Shaq’s condition appears to be a simple inflammation, an overuse issue.  He isn’t getting younger after all…  Parker’s injury, a muscle contusion, was clearly a result of a collision.  If it is a significant bruise, it could take a good four to six weeks for him to get back up to speed.  The trouble then is that Parker’s calf muscles will be somewhat de-conditioned, making them vulnerable should he return to play too early.  Of course, with playoffs already in sight, that is exactly what is likely to occur.

Achilles ruptures, on the other hand, are not generally associated with contact.  Most who suffer a ruptured Achilles feel or hear a “pop and think they might have been kicked.  Surgery is often performed quickly, to approximate the two ends of the tendon before the tissue shortens permanently.

What is the Achilles tendon?

Tendons attach muscles to bones.  The Achilles is thicker and more fibrous than most tendons and it connects the calf muscles (the bulky Gastroc in the upper calf and the smaller Soleus closer to the ankle) to the heel bone (calcaneus).  The Achilles tendon and calf muscles are put on stretch when the ankle is flexed up and it is shortened when the toes are pointed.  A tight Achilles or one that is overstretched can predispose to rupture.

If you think you have a tight Achilles, before stretching vigorously, it is important to identify whether the problem is actually with the tendon or if it lies with restricted ankle mobility.  Have a therapist check the range of motion at your ankle with the knee flexed.  The Gastroc muscle crosses the back of your knee as well as the ankle.  With the knee bent, the gastroc muscle is in a shortened position and will not restrict movement at the ankle.  Compare theses findings with the amount of ankle flexion range with the knee straight (with the Gastroc on stretch).  The latter is a measure of flexibility.  If your ankle mobility is significantly restricted, no amount of calf stretching will lengthen your Achilles tendon or even stretch your calf muscles.  The motion simply isn’t accessible to allow that to occur.

What are the consequences of Achilles rupture?

In addition to the pain and swelling that are expected with any sports injury, disruption of the connection between the calf muscles and the heel results in an inability to contract these muscles; That means that you cannot rise up on your toes or walk with a normal push off when weight-bearing on your injured side. Running and jumping are therefore also out of the question.   However, it may be possible to actively point your toes while you are not bearing weight due to the action of other muscles that help to provide this movement.

Why do Achilles tendons rupture?

There is an area of the Achilles that has less blood flow than the rest and it is thought that this section of the tendon may not be as strong.  As we age, tendons, as other tissues of the body, become less supple and may degenerate.  These are some reasons why tendinitis becomes more prevalent and ruptures generally occur in people over 30, especially in middle age.  Younger athletes generally experience a higher tear, well above the ankle, where the muscle joins the tendon (musculo-tendinous junction), though they too can experience a tear closer to the heel.

Some sports are more stressful to the calf muscles and Achilles than others.  Those that require the powerful push-off needed for running and jumping place the greatest demand, as do those like racket sports which entail a lot of stutter-steps and quick stops and starts.  Men are far more likely to suffer Achilles ruptures than women and it is thought that obesity adds to the stress on the Achilles, increasing risk of rupture.  Though this is not a factor for most elite athletes, football linemen and centers built like Shaq do place proportionately greater demand on the tendon.

Other predisposing factors for weekend warriors like you and me include stepping up activity suddenly and significantly  – either by increasing the intensity, frequency or duration of participation or perhaps beginning a new activity without preparation.  All of these increase the stresses placed on the Achilles. It is thought that weakness of the calf muscles, particularly the Soleus, may also be a factor causing the Achilles to rupture; The Soleus can be strengthened by pointing the foot — against resistance — while the knee is bent (as in a sitting position).  A history of multiple steroid injections at the Achilles may be to blame in some cases of rupture.  Be aware that manufacturers of certain medications, such as the antibiotic Levaquin, name tendon issues as a potential side effect.  Inform your physician if you begin to feel Achilles symptoms after beginning a new medication.

One exercise I strongly suggest you avoid is strengthening the Gastroc muscles of the upper calf by hanging the mid-foot and heel off a step or raised platform and doing heel-raises from this position of maximum stretch.  Repeatedly lowering the heel below the level of the step (with your body weight and gravity loading the Achilles tendon), puts the tendon at greater risk of rupture and jeopardizes the structures of an unstable mid-foot.  This is an exercise I see so often in the gym.  Yes, it is important to strengthen the calf, but it is recommended to do so from the more neutral foot–flat position.

How is an Achilles rupture diagnosed?

Physical exam is often pretty conclusive.  The first test is simply to squeeze the belly of the calf muscles and observe whether the foot points as the muscles are manually shortened.  Another obvious sign is when the examiner can move the ankle excessively into a dorsiflexed position (toes toward your nose) – with the knee straight.  As previously discussed, this motion is generally restricted by the tightness of the Achilles and in the case of rupture it is not.  A third test involves observing the motion of a needle inserted into the tendon as the foot is passively moved up and down.  An ultrasound exam and/or positive x-ray findings — particularly those in a lateral (side) view – support the diagnosis.

What are the treatment options?

Small tears may do well with immobilization.  Casting is generally done with the foot in a pointed position, which shortens the tendon allowing it to heal.  Bracing that restricts motion is an alternative. Athletes are not good candidates for conservative management, and those who do not undergo surgery should expect a long recovery (up to a year) before returning to sports.

Operative treatment is the gold standard for athletes, younger patients and those with a complete rupture.  Both treatments are followed by periods of decreased weight-bearing, though the surgical patient progresses at a much faster rate.  Rehab includes work on overall strengthening, cardiovascular conditioning and flexibility, as well as a focus on restoration of normal mobility in the ankle and foot, which become restricted from prolonged immobilization.

Outcomes

According to Wheeless’ Textbook of Orthopaedics, non-operative patients have an average re-rupture rate of 18% and can expect a decrease in strength and muscle endurance of 30%.  83% of surgical patients and 69 % of immobilization patients can expect to resume their pre-injury level of activity.  Wheeless also reported that 93 % of surgical patients were satisfied with the results of treatment, while only 66% of conservatively managed patients felt likewise.  Because of the positioning of the foot with the tendon in a shortened position while casted or braced, non-operative treatment generally does not restore the Achilles tendon to its full length.  In contrast, if immobilized with the ankle in a neutral position, the tendon is generally lengthened, leading to a poor outcome.

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What is a strain?

A strain results from a pull or overuse of a muscle and entails some level of damage to the fibers of the muscle itself or to the tendon that attaches the muscle to bone.  A Grade I strain, such as the one Pettitte’s MRI confirmed, is the least involved, and implies only mild disruption of the tissue.  In a Grade II injury, some of the fibers of the muscle or musculo-tendinous unit have been torn.  The most severe strain, a Grade III, is actually a complete rupture of the structure.

What are some of the signs and symptoms of a strain?

The first and most noticeable issue, of course, is pain.   The injured area also becomes inflamed, with the signs of inflammation being swelling, redness of the skin and warmth to touch.  Bruising may follow as the internal bleed of the muscle (in grades II and III strains) becomes more superficial.  Not only is there likely to be pain with use of the involved muscle, but pain may be present at rest as well.  A consequence of this swelling and pain is the inhibition of the muscle, resulting in weakness.

What muscles are involved in a groin strain?

The most commonly implicated muscles are the adductors, which is a group of four muscles comprising the inner thigh.  These muscles are the primary movers of the hip into adduction, or toward the midline, thus bringing one thigh in toward the other.  To help you remember that this is the action of the ADDuctors, it might help to know that the ABDuctors are those hip muscles that move the thigh away from midline.  Think ABDuct, to take away (from your other leg) versus ADDuct, to add to…

Note that issues with the abdominal wall, at the attachment of the abdominals to the pubic bone, may also be involved in a groin strain.  The adductor muscles are not the only ones that may be at fault.  I have alluded to this type of injury in a prior post and will dedicate a future column to this fairly common athletic injury, known as a sports hernia.

Andy Pettitte’s issue however, was reportedly one that is exclusive to the adductors.
The four adductor muscles are:

1. Adductor Brevis:  The word “brevis” implies that this muscle is shorter than its counterpart (longus).  In addition to adducting the thigh, this muscle laterally (outwardly) rotates the thigh as it adducts.  Its less significant role is to assists with flexing the hip.

2. Adductor Longus:  This is the longer muscle, and it originates at a different region of the pubic bone than does Brevis.  It functions in much the same way however.  Longus inserts further down the femur than Brevis, with both attaching to a ridge on the back region of the bone.

3. Adductor Magnus:  Magnus, as the root word implies, is the largest or broadest adductor muscle.  It originates both at the pubic bone and the lower portion of the pelvic girdle in front as well as at the sit bone (ischial tuberosity) in back.  It has a broad area of attachment at its distal (far) end, extending as far as the very end of the femur, just above the medial (inner) aspect of the knee joint.

In addition to this muscle acting to adduct the hip/thigh, its front (anterior) fibers assist in flexing the hip while the rear fibers assist in extending the hip.  Like Adductor Brevis and Longus, Adductor Magnus also plays a small role in lateral rotation.

4. Gracilis:  The most unique of the adductor muscles, gracilis is the only one of the four that crosses both the hip and knee joint.  It too originates at the pubic bone but inserts at the tibia (of the lower leg) below the inner aspect of the knee joint.  Two of the three hamstring muscles – the medial (inner) ones – also attach at this same area.

Because of its orientation, when it contracts drawing its lower portion toward the upper, Gracilis serves primarily as a hip adductor muscle.  However, because it inserts below the knee, it also assists the hamstrings in flexing (bending) that joint.  Unlike the other adductor muscles, Gracilis assists in rotating the femur (and tibia) medially (inward).  If the leg is stationary, the Gracilis acts as a hip flexor when it contracts, bringing the upper portion of the muscle toward the lower rather than the other way around.

What does treatment entail?

As for any inflammatory condition, ice and electric stimulation are initially used to minimize swelling and other complications of inflammation.  Certain types of massage are generally performed to promote healing and control the formation of scar tissue.  Gentle, pain-free stretching is also employed.  After the acute period, it is likely that heat followed by ice is utilized.  Controlled and progressive strengthening is instituted in a pain-free fashion and return to activity is promoted gradually.  Toward that end, Pettitte has reportedly begun a throwing program from increasing distances before attempting to pitch.  By doing so, he initially avoids the long stride length, ballistic motion and extreme follow-through that would aggravate his condition and would be required of him to pitch effectively.

If his coach is correct, Kalin Lucas should give David Beckham a call for a Q & A on what to expect next.  Mr. Beckham was headed to his fourth World Cup, a record for an English soccer player, when he left the field in tears on March 14^th after he too suffered an Achilles rupture.  Beckham wasted no time in having surgery, flying to see a specialist in Finland early the next morning for an Achilles repair.

Both Lucas’ and Beckham’s injuries were non-contact, typical of Achilles ruptures.  Lucas claimed not to have felt or heard the “pop”, often associated with Achilles injury, though he reportedly did think he might have been kicked — a sensation that is also classic for a rupture.  Beckham looked behind him when his injury occurred, as though he too may have suspected a kick to the calf.  Both players also likely experienced sharp pain.  Post-game, a teammate said that Beckham “felt the muscle begin to come up”.  This too is common; it is almost like firmly pulling an elastic band until it breaks and seeing the top half retract.  Surgery is often performed quickly, exactly for that reason – to approximate the two ends of the tendon it is often recommended to act before the tissue can shorten permanently.

What is the Achilles tendon?
Tendons attach muscles to bones.  The Achilles is thicker and more fibrous than most tendons and it connects the calf muscles (the gastroc in the upper calf and the soleus closer to the ankle) to the heel bone (calcaneus).  The Achilles tendon and calf muscles are put on stretch when the ankle is flexed up and it is shortened when the toes are pointed.  A tight Achilles or one that is overstretched can predispose to rupture.

What are the consequences of Achilles rupture?
In addition to the pain and swelling that are expected with any sports injury, disruption of the connection between the calf muscles and the heel results in an inability to contract these muscles; That means that you cannot rise up on your toes or walk with a normal push off when weight-bearing on your injured side. Running and jumping are therefore also out of the question.   However, it may be possible to actively point your toes while you are not bearing weight due to the action of other muscles that help to provide this movement.

Why do Achilles tendons rupture?
There is an area of the Achilles that has less blood flow than the rest and it is thought that this section of the tendon may not be as strong.  As we age, tendons, as other tissues of the body, become less supple and may degenerate.  These are some reasons why ruptures generally occur in people over 30 (Beckham is 34), and especially in middle age.  Younger athletes generally experience a higher tear, well above the ankle, where the muscle joins the tendon (musculo-tendinous junction), though they too can experience a tear closer to the heel.

Some sports are more stressful to the calf muscles and Achilles than others.  Those that require the powerful push-off needed for running and jumping place the greatest demand, as do those like racquet sports which entail a lot of stutter-steps and quick stops and starts.  Men are far more likely to suffer Achilles ruptures than women and though it is thought that obesity adds to the stress to the Achilles, increasing risk of rupture, that is clearly not a factor for elite athletes.

Other predisposing factors for weekend warriors like you and me include stepping up activity suddenly and significantly  – either by increasing the intensity, frequency or duration of participation or perhaps beginning a new activity without preparation.  All of these increase the demand placed on the Achilles. It is thought that weakness of the calf muscles, particularly the soleus, may also be a factor causing the Achilles to rupture; The soleus can be strengthened by pointing the foot — against resistance — while the knee is bent (as in a sitting position).  A history of multiple steroid injections at the Achilles may be to blame in some cases of rupture.  Be aware that manufacturers of certain medications, such as the antibiotic Levaquin, name tendon issues as a potential side effect.  Inform your physician if you begin to feel Achilles symptoms after beginning a new medication.

One exercise I strongly suggest you avoid is strengthening the gastroc muscles of the upper calf by hanging the mid-foot and heel off a step or raised platform and doing heel-raises from this position of maximum stretch.  Repeatedly lowering the heel below the level of the step (with your body weight and gravity loading the Achilles tendon), puts the tendon at greater risk of rupture.  This is an exercise I see so often in the gym.  Yes, you should strengthen the calf, but it is recommended to do so from the more neutral foot–flat position or not fully weight-bearing if on stretch.

How is an Achilles rupture diagnosed?
Physical exam is often pretty conclusive.  The first test is simply to squeeze the belly of the calf muscles and observe whether the foot points as the muscles are manually shortened.  Another obvious sign is when the examiner can move the ankle excessively into a dorsiflexed position (toes toward your nose) – with the knee straight.  This motion is generally restricted by the tightness of the Achilles and in the case of rupture it is not.  A third test involves observing the motion of a needle inserted into the tendon as the foot is passively moved up and down.  An ultrasound exam and/or positive x-ray findings — particularly those in a lateral (side) view – support the diagnosis.

What are the treatment options?
Small tears may do well with immobilzation.  Casting is generally done with the foot in a pointed position, which shortens the tendon allowing it to heal.  Bracing that restricts motion is an alternative. Athletes are not good candidates for conservative management, and those who do not undergo surgery should expect a long recovery (up to a year) before returning to sports.

Operative treatment is the gold standard for athletes, younger patients and those with a complete rupture.  Both treatments are followed by periods of decreased weight-bearing, though the surgical patient progresses at a much faster rate.

Outcomes
According to Wheeless’ Textbook of Orthopaedics, non-operative patients have an average re-rupture rate of 18% and can expect a decrease in strength and muscle endurance of 30%.  83% of surgical patients and 69 % of immobilization patients can expect to resume their pre-injury level of activity.  Wheeless also reported that 93 % of surgical patients were satisfied with the results of treatment, while only 66% of conservatively managed patients felt likewise.  Because of the positioning of the foot with the tendon in a shortened position while casted or braced, non-operative treatment generally does not restore the Achilles tendon to its full length.  In contrast, if immobilized with the ankle in a neutral position, the tendon is generally lengthened, leading to a poor outcome.

The Spartans of Michigan State will meet up with Cinderella Northern Iowa, a ninth seed, this Friday.  Tom Izzo is a great guy and a great coach.  His team has stepped up under pressure before, just as they did on Sunday.  Kalin Lucas will either be with them in spirit or cheerleading from he bench.  Maybe they can pull this one out in his honor.

First, what is a sprain?
You may recall from our discussion of the Tommy John procedure that a ligament is connective tissue that connects one bone to another at a joint to provide stability at that joint.  When a ligament is put on stretch it is considered sprained, and these traumatic injuries are labeled as either Grade I, II or III sprains depending on their severity.  A Grade III sprain IS a complete tear of the ligament – they are one and the same thing.

“High” versus “Low” ankle sprains:
The “low ankle sprain” is a relatively new term and one that is not used in the medical literature.  It is thrown about in the sports pages to distinguish the most common type of sprain from the more serious “high ankle sprain”.  The high sprain is a disruption of the connective tissue that attaches the bones of the lower leg (tibia and fibula) to each other in the area above the ankle joint.  As for all sprains, these are also classified as Grade I, II or III.  We will address the high ankle sprain in a later blog.

Type of sprains most commonly seen:

Lateral (Inversion) Sprains:
There are three ligaments supporting the outer ankle – one toward the front, one toward the back and one central ligament.  The outer ankle is sprained more frequently than the inner compartment for many reasons.  This type of sprain is called a lateral or inversion sprain and it occurs when a player rolls the ankle outward.  Because of the position of the foot at the time of injury, most often it is the front and central outer ligaments that are injured.

The ligaments of the outer ankle are not as substantial or strong as those supporting the medial compartment.  When a player lands on another player’s foot while coming down from a rebound (as Kobe did on January 14^th), it is easy to exceed their limit and wind up with a sprain. The nature of the ligaments themselves, coupled with lack of control of the landing position on an unstable surface sets the stage.

Medial (Eversion) Sprains:
The ligament on the inner side of the ankle is a broad, thick structure that is infrequently sprained.  Movement into eversion (rolling in) is limited to begin with and when this area is stressed, the ligament is so strong that it is more likely that its boney attachment will splinter off (this is called an avulsion fracture) than that the ligament will sprain/tear.  Occasionally, as for Anthony Randolph of the injury prone Golden State Warriors, a player will suffer both a lateral sprain (in his case a grade III of two outer ligaments) as well as an avulsion of the inner side.  This, boys and girls, is a very big problem.

Some predisposing factors to consider:
When team orthopedists perform physicals there are many things they examine to determine if an athlete has a history of sprains or an inclination toward having them.

1. A laxity of the ligaments is a dead give-away.  Ligaments don’t rebound like rubber bands – once stretched, they remain loose and therefore the joint they are intended to protect becomes vulnerable.  Scar tissue that forms in the healing process may provide some stability but is not as supple and isn’t a great substitute.
2. Tight tissues or joints. One weak link can cause a rippling effect. For instance, limited mobility of the first joint of the big toe can predispose a player to ankle sprains!  If the toe can’t extend back as it should, a player may have no choice but to roll outward at the ankle and onto the outer border of the foot when landing. 
3. Strength of the foot and ankle musculature (as well as that of the entire lower extremity).  Strength should be normal and similar on the right and left.
4. Single-leg balance.  Balance is evaluated with eyes open and closed as well as with challenges imposed.  If strength or balance is compromised, sprains might result.
5. Agility – the ability to quickly change direction – so important in running and cutting during sport.

Treatment & Healing Time
All of the above factors are also addressed in treatment of a sprain. However, athletes often push themselves to return to competition before they are ready.  Certainly they do so more than the rest of us (if we are smart anyway).  The daily pressure to play, the lure of the big game or being in the final year of a contract can be motivators that we will never know firsthand.  By example, Kobe Bryant aggravated his ankle on February 3^rd when Lamar Odom stepped on his foot as he was pivoting, again causing stress to the ligaments.  All the treatment and tape wasn’t enough to withstand the stress to the area – it simply hadn’t yet healed.

The severity of a sprain clearly impacts the healing time required.  Though even high school athletes often tape up and return to play within days of a Grade I sprain and 3-4 weeks of a Grade II injury, full healing can take a very long time.  In fact, studies show that ligament healing takes at least a year and that is why it is often said that a clean fracture (one that doesn’t require surgery) may be preferable to a Grade III sprain.  In a recent review of 31 studies done by van Rijn, it was reported that 5-33% of Grade III sprainers still had pain one year after injury and that full recovery was documented in only 36-85% of cases within three years (meaning 15-64% did not recover fully in that time).  He reported that 5-33% still experienced pain at one-three years and that 3% – 34% of the patients studied were at risk of re-spraining. Serious business.

Generally, after injury, the emphasis of early treatment is to reduce swelling and inflammation. This progresses to functional treatment rather than immobilization. In most cases for non-professional athletes, return to sports participation occurs when they have full ankle range of motion, at least 90% strength on the injured side and can run and change direction full-out and without pain.

Problem 1: Low Back Pain is probably the most typical complaint of women during pregnancy (besides excessive weight gain that is).

Contributing Factors: Ligaments are more lax (loose) during pregnancy, which can contribute to instability and also increase the stress to the spine and its supporting muscles. An increase and re-distribution of body weight as well as the resultant change in center of gravity also create more stress to the lower back.

Low Back Solutions: Prevent low back pain with attentiveness to posture – stand erectly and engage your abdominal muscles to avoid excessive arching of your low back. Bend and lift with care and with attentiveness to form – bending from your hips and knees rather than your back. Sleep on your side and, consider positioning a pillow between your knees or try cuddling up to a body pillow, resting your top arm and leg forward. If you experience low back symptoms, ask your doctor about a lumbo-sacral belt to provide additional support and avoid activities that reproduce symptoms. Consult with a physical therapist if your pain is debilitating – there are treatments and exercises that can help!

After the big day: Even once the baby is born, take care to continue the good habits outlined above.

A few more helpful hints: When lifting the baby from the crib, first move him/her close to where you are standing to avoid lifting while reaching forward. To lift a toddler from the floor, bend into a squat and lift from your legs or, if you have pain, have your young child climb onto a sofa and lift him up from that higher position. Switch off from one hip to the other when carrying a baby for a longer period and opt for one of the great carriers on the market if you will be holding the baby for an extended time (or better yet, use a stroller). To rise from bed, when lying on your back, roll to your side and push from your hands to reach a sitting position to avoid rising using an old-fashioned sit-up motion. Most importantly, get back on track with your fitness program once you’ve received your OB’s OK.

Problem 2: Abdominal Diastasis. Not every pregnant woman winds up with this problem and it is essentially impossible to prevent.

Contributing Factor: The abdominal diastasis is essentially a separation of the right and left sides of the front abdominal muscle (rectus abdominus) from their central attachment (the linea alba). Most often noted in the third trimester, the separation is a result of weakened connective tissue (from hormonal changes) coupled with the uterus pushing against the abdominal wall. This separation can be felt as you do a partial crunch, lifting your head and shoulders while you palpate.

Solutions: There are no solutions during pregnancy except not to let the diastasis worry you. In most cases it will resolve after the baby is born.

After the big day: Brace your abdominal muscles with your hands, pushing both the right and left sides toward the center if you have to cough. This will keep the sides of the muscle from pulling apart while it contracts more violently. When resuming your exercise program, begin by strengthening the more interior abdominal muscles (transverse abdominus) before focusing on the weakened rectus abdominus, avoiding crunches at the outset. Consult a resource on pregnancy and exercise for specific instructions.

Problem 3: Fatigue. Most women experience fatigue, especially during the first trimester.

Easy solution, sleep! Enjoy it too because down the road, sleep may be harder to come by!

Contributing Factor: Your body is undergoing significant hormone adjustments.

Solution: Don’t fight it! And it may seem counterintuitive, but consider beginning a low-level exercise program; a good walk, may help you to sleep better. As long as you don’t push your limits, there’s no time like the present…

After the big day: Once the baby is born sleep may really be at a premium. Try to rest when the baby naps and listen to your body. You are also burning a lot of energy/calories, particularly if you are nursing. The weight will come off if you eat sensibly – avoid going overboard counting calories – be sure to eat a sufficient amount and eat healthy calories to address your own nutritional needs.

Problem 4: General Fitness Concerns. The general rule is that if you’ve already been doing it, you can continue to do it – that goes for weight training, running, sports and sex. However, there are a few notable exceptions and rules to follow:

• Avoid exercises on your back after the first trimester (continue to work your abdominals in safer/recommended ways rather than crunches or the like).
• Lighten up! Pregnancy is not a time to set personal bests. Go easier on yourself.
• Don’t worry too much about your heart rate, but monitor your perceived exertion (RPE). If you feel like an activity is too strenuous, it is. STOP! If you experience light-headedness or dizziness, discuss it with your physician.
• Work to strengthen your pelvic floor muscles (the famous Kegel exercises).
• Avoid sports and activities that challenge your balance after the fourth month because during pregnancy balance tends to be more of an issue. You don’t want to fall.
• Listen to your body – even if you are doing an activity you’ve been doing all along, if it begins to feel awkward or uncomfortable, stop.

Enjoy your pregnancy and all that will follow. The time, as they all say, will go by so fast.

In 1999, we began with one small New York City office, and two employees.  Now we have twelve offices spanning the NYC metro area, with more than 45 physical therapists. 

Anniversaries are a time to look back – at the choices we’ve made and reflect on the good decisions and the mistakes.  It is also time to plan for the future.

If you look back to the beginning, why Recovery Physical Therapy even came into business, you’ll see the first good decision in a long line of great choices.  RPT started on the premise that this would be a company owned and managed by physical therapists.  Each Director has ownership in their facility which means that decisions are made from a clinical perspective and not by an accountant crunching numbers in a back office. 

Additionally, our President and CEO, practiced physical therapy in NYC for more than 20 years and understood that when patients are treated by licensed physical therapists patients heal faster with better overall outcomes.  He made the decision that licensed physical therapists would treat our patients.  Quality of care comes first. 

When I first came to work for RPT in 2003, our CFO took me on a tour of all six of our facilities.  As the day wore on, I started to panic, thinking I had made a big mistake. Each office was only treating a few patients at a time.  In my mind, clearly RPT was not doing well.  You see, I had previously worked at a competitor and physical therapists were constantly being pushed to see more patients in an hour, so I was used to offices loaded with patients. But not RPT.  It was quiet and calm in each office, one patient per physical therapist at a time.  It was just a different way of doing business.

We’ve also expanded with the same, “take our time” approach.   Each of our offices is strategically placed, based upon physician and patient feedback, as well as extensive research.  Instead of just blanketing the metro area with offices in order to “grow”, we’ve made decisions that make sense – such as, opening our Wall St office at 6 AM to accommodate our financial district patients to offering weekend hours at many of our “neighborhood” facilities.

Have there been missteps along the way?  Absolutely.  We’ve made some wrong hiring decisions, opened an office in an area that didn’t work out, and had to deal with our share of growing pains. Are their downsides to our philosophy?  In terms of volume, sure.  There are some insurance plans that we can’t participate with in-network simply because we can’t handle the number of patients that could potentially come our way. All in all though, the good far outweighs the bad.  We are blessed with a great leader, fabulous people, and loyal patients. 

Jim Cardone, our President and CEO, brings not only experience and expertise to the table; he has integrity and is an amazing leader.  He gives people what they need to succeed; he’s open to new ideas and supports our staff in all ways.

Our physical therapists are the best.  They are not only highly skilled practitioners, but they care about their patients’ recovery and treat them with highest level of attention. 

Our front desk staff greets our patients with a smile while untangling ever-changing insurance coverage and issues.  Kudos too, to our corporate staff who keep it all together behind the scenes.

Most of all, we are most grateful to all of our patients who have become like family to us.  We’ve watched many of you go on to achieve amazing things, like running a marathon after a debilitating injury or climbing to Mt Everest’s base camp.  Thank you for coming back again and again and for referring your friends and family to us. 

And to our physician partners, we look forward to continuing to provide the highest level of care that you’ve come to expect from us.  Thank you for believing in us.

 As we look ahead to the future, there will be bumps and bruises along the way but as long as we stay true to our core values, the future is limitless.

I recently finished the last batch and after sorting through hundreds of responses (and deciphering some chicken scratch writing), I was reminded of the integral role our physical therapists play in a patient’s life.  I have been a patient myself, so I know first-hand how PT can make a difference.  On a day to day basis however, my interaction with the physical therapists is on a completely different plain.  These surveys remind me what makes Recovery Physical Therapy truly extraordinary – their hands-on care, professionalism, knowledge and concern.

Our physical therapists are focused on positive patient outcomes, but most importantly, they care about their patients.  They want them to heal and get back to the activities they love.  Patients are treated with ‘hands-on’ care, kindness, warmth and laughter.

In terms of results, most of our patients are “very satisfied.” There are always helpful suggestions and sure, there are those select few who complain about everything.  (I’m convinced that they are put on this earth to make us better.)  But what always strikes me (especially when I’m somewhat crossed-eyed and covered in surveys) is the heart felt comments, handwritten praise and “thank you’s.” 

Let’s face it, no one wants to be in physical therapy.  It is not a something you choose to do. like personal training.  It can be painful and time consuming.  You may be there because of an injury, as a last resort before surgery or post-surgery.  But it works.  And it works even better when you are treated by kind and caring therapists.   A sense of humor doesn’t hurt either.   There is a camaraderie and friendship that builds, a feeling that “we are in this together” especially since appointments are usually for several weeks, 2-3 times per week.

Thank you to the patients who take the time to respond to our surveys with the helpful comments.  I couldn’t put it in a better way.  Patients really do know best. Here are a few comments, in your words:

“Even though other PT places are closer, I’ll travel  to RPT.  The staff is pleasant, courteous and helpful, which is so important – I speak from experience, I’ve had several PT experiences all over NYC!”

“My knee is 90% better than when I started 8 weeks ago.  No more pain and the swelling is down.  I will not need surgery as a result.  HOORAY and Thank you”

“John was fantastic.  He went above and beyond in terms of explaining things, being gentle and courteous, yet thorough.  He even checked in while he was on vacation.  John is wonderful!”

“Steve Frank has been outstanding.  He paid close attention to the issue and did everything to monitor and help my knee to improve.  I feel better knowing I have a PT in the city that I can turn to.  He was terrific in every way – thorough, caring and very professional.  I can’t praise him enough.   I’ve had PT at several facilities over the past 2 years and he is the best PT I have experienced.  He is thorough smart and gives detailed explanations to questions asked.”

“This is the 3rd time I’ve had PT but my first time at RPT.  I would definitely return here.  RPT ranks as the most professional, engaging and helpful.  Excellent service, professional staff and I’ve very pleased with my progress.  I thought everyone was great – wonderful hands-on therapy. Thank you!”

“Amie has been a phenomenal therapist.  She listens, answers any questions and all types of questions, cares and takes a genuine interest in the well-being and healing of her patients.  I could not have progressed to the level I am without her assistance and am truly grateful.  She also has a friendly, dedicated staff.”

“I don’t think I’d be able to stand up without the excellent care I received.  They were amazing.  They helped me to return to my activities while teaching me to be realistic about my limitations.  And they pushed me hard, which I needed, and got the job done within the very few visits allowed by my insurance.  Everyone was a nice as could be.  Thank you!”

“Usually I am a critic, however with the service at RPT, I have no recommendations for better service.”

Thank you too, to our team of physical therapists who heal, motivate and inspire us all.