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Research

Physical Therapy in Olympia, Tumwater and Lacey, Where should I go?

There are many fine physical therapy clinics in the Olympia, Tumwater and Lacey area. How do you chose where to go?

You can choose based on location. A friend of mine told me today she chose to go to physical therapy at a clinic close to her house. What would prompt a close choice versus reputation? Maybe she needed to go 2 or 3 times per week. If someone needs to go to PT 2 or 3 times a week for a month or so, then going close to your house would be very convenient, HOWEVER, ask yourself the question: does your condition warrant 2 or 3 times per week?

Recently a former patient returned for a new session of physical therapy. She is a fairly frail 80 something year old, and was sent for BOTH headaches AND shoulder pain by her physician. Her prescription from the physician was directed to be 2 to 3 times per week for 4 to 6 weeks. She may have thought she needed to come that often, but…….when I evaluated her headache AND shoulder pain, I determined that both problems were mainly caused by the same anatomical structure.

I gave her an exercise program based on this one problem, and added customized and specific exercises for the shoulders and neck. As of Friday (January 30) 100% better in the headache and 75% better in the shoulders. She came for 6 visits at 1 x per week.

So the bottom line is, unless you actually NEED to have therapy 2 or 3 times per week consider going somewhere that uses less visits more effectively and you may save yourself some time and money.

The therapists at Comstock Physical Therapy, Joyce Mills, Lori Waterman and Linnea Comstock have extensively studied the body to make our exercise programs very effective and efficient. Give us a call if you would rather go to PT once per week instead of three times a week!

Do you want radiation treatment for plantarfasciitis versus other treatments?

A flyer came in the mail last week from Capitol Medical Center that included an article about radiation treatment for plantarfasciitis.

(Plantarfasciitis is a very painful condition in the bottom of the arch of the foot when the plantarfascia, pictured below, becomes inflamed , causing a lot of pain with walking and standing and significant pain on the bottom of the feet after sleeping or sitting followed by getting up)

plantarfascia

plantarfscia

You can see the link to an advertisement for this on Comstock Physical Therapy’s link page.http://comstockpt.com/links-resources-directory/

I was SHOCKED and SURPRISED that radiation treatment is used for a diagnosis/condition that can be treated safely and effectively with no side effects. Many other treatments are available which treat plantarfasciitis without side effects.  I  researched information  about the level of radiation used for treatment of plantarfasciitis, and found that typically .5 Gy to 1 Gy dosage of radiation is given one time to someone with the heel pain.  (at the bottom of this article, please see the links that you can use to look up this information,   1 Gy = 1 Sv in Xray measurements) .  I also found out that this is higher than the maximum level of radiation considered safe for diagnostic x-rays and CT Scans.

What treatments does science tell us work? The summary linked below mentions shock wave treatment and physical therapy treatments being very good at  treating this condition.

http://www.ncbi.nlm.nih.gov/pubmed/24728397

Here is another very complete rundown of the science about what works to treat plantarfasciitis:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951039

Many treatments that help relieve plantarfasciitis are mentioned including stretching, rolling your arch over a can and massaging the bottom of the foot.  Physical therapy specifically helps by using the therapist’s hand to move the stiff joints on each other as well as massage the plantarfascia, and giving strengthening exercises to the feet, legs and hips the take stress of the plantarfascia using the muscles to support the legs instead.

Self treatments to help relieve plantarfascia also include these:

calf stretch

Calf and arch stretch using a towel. Consider keeping the towel near the bedside and performing before going to sleep and before taking first steps in the morning. Pull back on foot for 30 seconds 3 times with 30 seconds of rest in between.

 

soup can foot

Roll plantar fascia with can or ball. Consider keeping at the bedside and performing before going to sleep and before taking first steps in the morning. Roll plantar fascia for 1 minute 3 times with 30 seconds of reset in between.

 

 

manual therapy plantarfascia

Manual plantar fascia stretch with cross-friction massage. Stretch and massage before taking first steps for 1 minute 3 times with 30 seconds of rest in between.

 

If you do consider radiation treatment for plantarfasciitis, please ask about side effects, for your own benefit.

 

This link documents the dosage used in one treatment protocol for plantarfasciitis:   http://www.ncbi.nlm.nih.gov/pubmed/23443608

This link documents the level of radiation considered safe:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996147/

 

What can Physical Therapy do for me that I can’t do on my own?

I saw the question in the header on the Magnoliatherapyla.com FAQ website and thought to myself , “that IS a good question.”

Being an independent, strong-minded boot strapper I know I would wonder, “why can’t I just do it myself.” “I can save myself some money.” AND in the short run that may be true, but in the long run, it could be penny wise and pound foolish.

What if I have back pain; can’t I just “strengthen my core” and get better? It is true that much of your back pain will just go away with time…and it will come back unless the deeper core muscles are strengthened, GUARANTEED! How do I know? Our reflexes are meant to protect us, and before we get hurt, our deeper core muscles (defined as transverse abdominis, pelvic floor, multifidus and diaphragm) work together to contract in the just the right way and time to keep us stable BUT…(and this is a big BUT) after a back injury the smaller muscles get screwed up and they begin to misfire, and the larger bigger stronger ones take over…and that….ladies and gentlemen, means that there will be a lot of compression on the back discs and joints and that will lead to arthritis.

It’s a lot like caring for a car or truck…keep up with the 3000 mile oil changes and that baby will hum for a long time but avoid them and they break down a lot sooner!

How do you know if your health care provider is doing right by you?

On Friday a patient 0f mine came back for a recheck.  I hadn’t seen her in about a month.  She had started treatment about 3 months ago and had received 6 treatments before her recheck.

At her recheck she was doing much better,  in fact she was now able to lift rain soaked flower pots and could sleep through the night.  When she first started treatment she was waking up many times per night due hip pain, and could not tolerate more than 20 minutes or so of light yardwork due to back pain.    After receiving exercises for hip weakness based on Chris Powers PhD PT’s research at USC and exercises for multifidus/transverse abdominis/pelvic floor  coordination and strength training (core) based upon Paul Hodges PhD PT’s research at the University of Queensland she followed through diligently and is much better.

As I was finishing up treatment with her I remembered back to her first day of treatment when she brought in a thick  3 ring binder notebook.  This notebook was  FULL  of exercise sheets she had received from various gyms and physical clinics in another state, and she wanted to show them to me so I could get up to speed.  Very few of the exercises were based on Hodges’ or Powers’ research, and I thought to myself, “how can that be?”  How were these exercises missed?  and more importantly, what could she have done to get a jump start on knowing what questions to ask about her specific condition and what treatment was best?

One suggestion for future patients as to advance your knowledge about what kinds of treatment are best for your condition is to  log onto pubmed, http://www.ncbi.nlm.nih.gov/pubmed/ , a centralized database of up to date research and type in your condition are look through the research abstracts which can help you know what the latest findings and treatments are that are relevant for your condition.

For example:  type in “low back pain treatment guidelines” and here is the link’s first page  http://www.ncbi.nlm.nih.gov/pubmed/?term=low+back+pain+treatment+guidelines

Of if you want to know if a specific kind of treatment is helpful for your condition, such as “physical therapy” for hip arthritis, here is that link:  http://www.ncbi.nlm.nih.gov/pubmed/?term=physical+therapy+for+hip+arthritis

Happy Researching!

 

Why are some people knocked knee-ed on one side?

Here is an interesting case of a patient who injured her right knee with a cartilage tear about 15 months ago.

Her hip responded to the right knee injury by twisting in at the thigh and out at the shin.  The angle between the upper leg and lower leg is about 25 degrees, and on the left, her normal leg is about 10 degrees.  

After one treatment, and some home exercises her knee looked like this:

If you are interested in knee rehabilitation, here is a link

http://www.patellofemoral.org/pfoe/PDFs/Case_study_Mascal_Landers_Powers.pdf

Also a link to last week's blog post:

Surprising exercise for kneecap pain: hip rotation!