Monthly Archives: April 2014

Now at Elite Physical Therapy – Functional Dry Needling

Functional Dry Needling is a very effective manual therapy technique that I’ve been wanting to learn for some time now, and was recently trained though Kinetacore.  I’m very excited to be using this new technique and I’m already seeing some great results.

In this week’s blog post, I want to give some very basic background on what Dry Needling is, and is not.  The article below doesn’t mention this but I want to make it quite clear that this is not acupuncture.  The only similarity is the use of the same type of needle.  Dry Needling performed by a physical therapist requires a thorough musculoskeletal evaluation, and placement of the needle into specific taut bands of muscle (a.k.a. trigger points) that are pain generators and creating dysfunction within the system.

My knowledge of acupuncture is somewhat limited but generally speaking the points that are treated in the body are mapped out along ‘meridians’.  Needles are placed into these preset points and left for a certain amount of time.

There is a lot more to it than just this, and I think it is important to understand that there are differences.  The description of Functional Dry Needling below comes from the Kinetacore website.  It’s a quick primer on the technique.  If you want to see it in action, check out the video at the bottom of the page featuring Terry Bradshaw.

“Dry Needling is a general term for a therapeutic treatment procedure that involves multiple advances of a filament needle into the muscle in the area of the body which produces pain and typically contains a ‘Trigger Point’.   There is no injectable solution and typically the needle which is used is very thin. 

Most patients will not even feel the needle penetrate the skin, but once it has and is advanced into the muscle, the feeling of discomfort can vary drastically from patient to patient.  Usually a healthy muscle feels very little discomfort with insertion of the needle; however, if the muscle is sensitive and shortened or has active trigger points within it, the subject may feel a sensation much like a muscle cramp — which is often referred to as a ‘twitch response’.

The twitch response also has a biochemical characteristic to it which likely affects the reaction of the muscle, symptoms, and response of the tissue. Along with the health of the tissue, the expertise of the practitioner can also attribute to the variation of outcome and/or discomfort.  The patient may only feel the cramping sensation locally or they may feel a referral of pain or similar symptoms for which they are seeking treatment. A reproduction of their pain can be a helpful diagnostic indicator of the cause of the patient’s symptoms. Patients soon learn to recognize and even welcome this sensation as it results in deactivating the trigger point, thereby reducing pain and restoring normal length and function of the involved muscle.

Typically positive results are apparent within 2-4 treatment sessions but can vary depending on the cause and duration of the symptoms, overall health of the patient, and experience level of the practitioner. Dry needling is an effective treatment for acute and chronic pain, rehabilitation from injury, and even pain and injury prevention, with very few side effects. This technique is unequaled in finding and eliminating neuromuscular dysfunction that leads to pain and functional deficits.”

If you have further questions about the technique, or feel that this technique may work for you then feel free to contact us:  joe@elitepttc.com or 231 421-5805231 421-5805.

Explaining Pain

Pain is something many of us deal with everyday, whether it our own or working with others to help them overcome that pain.  At Elite Physical Therapy, we feel that it is very valuable for our patients to understand how pain works, and how we should deal with pain during the different stages of healing.  Chronic low back pain and neck pain are two very common cases where this new science is having a valuable impact.

This is a great video by Lorimer Moseley explaining pain and how it is processed by our brains.  Dr. Moseley and Dr. David Butler are definitely changing the way we think about pain in the medical professions.

https://www.youtube.com/watch?v=gwd-wLdIHjs&feature=player_detailpage

The take home message is that with chronic pain, the tissues are often completely healed, but the brain still perceives pain.  In this situation, movement and activity are often the best medicine.  You can’t hurt anything so try to do as much as you’re capable of doing without going overboard.  You may just gradually improve your functional abilities while decreasing pain using this approach.

 

Elite Physical Therapy Exercise of the Week – Wall Posture Shoulder Mobility

originally posted on SportsRehabExpert.com

This article was originally written for physical therapists and other clinicians dealing with shoulder pain and loss of motion so excuse some of the medical terminology.  I know a number of them read this blog so I’m leaving the article as is. 

The jist of this article is as follows:  most of us have too much extension (arch) in our lower spines, and we go into even more extension any time we try to raise our arms overhead.  Over time this can lead to shoulder pain and low back pain.  The article below describes a great warm-up exercise to improve shoulder mobility while controlling spinal posture. 

As always if you have any questions feel free to email me:  joe@elitepttc.com

Joe Heiler PT, CSCS

This is a great correction for the shoulder mobility movement patterns and also for the shoulder flexion component of the MS Extension pattern.  The lumbar spine frequently contributes excessive extension to the shoulder patterns when the shoulder itself is limited.  Mobility work is required to free up the shoulder, but this pattern will continue if motor control is not imparted to lock in the new range of motion.

I would not want to be her low back right about now!

The ‘wall posture’ as I describe it to the patient is an attempt to get the entire spine to touch the wall.  By having the feet out in front and knees slightly flexed it makes it easier to get the lumbar spine flat onto the wall which is really just a less extended, and probably more neutral position, for most folks. If you’re concerned that it is too much flexion, or if it is not well tolerated due to back pain, and towel roll/lumbar support could be used but contact must be kept at all times.

The cervical spine is a little trickier when it comes to proper positioning.  I will cue to get the spine to the wall, but to a point.  That cue will usually bring the chin down and back (into cervical retraction) which again will bring most folks to a more neutral posture.  Too ‘straight’ is not a normal position either and could affect the shoulder mobility component of this corrective so don’t force it.  If their forward head posture is so severe that their head won’t touch the wall without going into extension, then place a towel roll behind the head and require them to hold the towel in place as the arms go overhead.

Maintaining the proper positioning throughout the movement is the most important factor here.  The shoulder motions in the video are a challenge to that positioning.  When posture is lost, the movement is done.

Breathing is critical here as well.  My preferred way of cuing the breathing is to inhale at the bottom and slowly exhale during the overhead motion.  The more the ribs stay down in the front the better.  This can be incredibly hard for many people, and especially so for many overhead athletes, weight lifters, dancers, and gymnasts.

 

The order in which the motions are presented in the video go from easier to most challenging:

1)  Shoulder Flexion
2)  Shoulder Abduction (snow angels)
3)  Shoulder Abduction with External Rotation

If following the SFMA’s 4×4 matrix, this would be considered a level 4 posture, unloaded but with assistance (the wall as the positional cue) so 4:1.  Competency must be attained in each of the previous postural levels:  1)  supine/prone, 2)  quadruped, 3)  tall or half kneeling.

Progressions per the matrix:

4:2 – shoulder mobility work without the postural cuing or any activation
4:3 – loaded with cuing or activation.  Shoulder Flexion/Extension (reciprocal patterning) or pressing overhead with the spine against the wall or a corner (I prefer a corner to allow the shoulders to move more freely).
4:4 – loaded without cuing or activation – Shoulder Flexion/Extension in standing, any type of pressing.