Stretching

Why do you need to stretch? Stretching is one of the most under-rated things to do as a part of your daily exercise routine. If you go to the gym or exercise daily, do you also stretch? If you are aging, as we all are daily, are you stretching? Stretching does not have to be a formal 1 hour long session. Stretching can be as quick as 90 seconds!! Here, below are lists of the benefits, how to’s and when to stretch. There are a few precautions at the end to be mindful of, so please read until the end.  If you ever have any concerns or questions about stretching, please ask your physical therapist for help.

The Benefits of stretching - 

• Improves flexibility and range of motion in muscle and joints

• Relieves Pain by improving blood flow & elongation of muscles

• Better performance in mobility and activities

• Prevention of injury & Decreases the Risk of Injury

• Maximizes muscle efficiency and relieves muscle fatigue

• Increases blood flow to the muscle (improved circulation for healing)

• Stress relief by the release of endorphins giving you a feeling of tranquility

• Improves your quality of sleep

• Restores posture

• Improves energy levels

• Some studies have shown that stretching may actually lower cholesterol levels

• Some studies show stretching may reduce muscle soreness after a strenuous workout

How to stretch -

• Breathe – do not hold your breath while stretching. Take slow deep breaths to be able to relax

• Proper alignment and posture – make sure you are in the best position to stretch the muscle you are focusing on (you may overstretch your back when attempting to stretch your hamstrings). Please speak to your therapist if you are concerned regarding your positioning.

• Both sides-Left and Right – you don’t want to stretch one arm or leg, or one side of your neck/back & not the other

• Focus on major muscle groups or activity specific groups for the best benefits

• Move slowly into each stretch – rapid quick stretches when done improperly will cause muscle injury

• Static holds – always hold the stretch and NEVER bounce

• Hold the stretch for 30 seconds – stretching for less than 20 seconds shows no benefit. The muscle fibers need to be able to release to beneficially stretch

• o If there is a restriction or problem area, stretch for 60 secs
• o If you are older, stretch for 60 seconds
• o Younger children, stretch for 10 seconds

• Each muscle group should be stretched 2-4 times in a session

• No pain – stretching should never be painful. You may be stretching too aggressively or there could be an underlying issue. Please see your physical therapist if you continue to have pain while attempting to stretch – No pain, No gain does NOT work with stretching!

• Remember that the results of stretching are somewhat temporary. The gains you make in range of motion can be lost and return to the original length in about 4 weeks after cessation of stretching.

When do you stretch – Anytime!! Anywhere!!

• Regularly-at least 2-3X/week – muscles are elastic & are responsive to stretching, but if you don’t stretch regularly, they return to their original shortened length

• Always after activity – when they are at their “hottest”, they have the best circulation & response to stretching

• After waking up, directly before bed – if you are having pain, cramps or spasms that wake you up or more painful in the morning, stretch before you go to sleep. If you have pain when you wake up, stretch the first thing in the morning to relieve the pain.

• Midday fatigue – if you are sitting at your desk & are feeling sluggish & tired, STRETCH!!!! Better circulation means better levels of work & alertness.

Caution – Always check with your PT or physician before beginning any new exercises

• Do not stretch cold muscles as there can be more injury

• IF you have osteoporosis, be cautious - avoid leaning forward at the trunk or any excessive stretching or pulling

• Acute muscle strain or injury – while you may need to stretch a strained muscle, over stretching or being too aggressive, may cause an increase in injury or re-injure.

• Extra caution with use of steroids and other medications (increases risks of fracture or torn ligaments and tendons)

• RA or other connective tissue disorders, joint inflammation

• Progress gradually – range of motion isn’t gained overnight or over a few days – it may take weeks to see results, so don’t give up!

• Joint instability – if you have joint instability, you don’t need to stretch those muscles  of that joint

• Do not use the mindset of “No pain, no gain” while stretching

www.mayoclinic.org/healthy-lifestyle/fitness/in-debt/stretching/art
www.healthfitnessrevolution.com/top-10-health-benefits-of-stretching
www.stretching-exercises-guide.com
 

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What is Lymphedema and why should a see a PT for it?

Lymphedema is defined as swelling in an extremity.  It is most common in the upper extremities (one or both) but can also present in one or both legs.  It is caused by damage or malfunction of one or more lymph nodes which are used to funnel fluid out of the limbs as part of the immune system.   Early signs include swelling in the further aspect of the limb (ie hand or foot), a feeling of heaviness in the limb, difficulty with clothing or jewelry fitting properly, decreased range of motion, achy or sore limb, recurrent infections to the area and a thickening of the skin.  Lymphedema may be primary (originating on its own) or secondary (caused by something else). 
Primary Lymphedema is a rare, inherited condition in which the lymphatic system does not develop in a typical manor.  Secondary lymphedema is much more common and can be caused by Surgery, trauma, Cancer or cancer treatments and infection.  Risks of developing lymphedema increase with age, excessive weight and some forms of arthritis.  It is not uncommon for secondary lymphedema to develop years after its cause, especially in cases of cancer patients. 
There is no cure for lymphedema; however symptoms can be well managed with exercise, compression therapies, and massage.  Guided exercise using light, gentle contractions of various muscles helps to stimulate the lymph fluid and move it out of the limb to the next undamaged lymph node.  It will also improve the function and coordination of the limb making it easier to accomplish daily tasks.  Massage, when done correctly also facilitates movement of lymph fluid out of the limb and can reduce the heaviness and achiness of the condition.  Compression therapies include wrapping of the limb, the fitting of compression garments for daily wear and sometimes the use of a pneumatic pump on the effected limb.  
If you experience swelling of one or more limbs, please consult with a doctor as not all swelling is lymphedema and swelling can be a symptoms of a more serious problem.  If you are diagnosed with lymphedema, speak to your doctor about starting physical therapy to manage your symptoms and preserve your overall health and function. 

Resources:
Mayo Clinic and the National Lymphedema Network
 

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Physical Therapist: Your Overall Wellness Provider

Physical Therapists’ Role in Prevention, Wellness, Fitness, Health Promotion, and Management of Disease and Disability:
Physical Therapists play a unique role in the community by serving as a dynamic bridge between health and health services delivery for individuals and populations.  Physical therapists are not just experts in rehabilitation and habilitation, they also have the expertise and the opportunity to help individuals and populations improve overall health and prevent the need for avoidable health care services. 
A Physical Therapist provides:  Education, direct intervention, research, and collaborative consultation. 
“These roles are essential to the profession’s vision of transforming society by optimizing movement to improve the human experience.” – American Physical Therapy Association.
Physical therapist are uniquely educated and trained to adapt health care recommendations to the community environment where individuals live, work, learn, and play.  With this knowledge and ability physical therapists are able to adapt medical recommendations to specific environment, to meaningfully interpret health recommendations, to help individuals modify their health behaviors, and to ensure clinical and community services are integrated, available, and mutually reinforcing.
 

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Physical Therapy for Headaches and Migraines

If you experience headaches or migraines, you understand how debilitating this condition can be. Ninety percent of people with migraines are unable to work or function normally during a migraine attack. In those experiencing chronic daily headache (at least 15 episodes per month), depression, anxiety, and sleep disturbances are common. Despite the severe nature of this condition, most sufferers do not seek medical attention.1

There are several different types of headaches, the most common being migraine and tension-type headache. Migraine headaches are characterized by an intense throbbing pain on one or both sides of the head. This is usually accompanied by visual disturbances, nausea, vomiting, dizziness, sensitivity to sound, light, touch, smell, and even numbness and tingling in the face or extremities.1 In contrast, tension-type headaches are most frequently felt on both sides of the head, have a pressing/tightening quality (non-pulsating), are of mild to moderate intensity, and are not aggravated by routine physical activity (however this may vary among individuals).2

If any of these symptoms sound all too familiar, contact your physical therapist. Since headaches can be the result of complex neurological symptoms, a detailed history and examination must be performed by a physical therapist or medical doctor to rule out other causes. Unfortunately migraines are not well understood, and modern medicine has yet to find a cure. Research has, however, shown that physical therapy including dry needling can significantly reduce headache frequency/intensity and improve quality of life.

Several research studies have determined that dry needling combined with medical management provides long-term, significant benefits for patients experiencing chronic headache, particularly migraine.3 In fact, studies have found that dry needling can improve clinical outcomes beyond that which would be expected from medical management alone.4

Research has demonstrated that people with tension-type headaches have more trigger points (“knots”) in muscles of the head and neck compared with those who do not have headaches. Decreased neck range of motion and forward-head postures are also more common in those with tension-type headaches.5 Further research has found these patients have significantly decreased neck extension strength along with a tendency for weaker shoulder abduction strength.6 All of these issues – trigger points, tight muscles, weak muscles, and posture abnormalities – can be resolved with help from your physical therapist.

Following a thorough history and examination, your therapist will develop a plan of care tailored to your individual needs. A typical session would include manual therapy techniques (including massage, joint mobilizations, manual stretching, and dry needling), therapeutic exercises, postural stabilization, modalities, and education for dealing with chronic headache. Open communication with your therapist about response to treatment, during and after the session, is essential to optimize effectiveness. So seek medical attention for your migraines, and contact your physical therapist today!

References
1. Migraine Fact Sheet. Migraine Research Foundation website. Migraineresearchfoundation.org. Accessed March 13, 2016.
2. Chowdhury D. Tension type headache. Annals of Indian Academy of Neurology. 2012;15(Suppl 1):S83-S88. doi:10.4103/0972-2327.100023.
3. Vickers AJ, et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. BMJ. 2004;328:744. doi:http://dx.doi.org/10.1136/bmj.38029.421863.
4. Coeytaux RR, et al. A randomized, controlled trial of acupuncture for chronic daily headache. Headache. 2005 Oct;45(9):1113-23.
5. Fernández-de-Las-Peñas C1, Cuadrado ML, Pareja JA. Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache. Headache. 2007 May;47(5):662-72.
6. Madsen BK, Søgaard K, Andersen LL, Skotte JH, Jensen RH. Neck and shoulder muscle strength in patients with tension-type headache: A case-control study. Cephalalgia. 2015. doi: 10.1177/0333102415576726
 

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Understanding Ligament Injuries of the Knee

The knee is supported by 4 major ligaments. You always hear about athletes and injuries to the knee but understanding the structure of the knee helps you understand the injury.
The four major ligaments that the support the knee are as follows:

•  The anterior cruciate ligament (ACL) is one of the two major ligaments in the knee. It connects the thigh bone to the shin bone in the knee. ACL injuries are a common cause of disability in the knee. In the U.S., 95,000 people get them every year. They are more common in women than men.
• The posterior cruciate ligament (PCL) is the second major ligament in the knee connecting the thigh bone to the shin bone in the knee.
• The lateral collateral ligament (LCL) connects the thigh bone to the fibula, the smaller bone of the lower leg on the lateral or outer side of the knee.
• The medial collateral ligament (MCL) also connects the thigh bone to the shin bone on the medial or in side of the knee.

Injuries of the ligaments of the knees can occur through sports, trauma, falls, and can occur during car accidents.  Ligament injuries can occur during sports such as football secondary to contact and can also occur secondary to diagonal movements while running.   Basketball players, soccer players, skiers and gymnasts as well as other athletes can have ligament injuries.  But just because you are not an athlete does not mean that a ligament injury cannot occur. 

Certain movements or motions can cause an injury to ligaments in the knee.  For example:

ACL injury and other ligament injuries can be caused by:

• Twisting your knee with the foot planted
• Getting hit on the knee
• Extending the knee too far
• Jumping and landing on a flexed knee
• Stopping suddenly when running
• Suddenly shifting weight from one leg to the other
• Can also be caused by dash board to the knee during a car accident

Treatment of injuries to the ligaments of the knee depends on the ligament that is injured and the severity of the injury.  Not all ligament injuries require surgery.  Generally immediately following the injury you should rest, ice and elevate the injured knee and follow up with the doctor as scheduled.  Following seeing the doctor it will be determined if surgical intervention is needed.  Physical therapy in most cases is needed for strengthening of the knee whether it is pre-operatively or post operatively.

Physical therapy will include the evaluation and then the therapist will determine what is needed based on if a surgical repair occurred or if it is to help strengthen the knee.  You should follow up with therapy and perform your home exercise program as the therapist instructs.  If you have questions you can always contact a therapy clinic.

Sources:
http://www.webmd.com/fitness-exercise/guide/knee-ligament-injuries

http://www.webmd.com/pain-management/knee-pain/picture-of-the-knee
 

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What’s all of that colored tape about? The world of kinesiotaping

Kinesiotaping is a relatively new concept to the general public, but it has actually been around for more than 40 years. For me, Kinesiotaping first came out in the media in the Olympics when Kerri Walsh & Misty May-Treanor won their gold medals. Kerri Walsh was sporting this bright blue or black tape across her shoulder. “What is that?” seemed to be the world’s question. Although pictures may show the brand KT, this was the spark that lit my interest for kinesiotaping. Since then, I have taken 3 courses for kinesiotaping & have had significant results in the neurological environment, where individuals with strokes have benefited from kinesiotaping, as well as in the outpatient setting, where clients have had support & relief from diagnoses such as low back pain & plantar fasciitis or tendinitis.

As mentioned before with Kerri Walsh having KT on her shoulders, there are other brands of “tape” for purchase at retailers, but they do not have the therapeutic advancements that kinesiotape offers & has research to verify its affects. Unless you have been instructed by a trained professional, this tape is usually not beneficial when applied because of the lack of understanding & improper technique. The professionals who use kinesiotape have been to at least one class & can go to up to three then taking a test to become certified in kinesiotaping. If they have not attended a course, they at least have been instructed on each technique to provide the appropriate use & technique for the specific problem.

Kinesiotape comes in only 5 colors: white, black, blue, beige & pink. All of the colors are plant derived & the tape is latex free. Very seldom is there ever a reaction to the tape once it is applied. It is designed to assist in helping the body heal naturally on its own “while providing support & stability to the muscles & joints without restricting the body’s range of motion” (www.kinesiotaping.com). The application depends on the “direction and amount of stretch placed on the tape at the time of application” and can be utilized “in hundreds of ways and has the ability to re-educate the neuromuscular system, reduce pain & inflammation, optimize performance, prevent injury and promote good circulation and healing, and assist in returning the body to homeostasis” (www.kinesiotaping.com).

If you are interested in more information regarding kinesiotaping, please visit their website: www.kinesiotaping.com. And don’t forget to ask your therapist if they are trained or are educated in kinesiotaping! We look forward to helping you & your impairments.
 

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Preventing Injuries While Weight Training

With the new year here, several people have hit the gym enthusiatically to start a new exercise program for their New Year's Resolution!  However, many people are quickly sidelined with fitness injuries due to poor form or simply lack of focus.  When done correctly, training can help you lose fat, increase strength and muscle tone, and improve bone density.  If done incorrectly, weight training won't give you these benefits -- and may lead to injury. 

Poor technique while training can lead to muscle sprains, strains, stress fractures and other painful injuries that can hamper your training efforts.  If you're just getting started, work with a knowledgeable weight training specialist such as a physical therapist, athletic trainer or other fitness specialist who's familiar with proper training techniques.

Weight Training "Do's":

• Warm up - It is imperative to warm up before each workout to ensure proper circulation of blood and nutrients to the muscles and surrouding tissue.
• Lift an appropriate amount of weight - Start with a weight you can lift comfortably 12-15 times, anywhere from 1-3 sets of 12-15 repetitions.
• Use proper form - Learn to perform the exercises correctly.  Move through the full range of motion for your joints. The better your form, the better results you will see. 
• Breathe  - Do not hold your breath, which can increase blood pressure.
• Perform weight training at least 2 times a week.
• Rest  - Avoid working the same muscle group 2 days in a row. 
• Proper hydration and nutrition. 

Weight Traning "Don'ts":

• Don't skip the warm up - Cold muscles are more prone to injury than warm muscles. 
• Don't rush - Move the weights through a slow, controlled motion which helps isolating the muscle you are targeting.  Rest at least one minute between each exercise. 
• Don't overdo - Don't push yourself past the point of fatigue.
• Don't ingore pain - If you have pain with any exercise, stop.  Make sure the form is correct and decrease the weight.
• In order to maximize your results and benefits from weight training, make sure you follow these simple do's and don'ts to prevent exercise injuries. 

References:
http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/weight-training/art-20045842?pg=2
http://www.active.com/fitness/articles/how-to-prevent-injuries-during-exercise
 

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“Back” to School

September is National Backpack Awareness Month

Did you know that about over 2,000 backpack related injuries are reported every year?  That doesn't include the minor backaches children might not mention or that don't seem serious enough to treat. If you have children, then you know how heavy a backpack can get during the school year.  About 55% of students carry a backpack that is heavier than the recommended guideline of 15% of the student’s total body weight. The day-to-day repetition of carrying heavy school backpacks may place additional stress on the rapidly growing child’s spinal structures, making them more susceptible to postural changes. One study found a positive correlation between backpack weight and spinal deviations in the cervical (neck) and thoracic (mid-back) spines.

Guidelines for backpack use include:

• DO NOT let the weight of the backpack exceed 15% of their body weight
• Keep it close! Put the heaviest books closest to their back. The farther the weight is from their back, the harder the muscles have to work.
• Never more than four below. A backpack should never hang more than four inches below the waist and should fit comfortably on and below the shoulders.
• Don’t let it lean: Using only one strap puts extreme pressure on one side of the body. Slip on both straps for more even weight distribution.
• Put on some padding: Look for backpacks with two widely padded shoulder straps to protect the shoulders and better distribute weight.
• Wear the waist belt: Choosing a backpack with a waist belt (and using it!) can help transfer some of the weight from the back and shoulders to the hips and torso.
• Clean it out: Regularly go through their backpack and make sure they need everything that’s in there. If not, pull it out to help lighten the load. Several books/textbooks can now be viewed on the web or electronic devices.
• Try out a new set of wheels: If the school allows it, consider a backpack on wheels. This helps forgo any weight issues by bearing a backpack that’s too heavy.
• Good lifting: Remember to have them use good technique when lifting the backpack. Keeping the spine straight and bending with their knees.
• Exercise! Engage in regular exercise and stretching for the neck and back.

A Physical Therapist can help you choose a proper backpack and fit it specifically to your child. Children come in all shapes and sizes, and some have physical limitations that require special adaptations.
Additionally, we can help improve posture problems, correct muscle imbalances, and treat pain that can result from improper backpack use. We can also design individualized fitness programs to help children get strong and stay strong—and carry their own loads! Stop in and see us today.

- Bassam S. Kassab, DPT, Regional Director

California Physical Therapy Association (CPTA) © 2003
MoveForwardPT 2015

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STINGERS AND BURNERS

Football season is around the corner and the risk of stingers is common. These injuries are more prevalent in contact or collision sports.  A burner or stinger is an injury to the nerves that travel from your neck and down your arm. The injury is named for the electric shock or lightning bolt that can spread from the shoulder to the hand. In most cases the symptoms are temporary and will quickly go away.

Anatomy:

Nerves come off the spinal cord and travel down from your neck to your arm. These nerves make your limbs and body move and have sensation. These groups of nerves are called the brachial plexus and these are nerves that are injured with a stinger.

How does it occur?

The injury often happens when the head is forcefully pushed sideways and down.  The nerves can be stretched or compressed.  This is seen during a football tackle or blocking incident. Football defensive players and linemen may suffer from this injury.

What are the symptoms?

The stingers are usually in one arm. They can last for seconds to minutes but in 5-10% of cases can last for hours or days. The most common symptoms are:

• Burning or electric shock sensation down one arm
• Arm weakness
• A warm sensation or numbness down your arm

How is it treated?

Remove the athlete from the sporting activity until symptoms resolve. Rest your neck and arms, use ice on neck and shoulders, take an anti-inflammatory, do exercises to strengthen neck. Chronic stiff necks may be treated with massage, joint mobilizations, heat, muscle stimulation, dry needling.

How can I prevent a stinger?

Keep your neck muscles strong! Use good techniques in contact sports. Do not strike with your head when blocking or tackling.

When can I return to my sport or activity?

Returning to your sporting activity will depend on how soon your nerves recover. You must have full  range of motion of your neck, to be able to look fully over both shoulders, flex your neck forward until chin reaches chest, extend your head and move in the direction of ear to shoulders. If  any of these motions cause pain or burning into your neck or shoulder you are not ready to return to your sporting activity.

Make an appointment today at PRG to be instructed in strengthening exercises to cervical and thoracic spine to avoid injuries.

Melissa Langston MHSc, PT, MTC  Mt Pleasant SC

References: photo image from bing.com/images of brachial plexus injury.  The Sports Medicine Patient Advisor.  Pierre Rouzier 1999, pg 169-171.
 

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Why New Moms Need Physical Therapy!

 Physical Therapy can be very beneficial to new mothers, mothers to be, and future mothers.  Unfortunately this is a fact not well known by the public or other health care providers.  Remember, you are your best advocate for your individual health care, especially during and after pregnancy.  Therefore, before you give birth, ask your doctor if they refer to physical therapy after giving birth.  Let them know how physical therapy can help.

Ginger Garner, a physical therapist and mother, from “Modern Mom”, gives us 4 reasons to how physical therapy can help mothers.  These reasons include:

1. Managing Urinary and Fecal Continence
2. Prevent Scar Tissue Adhesions & Pelvic Pain
3. Manage Low Back Pain
4. Wellness for Future Pregnancies and Daily Life

If you are already experiencing these symptoms during pregnancy, then you should get a referral, or visit us directly for physical therapy now.  Do not wait until after giving birth.
The American Physical Therapy Association’s 2010-11 report titled Today’s Physical Therapist: A Comprehensive Review of a 21st-Century Health Care Profession, states “physical therapists are committed to facilitating each individual’s achievement of goals for function, health, and wellness.” The core values of a physical therapist are “altruism, accountability, integrity, clinical excellence, social responsibility, and compassion.”

The Physical Therapists here at Physical Rehabilitation Group can help you maintain physical wellness before and during pregnancy, as well as restore wellness postpartum.   Contact one of our locations and see how we can help.

Physical Therapy can help improve your quality of life!
Please Read the article below for more information of how physical therapy can help you!

www.modernmom.com/e1287d20-3b3d-11e3-be8a-bc764e04a41e.html

Courtney B. Andrews, DPT, Cert. DN
Physical Rehabilitation Group, LLC
Northeast Columbia Office

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Dry Needling Q & A

Despite being a popular topic for our team to discuss, Functional dry needling remains one of the most asked about topics in our clinics.  Often even if the patient has a basic understanding of what dry needling is there are misconceptions about it that are worth reviewing.

1) Dry needling is NOT acupuncture: while the procedures look similar to the untrained eye, dry needling uses several techniques that vary significantly from traditional acupuncture.  For example, dry needles are placed directly into knotted muscle tissues or trigger points at the point of pain, whereas acupuncture often has needle placement in a variety of areas based on eastern medicine techniques.  They also require different certifications and therefore no dry needle certified therapist will ever market what they do as acupuncture.   If you are interested in acupuncture you will need to seek out a licensed acupuncturist.  

2) Dry Needling can help both chronic and acute injuries: Often patients believe because they have had pain for a long time they would not make a good candidate for dry needling.  This is false.  While chronic or long lasting pain can often take more needling sessions to see lasting results, chronic pain patients can make significant gains or have pain resolve completely with the use of needling.  Sometimes needling is the best option for chronic pain patients because it increases blood flow and healing response to the area in question.  Conversely, patients with a new injury are sometimes hesitant to have needling done because they are afraid the area will become more irritated.  However, with these cases pain is usually caused by increased muscle trigger points and needling can provide the quickest results, with the best cases showing immediate improvement. 

3) The needles are not treated with anything: Often patients are hesitant to have needling done because of this misconception.  One of the best things about needling is that the needles do not have any medication on them which means there are no side effects and no complications with other medications.  They can also be applied over metal (such as joint replacements) so there are fewer complications or exclusions with needling than with almost any other treatment available. 

4) Fibromyalgia and needling: Again there is a misconception that if you have fibromyalgia you are not a candidate for needling.  Some of the best results patients with fibromyalgia get come from needling.  Most fibromyalgia patients dislike deep pressure because it increases their soreness.  Needling allows muscle pain to be addressed in such a way that only the muscle being treated is affected; not the more superficial muscles above it thus reducing pressure sensitivity. 

5) Conditions that can be improved through needling: Many times patients believe that only spinal conditions can be improved with needling.  Again this is false.  Training in needling includes techniques to treat headaches, jaw pain, scar tissue restriction, Tendon and ligament pain (especially in knees and ankles), muscle treatments at every joint, and even treatments to the bottom of the foot or the palm of the hand.  The best way to be sure whether or not you are a candidate is to ask your therapist if there are techniques for your specific injury. 
At Physical Rehab Group we have therapists available at each location that are certified to needle and happy to answer any of your questions so that you don’t miss out on this very valuable tool.  Please talk to your therapist today and see what we can do for you.

--Kim Snider, PT (Irmo clinic)

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Concussion

What is a concussion?
A concussion is a mild form of traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head. A fall, or blow to the body can also cause concussion due to rapid movement of the brain within the skull. Concussions are usually considered a “mild” injury, however the effects may be serious and lasting. Some of the most common causes of concussion include falls, motor vehicle accidents, sports related injury, and assault.

Symptoms of a concussion
Symptoms of a concussion generally fall under 4 categories: Physical, Emotional, Cognitive and Sleep.

• Physical: Headache, nausea or vomiting, sensitivity to light/noise, blurred vision, dizziness, balance problems, neck pain
• Emotional: More emotional, irritability, sadness, anxiety
• Cognitive: Feeling slowed down, “in a fog,” difficulty concentrating or remembering, confusion
• Sleep: Sleeping more, or less, than usual

Symptoms can last days, weeks, or longer.  Recovery may take longer in children, teens, and older adults. Those who have had concussion in the past are at greater risk for future concussion, and may take longer to recover.

Recovery
Rest is very important after a concussion to allow the brain to heal. Healing will take time, and one should return to normal daily activities only after symptoms have reduced significantly. If symptoms return, or new symptoms begin, you may be resuming activities too quickly. Try to avoid activities that put you at risk for another concussion, as those with more than one generally experience more long-term effects.

How can Physical Therapy help?
When symptoms subside, your physical therapist can assist you in progression of activities to get you to your prior level of function, or return to sport for athletes. For older adults, balance therapy and gait training are important aspect of rehab to reduce risk for falls and future concussion. Dizziness is often associated with TBI, and is commonly due to inner ear dysfunction. In such cases, one may benefit from vestibular rehab in addition to balance therapy. Any musculoskeletal issues such as neck pain, muscle strain, tension headaches, etc. will also be address by your physical therapist. Participating in a comprehensive rehab program following concussion has been shown to get athletes back to sport sooner than those who do not participate in a rehab program.

References:
http://www.cdc.gov/concussion/pdf/Facts_about_Concussion_TBI-a.pdf

NCPTA 2013 Fall Conference Lecture by Corina Martinez and Michael Essa: Concussion Discussion: Comprehensive Concussion Management for Physical Therapists
 

--C Giles, PT (Spartanburg clinic)

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Is Your World SPINNING?

Dizziness is a common symptom of a vestibular disorder, and 35% of adults over age 40 experience a vestibular disorder. (1) Potential causes include certain medications, viral infections, head injury, cardiovascular disorders, or a reason may not be identified. Dizziness often limits people’s daily activities and significantly increases the risk for falls. Nausea, vomiting, neck and shoulder tension, fatigue, and headaches are also common. The good news is that vestibular rehabilitation can alleviate these symptoms.

Vestibular rehabilitation is a specialized form of physical therapy that uses individualized exercises to resolve symptoms of dizziness. Therapists usually ask questions regarding your specific sensation of dizziness, past medical history, current medications, and lifestyles changes as a result of dizziness. Various tests are used to determine the specific motions and/or positions that cause dizziness (this is the unpleasant part!) Other measurements include strength, range of motion, sensation, coordination, balance, and so forth. Specific exercises based on the findings may include canalith-repositioning maneuvers, head and eye coordination, vestibular desensitization, and walking and balance activities.

The most common vestibular disorder is Benign Paroxysmal Positional Vertigo (BPPV). (2) In this case, small crystals in the inner ear become dislodged and send false messages to the brain regarding head position. People with BPPV frequently experience a spinning sensation, nausea, and vomiting with head movements (like looking up, rolling over in bed, or standing up). Treatment involves canalith-repositioning maneuvers that move the crystals back into place. Many research studies have shown excellent resolution of symptoms using these techniques, (3) often with only a few sessions of vestibular rehabilitation.
Regardless of the cause of dizziness, vestibular rehabilitation will address the specific symptoms and help restore normal daily activities. So stop the spinning, stop the dizziness, and feel better! For more information check out the Vestibular Disorders Association (online at vestibular.org) or contact your physical therapist.

References:

1. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults. Arch Intern Med. 2009;169(10):938-944.

2. von Brevern M, Radtke A, Lezius F, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78:710-715.

3. Helminski J, Zee D, Janssen I, Hain T. Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review. Phys Ther. 2010;90(5):663-678.

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Achilles Tendonitis

Definition:  

Achilles tendonitis is an over use injury that occurs at the Achilles tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel bone.  This can occur with runners and over use activity.  Achilles tendonitis can be treated conservatively but in more severe cases can lead to tendon ruptures that can lead to needing surgical repair.

Symptoms:

• Mild ache in the mid lower leg or above the heel after activity
• Can experience tenderness or stiffness, especially in the morning, which usually improves with mild activity
• Tenderness
• Pain
• Swelling
• Difficulty with activity

Causes:

Achilles tendonitis is caused by repetitive or intense strain on the Achilles tendon, the band of tissue that connects your calf muscles to your heel bone. This tendon is used when you walk, run, jump or push up on your toes.
The structure of the Achilles tendon weakens with age, which can make it more susceptible to injury .

Treatment options:

• Medication such as anti-inflammatory drugs such as Aleve and Ibuprofen
• Physical therapy
• Orthopedic inserts for shoes
• If the Achilles tendon becomes ruptured surgical repair may be required

Physical therapy treatment options:

• Stretching and strengthening exercises
• Manuel therapy
• Ultrasound
• Electrical stimulation
• Cold and heat therapy
• Dry needling
• Other treatment options determined by your therapist at evaluation and during treatments

References:
www.webmd.com/fitness-exercise/picture-of-the-achilles-tendon
www.mayoclinic.org/.../achilles-tendinitis/.../con-20024518

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Sacroiliac Joint Dysfunction

One of the most common causes of low back and pelvic pain occurs with injuries to the sacroiliac (SI) joint and ligaments.  SI joint dysfunction is often difficult to diagnose, as the pain patterns are frequently mistaken for muscle sprains, hip bursitis or nerve irritation in the low back. 

Sacroiliac (SI) Anatomy & Function

The SI joint is located in the pelvis, linking the iliac bone (pelvis) to the sacrum (lowest part of the spine above the tailbone). This joint transfers weight and forces between your upper body and legs. It is an essential component for shock absorption to prevent impact forces during walking from reaching the spine.

The sacroiliac joint is stabilized by a network of ligaments and muscles, which also limit motion. The normal sacroiliac joint has a small amount of normal motion of approximately 2-4 mm of movement in any direction. The sacroiliac ligaments in women are less stiff than in men, allowing the mobility necessary for childbirth.

 Chief Complaints:

• Low back pain (below L5)
• Lower extremity pain (numbness, tingling, weakness)
• Pelvis/buttock pain
• Hip/groin pain
• Unilateral leg instability (buckling, giving way)
• Pain worse when standing and walking and eases when sitting or lying down
• Pain with movements, such as standing up from a sitting position, turning in bed or twisting/turning

How is it Diagnosed?

When you see your physical therapist, the therapist will ask you questions about your current condition, such as:

• When did the pain start?
• What happened to cause the pain?
• Have you experienced similar symptoms in the past?
• Where is the pain located?
• What specific movements/activities cause your pain?

A physical evaluation will then be conducted.  The therapist may examine the position of your spine, conduct strength tests of the hip, pelvic and lower extremity muscles, and gently perform movement tests to assess mobility and flexibility.  Specialized tests will also be performed to rule out any problems requiring other medical intervention. 

How can Physical Therapy Help?

Your physical therapist will then design a personalized treatment plan based on your evaluation and goals.  Treatment will include:

• Manual therapy – includes soft tissue release or massage for tight/sore muscle groups, muscle energy techniques to correct pelvic/SI joint alignment, joint mobilizations
• Flexibility exercises – stretching exercises to improve flexibility of tight muscles
• Strengthening exercises – focused on weak muscles including the abdominals, pelvic floor and buttocks muscles
• Body mechanics – recommendations for proper body mechanics while sitting, lifting and carrying objects will be made
• Modalities – hot and cold treatments, electrical stimulation (uses electricity to target nerve fibers that send pain signals to the brain in order to provide pain relief)
• SI belt – wearing a SI belt will provide support and stability to the SI joint during daily activities as your strength returns and flexibility improves

References:
https://treatingpain.com/condition/si-joint-dysfunction
http://www.mayoclinic.org/diseases-conditions/sacroiliitis/basics/causes/con-20028653
http://si-bone.com/patients/si-joint-pain/sacroiliac-si-joint-anatomy/
http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=dc362d89-aa6d-4cb7-af04-d9e31f654d08#HowCanPhysicalTherapistHelp

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Patellofemoral Pain Syndrome (PFPS)

Don’t jump or run into Spring with pain!  Do not allow anterior knee pain to take the hop out of your step!    - Ali Clark, MPT, North Grove

Patellofemoral Pain Syndrome (PFPS) is a term that refers to a number of overuse injuries that cause pain in the front (anterior) part of the knee.  This injury is commonly seen in runners, jumpers, and cyclists who all put an increased amount of stress on their knees while exercising, but PFPS can also be seen in nonathletes.  Many things may contribute to the development of PFPS.  Problems may include:

• Tightness or weakness in thigh muscles
• Kneecap in an abnormal position
• Increase in activities that put stress over the knee (example: running, jumping, twisting)
• Foot structure (flat feet)

The knee joint is made up of the lower end of the femur (thighbone) and the upper end of the tibia (shin bone) and the patella (kneecap).  Many ligaments and tendons help stabilize and support the knee, along with muscles that help support the knee joint and make movements easier.  The patella sits in a groove of the thighbone and helps you to bend and straighten your knee.

PFPS occurs when structures around and in the knee joint become painful.  Tendons, cartilage that lines the knee joint, and the fat pad beneath the patella all can be affected by pain.

So what are some symptoms?

• Dull ache or pain behind or in the front part of the patella
• Symptoms more noticeable with deep knee bends, walking down stairs, going down hills/inclines
• Pain after sitting for extended periods of time (as if sitting through a movie)
• Pain when standing after sitting for a long time
• Popping, cracking, or grinding sensation when you bend and straighten your knee

How can physical therapy help?

Physical therapy can help decrease your pain and improve your knee function.  It is important to get medical help early in order to prevent further damage of surrounding knee structures and even avoid surgery!  A variety of treatment techniques can be used by physical therapists to help alleviate pain and symptoms.  Treatments may include: 

• Pain management with use of therapeutic modalities (ultrasound and iontophoresis)
• Soft tissue mobilizations
• Taping and/or bracing to correct patellar positioning
• Stretching/strengthening of thigh/lower leg muscles that are specific to your impairments
• Patient education and body mechanic training for return to exercise/activities
• Home exercise programs

Each patient is unique with symptoms and therefore a customized physical therapy program will be developed based on a complete examination that addresses patient specific needs.  Call or stop in to one of our clinics for a visit and speak to therapist!

References:
Patellofemoral Pain Syndrome.  Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=A00680
Runners Knee.  Retrieved from http://orthosurg.ucsf.edu/patient-care/divisions/sports-medicine/conditions/knee/runners-knee/
 

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Do You Have “Tech Neck”?

- Do you get neck, shoulder, upper back, or arm pain?
- Do you suffer from headaches or neck “fatigue”?
- Do you wake up with a stiff neck in the morning?

  You may have what we call “Tech Neck”. It is an ailment that occurs from being in a flexed-forward position for too long such as texting, talking on the phone, computer use, driving, reading, watching TV, and even eating. These activities increase the amount of stress and strain on your neck by more than 10 times rather than in its normal lordotic state of shock absorption.

• 90% of adults have a cell phone
• 58% of adults have a smartphone
• 42% of adults own a tablet 

Normal posture places approximately 12 lbs of pressure on each cervical disc. The slightest forward head position triples it! This forward head position also compresses the muscles at the base of the skull which all causes herniated discs, osteoarthritis, degenerative disc disease, headaches, and muscle spasms.
One thing you can do is to begin evaluating the position your head and neck is during phone or computer use. A quick test to assess if your posture is close to normal is the “wall” test. Try standing against a wall with your shoulders, buttocks, and back of your head touching the wall with your eyes looking straight ahead. Although this is “normal” posture, not everyone can achieve it.
The great news is there is help and conservative treatment for “Tech Neck”. The take home message is not to ignore your signs and symptoms. The incidence for this problem has increased over the past few years.

How does Physical Therapy help?
  Physical Therapists have many techniques/forms of treatment that may help.  Treatments may include education in body mechanics and posture as well as  ergonomics, joint mobilizations, cervical traction, spinal stabilization and cervical  strengthening exercises, nerve glides, dry needling, and modalities such as  ultrasound or electrical stimulation. All patients are unique with their pain and  presentation and each treatment will address each patient’s specific needs. A complete  exam, including medical history and a review of your symptoms, can help diagnose  “Tech Neck” and determine its cause and a customized Physical Therapy plan of care  will be developed.
  You can take steps to protect your neck and improve your quality of life. The  therapist can help guide and make suggestions for your future care. The earlier you  get into therapy, the better the outcome may be. Call or stop in to one of our many  facilities for a visit.
- The Advance Healthcare Network. www.advanceweb.com. Copyright 2014.
- Pew Research Internet Project. www.pewinternet.org. 2014.
 

--Bassam S. Kassab, DPT, Regional Director

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Graston Techniques

What is it and how can it help me?

Graston is an advanced method of instrument assisted soft tissue mobilization that can be performed by a physical therapist, chiropractor or athletic trainer. Stainless steel instruments are used to aid the clinician in the detection and treatment of soft tissue dysfunctions. The instruments are used to comb over and catch on fibrotic tissue which identifies areas of restriction.  The therapist will then mobilize, reduce/reorganize fibrotic restrictions in the neuro-musculoskeletal system by using the graston tools. There are six different tools that can be used to assist the therapist in treating different areas in the body. 
Historically, graston has been shown to be effective in restoring function to acute and chronic injuries, and pre and post -surgical patients. Graston techniques can be coupled with soft tissue mobilization, exercise, dry needling and modalities to return a patient back to performance of functional activities. Patients will usually receive two to three treatments per week over a 2-3 week period.

Check out grastontechnique.com for certified clinicians and call Physical Rehab Group to get started on treatment to improve your quality of life.

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What is direct access to Physical Therapy?

What is direct access to Physical Therapy?

Direct access to physical therapy is the ability of patients to be evaluated and treated by a physical therapist without a referral from a medical doctor or other healthcare practitioner.  If you feel you have an issue or injury that may benefit from the skilled treatment of a physical therapist call one of our locations today and let a physical therapist help you.  Direct access can also be referred to as a self-referral.

The American Physical Therapy Association (APTA) has lobbied successfully in many states to help change the law to allow patients direct access to physical therapy. By having direct access in each state, physical therapist are recognized as the licensed professionals of choice to initially manage musculoskeletal and movement disorders in patients.

In the state of South Carolina, you can be treated by a licensed Physical Therapist without a referral/prescription for 30 days.  If treatment needs to be extended beyond these restrictions, a prescription from your physician, dentist, or healthcare practitioner would be required.

Why Is Direct Access Important?

Healthcare is expensive.  A system that allows the patient to directly seek the services of a physical therapist can help save healthcare dollars by eliminating unnecessary tests or other specialist referrals. Many conditions can be successfully evaluated and treated with no expensive diagnostic testing.

Is Direct Access Safe?

Some opponents of direct access to physical therapy services argue that patients may be put at risk if they visit a physical therapist directly. Physical therapists lack the ability to order certain diagnostic tests or prescribe medication to help manage pain.

To date, there is no objective data indicating that self-referral to physical therapy puts patients at increased risk. Also, there is nothing indicating that self-referred patients consume more healthcare dollars during or after their physical therapy care.

Physical therapists are also trained to recognize "red flags" that may signal the need for more invasive medical intervention.  These “red flags” might indicate a diagnosis that is out of a physical therapist’s scope of practice.  In those cases, referral to your physician or healthcare provider is made immediately.

Will Direct Access Physical Therapy be covered by my insurance?

Most insurance groups will cover physical therapy under direct access and self-referral.  Benefits/coverage will be verified prior to your initial evaluation in our clinic.  If your insurance plan does not pay for services under Direct Access you can then obtain a referral/prescription from your physician or you can choose to pay out-of-pocket.

If you are suffering from a musculoskeletal condition that causes functional movement limitations, use your best judgment when deciding which healthcare practitioner to see. A visit to your local physical therapist is a safe place to start on the road to recovery.  If you are unsure if physical therapy is right for you, a discussion with your doctor may be necessary to help you decide.

If you have any additional questions or concerns about becoming a Physical Therapy patient as direct access, please call one of our clinics nearest you and our educated and friendly staff will help you with any questions you may have.

Sources:
Pendergast J, Kliethermes SA, Freburger JK, Duffy PA. A comparison of health care use for physician-referred and self-referred episodes of outpatient physical therapy. Health Services Research.

APTA Direct Access in Practice http://www.apta.org/directaccess/

--Courtney B. Andrews, DPT, Northeast Columbia, SC
 

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Understanding the Role of TENS Application in Therapy

Not long ago a prominent company released a home tens unit to the public available “over the counter, without a prescription”.  Since then I have heard many patients ask why they should come to therapy if this product can “cure” their pain.  As a therapist, I cringe when that commercial comes on now, but it has made the PT community aware of the confusion surrounding the use of E stim units (such as the TENS unit) and strengthened our resolve to educate those around us as to when and why the unit would be used.

So what is TENS?
TENS stands for Transcutaneous Electrical Nerve Stimulation.  It is applied topically to the skin (meaning the skin is not punctured to place the electrodes at the muscle level) and it is used most often for pain control.  It is typically applied in a rehab setting either prior to a therapy session or directly after.  Home units have been available by prescription for many years, where medical necessity has been shown and training given on the correct use of the units.

How does it work?
TENS units apply a low level electric current over the site of pain, which is registered by the nerve endings in the body’s tissue.  These currents are translated to the brain essentially drowning out pain impulses and overloading the brain with information.  The brain is not able to process all of this information so the pain impulses that would normally be received by the brain are missed or drastically reduced.  This effect can last several hours.  Also the influx of neural sensation causes a release of endorphins from the brain which is the body’s “feel good” response.  The result is a temporary window in which the patient feels less or no pain. 

The takeaway:
Of course as health care providers we want our patients to have access to things that help them manage their pain.  However it is important to know how something works and why you would use it prior to attempting it.  Everyone knows someone who has taken over the counter medications for prolonged amounts of time to manage pain.  However, it is common knowledge that doing so does not “cure pain” and is not recommended.  The same applies to this situation.

 Home TENS units are NOT A CURE for pain.  They are a TEMPORARY source of relief and if overused become less effective.  The ideal is to use them as part of a rehab program to help to make exercises, functional activities and manual treatments more tolerable in order to eventually return to a pain free and functional life.  Unfortunately, the way they are currently presented to the public holds the danger that people in pain will use them incorrectly as a substitute for traditional therapies and continue in movements and activities that further injure themselves.  This creates a potential of long lasting injury and by the time they finally realize their need to see a professional, the pain relieving qualities of the modalities used will be less effective or completely ineffective, meaning their overall healing time will be longer. 

If you or someone you know is using an over the counter device to manage pain please make sure to seek the opinion of a health care professional to see what other options can be used to actually cure pain and not just cover it up.  You can also contact Kimberly Snider at 803-781-3353 or ksnider@physicalrehabgroup.com.

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Taking a Step in the Right Direction:  Managing and Treating Plantar Fasciitis

Heel pain, commonly diagnosed as plantar fasciitis, is a condition that is reported to occur in one in ten people.  The plantar fascia is made up of a strong fibrous band that starts at the heel bone and connects to the base of the toes.  It provides support to the bottom of the foot and assists the foot in absorbing shock during functional activities and mobility.  When this band of tissue becomes swollen or inflamed, it is called plantar fasciitis. 

The most common symptom with this diagnosis is pain and stiffness at the bottom of the heel.  The pain is usually worse early in the morning when taking your first steps or when standing/sitting for a while. 

You are more likely to get plantar fasciitis if you:
• Have high arches or flat feet
• Run long distances, downhill or on uneven surfaces
• Are obese or gait weight suddenly
• High a tight Achilles tendon (which connects calf muscles to heel)
• Wear shoes with poor arch support or soft soles

How can physical therapy help?

Physical therapists are trained to evaluate and treat plantar fasciitis.  Your physical therapist will work with you to develop a program to decrease your symptoms which may include:
• Stretching exercises to improve flexibility of Achilles tendon, calf muscles and plantar fascia
• Selection of correct/supportive footwear
• Selection of correct shoe inserts that will reduce stress to plantar fascia
• Manual therapy, that includes deep soft tissue mobilization of the plantar fascia as well as joint mobilization of foot and ankle
• Iontophoresis, a method to deliver a medication through the skin
• Application of ice to decrease pain and inflammation
• Taping of the foot with kinesio tape to provide short term relief

Take a step in the right direction - see us at Physical Rehabilitation Group if you are suffering from symptoms associated with plantar fasciitis! 

References:

1.  http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004438/

2. http://www.resultsphysiotherapy.com/study-shows-plantar-fasciitis-sufferers-improve-more-with-manual-physical-therapy/

3. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004438/

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Stand up to Back Pain during Pregnancy

Pregnancy brings on many changes in a woman’s body to support the growing baby. In nine months time, a baby grows from the size of a dime to an 8 pound watermelon. Many people believe that if you’re going to be pregnant, then you’re going to have back and/or hip pain. There are several pregnancy symptoms that are expected but there are also some that you can do something about. This is not always the case. It’s true that between 49-68.5% of women experience low back pain (LBP) with pregnancy and about 20% endure pelvic pain (Ostgaard 1991, Wang S 2004). You don’t have to suffer because physical therapy can help!

There are certain risk factors that leave you more susceptible to back and hip pain, such as pain with previous pregnancies or if you experienced back pain prior to pregnancy. For this reason, many women will avoid future pregnancies. Even after the baby is born, 86% of mothers continued to have back pain (Brynhildsen J. 1998).

Pregnancy puts your body through a lot of changes in 9 months. In turn, your posture, alignment in your back and hips, as well as they way you walk, all change. The forces on your joints, like your hips and your knees, can actually increase by 100%. Your muscles get stretched in not only your abdomen, but also your pelvic floor as well, leading to incontinence.

What can you do?

In physical therapy, we are trained to teach you specific exercises to strengthen susceptible muscles, as well as stretch ones that are tight. Your hips and back can get out of alignment with all of the hormonal changes that go on in your body and we can gently put them back in place, and then show you how to do it to keep them in place. In turn, this will help your body support the growing baby with less strain on your joints leaving you less vulnerable to future back and hip pain.

Pregnancy and back pain don’t have to go hand and hand. If you are pregnant or have back pain since you were pregnant, contact us and let therapy help. Do you want to be able to enjoy your pregnancy and your child, without having to worry about your back?  There is something you can do about it!
 

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Introduction to Golf

Please join us for our next FREE class:

“Introduction to Golf specific stretches”

What: How a golf-specific stretching program both at home and on the course, can help to prevent nagging injuries, improve your swing mechanics, and keep you on the golf course!

Date: 5/20/14

Time: 5:30 pm – 6:45 pm

Where: 115 Deacon Tiller Ct, Suite 2
Duncan, SC 29334 

Call with any questions or to reserve your spot as space is limited.
(864) 587-1921
 

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Rotator Cuff Tendonitis

What are the causes?
The shoulder joint is a ball and socket type joint in which the top part of the arm bone (humerus) connects with the shoulder blade (scapula).  The rotator cuff is a group of four muscles that attach the humerus to the scapula.  The rotator cuff muscles help raise, rotate, and stabilize the shoulder.  The tendons of the rotator cuff pass underneath bony area on their way to attaching to the humerus.  Rotator cuff tendinitis occurs when the tendon rubs along the bone causing irritation and inflammation of the tendon.  This can be caused by:

• Poor posture caused by activities such as leaning over a desk
• Jobs that require prolonged positioning of the arm such as job duties of dental hygienists, hair stylists, and painters
• Sports such as baseball or swimming that require repetitive overhead activity
• Muscle tightness and/or weakness causing muscle imbalances surrounding the shoulder
• Bone spurs (overgrowth of bone) that narrow the space where the tendon passes

Over time the tendon may wear down and fray like a rope.  This can result in a rotator cuff tear!

What are the symptoms?
Pain is typically located in the front of your shoulder and can radiate to the side of your upper arm.  The pain commonly occurs during the following activities:

• Overhead activities such as brushing hair, reaching into a cupboard, or playing an overhead sport
• Reaching behind your back to perform activities such as washing your back or tucking in your shirt
• Laying on the involved shoulder

You may also have weakness and loss of motion making it difficult to raise your arm above your head or reach behind your back.

How can physical therapy help?
Physical therapy can help to decrease your pain and improve your shoulder function.  It is important to seek medical care early in order to prevent further damage of the rotator cuff tendon.  Early treatment can help you avoid surgery!  Physical therapy may involve the following:
• Patient education:  A physical therapist will suggest certain movements and activities to avoid or modify to allow the tendon to heal.
• Pain management: A physical therapist may use modalities such as ice, electrical stimulation, or iontophoresis to help decrease your pain.
• Range of motion: A physical therapist will teach you motion exercises and stretches to increase your shoulder mobility.  They may also perform manual therapy techniques to improve your shoulder range of motion.
• Strengthening: A physical therapist will assess the strength of your rotator cuff and scapular muscles; the therapist will then determine which exercises are best for your specific impairments.

References:
Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008;466(7): 1539–1554.

Senbursa G, Galtaci G, Atay A. Comparison of conservative treatment with and without manual physical therapy for patients with shoulder impingement syndrome: a prospective, randomized clincial trial. Knee Surg Sports Traumatol Arthrosc. 2007;15(7):915-921.

Impingement syndrome.  Retrieved from http://my.clevelandclinic.org/orthopaedics-rheumatology/diseases-conditions/hic-impingement-syndrome-of-the-shoulder.aspx

Physical therapist’s guide to rotator cuff tendinitis. Retrieved from http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=1bd18bbc-e7ea-436d-bc9e-ffee9c4dbd87#.U151eBbF_ww

Rotator cuff problems.  Retrieved from http://www.nlm.nih.gov/medlineplus/ ency/article/000438.htm

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Spring in for FREE classes!

With springtime approaching, more people will be getting out and enjoying the beautiful weather.  There's no better time to take advantage of this FREE class offering! Class topics will vary, so it is best to call any of the upstate clinics or check our website at www.physicalrehabgroup.com.

Our first class, which was held on April 8th, 2014, “Yoga Stretching for Back Pain” was a success. Participants enjoyed the information gathered and really benefitted from the stretching techniques they learned.  Our next class, “Exercises to Improve Your Balance” will be held on Tuesday, April 22, 2014, from 12:15 – 1:30 at 1075 Boiling Springs Road, Spartanburg, SC  29303.  Balance problems which can range from just feeling “unsteady” to having a balance disorders. When you’re outside, whether it is just walking, playing golf, or working in the yard, if you’re feeling even a little “off”, then you could be in danger of falling and risk of injury. Not only will the class test your balance, we will also show you some balance exercises making sure you can perform them at home so that you will be able to see improvements within yourself. Please call to sign up if interested.

If you are interested and would like to sign up, have any questions or have a topic that you would like to suggest, please email or call any of our 3 upstate locations:  North Grove in Spartanburg, 864.582.0019, Spartanburg, 864.580.2001, or Duncan, 864.587.1921. Take advantage of the free classes so that you can better enjoy the warmer temperatures!

We’d love to see you there!

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Physical Therapy for BPPV

Physical Therapy for BPPV
--Amanda Stinson, PT

What is vertigo?
At least 10 percent of all ER visits are related to dizziness or vertigo.  Step one for treating these patients is distinguishing between dizziness and vertigo.  Unlike dizziness, vertigo is the false sense of movement (usually that either you are spinning or your environment is spinning around you).  Vertigo is the result of a disruption of your vestibular system.  Since your vestibular system plays an important role in your ability to balance, a disruption in the system can lead to falls and consequent injuries.

What is BPPV?
Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo.  Studies have shown that 2.4% of individuals will experience BPPV at least once in their lifetime.  BPPV is vertigo that is triggered by changes in the position of your head.  Episodes of vertigo are brief (typically less than one minute) and can occur when you look up, bend over, roll over in bed, or transition from laying down to sitting up.  You may also experience nausea along with the vertigo.  The good news is that BPPV is the most successfully treated cause of vertigo!

What causes BPPV and how do physical therapists test for it?
Vestibular organs housed in your inner ear detect changes in head position.  BPPV occurs when otoconia (small calcium crystals) from the vestibule make their way into one of the semicircular canals.  This usually happens spontaneously, but may also be the result of a head injury.  These canals have connections to the muscles that move our eyes.  Physical therapists are able to detect the presence of BPPV by watching your eyes as you move as your body changes position.  When BPPV is present, a nystagmus (rapid involuntary eye movement) will occur at the same time as you feel the vertigo. 

How do physical therapists treat BPPV?
Physical therapists must first determine which ear is affected and then which canal within that ear is the source of the problem.  Physical therapists can then use their knowledge of the anatomy of the inner ear in order to help guide the crystals out of the semicircular canals and back to their proper place within the vestibule.  In most cases, vertigo can be completely resolved within 1-2 treatments of physical therapy!

References: 

1) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117684/  

2) http://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo

3) http://www.med.upenn.edu/solomon/images/BPPV.pdf

4) http://www.emedicinehealth.com/benign_positional_vertigo/article_em.htm
 

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Golf season is upon us!

--Brandon Hardee, PT

This past weekend gave us all a taste of the weather that should be coming our way with Spring fast approaching. That means it’s time to hit the golf course. As we return to sport after a long layoff, it is essential that we pay close attention to proper mechanics and appropriate pre-post activity stretching in an effort to prevent injury. For golfers, that most commonly is low back pain. According to an article in a 2004 edition of The American Journal of Sports Medicine, low back pain is the most common musculoskeletal complaint experienced by both amateur and professional golfers.1

There are many possible causes of low back pain. According to a 2003 study, overuse accounts for over 80% of golf-related injuries.2 Other possible causes include poor swing mechanics, poor conditioning, impaired core stability/activation during swing, impaired spinal rotation, impaired posture, and impaired hip internal rotation of lead leg, just to name a few. It is important that you understand that having pain with your golf game is abnormal. No pain, no gain” is a fallacy. Whether the pain is in your mid to low back, hips, knees, wrist, or elbow you should consult a Physical Therapist or rehab professional to address those areas of pain in order to prevent chronic dysfunction and to get you back on the golf course pain free.

While it is impossible to give a general exercise routine to prevent the occurrence of low back pain, below are a few important stretching and strengthening activities that can be very beneficial in preventing the occurrence of such injury, and keeping you on the golf course. If you have previously had surgery on the hip or spine, you should consult your physician and/or rehab professional before attempting these exercises.

Home Exercise Program
Feel free to contact us at any of our clinics throughout South Carolina to find out how we can help you stay on the golf course with a stretching and stabilization program fit to your specific needs based on a thorough evaluation.

References:
1) Vad VB, Bhat AL, Basrai D, Gebeh A, Aspergren DD, Andrews JR. Low back pain in professional golfers: The role of associated hip and low back range-of-motion deficits. Am J Sports Med. 2004;32(2):494-497.
2) Gosheger G, Liem D, Ludwig K, Greshake O, Winkelmann W. Injuries and overuse syndromes in golf.Am J Sports Med. 2003;31(3):438-443.
3) Lindsay D, Horton J. Comparison of spine motion in elite golfers with and without low back pain. J Sports Sci. 2002;20(8):599-605.

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Feeling your Sciatica is a “pain in the butt”?

--Bassam S Kassab, DPT,  Regional Director

Sciatica, pronounced (sigh-at-ih-kah), describes the symptoms of leg pain and possibly tingling, numbness or weakness that originates in the lower back and travels through the buttock and down the large sciatic nerve in the back of the leg to the foot.  The nerve might be pinched inside or outside of the spinal canal as it passes into the leg.  The pain might be worse when you sit, cough, or sneeze.  Sciatica may occur suddenly or it can develop gradually.  Less common symptoms might include the inability to bend your knee or move your foot and toes.

Many reasons exist as to why the sciatic nerve may be symptomatic.  Common problems resulting in sciatica may include a lumbar herniated disc, spinal stenosis, tightness from muscles or misalignmant of the pelvis, arthritic spurs of the spine, and spondylolisthesis.

Feeling concerned that these symptoms are here to stay and there is little you can do about these symptoms is common.  Fortunately, Physical Therapy can be very effective in treating these symptoms.

How does Physical Therapy help?

Physical Therapists have many techniques/forms of treatment that may help.  Treatments may include education in body mechanics and posture as well as ergonomics, muscle energy techniques, mobilizations, spinal stabilization and core strenthening exercises, nerve glides, dry needling, and modalities such as ultrasound or electrical stimulation.  The best therapy treatment for someone with sciatica varies greatly from person to person secondary to the many reasons the sciatica may be present.  All patients are unique with their pain and presentation and each treatment will address each patient's specific needs.  Therefore a customized Physical Therapy program will be developed.  A complete exam, including medical history and a review of your symptoms, can help diagnose sciatica and determine its cause.

You can take steps to protect your back and leg and improve your quality of life.  The therapist can help guide and make suggestions for your future care.  The earlier you get into therapy, the better the outcome may be.  Research recommends seeing a Physical Therapist with 3-4 weeks of onset to optimize outcomes.  Call or stop in to one of our many facilities for a visit.

--Goodman, Boissonnault, Fuller, Pathology. 2nd ed. Philadelphia, PA: Saunders: 2003. The Cleveland Clinic Foundation. copyright 1995-2010. www.spine-health.com Copyright 1994-2014.

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Scoliosis

Scoliosis is a medical condition that refers to an abnormal curvature of the spine. Most people’s spine are straight up and down from the cervical to sacral region. With scoliosis there is a lateral (side to side) curvature. The side to side curve can be a single “C” or double “S” curve. In a 3 curve (S) scoliosis the shoulder girdle, rib cage and pelvic girdle can be involved. This curvature usually begins or is noticed during the rapid growth phase that occurs with puberty.

The spine does not move in a one dimensional plane, therefore scoliosis will almost always develop in a three-dimensional pattern/distortion. This twisting actually rotates the vertebral bodies of the spine toward the convexity and the spinous process toward the concavity side of the curve. This positioning will require exercises to improve rib breathing and de-rotational exercises to improve alignment. Since scoliosis usually starts with a developing child parents can look for certain signs of one shoulder or hip higher than the other, rib hump, waist looks uneven or the child may favor or lean to one side. If any of these signs are present make an appointment with your MD for an accurate diagnosis. According to the National Scoliosis Foundation, available evidence suggests that exercise is beneficial and can improve breathing, posture, and self-esteem.

If you or your child has scoliosis call one of our many clinics to make an appointment with a Physical Therapist to get started on your individual exercise program to improve your quality of life.

References: National Scoliosis Foundation; Exercise and Adults with Scoliosis and Exercise for Adolescents Otman S., Kose N, and Yakut Y. (2005). The efficacy of Schroth’s 3-dimensional exercise therapy in the treatment of adolescent idiopathic scoliosis in Turkey. Saudi Medical Journal, 9, 1429-1435.

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Chronic Headaches - Physical Therapy Can Help You!

Are you someone that experiences headaches weekly, monthly, or even daily? Then you might benefit from physical therapy treatment. Headaches can be caused by a large range of conditions such as vascular problems, sinus issue, muscular issues, and joint related issues to name a few. Physical therapists can treat headaches that originate from the musculoskeletal system and are commonly caused by muscle tightness, decreased joint range of motion, spinal disc pathologies, poor posture, TMJ (Temporomandibular joint) dysfunctions, and many more. Living with chronic headaches can affect many aspects of our everyday lives. Studies note, at the age of 40, 70-80% of females and 60% of males report experiencing headaches in the US (Scher et al. 1999), and a lifetime prevalence is noted between 83-93% (Boardman et al. 2003). These reports show that the majority of the population will experience headaches at some point in their lives. Persistent headaches that are musculoskeletal in nature may not go away completely without the cause being addressed in physical therapy. In order for a physical therapist to diagnosis you with a musculoskeletal issue as the cause of your headaches, they would need to do a thorough and hands on evaluation. They would then address your cause or causes by using different treatment methods including soft tissue mobilization, trigger point dry needling, joint mobilization, ergonomic training, postural education, etc. Physical Therapy treatment for headaches can be very effective and could work quickly with proper intervention and education. Contact one of our locations nearest you and see how one of our Physical Therapist can help you become “headache free.”

References: Courtney N. Brasfield, DPT, Clinic Manager Northeast Columbia, Physical Rehabilitation Group, LLC. Scher Al, Stewart WF, Lipton RB (1999). Migraine and headache: a meta-analytic approach. In: Eds Crombit IK, Croft PR, Linton SJ, Lefesche L, Vonkorff M. Epidemiology of Pain. IASP Press, Seattle. Boardman HF, Thomas E, Croft PR, Millson DS (2003). Epidemiology of headache in an English district. Cephalalagia 23. 129-137

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Physical Therapy and TMJ Disorder.

What is TMJ disorder?
TMJ disorder or Temporal mandibular joint disorder is a common problem facing an estimated 20-30% of the adult population.  It is hallmarked by pain in the joint (where the mandible or jaw meets the skull), sometimes referring to nearby teeth, restriction in jaw mobility and popping or clicking with jaw movement.   Severe cases restrict diet and sometimes require surgery. 

Who Gets TMJ disorder?
Studies show that TMJ suffers tend to be otherwise healthy adults between the ages of 20-40 years with disc displacement rates peaking at age 30 and degenerative joint problems common after age 50.   For reasons unknown, females tend to develop the condition more often than males. 

What can be done for TMJ disorder?
The growing trend of treatment encompasses physical therapy in conjunction with dental interventions and splinting.  Physical therapists use a combination of stretching, joint mobilization, soft and deep tissue release, modalities and functional dry needling (FDN) to improve the quality of movement in the joint.   Dentists can fit patients for splints and night guards as well as other interventions to improve natural alignment.  With this combination of treatments prognosis for recovery is good. 
Recently several members of PRG have undergone additional training to better provide relief for this disorder so check today to see if TMJ physical therapy interventions are for you!

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Happy Halloween from Mt Pleasant

Congrats to our Mt Pleasant Clinic for finishing the "2013 Running Scared" run!

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Happy Halloween from North Grove

Every BODY needs Physical Therapy!!!!!

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Kinesio Taping as an adjunct to Physical Therapy

When watching the 2012 London Summer Olympics, did you find yourself asking, "What is that and why are athletes wearing tape on their body?" It's called Kenesio tape and it was designed in the 1970's by Kenzo Kase, a Japanese chiropractor and acupuncturist. His goal was to design a taping method that wasn't as restrictive as the typical athletic tape and one that could help with the body's healing process.

Kensio tape is a "flexible, latex-free tape that can be used on a wide array of populations from pediatric to geriatric, and can help treat a variety of orthopedic, neuromuscular, neurological, and other medical conditions." It's a taping technique that facilitates the body's natural healing process while providing support and stability to muscles and joints without restricting the body's range of motion. It is applied over muscles to reduce pain and inflammation, relax overused muscles, and to facilitate muscles in movement.

Physical therapists can use kinesio taping in combination with exercise, manual therapy and other forms of treatment for a variety of diagnoses. In order for the tape to be properly used in the outpatient physical therapy setting, an evaluation/assessment is needed prior to application of the tape. Once the target area is identified, the tape can be applied and pulled to different degrees of tension depending on the desired effect and result. Physical therapists and other health care providers can use the kinesio tape as an adjunct to other forms of treatment in order to provide the best outcome for the patient.

Uses for kinesio taping:

• Carpal tunnel syndrome
• Low back pain
• Knee conditions
• Rotator cuff injuries
• Tennis elbow
• Plantar fasciitis
• Patellar tracking
• Pre and post surgical edema
• Ankle sprains
• Postural re-education

Many of our PRG clinics offer kinesio taping - ask your physical therapist today how this taping method can help you during your rehabilitation!

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The MCU and Neck Pain

The Multi-cervical Unit (MCU) is a valuable tool that Physical Rehabilitation Group has available for you. It’s basically a machine that measures the motion and strength of your neck, and then, based on these findings, it is able to design a strengthening program for you to target the specific muscles that are weak. The MCU is able to show you the exact deficits you are having whether it is lack of motion or strength, in graphs and other visual aids available to you in great detail.

The MCU is used on patients who suffer from neck pain whether it’s from muscle tension headaches, herniated disc, whiplash, or arthritis in that it can progressively strengthen your neck while improving motion. When you’re having pain, whether chronic or acute, this can cause the muscles to get weak leaving you more susceptible to muscle spasms, poor posture, and in turn more pain and weakness. Since the MCU is able to identify weakness in particular muscles, we are able to strengthen those particular muscles. As Physical Therapist, the MCU allows us to obtain such detailed and accurate measurements that cannot be assessed any more precisely in any other way.

There have been numerous research articles out there that document the effectiveness of the MCU showing over 75% of patients improving with a history of chronic neck pain. Not only have there been improved results with increased motion but also strength with the MCU.  According to an article in Advance for Physical Therapy and Rehab Medicine entitled “Pain in the Neck”, when using the MCU:

• “…..nearly two-thirds of people with neck dysfunction and pain improved more than 60 percent of their perceived disability and more than doubled strength in the cervical musculature. Recent reported outcomes by Keating confirmed that up to 56 percent of patients with chronic neck pain make statistically significant improvements by using a multi-cervical unit. As a treatment device and evaluation tool for cervical dysfunction, a multi-cervical unit promotes improved treatment outcomes and creates the opportunity for better, more advanced research-supported treatment.”

If you are suffering from neck pain and are interested in learning more, contact our offices. The MCU is currently available in Spartanburg, Mt. Pleasant and Florence with more offices utilizing this in the future.

For further resources and reading:

http://www.btetech.com/mcu.htm
http://physical-therapy.advanceweb.com/Article/Pain-in-the-Neck-1.aspx

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How Trigger Point Needling can help you!

Brandon Hardee, PT, Clinic Manager – West Grove

Trigger point dry needling (TDN) is a treatment for muscular tightness and spasm, also known as trigger points, which commonly follows injury and often accompanies the degenerative process. These trigger points can be caused by poor posture, repetitive movements, poor movement patterns, trauma, joint and soft tissue restrictions, and can result in referred pain. Referred pain is pain which is perceived at a location different from that of the painful stimulus (see figure below). TDN involves the use of a fine filament form needle (typically seen in acupuncture) to treat a trigger point/dysfunctional tissue. The primary goal of treatment is to desensitize supersensitive structures and restore motion and function. TDN can be an effective method of treatment for, but not limited to:

• Cervical spondylosis
• Lumbar spondylosis
• Chronic headaches
• Knee pain
• Hip pain
• Radiculopathy
• Chronic back pain
• Shoulder pain
• Scapular pain
• Medial epicondylitis (golfers elbow)
• Lateral epicondylitis (tennis elbow).

Please stop by one of our many South Carolina locations to find out if Trigger Point Dry Needling is a treatment option for you. The following clinicians are trained and ready to help you at the following locations:

David Pegram, PT – Spartanburg, Blanding, Laurens
Bassam Kassab, DPT – Mt. Pleasant
Brandon Hardee, PT – Duncan, Spartanburg, Laurens
Kim Snider, DPT - Irmo

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APTA Responds to Dr. Oz Show Regarding Segment on ‘Cutting-Edge Solutions for Back Pain’

by Bassam S. Kassab, DPT
Regional Director

“It’s important for people, including all medical professionals, to realize that Physical Therapy treatment involves more than just ‘Ultrasound’ and ‘Tiger Balm’. The APTA did a great job critiquing Dr. Oz’s statement on a recent episode. Check out the article.”

[APTA Responds to Dr. Oz Show Regarding Segment on 'Cutting-Edge Solutions for Back Pain']

February 5, 2013
"Dear Producer:

APTA takes exception to the portrayal of ultrasound, Tiger Balm patches, and bumpy balls as "cutting-edge physical therapy treatments" for back pain in your recent segment "Cutting-Edge Solutions for Back Pain."

While modalities may be used by physical therapists as part of an overall treatment plan, the focus of physical therapy treatment for back pain is on evidence-based exercises to improve strength and flexibility, manual therapy to improve the mobility of joints and soft tissues, and patient education on ways to enhance recovery, prevent and relieve pain, and avoid recurrence.  These avenues of care offer long-term solutions rather than temporary, intermittent relief.

In addition, physical therapists advocate an individualized approach to treating back pain. Each patient is unique and is much more than the pain that he or she experiences. Patient goals, preexisting conditions, and comorbidities must be taken into account in order to provide patients with a valid, nonsurgical option that can restore and improve motion. The Low Back Treatment Guidelines published in the Journal of Orthopedic and Sports Physical Therapy clearly illustrate this approach.

Also noteworthy is a 2012 study published in the scientific journal Spine showing that early access to physical therapy by patients with low back pain improved patient outcomes and decreased health costs. Other studies have shown that physical therapy can be a cost-effective alternative to long-term use of prescription drugs or surgery. For instance, a 2012 study, also appearing in Spine showed that patients who received physical therapy soon (within 30 days) after an episode of acute low back pain had a lower risk of subsequent medical service usage (surgery or epidural steroid injections) than did patients who received physical therapy after a longer period of time had elapsed. In addition, a 2010 study in the Journal of the American Medical Association (JAMA) highlights the rise of complex and risky spinal fusion surgeries among Medicare patients with simple spinal stenosis, confirming the need to look at alternative methods of treatment such as physical therapy.

It is vital that consumers are made aware of the fact that physical therapists can help them with their back pain. To that end, we are pleased that Dr. Oz sought the advice of a physical therapist. However, viewers would have been much better served had they been educated on the breadth of evidence-based treatment approaches and the customized care available to them from a physical therapist.

Your viewers may learn more about conditions physical therapists treat and find a physical therapist in their area by visiting www.moveforwardpt.com.

Yours sincerely,

Paul A. Rockar, Jr, PT, DPT, MS
President
American Physical Therapy Association"

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