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Stepping Stones Rehab. Services

6320 159th St, Oak Forest, Suite F, IL 60452

PH: 708-687-8768, FAX: 708-364-0518

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Tommy John Surgery in throwing athlete

Posted on September 12, 2018 at 10:34 AM Comments comments (12470)
Tommy john surgery is the repair of ulnar collateral ligament of elbow. It is named after the pitcher from LA dodgers to get this surgery done in 1974 for the first time. 
This is a very big topic with lot of myths like after surgery you could throw even faster and harder which has been proven completely wrong. 
Recently as the need for speed has risen among young athletes these surgeries are becoming more common. 
Not only the need for throwing hard but also doing so without proper mechanics, without proper warm up and proper conditioning is also a contributing factor. 
Role of throwing curve balls at an early age before skeletal maturity has been regarded a contributing factor
but certain researches are finding that there might be no correlation.  see reference: 
If you walk around the baseball fields during the baseball season and watch pitchers you could see the variety of pitchers throwing different ways with ultimate main goal of throwing hard. 
Not only the young pitchers are at risk of causing damage to the ulnar collateral ligament (UCL) but the Major league pitchers are also in the news frequently even though they have full squad of sports physicians, trainers etc. 
My perception is that there should be focus upon full body conditioning, special focus upon throwing mechanics and proper routine before pitching in the game especially in the cold evenings. 
As the biometrics is taking over our sports where teams select bigger kids especially hitters, young pitchers strive to throw harder hurting themselves in the process sometimes. Advancement in equipment like composite bats and other material is also making harder for pitchers so they want to throw harder to get ahead in the game. 
There are some steps taken by certain organizations to change the bat composition to maintain a balance b/w bat and ball. 
Eventually the onus is on coaches and parents to talk to their young pitchers if they notice any early signs of discomfort before the serious damage is done. 
As some young pitchers would not complain even if they are hurting. One needs to be a good coach to spot these signs. 
Some signs could be shaking of the pitching arm after every pitch, sudden loss of speed and accuracy, sudden change in throwing mechanics to compensate for the painfully joint etc. 
Injury to throwing arm could be minimized by proper warm up before pitching, adequate resting period b/w days of pitching. 
There are certain group muscles of shoulder and forearm needs to be strengthened to put less strain at the Ulnar collateral Ligament on the medial inner side of elbow. 
Please talk to an Occupational therapist Physical therapist with experience in upper extremity rehab. to evaluate your son/daughter as soon as the pain develops. They can guide you with proper rehab. program to make faster recovery and them back on the field with confidence and help them achieve full potential safely. 
Arun Sharma 

Occupational Therapist / Certified Hand Therapist

Throwing Athletes Shoulder

Posted on July 1, 2016 at 10:50 AM Comments comments (10041)
Shoulder Pain In thrower athletes i.e pitchers , catchers has been a common problem.If symptoms are misdiagnosed or left unchecked can result in more severe pathology and disability potentially ending the career or loss of occupation. 
Most of these symptoms originate from minor trauma or cumulative stresses especially in younger athletes eventually leading to proximal instability at scapular region. Sometimes more serious injuries like SLAP tear are the underlying causes. 
Through evaluation by a therapist or doctor is required in order to establish proper diagnoses. Frequently symptoms are present away from the actual site of pathology leading to improper diagnoses. For example patient might c/o pain at the anterior aspect of shoulder , Lateral arm pain etc. 

Some of the symptoms which may require immediate attention :
1. Feeling of severe fatigue in arm sometimes explained by patients as " Dead Arm".
2. Affected arm is significantly lower than the non affected arm.
3. Pain in scapular region especially raised medial and lower part of scapula.
4. Clicking sensation at shoulder sometimes palpable hyper-mobility of joint causing stress on surrounding structures. 

Precautions to be followed in order to prevent these injuries:
1. Following proper bio-mechanics while throwing
2. Do not attempt to throw if in pain or fatigued as it might lead to undue stress or start to cause wear and tear at shoulder muscles and surrounding structures.

Please follow up with Rehab. professional ASAP who can identify the true nature/ cause of pathology because if remains unchecked patient might have to undergo surgery.
Proper interventions might include scapula specific stability exs, taping to support / rest hyper-mobile structures, rest, closely monitored strengthening program. 

Does my child have sensory dysfunction?

Posted on May 8, 2012 at 4:37 PM Comments comments (3752)
Sensory processing: What is it?  How does it work?
Sensory processing refers to the collective process of Reception, Perception, Processing of information and Response to it. Information is being Received from the environment via our sense organs, (vision-eyes, hearing-ears, smell-nose, tongue- taste, nose-smell, skin- touch) as well from our body, through muscles and movement receptors.
This information is consolidated in the mid brain and perceived by the various specialized regions of the brain. This in formation is then processed using previously stored information or"made sense of"  via communication between different parts of the brain. 
This is followed by a response, in the form of a physical movement, speech or social behavior.
Hence, an impairment in one or more of the 4 processes namely,reception, perception, processing and response can lead to visible challenges in physical, speech and language as well as social behaviors. 
Our muscle tone as well as the ability to perceive and respond to movement also provide feedback to the brain regarding the position of our body in space and hence our sense of well being, or feeling grounded. 
Hence we truly have 7 sensations which provide input or sensory input to our brain. 
Spontaneous and efficient acquisition of developmental processes is contingent upon synchronized working of all these processes.These are observed in the form of natural development of motor milestones, speech and language as well as cognitive and social emotional skills. 
Intact processes of of reception, perception, processing and output or response form the building blocks of all acquired skills. 
Motor skills such as sitting, creeping, walking running, reach, grasping and manipulation are centrally programmed skills. This alludes to the fact that these skills do not have to be taught. The human body is programmed to achieve these milestones with or without appropriate environmental conditions.
Language is however, an acquired skill,it is contingent upon afferent as well as efferent functions. Afferent pertains to incoming input or receptive language, also called as the understanding of verbal cues. Efferent refers to the ability to plan thoughts (ideation), execute planned thought and motor plan its verbalization. 
Hence deficiencies in any of the above components will be observed in its earliest form as delayed motor skills, atypical motor skills, language and speech delays and resultant social emotional challenges from being unable to communicate and/or execute motor movements in order to fulfill basic needs for children.
A child with disturbances with processing movement and body position will be seen as atypical motor function, difficulties with balance and motor planning.

This concept forms the building blocks of understanding the complex process of sensory integration. This has now been measured through a breakthrough study at UCSF. Link

Shilpa Sharma OTR/L.

Trigger Finger/ Locking finger

Posted on February 21, 2012 at 6:13 PM Comments comments (2397)
We always get patients in the clinic who c/o finger getting stuck in bent position and when patient pushes hard it snaps into extension as if trigger is released.  In worst cases finger gets stuck in bent position and patient has to use the other hand to extend the finger back. 
Often times it starts without pain and slowly gets very painful. Especially, when patients think that this is due to weakness in hand and they either buy some kind of gadget to improve grip strength which often backfires heavy gripping worsens the symptoms. 
Mostly these patients respond very well to steroid injections at the A-1 pulley region. In long standing cases where finger develops tightness in flexion, patients might benefit from Trigger finger release. 
Hand therapy helps in regaining range of motion in the affected finger or thumb after surgery. Splinting/ heat/ massage/ultrasound therapy/ tendon gliding exs/  activity modification could also help in resolving symptoms without surgery in mild cases. 

Carpal Tunnel Syndrome

Posted on January 15, 2012 at 1:51 PM Comments comments (2707)
Carpal tunnel syndrome is caused by pressure on the median nerve, it is the nerve in the wrist that supplies feeling and movement to parts of the hand especially thumb, index , middle and partial ring finger. 
It usually characterized by numbness, tingling, weakness, or muscle damage (long term) in the hand and fingers.
Common Causes:
1. Associated with repetitive work causing compression on the wrist i.e sewing, assembly line, vibratory tools, certain medical instruments etc.
2. certain metabolic disorders or conditions;
 Diabetes, pregnancy, Acromegaly, rheumatoid arthritis, menopause etc.
3. Direct trauma:
fractures of wrist and hand. 
  • Numbness or Tingling in the thumb and next two or three fingers of one or both hands
  • Numbness or tingling of the palm of the hand
  • Pain extending to the elbow
  • Pain in wrist or hand in one or both hands
  • Problems with fine finger movements (coordination) in one or both hands
  • Wasting away of the muscle under the thumb (in advanced or long-term cases)
  • Weak grip or difficulty carrying bags (a common complaint)
Tests/ diagnostics: 
Certain manual tests are performed by the doctor/ hand therapist to reproduce the symptoms confirming the diagnosis. EMG could be ordered by the physician in order to confirm the diagnoses and extent of nerve damage. 
In early onset cases changing the work environment , using adaptive devices and equipment , use of brace at night to support wrist could help resolve the symptoms.
Medication: Steroid injection, oral steroids, NSAID's to reduce pain and swelling could be tried and helpful in conjunction with hand therapy by a Certified hand therapist, who would perform detailed evaluation of symptoms and design the best treatment plan. 
In long term cases, surgery would be the best option and nerve structure starts to change with long term compression and may result in permanent damage. 
If left untreated, the nerve can be damaged, causing permanent weakness, numbness, and tingling. 
Surgery could be performed by a Plastic surgeon, Hand surgeon, Orthopedic surgeon or Neuro-surgeon.  
Call us at 708-687-8768 or fill out form here to get free evaluation or consultation. 

Elbow pain.. is it tennis elbow or golfers elbow

Posted on April 28, 2011 at 3:01 PM Comments comments (2510)
Often times people develop pain in elbow which usually gets worse in certain positions or activites like golfing, heavy gripping, hammering, turning knobs, using manual tools etc.
Elbow pain can be very disabiling; affecting work, leisure activity like golfing, sometimes even making it difficult to hold coffee cup.
These problems could develop from either the acute episode like weekend gardening , lifting , after common house projects requirning drilling etc, or could be the result of sports activities or cumulative trauma at work which causes slow tearing of tendons over the period of time.
Tendons on the back side of hand originate from the outer part of elbow and their origin at outer part of elbow is usually the culprit in "tennis elbow " or "lateral epicondylosis"
Tendons on the front of forearm or palm side of hand originate from the inside of elbow and usually the culprit in "Golfers elbow" or "Medial epicondylosis"
Common treatments include rest, icing and using the common counterforce back available over the counter.
If these problems linger on for a while one must seek the medical attention especially people who work in field like construction, sportsman or any other foeld requiring repetitive movment as it results in continuous wearing and tearing of structure.
Cortisine injections, PRP(plasma rich) injections or saline injections in the inflammed site are the common treatments to resolve symptoms with rehab. of injured structures.
Certain cases there might be surgery requires to clean the area with reaatching the tendons and in those cases long term rehab is required.
Key role of a therapist
1. Establishing a good history of problem to identify correct cause of pain. All patient are different and therapist should understand their need , occupation and goals during evaluation.
2. Detailed physical evaluation to understand symptoms
3. Establishing a treatment plan to help lead better life without apin and discomfort
Therapy is focused upon reducing inflammation at elbow region and improving function.
Therapist utilizes different modalities i.e ulrasound therapy, moist heat, TENS etc along with manual therapy i.e stretching, soft tissue mobilizations, specialized mobilization techniques etc. Therapist is also responsible for proper use of brace, band, taping etc.
Strengtheing in these cases should be done carefully as sometimes it can worsen symptoms and pathlogy.

Wrist Pain

Posted on January 13, 2011 at 11:36 AM Comments comments (2736)
Wrist pain can be very painful limiting factor in persons daily life. Wrist pain can affect lifting, carrying, pushing pulling, even weight bearing on affected wrist.
Wrist is very complicated joint with 15 bones, numerous ligaments and numerous tendons crossing around that region. Due to complexity in the anatomy of wrist it is very easy to overlook certain pathologies. 
There are many causes for wrist pain which may rage from simple sprain/strain ,tendonitis, arthritis to serious one like ligament tears, persistent cysts etc.
Any pain lasting for more than 3-5 days shuld be checked out by a experienced doctor and therapist to make proper diagnosis.   
wrist pain in pregancy and lactating mothers
Wrist pain can develop in pregancy along with c/o numbness and tingling in hands especially at night. This happens due to hormonal changes and retention of fluids causing compression in tunnel around wrist and is usually resolved after preganancy.
We have treated expecting mothers with conservative treatment once symptoms become unbearable or very painful to the point where sleep and daily function is affected. We use customized splinting, special exs and activites to minimize discomfort and pain making the pregnany more plesant and less stressful on body.
On the other hand mothers who are breast-feeding have to hold the baby in certain position using their wrist and forearm. Sooner or later in some cases mothers develop inflammation of tendons of wrist, thumb and or elbow causing severe pain and discomofrt while feeding the baby.
We treat these mothers for pain relief, reducing tenderness, modification and adaptation in position of baby while feeling, home exercises etc.
Wrist Pain...and How To Make It Stop!
In an age dominated by computers, wrist pain is an increasingly common complaint. There can be many sources of wrist pain, ranging from sudden onset (a fracture after a fall or trauma) to repetitive stress leading to arthritis or carpal tunnel syndrome.
If your pain has been going on for a long time, diagnosing the exact cause is something your physical therapist can help you with.  The RIGHT diagnosis can help you get the proper treatment.
So What Are Your Symptoms?
Symptoms can differ, depending on the cause. For example, osteoarthritis pain is usually described as "dull pain", almost like a toothache. Tendinitis may be a “sharp or stabbing” pain. If you have any tingling, or “pins-and-needles” type of sensation, it may be related to nerve pain, which is often present with carpal tunnel syndrome. The exact location and type of wrist pain will help your doctor and physical therapist reach a conclusive diagnosis. This will allow them to design a treatment plan to help you on the road to recovery. 
Two of the most common ways to injure your wrist are:
  • Sudden impacts. Falls are the most common cause of injury, especially falling with your hand stretched out straight. This can cause sprains, strains and even fractures.
  • Repetitive stress. Any activity that requires repetitive wrist motion – hitting a tennis ball, golfing, bowling, typing, or repetitive carrying of objects – can irritate the soft tissue in the wrist.
The FIRST Thing To Do...
  • If this is the first time your wrist is hurting, you may want to try applying ice for 15-20 minutes and taking some over-the-counter pain medicine (follow the instructions carefully). If the pain is severe, an over-the-counter wrist brace to reduce stress on the injured area is also a good idea.
  • If this is a re-injury, treat it with 15-20 minutes of ice and avoid any painful activities or exercises. If you had physical therapy in the past for the same condition, call your physical therapist to seek advice on which therapeutic exercises should be resumed (or avoided).

Why is my thumb hurting?

Posted on December 2, 2010 at 4:11 PM Comments comments (2900)
Thumb pain can be very disabling especially in the dominat hand as one can't hold things like pen, pencil, coffee cup etc making life miserable. There could be jus the pain in thumb region or it can also be associated with numbness and tingling sensation which indicates towards nerve involvment.
Causes of thumb pain:
There could be many causes of thumb pain but the most common are as follows
1. Pain at the base of thumb with or without grinding sensation is due to arthritis at the joint which is at the base of thumb. It is a very common condition and it could be very disabling and in some cases patients do need to get the surgery to relieve symptoms.
2. Pain on the back of thumb especially with movment is caused by the swelling/ inflammation of tendons crossing the wrist and can be very disabling and somehow is more prominant in women with 3:1 ratio.
3. often thumb pain is also associated with numbness and tingling in thumb and adjacent fingers which could be due to compression of median nerve at wrist resulting in carpal tunnel syndrome. This condition is very common with in pregnancy as hormonal changes and fluid retention causes pressure in the wrist compressing the nerve resulting in pain.
4. There can be clicking in the thumb associated with feeling of thumb getting stuck ( trigger thumb). Early onset can be treated with splinting and physical modalities along with cortisone injection. In some cases patient might have to go for trigger thumb release.
Most of these conditions needs to be evaluated by a skilled therapist who can differentiate b/w kind of pains, evaluate the structures involved and design a proper treatment plan which could prevent the need for surgery.
Feel free to ask me any questions through email or phone.


Posted on November 14, 2010 at 11:02 PM Comments comments (3657)
¨Many of us have poor posture.
¨This can result in neck pain.                  
¨Pain originating from the neck can, in some cases, cause one of two problems:
-Pain can travel down the nerves of the neck into the arms.
-Pain can travel upwards causing headaches.
There are several causes of headaches, but tension in the neck muscles is a common factor.
¨Most computer users round their shoulders and hold their head too far forward.
¨This results in aches and pains following long browsing / work sessions.
¨Spending too much time in one position, particularly the 'rounded, hunched forward' position can leave you fatigued, achy and rubbing your temples at
the end of the day.
What our specialized therapist can do?
Exercise therapy is a proven solution for headaches that stem from the neck. 
After an evaluation, we prescribe stretches and exercises to get you back to full functional levels. In some cases, medication may be necessary to help manage
the pain. In most cases of neck pain and associated headaches, therapy can help reduce your pain.There is a potential to decrease or eliminate the need for pain medication.
Pain relieving modalities, soft tissue moblization, heat & cold therapy, special exercises of neck and surrounding region all prescribed by a specialist dealing with these problem could resulve your problem in a short time.
Home Remedies:
If you are experiencing neck pain and headaches due to bad posture habits, try these simple tips:
nIf you hold the phone under one ear for too long or carry a heavy bag on one shoulder for a long time, TAKE BREAKS to eliminate the pain and switch sides at regular intervals of 10-15 minutes.
If you sit at a computer for a long time, get up and walk around frequently or, at least, change your head position. Keep your head and neck upright as much as possible by conducting regular, postural 'self checks'.
If you have been injured in an accident or are suffering from an injury, avoid hurting yourself further.
Call us today at 7086878768 , if you have any questions or comments.

The (In) Flexible and painful shoulder

Posted on November 12, 2010 at 3:12 PM Comments comments (2737)
The shoulder is one of the most flexible joints in the human body. We can move our shoulders in directions like no other joint. Owing to its flexibility, we can do things like paint a ceiling or pitch a baseball.
This flexibility comes at the price of stability. Since the shoulder is held together by ligaments and muscles, and has a lot of mobility, it is one of the most unstable joints in the body.
What’s your risk?
If you have a job or play a sport that requires a lot of shoulder mobility and flexibility, you may be at risk for shoulder injuries.
The following individuals, for example, are highly susceptible:
  • Overhead athletes, like tennis players, swimmers, baseball pitchers
  • Painters
  • Construction workers
  • Movers
Common Injuries Of The Shoulder
Common symptoms include:
  • Pain when raising the arm
  • Pain that persists beyond a few days
  • Swelling or bruising around the arm
  • Pain when leaning on, or sleeping on the affected shoulder
  • Weakness in the arm that stops you from lifting a grocery bag, reaching up, or pushing open a heavy door
  • Having difficulty or being unable to carry your child
  • Inability to use the arm
Overuse and trauma are the most common reasons the shoulder is prone to injury. The muscles that support the shoulder - the rotator cuff muscles - can suffer from wear and tear trauma. In some cases, where there is no known cause for shoulder pain. Years of poor posture or improper movement patterns can play a role.
Repetitive activities lead to repetitive stress injuries. Also, too much wear and tear of the shoulder muscles and the joint capsule, or even UNDERUSE of the arm itself, can lead to frozen shoulder.
If you suffer from any of the symptoms mentioned above, call our office today. Relief is just a phone call away! 708-687-8768
Call your shoulder rehab. specialist today:
Stress on your shoulder is one of the most common causes of shoulder injury, but one of the most overlooked reasons for shoulder injury is inactivity. When you don’t use the muscles regularly, they become weaker. The phrase “If you don’t use it, you lose it” is applicable to muscles.
If you don’t exercise the full range of your shoulder through moderate-intensity exercise, the risk of hurting your shoulder increases. Ligaments tighten, muscles weaken, and blood flow becomes inhibited. Over time, this can accelerate joint degeneration and trigger shoulder pain.
We have the solution.
  1. Regular exercise (power walking with good arm movement, swimming, golf, tennis) may minimize the onset and severity of shoulder pain.
  2. Proper body mechanics – this can be counter-intuitive. Ask your therapist if your body mechanics need to be corrected.
  3. Strength and Flexibility – balanced muscles of the shoulder, chest, upper back, and abdominals help keep your shoulder joints well-aligned and pain free.
Remember, common sense is the best line of defense against hurting your shoulder. It is important to not push yourself too much, especially if there is discomfort. Don’t do too much activity too soon. If you experience ANY pain in your shoulder with any activity, stop!  If it is MILD, use ice for 10-15 minutes and rest your shoulder. If pain persists for more than 1-2 days, call your doctor or physical therapist. Don’t ignore the pain.
The quicker the problem is addressed, the sooner you can begin healing and returning to your favorite activities.
We are here to serve you and help you achieve a speedy recovery as quickly as possible. We’ll give you a shoulder to lean on, so you have a healthy, pain-free shoulder.
Arun Sharma
hand and upper extremity rehab. specialist