Back Pain: Why so common?

Meet today’s guest blogger:

Dave Rubsam, physical therapist certified in Astym treatment

Dave Rubsam, PT, OCS

Dave has been a physical therapist for over 20 years, having graduated from the University of Iowa in 1989 with his masters in physical therapy. He practices at Marion Physical Therapy in the Marion, Iowa area, and has worked in outpatient settings most of his career. Dave has been board certified as an orthopedic specialist since 2001, and has been certified in the Astym system since 2003, which he uses extensively in his practice.

The statistics in the United States say that 8 out of 10 of us will suffer enough back pain at some point to have to change our plans and likely seek medical attention. But why is back pain so common? Let’s explore some reasons why, and we can each think of which of these (in any combination) might apply to us personally.

First, where does back pain come from? I like to tell my clients that it can originate from at least 5 different structures anatomically. The most feared is the disc, commonly diagnosed as a “disc bulge” or a “slipped disc” or a “herniated disc,” among others. The disc itself may create pain if injured, or it may create pain by pushing on or irritating a nerve running next to the disc. Next is nerve pain, most frequently called “sciatica” if affecting the large sciatic nerve running to the lower extremity, or nerve pain can affect any of the smaller nerves in the back itself, the abdomen or pelvis or groin areas. Nerve involvement may also create numbness, tingling, burning, or other abnormal sensations in the areas affected. Third, back pain may come from the facet joints, which are the small joints joining each vertebra in the spine to the ones above and below. Like any joint, these can be sprained or have arthritis affect them, creating pain in the middle of the low back, or just to either side. Fourth, the ligaments that link the vertebrae together may be sprained, just like an ankle sprain. And lastly, the muscles that surround the spine and pelvis and hip joints can be injured, creating spasm or tension in the low back, and possibly affecting any of the prior four structures, creating pressure and pain from them as well.

While not an exhaustive description of back pain, the discussion above should highlight the complexity of back pain, and should lead us to realize that “back pain” is not generic, and should not be treated generically—not every episode of back pain is the same, so treating back pain shouldn’t be the same every time. If you are experiencing back pain, look to the experts to help you obtain a plan of care that fits your situation. Your doctor can help with the medical management of your symptoms, and your physical therapist can help with the appropriate treatment and exercises to get you back to your regular activities as soon as reasonably possible. Treatments may include medications, modalities (the term for treatments such as heat, cold, ultrasound, electrical stimulation), and hands-on interventions like spinal mobilizations or manipulations, Astym treatment or other soft tissue work, exercises specific for your type of back pain, and help with proper lifting techniques and injury prevention ideas to keep your pain from returning.

What’s Your Astym Story?

Share your Astym story with us and our readers.Astym treatment has improved lives across the country. We would like to hear your story about what Astym did for you. Whether Astym helped you win a race or the big game, dance at your daughter’s wedding, or simply got you back to doing the things you love, we want to hear about it.

Here are some ideas of things you may wish to include in your story:

  1. What problem did you suffer from? How did this problem limit you – what things were you not able to do?
  2. How long did you suffer before you found Astym? Did you try other treatments that failed before you found Astym?
  3. How soon after receiving Astym treatments did your condition start to resolve? What things could you do again after receiving Astym treatment that you could not do before?
  4. How has your life improved now that you are well again?
  5. How has Astym met or exceeded your expectations?

*Such as patient, long-time runner, professional athlete, recreational athlete, tennis player, etc.

 

I give my full permission for all information I have submitted here to be disclosed and released on the internet or other publication.

Jumper’s Knee Treatment

Meet today’s guest blogger:

Noel Tenoso

Noel Tenoso, PT, DPT, OCS practices in the Portland, Oregon area and owns 2 clinics, Advance Sports & Spine Therapy. He has certifications in manual therapy and Mechanical Diagnostic Therapy with the McKenzie Institute. Both clinics have met the criteria of being certified McKenzie Clinics. He has been certified with Astym since 2005.

Pain in the front of the knee is very common in many types of sports that are associated with quick stops, starts, changes in directions, and jumping. “Jumper’s knee” or patellar tendinitis/tendinopathy is a condition that usually persists for more than 4-6 weeks after symptoms appear. Pain is generally intermittent and associated with activity.

 

Clinicians practicing Astym will find a nodule of tissue (scar tissue) just below the kneecap that correlates with the patient’s symptoms. This scar tissue may represent the dysfunctional healing of the tendon that can be addressed effectively with Astym treatment and exercises.

 

Clinically, a physical therapist can assist with management of jumper’s knee by stimulating the lower extremity with Astym treatment to assist with resorption of the dysfunctional tissue, and to stimulate production of new collagen tissue. In conjunction with treatment, the patient needs to participate by doing stretching exercises and increasing activity that will help guide the healing of this new tissue. Another important aspect of rehabilitation is making sure future recurrence is prevented by addressing the poor biomechanics that may have put too much pressure on the knees. A physical therapist can help to evaluate and educate the patient on how to reduce the stress to the knees through incorporation of the hips and proper trunk posture with quick stop/starts, changes of direction, and jumping.

 

Stretches that address improving flexibility of the muscles of the hips, quadriceps, hamstrings, and calf muscles in conjunction with Astym are helpful. Also “eccentric” exercises1 have been shown to help by doing lengthening exercises of the quadriceps with resistance to discomfort while squatting on a decline board.

 

1Jonsson P, Alfredson H. Superior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: a prospective randomized study. BJSM, 2005; 39: 847-850

Scar Tissue Associated With Breast Augmentation: Astym Treatment Helps Cosmetics

Meet today’s guest blogger:

Gus Gutierrez, PT, OCS, FAAOMPT
Gus is an owner of and serves as clinical director of BRPT-Lake, a multi-clinic private practice located in and around Baton Rouge, Louisiana, that specializes in the treatment of orthopedic patients and sports-related injuries. He received his Orthopedic Certified Specialization distinction in 1994 and then again in 2004. He is certified as a Level 2 Manual Therapist and is Fellow of the American Academy of Orthopedic Manual Physical Therapists. He has over 23 years of clinical experience and working with athletes on all levels. Gus has been certified in Astym since 2001. He is also certified in Kinesiology Taping and as an Active Release Technique practitioner for the upper extremity, lower extremity and spine.

In orthopedic settings across the world, Astym treatment has become the prime modality of choice in scar tissue reduction.  Dysfunctional scarring can result in restricted movement, stiffness, and an undesirable appearance.  Astym treatment can help eliminate scar tissue and thereby restore movement, eliminate pain, and deliver a more desirable appearance. Continue reading Scar Tissue Associated With Breast Augmentation: Astym Treatment Helps Cosmetics

IT Band Syndrome: The Solution to a Difficult Problem

Meet today’s Guest Blogger:

 Suzie Freeman, MPT, OCS physical therapist

Suzie Freeman, MPT, OCS
Suzie works as a Senior Physical Therapist at California Rehabilitation and Sports Physical Therapy in Huntington Beach, California. She earned her Bachelor’s Degree in Kinesiology from the University of California, Los Angeles, and then moved on to the University of Southern California for her Masters in Physical Therapy.  Suzie is the Center Coordinator for Clinical Education, as well as a Clinical Instructor, taking physical therapy students from local universities on a year-round basis. 

 

So, it’s the New Year, and you have taken up running, or recently increased your mileage.  Things are going great.  Your pants are looser, and you feel on top of the world.  Then, the side of your thigh or the outside of your knee starts hurting.  You have developed IT Band pain. You check the internet, and it is filled with stories of how stubborn IT Band pain is to treat, and how long it takes to recover; that is, if people recover at all.  Things seem pretty dismal.  You pop a few ibuprofens, try some ice, buy some new running shoes… but the IT Band pain just won’t go away.  You see your doctor, try some physical therapy; perhaps orthotics.  Still not better.  You wonder, “Is this the best the medical community can do for me?”

There is a lot of new research being done on this and other chronic problems with soft tissue and tendons.  Your doctor may have called your problem “tendonitis”, which is inflammation of a tendon (the structures that attach muscles to bones).  There are a lot of treatments for inflammation (i.e. ice, anti-inflammatory medication, cortisone shots, or rest).  These treatments may help, but only temporarily.  New research has shown that with many chronic tendonitis and chronic soft tissue cases, the problem does not even involve inflammation at all, and that’s why ant-inflammatory treatments don’t provide long-term relief.  As the machines that visualize the structures of the human body have gotten better, scientists can now see that the painful tendon is actually degenerating.  In a degenerative tendon, healthy tendon cells are replaced by fibrotic (scar) tissue.  Even the blood supply in a degenerative tendon looks different – there are actually areas where the tiny blood vessels are not even attached to the main blood lines.  That means that the blood products necessary for healing are not being delivered to the degenerated areas.  By the time a tendon is degenerative –due to injury or overuse – the body has tried to heal, but has done so in a very inferior way.

The question then becomes:  How do we get the body back on the right track to proper healing?

There is a new treatment available called “Astym”, which is often interpreted as “a stimulation of healing”.  It was developed by physicians, physical therapists, and university researchers who demonstrated that Astym is an effective treatment for resolving chronic tendonitis.  Certified Astym clinicians have been performing this technique around the United States for over 9 years and have been getting outstanding and consistent results.  It has been found that Astym treatment has a success rate of 92% with ITB Syndrome. (Source: Astym Analyst Outcome Report, courtesy of Performance Dynamics).

You can check the Astym website to see if there is a certified clinician in your area.  In the meantime, you can try this stretch to see if you can relieve your symptoms on your own.  Like most stretches, the position should be pain free and held for 30 seconds, and repeated several times throughout the day.

IT Band Stretch

 Effective IT Band Stretch

So, don’t let these chronic problems keep you from your sport or running.  Astym could be just what you need to get you back to doing what you love and into those tight pants again.

Tendonitis/Tendinosis: How Do You Get Better?

You need to first determine the underlying cause of your tendon pain.  Is your tendonitis (also called tendinitis) caused by inflammation?  If so, then it is the kind of tendinopathy that the healthcare system is best at resolving in short order.  The traditional treatments for inflammatory tendonitis are rest (which can include bracing), ice, and anti-inflammatory medicines, such as ibuprofen.  Once these treatments are applied, inflammatory tendonitis should resolve within 6 weeks.

If tendonitis recurs after these treatments stop, or if the condition does not resolve with these tendonitis treatments, then you may have a degenerative tendon disorder, more correctly referred to as tendinosis.  In order to resolve a degenerative tendinopathy (also called tendinosis or tendonosis), you must stimulate the affected tendon to heal or regenerate.  Since medical science only recently discovered that chronic tendonitis and tendinosis are mainly degenerative in nature, there are only a few treatments that work on stimulating regeneration.  Astym treatment was scientifically developed to stimulate regeneration of soft tissues, and has emerged as the treatment of choice in physical and occupational clinics nationwide to consistently resolve chronic tendonitis and other tendinopathies.

On a different front, physicians recently began injecting platelet rich plasma (PRP) into patients with tendinopathy in an effort to regenerate tendons.  Although many had hoped that this approach would prove to be effective in controlled studies, a recent well designed study was published in the Journal of the American Medical Association, and it showed that PRP injections were no more effective than placebo injections.  To view a copy of this journal article, click here: http://jama.ama-assn.org/cgi/content/long/303/2/144

Plantar Fasciitis, Achilles Tendonitis: A Patient Talks About a Treatment That Works.

Few things are more frustrating than having chronic plantar fasciitis and Achilles tendonitis (also spelled Achilles tendinitis).  Here is the story of one patient who suffered from Achilles tendon pain and plantar fasciitis, and tried multiple treatments before she finally got better with Astym at KORT physical therapy.

Lori Childs talks about Astym therapy at KORT

As an Achilles tendonitis treatment, Astym improves 94.7% of Achilles tendinitis (tendonitis), or Achilles tendinopathy cases.  Astym also resolves plantar fasciitis well, with 91.9% of plantar fasciitis or plantar fasciopathy cases improving after Astym treatment.   Chronic tendonitis can affect many areas of the body.  To view the resolution rates (outcomes) of Astym on particular types of chronic tendonitis/tendinosis, click here:  http://astym.com/upload/pdf/Astym%20Outcome%20Reports.pdf

Plantar Fasciitis: The Three Best, Most Effective Stretches for Athletes. Inside Tips From a Sports Medicine MD.

Plantar fasciitis causes a great deal of heel pain and disability among athletes.  As a sports medicine doctor, I have seen thousands of athletes sidelined by plantar fasciitis.  Most patients who receive Astym therapy respond favorably, and their plantar fasciitis resolves.  To find out if Astym therapy is right for you, please locate a provider near you, and schedule an appointment to be evaluated.

However, there are some athletes who struggle with relapse or their condition becomes chronic, or long term.  Some sports physicians and medical researchers suspect that a portion of these recalcitrant patients are not stretching properly, and that may be a factor in their failure to recover from plantar fasciitis.

Here are some stretches that may help you recover from plantar fasciitis:

Best plantar fasciitis stretch

Stretch #1:  Gastroc  Stretch: foot flat on the floor, knee straight, lean forward with your other foot extended in front of you, but keep most of your weight on your back foot until you comfortably feel the stretch in the back of your calf (gastroc muscle and Achilles tendon).

Stretch #2:  Soleus Stretch:  foot flat on the floor, KNEE BENT, lean forward on the other foot that is extended in front of you, but keep most of your weight on your back foot until you comfortably feel the stretch in the back of your calf (by bending your knee, you relax the gastroc muscle, which allows you to focus the stretch on the soleus muscle and the Achilles tendon).

Best plantar fasciitis stretch

Best Plantar Fasciitis StretchStretch #3:  Flexor Hallicus Longus (FHL) Stretch:  Often, plantar fasciitis sufferers will do some version of stretches #1 and #2 above, but fail to do this last stretch.  This stretch can often be the key in helping patients recover from plantar fasciitis.  Use a stair step or a wall to aid you in this stretch.  Stretch your toes up vertically using the wall or stair step and, keeping your heel on the floor, bend you knee slightly and push foward gently, until you comfortably feel the stretch in the bottom of your foot, the inside part of your ankle, and up the back of your calf.

As with any rehabilitation method, you should talk with your doctor prior to doing any stretching activity or other type of treatment.  In the cases of chronic plantar fasciitis,  experienced sports doctors often recommend that these stretches be done 2 times a day, with each stretch performed 3 times per session, and held for 40-60 seconds if a patient’s condition comfortably allows for this.

Botox® for Tennis Elbow?

Sounds strange to some people, but these injections are being tried to relieve tennis elbow pain, and with some success.  As a sports physician, I have seen many patients with tennis elbow.  I also do medical research, and as a result, I was invited to perform a review of a proposed article for a professional journal on botulinum toxin (Botox® is a trade name for botulinum toxin A) in the treatment of tennis elbow (lateral epicondylitis). This type of review is part of the peer review process that helps to ensure that quality articles get published in medical and scientific journals.  The editors of a peer-reviewed journal contact other researchers or knowledgeable professionals in the field to review  submitted articles and render an opinion on whether an article should be published, and what modifications, if any, should be made to the article before publishing.

The editors of a medical journal asked me to be a peer reviewer on an article about a study where botulinum toxin was used in the treatment of tennis elbow.  Overall, it was a good prospective, pilot study comparing botulinum toxin injections with corticosteroid injections in the treatment of acute and subacute tennis elbow.  After the review process, the study was published.  Here is a link to the abstract for that article (summary of the article):   http://www.ncbi.nlm.nih.gov/pubmed/20134306   Although I am not going to comment on this particular article, I do think commenting on this treatment approach in tennis elbow is worthwhile.   Significant study of this approach has not been done, however there does appear that at times, there may be some benefit to this type of injection.  There may also be a downside.

The seeming purpose of the injection is to lessen the pain of tennis elbow.  Botulinum toxin has been regularly used to paralyze muscles with great success, so it would follow that botulinum toxin could also paralyze or deaden sensory nerves and thereby relieve the pain of tennis elbow.  However, there has been no suggestion that botulinum toxin promotes any real healing of the degenerative tendinopathy, which is the actual underlying problem of chronic tennis elbow.   The real question is whether a decrease in the symptoms of tennis elbow would be due to the deadening of the sensory nerve, or could it be due to the weakening of the muscles that attach to the abnormal tendon which would decrease the stress on the tendon.

Short term tennis elbow (lateral epicondylitis) may be due to inflammation.  In short term cases of tennis elbow (less than four weeks), most healthcare professionals prescribe rest, ice and anti-inflammatory medication.  If these treatments do not resolve the tennis elbow and the condition persists, then the more chronic condition is often thought to be caused by degeneration and referred to as lateral epicondylosis, and other treatments or tennis elbow therapy are employed.

Longer term cases tennis elbow, also known as chronic lateral epicondylitis, lateral epicondylosis and elbow tendinosis/tendinopathy, can be treated by various means, including:

• Astym treatment
• Autologous Blood Injections
• Corticosteroid Injections
• Eccentric Exercise
• Electrical Stimulation and Iontophoresis
• Extracorporeal Shockwave Therapy (ESWT)
• Fenestration (percutaneous tenotomy)
• Friction Massage
• Glyceryl Trinitrate (Nitroglycerin) Patches
• Laser/Light Therapy
• NSAIDs/Anti-inflammatory Drugs
• Platelet Rich Plasma (PRP) Injections
• Prolotherapy (Sclerotherapy):
• Relative Rest/Splinting/Immobilization
• Stretching/Ice
• Surgery
• Ultrasound and Phonophoresis

Botulinum toxin injection has not made the list of the most common tendonitis treatments.  Since the purpose of the injection seems to be limited to pain relief with no healing benefit, it may not become a regular treatment for tennis elbow.  The downside of these injections can include muscle weakness and possible decrease in function while the botulinum toxin is active.  And although botulinum toxin may reduce pain, there is not any significant supporting evidence showing that it can improve function for patients with tennis elbow.

Research on Astym: Summary of Astym Treatment’s Evidence Base

At its core, Astym treatment was developed from solid basic science research to stimulate regeneration at a cellular level.  Following that, there were a number of case studies published and then a randomized controlled clinical trial on patellar tendinopathy.  A large randomized controlled clinical trial on lateral epicondylosis was awarded a platform presentation at the American Society for Surgery of the Hand’s national meeting, and is now being submitted for publication(for more information on this study, click here: http://blog.astym.com/blog/astym/0/0/effective-treatment-for-tennis-elbow-presented-at-hand-surgeons-meeting).

Several other studies have also been completed and are being prepared for publication or submitted for publication. To see a full listing of research on Astym treatment, please visit the research page by clicking here: http://astym.com/professionals/research.asp

One of the main reasons for the effectiveness of Astym treatment is its sound evidence base.  Astym treatment was scientifically developed to target the true underlying cause of many soft tissue problems:  degeneration and inappropriate scarring/fibrosis that interferes movement and causes pain.  One of the factors that guided the scientific research and development of Astym treatment was medical science’s recent discovery that tendinopathy is degenerative (worn or broken down) in nature and only rarely has a component of inflammation (the body’s immune system actively responding to an injury or threat).  Generally, most treatments of tendinopathy focus on reducing inflammation, and those treatments have not been very successful.  In light of the recent evidence indicating that degeneration is the underlying cause of tendinopathy, Astym treatment was developed with a focus on stimulating the regeneration of healthy tissue, rather than on reducing inflammation, and that is one reason why Astym is so effective at resolving tendinopathies.

In addition to ongoing clinical and scientific research, the Astym program also emphasizes the collection of practical, clinically useful information.  Astym treatment has put major effort into developing a reliable national outcomes collection system and database, where clinicians from all across the country independently enter data to create a national bank of dependable outcomes data.  These outcomes (treatment results) show the percentage of people with each condition that resolve (get better).  Not only does this provide a good real-world evidence base for Astym treatment, it also allows patients and health care providers to know how many treatments it should take to resolve a certain condition, and what percentage of those cases should resolve.  For instance, for a patient with plantar fasciitis, you can predict that in 10 therapy visits, 91.8% of patients will be improved or much improved.  To see a full listing of diagnoses and outcomes, click here:  http://www.astym.com/upload/pdf/Astym%20Outcome%20Reports.pdf

Restore – Revitalize – Recover