Thursday, March 2, 2017

Marijuana and Physical Therapy

Chronic Pain negatively affects

Last weekend, I had a previous patient tell me about their experiences with chronic pain, including their legal use of medical marijuana. 

It made me realize how uninformed I am about the effects of cannabis.  Since patients will ask their family doctor, Physical Therapist, Orthopedic doctor, and other healthcare providers about appropriateness, I thought it be best to deeper understand some facts.

Here are some facts;
  • Marijuana has been used for medicinal purposes for more than 4000 years.
  • It was used extensively in the United States for medical treatment well into the 20th century
  • In 1937, the US government put severe legal restrictions on the use, consequently reducing the use and availability
  • In 1970, it was declared a controlled substance, further restricting the use and limiting research on the analgesic effects

Lately, there has been a change in the medical thoughts on the substance due to the positive reduction of pain and other disorders with the use of cannabis.   Currently, medical marijuana is permitted in 1/2 of the states.  In addition, there are areas of our Physical Therapy practice that are sure to be affected for folks with chronic pain, hyperexciteability, inflammation, neurotic pain. 

A few key facts;

What conditions have been treated with medical marijuana with positive effects?
  • Glaucoma
  • Psychosis and anxiety
  • Seizure disorders
  • Tourette syndrome
  • Cancer related pain
  • Fibromylagia
  • Neuropaathic pain
  • Spasticity with multiple sclerosis
  • Rheumatoid and osteoarthritis
  • Chronic musculoskeletal pain

Adverse effects that could effect Physical Therapy

Short term impairments in cognition, memory, alertness, balance, and coordination, possibly affecting;
  • The ability to drive
  • The risk of falls
  • Workplace or school tasks

Although Medical Marijuana is not fully legal yet in our state, it appears it is soon to come.  I have a lot of reading still to do.

At The Physical Therapy & Wellness Institute,  Chronic Pain Physical Therapy programs are always aimed at reducing pain with education, manual skills, or modalities, and the use of cannabis may soon complement our work.

More discussions with the family and chronic pain doctors are a sure bet in my practice, to help me answer my patients when the time comes!

Robert Babb, PT
Physical Therapist at The Physical Therapy & Wellness Institute with locations in Lansdale, Quakertown, Montgomeryville, West Norriton, Glenside, Harleysville, and Souderton, PA

Monday, February 20, 2017

E-Stim:What is it Good For?

Electrical Stimulation: An Overview

If you have spent time in physical therapy while rehabilitating an injury, you may have experienced electrical stimulation, or “E-stim”. Patients are not always fully aware of the implications or purpose of the electrical stimulation, and so what follows is a brief introduction to inform you as to why your physical therapist may suggest that electrical stimulation to be an important intervention during the rehabilitation process.

There are different forms of electrical stimulation
(or “E-stim”) that serve a variety of functions. Perhaps the most well-known use of E-stim is for pain control. When E-stim is used for pain control, it is commonly referred to as TENS (transcutaneous electrical nerve stimulation). TENS is often utilized post-sessions to reduce joint or muscle pain; electrodes are placed at or around the site of pain to stimulate joint receptors and override the pain signal. This can especially important for individuals with osteoarthritis, back pain, or for patients in rehab following a surgery. One study reports that although TENS will not speed up or alter the longterm outcomes after shoulder surgery, the use of TENS has been shown to decrease opioid use in the first 72 hours and help to control postoperative pain (Thigpen et al). With the overdosing of narcotics and opioids to control pain in modern society, TENS is likely an underutilized alternative to pain management.

One key to maximizing the pain-relieving benefits of TENS is in the intensity of the signal. Studies indicate that the intensity should be turned at a level 3x the sensory threshold. What this means is that if you start to feel a tingle at 10mA (milliamp), you will gain the greatest pain relief if the treatment is turned up to 30mA. You may also notice that after a few minutes into a TENS session, the signal does not feel as strong. You may worry that you are no longer gaining the same benefit. However, it has been shown that although your perception of the signal may change, the activation of your sensory nerve fibers does not change (Pietrosimone et al). So if it feels stronger in the beginning, but less intense after a few minutes, you are still gaining the same pain-relieving benefit!

Another common function of electrical stimulation is for strengthening muscle, when it is known as NMES (neuromuscular electrical stimulation). “Isn’t that what the exercise is for?” you say. Absolutely! However, in order to understand why NMES is so helpful for strengthening, let’s take a look at one basic principle of strength training, the recruitment principle. The boiled down version of this rule says that when you strength train at low intensity (lifting light weights) or are doing aerobic exercise (walking), you are using your type 1 muscle fibers. When you are completing intense exercise (lifting heavy weights or with fast jogging/sprinting), you first recruit those same type 1 fibers, and then type 2a, and finally type 2 b fibers. So in order to get full benefit from strength training, you generally have to work extra hard in order to recruit all your muscle fibers. However, NMES skips right to the chase for you. It utilizes ‘’random recruitment’’ which means it automatically recruits all 3 muscle fiber types. How does this affect strengthening? For one, it results in increased pennation angle of fibers so that you can fit more contractile proteins in parallel throughout the muscle (Gondin, 2005). Let’s take a look at one study following ACL reconstruction.

When studying strength recovery of the quadriceps 6 weeks after ACL surgery, two groups were compared. One group utilized NMES, the other group utilized voluntary exercise (normal exercise routine, no NMES). The results weren’t even close. The NMES group had restore their affected leg’s quadricep’s strength to 70% of the unaffected leg’ strength, while the voluntary exercise group had only recovered about 50% of the strength. Bottom line: NMES restored strength quicker, which translates into quicker recovery time.

NMES is also viable in strengthening older adults (>65 yrs). Stackhouse et al reported that when using NMES on fatigued muscles, there was a 16% stronger muscle contraction with using NMES vs voluntary strength training.

 A third use of e-stim is for restoring functional control of muscles (functional electrical stimulation). This option can be utilized for someone who is having trouble activating key muscles to perform a basic movement. For example, in a patient who has had a stroke may have difficulty bringing their toes up towards their nose (dorsiflexion), which can manifest as a falling hazard when walking. FES can be used to stimulate the muscles in charge of dorsiflexion when this patient is walking, resulting in improved voluntary control of these muscles over time and increased safety.
SUMMARY To recap, e-stim is used for a variety of purposes, the most common of which are: pain control (TENS), strengthening (NMES), and to improve functional capacity (FES). All 3 use variations in certain parameters including signal frequency, phase duration, and amplitude to accomplish what each patient needs. Talk to your physical therapist or ask questions you may have regarding this effective intervention.

Gondin, et al. Electromyostimulation Training Effects on Neural Drive and Muscle Architecture. Medicine & Science in Sports & Exercise, 2005, Volume 37(8) pp. 1291- 1299.

L Snyder-Mackler. Strength of the Quadriceps Muscle and Functional Recovery After Reconstruction of the ACL: A Prospective Clinical Trial of Electrical Stimulation. Journal of Bone and Joint Surgery Vol. 77A, No. 8: 1166-1173, 1995

Mizner, et al. Early Quadriceps Strength Loss After Total Knee Arthroplasty. J Bone Joint Surg, 2005. 87 (5): 1047-1053

Pietrosimone BG, et al. Effects of transcutaneous electrical nerve stimulation and therapeutic exercise on quadriceps activation in people with tibiofemoral osteoarthritis. JOSPT. 2011 Jan;41(1):4-12.

Stackhouse et al. Maximum Voluntary Activation in Nonfatigued and Fatigued Muscle of Young and Elderly Individuals Physical Therapy 81(5):1102-9 · May 2001

Thigpen, Charles A, et al. The American Society of Shoulder And Elbow Therapists’ consensus statement on rehabilitation following arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2016. 25, 521-535.

Matthew J. Brennan PT, DPT
The Physical Therapy & Wellness Institute
 2456 W Main St. Norristown, PA 19403
 tel: (610) 630-0101 fax: (610) 630-1068

Tuesday, January 17, 2017

Which Shovel is Best for YOU?

Picking the Right Shovel

With winter in full swing it is important to make sure you have the proper equipment to keep you safe during the cold, slippery, winter months.

First of all, save all the hassle and install a heated driveway and walkways.

If not, then pay close attention !!!!

Facts and Myths of Shoveling

FACT: The Center for Injury Research and Policy, there are more than 11,000 medical                    emergencies each year related to shoveling snow. 

FACT: 2 minutes of shoveling snow can stress your cardiovascular system and raise heart
           rates past recommended levels.

MYTH: "When buying a shovel, bigger is better"

FACT: A shovel that is 18-22 inches wide is a good moderate size

Pros and Cons of Different Shovels


As always, be sure to stretch and take the proper precautions before shoveling to stay safe this winter! 

 PTW’s Stephen Linton, PT, DPT is the Clinical Supervisor at our Harleysville clinic. For an initial evaluation, call Steve at 267 932 9177 today!

Thursday, January 5, 2017

Stay Safe Shoveling This Winter!

The Proper Do’s and Do Not's of Shoveling Snow

 A 2009 medical study published in The American Journal of Emergency Medicine found that, on average, 11,500 people across the country suffer snow shoveling-related injuries and medical emergencies every year. 

This winter season protect yourself with these do’s and do not's of shoveling.

Do: Warm Up and Stretch
·      Spent 5-10 mins doing some marching in place, squats, lunges, shoulder rolls, hamstring stretches, and heel cord stretches. Cold, tight muscles are more prone to injury than warmed up, flexible muscles.

Do: Pick the right shovel
·       A small, lightweight plastic blade helps reduce the amount of weight that you are moving      A shovel with a curved handle or an adjustable handle length will minimize painful bending, requiring you to bend your knees only slightly and arch your back slightly, while keeping the shovel blade on the ground. 

Don’t:  Be Macho
·      If you’re inactive or have a history of low back or neck pain, hire someone to shovel the driveway for you – neighborhood kids are usually eager to get out make a little bit of money on their days off.
·       If you are going to shovel yourself, don’t try to lift large piles of snow.

Don’t: Delay
·      Fresh snow weighs far less than snow that has been sitting for a while. Waiting allows for the snow to compact and get wet, translates to becoming heavier or even worse turning into ice.

Do: Push the snow
·         If possible push the snow to a pile.  

Don’t: Twist and throw the snow
·      What you might not have known is that one shovelful of snow can weigh up to 20 pounds. But if you have to lift the snow, maintain good posture.

o   Stand with your feet shoulder width apart for balance and bend at the knees rather than at the waist or back.
o   Keep the shovel close to your body rather than extending your arms all the way.
o   Tighten your stomach muscles and then lift with your legs as if you are doing a squat.
o   Switch off between snow shoveling right-handed and left-handed, so that you’re working different muscles.

Do: Take your time
·      I know it’s cold but rushing and not paying attention to your body mechanics could increase your risk of injury.  Low back pain from shoveling is one of the common reasons for emergency room visits in the winter.
·      Shoveling is a form of weight lifting. You need to pace yourself and take regular breaks. If you feel any pain you should stop.

Do: Keep and cellphone handy
·      Just in case for emergencies. Always better to be safe than sorry.

Don’t: Continue if you are experiencing pain
If you do experience pain or an injury that continues throughout the day or weekend, you are welcome to utilize PTW’s FREE screenings and consultations. You can be assessed by a licensed physical therapist and given a recommendation based on the findings. Appointments are made within 24 hours of phone call.

 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 for an appointment as soon as possible!

Monday, January 2, 2017

Joint Health must items to do; Its about you!

Getting your joints healthy is directly proportional to your healthy mind, so consider some of the habits below from the experts who recommend them;

Your Joint Health is about you making change in 2017
Put down the Mobile phone:

The mobile phone creates "Technoference" with the folks you work with, your live with, folks in your community, interferes with new relationships, and weakens the quality and quantity of our face to face communications.  Pull out stamps for notes of gratitude, go see a concert with an old friend, even stop a neighbor at their mailbox to say hello.

Exercise for the fun of it 

Fit bits, computers, and personal trainers have increased our reporting measures on exercise, creating improved accountability for ones own personal health.  When it gets stale or you feel you need a break, , just get outside (cold or warm!) to have some fun.  Walking in fresh snow, in the rain, or on a super hot day excites your senses,  renews our spirits, brings back youth, and creates new ideas.

Get back to simplicity in eating

Starting a diet in January will help you maybe lose weight, but changing your life lenses may help you more.  Lifestyle change runs hand in hand with diet, and will help with successful long term health and weight maintenance.  For example, the simpler the food, the less the ingredients in what you eat becomes part of your lifestyle, rather than counting calories.  Forget the corn syrup, drive by fast food joints, drop the bleached foods, and eat to live instead of living to eat.

Meet more people

Meeting new people develops new relationships, builds confidence, expands your network, gives you fresh ideas, and builds your communication skills...all while having fun and being yourself!

Of course, some personalities clash, where relationships never build. That is OK, some folks assess your over a brief period of time.  They say it takes less than 30 seconds for folks to assess weather they like you or not (some say 7 seconds), so chances are the more people you meet, the more that may like you, the more you can do business with, or into your network of friends and colleagues!

Stand up more

We are sitting to return text, write emails, work from home at our desks, taking seats more at work.  In short, we were meant to be locomotive, so stand up when you can.  Get a stand up work station or desk that can raise when you want to stand.  Positive effects are well noted on reducing your weight,  in your on your cardiovascular system, blood glucose levels, joint health, reduction in back pain, and a whole lot more

Monday, November 28, 2016

Thankful for YOU!


With the Thanksgiving spirit in the air, I am especially thankful for the men and women that we get to serve on a daily basis!  It is both a joy and privilege to help patients rehabilitate through pain, sweat, and at times even tears  in order to reap the benefits and rewards of a better lifestyle with less pain and improved function. 

Celebrating the joy of performing stairs for the first time after a total knee replacement, throwing a ball with their son for the first time after surgery, and being able to get their coat on pain-free, are all celebrations within the past week that I have been able to share with my patients. PTW is especially thankful for you, our patients, our celebrations, our friends!

PTW's Tyler Haggerty is the Clinical Supervisor at Glenside For an initial evaluation, call Tyler at 215.887.2001 today for an appointment as soon as possible no prescription needed!

Thursday, November 17, 2016

Pain Free November

No Pain November!

    Don’t put off being in pain like men put off shaving in November!

Acute pain or pain that has lasted less than 3 months is generally much easier to treat then if you let it become chronic (3-6 mos)!

Many studies show that, “There was a lower risk of subsequent medical service usage among patients who received PT early after an episode of acute low back pain relative to those who received PT at later times.”2  

Studies also show that, “With chronic pain, one's nervous system is sometimes altered, making it more sensitive to pain. As a result, painful sensations might feel more severe and last longer.”1

Whether its back pain, neck pain, you rolled your ankle walking the dog, or you’re having frequent headaches, Physical Therapy can help!!

Don’t keep suffering in pain through the holiday season, schedule an appointment to get some pain relief and have an enjoyable holiday season!

 PTW’s Stephanie McDougal, PT, DPT is the Clinical Supervisor at our Souderton clinic. She provides expert clinical care and is a vestibular/concussion specialist. For an initial evaluation, call Steph at 215 855 1160 today for an appointment as soon as possible!

1.       Kam, K. (2011, February 18). Living with Chronic Pain: Is your pain acute or chronic? (L. Chang MD, Ed.). Retrieved November 9, 2016, from

2.       Gellhorn AC, Chan L, Martin B, Friedly J. Management Patterns in Acute Low Back Pain: the Role of Physical Therapy. Spine. 2012;37(9):775-782. doi:10.1097/BRS.0b013e3181d79a09.