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Hip, Knee and Shoulder Surgery: Understand Your Body to Regain Your Activity (Neuroscience Education)

Maybe it’s due to aging of the joint. Or maybe a previous injury. Whatever the reason, you find yourself no longer able to tolerate the pain and stiffness associated with your hip, knee or shoulder. The time has come for surgery.

The decision to go ahead with surgery is a big commitment. And certainly, it’s not something you’d choose to do if you didn’t feel it was absolutely necessary. But there is reason to be hopeful.

Whether you have are having a full joint replacement or other type of surgery, the good news is that these procedures have come a long way and are generally quite successful.1-3 The doctors will help repair the wear and tear of the joint and reduce the inflammation. The rest of the recovery process, however, will be largely up to you.

You have aspirations and specific things you want to achieve following the surgery. These can be anything from simply regaining function of the joint to performing daily life tasks to returning to activities you enjoy such as golf or gardening. So, what strategies will you employ on your path to recovery?


Education is Therapy
After surgery, you will most likely undergo physical therapy. This will help you improve your range of motion and gradually regain your strength. But in addition to exercise, education can also aid you in your recovery. In fact, scientific research has shown that understanding how pain works in the body can help you hurt less, exercise more and return to regular activities more quickly.4-6

Author, researcher and talented educator Adriaan Louw, PT, PhD has been spreading this positive message for several years now. He speaks on the value of this relatively new approach, known as pain neuroscience education, around the world to both clinicians and patients. As he likes to say, “Education is therapy” and “Know pain, know gain.”

The premise of neuroscience education is based on the principle that all pain is determined by the brain, which processes messages it receives from the nerves. By understanding how our body and brain work together in this way, it allows us to utilize that knowledge to lessen our pain and improve mobility.


Louw’s Neuroscience Books
Adriaan’s gift for making the science of pain accessible to everyone is evident in his presentations and books. He has a way of talking about pain that makes it less intimidating, and this is especially evident in his pain neuroscience education books. As the exclusive publisher of these books, OPTP carries the full series, which is now comprised of 11 titles.

Several of the books specifically address hip, knee and shoulder surgeries, revealing what to expect from the procedures before, during and after surgery. All titles feature memorable concepts that are explained through approachable language with metaphors, examples and illustrations. Most importantly, they are designed to help you harness the power of your brain to take control of your nerves and lessen pain, increase movement and return to regular activities as quickly as possible.



Recovery Ready
If you’re in the process of scheduling hip, knee or shoulder surgery and looking to get a head start on your recovery, consider learning more about pain neuroscience education. Not only is it a fascinating field, but you’ll discover knowledge that will guide you in your return to activity and success of your goals.

  1. Jolles BM, Bogoch ER. Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis. The Cochrane Database of Systematic Reviews. Jul 19 2006(3):CD003828.
  2. Chaudhury S, Gwilym SE, Moser J, Carr AJ. “Surgical options for patients with shoulder pain.” Nature Reviews Rheumatology. Apr 2010; 6(4):217-226.
  3. Coghlan JA, Buchbinder R, Green S, Johnston RV, Bell SN. “Surgery for rotator cuff disease.” The Cochrane Database of Systematic Reviews. Jan 23 2008(1):CD005619.
  4. Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Archives of physical medicine and rehabilitation. Dec 2011;92(12):2041-2056.
  5. Louw A, Puentedura EL, Mintken P. Use of an abbreviated neuroscience education approach in the treatment of chronic low back pain: A case report. Physiotherapy Theory and Practice. Jul 3, 2011.
  6. Moseley GL, Hodges PW, Nicholas MK. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clinical Journal of Pain. 2004; 20: 324-330.

READ MORE Adriaan Louw, PT, PhD - June 13, 2018


How to Choose a Foam Roller: 3 Features to Consider

So you’re going to get a foam roller? Seems like an easy enough decision to make. I mean, it’s a simple piece of foam, it can’t be that hard to figure out. But then you start looking at all the options out there, seeing the many different varieties. Pretty soon, it can become overwhelming.

Trying to decide which foam roller is best for you isn’t as easy as you might think, but it’s important. Choosing the right roller will help ensure effectiveness, usability and compliance. After all, if it doesn’t feel right you won’t be motivated to use it…and a roller that goes unused doesn’t provide much benefit!

In this article, we’ll look at three keys to consider when picking a roller, helping you break down the options. As follows, we’ve identified what we feel are the three most important factors; density, size/shape and construction.

  1. Density
Arguably the most important choice to make regarding your new foam roller is the density. You might also hear this referred to as the compression, firmness, cushion or “give,” which all mean the same thing. Generally, rollers can be broken down into three density categories; soft, medium or firm.


Soft
Soft density rollers have more “give” or cushion to them. They’re designed for those who are looking for more comfort as opposed to the deeper massage of firm and standard rollers. The soft density produces a massage that is gentler on the muscles, making it ideal for users with sensitive muscles or those who simply prefer a less intensive massage.
Standard
These rollers have a medium firmness. Their universal quality makes them ideal for both self-massage and exercise. They provide just enough firmness for deep massage while still having moderate cushion. Their medium density also serves nicely as stable props for use in core strengthening exercises such as those performed in Pilates and yoga.

Firm
For those seeking a deeper, more intense massage, firm density foam rollers are the answer. Athletes and highly active individuals often have tight muscles that can benefit from the penetrating nature of these rollers. Firm rollers are great at breaking up even the most constricted fascia (the interconnected web surrounding the muscles), a process known as myofascial release.  

  1. Size and Shape
There are also many different sizes of foam rollers on the market. While the majority are the traditional full-size round cylinders, many other sizes and even different shapes exist. Let’s take a look at some of the more common sizes to see how each lends itself to certain uses.

Standard Full-size
When most people think of a foam roller, this is usually what comes to mind. The typical full-size roller measures approximately 36” length x 6” diameter. This size is versatile for a variety of uses, including massage (ideally larger muscles groups like hamstrings, quads and the back), physical therapy and general exercise. Due to their three-foot length, these rollers are perfect for any type of exercise where you lie on the roller with it positioned vertically along the spine, such as Pilates or related core strength and balance movements.
Shorter Length
If you’re looking for a more portable roller, perhaps one that is travel size and you can take with you to the gym, physical therapy clinic or Pilates studio, consider a shorter length. Most shorter rollers have the same diameter as a traditional full-size (6” or thereabouts) but feature a shorter length; typically either 18” or 12”. In addition to the benefit of portability, they also make it easier to target certain muscle groups. The shorter rollers are ideal for targeting more precise areas such as calves, IT Bands or glutes.

Smaller Diameter
A smaller diameter roller — typically 4” — means that it will be lower to the floor and more stable. This is often important for physical therapy patients, aging users or those with a compromised sense of balance. Being lower to the floor means that it provides a safer, more stable feeling. It’s also easier to control while using for massage.
Ridges or Bumps
Need a little something extra? Some uniquely designed foam rollers offer protrusions for those that like a more invigorating massage or simply want the ability to target precise areas. Rollers with ridges, bumps or points can provide a deeper penetrating massage that breaks up fascia in even the most tight, compact areas.
Flat Half-size
There are a variety of foam rollers that lend themselves nicely to balance and core strength exercise. Although they come in a range of shapes, a typical size is a 36” length x 3” height that is cut in half the long way, making it rounded on one side and flat on the other. This shape is useful for physical therapy, Pilates, yoga, Feldenkrais® and general core strength exercise.

  1. Construction
Not all foam is created equal. Believe it or not, there is a fair amount of engineering that goes into the development of a foam roller. The way it is constructed helps determine its longevity — and primary location of use — important considerations to make before purchase.

Open-Cell
Rollers built with an open-cell construction, while suitable for massage and exercise, tend to break down much faster than closed-cell rollers. You’ll typically find open-cell rollers at your local big-box store and, while inexpensive, there are higher-quality closed-cell options available at affordable prices. Closed-cell foam rollers offer the durability you expect from a foam roller and are available in two types of foam; EPP and EVA.

EPP Foam
Rollers made from EPP foam beads are high quality but still relatively inexpensive. They’re versatile and suited for users of all levels. Because they offer a nice combination of durability and affordability, they make a great starting point for the average person while still being effective for the more advanced user. EPP rollers are designed to last much longer than open-cell rollers, though they do not offer the supreme durability of EVA foam.

EVA Foam
Rollers made from EVA foam deliver unmatched durability. These “professional strength” foam rollers are built to withstand the type of heavy, repeated use often found in gyms, clinics or Pilates studios where many people are using them throughout the day. The at-home user can also benefit from the longevity of these rollers, having confidence in knowing they will hold up for a longer time than any of the other foam types.

As you can see, there’s a bit of thought required before making your foam roller purchase. But put the time in up front and you’ll be rewarded with a roller that suits your comfort level and intended usage, motivating you to use it with consistency. Start with the big three features — density, size/shape and construction — and you’re well on your way to making the perfect selection.


Ready to browse all the options? View OPTP’s extensive selection of foam rollers, including the densities, sizes and foam types mentioned in this article.

READ MORE Josh Crane, OPTP Staff Writer - June 12, 2018


Care that Counts: Home Exercise Programs

For nearly 40 years, we’ve been manufacturing and supplying the highest quality manual and physical therapy equipment for your clinical use. During this time, we’ve also seen a growing demand for therapy and fitness tools for in-home exercise programs, and we acknowledge the importance your referrals have had with the increasing use of our self-care products by your clients and patients.   
 
Whether you’re a personal trainer, physical therapist, Pilates instructor or a chiropractor, we’re grateful for these referrals. When your patients and clients walk into our showroom or order products over the phone, they often mention you by name, providing praise for your services.
 
By recommending self-care strategies or prescribing home exercise to your clients, it shows that you’re genuinely concerned about their health and wellness. Ultimately, our products supplement the critical work that you do in the clinic or studio, and we’re proud to be your trusted resource for these solutions.  
 

Credibility & Safety

Over the years, we’ve been privileged to form solid relationships with numerous health professionals who are world-renowned experts. Many of our therapy and fitness tools are the result of these exclusive partnerships, which include prominent names like Robin McKenzie, Adriaan Louw, Eric Franklin, Lauren Roxburgh and many others.
 
What does this mean for you? By working with those who are leaders in their field, we are able to bring you innovative and dependable products you can trust. Their passion, like ours, is to create solutions that play an essential role in achieving the goals you set for your clients.

In addition, you can be assured that our products are designed with the highest safety standards. Items are manufactured with considerations for latex, flammability and other concerns. And many also come with information on operation instructions, safety precautions, contraindications and product care.
 

Proven Effectiveness

Evidence-based outcomes continue to suggest that self-care plays an important role in regaining healthy musculoskeletal function. For example, one study on osteoarthritis of the knee evaluated the effectiveness of clinically-applied treatment that included exercise and manual therapy versus a home-based exercise program.

The results indicated that, in addition to a reasonable schedule of clinical visits for the application of manual therapy and supervised exercise, a home exercise program provides important benefits such as an increase in the average distance of a six-minute walk.1 In addition, a home-based component for patients with ankle sprains has been found to increase attendance at clinic appointments and intervention completion rates.2

Whether you are recommending a Knee Glide® for knee replacement rehabilitation, Robin McKenzie’s Treat Your Own Back™ book for back pain, Handii™ Healthy Hands for hand therapy or any of our foam rollers for myofascial release and mobility, conservative care products increase patient adherence and improve the effectiveness of your practice.
 

Bringing it Home

The next time you have an opportunity to prescribe home exercise, consider our wide selection of self-care solutions. With categories like movement therapy, balance, posture, stretching, Pilates and many more, we offer tools that patients can easily use at home, helping them to develop consistent use, take pride in their care and establish positive long-term habits. We’re here to make your job easier and improve the health of your patients and clients.

Find solutions for your next home exercise program by checking out all of our tools, including more than 25 new products, in our latest professional catalog.

 
  1. Deyle, G.D., Allison, S.C., Matekel, R.L., Ryder, M.G., Stang, J.M., Gohdes, D.D., Hutton, J.P., Henderson, N.E., & Garber, M.B. (2005). Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomized Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home Exercise Program. Physical Therapy, 85(12), 1301-1317.

  2. Bassett, S.F., & Prapavessis, H. (2007). Home-Based Physical Therapy Intervention with Adherence-Enhancing Strategies Versus Clinic-Based Management for Patients with Ankle Sprains. Physical Therapy, 87(9), 1132-1143.


READ MORE Josh Crane, OPTP Staff Writer - June 5, 2018


The Squat: How to Improve Depth, Increase Muscle Activation and Protect the Low Back and Knees

The standard squat. It’s one of the most commonly performed exercises, yet it’s often feared. It’s the topic of many internet queries and qualms (try searching the web for “proper squat form”) and it’s simultaneously loved and hated for both its simplicity and challenging nature.    
 
Assuming the classic move is done correctly, it holds great potential beyond just stronger glutes and quadriceps. Its many benefits also include greater core strength and stability and improved hip mobility to name a few. It’s no wonder the squat is a trusted favorite among fitness experts, athletic trainers, physical therapists and movement specialists.
 
Development of a Training Tool
As someone with an affinity for rehabilitative exercise and fitness performance, I’ve made it my mission to understand as much as I can about squat mechanics. It’s become a passion of mine to try and make the squat safer and more effective for people of all abilities.
  
To help accomplish this, I set out to create an exercise tool that would aid those having difficulty accomplishing the squat movement. Nearly 35 years of professional development in the clinic and rigorous personal training and rehab in the gym led to a product that we now call the Performance Wedges™. And while this pair of foam wedges is a versatile companion for planks, pushups or balance-related moves, they’re especially valuable for assisting with the almighty squat.  
 
Throughout my research and training observations, I’ve found that using the Performance Wedges with my clients can result in the following three benefits.
 
1. Improved Depth
The ankles are an area that can often have limited flexibility, which is usually due to tightness of the gastrocnemius or calf musculature. This limited ankle range of motion can restrict the ability to achieve proper squat depth. But tightness in the calves and lower leg can easily be addressed with stretching.
 
To do this, we start by positioning the Performance Wedges in the incline position. The heels are placed at the low end of the Wedges and the toes near the grooves. Standing in this position, lean forward slightly to stretch the calves, holding for 45 seconds and repeating for three sets. Reducing calf (and lateral lower leg) tightness in this way will encourage improved ankle mobility that will help with squat depth.
 

 
In addition to stretching, the Performance Wedges can be used for depth assistance during the squat itself. To achieve this, we place the Wedges in the decline position with the heels at the top of the Wedge in the grooves and the toes toward the floor. Performing your squats with this setup places the low back in a more vertical position and allows for increased flexion at the hip and knees1. This not only aids in squat depth performance but also decreases stress in the low back area and potentially makes the movement more comfortable at the knees, allowing the fuller range of motion to be accomplished with more comfort and ease.
 
Decline Squat 
2. Greater Muscle Activation
Like most other exercises, the squat can provide great results when performed properly. This includes increases in strength and muscle activation; both of which should be goals regardless if you’re an athlete aiming for hypertrophy or a patient rehabilitating from injury.

To achieve these benefits though, depth is key. Generally, taking your squat depth below parallel is going to provide greater muscle activation for the glutes, hamstrings, adductors and quads.

As illustrated previously, we can use the Performance Wedges in the decline position (heels placed at the top, toes toward the floor) during the squat to place the low back in a more vertical position. This can make the movement more comfortable at the knees and allow for that deeper range of motion that produces greater muscle activation.3
 
3. Protection for the Low Back and Knees
Of course, no exercise is valuable if it results in harm. Preventing injury or pain in the low back area has always been a primary concern of mine, and it’s one of the main reasons why I developed the Performance Wedges.

Using the Wedges in the decline position helps prevent medial collapse of the knees (which can cause ACL injury) and allows for increased flexion at the hip and knees3. This increased knee and hip range of motion helps prevent rounding of the low back, in turn decreasing stress on this area.

But it’s not just the back that benefits. With the increased hip range of motion, it becomes easier to keep the knees from migrating too far past the toes. This, along with the cushioned nature of the foam Wedges themselves, helps support the knee joints and increase comfort during exercise. (While it is important to note that studies do show an increased force on the knees when the spine is in a more vertical position, it is negligible and safer compared to the stress of having the knees travel too far out over the toes.)

Additionally, the increased range of motion aided by the Performance Wedges may also help prevent hyperextension of the knee and valgus (collapsing of the knee inward), actions that can lead to knee pain4,5.

I’ve had the privilege of seeing many unique exercise products throughout my career. But I can say, thanks to a lot of effort that went into the design of the Performance Wedges, that I feel especially confident recommending this product to anyone looking to enhance strength and functionality throughout the body. The simplicity of its design — just like the simplicity of the squat itself — has reminded me that sometimes in life, the simple things provide the most value.

  1. Kim, S.-H., Kwon, O.-Y., Park, K.-N., Jeon, I.-C., & Weon, J.-H. (2015). “Lower Extremity Strength and the Range of Motion in Relation to Squat Depth.” Journal of Human Kinetics; 45, 59–69. http://doi.org/10.1515/hukin-2015-0007.

  2. Soma, M., Murata, S., Kai, Y., Nakae, H., Satou, Y., Murata, J., & Miyazaki, J. (2015). “Kinematic analysis during toe-gripping strength exertion: angular changes in the ankle joint and leg muscle activities.” Journal of Physical Therapy Science; 27(6), 1957–1960. http://doi.org/10.1589/jpts.27.1957.

  3. Hayley S. Legg, Mark Glaister, Daniel J. Cleather & Jon E. Goodwin (2016). “The effect of weightlifting shoes on the kinetics and kinematics of the back squat.” Journal of Sports Sciences; 35:5, 508-515, DOI: 10.1080/02640414.2016.1175652.

  4. Ota, S. et al., “Acute influence of restricted ankle dorsiflexion angle on knee joint mechanics during gait.” The Knee; Volume 21, Issue 3, 669 – 675.

  5. P. Tabrizi, W. M. J. McIntyre, M. B. Quesnel, A. W. Howard. “Limited dorsiflexion predisposes to injuries of the ankle in children.” The Journal of Bone and Joint Surgery [Br] 2000;82-B:1103-6. Received 21 April 1999; Accepted after revision 4 May 2000.

 
 * Always consult with your healthcare provider before starting any new exercise program.
 
 
The Performance Wedges, available exclusively from OPTP, were invented by Dr. Greg DeNunzio and personal trainer Luis Leonardo. They’re sold as a pair and can be used singly or together for squats, pushups, planks and a wide variety of other exercises in fitness, physical therapy, Pilates or yoga.

READ MORE Dr. Greg DeNunzio, DC, BSME - May 15, 2018


Thrust Joint Manipulation Skills for the Spine: A New Manual Therapy Textbook Delivering Clinical Pearls

Over the course of their combined 80 years of practicing and teaching manipulative therapy, Emilio Puentedura, PT, DPT, PhD, OCS, GDMT, CSMT, FAAOMPT, and William O’Grady, PT, DPT, OCS, COMT, DAAPM, FAAOMPT have developed a deep understanding of the why, when and how behind administering thrust joint manipulation.
 
Like anyone who devotes themselves wholeheartedly to a craft, they have acquired specific knowledge of the practice and honed their skills with laser precision. But for these two, simply becoming experts in their field was not enough. Their passion for helping others led to a desire to share their expertise, and so they authored a new manual therapy textbook published exclusively by OPTP.
 
Thrust Joint Manipulation Skills for the Spine, which includes access to videos demonstrating 45 manipulation techniques, is designed for both clinicians and students. The book demonstrates when and how to perform thrust joint manipulation techniques for patients with musculoskeletal dysfunction in the spine, providing numerous “clinical pearls” along the way.  
 
The book has already been well received and continues to garner recognition from the manual therapy world. We recently sat down with the authors to get their take on the unique value of its content, and here’s what they had to say.
 
 

Discover how these clinical pearls can enhance your practice and understanding of spine manipulation. Learn more about Thrust Joint Manipulation Skills for the Spine.

READ MORE Josh Crane, OPTP Staff Writer - May 10, 2018


From the Authors | Deborah Riczo: Sacroiliac Pain

In the second installment of our “From the Authors” series, Deborah Riczo tells us a little bit about herself, as well as her motivation for writing Sacroiliac Pain, an exclusive new educational and exercise book for those affected by sacroiliac dysfunction.

Shortly after graduating with my physical therapy license in the early ‘80s, I became an advocate for women’s health. While working full-time at MetroHealth Medical Center in Cleveland, Ohio, I started my first entrepreneur business along with my colleagues. Long before it became an accepted practice, we dedicated ourselves to providing healthy, safe exercise for women during pregnancy and in the postpartum period. We were recognized for our work and presented at the American Physical Therapy Association (APTA) national conference on the topic.

During this time, I was working part-time in the hospital clinic, working on my master’s in education and having two children. I became acutely aware of the problems of sacroiliac pain/pelvic girdle pain in this population. As we know, it often starts during pregnancy or postpartum and can continue thereafter.

I went back to school for my doctorate in physical therapy in 2007. As my “capstone” project, I chose to further investigate the exercise approaches I was using successfully in the clinic and compare them to the literature. My reputation with the physicians and my colleagues for treating sacroiliac pain continued to grow.

In 2011, I founded Riczo Health Education. My goals were, and still are, to:
  • Provide consumer health education, especially in the areas of:
    • Sacroiliac pain
    • Pregnancy and postpartum
    • Breast cancer
    • Health and wellness
  • Provide high-quality continuing education courses to health professionals
  • Provide dynamic presentations on a variety of healthcare topics to consumer groups
  • Provide experienced consulting to healthcare organizations and consumers
After more than 30 years as a practicing physical therapist at MetroHealth Medical Center, I retired in 2016 and am now focused exclusively on Riczo Health Education. It has been a wonderful journey, and I’m excited to continue branching out to create the largest ripple effect that I can!

In writing my first book, I sought to capture APTA’s vision; “The physical therapy profession will transform society by optimizing movement for all people of all ages to improve the human experience.” Sacroiliac Pain: Understanding the Pelvic Girdle Musculoskeletal MethodSM is a book based on a method that I developed and have been teaching to therapists since 2011. I partnered with the APTA Section on Women’s Health in 2016 to teach a two-day continuing education course to physical therapists, “Simplifying Sacroiliac Dysfunction,” also based on the method.

Ultimately, I wrote the book to reach out to those who are dealing with sacroiliac pain for either of two reasons; they have not sought medical help due to insurance reasons, or they have sought help but are still dealing with pain. The book is especially written for those being treated for sacroiliac pain with opioids or for those who are contemplating surgery. Of course, the book will not help everyone, as medical, psychological, spiritual, social, occupational and environmental situations all vary from person to person. However, in my experience as a practicing physical therapist, the Pelvic Girdle Musculoskeletal MethodSM is a very successful, cost-effective approach. I believe that the average person can pick up this book and benefit from it in some way, as it is holistic in its approach. Hope, belief and mindfulness are key, as well as movement and exercise. And of course, adherence!

Sacroiliac Pain is designed to help improve muscle imbalances and weakness by providing a simple approach. It begins with a background on recognizing sacroiliac pain; its common causes as well as muscles, joints and ligaments that are often involved. Additionally, the reader is made aware of how pain and fear of movement can result in decreased function and increased pain.

The section dedicated to the Pelvic Girdle Musculoskeletal Method provides step-by-step instructions for the exercises with supporting video links. We added the online videos as a convenient, visual way to help the reader understand the correct way to execute the movements.

In addition to the main exercises, we also included stretching exercises as well as instruction on breathing, which plays an important role in relaxation and pain management, along with mindfulness. Tips on beginning a walking program and progression to other forms of exercise are also included.

In the final section, the reader will find information regarding use of a sacroiliac belt and other frequently asked questions. An exercise planner is also included for logging workouts.

I hope that readers of this book who are struggling with sacroiliac pain find the tools they need for improving function, fitness and wellness. I’m optimistic that its approach will help to “optimize movement” and “improve the human experience” for many who read it.


Deborah B. Riczo, PT, DPT, MEd
Dr. Riczo has been a practicing physical therapist for over 37 years, the majority of it being in clinical practice at MetroHealth Medical Center in Cleveland, Ohio. She developed a continuing education course for physical and occupational therapists called “Simplifying Sacroiliac Dysfunction,” and has been teaching it since 2011. Deborah is the owner of Riczo Health Education and speaks nationally on sacroiliac dysfunction in addition to teaching physical therapy students who are at the doctoral level.

Discover a simple yet effective approach to addressing sacroiliac pain symptoms in Deborah’s book; Sacroiliac Pain: Understanding the Pelvic Girdle Musculoskeletal MethodSM.

For more info on sacroiliac pain, see Deborah’s blog at RiczoHealthEducation.com.

READ MORE Deborah B. Riczo, PT, DPT, MEd - April 13, 2018


Close to Home: Minnesota Physical Therapy Association Annual Conference

On Saturday, April 21st, the Minnesota Physical Therapy Association will be holding their annual conference. The event, named “Minnesota in Motion,” will be held at the Minneapolis Park Place DoubleTree by Hilton Hotel.

The one-day format will include the annual membership meeting, lunch, awards, exhibits and three separate sessions of educational courses, capped off with a “Celebration of Physical Therapy.” In addition, students from local PT programs will have a chance to share some of the research they’ve been conducting. Overall, the event promises to provide a great opportunity to learn, network and enjoy all things physical therapy.

As a Minnesota-based company, OPTP is looking forward to exhibiting at the local event and being part of the “hometown crowd.” Attendees who stop by our booth will get to see a variety of new and exclusive physical therapy products, including the following recently published books.

Pain Neuroscience Education: Teaching People About Pain
This clinician book provides an evidence-based perspective on how the body and brain work together to create pain, teaches how to convey this new view of pain to patients in a way that’s easily understood and demonstrates how to integrate pain neuroscience education into a practice. The revised second edition of Pain Neuroscience Education, which contains significant updates and new content, is written by physical therapists Adriaan LouwEmilio Puentedura, Steve Schmidt and Kory Zimney.

Thrust Joint Manipulation Skills for the Spine
This new manual therapy textbook explains when and how to effectively perform thrust techniques for patients with musculoskeletal dysfunctions in the spine. Thrust Joint Manipulation Skills for the Spine is designed to familiarize the reader with the concept of focusing to engage the barrier as it relates to patient comfort, and provides clinical pearls to enhance skill acquisition and technique. Perhaps most unique to the book is its access to videos demonstrating 45 techniques, allowing viewers to watch and learn from the authors and master clinicians; Emilio Puentedura and William O’Grady

Additional Physical Therapy Products
In addition to these books, OPTP will have an assortment of posture and back pain products such as lumbar rolls and other McKenzie Method® products, as well as hand therapy products like our Handii™ Healthy Hands. The versatile new Performance Wedges™ and Performance Block™, which offer endless exercise possibilities for increasing strength and range of motion, will also be on display. And of course, we’ll have products for myofascial release and massage therapy on hand as well, such as foam rollers and the new PRO Soft Release Ball, a soft density 5” diameter foam massage ball.

In Our Own Backyard
While our staff are accustomed to traveling far and wide for conferences and tradeshows — even internationally on occasion — it will be nice to stay close to home this time around. We’re looking forward to supporting the Minnesota Physical Therapy Association and encourage all those interested in attending to learn more and register at the annual conference website. We hope to see you there!

READ MORE Josh Crane, OPTP Staff Writer - April 13, 2018


From the Authors | William O’Grady: Thrust Joint Manipulation Skills for the Spine

In the first installment of our “From the Authors” series, Bill O’Grady tells us about his inspiration and intentions for writing Thrust Joint Manipulation Skills for the Spine, an exclusive new manual therapy textbook he co-authored with Emilio (Louie) Puentedura.

Louie and I had been teaching together for 10 years when we set out to write this book. Between the two of us, we brought almost 90 years of clinical experience and teaching to the table.

We both gravitated toward this field because we found that skillful application of these techniques provided such obvious successful outcomes. Its natural appeal was that we could witness immediate improvement in both the symptoms and quality of life for our patients.

We were fortunate to have great mentors and influences like Freddy Kaltenborn, Olaf Evjenth, James Cyriax, Stanley Paris, Geoff Maitland, Robin McKenzie, Dick Erhard, Peter Gibbons, Phil Tehan, David Lamb, Cliff Fowler, Erl Pettman and Laurie Hartman. Many of these renowned gentlemen authored their own textbooks on mobilization and thrust manipulation, and several of them were groundbreaking for our field. Needless to say, there are many books that provide descriptions of thrust techniques.

When Louie and I decided to write this book, we wanted to incorporate our education, clinical experience and teaching. Our goal was to publish a book that is simple to read and geared not only toward the entry-level and residency/fellowship student, but also the educator.  

The book includes a history of thrust joint manipulation (TJM) as well as research on the effectiveness, safety and clinical reasoning of using TJM. But we feel what makes our book most unique is the content in chapters five and seven.

Chapter five provides drills that both the student and educator can use to hone their thrust manipulation skills. There are drills in perfecting patient handling/palpation, stance, appreciating end feel as well as use of the core and larger muscle groups for control and speed development.

Chapter seven provides the “meat and potatoes” of the book. Each technique is briefly described, followed by the key recommendations of when to use it, which tests to perform after “red” and “yellow” flags are ruled out and the primary muscle groups that need to be activated to cue the operator and successfully perform the thrust. It is our belief that the larger muscle groups are responsible for speed and control while the hands are simply extensions of these muscles.  

Each technique is divided into five bulleted parts; “patient position,” “therapist position,” “points of contact,” “position for the thrust” and “application of the thrust.” Below each technique the reader will find tips for fine tuning and keys to success. These “clinical pearls” are provided to help the clinician/student perfect their TJM skills. The techniques and fine-tuning pearls are described in significant detail, providing the building blocks for effective and safe TJM to the spine.

Finally, the online videos provide both a “real time” thrust manipulation and a second step-by-step instruction of each technique. Easy online access allows the clinician to view techniques on their mobile phone or tablet from anywhere, at any time.


William H. O’Grady, PT, DPT, OCS, FAPTA, FAAOMPT, DAAPM
Dr. O’ Grady is a nationally recognized expert in the management of spinal disorders and has taught manipulative techniques for over 40 years. He has served as chair of the Board of Examiners for the American Academy of Orthopedic Manual Physical Therapists (AAOMPT), and as an instructor in advanced manipulation technique for the University of Southern California spine fellowship program as well as an adjunct professor at the University of Nevada, Las Vegas.


Discover how the clinical pearls from Bill and Louie’s book can enhance your practice and understanding of spine manipulation. Learn more about Thrust Joint Manipulation Skills for the Spine.

READ MORE William H. O’Grady, PT, DPT - March 21, 2018


Training for Balance: It's More Than Just an Act

When it comes to balance exercise, chances are you’ve seen some pretty amazing feats. But is performing one-legged squats on a tightrope while blindfolded really essential for developing balance? Or merely entertainment?

It’s easy to see why some might equate balance training to a circus act. Performed for the sake of function and fitness, however, this type of exercise has several valuable benefits, including development of strength, muscle control, body awareness and proprioception (perception of movement and spatial orientation).

In fact, some experts believe that balance and strength are inseparable, and we achieve them simultaneously through proper training. The battle cry of ZeSa® Fitness founder Shanti Rainey, for example, has become simply, “Balance is strength. Strength is balance.”

Here are three basic approaches you can take to balance training — along with some exercise and equipment recommendations — to help you get started.*

1. Instability from Your Body
Using your own body weight is always an effective way to exercise, no matter the discipline or goal. By simply placing yourself in unstable positions and attempting to hold them with control, you can enhance your sense of balance as well as improve core strength and stability.

Try it out: Using an exercise mat or balance pad, stand with your feet shoulder-width apart, and put your hands on your hips. Then, lift one foot and place it on the inside of your opposite leg. See how long you can stand on one leg in this position. Not as easy as it looks! Use a stopwatch to track your progress. Ready for the next level? Take your raised leg out to the side or in front of you as far as possible and hold it there.
 
Balance Pad Demo
 
 
2. Instability from Your Foundation
Any time you make the surface underneath you unstable it can quickly advance the degree of difficulty, and products like balance boards offer a safe way to do this. One of our favorites is the Wobblesmart®, a durable wooden board that allows you to easily adjust between six challenge levels by rotating a rubber dome on the bottom (each twist increases the angle by three degrees.)

Try it out: Since balance boards do not give you the stable foundation of a balance pad, start with easier, more basic movements. First, try standing on the board with both feet, shoulder-width apart, hands on hips. Then, progress to one leg or performing simple movements like a squat.
Wobblesmart Demo

A truly innovative product that offers additional possibilities for balance and fitness training is the new ZeSa® Activator Training Platforms. These unstable rotational platforms feature a swiveling top and are sold as a pair, which means they can be used singly or together. Because the ZeSa Activators pivot and rotate, they allow you to move through all three planes of motion; forward and backward, side to side and rotationally, stimulating maximum muscle recruitment. They’re ideal for a wide variety of exercises like planks, squats and pushups, as well as yoga movements.

Basic Squat
A standard squat movement can offer a great stability challenge when using both ZeSa Activators. To perform the movement, start by standing on both legs and maintaining your balance. Then, bend your knees and push your hips back. Lower your hips to 90 degrees. With control, use the strength of your legs and core to push back up to the starting position.
Zesa Demo

Another versatile balance tool to consider is the Disc O’ Sit Balance Disc. This inflatable disc can be used for postural training while seated as well as balance exercise while sitting or standing. The more you increase the inflation, the greater stability challenge it will provide.

Boat Pose
To perform this popular yoga move, sit in the middle of the Disc O’ Sit and balance yourself with control. Lean back slightly and raise your arms out to your sides to help steady yourself. Then, bend your knees and pull them in toward your chest. Use your core strength to hold this position with control for as long as possible.

Disc O Sit Demo

3. Instability from Weight
Traditional fitness equipment like barbells, dumbbells and kettlebells also offer great exercise options. For example, grabbing a dumbbell in each hand and walking around the room (often called a “Farmer’s Carry” and derived from the chore of steadily transporting heavy buckets of milk on the farm), can be highly effective for building strength and balance. Even if you don’t plan on milking cows, these types of exercises hold real-world application for tasks like carrying bags of groceries, moving furniture, etc.

Try it out:
Pick up a dumbbell or weighted exercise ball in one hand and walk around the room. Be mindful of your posture, making sure not to not let yourself tilt too much to the weighted side. Advance this exercise by performing an overhead carry; hold the weight in one hand above your head and walk around the room while maintaining your balance.
 
 
Ready for the “new school” method of weighted balance training? The ActivMotion Bar® features weighted ball bearings that shift inside the bar for an added test. It’s available in several different weights, but even the lighter versions offer a dynamic challenge as you use your core muscles to try and stabilize the rolling weight. It’s a great tool to enhance not just your balance but also body awareness and proprioception. The following exercise is just one of many that will really enable you to experience the effects of the Bar’s moving weight!

Lateral Lunge with Rotation
From a standing position, lunge to one side and swing the ActivMotion Bar across and behind your hip. Return to starting position by returning your trunk and the Bar to center as you step back from your lunge. Repeat on the other side. Increase your speed and use the momentum of the shifting weights to create resistance at the end ranges of motion.

Balancing Fun with Function
Whether you’re part of an active aging population looking to maintain body control, part of the fitness crowd focused on challenging your core strength and stabilization, or anywhere in between, balance training can play a crucial role in developing important functional skills that assist us in our everyday activities. And even though it doesn’t have to be a circus act, there’s still plenty of room for having fun while achieving your goals.

For more exercise and equipment ideas that will help you with your training, check out OPTP’s entire section of balance products.

* Always consult with your healthcare provider before starting any new exercise program.

READ MORE Josh Crane, OPTP Staff Writer - March 12, 2018


APTA CSM: New Evidence-Based Books Published by OPTP

It’s official. The 2018 American Physical Therapy Association Combined Sections Meeting in New Orleans was the largest ever, with more than 17,000 in attendance. OPTP enjoyed our time as an exhibitor at the event and we were grateful for the opportunity to unveil several new, exclusive books from authors who attended and presented at CSM.

We’re proud of our partnerships with these physical therapy experts and congratulate them on their newly published books! For those who couldn’t attend or didn’t get a chance to swing by our booth, here’s a quick look at a few of these new educational resources.
  • Pain Neuroscience Education. Written by Adriaan LouwEmilio Puentedura, Steve Schmidt, and Kory Zimney; all four of whom presented at the conference. The revised second edition of this book provides an evidence-based perspective on how the body and brain work together to create pain, showing how to convey this new view of pain to patients.
 Pain Neuroscience Education

The new Pain Neuroscience Education book from Adriaan Louw, Emilio Puentedura, Steve Schmidt, and Kory Zimney.


 
Louie and Bill

William O’Grady and Emilio Puentedura with their new book, Thrust Joint Manipulation Skills for the Spine.

 SMARTROLLER Guide

The SMARTROLLER® Guide to Optimal Movement, 2nd Edition by Stacy Barrows.

  • Sacroiliac Pain: Physical therapist Deborah Riczo authored this book, which provides basic education, screening guidelines, and exercises for those affected by sacroiliac dysfunction. It also includes access to online videos demonstrating exercises as well as an exercise planner for logging workouts.
Deb Riczo

Author Deborah Riczo shows off her new book, Sacroiliac Pain.


Again, congrats to these accomplished authors. We’re certain that the valuable information in their new books will help improve the health of many people. And of course, a big thanks to the APTA for putting on such an amazing event. We had a blast and we’re already looking forward to next year!

READ MORE Josh Crane, OPTP Staff Writer - March 2, 2018


Resistance Bands: The Ultimate in Exercise Versatility (Plus, 3 Must-Do Moves)

There’s no shortage of great exercise equipment out there. From stability balls to balance boards to various Pilates props to traditional free weights like dumbbells, most people will have no problem finding something to help them reach their fitness goals. In fact, it might be a bit overwhelming trying to figure out which items to make a part of your routine.

An All-around Champion
One type of exercise tool that almost anyone can use, enjoy, and benefit from is the versatile resistance band. Thanks to its simplicity, there’s not much of a learning curve required. And, because it can be used to perform so many different types of exercises, it can help people of all ages and ability levels achieve many different goals in physical therapy, general fitness, Pilates, and even more elite training.
Sanctband Exercise Tubing with Handles
One of the traits that makes the resistance band so adaptable is its varying degree of challenge. Products like Sanctband® Resistive Tubing with Handles, for example, are available in four color-coded levels of resistance, from light to extra heavy. This allows for progression as your strength increases. Or, if you prefer to work on muscle endurance, you have the option of performing a higher number of repetitions with the lighter bands.

Other products, like the Sanctband Loop Band and Sanctband Super Loop Band, also offer multiple resistance levels but allow for more niche training due to their unique design. Their continuous loop makes them ideal for hip abduction exercise, lateral band walks, sports-specific movements, and more.
Sanctband Loop Band
The “Take it with You” Tool
Another benefit of the admirable resistance band is its portability. Unlike larger, heavier, and more awkward exercise equipment, resistance bands generally fold up easily and can be taken with you wherever you go. This includes the gym, Pilates studio, rehabilitation clinic, or even hotel room while on travels. Some products, such as the Sport Cord® Kit, come with a convenient carrying bag for even easier transport.
Sport Cord Kit
All Muscles, Great or Small
Perhaps the greatest advantage of resistance bands, however, is their ability to provide a total-body workout from head to toe. Whether you want to focus on the larger muscle groups or isolate smaller ones, the exercise possibilities are endless. In the upper body, you can work the chest, back, shoulders, biceps, and triceps. Looking to target the lower body? Hit the quadriceps, hamstrings, hips, glutes, and calves. And don’t forget about your core; resistance bands make it easy to target both upper and lower abdominals, as well as the obliques and low back.  
 
One of the easiest ways to hit all these muscles effectively with your resistance bands is with the Resistance Band Wall Anchor by Bob and Brad. This set of three clips attaches firmly into a wall stud using the provided screws, securing your resistance bands during even the most intense exercise. In fact, each clip can accommodate a pull force of 800 pounds!
Resistance Band Wall Anchor
You can attach the three clips to lower, middle, and upper attachment positions on the wall. Installing at these multiple heights produces a variety of different angles for hundreds of movements. Additionally, each clip features three individual attachment points for your bands or tubes, allowing for even more options.

Created by physical therapists Robert Schrupp and Bradley Heineck, each wall anchor kit also contains a Sanctband resistive band, exercise poster, and access to online exercise videos to get you started. Below are three of the exercises featured on the poster; just a few of the hundreds that can be performed with the wall anchor kit. Get your resistance band setup ready and try them out!*

Resistance Band Lat Pulldown

Lat Pulls (Back, Shoulders)
  1. Attach the resistance band to a wall anchor clip positioned above your head. (Assembly instructions say the clip should be positioned at a height even with your wrist as you reach above your head.)
  2. Stand facing the wall clip. Grab each handle or end of the band and pull toward you, bending at the elbows and using your mid and upper back muscles to perform the pull. You should retract your shoulder blades toward each other and squeeze at the end of the movement.
  3. Hold for a second at the end of the movement, then gradually allow the band to release with control.
Resistance Band Core Twist
 
Core Twist (Abdominals, Obliques)
  1. Attach the resistance band to a wall anchor clip positioned at about shoulder height. (You can also perform this exercise starting from a lower or upper clip position.)
  2. Stand perpendicular to the wall clip. Grab each handle or end of the band with hands together.  
  3. From the waist, using your abdominals and obliques, turn your upper body out away from the wall clip as far as you can, making sure to keep your lower body still and planted.
  4. Hold for a second at the end of the movement, then gradually allow the band to release with control.
Wall Anchor Hip and Glute Extension
 
Hip & Glute Extension (Hips, Glutes, Hamstrings)
  1. Attach the resistance band to a wall anchor clip positioned just a few inches above the floor.
  2. Attach an ankle strap to each end of the band. Tighten the straps firmly around your ankles.
  3. Stand facing the wall clip and learn forward. Place both hands on the wall or solid object for support and balance.
  4. From the hip, using your glutes and hamstrings, pull the band back away from the wall clip. Keep your leg straight and do not bend at the knee.
  5. Go back as far as you can and hold for a second at the end of the movement. Then gradually allow the band to release with control.
The key to successfully performing these and other resistance band exercises is the ability to maintain smooth and controlled tension throughout the entire movement. If you’re used to working with free weights, machines, or pulleys, it’s a different feel and might take some getting used to, but you’ll quickly be able to develop the right tempo.

King of Versatility
Whether you’re ready to take your advanced training to the next level or just looking to increase mobility, endurance, and strength, resistance bands are a great option. They can also function as a warmup tool before your regular routine, or as part of a stretching regimen at the end of a workout to aid in recovery. With all this versatility, they might just become your favorite new exercise partner.


*Always consult with your healthcare provider before starting any new exercise program.   

READ MORE Josh Crane, OPTP Staff Writer - February 27, 2018


Play Jazz: OPTP Prepares for American Physical Therapy Association Combined Sections Meeting in New Orleans

As the winter weather carries on mercilessly here in Minnesota, our thoughts are already turning to warmer temperatures. And to a very festive, jazzy location: New Orleans, site of the 2018 American Physical Therapy Association Combined Sections Meeting, held February 21 - 24.

With over 12,000 health professionals set to attend, the annual Combined Sections Meeting is the largest conference on physical therapy in the country. OPTP will be an exhibitor and is preparing to showcase a wide range of new products, many of which are being unveiled for the first time at the event. Attendees can stop by the exhibit hall on Thursday, Friday, and Saturday to visit OPTP in booth #624.

Well Read…

Among OPTP’s new and exclusive products that will be on display are a number of books from accomplished authors, including several who will be presenting at CSM. Following is a preview of a few of these books, whose topics range from pain neuroscience to manual therapy to mindful exercise with a foam roller.
Pain Neuroscience Education

Pain Neuroscience Education: Teaching People About Pain

The revised second edition of this highly anticipated clinical guide contains significant updates. A book by clinicians and for clinicians, it provides an evidence-based perspective on how the body and brain work together to create pain, teaches how to convey this new view of pain to patients in a way that’s easily understood and internalized, and demonstrates how to successfully integrate pain neuroscience education into a practice.

The textbook is written by physical therapists Adriaan LouwEmilio Puentedura, Steve Schmidt, and Kory Zimney. Attendees of CSM will have a chance to hear all four of these esteemed authors present on various topics at the conference, and a list of their presentations sorted by name can be found on the APTA website.

Thrust Joint Manipulation Skills for the Spine

Thrust Joint Manipulation Skills for the Spine
This new manual therapy textbook explains how to effectively perform thrust techniques, allowing therapists and students engaged in the practice to understand and safely apply the concepts. Thrust Joint Manipulation Skills for the Spine is designed to familiarize the reader with the concept of focusing to engage the barrier as it relates to patient comfort, and provides clinical pearls along the way to enhance skill acquisition and technique.

Perhaps most unique to the book is its access to videos demonstrating 45 techniques, allowing viewers to watch and learn from the authors and master clinicians; Emilio Puentedura and William O’Grady.

SMARTROLLER Guide to Optimal Movement

SMARTROLLER® Guide to Optimal Movement, 2nd Edition
Written by physical therapist Dr. Stacy Barrows, this is a book for anyone who wants to move with greater comfort, ease, and mindfulness. It provides exercise instructions for the SMARTROLLER®, a unique two-sided foam roller that helps promote balance, awareness, and core strength, while recognizing tensegrity concepts.

New updates to the second edition of the book include quick lessons called “SMARTROLLER Shortcuts,” with links to online videos demonstrating the movements. The latest neuroscience and fascial research make the guide relevant for multiple areas of practice, including physical therapy, Pilates, Feldenkrais®, and yoga.

Sacroiliac Pain

Sacroiliac Pain: Understanding the Pelvic Girdle Musculoskeletal MethodSM

Physical therapist Deborah Riczo has authored this book, which provides basic education, screening guidelines, and exercises for those affected by sacroiliac dysfunction. It introduces the Pelvic Girdle Musculoskeletal MethodSM, a program that empowers individuals to monitor their sacroiliac (SI) pain symptoms and address them with exercises that focus on muscle imbalances and weakness, as well as stretches that can be enhanced with the OPTP Stretch Out Strap™.

Sacroiliac Pain also includes access to online videos demonstrating the exercises, an exercise planner for logging workouts, and an FAQ section that discusses when to use an SI support belt or other products such as the PFProp™, an exercise tool for strengthening the pelvic floor muscles.

More than Words…

Of course, OPTP will have more than just books at the booth. New therapy products like the OPTP Positioning Cube, PRO Soft Release Ball, and the Performance Block™ and Performance Wedges™ will be on hand. OPTP staff will be at the booth to discuss all items in more detail, answer questions, demonstrate products, and talk shop. There is even rumor of a book signing from some of the authors.

Between the top-notch programming, incredible lineup of presenters, and all the additional APTA activities and local flare of NOLA, CSM 2018 promises to be a memorable adventure. We’ll see you in New Orleans!

READ MORE Josh Crane, OPTP Staff Writer - February 13, 2018


Central Sensitization: Does the degree of Fibromyalgia-ness matter?

The combined 2017 International Pelvic Pain Conference (IPPS) and 3rd World Congress on Abdomino-Pelvic Pain in Washington, DC was well attended, well organized and an excellent combination of clinical expertise and research dissemination. Many great conversations and presentations centered around both central and peripheral drivers of persistent abdominal and pelvic pain.

Dr. Daniel Clauw set the tone in his keynote address on central and peripheral mechanisms. He presented on the degree of “fibromyalgia-ness” as measured on the Modified American College of Rheumatology Fibromyalgia Diagnostic Criteria (Mod ACR-FDC)(1) in conditions such as knee osteoarthritis, which historically have been equated with dominant nociceptive drivers, not central pain mechanisms.

Fibromyalgia-ness is a term coined by Wolfe (2009). (2) He writes that the symptoms of fibromyalgia (central sensitization) occur as a continuum in the population, rather than simply being present or absent (2). In disorders such as rheumatoid arthritis, lupus, low back pain, and pelvic pain to name a few, the Fibromyalgia (FM) score is more predictive of pain levels and disability compared to more objective measures of the disease and/or the tissues themselves(2,3).

Nineteen of the 31 points on the Mod ACR-FDC are based on how widespread the pain is, and the other 12 points are derived from co-morbid symptoms that accompany central sensitization including lack of sleep, fatigue, brain fog, headaches, lower abdominal pain and depression. A total score is created by adding up the two subscales. The cut-off for Fibromyalgia is 13 or greater. (1)

For anyone who knows me, it will not surprise you to hear that I have a love affair with questionnaires. Questionnaires help inform treatment, and allow us to direct appropriate treatment to the phenotypes of central pain mechanisms.

Dr. Clauw recommended that we use the Mod ACR-FDC to first reliably identify central pain mechanisms within conditions not historically linked with this clinical picture, such as knee osteoarthritis. The Mod ACR-FDC is a quick screen to assess how widespread the pain problem is, which is strongly correlated with central sensitization.

In Dr. Clauw’s study on knee osteoarthritis and total knee replacement (TKR), each one point increase in fibromyalgia-ness on the Mod ACR-FDC led to nine mg greater oral morphine requirement during post-surgical hospitalization, and 20-25 percent greater likelihood of failed pain relief from surgery. These phenomena were linear across the entire scale up to a total score of approximately 18, and equally strong even after individuals who met criteria for FM (total score of 13 or greater) were excluded. This phenomenon was much stronger than, and largely independent of, classic psychological factors for predicting central sensitization. 

Dr. Clauw reported that the most prevalent pain conditions in younger individuals are now thought to be more “central” than “peripheral.” Central pain mechanisms can also be identified within individuals who present with concurrent nociceptive or neuropathic pain states. Patients often present with a mixed pain state, and both nociceptive drivers and the nervous system need to be evaluated. 

This still remains deeply unappreciated in clinical practice so there is marked overuse of tissue-based treatments for persistent pain (opioids, injections, surgery, mobilizations) when the target should be the central nervous system (CNS). Rather than thinking of FM as a disease, think of it as a CNS-driven pathophysiological process that can co-exist with many other disease processes. 

Identification of central sensitization is vitally important. But what happens next? In the example above, which patients need to strengthen their quadriceps? Who should be operated on? Who should be mobilized or manipulated? Who needs pain education? Who would benefit from yoga, qi gong, or tai chi?

Let’s not create a “label” of central sensitization and get trapped in the same research quagmire as we have for the past few decades with non-specific low back pain (LBP). Low Back Pain is not non-specific, and neither is central sensitization. However, they are both complex disorders with characteristics significant to the individual and their presentation.

Long et al (2004) published an RCT in Spine demonstrating that 74 percent of 312 acute and chronic LBP patients have an identifiable directional preference by using a standardized mechanical assessment. (4) Their conclusions stated, “regardless of subjects” direction of preference (DP), the response to contrasting exercise prescriptions was significantly different: exercises matching subjects’ DP significantly and rapidly decreased pain and medication use and improved in all other outcomes. If repeatable, such subgroup validation has important implications for LBP management.” Despite the reliability of identifying directional preference, and the matched response in decreased pain and medication, mechanical pain has not become a recognized phenotype of LBP to assist research to target efficacious exercise prescription.

Let’s not get stuck in this same dilemma with central sensitization. We need to create phenotypic characteristics of central pain mechanisms and investigate the best interventions for each phenotype. This starts with utilizing validated questionnaires such as the Pain Catastrophization Scale (PCS), Tampa Scale of Kinesiophobia (TSK), Depression, Anxiety and Stress Scale (DASS-21), Positive Affect, Negative Affect Scale (PANAS) and Fremantle Back Questionnaire (FreBAQ) to identify the phenotypes of a sensitized state. There is already a cache of well-validated treatment modalities for the sensitized nervous system such as pain education, yoga, mindfulness meditation and qi gong/tai chi, all based on strong therapeutic alliance and self-efficacy, two further potential targets.

By way of example, mindfulness meditation is not going to be the panacea for everyone with central sensitization; however, certain phenotypic patient characteristics such as rumination, magnification, and a high degree of secondary suffering may be clinical indicators for those who would respond best to mindfulness meditation. However, if we don’t specifically measure rumination and magnification, how will we know?

And, if we don’t measure central pain mechanisms, we will remain focused on treating the nociceptive drivers. I, for one, will take Dr. Clauw’s recommendation and start looking at my persistent pain patient’s fibromyalgia-ness, and start assessing the clinical relevance of this new piece of research. I will compare it to using the Central Sensitization Inventory (CSI) for persistent pain, and assess which provides more clinically relevant and measurable information. They both measure the degree of central sensitization. Evaluate both in the clinic for yourself to see which best fits your practice and practice style.

Thank you Dr. Clauw for your inspiring lecture!
  1. Wolfe, F., Clauw, D., Fitzcharles, M., Goldenberg, D. Hauser, W. Katz, R., Mease, P., Russel, A., Russell, I., and Walitt, B. (2016). 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Seminars in Arthritis and Rheumatism, 46(3), pp. 319-329.
  2. Wolfe, F. (2009). Fibromyalgianess. Arthritis & Rheumatism, 61(6), pp.715-716.
  3. Clauw, D. (2014). Fibromyalgia. JAMA, 311(15), P.1547.
  4. Long, A., Donelson, R, and Fung, T. (2004). Does it matter which exercise? Spine, 29(23), pp.2593-2602.

About the Author
Carolyn Vandyken, BHSc (PT), Pelvic Health Physiotherapist, has practiced in a wide variety of clinical settings and has spoken at over 50 conferences and presentations throughout Canada and the United States. She owns a Canadian-based teaching company, Pelvic Health Solutions, and manages her own clinic, Huntsville Pelvic Health and Pain Centre in Huntsville, Ontario. 

READ MORE Carolyn Vandyken, BHSc (PT) - December 1, 2017


Playful Self-Care for Our Hands

Hands are truly amazing!

Our hands allow us to do everything from completing routine tasks to creating unique masterpieces. Unfortunately, many of us use our hands too much and the rest of our bodies too little. Repeated reliance on our hands for work and daily living often progresses toward overuse of our upper extremity muscles and joints.

Also problematic is our tendency to use one hand more than the other. And with so many everyday activities — computer use, texting, reading, driving, cooking — our hands are positioned out in front of our bodies, leading to postural stresses and muscle imbalances.

Awareness and Movement
Caring for hands requires moving your whole body in many ways — reaching, pushing, pulling, and climbing — actively exploring full end-range movements of your hips, spine, shoulders, arms and hands.  

Awareness of body positioning is also essential in caring for our hands. Any task that requires standing or sitting in one position for long hours can wreak havoc on posture. Ease the stress by increasing the variety of your movements and changing your position every 15–20 minutes. Nurture your hands with frequent movement breaks and keep your wrists neutral when using any equipment, limiting forceful pinching, gripping and holding.

One way we can be more aware of our positioning is to invite playful exploration into our daily routines. Spending a few minutes each day rolling with small bright-green balls called Small Health Balls™ is a great way to do this. These miniature massage therapy balls are designed to direct concentrated pressure to areas of tightness in our muscles and fascial tissues that are a result of poor posture, inflammation, or trauma.

The practice of ball rolling helps us notice our capabilities and imbalances, observe our movement patterns and postural habits, experience alignment and support, and connect our body and mind. Spontaneous rolling and releasing can restore and create healthful, efficient, and balanced movement and function.  

Finding the “Green Zone”
During ball rolling, the release of tightness and tension from our muscles and connective tissues often corresponds with a release of emotional stress and tension. Neuropsychologist Rick Hanson, PhD describes this responsive mode of the brain as the “green” zone. It is characterized by activation of the parasympathetic nervous system, with the body settling down, calming, repairing, refueling, and evoking feelings of gratitude, contentment, and kindness.

In contrast, the reactive mode is known as the “red” zone and defines the fight-or-flight sympathetic nervous system activation known for fear, intensity, possessiveness, and aggression. Although both brain modes are natural and necessary, our everyday wellbeing and long-term health benefit from leaving “red” and centering in “green” as often as possible.

Rolling with Small Health Balls helps discover physical barriers, welcoming “playing through” rather than “working through” difficulties, and leads to discovery of other barriers, including blockages in our thinking and feeling. As we invite the beneficial changes of softening and relaxing into our bodies, our minds and emotions follow.

Getting Rolling
Include ball rolling and self-massage techniques throughout each day to counteract some of the repetitive movements and poor postural habits associated with daily tasks. Here are a few movements selected from my latest book, Ball Rolling for Happy, Healthy Hands, to begin exploring self-care techniques for your hands, arms, shoulders and neck. Remember to breathe deeply and fully, releasing tightness and tension during every exhalation. Choose the amount of pressure that feels best for you, while staying mindful of your body posture and positioning.

Top of Shoulder Roll & Release

Benefits: Releases tightness and tension; improves posture; enhances neck and shoulder mobility
  • Slowly roll the ball on top of your shoulder, pausing on any tight or tender regions. Explore pressing with light to moderate pressure, releasing tightness and tension. Lift the elbow with your supporting hand to effectively guide the rolling movements.
  • Try adding neck movement while gently pressing the ball into a tender point – slowly bend your neck sideways toward the ball, then slowly away from the ball, and return to neutral. 
Outer Forearm Roll & Release

Benefits: Releases tightness and tension; improves elbow, forearm and wrist mobility; enhances arm function
  • Starting near your elbow, slowly roll the ball along your outer forearm toward your wrist. Pause and play on any tight or tender points. Try pressing the ball with very small, rhythmic side-to-side or circling motions, using light to moderate pressure.
  • Add wrist movement while gently pressing the ball into a tender point – slowly extend and flex your wrist. 
Thumb Roll & Release
Benefits: Releases tightness and tension; improves hand mobility and function
  • Starting near the base of your thumb, slowly roll the ball along the thumb region. Explore pressing the ball with light to moderate pressure and small, circular friction movements.
  • Add thumb movement while gently pressing the ball into a tender point – slowly move your thumb toward and away from the ball.
Knuckle Decompress
Benefits: Releases tightness and tension; improves hand mobility and function
  • Place a ball between two fingers and curl your fingers to make a loose fist. Slowly and gently squeeze two to three times. Repeat squeezing and letting go between each finger of both hands, including between your index fingers and thumbs.
  • Open your hands wide, extending and moving all fingers in a variety of directions.
After rolling, take a moment to notice any changes in your flexibility, ease of movement, comfort, and alignment. Exercise with the Small Health Balls encourages the body-mind connection while discovering movements that feel good to your hands, arms, shoulders, and neck. Make it a habit to perform these movements on a daily basis and don’t forget to have fun in the process — we’re more likely to adopt new routines of self-care when they’re enjoyable.


About the Author
Angela Kneale, OTD, MA, OTR/L, NBC-HWC, is an occupational therapist, integrative health coach, Franklin Method® educator, and certified Stott Pilates® instructor. Her professional experience includes industrial rehabilitation, employee wellness, and care for individuals with chronic pain, physical disabilities, and neurological issues. The author of eight books including the recently released Ball Rolling for Happy, Healthy Hands, Angela specializes in the integration of movement, breathing, postural alignment, and relaxation techniques for optimal health and wellbeing. Learn more at EmbodyHealthWellnessLife.com.

READ MORE Angela Kneale, OTD, MA, OTR/L, NBC-HWC - November 28, 2017


Manual Therapy Grant Winner Acknowledged

Holly Jonely becomes the latest recipient of AAOMPT & OPTP research grant


At the recent American Academy of Orthopedic Manual Physical Therapists (AAOMPT) Conference in Salt Lake City, Utah, physical therapists gathered from all over for several days of learning and networking.

As an exhibitor at the event, OPTP was showcasing its manual therapy products and educational materials, but was also excited to continue an important tradition.

For more than 10 years, OPTP has worked with the AAOMPT to provide grants for important research within the manual physical therapy field. Once again in 2017, we were proud to offer this funding to enable more great work to be done.

This year’s grant recipient was Holly Jonely of The George Washington University and Johns Hopkins Hospital. She and her research team will be investigating how manipulation of the spine could lead to improved breathing. Here are more details on their project:

Project Name
Thoracic manipulation to improve pulmonary ventilation

Project Summary
Pathology in ventilatory function (VF) is often treated by pharmacologic agents. However, the orthopedic components of thoracic excursion (TE) made possible by combined movements from costovertebral (CVJ), costotransverse (CTJ) and sternocostal joints, are not targets of pharmacologic interventions yet might play a key role in mediating VF. 

To date, very few studies have systematically examined joint manipulation procedures involving the joints of TE for the purpose of improving TE. This exploratory pilot study seeks to do so, aiming to:
  1. Examine the immediate effects as well as between-group effects of thoracic joint manipulation or sham intervention on VF and TE and;
  2. Determine the effects of thoracic manipulation or sham intervention on VF and TE after three sessions of thoracic manipulation interventions.
Project Team
The research team includes one principal investigator and four co-investigators. All five members are physical therapists, with three who are AAOMPT fellows, one who specializes in cardiopulmonary rehabilitation and patient care, and one who specializes in exercise physiology and pulmonary function.
  • Principal Investigator: Holly Jonely ScD, PT, FAAOMPT
  • Co‐Investigator: Josh Woolstenhulme, DPT, PhD
  • Co‐Investigator: Dhinu Jayaseelan, DPT, OCS, FAAOMPT
  • Co‐Investigator: Joseph Signorino, DPT, OCS, FAAOMPT
  • Co‐Investigator: Ellen Costello, PT, PhD
 
Congratulations to Holly and her team. We wish them the best as they begin work on this exciting project!

READ MORE Josh Crane, OPTP Staff Writer - November 22, 2017


Pilates Method Alliance Conference: Definitely Epic

The 17th Annual Meeting of the Pilates Method Alliance, held October 25-28, lived up to its claim of being “One Epic Pilates Conference.” From the amazing Indian Wells, California venue to a packed agenda, we take a look back at some of the event’s highlights.
 
A Fusion of Sport and Pilates
As an ESPN play-by-play announcer for Major League Baseball and college basketball, Jon Sciambi might not have been the typical keynote speaker for a Pilates conference. But as someone who finds balance in Pilates and connects it directly with athletics, he was the perfect fit.  
 
First introduced to Pilates by pitcher Jake Arrieta of the Chicago Cubs, Sciambi realizes the importance of the mind-muscle connection and sense of control that Pilates brings. As he puts it, “It helps me understand how, why and what is actually making something move and fire.” Understanding the anatomy of functional movement is definitely relevant to any athlete.
 
Sciambi addressed his philanthropic work as well, which involves fundraising for ALS, a condition he has personal experience with and for which he strives to bring awareness. He related this important mission to the work of improving lives through exercise, noting that “Carrying around the knowledge and ability to improve someone’s physical state is a powerful currency.” His message was inspiring, and the relationship of Pilates and sport is certainly one that will continue to gain momentum.    
 
A Wealth of Knowledge
Additional speakers from many different backgrounds also shared their knowledge during the event. In fact, over 50 presenters from around the globe provided expertise and insight over the course of the four days.
 

Eric FranklinAmong the many professionals in attendance was mind-body guru Eric Franklin. His famous Franklin Method® uses dynamic imagery, anatomical embodiment, and reconditioning movement exercises to improve how the body functions. Eric has a background as a dancer, and he has provided training to Olympic athletes and professional dance troupes such as Cirque du Soleil.
 

Elizabeth LarkamAnother mind-body movement educator and practitioner that presented was Elizabeth Larkam. Sharing much in common with Franklin, she also has a background in dance and has worked with Cirque du Soleil. She has created Pilates protocols for orthopedic, spine, and chronic pain diagnoses, and collaborated with physical therapists to help wounded soldiers using Pilates techniques.

 
Centered Book
Madeline Black, author and educator, also shared her insights at the conference. Madeline coaches and mentors advanced teachers, raising the level of education and quality in the Pilates industry worldwide. Madeline lives and works at Studio M in Sonoma, California, and is the author of the popular new book, Centered: Organizing the Body Through Kinesiology, Movement Theory and Pilates.


A Host of Cool Products
PMA 2017 wasn’t just about the sharing of information; it also spotlighted some of the industry’s best and most innovative Pilates products. Exhibitors ranged from studios to apparel to props. There was truly something for everyone who strolled through the exhibitor hall.    
 
OPTP brought many of its exclusive Eric Franklin items to the conference so that attendees could see firsthand the tools of his Franklin Method that he discussed in his presentations. The ever-growing collection of Franklin Method products provides users with tension release, efficient movement, and relaxation. Franklin is also the author of 13 educational books for both professionals and individuals, including the recently released Grow Younger Daily, as well as The Art & Science of Cueing, a guide for Pilates educators featuring mental imagery techniques.

Franklin Method Products
 
Also exhibiting was the popular ActivMotion Bar®, perhaps one of the most innovative products to capture the attention of the Pilates world in recent years. The bar features internal ball bearings that shift during movement, producing instability for a challenging workout on a mat or reformer. The 4-foot, 4.5-pound version, offered exclusively from OPTP, is the most popular ActivMotion Bar for Pilates. There is also an exercise manual developed by ActivMotion inventor Derek Mikulski featuring more than 40 Pilates, rehabilitation, and golf exercises using the bar.


 
A number of discs, balance boards, and similar products were also showcasing their applications for Pilates. One of these effective tools for developing strength and balance was OPTP’s Pro Rotating Discs™. With many versatile uses, the discs can help educate hip rotators, increase core strength, and improve range of motion. The rotating 11” diameter discs have their own instructional DVD, “Movement Techniques for Rotating Discs”, developed by the previously mentioned Elizabeth Larkam.

Pro Rotating Discs
 
Already Excited for 2018
Between all of the amazing speakers, motivational messages, and great products, it was hard not to be inspired by the PMA conference. And of course, the luxurious setting of the Renaissance Indian Wells Resort & Spa didn’t hurt, either. Even though we’re still awestruck by the experience, we’re already looking forward to next year…we can’t wait to see what 2018 holds in store.

READ MORE Josh Crane, OPTP Staff Writer - November 6, 2017


Shoulder Health: Exercises for Throwing Athletes

The crisp air descends upon us, and the leaves continue to fall earthward. It’s a beautiful time of year, and also an exciting one for many sports fans. From the MLB World Series to the football season revving into high gear, there’s no shortage of action.

The Golden Shoulder
Whether it’s baseball, football, or other sports that involve a throwing motion, athletes playing at any level know the importance of shoulder health and the risk of injury. In recent years, a strong push has been made in baseball to keep a close eye on the pitch count of players; a big step in the right direction. However, issues from repetitive arm movements can still occur for athletes, especially if proper precautions are not taken.

One of the more common shoulder conditions we hear about is the rotator cuff tear, which occurs when injuries to the muscles or tendons cause tissue damage in this area. The American Physical Therapy Association (APTA) has some good information on the anatomy and symptoms of a rotator cuff tear for those who want to learn more. Additional arm injuries include those to the elbow area, such as a tear in the Ulnar Collateral Ligament (UCL) that can result in the need for Tommy John surgery.

Warmup & Injury Prevention
While there are no guarantees when it comes to preventing injuries, there are a variety of healthy habits that we can practice to help reduce our risks. Proper warmup is certainly essential before playing any type of sport or starting an exercise workout. According to the Mayo Clinic, it can not only help reduce injury risk, but also improve athletic performance.

The warmup helps increase blood flow, raise body temperature, and generally prepare your body for the upcoming activity. The Mayo Clinic suggests that an effective warmup can involve doing the same type of activity you’re about to engage in, simply at a slower pace and reduced intensity. For throwing motion athletes, this might mean functional exercises that mimic the arm’s movement.
  1. Arm Circles. Arm circles are one simple way to increase blood flow and warm up the rotator cuff area. They can be done easily, both arms at once, by just creating small circular patterns. Perform the circles for 20-30 seconds, then reverse direction and perform for another 20-30 seconds.
  2. Arm Swings. Another simple method to ready the shoulder for activity is a basic pendulum movement. Start by holding on to a solid object such as a pole with one hand. Then, swing the other arm slowly out in front of the body, then behind the body, going back and forth. Try to gradually progress the range of motion.
Internal & External Rotation
Perhaps one of the best ways to warm and loosen up the shoulder is internal and external rotation. These movements are excellent for increasing flexibility and range of motion, and can also be key for aiding in injury prevention. Although these exercises can easily be done with resistance bands or resistance tubes, using a pulley system can provide constant, reproducible resistance and a smoother, more functional movement.

The TheraPulley® is a basic but versatile pulley system that can be used at home, while traveling, and on the field warming up before play. Unlike more elaborate systems, it packs up into a bag and can easily be taken with you anywhere you go; a portable “gym in a bag.”

The pulley has two anchors; one is stationary and attaches on top of the door, while the adjustable anchor attaches into the hinged side of the door. This allows for movement in different positions with resistance ranges from 1-20 pounds. Watch the video below to see how it works.

 

TheraPulley is an excellent functional mobility tool helping to improve joint range of motion, mobilize the joints, and increase blood flow to the muscles. The following shoulder internal and external rotation moves are just two of many exercises that can be performed with the TheraPulley.    

1. External Rotation - Elbow at Side
  • Mount the bracket on top of the door.
  • Insert the plastic lock into the hinge side of the door at the level of your elbow and close the door shut.
  • Place the desired weight in the bag. You can use cuff weights and/or household items. The external rotators are sensitive and can get strained if you use heavy weights. Start with light weights (one pound) and increase to your tolerance or as directed by your therapist or doctor.
  • Standing sideways with the targeted shoulder away from the door, grab the pulley handle at waist height and move away from your body. Keep your elbow bent at 90 degrees (forearm parallel to the floor).


2. External Rotation - Overhead
  • Mount the bracket on top of the door.
  • Insert the plastic lock into the hinge side of the door at the level of your shoulder and shut the door.
  • Place desired weight in the bag. You can use cuff weights and/or household items. The external rotators are sensitive and can get strained if you use heavy weights. Start with light weights (one pound) and increase to your tolerance or as directed by your therapist or doctor.
  • Standing facing the door, lift your arm and keep the elbow level with the shoulder. Keep your shoulder elevated and your elbow bent at 90 degrees. Grab the pulley handle and rotate the fist from horizontal level toward the ceiling (vertical position).


3. Internal Rotation - Elbow at Side
  • Mount the bracket on top of the door.
  • Insert the plastic lock into the hinge side of the door at the level of your elbow and shut the door.
  • Place desired weight in the bag. You can use cuff weights and/or household items. Start with light weights (one to two pounds) and increase to your tolerance or as directed by your therapist or doctor.
  • Standing sideways with the targeted shoulder close to the door, grab the pulley handle at waist height and move it to your stomach. Keep your elbow bent at 90 degrees (forearm parallel to the floor).


4. Internal Rotation - Overhead 90/90
  • Mount the bracket on top of the door.
  • Insert the plastic lock into the hinge side of the door at the level of your shoulder and shut the door.
  • Place desired weight in the bag. You can use cuff weights and/or household items. Start with light weights (one to two pounds) and increase to your tolerance or as directed by your therapist or doctor.
  • Standing facing away from the door, lift your arm and keep the elbow level with the shoulder. Keep your shoulder elevated and your elbow bent at 90 degrees. Grab the pulley handle and rotate the fist from vertical position to a horizontal level.


The TheraPulley is adaptable for anyone from professional athletes to rehabilitation patients. It has received support from throwing athletes for its role in promoting shoulder health, including high praise from MLB players such as Seattle Mariners hall of fame pitcher Jamie Moyer. As the oldest pitcher to ever start and win a game in the major leagues at the age of 49, Moyer credits much of his extended career and arm health to the TheraPulley.

Prevention is Protection
Preventive exercise can be extremely beneficial when it comes to shoulder health, regardless of your sport, activity, or level of intensity. Not only does a committed warmup aid in athletic performance (increased range of motion, flexibility, and strength), it can help reduce injury risk and ensure the longevity of the shoulder, one of the most mobile yet least stable joint regions in the body.

READ MORE Yousef Ghandour, PT, MOMT, FAAOMPT - October 24, 2017


An Exciting Time for Hand Therapy

Looking forward to the 40th ASHT Annual Meeting…and beyond

 
The American Society of Hand Therapists (ASHT) will be holding their 40th Annual Meeting in Anaheim, California this week, October 12-15. Forty years is a great milestone, and certainly worthy of a grand celebration.
 
Advancing the Industry  
The ASHT, whose members include occupational and physical therapists, physician extenders, surgeons, researchers, and administrators, has undoubtedly seen a lot of change over the course of those 40 years. Changes in the industry that include advances in technology, science, and knowledge of delivering care. In fact, their annual meeting plans to acknowledge this progression directly through its theme; “Inspired by Our Past to Imagine Tomorrow.”
 
According to the ASHT website, the organization is composed of “…hand therapy professionals dedicated to advancing the field of hand and upper extremity therapy by promoting education, advocacy, research, and clinical standards.” And this will be on display this weekend, with the annual meeting program set to include four clinically focused days, as well as a host of prominent speakers who are leaders in their specialties.
 
OPTP is looking forward to attending the event as an exhibitor, and plans to bring numerous hand therapy products to showcase. It’s the first of several October events that OPTP will be attending as part of a busy October therapy and fitness conference schedule. 

Handii™ Healthy Hands
Among the hand therapy products that OPTP will be demonstrating is the new Handii Healthy Hands. This exclusive tool provides resistance exercise that can improve mobility and strength in fingers, wrists, and arms. The hand exercisers come in four resistance levels and are small enough in size to be kept in a purse, gym bag, or even a pocket. Uses for the Handii Healthy Hands include the following:
  • Exercise both flexor and extensor muscles
  • Aid with arthritis or carpal tunnel syndrome
  • Assist elbow tendinitis and tendinosis rehabilitation 
  • Help advance upper limb movement for stroke patients
  • Perform isolation exercises for wrists and fingers  


Small Health Balls™ for Soft Tissue Release
Another hand therapy product that OPTP will have at the ASHT Annual Meeting is this set of four miniature massage therapy balls for soft tissue release. Constructed of latex-free rubber material, the Small Health Balls are firm enough to provide soft tissue release and help eliminate knots while increasing blood flow and hydration. 

The balls are ideal for massage of sore hands, wrists, and forearms in order to relieve tension from stress, poor posture, and repetitive movements. They can also be placed between the knuckles to help alleviate and prevent joint stiffness in the fingers, a common result of daily stressors such as typing on a keyboard. 

Additionally, occupational therapist and integrative health coach Angela Kneale is authoring a ball rolling hand therapy book that will soon be published by OPTP. The book will illuminate different exercises and movements to relieve tension using the Small Health Balls.  

The Future is Bright…
The ASHT 40th Annual Meeting promises to be an inspirational event. OPTP is looking forward to being a part of the weekend, which will be full of cutting-edge technology, innovations in care, and a wide variety of hand therapy products. For hand therapy patients, the future looks bright as they continue to be empowered by the restoring of function and opportunities to lead a fuller life.

READ MORE Josh Crane, OPTP Staff Writer - October 10, 2017


Trigger Points: How They Develop & How to Relieve Them

Many of us are familiar with the massage therapy term “trigger point.” But, outside of those who work with patients and deliver trigger point therapy on a regular basis, how many of us know how trigger points form? And what can be done to relieve these painful annoyances?  
 
How do they develop?
Trigger points develop as a result of muscular injuries, strains, and trauma. When muscle fibers, fascia, ligaments, or tendons become weakened, overstretched, or inflamed, tiny tears in the associated soft tissue can occur. As the tissue heals it contracts, becoming twisted and knotted. These knotted fibers restrict the fresh blood supply needed by the muscle cells. In addition, there is often a shortening of the muscle fiber to protect itself from further injury.
 
Additionally, structural imbalances, improper body mechanics, poor nutrition and mental or emotional stress are all factors. In effect, the muscle learns to avoid pain and guards against it by limiting its movement. This results in a loss of range of motion of the joint and the probability that the muscle and associated structures will develop trigger points. 1
 
Skeletal muscle, the largest single organ of the human body, accounts for 40 percent or more of body weight. As reported, there are 200 paired muscles, a total of 400 muscles, any one of which can develop myofascial trigger points.1
 
How do you locate them?
Trigger points are found within a hard, rope-like or knotted band of muscle. You will know when you have found one as it will be very sensitive to the touch. By sensing this tenderness, you are given an opportunity to become aware of it and to consider its cause. Muscles involved in past surgeries tend to have painful trigger points as do muscles located around the joints. Some points, particularly those between the shoulder blades, will be instinctively located, while others may require a bit of detective work on your part. Gentle stretching of your muscles on a regular basis will provide you with the clues you need to help yourself. 1
 
Most muscles and trigger points are paired. A point on the right side of your body has a corresponding point on the left side. Normally the most tender of these parallel points or muscles will be on the same side that’s painful. Pressure applied to this side will usually give the most relief. For best results, however, pay equal attention to points on both sides of your body.1
 
How do they affect the body?
Trigger points can affect movement by keeping muscles short and stiff, which reduces range of motion. They can maintain spasms in other muscles. They prevent muscles from relaxing, causing them to tire quickly, recover slowly from exertion, and contract excessively when they work. They can also keep muscles out of balance to the extent that they partially disarticulate joints, causing them to catch or pop when you move. 2
 
Movement requires some muscles to contract and others to lengthen. Trigger points can make a muscle reluctant to do either. Stretching or contracting irritates trigger points and increases pain, making you less and less inclined to move. Trigger point massage works extremely well for myofascial pain. Done correctly, it usually shows clear results within a week, often in just a day or two. 2
 
How do you perform trigger point massage?
Of course, one of the best ways to tackle nasty trigger points is to make an appointment with your massage therapist. But there are also many self-therapy tools on the market to help overcome the pain of trigger points. The following trigger point massage tools can help alleviate and prevent discomfort throughout the body.
 
OPTP MicroRoll™
This miniature foam roller measures just 9” in length and 2” diameter. In addition to its small, portable size, it also features circular ridges that provide extra pressure for deeper, more invigorating massage. The unique combination of ridges and small size make the roller ideal for precision targeting of sore muscles in the feet and arms. The MicroRoll is made from a soft EVA foam that provides a comfortable massage.





Thera Cane®
The winner of the “Best Massage Device” in 2011, 2012, and 2013 in About.com Readers’ Choice Awards, Thera Cane is an extremely popular therapeutic massager that is great for those hard-to-reach trigger points in the upper back, neck, and shoulder blade area. It lets you easily perform targeted, deep-pressure massage of sore muscles thanks to its unique design. Each Thera Cane comes with a manual featuring 39 illustrated uses, stretches, and myofascial trigger point information.
 


Franklin Method® Products
Mind-body guru Eric Franklin is famous for having created his Franklin Method, a movement therapy approach that uses exercises and imagery to help improve how the body functions. He has created several massage and trigger point products that are helpful in releasing tension in various parts of the body.




The Franklin Fascia Massager™ Oval is a small tool that is great for treating the hands, neck, and feet, but can be used to release tension and smooth out connective tissue anywhere on the body. The Franklin Fascia Massager Oval has points that provide a more intense massage and wake up the body’s sensory receptors.

 



The Franklin Fascia Ball is designed for rolling out fascia and providing trigger point therapy for comfort. It’s a great choice for hamstrings, glutes, IT bands, and more. The Franklin Fascia Ball is water-filled for a comfortable density and features a smooth surface.  






This pair of red Franklin exercise balls is perfect for massage of constricted fascia. The balls have a smooth surface and a 3” diameter that allows for precise trigger point relief on the shoulders, neck, and hips. The Franklin Mini Smooth Ball™ Set offers the ability to adjust firmness with inflation, a nice feature to personalize the level of comfort.

 


Breaking it down
The products above are just a small sampling of the many trigger point massage tools available. Find what works best for you and stick with it. Regardless of which massage device you try, applying consistent use and an adequate, “just right” pressure will help you conquer those feisty trigger points.
 
 
1) Hennessey, D (2006). Thera Cane Owner’s Manual. Denver, CO: Thera Cane Co.
2) Davies, C (2004). The Trigger Point Therapy Workbook: Your self-treatment guide for pain relief. Oakland, CA: New Harbinger Publications.

READ MORE Josh Crane, OPTP Staff Writer - October 6, 2017


Science Meets Design: The Rollga® Foam Roller

As a company that sells foam rollers as one of its primary products, we get asked the question quite often: “What’s the science behind a foam roller?” Or, as some put it, “Really…how can there be technology in a piece of foam?”

The Rollga® Dynasty, OPTP’s newest addition to its extensive lineup of foam rollers, offers answers to some of these questions. Shaped to fit the body, the Rollga has a unique contour design that allows for targeted, invigorating massage for tension relief and muscle recovery.

Rollga
As Rollga co-founder Tim Schmidt has noted, Rollga is also the only foam roller to pioneer cross-directional forces; its rounded edges produce multiple angles that stretch and separate the fascia, resulting in fascial shearing.

The roller’s rounded edges also offer protection for the ankle, thoracic spine, and hip while rolling. The less direct application of force means that we can spend more time rolling out fascia and less time hitting bones.

While it might not be the stuff of NASA engineering, it certainly shows how therapy and fitness products such as foam rollers are incorporating scientific smarts into their design.

Watch as Tim explains in more detail how the anatomy of the Rollga affects the anatomy of the body.

READ MORE Josh Crane, OPTP Staff Writer - September 27, 2017


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