Non-Invasive Pain Relief ~ Graston Technique™

by Lisa Wheldon, DPT

Elbowpain-htp

Ouch my aching elbow! Most of us are familiar with issues related to overuse injuries of our muscles and joints. Whether you are a weekend warrior that really tries to push it when they get in the gym and pulled in their calf, or you’re at work performing the same task over and over again and now your elbow just seems to throb. We are all familiar with injuries that just nag on and on, and think it will get better on its own. Well 6 months later you are still hobbling along because that calf hasn’t healed and you are constantly rubbing your elbow to make it feel better. There is no reason to live in pain. There are many non-invasive treatments at Hampton Physical Therapy. One of the options to treat musculoskeletal injuries is the Graston Technique™. This technique involves using an instrument to perform soft tissue mobilization, and it allows the therapist to not only detect scar tissue but treat it as well.

The therapist works the specialized tool along the affected area to assess for restrictions in the tissue. As this is taking place there are several physiological effects occurring at a cellular level. As pressure is applied tissue remodeling and fibroblast recruitment is taking place1,2. A fibroblast is a fiber producing cell that when it is stimulated can produce new tissue to an area to aid in healing. An inflammatory response takes place which allows for blood flow to a localized area. Mechanotransduction takes place, cells sense and respond to the force applied. The tissue responds by remodeling the tendon, muscle, cartilage or bone3. A piezoelectric phenomenon causes the soft tissue to generate an electrical signal when subjected to mechanical stresses. This occurs due to the shearing of collagen fibers past one another. Then there is the concept that soft tissue models around demand imposed on it.

The problem with thinking that your injury is just going to heal on its own is that you aren’t completely wrong. Yes it will heal but it won’t heal properly causing scar tissue to build up. If there is scar tissue in the muscle the muscle is now in a shortened position and can’t function properly. The muscle fibers are no longer sliding and gliding smoothly underneath the fascia, and can cause other issues in the chain. The muscle can now have limited range of motion causing the patient pain. So if you have been walking around with a calf strain for 6 months now and all of the sudden your knee or foot starts to hurt it could be caused by altering your gait due to the initial calf injury. Now your injuries are multiplying because you never addressed the root of your issue.

grastonThe Graston Technique™ could have ended all of this discomfort from the start. If you contact Hampton Physical Therapy from the time of initial injury or even now that you have several areas of discomfort you are still a great candidate for this treatment. Upon evaluation with the Graston tools the therapist can assess for any restrictions in the muscles and then treat those areas using the same tools. Following the Graston treatment the patient is then instructed in effective ways to properly stretch the affected areas to promote the blood flow that was just attained with the tools and aid in proper healing of the tissues. The patient will then perform strengthening exercises, and possibly ice and electrical stimulation if deemed appropriate for the patient. Frequently patients will ask how long it will take for positive effects to be noticed. The standard plan of care is twice a week for 4-5 weeks. The patient should notice improvements within 3 to 4 treatments. Typically patients are able to complete all of their daily activities following treatment. The Graston technique has positive outcomes in 75–90 percent of all conditions treated. It is equally effective in restoring function to acute and chronic injuries, and pre- and postsurgical patients.

Now that tight calf that was stopping you from getting back to running or that elbow that is stopping you from raking your yard can be treated. You could be back to your activity in just a couple weeks. With such a high likelihood for improvement why not give physical therapy a chance. Call me at Hampton Physical Therapy at: 603-474-2259 for more information on how this therapy could help you! Or visit us online at www.HamptonPT.com.

CITATIONS:
1. Gehlsen GM, Helfst R. Fibroblast response to variation in soft tissue mobilization pressure. Medicine and Science in Sports and Exercise, 31(4): 531-535.
2. Loghmani MT, Warden SJ. Instrument-assisted cross-fiber massage accelerates knee ligament healing. JOSPT 39(7): 506-514
3. Khan KM, A Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sp Med, 43(4): 247-251.

Iliotibial (IT) Band Syndrome in Runners

by Katherine Younes, DPT – Hampton Clinic

itbs-injury-hpt

As the fall approaches, many of you may be signing up for a 5k, 10k, or you may be an everyday runner. As many of you know, with running may come aches and pains. The most common overuse injury in runners is Iliotibial Band Syndrome.

What is Iliotibial Band Syndrome?

ITBS accounts for 12-14% of all overuse injuries in runners. The IT band consists of a thick, tight band of fascia located on the lateral aspect of the thigh. The IT band spans from the outside of the pelvis, runs over the lateral hip, and inserts into the lateral femoral condyle located just below the lateral knee. The continuous rubbing of the band over the boney prominences on the femur, combined with repetitive flexion and extension of the knee is believed to be the cause of ITBS. The good news? It is very treatable!

Signs and Symptoms of ITBS:

  • Stinging or sharp pain just above the knee joint on the lateral side of the knee

Swelling or thickness of the tissue just above the lateral aspect of the knee

Increased pain with activity: walking, running (downhill specifically)

Pain with bending and/or straightening of the knee, which can be made worse by pressing on the tissue on the lateral aspect of the knee

Causes of ITBS:

  • Poor footwear
  • Improper training: increase in mileage; change in type of training, change in training intensity
  • Running on cambered road surface
  • Running on an indoor track with tight turns
  • Muscle weakness: glute med, glute max, quads
  • Muscle tightness: IT band, quads, hamstrings

What can I do to treat my ITBS?

  • Ice – 15 minutes at a time, 1-2 times a day

IT band Stretch
it-band-stretch

  1. Use a rope or belt to wrap around your foot of the affected leg
  2. Cross the affected leg over the other and pull your foot up and out until a comfortable stretch is felt along your IT band.
  3. Hold for 10 seconds and return to starting position
  4. Repeat 10-15 times, 1-2 times a day

Foam Roll- massage
hip-roller

  1. Lay on foam roller on the affected side
  2. Start with the foam roller just above your knee and roll up to your hip. Repeat for 3-5 mins
  3. Can perform 1-2 times a day
  • Strengthen:

Hip Abduction Exercise
hip-abd

  1. Lay on your non-affected side with your bottom knee bent
  2. Keep top leg straight and raise leg up towards ceiling
  3. Return to starting position
  4. Perform 3 sets of 10 reps

Clamshell
hip-clamshell

  1. Lay on your non-affected side with both knees bent over one another
  2. Keep heels touching while opening and closing your knees
  3. Perform 3 sets of 10 reps

Bridges
hip-bridges

  1. Lay on our back with both knees bent up, feet on the floor
  2. Raise hips off the ground and return to starting position
  3. Perform 3 sets of 10 reps

Physical therapy is another option that can provide a wide variety of treatment techniques for this condition. Our team of physical therapists at Hampton Physical Therapy can provide strengthening exercises, stretches, Graston technique for soft tissue mobilization, Kinesiotaping, modalities and much more to provide you with a great outcome for your symptoms. Feel free to call our office or visit http://www.HamptonPT.com for more information.

  • Grau et al. The influence of matching populations on kinematic and kinetic variables in runners with Iliotibial band syndrome. Research Quarterly for Exercise and Sport. 2008; 79 (4): 450-457.
  • Shamus J, Shamus E. Case report: the management of iliotibial band syndrome with multifaceted approach: a double case report. International Journal of Sports Physical Therapy. 2015; 10 (3): 378-390.
  • Van Der Worp et al. Iliotibial band syndrome in runners, a systematic review. Sports Med. 2012; 42 (11): 969-992.

Plantar Fasciitis Are You at Risk?

by Kate Serodio, DPT, HamptonPT

flip-flops-hpt

 

Check all that Apply:

· Do you have high or low arches? ___

· Are you between 40-60 yrs. old? ____

· Do you run long distances, downhill or on uneven surfaces? ___

· Are you overweight or have you suddenly gained weight recently? ___

· Do you have a tight calf muscles? ___

· Do you Wear shoes with poor arch support or soft soles? Such as flip flops? Boat shoes? Or walk barefoot? ____

· Have you recently changed your activities? ____

· Do you like taking long walks on the beach? (no this is not the personal column!)___

· Recently suffered an injury on one side of your body and are now distributing all your weight on the other? ___

If you check YES to anyone of these then you are at risk!

Who is most likely to get a Plantar fasciitis?

Plantar fasciitis is the most common cause of Heel pain and affects 10-15% percent of the U.S population. It is estimated that 1 in 10 people will experience PF at some point in their lifetime Plantar fasciitis is responsible for more than 600,000 outpatient visits annually! PF is most common in overweight, middle aged, active and sedentary adults that demonstrate limited ankle dorsiflexion (toes pointed towards your head), and spend long periods of time on their feet. However anyone may be at risk if they recently changed their footwear or increased or modified their activity level.

What exactly is PF?

Plantar fascia is a thick fibrous non contractile connective tissue that originates from the bottom of your calcaneus (heel) and attaches to the base of your toes and therefor supports the arch of your foot. Historically, plantar fasciitis has been erroneously thought to be an inflammatory condition of the plantar fascia. More recently, the literature suggests that the condition is actually due to a noninflammatory structural degeneration due to repetitive micro trauma of the PF secondary to chronic overuse. You will most likely see a shift in the name from PF to plantar fasciosis in the years to come.

How will I know if I might have a PF?

Your healthcare provider or your physical therapist could easily determine if you have a PF based on your clinical exam. The telltale signs that you can look for are:

-Pain with initial steps or after a period of inactivity but also worse following prolonged weight bearing

-pain to touch the medial heel or arch

-pain when pulling your toes into extension (towards your, creating stretch on your arch)

– Heel pain precipitated by a recent increase in weight-bearing activity

-decreased ankle dorsiflexion (tight calf)

Could it be something else? (Differential diagnosis)

Yes, there are always other conditions that could be responsible for your heel pain such as:

· -Lumbar radiculopathy – (possibly coming from your back)

· -Fat-pad atrophy,

· -proximal plantar fibroma

· – Heel pain of neurogenic origin (tarsal tunnel syndrome, calcaneal nerve entrapment) if you have some degree of numbness/tingliness/burning you most likely have a nerve involved

What can I do to prevent PF?

plantar-exerc2
Step #1: Immediately start stretching!

Plantar fascia stretch: Grab your toes and pull them towards your head 30sec 3x

Calf Stretch: dips on the step: place one heel off the edge of a step, toes onto a rolled up towel, and shift your weight to this leg, lower your body weight onto this leg and hold 30sec/3x (you can bend your knee to target the soleus muscle and you can keep your knee straight to target the gastrocnemius muscle.

plantar-exerc

Step #2:

· Avoid flip flops or unsupportive footwear. Many people that suffer from a PF often overly pronate (arch falls in while weight bearing), this repetitive motion puts too much strain on the PF. Arch supports will help prevent PF

Step #3:

· Gradually modify your activity levels and new recreational activities. Just because it’s finally nice out doesn’t mean you should decide to run a 10k when you haven’t been training outside all winter. Different terrain affects your body differently. The beach for example can be extremely problematic by increasing the stress while walking or running due the give of the sand. The motion of the foot is exaggerated.
Step #4

· Change your footwear every 300-500miles or at least every year. Footwear is less supportive with use and also time. The rubber material become less supportive over time because rubber breaks down over time regardless of use.

Step #5:

· If you start to feel heel pain, immediately stop doing what you’re doing and stretch. If you recently changed footwear, stop and throw out the shoes/sneakers. I often have patients think that they just need to break in the footwear and then they’ll be fine. This is not the case with this condition, your condition will only get worse if you continue to use them. Give them to someone you don’t like!

Step #6:

· If your pain continues for more than a week with these conservative measures you should immediately seek a physical therapist evaluation (Medicare patient’s and patients with PPO’s do not need a referral, you can simply schedule an appointment) or consult with your primary care to go to PT immediately. Research suggests the longer you wait the longer it will take to resolve the condition

What do I do if I have Plantar Fasciitis?

Step #1:

Immediately start stretching as indicated above!

Have numbness or tingliness? Perform the exercise for only 3 seconds and repeat only30x, 3x/day. Nerves do not like to be put on stretch for long periods of time! This will help bring blood flow to the nerve and reduce intraneural swelling

Step #2:

Modify your footwear. Stop wearing nonsupportive footwear, yes that includes your new flip flops. I recommend keen sandals, they are extremely comfortable, supportive and essentially no break in period

Step #3:

Roll your arch with a tennis ball to stretch the PF

Step #4

Consult with PT or PCP to initiate therapy treatment. Physical Therapy is extremely beneficial and effective. Again, you are best to start therapy sooner than later. The longer you have the condition the longer the rehabilitation. In general, most patients will require 6wks of PT 2x/wk. in order to return to their prior level of function.

tapingWhat will Physical Therapy consist of?

Graston Technique: Graston Technique incorporates an instrument assisted soft tissue mobilization that allows the therapists to effectively detect and treat scar tissue and restrictions that affect normal function. Essentially, the technique aims to make a chronic condition acute again. Your body will then start to help and heal itself. For more information visit: HamptonPT.com

Manual mobilization: Your therapists will aim to increase your dorsiflexion by manual joint mobilization techniques and manual stretching.

Neural mobilization: The tibial nerve can often be involved. It’s important to add neural mobilizations if it is suspected that the nerve has become inflamed. This will help desensitize the nerve.

Footwear modifications: Your therapist will examine your gait and foot biomechanics and determine the best footwear for you. You may also be advised to utilize over the counter inserts or heel pads. Your physical therapist could also make you custom orthotics if deemed necessary. Most often over the counter inserts are sufficient.

A rocker bottom sneaker has also been found in the research to aid in some pain relief and decreased plantar fascia pain.

You may also benefit from changing footwear throughout the day if you must stand long periods of time. This will change the pressure distribution.
Exercises/Stretches: There are a series of exercises to help increase the mobility/flexibility of your ankle which will help decrease stress on your heel. You will also be advised in a progressive series of strength exercises to help build/support your arch.
Taping: Low dye taping is very beneficial in immediately eliminating a true plantar fasciitis. This may also be used to determine the need for inserts

Night Splint: A night splint may be advised however if you have nerve symptoms this may exacerbate your pain. A good rule of thumb, if it feels better in the morning then it’s helping. If it feels worse then don’t do that!

Do I need an injection? Injections can weaken the plantar fascia and put you at a risk of rupturing the PF. More conservative measures should be performed first and then determined once other measures have failed.

We at Hampton Physical Therapy treat this condition regularly and have great outcomes. If you have questions/concerns regarding your condition, please don’t hesitate to call and speak with one of our Doctors of Physical Therapy.

J Res Med Sci. 2012 Aug; 17(8): 799–804. Plantar fasciitis Mohammad Ali Tahririan, Mehdi Motififard, Mohammad Naghi Tahmasebi,1 and Babak Siavashi2

Journal of Orthopaedic & Sports Physical Therapy ,Volume 44, Issue 11 Heel Pain—Plantar Fasciitis: Revision 2014 Robroy L. Martin, PT, PhD, Todd E. Davenport, DPT, Stephen F. Reischl, DPT, Thomas G. McPoil, PT, PhD, James W. Matheson, DPT, Dane K. Wukich, MD, Christine M. McDonough, PT, PhD

Abduction in the plane of the shoulder blades

Rowing and Lat Pull Downs

General Tips and Advice:
Simple stretching routine to warm up your muscles before beginning your round

Hit a few balls on the driving range/warm-up area prior to hitting the course

Wear sunscreen, a visor/hat, and sunglasses to protect you and your eyes from the harmful UVA rays

Stay well hydrated during and after your game

When riding in the cart keep yourself, including your feet, inside the cart

Be aware of your environment and other players to avoid accidental soft tissue injuries…Fore!

Get sound advice from a professional regarding proper form, warm-up/stretching routines, and training techniques

Enjoy your golf season more by taking these tips and including them as part of your routine. Your game will likely improve and your body will thank you later. It is always good to have your golf swing checked by a professional to avoid poor swing mechanics, which can lead to compensation and overstressing your joints and muscles. Go get out there and have a great season! Most importantly be safe and have fun! For questions or consultation contact Hampton Physical Therapy http://www.HamptonPT.com/