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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


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

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

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

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

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

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

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

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

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

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

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


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


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

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


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


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.


References
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.


References
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


Fight Back: 3 (Inexpensive) Ways to Lessen Back Pain

Low back pain. Millions of Americans have had it or will have it at some point. It’s estimated that it affects nearly 80% of us at one point in our lives (Adriaan Louw, Everyone Has Back Pain, 2015). And then there’s the expense. Billions of dollars go toward medications and surgeries to combat the common condition, though these costly solutions may be temporary or ineffective.

So how do back pain sufferers, or those who might be forced to deal with the formidable beast somewhere down the road, rise to the challenge? Here are three simple and affordable (compared to the alternatives) actions we can take to help prevent or alleviate pain.

1.    Increase Movement
Sitting has actually been called the new smoking. While this may be a bit of a stretch, it goes to show that many experts agree on the dangers of prolonged sitting. The fact is, we’ve become a sitting society (sit in the car on the way to work, sit at work for eight hours, sit in the car on the way home, sit on the couch), and our spines — not designed for this — are feeling the effects.

Due to this stagnant behavior, we tend to suffer from a lack of blood flow and oxygen to the discs of the spine. As physical therapist and research specialist Adriaan Louw says, “Motion is lotion.” When we don’t move enough, we don’t hydrate the discs, leading to more stiffness and less flexibility (think Tin Man from Wizard of Oz).

So what’s the best way to increase movement? Most experts recommend 30-40 minutes of moderate exercise four days per week. But even those of us who are achieving that outside of work might still struggle with back problems if we spend numerous hours plastered to an office chair. To be aware of how long you’ve been sitting at work, set a reminder on your phone, watch, or computer that tells you to get up and move. Take periodic breaks to get water or just get up and walk around.

A great way to increase movement and provide the back with therapeutic exercise is to use a foam roller. Foam rollers provide rejuvenating massage and tension release, helping to hydrate fascia (the body’s connective tissue). These foam roller videos demonstrate how to foam roll to relieve lower back pain.

Can’t foam roll at work? Incorporate some basic stretching into your day as your job allows. Occupational therapist Angela Kneale provides some ideas on how to do this without even leaving your desk in her exercise book, Desk Pilates. Another excellent way to reduce sitting time is to use a raise-lower workstation that allows you to stand while at your computer; many companies are now implementing them.


2.    Improve Posture
Sure, we’ve all heard this one before. But the way we carry ourselves while walking, lifting heavy objects, sitting and sleeping has a direct impact on our spine. And as we know from point #1, many people spend a good portion of the day sitting, so proper posture and alignment is crucial.

The spine’s natural ‘S-shaped’ curve provides the key. Many people tend to slouch forward while at a desk or computer, eliminating their natural curve and proper alignment. It’s so easy to do, it usually happens without realizing it.

Spine Illustration

To counteract slouching, try a posture awareness device that keeps the head from moving too far forward. The OPTP Posture Supporter™ can be worn discreetly underneath clothes to help reduce poor postural habits. It promotes awareness of spinal posture and assists in retraction of the shoulders.

OPTP Posture Supporter
OPTP Posture Supporter™

Another product that helps promote proper sitting position is a lumbar roll. Placed behind your lower back (lumbar region of the spine) on a chair or vehicle seat, it encourages good alignment while providing a comfortable support. One the most popular pain relief products of all time is the Original McKenzie® Lumbar Roll™, a foam cushion that has helped thousands achieve freedom from low back pain. Its simple design is the brainchild of the late Robin McKenzie, a world-renowned therapist who was also responsible for the famous McKenzie Method® of self-treatment.
McKenzie Lumbar Roll
Original McKenzie® Lumbar Roll™

Recent advancements in technology also offer promise for posture improvement. Everything from wearable devices to computer screen sensors have been designed to detect your positioning, providing reminders and feedback for adjustment. Although prices are still fairly high for these new smart gadgets, the market will surely be seeing more of them in the near future.  


3.    Get Stronger
Our muscles can also be a culprit. Because the lower back is not an area of the body that is often worked in most exercise programs, the muscles in this region can become underutilized and weak. It’s important to include forms of exercise that directly address the low back, hips, pelvis, and abdominals, helping to make these core muscles stronger. Stronger back muscles will not only alleviate pain, but also help prevent injury, especially in the case of lifting heavy objects.

Training core muscles can be done in many ways. Simple, classic moves such as sit-ups, squats and planks can be easily performed using just your own body weight. Practices that endorse controlled, focused movement such as Pilates and yoga are also excellent for enhancing core strength. Consider signing up for a class with a local instructor or practicing basic moves at home. Many exercises can be done without the aid of equipment, though these core strength and stability products make excellent props for use during Pilates and general fitness routines. As always, make sure to consult with your physician before starting any exercise program.
io-ball
io-ball

Looking to give your conventional chair an upgrade? All those hours spent sitting at work can be put to better use by simply replacing a regular desk chair with a stability ball. Actively balancing on a stability ball requires the subtle use of core muscles, strengthening them while you’re responding to emails. It’s like a workout while you work!

Ultimately, it’s up to us to take control of our own back pain. It requires effort, but making small lifestyle changes can lead to big benefits down the road. Not everyone will be able to avoid injury, surgical procedures, or hospital stays. But for many of us, a little self-help can go a long way toward achieving an active, pain-free life. As Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure.” 

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


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