The enigma of low back pain… why nothing seems to help.

It is not uncommon for individuals experiencing low back pain to try to self-treat to address their pain and to hold off seeing their primary care physician or physical therapist. Often, this starts with a Google search on treatments, exercises, or stretches to manage low back pain.

Here is why this can be problematic…

There are a number of potential causes for your low back pain, and unless you are aware of the cause, some of the movements that are recommended may actually be causing more irritation.  In other words, stretches that may be beneficial for someone with a hpt2erniated disc can ultimately exacerbate pain with someone who has spinal stenosis.

To add another layer here, if you have any irritation throughout the sciatic nerve, which often accompanies low back pain, many stretches are going to feel fine while you are doing them, however your night pain will escalate. The same goes with various movements that you do throughout the day that don’t bother you while you are doing them, but make your evening pain worse. Unless you are aware of the movements you should avoid, you will have a hard time getting ahead of your pain.

This is just one of the reasons that we do free consultations for individuals at UBE Physical Therapy. We can assess your movements, and recommend how to proceed with managing your symptoms on your own. If you are still struggling with managing your pain after that, we are here for you.

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Trigger Point and Self-Myofascial Release With Lacrosse Ball

At UBE, our goal is to improve joint mechanics for suitable function and restore appropriate length tension relationships of soft tissue. Some of our manual treatment involve trigger point release techniques. Some of our patients can replicate these techniques at home using a tennis or lacrosse ball on the trigger point itself.

Trigger points are “knots” within a taut band of skeletal muscle that is often reactive, tender and irritable when pressure is applied to that area. If the trigger point is chronic, it may or may not be tender to touch and then is called a “latent” trigger point. Trigger points will often refer pain to nearby body regions, particularly if the trigger point is creating dysfunction with daily living.

Below are common applications of lacrosse ball trigger point therapy we teach our patients to overcome their functional obstacles:

 

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PECTORALIS MINOR

The pec minor responds well to using a lacrosse ball on the wall. By placing the ball about 2 inches below the middle of the clavicle, lean your body into the ball on the wall. Hold the ball in that location for a few seconds before moving the ball slightly to the next location.

 

 

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SCAPULAR BORDER

The area between the upper scapula and spine. Trigger points can be addressed with a lacrosse ball to help relax the upper traps that are often used in the activity. The progression would be to add dynamic movement of the arm into flexion overhead and back down to the hip for several reps.

 

 

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GLUTES

There are areas of the deep glutes that respond better to trigger point releasing with a lacrosse ball. While sitting on the floor, place the lacrosse ball toward the tissue near the greater trochanter (hip joint). Hold in this position for 30 seconds each side with light rolling pressure.

 

Foundational strength and why it’s important

Foundational strength refers to strength and stability surrounding the major joints in the body, typically involving smaller muscle groups. Improving foundational strength improves your overall mechanics and creates a stronger base from which to build upon.

Starting an exercise program without first addressing foundational strength can increase the risk of injury and limit your potential for strength gains causing a plateau in your fitness goals.

This recommendation also pertains to physical therapy clients recovering from chronic pain, injury or surgery. An exercise program should start with a good foundation upon which to build, and as the foundational strength improves, higher-level exercises are initiated with greater overall outcomes.

While working on foundational strength may not be as fun or glamorous as plyometrics and Olympic lifting, to get the results you are after, both in the fitness world and during your rehabilitation, you can’t skimp on this part of the program. 

Shoveling 101

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We live in Maine, there’s bound to be snow…and at times, a lot of snow.
With all the snow, there is a lot of shoveling that many Mainers will face.

Shoveling snow may be the most physically challenging exercise you face this winter (and many times into late fall and early spring). Snow shoveling is a repetitive exercise that can involve heavy weighted lifting and pushing. It can lead to muscle strain or injury, especially to the low back or shoulders if done incorrectly.

The American Physical Therapy Association (APTA) offers helpful tips to keep in mind when shoveling snow:

Prior to shoveling:

  • Stretch muscles to warm and loosen them to prevent strains and tears.
    • Warm up legs with slight knee bends that will prepare the lower half of your body for strenuous activity.
  • Avoid alcohol, cigarettes, and caffeine.
    • Each when paired with physical activity, may contribute to or impact long-lasting injury or health complications.
  • Avoid using a shovel that is too long, as this could make the snow pile heavier to lift, causing strain to your back.

During shoveling:

  • Take breaks when needed by walking around and standing up straight. If you have not regularly worked out recently, take several breaks.
  • Make sure to shovel smaller piles of snow at a time instead of very heavy piles
  • Bend at the hips and knees while keeping your abdominals tight when shoveling snow.
    • Lifting a heavy load with a rounded back increases stress on the spine.
  • Avoid twisting with a full shovel of snow.
    • After lifting, take 1-2 small steps to turn your body toward the snow pile.

It is important to keep hydrated with non-caffeinated beverages. Water is the best choice. To help avoid dehydration, keep a bottle of water readily available when shoveling.

After shoveling, you may experience some soreness. Stretching pre/post-shoveling will help limit the amount of soreness you will have. If your soreness lasts more than 48 hours, you may have an injury and should consult your physical therapist or other medical professional.

What is a Health Savings Account?

What is a Health Savings Account?

Due to rising health care costs, many employers are moving toward high deductible health plans (HDHPs) in attempts to cut overhead costs. However, these HDHPs are often offered in addition to a Health Savings Account.

A Health Savings Account (HSA) is a tax-deferred, private savings account, which allows individuals to pay for current and future medical expenses or preventative expenses with tax-free money.

What you need to know about your HSA

  • HSAs have contribution limits set by the IRS
  • Like a 401(k), you contribute pre-tax dollars to your HSA and can have a specified amount automatically deducted from your paycheck. You can even put your HSA balance into a variety of investment options.
  • Unlike an IRA/401k, you don’t pay taxes on withdrawals from your HSA as long as you are using it to cover qualified medical expenses.
  • There are no carryover limits if you carry a balance from year to year.
  • If you are no longer enrolled in a HDHP or if you are no longer employed with the company offering the HDHP and HSA, you don’t lose the money in your HSA account. However, you can no longer contribute to that account.
  • A HSA is very easy to use. No claims review involved. Just keep your receipts.

Qualified medical expenses allowed for use with your HSA

  • Medical expenses
  • Therapy
  • Weight loss program
  • Assistive devices such as crutches, walkers, and wheelchairs
  • Insurance premiums
  • Home improvements designed for injury prevention/safety
  • And many more. A comprehensive list is available at the IRS website, www.irs.gov in IRS publication 502.

 

 

 

What is Graston Technique®?

Graston Technique® is an evidence-based form of instrument assisted soft tissue mobilization to detect and break down scar tissue and fascial restrictions, as well as maintain optimal range of motion.

If you’ve ever “googled” or spoken to somebody who had heard of Graston, I’m sure it evoked some form of torture. However, Graston has been proven to treat common long-term soft tissue (muscle, nerve, tendon and fascia) injuries.

How does it work?
To gain better understanding of how Graston works, you must understand the body’s muscle tissue. As a muscle is overworked, or even during strengthening, micro-tears are created in the muscle fibers. Once the muscles start to build back up, this creates scar tissue/adhesions within the muscle fibers (as seen below) causing what many term as “knots”.

muscle-injury-tissue-progression-large

Think of it as using stainless steel instruments to smooth out knots within your muscles. The Graston tools help the therapist to detect the location of the damaged tissue through feel and sound.

With the use of specialized tools and comprehensive training, a certified Graston therapist is able to effectively address scar tissue, chronic inflammation, and adhesions which improves patient outcomes.

Side effects:
Due to the fact that the therapist is actually re-introducing a bit of trauma to the affected area, temporary inflammation and blood flow occurs. This may create a temporary reddening of the skin/tissue.

While there can be some slightly uncomfortable moments during the Graston process, this is dependent on the severity of the injury; however, the pain is not constant, and the certified therapists knows to apply only deeper pressures for short periods of time.

Commonly injuries in which Graston is used:

Muscle strains
Achilles tendinitis
Plantar fasciitis
Fibromyalgia
Cervical pain
Hamstring strain
Lateral epicondylitis
Rotator cuff tendinitis
Carpal tunnel syndrome
Scar pain
Ligament sprains
Ankle sprain
Patella Femoral Syndrome
Hip pain
Low back pain
ITB Tendinitis
Medial epicondylitis
Adhesive capsulitis
Wrist tendinitis

Graston will not be used solely in your therapy session; it is used as a tool in addition to other treatments to help aid in recovery. Incorporating stretching and strengthening exercises with the instrument assisted soft tissue mobilization aids in remodeling the injured tissue, which will help lead you on the road to recovery!

Want to know if Graston Technique® could help you? Give us a call at 992-4000!

 

 

 

What is Cupping?

fullsizerenderMyofascial Cupping, as it’s technical term, is a technique that uses negative pressure to create a suctioning effect to lift tissue. The tissue can then be moved/rolled across the body by the therapist to decompress underlying tissue.

Cupping dates back to ancient Greece and is common practice in traditional Chinese medicine.

How does it work?

  • Softens tight muscles and tone attachments
  • Loosens adhesions and lifts connective tissue
  • Brings hydration and blood flow to body tissues
  • Increases fluid movement which assists in recovery (i.e. decreased edema)
    • Increases nutrient-rich blood supply to injured area

What is it used for?

Poor Circulation
Sciatica
Low Back Pain
Chronic Pain
Muscular Aches
Pre- & Post-Operative Conditions
Bursitis/Tendonitis
Scoliosis
Myofascial pain syndrome
Carpal Tunnel Migraine & Tension Headache
ITB Syndrome
TMJ Dysfunction
Arthritis
Neuralgia
Athletic Stress & Injury
Plantar Fasciitis
Scars & Adhesions
Fibromyalgia

  • Cupping used as an adjunctive treatment combined with therapeutic exercises and manual work to maximize effect
    • Modified through a range of techniques, from lymphatic drainage to deep tissue release
    • Complements many health modalities such as medical massage and physical therapy

Side effects:

  • Some patients might experience slight discomfort or a tugging sensation when the skin is pulled up by suction
  • Patients may notice a circular bruise or redness
    • As the result of the skin being tugged upwards, sometimes capillaries under the surface of the skin tend to expand after the cup is removed, drawing blood toward the surface of the skin.

 

 

What is direct access?

DIRECT ACCESS
No referral? No problem!


You do not need a referral to be evaluated by a physical therapist, and you have the choice to determine which facility is right for you.
What is direct access?
o The ability to choose where you receive treatment without a prescription or physician referral. Maine state law allows direct access to physical therapists’ services for evaluation and treatment.
Direct access allows you:
o Freedom to choose PT’s based upon:
 Expertise/specialization
 Experience
 Location
 Value added service
o Immediate access to a PT for evaluation, diagnosis, and treatment without waiting for a doctor’s appointment
o Quicker healing
 Getting into treatment earlier leads to faster recovery
o Decreased secondary problems associated with delayed treatment
 Avoid unnecessary stiffness, scar tissue build-up, and prolonged pain
o Maximization of insurance benefits based upon deductibles, co-pays, and fee structures
A hospital-based facility may get paid up to four times the amount that a private physical therapist-owned facility gets for the same service. If your insurance benefit for physical therapy is limited by a price cap, which means the higher costs that a hospital-based facility already has will more quickly reduce your allowed dollar amount than at a private physical therapist-owned clinic. In short, your physical therapy benefit is effectively one quarter of what it should be if you go to a hospital-based outpatient facility.
What to expect:
o Evaluations are one hour, and upon completion of your physical therapy evaluation, we will determine your personal treatment plan.
 Most of our treatments are performed one on one, providing services you can’t perform adequately by yourself at home.
 If further diagnostic tools (e.g., x-ray, MRI, etc.) are needed to ensure proper care, your physical therapist will communicate findings with the physician of your choice.

Dry Needling – what you should know and why

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Trigger Point Dry Needling- What You Should Know
Trigger Point Dry Needling (TDN) is a physical therapy intervention involving a thin filament, similar to an acupuncture needle, that is inserted through the skin targeting myofascial trigger points in the underlying tissue. The term “dry” needling refers to the use of the needle in and of itself, as no medication is used in conjunction with the procedure. Other terms often used to describe the same technique are “intramuscular dry needling” and “intramuscular manual therapy”.
Is This the Same as Acupuncture?
These techniques are often confused with acupuncture; however, the only similarity is the use of a filament needle that is used to penetrate the skin. Acupuncture is based on Traditional Chinese Medicine and stimulates acupuncture points along energy lines called meridians. The thought is to restore “energetic Chi balance” to treat disease. Dry needling is based on Western medicine scientific principles and a plethora of research. TDN treats pain associated with trigger points causing muscular pain that can often radiate to various parts of the body depending on the location of the trigger point.
What is a Trigger Point?
Trigger points are “knots” within a taught band of skeletal muscle that is often reactive, tender and irritable when pressure is applied to that area. If the trigger point is chronic, it may or may not be tender to touch and then is called a “latent” trigger point. Trigger points will often refer pain to nearby body regions, particularly if the trigger point is creating dysfunction with daily living.
Why Dry Needling?
Often, when dysfunction occurs and it is deemed that it is muscular in nature, many of the muscles responsible for this dysfunction are deep muscles that are difficult to resolve with manual techniques, solely due to position of that muscle. Chronic muscle pain can also be difficult to resolve with manual soft tissue work alone, as the trigger points have likely been present for a substantial amount of time. For this reason, dry needling can often speed up your rate of recovery, and improvements in function are common immediately following the procedure. Despite this, dry needling is only a portion of the entire treatment plan, and manual techniques to restore motion and therapeutic exercises to address stability and function around that region should be incorporated into the treatment for optimal outcomes.
What To Expect During the Procedure
Typically, the needle is inserted for a period of 5-10 seconds and then promptly removed. There are instances when the needle would be inserted for a longer period of time, however, your therapist will talk with you about this prior to the procedure. The filament or needle used is very fine, and therefore, the patient may or may not feel the insertion of the needle. It is common to feel discomfort or some degree of pain when the needle penetrates the trigger point, and this discomfort can radiate to other body parts that are associated with the dysfunction, however, this typically subsides once the needle is removed.
Are There Risks and Side Effects?
It is not uncommon to feel soreness following the procedure due to a release of chemicals that occurs when the trigger point releases. This soreness often feels like you may have completed a workout, and can feel very fatigued. Serious side effects are very rare, and are preventable with sterile needle techniques and careful technique during the procedure. The two major risks are a puncture to the lung and infection. To avoid a lung puncture, only short needles are used throughout the thorax and specific procedures are used to angle the needle away from the lung fields.
The second major risk is infection. In order to guard against infection, the clinician wears gloves and uses sterile single use needles. Infection risk is extremely low and not a concern unless the patient is dealing with an active infection at the time of treatment.
Mild risks include bruising at the puncture site, and very small amounts of bleeding are common.  Applying pressure to the puncture site immediately following the procedure can minimize bruising and bleeding.
Common Conditions that Can Be Treated With Dry Needling
• Neck and shoulder pain
• Low back pain
• Plantar fasciitis and foot pain
• Achilles tendonitis/tendinosis
• Tennis/Golfers elbow
• Hip pain/Snapping Hip Syndrome
• General knee pain
• Headaches
• Improve ROM restrictions due to muscle spasms