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

Surgery

Physical Therapy…May I have a private room please!

When you go to a physical therapist have you been offered a private room or are you treated in an open gym, no curtains to provide privacy, with many other people in the gym?

As a patient YOU can choose what you want. When you go to your first PT appointment, make sure to let the scheduler know that you would like a private room, if you wish.

Many clinics have one or two private rooms and a large gym. It is less expensive to have an large open gym with a few private rooms than to have many private rooms and a smaller gym. Why? It is much more expensive to frame in, sheet rock, putty and paint walls then leave spaces open. Unfortunately you, if you are the patient, may be more likely to gently be guided to an open gym space due to the lest costly nature of this arrangement.

Recently my husband went with his buddies to go get coffee. He came home telling me they watched a lady receiving physical therapy in an open gym with lots of windows. They watched her on her hands and knees stretching her buttocks towards the window. Unfortunately they got quite a show.

What are the positives to private rooms?
1) you can have a candid conversation with your therapist about YOUR needs and wants.
2) You can move in physically awkward positions in privacy with your therapist. This is an advantage to you as you have more privacy; also your therapist may be more comfortable asking you to get into awkward positions (which may be helpful for your therapist to understand your problem) to assess your problem knowing she/he is not putting you in potentially embarrassing positions.

At Comstock Physical Therapy we have 3 private rooms and 2 other rooms in our gym which have full curtain coverage. Here is a video of our clinic on the inside. Take a look, you’ll see our private rooms.

Inside of Comstock Physical Therapy

Please feel free to request a private room as we are ready and able to accommodate your request and keep your needs in mind.

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

Do I REALLY need to go to physical therapy 2 or 3 times a week for 4-6 weeks?

Patients never really say it, but I can tell they don’t really want to commit to 2-3 times a week of physical therapy treatment.  I’m not sure I would want to commit to that much time, given my busy schedule.  So…..I often schedule patients 1-2 times  a week unless they hurt really badly or they have an injury, surgery or goal that demands they come in 3 times a week.

If you’ve had a fresh injury like an ankle sprain, knee sprain, etc, PT right away is important to keep you as mobile and strong as you can be without making your injury worse.  This idea applies to some surgeries (see the surgeries mentioned in this post http://comstockpt.com/2014/02/01/physical-therapy-hurt/).   You may wonder, what happens if I don’t go to PT early on?

Let me tell you, it is BAD news!  When you are in a lot of pain from an injury some  muscles shorten up and spasm to protect you and other ones get shut down.  As a matter of fact recent science has shown that the big  muscle on the front of your  thigh (the quadriceps) begins to get shut down by your central nervous system 12 hours after pain begins.

When your pain level is lower, and your condition not as fresh you can cut down to 1 to 2 times a week. Chances are you will do well at 1 x per week if you are consistent in doing the exercise program the therapist has given you for homework.

Talk to your PT, she or he will work it out with you.

Physical therapy- will it hurt?

People often wonder, if I go to physical therapy will it hurt?  Sometimes I’ve heard people say “PT” stands for “pain and torture.”

So, does physical therapy hurt?  This is the good news:  most of the time the answer is NO!

When will physical therapy hurt?   Once in a while the answer is yes, BUT that is because of the surgery you have had and the steps that you need to go through to get past the normal side effects of having a surgery.  What surgeries will be more painful to rehabilitate from?  In my experience as a physical therapist, new knee replacements seem to be the most painful.  Second to that is shoulder surgery.   The worse pain is usually there for a while only then gets better as you recover and move more, usually within a few weeks to a month.

When should physical therapy be comfortable?  Most of the time physical therapy should be comfortable and make you feel better as each treatment progresses.  The old adage of “no pain no gain” does NOT apply.  When you have an injury, working weak muscles until they are tired will be a good limit of exercise;  if you push past the muscle you are working feeling tired (heavy and achey)  you might cause more pain because your body is working in its weak zone and that is when more pain happens.

Will there be soreness after my physical therapy session?  It is pretty common for patients to feel sore after their PT appointment, especially your first visit because we have to have you move a lot to fully evaluate your problem.  Sometimes after introducing a new exercise, or increasing resistance you will be sore too.  You should not be in pain, however and if your soreness is there for more than 1-2 days, speak up on your next PT session because that is too long.

Most of the time physical therapy should be comfortable and leave you feeling good!