Posts in Manual Therapy
Dry Needling Improves Vertical Jump Performance
boulder-dry-needling-treatment

Photo Credit: IJSPT

Dry needling is a commonly utilized Physical Therapy intervention which can effectively reduce pain, improve pain, and improved muscle performance.  Physical Therapists aim to treat trigger points or knots in the muscles thought to either cause pain or limit mobility.  In the majority of cases, dry needling leads to an immediate improvement in range of motion, pain, and performance.

A recent article examined calf dry needling effect on functional movements including the vertical jump. Bandy and colleagues examined 35 healthy adults and tested their vertical jumps before and after a dynamic vertical jump.  As expected the group receiving dry needling significantly improved their vertical jump after the dry needling treatment over the placebo group.  This study adds to the literature supporting the use of dry needling for improvement quality of movement and performance.

To learn more on how dry needling can help decrease your symptoms and improve your performance contact your local Physical Therapy clinic.

 

Injections for Knee Osteoarthritis

Knee osteoarthritis is a common condition in aging adults leading to pain and reduced performance of daily and recreational activities.  Manual therapy and exercise remain a hallmark of conservative care for this condition and have been shown to delay or prevent the need for a total knee replacement.  In addition to exercise, corticosteroid injections are often proposed to patients in order to reduce pain and improve patient participation.  A recent study in the Journal of the American Medical Association examined the impact of these injections in patients with knee arthritis.

Henriksen and colleagues studied 100 patients and randomized them to either a corticosteroid injection or a placebo injection prior to undergoing Physical Therapy 3 days a week for 12 weeks.  These patients all had evidence of knee arthritis on x ray and reported pain with daily activities including walking.  All patients improved through the course of the study, but no significant differences were noted at 2, 14, or 26 weeks between the group receiving a corticosteroid injection or a placebo.   The authors concluded there was no additional clinical benefit of a steroid injection and Physical Therapy compared to Physical Therapy alone.  Thus, Physical Therapy was the main reason for the patient's improvement.   

Patients with knee osteoarthritis are encouraged to seek out a local Physical Therapist to implement an effective rehabilitation program.  

Does One Size Fit All in Physical Therapy?
low back pain-education-treatments

In our fast paced, instant gratification world we want solutions to our problems the same day as their arrival.  This is no different in low back pain, a common, costly condition affecting over 90% of adults.  Patient's hurting from low back pain symptoms often turn to the internet, friends, or their primary care physician for quick solutions to their problem.  Although low back pain is common, the reasons behind the pain are multifactorial in nature limiting the effectiveness of a one size fits all approach.  Thus, patients seeking advice online, from friends, or their physician may be given an inappropriate or ineffective treatment plan leading to lost time, lost employment and money.  In the past, clinical guidelines on low back pain have been created by medical and government agencies in an attempt to help guide decision making for all patients with low back pain.  Not surprisingly, research has shown the limitation of this one size fits all approach with lower costs and improved outcomes observed with Physical Therapy compared to guidelines.  

A more recent article in British Journal of Sports Medicine was published to compare the outcomes between general advice and patient specific Physical Therapy treatments (Ford et al. 2016).  200 patients with low back pain, less than 6 months in nature, were randomized to either an education group or to 10 sessions of Physical Therapy interventions including manual therapy and exercise.  Consistent with prior research a patient specific plan of care showed better outcomes at 10, 26, and 52 weeks compared with an education only approach.  

This article adds to the existing literature indicating the importance of early, patient specific Physical Therapy treatment compared to advice or a wait and see approach.  To learn more on how Physical Therapy can help get accelerate your recovery from low back pain contact a local Physical Therapist. 

Jaw Pain and Physical Therapy Treatments

Temporomandibular Disorders (TMJ/TMD)

Problem

TMJ/TMD are a major cause of non dental jaw and facial pain.  Approximately 18 million word days are lost annually per 100 million full time working adults due to symptoms of TMD (2).  

Women have a 3:1 greater ratio of incidence compared to men between age 30 and 50 (1).

Disk Displacement and Arthritic symptoms peak at age 30 and 50, respectively (1).

Symptoms can be broken down into 3 areas:

Muscle or myofascial pain (45%), Osteoarthritis (41%), and Osteoarthrosis

Physical Therapy Treatments

Review articles support a mulimodal approach for the management of TMD including: joint mobilization/manipulation, soft tissue mobilization, active exercise, proprioception training, and relaxation training (6,7,11).

boulder physical therapy treatments jaw pain face pain

Evidence for Physical Therapy Interventions 

Shiffman et al. found rehabilitation was as effective as arthroscopic surgery or arthroplasty (4).

Manual therapy has been shown to be more cost effective and less prone to side effects than dental treatments (5).

Dry needling of the facial muscles has shown positive results in recent trials (12).

Neuromuscular re education and behavioral changes are more effective than splinting (6).

Nicolakis et al. demonstrated >85% of patients with TMD treated with PT report excellent functional improvement, reduce pain, and improved ROM.  76% of patients required no further care up to 3 years after treatment (8,9).

Furto et al. demonstrated improved short term outcomes following Physical Therapy treatments involving manual therapy and exercise (10).

Manual therapy interventions to the cervical and thoracic spines, as well as, dry needling has demonstrated further improvements in pain and disability (12). 

When to Refer to Physical Therapy

Patients with TMD often display signs and symptoms including: TMJ pain and myofascial pain in the face, jaw or neck, TMJ sounds, restrictions, deviations, or deflections of the jaw during jaw opening and closing.

The American Association for Dental Research reports

"Unless there are specific and justifiable indications to the contrary, treatment of patients with TMD initially should be based on the use of conservative, reversible, and evidence based therapeutic modalities."

References

1. Manfredini, D. et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Oct;112(4):453-62.

2. Okeson, J. et al. Temporomandibular disorders in medical practice. J Fam Pract. 1996. 43(4):347-56.

3. Truelove, E. The efficacy of traditional, low cost and non splint therapies for temporomandibular disorder. A randomized controlled trial. J Am Dent Assoc. 2006.

4. Schiffman et al. Randomized Effectiveness Study of Four Therapeutic Strategies for TMJ Closed Lock J Dent Res 1986(1):58-63, 2007

5. Kalamir A, Pollard H, Vitiello
myofascial therapy for chronic myogenous temporoman- dibular disorders: a randomized, controlled pilot study. J Man Manip Ther. 2010;18(3):139-146.

6. Medlicott, M. et al. A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporo- mandibular disorders. Phys Ther. 2006;86:955-973.

7. Kalamir, A. et al. Manual therapy for temporomandibular disorders. A review of the literature. J Bodywork Movement Therapies. 2007.

8. Nicolakis, P et al. An investigation of the effectiveness of exercise and manual therapy in treating symptoms of TMJ osteoarthritis. Cranio. 2001. 19(1):26-32. 

9. Long term outcome after treatment of temporomandibular joint osteoarthritis with exercise and manual therapy. Cranio. 2002. 20(1):23-27.

10. Furto, E. et al. Manual physical therapy interventions and exdrcise for patients with temporomandibular disorders. Cranio. 2006. 24(4):283-91.

11. Shaffer, S. Temporomandibular disorders. Part 2: conservative management. JMMT. 2014.

12. Gonzalez-Iglesias, J. et al. Mobilization with movement, thoracic spine manipulation, cervical spine manipulation, and dry needling for the management of temporomandibu- lar disorder: A prospective case series. Phys Ther Theory and Prac. 2013.

 

 

 

 

Thoracic Manipulation and Shoulder Pain
boulder physical therapy thoracic manipulation shoulder pain

Treatment of the thoracic spine utilizing joint mobilization or manipulation is a excellent treatment approach to accelerate the recovery of patients dealing with neck, elbow, and shoulder pain.  Utilizing a regional interdependence approach where areas adjacent or distant to the site of pain are treated by the physical therapist, in addition to the painful area, lead to greater outcomes in fewer visits.  The benefits of manual therapy alone often last 1-2 days but when combined with physical therapy exercises can deliver both short and long term improvements in pain and function.  In our practice, manual therapy treatments produce a valuable reduction in a patient's pain allowing them to move with less discomfort as we transition into a strengthening program.  Previous research showed patient's receiving this combined approach demonstrates better outcomes and strength development than those receiving only exercise treatments (Bang et al. 2000). 

boulder physical therapy shoulder pain treatment

Recently, a review of the available literature on manual therapy in the management of shoulder pain was published in the Journal of Manual and Manipulative Therapy (Peek et al. 2015).  The pooled results of the 7 studies found between 76-100% of patients reported significant reductions in shoulder pain immediately after the thoracic manipulation.  Some of the studies demonstrated improved shoulder outcomes up to 1 year after the treatment period.  This review article adds to our available evidence supporting the utilization of thoracic manipulation during physical therapy treatments for shoulder pain.  To learn more about how thoracic manipulation can help you reduce pain and get back to your activities contact your local physical therapist.  

Sacroiliac Pain (SI) Pain and Physical Therapy Treatments
boulder physical therapy sacroiliac SI pain

Background

Sacroiliac (SI) joint pain is an less common source of low back pain but has a higher incidence pregnant and post partum patients, as well as, after trauma.

The incidence of SI pain in patients with low back pain is 13% (9-26%) (1). The majority of patients will report buttock pain (94%), lower lumbar pain (72%), lower extremity pain (50%), and groin pain (14%)(3).

In the past, the SI joint has been a difficult area to diagnose secondary to the lack of a gold standard diagnostic test and the diagnostic limitations of clinical testing involving static palpation and movement based tests.

These tests have been found positive in asymptomatic patients reducing their specificity for diagnosis (2).

A repeated motions examination of lumbar active range of motions movements is helpful is the ruling in or out of lumbar spine involvement prior to SI pain provocation testing (4). Patient’s with (+) provocative testing who did not centralize with lumbar motions have a 80% post test probability of having SI pain (+ LR 6.97). Patient’s with (-) provocation testing who did not centralize have a 5% post test probability of having SI pain (-LR 0.10)(4). 

boulder physical therapy SI pain examination

Physical Therapy Interventions

A multimodal treatment approach is indicated for patient's with SI pain including mobilization/manipulation, taping, strengthening exercises, and proprioception training.

Tullberg et al. showed the reduction in short term pain and movement, but not a change in bony landmarks on CT scan, after spinal manipulation in patients with SI pain (4).

Positive short and long term outcomes on both pain and disability have been observed using spinal manipulation for a sub group of patients with low back pain (5,6).

In a randomized controlled trial of spinal stabilization training compared to usual medical management, Hides et al. reported reduced recurrence (30% vs. 84%) and future medical care (42% vs. 15%) in the stabilization group. The risk of recurrence for the medical management group remained high up to 3 years(7). There does not seem to be an greater effect of local versus global stabiliza- tion training among patients who meet the spinal stabilization sub group criteria (8).

boulder physical therapy SI pain manipulation
boulder physical therapy core exercises

When to Refer to Physical Therapy

Patient’s with low back pain, pelvic pain, and groin pain with suspected SI joint pain should be referred to Physical Therapy.

Patient’s will benefit from early manual therapy and exercise interventions to reduce short and long term pain and disability. 

References

1. Maigne, J. et al. Results of Sacroiliac Joint Double Block and Value of Sacroiliac Pain Provocation Tests in 54 Patients With Low Back Pain. Spine. 1996. 21(16):1889-1892

2. Dreyfuss, P et al. Positive sacroiliac tests in asymptomatic adults. Spine. 1994. 19:1138-1143,

3. Slipman CW. et al. Sacroiliac joint pain referral zones. Arch Phys Med Rehab. 2000;8 1:334-8.

4. Tullberg, T. et al. Manipulation Does Not Alter the Position of the Sacroiliac Joint: A Roentgen Stereophotogrammetric Analysis. Spine. 1998. 23(10):1124-1128.

5. Flynn, T et al. A clinical prediction rule for classifying patients with low back pain who demonstrate a short term improvement with spinal manipulation. Spine. 2002; 27(24):2835-2843.

6. Childs, J. Fritz, J. et al. A Clinical Prediction Rule To Identify Patients with Low Back Pain Most Likely To Benefit from Spinal Manipulation: A Validation Study. Annals of Int Med. 2004/920-928.

7. Hides, J. et al. Long-Term Effects of Specific Stabilizing Exercises for First-Episode Low Back Pain. Spine. 2001. 26(11):243-248.

8. Koumantakis, G. et al. Trunk Muscle Stabilization Training Plus General Exercise Versus General Exercise Only: Randomized Controlled Trial of Patients With Recurrent Low Back Pain. Phys Ther. 2005;85:209 –225