Physical therapy ranks among the top treatment choices of their readers with back pain, according to a new Consumer Reports survey of more than 14,000 Americans who experience the condition. The report also recommends manual therapy (spinal manipulation) and exercise for low back pain. Physical therapists perform both of these types of treatments regularly. In fact, many of the studies supporting spinal manipulation and exercise for low back pain have been published by physical therapists.

More and more studies are showing that physical therapy is a great first choice treatment for low back pain.  Here are just a few:

1. Physical Therapy for Degenerative Disc Disease (common cause of low back pain)
2. Physical Therapy Exercises For Low Back Pain
3. Predicting patients that will benefit from spinal manipulation by a physical therapist

If you are interested in highly effective low back pain treatment contact Belmar Physical Therapy at (303) 274-2404.

A Few Facts About Falls

1. One-third of people over the age of 65 suffer from a fall each year.
2. Falls are the number one cause of hospital trauma admissions, injuries and accident-related deaths in this people over 65.
3. In 2002, fall-related injuries were the cause of death for approximately 13,000 Americans.
4. The National Safety Council expects the number of people over age 65 to double by the year 2030, which will potentially double the number of falls in this age group.

Why Do People Over 65 Fall More?

The ability to avoid falling is dependent on a persons ability to maintain balance in a variety of situations.  Maintaining balance is a complex process that relies on multiple sensory systems working together.  These sensory systems include receptors in the foot and ankle as well as the eyes and the inner ear.  The brain receives signals from these sensory systems and in turn sends signals to the muscles of the trunk and lower extremities to react and maintain balance.  As we age the sensory systems may become slower and the muscles may become weak and unable to adjust quick enough or powerful enough to avoid falling.

Preventing Falls: The Good News!

Falls in this population can be avoided with proper education and training.  Stopfalls.org is a great resource for education on this topic.  You can download a flyer from their site called Fall Prevention Tips here.  Education is a vital component to fall prevention.  However, at least one study has found that balance training exercises provided by a licensed physical therapist can be even more effective than education alone.  These exercises focus on improving positional sense as well as strengthening of the lower extremities and the core muscles of the trunk so that they can react more effectively to correct a loss of balance.

If you live in the Lakewood, CO or the Denver Metro area and you or a loved one would like to stay out of the hospital by avoiding a fall please contact Belmar Physical Therapy at (303) 274-2404.

What is Thoracic Manipulation?

The thoracic spine is the part of the spine where your ribs attach.  This area is below the neck and above the low back.  A physical therapist performs thoracic manipulation by applying a quick push to this area.  This quick impulse may or may not cause a harmless pop to occur.

What Are The Benefits of Thoracic Manipulation for Neck Pain?

More and more studies are showing the benefits of manipulating this area for neck pain.  A recent study in the Journal of Orthopedics and Sports Physical Therapy found that patients with acute neck pain who received this thoracic spine manipulation had superior clinical benefits that persisted beyond the 1-month follow-up period.  You can view a synopsis of the article here.

Here is a video demonstration of thoracic manipulation:

The Following Links Provide Further Support For The Use of Thoracic Manipulation by Physical Therapist For Neck Pain:

1. Thoracic Manipulation For Radiculopathy
2. Short term effects of thoracic manipulation for neck pain
3. Immediate effects of thoracic manipulation for neck pain
4. Improvements in neck range of motion after thoracic manipulation
5. A way to determine which patients will benefit from thoracic manipulation

We have found the use of thoracic spine manipulaiton combined with patient education, specific exercises and other manual therapy techniques to be very effective in alleviating neck pain.  If you live in the Lakewood, CO area and would like relief from this very debilitating condition contact Belmar Physical Therapy at (303) 274-2404.

What is Adhesive capsulitis?

Adhesive capsulitis, also known as frozen Shoulder, is a disorder of the shoulder in which the capsule surrounding the joint becomes inflamed and stiff.  As the condition worsens range of motion of the shoulder is severely reduced.  The exact cause of frozen shoulder is unknown.  However, there are a number of risk factors for this problem including diabetes, stroke, trauma, lung disease, connective tissue disorders and heart disease.  Frozen shoulder usually occurs in 3 phases:

People with Frozen Shouler typically lift the entire shoulder girdle when attempting to lift the shoulder.

1. The Freezing Phase: This is the most painful stage.  Pain occurs with any movement and there is a gradual reduction in range of motion.
2. The Frozen Stage: During this stage the pain in the shoulder gradually decreases.  However, the shoulder is extremely stiff during this stage.
3. The Thawing Stage: During this stage range of motion of the shoulder gradually returns to normal.

Each stage can last months and full resolution can take over a year.

What is The Best Treatment For Adhesive Capsulitis?

Physical therapy can be very effective in decreasing the duration of frozen shoulder as well as improving function during this period.  However, it is important that the physical therapist use effective treatment techniques.  A recent study in the Physical Therapy Journal examined the records of 2,370 patients (That’s alot of patients!) with adhesive capsulitis to see which treatments were effective in decreasing pain and improving function and which treatments were not effective.

The treatments that increased the likelihood of pain reduction and improved function were:

1. Joint mobilization performed by a licensed physical therapist.
2. Exercise

The treatments that decreased the likelihood of pain reduction and improved function were:

1. Ultrasound
2. Massage
3. Iontophoresis (Delivery of steroid with electrical stimulation)
4. Phonophoresis (Delivery of steroid with ultrasound)

You can view a synopsis of the article here.

If you think you may have adhesive capsulitis (frozen shoulder) we would be glad to help you. Please contact Belmar Physical Therapy at (303) 274-2404.

What is Plantar Fasciitis?

The Plantar Fascia is a thick band of connective tissue that supports the arch of the foot.  This band of connective tissue runs along the bottom of the foot from the heel to the toes.  The plantar fascia is an important energy storing structure acting like a spring to assist pushing off of the foot during walking and running.  Plantar fasciitis occurs when this band of tissue is overloaded and becomes inflamed or irritated.

What Are The Symptoms of Plantar Fasciitis?

1. Pain on the bottom of the foot towards the heal.
2. The pain is usually worse with the first few steps in the morning or after sitting for a long time.
3. Increased pain after weight bearing exercise.

What Are The Possible Causes Plantar Fasciitis?

The possible causes are:

1. Abnormal foot mechanics such as excessive pronation (flattening)
2. Abnormal hip and knee mechanics placing increased stress on the foot.
3. Tight calf muscles placing increased stress on the foot.
4. Wearing shoes that lack arch support.
5. A sudden increase in weight bearing activities such as running.
6. Weight gain placing more pressure on the feet.
7. Pregnancy due to added weight and softening of the plantar fascia due to hormonal changes.

How is Plantar Fasciitis Treated?

We have found the EdUReP (Education, Unload, Reload, Prevention) model to be very effective for treating Plantar Fasciitis.

1. Education: The patient is educated regarding predisposing factors and mechanical faults that may be contributing to overload of the plantar fascia.
2. Unload: A period of rest is recommended and the plantar fascia is unloaded by improving hip and knee mechanics as well as stretching the calf muscles.  Calf stretches must be altered to isolate the stretch to the calf without stretching the plantar fascia (see our self management hand out).  We do not recommend stretching the plantar fascia because we feel that excessive elongation of this tissue is the cause of the pain in the first place.  Orthotics may also be necessary to help unload the plantar fascia.  The pain can often be managed with ice and self massage.
3. Reload: Once the pain is diminished wight bearing exercise is slowly reinstituted into the patients program.
4. Prevention: The patient is further educated regarding ways to prevent recurrence.  This includes instituting recovery weeks into their training program and exercises to maintain proper mechanics of the lower extremity.

We’ve made a self-management handout for treating plantar fasciitis. Click on the link to download.

If Pain Persists and You’re In the Denver Metro Area

Schedule an appointment with our staff of licensed Physical Therapists. We’ll do a thorough exam and evaluation and suggest a course of treatment. If you’re not local to Belmar Physical Therapy then please contact a local, licensed therapist in your area.

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.

Belmar Physical Therapy is now a member of the Pacificare and Secure Horizons physical therapy network through our affilitation with OptumHealth.

If you are a Pacificare or Secure Horizons member in the Denver or Lakewood, CO area and you are interested in the best possible results from physical therapy contact us at (303) 274-2404.

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.”