Tag: orthopedics

Bringing Things into Balance: The Relationship Between Low Back Pain and the Pelvic Floor

On By bbpt1In BBPT Health Tip, Core Stability, fitness, Health, health awareness, injury prevention, physical therapy, UncategorizedLeave a comment

By: Katie Parrotte, PT, DPT, OCS, CFMT

Back Pain or Fitness (2)The Occurrence of Low Back Pain

Low back pain is the most common cause of disability and lost work time among working-age adults in industrialized countries (1). In fact, the worldwide prevalence of chronic low back pain has been estimated to be 11.9% of the population on a given day, and 23.2% of the population in a one-month period (2). That is a significant number of people! Determining effective treatments for low back pain can be challenging for various reasons: 1. there are no clearly defined risk factors that predict the development or outcome of low back pain; 2. most patients do not present with any significant findings physiologically or anatomically; 3. and pain can generate and spread at numerous locations within the nervous system, and can constantly change (1).

Treatment of Low Back Pain

There are many challenges associated with low back pain diagnosis and outcomes. Because of this, and the fact that so many people across the globe are impacted by it, there are many options out there for treating this condition. Some methods that have been proven to be effective are spinal manipulation (a high-velocity thrust applied directly on the vertebrae, or backbones, to improve movement and decrease pain), trunk coordination, strengthening, and endurance exercises (to target deep abdominal and back muscles that help to stabilize the spine), general fitness exercise, and patient education (1). These types of interventions are certainly helpful and have allowed many individuals experiencing low back pain to return to their daily lives. However, perhaps the areas that are being addressed with these interventions are not getting to the whole story… There is another area of the body that plays a significant role in the stability of the back but does not regularly get addressed with standard treatment to low back pain: the pelvic floor.

Treating the Pelvic Floor to Address Low Back Pain

Several studies have looked at incorporating pelvic floor-specific strengthening programs in the treatment of chronic low back pain. One study looked at women who were experiencing low back pain and urinary incontinence (the involuntary leakage of urine) (3), while two others looked at individuals experiencing chronic low back pain independently in men and women (4, 5). In all three studies, investigators compared “routine” physical therapy to routine physical therapy plus the addition of pelvic floor strengthening. Results revealed that incorporating pelvic floor strengthening decreased low back pain, decreased the incidence of urine leakage in the case of urinary incontinence, improved function based on specific questionnaires, and increased pelvic floor strength and endurance (3-5). This strengthening was completed by either performing isolated pelvic floor contractions (4, 5), or performing abdominal and pelvic floor muscle contractions while performing specific stabilizing exercises (3).

The Relationship Between the Pelvic Floor and the Low Back

Why did strengthening the pelvic floor make a difference in the above studies? This is likely because the pelvic floor is one of the muscle groups that contributes to overall spine stability; the others include the diaphragm, the transverse abdominis (a lower abdominal muscle), and deep muscles in the low back (3). Several studies out of Norway and Sweden have revealed that in women without pain, the pelvic floor activates just prior to arm or leg movement (6-8). This is important because it reveals that when the pelvic floor is working efficiently, it provides stability to the trunk and pelvis, allowing for functional postures and movements to occur.

Conclusion:

The pelvic floor is an important stabilizer of the spine and pelvis, and activates just prior to movement to allow for efficient function. When an individual is experiencing low back pain, not only do the abdominals and low back muscles require strengthening, focusing on the pelvic floor can help to eliminate pain and resume daily function.

If you or someone you know is struggling with unresolved low back pain, make an appointment with a pelvic floor physical therapist today for further assessment. Feel free to contact our midtown office at 212-354-2622 or our downtown office at 212-267-0240, or visit our website (www.beyondbasicsphysicaltherapy.com) for more information!

Thank you so much for reading our blog.

K5 (2)

Katie Parrotte, PT, DPT, OCS, CFMT practices at our midtown location.

If you have questions about orthopedic, pelvic, or sports physical therapy, including back pain, BBPT is offering free phone consults to those living in the greater NYC area for a limited amount of time!

Beyond Basics Physical Therapy

212-354-2622 (42nd Street Location)

212-267-0240 (William Street Location)

Sources

 

1. Beattie PF. 2016. Current concepts of orthopedic physical therapy – the lumbar spine: physical therapy patient management using current evidence, 4th edition. (p. 3) Orthopedic Section – APTA.

2. Hoy D, Bain C, Williams G, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012; 64 (6): 2028-2037. doi:10.1002/art.34347.

3. Ghaderi F, Mohammadi K, Sasan RA, et al. Effects of stabilization exercises focusing on pelvic floor muscles on low back pain and on urinary incontinence in women. Urology. 2016; 93: 50-54.

4. Mohseni-Bandpei MA, Rahmani N, Behtash H, et al. The effect of pelvic floor muscle exercise on women with chronic non-specific low back pain. Journal of Bodywork & Movement Therapies. 2011; 15: 75-81.

5. Bi X, Zhao J, Liu Z, et al Pelvic floor muscle exercise for chronic low back pain. Journal of International Medical Research. 2012; 41 (1): 146-152.

6. Sjodahl J, Gutke A, Ghaffari G, et al. Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the active straight leg raise in women with and without pelvic girdle pain: an experimental study. Clinical Biomechanics. 2016; 35: 49-55.

7. Stuge B, Saetre K, Hoff BI. The automatic pelvic floor muscle response to the active straight leg raise in cases with pelvic girdle pain and matched controls. Manual Therapy. 2013; 18: 327-332.

8. Sjodahl J, Kvist J, Gutke A, et al. The postural response of the pelvic floor muscles during limb movements: a methodological electromyography study in parous women without lumbopelvic pain. Clinical Biomechanics. 2009; 24: 183-189.

Sacroiliac Joint Dysfunction

On By bbpt1In Core Stability, fitness, injury prevention, orthopedics, physical therapy, UncategorizedLeave a comment

Pelvic 3

By: Kaitlyn Parrotte, PT, DPT, OCS, CFMT

What is the sacroiliac joint?

You’ve probably heard of SI pain, but what is the SIJ and what can we do if something goes wrong?

The sacroiliac joint (SIJ) connects the sacrum, the wedge-shaped bone at the bottom of the spine, to the ilium, which is one of three bones that make up each half of the pelvis. (1) The sacroiliac joint is designated as a diarthrodial joint, which means it is a moveable joint that is surrounded by connective tissue. (2,3) Each joint is supported mainly by ligaments that lie in front and behind it, that are made up of strong, threadlike types of connective tissue. Stability is also enhanced through ligaments that connect between the spine and the sacrum (sacrospinous ligament), and the sit bone and the sacrum (sacrotuberous ligament). (2)

The SIJ helps us to walk and change positions by being stable enough to move weight from the spine to the legs, while allowing for a small amount of movement between the spine and the pelvis. This small amount of movement between the spine and the pelvis is also important as it allows for the pelvis to expand to make childbirth easier. (2,4) These functions can occur due to the unique design of the SIJ.

According to a well-known researcher named Andry Vleeming, the SIJ gains its stability in one of two ways: through form closure or force closure. Form closure refers to the stability provided by the bony surfaces of the sacrum and ilium, which fit together like a puzzle. You may use this type of stability, for instance, when you are lifting a heavy box, or pushing a very full cart of groceries; you want your SIJ to be as immobile as possible so your trunk can be stiff and rigid, allowing you to move a heavy load without overstressing any muscles in your back. Force closure describes stability occurring through the ligaments and muscles around the joint; this allows for more movement to occur. For this type of stability, think salsa dancing. In salsa dancing you need a great deal of hip and pelvic movement; however, you need those movements to be in control so you can move with precision along with the quick beat of the music. (5-7)

 

What is sacroiliac joint dysfunction?

Sacroiliac joint dysfunction (SIJD) is a common cause of low back pain, accounting for up to 40% of cases of nonspecific low back pain. (4,8) It can occur in any population: males and females; those with a sedentary lifestyle and those who are athletes. However, there seems to be a slightly greater occurrence in women, with the theory being that since the joint surface in women is smaller and less curved, the SIJ may become dislodged more easily. (2,4) SIJD can have a negative impact on quality of life, from being less active to having a financial impact. For instance, indirect health-care costs associated with low back pain range from $7-$28 billion per year, and individuals lose an estimated 5.2 hours of work time per week. (4)

The origin of SIJ pain is unknown; however, factors that may contribute include fractures, ligamentous injuries, or inflammation that occur with excessive stress to the SIJ. (8) Risk factors for developing SIJD include abnormal walking patterns, differences in leg length, scoliosis (abnormal curvature of the spine), heavy physical exertion, trauma, pregnancy, and back surgery. (8) Presentation of symptoms can vary quite a bit; however, individuals with SIJD often present with achy low back pain that can make it difficult to find a comfortable position. Pain may worsen with running, climbing stairs, or standing from a seated position. Also, if pain is truly coming from the SIJ, a person will not experience symptoms down into the leg, as is seen with sciatic nerve involvement. (4)

 

How is SIJD diagnosed?

SIJD can be very challenging to diagnose due to the complexity of the joint itself, as well as the variation in pain patterns that can be seen; thus, if you visit a healthcare provider, you may find he or she performs an array of components in an examination. Many individuals have tenderness with touch over the joint; this can help a healthcare provider rule in SIJD. (2,8). Also, various orthopedic tests can be performed that put stress on this joint, such as by putting a person’s trunk or leg in a certain position to see if it recreates symptoms. (2) Imaging can be performed in this area, but it rarely provides clear information that can help make a diagnosis; however, a doctor might recommend it if there is a concern for infection, inflammation, fracture, or other more serious conditions. (2) Injections into the SIJ itself can also be used to help diagnosis this condition, and are shown to be one of the single-most definitive diagnostic tools available. (2) Overall, effective diagnosis for dysfunction at the SIJ requires the use of multiple tools to help increase the accuracy of the condition being ruled in or out.

 

How can this impact function? Why does it matter?

It is hypothesized that SIJD can have such a significant impact on quality of life because it results in inadequate stability at the joint during movement. If the SIJ is unable to maintain an optimal level of stability, then excessive stresses will likely be placed on surrounding structures and tissues when each leg has body weight going through it. This can lead to other areas of pain, and potentially start the process of degeneration. (4) A recent research group looked at the impact of SIJD on a simple, but common functional task of rising from a chair. They found that in individuals with SIJD, there were significant differences in the amount of weight a person was putting through the leg on the painful side, as well as in the amount of bend at the hips when sitting. They also found that when individuals began to rise from a chair, muscles on the side of SIJ did not turn on right away, which means the muscles were not helping to keep the SIJ from moving too much. (4) Thus, this condition can make it challenging to use the body efficiently due to pain and weakness, which can negatively impact function throughout a given day.

 

What can physical therapy do?

Once a person is diagnosed with SIJD, what can be done? Research has shown that non-surgical treatment, such as physical therapy, can be very beneficial for someone with SIJD. If you see a physical therapist, you will likely receive some variation of joint mobilization and exercise, which is shown to help achieve significant improvements in pain, function, alignment, and muscle control. Exercise programs that emphasized pelvic stability through core, pelvic floor, and gluteus (hip and buttock) exercises, as well as increasing the strength of hip rotator muscles, decreased pain and decreased reported disability after a range of 8-12 weeks. (8,9) In other studies, an exercise program that focused mostly on gluteus maximus strengthening was utilized, since this muscle is considered one of the primary stabilizers of the SIJ. The exercises in these programs included bridging, single leg bridging, hip extension on hands and knees, fire hydrants, deadlifts, and single-leg squatting. In these studies, participants reported less pain after the course of treatment, demonstrated increased muscle strength, and returned to normal daily activities. (10,11) While there is no set exercise protocol established at this point, a strengthening program, with or without a home program, is a mainstay for treating this condition, and results in improved function.

 

Are there other treatments?

In some cases, physical therapy alone is unable to resolve the issue. In these situations, a patient may be given an injection of corticosteroids to decrease inflammation, in or around the SIJ. Prolotherapy is also sometimes used in this population to help reconstruct or regenerate damaged or weakened connective tissue. While it is helpful to know what other options are out there, it is important to note that the research in these areas is continuing to develop, and there is no consensus on dosage or who is the optimal candidate. (2)

 

Conclusion

The sacroiliac joint is a complex joint between the back and the pelvis, that allows for minimal mobility, and is required to maintain stability between the trunk and the legs. It can become painful due to direct or indirect trauma, which can have a significant impact on function and quality of life. While diagnosis can be tricky due to the wide variety of symptoms, research is finding that conservative care through physical therapy can make a significant difference by promoting optimal alignment and stability. If you or someone you know is struggling with sacroiliac joint dysfunction, make an appointment with a physical therapist today to help improve function. Feel free to contact our office at 212-354-2622, or visit our website (www.beyondbasicsphysicaltherapy.com) for more information!

 

 

Sources:

1. Ullrich, Peter F. “Sacroiliac Joint Anatomy.” Spine-Health, www.spine-health.com/conditions/spine-anatomy/sacroiliac-joint-anatomy.

2. Peebles R, Jonas CE. Sacroiliac joint dysfunction in the athlete: diagnosis and management. Current Sports Medicine Reports, vol. 16, no. 5, 2017, pp. 336-342.

3. “Diarthrodial Joint.” Biology Online, www.biology-online.org/dictionary/Diarthrodial_ joint.

4. Capobianco RA, Feeney DF, Jeffers JR, et al. Sacroiliac joint dysfunction patients exhibit altered movement strategies when performing a sit-to-stand task. The Spine Journal, 2018, DOI: https://doiorg/10.1016/j.spinee.2018.03.008.

5. Vleeming A, Stoeckart R, Volkers AC, et al. Relation between form and function in the sacroiliac joint. Part I: Clinical anatomical aspects. Spine, vol 15, 1990, pp. 130-132.

6. Vleeming A, Volkers AC, Snijders CJ, et al. Relation between form and function in the sacroiliac jt. Part II: Biomechanical aspects. Spine, vol 15, 1990, pp. 133-136.

7. Vleeming A, Schuenke MD, Masi AT, et al. The sacroiliac joint: an overview of its anatomy, function, and potential clinical implications. J Anat, vol 221, 2012, pp. 537-567.

8. Al-Subahi M, Alayat M, Alshehri MA, et al. The effectiveness of physiotherapy interventions for the sacroiliac joint dysfunction: a systematic review. J Phys Ther Sci, vol 29, 2017, pp. 1689-1694.

9. Albright J, Allman R, Bonfiglio RP, et al. Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Rehabilitation Interventions for Low Back Pain, Physical Therapy, vol 81, n 10, 2001, pp. 1641–1674.

10. Added MAN, de Freitas DG, Kasawara KT, et al. Strengthening the gluteus maximus in subjects with sacroiliac dysfunction. International Journal of Sports Phys Ther, vol 13, n 1, 2018, pp. 114-120.

11. Yoo WG. Effect of the single-leg, lateral oblique, decline squat exercise on sacroiliac joint pain with knee pain. J Phys Ther Sci, vol 28, 2016, pp. 2688-2689.

Joint Changes in Arthritis are Permanent, but Pain Does Not Have to Be

On By bbpt1In Core Stability, education, fitness, Health, health awareness, injury prevention, orthopedics, running, sports, strength, UncategorizedLeave a comment

stick man

Fiona McMahon PT, DPT

May is arthritis awareness month. Arthritis can come in many different forms. It can be a result of wear and tear or it can be a response to an autoimmune condition. There are many different types of arthritis, but the fact remains that in all of these different types of arthritis, once the damage to the joint is done, it is done. Currently, we have no way of repairing the joint outside of joint replacement. You may be thinking, if the damage is done, why bother spending my precious time and money in physical therapy? The reason is that physical therapy and lifestyle management can make a huge difference towards reducing your pain, improving your function, and even preventing the progression of joint break down. Physical therapy has been proven to help reduce pain and increase function, and in many cases, avoid surgery.

Physical therapists are movement experts. It seems obvious that they should be the providers directly involved in restoring function to individuals with diseases of the joints. For both rheumatoid conditions as well as osteoarthritis, physical activity is considered the first line intervention for improving pain and function. This is not to say that exercise will replace disease modifying arthritis drugs (DMARDs) in cases of rheumatoid arthritis. It is saying treatment is not complete until you address the strength, pain, and range of motion problems that occur with arthritis.

Physical therapy will not change the conditions of joints that have been damaged by arthritis; however, physical therapy is paramount to improving the prognosis of arthritis by helping to improve the strength around the joint, range of motion, and stability of the joint to prevent further cartilage and joint break down. Physical therapy can also have a marked effect on the pain and function, and can open up your world to things that were once too painful. In a meta-analysis study conducted by Sampath and colleagues, two common physical therapy techniques, manual therapy (work on the joints) and exercise therapy were examined to assess the efficacy of these techniques on pain and function in individuals with arthritis. The study found strong evidence that exercise therapy and manual therapy were good at reducing pain and improving function in people with arthritis.

Physical therapy is so worth the investment. It is an investment in your comfort, the ability to do the things you love, and commonly helps people stave off needing a joint replacement. Full disclosure, I’m partial to our clinic, Beyond Basics Physical Therapy (understatement of the year, I know). What makes us so special is that we have the manual therapy, exercise and orthopedic experts. We all come from various orthopedic (joint and muscle PT) backgrounds including the Postural Restoration Institute (PRI) and the Institute of Physical Art (IPA) and many of us have earned advance orthopedic certifications such as the Certified Functional Manual Therapist (CFMT), Certified Orthopedic Specialist (OCS), and Postural Restoration Certification (PRC) distinctions. What this means is our therapists have the knowledge and skill set to go above and beyond the basics in our hour long treatments to treat you head to toe, improving the way your body moves and more importantly, how it feels. Click here to read more about the ins and outs of the CFMT certification and how it can take you to the a place of less pain and more function here.

Another thing to keep in mind is your weight. When it comes to management of arthritic conditions, additional pounds put additional stress on your joints and can hasten the progression of joint break down. Losing pounds can be a big task when your joints are not feeling their best. Your physical therapist can guide you through exercises that are efficient for weight loss and do not exacerbate your symptoms. We also can provide a valuable link to get you set up with proper nutritional support to help manage weight.

Once the damage is done by arthritis it is done; however, that does not mean you are condemned to pain, decrease function and continued deterioration. Get physical therapy today for pain relief and to get moving again!

We have two clinics. One in Midtown Manhattan and one Downtown. We also offer Pilates and personal training at our clinics, which can help get you back into an exercise routine.

Give us a call today to find out more:

212-354-2622 (Midtown)

212- 267-0240 (Downtown)

Heidari B, Rheumatoid Arthritis: Early diagnosis and treatment outcomes. J Capsian Internal Med. 2011: 2(1) 161-70

Hootman J, Murphy L, Omura J, et Al. Health care provider counselling for physical activity among adults with arthritis. Morbidity and Mortality Weekly Report. 2018; 66(51-52) 1398-1401

Sampath K, Mani R, Miyamori T, et al. The effect of manual therapy or exercise therapy or both in people with hip osteoarthritis: a systematic review and meta-analysis. Clinical Rehab. 2016; 3-(12) 1141-55

Wang Y, Lombard C, Hussain S, et al.Effect of a low-intensity, self-management lifestyle intervention on knee pain in community- based young to middle-aged rural women: a cluster randomised controlled trial. Arthritis Research & Therapy. 2018; 20(74)

Why seek out a physical therapist with advanced orthopedic training? The case for CFMT and OCS

On By bbpt1In BBPT Health Tip, bladder, bowel, breast cancer, cancer, Cold Laser, constipation, Core Stability, dance medicine, diastasis recti, education, Endometriosis, fitness, Health, health awareness, Incontinence, injury prevention, marathon, orthopedics, Painful Bladder Syndrome/IC, Painful Sex, Pelvic Pain, physical therapy, Pregnancy and postpartum, prostate cancer, running, sexual health, sports, strength, Uncategorized, urinary dysfunction, vaginismusLeave a comment

Pelvic 3By: Kaitlyn Parrotte, PT, DPT, OCS, CFMT

If you have perused our website, you might have noticed that here at Beyond Basics, we have many physical therapists who have a CFMT certification, or are in the process of completing one. Now the question lies, what is a CFMT? How is this approach unique? How can this approach be of benefit to me?

The acronym CFMT stands for Certified Functional Manual Therapist. This certification is through the Institute of Physical Art (IPA), which is an organization founded by two physical therapists, Gregg and Vicky Johnson.

With the CFMT approach, we evaluate and treat every individual’s mechanical capacity (how your tissues and joints move), neuromuscular function (how your system stabilizes itself, and the coordination of muscle activation), and motor control (how an individual moves and performs daily tasks). Furthermore, we assess and retrain how these three individual components interact to ensure each person can return to the tasks/activities they need and love to do.

What this means is, when a new patient walks through our door, we don’t just focus on one small area, such as only the knee in which you report pain. Instead, we will look at the big picture by assessing your strength, amount of limb and segmental motion available to you, posture and alignment, and movement, which can be as simple as getting out of a chair, or a higher level activity such as running, weight lifting or other sport-related activity. This will allow us to get a thorough impression of what impairments you might have, and will help us determine what the cause of your symptoms and functional limitations is (what is the driver?). From here we can figure out the most effective approach to your treatment, and will apply progressive interventions that help to ensure continued benefits from each session. We have found that this approach commonly gets you back to your activity or sport faster!

Now you may be asking yourself, “Well this sounds interesting, but why does it matter?” Looking at the whole person and treating your system overall, allows us to make lasting changes, not only to a specific body part that is causing problems for you, but also with your habits of how you hold yourself and move. By becoming more aware of your body and moving with more efficiency, you will find day-to-day activities, and even sporting activities, are easier for you to perform. Furthermore, and most importantly, if you are able to move and live in a more efficient way, you are decreasing the risk of future injury.

So whether you are experiencing incontinence, pelvic pain, low back pain, or a shoulder injury, having a knowledgeable therapist work with you, can make a significant impact on your function and quality of life.

 

Shoulder Pain – What Can Be Done?

On By bbpt1In Health, health awareness, injury prevention, orthopedics, sports, strength, UncategorizedLeave a comment

Back and Shoulder Pain

Kaitlyn Parrotte, PT, DPT, OCS, CFMT

Shoulder pain is a fairly common issue amongst adults, with a reported lifetime incidence of up to 70% in various countries and estimates of cost burden up to $7 billion a year for treatments of it.

Subacromial shoulder pain is defined as pain that originates from the subacromial space, which is a very small area between part of the shoulder blade called the acromion (“roof of the shoulder”), and the shoulder joint (the glenohumeral joint). In this area lies the rotator cuff tendons and the subacromial bursa (a fluid filled sack that helps minimize friction on these tendons). Subacromial shoulder pain is commonly located on the top and outside of the shoulder, and is often aggravated by overhead activity. The pain from this area is typically caused by inflammation and/or tearing of the rotator cuff tendons, as they are pinched/rubbed against the underside of the acromion.

There have been multiple research studies that have looked into the benefit of surgery for the treatment of subacromial shoulder pain. Today, we will be focusing on one article that looks at the effect of arthroscopic subacromial decompression (a common surgery for pain by removing tissue), as compared to a placebo surgery (no tissue actually removed), and no treatment. Here is a quick summary of the study:

313 patients were randomly assigned to treatment groups: 106 to decompression surgery, 103 to arthroscopy only, and 104 to no treatment. For the decompression surgery, surgeons removed soft tissue and other structures within the subacromial space, a nearby ligament, and removal of any bone spurs. For the arthroscopy, structures were inspected and irrigated, but nothing was removed or repaired. Following surgery, both groups (decompression and arthroscopy) received appropriate post-operative care, including follow-ups with the surgeons, as well as physical therapy. Those participants assigned to the no-treatment group attended one reassessment appointment with a shoulder specialist, 3 months after entering the study, but with no planned intervention. The pre- and post-test findings were mainly based on a functional shoulder measure.

The findings in this study turned out to be very interesting, although perhaps not what the authors originally intended. Not because both surgical groups reported higher scores on the functional measure, as compared to the no-treatment group, which is something that one can expect when an intervention is appropriately applied. The main take home message from this study is not even that researchers reported participants in both surgical groups ended the study with similar outcomes. A major plot twist in this article is that both surgical groups were given physical therapy post-operatively. Remember, the group who received arthroscopy did not actually have any structures repaired or removed, yet this group made statistically significant gains after all intervention were completed, that matched, if not bested, the results of an actual surgical intervention. How could this occur? We must consider the common denominator – physical therapy! Physical therapy is the only thing that both groups had in common, so it is safe to assert that it likely played a significant role in the improvement of shoulder pain.

If that isn’t convincing enough, let’s now focus on a research article that takes a closer look at the impact of physical therapy for patients with subacromial impingement syndrome. This article published in 2012 looked at a specific exercise routine vs generalized exercise for 102 patients in Sweden, who had already failed conservative treatments for their shoulder pain, and would likely become candidates for surgery due to their continued pain. Participants in both groups received a subacromial injection of corticosteroids two weeks prior to the commencement of any exercise. The control group received general exercises that including shoulder and neck movements and stretches. The experimental group was given six exercises to perform, which included eccentric strengthening of the rotator cuff, meaning these muscles were actively controlling resistance while lengthening, stabilizing exercises of the shoulder blade, and stretching of the back of the shoulder. After performing these exercises two times per day for up to 12 weeks, and attending one physical therapy session per week, these patients reported significant improvements in functional measures for the shoulder, as compared to the control group. The authors also reported that significantly fewer participants from the specific exercise group opted for surgery after the trial was over (20%), as compared to 63% from the control group. This study not only shows that physical therapy is beneficial for decreasing subacromial shoulder pain, but it also proves that when it is tailored specifically toward the needs of an individual condition or presentation, it can still be effective even after a person has failed conservative treatment.

In summary, subacromial shoulder pain is a very common condition, that can successfully be treated with physical therapy, even if conservative treatments have previously failed to relieve symptoms. The emphasis must be on finding the correct intervention program that meets the needs of each individual patient. If you or someone you know is dealing with shoulder pain, whether it is new or old, you could benefit from a tailored physical therapy program. Here at Beyond Basics Physical Therapy, all of our therapists have extensive training and are experts in orthopedic and sports-related injuries, and will work one-on-one with you to develop a rehab program that helps you achieve your goals, so make and appointment today!

 

 

Sources:

1. Cadogan A, Laslett M, Hing WA, McNair PJ, Coates MH. 2011. A prospective study of shoulder pain in primary care: prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskeltal Disorders, 12 (119).

2. Kulkarni R, Gibon J, Brownson P, et al. 2015. BESS/BOA Patient care pathways – subacromial shoulder pain. Shoulder & Elbow, 7 (2), 135-143.

3. Mesilin RJ, Sperling JW, Stitik TP. 2005. Persistent shoulder pain: epidemiology, pathophysiology, and diagnosis. Am J Orthop, 34 (12 Suppl), 5-9.

4. Beard DJ, Rees JL, Cook JA, et al. 2017. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. The Lancet, 17 (32457), doi: 10.1016/S0140-6736.

5. Holmgren T, Hallgren HB, Oberg B, et al. 2012. Effect of specific exercise on need for surgery in patients with subacromial impingement syndrome: a randomized controlled study. BMJ, 344 (787), doi: 10.1136//bmj.e787.

Marathon Prep with Beyond Basics: Weeks 1-3

On By bbpt1In Core Stability, education, fitness, Health, health awareness, injury prevention, marathon, physical therapy, Uncategorized1 Comment

Fiona McMahon PT, DPT and Jessica Babich PT. DPT

15 KFiona: Hi everyone! It’s been a few weeks since our last update. I am currently halfway to our $3,000 fundraising goal for the Tisch Multiple Sclerosis Research Center of New York. Beyond Basics Physical Therapy and I are raising money by running the New York City Marathon and taking donations. If you wish to donate here.

As far as training, things have gone well. The last 12 weeks of training have largely consisted of building a solid base with a whole lot of speed play to improve my lactic acid tolerance (you know, that burning feeling in your muscles, when you are really working hard). This will hopefully improve my ability to hang in there at a consistent speed throughout the race. In the next 12 weeks the amount of speed play will decrease and the mileage will slowly start to build, culminating with two 20 milers before the actual marathon.

So far my average pace has been slightly faster than goal and I have noticed that for the most part I feel stronger and more powerful than I had in the past. Also, the nagging calf pain sensation I had complained about in the past is now improving and occurs much less frequently. I’ve been doing my home exercise program that my physical therapist, Jessica Babich,  recommended on top of my pre-existing routine of strengthening, rolling, and stretching.

Here’s a little of what we worked on in our last 3 visits to help meet our goals, of running faster with less pain:

Week 1: Facilitation with theraband, core activation

On week one, Jessica worked to help get my core to fire more consistently. This is important to allow for greater push-off and power and can hopefully lead to reduced risk of injury. This stuff is hard! Jessica would put my body in a specific position and apply resistance to wake up my long dormant muscles. I broke a sweat but could definitely tell it was working.

Week 2: Ankle ( devil spawn)ankle.jpg

I hated it. But I loved the results. In my earlier blog I wrote about how I hurt my ankle doing a handstand (again, don’t ask). In my initial evaluation, Jessica noticed that I wasn’t quite pushing off well enough through my right side. Basically, I was using my left side to get my power, and the right side was just going along for the ride. No good. Not efficient. Jessica worked on getting the bones in my foot to glide the way they need to in order to improve my range of motion in that foot. Once I had the new range of motion, she gave me some exercises to help teach (we call it neuromuscular re-ed), the foot what to do. The process wasn’t exactly comfortable, but it wasn’t too bad either. I’ve definitely subjected myself to training runs that felt worse.

Here’s what was super neat about this whole deal. I had been doing some plyometric work on my own to help train power and speed. Prior to this visit, one of the exercises I was doing, was the box jump. It is what it sounds like, jump up onto this special cushy box. I started off jumping 24 inches, but I noticed I was really just doing a glorified hop, using my left leg to do all the work. Dumb, dumb, dumb, dumb. On my own I regressed myself to a 12 inch box and tried hopping onto it with each leg (to get right leg in on the action and pulling it’s own weight). IT WAS SO HARD. It was like my body had no idea how to get itself on to the box when I used my right leg, My left leg was more than happy to do single leg box jumps all day, but righty definitely wanted to take the L (that means loss, not the L -train) on that one. But after the ankle treatment with Jessica, a 12 inch single leg box jump was easy, peasy, lemon squeezy. In fact, I progressed myself to the 16 inch box the next gym session. Currently, I am doing 18 inch single leg box jumps and am back to 24 inch box jumps with both legs. Right?! Wild!

BUT THAT’S NOT EVEN ALL OF IT! I started to find on my shorter runs I could more easily keep a 8:30 pace (goal) without additional effort than I had spent on my slower runs. I eventually started doing those runs at 8 minute pace and 7:30 pace to spice it up. This past weekend I was able to do a 15K (9.3 miles) at 8:00 pace which is something I’d never dreamed of. It’s been really neat. I’ve had 3 rounds of physical therapy, and no one has ever addressed my feet which has made such a difference.

Week 3 : Myofascial release

This was the week of the monster cold(S), there were two separate colds and I was not able to run the way I would have liked. I still made my pace and snuck a couple in at 8 minute flat pace, but I did end up missing a few runs. When I saw Jessica, I was just about to slip into the terrible chasm of phelgmy awful misery for the next week and Jessica being extremely thoughtful and perceptive recognized what was afoot.

This session was the most passive of the sessions and she worked on my tight and tender leg muscles and I felt much better following the appointment.

Objective findings:

This is where we put our money where our respective mouths are and see if there is any improvement on the test we conducted during the initial evaluation.

Previous findings:

Lumbar protective mechanism (Institute of Physical Art) : We started with absent initiation in all four quadrants; meaning I had poor core control and was pretty wobbly.

Current Findings

Lumbar protective mechanism (Institute of Physical Art) : Right flexion 2/5, left extension sluggish 1/5, left flexion sluggish 1/5 right extension sluggish ⅕; what this means core is actually working to stabilize me while I run! It’s not super strong but it’s getting there.

Fiona’s impression:

So far I feel really good. I am experiencing less of my typical aches and pains and am feeling stronger and more confident in my runs. I have had several 6 mile training runs at about 7:30 minute miles, which is the fastest I’ve ever run that distance, which is so, so, so exciting. It’s hard to nail down exactly where my speed increase came from. I am doing more skilled physical therapy which has improved my core control and ankle range of motion, and I feel as though I push harder through the ground and float as I leave it. It’s an exhilarating feeling I haven’t had since running cross country in high school! And I also am much more focused in my speed workouts than I used too. Along with speed, Jessica has managed to inject a bit more joy into my running.

If you care to support New York Tisch Multiple sclerosis center through Beyond Basics Physical Therapy and Fiona McMahon’s running efforts please click here to help contribute to the ground breaking work they are doing for people with multiple sclerosis.

Preparing for the Marathon with Physical Therapy at Beyond Basics!

On By bbpt1In fitness, marathon, orthopedics, physical therapy, running, sports, strength, UncategorizedLeave a comment

JHO-Muscogee Moms Contest-Blog

Fiona McMahon, DPT

Hi all! If you have been following our blog, you should be aware that Beyond Basics Physical Therapy and I are teaming up to raise money the Tisch Multiple Sclerosis Research Center of New York with Team Tisch MS. I’m hoping to raise $3,000 dollars to support multiple sclerosis research.  We have currently raised approximately $1,500!. Please support us and click HERE to donate. What puts the fun in this fundraiser ( sorry, not sorry about the pun) is that we get to get donations through running the New York Marathon, which I will be running in November.

I have run 4 marathons before including New York, and even though my timed goals were not lofty ( I really only cared about dragging my body from A to B 26.2 miles later), I relied on PT every single time, to keep my body whole and prevent me from sustaining race ending injuries. This year is no different and this week I will be having my first appointment with Jessica Babich, at Beyond Basics.

 

Why go to Physical Therapy if you are not injured?

No matter how you cut it, physical therapy is an investment. Based on your insurance, co-pays can vary to very little to more expensive, and no matter how much you are paying, the time it takes to go to physical therapy and diligently do your exercises is a finite resource. So why add more tasks to an already arduous training schedule? For me, the answer is easy, I want my body to not only run a faster marathon this fall, but I want to do so in a health way to protect my joints, ligaments and muscles, so I can not only continue to run, hike, ski, and play outside, but also so I can continue working without pain.

But aren’t you a PT, can’t you just PT yourself?

One of the most powerful and surprising lessons I’ve learned through being a physical therapist is, it is really hard to be objective about your own body. Physical therapists are trained to see large scale impairments like weak hip strength, which I know for a fact is something I need to work on, but also small scale impairments in movement, like slightly more pronation on the right foot than the left, those are things another practitioner needs to observe from the outside to diagnose and treat. Having an objective movement analyst ( aka a physical therapist), can help you see weaknesses, and alignment issues that even the most expert observer may miss on themselves. Long story short, you don’t know what you don’t know.

Why someplace like Beyond Basics Physical Therapy

I work at Beyond Basics, so full disclosure, it is the most convenient place I could go. That being said, it is also the best place I could go. Physical therapy clinics come in “flavors” and for someone hoping to truly optimize their performance, Beyond Basics Physical therapy and clinics with the same “flavor” are where to go. What makes Beyond Basics physical therapy so special is the hour one-on-one treatment they offer. This allows us to address all three pillars of movement, efficiently, effectively, and completely. The three pillars are mechanical, ( tightness, or lack thereof, of muscles, joints, fascia and ligaments as well as bony alignment), strength (how strong is a particular muscle and is it strong enough to do it’s job), and finally neuromuscular control, ( do your muscles do the right thing at the right time, this is really important to stabilize the joints of the leg and back, and is often overlooked in some busier physical therapy practice). Other physical therapy practices have a slightly different flavor. They may have a one physical therapist treating 4 patients and hour. Even if time is divided up perfectly equitably between patients, this allows the therapist of only 15 minutes on hands-on treatment to correct mechanical and neuromuscular issues, therefore leaving 75% of the time doing exercises with other patients. That flavor of physical therapy can work for some people, especially those who like to socialize with other patients during treatment, but for me, marathon training is too hard to only get 15 minutes of hands on time and spend 45 minutes doing exercises in a crowded gym. I feel that I am perfectly capable of doing my assigned exercises regularly as part of my home program. I would much prefer to work with a therapist who can tailor my treatment to suit my needs, not one who has to juggle the time constraints of treating multiple patients at once.

How are you preparing for PT?

Beyond Basics Physical Therapy is based out of New York. Like most states in the USA, New York has direct access, so I don’t need to have a prescription to come in. I will be bringing a few things to my appointment that I think are essential: health history, attire, and attitude.

Health History: Health history is a big one. In physical therapy a complete health history includes your current medications, and medical conditions, past injuries ( this is really important, and things like an ankle sprain a few years ago can clue us in on a lot ), and other factors like stress, amount of sleep you typically get, how much you work out and what you do, and diet.

Attire: Another important and sometimes overlooked item on the list. Your physical therapist will have to examine different areas on your body, as well as have access to treat those areas. Loose fitting shorts and an athletic top are a good bet. Even if you are going to physical therapy, for a condition like pelvic floor dysfunction, your therapist may ask you to do exercises, so it wise to bring workout clothes to your appointment. If you are a runner, bring in your shoes. The wear pattern on used pair of running shoes can provide heaps of valuable information.

Attitude: This is super important. Physical therapy is a partnership between you and your physical therapist. For me I already, foresee finding time to do the exercises that Jessica will prescribe to be a challenge. But the fact is, home exercise is part of the deal, and I won’t get nearly as much benefit from physical therapy alone, versus physical therapy with home exercise. Like I said before marathon training is simply too hard to just go through the motions at physical therapy.

 

What are your goals and what do you expect to gain from physical therapy?

Like I said before, I want to stay as healthy for as long as possible, but I would be lying if I said my primary goal wasn’t to increase my time. I want to put my money where my mouth is and put all my old times out in the open. So you can know where I am starting from and where I hope to go.

Here are my past times:

Mount Desert Island 2010: total time 3h 56 minutes 18 second: 9 min per mile pace

Mount Desert Island 2011: total time 4h 05 minutes 21 second: 9 min 22 seconds per mile pace

Sugarloaf 2011: total time 3h 52 minutes 25 second: 8 min 51 seconds per mile pace

New York City 2013: total time 4h 0 minutes 47 second: 9 min 11 seconds per mile pace

Here’s my dream goal for this race:

3 hours and 45 minute at 8: 35 pace.

As you can see, it’s 7 whole minutes faster than my fastest race over 7 years ago . To get there, I can’t get injured and I certainly can’t waste any precious energy during the race running inefficiently. I know that Beyond Basics will give me the best chance to meet my goals.

If you are looking to increase your performance in your sport of choice come see us to make sure you are getting the most power out of your serve, swing, or stride. Click here to access our home page and make an appointment today.

Continue to follow us here, on Instagram, and on Facebook to see my progress in physical therapy as well as my progress towards my goal of raising $3,000 dollars for MS research. If you care to donate please click here to donate to this worthy cause