Are Breast Implants Safe?

Are breast implants safe? In a word, yes. During the 1990s, medical problems in women who had silicone implants caused concern for the US Food and Drug administration (FDA), resulting in their removal from the market in January 1992 (except in very limited cases). Two implant manufacturers continued studying patients and presented safety data leading the FDA to reintroduce silicone breast implants in November 2006.

Concerning to most women are capsular contracture (abnormally thick scar around the implant) and implant rupture. Both often require surgery. For cosmetic breast surgeries, the FDA regulated studies showed only 8 in 100 women are at risk for capsular contraction at three years and only 19 in 100 at ten years. The implant rupture risk was less at 5 in 1000 at 3 years and 9 in 100 at 10 years.

No implant lasts forever.
Reoperation may be required for any number of reasons. The longer you have your implants, the more likely the need for revision surgery. For years, breast augmentation has been the number one cosmetic surgery only now being rivaled by liposuction. Core studies demonstrated that silicone implants have an acceptable safety profile. Talk to your plastic surgeon if you are interested in learning more about implants and breast


Concussion Care for Athletes

With the CDC reports that concussion rates have doubled in the last 10 years, it is imperative to have heightened awareness of the signs and symptoms to ensure proper management. Concussion symptoms can range in severity and presentation, making diagnosis and treatment challenging. It is important to remember that one does not have to lose consciousness to suffer from a concussion. In addition, loss of consciousness is not a severity indicator of the injury. The two most reported signs of concussion are headache and dizziness, however some other symptoms include nausea, vomit-ing, fatigue, irritability, feeling slowed down or “foggy”, difficulty with concentration/memory, balance disturbance, changes in sleep patterns, decreased appetite, blurred vision and sensitivity to light or noise.

When people think of sports-related concussions, most think of football as the main sport associat-ed with risks of concussion. While football does carry a high risk, especially for male athletes, it is important to understand that other sports such as soccer and ice hockey are also high incident sports, with soccer being the sport most commonly associated with concussions for female athletes. A concussion is sustained by force or trauma to the head or upper body that causes the brain to shake inside of the skull. Athletes are at risk for concussion in any sport-related activity that in-volves physical contact with other players and/or the ball. When a concussion is expected, immedi-ate medical attention is critical to prevent repeat injury. For most athletes, a concussion can heal with cognitive and physical rest and graded re-entry to physical activity. However, if the athlete returns to play too soon and they sustain a repeat injury the deficits can be long lasting. A physi-cian who specializes in sports-related concussions is key in managing recovery, monitoring pro-gress, and making additional recommendations along the healthcare continuum if needed.

For athletes with concussive symptoms that persist, the standard of care should include a multidis-ciplinary pathway for rehabilitative services, with a Sports Medicine physician champion. This may include Neuropsychological testing and/or counseling, Physical Therapy for balance and con-ditioning, and Speech Therapy for cognitive retraining. Therapy should be patient focused, target-ing physical and cognitive deficits that impair ability to complete daily tasks and should be reported back to the ordering physician to monitor progress.

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Julie Scott, MS, CCC-SLP
Riverside Outpatient Therapy-Shoreview

Riverside Tappahannock Hospital Offers Balance Assessment

hAn innovative balance assessment and treatment tool that combines a popular video game balance board with cutting-edge diagnostics and treatments is now available for patients at the Riverside Tappahannock Hospital Physical Therapy Department.

The HUMAC Balance System, designed by CSMi, couples a popular gaming balance board with company software to give patients a balance assessment. Craig Secor, a Riverside Tappahannock Hospital physical therapist, called the versatile tool helpful for many different types of patients.

This includes the young and active, such as athletes recovering from injuries through physical therapy, older adult patients who have had joint replacements, or people suffering from vestibular or other balance- and motion-related issues.

“I like its versatility between patient populations,” Secor said. “You can use it on athletes, and make things really hard, or your 80-year-old patient who has had multiple falls over the past few months.”

The HUMAC Balance System is able to treat patients with a number of needs, whether it’s balance, vestibular and neurological disorders, or recovery from joint replacement or other orthopedic surgeries, or concussions.

“It’s just a great balance tool for anyone,” Secor said. “I can show you how much weight you’re putting on one leg. It’s opened the door as far as balance assessment and weight-bearing treatment.”

One of the unique features of the assessment tool is a meter that shows weigh shifts. For example, putting more weight on one leg over the other.

“They can visually see themselves do that,” Secor said. “We used to just use mirrors, but that’s not as visually beneficial. You can have them actually feel what 50 percent weight bearing means. Or 25 percent. You can actually put them on there and have them feel what 25 percent feels like.”

Patient profiles that are individualized or customized are set up on the computer to track progress and results.

“We can test a patient, treat them and reassess them a few weeks later,” Secor said.

For more information about the HUMAC Balance System, or to set up an assessment, contact the Riverside Tappahannock Physical Therapy Department at 804-443-6090.

About the Riverside Tappahannock Hospital Physical Therapy Department

The Riverside Tappahannock Physical Therapy Department provides physical therapy services for acute care, outpatient and skilled nursing units. The purpose of physical therapy is to restore function, relieve pa

in, promote healing and learn to adapt to a disability. The Physical Therapy Department provides services to individuals of all ages, focusing on patients 14 years and older. Conditions addressed include, but are not limited to:

  • Orthopedic disorders
  • Neurologic disorders, to include stroke rehabilitation
  • Wound care
  • General rehabilitation
  • Pain management

Manual Therapy

Manual therapy may be successful where other more generic therapy treatments have failed. When an acute injury does not heal properly, it can leave a patient with chronic pain. Chronic pain is defined as pain lasting for 6 months or longer. Often a patient with chronic pain has received various treatments with the hope to control their pain. Manual therapy is especially helpful for chronic pain as it tries to direct the treatment at the source (cause) of the pain. This is a hands – on (manual) approach to the assessment and treatment of certain kinds of physical conditions that affect muscles, joints, nerves and fascia.

Manual therapy is a general term for therapy treatments that are hands on. The therapist is applying specialized treatments individualized for the patient typically through the therapist’s hands. This includes but is not limited to joint mobilizations, muscle energy techniques and manipulations, myofascial release, soft tissue mobilization, and muscle re-education.   Manual therapy can be used for any age range to decrease pain and improve function of chronic pain, acute pain, various muscle skeletal (orthopedic) conditions, neurological conditions, and athletic injuries. Manual techniques should be used in conjunction with exercises to give the greatest results.

Joint mobilizations are a form of manual therapy. For numerous and various reasons a joint can move incorrectly. Joint mobilizations try to increase the lubrication, nutrition, and restore proper mechanics of the joint. Once a joint can move with greater ease, it can allow muscles to stop guarding and relax.

Muscle energy techniques and manipulations of the spine are the terms used to correct spinal mechanics. It works the same way as joint mobilizations.

Myofascial release is a way to decrease pain by breaking up scar tissue. The body heals through producing scar tissue. Scar tissue is good unless the scaring process goes on too long. When something has not healed properly, it will keep laying down more and more scar tissue. This can compress the nerves around an area creating pain. Myofascial release tries to reorganize the scar tissue causing changes in the fluid around tissues, so that the tissue will not compress the nerves as much.

Soft Tissue mobilization tries to release the knots in the muscles. Some people refer to this as a deep tissue massage, or trigger point releases.

Once the joints and soft tissue are working properly, it is time to re-educate a muscle. Muscle re-education are exercises that will help the muscle function the way it is supposed to work.  Some people may be strong but they lack the endurance needed for a task. While others may lack stability, or the muscle may stay in a contracted shortened state. There are different techniques and exercises to restore the natural way the muscle was meant to function.

Not all therapy is the same, certified manual therapists require advanced levels of training. Most patients will significantly improve with this more advanced form of therapy. You will need a doctor’s prescription to come to therapy (and for insurance to approve), and let your doctor know if you would like a certified manual therapist. If you have any questions please call the phone number or by above e-mail.


Brian Stisser PT, CIMT

Your Landing Gear

Patellafemoral Pain Syndrome in Gymnasts: Proper Landing Technique

Patellafemoral pain syndrome is a term used to describe the pain behind or around the kneecap (patella) resulting from problems with the patellafemoral joint due to over- use, muscle imbalances, abnormal gliding of kneecap, and alignment problems. This is one of the most com- mon causes of knee pain in athletes and represents ap- proximately 60% of gymnastic knee disorders. The knee is a major shock absorber during landing activities and peak vertical ground reaction forces could be 8-14x the gymnast’s body weight.

Screen Shot 2015-04-08 at 2.11.26 PMPatellafemoral pain syndrome causes pain under or around the kneecap, which can be on one or both legs, that is aggravated by prolonged sitting, squatting, run- ning, jumping, or walking downstairs. There are many factors that may contribute to the development of patel- lafemoral pain syndrome. Overuse, overload, along with repeated bending of the knee may increase pressure be- tween the kneecap and the thighbone, irritating the un- dersurface of the kneecap (articular cartilage), leading to its degeneration. This cartilage degeneration is also known as chondromalacia patellae. Muscle imbalances resulting from tightness or weakness of the thigh and hip muscles can also cause abnormal gliding of the kneecap, leading to inflammation and pain. Abnormal gliding of the kneecap towards the outside of the groove can lead to damage to the cartilage underneath the kneecap. Alignment problems are caused if the bones in the lower leg are abnormal, which include an increased angle be- tween the thighbone (femur) and shinbone (tibia), flat feet, and knock-knees.

One thing that will increase the angle between the thigh- bone and shin is how the gymnast lands. The picture above shows a gymnast landing in more of a knock-knee position, increasing the angle of the knee joint, thus in- creasing forces through the patellafemoral joint. The gymnast should land with knees directly over feet not allowing them to dive inward into the knock-knee posi- tion. Making sure the gymnast is aware of how they are landing is crucial. The gymnast needs to practice the proper landing technique to make it second nature along with strengthening the proper muscle groups to include the outside hip muscles.

If patellafemoral pain does occur the treatment is to control the pain by resting, taking anti-inflammatory drugs, and using ice packs. Modifying the activity level avoiding the motions that irritate or overload the kneecap can help. The gymnast can try non- impact aerobic exercises to maintain their fitness level, such as swimming which will not make the pain worse. Strengthening all the musculature of the affected lower extremity, especially the hips, may help take pressure of the kneecap along with stretch- ing tight muscles (quadriceps, iliotibial band, and hamstrings). Also when the gymnast is not in the gym evaluating their footwear, changing shoes, or wearing arch supports may improve lower extremity biomechanics by preventing excessive pronation (flattening) of foot to take pressure off the patella- femoral joint.

Stepahanie Barnes, DPT

Stepahanie Barnes, DPT

Riverside Running Analysis

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Justin Kelly DPT, MDT

As the weather starts to warm up, running becomes a more popular way to get back in shape. Whether it is going for a run on a picturesque trail or on a treadmill in a gym, running puts specific reaction forces on joints and muscles that the body has to absorb or distribute. Injuries from running occur quite frequently in both novice and seasoned runners. At Riverside Physical Therapy, we have developed a video running analysis program that looks at various running styles, including barefoot running, in order to correct, improve, and decrease potential injuries for all distances.


With the use of Dartfish movement analysis software, a runner is filmed from the front, back, and side at various angles and the video is reviewed by a physical therapist. The video of your running is broken down to 30 frames per second to better identify specific points to improve upon. Based on the results of the video analysis, the physical therapist will tailor an exercise program designed to improve efficiency of running gait and decrease any pain causing movement. The therapists at Riverside Physical Therapy Denbigh are trained in a variety of hands-on manual techniques including Kinesiotaping, orthotic fitting, muscle energy techniques, and mobilization through movement that help facilitate weak muscles, as well as improve posture and alignment. Ask your doctor for referral or call the clinic and inquire about Riverside’s Running Analysis Program. Justin Kelly, DPT, MDT is a McKenzie Certified therapist and running specialist. He is located at Riverside Denbigh Physical Therapy. Call 757-968-5332 to schedule an appointment.

The Season that Never Ends: Overuse Injuries in Youth Athletes Part 2

Dr. Smith, DO, CAQSM

Dr. Smith, DO, CAQSM

By: Dr. J.A. Smith, DO, CAQSM, Riverside Orthopedics, Sports Medicine & Physiatry Specialists

In my previous post, I discussed some of the causes of the rise of overuse injuries among young athletes. Here, I’ll provide some recommendations to avoid these injuries and keep your children having fun on the field (or court) for years to come.

Play More
As in, play more sports. Instead of playing in winter, spring and summer baseball leagues, children can reduce their risk of overuse injuries by playing different sports. Break up baseball seasons with a soccer camp or a few weekends playing golf with dad. Research even suggests that single sport specialization does not improve a child’s chances of becoming an elite athlete.

Play Less
While it seems logical that more play and practice leads to better performance, the opposite may actually be true for youth athletes. Studies show that children involved in intense competition within a sport for a decade are more likely to experience burn out by the time they reach college. Children should take at least a few months off (we recommend at least 2 months) from their main sport of interest to explore other activities and hobbies. As they are resting the muscles involved in their primary sport, children can also develop new physical skill sets.

Parent and coaches don’t have to worry about an extended time off affecting later performance. Research shows that those who take up a sport in their late teens can catch up very quickly to those who started playing years earlier.

Just Play
Sports should be an outlet for kids to have fun. Young athletes will benefit physically and psychologically if games and matches are supplemented with play that is less structured and less competition-driven.

Read Part 1