Do you suffer from gluteal amnesia?
Do you suffer from gluteal amnesia? This “Amnesia” could be the reason for your back, hip, knee or foot pain.
Supplements for Joint Health
Let’s talk about 4 different supplements that help repair joint tissue and aid in the relief of joint inflammation.
These are the supplements that Chris takes every morning especially since getting the news (as many of you may have heard) that he has moderate arthritic changes in both of his hips. Life catching up to the old guy…ha! Chris has researched and trusts the sources for these supplements.
What NOT To Do After a Total Hip Replacement!
Here is a video of the Top 3 mistakes not to make after a total hip replacement from 2 orthopedic surgeons:
Got some toe pain? Try this!
Many of you may have seen or tried YogaToes before.
But, what about the Foot Alignment Sock?
Having hip pain? Have you tried hip traction before?
It REALLY helps!
If you have or if this is new to you follow along with our video to learn how to do hip traction at home!
Do You Really Need To Stretch Your Hamstrings?
Fall has arrived. Amazing colors once again. Should you stretch your hamstrings before hiking thru the fall colors? Read on to see if you should…or if you shouldn’t….
I want to share with you what my staff and I have learned to maximize your health and wellness and to keep you up-to-date on the happenings at OrthoWell. So read on and let’s keep you on track.
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Do you really need to stretch your hamstrings??
So what if I told you that there is actually very little research that substantiates any long lasting effects of stretching? What if I also told you that you may not even have to stretch your hamstrings to get a release of the stiffness? Would that make you stop stretching or does stretching actually make you FEEL good?
I have been practicing PT for 26 years and I can honestly say that my patients have had some pretty amazing results with the soft tissue work that we do in combination with stretching exercises. Just look at our Success Story page. If you are reading this right now, you may actually be one on them. There are some things that get our patients better that may not have a lot of research-substantiated evidence.
In a 2010 article by Wepppler and Magnusson, they point out that there is only a transient mechanical increase in length of tissue after stretching. In other words, the muscle stretch recoils after the stretch is removed. How long the stretch lasts depends on the magnitude and the duration of the stretch. So then, how hard should you stretch and why do we only hold our stretches for 30-60 seconds?
We have used the evidence gathered from the study of tissue deformation or biorheology to determine that the optimum amount of time to acquire the most dramatic “viscoelastic” elongation of tissue is between 30-60 seconds. Yes, there is a much more gradual elongation after that time but who has the time to wait…right? There was a study in 2004 by Guissard and Duchateau that showed partial maintenance of tissue elaongaton 30 days after the program when patents were performing 20 minutes of stretching 5 days per week. So yes, you reap what you sow when it comes to the time spent stretching.
The Sensory Theory of stretching means that we achieve an increase in length while stretching due to a “stretch analgesia” effect in which “it doesn’t hurt as much” so you FEEL as though you can stretch further into the range. So what is wrong with that? If you stand all day and your hamstrings are working overtime to keep you upright and stable, what happens to the tissue? It becomes “stiffer”. This may be due to scar tissue, waste products, and trigger points that form due to this constant state of contraction. Intuitively, it makes sense to perform massage and stretching to counteract these effects. However, is this the cure for the stiffness? Gary Cook, a world renowned PT, who has revolutionized the way that we that we think of functional training would say unequivocally NO!
Gary Cook claims that the “stiffness” we feel is reflexive. It is due to the stabilizing effect that our muscles need to perform on a daily basis in order to control faulty movement patterns and faulty postures. Some parts of our bodies are stabile and other parts are very mobile. For example, your lumbar spine tends to be mobile or “sloppy” as Gray Cook would say. Many people are unaware of how to engage their core or how to perform proper body mechanics to prevent stress to the lumbar spine. Our hamstrings can be the first line of defense when it comes to stabilizing the spine.
If you are unaware of how you stand, you could be placing your pelvis in an anteriorly rotated position. When your pelvis rotates forward, it places a “pinch’ or a stress on your lumbar spine. Your hamstrings will consequently contract in order to correct your alignment and “pull” your pelvis posteriorly. What happens when you squat or roll out of bed? If you are not engaging the proper core and hip muscles then your hamstrings continue to fire in order to stabilize your spine. There you have it. The viscous cycle for constant hamstring stiffness.
So how do you become more stabile? First of all, you need to become reacquainted with your core. Just doing planks may not be enough. You need to be evaluated to determine any faulty movement patterns. If you don’t correct the faulty patterns, then you are reinforcing bad habits and putting yourself at risk for injury. Gray Cook has developed Functional Movement Screens to determine exactly where your deficiencies are. In addition to this, we have put together a version of the Selective Functional Movement Screen in our clinic. Based on the results of our screen, there are many types of corrective exercises that can be instructed to get you back on track.
In conclusion, you need to realize that “stiffness” anywhere in your body could be multifaceted.- especially with your hamstrings. Does this mean that you should never stretch or massage your hamstrings? NO. Stretching can certainly make you FEEL better but you need to realize that stretching alone may not be the cure. In the words of Gray Cook
“If the body doesn’t stabilize correctly, it will figure out another way to get stability: it’s called stiffness.”
So what you THINK is causing your stiffness may NOT be the reason. We all need to think outside the box. You are guaranteed that when you come to see us at OrthoWell PT
All the Best!
Chris
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Drinking the Cross Fit Kool-Aid!
Harry feels better now than ever before…
I enjoy CrossFit because it consistently gives me a good workout. The workout ideology of CrossFit prides itself on never falling into a routine. This means every workout is something new that will not only work you out in a new way, but also help you to identify some new skill that you could improve upon. When working out with good form and responsible weight/volume, the benefits of Crossfit also translate to your functional daily activities. After a year of Crossfit I can truly say I have witnessed these benefits during my day to day activities.
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MOUNTAIN RUNNING CHAMPION..
Matt Veiga
As many of you have heard in the clinic I do a lot of mountain racing. This past weekend I had the luck to have a repeat win at one of the hardest races in the circuit. Check out my interview on levelrenner.com to get a little glimpse into the head of the Female winner Leslie and myself about how the race went down and up in this case.
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Prevent Your Pain from EVER coming back
Click the link to read about
this new option at OrthoWell
Our wellness maintenance program is for those of you who want consistency of care after being discharged from physical therapy in order to prevent any reccurence of pain. We have three different plans the we offer that you can read about by clicking the link above.
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SUCCESS STARTS HERE!
5/31/16
“I would like to thank Chris, Katie and crew for the outstanding care I received after my Achilles surgery. Their knowledge, experience and attention to detail allowed me to expedite my recovery. Thank you.”
– Marc S.
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FREE INJURY SCREENING
Dont forget to take advantage of our Try Before You Buy program.
We offer a FREE, no obligation injury screening for YOU, a FAMILY MEMER or a FRIEND. Just click the link below or send it to someone who may need our help.
Plantar Fasciitis & Foot Orthotics
Yes. We treat a lot of plantar fasciitis. There is a lot of foot pain out there. While performing a literature review of heel pain in 2005 (follow this link to READ MORE), I made reference to several articles about the prevalence of heel pain. One United States study estimated that one million patient visits each year are for the diagnosis and treatment of plantar heel pain. This disorder appears in the sedentary and geriatric population, it makes up one quarter of all foot injuries in runners, and is the reason for 8% of all injuries to people participating in sports. As many of you know, all that we do regarding foot orthotic fabrication and physical therapy is with good, evidence-based reason. I fabricate custom foot orthotics based on sound biomechanical principles and evidence-based research. Patients are always asking me “so how will foot orthotics help my plantar fasciitis?” Here is the answer! I have included both a clinical description as well as a more basic description in the video. This will allow you to refer your doctor and/or PT as well as a relative who may ask WHY or HOW we made your foot orthotics. I have included references for several articles that have had a profound influence on my treatment and fabrication philosophy regarding plantar fasciitis. I would like to share my insights with you.
It has been my experience that positive results can be achieved much more quickly for cases of plantar fasciitis using the combination of softer materials to cushion the foot in combination with stiffer, denser materials to redistribute pressures on the foot. My direct molding techniques produce a total contact orthotic which reduces weight bearing pressure on both the heel and forefoot. These findings for total contact orthoses have been confirmed by both Mueller et al10,11 and Ki et al12. As you can see from my samples on the video, I utilize softer materials as a top layer with the addition of a heel pad on the bottom. I reinforce the arch in order to redistribute pressures up against the talonavicular joint (or midfoot). I utilize a forefoot valgus post (higher on the outside of the forefoot) with a slight reverse Morton extension (ledge under toes 2-5) in order to plantar flex the first ray (big toe lower than the other four toes) and unload both the fascia and 1st MTP joint (big toe joint) As I tell my patients, the foot orthotic is only as good as the shoe you put around it. Our best results with the over-pronating foot are achieved via the combination of motion control shoes and custom orthoses.
In regards to prefabricated orthotics such as ALine, it is one-shape-fits-all and only utilizes rearfoot posting “to help align the leg from foot to hip” per the website. The concept of rearfoot posting for biomechanical control is a much debated topic in the literature. Forefoot modifications are not an option. It is also a very rigid material against a painful heel. It has been my experience that prefabs such as ALine or Powerstep are a good option for the younger, athletic patient.
Don’t forget, our custom foot orthotics range in price from $120 to $165. I direct mold, fabricate, educate and issue in one hour! All adjustments included. Our WalkWell guarantee since 1997!!
Research findings continued……
Research done by Kogler1,2,3 et al has been instrumental in determining the appropriate type of rearfoot and/or forefoot posting for foot orthotics for plantar fasciitis. Kogler showed that rearfoot posting had little effect on plantar fascia strain, forefoot varus posting increased the stress, and forefoot valgus posting actually decreased the strain. Kogler concluded that foot orthotics which raised the talonavicular joint and prevented dorsiflexion of the first ray were most effective in reducing the strain on the central band of the plantar fascia. I recently made orthotics for a patient who said her doctor issued bilateral heel lifts “to take the stress off of the fascia”. Kogler actually showed no change in plantar fascia strain using heel lifts. However, heel lifts have been shown by Trepman et al4 in 2000 to decrease the compressive forces in the tarsal tunnel. Benno Nigg5, a researcher in Canada, has also published over 200 articles on biomechanics. He has stated that based on his results, custom foot orthotics, on average, control only 2-3 degrees of motion. This would be his kinematic results, however, he has done a lot of enlightening research on the kinetic effects of foot orthotics. A little bedtime reading for you!
Paul Scherer6,7,DPM has published several articles on the effects of custom orthotics on the 1st MTP joint. The concept of maintaining the first ray in a plantar flexed position unloads both the 1st MTP joint as well as the plantar fascia. Howard Dananberg8,DPM has also written several articles on this topic. Doug Richie9,DPM has been a great resource for the evidence behind the treatment of plantar fasciitis as well as posterior tibialis dysfunction. You may have heard of the Richie brace. Dr Richie states that the “most effective foot orthotic for plantar fasciitis is one that hugs against the navicular and flares away from (or plantar flexes) the first ray.”
1.Kogler, G. F.; Solomonidis, S. E.; and Paul, J. P.: Biomechanics of longitudinal arch support mechanisms in foot orthoses and their effect on plantar aponeurosis strain. Clin. Biomech., 11: 243-252, 1996.
2.Kogler GF, Veer FB, Solomonidis SE, et al. The influence of medial and lateral placement of wedges on loading the plantar aponeurosis, An in vitro study. J Bone and Joint Surg Am. 81:1403-1413, 1999
3.Kogler GF, Veer FB, Verhulst SJ, Solomonidis SE, Paul JP.
The effect of heel elevation on strain within the plantar aponeurosis: in vitro study.
Foot Ankle Int. 2001 May;22(5):433-9.
4.Trepman E, Kadel NJ: Effect of foot and ankle position on tarsal tunnel compartment pressure. Foot Ankle Int 20(11):721, 2000
5.Nigg, B. Biomechanics of Sport Shoes. 2011
6.Scherer PR, Sanders J, Eldredge, DE, et al. Effect of functional foot orthoses on first metatarsophalangeal joint dorsiflexion in stance and gait. J Am Podiatr Med Assoc 2006;96(6):474-481.
7.Scherer,P. Recent Advances in Orthotic Therapy. 2011
8.Dananberg HJ. Functional hallux limitus and its relationship to gait efficiency. J Am Podiatr Med Assoc. 1986; 76(11):648-52
9.Richie,D. Offloading the plantar fascia: What you should know. Podiatry Today, Vol 18. Issue 11, Nov 2005.
10.Mueller MJ, Hastings M, Commean PK, et al. Forefoot structural predictors of plantar pressures during walking in people with diabetes and peripheral neuropathy. J Biomech 2003;36(7):1009-1017.
11.Mueller MJ, Lott DJ, Hastings MK, et al. Efficacy and mechanism of orthotic devices to unload metatarsal heads in people with diabetes and a history of plantar ulcers. Phys Ther 2006;86(6):833-842.
12.Ki SW, Leung AK, Li AN. Comparison of plantar pressure distribution patterns between foot orthoses provided by the CAD-CAM and foam impression methods. Prosthet Orthot Int 2008;32(3):356-362.
SI Joint Pain & Dysfunction. Do U Have It?
The sacroiliac or SI joint is the articulation between the bone at the base of the spine called the sacrum and the bones on both sides of the pelvis called the ilium. Refer to the picture below.
Over 22 years of physical therapy, I have treated many patients with low back and buttock pain who were diagnosed with an SI joint dysfunction. The difficulty with diagnosing an SI joint dysfunction is that the SI joint has no specific distribution pattern of pain. Pain directly over the SI joint does not necessarily mean that the joint itself is involved. SI joint pain can very often be referred pain from other structures such as the disc, nerve root, or facet joints of the lumbar spine. Many physical therapists or physicians attempt to diagnose an SI joint dysfunction through palpation of bony landmarks as well as assessment of SI joint mobility. There is only a very small amount of motion in the SI joint i.e. 2-3 mm or 2-3° of gliding or rotation thereby making an accurate diagnosis very difficult. In addition, evidence based research refutes the reliability and validity of accurately assessing bony landmarks and SI joint mobility. McGrath et al has published an article, entitled “Palpation of the sacroiliac joint: an anatomical and sensory challenge” in which the concept of SI joint palpation is scrutinized. Freburger and Riddle performed a literature review looking at our ability to perform SI joint motion testing. They found poor inter-tester reliability, low sensitivity, and low specificity in several commonly performed tests. Inter-rater reliability is essentially the ability for multiple practitioners to come to the same diagnostic conclusion. If you have multiple individuals perform the same test, the results should be the same. Riddle and Freburger in another study noted that the ability to detect positional faults of the SI joint also has poor reliability. At present, the only acceptable method of confirming or excluding a diagnosis of a symptomatic SI joint is a fluoroscope guided intra-articular anesthetic block ie an injection directly into the SI joint. (Laslett et al) So how can I, as your physical therapist, assist in the diagnosis of an SI joint dysfunction? The answer: SI joint provocation tests!
Two recent studies by Laslett et al and Van der Wurff et al have demonstrated that there isn’t just one key or ideal SI joint provocation test. However, by performing several tests together, you can increase your sensitivity and specificity of detecting an SI joint dysfunction. Both studies reported that the accuracy of detecting SI joint dysfunction is increased if least 3 of the 5 tests are positive. Furthermore, if all 5 tests are negative, you can likely look at structures other that the SI joint. Van der Wurff et al reported that if at least 3/5 of these tests were positive, there was 85% sensitivity and 79% specificity for detecting the SI joint as the source of pain. Interestingly, another study by Kokmeyer et al agreed with the previous findings, but also noted that the thigh trust test alone was almost as good at detecting SI joint dysfunction as the entire series performed together.
Combining the two studies, there are 5 provocation tests to perform when attempting to diagnose SI joint pain:
- Thigh thrust/Femoral Shear test
- SI Distraction Test
- SI Compression Test
- Gaenslen’s Test
- FABER / Patrick’s test
The following video will demonstrate these tests. I would like to thank Mike Reinold, PT for his blog information that was used to complete this explanation of SI Joint dysfunction. Check out the video below!!
CORRECTION: I would like to clarify the SI distraction test as described in Laslett. I believe that he considers the direct posterior shear of the innominates as a distractive force of the ilium away from the sacrum. I initially interpreted this test as a compression of the SI joint via a distraction of the ASIS’s. I guess it depends on HOW you apply the force to the ASIS’s. Also, the sidelying “compression” test needs to be performed in a straight, linear fashion as well in order to compress the SI joint. It is important to place a towel roll under the lumbar spine in women in order to prevent sidebending stress t the lumbar spine. In OMT, we use the sidelying position to “distract” the SI joint using more of a rotational force on the lateral edge of the ilium in order to “open up” and distract the SI to get a feel for joint play. As you can see, these tests are not definitive for exactly HOW they stress the joint but they are specific for a stressing maneuver TO the SI joint.
Nerve Mobilization Techniques
I would like to highlight one of the unique treatment techniques that we offer at OrthoWell. As many of you know, we spend a lot of quality time during our biomechanical evaluation trying to “figure things out”. This is the reason that several of our referring physicians call us “THINKERS”. We pride ourselves in determining your functional diagnosis. This diagnosis is what we use to develop your plan of care and to educate you in how to alleviate your pain or dysfunction. Many of our patients have seen several physicians or therapists before hearing about us. For this reason, we offer specialized evaluation and treatment services that our patients may not have heard of and that may be appropriate to alleviate symptoms that have been unresponsive to prior interventions. One of these is Nerve Mobilization or NeuroMobilization. So what is it?
What is NeuroMobilization?
NeuroMobilization or Nerve Mobilization is a technique that we utilize to treat nerves that may be adhered, irritated, or compressed. Many patients that have been unresponsive to other physical therapy and present with a chronic history of referred symptoms like pain, numbness, or tingling into the arms or legs may respond to NeuroMobilization. Every patient that presents with referred symptoms or pain that has been unresponsive to localized treatment receives a complete neural tension evaluation. Neural tension testing is a way for your therapist to determine the extent of nerve involvement. By mobilizing a nerve, we can determine, in combination with manual traction and sensitizing maneuvers, whether your pain is originating from the spine or the periphery.
NeuroMobilization Techniques
We can then perform NeuroMobilization techniques utilizing controlled neural tension maneuvers to mobilize the nerve up and down. David Butler,PT, has been at the forefront of these techniques for over 20 years. Although we still do not completely understand the exact mechanism, he proposes that NeuroMobilization (what David Butler calls Neurodynamics) can accelerate nerve healing and quiet down what he calls an “altered impulse generating system (AIGs)”. These AIGs may respond to the oscillations of NeuroMobilization by enhancing circulatory exchange or ion transfer in and around the nerve. You can read more about the techniques and science in David Butler’s book The Sensitive Nervous System.
Here is a video that highlights a sciatic nerve tension test and Neuromobilization.