Tuesday, June 30, 2009

4 Ways to Ease Symptoms Associated with Sciatica

Sciatica describes a cluster of symptoms rather than a true diagnosis and involves irritation of the sciatic nerve and/or it’s branches as they exit the spine. These symptoms can include back and/or leg pain (usually just one leg), abnormal sensory symptoms such as numbness and tingling and weakness or difficulty controlling the affected leg. Most people do not present with all of these symptoms, but in severe cases all may be found.

As stated, sciatica is really a set of symptoms and can be caused by several insults including: disc herniations (bulges), spinal stenosis, piriformis syndrome or some external source usually related to postural habits. All of these causes involve some form of compression on either the spinal nerve roots or on the sciatic nerve itself and can eventually lead to irritation and pain. So, it makes sense that the goal of conservative therapy would be to alleviate this pressure and restore normal mechanics to the spine and pelvic region in order to prevent the condition from returning. In cases where severe spinal stenosis or a large disc herniation is present, physical therapy may not be effective and surgery may be the only option.

The following techniques can be used to alleviate sciatica and should not cause increased symptoms. If increased pain, numbness or weakness is experienced, then a medical professional (orthopedic physical therapist or orthopedic medical doctor) should be consulted.

#1 - Lumbar Prone Press-up
The lumbar press-up stretches the spine into extension and is often useful in reducing pain associated with disc pathology. However, extension of the spine may make symptoms associated with stenosis worse, so be sure symptoms are not increased while in this position. Perform as needed to alleviate symptoms and hold 15-45 seconds.

#2 - Lumbar Flexion Stretch
This stretch will round the low back, which will reduce pressure over nerve roots associated with spinal stenosis. Perform as often as needed and hold 15-45 seconds.

#3 - Piriformis Stretch
This stretch helps to loosen the piriformis muscle which is a rotator of the hip and located under the gluteal (buttock) muscles. The sciatic nerve runs directly under this muscle, so when it is tight extra compression can be caused over the nerve. Hold the stretch 30 seconds to 1 minute. Start with the stretch on your back and move to the stomach down version if the first one is too easy. Both pictures show a stretch of the left piriformis and should be felt in the buttock region.

#4 - Piriformis Self Massage
Using a foam roller or tennis ball as shown in the picture can be a great tool for easing piriformis tightness and reducing pain. The right piriformis is being worked in the picture. Spend 2-3 minutes on the roller as needed to alleviate symptoms.

Thursday, June 25, 2009

5 Strategies to Rid Yourself of Tennis Elbow

Tennis elbow or lateral epicondylitis, as it is known in the medical world, involves irritation of the common extensor tendon at the lateral epicondyle of the elbow. That sounded a little technical. To put things plainly, the lateral epicondyle is a bony knob on the outside of the elbow where the tendon of the muscles that extend the wrist attaches. With overuse this tendinous attachment can become inflamed resulting in pain.

Due to the fact that tennis elbow is often an overuse type of condition, rest is usually indicated to fully recover and return to 100% of normal function. Besides rest, these 5 tips will get you on the road to recovery.

Strategy #1 - Ice cup massage
If you are currently experiencing symptoms of tennis elbow, a very inexpensive home treatment involves filling a dixie cup with water and placing it in the freezer. After the water has frozen, remove the cup, peel back the top until the ice is exposed and then slowly rub the ice over the lateral epicondyle. The recommended time is 5-7 minutes, no longer.

Strategy #2 - Transverse friction massage
Another home treatment involves finding the most tender spot along the tendinous attachment at the lateral epicondyle and rubbing back forth in a perpendicular direction with a moderate amount of pressure. After several minutes, the area should begin to feel less pain or even a numb sensation. If more pain is provoked then lessen your pressure. Limit the treatment to no more than 5 minutes and ice afterwards.

Strategy #3 - Stretch the wrist extensors
Because the wrist extensors and their common tendon are involved in this condition, stretching such tissue is important. Follow the picture and hold for 30 seconds. Repeat 2 times.

Strategy #4 - Strengthen the wrist extensors
Tennis elbow occurs when the wrist extensors cannot meet the demand being placed on them. So, increasing strength is vital to preventing this condition from returning. Pain should not occur with the strengthening exercise pictured below. If pain does occur lessen the weight being used or you may have to postpone strengthening a week or two until inflammation has reduced.

Strategy #5 - Use a tennis elbow brace
Another option to reduce irritation at the lateral epicondyle is to use a tennis elbow brace or band. These bands are worn just below the lateral epicondyle and work by reducing the amount of stress that is transmitted to the tendinous attachment at the lateral epicondyle.

Controlled Instability & Balance

Balance is a key mechanism to help any individual perform better and live more safely, as well as functionally keep your mind & body synchronized for daily living. In addition, it is one of the easiest parts of the neuromuscular system to train! Improvement for balance exercises has also been suggested as being one of the fastest mechanisms to adapt within a training program.

Unfortunately, balance is also one of the most underrated mechanisms in any individual's training program, which in-turn makes the person more susceptible to joint dysfunction and injury. Without the sensory skills and feedback to maintain proper alignment of the body throughout different planes of motion, the joint's connecting muscles may become tight and overactive, or weakened and underactive, which may lead to even more imbalances elsewhere in the body. Scroll down below for Tom's post The Hip Bone is Connected to the Knee Bone below for more information on such relationships, or what one of my favorite professors from UCSB referred to as "Interconnected-ness".

When starting a balance training program, please remember to always perform the exercises in a training environment that is as unstable as can safely be controlled, also know as controlled instability. If needed, practice near stationary objects of proper height, i.e. facing a countertop for quick hand support, or in an area free of smaller objects that may be easily tripped on. Many products are available to assist with balance programs, such as half foam rolls, Airex Pads, and Dyna Discs, and can mostly be found at Big 5 Sporting Goods stores, or online. Others may find it's easier just try and progress to balancing on couch cushions placed on the floor. Whatever you decide, try something like this to start off with, before moving onto a more challenging surfaces:

1. Single Leg Balance - 10 repetitions for 10 second holds each repetition

If able to successfully complete, move onto this:
2. Single Leg Balance - with free leg reaching forwards, then reaching to the side, then reaching backwards- one "round" without needing to touch the ground - 5 repetitions of 5 rounds

If able to successfully complete, move onto this:
3. Single Leg Balance - with arms moving from pointing to the ground, to pointing to the ceiling, like a slow-motion jumping jack without the jump. If able to complete this, grab some small free-weights (or soup cans) and attempt the same motion. 3 repetitions of 10 "jacks"

Proper cues for all stationary balance exercises:

  • Do not lock your knee straight- always keep the knee slightly un-hinged as to not restrict blood flow

  • When balancing, draw your navel in and activate your gluteal muscles- this will help!

  • Chose a spot on the ground 5 or 6 feet in front of you to stare at when balancing, not the mirror or any moving objects

  • When performing balance exercises, make sure the knee of the balance leg stays in lines with your toes- any pressure of the knee moving either way beyond the line of your toes may stress your knee

  • Keep your hips and shoulders level, to maintain optimal lumbo-pelvic-hip complex balance

  • Try and keep the arch of the balance foot up! Don't let the foot collapse flat to the surface. Try this by curling your big toe down, and then trying to raise the inside arch of your foot

  • Always be progressive. Trying doing the above routine first as is, then progress to slightly more-challenging surfaces.
If you are unable to perform these tasks, just keep trying! That's the beauty of balance training- unless you know of predetermined conditions or are taking medications that will prevent you from completing these tasks, you will be able to adapt and improve your balance.

Monday, June 22, 2009

5 Tips to Avoid Travel Associated Aches & Pains

It’s summer time again and that means people are heading off on vacation to catch up on a little rest and relaxation. One would think that a week or two of relaxing would be the perfect prescription for nagging low back or neck pain, but in many cases the opposite may be true. Most trips include sitting for extended hours in a car or plane to reach a particular destination, increased stress at the beginning and end of the trip, eating junk food, drinking alcohol and most likely exercising less. All of these factors can lead to increased aches and pains and make your trip that much less pleasurable.

In order to reduce the effects on your system associated with travel, implement these tips and you will hopefully feel like a million bucks by the time you return home.

Tip #1 - Move Regularly

Whether traveling by car, plane, train or some other method of transportation, prolonged sitting is usually involved. Extended periods of sitting often results in tightness through the spinal, pelvic and lower extremity musculature and may ultimately bring on a pain response. Ideally, a person should plan on getting up at least once every hour and spending approximately 5 minutes walking and stretching.

Tip #2 - Stretch Muscles Prone to Tightness

1: Neck half-circles - roll the head from one shoulder across the chest to the other shoulder to maintain the flexibility of the neck musculature

2: Seated lumbar stretch - reach your right hand to your left knee and twist your spine to look as far behind you as possible. hold 10-20 seconds and repeat on the other side.

3: Standing hip flexor/calf stretch - stand in a lunge stance with one leg forward and the other behind you. Keeping your spine straight lunge forward until you feel a stretch at the front of the thigh and in the calf of the leg that is behind you. Hold for 10-30 seconds and repeat on the other side.

4: Standing hamstring stretch - with your knee locked out, bend forward toward your toes until you feel a stretch at the back of the thigh. Hold 10-30 seconds.

Tip #3 - Pack a back or neck support and use heat and ice packs

Using a portable lumbar or neck (cervical) support on long plane or car rides will provide stability to the spine’s natural curves and help reduce pain. Also, filling a small bag with ice or packing portable heat packs that warm upon opening can be great tools for reducing pain.

Tip #4: Pack light and lift with proper body mechanics

Heavy luggage is often a recipe for low back pain, so only take those necessary items. Once your suitcase is packed with only the essentials, make sure to lift slowly and in such a way that allows you to keep your back straight and requires that your legs do the work. On plane rides, don’t be shy to ask someone for help when loading into the overhead compartment. Lifting 45 pounds above shoulder level puts a great deal of stress on the low back, shoulder and shoulder blade/neck musculature and can cause an instant muscle strain if not performed in a controlled manner.

Tip #5 - Drink plenty of water and avoid alcoholic beverages

It’s definitely okay to consume alcohol, but make sure you follow up with plenty of water. Alcohol is known to inhibit anti-diuretic hormone, which leads to increased urination and dehydration. Our muscles, tendons, cartilage and most other structures depend on water for normal flexibility, so being dehydrated can contribute to increased stiffness and pain.

Thursday, June 18, 2009

National Academy of Sports Medicine & The OPT Model

The National Academy of Sports Medicine was first introduced in 1987, and today is one of the top authorities in promoting tools and research for health, fitness, sports performance, and sports medicine. The Academy has helped thousands in their journey to become better athletes and healthier individuals. NASM is also one of the few organizations that will focus on Corrective Exercise Prescription, which focuses on the prevention and re-introduction of past injuries. It is for these reasons that I recommend NASM’s Optimum Performance Training Model, also known as the OPT Model, to any patient after completing physical therapy treatment.

The OPT Model
PHASE 5 Power Training
PHASE 4 Maximal Strength
PHASE 3 Hypertrophy
PHASE 2 Strength Endurance
PHASE 1 Stabilization Endurance

Each phase of the OPT Model contains particular exercises and set/rep schemes that are designed to progress you to the next level of performance. Phase 1 – Stabilization Endurance can often be the first priority when embarking on new fitness goals. Enhancing joint stability, increasing flexibility, improving reaction time, and enhancing control of posture are all to be focused on at this time. Once stabilization of the joint(s) is achieved and the individual can maintain stability, they may begin working on Phase 2 – Strength Endurance. This phase is designed to further improve stabilization, increase strength, improve work endurance and increase lean body tissue. It requires active flexibility and may be accompanied with moderate resistance exercise. The principles of these two phases are the groundwork to any individual’s health and wellness. We would all have a lot less low back pain, headaches, hypertension, and injuries if we focused on stabilization and strength endurance!

Phase 3 – Hypertrophy Training, along with phases 4 and 5, is where personal trainers can bring you closer to your new goals, avoiding the fearful thoughts of re-injury in a safe and controlled environment. This phase, along with Phase 4 – Maximal Strength Training, will help you achieve quicker reaction speeds, increase strength, and improve peak force and muscle use. As trainers, we consider these to be the most important part of post rehabilitation, because the stronger you get, the less likely you are to become reinjured!

Phase 5 – Power Training should be the goal for any healthy individual, as this phase can help not just with your daily lifestyle, but it improves your athletic performance. Phase 5’s purpose is to enhance neuromuscular efficiency, improve prime muscle strength, increase the rate of force power, and enhance speed strength.

Most athletes will cycle through each phase periodically so that the body is consistently adapting to an ever-changing environment, avoiding training plateaus. Whether you’re a weekend warrior training for a 10k run, or a competitive athlete looking for your next edge up on the competition, training the entire spectrum of the OPT Model will benefit your health and wellness, as well as prevent re-injury.

For more information on The National Academy of Sports Medicine, visit http://www.nasm.org/ or contact Zack Bertges at Zack@hayashidapt.com

Tuesday, June 16, 2009

Robotic Knee Orthosis Being Tested

Tibion Bionic Technologies has developed an electric knee orthosis that may be used to help patients suffering from a variety of conditions including neurologic disorders, surgery, generalized weakness and osteoarthritis. The orthosis has the ability to detect the user’s actions and assist them as needed whether that be with walking, getting up from a chair or going up and down stairs just to name a few options.

To read further check out the full article from MedGadget

Wednesday, June 10, 2009

The Hip Bone is Connected to the Knee Bone!

Have you ever experienced pain at the front of your knee when squatting or with prolonged sitting?

This type of pain can be due to various causes, one of which includes patellofemoral joint syndrome. The patellofemoral joint is formed by the articulation between the knee cap (patella) and the femur (large bone of the upper thigh) and relies on precise tracking of these two surfaces to function correctly (see image below). If the patella does not track correctly within the femoral groove then excessive wear and tear of the cartilage supporting this joint can result leading to inflammation and pain.

Because the knee joint is a hinge joint, meaning it only moves forward and backward (extension & flexion), it is highly dependent on control at the hip and ankle joints, which have more motion available. Numerous studies over the last several years have shown that strengthening and improved coordination at the hip and ankle can lead to improved knee mechanics, decreased patellofemoral joint symptoms and preservation of the underlying cartilage.

Try these exercise to strengthen your lateral hip musculature and you’re knee will thank you.

Exercise #1: side plank

Exercise 2: fire hydrant

Exercise #3: hip abduction

Monday, June 8, 2009

Who's the Musculoskeletal Expert...Your Physician or Your Physical Therapist?

I hope the answer to this question does not surprise you, but your physical therapist is the correct choice!

A study published in the BioMed Central Journal of Musculoskeletal Disorders tested physical therapists and physical therapy students and compared their results with that of physicians from a variety of specialties and medical residents on their knowledge of musculoskeletal medicine. The study showed that licensed physical therapists and physical therapy students in their last year of school scored higher than medical residents and all physician specialties except orthopaedic surgeons (see graph below).

With these results in mind, I ask that you support direct access legislation to physical therapy services in your state. Many states have passed direct access laws, which means the consumer can go directly to a physical therapist for musculoskeletal problems without having to spend extra time and money by having to see their physician first. However, some states have not passed direct access or have some limited version at this time.

For more information on direct access and to see what is going on in your state, please check out this link from the American Physical Therapy Association. At the bottom of the page is a link to a document showing current direct access laws in each state.

Thursday, June 4, 2009

Sprain or Strain...What's the Difference?

Many of us have suffered an injury and been diagnosed as having either a sprain or strain. I often hear patients and individuals outside of physical therapy using these two terms interchangeably when really they refer to two very different injuries that affect two very different tissue types.

Sprains are injuries that affect ligaments, which are the passive stabilizers of our joints and cross from one bone to another bone. They usually occur when a given joint is taumatically pushed beyond it’s normal range of motion and will often result in a “pop” type sound. Sprains can be graded into three groupings (grade 1, 2 & 3) based on the pain and the amount of laxity found in a given joint upon clinical inspection.

Grade 1: pain and no joint laxity
Grade 2: pain and some joint laxity
Grade 3: no pain and complete ligament tear (very lax)

The diagram below shows a grade III ligament injury

Strains refer to injuries of the musculotendinous unit, which includes a muscle and the tendon that secures it to the bone.

The diagram shows the calf muscles (gastrocnemius & soleus) and the achilles tendon, which attaches these two muscles to the calcaneus bone of the foot.

Strains occur when the length or strength of a given musculotendinous unit is exceeded. Basically, if a muscle is stretched beyond it’s normal length or asked to support a load that it is not strong enough to support. When either of these things occur, small microtears will occur within the muscle leading to soreness. In severe cases the tendon can actually be torn away from the bone, which is termed an avulsion.

Hopefully this clears up the difference!

Monday, June 1, 2009

The Low Down on Stretching

When and how much to stretch is always a question that comes up in physical therapy. I will usually encourage my patients to perform a dynamic warm-up prior to their regular exercise of choice and then perform static stretches after exercising.

For those who are not familiar with these terms, a dynamic warm-up basically means you spend 10-15 minutes going through the motions of the exercise you are intending to complete, but at maybe 25-75% in order to make sure your tissue is warm. Static stretching, on the other hand, is what most of us think of as stretching and includes holding a particular stretch position for 30 seconds to 2 minutes.

A recent article from the Running Doc gives a good summary of current stretching recommendations that can be useful not only for runners, but for the rest of us as well.