Our rotator cuff is a series of four muscles that envelopes the shoulder joint.  When contracted, they produce rotation of the arm and some elevation. With age also comes the degeneration of both the shoulder joint as well as the tendons and muscle fibers of the rotator cuff.  A Physical Therapist can assess degeneration.  This creates a vulnerable environment to injury with lighter force.  On the other hand, this joint and muscle combo is stronger when you are younger and can withhold stronger forces.  When tears do occur, it is likely to be where the muscle fibers and tendon fibers connect.  Tendons do not have the best flow of blood through them, making a rotator cuff repair tricky.  Obviously there are two types of tears, being complete and partial.  A complete tear will never heal on its own and always will require surgery.  However, it is said that physical therapy post op is as important if not more important than the surgery itself when dealing with a rotator cuff repair.  A partial tear may also require surgery, but physical therapy itself may be used sometimes.  Physical therapy is a more natural healing process for the body rather than surgery and surgery in this region can permanently make muscles less effective in the future.  Symptoms of a tear include sharp pain while trying to lift the arm or just moving it along a certain point in your range of motion.  Decreased range of motion and effectiveness of the muscle will also occur after a tear, as well as sharp pain in the region before bedtime.  A rotator cuff repair does not happen by itself, but requires specific physical therapy.   This physical therapy may have goals such as increasing range of motion and muscular strength in the region.  Both of these will help blood reach the area, allowing a quicker process for a rotator cuff repair to occur.  One thing to keep in mind while participating in this physical therapy is to stay on schedule with the exercises.  Trying to overdo it too quickly will most likely lead to more harm than good, especially when dealing with a rotator cuff repair.

The ankle has the responsibility of carrying all of the body weight while standing.  This heavy load day after day could lead to chronic or sporadic acute ankle pain.  The ankle is a pretty secure joint, and usually is not associated with chronic pain as much as the knee.  However, when there is ankle pain, it could be much tougher to diagnose the injury.  Consult your physical therapist to assess ankle pain.  Many people sprain their ankle during activity, and it is shown that when you have sprained your ankle in the past that you are more likely to develop arthritis in the joint.  A good way to tell if you have arthritis of the ankle is to move it along the full range of motion and if you have pain and a slight crunching sound in any one or more places, you most likely have lost a significant amount of cartilage in that area and also consult your physical therapist.  Another common injury is a strain on the tendon of the peroneus muscle (runs on the outside of the leg and down below the ankle on the outside “bump” right before the foot). This muscle can be easily overstretched due to over inversion or inward twisting of the ankle causing ankle pain that may be mistaken for a common sprained ankle.  Something else that causes ankle pain is called sinus tarsi syndrome, or inflammation between the bone that is below the lower leg bone and the heel “lower ankle bone”.    A deteriorating ailment to the back of the ankle at the Achilles tendon is showing up in more and more athletes that are reaching older age.  If you have pain here, get it checked out because an Achilles tear is a serious problem.  Consult your physical therapist regarding pain in the back of the ankle.  Tendonitis to a muscle tendon on the inside of the ankle may also occur due to overuse and will cause ankle pain and swelling on the inside ankle area.   Most of these conditions involve swelling which pinches tiny nerves in the area therefore causing ankle pain.  Ice therapy can reduce this swelling and ankle pain that comes with it.  Heat therapy on the other hand gets tiny capillaries to dilate and give blood to the injured structure.  Your physical therapist can decide which modality to use.  Physical therapy for ankle pain is diverse, and may last weeks to months.  A common goal of this therapy is to not only heal the wounded structure, but strengthen the associated structures as well.  This will help prevent an injury to the area in the future and stabilize the ankle joint too.  Another goal is to build confidence through physical therapy.  Your physical therapist can decide on an appropriate plan.  When something is tender or has gotten hurt in the past, the patient may be hesitant to use it like he/she used to.  Reestablishing confidence with the joint through physical therapy improves the quality of life and could condition and heal the structure quicker all at the same time.