Dizziness & Vertigo ~ PT Can Help!

Hampton Physical Therapy treats Vertigo and Dizziness

By Lisa Wheldon, DPT, Hampton Physical Therapy – Seabrook NH Clinic

Have you ever rolled over in bed and suddenly the room starts spinning? Maybe you went to get your hair done at the salon and you tipped your head back in the sink and you became nauseated. Or every time you go to get up from laying down you feel like you might fall over. All of these events could be the result of a condition typically referred to as vertigo. Vertigo is defined as a sensation of whirling or movement that results in an error message in the central process of position, space, and time. So your brain can’t sense where you are in space causing you to feel dizzy. 20-30% of adults experience dizziness in their lifetime.1

Day after day I hear my patients mention that they can’t do a certain activity because they get light headed or nauseous. This doesn’t have to be the case. Physical therapy can evaluate and likely treat this condition when appropriate. 90% of the time this condition is caused by BPPV (Benign paroxysmal positional vertigo).2 BPPV is a condition that is most commonly seen with people over the age of 50.2 “Most often, BPPV occurs spontaneously, but it also may follow head trauma, neuritis affecting the superior vestibular nerve, or ischemia in the distribution of the anterior vestibular artery.”3 What happens occurs in the inner ear and it affects the vestibular system. This system is in charge of coordinating movement with where the body is in space. Inside the inner ear are crystals (otoconia) located in the canals (semicircular canals) and may become dislodged and throw off a person’s proprioception (sense of where they are in space). If this occurs the individual can have the feeling of the room spinning around them causing nausea, light headedness, and even potentially fall over!

Research has shown that vertigo treatment can be
87% effective in just three physical therapy treatments

At Hampton Physical Therapy, a full assessment can be performed to screen out what could possibly be causing your dizziness then direct you to the appropriate treatment. If we don’t feel you are appropriate for therapy we will direct you to correct line of treatment possibly involving neurology, cardiology, or your PCP. vertigo-manouverIf we do find that you test positive for BPVV through our testing maneuvers we can treat you that day. Treatment will involve different maneuvers to help re-position the crystals through the canals and go back into their proper place. After your treatment you will be instructed on proper at home care. A majority of the time your symptoms could be resolved in this first treatment. Could you imagine you’ve been suffering with this awful dizziness for years and in just one treatment your symptoms could be resolved or greatly reduced? Research has shown that treatment can be 87% effective in just three treatments.3

balanceAdditional treatments would typically include performing the maneuvers again if you are still suffering from unsteadiness. Also, different exercises can be done to improve balance and visual acuity. VOR (vestibular ocular reflex) exercises, balance training, and soft tissue or spinal manipulation treatment for muscular issues. VOR exercises include gaze stabilization exercises, balance retraining, and vestibular habituation. Gaze stabilization is done to help someone’s ability to stabilize, track, and pursue an object with their vision. This helps someone that may be motion sensitive. Balance retraining involves challenging how someone reacts to sitting or standing on different stable or unstable surfaces. Habituation involves upsetting the persons’ vestibular system and actually making them feel dizzy A comprehensive home exercise program is created for the individual to challenge their vestibular systems.

These exercises can also be useful in treatment with patients with post-concussion symptoms. After a head injury where someone loses consciousness this patient has a concussion. So there has been trauma and damage to the brain. Patients can suffer from an under active vestibular system Following this injury people can suffer from memory fog, vision issues, fatigue and just not feeling like themselves. It is recommended that for proper healing of the brain tissue they should abstain from their sport or typical activity level for 30 days.3 If symptoms persist for longer than 90 days the person falls under the post-concussion category.3 These patients can benefit from physical therapy.

If you are suffering from dizziness Hampton Physical Therapy is here to help. Call for an evaluation. When you call we recommend stopping any anti-dizziness medication for 24 hours prior to treatment in order to be properly screened.  We can get you scheduled ASAP, you should bring a driver for your safety.

Don’t suffer any longer when you can be seen in a matter of days and start living your life again!

REFERENCES
1. Neuhuaser HK. The epidemiology of dizziness and vertigo. Handbook Clinical Neurology. 2016;137:67-82. doi: 10.1016/B978-0-444-63437-5.00005-4.
2. American Musculoskeletal Institute. Vestibular rehabilitation specialist handbook. 2017.
3. Herdman SJ. Benign Paroxysmal Positional Vertigo.
https://www.ptnow.org/clinical-summaries-detail/benign-paroxysmal-positional-vertigo-bppv. April 2018.

Are Shin Splints Wrecking Your Run?

Physical Therapy Can Help!
shinsplints-hpt
By Jessica Leberman, DPT – Hampton Clinic

Medial Tibial Stress Syndrome (MTSS) more commonly referred to as “shin splints” is an injury of the lower leg that primary occurs in the exercising population1. MTSS makes up to 16% of injuries that occur in runners2. MTSS typically presents as pain along the lower 2/3rd of the tibia (shin) bone with activity. Often, the pain is worst immediately upon initiating exercise it then, however, eases as the exercise continues and subsides entirely once stopping exercise. The presentation can vary and as the condition worsens pain at rest can occur.3

What Causes Medial Tibial Stress Syndrome?

As the name indicates, MTSS is a repetitive overuse injury usually affecting runners, dancers and others that participate in athletic-related activities. The pathophysiology of MTSS is thought to be due to periostitis of the tibia that occurs when the tibia is placed under repetitive loading. Biomechanical faults within the lower leg such as specific calf and ankle muscle dysfunction can lead to over-loading/bending the tibia with exercise.3

overpronationRisk Factors of Medial Tibial Stress Syndrome3

  •    -Elevated Body Mass Index (BMI)
  •    -Abnormal ankle range of motion
  •    -Over pronation (flat feet)
  •    -Abnormal hip range of motion
  •    -Females > Males

Prevention2

Not all risk factors are completely controllable to prevent MTSS, therefore, it is important to control the factors that can be controlled such as;

  •    -Proper footwear for exercise
  •    -Slowly/gradually increasing exercise regimen
  •    -Avoiding running too much on hard and/or inclined surfaces

    stretch-leg-hpt(Dr Jessical Leberman treating a patient with shin splint pain)

How Physical Therapy Can Help

The focus of Physical Therapy for MTSS (shin splints) is multifactorial. Initially, soft tissue and joint mobilization manual techniques, stretching, and modalities will be used to reduce inflammation and pain levels and promote healing to the injured area. Guided strength work will be involved to reduce over loading through the tibia. Additionally, your physical therapist will assess foot mechanics to ensure proper footwear is worn to better improve force distribution during exercise. Lastly, your PT will help guide/modify your exercise/training regimen to ensure return to normal activity levels is done correctly to reduce risk of re-injury.3

Contact Hampton Physical Therapy or visit us at www.HamptonPT.com to learn more.

References
1. Winkelmann ZK, Anderson D, Games KE, Eberman LE. Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. J AthlTrain. 2016 Dec;51(12):1049-1052
2. Craig DI. Medial tibial stress syndrome: evidence-based prevention. J Athl Train. 2008 May-Jun;43(3):316-8.
3. Galbraith RM, Lavallee ME. Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med. 2009 Oct 7;2(3):127-33.

 

How Stretching Will Improve Your Life!

By Kate Serodio, DPT
Why Stretching will improve your life - By Kate Serodio, DPT

From childhood, we’ve all been reminded to sit up tall, not slouch, stretch, and pull your shoulders back for good posture. If you engage in a sport or even go for a walk, it has embedded in your mind “make sure you stretch before, after, and maybe even in between”. If something hurts, “just stretch it out.” We have all accepted this as common knowledge and most of us have never questioned this advice. But why haven’t we questioned this? We do not question it because stretching is an instinct.

Stretching is instinctive for both animals and humans. You wake up in the morning, what do you do? You stretch, it feels good. You yawn, what happens? Naturally, you stretch. You sit on a plane for hours wondering why an airline that would ever make seats this tight. You finally stand up, what do you do? You stretch! And swear you’ll consider buying extra leg room next flight! Your body knows what you need. You need to stretch! We all intuitively know that stretching is good for us.

Pain reduction, increased mobility, posture improvement, better sleep and even weight loss are all benefits of regular stretching.

Numerous supportive research articles support the benefits of stretching. The literature has concluded that the three main stretch types (static, dynamic and pre-contraction facilitation (PNF)) are all beneficial for increasing range of motion or mobility. In fact, a 2011 randomized control trial by marshal et al. found a 20% increase in H.S flex after a 4-week stretching program, that’s a lot! A systematic review performed by Harvey 2002 resulted in an increased flexibility across several joints. They concluded that regular stretching can increase joint range-of-motion by a mean 8 degrees for >1 day after stopping stretching! This is very encouraging; your stretching gains are still present over a day later. It is important to note that PNF stretching, in comparison to static and dynamic stretching has been found to cause larger magnitude of gains within subjects range of motion both active and passive (Hindle et al). Therefore, PNF has been shown to be the superior stretch type for increasing joint mobility.

stretching

There is no doubt that stretching increases flexibility but the more recent controversial question has been does stretching increase performance? The recent literature has suggested that PNF stretching and static stretching prior to exercise has been found to decrease performance when maximal muscle effort is requires such as during sprinting, plyometrics, cutting, weightlifting, and other high intensity exercises (Hindle et al). However, key et al 2012 did a systematic review and found that performance was only compromised with longer duration of stretch holds >60 seconds. Dynamic stretching, on the other hand, has been found to increase performance prior to sport in numerous studies (Page 2012). Therefore, it is fair to say that all stretch types are appropriate for increasing mobility and performance in submax activities such as jogging but when your goal is to enhance performance for a maximal muscle effort you should opt for a dynamic stretch prior to the event.

Stretching for Injury recovery has been well documented to be beneficial and is used in almost every post injury rehab protocol. The literature is limited on stretching alone as most studies have stretching combined with strengthening and other modalities.

As a Physical Therapist, I can tell you that stretching is extremely beneficial and nearly always a needed intervention for recovery. When you have an injury the resulting scar tissue is weaker, less elastic, and highly prone to re-injury since it does not have the same elasticity as your prior healthy tissue.

Stretching during the healing process and remodeling phase allows for the scarring to be minimal and the damaged tissue will be able to function as it is designed. If stretching is not introduced you will most likely suffer fibrotic tissue that will lack the mobility needed to function.

So, why stretch?

You’re aging:

As most of us know, as we age we lose mobility. Bassey et al 1989 found that flexibility has been shown to decrease up to 50% in some joint areas with chronological age. From a population base of 1000 elderly men and women and they found 10 deg loss of flexibility per decade! It is unfortunate but as we age, we lose mobility. Without stretching, loss of motion and function is inevitable.

You have Poor Posture:

Poor posture over time leads to injuries due to poor alignment of your bones and soft tissues. The result are muscle imbalances and potential impingement from abnormally biomechanics. You need to stretch in order to maintain correct alignment, which will ultimately prevent injury and keep you upright and moving with full strides

You want superior Performance:

Perhaps you are an athlete looking for that cutting edge. Stretching with PNF has been shown to have a significant increase in both stride rate and stride length (caplan et al) Routine stretching could be the difference for a runner winning a silver or a gold. Perhaps you do CrossFit or you are a body builder. As you build strength the result is small micro tears in the muscles in order to build more muscle, this is a natural process of building muscle but over time, you will see mobility loss without incorporating stretching

You have Pain:

Stretching increases blood flow to your joints and muscles. It opens the fascia and helps pump blood so it can flow more freely through. This helps alleviate pain and helps expedite the healing process

You want a relaxing experience that benefits your body:

Stretching feels good. As we discussed, you instinctively want to stretch, your body knows it is good for you. Regular stretching either self or assisted can be relaxing and therapeutic. It can help improve hydration, improve circulation, elimination of waste, reduce stress, and improve sleep.

Professional One-On-One Assisted Stretching is sweeping the nation!
kate-stretch

Now available in the Seacoast!

We all know we need to stretch but unfortunately we either don’t make time for it, we’re afraid to injure ourselves, we don’t know how to stretch, or we struggle stretching ourselves due to lack of mobility. Those that are not disciplined or simply aren’t flexible enough should seek out a professional stretcher. Even someone that can independently stretch would benefit from a professional stretcher, since it is impossible to stretch yourself as good as someone else can. Fortunately, there is a a new PROFESSIONAL STRETCHING BUSINESS in Portsmouth that can do your stretching for you! Rezilient a stretch studio providing individual assisted manual stretches for the full body. Rezilient has trained stretchers that provide one-on one hands on stretching in a comfortable spa like environment. The various techniques are backed by science and created by highly trained Physical Therapists: Dr. Kate Serodio (owner of Hampton Physical Therapy) and Dr. Dan Fleury. For more information, please visit www.Rezilientme.com

REZILIENT

Bassey, E.J., et al. 1989. Flexibility of the shoulder joint measured as range of abduction in a large representative sample of men and women over 65 years of age. European Journal of Applied Physiological and Occupational Physiology, 58 (4), 353–60.

Proprioceptive Neuromuscular Facilitation (PNF): Its Mechanisms and Effects on Range of Motion and Muscular Function. Kayla B. Hindle, Tyler J. Whitcomb, Wyatt O. Briggs, and Junggi Hong

Med Sci Sports Exerc. 2012 Jan;44(1):154-64. doi: 10.1249/MSS.0b013e318225cb27. Effect of acute static stretch on maximal muscle performance: a systematic review. Kay AD, Blazevich AJ.
A randomized controlled trial for the effect of passive stretching on measures of hamstring extensibility, passive stiffness, strength, and stretch tolerance

Paul W.M. Marshall. Anthony Cashman, Birinder S. Cheema. School of Biomedical and Health Science, University of Western Sydney, Australi Int J Sports Phys Ther. 2012 Feb; 7(1): 109–119.

Current Concepts in Muscle Stretching for Exercise and Rehabilitation. Phil Page, PT, PhD, ATC, CSCS, FACSMER