Would you like to feel happy and vibrant EVERY day? Here’s how.

Spring has sprung, but it sure didnt feel like it last week. So how do you feel when it is sunny and warm versus cold and damp? There may be a physiological reason why you feel down or painful on cold and damp days. Check out the posts below to see why.

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.


 

HOW TO FEEL HAPPY & VIBRANT

EVERY DAY

 No, I havent found the fountain of youth or am advocating that everyone apply for a medical marijuana card. lol. But…there are a few things that could make your body work more efficiently on good weather days as well as bad ones. Knowledge is power so I want to share a few things with you. 

So WHY do you feel stiffer or more painful on rainy days??

 A recent systematic review of the relationship between joint pain and weather found no consensus on the issue. However, several researchers have found evidence that a decrease in the barometric pressure associated with a storm front can increase the pressure inside your joints thereby potentially increasing your stiffness or pain. 

 VITAMIN D

 study published in the Archive of Internal Medicine in 2009 showed that Vitamin D  levels have “plummeted” among ALL U.S. ages, races, and ethnic groups over the past two decades. Because there are such small amounts of Vitamin D in food, the only 2 ways to get adequate amounts is thru direct sun exposure or via supplements.Over the past 10 years, several researchers have found an association between extremely low vitamin D levels and chronic, general pain that doesn’t respond to treatment. Check it out HERE. So start taking your Vitamin D! Click here for a great source of Vitamin D. 

EXERCISE-The Happy Drug

 Did you ever notice how some people are addicted to exercise? There are good reasons for that (some bad if you push through pain…..) Exercise releases endorphins which are your body’s natural painkillers and “feel good” hormones. Read more HERE.

Turmeric-The Spice of Life

You may know turmeric as that yellow spice that is used in indian curry dishes. The active ingredient in turmeric that has been extensively researched and provides more health benefits than there is room on this page is curcumin. One of the main reasons people take curcumin is for its potent natural anti-inflammatory properties. It is important to take curcumin with a pepper based supplement to maximize the effects such as Pure’s Curcumin with Bioperine. You can read more about turmeric HERE

 So what should you take for supplements??

 If you want even more information, then you could read my post on  which vitamins and supplements are best for you. CLICK HERE. 


GET RID OF SURGICAL SCARS

AND

GET A FREE FACIAL FOR TRYING 

 Dear OrthoWell patients, 

 My name is Andrea Linn and I am currently a patient at OrthoWell PT. I just had an ACL reconstruction.

I was born in Europe- Hungary. I went to school there to be a cosmetologist. In the USA, I have worked for many prestigious beauty brands but my most favorite is Le Metier de Beaute. I want to share with my secret for getting rid of surgical scars-quickly. 
 
Does it take long for your surgery scar to heal? Do you need extra nourishment for your body skin? Would you like to erase signs of aging from your body?
 
I have a recommendation for you: Le Metier de Beaute’s fantastic Vital ET Recovery Boost.
 
Redefine Age
Replenish, repair and protect your entire body with Vital ET Recovery Boost – Body. This highly effective form of Vitamin E protects you against free radicals. Free radicals are known to damage collagen, create dryness and lead to the development of fine lines and wrinkles. This deeply reparative serum will drive super antioxidants and vitamins directly into your skin, leaving you with it glowing and age-resistant.
 
Key Ingredients:
TPM® Technology. Vital ET®, a patented technology that decreases redness and swelling while fortifying resistance to inflammation caused by environmental stressors.
 
Usage:
Apply to clean skin in the morning and/or evening. Gently massage Vital ET Recovery Boost – Body over entire body. Pair with SPF protection when going out in the sun.
 
6.35 fl. oz. / 180 mL  $125.00
 
Small samples will be available at the front desk. Please try them.
:
Le Métier de Beauté is one of today’s most technologically advanced skincare brands using a unique TPM technology. TPM increases the therapeutic benefits while reducing redness- inflammation – irritation.
Le Métier de Beauté (which translates to “the craft of beauty”) is known for its award-winning Peau Vierge Anti-Aging Complexe. The line also features stunning makeup and has collaborated with couture and ready-to-wear designers Georgina Chapman and Keren Craig of Marchesa on a fashion-inspired color collection.
 
Le Metier de Beaute features incredible anti-aging skincare and make up — everything that your face and body needs. 
 
Patients of Orthowell Physical Therapy are invited to a complimentary anti aging mini facial in Newburyport or Beverly.
 
Please contact Andrea to schedule your appointment.
 
If you have any questions don’t hesitate to contact Andrea

Prevent Your Pain from EVER coming back

Click the link to read about

this new option at OrthoWell 

Wellness Maintenance Program

 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.


SUCCESS STARTS HERE!

4/27/16

The winter of 2015 had me shoveling so much snow on our alpaca farm.  Spring into summer convinced me my sore shoulder wasn’t just going away.  I quit “using” my arm as it hurt to even raise it.  I procrastinated so long that I thought for sure I would have to have surgery.  I was in such pain that I finally saw a surgeon.  He strongly suggested I try PT and said he’d heard good things about OrthoWell.  Talk about life changing!  After 5-6 weeks of working with Chris and his team, I have to say that I’m calling this just short of a miracle!  Everything was explained to me and shown to me in a clear and concise manner.  I am looking forward to having my life back this summer, if that sounds dramatic, well, it is! 

                                                                                                             – Olivia Sanderson


WALL OF FAME

Here is the update on our Wall of Fame in Beverly. We are proud of our patients and the success that they have had.  If you have previously provided us with a testimonial, we would love to take your picture with your therapist and hang it with your testimonial for display it in our clinic!  Seeing is believing! 

All the Best,

Chris

 

 

 

 

 

Eccentric Exercise Helps Knee Pain

Patellar Tendonitis, or runners knee, is a common over-use injury that causes pain and stiffness in the front of the knee. Chronic pain can lead to physiologic changes in the structure of the patellar tendon. This new study from JOSPT shows increased micro-circulation of the patellar tendon after prescribed eccentric exercises. Eccentric exercises are lengthening contractions such as slowly lowering during a squat or slowly bending your knee from a fully straightened position. Eccentric exercise can more readily bring nutrition to the tendon and create a healing environment that will reduce pain and stiffness. This approach is very similar to the eccentric protocol that we use to treat achilles tendonitis. The key is in the exercise prescription-so give us a call!

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.

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.

Foam Rolling Technique

As most of you know, a very important part of our practice is the treatment of soft tissue dysfunction. This may be in the form of a muscle “knot”, chronic scar tissue, or post-surgical stiffness. We have many names ie “the doctors of knotology” and “the Marquis de Sade” to name a few. In spite of the many terms of endearment, at OrthoWell, we get our patients better- Faster! because of our approach. A very important part of your recovery has to do with your home program. Every conditioning program should include stretching, strengthening, cardio, and a close fourth should be self-massage and/or self-mobilization. Many of you have experienced “the twins” (my double tennis ball massager) as well as the foam roller. It is important to address your chronic “knots”, scar tissue, and muscle sensitivities in order to promote optimal tissue dynamics and to prevent future pain syndromes related to poor tissue dynamics.

The following video highlights our foam rolling strategy for your lower extremities. Each muscle group should receive 5-10 passes along the foam roll. The amount of weight you impart upon the roll will be dictated by your tolerance. Yes, this should hurt! Only mild to moderate pain, nothing severe. Use your arms and opposite leg to control the pressure being applied. Try to identify key areas along the way that may need additional passes. Yes, over time, the pain will subside and your pressure will increase. Consistency is the key. Ideally, stretching and self-massage should happen daily. Here is a run down of what is happening in the video.

1. In the first part of the video, I am treating the quadriceps. Longer muscles need more attention. Perform 5-10 passes each at the upper end, middle, and lower end of the muscle.

2. Turn 45 degrees and perform the same treatment at the junction between the quadriceps and iliotibial band(ITB). Pay close attention to the lower end near your patella.

3. Turn another 45 degrees and, in the same manner, treat directly along all three aspects of the ITB.

4. Next, turn over and treat your upper glute area. Cross one leg over the other as shown. The leg that is crossed is the side you are treating. Perform 5-10 passes.

5. Move down to the hamstrings and treat the upper, mid, and lower ends. Place your opposite leg on top of the treatment leg in order to impart more pressure.

6. Next, treat the calf muscle. Place the opposite leg on top for more pressure. Treat the entire length of the calf. You can also perform an up/down ankle movement in order to help glide the stiff tissue while imparting pressure onto the roll.

7. Finally, treat the inner thigh or adductor muscle group. It may be easier to use the 6” roll to treat this area effectively. You can purchase a white 6” roll which is the same material as the 4” or you may purchase the black roll which is firmer than the white.

Keep on rollin’