Your outcome matters!

Choose JOI, the region’s leaders in effective, healthyrehabilitation . JOI Rehabilitation

has nine convenient locations to

serve you.

��Beaches 436 Jacksonville Drive Jacksonville Beach, FL 32250 P: 904.247.3324�F: 904.247.3926

��North12961 North Main Street Suite 201 & 202 Jacksonville, FL 32218 P: 904.757.2474�F: 904.757.5541

��Point Meadows (Gate Parkway & 9A) 7740 Point Meadows Drive Suite 1 & 2 Jacksonville, FL 32218 P: 904.564.9594�F: 904.564.9687

��Riverside 4339 Roosevelt Boulevard Suite 300 Jacksonville, FL 32210 P: 904.389.8570�F: 904.389.8599

��San Marco 1325 San Marco Boulevard Suite 102 Jacksonville, FL 32207 P: 904.858.7045�F: 904.858.7047

��South14985 Old St. Augustine Road, Suite 106 Jacksonville, FL 32258 P: 904.288.9491�F: 904.288.9698

��University 5737 Barnhill Drive Building B, Suite 204 Jacksonville, FL 32207 P: 904.733.9948�F: 904.733.9984

�� Mandarin 12276 San Jose Blvd Suite 716 & 717 Jacksonville, FL 32223 P: 904.288.9604�F: 904.288.9643

��Orange Park 1845 Town Center Blvd Suite 410 Fleming Island, FL 32003 P: 904.621.0396 F: 904.621.0397

Meet Our Staff

The American Board of Physical Therapy Specialties and the American Physical Therapy Association have identified eight areas of clinical expertise encompassing Cardiopulmonary, Clinical Electrophysiology, Geriatrics, Neurology, Orthopaedics, Pediatrics, Sports, and Women's Health Physical Therapy. There are only 775 Sports Certified Specialists in the US, 22 in Florida, and only 2 in Northeast Florida!! The only 2 in the city are employed by JOI Rehabilitation. Congratulations to Fred Baldwin and Robby Hoenshel on their accomplishment of achieving this specialization!

Clinical specialization in physical therapy responds to a specific area of patient need and requires knowledge, skill, and experience exceeding that of the physical therapist at entry to the profession and unique to the specialized area of practice. The specialist certification program was established to provide formal recognition for physical therapists with advanced clinical knowledge, experience, and skills in a special area of practice and to assist consumers and the health care community in identifying these physical therapists.

Congratulations also goes out to Kimberly LeRoy of the Beach Rehabilitation for obtaining her Certified Hand Therapist (CHT) certification. The CHT specialization puts her in an elite category of therapists, as there are only 5,150 Certified Hand Therapists in the United States. JOI is proud to employ 11 Certified Hand Therapists.

Fred Baldwin – Mandarin Fred has been part of the JOI Rehab team since 2006, and is currently Site Coordinator of our Mandarin location. He is a Board Certified Clinical Specialist in Sports Physical Therapy. He is a Certified Athletic Trainer and Performance Enhancement Specialist from the National Academy of Sports Medicine. He also assists with sports medicine coverage at The Bolles School.

Robby Hoenshel - San MarcoRobby has been with JOI since 2004 at our San Marco location. He is a Board Certified Clinical Specialist in Sports Physical Therapy. He is a certified Strength and Conditioning Specialist, Performance Enhancement Specialist, and is a Corrective Exercise Specialist. He provides athletic training coverage at Bolles and other high schools around Jacksonville.

CONGRATULATIONS!

JOI Now Offers Orthotic Services By Pedascan Orthotics are comfortable custom-fit inserts for your running or walking shoes. They are especially helpful in easing pain in the feet, ankles, shins, knees, hips, and the lower back.

Your visit will take 30 minutes and includes: �� Gait analysis �� Flexibility screening �� Examination of current running shoes �� Home exercise program (if required) �� Suggestions for proper running shoes

We offer this professional customized service for only $138. No prescription or referral is required.

Pedascan allows us to quickly and accurately “cast” your foot for orthotics.

For more information on the benefit of orthotics or to make an appointment, contact any of the nine

JOI Rehabilitation locations! www.JOIonline.net

Ergonomics– It’s for Everyday By Christine Harrison OTR/L

SPRING 2010

Presented by JOI Rehabilitation • A Patient Education Newsletter

Official Sports Medicine Partner

Ergonomics is the study of how a workplace and the equipment used there can best be utilized or designed for comfort, efficiency, safety, and productivity. However, it also applies to everyday life. How we sit, carry our stuff, and perform house or yard work are just a few of the activities that can have an effect on our bodies’ well-being. If we give these actions some thought, we can reduce the stress and strain on our joints and muscles. Repeated stresses and strains on your body can develop into several conditions, such as tendonitis, carpal tunnel syndrome, “pinched” nerves, arthritis, and backaches.

Sitting is a simple task, right? Not if you slouch or sit in a poorly fitting chair for long periods of time. You need a chair that allows your feet to touch the floor, and supports your back and arms. If you are seated at a desk and working on the computer, you should keep your elbows bent at 90-to-100 degrees, wrists straight, and fingers relaxed when using the keyboard or mouse. Do not maintain the same posture for too long or hold or turn your head constantly to one side. Change positions or get up and walk around every 20-30 minutes.

Whether carrying a handbag, backpack or computer bag, take notice of how you carry it. Improperly carrying a bag on your shoulder can strain the shoulder and back muscles, restrict blood flow and pinch nerves. If the bag has a single strap it should be wide, keep the bag as light as possible and alternate shoulder use periodically. If it has two straps, wear them over both shoulders evenly to distribute the weight. Adjust the straps to hold the bag in the mid-back area not extending into the lower back. Organize the bag contents so heavier items are closest to your back. Backpacks should not be overloaded. It is generally

recommended that backpacks are no heavier than 15% of your total body weight.

House and yard work can also take a toll on our bodies especially if we are “out of shape.” If you have decreased strength and stiff joints, a little yard work can stress the joints and muscles. You should avoid prolonged overhead arm work, prolonged reaching with an extended arm, repetitive or prolonged bending and straightening of your wrist, prolonged bending at your waist, and prolonged standing. When picking up heavy items, remember to lift straight up holding the item close to your body keeping your knees and hips bent.

Awareness of proper positioning, routine exercise, stretching, and getting plenty of rest at night can reduce the potential for injury and discomfort in our everyday lives.

Come Visit Our New Orange Park/Clay County Locationat Fleming Island!

-Now Open-1845 Town Center Blvd. Suite 410 Fleming Island, FL 32003 P: 904.621.0396 F: 904.621.0397

Hours of Operation Monday, Wednesday, Friday - 8 a.m. to 6:30 p.m. Tuesday and Thursday - 7:30 a.m. to 1:00 p.m.

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Your outcome matters! Choose JOI, the region’s leaders in effective, healthy rehabilitation.

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By Barbara Short, DPT

Pain Management After Total Knee Replacement

By Michelle Duclos, MA, ATC, LAT

What is a Certified Athletic Trainer? In most of the Physical Therapy clinics operated by

Jacksonville Orthopedic Institute, many patients are treated by certified athletic trainers. JOI employs the largest number of certified athletic trainers in Jacksonville. What is a Certified Athletic Trainer?

Certified athletic trainers, or ATCs, are health care professionals that specialize in the prevention, evaluation, and treatment of injuries and illness in the athletic and physically active population. Certified athletic trainers are often referred to as “trainers” leading a person to falsely believe that ATCs are the same as personal trainers. Certified athletic trainers are required to have at least a bachelor’s degree from a nationally accredited athletic training education program. Many ATCs choose to continue their education, earning a master’s degree to supplement their knowledge and gain experience. They are also required to maintain current First Responder CPR/AED certifications as well as a national certification. In the State of Florida, certified athletic trainers are required to be licensed as well.

Certified athletic trainers have a background in acute care and assessment of injuries and illnesses, exercise physiology, anatomy and physiology, kinesiology, biomechanics, nutritional aspects of injury and illness, pathology of injury and illness, pharmacology, psychosocial intervention and referral, strength training and reconditioning, therapeutic exercise and rehabilitative techniques, and therapeutic modalities. They

possess the added skills necessary to evaluate injuries on the field and determine if the athlete needs to be transported to the emergency room, seen in the office by a doctor, or can be treated by the athletic trainer at the school.

JOI provides athletic training services to several high schools in Jacksonville including Bishop Kenny, Episcopal, Providence, Bolles, Bishop Snyder, Stanton, and First Coast High Schools. They provide athletic training services to Florida State College at Jacksonville as well. These athletic trainers serve as a liaison between the athletes and orthopedic physicians at JOI.

Pain is a major concern for many patients after a total knee replacement. The surgery takes a large toll on the body, and for this reason, one cannot expect to resume his or her regular daily activities right after surgery. The damage caused to the knee joint happened over time; therefore, healing and recovery will also need to happen over time.

Pain, swelling, and over-activity are all related. The remedy to all three is rest. The knee is the biggest, most complex and nerve-rich joint in the body. When overused, the knee will react sharply, causing discomfort and pain. Instead, one should try to be active in short spurts and rest for longer periods of time in between. As the knee feels stronger and has less pain and swelling, one may try to increase his or her activities, as tolerated.

After your knee surgery, your orthopedic surgeon will most likely have you on narcotic pain medication. You can expect to be medicated for at least a few weeks. As with all narcotics, there are side effects, therefore one should follow the instructions exactly as they are prescribed. The importance of medication is stressed for one simple reason. Pain causes swelling, which can interfere with your physical therapy, your healing, and your progress. At lower pain levels, the medication your doctor gives you will work more quickly. However, the more the pain is permitted to build up, the longer the drug takes to become effective. Weeks after the surgery, you may still need pain pills even though you are getting back to normal activities. This is true especially at night when pain tends to become more obvious. Ice is also essential for pain management in knee replacement surgery recovery. Ice can reduce painin combination with medication, and with less severe pain, it can be used on its own. Lastly, elevate your legs and rest while you are icing.

It is important to remember that sometimes pain can persist in one form or another for many weeks. This is normal. In addition,your physical therapy may cause some pain in your joints. You can prepare yourself for this pain with a dose of medication about an hour before your physical therapy sessions.

Educating yourself about pain before you are in pain can significantly reduce fears and help you manage your expectations. Follow a simple mantra when practicing pain management for total knee surgery: Rest, Ice, Medicate, Elevate.

Osgood-Schlatter Disease By Matthew Fehniger, PT, MSWhat is Osgood-Schlatter disease?

Osgood-Schlatter disease is a painful enlargement of the bump of the shin bone (tibia) just below the knee. This bump is calledthe tibial tuberosity. The tendon from the kneecap (patella) inserts here. Osgood-Schlatter disease is most often seen in children between the ages of 10 and 15 and usually appears during a period of rapid growth.

How does it occur?Osgood-Schlatter disease is caused by overuse of the knee in normal childhood and sporting activities. It is possible that

muscles are too tight in the front of the thigh, the back of the thigh, or in the calf.

What are the symptoms?Your child will complain of a painful bump below the kneecap. The parents or child may notice a bony enlargement at the top

of the shin bone. The pain will sometimes come and go, and usually it is gone by the time your child has stopped growing. Sometimes young adults can have pain in the area of the bump. Your child will always have a bump even after the pain has gone away.

How is it diagnosed?Your child’s health care provider will do a physical examination of the knee and review your child’s symptoms. X-rays show an

enlarged tibial tuberosity. An X-ray may also show irregular or loose bony fragments from the tibial tuberosity.

How is it treated? Your child may need to rest or complete activities that do not cause knee pain. Ice packs should be applied to the knee for 20 to

30 minutes every 3 to 4 hours for 2 to 3 days or until the pain goes away. If the knee is swollen, it should be elevated by placing a pillow under it. Your child’s health care provider may prescribe a special padded brace. He or she may prescribe an anti-inflammatory medication and may recommend exercises.

When can my child return to his or her sport or activity?The goal of rehabilitation is to return your child to his or her sport or activity as soon as is safely possible. If your child returns

too soon the injury may worsen, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to his or her sport or activity will be determined by how soon your child’s knee recovers, not by how many days or weeks it has been since the injury occurred. In general, the longer your child has symptoms before starting treatment, the longer it will take to get better. Your child may safely return to his or her sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:

�Your child's tibial tuberosity is no longer tender.�The injured knee can be fully straightened and bent without pain.�The knee and leg have regained normal strength compared to the uninjured knee and leg.�Your child is able to: Jog straight ahead without limping. Sprint straight ahead without limping. Do 45-degree cuts. Do 90-degree cuts. Do 20 yard figure-8 runs. Do 10-yard figure-of-eight runs. Jump on both legs without pain and jump on the injured leg without pain.

How can Osgood-Schlatter disease be prevented?Osgood-Schlatter disease may be difficult to prevent. The most important thing to do is to have your child limit activity as soon

as he or she notices the painful bump on the top of the shin bone. Proper warm-up and stretching exercises of the thigh, hamstring, and calf muscles may help prevent Osgood-Schlatter disease.