Have you ever talked with a friend, family member, or coworker, and they mentioned spraining an ankle or straining a hamstring? Were you unsure what they meant? Or maybe why one person had surgery and another person went to physical therapy? So, what exactly do sprain, strain, and severity mean, and how will they be managed?

Sprain, Strain, and Severity

A strain is damage to the tissue that connects muscle to bone. Either the muscle or tendon is damaged. A sprain is damage to the tissue that connects bone to bone. These are ligaments. In its most basic definition strain = muscle/tendon damage and sprain = ligament damage. Ligaments are responsible for helping to hold and stabilize our bones together. Muscles are responsible for movement. Strains and sprains are classified into 3 categories, grade I, II, or III.

Sprain/Strain Severity Grades

Strains

• A grade I strain involves less than 5% damage to the muscle fibers or tendon. Typically, there is very minimal swelling, and it is only at the sight of the injury. You may have slight pain with daily activities but will still demonstrate full motion and strength. Overall, function does not change.
• A grade II strain means a partial tear and involves various amounts of a muscle tear. A low grade type II strain means less than 1/3 of the muscle fibers are torn. A medium grade type II strain involves 1/3-2/3 of muscle fibers.  A large grade type II strain means more than 2/3 but less than 100% of the muscle fibers are torn. With a grade II strain there is frequently bruising with moderate amounts of swelling. Normally there is an increase in pain with movement as well as associated loss of motion and strength. Typical daily activities are often limited/painful. Overall function will be slightly-moderately limited.
• A complete tear is a grade III strain (rupture). This will present with significant bruising and edema. Patients often hear a “pop” when the injury occurs. There will be a loss in motion and strength. In addition, it will be very tender to touch. Overall function is greatly limited.

Sprains

• A grade I sprain is very similar to a grade I muscle strain. Typically, less than 5% of ligament fibers tear. You may experience slight pain but overall function and movement do not change. There won’t be any joint laxity with this type of tear.
• A grade II sprain is similar to a grade II muscle strain in the number of fibers torn. Often there will be an increase in pain, especially over the ligament. There will likely be an increase in swelling and bruising. There can be an increase in joint laxity.
• Lastly a grade III sprain is similar to a grade III strain, and the entire ligament tears. Often times it is very painful. You may hear an audible pop with the injury. This will have a large amount of swelling and bruising. Typically, the joint is very lax after this type of injury.

Treatment

As with all injuries a variety of factors will go into your treatment plan. These include age, injury location, other structures involved, activity level, overall functional impact of the injury, and your goals. Grade I sprains/strains will normally receive conservative treatment such as resting or physical therapy. Sprains/strains that are Grade II often times will have conservative approaches but other treatments are possible such as injections and surgical procedures. Grade III sprains/strains often involve surgery to repair the damage, however some people are able to function fully and not need any surgical intervention because they respond well to conservative management. If you are worried about a sprain, strain, and severity of your injury, talk to your physical therapist!

References

1. Andrews, K., Lu, A., Mckean, L., & Ebraheim, N. (2017). Review: Medial collateral ligament injuries. Journal of Orthopaedics, 14(4), 550–554. https://doi.org/10.1016/j.jor.2017.07.017

2. Chan O, Del Buono A, Best TM, Maffulli N, Chan, O., Del Buono, A., Best, T. M., & Maffulli, N. (2012). Acute muscle strain injuries: a proposed new classification system. Knee Surgery, Sports Traumatology, Arthroscopy, 20(11), 2356–2362. https://doi.org/10.1007/s00167-012-2118-z

3. Gray, A. M., & Buford, W. L. (2015). Incidence of Patients With Knee Strain and Sprain Occurring at Sports or Recreation Venues and Presenting to United States Emergency Departments. Journal of Athletic Training (Allen Press), 50(11), 1190–1198.

In the early days postpartum, mothers planning to breastfeed will typically be visited by a hospital lactation consultant or trained nurse in order to check how baby is feeding, and then 48 hours later you’re off and on your way home! Sometimes, concerns arise in those next few weeks, often sparked by pain with latching, difficulty gaining weight, or mother’s concerns with milk supply. These are all excellent reasons to meet with a certified lactation counselor (CLC). One of the primary details that a CLC will assess, as well as medical histories, is the latch. So what exactly is a “good” latch?

What Exactly Makes a Good Latch?

• An infant’s latching process should ideally start when the infant is quiet but alert and showing early feeding cues. A baby that is crying may need to be soothed before attempting to feed.
• Baby’s body should have shoulders and hips in alignment, with both hands around the breast, and the head turned towards mom. If you could read what was on baby’s shirt, you’d need to turn that baby tummy to tummy with mom.
• Baby’s latch should start with a big, open mouth, landing on the nipple with bottom lip and tongue first.
• Both upper and lower lip should seal around the breast, maintaining that wide mouth the entire feed.

Why Does it Hurt to Nurse My Baby?

Breastfeeding should really never hurt. Even in those first few days, when some soreness and adjustment can be noticeable, you should never feel like curling your toes or dreading the next nursing session. If you do, that’s okay! There are usually small adjustments that can be made to get you on the road to success. Some of the main reasons for pain while nursing include:

• A shallow latch, with baby attempting to pull milk too low on the breast tissue or nipple.
• Oral restrictions. Ah, those tricky tongue ties. A limitation in the movement of the tongue often leads to a baby who compensates with munching on the nipple – ouch!
• Clogged ducts and mastitis cause pain within the breast tissue that increase when baby latches. Be sure to feed on demand and avoid tight fitting bras or clothing to reduce the risk!

If this feels difficult, painful, or just confusing, a visit with a CLC is a great next step. Often times, nursing can be adjusted and improved in just a few visits. The early days of motherhood can be hard, but our CLC at MOSAIC is ready to support you! Also, check out the Office On Women’s Health for tons of additional information and resources.

What is pelvic girdle pain? It is pain on the backside of your pelvis by your sacroiliac joints (SIJ). It can occur separately or with low back pain or pain on the pubic symphysis (front of your pelvis). The pelvis is made up of 2 bones that join together at the base of the spine (sacrum) and in the front (pubic bone). It is strong enough to support the body and flexible enough to absorb the impact of your feet hitting the ground. Pelvic girdle pain is most commonly seen during pregnancy and postpartum and is more common in women than men. This can also be caused by trauma or arthritis.

Pelvic girdle pain is NOT the same as low back pain. This is because the pain originates from the pelvis rather than the low back and spine. It does not present with sensory changes or weakness. It is possible to have one sided or double-sided pelvic girdle pain in regards to the sacroiliac joints.

What Can Cause Pelvic Girdle Pain?

Although the biomechanical cause is uncertain, the cause may be an imbalance of the coordination of ligaments, muscles, and joints in the posterior part of the pelvis. Changes in hormones, especially during pregnancy, may cause this to occur. However, it has been shown that there is no significant difference between women who develop joint laxity and those who do not. A relationship does exist between SIJ laxity and pelvic pain. Women with more laxity or range of motion can have decreased pain if they have adequate motion control.

It can also be possible that stabilizing TOO much can be a cause of pelvic girdle pain. Remember, our pelvis is part stability and part flexibility! Some people can have a tendency to be a butt clencher or ab clencher. Some people have muscles that are too tight in their pelvic floor or back. Too much muscle tension makes it difficult for the muscles to relax. That causes us to lose the flexibility we need within our pelvic girdle.

What Can Help?

There are many factors that can cause pelvic girdle pain. Every situation depends on the person. It is best to have an evaluation by a physical therapist. We will put you through a series of tests and movements. This will confirm if it is true pelvic girdle pain or if the pain is coming from somewhere else. Depending on the sensitivity of pain, you may need to modify some movements. These modifications can include standing on one leg, crossing legs, leg position while turning in bed, or lunging. It will depend on your symptoms! Sometimes you can continue to perform your same activities by learning how to stabilize with your core muscles or teaching your muscles how to  relax. The best strategy is a combination of manual therapy, stabilization exercises, use of stabilizing tools such as an SI belt, and education of any lifestyle or biomechanical modifications.

Remember, it is not a one-size-fits-all when it comes to rehabilitation, especially for pelvic girdle pain. If you have more questions or are experiencing pain that sounds similar to this, reach out to our pelvic health physical therapist at MOSAIC! To learn more, visit the Pelvic Health Rehabilitation Center or read the Physical Therapy Standard of Care.

During the COVID-19 pandemic, activity levels dropped for a lot of people. Between stay at home orders, gym closures, and working from home, people became more sedentary. On top of that, there were shortages of equipment like dumbbells and bicycles, making staying active at home difficult even if you wanted to. But this summer, things look different; vaccines are widely available, restrictions are loosening, and people are looking to get active and enjoy the warm weather. That’s all good news, but if you had a long break from activity, your body might not be ready to jump right back in. Here are a few tips for help with returning to activity after the pandemic without getting hurt:

Start Slow

• If you’re a runner, think about a walk to run program
• If you’re a weight lifter, start with lighter weights and less reps.
• Whatever your activity of choice is, start with short periods of activity and gradually work your way back up.

Warm Up and Cool Down

Warming up gets your heart and lungs ramped up and prepares your muscles and tendons for the increase in activity about to come. Include some light cardio like jogging, calisthenics, or cycling, followed by active stretching like butt kicks, high knees, or yoga.

Cooling down transitions your body back to a lower state of stress – it brings your heart rate and breathing down, decreases blood flow to your muscles and back to places like your digestive system, and helps you relax. It’s also a great place for static stretches if you need some work on your flexibility.

Take a Day Off

Rest days let your body recover and keep you from getting burned out. Not enough exercise isn’t good for you, but too much of a good thing can cause problems too.

Watch for Early Signs of Injury

Some soreness for a few days after activity is normal, especially if you’ve had a long break. But there are a few common issues to watch out for as you return to activity:

• Swelling or bruising
• Joint pain, especially in the knees or shoulders
• Foot pain, which could be a sign of plantar fasciitis
• Muscle strains – particularly common in the hamstrings
• Sprains – most common in the ankle

Any of these issues justifies a call to your physical therapist. Getting checked out early can prevent an injury that derails your attempt to return to activity. PTs see all of the issues just mentioned on a regular basis and can help safely guide you back into a more active lifestyle. If you need help returning to your favorite activity after the pandemic, call MOSAIC today.

Pick’s disease is a rare condition that causes progressive and irreversible dementia. Unlike Alzheimer’s disease, Pick’s disease only affects certain parts of the brain. It is known as frontotemporal dementia (FTD) because it affects the frontal and temporal lobes of the brain. Our frontal lobes control our ability to plan, organize, make sound judgement, control our behavior and emotion, recall information and multi task. Our temporal lobes are responsible for our use of language and our emotional responses. In Pick’s disease an abnormal amount or type of protein collects in the nerve cells of the brain. This specifically occurs in the frontal and temporal lobes. This causes brain tissue to shrink. As a result, a person with Pick’s disease shows a slow progressive deterioration of behavior, personality and/or language. The exact cause is unknown. Scientists suspect a genetic link, thus making it a hereditary disorder.

What are the Symptoms of Pick’s Disease?

Symptoms of Pick’s disease vary, but behavior and personality changes are the primary early signs. Behavioral symptoms may include moodiness, compulsive or inappropriate behavior, withdrawal, disinterest in previously enjoyed activities, poor hygiene, and poor social skills. Cognitive and language deficits will also appear. These include:  memory loss, deficits in speaking, understanding, reading and writing, remembering familiar names/words, and echoing what has been said. Complete loss of speech may eventually occur. Physical changes may include weakness, muscle rigidity, difficulty moving and urinary incontinence.

Pick’s disease is diagnosed through a thorough medical history, brain imaging, physical and neurological assessments, diagnostic tests, and information provided by family members. Assessments may include scans such as MRI, CT, PET, and evaluation by speech pathology, occupational therapy and physical therapy.

There are no known treatments to cure or stop the progression of this disease. Medical management focuses on control of symptoms associated with the disease, with the goal of maximizing function as long as possible. It is possible to use medication to control symptoms of mood or behavior.

How Can Speech Therapy Help?

Speech therapy is often of benefit in the early stages of the disease. Aphasia is an early symptom of Pick’s disease. It is characterized by difficulty understanding words/sentences, retrieving words, writing, or producing speech sounds. Speech therapy can improve ability to communicate. It will help someone with this diagnosis maintain their highest level of function as long as possible. Speech therapy will also focus on teaching family members to communicate with their loved one as the disease progresses.

Although Pick’s disease is progressive, a combination of medical management and speech therapy will help a patient maintain his/her cognitive function and ability to communicate as long as possible. Accessing services early in the disease process is essential. Click here to learn more about this disease. Or, call MOSAIC today to set up a speech evaluation.

Research shows that putting your baby to sleep on their back carries the lowest risk for SIDS, or Sudden Infant Death Syndrome. Parents should always put their baby to sleep on their back. But, at some point, you might find your baby sleeping on their stomach after you put them to sleep on their back. So, when is it safe to do so, and why should you care?

What is SIDS?

SIDS is the sudden, unexplained death of a baby under 1 year of age that often occurs during sleep or in the sleep area. No known cause of death can be found even after a complete investigation.

Facts about SIDS

• SIDS is the leading cause of death among babies between 1 month and 1 year of age.
• Most SIDS deaths happen in babies between 1 month and 4 months of age, and the majority (90%) of SIDS deaths happen before a baby reaches 6 months of age. However, SIDS deaths can happen anytime during a baby’s first year.
• Slightly more boys die of SIDS than girls.

Keep Your Baby Safe During Sleep

So, what can you do to keep your baby as safe as possible while they sleep? Place your baby on their back for all sleep times, both naps and at night. Keep their sleep area simple. A firm mattress with a fitted sheet is all you need. No blankets, pillows, bumper pads, or stuffed animals. Have your baby sleep in the same room as you for at least the first 6 months and up until your baby is 1 if possible. While doing these things does not eliminate the risk of SIDS completely, it greatly decreases it. For more tips on how to keep your baby safe during sleep, check out what the CDC has to say.

What About Tummy Time?

Every baby needs safe, supervised tummy time every day, throughout the day, from the time they are born! Start with a few minutes at a time, multiple times a day. Gradually increase the amount of time your baby is on their stomach each session.

When Can Baby Sleep on Their Stomach?

Always put your baby to sleep on their back. But your baby may start to roll onto their stomach at night between 4 and 6 months of age. To be most safe, your baby should be rolling over from back to stomach AND from stomach to back consistently before you start leaving them on their stomach to sleep. If they aren’t rolling intentionally AND consistently but somehow end up on their tummy while sleeping, then yes, you need roll them back over onto their back. To learn more about helping your baby learn how to roll, check out our Rolling gross motor milestone blog.