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Bluegrass Doctors of

Physical Therapy, PLLC



Summer is approaching!!!!

Posted on May 2, 2016 at 5:45 PM

With Summer around the corner, many people are taking up tennis, and even the relatively newer sport of pickleball. 

Here are a few common ailments that can sneak up on you if you dont keep things in check!!



1) The Infamous Tennis Elbow

What is it? Tennis Elbow is a condition where the outer forearm muscles become inflamed or have small tears which causes pain on the outer part of the elbow.

What are the symptoms? Pain and tenderness on the outside of the elbow, which may travel down towards your wrist. Pain when bending or lifting your arm, gripping your racket or twisting your forearm. Pain and stiffness when fully extending the elbow.

Why does tennis cause it? Players tend to overload the forearm muscles, particularly when new to the sport. Additional causes include a faulty backhand technique and a tendency to swing from the elbow, leading the racket.

How can you avoid it?

Check the string tension of your racket and reduce this if necessary, as less tension means less impact on your forearm muscles.

Talk to us about specific exercises to avoid having this sometimes complicated injruy. 

2) Tennis Shoulder (SAY WHHHAA???)

What is it? There are 4 rotator cuff muscles in the shoulder which help aid shoulder movement in all directions. Tennis shoulder (also known as rotator cuff tendinitis) occurs when the tendons of these muscles become inflamed and irritated.

Why does tennis cause it? Tennis shoulder is caused by the tremendous repetitive forces which occur when hitting the ball. Over time, this damages and inflames the tendons, causing tendinitis.

What are the symptoms? Weak shoulder movements, pain when putting your arm behind your back, pain when raising and lowering your arm, clicking or flicking sensation when raising your arm, swelling at front of your shoulder, stiff and restricted shoulder movement.

How can you avoid it?

Work on strengthening your shoulder muscles so they can cope with the repeated motion of swinging the racket to the ball.

Stretch your shoulders thoroughly before playing, Tight muscles restrict movement and are more likely to inflame due to friction.

If you need specifics please give us a call. 

3) Wrist Strain

What is it? A wrist strain occurs when the tendons of your wrist muscles become damaged.

What are the symptoms? Pain around the wrist, swelling and perhaps bruising in the area, spasms in your wrist muscles, some loss of movement and flexibility in the wrist.

Why does tennis cause it? A wrist strain is caused when tendons in the area are over stretched in a forceful nature. In tennis players often go to strike the ball with the racket and misses, they yank their wrist which damages the tendons. It can also be caused during return shots, when the ball travels with force and causes both your racket and wrist to bend backwards.

How can you avoid it?

Make sure your racket is the correct weight with the correct handle size to suit your individual grip and swing, and use the “hand shake grip” with the arm in an L shape position.

It’s also a good idea to invest in wrist supports and shoes with strong grip, to prevent unnecessary injuries when tripping over.

4) Lower Back Pain

What is it? Lower back pain is a very common tennis ailment and the pain can come in all different forms, from sharp sudden pains to dull and long lasting aches.

What are the symptoms? Sudden, sharp persistent pain that may be worse after prolonged standing, sitting or running, muscle spasms in the area, pain that radiates down to your glutes and even hamstrings.

Why does tennis cause it? During service strokes, players exaggerate the arch in their back to increase power, which puts pressure on the tissues and joints of the spine. Overuse is a frequent cause, due to repeatedly rotating, flexing and extending the spine when serving.

How can you avoid it?

Wear shoes with plenty of cushioning to help absorb the impact caused by running around the court when playing tennis.

Strengthen your abdominal and lower back muscles so they are as prepared as possible, also remembering to stretch your lower back and hamstrings thoroughly.

Lower back mobility exercises are also important, so rotate from side to side before a match.

5) Ankle Sprains

What is it? An ankle sprain, also known as a twisted ankle, occurs when the ligaments within the ankle become overstretched and damage.

What are the symptoms? Swelling, bruising, tenderness, pain in the area, stiffness and trouble weight bearing.

Why does tennis cause it? The most common cause of an ankle sprain in tennis is twisting, rolling over on the ankle or landing on the outside part of the ankle. Most injuries occur towards the end of the match when the player is tired and less alert.

How can you avoid it?

Ensure your shoes are supportive and consider wearing an ankle support. It’s worth taping your ankle if you’ve sprained it before, to help avoid a repeat injury.

Focus on conditioning and stamina when working out off the court, so that you don’t get tired towards the end of matches.

Use balance and coordination exercises to improve the proprioception of the ankles. One legged exercises and wobble board programs are ideal for this. Don't forget those glute strengthening exercises!!!!!!

Remember, have a great safe and FUN summer!!!!

Simple preparation can also help, so remove all balls from the court to avoid tripping hazards!

OK City Surgery Center

Posted on May 2, 2015 at 9:35 PM

OKLAHOMA CITY – Taking a “cash only” free market approach, the Surgery Center of Oklahoma City is causing a stir locally, and attracting nationwide attention.


What the company calls “price transparency” with guaranteed rates for procedures is even triggering a home-grown version of medical tourism.


A company in the Dallas metroplex has designated Surgery Center a partner for employee health care. Savings from procedures performed at the center, even with lodging and travel covered, yield lower costs for the employer.


Admirers laud physician-founder Dr. Keith Smith, who founded the center in 1997, for “lighting a candle, rather than cursing the darkness.”


At a state Capitol event, Dr. Smith explained the center’s up-front pricing of medical procedures in diverse areas of practice, including orthopedics, ear/nose/throat, general surgery, urology, ophthalmology, foot and ankle, and reconstructive plastics.


Bottom line, the institution’s operational structure and market-oriented billing methods provide an intriguing alternative to the third-party payer systems that now dominate American health care, including the highly centralized structure envisioned under the Affordable Care Act, or “ObamaCare.”


The center has avoided entanglement in Medicare and Medicaid, and only carefully engages with private health insurance plans.


This week, Brandon Dutcher and Tina Dzurisin of Oklahoma Council of Public Affairs hosted a seminar to tout Smith’s work, which has begun over the past few months to garner favorable attention in local news reports. Lobbyists for major health care institutions in the region were present, as well as association executives interested in the Center’s approach, either to support or oppose it.


That’s not all: Reasontv has taken notice, producing a mini-documentary on the price transparency, overall efficiency and affordability in the Surgery Center’s approach.


Three years ago, Dr. Smith, who describes himself as a libertarian, began to post prices for 112 common surgical procedures at the facility, which was established with his partner, Dr. Steve Lantier, in 1997.


The original founding of their health-care business was predicated on the confidence they could provide top-tier procedures at a fraction of the cost traditional hospitals charge. Their already-successful venture took off after the online price posting was implemented.


He recalls, “The first people who showed up at our door were Canadians. Then we heard from the heads of Human Resource departments at local and regional companies.”


The center works directly with several businesses that are self-insured, and which pay employee bills directly. Today, Smith reported, the vast majority of patients at the center are individuals drawn initially by lower prices, and retained by high-quality care.


The center lists a guaranteed price for procedures, including facility fee, surgeon’s fee and anesthesiologist’s fee. Prices listed include those for initial consultation and uncomplicated follow-up.


Not included in the listings are diagnostic studies prior to surgery, consultations, therapy and rehabilitation, hardware or implants. As Smith noted, hardware and implants are priced at cost with no mark-ups. Overnight stays at the facility are not included, nor are lodging and travel expenses.


As a practical matter, the center’s approach leads to patient bills that can be laid out, with all costs listed, on a single page. The actual cost of the center’s procedures is sometimes one-tenth, and often around one-sixth, of the price at a traditional hospital.


The Reasontv video, shown at the Capitol briefing, highlighted some of the most dramatic price differentials, including for a “complex bilateral sinus procedure.” At the Surgery Center, the all-inclusive price is $5,885. At nearby Integris Hospital the price in 2010 was $33,505 – but that did not include either the surgeon’s or the anesthesiologist’s fees.


In response to a question from CapitolBeatOK, Dr. Smith said there are presently no legal impediments to the Surgery Center’s approach embedded in the Affordable Care Act, widely deemed “Obamacare.” He said he hopes that remains the case, but pointed out that regulatory mandates are a moving target under the law.


The Surgery Center of Oklahoma City does not deal with Medicaid or Medicare systems, although some patients access those systems separate from the center’s work.


While making it clear he is no fan of big insurers, Dr. Smith said the potential key impediments to emergence of more systems like his are “The federal government, the federal government, and the federal government.” He said what he dubbed “the Unaffordable Care Act” is “driving out what’s left of markets in American health care.”


In dialogue with CapitolBeatOK, Dr. Smith said the center’s approach is helping to restore an old-fashioned medical ethic for provision of charity care. Many referrals to the hospital come from churches and other groups helping the poor. Patients are encouraged in those cases to pay what they can, while physicians and anesthesiologists can (and often do) waive their fees for individuals in need.


Surgery Center does work with insurance companies, but that triggers a separate pricing structure. Dr. Smith explained, “We take on a lot of risks when we file with insurance companies, so we have to charge for that risk.”


Oklahoma Commissioner of Labor Mark Costello, who attended the Capitol briefing, will be presenting an Entrepreneurial Excellence Award to Surgery Center next month.


Dutcher, vice president at OCPA, reflects, “The remarkable things Dr. Smith and his colleagues are doing deserve to be spotlighted. They are demonstrating that competition and price transparency can drive down costs in health care just as in every other sector of the economy.”



Medical Article About Shoulder Impingement

Posted on November 19, 2014 at 8:45 PM

In 1972, Dr. Neer first introduced the concept of rotator cuff impingement to the literature, stating that it results from mechanical impingement of the rotator cuff tendon beneath the anteroinferior portion of the acromion, especially when the shoulder is placed in the forward-flexed and internally rotated position.[1]


Neer describes the following 3 stages in the spectrum of rotator cuff impingement:Stage 1, commonly affecting patients younger than 25 years, is depicted by acute inflammation, edema, and hemorrhage in the rotator cuff. This stage usually is reversible with nonoperative treatment. Stage 2 usually affects patients aged 25-40 years, resulting as a continuum of stage 1. The rotator cuff tendon progresses to fibrosis and tendonitis, which commonly does not respond to conservative treatment and requires operative intervention. Stage 3 commonly affects patients older than 40 years.


As this condition progresses, it may lead to mechanical disruption of the rotator cuff tendon and to changes in the coracoacromial arch with arthritis along the anterior acromion. Surgical  anterior acromioplasty and rotator cuff repair is commonly required. In all Neer stages, etiology is impingement of the rotator cuff tendons under the acromion and a rigid coracoacromial arch, eventually leading to degeneration and tearing of the rotator cuff tendon.


Although rotator cuff tears are more common in the older population, impingement and rotator cuff disease are frequently seen in the repetitive overhead athlete. The increased forces and repetitive overhead motions can cause attritional changes in the distal part of the rotator cuff tendon, which is at risk due to poor blood supply. Impingement syndrome and rotator cuff disease affect athletes at a younger age compared with the general population.


The shoulder consists of 2 bones (humerus, scapula), 2 joints (glenohumeral, acromioclavicular), and 2 articulations (scapulothoracic, acromiohumeral) that are joined by several interconnecting ligaments and layers of muscles. Minimal bony stability in the shoulder permits a wide range of motion (ROM). Soft tissue structures are the major glenohumeral stabilizers. Static stabilizers consist of the articular anatomy, glenoid labrum, joint capsule, glenohumeral ligaments, and inherent negative pressure in the joint. Dynamic stabilizers include the rotator cuff muscles, long head of the biceps tendon, scapulothoracic motion, and other shoulder girdle muscles (eg, pectoralis major, latissimus dorsi, serratus anterior). The rotator cuff consists of 4 muscles that control 3 basic motions, abduction, internal rotation, and external rotation. The supraspinatus muscle is responsible for initiating abduction, the infraspinatus and teres minor muscles control external rotation, and the subscapularis muscle controls internal rotation. The rotator cuff muscles provide dynamic stabilization to the humeral head on the glenoid fossa, forming a force couple with the deltoid to allow elevation of the arm. This force couple is responsible for 45% of abduction strength and 90% of external rotation strength. The supraspinatus outlet is a space formed on the upper rim, humeral head, and glenoid by the acromion, coracoacromial arch, and acromioclavicular joint. This outlet accommodates passage and excursion of the supraspinatus tendon. Abnormalities (including trigger points situated within the muscle belly) of the supraspinatus outlet have been attributed as a cause of impingement syndrome.


Impingement implies extrinsic compression of the rotator cuff in the supraspinatus outlet space. Bigliani and associates discovered and described how variations in acromial size and shape can contribute to impingement. Cadaveric studies show 3 variations in acromion morphology, as follows: type 1 is flat, type 2 is curved, and type 3 is hooked anteriorly. Although the curved configuration was the most common (43% prevalence, compared to 17% flat and 40% hooked), the hooked configuration most strongly was associated with full-thickness rotator cuff tears. Other sites of impingement in the supraspinatus outlet space include the coracoacromial ligament (where thickening can occur) and the undersurface of the acromioclavicular joint (where osteophytes can form). The medial coracoid rarely is involved. These impingement sites in the supraspinatus outlet are compressed further when the humerus is placed in the forward-flexed and internally rotated position, forcing the greater tuberosity of the humerus into the undersurface of the acromion and coracoacromial arch. Nonoutlet impingement also can occur. Causes may be loss of normal humeral head depression from either a large rotator cuff tear or weakness in the rotator cuff muscles from a C5/C6 neural segmental lesion or a suprascapular mononeuropathy. This condition also may occur because of thickening or hypertrophy of the subacromial bursa and rotator cuff tendons.



Overuse or repetitive microtrauma sustained in the overhead position may contribute to impingement and rotator cuff pathology. Shoulder pain and rotator cuff disease are common in athletes involved in sports requiring repetitive overhead arm motion (eg, swimming, baseball, volleyball, tennis). Secondary impingement often is attributed to impingement, which seldom is mechanical in nature in young athletes. Rotator cuff disease in this population may be related to subtle instability, and, therefore, may be secondary to such factors as eccentric overload, muscle imbalance, glenohumeral instability, or labral lesions. This has led to the concept of secondary impingement, which is defined as rotator cuff impingement that occurs secondary to a functional decrease in the supraspinatus outlet space due to underlying instability of the glenohumeral joint. Secondary impingement may be the most common cause in young athletes who frequently place large, repetitive overhead stresses on the static and dynamic glenohumeral stabilizers, resulting in microtrauma and attenuation of the glenohumeral ligamentous structures, which leads to subclinical glenohumeral instability. Such instability places increased stress on the dynamic stabilizers of the glenohumeral joint, including the rotator cuff tendons. These increased demands may lead to rotator cuff pathology (eg, partial tearing, tendonitis). Furthermore, as the rotator cuff muscles fatigue trigger points develop which can contribute to prolonging the patients cycle of pain. This in turn can cause the humeral head to translate anteriorly and superiorly, impinging upon the coracoacromial arch. This leads to rotator cuff inflammation.


See this article:




In these patients, treatment should also address underlying instability as well as trigger point muscle dysfunction. The concept of glenoid impingement has been advanced as an explanation for partial-thickness tears in throwing athletes, particularly those involving the articular surface of the rotator cuff tendon. Such tears may occur in the presence of instability due to increased tensile stresses on the rotator cuff tendon from abnormal motion of the glenohumeral joint or increased forces on the rotator cuff necessary to stabilize the shoulder.

 Arthroscopic studies of these patients note impingement between the posterior superior edge of the glenoid and the insertion of the rotator cuff tendon with the arm placed in the throwing position (abducted and externally rotated). Lesions were noted along the area of impingement at the posterior aspect of the glenoid labrum and articular surface of the rotator cuff. This concept is believed to occur most commonly in throwing athletes and must be considered when assessing for impingement.