pain Archives - Page 2 of 3 - Orthowell Physical Therapy

By admin Clinicians, Other, Pain Management, Pain Management, Patients, Special Techniques, Special Techniques, Uncategorized

Proper Breathing – The Cure for Pain & Stress?

What do you think of when you visualize someone who is really stressed out? It sure seems like some people are wound tightly these days. I have had my own issues with stress. I’m sure you have too. I find myself talking more and more with my patients about the effects of stress and how beneficial diaphragmatic breathing and proper nutrition can be. We will discuss nutrition in an upcoming post. You also need to be aware of other possible manifestations of stress like increased muscle tone, rapid heart rate, palpitations, increased blood pressure, GI distress, mood swings, loss of appetite, and sleep disturbances to name just a few. These symptoms make living a happy, relaxed and “normal” life much more difficult.

So what about the relationship between stress and breathing? Breathing occurs at a very primal level. If you don’t breathe, you don’t live! Your body will do whatever it takes to draw air into the lungs. Instead of using the diaphragm, it may recruit other accessory muscles in your neck or low back. This pattern reinforces poor posture and causes impaired flexibility which can promote shallow, ineffective breathing. It prevents the ability to exhale fully and to perform a proper, full diaphragmatic breath. Lets review what that means.

First of all, when performing a diaphragmatic breath, your belly should expand outward. This is due to the downward movement of your diaphragm as you inhale. Secondly, your lower ribcage should expand. Thirdly, your upper ribcage will expand during a maximal inhalation. Your ribcage should expand as a unit. It should NOT elevate. Movement of your ribcage upward, shoulder shrugging, or contraction of your neck muscles are all signs of faulty breathing patterns. Remember that slouched sitting and forward head posture encourages shallow breathing and prevents full, complete expansion of your ribcage. We discussed breathing pattern disorders in relation to CORE activation during my last post and video demonstration. Here it is in case you missed it:

So what does the research say about the link between pain and breathing disorders? A very interesting phenomenon is the prevalence of pain syndromes that are NOT caused by a specific organic illness. Katon & Walker (1998) noted that patients with the most common physical symptoms (i.e. abdominal pain, chest pain, headache, back pain), are responsible for half of all primary care visits in the USA, and yet only 10%–15% of these are found to be caused by organic illness! All these symptoms are well recognized as capable of being the result of breathing pattern disorders.

Perri and Holford (2004) evaluated 111 patients attending a chiropractic pain clinic and found 56.4% demonstrated faulty breathing on relaxed inhalation, increasing to 75% when taking a deep breath. 87% reported a history of various musculoskeletal pain problems. Based on this population, they observe that: “Chances are 3 in 4 that new patients seen today will have faulty breathing patterns.”

So what does the research say about the effects of breathing exercises on stress? Remember, stress reactions are controlled by our autonomic nervous system i.e. sympathetic and parasympathetic. Fight or flight? In Pal and colleagues, breathing exercises were shown to enhance the parasympathetic (inhibitory or calming) effects and decrease the sympathetic (excitatory) effects of muscles and nerves. They improve respiratory and cardiovascular function and improve both physical and mental health. Convinced yet?

So how do you begin breathing exercises?The first step is understanding that the relaxation response has to be relearned. You need to learn how to identify and turn off the stress response. As stated by Kabat-Zinn, “you need to learn how to replace negative thoughts and physical tension with regular practice of ‘calm stillness of mind and body’ “. Buddha is in the house! The next step is to schedule regular daily practice. You need to invest 10-15 minutes at least one time every day. According to Leon Chaitow, we need to “restore an energy-efficient, low chest, nose-breathing pattern with a relaxed pause at the end of exhalation”. He calls it “low slow nose breathing”. Initially, lay comfortably supported by pillows in a quiet room. Progress to sitting once a positive outcome is achieved in lying. You need to reinforce proper posture at home, work, and car and realize that breathing and relaxation techniques only help eliminate the symptoms, not the causes of stress. Be honest about making realistic lifestyle changes. The video below demonstrates a method that uses both breathing and physical relaxation techniques.

Remember that breathing drives everything that happens, both good and bad, throughout our entire bodies. So breathe right to live right!!

By admin 0 Comments All, Clinicians, Pain Management, Pain Management, Patients, Special Techniques, Special Techniques

EXPLAIN PAIN!! THE WHY & HOW.

First of all, I would like to apologize to everyone who is reading this article. I apologize for the fact that you have pain, whether chronic or acute, that may be as a result of unfortunate circumstances or the result of an inadequate health care system. Pain is very misunderstood even in the medical community. Chronic pain sufferers can be stigmatized because of this lack of understanding. Currently, one in four Americans have chronic pain. That’s 75 million people! I want to reassure you that there is an answer. There is a physiological reason WHY you have pain. I want to convince you that the pain you feel may not be coming from where you think and feel it is. You WILL get better. Let me explain your pain!

Anatomically, we are essentially all the same. Each of us has approximately 206 bones, 640 muscles, and 400 nerves in our bodies. Our spine consists of 24 vertebra which are attached via ligaments and muscles to our head at the top and to our sacrum and pelvis at the bottom. Each vertebra is separated from the next via our discs. At each vertebral level, there is a spinal nerve that exits a small hole called a foramen. This nerve is the connection between your spinal cord and the rest of your body. Each spinal nerve sends branches to specific locations in your body. They connect the muscles adjacent to your spine to the small nerves at the ends of your fingers and toes. Think about your spine as the tree and the nerves as all of the branches.

Your nerves respond to any and all types of stimulation such as touch, temperature, pressure, pain and relay a message thru the spinal nerve to your spinal cord and then up to your brain. Impulses and/or commands from your brain are then transmitted back down the spinal cord to the spinal nerve and out to the targeted area. This communication system is active ALL the time. Our brain determines whether we are consciously aware of it or not. For example, if you are running from a lion attack and step on a tack do you think your brain will tell you “Ouch! Stop. You stepped on a tack?” Hopefully not or else “Dinner is Served!” So what happens if something goes wrong with this system? What happens if this system becomes over-sensitive?

As mentioned above, we have 400 nerves in our bodies. That amounts to 45 MILES of nerves! So how does a nerve “talk” to the brain? At rest, a nerve is always “listening”. Every nerve has a certain threshold that, once surpassed, will generate an electrical signal (called an action potential) that will be sent thru the spinal nerve to the spinal cord and up to the brain. If the threshold isn’t reached, then the nerve just continues to “listen”. For example, how long does it take for you to shift your weight while sitting in the movie theater? The threshold of your “buttock nerves” has been surpassed when your brain tells you to shift your weight. This threshold is different for everyone. In the diagram below, you can see that that the resting state of the nerve is at a certain level while it is “listening”. After the action potential occurs, the nerve returns to its previous resting state. However, in certain circumstances, the nerve does NOT return to the previous resting state and the nerve remains in a heightened state. It is essentially MORE sensitive, or hypersensitive, and will fire an impulse much more easily.

After an injury, 1 in 4 people experience this heightened nerve state. Why? The answer has a lot to do with the individual’s response to stress. For example, people that get injured in a stressful environment such as a car accident, playing competitive sports, or a stressful job are 7-8x more likely to develop a chronic pain syndrome. In addition, emotional responses to the injury such as worry, fear, and anxiety perpetuates this stress cycle. To use the lion example above, this fear is like an ongoing emotional lion attack to the nerves of a chronic pain sufferer. The Kendall study found that the biggest predictor of developing chronic pain is FEAR! Fear that your pain will not go away. Fear that your life will never return to normal. All of these responses have one thing in common physiologically, they release both inflammatory chemicals and several stress hormones including one that I am sure you have heard of called ADRENALINE.

Throughout the length of our nerves, there are channels or pores that open or close in response to physical or chemical stimulation. They are called ion channels. The amount and type of ion channels are based on our genetic coding as well as what our brain THINKS we need to survive. Ion channels live for only 48 hours so the amount and type is always changing. When the channel is closed the nerve is “listening”. When it is open the nerve is “reacting”. During cold weather we produce more temperature sensitive channels. During times of stress or fear we produce more adrenaline sensitive channels. The more that we focus on the pain, the more that our brains perceive a threat and continue to send inflammatory chemicals and adrenaline into the area. This response is like a constant “knock on the door” of the ion channels. Regular ion channels stay open for milliseconds. Certain adrenaline channels can stay open for up to 5 minutes! As a result, the nervous system up-regulates and becomes much more sensitive. Can you see the physiological link now between your emotions and your nerves? The initial trauma or injury caused your pain, but it is your BRAIN that perpetuates the pain.

Logically, your next question would be “Is that what’s wrong with me” and “How do we know this?” The explanations are based on what we know about nerve science. We know that you have a pain syndrome based on your physical examination and what you have told us about your pain.

Your next question may be “Why did this happen to ME?” As I mentioned earlier, 1 in 4 people after a traumatic event develop chronic pain. The greatest predictor of chronic pain is uncontrolled acute pain from the injury. Medications, icing, rest, bracing are important strategies in the beginning. Our brain determines our pain tolerance and everyone is different in this regard. Having high levels of stress chemicals in our system not only perpetuates the pain cycle, it also leads to chronic fatigue, depression, mood swings, and sleep disorders to name a few.

So then, “What can we do to treat it?” Our objective is to determine what we can physically as well as mentally do to control your pain. The more that you understand your pain, the more control you have over your brain. Studies have been done that demonstrate a significant reduction in perceived pain just by understanding the physiological process. So re-read this article several times until you REALLY get it. Doing this means you are already moving in the right direction! Choosing the right medications is an important part of the healing process as well. Non-steroidal anti-inflammatories (NSAID’s) such as ibuprofen and Aleve may help. Medications such as Cymbalta, Lyrica, and Neurontin(Gabapentin) function by plugging the openings in your ion channels. Narcotics such as morphine can actually make nerve pain worse! As a side note, your brain can produce pain relieving chemicals that are 50x more powerful than any drug that your doctor can prescribe.

So how do we turn on our brains? As I mentioned earlier, education is the key. The more you know, the more you control. Secondly, choose your foods wisely. Tryptophan is an amino acid that cannot be produced by our bodies. It is a powerful precursor to the “happy” hormone our bodies produce called serotonin. High levels of serotonin can also aid in plugging holes in ion channels. Serotonin is also a precursor to melatonin which plays an important role in mood and sleep disorders. Foods with high levels of tryptophan are turkey, bananas, soy products, tofu, almonds, sesame seeds and walnuts. Lastly, the right type of physical activity is key to controlling your pain and normalizing your nervous system. “Move it or lose it!” certainly applies in this case. There is Gold Level evidence in the literature that aerobic activity performed daily for 10 minutes at 50% max effort can reduce chronic pain. Aerobic exercise cleanses our system of inflammatory chemicals and stress hormones. The most important things that our nerves need to heal are proper movement, adequate space to move, and lots of blood! Our nerves constitute 2-3% of our body weight and use 25% of our blood. The circulation to a nerve will be cut off if the nerve is stretched more than 7-8%. It is very important to determine what kind of movement and/or irritability is occurring in the nervous system. We call this nerve movement “neural dynamics”. Stretching a nerve is NOT something that you want to do. A qualified physical therapist will perform a thorough assessment of your neural dynamics and establish an appropriate plan of care to restore proper and painfree nerve mobility. Manual techniques such as soft tissue and joint mobilizations, Primal Reflex Release Techniques and spinal manual traction can also be beneficial. Hands-on techniques can help to retrain your brain and to desensitize the system. Proper diaphragmatic breathing is also key. If you don’t get enough oxygen, how will you feed your healing nerves?

Once again, I apologize to everyone who has read this article. I know that having pain every day must be very difficult and challenging. I want you to know that there is HOPE. Reading my article is only the beginning. Please let me know if we can help you further.

By admin 0 Comments All, Clinicians, Hip, Other, Pain Management, Pain Management, Patients, Running, Running, Shoulders, Special Techniques, Special Techniques, Spine, Spine, Uncategorized

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.

By admin 0 Comments All, Clinicians, Other, Pain Management, Pain Management, Patients, Spine, Spine, Uncategorized

Headaches!! Aspirin or Exercise?

One of the most common types of stress-related headaches is called a cervicogenic headache. This type of headache is the result of referred pain from boney or soft tissue structures in the neck. When your upper trapezius goes tense from stress and one of the attachment sites of the trapezius is the base of your skull, what do you think the end result could be? That’s right. A cervicogenic headache. When it comes to special testing such as XRays or MRI, there is no clear relationship between degenerative changes of the discs or cervical vertebrae and headaches (Ylinen et al 2010). As a result, most of our assessment comes from functional and palpation testing of the cervical joints and soft tissue. Conservative management of neck and headache pain often includes passive therapies such as the many specialized soft tissue techniques that we offer at OrthoWell Physical Therapy. But what does the research say about exercise-based interventions? Do neck exercises help cases of cervicogenic headache? According to Ylinen et al 2010, they certainly do. The strength group performed one set of 15 reps (in four directions) of cervical resistance training using rubber bands, upper extremity dumbbell exercises, and neck stretches 5x/week in combination with 4 hands-on physical therapy treatments. The control group performed only daily neck stretches, cardio 3x/week, and no physical therapy. What they found, at a 12 month follow-up, was that headache pain decreased by 69% in the strength group and only 37% in the control group. A more detailed analysis of the study can be found at the Theraband Academy website. In conclusion, the evidence-based combination of hands-on physical therapy, exercise, and patient education would be the best approach to resolving cervicogenic headaches.

By admin 0 Comments All, Clinicians, Knee, Knee, Other, Pain Management, Pain Management, Patients, Running, Running, Special Techniques, Special Techniques

Why does your knee keep on hurtin’?

As the adage goes “ The more treatments we have for something, the more we don’t understand the cause”, it seems that anterior (front) knee pain or patellofemoral (kneecap) dysfunction would fall into that category. We understand that a torn meniscus or torn anterior cruciate ligament requires surgery. So how about that nagging, chronic pain in the front of your knee. The kind of pain that returns on a whim and makes you think twice about returning to your break-dancing hey day at your nephew’s wedding. The kind of “twinge” that shrinks your confidence on the 18th hole of your company’s summer, for-boasting-rights golf outing. The reason—not as obvious. So here’s one for you, for boasting rights, of course. In Dye et al (AJSM 1998), the lead researcher decides that he would be the guinea pig in a “mapping” of pain responses during arthroscopic probing, WITHOUT anesthesia, of his anterior knee and patellofemoral joint. Ouch!! The authors rated the level of conscious awareness from no sensation to severe pain. They also subdivided the results based on the ability to accurately localize the sensation. So what did they find? They found that palpation to the anterior synovial linings and capsule (front aspect of the inside of the knee joint), retinaculum (ligament on either side of the knee cap), and fat pad (underneath the patellar tendon) produced moderate to severe pain. The most interesting thing about this study, besides the masochistic aspect, is that NO sensation was detected on the patellar articular cartilage (the underside of the kneecap) even in high level “chondromalacia” or arthritis of the undersurface of the kneecap. The implication of this study is that anterior knee pain is NOT caused by the patellofemoral or kneecap joint.

To take it a step further, Faulkerson et al (Clin Orthop 1985) reported a direct relationship between the severity of pain in the anterior knee and the severity of neural damage within the lateral retinaculum (ligament on the outside of the kneecap). They found that patients presenting with moderate to severe pain were found to have the highest degree of change in the neural tissues of the lateral retinaculum. Very interesting! I’m sure you would agree.

What this means for your therapy is that we can utilize manual therapy and taping strategies to address the neural and soft tissue changes in the lateral retinaculum. KinesioTaping techniques can produce a “proprioceptive override” effect in which the stimulation of the tape on the skin can override and cancel out the pain receptors. This, of course, is an adaptive process that occurs through consistent intervention and compliance with a home exercise program. Let us show YOU how to get back control of your knee pain.

By admin 0 Comments All, Article Reviews, Clinicians, Elbow/Wrist/Hand, Foot Orthotics, Foot/Ankle, Foot/Ankle, Hip, Knee, Other, Pain Management, Pain Management, Patients, Running, Running, Shoulders, Shoulders, Special Techniques, Special Techniques, Spine, Spine

KinesioTape-The Evidence

I have received several comments from bloggers that “there is no evidence” regarding the effectiveness of Kinesiology Taping or KinesioTaping Techniques. I would like to share with you some very detailed clinical study outcomes that are present, and copied here, from the SpiderTech website. This post is definitely more clinical in nature, but it can certainly help any interested patient or practitioner in understanding the evidence behind the WHY and HOW of KinesioTaping.

The Clinically Proven Effectiveness of Kinesiology Taping

Taping is widely used in the field of rehabilitation as both a means of treatment and prevention of sports-related injuries. The essential function of most tape is to provide support during movement. Some believe that tape serves to enhance proprioception and, therefore, to reduce the occurrence of injuries. The most commonly used tape applications are done with non-stretch tape. The rationale is to provide protection and support to a joint or a muscle. Utilizing existing stretch tape, investigators have shown clinical improvement in patients with grade III acromioclavicular separations, anterior shoulder impingement, and hemiplegic shoulders. In recent years, kinesiology tape has become increasingly popular as a therapeutic treatment option in North America and Europe. Kinesiology tape was developed in the 1970’s and was engineered to mimic the qualities of human skin. It has roughly the same thickness as the epidermis and can be stretched between 130% and 140% of its resting length longitudinally. The application techniques were developed through the use of applied kinesiology taping, which
logically gave the therapy and material its name. The tape reportedly has several benefits, depending on the amount of stretch applied to the tape during application: (1) to provide a positional stimulus through the skin, (2) to align fascial tissues, (3) to create more space by lifting fascia and soft tissue above the area of pain/inflammation, (4) to provide sensory stimulation to assist or limit motion, and (5) to assist in the removal of edema by directing exudates toward a lymph duct. The clinical information on kinesiology tape suggests improved function, pain, stability, and proprioception in pediatrics and patients with acute patellar dislocation, stroke, ankle and shoulder pain, and trunk dysfunction. The respective information comes from case series and pilot studies, the most important of which are summarized in the following:

In a prospective, randomized, double-blinded, clinical trial using a repeated-measures design Thelen et al. investigated the clinical efficacy of kinesiology tape for shoulder pain. Forty-two subjects clinically diagnosed with rotator cuff tendonitis/impingement were randomly assigned to 1 of 2 groups: A therapeutic kinesiology tape group or a sham kinesiology tape group. The therapeutic kinesiology tape group showed immediate improvement in pain-free should abduction after tape application. It was concluded that kinesiology tape may be of some assistance to clinicians in improving pain-free active range of motion immediately after tape application for patients with shoulder pain.

In 2009, Fraizer et al. examined in a case series the clinical outcomes for patients with shoulder disorders who were treated with a comprehensive physical therapy program that included kinesiology taping techniques. Five patients
were treated with this taping method among other interventions. All patients demonstrated clinically important improvements in function. The authors concluded that kinesiology taping should be considered as an optional clinical
adjunct in the treatment of shoulder pain as part of a comprehensive physical therapy regimen.

Also in 2007, Yoshida et al. studied the effect of kinesiology tape on lower trunk range of motions. Thirty healthy subjects with no history of lower trunk or back issues participated in the study. Based on their findings, the authors determined that the application of kinesiology tape applied over the lower trunk may increase active lower trunk flexion range of motion.

In 2007, Lie et al. studied the application of kinesiology tape in patients with lateral epicondylitis. The experimental results indicated that wearing kinesiology tape causes the motions of muscle on the ultrasonic images to be enhanced which the authors believe to indicate that the performance of muscle motion was improved.

The effect of taping using kinesiology tape in an acute pediatric rehabilitation setting was investigated in a 2006 pilot study by Yasukawa et al. The purpose of this pilot study was to describe the use of the kinesiology tape for the upper extremity in enhancing functional motor skills in children admitted into an acute rehabilitation program. Fifteen children (4 to 16 years of age), who were receiving rehabilitation services participated in this study. The improvement from pre- to post-taping was statistically significant. These results suggest that kinesiology tape may be associated with improvements in upper-extremity motor control and function in the acute pediatric rehabilitation setting. The authors concluded that the use of kinesiology tape as an adjunct to treatment may assist with the goal-focused occupational therapy treatment during the child’s inpatient stay.

In 2009, Tsai et al. evaluated the effects of a bandage replacement by kinesiology tape in decongestive lymphatic therapy (DLT) for breast-cancer-related lymphoedema. Forty-one patients with unilateral breast-cancer-related lymphoedema for at least 3 months were included in this study. The study results suggested that kinesiology tape could replace the bandage in DLT, and it could be an alternative choice for the breast-cancer-related lymphoedema patient with poor short-stretch bandage compliance after 1-month intervention.

As published in the journal Top Stroke Rehab., Jaraczewska et al. indicated that kinesiology tape could improve the upper extremity function in the adult with hemiplegia. The article discusses various therapeutic methods used in the treatment of stroke patients to achieve a functional upper extremity. The only taping technique for various upper extremity conditions that had previously been described in the literature is the athletic taping technique. The authors concluded that kinesiology taping in conjunction with other therapeutic interventions could facilitate or inhibit muscle function, support joint structure, reduce pain, and provide proprioceptive feedback to achieve and maintain preferred body alignment. Restoring trunk and scapula alignment after the stroke is critical in developing an effective treatment program for the upper extremity in hemiplegia.

The clinical efficacy of kinesiology taping in reducing edema of the lower limbs in patients treated with the Ilizarov method was investigated by Bialoszewski et al. The study involved 24 patients of both sexes subjected to lower limb lengthening using the Ilizarov method who had developed edema of the thigh or leg of the lengthened extremity. The mean age of the patients was 21 years. The patients were randomized into two groups of twelve, which were then subjected to 10 days of standard physiotherapy. The study group was additionally treated with kinesiology taping (lymphatic application), while the control group received standard lymphatic drainage. The application of kinesiology taping in the study group produced a decrease in the circumference of the thigh and leg statistically more significant than that following lymphatic drainage. It was concluded that kinesiology taping significantly reduced lower limb edema in patients treated by the Ilizarov method and that the application of kinesiology taping produced a significantly faster re-education of the edema compared to standard lymphatic massage.

Hsu et al investigated the effect of elastic taping on kinematics, muscle activity and strength of the scapular region in baseball players with shoulder impingement. Seventeen baseball players with shoulder impingement were recruited from three amateur baseball teams. All subjects were taped with both the kinesiology tape and a placebo tape over the lower trapezius muscle. The kinesiology tape resulted in positive changes in scapular motion and muscle performance. The results supported its use as a treatment aid in managing shoulder impingement problems.

By admin 0 Comments All, Clinicians, Foot Orthotics, Foot Orthotics, Foot/Ankle, Foot/Ankle, Hip, Knee, Other, Pain Management, Pain Management, Patients, Running, Special Techniques, Special Techniques

Reebok pays 25M – Kick in the Butt!

As an addendum to the my last post “Whats Up with the Shape-Ups?”, guess what happened to Reebok? They have to pay 25 million due to false “toning” claims. Talk about a kick in the butt!! Read on.

PORTLAND, Ore. — Reebok will need to tone down advertising for its shoes that claim to reshape your backside.

The athletic shoe and clothing company will pay $25 million in customer refunds to settle charges by the Federal Trade Commission that it falsely advertised that its “toning” shoes could measurably strengthen the muscles in the legs, thighs and buttocks. As part of the settlement, Reebok also is barred from making some of these claims without scientific evidence.

“Settling does not mean we agree with the FTC’s allegations,” Dan Sarro, a Reebok spokesman, said in a statement Wednesday. “We do not. We have received overwhelmingly enthusiastic feedback from thousands of EasyTone customers.”

It’s the latest controversy surrounding so-called toning shoes, which are designed with a rounded or otherwise unstable sole. Shoemakers say the shoes force wearers to use more muscle to maintain balance and consumers clamored for them, turning toning shoes into a $1.1 billion market in just a few years. Companies such as Reebok, New Balance and Skechers have faced lawsuits over their advertising claims. But the FTC settlement, announced Wednesday, is the first time the government has stepped in.

Reebok International Ltd. makes a range of toning products, including its RunTone running shoes, EasyTone walking shoes and flip flops and some clothing. The company, which is owned by Adidas AG, said that its toning shoes were one of its most popular product launches ever when they debuted in 2009. The company marketed them heavily with ads featuring women in short shorts and with shapely bottoms; one ad even said the shoes would “make your boobs jealous”.

The FTC took issue with Reebok’s ads that claimed its EasyTone footwear had been proven to lead to 28 percent more strength and tone in the buttock muscles and 11 percent more strength and tone in hamstring and calf muscles than regular walking shoes. The FTC said it could not disclose if it was pursuing similar actions against other shoe makers.

“We think this is a real victory for consumers,” said Dana Barragate, an FTC attorney involved in the case. “We hope it sends a message to businesses that if they are going to make claims they must be justified.”

Shoe makers, including Reebok, have funded studies and say they have anecdotal evidence that proves they are effective. Several experts have questioned their validity and the American Council on Exercise, a nonprofit fitness organization, conducted a study that found toning shoes failed to live up to the claims of shoe makers. However, the council said the shoes could be beneficial to one’s health if they motivate people to get moving.

Christopher Svezia, with the Susquehanna Financial Group, said many shoemakers have changed their advertising approach as criticism has mounted. “The emphasis has moved to fitness instead of making these kinds of claims and promises,” he said. “The question is who is next and how much is it going to cost them.”

The industry has faced other issues. There have been some injuries reported by wearers who have found themselves with shin splints, twisted ankles and sore muscles from the new gear and motions. Shoe makers suggest new wearers ease into wearing them.

Toning shoes were once the fastest-growing segment in the footwear industry, but recently lost some ground. SportsOne Source Group said that the $1.1 billion market of 2010 is expected to fall about 40 percent to $650 million in 2011 after Skechers flooded the market with products, forcing prices down. However, SportsOne Source said the number of shoes sold is only expected to fall 5 percent, suggesting there is still fairly strong demand.

Rebecca Sayre of Seattle, who bought a pair of Skechers more than a year ago, said they made her legs stronger and posture better. But, she says: “They’ve lost their luster.”

Story posted 2011.09.28 at 08:41 PM EDT

By admin 0 Comments All, Hip, Knee, Patients, Running

How “HIP” is your knee pain?

“The knee bone’s connected to the…hip bone” may be your therapist’s greatest clue to solving your knee pain. How many patients have gone to physical therapy for knee pain and received an ultrasound & quad exercises only to be disappointed in his or her outcome? What exactly is the link between knee pain and hip weakness? What does the research tell us?

Patello-femoral pain syndrome (PFPS) (pain under the kneecap) is the most common condition seen in an orthopedic practice. It is the most prevalent injury in persons who are physically active. Iliotibial band syndrome (ITBS) is the second most common overuse injury in runners. Anterior cruciate ligament (ACL) injuries are one of the most common ligament injuries in people who engage in athletics. What common factor contributes to ALL of these orthopedic conditions? You guessed it!! Weak hips! Read on for the proof.

In a recent review of the literature, Reinman cited 51 articles that provide some degree of evidence correlating hip weakness to knee loading and knee injury. The position of the knee relative to the hip during weight bearing activities is a predictor of dysfunction. Excessive hip adduction and internal rotation (turning in of the knee such as being bow-legged) can adversely affect the motion and forces that act upon the entire lower extremity. This combined motion produces a “dynamic” knee valgus. A valgus force places a tensile strain on the iliotibial band as well as the soft tissue restraints on the inside of the knee, particularly the ACL and medial collateral ligament. Claiborne et al and Hollman et al have reported that reduced hip strength is related to greater knee valgus angles. In the presence of hip abductor weakness (muscle that raises your leg out to the side), the opposite hip may drop during single-leg support causing a Trendelenberg sign. This is especially apparent during a slow, “controlled” descent down a step. A great functional test!

Why is it that the incidence of ACL injuries and PFPS is greater in women? Prins et al concluded that females with PFPS exhibit impaired strength of the hip extensors, abductors, and external rotators. Chen and Powers report that females with PFPS exhibit excessive “dynamic” Q-angles, especially with descending stairs. Pollard et al states that females demonstrate insufficient utilization of the hip extensors due to decreased knee and hip flexion during a jump squat for example. This leads to increased quad activation in the presence of a valgus knee and localizes the impact load onto the patella to a much smaller surface area. Hence, more pain!

So what if you’re a runner? Ferber et al looked at 283 studies that examined running-related injuries and concluded that the connections between weak hips and running were far more conclusive than the connection with flat feet (over-pronation). Interestingly, Earl et al prescribed a hip strengthening program to healthy female runners for 8 weeks and, in addition to improved hip strength, they measured a 57% decrease in pronation (flat foot) while running. Strengthen the hips and ditch the orthotics? Maybe.

If it hasn’t become obvious yet, hip weakness has been proven as a predictor of knee dysfunction. So in addition to your runs or to your crunches, you need a hefty dose of hip resistance training. Call us and we can get you started!!

By admin All, Clinicians, Knee, Pain Management, Pain Management, Patients, Special Techniques, Special Techniques

Kinesio Taping – How does it work?

Kinesio Tex tape is the world’s #1 elastic Kinesio tape. It is used by 78,000 practitioners in the United States and 150,000 worldwide. It is being used by professional athletes and Olympians such as Kerri Walsh of the gold medal winning US women’s beach volleyball team. Here at OrthoWell/WalkWell, we are KT1 and KT2 certified in the Kinesiotaping Method. How does Dr. Kenzo Kase , the inventor of Kinesio Taping, explain the concept of Kinesio Taping?

“ The concept of Kinesio Taping is the replication of the therapist’s hands on the patient’s skin using Kinesio tape. The Kinesio tape mimics the qualities of the patient’s skin and success of the Kinesio Taping method depends on two factors. One , proper evaluation of the patient’s condition by the therapist. Two, proper application of the Kinesio Taping technique.”

So how does Kinesio Taping work?

AFFECTS ON MOVEMENT

Proprioception is our ability to sense our body’s static position in space. Kinesthesia is our ability to sense how our bodies move through 3-dimensional space. This “sense” occurs through several different types of sensory organs under our skin and around our joints that provide our brains with information about pressure, vibration, touch, temperature, and tension. The effectiveness of the Kinesio tape lies in its ability to alter the sensory feedback that enters your nerves in the area that the tape is applied. The contact of the tape on the skin appears to increase the ability of the joint and/or tissue to detect movement and to respond to outside forces. As a result, this has a positive effect on the communication between your brain and the affected tissue which, in turn, could enhance athletic or movement performance.

AFFECTS ON PAIN

The sensory feedback from the tape has been hypothesized to reduce pain by stimulating large nerve fibers under the skin. The input from these nerves fibers travels more rapidly to the brain than the input from pain receptors. This is the concept of the Gate Control Theory of pain in that the sensory input overrides the pain input, thus, reducing the sensation of pain.

AFFECTS ON SWELLING

An important concept of applying Kinesio tape is “less is more”. Athletic taping is used with tapes of high tensile strength in order to stabilize and/or reposition a joint. Once applied, the tape resists being stretched. Kinesio tape is applied with low levels of tension. In most applications, the tape is applied with the affected tissue in a stretched position so that the tape has a convoluted appearance when the tissue is at resting length. As a result, the tape has a “lifting” effect on the skin which improves circulation and lymphatic drainage below the level of the skin. This effect can create channels of low pressure in a congested area as well as assist in opening the epithelial flaps that are present on lymph vessels resulting in a significant reduction in swelling.

“>Check out our You Tube video link in the slider on the bottom of this page to see a Kinesio Taping technique for reducing knee swelling.

Check out our post on the research behind KinesioTape.

By admin Clinicians, Pain Management, Patients, Shoulders, Special Techniques

The Subscapularis Release Miracle!! Impingement And Beyond….

Subscapularis Release for Shoulder Pain

The main purpose of the rotator cuff is to keep the head of the humerus bone centered within the shoulder joint The subscapularis muscle functions as the internal rotator of the rotator cuff. It serves to hold the head of the humerus down and to limit forward glide of the humerus while the arm is raised. It is a powerful stabilizer of the shoulder. Repetitive overhead activity such as throwing or swimming may create micro-trauma to the fibers of the subscapularis. The healing process may lead to adhesion formation with a subsequent imbalance of the rotator cuff leading to altered shoulder biomechanics. The genesis of shoulder impingement syndrome!

Subscapularis Treatment

Manual therapy plays a pivotal role in the effective and expeditious treatment of impingement syndrome as well as recovery from a Type II SLAP repair surgery. Active Release Technique has been clinically shown to resolve the impingement pain caused by a subscapularis dysfunction in as few as 2-6 sessions. We assess the length of the muscle from the lesser tuberosity of the humerus to the subscapular fossa in order to locate the lesion. The lesion is tensioned in a slackened position as the arm is taken through a range of external rotation and elevation in order to release the adhesion. Refer to pictures below. The release is also demonstrated on my website at orthowellpt.com.

Standard Type II SLAP repair protocols limit the PROM of external rotation from 0-30 degrees for the first 4 weeks post-op. Most patients are placed in a sling in an internally rotated position. Therefore, this limits the mobility of the subscapularis. Trevor Winnege,DPT demonstrated that massage of the subscapularis in combination with PROM during the first post-op month improved the external rotation motion of the shoulder by 24-25 degrees at the 4 week mark compared to a control group that received PROM only. Check out the free shoulder pain treatment guide to learn more.

Keeping you informed of the latest and most efficacious physical therapy interventions is our goal at OrthoWell Orthopedic and Sports Physical Therapy and WalkWell Rehabilitation. Please call if you have any questions about our subscapularis release and whether it would be right for you.

All the best!

Chris Dukarski,PT, Owner of OrthoWell and WalkWell

Tag: pain