We are excited to welcome Lynsey Wagner, PT, DPT, OCS to the Rock and Armor Team! Lynsey will be treating patients in our Boise location (104 W 53rd St, Garden City) and specializes in Women’s Health and Orthopedic Physical Therapy. Lynsey will be seeing patients starting Monday 3/1/2021. To schedule with Lynsey call 208-375-5511
https://www.rockandarmor.com/garden-city-physical-therapy.html
We are beyond excited to open our second Rock and Armor location to serve the Treasure Valley! Rock and Armor Boise will be located in Boise/Garden City at the Dragila Vault Club on W 53rd and Chinden (by the Fairgrounds). Experienced local Physical Therapist, Jerrod Ackerman, joins our team as the clinic Physical Therapy Manager. We will slowly integrate sports performance training as the demand increases.
Jerrod will begin accepting Physical Therapy patients now with a start date of June 15th.
Please call 208-917-2660 to schedule a Physical Therapy evaluation at this location. You will receive the same level of care and love as our Meridian clinic!
Thank you Treasure Valley for allowing us to serve you
Kailey Rote, SPT
What is it?
Tennis elbow, also referred to as lateral epicondylalgia, is tendonitis at the extensor tendon of the elbow. Tendonitis occurs when there is irritation or inflammation of a tendon, or where a muscle attaches to bone. This is common in individuals performing a repetitive motion, which repeatedly places the same stress on the irritated tendon. An individual with tennis elbow experiences pain in the soft tissue region at the lateral portion of the elbow or upper part of the forearm.
Someone with tennis elbow might report pain following activity that involves repetitive wrist extension, pain radiating down the forearm, and difficulty or weakness gripping objects. Upon physical examination, multiple findings are present: point-tenderness at the lateral elbow, weak and painful wrist extension, weak grip strength, pain or decreased range of motion into elbow extension, wrist flexion, and a position with the palm facing down and fingers shifted away from the body.
Who does it affect?
Tennis elbow most commonly affects males and females between the ages of 30 and 50 years. Those performing computer work, heavy lifting, repetitive vibration, and repeated wrist extension (ie. manual labor, housework, tennis, musicians, manual wheelchair users, etc.) tend to experience these symptoms. It is often carpenters, painters, electricians, and landscapers that present with this condition as they are repeatedly using the extensor muscles on their dominant side to complete their job.
Risk factors, predisposing one to experience tennis elbow, include: 30-50 years old, manual labor, smoking, carpal tunnel syndrome, DeQuervain’s tenosynovitis, oral corticosteroid therapy, repetitive activities for more than one hour per day.
How is it treated?
Physical therapy treatment is appropriate and often beneficial for those with tennis elbow. Initially, a counter-force brace, to reduce the load on the extensor group, can be placed just past the elbow during painful activities. Deep massage to this region, as well as ultrasound can decrease pain and stimulate an increase in blood flow. Stretching and strengthening (isometric, concentric and eccentric contractions) of the muscles of the forearm promote healing as well. A good place to start is to extend the arm on the affected side (palm down), and with the unaffected hand, pull the hand gently towards your body. Dry needling, performed by certified physical therapists, involves insertion of a fine, sterile needle into the tissue and muscle to promote healing and reduce pain. This technique, along with the previously mentioned treatment approaches, can lead to decreased pain and increased function allowing earlier return to work tasks, sports, and other chosen activities.
If you would like to be treated at Rock and Armor for Tennis Elbow, call 208-917-2660 or visit www.rockandarmor.com
Reference List
Rock and Armor’s Concussion rehab program is designed to help you get back to doing what you love. We are certified through Evidence in Motion’s (EIM) Concussion Certification Program to diagnose symptoms, treat your concussion, and evaluate your ability to return to work/sport. We work closely with your physician, athletic trainer, employer, and school to achieve the best possible outcomes.
How do we diagnose concussions?
We utilize in-depth screens examining neurological, vestibular, and ocular systems which are commonly affected by concussions.
We also utilize specific tests to help determine the appropriate course of treatment and to re-evaluate the patients readiness to return to sport or work.
How do we treat concussions?
We treat concussions by determining which systems have been affected and treating these systems via specific exercises and manual therapy.
We screen the vestibular system and challenging and improving the patients balance.
Screening the ocular system and correcting visual dysfunction with specific exercises is a vital part of the return to play process.
We also treat cervical dysfunction and pain via joint mobilization, manipulation, and cervical control exercises.
We provide an in depth education on rest, return to sport/work progressions and symptom management to both the athlete and the parent.
We utilize sub-threshold training to safely return the patient back to their respective athletic/work environment.
Overview
Concussions are a form of mild traumatic brain injury (TBI). Treating them requires a team approach and is multi-factorial and complex. Recovery can range from one week, up to many months This brochure is intended to be an informative broad overview, and is not completely comprehensive. Your concussion certified Physical Therapist at Rock and Armor is happy to discuss all of your questions in detail while working through the process. Thank your for allowing us to help you with this process.
To schedule an appointment at Rock and Armor for Concussion Rehab, please call 208-917-2660.
Athletes, are you ready to get bigger, faster, stronger, and more explosive this summer. Get the edge on your competition with one of our summer classes. We have something for everyone, ages 3 to adult! Don’t see the classes that works for you, try a one-on-one personal training sessions with one of our incredible trainers. Our prices are the best in the Treasure Valley and all of our trainers are former collegiate athletes.
visit https://payment.rockandarmor.com/class-schedule/ to sign up today!
Rock and Armor Physical Therapy and Sports Performance, LLC offers a unique approach to athletic enhancement, fitness, and healing for active individuals of all ages.
We are sports enthusiasts who believe fitness and healing should be fun, and occur in open spaces free from confinement. Our 8,000 SF facility allows athletes and active individuals to rehabilitate injuries in a setting that feels more like a gym, field, or court, and less like a doctor’s office.
We believe individuals seeking to perform at the highest possible level should have 1-on-1 guidance with state of the art trainers and therapists who were previously high-level athletes, allowing them to directly relate to the emotions and challenges presented.
We believe in creating an environment where the waiting room feels like a coffee shop or sports bar, the music is upbeat and uplifting, and the staff are former athletes enthusiastic to work with you.
Sports Hernia vs Inguinal Hernia
Sports Hernia1
There are two main types of hernias either a sports hernia or an inguinal hernia. Sports hernias are a soft tissue injury to the groin area commonly affecting the abdominals and inner thigh muscles (hip adductors). Sports hernias are caused by fast rapid exercises that involve changing direction rapidly and aggressively. They commonly occur in vigorous sports such as ice hockey, soccer, wrestling and football. Symptoms of a sports hernia include: pain in the groin at the time of injury, the pain gets better at rest and worse with activity especially twisting movements. A sports hernia does not cause a visual bulge in the groin like an inguinal hernia does but over time a sports hernia may lead to an inguinal hernia and abdominal organs may press against the weakened soft tissues and form a visible bulge. Without treatment this injury can result in chronic, disabling pain that prevents you to return to sports. An MRI may be used to determine if you have a sports hernia and/or bone scans too determine other possible causes of pain. Treatment options include either surgical or non-surgical and rehabilitation takes 4-6 weeks and 6-12 weeks respectively.
Inguinal Hernia2
Inguinal Hernias are weakness in the muscles and tissues of the groin. There are two main areas for inguinal hernias either the inguinal canal or the femoral canal. With an inguinal hernia the abdominal organs can protrude through the weakened area in the lower abdomen/groin. If there is a visual bulge you should seek medical attention immediately to determine if the blood flow is being restricted to your organs. Factors associated with groin hernias include: smoking, long-term coughing, obesity and straining during urination or bowel movements. Groin hernias are more common in men and 25% develop a hernia over their lifetime.
There are both surgical and non-surgical options for an inguinal hernia. Non-surgical approach consists of strengthening the abdominal musculature and trying to maintain the organs inside of the abdomen. Sometimes a hernia truss undergarment is worn to help the organs remain inside of the abdomen. Inguinal hernias rehabilitation takes about 6-12 weeks for both surgical and non-surgical options.
If you think you may have a sports hernia or an inguinal hernia, we can help! Call Rock and Armor at 208-917-2660
Reference List
2.Hewitt DB. Groin Hernia. JAMA. 2017;317(24):2560.
Shoulder Instability
At Rock and Armor we treat a wide variety of shoulder conditions. Today we will discuss shoulder instability a common injury that we treat both conservatively and also post-surgically. Shoulder instability can be caused by many reasons but two common mechanisms are by trauma to the shoulder or by having a genetic pre-disposition to dislocation such as a shallow shoulder socket, loose shoulder ligaments, and/or weak shoulder musculature.
Shoulder instability can be unidirectional, bidirectional or multi-directional. There are two main ways we look at how to treat instability clinically at Rock and Armor including: Traumatic, Unidirectional instability with, Bankart lesion requiring, surgical repair (TUBS) and Atraumatic onset of, Multi-directional instability that is, Bilateral, Rehabilitation is treatment or surgical, Inferior capsule repair and rotator, Interval repair. (AMBRI).
Shoulder rehabilitation for instability includes: proprioceptive glenohumeral stabilization exercises, scapular and humeral stabilizers (subscapularis and infraspinatus). There will be a progression from isometric and closed chain exercises initially too closed chain multi-direction functional movements later on. Typical rehabilitation for shoulder instability takes approximately 6 months to fully recover.
If you’ve had a dislocation, subluxation, or other shoulder instability, we can help you with the rehab process to get back in the game. Call 208-917-2660 to schedule an appointment with one of our Doctors of Physical Therapy today.
Reference List
Subacromial Impingement Syndrome (SAIS)
By Christopher Edwards, SPT
Subacromial Impingement Syndrome, or SAIS, represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy, calcific tendonitis and complete rotator cuff tears. The etiology is multi-factorial, and it has been attributed to both extrinsic and intrinsic mechanisms. Management includes physical therapy, injections and surgery. We have great outcomes working with these injuries at Rock and Armor Physical Therapy and Sports Performance.
SAIS is the most common disorder of the shoulder, accounting for 44–65% of all complaints of shoulder pain during a physician’s visit. The subacromial space is defined by the humeral head inferiorly, the anterior edge and under surface of the anterior third of the acromion, coracoacromial ligament and the acromio-clavicular joint superiorly. The height of the space is approximately 1.0 to 1.5 centimeters. Structures that are located in this area include: the rotator cuff tendons, the long head of the bicep’s tendon, the bursa, and the coracoacromial ligament. Any abnormality that disturbs the relationship of these subacromial structures may lead to impingement.
There are three stages of impingements stage I-III. Stage-I has swelling and bruising of the subacromial bursa and is typically in patients who are less than twenty-five years old. Stage-II impingement represents age related changes, such as fibrosis and tendinitis of the rotator cuff, and is typically in patients who are twenty-five to forty years old. Stage-III impingement is more chronic changes and includes partial or full tears of the rotator cuff and is usually seen in patients over forty years old.
Patients with subacromial impingement generally have decreased scapular posterior tilting, and decreased upward rotation. Weak or dysfunctional scapular musculature, fatigue of the infraspinatus and teres minor and changes in the spinal alignment have all demonstrated a change in scapular kinematics
Both anatomical and biomechanical mechanisms can narrow the subacromial space. Anatomical factors that may narrow the space include variations in shape of the acromion, orientation of the acromion or osseous changes to the acromio-clavicular (AC) joint or coracoacromial ligament. A widely used classification system for acromial shape is flat (type I), curved (type II), or hooked (type III), Another possible source of narrowing in the subacromial space is thickening of the coracoacromial ligament. Biomechanical mechanisms that can cause SAIS include excessive superior translation of the humeral head or abnormal scapular motion that causes the acromion to move inferiorly. These include shortening of the posterior-inferior glenohumeral joint capsule and decreased rotator muscle performance.
Clinically patients that present with SAIS will most likely have an insidious onset or report that it has gotten worse overtime. They will experience pain at night. The patient will most likely have a positive Neers test, Hawkins Kennedy test, empty can test, and lift-off test. There is moderate evidence that exercise and manual therapy is the best treatment approach. It has been shown that the outcomes are similar for patients with SAIS that have been treated conservatively or surgically. However, there are better outcomes for patients that receive surgery if they have failed conservative treatment.
If you have shoulder pain, think it may be SAIS, and would like to get it looked at, our expert team at Rock and Armor is happy to help. Call 208-917-2660!
Reference List
In the upcoming months and year there will be some national chain training facilities moving into the Treasure Valley. As the Treasure Valley grows, we are seeing more and more businesses of all kinds gravitate to the area. Sports Performance and Training is no different.
As these shiny new models roll into town, be educated consumers when choosing any product, especially a training facility:
Thank you for training and working with us here at Rock and Armor. We desire to see this community grow and all individuals achieve their goals. We believe we offer a higher level product at a better price than any existing training facility in the Treasure Valley, and any franchise/chain that will come in the future. If you have not already tried Rock and Armor, today is a great day to start! Call us at 208-917-2660 to schedule an appointment today!
Anterior Cruciate Ligament (ACL) injuries can be an excruciating ordeal to overcome. There are so many questions such as graft options, physicians, rehab protocols, etc. We can help guide you at Rock and Armor, if you have suffered this injury. Below are some key points nicely put together by one of our current students, Chris Edwards, SPT, from Eastern Washington University.
ACL Graft Options1
1. Bone-Patellar Tendon-Bone (BTB) autograft- Is considered the gold standard in ACL reconstruction. Requires the harvest of the central third of the patellar tendon with attached bone blocks from the patella and tibial tubercle. BTB is the graft of choice for active individuals especially under the age of 25.
Advantages- Bone to bone healing, ease of harvesting, good clinical outcomes, lower graft failure rates.
Disadvantages- Anterior knee pain, low risk of patella fracture and patellar tendon rupture.
2. Quadrupled Hamstring graft- Semitendinosus and Gracilis tendons are harvested from their pes anserine attachment and then folded to form a quadrupled construct.
Advantages- Decreased donor site morbidity and greater initial biomechanical strength.
Disadvantage- less reliable healing because it relies on bone growth into tendinous soft tissue opposed to bone to bone healing, also unable to stretch hamstrings for up to 6 weeks post-surgery.
3. Allografts- Include cadaveric patellar, quadriceps, hamstring, and achilles tendons.
Advantages- eliminates harvest site morbidity
Disadvantages- infection risk, increased failure rates in more active individuals (due to graft weakening from sterilization processes).
Technique2
Attachments: Tibial attachment- medial to the anterior horn of lateral meniscus, Femoral attachment- posterior lateral aspect of the intercondylar notch on lateral femoral condyle. Graft fixated with interference screws, Graft strongest and fixation weakest initially.
Incisions- Two 1 cm incisions around the patella tendon for the arthroscopy equipment. Small 2cm incision below the joint along the inside of you knee where the tunnels are drilled and the graft is obtained, small incision above and outside the knee where the fixation for the graft on the femur was placed.
Protocol3
Pre-Operative: increase range of motion (ROM), decrease swelling, decrease pain, restore normal strength for ADL’s and gait, prepare for surgery.
Post OP days 1-10: RICE medicine, early ROM exercises (passive extension exercises, seated AAROM for knee extension and flexion), quadriceps strengthening (quad sets, SLR in immobilizer), hamstring strengthening (heel slides, avoid until 4-6 weeks if hamstring graft used), 50% weight bearing use two crutches, suture removal, maintain passive extension, and return to desk job.
Days 10-14: Maintain full passive knee extension, achieve 100-120 degrees of knee flexion, develop muscle control to wean off knee immobilizer (able to perform SLR with no sag), early closed chain exercises (partial squats, calf raises), 50-75% weightbearing use 1 crutch (progress to no crutches if they can walk with no limp with a reciprocal gait pattern), and stationary bike (if 100 degrees of knee flexion).
Weeks 3-4: Full extension ROM, continue strengthening exercises, expected ROM 100-120 degrees of knee flexion (add wall slides), and start elliptical training.
Weeks 4-6: Push ROM exercises want 125 degrees of knee flexion (closing in on full flexion), strength building (Goal at week 6 is affected leg quad strength to be 60% of non-affected), add double leg balance activities (airex pad, tilt board).
Week 6-12: Week 6 want to maintain full extension and receive 135 degrees of knee flexion, can start hamstring curls if hamstring graft used, start flat treadmill, begin outdoor bike on flat road, strengthening exercises (week 8 goals are quadriceps and hamstrings of affected leg to be 80% of non-affected leg), add single leg balance activities if good knee control.
Week 12-20: Continue strengthening, introduce light jogging and running if can perform all ADLs and exercises without an increase in swelling, introduce agility.
24 weeks: Earliest you should plan to return to sport. Return to sport goals include quadricep and hamstring strength at least 80% of unaffected limb, full motion, no swelling, good stability and can complete a running program.
Return to Sport Tests4,5
Return to Sport tests include: Y balance, triple hop test, single hop distance test and isometric knee extension strength. Experts recommend not to return to sport until the Y Balance ANT has < 4 cm difference between affected and non-affected leg, be able to jump at least 90% the distance on the affected leg as the non-affected leg and to have at least 85% strength in the hamstrings and quadriceps on the affected side compared to the non-affected side.
If you need some guidance following ACL injury, please feel free to reach out to us at rockandarmor@yahoo.com, call 208-917-2660, or DM us on instagram or FB @rockandarmor
Reference List
1. Klinge SA, Sawyer GA, Hulstyn MJ. Essentials of Anterior Cruciate Ligament rupture management. Rhode Island Medical Journal. 2013;96(5):28-32.
2 Hosea, T. ACL reconstruction: techniques and avoiding pitfalls. University Orthopaedic Associates. 2015;1-38..
3. Evans, IK. ACL reconstruction rehabilitation protocol. Sports Medicine North Orthopedic Specialty Center. 2018; 1-23.
4. Teyhen DS, Robertson J. Return to sport: when should an athlete return to sport after an ACL surgery?. J Orthop Sports Phys Ther. (2011);41(6):388.
5. Garrison JC, Bothwell JM, Wolf G, Aryal S, Thigpen CA. Y balance test™ anterior reach symmetry at three months is related to single leg functional performance at time of return to sports following anterior cruciate ligament reconstruction. Int J Sports Phys Ther. 2015;10(5):602-11.
