Our trained staff members aren’t just excellent healers and therapists. They’re also authors! Please take some time to read a few of the publications and articles from the experts here at Diverse Sports Physical Therapy, and discover some entertainment and information you can use!

Handlebar Palsy

Have you ever experienced numbness or tingling into the pinkie or ring finger after riding your bicycle? If so, then there is a good possibility that you have suffered from a condition called ulnar neuropathy, otherwise known as “Handlebar Palsy” or “Cyclist’s Hands.” Handlebar palsy is a condition where the ulnar nerve becomes damaged from prolonged pressure or repetitive forces placed on the medial portion of the palm from the bicycle’s handlebars.  The focal injury to the neural tissue inhibits the electrical conduction of nerve impulses to pass through the site of injury and into the hand.

Handlebar palsy symptoms are not limited to multiday cycling events but can become present after a single riding episode. Common indicators of this condition are numbness or tingling into the pinkie and ring finger, and/or weakness or clumsiness of the hand. You may notice a difference in the functional activities you perform throughout the day such as: weakness when grasping a pen or holding paper, shaking hands and/or pain with pressure over the medial portion of the palm.

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If these symptoms are left unattended to, they can become a chronic condition that can cause permanent sensory and motor changes.

Becoming proactive by implementing the following recommendations will be helpful in preventing the onset or re-occurring symptoms of handlebar palsy. Adjust the settings of your bike so that you are in a more upright position. This will relieve some of the pressure on the wrists and hands. When the handlebars are too low, the seat is tilted downwards, or the bicycle frame is too large for the rider, your body weight will be thrust forward onto the handlebars. This will increase the force through the pinkie side of the wrist and thus increase your risk for handlebar palsy. Other preventative measures are wearing padded gloves, adding padding to your grips and/or having good front shocks to absorb the repetitive vibrations from rough terrain. Constant adjustment of hand position and taking breaks regularly will provide pressure relief and reduce the risk of injury. Also, prior to riding, a session of wrist stretching will help the hands and wrists accommodate the force being applied through the handlebars. Two excellent stretches to include are as follows: 1) bring your arm straight out in front of you with your palm upwards, grab your fingers and gently pull down. 2) Bring your arm straight out in front with palms facing down – grab fingers and gently pull down the same as above.

The terrain and environment traveled while bike riding dictates the force that will be transmitted into your wrists, arms and shoulders, which puts your shoulder stabilizer muscles under a significant amount of strain. If these muscles are not properly strengthened they will not be able to do their job by absorbing and providing a cushion for the forces created under the bike riding conditions. Your wrists and arms will overcompensate to absorb the vibrations created from the handlebars, which in turn increases your risk of developing handlebar palsy. Preventative measures are to implement an adequate strengthening regime for the shoulder blade stabilizer muscles. A few examples of excellent exercises to include in your weekly exercise program that will target these muscles are push-ups, walking planks and military crawls.

With proper education, training and equipment a person can minimize and prevent these uncomfortable injuries. If any of these symptoms persist over time a consultation should be made with a physical therapist. Handlebar palsy has been effectively treated with physiotherapy services.

Knee Pain With or Without Trauma

Musculoskeletal problems were the leading cause of officers to take sick leave ( Gyi and Porter, 1997). Due to the various job demands that are required for an officer, an assortment of knee injuries could occur. Some knee injuries may be insidious (gradual onset) or may be traumatic. The common injuries in the knee that an officer may develop are patellofemoral pain syndrome (PFPS), a tear or sprain to any of the ligaments around the knee (anterior cruciate ligament, medial collateral ligament, posterior cruciate ligament, and lateral collateral ligament), a tear in the meniscus, a muscle strain or tear around the knee joint (hamstrings, quadriceps, and gastrocnemius), or a meniscus tear. An understanding of the mechanism of injury, diagnostic testing such as xray, ultrasound or MRI, special testing to the ligaments, muscles and knee joint, and finding movements that irritate or help the knee can all lead to a proper diagnosis of the knee injury. This is usually done with a doctor and a physical therapist. Once the diagnosis is determined, a unique treatment plan is created with the patient’s goal in mind to get them back to work.

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A treatment plan from a physical therapist usually includes manual therapy, acupuncture, intramuscular stimulation (IMS), ultrasound, transcutaneous electrical stimulation (TENS), heat or ice, and tape. This helps to relax tight muscles, increase blood flow or to improve a stiff joint to increase range of motion, and to reduce pain. A thorough exercise program is given to a patient to strengthen weak muscles, stretch out tight muscles to get them back to work or into their sports or regular activities as soon as possible and safely. A physical therapist will not only look at the knee joint, but exam the joint above and below (ankle and foot, hips and back) to further determine if the alignment of the body or another problem in a different area is causing knee pain. Therefore orthotics can help decrease one’s knee pain or prevent it from occurring in the future.

What You Need to Know About Orthotics

Orthotics are a special insole for one’s shoes. There should be two goals with the use of an orthotic; promoting optimal position of the foot and working as a proprioceptive device for the foot. These two goals work in conjunction to promote optimal biomechanics of the foot, ensuring proper alignment of the body and efficient biomechanics, especially when walking or running. Orthotics can be used as effectively as part of a treatment plan for a variety of conditions. These conditions are not limited to the foot, as mentioned previously, improper alignment and compromised mechanics in the foot can lead to various conditions in the knee, hips, and even the low back. The orthotics aim to correct that misalignment to aid in an effective treatment protocol. The benefits of orthotics go beyond using them as an immediate treatment resource, as they can also be used for preventative measures. A misalignment or biomechanical compromise, such as flat (pronated) feet does not mean symptoms may show immediately. However, it may express itself symptomatically over repeated use of the foot (i.e. walking/running). A common example of this is plantar fascitis. A physiotherapist is able to identify these compromises in one’s biomechanics, and is able to prescribe orthotics as an effective preventative measure.

There are many types of orthotics available today. They are typically categorized into two maingroups; custom orthotics and over the counter orthotics, also known as prefabricated orthotics. Custom orthotics are the gold standard in orthotics, as they are custom made to an individual’s feet by a team of healthcare professionals. They are typically made with a biomechanical assessment of the individual, an assessment or scan of a person’s gait (walking pattern), and a casting of the individual’s feet. Prefabricated orthotics are purchased over the counter, and are not custom made per individual. However, they can offer similar support to one’s feet, and are typically more affordable. It is always recommended that a healthcare professional be consulted prior to purchasing prefabricated orthotics, to ensure that the orthotic being purchased will be effective for the individual.

Original Paper:
D. E. Gyi and J. M. Porter
Musculoskeletal problems and driving in police officers
Occup Med (Lond) (1998) 48 (3): 153-160 doi:10.1093/occmed/48.3.153

Low Back Pain and Police Officers

Low back pain is a leading cause of work related disability across many professions and policing is no exception. Prolonged sitting, driving, running, infrequent resistant lifting, and standing with a heavy duty belt as well as the vest are some of the common causes of the low back pain. Some studies suggest that the one-year prevalence rate of low back pain among police officers is greater than 40%. Low back pain can also result from poor sitting posture to injuries sustained during a motor vehicle accident. In most minor cases low back pain is nothing to be too concerned about as it typically resolves within 1-6 weeks. Some self-management strategies that can be utilized when experiencing low back pain include: staying active, returning to work as soon as possible, using ice/heat or a combination of the two, and using over the counter medications.

If you are experiencing low back pain that is disabling, non-resolving and or persistent continues to get worse or is causing significant limitations in function you should consult a spinal care special such as a physiotherapist for an assessment.  Your physiotherapist will conduct a thorough biomechanical assessment in order to rule out the presence of any serious medical conditions and identify the root cause of your low back pain. After completing the assessment your therapist will develop a customized treatment plan for you that will address your symptoms and help restore proper function.

Low back treatments are specific to each patient and may very slightly between practitioners, but commonly include: heat or cold packs, deep tissue release techniques, stretching techniques, dry needling or acupuncture, spinal mobilization or manipulation, muscle stimulation, ultrasound, therapeutic exercise and education.