Rehabilitation

TMJ – Temporomandibular Joint

Temporomandibular Joint

Temporomandibular joint aka TMJ is pain in and around the ear where the mandible attaches to the skull. The temporomandibular (TMJ) joint allows you to open and close your mouth for chewing, talking and yawning. Dysfunction of this joint causes jaw pain, headaches, swelling, numbness, radiating pain, stiffness, jaw locking, clicking and popping.

Occasionally acute TMJ pain will improve without treatment using home remedies such as soft food, heat, ice and NSAID’s. However, TMJ can develop into chronic pain and need physical therapy help to resolve pain and restore joint function. Our out-patient clinic uses manual techniques to relax the surrounding joint muscles, integrative dry needling, ultrasound, joint tapping, electrical stimulation, heat and ice to resolve pain and restore function.References

Temporomandibular Joint Dysfunction. (2017, January 2).

Retrieved from https://www.nidcr.nih.gov/sites/default/files/2017-09/less-is-best-tmj.pdf

TMJ – Temporomandibular Joint 2019-07-15T14:48:58+00:00

How CBD oil can aid in your Physical Therapy Regiment

Since CBD Oil (cannabidiol oil) has made it’s debut on the shelf, we’ve seen an increase in the amount of patients that are using, or wanting to use it. We get asked a lot, “What is CBD oil?” ; “Can it be beneficial for me?” ; “Will I get a high from using it?”. While you cannot get a High from using CBD oil, it does depend on the patient and the ailments that those patients have, and just how beneficial CBD oil will be to them. There are about 110-120 compounds of cannabinoids found in the Cannabis Plant. There is still so much to learn and it’s science is still young.

The CBD oil compound and the THC compound are the most studied cannabinoids. We see a lot of patients who are in a chronic, constant state of pain. Most of them are on opioids and have been on them for quite some time. To the point where they are unable to drive themselves to their appointments. With the demand to reduce the amount of opioids being given out, pain management doctors are relying more heavily on the Physical Therapist to help aid them in which patients are in true need of controlled pain medicines and what can be helped through being active. We know that when you work-out and exercise, your body releases endorphins which stimulate a series of things in the brain and body and makes you overall happier and healthier.

CBD does not alter the cognitive state of patients like THC does, but it is useful in pain treatment because it stimulates the human body to produce endocannabinoids. Endocannabinoids are neurotransmitters naturally found in the human body that help regulate many functions including sleep, appetite, mood, memory and pain sensation. When you engage in physical exercise, the level of endocannabinoids rises in response. How CBD oil modulates pain is not completely understood, but pain management doctors believe that it inhibits pain impulses from reaching the brain and working on certain receptors.

If you are experiencing pain and are wanting to try CBD oil to help control it, I would talk to your Dr. first to make sure they don’t see any potential risks involved for you, and remember, your Physical Therapist can help aid in that decision by giving you a thorough evaluation and setting you up on an active regiment that could reduce your use of opioids.

References:

APTA CBD and Physical therapists article

https://coloradopaincare.com/effects-of-cbd-oil-pain-management-doctors-explain/

https://draxe.com/cbd-benefits/

https://www.medicalnewstoday.com/articles/319475.php

How CBD oil can aid in your Physical Therapy Regiment 2019-06-14T15:30:00+00:00

Breathe Easy

Chest Physical Therapy

Chest physical therapy (Chest PT) is a manual physical therapy technique used for airway passage clearance. It consist of percussion, vibration, deep breathing and coughing. The technique is used to create a productive cough to clear mucus and fluid from the five lobes of the lungs. Chest PT can be used for various diagnosis such as flu, cold, asthma, pneumonia, bronchitis, chronic obstruction pulmonary disease (COPD), neurological disorders, or bed bound persons.

The two main techniques are percussion and vibration. Percussion is done by slightly cupping the hand and clapping against the chest wall. Having the hand cupped provides comfort and less of a slapping sensation. Vibration is performed by gently shaking the chest wall with a flattened hand to loosen the mucus from the lungs. Person is placed in various positions to allow postural drainage to assist with the production of mucus. Each technique is then followed by attempting a productive cough to expel the mucus.

Our clinic provides manual chest therapy for all ages and we highly recommend this treatment for cold and flu season to prevent pneumonia and other complications from congestion.

Cystic Fibrosis Foundation. Chest Physical Therapy. Retrieved from https://www.cff.org/Life-With-CF/Treatments-and-Therapies/Airway-Clearance/Chest-Physical-Therapy/

Breathe Easy 2019-01-22T19:42:29+00:00

Adhesive capsulitis

Adhesive capsulitis or commonly known as “frozen shoulder” is the tightness, lack of use and the pain associated within the shoulder joint. Frozen shoulder can be caused by an injury or arthritis that then results in lack of use and loss of function. Injuries such as stroke, fractures, falls, or prolonged immobility after a shoulder surgery are examples of common causes. People over 40, particularly women, are more susceptible to adhesive capsulitis.

Physical therapy is the most common prescribed tool for improving adhesive capsulitis. Joint mobilizations, aggressive stretching, and range of motion exercise are techniques used during each session. Physicians may prescribe steroids or an injection into the joint for relief. In some cases, an orthopedic consult may be needed. An orthopedic surgeon would surgically clean the inside of the joint to remove arthritis, scar tissues, or tears and free the capsular space.

Preventive exercise can be beneficial. Contacting an experienced physical therapist is key. Physical therapy will guide the person through appropriate care. If suspicion of a frozen shoulder is occurring, range of motion exercise and joint mobilizations will be used.

Mayo Clinic Staff. (2018, July 20 2018). Frozen Shoulder. Retrieved from https://www.mayoclinic.org/diseases-conditions/frozen-shoulder/symptoms-causes/syc-20372684

Adhesive capsulitis 2019-03-06T15:35:28+00:00

Integrative Dry Needling:

Integrative dry needling is a highly effective form of physical therapy for the treatment of a multitude of musculoskeletal and neuromuscular conditions.  It is not appropriate for all conditions or pathologies and the use of the technique will be at the discretion of your Physical therapist.

How does it work?

Integrative Dry Needling (IDN) is not acupuncture (traditional Chinese medicine), it is based on neuroanatomy and modern scientific study of the musculoskeletal and neuromuscular systems.  A very fine filament needle is inserted through the skin and into the deeper tissues that are considered trigger points to your pain.  DN works by causing a micro lesion within the pathological tissue thus breaking up shortened tissues, inhibiting a reflex arc from the nervous system to the tissue, normalizing the inflammatory response, and centrally mediating the pain.  This mechanical and neuromuscular effect provides an environment that enhances the body’s ability to heal which ultimately reduces pain.

What conditions can be treated?

Conditions include, but are not limited to Chronic and Acute neck, back and shoulder pain, arm pain (tennis elbow, carpel tunnel, golfers elbow), headaches to include migraines and tension-type headaches, jaw pain, buttock pain and leg pain (sciatica, hamstring strains, calf tightness/spasms), Plantar Fasciitis, Fibromyalgia, Osteoarthritis, Rheumatoid Arthritis… as well as others.

Are the needles sterile?

Yes, we only use sterile disposable needles.

Is the procedure painful?

The fine filament needle is very thin, solid, and flexible, which allows for the needle to be pushed through the skin versus cutting the skin.  This helps reduce any discomfort that may occur with the procedure.  We strive to make the treatment virtually painless however at times a local twitch response of the muscle may be felt.  When the needle is inserted into the pathological tissue the local twitch response sensation is normal and is felt only momentarily.  These sensations are perfectly normal and even a desirable response.  Your PT will make every effort to make your experience comfortable and therapeutic.

How will I feel after the Dry Needling treatment?

This will vary but many patients experience immediate relief of their symptoms and an increase in range of motion.  Soreness can also be a common response from the needling but does not occur with all people.  Some individuals may experience an immediate achiness or a delayed soreness the next day.  The soreness, if present, will usually last 1-2 days, use of heat and light message and movement will be beneficial.  Mild Bruising may also occur, but is rare.  Application of ice on the bruise will help with the soreness and the skin discoloration will last several days but is not harmful.  It is uncommon but possible that the treatment may temporarily increase your symptoms.  This is not unusual but if this continues past the 1-2 day window, inform your PT to allow adjustment of your program to enhance your comfort the next time.  This does not mean that needling will not be beneficial to your condition.

Will I continue to do exercises or receive other treatments?

Yes, your personalized physical therapy program will still integrate traditional physical therapy methods including Manual therapy, Therapeutic exercise, endurance training, stabilization and posture training.

How many Treatments will I need?

This will depend on the category you fit in, which is determined by the state of the injury and your overall health.  Remember we are attempting to cause mechanical and biochemical changes without any pharmacological means.  Therefore, we are looking for a cumulative response to break the pain cycle.  Your PT will be able to give you more insight after your evaluation.

What should I do to prepare for the treatment?

·       Do not eat 30 mins before the treatment

·       Be well hydrated but empty your bladder prior to treatment

·       Wear lose fitting clothing, shorts, or bathing suit for easy access to your painful areas

What Should/can I do after treatment, what should I avoid?

Our recommendations vary depending on the amount of soreness you have and on the individual response to the treatment.  Recommendations may include increasing your water intake, applying heat or ice over the area, gentle stretched and modifications of activities.

Is Dry Needling treatment covered by my insurance?

This is a Physical Therapy treatment and is NOT acupuncture therefore your coverage of DN should correspond with your Physical Therapy Benefits.  You can discuss this further with administrative staff if you require more information.

Not all medical or physical therapy professionals are trained to perform the Integrative Dry Needling treatment technique.  The physical therapists at OUR CLINIC have advanced training and have been certified through the Integrative Dry Needling Institute.

Integrative Dry Needling: 2019-01-22T19:42:29+00:00

Shoulder Pain

Many American’s suffer with shoulder pain for several different reasons. Shoulder pain can be the result of rotator cuff tear, bursitis, tendonitis, labrum tear, frozen shoulder, osteoarthritis and impingement. Physical therapy is usually the first line of care and the gold standard in treating shoulder pain. Physical therapy can restore active range of motion, reduce inflammation, pain and restore stability and strength.

Rotator cuff tear is either incomplete (partial) or complete tears (full thickness) (McKinnis, 2014). The cause of rotator cuff tear could be from traumatic injury or from progressive tendon tearing during overhead repetitive activities (McKinnis, 2014). The rotator cuff is made up of 4 muscles, subscapularis, supraspinatus, infraspinatus and teres minor. The most common tendon tear is the supraspinatus muscle. Imaging to diagnose a rotator cuff tear is MRI or US.

Shoulder bursitis is usually a gradual onset of pain caused by repetitive activities resulting in inflamed bursa. Shoulder pain is usually worse lying on affected side. The most cost effective and useful imaging modality to diagnose shoulder bursitis is US (McKinnis, 2014). Shoulder tendonitis also known as shoulder impingement is caused by repetitive overhead activities or trauma. Pain is usually gradual and worse with resistance. At initial injury (RICE) rest, ice, compression and elevation is useful in pain relief. Again US is the least expensive imaging modality to use to diagnosis shoulder tendonitis and / or impingement (McKinnis, 2014).

Labrum tear is usually from shoulder trauma injury causing pain with overhead activities, and instability. There are two types of labrum tears SLAP involving the superior labrum and Bankart involving the inferior labrum. Treatment is usually NSAID’s and RICE rest, ice, compression and elevation. If pain persist and shoulder is increasingly unstable surgery may be needed to restore stability. Imaging to diagnosis shoulder labrum tear is MRI (McKinnis, 2014). Frozen shoulder is a gradual increase in pain that cause loss of joint movement and can occur after shoulder injury or lifting something heavy. Physical therapy is the first and best treatment for pain and restoring joint mobility. Imaging for diagnosis is usually plain radiography and MRI (McKinnis,2014).

Osteoarthritis is the most common reason for shoulder pain in glenohumeral joint and acromioclavicular joint. Osteoarthritis of shoulder generally is gradual onset of pain and loss of mobility and responds to NSAID’s and physical therapy to resolve pain and  immobility. Imaging to diagnosis shoulder OA is plain radiography which is the least expensive, then MRI followed by CT (McKinnis, 2014). Shoulder pain is extremely common in both men and women of all ages. Surgery is usually the last resort and should be avoided if possible. Physical therapy is the gold standard of care and most effective treatment to restore range of motion, strength, function and resolve pain.

References
McKinnis, L. N. (2014). Fundamentals of musculoskeletal imaging.

 

Shoulder Pain 2019-01-22T19:42:29+00:00

Lymphedema

The Function of a Physical Therapist Treating Lymphedema

Lymphedema is progressive chronic swelling usually in extremities, but can occur in the chest, stomach and groin regions. Currently there is no cure for lymphedema, but treatment from a physical therapist is extremely helpful to prevent immobilizing side effects and possible dangerous complications (APTA.org, 2009).

Prompt discovery of limb and / breast lymphedema is key to managing and preventing complication (APTA.org, 2009). In our practice we work closely with physicians and patients to treat lymphedema quickly with minimal to no pain. We use manual lymphatic drainage therapy and begin immediate compression for long term management.  Other physical therapy terms used to describe lymphedema treatment are decompression therapy, complete decongestive therapy and complex physical therapy (APTA, org,2009). Complex physical therapy for lymphedema is the gold standard of care and includes: manual lymphatic drainage, compression garments, exercise and education about skin and nail care (APTA.org, 2009). In most cases patients who receive lymphedema therapy see an 80% improvement in just one to two weeks.

Evidence based research has proven success in lymphedema treatment and management using patient education, exercise, compression and lymphedema therapy can stop lymphedema from returning (APTA.org, 2009). Early onset of lymphedema improves outcomes and reduces complications. Patients with breast cancer should be aware of the risk factors and warning signs that include:

Risks

  • Overweight or increasing weight during and throughout cancer treatment.
  • Lymph node removal
  • Radiation therapy
  • Infection or blood clot in affected extremity.

Warnings

  • Pain and fullness in affected limb
  • Tightness in affected limb
  • Noticeable swelling in affected limb
  • Numbness and tingling in affected limb (APTA.org, 2009).

In conclusion, the role of physical therapist treating patients with lymphedema is to help patients identify lymphedema early to prevent lasting side effects and possible dangerous complications. Currently there is no cure for lymphedema. However, treatment from a physical therapist is highly successful in eliminating lymphedema and preventing reoccurrences.

Sincerely, Sherri Boos, PT, DPT

References
Physical Therapist Play Integral Role in Lymyphedema Prevention, Treatment. (2009). Retrieved from APTA.org, 2009
Role of Physical Therapist in the treatment of Lymphedema. (2009). Retrieved from http://APTA.org

 

 

Lymphedema 2019-01-22T19:42:32+00:00

Total Knee Arthroplasty

Total knee arthroplasty aka total knee replacement is a surgical procedure that has proven success relieving pain for people who suffer with knee difficulties from an injury, degenerative disorder and inflammation (Klein, 2006). In the United states alone over 300,000 total knee procedures are performed and these numbers increase as younger people need a total knee replacement (Klein, 2006). A total knee replacement procedure is a difficult surgery to recover from and should be taken very seriously. The complication are: severe pain, bruising, swelling, blood clot, temporary and permanent paralysis, infection, numbness and even death.

There are several things that help a person’s total knee outcome a success: good physical health and strength, weight, flexibility, education about the procedure and expected loss of function and nutrition to improve healing. Pre-habilitation is program that our facility offers to encourages your success after this procedure. Pre-habilitation is usually just a few visits to educate you about the produce, nutrition, possible loss of function, strengthen specific muscles and stretch tight muscles and joints.

Klein, L. J. (2006, October 18). Total Knee Replacement (CBM 2003-2). Retrieved from https://www.nlm.nih.gov/archive/20061214/pubs/cbm/tkr.html#110

Total Knee Arthroplasty 2019-01-22T19:42:33+00:00

Pre-habilitation

Pre-habilitation is physical therapy prior to a surgical procedure or chemo therapy for strengthening, conditioning, and education to ensure a successful outcome. Many people feel better prepared for surgery or chemo after a strengthening program because it strengthens weak muscles that could prevent you from getting out of bed, walking to the restroom and walking in the halls. Many times after a surgical procedure or chemo, patients are forced to go to a nursing home or hospital rehab because their functions have diminished, leaving them unsafe to go home (Ries, 2016). Going to a nursing home, or anywhere other than home, can devastate you and your family members. Pre-habilitation will help you prevent unexpected discharge planning.  In addition, prehab will provide post-op education, procedure precautions, home adaptation, and walking with assistance and/or a device, increasing a patient’s success rate.
Pre-habilitation is an individualized plan of care based on your needs and desires. Your therapist will evaluate you and your needs to develop a plan of care and home exercise program. The home exercise program allows you to become comfortable and familiar with the exercise program you will most likely be doing while in the hospital. Some pre-habilitation programs are 1 visit, while others are a few weeks. Our clinic will help you decide what works best for you.
Respectfully,
Sherri Boos, PT, DPT
 References
Ries, E. (2016). Better Sooner and Later: Prehabilitation. PT in Motion, 1-12. Retrieved from http://www.apta.org/PTinMotion/2016/2/Prehabilitation/
Pre-habilitation 2019-01-22T19:42:33+00:00