Graston Technique and Plantarfasciosis

I can’t believe it’s taken me 3 years to think of this but I decided it would be helpful to shoot an educational video about Graston Technique and how we use it here at Elite Physical Therapy.  More and more doctors in this area are recommending Graston Technique specifically, but often the patient has no idea what it is.  Hopefully this video will help to explain.

I also show a quick demo of how I would treat plantarfasciosis (the chronic equivalent of the more popular term plantarfascitis).  I’ll be posting more examples of how we use Graston Technique, but for now this is one of the more common areas we treat.

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Back Pain Prevention – The Glute-Ham Raise

Low back pain is a huge part of what we treat at Elite Physical Therapy and Sports Performance.  Even folks coming in for treatment with knee replacement or shoulder pain (just a couple examples), will often complain of pain and tightness in their low back as well.   Dysfunction and pain in the lower back can certainly contribute and cause problems in other areas of the body.

This is article #2 in a series of articles written by Andy Barker (SportsRehabExpert.com contributor) and myself that discuss how to spare your lower back during the performance of popular strength training exercises.  Hopefully you’ll find some good tips to keep that spine healthy all the while making great gains with your training.

Enjoy and if you have any questions feel free to email me:  joe@elitepttc.com

by Joe Heiler PT, CSCS

originally published on SportsRehabExpert.com

The glute-ham raise has always been one of my favorite exercises, but what I’ve realized is that most people are going to rely too much on their spinal erectors to complete the movement at the expense of the glutes and hamstrings. Over the past couple summers I’ve worked with numerous athletes with sore backs from performing this movement, or they just felt this movement was supposed to work their backs because this is where they feel it the most.

It’s called a glute-ham raise for a reason so finding a way to lock out the lumbar spine is critical. Performing a bit of a posterior pelvic tilt will allow the athlete to ‘lock the ribs to the pelvis’ on the front side, and then place all the emphasis on the glutes and hamstrings as in the video below.

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Training to Prevent Low Back Pain – Feet Raised Bench Press

Low back pain is a huge part of what we treat at Elite Physical Therapy and Sports Performance.  Even folks coming in for treatment with knee replacement or shoulder pain (just a couple examples), will often complain of pain and tightness in their low back as well.   Dysfunction and pain in the lower back can certainly contribute and cause problems in other areas of the body.

In the coming weeks I’ll be posting a series of articles written by Andy Barker (SportsRehabExpert.com contributor) and myself that discuss how to spare your lower back during the performance of popular strength training exercises.  Hopefully you’ll find some good tips to keep that spine healthy all the while making great gains with your training.

Enjoy and if you have any questions feel free to email me:  joe@elitepttc.com

 

by Andy Barker PT

originally posted at SportsRehabExpert.com

I think we do a great job at cueing and coaching good pelvic position when using standing based gym exercises.  Equally, cueing the same position in supine in an unloaded state we also get it right.

However, when adding load to supine based exercises good pelvic form is often lost.

A great example of this is the bench press. Often when the load goes up so does load through the back as compensatory lumbar extension assists the lift. This is especially so when the feet are placed on the floor either side of the bench.

One easy way to reduce the effects of possible lumbar compensatory extension is to raise the feet to put the pelvis into posterior tilt and hence out of lumbar extension. This is shown in the video below:

Feet Raised Bench Press

One potential problem with the above technique is that athletes may feel less steady with the feet not placed on the floor and hence unable to shift as much load. This might be particular so the wider the athlete and/or the narrower the bench used.

As a result an alternative way to increase support whilst also raising the feet is using plyo boxes to act as foot platforms. Using the boxes allows athletes to push into the floor, via the boxes, as they would in a standard bench press, although in a much better pelvic position. This is shown in the video below:

Feet raised bench press (plyo boxes)

Have a blast and let me know what you think

BIO

Andy is the current head physiotherapist for the Leeds Rhinos first team squad and has been involved with the club for the past six seasons.

He graduated in Physiotherapy from the University of Bradford with a first class honours degree which followed on from a previous Bachelor of Science degree from Leeds Metropolitan University in Sports Performance Coaching.

Andy currently works privately in addition to his sporting work and has also previous experience within National League basketball and professional golf.

Andy has a keen interest in injury prevention and the biomechanics of movement in which he is continuing his studies with the start of a MSc degree later this year in Sports and Exercise Biomechanics.

Andy is also the creator and author of rehabroom.co.uk. RehabRoom is a free online rehab resource site aimed at but not exclusive to physiotherapists, strength and conditioning coaches and personal trainers. To visit the site, click here:  www.rehabroom.co.uk

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CrossFit and Injury Prevention

I recently interviewed Todd Nief, a CrossFit coach from SouthLoop Strength and Conditioning in Chicago.  It’s posted over at SportsRehabExpert.com on a free page here:  http://www.sportsrehabexpert.com/public/931.cfm?sd=2.  If you’re into CrossFit, or even just thinking about it, you’ll definitely pick up some good tips from Todd.

Teaching the Olympic Lifts, power lifts like the squat and deadlift, and kettlebell lifts are some of the things I enjoy the most about my job.  Unfortunately I also see a lot of athletes, and adults, that get injured performing them. I don’t know that most people understand how complex these lifts can be, and how easily things can go wrong.

Power Clean Start Position

So whether you want to incorporate these lifts into your program, or need to recover from injury and get back into hard training, there is no better place to go than Elite Physical Therapy and Sports Performance.

Learn to do these movement correctly and you’ll see some great results!

 

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Functional Dry Needling for Low Back Pain

Functional Dry Needling has been a great addition to my manual therapy ‘tool box’ especially for those with low back pain.  Recently, Nelson Min PT from Kinetacore (the group that trained me) wrote a short article on using dry needling for patients with spinal stenosis.

Spinal stenosis is one of the most common causes of low back pain in folks 50+ years of age.  The most common presentation is pain with standing and walking that is relieved with sitting down, forward bending, or lying down.

So here is Nelson’s article on Functional Dry Needling and the treatment of Spinal Stenosis:

“I listen for several things when evaluating a new patient with low back pain.  I take particular interest when my patient informs me that their pain increases with prolonged standing or walking versus pain that increases with prolonged sitting.  An older patient that tells me that their back pain increases with prolonged standing and walking, and is then relieved immediately with sitting, makes me suspect stenosis.  For someone younger, I am suspicious of spondylosis or some other instability.  I would confirm this with my biomechanical exam but this little detail in the patient’s history often steers me in the right direction.”

Listen to your patient — he is telling you the diagnosis.  – William Osler MD

To continue reading, head on over to Kinetacore.com

If you have questions on Functional Dry Needling or the treatment of back pain, feel free to email joe@elitepttc.com or call me at 231 421-5805231 421-5805

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Elite Physical Therapy Exercise of the Week – Standing Trunk Rotation for Golfers

Originally posted on SportsRehabExpert.com

It’s that time of year when we’re all going to start seeing more golfers coming in with injuries. The standing thoracic rotation assessment is one I picked up from TPI a few years ago, and what I’ve found is that is often a difficult pattern for many golfers to manage. This main objective of this movement is to look at the golfer’s ability to separate the trunk and hips, but what is often overlooked is the ability of the golfer to maintain cervical stability with trunk rotation.

The golfer is to assume a 5 iron posture – pretend you have a five iron addressing the ball – cross the arms over the chest, and then rotate the trunk as far as possible in each direction while stabilizing the pelvis and hips. There is no set ROM requirement in the assessment as it meant to look at the ability to stabilize and separate the upper and lower body, but I’d still like to see at least 45 degrees of rotation in each direction.

The other big thing to look at here is the ability of the golfer to keep his head down on the ball. This requires a significant amount of cervical spine rotation as the trunk moves ‘under’ the neck. As you can probably see in the video, its quite a chore for me to maintain this posture.

Obviously the qualities will improve the mechanics of the golf swing and contribute to more consistent accuracy. An inability to maintain optimal posture and control throughout the swing will not only be detrimental to the swing but can also create undo stress on the cervical spine, shoulders, and lumber spine.

Assessing cervical ROM and stability is crucial but often overlooked in this population, and it seems like I end up treating a few of these folks every summer. Establishing full ROM is the first step and then working motor control back into rotational patterns at lower postures is a prerequisite.

Poor trunk rotation mobility and motor control can also take it’s toll on the shoulders. The shoulders can be forced into excessive ranges of motion during the back swing and follow through, and over time can lead to injury here as well.

I recently assessed a high school golfer with bilateral congenital shoulder instability who was having shoulder pain during his swing. He was mobile as could be through his spine but was lacking proper control in standing thereby over reaching through the shoulders. Improving control in this standing patten went a long way toward eliminating his pain during the golf swing.

Standing trunk rotation with pelvic stabilization can be a great assessment for your golfers, as well as other rotational athletes, and can also be used as a corrective or warm-up activity.

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Graston Technique Interview – Joe Heiler and Ashli Linkhorn

I recently did an interview on the GT forum along with Ashli Linkhorn (head chiropractor – NCCA Women’s College World Series) in which we discussed the benefits of Graston Technique and how it can be used as part of the rehabilitation process with baseball/softball players.  Some nice info in the interview although I really can’t stand listening to myself on these things.  They will be doing one podcast per month so if you’re interested in GT, or are a practitioner, hopefully there will be some valuable info.

Graston Technique in the Treatment of Injuries to Baseball Players

http://www.conferencingexchange.com/GT

If you have any specific questions about Graston Technique you can email me:  joe@elitepttc.com or head on over to the GT website.

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Now at Elite Physical Therapy – Functional Dry Needling

Functional Dry Needling is a very effective manual therapy technique that I’ve been wanting to learn for some time now, and was recently trained though Kinetacore.  I’m very excited to be using this new technique and I’m already seeing some great results.

In this week’s blog post, I want to give some very basic background on what Dry Needling is, and is not.  The article below doesn’t mention this but I want to make it quite clear that this is not acupuncture.  The only similarity is the use of the same type of needle.  Dry Needling performed by a physical therapist requires a thorough musculoskeletal evaluation, and placement of the needle into specific taut bands of muscle (a.k.a. trigger points) that are pain generators and creating dysfunction within the system.

My knowledge of acupuncture is somewhat limited but generally speaking the points that are treated in the body are mapped out along ‘meridians’.  Needles are placed into these preset points and left for a certain amount of time.

There is a lot more to it than just this, and I think it is important to understand that there are differences.  The description of Functional Dry Needling below comes from the Kinetacore website.  It’s a quick primer on the technique.  If you want to see it in action, check out the video at the bottom of the page featuring Terry Bradshaw.

“Dry Needling is a general term for a therapeutic treatment procedure that involves multiple advances of a filament needle into the muscle in the area of the body which produces pain and typically contains a ‘Trigger Point’.   There is no injectable solution and typically the needle which is used is very thin. 

Most patients will not even feel the needle penetrate the skin, but once it has and is advanced into the muscle, the feeling of discomfort can vary drastically from patient to patient.  Usually a healthy muscle feels very little discomfort with insertion of the needle; however, if the muscle is sensitive and shortened or has active trigger points within it, the subject may feel a sensation much like a muscle cramp — which is often referred to as a ‘twitch response’.

The twitch response also has a biochemical characteristic to it which likely affects the reaction of the muscle, symptoms, and response of the tissue. Along with the health of the tissue, the expertise of the practitioner can also attribute to the variation of outcome and/or discomfort.  The patient may only feel the cramping sensation locally or they may feel a referral of pain or similar symptoms for which they are seeking treatment. A reproduction of their pain can be a helpful diagnostic indicator of the cause of the patient’s symptoms. Patients soon learn to recognize and even welcome this sensation as it results in deactivating the trigger point, thereby reducing pain and restoring normal length and function of the involved muscle.

Typically positive results are apparent within 2-4 treatment sessions but can vary depending on the cause and duration of the symptoms, overall health of the patient, and experience level of the practitioner. Dry needling is an effective treatment for acute and chronic pain, rehabilitation from injury, and even pain and injury prevention, with very few side effects. This technique is unequaled in finding and eliminating neuromuscular dysfunction that leads to pain and functional deficits.”

If you have further questions about the technique, or feel that this technique may work for you then feel free to contact us:  joe@elitepttc.com or 231 421-5805231 421-5805.

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Explaining Pain

Pain is something many of us deal with everyday, whether it our own or working with others to help them overcome that pain.  At Elite Physical Therapy, we feel that it is very valuable for our patients to understand how pain works, and how we should deal with pain during the different stages of healing.  Chronic low back pain and neck pain are two very common cases where this new science is having a valuable impact.

This is a great video by Lorimer Moseley explaining pain and how it is processed by our brains.  Dr. Moseley and Dr. David Butler are definitely changing the way we think about pain in the medical professions.

https://www.youtube.com/watch?v=gwd-wLdIHjs&feature=player_detailpage

The take home message is that with chronic pain, the tissues are often completely healed, but the brain still perceives pain.  In this situation, movement and activity are often the best medicine.  You can’t hurt anything so try to do as much as you’re capable of doing without going overboard.  You may just gradually improve your functional abilities while decreasing pain using this approach.

 

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Elite Physical Therapy Exercise of the Week – Wall Posture Shoulder Mobility

originally posted on SportsRehabExpert.com

This article was originally written for physical therapists and other clinicians dealing with shoulder pain and loss of motion so excuse some of the medical terminology.  I know a number of them read this blog so I’m leaving the article as is. 

The jist of this article is as follows:  most of us have too much extension (arch) in our lower spines, and we go into even more extension any time we try to raise our arms overhead.  Over time this can lead to shoulder pain and low back pain.  The article below describes a great warm-up exercise to improve shoulder mobility while controlling spinal posture. 

As always if you have any questions feel free to email me:  joe@elitepttc.com

Joe Heiler PT, CSCS

This is a great correction for the shoulder mobility movement patterns and also for the shoulder flexion component of the MS Extension pattern.  The lumbar spine frequently contributes excessive extension to the shoulder patterns when the shoulder itself is limited.  Mobility work is required to free up the shoulder, but this pattern will continue if motor control is not imparted to lock in the new range of motion.

I would not want to be her low back right about now!

The ‘wall posture’ as I describe it to the patient is an attempt to get the entire spine to touch the wall.  By having the feet out in front and knees slightly flexed it makes it easier to get the lumbar spine flat onto the wall which is really just a less extended, and probably more neutral position, for most folks. If you’re concerned that it is too much flexion, or if it is not well tolerated due to back pain, and towel roll/lumbar support could be used but contact must be kept at all times.

The cervical spine is a little trickier when it comes to proper positioning.  I will cue to get the spine to the wall, but to a point.  That cue will usually bring the chin down and back (into cervical retraction) which again will bring most folks to a more neutral posture.  Too ‘straight’ is not a normal position either and could affect the shoulder mobility component of this corrective so don’t force it.  If their forward head posture is so severe that their head won’t touch the wall without going into extension, then place a towel roll behind the head and require them to hold the towel in place as the arms go overhead.

Maintaining the proper positioning throughout the movement is the most important factor here.  The shoulder motions in the video are a challenge to that positioning.  When posture is lost, the movement is done.

Breathing is critical here as well.  My preferred way of cuing the breathing is to inhale at the bottom and slowly exhale during the overhead motion.  The more the ribs stay down in the front the better.  This can be incredibly hard for many people, and especially so for many overhead athletes, weight lifters, dancers, and gymnasts.

 

The order in which the motions are presented in the video go from easier to most challenging:

1)  Shoulder Flexion
2)  Shoulder Abduction (snow angels)
3)  Shoulder Abduction with External Rotation

If following the SFMA’s 4×4 matrix, this would be considered a level 4 posture, unloaded but with assistance (the wall as the positional cue) so 4:1.  Competency must be attained in each of the previous postural levels:  1)  supine/prone, 2)  quadruped, 3)  tall or half kneeling.

Progressions per the matrix:

4:2 – shoulder mobility work without the postural cuing or any activation
4:3 – loaded with cuing or activation.  Shoulder Flexion/Extension (reciprocal patterning) or pressing overhead with the spine against the wall or a corner (I prefer a corner to allow the shoulders to move more freely).
4:4 – loaded without cuing or activation – Shoulder Flexion/Extension in standing, any type of pressing.

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