These are some components that I think physicians should look for when they receive Plan of Cares back from a Physical Therapist.  Notice that all of these should require one on one training, and use very little modalities!!

Therapeutic exercise covers a wide range of exercise activities and techniques. Exercises includes stretching, range of motion exercises, strengthening exercises, neuromuscular re-education, breathing exercises, aerobic and muscular endurance activities, aquatic exercise, gait training, balance and coordination training, posture awareness, body mechanics and ergonomic training. Therapeutic exercise is on of the main rehabilitation tools used to correct impairments in alignment, muscle length, and pattern of movement to restore function and improving existing ability. Manual Therapy

Manual therapy is a systemic method of evaluating and treating dysfunctions of the neuromuscular skeletal system in order to relieve pain, increase or decrease mobility, and normalize function. Dysfunctions of the joints between vertebrae, ribs or joints may be corrected through manual therapy techniques. Once proper alignment of the spine or biomechanical alignments of joints are achieved, proper function is maintained through neuromuscular activity, posture awareness training and movement training. Manual therapy includes joint mobilization, manipulation, muscle energy and neural mobilization. Muscle Energy

Muscle energy is a direct, manual therapy technique to improve spinal alignment, increase range of motion, normalize muscle tone and decrease pain. This technique was developed by and osteopath and improves the biomechanics of the spine and extremity joints. The client has full control with this type if adjustment. After specific positioning, the client contracts a specific muscle to realign the joint involved. This creates a muscle balance around the joint that helps to maintain the alignment.

Neural Mobilization
The nervous system like the muscular system needs to be flexible and mobile for normal movement. Injuries and surgeries affect the nervous systems ability to “glide” properly throughout the body. Neural mobilization is the technique used to restore the proper pain free mobility of the nerves in the arms and legs. The therapist uses a specific movement when guiding the client’s extremity to facilitate the nerve to glide.

Strain/Counterstrain
This technique is derived from the work of osteopath, Lawrence Jones. It is used to reduce hypertonicity in both protective muscle spasm and the spasticity of neurologic manifestation. Orthopedic clients enjoy improved function and decreased pain with increased motion. Chronic pain patients experience decreased discomfort, possibly less inflammation and more functional movement.

Myofascial Release (aka soft tissue mobilization)
Myofascial release is a technique used to develop a well-balanced, mobile body within the skeletal and soft-tissue systems. The fascial system consists of connective tissue sheaths that spread throughout the body in a three-dimensional web. Fascia is connective tissue and provides a structural, protective and nutrition role in the support of the body. Restrictions within the fascial system can contribute to pain and decrease in function. These restrictions can be caused by postural imbalances, trauma, surgery, inflammation, abnormal tension and pressure. Fascial mobilization decreases pain, increases joint motion, and restores balance to the musculoskeletal system.

McConnell Method Taping is a technique used for patellofemoral syndrome, plantar fascia, and scapulothoracic and hip joint dysfunctions. It is used to improve contact areas for weight-bearing cartilage, improve alignment and assisting in restoration of normal movement patterns, alter length-tension properties of muscle, stretching of shortened tissue and unloading of inflamed or injured tissues.

Balance and Coordination
Improve your balance and coordination, decrease chance of falls and improve your recovery from the floor. Our therapists will prescribe home and clinical exercises based on a functional and dynamic approach to address your balance and coordination deficiency. Your exercise program will carry over into your sports and activities of daily living.

Posture Awareness Training
Posture is generally an indicator of a person’s overall health. Poor Posture can be an indication of muscle imbalance, or compensatory changes in the spine. Our Physical therapists can prescribe exercises for posture correction and prevention. We also offer a computerized posture analysis that provides detailed information about your postural faults.

Body Mechanics/Ergonomics
Many injuries can be prevented by the use of good body mechanics. By using proper body mechanics, the body is placed in its optimal alignment for the task at hand. Using proper body mechanics can reduce joint stress, strain and fatigue, and reduce the risk of overuse injuries. Ergonomic education enables a client to understand how their body is affected by any objects which he is interacting with; such as computer station or driving position in a vehicle. Clients are shown different ways to modify these arrangements so they can prevent or reduce injury. Good body mechanics and ergonomic environments are essential in the prevention and treatments of back and neck pain.

Movement Training
This is a method of diagnosis and treatment for movement impairment syndromes as classified by Shirley A Sahrmann PT, PhD, FAPTA. Examination involves identifying impairments in alignment, muscle length, and pattern of movement and their relationship to musculoskeletal pain syndromes. Physical therapists develop precise therapeutic exercise programs and correct faulty posture and movement associated with functional activities.

UNIQUE SKELETAL MUSCLE DESIGN CONTRIBUTES TO SPINE STABILITY

Published by Tamer Issa, PT, DPT, OCS at 12:52 pm under Arthritis, Benefits of Physical Therapy, Dry Needling, Exercise, Low Back Pain, Spinal Conditions

ScienceDaily (Jan. 7, 2009) — The novel design of a deep muscle along the spinal column called the multifidus muscle may in fact be key to spinal support and a healthy back, according to researchers at the University of California, San Diego School of Medicine.

Their findings about the potentially important “scaffolding” role of this poorly understood muscle has been published on line in advance of the January issue of the Journal of Bone and Joint Surgery.

“The multifidus muscle was formerly thought to be relatively unimportant based on its fairly small size,” said Richard L. Lieber, Ph.D., Professor and Vice Chair of UC San Diego’s Department of Orthopedic Surgery and Director of the National Center for Skeletal Muscle Rehabilitation Research, based at UC San Diego. Lieber is also Senior Research Career Scientist at the Veterans Affairs San Diego Health System. “Our research shows that it’s actually the strongest muscle in the back because of its unique design. It’s like a long, skinny pencil packed with millions of tiny fibers.”

The researchers discovered that the multifidus has a unique packing design consisting of short fibers arranged within rods, and that these fibers are stiffer than any other in the body. Using laser diffraction methods that they developed to measure muscle internal properties during back surgery, they demonstrated that the multifidus’ unique design serves a critical function as a stabilizer of the lumbar spine. These findings could have implications for surgery, according to Steven R. Garfin, M.D., Professor and Chair of UCSD’s Department of Orthopaedic Surgery.

“It is important to identify what each individual muscle does, and this is just a start, showing that the multifidus contributes significantly to spinal stabilization,” said Garfin. “The more we know about what muscles do, the better we can devise therapeutic interventions such as physical therapy to target specific muscles.”

Garfin explained that currently surgery to treat spinal disorders could actually disrupt the multifidus muscle, which could lead to decreased stabilization and lower back pain. Minimally invasive spine surgery techniques strive to minimize surgical trauma to these muscles in order to best preserve their function.

The lower back, or lumbar spine, can be vulnerable to many pain-causing injuries or disorders because the lumbar vertebrae carry the most body weight and are subject to the most force and stress along the spine. Muscular instability is a risk factor in many injuries and consequent chronic lower back pain, according to Lieber.

“The multifidus back muscle keeps us vertical and takes pressure off the discs,” said Lieber. “When muscle function is poor due to back problems, support is lost.”

He explained that many muscles get weaker as they are extended. But the researchers discovered that, unlike all other muscles, the multifidus actually becomes stronger as it lengthens, when the spine flexes.

“The length of the sarcomere—the structure within the muscle cell where filaments overlap to produce the movements required for muscle contraction—is shorter in the multifidus than in any other muscle cell,” explained study’s first author Samuel R. Ward, P.T., Ph.D., Assistant Professor of Radiology at UC San Diego School of Medicine. “But as it gets longer, for instance as a person leans forward, the multifidus actually strengthens.”

Contributing authors to the study include UCSD researchers Choll W. Kim, M.D., Ph.D., Carolyn M. Eng, B.S., Lionel J. Gottschalk, B.S.; and Akhito Tomiya, M.D., Ph.D. Tohoku University School of Medicine, Sendai, Japan. Research was supported by the Department of Veterans Affairs Rehabilitation, Research and Development; the National Institutes of Health and DePuy Spine of Raynham, MA.

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Adapted from materials provided by University of California - San Diego, via EurekAlert!, a service of AAAS.

DRY NEEDLING- A REVOLUTIONARY APPROACH TO TREATING MUSCLE PAIN

Published by Tamer Issa, PT, DPT, OCS at 12:30 pm under Dry Needling, Myofascial Pain, Pain

Myofascial pain syndrome is a common muscle pain condition that is often overlooked in medical and clinical practice settings today. It is often characterized as a chronic pain condition and confused with fibromyalgia syndrome. In reality, myofascial pain can be acute or chronic in nature.  Myofascial pain is characterized by the presence of myofascial trigger points, which are hyperirritable contraction knots found in tight bands of muscles. Trigger points can cause localized pain or can refer pain to other areas of the body. A muscle that is burdened with trigger points could lose its flexibility, strength and coordination which may contribute to the formation or sustenance of other musculoskeletal problems. Myofascial trigger points are treated by various medical practitioners in numerous ways, including by injections, dry needling, manual techniques, massage therapy, stretching, and relaxation techniques.

Dry needling is an effective and efficient therapy method for the treatment of myofascial trigger points.  Trigger point dry needling is performed by medical doctors, physical therapists, nurses, chiropractors, and dentists that are specifically trained in the technique. The approach is based on Western anatomical and physiological principles. The technique utilizes fine solid acupuncture needles to release trigger points in muscle, but in all other aspects it is different than traditional acupuncture. Other terminology used to describe similar techniques to dry needling includes intramuscular stimulation (IMS) and twitch-obtaining intramuscular stimulation.

Dr. Janet Travell first described trigger point injections in the early 1940’s. Injections are performed by injecting trigger points primarily with saline or analgesics. Through the years it has been shown that it is not the substance that is being injected that is providing the therapeutic benefit, but rather the mechanical stimulus of the needle hitting the trigger point. When a needle tip hits a trigger point, a characteristic ‘local twitch’ is noted by the clinician and the client. This local twitch is involuntary. It has been shown that the elicitation of local twitch responses is the most important aspect in obtaining a successful therapeutic outcome for trigger point deactivation. There are a number of hypotheses as to the reasons why dry needling works. Dry needling and the subsequent local twitch responses may mechanically disrupt the contracted nature of the trigger point. Dry needling stimulates certain sensors in the body which modulate pain signals. Dry needling and the subsequent local twitch responses can cause local biochemical changes and result in an increase of blood flow in the trigger point area.

The benefits of trigger point release through dry needling include a decrease in the tightness and the pain associated with a particular muscle. Often times an immediate improvement is noted. Dry needling is tolerable for most, but not all people. A limited amount of muscle soreness is to be expected for 1-2 days, after which the soreness resolves. Dry needling is never used as an isolated treatment; it is followed by myofascial release and soft tissue work to minimize soreness and to maximize connective tissue flexibility. Other important aspects of musculoskeletal improvement of pain and function requires addressing possible contributing factors which includes the presence of joint or spinal dysfunction, postural imbalances, poor coordination of movement and poor posture and body mechanics with activities of daily living.

Not all medical professionals are trained in the assessment or treatment of myofascial trigger points. Trigger point dry needling requires highly specialized training. One must be adept at finding trigger points before one can attempt to treat them. If you have suffered of pain or tightness of muscular origin, I would urge to consider the possibility of trigger point dry needling as a treatment option. It has made a world of difference in many people’s lives.

Archive for the 'Dry Needling' Category

Mar 16 2008

DRY NEEDLING- A REVOLUTIONARY APPROACH TO TREATING MUSCLE PAIN