Understanding ITB Syndrome & Solutions

The knee is a hinge joint, meaning its function
of movement is in one plane, in this case, the
straightening and bending of the leg. The
knee joint also has a varying list of muscles,
tendons and ligament that attach to it. One of
the largest attachments being your Iliotibial
Band: ITB. The ITBand is not a muscle but a
thick band of fibrous tissue that runs along the
outside of your leg. It starts at the hip and
extends to the outer side of the shinbone just
below the knee. Due to its length, it attaches
to other muscles along the way such as the
glute muscle: gluteus medius, hip flexor: TFL and quad muscle: vastus lateralis.

Why does it hurt?

Because the ITBand is not a muscle, it can’t really be strengthened or stretched so it’s important to improve strength and flexibility in surrounding muscles. Any deficit in those muscles could cause ITBand Syndrome. ITBS is when the IT band becomes too tight. This causes friction at the top of your hip or on the lateral side of the knee and can result in swelling and pain.

Temporary relief for ITBS includes:

• -  Foam Rolling

• -  Ice Pack

• -  Gentle Massage

• -  Standing ITB Stretch

Long term ways to fix and prevent ITBS include exercises:

• Bridge: Aim for 2 sets of 15 repetitions, 3-4 days per week. Start with bodyweight until 15-20 repetitions are easy, then consider adding weight to your hips or expiriment with more challenging variations inculding offset or single leg bridges to keep the level of difficulty high enough to stimulate muscle growth. Take 1-2 minutes between sets. Push yourself!

• Single-Leg Dead Lift: Dosing is the same as the bridges. They key? Make sure your body knows it is weak otherwise it will not get stronger! Mack sure to keep a neutral spine and use your hips to lift, not your back. Practice with NO weight to start, making sure you are eble to feel your “posterior chain” working, meaning your gluteals and hamstrings lengthening and shortening to lift your turnk. Add weight accordingly for fatigue between 12-15 reps.

• Banded 3-way: Designed for both strength and endurance. Perform 10-15 light repetitions in each direction on both legs as part of your running warm-up to activate and bring awareness to your gluteals. After your run or on a different day, use a harder band or perform more repetitions until you reach fatigue. Take several minutes and perform another round, starting with the opposote leg standing as your first set. Perform 4 x week.

You Have A Lot Of Nerve (s).

The nerves in our bodies are like cables that carry electrical impulses between your brain and the rest of your body. These impulses help you feel sensations like pain, temperature, fine touch, etc and move your muscles. Every muscle in our body is supplied by certain nerves. Disruption of these nerve paths such as impingement, injury, or severed nerve can cause issues to surrounding muscles, like numbness, tingling, no activation, sharp pain.

Upper Body Nerves:

• -  Median Nerve: Thumb opponens, wrist pronation, thumb/index, middle finger. Difficulty opening jar,

  Carpal tunnel, Repetitive use

• -  Ulnar Nerve: Pinky opponens, ulnar flexion, pinky and outer ring finger. Difficulty carrying heavy load,

  pain from punching, fall on outstretched hand

• -  Radial Nerve: Wrist extensors, triceps, lateral tricep, top of forearm. Tennis elbow, shoulder pain with

  pressing, difficulty in a push up

• -  Musculocutaneous: Biceps, radial side of forearm. Bicep tendonitis, golfers elbow, shoulder impingement

  syndrome

• -  Axillary: Deltoid, lateral arm at base of deltoid. Shoulder pain, Poor shoulder rotation

• -  Suprascapular: Supraspinatus, Infraspinatus. Almost all shoulder problems, especially rotator cuff

  muscles, fall on shoulder

  Lower Body Nerves

• -  Tibial Nerve: Gastroc activation and endurance. Low back pain, ankle sprains, poor balance, hamstring

  injuries, plantar fasciitis/heel pain, lateral knee pain

• -  Peroneal Nerve: Ability to maintain neutral in calf raise, lateral lower leg strength. Low Back Pain, ankle

  instability, drop foot

• -  Sural Nerve: Lateral calf sensation. Achilles tendonitis, Recurrent ankle sprains

• -  Femoral Nerve: Psoas and quad strength. Poor squatting, medial knee pain, hip flexor pain

• -  Obturator Nerve: Adductor strength. Adductor pain or strains

• -  Saphenous Nerve: Medial thigh, knee and shin sensation. Meniscus, MCL surgery, medial ankle pain,

  bunion

• -  Lateral Femoral Cutaneous Nerve: ITB, lateral thigh sensation. ITB pain, lateral leg pain

Do Cortisone Shots Work?

Have you ever been recommended cortisone injections to alleviate pain associated with conditions like arthritis, carpal tunnel syndrome, bursitis, or tendonitis? What exactly are cortisone injections, and how do they work? Cortisone injections are corticosteroids that act as fast-acting anti-inflammatories, helping to manage symptoms and prevent further damage to the joints and surrounding tissues. However, the effectiveness and duration of cortisone injections vary depending on factors such as the individual's pain level, the location and type of pain. Therefore, it is crucial to consult with your doctor to determine if you are a suitable candidate for this treatment.

The glenohumeral joint is a common place to recieve an injection

💉While cortisone offer several benefits, it's essential to consider the potential adverse effects before deciding if cortisone injections are right for you. These adverse effects may include mood changes, weight gain, increased appetite, impaired wound healing, blurred vision, high blood pressure, and nervousness, etc. Cortisone injections generally provide relief for a few weeks to months, but it is generally advised by doctors not to exceed 3-4 injections per year.

📚A research study conducted on 225 participants with frozen shoulder and examining the effects of the cortisone injections to a group that received a placebo injection. The study found significant improvements in shoulder range of motion and pain levels among those who received the injections. Specifically, participants displayed increased shoulder range of motion for a total of 24 weeks, which was the most notable benefit. While the participants' pain levels did improve significantly for the first 8 weeks with cortisone injections, the pain reduction was not significantly different compared to the group that received the placebo injections. This discrepancy may be attributed to the temporary nature of the injection's pain-reducing effects, as opposed to the longer-lasting improvements in range of motion.

Physcial Therapy Can Relieve Osteoarthritis Pain

Have you been experiencing hip pain lately? Hip osteoarthritis is a common condition that affects millions of people and can be influenced by various factors like age, BMI, genetics, and overall health. As you get older, especially after the age of 50, the prevalence of hip osteoarthritis tends to increase. The condition often presents with joint pain and stiffness, particularly in the morning upon waking, which usually lasts for about an hour. However, with movement, the synovial fluid in the joint helps to lubricate it, providing more ease of movement.

Hip osteoarthritis is a type of arthritis that causes the bone to degenerate, leading to decreased density and support. It can also affect other areas of the body, such as the feet, fingers, and knees. When symptoms significantly impact daily activities, knee or hip replacements using artificial joints may be considered.

To evaluate your physical progress during therapy, there are reliable guideline tests available. These tests may include the 30-second chair test for lower extremity strength or the Berg Balance Scale. These assessments will help identify any limitations and guide improvements for better hip function.

Manual therapies, such as soft tissue massage and joint mobilizations, have shown promising results over a 6-12 week period. Focusing on specific muscles like the glutes, piriformis, iliacus, psoas, quads, and IT band can improve hip mobility by aligning the muscle fibers properly. Additionally, physical therapists can perform hip joint distraction, a technique that separates the femoral head from the acetabulum, reducing pressure on the joint and improving joint mobility at the capsular level.

Muscle Energy & Stretching Strategies For The Sacroiliac Joint!

Muscle energy techniques aim to enhance range of motion by targeting muscle contraction and progressive lengthening. Unlike regular static stretching, where you hold a position, such as touching your toes while standing to stretch your hamstrings, muscle energy techniques require the active participation of both the physical therapist and the patient. These techniques operate on the principle of reciprocal inhibition, meaning that by activating the opposing muscle, you can improve muscle length. For instance, if you have limited hamstring flexibility, contracting your quadriceps will lead to an increased range of motion in knee extension.

Research indicates that combining muscle energy techniques with other treatments, such as maitland joint mobilizations, TENS, specific exercises, interferential therapy, and trunk stabilization, can yield significant improvements in both acute and chronic low back pain. In one study, the combination of muscle energy techniques and maitland mobilization resulted in reduced low back pain and increased hip mobility after six treatments.

When using muscle energy techniques for the sacroiliac joint, it is crucial to assess whether the joint is in a posterior or anterior pelvic tilt. One technique for correcting the sacroiliac joint involves placing a foam roller between your legs. Hold the foam roller behind your knees on the side with anterior pelvic tilt and on the front portion of your opposite leg that’s in posterior pelvic tilt. Push down into the foam roller with the anterior pelvic tilt leg while simultaneously pulling up with the opposite leg. Hold this for 5 seconds and repeat 5 times. This technique can often provide significant relief within minites and reduce the feeling of uneasiness walking or lifting.

Irritating Trigger points? Knot A Problem With Physical Therapy!

Physical therapy treatments encompass a variety of manual techniques including soft tissue massage, trigger point release (TpR), muscle energy techniques, joint mobilizations, & mobilizations with movements. By incorporating a comprehensive physical therapy regimen that targets static strength, dynamic strength, mobility, and proprioception, you can enhance your functional abilities.

Soft tissue massage is a commonly used technique to promote muscle relaxation through methods such as kneading, effleurage, & petrissage etc. Have you ever experienced muscle knots? These knots, known as trigger points, often result from acute trauma or repetitive stress. One common area where people develop knots is in their upper trapezius muscle from physical & emotional stresses. Poor sitting posture can contribute to repetitive stresses if you have a desk job or spend long periods commuting in a car, you may then unknowingly adopt a forward head posture. This can lead to a condition called upper crossed syndrome, wherein the upper traps & pectoral muscles become tight while the rhomboids & deep neck flexors weaken.

Knots manifest as tight bands within your muscle fibers & can cause localized or referred pain. Referred pain refers to when a knot in one area of a muscle leads to pain in another area. For example, knots in the upper trapezius muscle can cause referred pain resembling cervicogenic headaches (Ram Horn pattern). Research has shown that TpR to the upper traps for a total of 6 minutes helped to improve cervical range of motion & pain by the 4th visit. TpR techniques alleviate pain through the pain gate theory, which involves the spinal nerves regulating which pain signals reach the brain for perception. Applying pressure to a knot, the larger nerve fibers are stimulated, thereby diminishing the pain originating from the knot itself. Additionally, this technique enhances blood & lymphatic flow to the affected muscle, reducing pain.

Decrease Pain & Increase Mobility With Muscle Energy Techniques (METs)

Muscle energy techniques aim to enhance range of motion by targeting muscle contraction and progressive lengthening. Unlike regular static stretching, where you hold a position, such as touching your toes while standing to stretch your hamstrings, muscle energy techniques require the active participation of both the physical therapist and the patient. These techniques operate on the principle of reciprocal inhibition, meaning that by activating the opposing muscle, you can improve muscle length. For instance, if you have limited hamstring flexibility, contracting your quadriceps will lead to an increased range of motion in knee extension.

Research indicates that combining muscle energy techniques with other treatments, such as maitland joint mobilizations, TENS, specific exercises, interferential therapy, and trunk stabilization, can yield significant improvements in both acute and chronic low back pain. In one study, the combination of muscle energy techniques and maitland mobilization resulted in reduced low back pain and increased hip mobility after six treatments.

When using muscle energy techniques for the sacroiliac joint, it is crucial to assess whether the joint is in a posterior or anterior pelvic tilt. One technique for correcting the sacroiliac joint involves placing a foam roller between your legs. Hold the foam roller behind your knees on the side with anterior pelvic tilt and on the front portion of your opposite leg that’s in posterior pelvic tilt. Push down into the foam roller with the anterior pelvic tilt leg while simultaneously pulling up with the opposite leg. Hold this for 5 seconds and repeat 5 times. This can help to immediately show improvement in any deviations in leg length which may help with feeling of uneasiness with walking.

Deep Vein Thrombosis (DVT) - A Quiet Killer

For individuals considering total knee arthroplasty (TKA) or total hip arthroplasty (THA), it's crucial to understand the potential risks associated such as deep vein thrombosis (DVT). But what exactly is DVT? As blood circulates by your arteries and veins throughout your body, limited leg movement after surgery can lead to the formation of blood clots. Symptoms of DVT may include a sensation of heaviness, pain, cramping, swelling, redness, and warmth in the affected leg. Ignoring preventive measures and remaining unaware of DVT can result in complications, as the blood clot from the deep veins in your legs can dislodge and travel to the lung's blood vessels, causing a pulmonary embolism.

Studies have shown that being sedentary for three days following TKA surgery increases D-dimer levels, a protein associated with blood clotting. On the other hand, early mobilization, such as walking, has been clinically proven to help prevent the occurrence of deep vein thrombosis. In a research study, blood samples were taken before and after TKA surgery, focusing on the D-dimer protein. It was found that individuals who started walking within one week after surgery had D-dimer levels that were 2.5 times lower than those who started walking in the second week. While results varied depending on factors like age, sex, and medical history, the overall evidence supports the inclusion of early mobilization for enhanced recovery.

Receiving guidance from a physical therapist can facilitate a smooth transition to early ambulation. They will assist you with biomechanics, strength training, range of motion exercises, and balance improvement. Ankle pumps are an additional exercise that can be beneficial. This exercise involves contracting your calf muscles to promote blood flow, especially when performed in an antigravity position. To do this, lie on your back and elevate your leg above heart level. Then, imagine that you are stepping on and off the gas pedal of a car.

Sleep For Your Spine

How many hours do you typically sleep at night? What is your sleep position? How many pillows do you use? These are just a few of the questions that a physical therapist might ask you because sleep plays a crucial role in addressing issues like lumbar, thoracic, or cervical spine pain, as well as shoulder pain. The duration of sleep can also impact your stress levels!

If you find yourself dealing with high-stress situations that affect your sleep, Anderson & Cattone PT can provide assistance with the Neubie Nufit, an electrical modality designed to train your nervous system from a parasympathetic to sympathetic. To determine if the "master reset" technique is suitable for you, your PT or PTA will conduct a test where clamps are placed around your wrist to assess your heart rate variability (HRV). This test yields objective data such as your deep sleep, which should be 21-30% of your entire sleep. A post HRV test will be performed to evaluate any improvements in your scores after a single session. Consistent use of the Neubie Nufit can lead to sustained results over time.

Now, if you are experiencing spine or shoulder pain, it could be related to your sleep habits. It is generally recommended that adults get at least 7 hours of sleep per night. During those 7 hours, your body is relatively inactive. Therefore, maintaining awkward positions for extended periods can lead to aches & pains. If you sleep on your side & experience shoulder pain, consider switching to a back-sleeping position with a pillow that doesn't excessively flex your neck (creating a chin-to-chest position). Sleeping on your back with just one pillow & placing multiple pillows under your knees helps align your cervical, thoracic, & lumbar spine in a neutral position. This neutral alignment prevents the surrounding muscles from becoming tight in the morning & can be beneficial for individuals with arthritic spines, as it minimizes painful positions for the cartilage between your vertebras.

Why Poor Posture Leads To Pain

Poor posture? How you stand plays a huge role in the function of your back because this determines the weight distribution placed on your muscles & joints. There are many forms of poor postures, like lumbar lordosis, sway back, flat back, round back, thoracic kyphosis etc. With all poor postures, it affects not only the back but also the shoulders, head, knees & ankles posture.

Poor posture is a leading source of Musculoskeletal pain

Thoracic kyphosis is the presentation of the forward head posture & rounded upper back. This can be caused by other pathologies like Scheuermann’s Disease, vertebral compression fractures, & ankylosing spondylitis. This relates to what is known as “upper crossed syndrome” with weak deep cervical neck flexors, lower traps, upper erector spinae, & rhomboids while also having tight pectorals + upper traps. The body then compensates for this with lumbar lordosis.

Lumbar lordosis is an excessive curve to your lower spine, similar to standing in a power pose with your chest up & butt back. The pelvis is in anterior pelvic tilt, causing adaptive shortening or weakening of the muscles that are supposed to support the pelvis in a neutral position. The anterior rotation pelvis is guided by increased tightness in your quadratus lumborum, erector spinae + hip flexors.

Swayback is common in women who have been pregnant. As the baby grows, the weight distribution becomes more anterior, so the hips begin the drive forward in relation to the shoulders & feet. The pelvis then tilts posterior, meaning the hamstrings + glutes are tight & the hip flexors + lower abdominals are elongated.

Because what happens at the thoracic affects the lumbar spine & vice versa, a 12-week research study has proven that implementing a strength program of the rhomboids, deep neck flexors, & the lumbopelvic muscles in combination with stretching the pecs, hamstrings/hip flexors within 3 sessions has decreased the angle of the forward head, sway back, kyphosis & lordosis to a more normal range.

Do you question your posture? “Sit-up-straight” may not be a the que cut out for you - In, fact, it could be the hidden factor to address for fixing your pain. Get a personalized postural assessment @ Anderson & Cattone P.T.

Hip Pain: Common Causes & Treatment

What Is My Hip Pain From?

It could be related to the bone, muscle, tendon, ligaments, joint structure, nerve, or bursa. The hip takes on a ton of load during our daily life, but these structures help absorb the shock & make functional activities, like walking, more comfortable for us. The hip is similar to the shoulder in that it's a "ball & socket" cushioned with a labrum that provides the joint with negative pressure to keep it from coming out of the socket with movement.

With the younger population, Legg-Calve-Perthes or Slipped Capital Femoral Epiphysis (SCFE) is more common. SCFE is impairment caused by the femoral head slipping backward on the femoral neck causing pain with activity & standing. This is typically seen in the growing years of 10-17-year-old boys. Surgery is required to help with the realignment of the ball & socket joint but physical therapy can help to safely regain the functional range of motion & strength back into the hip.

60.5% of hip pain can be correlated to femoroacetabular impingement (FAI), a pain caused by abnormal bony growth from either the head of the femur (Type: CAM) or the pelvis acetabulum (Type: Pincer). Symptoms are aggravated by hip flexion movements because of the loss of free space for smooth movement as the two bones glide along one another. Symptoms can include clicking & C-sign pain. C-sign pain is making a C with your hand & wrapping that around your outer hip.

FAI surgery is an option but can be treated conservatively with physical therapy as it has a success rate ranging from 39-82%. Based on research, a few of the components of the conservative treatment provided strengthening, activity modification, movement pattern training & trunk stabilization. With a trained physical therapist, we can offer joint mobilizations to help relieve the joint from pain & a safe progression for glute strengthening. Glute strengthening has been proven to play an essential role in hip stability & alignment, minimizing unwanted force through the hip joint.

Is It Really Sciatica?

Muscle weakness, numbness, tingly, achiness, burning sensation down the leg? Sounds like “SCIATICA”. But is it really?

There are many causes such as radiculopathy, peripheral neuropathy, central stenosis etc., that can present as “Sciatica”.

The sciatic nerve consists of multiple nerves from L4-S3 so it’s responsible for the action of knee flexion, ankle plantarflexion (tiptoe), and toe flexion. It also provides sensation to the lower leg & foot.

Radiculopathy is the compression of the nerve root which exits immediately from the vertebra. Since it occurs just as it exits the spinal cord, it affects the entire nerve pathway. An example would be the most common, disc herniations which are reportedly 90% of cases.

Peripheral neuropathy is the impairment of the sciatic nerve from a peripheral structure from the spinal cord such as the piriformis muscle. This is called Piriformis Syndrome! Tightness in the muscle is caused by prolonged sitting or improper stretching post-exercise. Stretching the piriformis is easy & it can be done while you're at work or watching TV at home. PIGEON POSE! Find a counter high enough & put your leg into a figure 4 position, & lean your trunk forward for a more intense stretch in the butt region.

An at-home treatment would be nerve flossing! It's easy to do & has been clinically found to show significant improvement in pain, mobility, & disability. Lay on your bed with no pillow under your head, & with your knee straight, raise your involved leg to a height that is near your PAIN-FREE end range. In that position, try to hold your leg & add in some ankle pumps back & forth 10x for 3 sets. Rest as needed!!

Come visit us for a full assessment of your spinal mobility & muscle integrity to get a full exercise program that will help your sciatica related symptoms whether it’s caused by radiculopathy or peripheral neuropathy!

Do You Have A Sponylosis or Sponylolisthesist?

Did you recently get an X-ray, MRI, or CT scan of your spine? Did it show that there were findings of SPONDYLOSIS or SPONDYLOLISTHESIS & still wonder what that means exactly?

Well, research shows that it affects about 3-10% of the general population from repeated overload, common in athletes or jobs that require a lot of lumbar extension & rotation.

If we look at the image with the “dog-shaped structure,” spondylosis is a fracture of the neck of the dog which is the pars interarticularis of the vertebra. If untreated, it can cause spondylolisthesis, where the vertebra slips forward.

Spondylosis can overtime affect your intervertebral discs, which are the cushions between each vertebra to help absorb shock. Like a jelly donut, the disc is filled with gel that if obstructed it begins to leak, leaving the disc unable to absorb the shock & compresses spinal nerves. Spondy can also cause osteophytes (bone outgrowths) & spinal ligaments laxity, affecting your spine's mobility to either hyper & or hypomobile.

Signs & symptoms:

• Increased muscle tone and Dull ache

• Sensory & sensory impairment

• Pain with spinal extension

With physical therapy, we can help to treat your signs & symptoms!

Maitland Mobilizations: to increase mobility in the spine & surrounding joints. This will also help to avoid your muscles compensating & becoming tight. Research supports that this had the most effect for improving pain & range of motion within 4 weeks. See a physical therapist as this requires a specific technique!

Soft tissue massage: improves muscle tone for appropriate functional mobility & activation. Specifically to the quadratus lumborum & erector spinaes muscles, this will help to prevent excess lumbar extension

Strengthening program: strengthening the gluteus medius! (read the previous post about glutes importance)

Cardiovascular Health and Blood Pressure

Looking to improve your cardiovascular health? Wondering if physical therapy is right for you with a pre-existing heart condition, or looking to enter a marathon, enjoy a long bike ride with your family, or swim some laps for the summer?

The heart is the major organ that pumps oxygenated blood throughout your body to supply the organs and help filter out waste. It acts on the sympathetic and parasympathetic nervous system which is the flight or fight, and rest + digest. These nervous systems get your heart rate up and then down with and after exercise.

Blood pressure tells us about the pressure within the arteries when the heart contracts and relaxes. The contraction phase known as “systolic pressure” is the top number, while the relaxation phase known as “diastolic pressure” is the bottom. Suppose you present in the above normal levels (table above); in that case, this alters the oxygen distribution to different organs, and can lead to an enlarged heart, coronary artery disease etc. due to narrowed arteries.

The heart can be exercised to help it’s ability to efficiently contract and pump blood through the narrowed arteries which then improves blood pressure. Research has shown that 16-week intensive cardiovascular training has helped lower both systolic and diastolic pressures by improving vascular stiffness and function.

Monitor your vitals at home:

Blood pressure: with a manual or automatic blood pressure cuff. Take it immediately before and after exercise. Immediately after exercise, the systolic number may increase by 10, but the diastolic should remain fairly constant.

Physical therapy can help set a specialized and safe plan of care in improving your cardiovascular health, while keeping other impairments in mind.

ACL Tears, Repairs And Treatment

ACL injury?

Looking to get ACL reconstruction? Or recently had an ACL repair?

ACL injuries are common in sports or heavy labor occupations due to the rapid cutting movements, landing improperly, & direct blows to the knees.

ACL = Anterior Cruciate Ligament. A band-like structure that attaches from the tibia to the femur which is responsible for knee stability, prevention of anterior translation & excess rotation of the tibia. With a torn ACL, it is common to experience swelling, loss of range of motion, & feeling of the knee “giving out” when walking/running. There are different grades to ACL injuries, with Grade 1 being mildly stretched ACL, Grade 2 being partial & Grade 3 being complete. Grade 1’s can be treated nonsurgically but grades 2 & 3 may require surgical treatment.

PT can help to improve knee pain with pre & post-operative treatment.

Pre-operative rehab will focus on strength training, balance, gait, & plyometrics. Pre-rehabilitation at an average of 3x/week for 14 weeks significantly improved physical function compared to no pre-rehab.

Post-operative treatment can take roughly 6-12 months & begins the day of or the following day after surgery with working on swelling, balance, lower extremity strength, proprioception, balance, endurance, power, & return to functional activities. Within the first 3 weeks, the tendon graft (hamstring/patellar tendon) used for ACL reconstruction will still be revascularizing so this phase is a slow progression to exercise.

Special tests from a physical therapist & an MRI can assess the integrity of your ACL. The special test used in the clinic is the “Anterior Drawer Test,” where PTs look at how far your tibia translates. Torn ACLs can also be accompanied by a tear of the medial meniscus & medial collateral ligament, the knees shock absorber & knee stabilizer, respectively.

For PREHAB & POST-OP ACL reconstruction, see a physical therapist who can help create a SAFE yet progressive plan of care to return to your hobbies!

Good Gluteus Medius Function Prevents Pain

A muscle that plays a huge role in the spine, hip, knee, ankle & foot pain. The gluteus medius attaches from your ilium to the greater trochanter & its main action is hip abduction + extension for hip stabilization. 

In physical therapy, we can independently assess your gluteus medius through muscle strength tests, adding resistance to your leg and watching how you walk to see if you have a “Trendelenburg Gait.” This means your gait may look like a catwalk with your hips swaying & dropping the opposite hip. Typically with gait, the goal is for your hips to remain level with each step so that you are not compensating such as leaning your body to maintain a center of gravity for balance. 

Much research has linked gluteus medius injuries or weakness, to the low back, hip, SIJ, knee, ankle, & foot pain, as it is a huge contributor to influencing load through all these joints with functional movements. This link is an example of “regional interdependence,” where improper biomechanics of one area can impact an area that may seem unrelated. 

Glute bridges: 

Electromyography research has shown that supine glute bridges highly isolate gluteus medius activation. Find a flat surface to lay on, bend your knees roughly 135 degrees. Having it at this degree rather than 90 will help bias glute activation rather than hamstrings. Use your glutes to lift your hips off the floor; it helps to imagine pushing off the floor with your heels! If that’s easy, then progress to single-leg glute bridges in the same setup but keep one knee straight & off the floor (match the thigh height of your elevated leg to your planted leg the entire time). 

Could Tight Hamstrings Be Causing Your Low Back Pain?

SITTING A LOT? LOW BACK PAIN? Let’s look at your hamstrings!

(Slide 1) Your hamstrings consist of 3 muscles that attach from your sit bone (ischial tuberosity) and insert into your tibia.

SO, tightness in this muscle can cause a disturbance in your lumbopelvic rhythm by rotating the pelvis into posterior pelvic tilt, resulting in a flat back lumbar spine → low back pain. [1]

Your muscles consist of sarcomeres, the contractile units, so as you contract your muscles, the actin and myosin filaments within the sarcomere overlap. In contrast, stretching a muscle will then elongate the sarcomere pulling the actin and myosin further from one another. As the sarcomeres lengthen, so do the muscle spindles, which send a signal to your brain to familiarize itself with the stretch signals. (2)

Research has proven that 10 minutes of stretching display improvements in hamstring muscle length with significance in pain reduction during work and rest compared to those who solely performed strengthening exercises. (1)

Here’s an exercise to try at home! Find a doorway and lie on the floor. Have one leg through the door to place your opposite leg on the wall. Keep that knee STRAIGHT but start slowly; it’s okay to begin your butt further away from the wall. Find a tolerable distance away from the wall but still feel that stretch. The great thing about this stretch is that you can do some work on your phone or watch TV while you stretch each leg. Don’t be afraid to break the stretch into shorter intervals, just aim for 10 minutes each leg per day!

Easy Carpal Tunnel Cures

Numbness or tingling in your hands? Difficulty grabbing items with your hands?

That numbness/tingling sensation or muscle weakness could be due to peripheral neuropathy. Peripheral neuropathy is the effect of irritation of a nerve that occurs in the peripheral nervous system. The most common upper extremity peripheral neuropathy is carpal tunnel syndrome, affecting 4-6% of the population. That’s because the carpal tunnel is a compact space that consists of a border of the carpal bones as the “floor” and a transverse carpal ligament as the “roof.” Between the small area of the floor and roof are 9 tendons and the median nerve. Carpal tunnel syndrome affects the median nerve, which is responsible for your thumb's motor function and the sensation to the thumb -> ring finger.

✅ The setup of your desk matters! We want an ergonomic posture with your elbows near your body with about a 90 degree bend. This posture helps to take pressure off your palm where the carpal tunnel and median nerve lie.

✅ Come and see a professional for joint mobilizations of the carpal bones and wrist; this will help increase the carpal tunnel's space to allow the median nerve to move more freely and avoid compression.

✅ Research has found that nerve glides effectively treat carpal tunnel syndrome by reducing pain and improving hand function. Nerve glides work by allowing the proximal to distal portion of the nerve to slide under structures such as muscles, tendons, ligaments so the nerve can fire appropriately. You can attempt a median nerve glide at home by pretending you are a server holding a tray with your upper arm parallel to the floor. Keep your wrist extended the whole time, and straighten your elbow! You may feel a slight pulling in the arm, which is totally normal! Repeat 10x.

The Importance Of Big Toe Extension

Your big toe extension plays a crucial role in both balance and forward motion. As we push off from ground contact, our big toe extends. The extension pulls the plantar fascia to effectively stabilizing the foot through the ‘windlast mechanism’ (process by which big toe extension supinates the foot). The benefits of a stable foot at push off are huge; this rigidity at push off gives you a stiff lever in which to generate large amounts of force (think of a stiff spring as opposed to a floppy spring!). If big toe extension is lost, not only do we lose stability at push-off, but something else up the chain can start to compensate leading to further dysfunction and eventually pain. A few common things happen …

Increased Knee Flexion

Very little in the body works in isolation. The right amount of big toe extension allows for your foot to supinate (heel turning in (the opposite to pronation), this allowing your knee to externally rotate so as to achieve full knee extension, creating power in your stride and lowering stress through the knee joint. Poor big toe extension = opposite, forcing your knee to stay flexed through toe-off, leading to poor pronation control that can eventually cause foot pain, knee pain and even hip pain.

Decreased Hip Extension

A lack of big toe extension causes the body to push off of the other toes; toes not built for the job. This excess stress can cause foot and ankle pain. Poor great toe extension also forces the heel to come off too soon: again with excessive knee flexion, preventing hip extension (bringing your leg behind your hips), as the angle of the toe simply does not allow the angle required at the hip. This lack of hip extension can then tighten your hip flexors and reduce gluteal activation; both of which can lead to dusfynbction elsewhere..

Increased Back extension

A lack of hip extension can then lead to an increased arch in your back as compensatory means to keep the appropriate stride length necessary for walking and running. Repetative arching and overuse (coupled with poor gluteal strength and/or hip flexor tightness), can then lead to serious low back problems and pain!

Great toe extension is critical for preventing foot pain, knee pain, hip and back pain. So can we improve toe extension? Absolutely. Talk with a qualified physical therapists to determine the appropriate plan of care. Skilled manual therapt and a personalized home exercise program may be all you need.

P.T. For Long Term Covid

Check out what Jason Waz at NeuPTTech (The leading authority on NeuFit Neubie technology within physical therapy) has to say about Physical therapy and long term Covid (below).

*** Anderson & Cattone Physical Therapy and NeuPTTech work together closely to provide the best possible care for our patients. Please don’t hesitate to contact us with questions about your needs.

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⚡️ PT FOR LONG COVID CAN HELP SOLVE THE NEXT PUBLIC HEALTH DISASTER

December 8, 2022 Jason Waz

Long COVID

Thanks to the advancements in physical therapy programs for Long COVID, physical therapists currently have the opportunity to positively affect a large number of struggling individuals in their community who have had COVID-19 and now are experiencing long-haul symptoms.

A December 2022 article from CNBC recently validated the work NeuPTtech and our partners at HerQuest have been developing in this regard. 

We recognized Long COVID as the “Next Public Health Crisis,” and now these fears are affirmed. Long COVID is also known as long-haul Covid, post-COVID, post-acute COVID syndrome or its scientific name “post-acute sequelae of Covid” or PASC. At this point, almost every American has experienced COVID-19, and up to 30% of those affected now suffer from a chronic illness as a result of that infection. 

The APTA lists the most common lasting Long COVID symptoms as follows:

• Fatigue or weakness

• Body aches

• Shortness of breath

• Trouble concentrating

• Headache

• Muscle or joint pain

• Poor endurance or no ability to exercise

• Sleep problems

• Gastrointestinal symptoms

• Anxiety or depression

• Fast or pounding heartbeat

• Brain fog or memory issues

The CNBC publication estimates that this long-haul COVID has left as many as 23 million Americans looking for answers, at a cost to the U.S economy of roughly $3.7 trillion!

According to the author Greg Iacurci:

“Studies suggest subsequent infections raise the chances of an ‘adverse’ outcome, including hospitalization and death. The virus has killed more than 1 million Americans to date, and some 2,000 more die each week, according to the Centers for Disease Control and Prevention.”

Nevertheless, despite its dire outcomes, not much is known about the illness. It can be very difficult to diagnose because its list of symptoms range in the hundreds, many of which lead to debilitating results for patients.

How Physical Therapists Can Serve Patients with Long COVID

As PTs, we’re familiar with patients who have severe pain or limitations to everyday functionality which has left them feeling hopeless. Our vocation is never as fulfilling as when we are able to help them regain strength, movement – and most of all, hope.

Patients suffering from post-acute COVID syndrome are often hopeless. And they are numerous. 

According to Dr. Peter Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital and a dean at Baylor College of Medicine:

“There are just large numbers of people affected by this. This could be game-changing in terms of how we do medical practice.”

Unfortunately, this lingering illness is having a devastating impact on families within communities all over the U.S. – the very same communities your practice is on a mission to serve. 

So, how do we deliver hope to people whose lives have been upturned by this disease? People of all ages and walks of life. People who were previously healthy. People who can no longer work or care for their families.

This is the opportunity for the physical therapist to treat Long COVID in a way others cannot.

Physical therapy is more than just helping alleviate pain and restore mobility. Thanks to incredible advancements in physical therapy technology, we can now target the patient’s nervous system and understand exactly where their dysfunction lies. 

The Physical Therapy Technology Treating Long COVID

And that is why we are developing programs to use Heart Rate Variability assessments for Long COVID patients to identify any imbalance within the patient’s nervous system. It is likely the first time the patient has a test report that can give some insight as to why they are feeling how they are feeling. From there, we utilize the NEUBIE device to reeducate their autonomic nervous system (ANS). By using the proprietary e-stim machine alongside pulsed electro-magnetic field therapy, PTs can help patients balance their “fight or flight” conditions and finally begin to heal. 

NeuPTtech has pioneered the treatment of Long COVID with physical therapy by mapping out plug-and-play protocols that are specific for HRV, NEUBIE and PEMF as they relate to the patient’s symptoms. 

The Physical Therapy Protocols for Long COVID Patients

According to the U.S. Department of Health and Human Services, too many healthcare providers are writing off Long COVID symptoms as “byproducts of anxiety and depression, or even worse, laziness and an excuse not to work.” 

“It’s sucking the hope out of patients,” says Jason Waz, founder of NeuPTtech. “The individuals I’m treating in my practice in Tampa all want to get back to work and back to their lives, but they just don’t have a plan or effective treatment to get there. NeuPTtech has developed these protocols for just that purpose.”

The CNBC story outlines the plight of Sam Norpel, a woman suffering from Long COVID symptoms but who continued to be dismissed by healthcare providers.

Iacurci explains:

“Neurologists would see Norpel twitch and instead focus just on her migraines, she recalled. One told her to stop reading literature on long Covid when she mentioned the disease during an appointment. She eventually had a consultation in August at the Mayo Clinic, where she was told: ‘We believe you — you have long Covid.’‘

The fact that she was finally being validated left Norpel in tears.