Posts tagged manual therapy
Physical Therapy Exercises Are Cost and Clinically Effective Compared To Primary Care Alone For Knee Arthritis
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Physical Therapy interventions including manual therapy and exercise remain the primary intervention for patients with knee arthritis. These treatments have been shown to delay or prevent the need for costly, more invasive treatments including total knee replacement. Prescribed Physical Therapy exercises are designed to reduce pain, improve mobility, and increase a patient’s leg strength. Stronger muscles attenuate forces across the painful knee joint allowing a patient to achieve a higher level of physical function and participation their prior levels of activity. Additional treatment options available to patients include primary care or orthopedic management involving diagnostic imaging, medication, injections, and education. A recent study compared the cost and clinical effectiveness of usual care versus Physical Therapy management for patients with knee arthritis.

A randomized controlled trial in the journal Osteoarthritis and Cartilage was conducted to compare the effectiveness of different conservative interventions among patients with hip or knee arthritis (Abbott et al. 2019). Authors randomized 206 patients with either hip or knee arthritis to one of four groups: usual medical care, supervised Physical Therapy Exercises, manual Physical Therapy, or combined manual and exercise Physical Therapy. Physical Therapy participants were provided with 10, 50 minute sessions including follow up “booster” sessions at 4 and 13 months. Authors found the greatest cost and clinical effectiveness in the patients who received supervised Physical Therapy exercises in addition to usual care.

Physical Therapy Offers Equivalent Outcomes To Surgery For Carpal Tunnel
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Carpal tunnel syndrome or the entrapment of the medial nerve at the wrist is a condition leading to pain, numbness, and pins and needles sensations along the palm side of thumb, index, and middle fingers. If the entrapment continues weakness can be experienced in the wrist and hand. Contributing factors include loss of nerve and wrist mobility, muscle imbalance, and work ergonomics. Although surgery remains a common intervention, previous research has shown no difference in long term outcomes between surgery and Physical Therapy for patients with carpal tunnel surgery (Fenandez de las Penas et al. J Pain. 2015.). A recent research study compared the cost of these Physical Therapy interventions for patients with carpal tunnel syndrome.

Journal of Orthopedic and Sports Physical Therapy published a recent article on the cost effectiveness of either Physical Therapy or surgery for the treatment of carpal tunnel (Fernandez de las Penas et al. 2018). Authors randomized 118 patients with carpal tunnel to either a surgical intervention or Physical Therapy consisting of 3 sessions of manual therapy, nerve mobilizations, and home exercises. As expected, patients in the surgical group required greater numbers of additional treatments, days lost from work, and greater costs compared to patients in the Physical Therapy group. In addition, this study supported previous research findings on equivalent outcomes found between surgery and conservative care treatments for patients with carpal tunnel.

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Upper Cervical Spine Treatment Improves Outcomes In Patients with Jaw Pain and Headache
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Temporomandibular joint (TMJ) pain or Temporomandibular Disorder (TMD) is a painful condition limiting a patient’s ability to utilize the joint moving the lower jaw on the skull. When painful this joint limits an individual’s ability to eat, speak, and yawn. Pain is often felt in front of the ear over the joint surfaces. In addition to joint pain, patients often experience significant soft tissue and pain in the muscles involved in the aforementioned functions.

The upper cervical spine composed of the upper two vertebrae and the skull has an important contribution to TMJ function. These two regions of the upper quarter work closely together during normal head, neck, and jaw movements. Researchers and clinicians often find restrictions in the mobility and motor function of the upper cervical spine in patients with jaw pain. In our Boulder Physical Therapy practice, we find optimal outcomes after treating both regions in patients with jaw pain. A recent research article supports this treatment approach.

Calixtre and colleagues examined the impact of upper cervical manual therapy and deep cervical flexor strengthening in patients with TMD and headache (J Oral Rehabil. 2018). Authors randomized 61 patients to either upper cervical mobilizations and strengthening exercises or a control group. Patients in the intervention group received manual therapy and exercise interventions over 5 weeks. Authors reported significant reductions in both headache symptoms and oral, facial pain in the intervention group. This study highlights the importance of examining and treating adjacent body regions to the area of a patient’s pain.

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No Additional Benefit Of Injection Over Physical Therapy Interventions For Shoulder Pain
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Subacromial impingement syndrome is the most common cause of shoulder pain. These symptoms are easily treated with Physical Therapy interventions including manual therapy and exercise. Specifically, strengthening exercises for the shoulder blade and shoulder improve both the quantity and quality of shoulder movements treating both the source of impingement pain and the underlying cause. Physical Therapy exercises remain the gold standard for treatment of impingement, but injections are still utilized by physicians to treat these symptoms. A recent research paper examined the benefits of an injection combined with Physical Therapy compared to Physical Therapy alone.

A randomized controlled trial in the British Medical Journal compared these two treatment approaches in 232 patients with shoulder impingement (Crawshaw et al. 2010). Patients were randomized to either a manual therapy, exercise, and an injection or manual therapy and exercise alone. Treating Physical Therapists were able to select the most appropriate manual therapy and exercise interventions based on the patient’s needs. Authors reported both groups improved over time, but no differences between groups on either pain or function were found at long term follow up. Thus, the improvements in shoulder pain and function can be attributed to the manual therapy and exercise interventions. No further benefit was found in the patients receiving injections.

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Addition of Dry Needling Improves Effectiveness of Physical Therapy Treatments for Heel Pain
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Plantar fasciitis is the most common cause of plantar heel pain and is estimated to affect 10% of the general population through their lifetime. Proper nomenclature of the pathology is dependent on the tissue involved and how long the symptoms have been in existence. “Fasciitis” suggests an acute inflammatory response, where “fasciosis” illustrates a chronic degenerative response without inflammation. Both terms describe impairments to the insertion of the plantar fascia and/or toe flexors as they attach to the medial heel. Both pathologies are also categorized by increased pain on the inside/plantar aspect of the heel, namely during the “first steps” in the morning or increased weight bearing activities throughout the day.

Manual therapy with exercise has proven to be the best course of action to manage pain and dysfunction of plantar fasciitis, however a recent study investigated the benefit of Electrical Dry Needling (EDN) as an adjunct treatment (Dunning et al. PLOSone, 2018). The study divided 111 participants into 2 groups (standard treatment without EDN vs. standard treatment with EDN). Both groups received up to 8 treatments in a 4-week period. The authors concluded the EDN group’s pain and disability improved significantly at 3 months after treatment compared to treatment without EDN.

To learn more about how Electrical Dry Needling can decrease pain and improve function, contact your local, trusted Physical Therapist.

Addition of dry needling improves the effectiveness of Physical Therapy treatments for knee arthritis
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Knee arthritis is one of the leading causes of disability and reduced activity in the United States.  Physical Therapy interventions, including manual therapy and exercise, remain the foundation of conservative care for this diagnosis.  When combined, manual therapy and exercise, have been shown to reduce pain, stiffness, weakness, and disability in patients with knee arthritis.  These interventions are superior to exercise alone, a wait and see approach, or usual care management.  Recently, dry needling, as well as, dry needling with electrical stimulation have been utilized clinicailly in the treatment of knee arthritis.  Authors report improved circulation, joint lubrication, and levels of inflammation following dry needling with electrical stimulation.  

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  A recent research article in the Clinical Journal of Pain randomized 242 patients with knee arthritis to one of two groups, manual therapy and exercise or manual therapy and exercise combined with dry needling and electrical stimulation.  Participants completed similar manual therapy and exercise programs and were seen 1-2 times per week over a 6 week period.  Authors reported significantly better pain and disability scores at 6 weeks and 3 months in the participants who also received dry needling.  In addition, participants receiving dry needling were almost twice as likely to have stopped their pain medication use.  As expected, a higher percentage of participants in the dry needling group reported a significant improvement in perceived recovery.  

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