September Newsletter. In This Issue: John Fiore, PT

Transcription

1 September Newsletter September,20, 2013 Volume 1, Number 9 In This Issue: Hip Pain: Early Treatment Is Key Sapphire Physical Therapy Welcomes Jesse Dupre, DPT Dry Needling: An Excellent Treatment for Myofascial Pain Links to Our Favorite Sites: Related Sites: The Runners Edge: Missoula s hub for running gear, information, and races Run Wild Missoula membership promotes running, training, and racing in Missoula Find us on Facebook: For more information on the services provided by Sapphire Physical Therapy or to read more related articles, see our website or give us a call. Sign up for the Sapphire PT enewsletter at sapphirept.com Contact Us: (406) Hip Pain: Early Treatment Is Key John Fiore, PT Hip pain is a common occurrence experience by a wide variety of individuals ranging from young to elderly. Both sedentary and active athletic individuals experience hip pain. The crucial reason for early treatment of hip pain lies in the wide variety of causes of hip pain. My observation of human nature is that we tend to ignore pain initially, anticipating its departure as miraculously as its arrival. Hip pain, however, can be a localized pain response, or a symptom signaling a much more serious issue apart from the symptomatic hip. Ignoring the check engine light on the dashboard of your automobile is not a good idea. Ignoring the annual April 15 th tax filing date is not a good idea. Ignoring hip pain is not a good idea either due to the implications of hip pain and dysfunction. The hip joint is the key lower extremity weight bearing joint in both sitting and standing. The hip represents a transition between the more stable thorax, pelvis, and core musculature, and the more mobile lower extremity. Like any structure engineered to withstand the use and abuse of weight bearing and the compression of sitting, the hip joint is a remarkable structure (see figure 1). The femur bone is a long lever which transmits the force of weight bearing distally to the lower leg and foot and proximally to the hip joint and pelvis. The head of the femur is seated deep within the socket of the acetabulum of the pelvis (ilium). The deep fitted ball and socket joint of the hip allows it to absorb and transmit an incredible amount of power and force with little chance of dislocation. The musculature surrounding the hip represents the greatest concentration of strength in the human body. The gluteus maximus, gluteus medius, rectus femoris, biceps femoris, and hip rotators together propel us forward with ease. Hip strength, mobility, and core stability permit us to walk on two legs (bipedal locomotion) in contrast to the majority of mammals.

2 Figure 1 Us: John Fiore, PT: john@sapphirept.com Rachael Herynk, DPT: rachael@sapphirept.com Jesse Dupre, DPT: jesse@sapphirept.com Find Us: Sapphire Physical Therapy 1705 Bow Street * Missoula, MT Map: Our Services: Orthopedic injuries Back and neck pain Running overuse injury and prevention Running biomechanical gait analysis Cycling injuries & biomechanical bike fitting Work related injuries Work Hardening & Functional Capacity Evaluations Pre and post-operative rehabilitation Core strengthening & conditioning programs Women s health With such a marvelous anatomical structure, what can possibly go wrong with the net result of hip pain? Hip joint mechanics (or arthrokinematics) is disrupted by two main contrasting causes: OVERUSE and UNDERUSE. OVERUSE Highly repetitive physical activity increases the load stress through the hip joint. Repetitive running, jumping, lateral movement, lifting, and twisting increase and change the degree and translation of force through the hip joint. If the hip joint lacks the necessary range of motion or freedom of movement, the joint mechanics will begin to show wear. A simple range of motion evaluation and joint capsule mobility evaluation can reveal asymmetries in hip joint motion. Failure to heed the warning signs of hip stiffness and soreness may accelerate the degenerative process, leading to osteoarthritis of the hip. Failure of the hip and core musculature to support and stabilize the demands placed upon the body (lower extremities, hip, knee, ankle joints) results in compensatory movement patters. A prime example is weakness of the gluteus medius muscle (see figure 2). The gluteus medius is

3 All insurance accepted Cash payment discount notoriously an under-achiever muscle and is often found to be weak even in strong, athletic individuals. The body compensates by using the second string muscle to pick up the slack. In this case, the hip flexor (tensor fascia latte or TFL) picks up the slack, resulting in overuse of the TFL and iliotibial band pain and dysfunction. A wide variety of compensatory movement and muscle firing patterns can be identified by a physical therapist trained to detect functional strength deficits. While your pain may be in your hip, the underlying cause may be weakness of a muscle in proximity to the hip or even a great distance away (i.e. foot weakness, lower leg weakness, abdominal weakness). The lumbar spine also refers pain to the hip and must be evaluated in the presence of hip pain to rule out a degenerative problem in the lumbar spine and/or a nerve root issue. Figure 2 UNDERUSE Although the mechanism of injury contrasts overuse, underuse of the hip joint can result in more serious damage and less favorable outcomes. The joints in our body are designed to MOVE. Every articular joint in our body is coated with hyaline cartilage and wrapped with a capsule containing a selflubricating mechanism. Synovial fluid is secreted by the hip joint capsule synovium with repetitive joint motion. Synovial fluid is such an amazing lubricant that no synthetic replacement has been developed as a substitute. Lack of hip joint movement results in decreased synovial fluid secretion. A dry hip joint is a stiff joint very susceptible to osteoarthritis. The main cause of hip joint stiffness and a concomitant

4 decrease in synovial fluid secretion to lubricate the joint is SITTING. If you sit for a living or are less active physically, try to get up every hour and move your hip joints. Simple high knee marching in place and hip stretching will go miles toward preserving your hip s self-lubricating mechanism and decrease the likelihood of osteoarthritis. Underuse also includes global hip, lower extremity, and core muscular weakness. Again, muscular strength supports the hip joint and provides the movement and stability required for daily life. Strengthening the hip, leg, and core musculature in functional, weight bearing positions are an efficient way to insure your hip is supported and protected. The physical therapists are trained to detect compensatory movement patterns, strength deficits, and underlying medical (referred pain) causes of hip pain. Our manual therapy treatments utilize joint mobilization to restore normal, healthy hip joint motion to slow down or stop the possible degenerative processes at work. Don t ignore your body s check engine light. Call Sapphire Physical Therapy to improve the way you move and function. Sapphire Physical Therapy Welcomes Jesse Dupre, DPT Sapphire Physical Therapy is pleased to announce the addition of Jesse Dupre to our physical therapy staff. Jesse completed

5 his final clinical internship at Sapphire PT last winter-spring. Jesse is originally from Helena, Montana. After spending several years in Bozeman working on undergraduate studies, Jesse graduated in 2013 from the University of Montana, earning his Doctor of Physical Therapy degree. His professional interests include orthopedic physical therapy, with an emphasis on manual techniques to help restore normal biomechanics and allow people to return to their normal, active lives. Jesse enjoys spending time in the great outdoors of Montana hiking, mountain biking, downhill skiing and fly-fishing. He is excited to be a part of the Sapphire team and to work with the Missoula community! Dry Needling: An Excellent Treatment for Myofascial Pain John Fiore, PT DRY NEEDLING EXPLAINED Dry needling is a cutting edge soft tissue and musculoskeletal pain treatment offered by Sapphire Physical Therapy. Licensed physical therapists with specialized dry needling training are now incorporating dry needling into physical therapy treatment plans with impressive results. Most people are familiar with acupuncture which differs from therapeutic dry needling. Acupuncture has been practiced for thousands of years. Acupuncture treatment is based on the Yellow Emperor s Canon of Internal Medicine which was written between 206 BC and 220 AD. The Canon integrated various channel theories into one system based upon the limited neuroanatomical knowledge of the time. i Yun-tao Ma, PhD has bridged the gap between ancient Chinese acupuncture philosophies and the neuroanatomical knowledge of western medicine to create the integrative dry needling treatment approach. Based on cellular biology of tissue healing and its

6 relationship with the peripheral and central nervous systems of the body, Dr. Ma has facilitated safe, effective dry needling techniques to reduce pain and stimulate tissue healing in the physical therapy outpatient setting. Various theories have existed for thousands of years for the presence of tender points or trigger points in predictable locations throughout the body. Treating such tender points (acupressure points) released tension and eased pain. What ancient practitioners did not realize, however, is the fact that pressure through a sensitive acupressure point stimulates a sensory nerve ending. The sensitized sensory nerve relays a message to the spinal cord where the central nervous system transmits the information to the brain. Sensory input is processed in the brain and a range of neurobiological events are set into action depending on how the stimulus is perceived. Dry needling, therefore, activates the body s natural healing potential by specifically targeting and balancing the sympathetic nervous system to facilitate healing on a cellular level (at the site of the needle lesion or the injured body area). Dry needling also stimulates parts of the brain that activate the principle survival mechanisms-the nervous, endocrine, immune, and cardiovascular systems- and normalize ii iii the physiological activities of the whole body. RESEARCH SUPPORTING DRY NEEDLING EFFECTIVENESS Recent research published in the Journal of Orthopedic & Sports Physical Therapy (JOSPT, September 2013) supported the effectiveness of dry needling in reducing neck and upper extremity pain. iv Dry needling is an effective way to release tight bands of muscle, known as trigger points, which leads to a reduction of pain and return of function.

7 DRY NEEDLING TREATMENT OUTCOMES Dry needling treatment utilizing the Integrated Neuromuscular Acupoint System is painless 80% of the time. The treatment approach results in complete resolution of symptoms in 28% of cases, resolution of symptoms for six-months or more in 64% of cases, and marginal results in just 8% of cases. v Dry needling treatment begins with a Quantitative Evaluation to determine the distribution of acupoint sensitivity in two key body areas (lateral forearm H1point & lateral lower leg H4 point). The distribution of sensitive acupoints effectively predicts the number of recommended treatments. Athletic injuries, acute pain, tendonitis, tendonosis, joint pain, back and neck pain, muscular guarding, delayed onset muscle soreness, cumulative stress (overuse injuries) injuries, and joint stiffness all respond remarkably well to dry needling treatment. Dry needling also increases the effectiveness of physical therapy exercise and manual techniques by reducing pain and compensatory movement patterns resulting from stiffness, tightness, and pain. DRY NEEDLING TREATMENT Following a comprehensive medical history screen and physical therapy objective evaluation, dry needling may be determined to be an effective component of your treatment. In addition to treating any painful or injured areas, a sequential series of key body locations (homeostatic points) may be included in the dry needling treatment. Needling of the body s 24 homeostatic points restores homeostasis in the body and boosts our healing capacity. vi When homeostasis declines, homeostatic acupoints are gradually transformed from a latent phase (non-sensitive) to passive or active phase (sensitive with or without palpation). The positive systemic response to dry needling the 24 homeostatic points makes it possible not only to treat the localized injury, but also to predict the response to treatment. Treatment duration varies based upon the patient injury and overall health (self-healing potential determinant). Dry needling can be incorporated into your physical therapy exercise and manual therapy treatment to bring about more timely results and functional improvement. Call John Fiore at Sapphire Physical Therapy to learn more about dry needling or schedule an appointment to see how dry needling can be an effective, efficient addition to your physical therapy treatment plan.

8 i Ma YT: Biomedical acupuncture for pain management: an integrative approach. Philadelphia, PA. Elsevier Churchill Livingstone ii Tracey KJ: The inflammatory reflex, Nature 420: , iii Wang H, it al: Nicotine acetylcholine receptor alpha7 sub-unit is an essential regulator of inflammation, Nature 420: , iv J Orthop Sports Phys Ther 2013;43(9): Epub 11 June v Ma YT: Biomedical acupuncture for pain management: an Integrative approach. Philadelphia, PA. Elsevier Churchill Livingstone vi Dung HC: Anatomical acupuncture, San Antonio, TX, 1997, Antarctic Press.