FAQs

Shoulder:

Why does my shoulder pop when I move it?
The shoulder sometimes makes noises and feels like it is clicking with movement. This typically due to scar tissue formation, lack of stability in the joint, rubbing of inflamed tissues or degenerative changes. Unless the noises are painful or you feel like your shoulder is ‘popping out’ the noises are okay temporarily and will likely go away as your physical therapy progresses.

Why does it hurt to lower my arm once I have raised it in the air?
When you raise your arm overhead, the active muscles shorten as they work. This is called a concentric contraction. When you lower your arm, gravity is the primary force acting on your arm. The muscles that you used to get your arm up are now acting against gravity to slow the movement down. This causes the active muscles to become longer as they work. This is called am eccentric contraction and is actually more powerful than the concentric contraction. Weakness and poor timing of the eccentric contraction can cause significant pain.

Why does it hurt at night when I am trying to sleep?
When you are lying down, your shoulder blade is positioned differently than when you are standing or sitting. This changes the position of the shoulder and therefore can cause pain. Also, when you are trying to sleep, you are much more likely to concentrate on your pain compared to when you are awake and active. Side lying on the sore shoulder causes direct pressure and often pain. Side lying on the opposite shoulder can cause the sore shoulder to pinch soft tissue as it crosses your body.

What is the rotor cup?
THERE IS NO SUCH THING!!! You actually have a ROTATOR CUFF for each shoulder. This is a term used to describe four muscles and their tendons that act to support the ball-and-socket portion of the shoulder. These muscles attach to the shoulder blade and to your arm. They provide stability during overhead movements and are responsible for rotation movements in the shoulder.

Why am I able to lift heavy objects at work but I can’t reach the top of my head to comb my hair or reach behind my back to tuck in my shirt?
Certain movements are typically more painful in an injured shoulder. These movements are internal rotation and external rotation. Tucking in your shirt uses internal rotation and many overhead movements require external rotation (think about throwing a baseball, starts with external rotation, ends with internal rotation). Also, the length of the lever arm can change the level of pain and/or ability. Objects closer to you are easier to lift while lifting the same objects with your arm outstretched is more difficult.

Low Back Pain:

Why do my legs hurt more than my back?
Leg symptoms associated with low back pain can be attributed to nerve irritation that occurs in the lumbar spine. The location and severity of leg symptoms (including pain, numbness, and tingling) depends on the spinal level and amount of inflammation present. Leg symptoms can be a result of many spinal diagnoses including a herniated disc, spinal stenosis, piriformis syndrome and sciatica to name a few. One of the main goals of treatment is to centralize any leg symptoms to the problem area in the low back. Your therapist will give you a variety of stretches and exercises to accomplish this goal.

Why does my pain change when I am sitting or standing?
Sitting increases pressure on the discs in your spine. If you have a problem with the disc, the increased pressure from sitting may increase your symptoms. Standing requires more spinal stability, if you have muscle weakness and instability in the spinal musculature, standing or walking may increase your pain. Also, in cases of spinal stenosis, standing or walking can limit the space around the nerves in your back and therefore cause more pain.

Why do my ankles get swollen?
There are various causes of swelling in the lower legs. The most prominent is gravity. When you sit or stand, gravity pulls fluid down toward your ankles. Normally, muscle pumping action and your circulatory system bring the fluid back up to your heart where it then re-circulates or is expelled. This can be impaired by poor circulation, nerve injury, muscle weakness, inactivity, and metabolic or endocrine disorders. Elevation above the level of the heart, ankle pumping, and general exercise using the legs can help in most cases. Working closely with your doctor and physical therapist is vital to treating the cause of the swelling.

Knee:

Why does my knee pop/click/buckle?
When scar tissue, inflammation, misalignment, or degenerative changes are present in the knee, noises, also know as crepitus, may occur with movement. The knee cap, or patella, moves in a track when you bend and straighten the knee. This movement can cause tissues to rub against each other and make noises. The noises and any associated pain should be reduced or eliminated with physical therapy treatment and strengthening.
Sharp pains associated with noises or ‘pops’ that occur with a patellar dislocation are much more serious and typically involve soft tissue damage in and around the joint.
A knee that buckles or gives out is most likely caused by weakness in the muscles surrounding the knee. Poor timing, lack of muscle coordination, general laxity and hypermobility can also contribute to an unstable knee. Buckling that does not improve with physical therapy may indicate a more serious problem with the soft tissues of the knee.

Why is it more difficult to go down stairs versus up stairs?
Going up stairs uses your leg muscles to push one leg at a time up each step. While going up the stairs the quadriceps muscle (top of your thigh) becomes shorter as it contracts. This is called a concentric contraction. When you go down the stairs, the quadriceps has to slow your body down against gravity while actually getting longer. This is called an eccentric contraction. The eccentric contraction is more powerful than the concentric contraction so if the mechanics of the knee are not correct, you are more likely to have difficulty or pain with an eccentric contraction. The quadriceps muscle is vital to knee health because the knee cap, or patella, is controlled by the quadriceps.

Why am I having more pain when I stand up after I have been sitting?
While you are sitting your knees tend to stay in a fixed position and become more stiff. If there is swelling in the knee, the fluid isn’t able to circulate well because your knee isn’t moving much. Once you stand, your body weight puts compressive forces on the joint and can cause pain. Once the fluids begin to circulate again, and the knee loosens up, the pain lessens and you are able to walk with less pain or without pain.

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