Prehabilitation: It’s Effectiveness and Why It’s Worth Your Time!

By: Dr. Tyler Fallon, PT, DPT, CSCS

Everybody develops an orthopedic injury at one point or another. It is an unfortunate circumstance that all humans must deal with and it can often be very difficult both physically and mentally. Some injuries can be major, others quite minor depending on the situation. Surgery is an intervention that is not preferred by most initially and often acts as a last resort after conservative management has been tried. Surgery, however, can produce miraculous results that can be life restoring and allow people to live with a higher quality of life. Prehabilitation is the act of preparing for surgery or preventing injury through physical and lifestyle changes including strength and flexibility training, functional training, nutritional adaptations and emotional/stress management.

Prehabilitation plans prescribed by a licensed professional can vary greatly from patient to patient depending on each individual’s needs and the circumstances at hand, for example, preparing for a knee surgery versus an athlete looking to prevent common injuries of a busy and long athletic season. Significant research exists within the medical profession, proving that an implemented and consistent prehabilitation program can reduce post-operative pain / discomfort, speed up recovery, and result in accelerated returns to sport, work, and lifestyle. In general, if you can improve a person’s functional capacity before an anticipated surgery or athletic season, it is reasonable to infer that that individual will be able to rebound at a faster rate from an injury or surgery.

Let’s take an ACL injury that a young athlete may sustain, a common athletic injury, with over 150,000 ligament ruptures per year. Physical therapy is usually recommended by surgeons for about a month prior to surgery.  A prehabilitation program monitored by a physical therapist will focus primarily on four goals before surgery – 1. Reduce pain, inflammation, and swelling 2. Normalize range of motion 3. Comprehensive lower leg strengthening program 4. Education on expectations and the plan before and immediately after surgery, along with preparing the patient mentally for potential challenges they may face.  Undoubtedly after surgery, and even the strongest athletes in the world, will lose strength or atrophy primarily in the quadriceps, hamstring, gluteal, and calf muscle groups. Increased inflammation and swelling is experienced after surgery as the body recognizes a traumatic experience and attempts to heal itself. Inflammation and swelling can shut down muscle groups and cause them to atrophy or lose strength quickly. Many patients ask, “What is the point of strengthening a leg before surgery if you will lose the strength anyway?”  The truth is, if you start from a level of strength that is higher than previously, then recovery during the earlier stages of surgery will be faster as you lose less ‘net strength’.

The program given to a patient by a physical therapist will be specific to the person, their athletic goals, and current strength levels in order to maximize the amount of strength gained in the weeks leading up to surgery and facilitate a faster recovery time during the early stages. The hard work someone puts in prior to surgery makes a large difference, and I’ve seen that not only within my own practice clinically, but also within the medical research.

Therefore, a physical therapist is able to utilize a prehabilitation program in several different ways. If you sustained a musculoskeletal injury and are not sure what you should do, it is always best to seek advice from a medical professional. A physical therapist would be able to diagnose the severity and recommend any imaging that may be necessary, along with getting you started on the appropriate flexibility and strengthening program whether surgical intervention is needed or not. Secondly, if you didn’t sustain an injury but you are an athlete or active person, a physical therapist can perform a full body assessment to see if there are any areas of improvement or compensation. They would be able to implement a customized prehabilitation program that would be solely focused on injury prevention and enhancing your overall sports / activity performance.  With either scenario, a physical therapist would be able to provide the necessary education, care, and appropriate plan of action to ensure your absolute best possible recovery and outcome!

Chiropractic Care Helps With Your Pain & Keeps You Functioning At Your Highest Capacity

By: Dr Elan Michael, DC

Growing up with a grandfather, who was not only a Chiropractor, but lived and breathed chiropractic care, the idea of preventative medicine was always second nature to me.  In America, we practice dental health and hygiene, blood screenings and non-stop testing, yet the idea of preventative treatment for the spine eludes us. Chiropractors may call this maintenance care, but spinal hygiene is important to ensure our backs function at its highest potential.  Back pain is usually reoccurring or chronic, and most patients are symptom guided, which means they seek care when and only when they feel pain. However, why must we wait until we feel the sometimes paralyzing pain from the low back, if studies show regular maintenance care can prevent us from experiencing those symptoms?

A study in 2018 by Eklund A, et al, set out to study the benefits, if any, of maintenance care for low back pain, compared to symptom guided therapy – essentially examining preventative care and spinal hygiene.  The conclusion noted maintenance care was more effective than symptom-guided treatment in reducing the total number of days over a years’ time with bothersome non-specific low back pain. By taking care of our spines, like we do with so many aspects of our body, we can reduce pain.  Those who have had debilitating low back pain can appreciate how important that is. Furthermore, patients who respond well to the initial course of chiropractic treatment will respond even better to maintenance care. 

We have heard the complaints made by some, “once you go to a chiropractor you have to keep going “, yet the same argument is not made about the dentist, or optometrist, or so forth.  One of the biggest risk factors of having low back pain, is a history of back pain. Considering the statistics that 90% of the population will at one point experience low back pain, this leaves 90% of us at higher risk of experiencing it again. 

So what are our options when we first experience back pain or any pain?  Some will head to their primary care physician or orthopedic who will prescribe muscle relaxers and pain medication.  This will dull our pain until the body eventually heals the current episode and the pain ultimately subsides. Some will get prescriptions for physical therapy, as well, which will help the patient stabilize and strengthen the back for a number of visits.  The patient at this point will feel better and think they are cured and go back to their regular day to day, usually no longer continuing the rehab exercises. Now, since the statistics show a history of low back pain is a leading indicator of future low back pain, most patients will have a recurrence of this pain.  The underlying issues of the spine have not been addressed and corrected, the stabilizing rehabilitative exercises have stopped, and it will be only a matter of time before the back seizes up again.

Some patients will go to the Chiropractor when they initially feel low back pain for the first time. They will be treated and the spine will be addressed, pain will disappear, and they will be given stabilizing exercises for the low back.  At this point patients face a fork in the road, either they no longer receive treatment because the symptoms are gone, or participate in maintenance care, and periodically make sure the spine is functioning at its highest capacity. The research shows the best way to reduce the amount of low back pain in the future would be take the approach of maintenance care, and with the risk profile of chiropractic treatment being so low it seems as a no brainer.

As a child, having the privilege of growing up with chiropractic care and, as an adult, my own brother as my Chiropractor, I am living proof of the benefits of maintenance care.  It has helped me to prevent injury, reduce pain, and keep me functioning at my highest capacity. Chiropractic care combined with stabilizing exercises can be a life changer for most of the population, once we escape the idea of only going to the doctor when in pain.  That is the hurdle ahead of us, and that is the hurdle that we will jump over together, as the most recent research and evidence propels us.

Graston Technique: Used for Recovery & Rehab!

By: Justen Lopez, MS, ATC/L, PES, GTS

Graston Technique is a specific brand of instrument-assisted soft tissue mobilization devices used to treat soft tissue injuries or fascial restrictions, as well as help assess the kinetic chain and various pathologies. Composed of stainless steel and designed with unique treatment edges and angles, Graston instruments allow the clinician to sweep through a particular area to help restore movement and function in addition to helping with the healing process. These instruments have a wide range of conditions and injuries that they can treat for people of varying levels of activity.

When thinking about who needs treatments such as Graston Technique, one usually thinks of athletes and the active population. Graston Technique has many benefits for people within this population from assisting with maintaining functional motion to rehabbing injuries. Many Certified Athletic Trainers and Doctors of Physical Therapy utilize Graston Technique in the preparation, treatment, and recovery of their physically active patients, and it can be a great supplementation to therapeutic exercises and other manual techniques.

You do not need to be an athlete to be able to benefit from Graston Technique. Regardless of lifestyle, everyone ends up dealing with some sort of soft tissue issue at some point in their life. Whether it is tightness from sitting at a desk all day, that long term injury you never saw someone about and learned to live with, or excessive typing at work, fascial restrictions can occur, limiting range of motion and function. The Graston Technique Specialists can use the instruments to loosen up those fascial connections, improving range of motion and function.

The instruments work by using the specifically designed treatment edges and angles to glide across the skin, feeling for a variety of signs in the tissue, such as tissue density, the presence of myofascial adhesions, or scar tissue. The mild to moderate pressure of the instruments compress and then stretch the tissue repeatedly, which over time can lead to several physiological changes. While originally derived from the ancient Chinese healing technique of Gua Sha, Graston Technique has a firm foundation in evidence-based medicine. Research studies have shown that Graston Technique can help separate and break down collagen cross-links (ie. scar tissue and fascial adhesions), inhibit abnormal muscle tone (muscle guarding), modify neural sensitivity and input, help with angiogenesis to an area (stimulation of new blood vessels and localized blood flow), and increase cellular activity in the tissue (recruiting fibroblasts and mast cells for proper healing).

In order to effectively treat a particular condition, healthcare professionals need to complete the Graston Technique Basic course, while some go on to complete the Advanced course and become Graston Technique Specialists. Through these courses, clinicians learn a variety of treatment strokes, sequencing of those strokes, how to integrate Graston Technique with therapeutic exercise and stretching, indications and contraindications, and the variety of conditions that may benefit from this type of treatment.

Graston Technique can be used to treat a whole host of injuries, including tennis or golfers elbow, Achilles tendonopathy, patellar tendonopathy, sprains and strains, cervicogenic or tension headaches, carpal tunnel syndrome, plantar fasciitis, rotator cuff tendonopathy, and back pain, and many more. Most people are able to pick out at least a couple of conditions from this list that they have experienced before. Through a combination of Graston Technique and therapeutic exercise, pain from these conditions can be reduced and motion restored. In the clinic, we often see these injuries from the gym, soccer, basketball, cycling/spinning, tennis, golf, and baseball, from professional athletes to the weekend warrior to the less active population. Regardless of how it happened, it needs to be evaluated and treated so that you can get back to performing at a more effective, pain-free level.

At ProClinix Sports Physical Therapy, our Physical Therapists, Certified Athletic Trainers, and Chiropractors utilize instrument-assisted soft tissue mobilization in concert with other manual techniques and exercises in treating our patients. Benefits of Graston Technique can be experienced with routine maintenance, acute injury, or that chronic issue you have been putting off dealing with in hopes of it going away on its own, so come get evaluated by one of our practitioners today!

Hamstring Strains: Why They Occur And What To Do About Them

By: Dr. James Cassell, PT, DPT

Hamstring strains are a very common injury, typically occurring during running sports. The hamstrings are a group of 3 muscles on the back of the thigh: biceps femoris, semitendinosus and semimembranosus. They flex (bend) the knee and also extend the hip, additionally, they act to decelerate the knee during running. Hamstring injuries can range from a minor strain or pull, to a complete tendon rupture, with treatment depending upon the extent of the damage.

A grade I strain of the hamstrings occurs when the hamstrings are overstretched, but no tearing occurs to the muscle fibers. This is the most common injury to the hamstrings, and typically occurs from running, especially if the hamstrings aren’t sufficiently warmed up. The recovery for a grade I hamstring strain can take anywhere from 1 to 3 weeks, with treatment focusing on decreasing pain, improving hamstring flexibility and restoring normal dynamic function through the hamstrings entire range of motion.

Improving hamstring flexibility is very important for maintaining healthy function and for preventing re-injury, which tends to happen with hamstring strains. Static stretching; which is when you hold a stretch for a given duration (30-60 seconds) without any further movement, is used to cause permanent changes in tissue length – meaning that this type of stretching actually increases flexibility. Dynamic stretching; such as doing high kicks and walking hamstring stretches, are used as a warm up, as these movements prepare the hamstrings to be quickly stretched, as they would be during activity/sport.

In addition to stretching and proper warm up, eccentric strengthening of the hamstrings is essential. The eccentric contraction of a muscle is when the muscle is being elongated against resistance. An easy way to think of this, is when you are doing a biceps curl, lifting the weight up is the concentric biceps contraction, and lowering the weight is the eccentric biceps contraction. For the hamstrings, the eccentric contraction occurs when the knee is being straightened. This is important, because while running, the hamstrings eccentrically contract to slow down the knee while it is being straightened and again when the front foot hits the ground during running. Eccentric strengthening would include exercises such as Romanian deadlifts, lying hamstring curls and physioball bridge hamstring curls, with a 5 second lowering portion of the movement. Ideally, hamstring strength would be at least 60% of quadriceps strength, otherwise the quadriceps will overpower the hamstrings during running.

Grade II hamstring strains are more severe than grade I, in that there is some degree of tearing of tendon/muscle. If you strain your hamstring, and it starts to turn purple, you have at least a grade II strain, as the blood which causes the bruising is only present due to a structure tearing – you’ll also probably be limping. Grade II strains can take up to 2 months to recover, as more healing needs to occur than with a grade I. The treatment is similar to a grade I, in that flexibility and eccentric strengthening are focused on, however the aggressiveness of a treatment program is dialed back significantly, as immediately doing dynamic stretching may progress tearing or re-aggravate symptoms.

Another component to treatment is soft tissue massage, either in the form of deep tissue massage, Graston TechniqueⓇ or Active Release TechniquesⓇ. This is important for grade II strains, as it helps to prevent scar tissue from adhering to surrounding tissue. Scar tissue will develop regardless, as that’s part of the healing process, but we want to keep the scar tissue as mobile as possible, as it is a thicker, less elastic type of tissue, which we do not want to be present in a muscle which needs to be moving quickly.

Lastly, grade III hamstring strains are actually complete ruptures, which can occur to 1, 2 or all 3 of the hamstrings. If this occurs, the hamstrings will turn purple and you may be unable to walk due to the pain and inability to move your leg. This injury requires surgical intervention to re-attach the hamstrings. The recovery for a hamstring rupture can take up to 1 year to restore full dynamic function, with many surgeons having different post-operative protocols to follow.

If you sustain a hamstring injury and not sure the level of injury, it is always best to seek medical attention. A physical therapist would be able to diagnose the severity and recommend any imaging that may be necessary, especially if there is a complete rupture or suspicion of one. They would also be able to help with the recovery and potential re-injury of a grade I or II hamstring strain.

Addressing Your Flat Feet Can Help Relieve Pain & Prevent Injury!

By Dr. Brittany O’Rourke, PT, DPT

Have you been told you have “flat feet” or do you feel like the arch of your foot collapses or is not as strong as it used to be? Have you been told you need orthotics, or have you been wearing orthotics for years and continue to feel aches and pains? There is something else you can do about your flat feet! Physical therapists and chiropractors are trained to assess foot posture and entire body alignment to help provide suggestions to help relieve associated pain and prevent injuries. Research supports that exercises can be prescribed to help strengthen the muscles in your foot to help support your arch in both normal feet and flat feet.

I have been trying to strengthen my arch with exercises I found online, but they are not working! There are many reasons why you could have developed a collapsed arch as everyone’s body is different. You could have developed a flexible flatfoot deformity as a child and could benefit from foot/ankle strengthening and an orthotic. You could have gradually began walking with your feet turned out to compensate for tightness in your hips. This abnormal walking pattern overtime can put increased load on the arch of your foot, in which you could benefit from hip stretching in addition to foot/ankle strengthening. Walking mechanics can also be affected by tightness in your calf and stiffness in your ankle and these compensations can put increased load on the arch of your foot, in which you could benefit from calf stretching and manual therapy to improve joint mobility in your foot/ankle. Each case is unique and requires an individualized plan of care to treat, so getting a full body assessment including a gait assessment by a healthcare professional is important in developing the correct exercise program for you!

Is an orthotic enough to support my arch?Orthotics provide a passive restraint to help support the arch, but when barefoot, you no longer have that support. You need an active restraint created by your muscles to help actively support your foot as well. It is also important not to forget that there may be other imbalances in your body that need to be addressed, that an orthotic can not help, to decrease load on the arch of the foot.

I have flat feet and pain in my knee, could this be associated?Ever hear the song “The foot bone connected to the leg bone, the leg bone connected to the knee bone, the knee bone connected to the thigh bone, the thigh bone connected to the backbone”? Having flat feet could contribute to injuries in the foot/ankle, knee, hip, and even back. The collapsed arch can lead to internal rotation of your lower leg and knee, putting increased strain on your knee, which could eventually create an overuse injury. Flat feet could also be associated with weakness or impaired posture/biomechanics at the knee or hip. Weakness in the hip muscles, especially the gluteal muscles, can lead to increased internal rotation of the thigh, knee, and lower leg. This can put increased load on the arch of your foot and with time could lead to a collapsed arch. Other joints in addition to the painful area often need to be addressed to help get to the root of the issue to effectively relieve strain and promote healing.

I don’t have flat feet, but my feet hurt, what should I do?Come get an assessment done by one of our skilled physical therapists or chiropractors! You may have a muscle imbalance somewhere in your body or there could be tightness in your foot/ankle or even hip, which could be contributing to your pain. Everyone is unique with different biomechanics so those exercises online for “foot pain” may not be for you! Come get assessed to find out which exercises you should be doing specific to your body’s impairments to help relieve your pain and prevent injury!

ACL Injuries Growing Occurrence – How To Prevent & Rehabilitate Them!

By: Rachel Amarosa, ATC

With the growing popularity and participation of adolescence sports, there has been a substantial increase in the occurrence of youth athletic injuries nationwide. ACL injuries are one of the more devastating and frequent injuries that occur in our athletic youth population today. The ACL or Anterior Cruicate Ligament, is one of four major ligaments that provides stability in the knee joint. Ligaments are non-stretchable, strong fibers that hold bones together. A lot of times when the ACL is either injured or torn – it is common to have an injury to the MCL (Medial Cruicate Ligament) and / or the meniscus structures as well. The MCL is another one of the four major ligaments of the knee that provides stability and the meniscus is soft tissue that acts like a cushion within the knee joint, between the tibia and femur bones. An injury to the MCL or mensicus in association with an ACL injury can make the overall return to sport slightly more complicated and usually longer.

Here Comes The Shocking News: Nearly one in every sixty adolescent athletes will suffer an ACL injury during their athletic participation. Many of these athletes will then undergo an ACL Reconstruction (which is a 6 to 12 month recovery). In adolescent athletes, females are up to eight times more likely to tear their ACLs compared to their male counterparts. There are several studies that indicate anatomical, physiological and behavioral factors between males and females that are the reasons for such a large ratio difference. The differences in strength, landing mechanics, cutting mechanics, hormone levels and training programs have all been identified as possible risk factors for ACL injuries in adolescence females. Furthermore, most of those ACL injuries occur with little to no contact! I will repeat that – Most ACL injuries occur with little to no contact! Most non-contact ACL injuries occur from cutting (a sudden change in direction), sudden deceleration, or by landing incorrectly from a jump. All these movements happen across most sports, making it all the more important to learn what you can do to help reduce the risk!

Many well designed sports training programs will create comprehensive workouts to prevent several types of sports related injuries. For an ACL prevention training program, it needs to include – balance, proprioception, strengthening, endurance, conditioning, agility, proper landing mechanics and sports specific exercises. Key is to make sure you are doing exercises properly with a focus on quality of movement! In addition to learning general prevention of an initial ACL injury, it’s important to consider how athletes return to sports following an ACL injury. After an ACL reconstruction, an athlete can expect to need Physical Therapy for a minimum of 6 months and upwards of one full year! Physical Therapy will help you regain full range of motion, stability and strength. They will also address proper movement patterns, landing techniques and sports specific training. However, it then becomes essential to continue a comprehensive training program because adolescent athletes with an ACL injury have a 15 times greater risk, compared to an athlete without a previous ACL injury, of sustaining a second ACL injury of either the same or opposite leg after returning to sports. Research has shown that even though an athlete is cleared to return to their sport, often times there continues to be some residual muscle weakness and asymmetry, along with compensatory movement patterns. This fact not only shines a light of focus on continuing a training program after sustaining an ACL injury but should make you do whatever you can to prevent an ACL injury in the first place!

Understanding the need and timing of certain interventions is hard for an adolescent athlete to do on their own. It can require some help from their families, coaches and local professionals. Physical Therapists and Certified Athletic Trainers are healthcare professionals that can perform extensive functional assessments and screenings to help determine where the weaknesses, imbalances and concerns can be for your athlete. For the female adolescent athlete there is a hyper focus on assessing their proper landing mechanics, form when squatting & lunging, and general testing of their overall lower extremity strength. They then use the information to provide a comprehensive training program designed to help prevent the risk of an unwanted ACL injury along with many other types of injuries as well!

How Chiropractic Care Can Help Your Sciatica!

By: Dr. Ivana Monserrate, DC

Sciatica is not a condition – it is a symptom, therefore, there is always an underlying problem and cause of the sciatic nerve being compressed. Sciatica is a term to describe the sensation of sharp, dull, achy, numb or tingling pain into the buttock, leg or foot. Causes of sciatica include, but not limited to, a bulging or herniated disc, scar tissue, bone spurs, pregnancy or tightness of the piriformis muscle. Because the sciatic nerve is the widest and longest nerve in the body, the effects, when compressed, can be debilitating. Fortunately, Chiropractic care has a long history of success in treating sciatica. Not only does Chiropractic provide a conservative, non-surgical and drug-free option for cure but it also targets and addresses the root cause of the sciatica symptoms. 

When going to a Chiropractor they first will determine the cause by taking a medical history and doing a physical and neurological examination. If needed, a Chiropractor can order any additional tests including x-ray or MRI to help further confirm diagnosis. Differentiating the cause of the sciatica helps delegate the proper treatment protocol. For instance, if the cause is the piriformis muscle being tight, the treatment may consist of piriformis stretching and strengthening of the area. On the other hand, if the cause is from the lumbar discs, relief may be achieved more from traction of the lumbar spine, massage or manual therapy of the lumbar musculature, and possible chiropractic manipulation. 

As mentioned before, one cause of sciatica can be a tight piriformis muscle, otherwise named as Piriformis Syndrome. The piriformis muscle is a small muscle that lies deep in the buttock, connecting from the sacrum or tailbone to the hip. It helps turn the thigh outward. The sciatic nerve either travels under or through this piriformis muscle, which explains why it can get compressed by tightness of the muscle. 

How does the piriformis get tight anyway? In 90% of the population, the sciatic nerve passes directly through the piriformis muscle.  In the remaining population it may travel above or under the muscle. The piriformis can get tight from sitting in the same position for periods at a time, running/walking, falling on the buttocks, misalignment of the pelvic bones or exercising without stretching. For those who walk with their feet outward may be at risk for Piriformis Syndrome. When diagnosing Piriformis syndrome the patient will have tenderness, pain and possible weakness when the piriformis muscle is touched. It is possible for the patient to also experience the sciatica pain increase when the piriformis is touched. This point of tenderness will help a Chiropractor differentiate between sciatica coming from the piriformis muscle or another source like the low back. 

How does a Chiropractor cure Piriformis Syndrome? Once diagnosed, the chiropractor will determine the proper treatment protocol. The protocol may include stretching, massage or myofasical release techniques such as Active Release Technique (A.R.T) to the piriformis muscle.  Because the piriformis muscle attaches to the pelvic bones, joint mobilization may also be found necessary. Lastly, rehabilitative stretches may be given for the patient to complete at home to continue decreasing the tightness and compression on the sciatic nerve. Common stretches given may include a figure 4 or pigeon stretch. 

Another cause for patients experiencing sciatica could be from a lumbar disc bulge or herniation. In this case, the patient will experience pain and tenderness in the low back mostly. The sciatica symptom can extend into the buttock, back of thigh, calf and foot. Usually when the cause of the sciatica is a lumbar disc, a patient may not get as great of relief with massage or A.R.T of the piriformis as they would with A.R.T of the lumbar musculature. Patients may also have increased pain and sciatica symptoms when coughing, sneezing or sitting on the toilet as well as decreased range of motion of the low back. In some cases, the chiropractor may find it necessary to order an x-ray, MRI or other imaging studies to help confirm diagnosis.     

Overall, with the appropriate treatment protocol and correct diagnosis of the cause of sciatica, Chiropractic care has proven success in resolving the issue. By taking breaks from sitting, stretching of the gluteal area and proper lifting or posture techniques, sciatica can be prevented. Lastly, every patient is different and depending on severity and other factors helps determines progress and length of recovery. 

Suffering from Back Pain? How Acupuncture Can Help!

By: Andrea Gurciullo, LAc, MTOM

Many people can benefit from Acupuncture as a conserative treatment for pain along with treating many other medical injuries and conditions. Acupuncture improves the body’s functions and promotes the natural self-healing process by stimulating specific anatomic sites–commonly referred to as acupuncture points, or acupoints. The most common method used to stimulate acupoints is the insertion of fine, sterile needles into the skin. Pressure, heat, or electrical stimulation may further enhance the effects. Other acupoint stimulation techniques include: manual massage, moxibustion or heat therapy, cupping, and the application of topical herbal medicines and linaments.

Traditional Chinese Medicine is based on an ancient philosophy that describes the universe, and the body, in terms of two opposing forces: yin and yang. When these forces are in balance, the body is healthy. Energy, called “qi” (pronounced “chee”) flows along specific pathways, called meridians, throughout the body. This constant flow of energy keeps the yin and yang forces balanced. However, if the flow of energy gets blocked, like water getting stuck behind a dam, the disruption can lead to pain, lack of function, or illness. Acupuncture therapy can release blocked qi in the body and stimulate function, evoking the body’s natural healing response through various physiological systems. Modern research has demonstrated acupuncture’s effects on the nervous system, endocrine and immune systems, cardiovascular system, and digestive system. By stimulating the body’s various systems, acupuncture can help to resolve pain, and improve sleep, digestive function, and sense of well-being.

Nearly 8 out of 10 people will suffer from back pain at some point in life.  Back pain is one of the top reasons people seek medical treatment. Current western medical treatment includes pain meds, steroids, surgical intervention and muscle relaxers.  While these things may help for short periods it is not a fix and more often than not they cause more harm than good.  

The good news is that current research suggests that Acupuncture provides significant relief for back pain. Guidelines from the American Pain Society and American College of Physicians say doctors should consider acupuncture as an alternative therapy for patients with chronic low back pain that’s not responding to conventional treatment. While I agree with that statement at some level in my opinion it’s best to be evaluated by an MD and seek out Acupuncture before you resort to using pharmaceuticals that may lead to problems with addiction. 

Next most people wonder what happens at their first session. First, your acupuncturist will ask about your health history. Then, he or she will examine your tongue’s shape, color, and coating, feel your pulse, and possibly perform some additional physical examinations depending on your individual health needs. Using these unique assessment tools, the acupuncturist will be able to recommend a proper treatment plan to address your particular condition. To begin the acupuncture treatment, you lay comfortably on a treatment table while precise acupoints are stimulated on various areas of your body. Most people feel no or minimal discomfort as the fine needles are gently placed. The needles are usually retained between five and 30 minutes. During and after treatments, people report that they feel very relaxed.

The frequency and number of treatments differ from person to person. Some people experience dramatic relief in the first treatment. For complex or long-standing chronic conditions, one to two treatments per week for several months may be recommended. For acute problems, usually fewer visits are required, usually eight to ten visits in total. An individualized treatment plan that includes the expected number of treatments will be discussed during your initial visit.

What You Should Do For Activity Cycling And Pre-Season Training.

By: Eric Faatz, MS, ATC

Exercise and sport activities are two of the best ways to increase your cardiovascular health, build and maintain musculoskeletal tissue, and overall increase ones mood through a means of stress relief. The reason that our bodies respond with such positive outcomes is due to our ability to adapt to the activity that we enjoy taking part in. For example, as we start to get better at running the lower extremity and core muscles develop, the heart becomes stronger and more efficient at pumping blood, and the lungs capacity to use oxygen increases. These adaptations are what make exercising and participation in sports a great addition to anyone’s lifestyle. With such amazing benefits one might think that the more often and the longer we participate in our chosen activity the better the benefits will be! This where our bodies become very complicated. 

In a study by Neeru Jayanthi, MD et al, 2013 May, it was identified through survey that specialization in sports/activity increased the rates of injury, increased psychological stress, and quitting sports at a young age. Another study by M. Kellman Scand J Med Sci Sports 2010, indicated that participation in a sport/activity for a prolonged period can cause chronic over-fatigue, increased injury risk, decreased cognitive performance and lower metabolic rate. The possibility of this happening might be enough to deter someone from sport/activity participation. But there is a way to continue enjoying the activities that we enjoy doing, while minimizing the negative side effects and increasing the ability to reap the benefits. 

This concept is called periodization or activity cycling. While this can be complicated, it can also be as easy as having planned breaks in your sports or activity regime. A general good practice rule would be that every 8 to 10 weeks of participation should be followed with at least 2 weeks of a break from that particular activity. During this 2 week break period, we should aim to still be active within a separate form of exercise. Instead of playing tennis, we could instead 

go hiking as a form of exercise or go swimming to limit the amount of force going through our joints and muscle to allow for proper recovery. During this time, it is also wise to address any weaknesses, inflexibilities, or asymmetries you may have throughout your body. This will ensure optimal level of function and performance while lowering your risk of injury for when you return to your activity. Best way to address any asymmetries is to consult with a medical professional such as a Physical Therapist or a Certified Athletic Trainer.  These health care professionals specialize in performing complete and thorough functional and postural assessments and screenings. With these findings, they would be able to create a unique exercise program that can be a preseason or pre-activity program that’s geared towards injury prevention and improving your sports performance. The same goes for athletes that need to prepare for pre-season. As we all either know or have experienced, pre-season can be tough on the body – really tough. However, the healthcare professionals listed above can help. They would be able to help prepare and address any potential issues so the athlete can avoid an injury before the season even starts.

Your Job Doesn’t Always Have To Be A “Pain In The Neck”

By: Amanda Notley, PT, DPT

Picture this, it’s five o’clock on a Monday and you are done with work for the day. You should be feeling relieved to finally go home after a long day’s work, right? Not if you are the majority of people who work behind a desk all day in today’s society. If that’s the case, you are probably leaving work in pain, feeling stiff and all you want to do is crawl into bed. It’s no surprise that this is a very common issue in the workplace that can cause a variety of musculoskeletal disorders in the neck and shoulders. If not addressed properly, serious conditions could develop later on (such as tendonitis or nerve pain). Although there are many factors that can possibly contribute to this pain, you would be surprised at the fact that many can be addressed without even leaving your seat.

The reasons that contribute to this pain are vast but the main one that seems to stick out across the board is poor posture. This “poor” posture involves increased kyphosis of the cervical spine, (which is essentially an excessive forward head posture) rounded shoulders, and increased thoracic kyphosis (meaning your mid back is excessively bent over like a hunchback). This posture causes muscles in the front of your chest, shoulders, and neck to shorten which pulls on the structures they attach to, causing discomfort and stiffness. On the other hand, muscles in the back of your neck, shoulders and mid thoracic spine are lengthened. Over time this lengthening causes the muscles to fatigue faster which means that those muscles will not do a good job in stabilizing your joints correctly, thus causing pain and soreness.

There are many ways to relieve this discomfort at work, most of which can be done right at your workstation. One of the most common problems leading to poor posture include how your work space is set up. The last thing you are probably thinking about at work is how high your computer monitor is set up or how far back your chair is positioned from the desk. The reason being, is that maybe you are not aware of how your setup is negatively affecting your body or it may be because you have a report that is due in an hour and don’t have time to waste rearranging your desk or remembering to sit up straight. During hectic and stressful times at work, it is especially important to have your workstation set up in a way that is conducive to maintaining good posture.

There are four main parts to your workstation that you most likely have to adjust yourself to on a daily basis as opposed to adjusting the component to YOU. For example, your office chair should provide support while sitting, whether it is through the type of padding used or whether it is by using a lumbar support (if not available you can roll up a small towel and place it behind your lower back for support). You also want to make sure that your chair is not positioned too close or too far away from your desk, in order to prevent putting strain on your muscles to try to see things clearly or having to over stretch to reach things on your desk. It is important to adjust the height of the chair in order to avoid putting unnecessary stress on the hands and wrists when typing or on the neck when looking at the computer. Ideally you want to adjust the height of your chair so that your feet are flat on the floor and your thighs are parallel to the floor. The same idea goes for your desk adjustments. If you cannot adjust the height of the desk, you can put books or blocks underneath the computer monitor in order to make up for the difference in height to keep the monitor at eye level. At the end of the day you want the joints that are resting (hips/knees/elbows) to be as straight and level as a ninety degree angle in order to avoid overstretching or tightening of certain muscles. If your job requires you to use the telephone constantly, look into a more “hands free” or bluetooth headset type of telephone instead of cradling the phone between your head and neck. The path to maintaining good posture and decreased pain has to start at the workspace first to encourage well-aligned posture. By making these adjustments, your body will thank you and you will feel the benefits.

Once good posture is attained and practiced routinely throughout your work day, the last and equally important step is to keep your body moving and exercise the correct muscles. If correcting your posture and workstation doesn’t provide pain relief, seeing a physical therapist may be next on your agenda. A physical therapist can prescribe the corrective exercises needed to stretch the muscles that are painful due to unnecessary tension and strengthen the muscles that provide stability.