.

 

If you’ve had a concussion, especially one with noticeable symptoms for long periods of time afterwards, you know how greatly it can impact your daily life. It is important to know that you do not have to just live with these symptoms and hope they go away. Physical therapy after a concussion (even months later) can help you return to your normal life faster. When looking for a physical therapist to help you, it is best to find a therapist who specializes in concussion rehab. We can use our training and skill set to help your brain recover and return you to the activities you love. 

Here at Peak Physical Thearpy we have specialist in just about anything you can think of. Today Jamie Snowden is going to answer all our most frequently asked questions surrounding your bladder health.

How often should I go? How much is normal?

Assuming you're appropriately hydrated, voiding (peeing) 5-8 times throughout a 24 hour period is considered normal and healthy. Usually every 2-4 hours depending on time of day. Around 250-550 ml (8.4-18.5 ounces) per void is normal.

While you're peeing, try counting how many "mississippi" seconds it takes to fully void. Around 8 seconds is a good goal.
 

I limit how much fluid I drink during the day so I don't have to go as often. Is that healthy?

This may seem counterintuitive, but limiting your fluid consumption can lead to concentrated urine (you know the dark yellow color) which is actually an irritant to the bladder. This can lead to urinary incontinence or leaking.
 

I drink plenty of coffee, sparkling water, and tea during the day. That counts, right?

Although fluid, these beverages can be a bladder irritant to some individuals. Ideally, you are consuming 1/2 your body weight in ounces of fluid a day, and 2/3 of that being water.
 

I always need to pee in the middle of the night. Is that okay?

It's okay to go up to 1 time per night. More often than that is disruptive to sleep and may indicate a need for behavior modifications and bladder retraining.
 

I hate sitting on public toilets, so I always hover. That's fine, right?

We understand the need for cleanliness, however, hovering over a toilet while attempting to void can send the wrong signals to your bladder. In order for you to fully empty your bladder, your pelvic floor actually needs to relax. This allows a natural reflex that causes the bladder to contract and urine to leave the body. If you are hovering, your pelvic floor is likely contracting which disrupts that natural cycle making it difficult to fully void. Best practice is to wipe down the seat or use a seat cover and sit down fully.
 

As mentioned in our previous Pelvic Floor Physical Therapy video, your pelvic floor plays a vital role in your bladder function. If you’re concerned about your bladder habits, or wondering if what you’re experiencing is normal/healthy, consider scheduling a pelvic floor evaluation with one of our Pelvic Health Specialists. We love to help!