What is evidence- based medicine? How can it help you get out of musculoskeletal pain?
Evidence-based physical therapy (EBPT) has been defined as “physiotherapy informed by relevant high quality clinical research” (Herbert, Jamtvedt, Mead & Hagen, 2005, p. 1).
“The practice of evidence-based physiotherapy should be informed by the integration of relevant high quality clinical research, patients’ preferences and physiotherapists’ practice knowledge” (Herbert, p. 2).
In the event that high quality clinical research is not available, good practice must make use of other sources of information such as peers, practice guidelines, practice knowledge, and any other lower quality research to inform action in practice.
Why practice (EBPT)? The practice of EBPT really comes from making the “cost effectiveness of physiotherapeutic intervention in comparison with other … treatment, or no treatment at all” make clinical sense (Koes, 1997).
Another reason for the existence of EBPT, is because it is “the best strategy clinicians can use to cope with the potential chaos and uncertainty of modern clinical practice, and to meet the ethical imperative of providing the best possible care for our patients” (Sherrington, Moseley & Herbert, 2001, p. 125).
Goals of (EBPT). Following evidence based practice procedures helps to:
• make sure that all decisions made for patient care take into account “the best available evidence”
• better plan and evaluate service delivery
• better analyze research studies and direct those findings to better care
• take better measurement and do interpretation of outcomes to provide the best care possible
• provide better patient information
• better understand the reasons for lack of compliance by patients in relation to their PT care
• accurately gauge the relationship between patients and physical therapists and its effect on health-related outcomes.
• develop theories based on evidence in practice.
Evidence Based Physical Therapy research and hands on treatments have substantiated that the below mentioned modalities when performed by a skilled licensed physical therapist will improve shoulder range of motion, improve strength, decrease pain and improve functional daily activities. These modalities include: strengthening exercises for scaplular stabilizers (serratus anterior, rhomboids, middle and lower trapezius) and rotator cuff muscles; soft tissue mobilization (massage) especially to the pec. Minor, supraspinatus/infraspinatus/subscapularis; gentle glenohumeral joint mobilizations; and self capsular mobilization with tennis ball as I demonstrate in this video…..CLICK HERE to see how you can floss away your pain.
If you would like more information about how you can help yourself get out of pain or would like to consult with me regarding Physical Therapy for your shoulder or other aching/painful body parts please contact me at gregsterner@fitnesstogether.com or call 619.756.7500.
Greg Sterner, Licensed Physical Therapist, Owner
Fitness Together Point Loma @ Liberty Station
Floss Away Your Shoulder Pain with Evidence Based Physical Therapy Techniques
How to use FMS (Functional Movement Systems) and Corrective Exercise to improve your movement.
Today we are going to dig a little further into FMS. What is FMS (Functional Movement Systems)? How it Can Help You?
If you are and athlete or have pain possibly caused by a faulty movement pattern, continue to read. The Functional Movement Screen captures fundamental movements, motor control within movement patterns, and competence of basic movements uncomplicated by specific skills. It determines the greatest areas of movement deficiency, demonstrates limitations or asymmetries, and eventually correlates these with an outcome and score. Once the greatest asymmetry or deficiency is observed, then specific corrective exercises are prescribed to facilitate proper movement sequence and form.
Nike, Titlelist, and the N.F.L combine now all incorporate FMS into their athletes training protocols. There has been a dramatic shift in the physical therapy world over the past decade in now attempting to improve movement patterns with corrective exercise versus just trying to strengthen weakened, isolated muscle groups.
Test 1: Deep Squat:
The squat is a movement needed in most athletic events. It is the ready position and is required for most power and lifting movements involving the lower extremities. The deep squat is a test that challenges total body mechanics when performed properly. It is used to assess bilateral, symmetrical and functional mobility of the hips, knees and ankles. The dowel held overhead assesses bilateral, symmetrical mobility of the shoulders as well as the thoracic spine. The ability to perform the deep squat requires appropriate pelvic rhythm, closed-kinetic-chain dorsi-flexion of the ankles,flexion of the knees and hips and extension of the thoracic spine, as well as flexion and abduction of the shoulders.
Today we focus on squats and 2 kinds of issues people have with squats and how to correct them. One is knee issues and the other is ankle issues. Greg Sterner, Licensed Physical Therapist, Owner Fitness Together Point Loma Personal Training Gym, demonstrating some corrective exercises in the video below.
How to Relieve Back Pain in 10 Steps By Andrea Stanley
For anyone who’s ever suffered from back pain (80 percent of you will have some type of back problem, according to the American Chiropractic Association), beating it seems like a giant job that only a powerful dose of meds can handle. While popping a pill may give you a break from the aches, it won’t cure the cause of your chiropractic cricks. But you don’t need to hobble around in discomfort, either. Here’s how to relieve back pain (no prescription needed!)—we’ve got your back.
1.Fight the Hunch
2. Ease Up on the Cocktails
3. Take a Walk
4. Pay Attention to Your Breathing
5. Add Ice (Not Just to Your Back)
6. And Heat, Too
7. Sip Turmeric Tea
8. Try Willow Bark
9. Hit Up a Yoga Class
10. Rub On Capsaicin
Click here for more information.
What Functional Movement Screen (FMS)?
What is FMS (Functional Movement Systems)? And How it Can Help You.
If you are and athlete or have pain possibly caused by a faulty movement pattern, continue to read. The Functional Movement Screen captures fundamental movements, motor control within movement patterns, and competence of basic movements uncomplicated by specific skills. It determines the greatest areas of movement deficiency, demonstrates limitations or asymmetries, and eventually correlates these with an outcome and score. Once the greatest asymmetry or deficiency is observed, then specific corrective exercises are prescribed to facilitate proper movement sequence and form.
The original idea of the screen was to portray movement-pattern quality with a simple grading system of movement appraisal; it was not intended to diagnosis or measure isolated joint movement. Attempting to measure and isolation does a disservice to the pattern—the body is too complex to take isolated movements seriously in the initial stages of screening.
The FMS is comprised of seven movement tests that require a balance of mobility and stability. The patterns used provide observable performance of basic, manipulative and stabilizing movements by placing clients in positions where weaknesses, imbalances, asymmetries and limitations become noticeable by a trained health and fitness professional.
The screen’s usefulness is its simplicity, practicality and ability to fill a void in the toolbox we use to judge performance and durability. It is not intended to determine why a dysfunctional or faulty movement pattern exists. Instead, it’s discovery of which patterns are problematic. The FMS exposes dysfunction or pain—or both—within basic movement patterns.
Those who score poorly on the screens are using compensatory movement patterns during regular activities. If these compensations continue, sub-optimal movement patterns are reinforced, leading to poor biomechanics and possibly contributing to a future injury.
Nike, Titlelist, and the N.F.L combine now all incorporate FMS into their athletes training protocols. There has been a dramatic shift in the physical therapy world over the past decade in now attempting to improve movement patterns with corrective exercise versus just trying to strengthen weakened, isolated muscle groups.
McKenzie Exercises for the Neck
By KEITH STRANGE
Overview
The McKenzie rehabilitation method is a physical therapy methodology that teaches patients exercises to help manage pain that originates in the spine, according to Wellness.com. It is also effective at treating chronic neck pain that is caused by long-term force in one direction by helping to restore range of motion in your neck. You should always check with your doctor before starting any rehabilitative exercise program.
Lying Neck Stretch
This exercise is performed while lying on your stomach and can be effective at helping alleviate neck pain caused by stiffness. Lie down on your stomach with both arms relaxed at your sides and your head turned to one side. Relax and allow your body weight to stretch your neck in the direction your head is turned. Steps Physiotherapy recommends you hold this position for five to 10 minutes and perform this exercise several times throughout the day.
Chin Tuck
The McKenzie chin tuck, or head retraction, can be performed either from a sitting or standing position and can help lengthen the upper spine, according to Dr. Shane Mangrum. It is performed by keeping your eyes focused on something in front of your and pulling your head back toward your shoulders, while keeping your head as stationary as possible. On the website, BackExerciseDoctor.com, Mangrum suggests you perform the chin tuck multiple times daily to help alleviate neck pain.
Neck Mobility Exercises
These exercises can be performed from either a standing or sitting position, and include range of motion activities for your neck. Stand or sit with your mouth closed and your eyes facing forward. Begin by moving your neck to one side with your eyes still facing forward and hold this movement as prescribed by your doctor. Repeat on the other side. Follow these exercises by turning your head slowly to one side, then the other, using slow and controlled motions. Repeat these exercises as directed by your physician.
For full article Click here
6 Exercises To Reverse Bad Posture by Morgan Sutherland
Did you know that for every inch the head moves forward in posture, its weight on your neck and upper back muscles increases by 10 pounds?
For example, a human head weighing 12 pounds held forward only 3 inches from the shoulders results in 42 pounds of pressure on the neck and upper back muscles. That’s the equivalent of almost three watermelons resting on your neck and back!
When you neglect your posture, you invite chronic back pain. Rounding your low back while sitting for extended periods of time in front of a computer, standing for hours stooped over, sleeping improperly and lifting poorly can all lead to debilitating aches.
Maintaining the natural lumbar curve in your low back is essential to preventing posture-related back pain. This natural curve works as a shock absorber, helping to distribute weight along the length of your spine. Adjusting postural distortions can help stop back pain.
A basic remedy to sitting all day is to simply get up! Frequently getting up from a seated position and doing these six quick and easy realignment exercises can help you reeducate your muscles from getting stuck in a hunched over cave man position.
For full exercises and examples Click here
6 Steps to Get Pain Relief with Physical Therapy and Exercise
6 Steps to Get Pain Relief with Physical Therapy and Exercise by Sylvia Marten
The use of some type of physical therapy or exercise is integral to almost all forms of back and neck pain treatment. Sometimes physical therapy and exercise are the first lines of treatment, other times it may help manage chronic pain, or provide rehabilitation after surgery. But did you know that both gentle back exercise and physical therapy play a vital role in relieving pain?
Physical therapy and exercise are perhaps the most mainstream of all non-surgical treatments for back pain and neck pain. And unlike other conservative treatments (medication, injections, etc.), physical therapy can also help prevent and/or lessen future recurrences of back pain or neck pain. Below are 6 steps you can take to get pain relief from incorporating physical therapy or another kind of exercise into your routine.
Please remember that it is always advisable to check with your physician prior to beginning any exercise program.
Find the right type of help.
Depending on your condition, you may need a healthcare professional to help you develop an appropriate list of activities to engage in and to avoid, as well as to develop and instruct you on an appropriate exercise program.
1. Several different types of health professionals may provide physical therapy, including physical therapists, many chiropractors, and physical medicine and rehabilitation physicians (physiatrists).
2. Alleviate the acute pain before you begin to exercise.
When you’re in a lot of pain, the thought of active rehabilitation and exercise can be pretty daunting. 1 or a combination of the following passive pain-relieving techniques (modalities) may be used:
-Electrical stimulation (e.g. TENS units)
-Heat and/or cold therapy
-Ultrasound
-Massage therapy
-Manual manipulation
-Other treatments may also be needed to sufficiently reduce your pain. All of the above therapies are designed with one goal in mind: providing enough pain relief to help you progress to an active exercise program.
3. Get others in your camp.
The common belief is that to heal back problems, those who experience pain should refrain from physical activity. Consequently, many of your friends or family may encourage you to rest if the exercise is causing you to struggle. By explaining ahead of time, they can understand how active rehabilitation is best for managing your condition. If you want support or help, you can also ask them to join you or encourage you during your exercises.
4. Engage in active physical therapy (exercise).
Active exercise is necessary to help the back heal and stay healthy. While some of the muscles that provide support for the spine are used in everyday life, most do not get adequate exercise from daily activities and tend to weaken with age unless they are specifically exercised.
Any exercise program for the back should include a combination of stretching, strengthening, and low-impact aerobic exercise.
Also consider water therapy. Exercises that would normally be too painful to do on land, such as walking, often become tolerable to do in the water. Not only does the water provide the therapeutic effect of relieving pain, it helps get you ready for more extensive exercise.
5. Expect some initial discomfort.
Beginning an exercise program after an episode of back pain, or if you suffer from chronic back pain, will almost always cause some increase in your pain at first.
However, the pain experienced when doing an appropriate exercise program for back pain should be “good pain.” This pain is to be expected as a natural part of increasing activity—stretching tissues that have become stiff and using muscles in unfamiliar ways. It is the kind of pain that you might experience after going to the gym for a tough workout, and can actually be a signal that you are getting better.
See Stretching for Back Pain Relief
Of course, if the pain is severe, then it is time to reassess your exercise program. Discuss this with your physical therapy professional – it could be that just one of the exercises in your program is causing the pain and discomfort, or that you need to improve your form on certain exercises. Only you can decide what normal discomfort is or if the level of pain is signaling that your body is warning you to stop what you’re doing.
6. Carefully pace yourself.
When returning to activity after an episode of pain or following surgery, you absolutely will want to pace yourself. The danger is getting in a pattern of beginning a day with minimal pain, and subsequently engaging in so many activities that you relapse with severe pain.
A much healthier approach to rehabilitation is to pace your activities regardless of how you are feeling in order to keep the pain under relatively good control and prevent a flare-up.
Whether used alone or in combination with other treatments, physical therapy and exercise are essential to help reduce and manage your pain, as well as to sustain your long-term recovery and prevent a future recurrence of pain. Hopefully, this will help you find and maintain a physical therapy program that works for you.
For the full article and more information Click here
How to fix your aching back using the McKenzie Method
The McKenzie method is a classification system and a classification-based treatment for patients with low back pain. A acronym for the McKenzie method is mechanical diagnosis and therapy (MTD). The McKenzie method was developed in 1981 by Robin McKenzie, a physical therapist from New Zealand.
The McKenzie method exists of 3 steps: evaluation, treatment and prevention. The evaluation is received using repeated movements and sustained positions. With the aim to elicit a pattern of pain responses, called centralization, the symptoms of the lower limbs and lower back are classified into 3 subgroups: derangement syndrome, dysfunction syndrome and postural syndrome. The choice of exercises in the McKenzie method is based upon the direction (flexion, extension or lateral shift of the spine). The aims of the therapy are: reducing pain, centralization of symptoms (symptoms migrating into the middle line of the body) and the complete recovery of pain. The prevention step consists of educating and encouraging the patient to exercise regularly and self-care. All exercises for the lumbar spine are repeated a number of times to end-range on spinal symptoms in one direction. When you do only 1 repetition, this will cause pain. When you repeat it several times the pain will decrease. Also after movement termination the changes in pain intensity can persist, which leads to a treatment modality. A single direction of repeated movements or sustained postures leads to sequential and lasting abolition of all distal referred symptoms and subsequent abolition of any remaining spinal pain. For more information on the McKenzie method, Click here
In 10 days, with five physical therapy sessions and me faithfully doing the “extension” exercises four to six times a day at home, I achieved total relief from my severe back pain. From the very first day, the McKenzie therapist told me I should continue playing golf because walking was good for the back, but he told me to do the standing extensions between swings. I played golf after every therapy session. But keep in mind that if your pain has been present for many months, it will likely take longer to gain relief. Give yourself a couple of weeks of faithfully doing the exercises.
As long as I continue doing the extension exercises, along with maintaining correct posture, I expect I’ll continue to have a pain-free back. I now do the extension exercises described above twice a day as part of my normal routine, plus I’ve added several flexion exercises, that is, exercises that have me bending my spine forward. Doing the flexion exercises once you are healed is necessary because the healed tissues and any scar tissue formed during the healing process must be made pliable again so it is not subject to overstretching and re-injury. Flexion exercises include the several bending forward movements (toe-touching, etc.) traditionally recommended to stretch the back muscles. Go slowly when resuming the flexion exercises.
It is important to remember that every session of flexion exercises must be followed by a few extension exercises. Simple standing extensions will suffice.
I do both flexion and extension exercises now, but I do far more extension exercises. Almost every time I rise from a sitting position, I do a couple of standing extensions. And while playing golf, I perform standing extensions before I swing the club and at any time my back feels a bit tight. Good posture, of course, has become part of my life.
For the full article Click here
Falls in Senior Population: Can We Prevent Them?
30% of people over the age of 65 years fall 1 or more times in a year. Falls are the leading cause of death from injury in elderly adults. In 2003, 13,700 people died from falls. A fall is defined as an event that results in a person coming to rest unintentionally on the ground or on a lower level but not caused by an internal trauma (e.g. stroke). Intrinsic risk factors include: Medical Condition, Cognition, Psychosocial, Sensory, Central Processing, and Musculoskeletal.
Medical risk factors include: Co-morbidities (Pulmonary Disease, MS, Prolonged bed rest, Stroke, Diabetes) and Polypharmacy (overmedicated). It has been documented that 4 or more prescribed medications significantly increases risk for falls. Meds used to treat hypertension, heart disease, and depression may cause dizziness. Cognition which includes safety awareness, attention, and judgment combined with Psychosocial (depression, anxiety) attributes can also greatly affect fall risk. Central Processing concerns area of: limits of stability, reaction time, anticipatory reactions, and postural Stability. Sensory Loss is quite evident in a majority of falls and will encompass losses in one or all of the following: Vision, Vestibular, and Somatosensory (impaired position sense). Musculoskeletal deficits include: Losses in Strength, flexibility, endurance, and postural alignment; Gait (decreased step length, increased step frequency, decreased speed, and increased lateral sway); and Coordination (ability to change directions).
Extrinsic factors include: Environment, Social, History of Falls, and Activity level. History of falls is especially relevant if history of: 1 or more falls in a year, falling indoors, or an inability to get up after fall. Exercises to Prevent Falls include: Tai Chi, Individualized multidimensional exercise program and Exercise in physical therapy sessions with appropriate home exercises will decrease risk for falls and improve Mobility Assessment scores. Loss of balance and falls could be prevented with seniors if adults take measures to protect themselves, much as they do against health conditions such as heart disease. An assessment and treatment by a Licensed Physical Therapist is the obvious choice in obtaining this protection. Loss of balance and limitations in mobility can be effectively prevented, reversed, or delayed by physical therapy treatments. A comprehensive balance assessment performed by a physical therapist can determine the factors as above that are contributing to an individual’s fall risk. A physical therapist plan of care will include exercises to improve strength, aerobic capacity, flexibility, proper gait, and the function of the vestibular system. Balance training and fear management will also be addressed.
For more information on the physical therapist’s role in preventing falls contact:
Greg Sterner, Board Certified Orthopedic Clinical Specialist in Physical Therapy, Owner
San Diego Sports Physical Therapy
2750 Dewey Rd. Ste 101
San Diego, CA 92106