ACTIVE P.T. SOLUTION S ...BECAUSE LIFE SHOULD BE ACTIVE APTS Monthly Office Hours: VOLUME VII, ISSUE VIII AUGUST 2017 Monday - 8:00am - 5:30pm Tuesday - Runners and Pain 8:00am - 7:00pm Wednesday - As the summer progresses, recrea- cises such as bridging, side leg lifts, and ferred to as cinema or movie sign. tional athletes will continue to hit the squats leaning into an exercise ball will This is not commonly present in a 8:00am - 5:30pm road for their daily sessions. be helpful in correcting that weakness mechanical PFPS. Riding a station- Thursday - Unfortunately a large percentage of and reestablishing correct mechanics ary bike or using an elliptical are these individuals will have their exer- on foot plant during the running gait. If tolerable or even pain free; this is 8:00am - 5:30pm cise goals fall short due to injury. your pain is not improving and you because neither requires you to be One of the most common injuries in have received treatments such as ul- in single limb stance (standing on Friday - the recreational runner is . trasound, electrical stimulation, ice, one leg) at any given point in time 8:00am - 4:00pm and knee exercises you should try such as in running. The single limb Commonly referred to as “runner’s alternative treatments and be evalu- stance is what puts the most stress Location: knee” or patellofemoral pain syndrome ated for underlying conditions. on the knee. While patients who (PFPS) this type of pain is worse with 91 Columbus Street have plica syndrome will get activity and improved with rest or Several stronger with their strengthening Auburn, NY 13021 stopping the running program. While underlying program, and their pain will subside the majority of runner’s knee can be conditions with reduction or ceasing running P: (315) 515-3117 resolved with a combination of physi- can be the activities, the pain returns with cal therapy treatments and stability cause of running in the same predictable exercises, there are occasional un- knee pain manner as it did before the derlying problems with the patient’s that fails to strengthening program. PFPS has a INSIDE THIS anatomy that may slow progress. The improve very good track record of resolu- ISSUE: faster the underlying problems are with com- tion with a comprehensive program recognized the more efficiently the prehensive of manual therapies, hip patient can be managed. Efficient physical strengthening, and balance training. Runners and Knee 1 management leads to faster resolu- therapy. One of the more common Pain tion of his or her knee pain and re- conditions is known as a synovial plica If you are a runner suffering from turn to his or her recreational run- band. This is basically an extra piece of pain in the front of the knee and Exercise of the 2 ning. tissue that remains in the knee from you have attempted self-care with a Month: Sidelying birth. Normally the plica is painless, hip and knee program but continue The knee is made up four bones: the but the stress of athleticism will irri- Hip Abduction to battle knee pain, you should femur or thighbone above, the tibia tate and thicken the plica turning it seek out an opinion of a healthcare What’s Going on 2 and fibula below, and the patella or painful. Once the band becomes pain- provider with sports injury experi- at APTS? kneecap that sits in a groove on the ful, ice and rest will usually reduce the ence and training. A healthcare femur. In the past, it was believed pain. Returning to running often exac- provider trained in the manage- that the kneecap itself moved to the erbates the plica. Unfortunately, the ment of sports injuries and who is APTS Night at the 2 outside and this was the cause of pain most efficient treatment for a sympto- familiar with runners can let you Auburn Doubledays in the knee. Today research has matic plica band is arthroscopic surgi- know from a history and physical shown that it is not the kneecap that cal removal. examination if a plica band should moves to the outside, but the femur Knee Pain: Meniscus 3 be suspected. Generally speaking, if Tears and Baker’s moves to the inside, giving the per- Here are some helpful clues to help the pain is present for 6-8 weeks Cysts ception that the kneecap moves to differentiate a mechanical patel- and is not resolving to the point the outside. This happens in large lofemoral pain syndrome (PFPS) from that you can return to your previ- APTS Recipe Box: Avo- 3 part due to weakness of the hip mus- synovial plica syndrome: Runners with ous running routine, a medical cado Tuna Salad or Pine- cles that should contract and stabilize a plica syndrome usually have pain apple Shrimp on Bok opinion is in order and will ulti- Choy the femur at each step in the running with running in a very predictable time mately save you time, money, and or walking gait. frame. For example, the pain usually frustration. Don’t wait for it to Nutrition 101: Top 4 comes on at a predictable time or “just go away” because it won’t! Diet Changes for If you are experiencing simple run- distance into a run. Sitting for long Autoimmunity, Part 1 ner’s knee because of poor mechan- periods in a movie, car, plane, etc., Article by Dale Buchberger, ics from hip muscle weakness, exer- cause pain and stiffness. This is re- DC, PT, CSCS P A G E 2 Exercise of the Month: Sidelying Hip Abduction

Sidelying hip abduction is an exercise against a wall. You want your head, Perform 2 sets of 10 repetitions to to work the outer hip muscles that upper back, buttock, and heel all to start, and gradually work your way often get neglected in daily life. be touching the wall. You can also up to 2 sets of 30 repetitions per Almost everyone’s hips are weak rest your head down on your arm or day. Once you reach 2 sets of 30 because we walk forward and not a pillow if that position is more comfortably, you can drop your sideways. When your hips are weak, comfortable for you. The bottom leg repetitions back down to 10 and add the entire lower leg suffers, from the can be bent (as shown) or straight— a one pound cuff weight to your knee to the ankle and foot. again, whatever is more comfortable ankle. Then gradually increase your for you. repetitions to 30 and continue this Hip abduction is the act of bringing cycle, up to 5 pounds. your leg away from the center of To perform the exercise, lift the top your body. The key with this exer- leg slightly higher than your hip while As always, if you experience any cise is keeping your foot pointing keeping your knee as straight as pain, discomfort, or dizziness, dis- Sidelying hip abduction, straight forward—in this case, paral- possible and your foot in a neutral continue the exercise and consult lel to the floor—so as to not twist position (as stated previously). Do your health care professional! start and end position the hip in its socket, and also to not not point your toe; keep foot flexed (top), exercise position lift your leg too high. toward you. No need to hold the leg, just lower slowly to midline (as (bottom) The best way to position yourself for shown), not all the way to the floor. this exercise is to lie with your back

Sign up for the What’s Going on at APTS?

Downtown Auburn Mile Kyle Brunnell, a second year PT Dale is in Taiwan. He will take his and recreational runners and walkers. student from Utica College, has board exam in October. Claire It begins at Pettigrass Funeral Home online only at been doing his first clinical internship Sargeant, a former front desk em- on Genesee Street and loops around with us since July 10. He will be here ployee and PT student at Ithaca Downtown Auburn, ending at Prison www.lightboxreg.com/ until August 18. College, will once again be part of City Pub and Brewery on the corner the APTS team, this time working as of State and Dill Streets. The Auburn Dr. Buchberger continues to pre- an aide in the clinic for 3 weeks in B.I.D. is sponsoring Music on the Mall downtown-auburn- pare for his trip to Taiwan. He August while Dale is in Taiwan. featuring Mere Mortals that night after leaves August 13 and returns August We’re very excited to have James’s the race, and A.T. Walley’s will be mile_2017 31, returning to the clinic on Tues- and Claire’s help! serving beverages and hot dogs. Sign day, September 5. up online only at $12 in advance The Downtown Auburn Mile, spon- James Martin, PTA, is now a part- www.lightboxreg.com/downtown- sored by Active PT Solutions, is time part of the APTS family! We auburn-mile_2017 $12 in advance, $20 on race day taking place Friday, August 25, at hired James under a temporary $20 on race day. This event is family 7:00 PM. This race is for competitive license to help out in the clinic while friendly and all ages are welcome! APTS Night at the Auburn Doubledays

Active Physical Therapy Solutions pictures with fans. Dale and Jason sponsored its 4th Annual Buyout threw out the first pitch simulta- Night at Falcon Park, home of the neously, Dale being a right-handed Auburn Doubledays, on Thursday, pitcher and Jay being left-handed. August 3. Jason Stanford, The attendance that night was former Cleveland Indians 1619. We look forward to this pitcher, Buffalo Bisons all every year! time strikeout king, and friend of Dr. Dale Buchber- ger, joined the staff of APTS to sign autographs and take

APTS MONTHLY VOLUME VII, ISSUE VIII P A G E 3 Knee Pain: Meniscus Tears and Baker’s Cysts

A meniscus tear is a common knee knee. The pain may cyst to develop behind both at injury. The meniscus is a rubbery, C- come and go for years the same time. shaped disc that cushions your knee. if the tear is not Each knee has two menisci (plural of treated or rehabili- A Baker's cyst can develop if there is an meniscus): one at the outer edge of the tated. underlying problem within the knee, A torn meniscus knee (lateral meniscus) and one at the such as arthritis (including osteoarthritis inner edge (medial meniscus). The me- When severe tears and rheumatoid arthritis), or a tear in a can lead to nisci keep your knee steady by balancing occur, pieces of the meniscus. This type of Baker's cyst is the your weight across the knee. A torn torn meniscus can most common and may be referred to knee instability, meniscus can prevent your knee from break loose and move into the joint as a secondary Baker's cyst. functioning correctly. space. This can cause your knee to inability to catch, pop, or even lock. You may not In a secondary Baker's cyst, the underly- A meniscus tear is usually caused by be able to fully straighten or bend your ing problem within the knee joint causes twisting or turning quickly and forcefully, knee. Your knee may feel "unstable" or too much synovial fluid to be produced move your often with the foot planted while the “give way” when weight bearing on the within the joint. As a result, the pres- knee is flexed. Meniscus tears can occur injured leg. It will usually swell and be- sure inside the knee increases. This has knee normally, when you lift something heavy or during come stiff right after the injury or within the effect of stretching the joint capsule. sporting events that involve stop-and-go 24 hours of suffering the injury. The joint capsule bulges out into the or chronic knee movements. The risk is particularly high back of the knee, forming the Baker's for athletes, especially those who par- If you are older and your meniscus is cyst that is filled with synovial fluid. This pain. A Baker’s ticipate in contact sports, such as foot- degenerated, you may not know what results in limited ability to bend the ball, or activities that involve pivoting you did to cause the tear. For example, knee, especially with attempting to squat cyst can and sudden stops, such as soccer, tennis, you may only remember feeling pain down. The Bakers cyst can expand and or basketball. As you age, your meniscus after you got up from a squatting posi- shrink over time. Generally surgery is develop if there will begin to degenerate and wear. This tion. Pain and slight swelling are often not indicated for a Baker’s cyst, but can make the meniscus more susceptible the only symptoms. draining it is an option. is an underlying to a tear. Even kneeling, deep squatting, or lifting something heavy can some- A torn meniscus can lead to knee insta- Meniscus tears that prevent full function problem within times lead to a torn meniscus. In older bility, inability to move your knee nor- after conservative treatment (physical adults, degenerative changes of the knee mally, or chronic knee pain. You also therapy, strengthening program, Active may contribute to a torn meniscus. If a may be more likely to develop os- Release Techniques, Extra-corporal the knee, such meniscus is degenerated, simply rolling teoarthritis in the injured knee several Shock Wave Therapy, etc.) for 6-8 over in bed can result in a tear. years following the injury. weeks may require arthroscopic sur- as arthritis or a gery. While no one wants surgery, Larger tears can cause pain at the side A Baker's cyst is a fluid-filled pouch that sometimes surgery is necessary to re- meniscal tear. or center of your knee. Swelling gets can develop behind the knee and is gain full function. Meniscus tears com- progressively worse over 2 or 3 days. commonly associated with a meniscus monly fall into this category. Once the This may make your knee feel stiff and tear. It is named after doctor William meniscus tear is either debrided or limit how you can bend your knee, but Baker who is reported to first describe repaired, supervised physical therapy walking is usually possible with a notice- this condition in approximately 1877. It will quicken your return to your pre- able limp. You might feel a sharp pain is also sometimes referred to as a pop- injury level of activity. Remember, it’s when you twist your knee or attempt to liteal cyst. The cyst can vary in size from your right as the patient to choose squat down. These symptoms may re- a very small cyst to a large cyst that is a which physical therapist you see! solve in 3 or 4 weeks but can recur if number of centimeters across. Although Article by Dale Buchberger, DC, you inadvertently twist or overuse your possible, it is uncommon for a Baker's PT, CSCS

APTS Recipe Box: Avocado Tuna Salad or Pineapple Shrimp on Bok Choy

This is a quick and easy healthy lunch or snack together. Add tuna, salt, and pepper. Stir to separated into individual leaves, or baby bok with just 4 ingredients. And it’s gluten free, combine. Taste and adjust as needed. Fill avo- choy leaves. dairy free, and paleo! cado shells with tuna salad and serve. Source: http://cookeatpaleo.com/paleo- Instructions: Cook shrimp and place in large Ingredients: 1 avocado; 1 lemon juiced, to avocado-tuna-salad/ bowl. Add cucumber, pineapple, cilantro, and taste; 1 tablespoon chopped onion to taste; 5 lime juice and stir to combine. Arrange leaves of ounces cooked or canned wild tuna; sea salt to Another great quick and easy lunch or snack choice on serving platter and spoon 2 table- taste; fresh ground pepper to taste. option is pineapple shrimp on bok choy leaves. spoons of mixture onto each leaf and serve. Source: http://www.100percenthealth.us/ Instructions: Cut the avocado in half and Ingredients: 1/2 pound cooked, peeled shrimp, 6-months-to-year-1/autoimmune- scoop the middle of both avocado halves into a tails removed; 1 large cucumber, peeled, seeded, healthy-meals-recipes/ bowl, leaving a shell of avocado flesh about 1/4 and diced; 2 1/2 cups diced pineapple from 1/2 -inch thick on each half. Add lemon juice and fresh pineapple; 1/4 cup fresh chopped cilantro; onion to the avocado in the bowl and mash 3 tablespoons lime juice; 3 heads Belgian endive, At Active Physical Therapy Solutions, we utilize the most cutting edge treatment and management techniques available. Our goal is to deliver the best possible healthcare in Active P.T. Solutions a friendly, caring, and well-organized 91 Columbus Street environment. Our staff is here to Auburn, NY 13021 provide active solutions to achieving Phone: 315-515-3117 Fax: 315-515-3121 your personal goals! E-mail: [email protected] website: www.activeptsolutions.com ...BECAUSE LIFE SHOULD BE Get Well...Get Active...Be Active ACTIVE! Newsletter Edited by Carolyn B. Collier, PTA Nutrition 101: Top Diet Changes for Autoimmunity, Part 1

In autoimmune disease, the body starts to target that are loaded with hydrogenated oils, high gut lining and cause the immune system to react its own organs since the body is unable to differ- fructose corn syrup, artificial sweeteners, trans- even more. entiate between a foreign invader from the body’s fats, refined grains, and sodium chloride  Tree Nuts—are one of the top allergens and own tissue. The body also may not be able to (processed white table salt). regulate how intense the immune response is most common food sensitivities. Those with  Sugar—glucose, fructose, and sucrose weakens leading to damage to various parts of the body. autoimmune disorders are more likely to have a This is why what you put in your body is crucial the ability of white blood cells to destroy biologi- sensitivity or allergy to nuts (and seeds) than when dealing with autoimmune conditions. If your cal agents. This weakening begins within a half- other people. An elimination diet should be done body is already under attack from your own im- hour of eating sugar and lasts for 5 hours. to determine if you have a sensitivity to a certain nut or not. Keep in mind that once an allergy is mune system, it is necessary to remove any foods  White table salt—too much refined and proc- that are going to cause additional inflammation and present, it will not go away and you need to essed salt may be one of the environmental remove this food from your diet for life. damage. Examples of autoimmune diseases include factors causing an increase in autoimmune dis- lupus, celiac disease, Type I diabetes, Graves dis- eases. Table salt contains sodium chloride among  Cross-reactive foods—are foods that the ease, inflammatory bowel disease, psoriasis, rheu- other chemicals, iodine, preservatives, and some- immune system mistakes for gluten. They include matoid arthritis, Hashimoto’s thyroiditis, and even times sugar; sea salt does not. milk chocolate, instant coffee, all cereal grains, multiple sclerosis. corn, rice, yeast, millet, and milk. People sensitive  Grains—can cross-react with gluten, meaning The following trigger foods cause digestive and to gluten must also consider eliminating these they cause an immune response in some people. immune system problems, which include gut in- foods. Cross-reactive grains include rye, barley, spelt & flammation, imbalances in gut flora (dysbiosis), kamut, oats, millet, corn, and rice.  Nightshade vegetables—such as tomatoes, damaged structural integrity of the intestines eggplant, potatoes, peppers, and even goji ber- (“leaky gut”), nutrient deficiencies, and immune  Legumes—including bean, lentils, peanuts, peas, ries, can increase inflammation and joint pain in system impairment. Often these foods do damage and soybeans, are high in lectins and saccharides those with autoimmune disease. without causing obvious digestive distress. (sugars) that feed harmful intestinal bacteria and It can be daunting to contemplate the dietary changes The top trigger foods to remove are: damage the intestinal barrier (“leaky gut”) and can lead to autoimmunity. that are usually needed in order to reverse your auto-  Gluten—the gluten found in products today immune condition(s). But, many have done it with has been man-made and manipulated in  Dairy—drinking milk has been associated with wonderful results. Once you experience freedom from processing so that gluten is extremely diffi- an increased risk for numerous autoimmune symptoms by removing your food triggers and adding cult for the body to recognize. diseases because it is difficult to digest and causes in nourishing foods, you’ll be glad you did! inflammation.  Processed foods—the Standard American Article by Carolyn Collier, PTA Diet (S.A.D.) is filled with processed foods  Eggs—particularly egg whites, can permeate the Sources: http://www.healingisfreedom.com/science/top-five- autoimmune-triggers-food/, https://www.consumerhealthdigest.com/