165 Lilly Rd NE, Suite B, Olympia • 360.455-8014

Sports Therapy

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/

 

Why are you giving me Shoulder Blade exercises if I have Shoulder pain–Part 3 Olympia WA

The video demonstrated below, by an orthopedic surgeon, shows the mechanics of why shoulder impingement happens with the tendons.

See the small space between the ball acromium? That is where the impingement happens. Making sure the supraspinatus tendon, which pushes the ball down as the arm bone is lifted by the deltoid, is working well is a big part of the picture of shoulder healthy function. BUT….if you raise the shoulder blade UP by STRENGTHENING the muscles which lift it up, (such as serratus anterior) and STRETCH muscles which PULL it down (such as latissimus dorsi) you can gain more space, which puts less pressure and pinch on the supraspinatus tendon.

serratus muscle upwardly rotates the shoulder blade

serratus muscle upwardly rotates the shoulder blade

latissimus dorsi pulls shoulder blade down

latissimus dorsi pulls shoulder blade down

http://comstockpt.com/2011/11/22/neck-pain-stretches-out-olympia-wa/ This link will show you some latissimus stretches, and if you refer to Part 1 in this series of blog posts, with the man leaning against the wall you can see how to strengthen the serratus anterior

Why are you giving me Shoulder Blade exercises if I have Shoulder pain–Part 2

More about how the shoulder blade works with the shoulder and how bad shoulder girdle strength can cause shoulder impingement. The image and movie clip below show shoulder blade elevation, with the actress in the video showing LESS elevation and upward rotation on the left than the right.

scapular elevation and upward rotation

scapular elevation and upward rotation

Like this:

The space between the ball (humeral head) and the shelf above (acromium) which sits on the shoulder blade is where impingement of one or two of the rotator cuff tendons happens (supraspinatus or infrapinatus).
Here is an image of a normal shoulder and one with impingement:

normal shoulder anatomy

normal shoulder anatomy

shoulder pain impingement

shoulder pain caused by impingement

If the shoulder blade is hanging low (like the one on the left in the video) the space for the tendon is a lot smaller. So doing shoulder blade strengthening exercises to elevate the shoulder blades will help with shoulder blade pain itself.

Why are you giving me Shoulder Blade exercises if I have Shoulder pain?

Have you been to PT for shoulder pain? Have you been given shoulder blade strengthening exercises plus actual shoulder exercises?
Here is a picture of an actual shoulder (ball and socket) exercise:

infraspinatus strengthening

shoulder pain exercise

Here a picture of a shoulder blade (scapula) exercise:

serratus anterior

one arm wall push up

If I were a patient, I'd be thinking, "those therapists sure are giving me a lot of exercises." The truth is, the shoulder blade has to elevate and rotate up for your arm to reach all the way up overhead.

scapular elevation and upward rotation

scapular elevation and upward rotation

In fact, if the shoulder blade does NOT raise up, the rotator cuff muscles will get pinched when the arm raises up.
impingement

shoulder impingement

So, in fact to really get better from shoulder pain a person needs BOTH shoulder and shoulder blade exercises.