What is Dry Needling?

Levator scapulae trigger point pain pattern

Dry Needling is a procedure in which a needle, often an acupuncture needle, is inserted into the skin and muscle directly at a myofascial trigger point. A myofascial trigger point consists of multiple contraction knots, which are related to the production and maintenance of the pain cycle.

How Does Dry Needling Improve Function?

If you desire a long and successful career in baseball, at any level, read further to see how Belmar Physical Therapy can help you achieve your goals.

In the last two decades, top level managers have focused less on speed and more on injury prevention for success in the sport of baseball.

My Shoulder Already Hurts, What Do I Do?

Even if you’re currently experiencing shoulder pain, it’s not too late!

Many injuries can be successfully treated with a well-structured and carefully implemented non-operative rehabilitation program by a Physical Therapist.

The overhead throwing motion is an extremely skillful and intricate movement that is very stressful on the shoulder joint complex.

The overhead athlete places extraordinary demands on this complex. The thrower’s shoulder must be loose enough to allow extreme motion, but be stable at the same time. This requires a delicate balance. Experts refer to this balance as the “thrower’s paradox.”

Scientific studies show that changes occur in the shoulder from the repetitive microtrauma that occurs during overhead throwing.

The Types of Injuries That Occur Are:

1. Anterior Instability
2. Impingement
3. Biceps Tensonitis
4. Rotator Cuff Tendonitis

The physical therapists at Belmar Physical Therapy continuously review the scientific literature in order to provide the most successful treatment possible. Physical therapy treatment focuses on the restoration of normal movement of the shoulder complex during the rehabilitation program.

The Treatment Consists of:

1. Controlling inflammation.
2. Restoring muscle balance.
3. Improving soft tissue flexibility.
4. Improving strength of the throwing muscles.
5. Enhancing control of the shoulder complex.

Call Belmar Physical Therapy today at (303) 274-2404 to start improving your performance through injury prevention or treatment.

What Are Shin Splints?

Shin splints, or medial tibial stress syndrome, is an overuse injury that causes lower leg pain. This problem is the cause in 18% of running injuries and is 2-3 more prevalent in women than men. Shin splints are primarily caused by a mismatch between overload and recovery during weight bearing exercise. High-stress impact loading during running or walking places an increased stress on the lower leg bone (tibia). When this stress increases gradually the bone strengthens in order to handle the load. Shin splints occur when the body’s ability to strengthen the bone is not able to keep up with the stress being placed on the bone. This imbalance of bone strengthening and stress causes small cracks in the bone and inflammation of the surrounding tissue.  The pain from shin splints can be classified into 4 stages in order of severity:

1. Light pain or stiffness after working out.
2. Pain at the beginning of a work-out which dissapears during the warm-up.
3. Pain during the work-out, but also after the workout and during the night. The pain subsides after long rest and inactivity.
4. Constant pain. The pain does not dissapear after rest.

What Mechanical Factors Contribute to Shin Splints?

1. Excessive flattening (pronation) of the feet when walking or running.
2. Tight calf muscles.
3. Weak ankle stabilizer muscles (soleus, flexor digitorum longus, posterior tibialis).
4. Walking or running on hard surfaces.
5. Walking or running in old shoes.

What is the Preferred Treatment for Shin Splints?

1. Ice


Superfeet are an inexpensive orthotics option.

2. Rest (The amount of rest depends on the stage above).
3. Anti-inflamatory medication (prescribed by a medical doctor).
4. Orthotics to support the arch of your foot and decrease the flattening of your feet.
5. Make sure you shoes are not too old (running shoes should be replaced every 300-600 miles).
6. Run or walk on softer surfaces such as dirt.
7. Increase the endurance of your ankle muscles with these exercises.
8. Stretch your calf muscles.
9. Cross-train to give your body a break from high-stress impact loading (cycling and swimming are great choices for maintaining aerobic fitness while resting the injury).
10. When you are ready to resume training, gradually increase your duration and intensity so that the bones can keep up.
11. Prevent recurrence by instituting rest weeks into your training (We recommend an active rest week of 1/2 your usual training duration and intensity every 4th week).

If you live in the Denver or Lakewood, CO area and would like help treating or preventing shin splints give us a call at (303) 274-2404.  If you do not live in our area and have more questions about this or any other orthopedic problem please contact us and we would be glad to help.

For years, the first line of treatment for painful tendons has been anti-inflamatory treatments such as medication and ice.  However, recent studies have concluded that inflamation is not a factor in persistent tendon pain explaining the lack of results with this treatment approach.  These studies have concluded that excessive loading causes weakening of the tendons structure leading to pain. These recent advances in the understanding of tendon problems have lead to the development of the EdUReP (Education, Unloading, Reloading, Prevention) model for treatment.

Treating Tendonitis with EdUReP

Following is a summary of the EdUReP approach.

• Education: The patient is educated in the basic physiology of tendinopathy as well as how their posture and activities may be contributing to overuse of the tendon. The patient and the physical therapist work together to find ways for the patient to perform activities while minimizing stress to the tendon.
• 

  Kinesio tape can help "unload" the painful tendon.

  Unloading: During this phase of treatment the therapist uses patient specific strategies to minimize load to the tendon.  These strategies may include external supports (braces, orthotics or taping), strengthening of other structures that may be underused or stretching of tight structures that are placing more strain on the tendon.

• Reloading:  Once adequate pain control has been achieved through unloading the tendon needs to be strengthened in order for the patient to return to regular activity.  One such strategy is the use of eccentric strengthening exercises discussed in our Get Eccentric” post.  During this stage exercises of progressive difficulty are administered until the patient is able to tolerate the loads required for their particular activity.

• Prevention:  This phase occurs once the patient is able to return to their activities pain free.  Prevention may include re-emphasis of prior education as well as adaptation to technique and form.  The ultimate goal is the patients independence in self-management.
  

  Once adequate pain control has been achieved the patient is given progressive exercises to "reload" and strengthen the tendon.

What is Iliotibial band Syndrome?

The iIliotibial (IT) band is a thick connective tissue that runs from the outside of your hip to the outside of your Knee. The outside of your thigh bone at the knee has a slight bump (Gerdy’s Tuberce). Iliotibial band syndrome is caused by excessive friction of the iliotibial band over as it slides over this bump during repetitive bending and straightening of the knee resulting in friction and irritation.  This problem is often associated with running, cycling or walking long distances.

What Mechanical Factors Contribute to IT band syndrome?

• Excessive flattening of the feet when walking or running.
• Weak hip muscles causing excessive rotation of the hip.
• “Bow legged” knees.
• Tight calf muscles.
• Tight iliotibial band.
• Riding a bicycle with a seat that is too high.

I was recently reminded of what I do as a physical therapist during an encounter with a friend last week.  My friend is an avid runner and as he has gotten older he has found that he has various aches and pains when running.  Last week he came to me complaining of calf pain and asking if I had any stretches for him.  Luckily I had a little time and I  performed an evaluation.

A rear view of the Tibialis Posterior muscle.

I asked Tom several questions about his pain, analyzed his gait, looked at his feet while standing, performed range of motion tests of his ankle and knee, performed strength tests of his lower leg muscles.  After this evaluation I found that Tom actually had a strain of his Tibialis Posterior muscle.  I explained to Tom that this muscle is underneath the calf muscle and runs to the bottom of the foot to support the arch.  Tom’s arch was collapsing when he put weight on his foot and the Tibialis Posterior muscle was having a hard time controlling this resulting of a strain of the muscle.

I recommended that Tom start using an over the counter orthotic with a firm arch support as well as icing the affected muscle.  Tom called me this morning to tell me that he was no longer having the pain.  Tom then asked me how I knew what the problem was.  

I said to Tom:

“That’s what I do.  I am a Physical therapist.”

The Wrong Way to Stretch Your Hamstrings

I was in the stretching area of the gym the other day and I saw a lot of people stretching their hamstrings. Some properly and many improperly. The number of people stretching their hamstrings improperly prompted me to write this blog.

The Biggest Mistake in Hamstring Stretching

As the first two pictures show, the biggest mistake people make when stretching their hamstrings is rounding out the back.  This results in stretching the back much more than the hamstring muslces.  I have actually had patients who have injured their back stretching this way.

Hamstring Stretches: The Right Way

Here are some examples of the proper way to stretch the hamstrings in multiple scenarios. Notice how the patient in the pictures keeps the back straight at all times. This results in isolating the hamstring muscles and protecting the low back.

Hamstring Stretch 1

Sit on the edge of a chair with one leg extended out straight. Keep your back straight by keeping your chest up. Lean forward at the hip until you feel a stretch in the back of the thigh.

Hamstring Stretch 2

Place your foot on a chair. Keep your back straight by keeping your chest up. Lean forward at the hip until you feel a stretch in the back of the thigh.

Hamstring Stretch 3

Support the thigh with both hands then straighten the knee until you feel a stretch in the back of the thigh.

Here is a handout with the above sample hamstring stretches.

If you need further assistance with hamstring stretches or performing any other exercises please contact Belmar Physical Therapy in Lakewood, CO.

What athlete wouldn’t like to reduce their injuries and extend their career? Does the name Dara Torres ring any bells?

It may be as simple as PEPping up your workouts if recent evidence is any indicator. Recent research indicates that specific exercise training can help reduce the risk of injuries in female athletes, specifically tears of the anterior cruciate ligament (ACL), which is a common knee injury in athletes that participate in sports such as soccer or basketball.  The ACL is crucial for stability of the knee joint during activities such as jumping and quick changes in direction.  Injuries to the ACL often require surgery and extensive physical therapy, so they are usually season-ending.  Studies show that females may be four times as likely to suffer an ACL injury compared to males competing in the same sports.  This is due in part to a difference in the way that men and women contract the muscles around the knee, along with structural variations in the knee between the two genders. 

Specialized exercise programs such as the  Prevent Injury, Enhance Performance (PEP) program , typically conducted by a physical therapist, involve a combination of stretching, strengthening, agility, and jumping.  This program emphasizes learning and using proper mechanics of the body to avoid compensation movements that could later cause injury.  Through practice, good movement patterns are reinforced so the brain later recognizes them as normal, automatic movements.  A study recently published in the American Journal of Sports Medicine showed that a group of  female athletes performing the PEP program demonstrated a 41 percent lower rate of ACL injury compared to those doing a regular warm-up.

Medical News Today has published an overview of the study along with an endorsement by the the American Physical Therapy Association which concurs with the study’s findings that a specialized program such as PEP could lower the overall ACL injury rate among female athletes.

If you are interested in participating in sports at the highest level possible, contact Belmar Physical Therapy to find out how we can help you add PEP to your training program to boost performance and prevent season ending injuries.