Tuesday, January 23, 2018

What A Pain In the Neck (Literally)!

A Strengthening Approach to Non-Specific Neck Pain

Neck pain is something that affects approximately 30% to 50% of the general population and causes extensive issues in an individual’s personal and professional lives. The complexity and sheer number of the structures located in this area contribute to its widespread effects and make it difficult to effectively apply a standardized and generalized treatment; potential pain generators include nerves, bones, discs, fascia, ligaments, and muscles. Mechanism of injury is an additional factor to consider; pain will present differently if caused by trauma (i.e. whiplash stemming from a car accident) or if by degeneration (normal wear and tear). In this blog, we will briefly discuss nonspecific mechanical neck pain, which first needs to be defined.

In short, nonspecific mechanical pain refers to a source of pain other than a nerve issue (with radiating pain down into the arm), fractures, rheumatological disease, tumors, or systemic disease. Essentially, when an individual has been screened for red flag symptoms (tumors, arterial insufficiency, fractures, instability, etc.) they are left with a number of mechanical drivers of pain that lies with one or more of the structures listed above. What this means is that after you are cleared from having anything like a cervical fracture, spinal cord compression, etc, there are a number of ways to identify the culprits and treat your pain.

Often times, we ignore our pain and simply assume it will go away on its own. A study by Ylinen et al, JAMA 2003 set up 3 groups in an experiment: a home stretching program without skilled physical therapy, a supervised strengthening program, and a supervised endurance program. The strengthening and endurance program both had significant changes in pain and (not surprisingly) strength measurements as compared to the non-supervised home stretching program (the people who hope it will go away). Perhaps the most exciting thing about this study was that these changes were still significant at the 3 year follow up.

Celenay et al. discovered that manual therapy (when physical therapists put their hands on you to help mobilize joints and tissues) was additionally helpful. In fact, the group in this study that received manual therapy in addition to neck stabilization exercises had greater outcomes than just the stabilization group in relation to improving disability, pain intensity at night, rotation motion (think driving!), and quality of life.

Another study looked at EMG activation of different cervical musculature, and what they found is significant. In those without neck pain, there was less activation of the superficial neck muscles (the ones you can see in the mirror when you move your neck) and greater activation of the deep neck flexor muscles, longus colli and longus capitus (these muscles are deep and cannot be felt).The reverse was also true: in those who had neck pain, they tended to have greater activation of their superficial muscles and did not activate their deep neck flexors effectively. What this means is that in those with mechanical neck pain, it is potentially helpful to learn how to activate those deep neck muscles: longus colli and longus capitus.

One test to assess a patient’s ability to recruit their deep neck muscles is the aptly named Deep Neck Flexor Endurance Test. This test is completed with the patient in supine and knees bent. They then tuck their chin and lift their head 1 inch from the table. Any dropping of the head or substitution from those superficial muscles is the end of the test. Normative data suggests that in those without neck pain, men scored 38.9 seconds and women scored 29.4 seconds. However, those with neck pain were found to have significantly decreased deep neck flexor endurance, average of 21.4 seconds. Weakness of the deep neck muscles and over-activation of the superficial ones commonly leads to a position of forward head postures, as we often see in those who work with computers.

In short, there are ways that physical therapists can help identify the pain-causing structures in your neck and apply an evidence-based effective treatment to get you back to living life without that nagging injury.

Matthew J. Brennan PT, DPT
The Physical Therapy & Wellness Institute


PTW’s Matt Brennan, DPT is a staff physical therapist at our West Norriton location. For an initial evaluation, call Matt at 610 630 0101 today! 


References
Celenay, Seyda et al. A Comparison of the Effects of Stabilization Exercises Plus Manual Therapy to Those of Stabilization Exercises Alone in Patients with Nonspecific Mechanical Neck Pain: A Randomized Clinical Trial. Journal of Orthopedic and Sports Physical Therapy. 46:2.2016
Domenech MA, Sizer PS, Dedrick GS, McGalliard MK, Brismee JM. "The Deep Neck Flexor Endurance Test: normative data scores in healthy adults." PM R. 2011 Feb. Web. 08/18/2012.
Fall et al. Spine 2004
Kay et al. Cochrane Database. 2005.

Ylinen et al, JAMA 2003

Wednesday, December 20, 2017

How to Stay Active for the Long Term

Change the Calendar, Change Your Routines!

This time of year always brings memories back of performing in the ballet version of The Nutcracker. It really was an amazing time but it was also physically demanding. By the end of the run, I would need a few days of rest before I could get back to being my active self, even as a teenager.  When people find out I am a physical therapist that used to dance, the response is usually, "Oh, so you got into physical therapy because you got hurt at some point, right?" Actually...no. I was lucky enough to make it through my dance career without any major injuries. However, looking back, I really don't think it was all luck.

In addition to dance, I also played lacrosse. Yes, those are two very different physical activities, but that's the point. I would do weight lifting, sprinting, practice for lacrosse a few times a week and then have dance class and rehearsal the other days. By constantly changing up what my body was doing, I didn't allow for wear and tear injuries to occur and my body's strength was well rounded. I was reaping the benefit of cross training.

The metaphor I use with patients is this: when you look at the stairs of an old house, the wood is worn down in places where people placed their feet for decades. Your body is the same way; if you always do the same activities week

after week, your body gets worn down in the same ways. What wasn't a problem before is now painful or hard to do. That's why your, physical therapist/physician/trainer/chiropractor/etc might tell you to change things up in your fitness or activity routine.

Cross training is a proven concept. Professional athletes take yoga to stretch and unload joints. Factory line workers change positions on the line to prevent overuse injuries. So how does this relate to you? Someone who plays basketball often may want to do something different once a week, like a spin class. Now, you're not wearing down your body in the same way and you're making your strength well rounded. If a teacher spends all day standing, swimming would be a good way to unload joints while still working on cardiovascular fitness.

Whether you are a dancer, athlete, manual worker, or just trying to stay active for the long run (which should be everyone's goal), cross training is an important concept for everyone to practice. Physical therapists can help by evaluating your current weakness and figuring out ways to fix them. A physical therapy consult is a good way to get started.


 PTW’s Sean Vanin, DPT is the Clinical Supervisor at our Quakertown clinic. For an initial evaluation, call Sean at 215 538 9911 today! 

Why Stretch?

The Importance of Stretching!

It’s cold out… you don’t want to go to the gym…. you really don’t want to waste time stretching….
Believe me, I get it. I am definitely one of those people that needs to give their self a little pep talk in the winter to stay with my workout plan and stretching.
It is important to properly warm-up and stretch before exercising or participating in some of those enjoyable snow activities like snowball fights and skiing/snowboard and the not so enjoyable ones like shoveling.

Stretching has been shown to have many benefits:

Decrease Risk of Injury – stretching before participating in something physical prepares your muscles to function at their optimal performance.  They are now ready to adapt to the changes that your muscles go through when being physically active.

Improve Flexibility and Range of Motion – I hear daily that “I used to be able to touch my toes as a kid.” Well the reason you can’t anymore i
s because you didn’t keep up with stretching as your bones grew and muscles lengthened.  Don’t worry; you can still improve your flexibility if you work at it.

Reduce pain and stiffness – In many cases a lot of patients low back pain and knee pain is due to their muscles being very tight which causes the joints to not move properly and therefore put abnormal stresses on joints and cause pain.

Improve blood flow and circulation – Stretching helps to improve blood flow and circulation by allowing for enhanced transportation of oxygen and nutrient-rich blood throughout the body.

Minimize wear and tear on joints – Again, if muscles are at the appropriate length and tensions then they don’t cause abnormal stress on joints which can lead to premature joint breakdown and arthritis.  

Improve muscular function – Stretching helps to improve oxygen and nutrient rich blood to circulate better throughout the body and also helps to remove the byproduct lactic acid from your system more quickly. It also helps to prepare the muscles for activity which is especially true in the case of dynamic stretching.


Reduce stress – Chronic stress can cause a number of undesirable responses in the body. Regular stretching has been shown to reduce mental tension, and when combined with mindful breathing techniques, it may also help to decrease anxiety and depression.

PTW’s Stephanie McDougal, PT, DPT is the Clinical Supervisor at our Souderton clinic. For an initial evaluation, call Steph at 215 855 1160 today! 

Wednesday, December 6, 2017

Winter Is Coming...

Winter Is Coming...Be Prepared!

There is a lot to think about when it starts to snow in the winter.  How am I going to shovel?  How will be able to get my car out?  How am I going to get to all my appointments?  However, one thought that causes the most fear in many people is, "What if I fall on the ice?"  What if I told you balance and strength training could reduce your risk of falls?  

In physical therapy, one of the components we constantly assess for patient's wellbeing is their balance.  There are a multitude of tests that tell us if someone is at a higher risk for falls because of poor balance.  When we discuss balance in PT, we talk about a very important system called the proprioceptive system.  This system is involved in telling your body when it is starting to sway or fall.  It then is supposed to tell your body which muscles to activate to keep yourself from falling.  This system becomes less and less effective as people age, or if it is not used.  

So why is this system so important then?  It is the safety mechanism built into your body that keeps you from falling.  Walking on the sidewalk, climbing stairs, reaching out of your base of support, etc. all activate this system, but is that enough to get you prepared to walk on slippery surfaces?  Additional balance training exercises would be required to truly prepare your proprioceptive system for the challenges that come with snowy and icy sidewalks in the winter.  This is because the only way to truly prepare for walking on unsteady surfaces is to practice on unsteady surfaces in safer conditions.  


If you're concerned about getting around this winter, talk to your PT and see if additional balance training is something you would benefit from.  Because "Winter is coming", will you be ready for it? 

PTW’s Brandon Lewandowski, DPT is a PTs at our Lansdale clinic. For an initial evaluation call 215 855 9871 today!

Wednesday, November 1, 2017

"I Was Feeling Great Until..."

“How are you feeling today?"

“I was feeling great until the cold, rainy weather started yesterday and caused my joints to hurt”

This is a very common conversation that I have with patients the day of or after we experience weather changes, especially those that involve rain, cold, and clouds.  This is not the patient’s imagination at all.  Patients with musculoskeletal conditions, such as arthritis, are more susceptible to experience increases in pain levels when the weather changes.  Patients may be attending therapy for a sports injury, post-surgical rehabilitation, balance impairments, and more.  With the addition of joint pain, secondary to weather changes, a patient could easily get discouraged and want to lay around and rest because the weather has now made their current ‘injury’ much worse.

When barometric pressure and temperature fall, as when a storm rolls in, the pressure against the body begins to fall as well. When this occurs, it is believed that the pressure change causes joint capsules and surrounding tissues to swell.  The swollen and enlarged tissues may be irritating the joints and cause associated pain.  Many of my patients know that getting heat at the end of a session makes them feel loose and relaxed.  The opposite is true with weather.  Colder outdoor temperatures can cause muscles, ligaments, and joints to become stiffer and more painful, especially when someone already has an associated musculoskeletal condition.

For example, it has been found that every 10-degree drop in temperature causes incremental increase in joint pain. Swelling then can cause inflammation and associated discomfort.  The same is true, that when the weather warms up and barometric pressure increases, pain relief may occur in the joints.

There are ways to help manage this increase in pain! Although you cannot change the weather there are things that you can do to ease pain associated with weather changes, such as:

First, stay active! Inactivity can make joints stiffer and more painful.  Many people think that rest will help to ease pain but this is usually not the case.  Stretching, walking, bike riding, doing yoga, working out in a warm pool (Like the two at PTW Lansdale), and many others are ways to increase flexibility and reduce occurrence of swelling in joints.  Give PTW a call and schedule a time to use our Alter G anti-gravity treadmills or deep water 94 degree aquatic therapy pools.  These are great low-impact ways to keep your joints moving and decrease overall pain.

Second, after a conversation with your primary care physician, taking an anti-inflammatory medication can help to decrease swelling in joints.

If you experience joint pain, keep moving, and always feel free to ask your physical therapist for suggestions on how to manage this pain.  Luckily, there are many ways to keep moving and your therapist can come up with an individualized way to manage weather-related pain.  This will allow you and your therapist to spend more time addressing the condition you started therapy for in the first place and get back to doing your favorite daily activities!


PTW’s Jackie Kern, DPT is a Staff Physical Therapist at our West Norriton clinic. For an initial evaluation, call Jackie at 610 630 0101 today!

Thursday, September 28, 2017

Back to School?...Don't Go with Back Pain!

Back Pack Health and Safety Tips

It is that time of year again. Everyone should know be settled into the school year so now the dreaded homework and project assignments are being piled on. For those kids affected by the Methacton School District strike, they are playing catch-up on the missed work. A major cause of muscle strain and back problems in our youth is due to overloaded backpacks.  Homework assignments and projects lead students to stuff their school bags with heavy text books and folders. Over the course of a full school year this really wears on the spine and can lead to development of scoliosis and muscle injury.

The key to a healthy spine is to balance out the load the spine receives when lifting and carrying objects.

  1.  So first, adjust the straps on the backpack so that they sit securely on your shoulders and that the backpack does not sag too low and pull your spine backward.
  2. Avoid single arm carrying of the backpack as this will through you off balance
  3. If you must take home heavy books try and carry one or two in front of you so that the backpack is lighter and now you have counter weight in the front. Ideally, a backpack should weigh only 15% of the child’s weight.
  4. Finally, if at all possible leave those heavy books at home or in school. Take advantage of the online versions of the books. So if you can use a tablet in school, load the eBook on the tablet. The same goes for home, if you need to use the book in school and don’t have a tablet at school, then load the eBook on your home computer or tablet.

Following these tips will save you from nagging muscle pain and help prevent scoliosis, which is especially common in young females. Taking care of your spine at an early age will minimize the risk of injuries later on in life.


Stop in to PTW West Norriton for more information and consultation on how to keep that young spine healthy!

PTW’s Marc Schottle, DPT is the Clinical Supervisor at our West Norriton office. For an initial evaluation, call Marc at 215 630 0101 today!

Friday, September 8, 2017

Free Healthcare for the rest of the year: Health-O-Nomics 2017



Helathcare services to consider once your deductible has been met

Health-O-Nomics 2017
Feeling pain free again without the healthcare costs!

Health care costs are at an all-time high, with no signs of relief.

Except, for some, right now, your costs are lower now than they were a few months ago!  If you have a deductible healthcare plan, your financial responsibility very well could be met for the year. 

That is good news!
This may be the time of year you get that aching knee looked at by a surgeon, and if you need surgery, consider it before the end of the year.

Or consider getting that aching back evaluated by a Physical Therapist.  You know, the soreness that keeps you from the gym, maybe that aching knee that prevents you from yard work, or the painful shoulder that keeps you up at night, there is low cost relief available right now.  

For some, there is no financial responsibility to visit a licensed professional for the benefits of:

  • Pain relief
  • Education on self-management
  • To get stronger
  • To gain flexibility

At PTW
We are ready to serve and help you with Anti-Gravity Treadmills (like walking on the moon, pain free!), Aquatic Therapy, modalities for pain relief, with our Doctors of Physical Therapy who can offer solutions to improve your function and performance in 2018.

The Physical Therapy and Wellness Institute has direct access, licensed Doctors of Physical Therapy at 7 locations, where no doctor prescription is required.

What makes you feel good won’t hit you in the pocket!

Robert Babb, PT, MBA is a practicing Physical Therapist and President of the Physical Therapy & Wellness Institute serving the suburban Philadelphia area.