Conservative Management of Joint Pain. John C. Hughes, D.O. Aspen Integrated Medicine
|
|
- Julian Boyd
- 5 years ago
- Views:
Transcription
1 Conservative Management of Joint Pain John C. Hughes, D.O. Aspen Integrated Medicine
2 Overview: Osteopathic Treatment of Joint Pain Osteopathic Medicine: DO defined, Principles DO techniques for knee, back, hip, shoulder pain: Direct versus Indirect Focus: Counterstrain Injectional Therapy for joint pain Pathophysiology of Joint injury Proliferative Therapy Medications/ Supplementation for Pain
3 Osteopathic Medicine: DO history Developed in the late 1800 s alongside allopathic (M.D.) medicine Founded by A.T. Still, M.D., who rejected the harsh drug treatments used then for manual medicine Still was accepted by the medical community but chose to start his own schools because his holistic philosophy was fundamentally different
4 Osteopathic Medicine: DO Defined Many D.O. s practice in typical allopathic settings as surgeons, internists, or primary care settings Traditional osteopathic doctors make up about 10% of all those trained and are those who continue to utilize their hands to manually treat patients.
5 Osteopathic Medicine: DO Defined A D.O. is different than the other therapists because, in the U.S., a D.O. is a medical physician Traditional osteopathic doctors use very specific forms of manual medicine, unlike any other manual therapist. An important note: A D.O. is not a therapist. When an osteopathic doctor places his or her hands on a patient, he or she is practicing medicine. Insurance companies reimburse D.O. s at a higher rate for osteopathic manual medicine than any other manual therapies
6 Osteopathic Medicine: DO Principles 1) The body is a unit; one cannot treat a part of the body without consider its entirety. 2) Structure and function are reciprocally interrelated. 3) The body is capable of self-regulation, self-healing, and health maintenance. 4) The nervous system controls, influences, and integrates all bodily functions. 5) Rational treatment is based on an understanding of these principles.
7 Osteopathic Techniques for Joint Pain counterstrain indirect balancing myofacial release cranial therapy lymphatic drainage facilitated positional release HVLA, muscle energy
8
9 Osteopathic Techniques: Direct Direct: Attempt to direct body parts into and often through their physiological and anatomical barrier Examples: Muscle Energy, HVLA (High Amplitude, Low Velocity), Stretching, ROM exercises Demo Great for Cervical, Mid-Back, Low back somatic dysfunctions (facet joints, intercostal areas, some tight muscles, frozen shoulders) in young, healthy patients Used by Chiropractors, Physical Therapists frequently
10 Osteopathic Techniques: Direct Pros: Often provides quick relief for patients, can encourage healthy physiology Cons: Rarely provides permanent changes to the tissue, patient has to return frequently to find relief Rationale: The body cannot adapt and hold to the often abrupt changes created by these often rapid lengthening therapies (that go beyond the physiologic barrier) Dangers: Can be damaging to body tissues, joints
11 Osteopathic Techniques: Indirect Indirect: Attempt to direct body tissues (muscle, bone, fascia, tendons) away from their anatomic or physiological barrier Examples: counterstrain indirect balancing myofacial release cranial therapy
12 Osteopathic Techniques: Indirect Pros: More sophisticated techniques as they work with the body s own physiology; great for older, postsurgical patients, after trauma; very effective and calming to the body; provide lasting, often permanent changes; not forceful--minimal risk of damaging tissue Rationale: The body can adapt to the physiological changes fostered by indirect techniques Cons: Require more patience and more time to do techniques; difficult for patients to do own their own; do not provide immediate popping sounds
13
14 Indirect Techniques: Counterstrain Used mostly by traditional osteopathic doctors, some chiropractors, and a few physical therapists Counterstrain: Developed by Laurence Jones, D.O. Definition: a passive positional technique that places the body in the position of greatest comfort, thereby relieving pain by reduction and arrest of inappropriate proprioceptor activity that maintains somatic dysfunction
15 Counterstrain: How does it help? A somatic dysfunction might be defined as any body part dysfunction that presents itself with a restriction of motion, tissue texture changes, asymmetry, or temperature changes For example: A knee joint sprain presents with restriction of motion The knee joint motion is most restricted at one point Likewise, the knee joint is also least restricted at one point Demo
16 Counterstrain: How Does It Work? Technique: Could be thought of as the opposite of stretching (as the goal is to find the greatest position of ease) Directed not at tissue damage itself but to the aberrant neuromuscular reflexes within the tissue In particular, counterstrain is directed at muscle spindles within the extrafusal fibers of muscles Muscle spindles are highly specialized sensory receptors which consist of a connective tissue sheath holding 5-12 intrafusal fibers (about 3mm long each)
17 Counterstrain: How Does It Work for Pain? On the polar, contractile ends of these intrafusal fibers, there are gamma motor neurons that terminate there after originating on the ventral horn The contractile ends of the intrafusal fibers are sensitive to changes in length (that occurs with muscle stretching) When the extrafusal fibers of the muscle are stretched, the intrafusal fibers are activated to resist the stretch through an efferent neurofeedback to the gamma motor neurons
18 Counterstrain: How does it Work for pain? The gamma motor neurons thus provide a necessary CNS control to allow appropriate stretching and resistance With more stretching of the large extrafusal muscle fibers (as often occurs with trauma, aka somatic dysfunction), there is more gamma motor stimulation so there is a greater reflexive resistance to the stretch created by feedback from the intrafusal muscle fibers
19 Counterstrain: How does it Work for pain? In short, the greater the trauma/ the greater the stretch, the more gamma excitement is present in the CNS Counterstrain works by approximating the muscle by passive shortening in order to decrease gamma gain (aka gamma excitement) to turn off the reflexive contraction by initiated by the intrafusal fibers of the muscle spindles A muscle that has been approximated can then return to its lengthened form allowing increased range of motion, less spasm, and ultimately less pain
20 Counterstrain: How does it Work?
21 Counterstrain: Figures
22 Counterstrain: Figures
23 Clinical Data: Counterstrain Effect of Counterstrain on Stretch Reflexes, Hoffmann Reflexes, and Clinical Outcomes in Subjects With Plantar Fasciitis JAOA Vol 106 No 9 September Conclusions: Clinical improvement occurs in subjects with plantar fasciitis in response to counterstrain treatment. The clinical response is accompanied by mechanical, but not electrical, changes in the reflex responses of the calf muscles.
24 Clinical Data: Counterstrain Stretch Reflex and Hoffmann Reflex Responses to Osteopathic Manipulative Treatment in Subjects With Achilles Tendinitis JAOA Vol 106 No 9 September Conclusion: The reduction of stretch reflex amplitude with OMT, together with no change in H-reflex amplitude, is consistent with Korr's proprioceptive hypothesis for somatic dys-function and patient treatment. Because subjects' soreness ratings also declined immediately after treatment, decreased nociceptor activity may play an additional role in somatic dysfunction, perhaps by altering stretch reflex amplitude.
25 Counterstrain: Further References Korr s Theory Immediate effects of the strain/counterstrain technique in local pain evoked by tender points in the upper trapezius muscle Clinical Chiropractic, Volume 9, Issue 3, Pages osteopathic treatment when compared to standard medical treatment helped patients with chronic injuries find pain relief in less visits and less medication
26
27 Injectional Therapy for joint pain: Physiology of Acute Sprains Inflammation phase--damaged cells release cytokines and other mediators that cause vascular dialation and permeability PMLs, followed by macrophages enter the scene and along with other cells, stimulate the migration and proliferation of fibroblasts Proliferative phase of connective tissue healing--fibroblasts encourage synthesis of procollagen matrix (2-3 days after injury) Vascular buds form increasing blood supply (3-4 days) and new tissue forms
28 Injectional Therapy for joint pain: Physiology of Acute Sprains Remodeling phase: Collagen type I changes to collagen type III and fibrils increase along lines of stress to become tightly packed (2-3 weeks) Collagen thickens and increases to preinjury length but with only 50 to 70 % tensile strength (without additional injury to stimulate fibroblasts) With severe injury, the healing process may stop before the tissue is sufficiently competent for everyday use The term degenerative is often used to describe this inadequate healing and resulting body structure (other terms include chronic tendonitis, DDD, OA, etc.)
29 Injectional Therapy for joint pain: Degenerative, Chronic Tissue-Why painful? Nerve density at periosteum and periosteal attachments of tendons and ligaments is 2nd only to skin Without functional sufficiency, pain mechanoreceptors function as chronic nociceptors
30 Injectional Therapy for Joint Pain: Is blocking inflammation the answer? Cortisone injections: block inflammation, stop the healing cascade, decrease immune function (risking microbial infection), cause tendon weakening, atrophy, or ruptures Antinflammatory medications: block healing cascade
31 Injectional Therapy for joint pain: What is Proliferative Therapy? Prololiferative therapy (or Prolotherapy) is defined as the injection of irritant or proliferant solutions into the affected ligaments, tendons, and/or joints. This type of injection leads to local inflammation in the injected area. The localized inflammation triggers a wound healing cascade, resulting in the deposition of new collagen, New collagen shrinks as it matures. The shrinking collagen tightens the ligament that was injected and makes it stronger
32 Injectional Therapy: History of Prolotherapy The concept of Prolotherapy originated in the non-surgical treatment of hernias, varicose veins, and hemorrhoids, If the connective tissue in the veins becomes weakened, hemorrhoids and varicose veins form. Weakness in the collagen, of course, causes ligament laxity and tendon degeneration with resultant chronic pain. Most of the early innovators in injection treatment method were surgeons who were looking for methods to improve surgical outcomes or replace surgery with more conservative methods.
33 Injectional Therapy: History of Prolotherapy The injection of hernias, varicose veins, and hemorrhoids was called Sclerotherapy, because the injection "sclerosed," or scarred, the area. Hippocrates, the father of Western medicine, introduced heated metal probes into the dislocated and painful shoulders of javelin throwers. He believed that this would tightened the shoulder capsule by creating tough scar tissue and that the scar tissue would keep the shoulder in place. Dr. George S. Hackett developed modern prolotherpy beginning in 1939; Unlike the sclerotherapists, Hackett used an irritant that helped proliferate healthy collagen
34 Prolotherapy: Solutions, Technique Proliferative substances have varied over the decades but have included phenol, glycerin, sodium bicarbonate, dextrose, sodium morruhate, hypertonic saline Dextrose is commonly used as a proliferant today These substances are injected at the bony attachments of tendons and ligaments to improve their integrity
35 Prolotherapy: Explained Dextrose is thought to "dehydrate" the injected tissues, causing an injury signal for the body, and initiating the healing process. Dextrose has been shown to be a growth stimulant on it's own as well. This healing process is one of inflammation restarts the normal healing cascade that would occur with an acute injury
36 Prolotherapy: Clinical Evidence 1800 patients followed for 2 years; 80% showed marked improvement in upper and lower body pain; Hackett GS: Prolotherapy in whiplash and low back pain. Postgrad Med 27: , 1960 Two RCTs (160 participants) found that prolotherapy injections, given with spinal manipulation, exercise, and other therapies, are more effective than control injections for chronic low-back pain and disability.
37 Prolotherapy: Clinical Evidence 60% increase in collagen fibril diameter measured at 3 months after 6 weekly injections in patients with low back pain; Klein RG, Dorman TA, Johnson CE: Proliferant Injections for Low Back Pain: Histological Changes of Injected Ligagments and Objective Measurements of Lumbar Spine Mobility Before and After Treatment J Neurol Orthop Med Surg 10: , 1989 Osmolarity studies: Elevation osmolarity by as little as 50 mosm has been found to activate multiple growth factors including PDGF
38 Prolotherapy: Clinical Evidence Response of Knee Ligaments to Prolotherapy in a Rat Injury Model; Am J Sports Med July 2008 vol. 36 no Conclusion: Dextrose injections increased the crosssectional area of MCLs compared with saline-injected and uninjured controls. Dextrose injections did not alter other measured properties in this model.
39 Prolotherapy: Clinical Evidence A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma; British Journal of Sports Medicine 2009;43: Conclusions: There is strong pilot-level evidence supporting the use of prolotherapy, polidocanol, autologous whole blood and platelet-rich plasma injections in the treatment of LE.
40
41 Medications/ Supplementation for Pain Oral Supplements: Traumeel Systemic Enzymes Curcumin SOD Oral Medications: 1st choice: Ultram 2nd choice: Percocet or Tylenol Not recommended: Ibruprofen, other Cox 2, steroids
42 Medications/ Supplementation for Pain Topical Medications: Lidocaine cream (postoperative neuralgia) Topical Supplements: DMSO Traumeel Capsaicin
43 Other Supplements/ Medications: Glucosamine Hyaluronic Acid (Injections): occasional
44
PROLOTHERAPY Joel Berenbeim, D.O.
PROLOTHERAPY Joel Berenbeim, D.O. CSPOMM PROLOTHERAPY Prolos- To stimulate growth Prolotherapy involves the injection of irritant solutions into weakened or stretched ligaments which are a source of chronic
More informationAmerican Association of Orthopaedic Medicine Position Statement
American Association of Orthopaedic Medicine Position Statement Prolotherapy for the Treatment of Back Pain This pronouncement was written for the American Association of Orthopaedic Medicine by Robert
More informationChiropractic Glossary
Chiropractic Glossary Anatomy Articulation: A joint formed where two or more bones in the body meet. Your foot bone, for example, forms an articulation with your leg bone. You call that articulation an
More informationThe Nervous System S P I N A L R E F L E X E S
The Nervous System S P I N A L R E F L E X E S Reflexes Rapid, involuntary, predictable motor response to a stimulus Spinal Reflexes Spinal somatic reflexes Integration center is in the spinal cord Effectors
More informationIntroduction to Prolotherapy
Marc N. Dubick, M.D. Interventional Pain Management 2097 Henry Tecklenburg Drive Suite 203 West Charleston, SC 29414 843-573-3444 Office 843-769-4312 Fax Introduction to Prolotherapy What is Prolotherapy?
More informationCronicon ORTHOPAEDICS
Cronicon OPEN ACCESS ORTHOPAEDICS Research Article A Comparative Study of the Effectiveness of Two Manual Therapy Techniques on Pain and Lumbar Range of Motion Bhojan Kannabiran*, J Divya J Pawani and
More informationAcute. Chronic. Tendinopathy: Acute vs. Chronic Differences in Anatomy, Symptoms & Treatment
Tendinopathy: Acute vs. Chronic Differences in Anatomy, Symptoms & Treatment Science and Management Symposium SAM 2018 Marlene Reid, DPM FACFAS, FACFAO, FASPS Tendinopathy Tendinopathy is a failed healing
More informationMUSCLE ENERGY FOR CERVICAL SPINE. Dr. Gabrielle Koczab, DO Medical director Bedford Primary Care Core Teaching Faculty UH Regional Hospitals
MUSCLE ENERGY FOR CERVICAL SPINE Dr. Gabrielle Koczab, DO Medical director Bedford Primary Care Core Teaching Faculty UH Regional Hospitals LEARNING OBJECTIVES 1. List conditions in which muscle energy
More informationPOSITIONAL RELEASE: Strain-Counterstrain. Theresa A. Schmidt, DPT,MS,OCS,LMT,CEAS,CHy.
To comply with professional boards/associations standards: I declare that I or my family do not have any financial relationship in any amount, occurring in the last 12 months with a commercial interest
More informationOsteopathic Manipulation Background and Indications
Osteopathic Manipulation Background and Indications Kelley Harmon, D.O. Maine Dartmouth Family Medicine Residency MaineGeneral Medical Center Augusta, Maine Regional Assist. Dean, University of New England
More informationHiroyuki Hayashi The benefit of Manual Osteopath treatment effect for lower back pain
The benefit of Manual Osteopath treatment effect for lower back pain 1. What is the Manual Osteopath? Osteopathy is a type of alternative medicine and is a form of drug-free non-invasive manual medicine
More informationChapter 10: Flexibility. ACE Personal Trainer Manual Third Edition
Chapter 10: Flexibility ACE Personal Trainer Manual Third Edition Flexibility: A Definition Flexibility is the range of motion (ROM) within a joint along the various planes of motion. A number of factors
More informationTECHNOLOGY AND HOW WE USE IT TO DAMAGE OURSELVES WILLIAM A. DELP, DO ASSISTANT PROFESSOR OF OMM GA PCOM
TECHNOLOGY AND HOW WE USE IT TO DAMAGE OURSELVES WILLIAM A. DELP, DO ASSISTANT PROFESSOR OF OMM GA PCOM OBJECTIVES Understand how we interact with technology new and old Understand how injury occurs Texting
More informationTWENTY COMMON QUESTIONS ABOUT PROLOTHERAPY DAVID HARRIS, M.D.
TWENTY COMMON QUESTIONS ABOUT PROLOTHERAPY DAVID HARRIS, M.D. 1) Is Prolotherapy painful? The injection is considered mild to moderately painful, and there is typically a "flare" of soreness for 3-7 days
More informationORTHOPEDICS BONE Recalcitrant nonunions In total hip replacement total knee surgery increased callus volume
ORTHOPEDICS Orthopedics has to do with a variety of tissue: bone, cartilage, tendon, ligament, muscle. In this regard orthopedic and sports medicine share the same tissue targets. Orthopedics is mostly
More informationSCS FAMILY MEDICINE Introduction in Osteopathic Principles & Initial Osteopathic Evaluation for Low Back Pain
SCS FAMILY MEDICINE Introduction in Osteopathic Principles & Initial Osteopathic Evaluation for Low Back Pain CATHERINE DONAHUE D.O. ASSISTANT PROFESSOR DEPARTMENT OF OMM MSUCOM WHAT WE WILL COVER Osteopathic
More informationOTM Lecture Gait and Somatic Dysfunction of the Lower Extremity
OTM Lecture Gait and Somatic Dysfunction of the Lower Extremity Somatic Dysfunction Tenderness Asymmetry Range of Motion Tissue Texture Changes Any one of which must be present to diagnosis somatic dysfunction.
More informationRobert P Schneider DO FAAFP MYOFASCIAL RELEASE
Robert P Schneider DO FAAFP MYOFASCIAL RELEASE Objectives Review basic anatomy. Describe diagnosis of somatic dysfunction using a fascial model. Summarize the basic concepts of myofascial release (MFR)
More informationManipulation according to Maigne
1 Manipulation according to Maigne Roger Baecher, MD Roger BAECHER, MD March 2001 1st International Congress of Osteopathic Medicine Freiburg / Breisgau Germany, 15-18 September 1st International Congress
More informationWhiplash! The 3 Phases of Healing Introduction-Full recovery from a whiplash injury requires chiropractic care. and the insurance you already have
Whiplash! The 3 Phases of Healing Introduction-Full recovery from a whiplash injury requires chiropractic care. and the insurance you already have will most likely cover chiropractic treatment for a whiplash
More informationLocation of Pain/Symptoms Where do you feel the pain/symptoms? Can you point with one finger to location of pain? Is the pain general or localized?
Injury Evaluation History A complete and accurate medical history is one of the most important and useful parts of the clinical examination. A complete history consists of past history and a history of
More informationTrauma and Immobilization SCAR. Summary: Acute Inflammation & Healing. TRAUMA Wound Healing: Three Phases
Upper Extremity Stiffness and Contracture After Trauma Phil PT, PhD, FAPTA mcclure@arcadia.edu Trauma and Immobilization SCAR TRAUMA Wound Healing: Three Phases Inflammation (0-5 days) Fibroplasia (Repair,
More informationJournal of Orthopaedic & Sports Physical Therapy. January 2012; Volume 42; Number 1; pp. 5-18
1 Upper Cervical and Upper Thoracic Thrust Manipulation Versus Nonthrust Mobilization in Patients With Mechanical Neck Pain: A Multicenter Randomized Clinical Trial Journal of Orthopaedic & Sports Physical
More informationposition to influence or control the content of this No faculty or planning committee member in a presentation has any relevant financial
Introduction to Osteopathic Principles and Practice Presented by Brandon Isaacs, DO, FAAFP Associate Dean of Postdoctoral Education Associate Professor of Family Medicine Pacific Northwest University of
More informationInflammation is Not the Enemy
6/22/2017 Inflammation is Not the Enemy Sean Mulvaney, MD 1 6/22/2017 2 6/22/2017 Lascaux 7.4 Billion 3 This image cannot currently be displayed. 6/22/2017 Goals 4 ANTI INFLAMMATORY THERAPIES NSAIDS 5
More informationDr. Allen Hooper Sports Clinic at City Centre Main Street Penticton, British Columbia V2A 5B7 Phone: Fax:
Dr. Allen Hooper Sports Clinic at City Centre 207 399 Main Street Penticton, British Columbia V2A 5B7 Phone: 250-487-1455 Fax: 250-487-1453 PROLOTHERAPY What is prolotherapy? Prolotherapy, or proliferation
More informationTreatment of Lateral Elbow Tendinopathy: Medical and Surgical Interventions
APPENDIX G Treatment of Lateral Elbow Tendinopathy: Medical and Surgical Interventions The purpose of this document is to provide information for physiotherapists of common medical and surgical interventions
More information0RTHOPEDIC MASSAGE. Orthopedic Massage Benefits. Orthopedic Massage Applications
0RTHOPEDIC MASSAGE Orthopedic Massage involves therapeutic assessment, manipulation, and movement of locomotor soft tissues to eliminate pain and dysfunction throughout the body. It is more than a technique.
More information1 Original Article A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction
1 Original Article A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction European Spine Journal July 27, 2005 Manohar M. Panjabi From the Department of Orthopaedics
More informationTOP RYDE CHIROPRACTIC
1. Ankle Pain Conditions Helped by Chiropractic The ankle joint is made up of ligaments, tendons, nerves, and a disc to cushion motion. Distortions of motion of the ankle can strain the ligaments and muscles
More informationTHE MUSCULAR SYSTEM CHAPTER 5
THE MUSCULAR SYSTEM CHAPTER 5 MUSCULAR SYSTEM Only tissue capable of shortening or contracting Responsible for both powerful and graceful movements Control movements of eyes, food, and heart Three categories
More informationSession 748 Moving From Function To Dysfunction By: Greg Roskopf, MA
Session 748 Moving From Function To Dysfunction By: Greg Roskopf, MA We Must Determine The Physical Characteristics Of Each Client Proper Assessments will dictate each clients physical capabilities I don
More informationTOPAZ TM What you should know
TOPAZ TM What you should know Not for distribution in the United States. Need to know 2 Tendon: is a tough band of fibrous connective tissue that connects muscle to bone and is capable of withstanding
More informationNorth Texas Musculoskeletal Medicine Enhancing the body s innate ability to heal
Enhancing the body s innate ability to heal Ntxmsk.com 817.416.0970 Dennis E. Minotti II, D.O. Thank you for your interest in, procedures that are radically changing treatment of musculoskeletal conditions.
More informationNon-Pharmacological Interventions for Pain:! Chiropractic Manipulative Therapy!
Non-Pharmacological Interventions for Pain:! Chiropractic Manipulative Therapy! Dr. Marie Rudback, DC, CCSP, ART! Chiropractic Physician, Certified Chiropractic Sports Physician, Active Release Technique
More information7/5/2011. Regenerative injection therapy (Prolotherapy) Evolution. Objectives. Ayman A. Halim, MD Director of UNT Pain clinic Fort Worth, Texas
Regenerative injection therapy (Prolotherapy) Ayman A. Halim, MD Director of UNT Pain clinic Fort Worth, Texas Evolution A joint is only as strong as its weakest ligament George Hackett,MD Objectives Scientific
More informationA Patient s Guide to Platelet-Rich Plasma Treatment of Musculoskeletal Problems
A Patient s Guide to Platelet-Rich Plasma Treatment of Musculoskeletal Problems Iain is a specialist in musculoskeletal imaging and the diagnosis of musculoskeletal pain. This information is provided with
More informationDizziness, Unsteadiness, Visual Disturbances, and Postural Control: Implications for the Transition to Chronic Symptoms After a Whiplash Trauma
Dizziness, Unsteadiness, Visual Disturbances, and Postural Control: Implications for the Transition to Chronic Symptoms After a Whiplash Trauma 1 Spine December 1, 2011; Volume 36, Number 25S, pp. S211
More informationPOSITIONAL RELEASE: Strain-Counterstrain. Theresa A. Schmidt, DPT,MS,OCS,LMT,CEAS,CHy.
To comply with professional boards/associations standards: I declare that I or my family do not have any financial relationship in any amount, occurring in the last 12 months with a commercial interest
More informationAcute Soft Tissue Injuries
Acute Soft Tissue Injuries Classic Soft-Tissue Injury Response Sequence: v inflammatory phase v proliferative phase v maturation phase Inflammation v pathologic process consisting of dynamic complex of
More informationServers Disease (Calcaneal Apophysitis ) 101
Servers Disease (Calcaneal Apophysitis ) 101 Servers Disease Causes a disturbance to the growing area at the back of the heel bone (calcaneus) where the strong Achilles tendon attaches to it. It is most
More informationA Patient s Guide to Platelet-Rich Plasma Treatment of Musculoskeletal Compliments of: The Central Orthopedic Group
A Patient s Guide to Platelet-Rich Plasma Treatment of Musculoskeletal Problems The Central Orthopedic Group 651 Old Country Road Plainview, NY 11803 Phone: 5166818822 Fax: 5166813332 p.lettieri@aol.com
More informationManual Manipulative Medicine: A Structural Examination for Lower Back Pain. Friday, October 2, :30 AM - 12:00 PM W116.
Manual Manipulative Medicine: A Structural Examination for Lower Back Pain Friday, October 2, 2015 10:30 AM - 12:00 PM W116. Level: Beginner No Financial Disclosures Amir Mahajer, DO Ronald Tolchin, DO
More informationMcKenzie Extremity Talk.
McKenzie Extremity Talk www.fisiokinesiterapia.biz New Zealand Physical Therapist Robin McKenzie Robin McKenzie was made an Officer of the Most Excellent Order of the British Empire in 1990 and appointed
More informationDocumentation and Billing For Myofacial Disruption Treatment
Documentation and Billing For Myofacial Disruption Treatment Page 1 of 7 Documentation Requirements The following information comes directly from the American Medical Association CPT coding Committee:
More informationPost-op / Pre-op Page (ALREADY DONE)
Post-op / Pre-op Page (ALREADY DONE) We offer individualized treatment plans based on your physician's recommendations, our evaluations, and your feedback. Most post-operative and preoperative rehabilitation
More informationLesson 6.4 REFLEXES AND PROPRIOCEPTION
Lesson 6.4 REFLEXES AND PROPRIOCEPTION (a) The Reflex Arc ~ ~ ~ TOPICS COVERED IN THIS LESSON (b) Proprioception and Proprioceptors 2015 Thompson Educational Publishing, Inc. 1 What Are Reflexes? Reflexes
More informationProlotherapy: Prolozone:
Prolotherapy, Prolozone, Platelet Rich Plasma (PRP), Trigger Point Therapy, Therapeutic Ultrasound, Prologel, Kinesio Taping Informed Consent and Before After Care Instructions I,, have been advised and
More informationJMSCR Volume 03 Issue 01 Page January 2015
www.jmscr.igmpublication.org Impact Factor 3.79 ISSN (e)-2347-176x Management of Chronic Plantar Fasciitis using Hyperosmolar Dextrose Injection Authors Ansarul Haq Lone 1, Omar Khursheed 2, Shakir Rashid
More informationEastern Bodywork & Neuromuscular Sports Injury and Medicine Massage Therapy Explained
Eastern Bodywork & Neuromuscular Sports Injury and Medicine Massage Therapy Explained LA#8419 You Can Experience Ease of Movement Once Again! Call Today for your appointment! Higher Purpose Healing 1 (504)
More informationPolicy Specific Section:
Medical Policy Spinal Manipulation under Anesthesia Type: Investigational / Experimental Policy Specific Section: Medicine Original Policy Date: Effective Date: February 26, 1997 July 6, 2012 Definitions
More informationPROLOTHERAPY. What is it and why is Prolotherapy the foundation of Regenerative Medicine?
PROLOTHERAPY What is it and why is Prolotherapy the foundation of Regenerative Medicine? MAYO FRIEDLIS,MD Stem Cell Arts/National Spine and Pain Washington DC AAOM Seattle WA, 0417 My Experience 25 years
More informationUTILIZING CPT AND HCPCS CODES FOR HEALTHCARE REIMBURSEMENT: A guide to billing and reimbursement of SpiderTech kinesiology tape products
UTILIZING CPT AND HCPCS CODES FOR HEALTHCARE REIMBURSEMENT: A guide to billing and reimbursement of SpiderTech kinesiology tape products Billing and coding of taping and strapping services can be a complex
More informationCHIROPRACTIC -HOW IT AFFECTS YOU. Dr Milan Hari M- CHIRO. S.A GT Practitioner 07 June 2013
CHIROPRACTIC -HOW IT AFFECTS YOU. Dr Milan Hari M- CHIRO. S.A GT Practitioner 07 June 2013 Chiropractic Chiropractic focuses on disorders of the musculoskeletal system and the nervous system, and the effects
More informationDermomyofascial Restoration. The ProSport Academy Therapist Mentorship Dave O Sullivan
Dermomyofascial Restoration The ProSport Academy Therapist Mentorship Dave O Sullivan Dermomyofascial Restoration Includes: 1. Dermomyofascial Testing 2. Dermomyofascial Restorative Mobilisations Dermomyofascial
More informationHistory of Manual Therapy
Manual Therapy: Mobilization, manipulation of soft tissues, massage A systematic method of evaluating and treating dysfunctions of the neuromusculoskeletal system in order to relieve pain, increase or
More informationPrinciples of Treatment. Case Studies. Principles of Treatment. Clinical Perspectives for the GP
Principles of Treatment Clinical Perspectives for the GP Case Studies 1. Jumping athlete with an acute exacerbation of chronic patellar tendinopathy major competition in 9 days time 2 week tournament 2.
More informationPlantar Fasciitis and Heel Pain
PATIENT INFORMATION Plantar Fasciitis and Heel Pain What is plantar fasciitis? Heel pain and plantar fasciitis Plantar fasciitis causes pain under your heel. It usually goes in time. Treatment may speed
More informationLASER THERAPY FOR PHYSIOTHERAPISTS
BioFlex Laser Therapy presents LASER THERAPY FOR PHYSIOTHERAPISTS Expand your knowledge. Build your practice. Did you know? Laser Therapy is one of the strongest evidence-based therapies according to Clinical
More informationThe Chiropractic Neck Book
The Chiropractic Neck Book A Painful Neck Problem Many people have neck pain at some point in their lives. Pain is often the result of injuries or other problems that cause the spine to be misaligned.
More informationAdjunctive Treatments for Tendinopathy. Brendan O Neill Sports Physician Anglesea Sports Medicine Unisports Sports Medicine
Adjunctive Treatments for Tendinopathy Brendan O Neill Sports Physician Anglesea Sports Medicine Unisports Sports Medicine About Me Sports Physician Unisports Sports Medicine Anglesea Sports Medicine BikeNZ
More informationMUSCLE HYPOTONIA, MUSCLE IMBALANCE AND PAIN
MUSCLE HYPOTONIA, MUSCLE IMBALANCE AND PAIN А. Subject of Study 1.Topical Character In manual medicine the subject of study is the muscular-skeletal system dysfunction such as Muscle shortening, Trigger
More informationPiriformis Syndrome. Midwest Bone & Joint Institute 2350 Royal Boulevard Suite 200 Elgin, IL Phone: Fax:
A Patient s Guide to Piriformis Syndrome 2350 Royal Boulevard Suite 200 Elgin, IL 60123 Phone: 847.931.5300 Fax: 847.931.9072 DISCLAIMER: The information in this booklet is compiled from a variety of sources.
More informationOMT Boot Camp. OMT Test Format and Test Taking Skills (Written and Practical) Thomas E. Sabalake, DO
ACOFP 54 th Annual Convention & Scientific Seminars OMT Boot Camp OMT Test Format and Test Taking Skills (Written and Practical) Thomas E. Sabalake, DO ACOFP OMT BOOT CAMP 2017 OMT TEST FORMAT AND TEST
More informationRicardo E. Colberg, MD, RMSK. PM&R Sports Medicine Physician Andrews Sports Medicine and Orthopedic Center American Sports Medicine Institute
Ricardo E. Colberg, MD, RMSK PM&R Sports Medicine Physician Andrews Sports Medicine and Orthopedic Center American Sports Medicine Institute Pathophysiology of chronic orthopedic injuries Definition of
More informationTotal Body Balancing An integrative approach to optimum treatment and balance Kerry D Ambrogio D.O.M., A.P., P.T., D.O.-M.T.P.
Total Body Balancing An integrative approach to optimum treatment and balance Kerry D Ambrogio D.O.M., A.P., P.T., D.O.-M.T.P. Each day as a practitioner I am faced with the challenge of trying to understand,
More informationChapter 13. The Nature of Muscle Spindles, Somatic Reflexes, and Posture
Chapter 13 The Nature of Muscle Spindles, Somatic Reflexes, and Posture Nature of Reflexes A reflex is an involuntary responses initiated by a sensory input resulting in a change in the effecter tissue
More informationCENTRAL NERVOUS SYSTEM
Gray s Anatomy states that every organ, system and function of the human body is under direct control of the central nervous system 1 An intact nervous system will lead to optimum functioning of the human
More informationLABETTE COMMUNITY COLLEGE BRIEF SYLLABUS. Please check with the LCC bookstore for the required texts for this class.
LABETTE COMMUNITY COLLEGE BRIEF SYLLABUS SPECIAL NOTE: This brief syllabus is not intended to be a legal contract. A full syllabus will be distributed to students at the first class session. TEXT AND SUPPLEMENTARY
More informationStretch reflex and Golgi Tendon Reflex. Prof. Faten zakareia Physiology Department, College of Medicine, King Saud University 2016
Stretch reflex and Golgi Tendon Reflex Prof. Faten zakareia Physiology Department, College of Medicine, King Saud University 2016 Objectives: Upon completion of this lecture, students should be able to
More informationMake sure you have properly fitting running shoes and break these in gradually. Never wear new running shoes for a race or a long run.
Common Running Injuries We are delighted that you have decided to run in the next Bath Half Marathon and very much hope that you have good running shoes, undertake a regular training programme and don
More informationProlotherapy. Description
Subject: Prolotherapy Page: 1 of 9 Last Review Status/Date: December 2014 Prolotherapy Description Prolotherapy describes a procedure intended for healing and strengthening ligaments and tendons by injecting
More informationRestoring Range of Motion and Improving Flexibility.
Restoring Range of Motion and Improving Flexibility www.fisiokinesiterapia.biz Importance of Flexibility Important Goal: Restore or improve to normal pre-injury range of motion With injury there is generally
More informationProView. BC Region Winter Season 2014/2015 FEATURED ARTICLE. the INSIDE SCOOP What to know about stretching EFFECTIVELY by Majorie Lauzon
ProView BC Region Winter Season 2014/2015 FEATURED ARTICLE the INSIDE SCOOP What to know about stretching EFFECTIVELY by Majorie Lauzon photo: Tom Fuller SKIING Biomechanics What to KNOW the inside scoop
More informationStrain-Counterstrain. Harmon Myers, DO and Julie Jernberg, MD
Strain-Counterstrain Harmon Myers, DO and Julie Jernberg, MD Origin of Counterstrain Lawrence Jones, DO Original Patient: 4 Months of lower back pain, sleep deprivation and high velocity therapy Jones
More informationMechanism of Injury, Trauma, Subluxation and Instability Outline
Spinal Trauma Instructor: Dr. Jeffrey A. Cronk, DC, CICE Director of Education, Spinal Kinetics. CICE, American Board of Independent Medical Examiners. Mechanism of Injury is just something that you must
More informationNorth Texas Musculoskeletal Medicine Enhancing the body s innate ability to heal
Enhancing the body s innate ability to heal Ntxmsk.com 817.416.0970 Dennis E. Minotti II, D.O. Thank you for your interest in, procedures that are radically changing treatment of musculoskeletal conditions.
More informationCENTRAL NERVOUS SYSTEM
By Keith Wassung Gray s Anatomy states that every organ, system and function of the human body is under direct control of the central nervous system 1 An intact nervous system will lead to optimum functioning
More informationDays, weeks and months of medication might have seem ineffective, but this is pure bliss. This is unadulterated medicine, nature at its best.
Don t be ashamed to cry. People would understand. It s not just the pain that gets you, it s the inability to do what you want, when you want to. You are stuck. Stuck in a continuous cycle of despair and
More informationMichael, J./ Gyer, G./ Davis, R. Osteopathic and Chiropractic Techniques for Manual Therapists
Michael, J./ Gyer, G./ Davis, R. Osteopathic and Chiropractic Techniques for Manual Therapists zum Bestellen hier klicken by naturmed Fachbuchvertrieb Aidenbachstr. 78, 81379 München Tel.: + 49 89 7499-156,
More informationSpineFAQs. Neck Pain Diagnosis and Treatment
SpineFAQs Neck Pain Diagnosis and Treatment Neck pain is a common reason people visit their doctor. Neck pain typically doesn't start from a single injury. Instead, the problem usually develops over time
More informationIntroduction. Anatomy
the patella is called the quadriceps mechanism. Though we think of it as a single device, the quadriceps mechanism has two separate tendons, the quadriceps tendon on top of the patella and the patellar
More informationOMT for the Pregnant Patient
OMT for the Pregnant Patient Presented by: Kristie Petree, DO Assistant Professor of Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine Georgia Campus Philadelphia College of Osteopathic
More informationDepartment of Neurology/Division of Anatomical Sciences
Spinal Cord I Lecture Outline and Objectives CNS/Head and Neck Sequence TOPIC: FACULTY: THE SPINAL CORD AND SPINAL NERVES, Part I Department of Neurology/Division of Anatomical Sciences LECTURE: Monday,
More information17/06/2010. Dean Somerset BSc. Kinesiology, CSCS, CEP, MES
STRENGTH TRAINING LOW BACK INJURIES WITH MYOFASCIAL SLING SYSTEMS Dean Somerset BSc. Kinesiology, CSCS, CEP, MES A little about myself... BSc. Kinesiology CSCS NSCA CEP CSEP MES AAHFRP PRO Trainer, Can
More informationFlexibility Assessments and Exercise Programming for Apparently Healthy Participants
Thank you for downloading this excerpt! Visit Read & Research tab on the ACSM website to find out more about this and other ACSM publications: https://www.acsm.org/readresearch/books. The American College
More informationA Patient s Guide to Medial Epicondylitis (Golfer s Elbow) William T. Grant, MD
A Patient s Guide to Medial Epicondylitis (Golfer s Elbow) Dr. Grant is a talented orthopedic surgeon with more than 30 years of experience helping people return to their quality of life. He and GM Pugh,
More informationTreating Chronic Tendon Pain at the Source
Treating Chronic Tendon Pain at the Source Causes of Tendon Pain Tendons are strong, flexible bands of connective tissue that connect muscle to bone, and transmit the energy needed to allow muscles and
More informationAcute Low Back Pain. North American Spine Society Public Education Series
Acute Low Back Pain North American Spine Society Public Education Series What Is Acute Low Back Pain? Acute low back pain (LBP) is defined as low back pain present for up to six weeks. It may be experienced
More informationAn Introduction to Scandinavian Mobilization Therapy
An Introduction to Scandinavian Mobilization Therapy Page 1 Definition Scandinavian Mobilization Therapy is based upon Contemporary Naprapathic Manual Medicine, therapeutic passive exercise, and the American
More informationNorth Texas Musculoskeletal Medicine Enhancing the body s innate ability to heal
Enhancing the body s innate ability to heal Ntxmsk.com 817.416.0970 Dennis E. Minotti II, D.O. Thank you for your interest in, procedures that are radically changing treatment of musculoskeletal conditions.
More informationUNIT 2.- SPORT INJURIES: SYMPTOMS AND TREATMENT
UNIT 2.- SPORT INJURIES: SYMPTOMS AND TREATMENT Every year, millions of teenagers participate in high school sports. An injury to a high school athlete can be a significant disappointment for the teen,
More informationChiropractic , The Patient Education Institute, Inc. amf10101 Last reviewed: 01/17/2018 1
Chiropractic Introduction Chiropractic is health care that focuses on disorders of the musculoskeletal system and the nervous system, and the way these disorders affect general health. Chiropractic uses
More informationJessica Jameson MD Post Falls, ID
Jessica Jameson MD Post Falls, ID Discuss the history of interventiona l pain Discuss previous tools to manage chronic pain Discuss current novel therapies to manage chronic pain and indications HISTORY
More informationA Patient s Guide to Trochanteric Bursitis of the Hip
A Patient s Guide to Trochanteric Bursitis of the Hip Iain is a specialist in musculoskeletal imaging and the diagnosis of musculoskeletal pain. This information is provided with the hope that you can
More informationDeep Penetrating Light
Deep Penetrating Light Power for Muscle & Pain Relief The secret is in the science the power is in the light Relief from Pain & Sore Muscles LED Technologies, LLC manufacturers the DPL Therapy System for
More informationSurgical Wounds & Incisions
Surgical Wounds & Incisions A Comprehensive Review Assessment & Management Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C Advanced Practice Nurse / Adult Clinical Nurse Specialist www.woundcarenurses.org 1
More informationSoft Tissue Mobilization for Cervical and Shoulder Disorders
Soft Tissue Mobilization for Cervical and Shoulder Disorders By William J. Hanney, DPT, PhD, ATC, CSCS Approaches to STM Deep friction massage Trigger point therapy Myofascial Release Rolfing Feldenkrais
More informationTherapeutic Ultrasound
THERAPEUTIC ULTRASOUND Therapeutic is a form of MECHANICAL energy Mechanical vibration at increasing frequencies is known as sound energy. Below 16Hz, these vibrations are not recognizable as sound The
More informationTHE ADVANTAGES OF INTERMITTENT PNEUMATIC COMPRESSION AND CRYOTHERAPY TREATMENT FOR POST-OPERATIVE PATIENT CARE
THE ADVANTAGES OF INTERMITTENT PNEUMATIC COMPRESSION AND CRYOTHERAPY TREATMENT FOR POST-OPERATIVE PATIENT CARE WWW.GAMEREADY.COM 1.888.426.3732 CONTENTS INTRODUCTION SURGERIES THAT BENEFIT FROM INTERMITTENT
More information