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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.

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.


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.

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

Aging Well: Stay Active to Stay Young

One of the biggest challenges with growing older is that we begin to lose our overall body awareness. This unfortunate (and unstoppable) fact is one of the reasons why there is a direct correlation between falling injuries and age.

Let’s try a simple test. Reach both arms straight over your head and point your index fingers toward one another. Now, without looking up, try to touch the tips of your index fingers together directly overhead. Can’t quite get it? It’s okay, most people can’t do it on their first try, but they can get close.

How do you know where your arms, hands, and fingers are, even when you can’t see them? Body awareness. In this case, the sensory receptors (also known as proprioceptors) in your skin, muscles, and joint capsules were communicating with your brain to tell you where your limbs were, even though you couldn’t see them.

This crucial sense is necessary for many of the basic activities and tasks that each of us performs on a daily basis. And while our body awareness is slowly diminishing as we age, all hope is not lost.

That’s because there’s a second contributor to our body awareness ability — and this one’s actually under our control.   

Move It or Lose It
Lack of movement throughout your life is just as bad as, if not worse than, the physical aging process on your body’s internal balance and health systems. Living a life without exercise or physical activity can, simply put, speed up the aging process.

Aging Chart

Look at the chart above. Notice how from birth (the big red dot) as we age, our body awareness abilities are actually increasing (think going from crawling to walking to running as a child). This happens all the way until the age of around 16-18, when we are done growing through puberty and enter adulthood. Then, things start to go downhill, first slowly and then faster as we age.
But here’s the good news. Notice the people who follow the path on the red line. They have exercised their entire lives, ate well, and have generally taken good care of themselves. Those on the yellow line decided to ignore exercise and eat poorly. The result? Even though these two groups of people are the same age, one of them is living a fulfilling life while the other has limited functionality.  
We can choose to exercise, or we can choose to surrender our body’s mobility.  
Movement is Medicine
So we know that movement keeps your body awareness systems activated, your muscles strong, and your mind sound. It can also keep you free from disease, disability, and ailments, and allows you to do what you love. It truly is a medicine.

But what types of movement should we be doing? Are there certain exercises that are better than others when it comes to turning back the hands of time in regard to our balance and body awareness?

The ActivMotion Bar® was a training tool developed to address these exact needs. ActivMotion Bars are hollow and partially filled with ball bearings that shift during movement. This shifting weight allows you to feel and hear your imbalances as you try to keep the bar stable, training your senses and body awareness.

The 4.5lb ActivMotion Bar, the shortest and lightest weight of all ActivMotion Bars, is the easiest to control but still provides a great workout that builds balance, core strength and stability, and body awareness. It’s an ideal tool for active aging exercise and for anyone looking to focus on their proprioception abilities.

Most importantly, the shifting weight more closely imitates the tasks we are faced with in our daily lives. Its dynamic, constant state of motion means that we are always trying to maintain stability; unlike the static, repetitive movements performed with traditional exercise equipment. The ActivMotion Bar is more representative of real life activities such as gardening, tennis, and playing with children, and helps us prepare our body for doing what we love.

The video below features four exercises performed with the ActivMotion Bar. The moves are specifically focused on the development of proprioception and body awareness. Each can be adapted in different ways to allow for varying degrees of challenge.   

Age is But a Number
While there’s probably no such thing as a fountain of youth, that doesn’t mean we can’t do our best to fight Father Time. As they say, age is merely a number. Stay young by staying active; focus on your proprioception abilities with exercises that challenge your body awareness, core strength, and balance. It’s never too late to start, and your future self will thank you.     

About the Author
Derek Mikulski, BS, CSCS, CPT, is the creator of the ActivMotion Bar. He holds degrees in exercise physiology and health promotion, and also has fitness certifications from NASM, NSCA and NPTI. He launched ActivMotion in 2013, aspiring to build a stronger world through innovation grounded in sound fitness and training theory.

READ MORE Derek Mikulski, BS, CSCS, CPT - September 15, 2017

The 3 Most Common Running Injuries & How to Treat Them

Whether you run to reduce stress, beat the clock, or attain a leaner figure, it’s a lifestyle that’s hard to give up…even in the face of injury.

Over one-third of runners sustain at least one soft tissue injury over the course of a year.1,2 The following three types of injuries are some of the most common, and ones that you’ll likely experience at some point if you haven’t already. But don’t fear, we’ve identified therapy products for each condition to help expedite the recovery process.

Iliotibial Band Syndrome (ITBS)
ITBS is an overuse injury that presents itself in up to 12 percent of runners each year, and it is the most common cause of lateral knee pain in running athletes.4 Significant risk factors include downhill running and an abrupt increase in running distance, pace, or frequency.

One of the best ways to tackle Iliotibial Band Syndrome is through myofascial release with a foam roller. Foam roller therapy is an essential aide for several running injuries, including ITBS.3 If you’re new to foam rolling, it can be a bit overwhelming as foam rollers come in all shapes, sizes, and densities. This page provides a brief introduction to foam rollers to help you get started.

Once you’ve found your roller, take advantage of the many educational resources out there that will help you use it. Foam Roller Techniques by Michael Fredericson, MD features color illustrations and clear, step-by-step instructions to effectively massage and stretch a runner’s most important muscle groups, including the IT Band. Check out the video below and see how to massage the IT Band and other sensitive areas with your roller.

Shin Splints & Ankle Sprains
About 10-20 percent of all runners experience a bout of medial tibial stress syndrome (MTSS), or shin splints, at some point during their career.8 For inflammatory conditions like shin splints or ankle sprains, ice, rest, and orthotic shoe inserts are commonly prescribed.

Kinesiology taping, however, offers additional options for pain modulation and return to function. Unlike conventional tapes, SpiderTech® kinesiology tape has the same weight, thickness, and elasticity as human skin, allowing it to work naturally with the body’s own sensory system to reduce pain and provide natural stability. It’s available in more than a dozen pre-cut applications, including designs for the ankle as well as a foot arch and calf combo.  

Another way to address shin splints, ankle sprains, and calf strains is with the OPTP SlantTM. This pair of lightweight foam wedges allows for simple stretching exercises. Their 18-degree incline is ideal for stretching the hamstrings and calves to help with tight fascia and strengthening of the tissues in this region.

Plantar Fasciitis
Plantar fasciitis is the third most frequent injury among runners.5 It is characterized by inflammation in the long tendon at the bottom of the foot, which stretches from the heel to the toes. Although the etiology of this condition is controversial, several risk factors, including high body weight and reduced ankle dorsiflexion, have been associated with increased incidence rates.6 Research suggests that conducting tissue-specific plantar fascia stretching several times a day helps alleviate and prevent pain due to chronic plantar fasciitis.7

With a cradle design that encompasses the foot, the Stretch-EZ™ is a unique stretching aide that assists with plantar fasciitis, as well as calf, thigh, hip and low back strains and injuries. By inserting the foot into the cradle and pulling back, it produces superior dorsiflexion of the toes that stretches the plantar fascia. Since the Stretch-EZ features multiple strap loops, it allows you to safely and easily control each stretch.Half Balls

A lot of runners are told to use a tennis ball or lacrosse ball for their plantar fasciitis. While this can be a viable option, there are plenty of products out there designed specifically for massage of the foot. These Half Balls are the ideal texture and firmness for that purpose. The flat bottom ensures they won’t roll away during use, making it easier to target specific areas for a better massage and stretch of the plantar fascia.

Back Up and Running
Perhaps you’ll be one of the fortunate ones who’s able to steer clear of these running injuries. But if not, you now have some basic knowledge to guide you on the path to recovery. Hopefully, with consistent use of the right therapy tools and a mental approach grounded in patience, you’ll be back out on the pavement and trails before you know it.

* For your safety, always consult with your healthcare professional before starting any type of exercise or stretching program, especially if you have any health concerns. Products mentioned in this article are intended to provide therapeutic relief but do not guarantee cure of condition.

1 Buist I, Bredeweg SW, Lemmink K, et al. Predictors of running-related injuries in novice runners enrolled in a systematic training program: a prospective cohort study.
Am J Sports Med. 2010; 38(2):273-280.
2 Rauh MJ, Koepsell TD, Rivara FP, et al. Epidemiology of musculoskeletal injuries among high school cross-country runners. Am J Epidemiol. 2006; 163(2):151–159.
3 Fredericson M, Weir A. Practical management of iliotibial band friction syndrome in runners. Clin J Sport Med. 2006; 16(3):261-268.
4 Fredericson M, Wolf C. Iliotibial band syndrome in runners. Sports Med. 2005; 35(5):451-459.
5 Ribeiro AP, Trombini-Souza FT, Tessutti VD, et al. The effects of plantar fasciitis and pain on plantar pressure distribution of recreational runners. Clinical Biomechanics.
2011; 26:194-199.
6 Riddle DL, Pulisic M, Pidcoe P, et al. Risk factors for plantar fasciitis: a matched case-control study. Journal of Bone & Joint Surgery. 2003; 85A (5):872-877.
7 DiGiovanni BF, Nawoczenski DA, Malay DP, et al. Plantar fascia–specific stretching improves outcomes in patients with chronic plantar fasciitis: a prospective clinical trial with two-year follow-up. J Bone Joint Surg Am. 2008; 88:1775–81.
8 Hubbard TJ, Carpenter EM, & Cordova ML. Contributing factors to medial tibial stress syndrome: a prospective investigation. Med Sci Sports Exercise. 2009; 41(3): 490-496.

READ MORE Josh Crane, OPTP Staff Writer - July 31, 2017

Every Patient with Chronic Pain Has a Brain

Whenever I make the statement “every patient has a brain,” I hear the same joke: you haven’t met my patient. Of course, they’re kidding, but there’s a dangerous assumption in their joke. What’s more concerning is that many clinicians have seemingly forgotten that every patient has a brain. There are three major issues that warrant discussion.

Tissues and Pain
First, let’s discuss the assumption that pain comes from tissues. The Cartesian model that correlates tissue issues (nociception) to pain is over 350 years old, and it’s still doctrine in medicine and various therapies. The model is false. You can have tissue injury and no pain. You can have pain and no tissue injury. For too long, practitioners and patients have sought answers to their pain by exploring the various tissues, including joints, muscles, ligaments and more. Pain is a leading reason that people seek care, and when they do seek help for pain, they are presented with a tissue-based model to explain their pain.

Think about it: A patient comes to you seeking help for pain, and you teach the patient anatomy! No wonder pain rates in the US have doubled in the last 15 years alone. Never before have we performed as much surgery or prescribed as much medicine for pain in the history of mankind, and pain rates are ever-increasing. A large portion of the blame should be leveled at these outdated models. It’s time practitioners wake up and realize people in pain are interested in…pain! This leads us directly to the second issue.

Pain Neuroscience Education
There is also an assumption that patients are not smart enough to learn the latest neuroscience of pain. Shame on us for thinking that. Research has shown patients are, in fact, able to understand the biological processes of pain. Pain neuroscience education (PNE) takes complex neurobiological and neurophysiological processes and explains pain to patients via metaphors, examples, and pictures. We have been teaching people about pain for years, in various countries, to different age groups, in different languages, to various ethnicities, etc. The end result? They all get it. The best part is they experience less pain and disability; move and function better despite no hands-on interventions; catastrophize less; are less afraid and are able and willing to move further into pain during exercise and functional tasks.

Healthcare education has simply become a display of knowledge. “Let me tell you how much I know about….” The language we use is completely foreign to patients. Even more worrisome, the current medical vocabulary contains various terms and languages that actually increase fear and anxiety. Ever been guilty of using terms like “torn,” “ripped,” “instability,” “bleeding,” “rupture” and so forth?

Top-down Approach: Brain First
The third issue needs special attention. Manual therapy, electrical modalities, exercises and so forth have been around for decades and form the mainstay of many therapies. These approaches are still based on the Cartesian model: intervene on tissue level and pain will get better. How is that working out for us? One in four Americans has persistent pain. The key issue is right in front of you, every day. It’s attached to your patient. Every patient has a brain! Current therapies focus so heavily on a bottom-up approach they forget this simple fact. The sad reality is that the cognitive approaches, such as pain neuroscience education and altering a patient’s beliefs, may be far superior in their outcomes compared to traditional bottom-up treatment models.

Pain is 100 percent produced by the brain based on the perception of threat. What a patient thinks and believes contributes to their pain experience considerably. Altering what a patient thinks or believes can alter the patient’s pain experience, hence the “top-down” approach. It is suggested that this approach could be far superior to the typical bottom-up approach. For example, patients who receive sham surgery for compression fractures, but believe the tissue issues are fixed during the surgery, perform just as well as patients who actually have the compression fracture surgically corrected. For patients with chronic pain, functional MRI scans show reduction of brain activity after pain neuroscience education, results that are far superior to any narcotics currently used on the market. Spinal movements and neurodynamic test improves significantly in patients after receiving PNE and no hands-on therapy.

To date, a dozen high-quality randomized controlled trials and two systematic reviews have shown that when people in pain are taught more about their pain, their pain decreases, function improves, catastrophization reduces and they’re more interested in movement and exercise. Now, imagine you do both: a bottom-up and top-down approach. All clinicians talk to their patients. Sure, you could chat about last night’s game or the local weather report, but why not use any/all clinical time to teach patients about pain? You could teach them while doing the movement-based approaches of manual therapy, exercise and more.

It’s Time to Start Treating the Brain
Pain neuroscience education provides clinicians with step-by-step, validated, evidence-based approaches to treat patients with chronic pain. We have the research data to prove we don’t just merely “manage” these patients’ pain, but can actually help them recover and experience less pain and disability. The best part is that our current research (various papers accepted for publication or under review) has shown that PNE is helpful for patients in the acute and sub-acute phase. In these scenarios, patients not only experience less pain and disability, but pain neuroscience education may in fact preempt the development of chronic pain. Chronic or acute, we know where all pain is produced. It’s time we start treating the brain, as well as the body.

About the Author
Physical therapist, neuroscience researcher and author Adriaan Louw has been teaching throughout the US and internationally since 1996. Adriaan has authored and co-authored numerous articles, books and book chapters related to spinal disorders and pain science.

1. Gifford LS. Pain, the tissues and the nervous system. Physiotherapy. 1998;84:27-33.
2. 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.
3. Louw A, Butler DS, Diener I, Puentedura EJ. Development of a preoperative neuroscience educational program for patients with lumbar radiculopathy. American Journal of Physical Medicine & Rehabilitation / Association of Academic Physiatrists. May 2013;92(5):446-452.
4. Puentedura EJ, Louw A. A neuroscience approach to managing athletes with low back pain. Phys Ther Sport. Aug 2012;13(3):123-133.
5. 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.
6. Moseley GL. Reconceptualising pain according to modern pain sciences. Physical Therapy Reviews. 2007;12:169-178.

READ MORE Adriaan Louw, PT, PhD - July 25, 2017

Tools to Improve the Practice: ActivMotion Bar®

The Bar and its Activating Functional Mobility book provide a host of effective exercises for physical therapy patients

When I first picked up an ActivMotion Bar®, I was instantly intrigued. So many ideas came into my head, I spent a few hours testing it out and I was instantly hooked. I brought it to work the next day and started integrating the Bar into the exercise programs of many of my patients – those dealing with balance issues, those with trouble correcting scapular dyskinesia, post-ACL reconstruction patients learning to use full knee extension and maintain their stability in standing, and patients learning to stabilize their entire bodies by connecting their scapula, trunk, and pelvis with dynamic movements.
Incredible Sensory Feedback
I use a wide variety of techniques and tools to facilitate and correct functional movement patterns, and I was surprised how the Bar not only fit into each patient’s exercise program but how much better it was than other tools. ActivMotion Bars provide the feedback that our patients need to be aware of and self-correct dysfunctional movement patterns. As we all know, self-awareness plus quality feedback provide the best environment for learning. The sensory feedback provided by the Bar is almost more accurate than we as PTs can be with our own eyes and movement assessment skills. It is more sensitive and more tactile, as a slight hike of the shoulder or a dip of the hip into Trendelenburg can cause the rolling steel weights to shift and let the user know that they’ve lost their stable position. In addition, it gives them feedback when they’re doing the exercise correctly, as they can feel the weights become stable, but not static, inside the Bar. I enjoyed seeing my patients respond quicker, become more motivated, and enjoy their exercise programs more when using the Bar. I soon saw many of my patients carrying the Bar around the clinic and asking to use it even for exercises that had not previously involved the Bar.
Creating a Comprehensive Program
When I was approached by ActivMotion and OPTP to come up with a manual for how to apply the Bar to the field of outpatient physical therapy, I felt challenged in creating something that would accurately represent the Bar and all of its capabilities. How do I build a systematic functional exercise program for something that is so dynamic? We collaborated, and eventually came up with a system of three different ways to use the Bar; the first two using the Bar for facilitation and the third using the Bar for eccentric resistance. I brainstormed daily in the clinic and compiled a list of exercises, then categorized them in to the three cardinal planes of motion (sagittal, frontal, and transverse) to provide a comprehensive program of corrective functional movements. The result is Activating Functional Mobility: A Guide to Rehabilitation Training with the ActivMotion Bar.
Breaking Down the Exercises
The exercises are divided into sections that each address a common area of instability: Scapular instability, trunk instability, and hip/pelvic instability. Having to hold and stabilize the Bar actually makes every exercise a scapular stability exercise. We commonly refer to the “core” as simply trunk and lower body stability, but it is important to include the scapula as it is the proximal attachment of the upper extremities to the trunk. As there is no inherent joint space or ligamentous stability in the scapulothoracic joint – only muscle attachments – nearly all stability here relies on muscular control. Within each section (scapular, trunk, and hip/pelvic) there are 9 different exercises: three levels of exercises in each of the cardinal planes of motion. From here we can start our patients with a beginner level exercise in any of the planes of motion and progress them from using the Bar to provide tactile feedback to assist with stabilization, to using the Bar for dynamic resistance and eccentric loading of the joint stabilizers.
Beginning Level Exercises: Introducing Balance & Proprioception
The beauty of the ActivMotion Bar lies in its versatility. The beginner level of exercises in each section of stability involves using the Bar pressed against the body to physically create a closed-chain connection between the body and the Bar. The tactile feedback of the Bar’s connection to the body as well as the tactile and auditory sensations of the rolling steel weights shifting as the patient strives to find equilibrium help to stimulate the patient’s proprioceptive systems and facilitate a correction of that movement through increased self-awareness. The beginner level of exercises involve keeping the Bar parallel to the floor and are more isolated movements focused on gaining static stability through tactile sensation. A hook-lying bridge while pressing the Bar into the hips is an example of a beginner level sagittal plane exercise. Using the Bar to anchor the upper extremities to the trunk and facilitating symmetry in the hips and pelvis is great for correcting common deviations of lumbar extension, asymmetrical hip extension, and muscle imbalances between sides.

Intermediate Level Exercises: Increasing the Core Stability Challenge
The intermediate level of exercises in each section of stability involves moving the Bar with the body, while also maintaining a parallel position of the Bar to create balance. Exercises in this section require more stability than the beginner section as the patient now has to work to control their body and the Bar together in more active, dynamic movement patterns. The intermediate level progression of the hook-lying bridge is the side plank hip swing, in which the patient maintains a stable forearm side plank with the Bar balanced on the top leg and flexes and extends the top hip. Maintaining a balanced position of the body while moving the top leg and Bar together dynamically improves hip and pelvic stability in individuals with gait deviations. The patient can hear and feel the weights in the Bar shifting if they don’t maintain neutral hip abduction, and they are simultaneously working on trunk and scapular stability to keep their balance.

Advanced Level Exercises: Dynamic Moves, Full Range of Motion
The advanced level of exercises in each section of stability involves tipping, tilting, or swinging the ActivMotion Bar to create dynamic resistance throughout the full range of motion and provide eccentric core muscle activation at the end ranges of the movement pattern. Patients can feel and hear the active resistance shift within the Bar, and use this as feedback to create a rhythm and sequence the movement correctly. As patients tip, tilt, and swing the Bar, the resistance shifts to the end of the Bar and creates an eccentric force resulting in even greater contraction of the major core muscles as they work to control the increased weight. In Activating Functional Mobility, the advanced level sagittal plane hip/pelvic stability exercise is the static lunge with overhead sidebend. The sagittal plane muscles are working to maintain a stable position of the lower extremities, while the trunk and scapular muscles activate dynamically to tip and tilt the Bar and create a sense of dynamic instability for the lower extremities. This exercise could also be considered an advanced frontal plane stability exercise for the trunk and scapular stabilizers.

An Excellent Method of Corrective Exercise
In nearly every exercise performed with the ActivMotion Bar, users are truly required to stabilize their entire body, making the Bar a very effective and efficient tool for facilitating functional movement patterns in corrective exercise. Capturing the benefit of these traits, Activating Functional Mobility contains an overview on the science behind facilitating stability and proprioception in the human body. It also contains information regarding the unique aspects of the ActivMotion Bar, and instruction on cueing fundamentals to assist you in helping your patients use the Bar to its fullest potential.

READ MORE Nicole R. Bushong, PT, DPT, RYT-200 - June 1, 2017

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