Tag Archives: manual therapy

Elite PT January Newsletter – Therapist Spotlight: Kristy Ockert

Hi everyone

Hope you had a great Christmas and New Years.

2017 was a great year for us at Elite Physical Therapy and hopefully 2018 will be more of the same.  It’s a blessing for us to be able to work closely with clients like yourself.  We really love getting to know our clients and helping them to achieve their rehabilitation and training goals.  It’s awesome to be able to do something you love for a living, and hopefully it shows!

Free Screening Day

We’ll be hosting another free screening day coming up in February (date to be announced soon).  This is an annual service we’ve started providing to the following:

  • All past physical therapy clients
  • All present clients who have another problem currently not being treated
  • All loved ones, family, friends, neighbors and co-workers of our past and present patients

If you are having pain or problems with day to day activities such as walking, standing, sitting for long periods, going up or down steps, getting in and out of the car, sleeping or driving, then this is an excellent opportunity to see one of our world-class therapists, find out the cause of your problem, and get some treatment ideas.

I’ll be sending out an email soon with more information on how you can take advantage of this free offer.

Therapist Spotlight – Kristy Ockert MSPT

Kristy Ockert began working at Elite Physical Therapy 2 years ago and overall has been practicing since 2002 in the outpatient setting. She earned her Bachelor’s degree in Kinesiology with a specialization in Health Promotion from Michigan State University and her Master of Science in Physical Therapy degree from the University of Colorado Health Sciences Center. Kristy is a Certified Kinesio Taping Practioner (CKTP) and enjoys treating a wide variety of patient populations including post-operative, athletes, and patients with spinal dysfunctions.

She has enjoyed furthering her education with a Pilates specialization and various manual techniques including Graston Technique, Functional Dry Needling, Muscle Energy Technique (MET), Muscle Release Technique (MRT) and Myofascial Release (MFR). Kristy is passionate about providing one on one care to her patients and taking into account all pieces of their individual health puzzle for restoring optimal wellness and return to function.

Q & A:

What got you interested in physical therapy as a career?

It’s a long story!  When I was younger, I wanted to become a teacher, like my mom.  As I got into high school, I knew I wanted to be a doctor – either a pediatrician or sports medicine physician so I could focus on optimizing health for kids and athletes.

My first glimpse of PT was as a patient when I was injured during my high school senior year softball season.  I had a great PT and PTA work with me, but I didn’t think much of it until my senior year of college at MSU.  I decided that I did not want to go to medical school any longer and was looking for a new career path.

After some research and lots of deliberation, I changed my major from Human Biology to Kinesiology, which is the study of human movement.  I finally loved my classes – movement throughout the lifespan, biomechanics, adaptive movement, etc.  It all seemed to fall into place after that.  I got in touch with my former PTA and asked if I could interview her for a class assignment.  It turned into shadowing and weekly volunteering in a small outpatient clinic.  I was hooked!  If I were to become a physical therapist, I could work in the health care field with people of all ages and teach them about how to optimize their movement for improved quality of life.

Over the past couple years you’ve become certified in Graston Technique and dry needling.  Any other techniques you really like to use?

I also enjoy being a Certified Kinesiotaping Practitioner.  Whether it is to help with swelling, bruising, or scar tissue, working on retraining a muscle with proper activation or even unloading an injured area, Kinesiotape has so many uses.

What are your favorite things about being a PT?

I enjoy working with closely with people whether it’s younger athletes, weekend warriors, middle aged or even geriatric patients interested in remaining active.  If there are a few exercises, hands on techniques, and instruction in daily modifications that can make someone’s life more functional and optimize their movement, I’m happy!  I love seeing the changes that people go through from the start to finish of therapy.

Outside of working at Elite, what kinds of things do you and family enjoy?

I enjoy spending time with my husband of 16 years, Ken, and our three kids Carter (14), Peyton (11), and Emma (8).  We love watching movies, going to the beach, bowling and skiing as a family.  I also have a love-hate relationship with winter running, so I’m going to try snowshoeing with my running buddies this year for our longer distances to gear up for the 2018 racing season!

Kristy Ockert
 

 

 

 

 

 

Testimonial

Thank you, thank you, thank you!! After 5 years of physical therapy at numerous other locations, false diagnosis and lack of improvement, MRI’s that showed nothing, Kristy and Lydia correctly diagnosed the problem with my daughters knee and have fixed the problem! You have got her active again with little to no pain. You have brought a smile to her face and to her parents face as well! Thank you for getting her back to healthy! 5 stars isn’t enough! – M.R. Ludington

Sore Knees???
Pain site does not always equal pain source!

Just because your knee hurts doesn’t necessarily mean that the problem lies only with that knee.  You’ve got numerous joints above and below that must move correctly to take the pressure off the knees.

One of the prime examples (or prime offenders) is the ankle joint.  A stiff ankle will negatively affect your walking and running stride, ability to squat down, walk up/down stairs, balance, and more.

The client from the testimonial above was a great example of this.  Resolving her ankle mobility limitations went a long way toward making her knees feel better.

Check our the link below for a short article/video on how we assess and solve the problem of ankle mobility:  http://www.elitepttc.com/ankle-mobility-update/

This is exactly the kind of thing our free screening day is for!

Til next month

Joe Heiler PT

Elite PT November Newsletter – What PT Should Look Like

Hi guys

Hope you’re having a great week so far!  It’s time for another monthly newsletter so here is what’s going on this month at Elite PT:

  • What High Quality PT Should Look Like (my rant for the month)
  • Manual Therapy – What Can It Do For You?
  • Exercise of the Month – Bird Dog for Lower Back Pain

What High Quality PT Should Look Like

This is my rant for the month.  Twice in the past week we’ve had patients come to us that have failed PT elsewhere and were pretty much ready to give up and ‘just live with it until they were talked into giving us a try by previous clients of ours.

In both cases these folks actually saw their PT’s only briefly then were passed off to the tech, were left to do their exercises on their own most of the time (since the therapist was busy with other patients), and received little to no manual (hands-on) therapy.

Needless to say the results were not what these folks were hoping they would be!

I know I’m tooting our own horn here and I don’t normally like to do this but it really bothers me when the PT factories out there give us smaller practices a bad name.  High quality physical therapy practices should look like this:

  • One-on-one treatment sessions
  • Working closely with a PT, PTA, or Athletic Trainer.  No Tech’s!
  • A healthy dose of hands on manual therapy when needed
  • Exercise is closely supervised by your therapist
  • You know exactly what you need to do at home to make the treatment process a success

At Elite PT, we guarantee all of the above.  If you’re going to spend your hard earned money on physical therapy services then it should be somewhere where the focus is on YOU!

I feel better now.  Thanks for listening!

Manual Therapy – What can it do for you?

Manual therapy can be described simply as hands-on therapy.  Most patients are familiar with massage but there are many beneficial techniques to decrease pain and improve mobility.  There are a number of hands-on techniques we use in addition to using instruments like Graston Technique and Dry Needling.

Exercises and stretching are great but often aren’t good enough to stand alone.  Manual therapies can quickly decrease pain and get you moving again much faster when combined with exercise.

Case in point:  One of our clients,struggling elsewhere, came to us with a very stiff and painful ankle post-surgery.  He was very limited with his motion which was making it difficult to walk and do stairs.  He reported only one session of light massage in his previous 3 weeks of physical therapy and the rest of the time was spent working on stretching and balancing.

Check out the picture below to see how much ankle bend (dorsiflexion) he had walking in the door on day 1:

Ankle Dorsiflexion

The knee is stuck 2″ behind the big toe!

Now check out how much ankle bend he had after one treatment session with us:

Ankle Dorsiflexion 2

The knee is a 1/2″ past the big toe now

He came back for his second visit reporting that pain was reduced significantly and he was walking much better.

This is just one example of how quickly things can change with a little focused hands on therapy and exercise with a purpose.

If you want to learn more about how we use Graston Technique (one of our favorite manual therapies) to treat the foot and ankle then click the link here:  https://youtu.be/Ah2ZUpMuUjk

Exercise of the Month – Bird Dog

The bird dog is a very popular PT exercise plus you’ll find it in a lot of Yoga and Pilates classes as well. It can be used to address strength and stability from the neck down through the hips but there are some very specific things that need to be done to make it truly effective.

Check out the video below to see how we get the most mileage out of a seemingly simple exercise (and another reason why your therapist needs to be working with you one-on-one).  The corrections in this video are specifically for those who are dealing with lower back pain but can also be used to enhance stiffness and strength through the muscles of the core.

https://youtu.be/BC7iSY9PtP4

_________________________________________________________________

Have a great Thanksgiving and enjoy the rest of the month.  Talk to you in December!

Joe Heiler PT

Back Pain and Sciatica – Part 2

Last month I posted a case study showing how we treat back pain and associated ‘sciatica’ like symptoms here at Elite Physical Therapy in Traverse City.  You can find that article here:  http://www.elitepttc.com/back-pain-and-sciatica-physical-therapy-treatments/

This month’s case study is a little different in that the presentation and location of the pain were quite different but it still comes down to playing detective to determine where the patient’s symptoms are really coming from.  Before we get started here, I’m re-posting the picture of the dermatomes of the body (basically the sensory distribution of the nerves from the spine) so be sure to check that out.  Pretty cool how we were created for sure!Dermatomes

Case Study #2

The patient in this case presented to our clinic with pain shooting into the front of his hip and groin as well as down the front and side of his thigh.  He also reported minor back pain but it was nothing compared to the pain in his leg.  The patient reported having this pain on and off over the past couple years especially when exercising but recently it was much more constant and severe.  In the past he had been diagnosed with IT Band syndrome (pain laterally in the hip and thigh might make you think that), and more recently with a hip flexor strain (could also make sense now that he was having more pain into the front of the hip and groin).

Exam

  • minimal tenderness to the ‘hip flexor’ muscles anteriorly, slight weakness with manual muscle testing but no pain (probably not a hip flexor strain).
  • moderate tenderness and active trigger points in the lateral hip musculature that referred pain down the lateral thigh to the knee (could be part of IT Band syndrome).
  • springing of the lumbar vertebrae at L2 and L3 reproduced the typical symptoms  he felt into his anterior hip/groin as well as lateral thigh (Bingo!)

Treatment

Dry needling was performed at the levels of L2 and L3 along with electric stimulation for 10 minutes, and followed up with Graston Technique (GT) to decrease tone and improve mobility of the superficial fascia and muscles of the mid and lower back.

A couple exercises were given to maintain, and hopefully even improve, the mobility gained through the spine and hips as a result of the dry needling and GT.

Results

The patient reported a significant decrease in the anterior hip and groin symptoms as well as a moderate improvement in lateral hip and thigh symptoms.

During the second treatment session I decided to treat the muscles of the lateral hip as well since they also referred pain into the lateral thigh.  This was done with by dry needling + e-stim just like we had done in the low back.

By the third treatment session a few days later the patient was reporting a significant reduction in lateral hip and thigh symptoms as well.

Final Thoughts

It took a few more treatments to completely resolve this patient’s symptoms but it’s nice to see an immediate decrease in symptoms to know that you are treating the right areas.  With a thorough evaluation process it wasn’t hard to figure out that the patient’s symptoms were primarily coming from his spine which was quite a different diagnosis than what was previously thought.

A little detective work plus effective treatment tools like dry needling and Graston Technique can make a huge difference in patient outcomes especially in these ‘sciatica’ cases.  If you have similar types of symptoms or pain that just doesn’t ever seem to get better then give us a call!  If you have any questions feel free to email me:  joe@elitepttc.com

Back Pain and Sciatica – Physical Therapy Treatments

This month I figured I’d post on a couple case studies related to back pain and sciatica, and how we evaluate and treat cases like this at Elite Physical Therapy.  We’ve had a lot of great success with these folks so thought I’d share a couple examples.

Back pain, and associated leg pain, can be difficult to treat but we like a challenge!  Playing detective can be fun if you know what to look for.  Check out the pictures below that show the paths the spinal nerves take throughout the body.  Leg pain (or what many people like to call ‘sciatica’) can follow a number of paths down the leg and sometimes that can be a dead give away to identify exactly where the pain is coming from.

dermatomes

***The letter and numbers above correspond to a particular spinal nerve, i.e. L4 means lumbar spinal nerve #4 ***

There are other ways to narrow down the location of the problem as well:

  • the muscles will be painful to palpation at a specific vertebral segment and may even refer pain down the leg when palpated with deeper pressure.
  • reflexes may be diminished.  A slow or non-existent patellar tendon reflex corresponds with lumbar spinal nerve #4.
  • Muscles may test weaker on the affected side which may indicate an injury to a particular spinal level or nerve.  An example of this would be weakness in the calf muscles (can’t lift up on to the toes) which are controlled by the first two sacral nerves (S1 and S2 on the chart).

So here’s a great example of a number of these factors all lining up and how quickly the pain and loss of function can be addressed.

Case Study #1

The patient in this case had left sided low back pain and pain running down through the back of her hip and leg to the mid-calf.  She felt a ‘pop’ in her back and immediate leg pain as a result of pushing and twisting trying to put a heavy object in the back of her truck.  She is an avid runner but even standing and walking significantly increase her pain after 10 minutes.

Exam

So here is what I found:

  • Symptoms following the S1 and 2 dermatomes down the back of the left leg
  • Increased muscle tone/spasm at the S1 and S2 levels of the spine, and these muscles are tender to palpation.
  • ‘Springing’  or pushing down on the S1/S2 vertebrae reproduced the symptoms into the back of her hip/upper thigh.
  • She could do only 12 calf raises on her left leg while doing 25 on the right side (this muscle corresponds with S1 and S2 nerves).
  • Achilles reflexes normal (S1 reflex)

It’s nice when everything points back to a specific level or two like that.  Doesn’t always work that way but when it does it makes me much more confident that we can knock this out quickly.

Treatment

In this case I chose to use dry needling to address the muscles at the S1 and S2 spinal levels on both sides of the spine.  Once the needles were placed I attached an electrical stimulation unit and she just relaxed for 10 minutes.  Dry needling in conjunction with e-stim are shown in the research to decrease tone within the muscles as well as alleviate pain through a number of local and global factors.

The patient was instructed in two exercises that had multiple purposes:

  • decrease pain through relaxation of the over worked muscles of the back and anterior hip
  • facilitate improved stability through the lumbar spine and pelvis

Pretty simple exercises that are beyond the scope of this article but lots of bang for your buck when they only take 5 minutes 2-3 x per day.

Results

The patient had near full resolution of symptoms for two days after the first session.  Her exercises relieved her pain at home and she could walk as much as she wanted.  She tried to run on the third day but was unable due to pain.

We repeated the same dry needling + e-stim treatment during the second visit and followed it up by progressing her exercise program.

The patient cancelled her appointment the next week as she reported being completely pain free and back to running.

Final Thoughts

Sometimes it just works that well but I certainly won’t make that guarantee in every case!  Back pain and ‘sciatica’ cases can be quite complex but knowing how to put together all the puzzle pieces definitely helps.

That’s probably enough to wrap your head around for this time.  Next month I’ll post another case study but with a different symptom presentation.  In the meantime if you have any questions just shoot me an email:  joe@elitepttc.com or call 231 421-5805.

Graston Technique – Treating the Painful Shoulder

Here is the video I promised using Graston Technique to treat soft tissue dysfunction in the posterior shoulder girdle using and in particular the trigger points that can refer pain to the front of the shoulder and down the arm.

If you haven’t read the previous article discussing why we would want to treat this area, you can check that out here:  http://www.elitepttc.com/blog/trigger-points-and-shoulder-pain/

If you have any questions concerning Graston Technique, Dry Needling, or shoulder pain please contact us at 231 421-5805 or Joe@elitepttc.com

Functional Dry Needling for Low Back Pain

Functional Dry Needling has been a great addition to my manual therapy ‘tool box’ especially for those with low back pain.  Recently, Nelson Min PT from Kinetacore (the group that trained me) wrote a short article on using dry needling for patients with spinal stenosis.

Spinal stenosis is one of the most common causes of low back pain in folks 50+ years of age.  The most common presentation is pain with standing and walking that is relieved with sitting down, forward bending, or lying down.

So here is Nelson’s article on Functional Dry Needling and the treatment of Spinal Stenosis:

“I listen for several things when evaluating a new patient with low back pain.  I take particular interest when my patient informs me that their pain increases with prolonged standing or walking versus pain that increases with prolonged sitting.  An older patient that tells me that their back pain increases with prolonged standing and walking, and is then relieved immediately with sitting, makes me suspect stenosis.  For someone younger, I am suspicious of spondylosis or some other instability.  I would confirm this with my biomechanical exam but this little detail in the patient’s history often steers me in the right direction.”

Listen to your patient — he is telling you the diagnosis.  – William Osler MD

To continue reading, head on over to Kinetacore.com

If you have questions on Functional Dry Needling or the treatment of back pain, feel free to email joe@elitepttc.com or call me at 231 421-5805231 421-5805

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.