Meet today's guest bloggers:



Dr. Timothy W. Flynn, PT, PhD
Dr. Flynn is board certified in Orthopaedic Physical Therapy (OCS), a Fellow of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT), and a frequent research presenter at state, national, and international meetings. Dr. Flynn is widely published including 5 textbooks, 6 book chapters, over 50 peer-reviewed manuscripts on orthopaedics, biomechanics, and manual therapy issues. He was the editor and author of The Thoracic Spine and Ribcage - Musculoskeletal Evaluation & Treatment and The Users' Guides to the Musculoskeletal Examination, and the author of 3 educational CD-ROMs on Orthopaedic Manual Physical Therapy. Dr. Flynn has received numerous research grants. Awards include the James A. Gould Excellence in Teaching Orthopaedic Physical Therapy, the Steven J. Rose Excellence in Research (twice), the AAOMPT Outstanding Research Award (twice), and the Distinguished Alumnus- Marquette University Program in Physical Therapy. Dr. Flynn continues to maintain an active research agenda in the areas of spinal and extremity manipulation, low back disorders, characterization of spinal instability, and the development of clinical prediction rules.
Dr. Flynn is an expert clinician who is dedicated to providing the highest quality care possible. His primary clientele is made up of individuals suffering from low back pain, chronic spinal disorders, failed back surgeries, and chronic pain disorders. Dr. Flynn's clinical expertise is frequently sought by national and international clients. He is on the executive board of Evidence in Motion (www.evidenceinmotion.com) an education and practice consultation company which passionately promotes a culture of evidence-based practice within the physical therapy profession. Dr. Flynn is the immediate past President of the American Academy of Orthopaedic Manual Physical Therapists (www.aaompt.org), an Associate Editor for the Journal of Orthopaedic & Sports Physical Therapy (JOSPT), and editorial board member of Manual Therapy. He is a Distinguished Professor of Physical Therapy at Rocky Mountain University of Health Professions (www.rmuohp.edu) where he teaches professional and post-professional students in the area of musculoskeletal management, advanced manipulation skills, and evidence-based practice.



Dr. Terry Gebhardt, PT, DPT
Dr. Gebhardt completed his Master of Physical Therapy at the U.S. Army-Baylor University Graduate Program in 1998. During Dr. Gebhardt's 7 years of physical therapy practice in the Army he specialized in treating a broad range of musculoskeletal injuries. He has worked extensively with injury prevention initiatives and has been a leader in the development of training programs designed to maximize fitness while preventing injury. Dr. Gebhardt relocated to Colorado in 2004 to complete his Doctorate of Physical Therapy degree and Fellowship in Manual Therapy at Regis University. His areas of clinical expertise and interest include spine and sports rehabilitation where he incorporates his passion for fitness with physical therapy.
Dr. Gebhardt is an avid back country skier and ultramarathoner. He is a member of the American Physical Therapy Association (APTA), American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) and a Certified Strength and Conditioning Specialist (CSCS). He has also published research in the Journal of Orthopaedic and Sports Physical Therapy and is currently active in clinical research.

Carpal Tunnel Syndrome:  Advice from the Experts

If you experience wrist and hand pain with numbness or tingling into your hand you may have carpal tunnel syndrome.  Other common symptoms include weakness in the thumb muscles, loss of hand motion and increased pain at night.   Carpal tunnel syndrome affects 2-5% of the population and most commonly affects individuals between the ages of 40-60.  It frequently affects individuals whose occupations require the wrist to be flexed or extended for long periods of time, such as jobs that require computer work.  Also, repetitive motion or gripping activities and exposure to repetitive vibrations such as power tools can contribute to carpal tunnel syndrome. If you suspect that you have carpal tunnel syndrome, you should see a doctor to be properly diagnosed and explore treatment options.

Common treatments for carpel tunnel syndrome include rest, anti-inflammatory medication, night splints to immobilize the wrist, physical therapy, and steroid injections.  If these options fail, surgery may be recommended.  Although carpal tunnel syndrome is caused by increased pressure on the median nerve which travels through the carpel tunnel at the wrist, it is important to remember that the median nerve originates in the neck and the neck must be addressed when treating carpal tunnel syndrome.  While 14% of individuals with carpal tunnel syndrome have neck pain, neck pain does not need to be present in order for the neck to be a contributing factor to symptoms.  The key point is to treat the upper extremity nerve and muscle system and not simply focus on the location of pain.  In the case of carpel tunnel syndrome, this means treating the upper back, neck, and the course of the nerve (from the neck down to the shoulder, elbow, wrist, and hand).  Even if nerve testing reveals poor conduction to the median nerve at the carpal tunnel, this can frequently be improved by treating the entire nerve and muscle system in the involved arm, which can often help avoid the need for surgery. 

A thorough examination by your physical therapist will help you determine the best conservative treatment options for you.  This treatment will frequently include gentle spinal manipulation of the upper back and neck, nerve sliding/gliding exercises to treat the nerve from your neck to your hand, and “hands-on” techniques to mobilize the bones of the wrist and hand.  Tight bands or knots called trigger points are commonly found in the muscles of the forearm and the muscles around the upper back and neck in patients with carpal tunnel syndrome.  These can be treated with trigger point dry needling or massage. 

The repetitive motions or stress associated with carpal tunnel syndrome can also cause tightness and possible degeneration in the soft tissues (muscles, tendons, and ligaments) around the carpal tunnel.  ASTYM treatment can help relieve this stiffness and regenerate the soft tissues.

Finally, poor posture will place increased stress on the nerves coming out from the neck and going to the hand.  Maintaining good posture and taking frequent breaks when working at your computer will help alleviate this stress.  Also, having the proper ergonomic set up at your computer to minimize stress on the neck, upper back, and wrists will also reduce your chances of experiencing carpal tunnel symptoms.

If you suffer from carpal tunnel syndrome, it is important to treat the body as a system and not simply focus on the carpal tunnel.  Just because your pain may only be in your wrist or hand does not mean that the source of all your symptoms is in the wrist and hand.  Your upper back and neck are likely contributing factors and should be treated along with the hand and wrist.  A comprehensive conservative treatment program addressing all contributing factors will help you avoid more aggressive and costly procedures such as surgery.

Meet today's guest bloggers:



Dr. Terry Gebhardt, PT, DPT
Dr. Gebhardt completed his Master of Physical Therapy at the U.S. Army-Baylor University Graduate Program in 1998. During Dr. Gebhardt's 7 years of physical therapy practice in the Army he specialized in treating a broad range of musculoskeletal injuries. He has worked extensively with injury prevention initiatives and has been a leader in the development of training programs designed to maximize fitness while preventing injury. Dr. Gebhardt relocated to Colorado in 2004 to complete his Doctorate of Physical Therapy degree and Fellowship in Manual Therapy at Regis University. His areas of clinical expertise and interest include spine and sports rehabilitation where he incorporates his passion for fitness with physical therapy.
Dr. Gebhardt is an avid back country skier and ultramarathoner. He is a member of the American Physical Therapy Association (APTA), American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) and a Certified Strength and Conditioning Specialist (CSCS). He has also published research in the Journal of Orthopaedic and Sports Physical Therapy and is currently active in clinical research.




Dr. Timothy W. Flynn, PT, PhD
Dr. Flynn is board certified in Orthopaedic Physical Therapy (OCS), a Fellow of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT), and a frequent research presenter at state, national, and international meetings. Dr. Flynn is widely published including 5 textbooks, 6 book chapters, over 50 peer-reviewed manuscripts on orthopaedics, biomechanics, and manual therapy issues. He was the editor and author of The Thoracic Spine and Ribcage - Musculoskeletal Evaluation & Treatment and The Users' Guides to the Musculoskeletal Examination, and the author of 3 educational CD-ROMs on Orthopaedic Manual Physical Therapy. Dr. Flynn has received numerous research grants. Awards include the James A. Gould Excellence in Teaching Orthopaedic Physical Therapy, the Steven J. Rose Excellence in Research (twice), the AAOMPT Outstanding Research Award (twice), and the Distinguished Alumnus- Marquette University Program in Physical Therapy. Dr. Flynn continues to maintain an active research agenda in the areas of spinal and extremity manipulation, low back disorders, characterization of spinal instability, and the development of clinical prediction rules.
Dr. Flynn is an expert clinician who is dedicated to providing the highest quality care possible. His primary clientele is made up of individuals suffering from low back pain, chronic spinal disorders, failed back surgeries, and chronic pain disorders. Dr. Flynn's clinical expertise is frequently sought by national and international clients. He is on the executive board of Evidence in Motion (www.evidenceinmotion.com) an education and practice consultation company which passionately promotes a culture of evidence-based practice within the physical therapy profession. Dr. Flynn is the immediate past President of the American Academy of Orthopaedic Manual Physical Therapists (www.aaompt.org), an Associate Editor for the Journal of Orthopaedic & Sports Physical Therapy (JOSPT), and editorial board member of Manual Therapy. He is a Distinguished Professor of Physical Therapy at Rocky Mountain University of Health Professions (www.rmuohp.edu) where he teaches professional and post-professional students in the area of musculoskeletal management, advanced manipulation skills, and evidence-based practice.

Hamstring Strain and Injury:  Advice From The Experts, Part II

In Part I of this entry, we discussed some of the most effective treatments for chronic hamstring strains and injuries.  Despite being pain-free with typical daily activities, many athletes continue to have pain with their sport several months and even years after a hamstring injury.  Unfortunately, there is a high recurrence rate of hamstring strains because of incomplete rehabilitation or returning to sport too soon.  Residual scar tissue and persistent muscle weakness are two common reasons for the persistent pain and high recurrence rate following a hamstring strain.

Fortunately, regardless of how long the injury has persisted, Trigger Point Dry Needling and ASTYM treatment can help  reduce or eliminate scar tissue and knots in the muscle called trigger points.  These hands-on treatments combined with the appropriate exercise routine can help resolve even the most chronic hamstring strains.
 
Considering there is such a high recurrence rate of hamstring strains, many have asked what can be done to prevent these injuries from recurring  and even better, prevent them from happening in the first place.  Although hamstring stretching is commonly recommended for injury prevention, a hamstring flexibility program has not been shown to reduce the incidence of hamstring injuries and in fact it may lead to what is called stretch weakness, where the muscle is highly flexible but weak and prone to injury.  In contrast, several studies have found the incorporation of specific strengthening called eccentric exercises into a training program can significantly reduce  hamstring strain injuries.  Eccentric exercise involves slowly straightening your knee against resistance (working your hamstring muscles) so that the muscle is engaged while it is lengthening.  If you are recovering from an acute or chronic hamstring strain, your physical therapist can help you determine when it is appropriate to begin eccentric training.  It is important to start slowly when beginning an eccentric strengthening program, as there tends to be greater muscle soreness associated with this type of strengthening.
 
In addition to eccentric training, exercises that focus on neuromuscular control of your core muscles and lower extremities have been shown to accelerate injury recovery and prevent re-injury.  Think of neuromuscular control as the system that creates coordinated movement.  This control system frequently “shuts down” following injury.  Simply strengthening the muscles is usually not enough to restore neuromuscular control.  Exercises to re-establish the motor control are critical in preventing injury recurrence.   Examples of such exercises following a hamstring strain include high knee marching, skipping, and explosive running starts with a focus on leg power development.  Finally, a program emphasizing varying trunk movements during running (e.g. upright posture, forward flexed and forward flexed and rotated) has been shown to reduce hamstring injury recurrence by 70%.
 
If you participate in sports where hamstring injuries are more common such as running, soccer, softball, and tennis, remember to include exercises similar to those listed above to reduce your risk of hamstring injury.  Your physical therapist or personal trainer can help you develop the optimal training program.  If you happen to be one of the unfortunate ones who is still suffering from a chronic hamstring injury, remember you do not need to put up with the pain.  There are effective treatments available to help you return to the sport you love.

Meet today's guest bloggers:



Dr. Timothy W. Flynn, PT, PhD
Dr. Flynn is board certified in Orthopaedic Physical Therapy (OCS), a Fellow of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT), and a frequent research presenter at state, national, and international meetings. Dr. Flynn is widely published including 5 textbooks, 6 book chapters, over 50 peer-reviewed manuscripts on orthopaedics, biomechanics, and manual therapy issues. He was the editor and author of The Thoracic Spine and Ribcage - Musculoskeletal Evaluation & Treatment and The Users' Guides to the Musculoskeletal Examination, and the author of 3 educational CD-ROMs on Orthopaedic Manual Physical Therapy. Dr. Flynn has received numerous research grants. Awards include the James A. Gould Excellence in Teaching Orthopaedic Physical Therapy, the Steven J. Rose Excellence in Research (twice), the AAOMPT Outstanding Research Award (twice), and the Distinguished Alumnus- Marquette University Program in Physical Therapy. Dr. Flynn continues to maintain an active research agenda in the areas of spinal and extremity manipulation, low back disorders, characterization of spinal instability, and the development of clinical prediction rules.
Dr. Flynn is an expert clinician who is dedicated to providing the highest quality care possible. His primary clientele is made up of individuals suffering from low back pain, chronic spinal disorders, failed back surgeries, and chronic pain disorders. Dr. Flynn's clinical expertise is frequently sought by national and international clients. He is on the executive board of Evidence in Motion (www.evidenceinmotion.com) an education and practice consultation company which passionately promotes a culture of evidence-based practice within the physical therapy profession. Dr. Flynn is the immediate past President of the American Academy of Orthopaedic Manual Physical Therapists (www.aaompt.org), an Associate Editor for the Journal of Orthopaedic & Sports Physical Therapy (JOSPT), and editorial board member of Manual Therapy. He is a Distinguished Professor of Physical Therapy at Rocky Mountain University of Health Professions (www.rmuohp.edu) where he teaches professional and post-professional students in the area of musculoskeletal management, advanced manipulation skills, and evidence-based practice.



Dr. Terry Gebhardt, PT, DPT
Dr. Gebhardt completed his Master of Physical Therapy at the U.S. Army-Baylor University Graduate Program in 1998. During Dr. Gebhardt's 7 years of physical therapy practice in the Army he specialized in treating a broad range of musculoskeletal injuries. He has worked extensively with injury prevention initiatives and has been a leader in the development of training programs designed to maximize fitness while preventing injury. Dr. Gebhardt relocated to Colorado in 2004 to complete his Doctorate of Physical Therapy degree and Fellowship in Manual Therapy at Regis University. His areas of clinical expertise and interest include spine and sports rehabilitation where he incorporates his passion for fitness with physical therapy.
Dr. Gebhardt is an avid back country skier and ultramarathoner. He is a member of the American Physical Therapy Association (APTA), American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) and a Certified Strength and Conditioning Specialist (CSCS). He has also published research in the Journal of Orthopaedic and Sports Physical Therapy and is currently active in clinical research.



Hamstring Strain and Injury:  Advice From The Experts, Part I

Those of you who suffer from chronic hamstring strains know how frustrating this recurrent injury can be.  Hamstring strains and injuries typically occur with high-speed activities such as sprinting, soccer, or tennis.  As physical therapists, we treat an increased number of hamstring strains as recreational league softball gets into full swing.  Many “weekend warrior” athletes are not adequately conditioned or prepared for the quick starts and change of directions required for these sports.  Minor muscle strains may resolve with rest, gentle pain-free movement, and ice over a couple weeks.  More serious hamstring strains may cause swelling or bruising and can take several weeks to months to resolve.  Strains that occur where the hamstring muscle attaches at the “sit bone” tend to take longer to resolve than strains that occur in the muscle belly.

If a muscle strain is not treated appropriately there is greater chance for another strain to occur leading to a chronic injury.  The hamstring may not be painful with typical everyday activities, but can be aggravated as the athlete returns to running or sports requiring quick movements.  Residual scar tissue at the injury site and persistent muscle weakness are two common reasons for the increased re-injury rate.  As the muscle remodels itself following a strain, scar tissue forms at the injury site.  Early, pain free movement can help reduce the formation of scar tissue.  However, excessive hamstring stretching should be avoided as it can result in dense scar tissue formation.  As the muscle continues to heal and pain decreases, specific strengthening exercises called eccentric exercises should be included in the rehabilitation program.  Eccentric exercise involves slowly straightening your knee against resistance (working your hamstring muscles) so that the muscle is engaged while it is lengthening. Your physical therapist can show you how to perform these exercises.  Part II of this entry will provide more detail on rehabilitation exercises following a hamstring strain and tips for preventing hamstring injuries.

Even if you have suffered from a chronic hamstring strain for years, there are pulled hamstring treatments that can reduce the residual scar tissue, improve your strength, and get you back to full activity pain-free.   The scar tissue that forms around the injured muscle can create a knot in the muscle known as a trigger point.  While massage can effectively release these trigger points, a technique called trigger point dry needling can be more effective because the muscle can be directly treated at a deeper level by penetrating the skin with a fine needle.  Trigger point dry needling uses fine filament type needles to release the trigger points in the muscle.

The scar tissue can be effectively treated with ASTYM treatment.  With ASTYM your therapist will use instruments instead of her hands to engage the scar tissue and induce its resorption by the body.  Also, ASTYM will help regenerate any degenerated soft tissues in the area and stimulate the muscle and/or tendon to remodel itself.  A key part of the remodeling process is to apply controlled stress to the healing tissue with specific stretching and strengthening exercises.  ASTYM and controlled stress will help the muscle remodel and become stronger, and help prevent scar tissue from forming.  Your physical therapist can help you determine the appropriate exercise to stress the muscle enough to make it stronger while not causing damage.  So remember the good news if you continue to be plagued by a chronic hamstring injury...you can get back to the activities you love pain-free!

Dr. Tim Flynn and Dr. Terry Gebhardt are physical therapists and owners of Colorado Physical Therapy Specialists in Fort Collins, Colorado, the website of their practice is www.colpts.com.

Meet today’s guest bloggers:

Kris Korsan, PTA (left) has been a physical therapy assistant for 20 years, and co-owns City Center Rehabilitation, a private orthopedic and sports medicine clinic in Peru, Illinois.

Tracy Daugherty, M.S., ATC, PTA (right) has been a certified athletic trainer for 14 years and a physical therapy assistant for four years.  Ms. Daugherty works with Ms. Korsan at City Center Rehabilitation in Peru, Illinois.

Chronic Tennis Elbow That Would Not Improve With Other Treatments Finally Gets Better With ASTYM

Several years ago, I had a client who was a mechanic with bilateral elbow lateral epicondylitis (tennis elbow on both arms).  He received traditional treatments of anti-inflammatories, iontophoresis/phonophoresis, modalities of e-stim and ice, stretching, and gentle strengthening exercises.  He was unable to rest his elbows due to his job demands.  After his bilateral tennis elbow had no success with multiple other therapies, he finally received an order for ASTYM treatments at a clinic that was more than an hour’s drive from his home. He came into our clinic to show me his outcome after 3 weeks.  He was very happy with the ASTYM results.   After ASTYM treatment, he was able to get back to doing a full day’s work as a mechanic. Other than the initial bruising, he was satisfied with his quick turn around and ability to function with less pain.  Of course, I asked what therapy was helping him so much, and he emphatically said “ASTYM”.  I decided that this may be a service our rural area could use and signed up for the certification class in Indiana.

We have been using ASTYM in our clinic for the last 5 years, with several success stories.  We mostly see foot tendinopathies for ASTYM referred from a local podiatrist, but the occasional elbow or IT Band syndrome will also get referred to us.  One such case was a 46 y/o female marathoner with bilateral plantar fasciitis who was treated successfully last fall and was able to resume running, which she had to stop because of foot pain.  She entered a half marathon and was able to start training after 7 weeks of ASTYM treatments.

ASTYM results are quick, with client compliance being important to perform proper soft tissue stretching and training techniques. When clients are properly educated and see their function and pain improving, compliance in their program makes the system work.  Since we see quite a few ASTYM clients, we have sent another PTA from our clinic to obtain the certification.  We feel it is a useful tool to help our community and allow our practice to grow.

Meet today's guest bloggers:



Dr. Timothy W. Flynn, PT, PhD
Dr. Flynn is board certified in Orthopaedic Physical Therapy (OCS), a Fellow of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT), and a frequent research presenter at state, national, and international meetings. Dr. Flynn is widely published including 5 textbooks, 6 book chapters, over 50 peer-reviewed manuscripts on orthopaedics, biomechanics, and manual therapy issues. He was the editor and author of The Thoracic Spine and Ribcage - Musculoskeletal Evaluation & Treatment and The Users' Guides to the Musculoskeletal Examination, and the author of 3 educational CD-ROMs on Orthopaedic Manual Physical Therapy. Dr. Flynn has received numerous research grants. Awards include the James A. Gould Excellence in Teaching Orthopaedic Physical Therapy, the Steven J. Rose Excellence in Research (twice), the AAOMPT Outstanding Research Award (twice), and the Distinguished Alumnus- Marquette University Program in Physical Therapy. Dr. Flynn continues to maintain an active research agenda in the areas of spinal and extremity manipulation, low back disorders, characterization of spinal instability, and the development of clinical prediction rules.
Dr. Flynn is an expert clinician who is dedicated to providing the highest quality care possible. His primary clientele is made up of individuals suffering from low back pain, chronic spinal disorders, failed back surgeries, and chronic pain disorders. Dr. Flynn's clinical expertise is frequently sought by national and international clients. He is on the executive board of Evidence in Motion (www.evidenceinmotion.com) an education and practice consultation company which passionately promotes a culture of evidence-based practice within the physical therapy profession. Dr. Flynn is the immediate past President of the American Academy of Orthopaedic Manual Physical Therapists (www.aaompt.org), an Associate Editor for the Journal of Orthopaedic & Sports Physical Therapy (JOSPT), and editorial board member of Manual Therapy. He is a Distinguished Professor of Physical Therapy at Rocky Mountain University of Health Professions (www.rmuohp.edu) where he teaches professional and post-professional students in the area of musculoskeletal management, advanced manipulation skills, and evidence-based practice.



Dr. Terry Gebhardt, PT, DPT
Dr. Gebhardt completed his Master of Physical Therapy at the U.S. Army-Baylor University Graduate Program in 1998. During Dr. Gebhardt's 7 years of physical therapy practice in the Army he specialized in treating a broad range of musculoskeletal injuries. He has worked extensively with injury prevention initiatives and has been a leader in the development of training programs designed to maximize fitness while preventing injury. Dr. Gebhardt relocated to Colorado in 2004 to complete his Doctorate of Physical Therapy degree and Fellowship in Manual Therapy at Regis University. His areas of clinical expertise and interest include spine and sports rehabilitation where he incorporates his passion for fitness with physical therapy.
Dr. Gebhardt is an avid back country skier and ultramarathoner. He is a member of the American Physical Therapy Association (APTA), American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) and a Certified Strength and Conditioning Specialist (CSCS). He has also published research in the Journal of Orthopaedic and Sports Physical Therapy and is currently active in clinical research.


Tennis Elbow and Golfer’s Elbow:  Advice from the Experts

As summer gets into full swing, many of you may be returning to the golf course and tennis courts for the first time since last season.  Hopefully, the winter layoff didn’t hurt your game too much!  Tennis and golf are known to place increased stress on the elbow and lead to irritation of the tendons around the elbow.  These conditions are commonly called “tennis elbow” and “golfer’s elbow”.  A gradual increase in your activity level and a focus on proper technique can help prevent these injuries from occurring.  Proper warm up and stretching the forearm muscles also help with prevention and can be a great place to start treatment if you do begin to have pain.  Rest, ice, and an anti-inflammatory medication help reduce symptoms in the early stages of an injury, but have limited effectiveness as the injury progresses.

It was previously thought that the pain associated with chronic tendon pain or “chronic tendonitis” such as tennis elbow, was due to inflammation.  However, recent research has shown the tendon to have very little, if any inflammation.  Instead, repetitive stress on the tendon causes an over development of scar tissue which effectively weakens the tendon.  This is important when we consider the best treatment approach.  While rest, ice, and anti-inflammatory medication may initially reduce the pain, they don’t necessarily address the root cause of the injury.  The most effective treatment will help stimulate the tendon to remodel itself and get stronger.  A type of strengthening exercise called eccentric exercise has been shown to be very effective at stimulating tendons to remodel and become stronger leading to a reduction in pain.  Eccentric exercise involves slowly lowering a weight against resistance so that the muscle is engaged while it is lengthening. Your physical therapist can show you how to perform these exercises.  Recently, a specific physical therapy approach called ASTYM (www.ASTYM.com) has been found to reduce or eliminate any scar tissue that has resulted from the chronic irritation of the tendon and also help stimulate the regeneration and remodeling of the tendon. 

In addition to treating the tendon directly, it is also important to consider other factors that may be contributing to the tendon pain.  Two common factors include tightness or “trigger points” in the forearm muscles and stiffness in the joints of the neck and arm.  The forearm tightness can be addressed with stretching, massage, and trigger point dry needling, while the elbow joint pain can be treated with “hands on” treatment called manipulation.  Additionally, recent clinical trials have shown that treatment of the neck with gentle mobilization or manipulation can reduce the pain associated with tennis elbow.  Treating the upper back and neck can relieve tension on the nerves that go to the elbow thereby helping reduce pain.

Corticosteroid injections are also commonly given for tennis elbow.  However, a recent study compared the effectiveness of a steroid injection, physical therapy, and a “wait and see” approach.  Physical therapy treatment included the eccentric exercise and elbow mobilization mentioned previously.  The results showed individuals who got the steroid injection did only slightly better than the other two groups during the first 6 weeks.  However, after one year, the group that got the steroid injection had a higher recurrence rate of tennis elbow than either of the other two groups.  Those who received the cortisone injection did even worse than the “wait and see” group who had no interventions after one year.  Although an injection may provide short term relief, it may do more harm than good long term. 

So if you or someone you know is suffering from elbow pain whether it is from tennis, golf, or gardening, remember a comprehensive treatment approach will give you  the best chance of getting back to the activities you love quickly and prevent them from returning.

Dr. Tim Flynn and Dr. Terry Gebhardt are physical therapists and owners of Colorado Physical Therapy Specialists in Fort Collins, Colorado, the website of their practice is www.colpts.com.

Meet today’s guest bloggers:


 
Dr. Timothy W. Flynn, PT, PhD

Dr. Flynn is board certified in Orthopaedic Physical Therapy (OCS), a Fellow of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT), and a frequent research presenter at state, national, and international meetings. Dr. Flynn is widely published including 5 textbooks, 6 book chapters, over 50 peer-reviewed manuscripts on orthopaedics, biomechanics, and manual therapy issues. He was the editor and author of The Thoracic Spine and Ribcage - Musculoskeletal Evaluation & Treatment and The Users' Guides to the Musculoskeletal Examination, and the author of 3 educational CD-ROMs on Orthopaedic Manual Physical Therapy. Dr. Flynn has received numerous research grants. Awards include the James A. Gould Excellence in Teaching Orthopaedic Physical Therapy, the Steven J. Rose Excellence in Research (twice), the AAOMPT Outstanding Research Award (twice), and the Distinguished Alumnus- Marquette University Program in Physical Therapy. Dr. Flynn continues to maintain an active research agenda in the areas of spinal and extremity manipulation, low back disorders, characterization of spinal instability, and the development of clinical prediction rules.
Dr. Flynn is an expert clinician who is dedicated to providing the highest quality care possible. His primary clientele is made up of individuals suffering from low back pain, chronic spinal disorders, failed back surgeries, and chronic pain disorders. Dr. Flynn's clinical expertise is frequently sought by national and international clients. He is on the executive board of Evidence in Motion (www.evidenceinmotion.com) an education and practice consultation company which passionately promotes a culture of evidence-based practice within the physical therapy profession. Dr. Flynn is the immediate past President of the American Academy of Orthopaedic Manual Physical Therapists (www.aaompt.org), an Associate Editor for the Journal of Orthopaedic & Sports Physical Therapy (JOSPT), and editorial board member of Manual Therapy. He is a Distinguished Professor of Physical Therapy at Rocky Mountain University of Health Professions (www.rmuohp.edu) where he teaches professional and post-professional students in the area of musculoskeletal management, advanced manipulation skills, and evidence-based practice.
 


Dr. Terry Gebhardt, PT, DPT

Dr. Gebhardt completed his Master of Physical Therapy at the U.S. Army-Baylor University Graduate Program in 1998. During Dr. Gebhardt's 7 years of physical therapy practice in the Army he specialized in treating a broad range of musculoskeletal injuries. He has worked extensively with injury prevention initiatives and has been a leader in the development of training programs designed to maximize fitness while preventing injury. Dr. Gebhardt relocated to Colorado in 2004 to complete his Doctorate of Physical Therapy degree and Fellowship in Manual Therapy at Regis University. His areas of clinical expertise and interest include spine and sports rehabilitation where he incorporates his passion for fitness with physical therapy.
Dr. Gebhardt is an avid back country skier and ultramarathoner. He is a member of the American Physical Therapy Association (APTA), American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) and a Certified Strength and Conditioning Specialist (CSCS). He has also published research in the Journal of Orthopaedic and Sports Physical Therapy and is currently active in clinical research.

Stopping Heel Pain:  Advice from the Experts on Plantar Fasciitis

Do you ever wake up with pain in the heel of your foot first thing in the morning?  If so, you may have plantar fasciitis which is the most common type of heel pain.  Plantar fasciitis typically feels like a sharp pain in the heel and sometimes travels into the arch of your foot.  The pain is usually worse with standing after lying down or sitting for prolonged periods of time.  The pain may ease some with walking, but will generally increase by the end of the day or with activities such as running. 

The plantar fascia is a thick ligament on the bottom of the foot that connects the heel to the toes and helps support the arch.  It was previously thought that the pain from plantar fasciitis was caused by inflammation of the plantar fascia.  However, recent research has shown there is rarely inflammation in the plantar fascia in patients with heel pain.  Instead of inflammation, there are degenerative changes in the plantar fascia.  This has obvious treatment implications.  Traditional treatment for plantar fasciitis frequently targets inflammation and includes ice, anti-inflammatory drugs, or steroid injections.  While these interventions may help decrease your pain, symptoms frequently return because the root cause of the problem is not addressed. 

Stretching the plantar fascia and calf muscles along with decreasing activity can frequently ease the pain.  An arch support may also help support the plantar fascia.  However, if these simple remedies fail to relieve symptoms, it is likely the addition of “manual” or “hands-on” treatment will help.  The degenerative plantar fascia can be addressed with a treatment called  ASTYM (www.astym.com) which has been shown to be effective in stimulating ligaments to regenerate and heal.  The optimal treatment program will not only address the degenerative plantar fascia, but also address other factors that can contribute to the painful heel.  These may include tightness in the calf muscles, stiffness in the ankle, knee and hip joints or weakness in the hip or leg muscles.  A thorough examination will identify if these may be contributing to the symptoms.  The calf muscles will frequently have tight bands or “knots” in the muscles commonly called “trigger points”.  Releasing these trigger points with “hands on” massage techniques can help reduce plantar fasciitis pain.  The trigger points can also be released with a technique called trigger point dry needling which involves the insertion of a very small needle into the muscle.  A recent clinical trial has also shown “hands-on” treatment to the plantar fascia and joint mobilization to loosen stiffness in the foot, ankle, knee, or hip combined with specific exercise is more beneficial for relieving plantar fasciitis than exercise and commonly used treatments such as ultrasound and iontophoresis (a treatment where electricity is used to administer a steroid medication).

If you suffer from plantar fasciitis, it is important to remember treatment should include more than simply treating your heel.  Although your pain may only be in your heel, other factors are likely contributing to your pain.  Even if you have been suffering from plantar fasciitis for years, there is still hope for getting you back to the activities you love.  
 
Dr. Tim Flynn and Dr. Terry Gebhardt are physical therapists and owners of Colorado Physical Therapy Specialists in Fort Collins, Colorado; the website of their practice is www.colpts.com.

Meet today's guest blogger:



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. 

            In our last discussion, we talked of the structural causes or origins of back pain, and spoke of how we may need professional guidance to help us sort out what type of back pain we are having. Now, I’d like to talk about some pitfalls of how we cause back pain to happen, and tie these errors to the sources of pain we now understand.

            Back pain can be the result of a traumatic one-time injury like a car accident, a bad fall, or a sports collision. Just like a sprain or a broken bone, these injuries have significant forces involved, and it is no surprise the back can be affected if it is the part of the body impacted by those forces. If so, any of the 5 structures (disc, nerve, joint, ligament, or muscle) we spoke of can be damaged, creating pain. However, trauma is not the most common cause of low back pain (LBP).

            The most common cause of LBP is repetitive stress. This stress can take many forms, including poor posture, sustained positions (especially in poor posture), poor lifting technique or improper body mechanics, poor strength or flexibility (or both), and inadequate fitness. Other factors involved are the amount or frequency of lifting, type of job or recreation, smoking, and nutrition.

            Poor posture takes the spine out of its natural position and creates excessive bending of the spine, creating abnormal tension on one side and abnormal compression on the other. Eventually some part of the spine or its supportive musculature will begin to break down in response, creating pain in the back, and sometimes elsewhere as well. Sustained positions, even if in good posture, can create excessive strain on our muscles and joints. Virtually all of our tissues thrive on movement, to relieve tension, to promote circulation, and to create joint fluid movement; all helping to bring nutrition to our tissues and take waste products away.

            How we move and how we lift can be a major cause of back pain. Lifting improperly puts too much stress on our spine, rather than in the joints and muscles of our arms and legs that were designed to carry the burden of lifting. Even bending over at the waist rather than bending our knees and hips creates a large amount of stress on our low back—made even worse if we add reaching, twisting, or lifting to that bend. If we have a job that includes heavy lifting, prolonged sitting, awkward body positions, or lots of repetition, we are set up to have higher risk of injury.

Meet today's guest blogger:




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.

Meet today's guest blogger:



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

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.

Breast augmentation patients often have to deal with the negative effects of scar tissue.  ASTYM can be a very effective treatment approach along with prolonged stretching.  A patient presented with complaints of implant stiffness and lack of descent as compared to the opposite implant.  Measurements from the distal clavicle to the start of the implant revealed a 6 cm difference. The patient was very self-conscious and avoiding wearing certain clothes.  Treatment was started with the use of ASTYM and stretching performed throughout the chest and axilla region.   After 12 treatments, the difference decreased to 2.5 cm.   The patient was very pleased with her progress and avoided having an additional surgical debridement procedure.  ASTYM treatment often resolves many scar tissue and contracture problems, which allows for the restoration of appealing cosmetics.

Meet today’s Guest Blogger:

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

Meet today’s Guest Blogger:

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

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.

 

Meet today's guest blogger:



Stephanie Penny, PT, DPT

Stephanie practices at Lakeshore Sports Physical Therapy in Chicago, Illinois. She earned her Doctor of Physical Therapy degree from Central Michigan University in 2008. She has a special interest in sports medicine and vestibular rehabilitation, has completed coursework in manual therapy, and is a certified ASTYM® provider. Stephanie is an active member of the American Physical Therapy Association.

Elite runners alternate between intensive physical training and recovery to improve performance.  However, many runners fail to maintain a balance between intensity of training and appropriate recovery, resulting in a breakdown of tissue reparative mechanisms which eventually leads to overuse injuries.  Historically, these injuries have been referred to as “tendinitis” or “tendonitis”, words that point to inflammation as the cause of the problem.  While true inflammation of a tendon occurs after traumatic injury, research has demonstrated that most non-traumatic overuse injuries are degenerative in nature.  Since the body’s healing process relies on a series of events heralded by the arrival of inflammatory cells, many overuse injuries do not benefit from the body’s normal healing process which results in a progressive, degenerative process.

For elite runners, injury to the Achilles tendon is a common experience with an annual incidence of 7% to 9% in top level runners. (Reference #1)  One study of runners found that the odds of developing Achilles problems were 10 times greater in runners than in age-adjusted controls. (Reference #2)   Risk factors for developing Achilles tendonosis include excessive mileage, sudden increases in intensity, inadequate warm-up and stretching, and muscle imbalances.   Mechanically, Achilles tendinosis is most commonly precipitated by excessive foot motion, shortened calf muscles and weakness in the gastrocnemius-soleus (calf) muscle. (Reference #3)

In running, the gastrocnemius-soleus musculature controls the transition of the lower leg over the foot and ankle after initial contact, requiring significant eccentric muscle control and shock absorption.  If the gastrocnemius-soleus is not conditioned to handle the forces of running, the Achilles tendon can be overloaded and strained.

Traditionally, conservative rehabilitation for Achilles tendon pain was rest, ice and non-steroidal anti-inflammatory medications (NSAIDS).  However, this treatment did not address the root causes of the problem and more current rehabilitation now incorporates eccentric strengthening to assist in strengthening the muscle and improving the health of the tendon.  Eccentric strengthening exercises load a muscle during the lengthening phase of a movement, such as holding a weight in your hand with the elbow bent and then lowering it slowly to straighten the arm.

A study in the American Journal of Sports Medicine examined a group of runners with chronic Achilles tendinosis and compared the results of surgery of the Achilles tendon with eccentric calf strengthening.  The reported results included a recovery time of 12 weeks for the eccentric strengthening group and six months for the surgical group. (Reference #4)  

Physical therapists incorporate eccentric strengthening in rehabilitation programs for Achilles tendinosis, but many are also starting to utilize additional techniques to assist with collagen regeneration and healing.  ASTYM treatment is a soft tissue therapy that stimulates regeneration of tendons and other soft tissues through the application of shear forces via hand held instruments;  ASTYM also stimulates the body’s natural healing response, resulting in the resorption and remodeling of scar tissue. This effective therapy incorporates a customized program of stretching and exercise, which positively influences the alignment of the newly developed collagen. You can visit www.astym.com for more information or to locate an ASTYM provider near you.

1. Lysholm J, Wiklander J. Injuries in runners. Am J Sports Med 1987;15(2):168–71.  
2. Kujala UM, Sarna S, Kaprio J, et al. Heart attacks and lower-limb function in master
            endurance athletes. Med Sci Sports Exerc 1999;31(7):1041–6.
3. McCrory J, et al. Etiologic factors associated with Achilles tendinitis in runners. Med and Science in Sports and Exercise. 1999;31 (10): 1374-81.
4. Alfredson H, Pietila T, Jonsson P, et al. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med 1998;26(3):360–6.

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 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.

Often times patients who develop rib pain with no known etiology (cause) are processed through the medical system undergoing countless medical diagnostic tests and consultations.  Physical therapy needs to be part of the assessment team to determine whether treatment for soft tissue and joint restrictions can be helpful.  Often time these patients respond very quickly to manual therapy techniques including joint manipulation, mobilizations and ASTYM for the intercostal soft tissues.

A patient with a 3 month history of mid costal (rib) pain was referred to me by an Orthopedist that believed ASTYM could be helpful and asked us to assess her.  Clinically she presented with all the signs and symptoms of costochondritis as he indicated.  After 6 treatments including ASTYM, rib mobilizations and thoracic manipulation she was 100% better.  She is instructed in postural exercises for home and given foam roller exercises.  This is an example of how physical therapy can be an important part of the consultation algorithm and ASTYM can be an effective adjunct to your manual joint mobilization techniques.

 

Meet today's guest blogger:



Kristy Uddin, OTR/L, ASTYM Provider
Integrated Rehabilitation Group, Inc.
Locations throughout the greater Puget Sound, Washington area
Pacific Avenue Hand Therapy - (425)374-2846
Snohomish Physical Therapy - (360)568-7774

How does this condition develop?  De Quervain's tendinitis is caused when tendons on the thumb side of the wrist are swollen or irritated. The irritation causes the lining (synovium) around the tendon to swell, which changes the shape of the compartment. This makes it difficult for the tendons to move as they should. Activities such as opening jars, wringing out washclothes or sponges, cutting with scissors, any activity that involves ulnar deviation and weight on the wrists (lifting a frying pain or heavy objects out of the oven that put resistance on your wrists. 


What are the symptoms?
• Pain may be felt over the thumb side of the wrist. This is the main symptom. The pain may appear either gradually or suddenly. Pain is felt in the wrist and can travel up the forearm. The pain is usually worse when the hand and thumb are in use. This is especially true when forcefully grasping objects or twisting the wrist.
• Swelling may be seen over the thumb side of the wrist. This swelling may occur together with a fluid-filled cyst in this region.
• A "catching" or "snapping" sensation may be felt when moving the thumb.
• Pain and swelling may make it difficult to move the thumb and wrist.
• Numbness may be experienced on the back of the thumb and index finger. This is caused as the nerve lying on top of the tendon sheath is irritated.

What tests are done to determine what it is? 
The Finkelstein test is conducted by making a fist with the fingers closed over the thumb and the wrist is bent toward the little finger. The Finkelstein test can be quite painful for the person with De Quervain's tendinitis.
Tenderness directly over the tendons on the thumb side of the wrist is a common finding with this test.


How can you make the pain go away?  (Conservative care & surgery)
• Conservatively - Splints. Splints may be used to rest the thumb and wrist
• ASTYM treatment
• Anti-inflammatory medication (NSAIDs). These medications can be taken by mouth or injected into that tendon compartment. They may help reduce the swelling and relieve the pain.
• Avoiding activities that cause pain and swelling. This may allow the symptoms to go away on their own.
• Corticosteroids. Injection of corticosteroids into the tendon sheath may help reduce swelling and pain.

If you elect surgery what is the goal?  
Surgery may be recommended if symptoms are severe or do not improve. The goal of surgery is to open the compartment (covering) to make more room for the irritated tendons.