The myth of core stability?!

A very famous subject in all schools of Physical Therapy. Is it true or not? Is it something that can be applied in practise or not? The myth of core stability is a very interesting work by Professor Eyal Lederman. Whether you agree or not, it worths reading it since it stimulates your brain.

Sports Hernia Repair Protocol

Athletes who suffer from sports hernia use the following treatment protocol recommended by sports hernia surgeon Jeffery Hoadley, developed in conjunction with Scott Kneller, the Atlanta Falcons PT, DPT and Rehabilitation Coordinator, and Cara Yano, MPT at Atlanta Sports Medicine and Orthopedic Center.

SaveYourSelf.ca - Your Back Is Not “Out” and Your Leg Length is Fine

The story of the obsession with crookedness in physical therapy and treatment for chronic pain. A must read for every healthcare professional (and everyone in general).

“Structuralism” is the excessive focus in the physical therapies on crookedness or “mechanical” problems in the body — what I call the biomechanical bogeymen. It is the source of much bogus diagnosis — things like tilted pelvises, short legs, abnormal spinal curvatures, or “misaligned” anything — and the cause of much therapeutic barking up the wrong tree. Such factors are much less important than many people still believe.

Read the rest.

Amyotrophic Lateral Sclerosis Association

Established in 1985, The ALS Association is the only national non-profit organization fighting Lou Gehrig’s Disease on every front.  By leading the way in global research, providing assistance for people with ALS through a nationwide network of chapters, coordinating multidisciplinary care through certified clinical care centers, and fostering government partnerships, The Association builds hope and enhances quality of life while aggressively searching for new treatments and a cure.

As the preeminent ALS organization, The Association leads the way in research, care services, public education, and public policy — giving help and hope to those facing the disease.  The Association’s nationwide network of chapters provides comprehensive patient services and support to the ALS community. The mission of The ALS Association is to lead the fight to treat and cure ALS through global research and nationwide advocacy, while also empowering people with Lou Gehrig’s Disease and their families to live fuller lives by providing them with compassionate care and support.

Amyotrophic lateral sclerosis (ALS), often referred to as "Lou Gehrig's Disease," is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. Motor neurons reach from the brain to the spinal cord and from the spinal cord to the muscles throughout the body. The progressive degeneration of the motor neurons in ALS eventually leads to their death. When the motor neurons die, the ability of the brain to initiate and control muscle movement is lost. With voluntary muscle action progressively affected, patients in the later stages of the disease may become totally paralyzed.

A-myo-trophic comes from the Greek language. "A" means no or negative. "Myo" refers to muscle, and "Trophic" means nourishment–"No muscle nourishment." When a muscle has no nourishment, it "atrophies" or wastes away. "Lateral" identifies the areas in a person's spinal cord where portions of the nerve cells that signal and control the muscles are located. As this area degenerates it leads to scarring or hardening ("sclerosis") in the region.

As motor neurons degenerate, they can no longer send impulses to the muscle fibers that normally result in muscle movement. Early symptoms of ALS often include increasing muscle weakness, especially involving the arms and legs, speech, swallowing or breathing. When muscles no longer receive the messages from the motor neurons that they require to function, the muscles begin to atrophy (become smaller). Limbs begin to look "thinner" as muscle tissue atrophies.

Joint Play Techniques In Assessment And Therapy For Upper And Lower Extremities

Beautiful and very detailed website to provide both students of physiotherapy and physiotherapists alike, with an interactive online information source for manual mobilization of the extremities.

Physical therapists with prescribing rights - yes or no?

UK physiotherapists have won a long-fought battle to be able to improve their patients’ care by prescribing them medicines without needing a doctor to sign off their decision.

You can read the rest of the Chartered Society of Physiotherapy's announcement here.

An issue that will arise a lot of discussion worldwide, for sure. There are a lot of things you can say against this decision, but of course a lot of things you can say to support it too.

For sure, this decision will give Physical Therapists an extra tool in their arsenal, which may be very effectively used for the good of the patient. At the same time, it may reduce the health care system costs, because it will give to patients direct access to a complete health care profession in the cases of simple disorders that need physiotherapy and do not require the physician's involvement.

The major argument against this, in my opinion, is the education and training a Physical Therapy student receives. With most of the educational programs being 3 years of mostly practical knowledge and Physical Therapy techniques, the Physical Therapists do not gain the required knowledge of the human organism. The average Physical Therapy student focuses mainly on the musculoskeletal, the nervous, the cardiovascular and the respiratory system - and very briefly. He/she does not know enough about the immune system, the endocrine system, the gastrointestinal system, and many other things that are of extreme importance in order to deeply understand the amazing human structure, such us embryology, histology, microbiology, pathology, etc. Moreover, there is no obligation for Physical Therapy graduates to work in a hospital or together with a doctor in order to gain experience in prescription.

The human organism is an extremely complex system, that amazes me every time I read about it. Just giving an anti-inflammatory drug or an analgetic may seem a quite simple thing, but I believe it is much more complex. A lot of things need to change in our educational system before this can become true for the good of the human being.

I have a lot of doubts on how inflammation is treated by our medical care system and how disease is perceived. I fear that this decision will make us - human beings - focusing more and more on "killing" the symptoms of our diseases, than on really improving our quality of life.

Spinal cord neurodynamics

A very interesting subject in neurodynamics is the points of convergence of neural tissue. In simple words, these points are the places in the body where two sides of the the neural tissue cord (either in the spinal cord or in the peripheral nerves) come closer to each other. This is happening when the therapist is extending of flexing the limbs or the spine. And this technique is believed that can play a major role in cases of pain due to nerves' compression somewhere along their course.

The following part is a very short part of Chapter 2 summary of “Clinical Neurodynamics” by Michael Shacklock. You can find a short summary of the whole chapter here, or you can buy the book here.

The spinal cord tends to move towards various specific segments. These areas are termed zones of convergence, and these areas include C5-6 and L4-5.  For example, tissues above C5-6 will slide toward this zone, as will tissues below this segment. The midpoint at which tissues diverge is at T6. At this point, tissues below T6 will converge towards L4-5, and tissues above T-6 will converge to C5-6.

Healthy notions of self through neuroscience knowledge

So... what is NOI?

Neuro Orthopaedic Institute (NOI) Australasia has been in operation for 20 years, with highly qualified instructors working on all continents with multidisciplinary audiences. Organising over 100 seminars a year throughout the world, NOI’s faculty members are active in many conferences, university programmes and other postgraduate education sessions. The company reinvests in education and clinically based research and Noigroup Publications has grown from the demand for resources to support this emerging research.

The essence of NOI

Our vision is to seed ‘healthy notions of self through neuroscience knowledge’ worldwide. There are currently five critical conceptual change issues which underpin this: 

Injury or disease does not mean that you feel pain.

The nervous system moves and stretches as we move.

Pain, stress and performance are outputs of the brain.

Knowledge and movement are the greatest pain and stress liberators.

Nervous system plasticity gives new hope and technique.

The biopsychosocial approach, or the merging of the biology of human pain, stress and performance with the psychological and social environment, is the basis of the NOI educational philosophy. It is essentially ‘scientific holism’. Derived mostly from British science, the approach is best typified by Wall and Melzack’s (2005) ‘Textbook of Pain’. 

NOI also espouses strong clinical reasoning strategies, again arising from British critical thinking and later, Australian manual therapy.

Assessment and management of the physical aspects of the nervous system and brain sciences with a focus on neuroplasticity - particularly how the brain represents our body - is an important focus.

Overall, the nervous system is a remarkable, mobile, complex, plastic and changeable organ, and this impacts on both acute and chronic injuries and disease. The NOI education system covers acute and chronic musculoskeletal, central and peripheral, and neuropathic pain states. 

Can you define health?

Can you define health? OK, we all know the definition of health by the World Health Organization. And I totally agree with this definition. But I want something more. I want something that I can apply to my self in practical terms as well to people that I am trying to treat.

The last 4-5 years in my life I came across to an excellent definition of health by a medical doctor specializing in Homeopathy. Dr. George Vithoulkas (introduced to me by Dr. Spyros Kyvelos) gives an excellent definition for health, in my opinion. You should read his article here in order to completely understand his point of view.

I always keep in my mind the following major points:

Health is:

- freedom from pain at the somatic level
- freedom from lust at the emotional level
- freedom from selfishness at the mental level

And a great way to measure health is the degree of creativity of the individual.

As Dr. Vithoulkas says "these are rules that nobody can escape from, whether he likes it or not". And I feel blessed that I met this man and his point of view on medicine as a science.

The Resource - Physical Therapy Modalities Manual

A great modalities manual that explains in simple terms all the modalities used in Physical Therapy. It is true that these modalities are losing ground against manual therapy, kinesiotherapy and other more manual techniques, but it would be wrong to completely deny their use and effect on the human body. Anyhow, a good Physical Therapists should have all the possible tools in his arsenal and use each one when appropriate. Not every body is the same and or responds in the same way to every modality. Sp, the challenge for the Physical Therapist is to recognise and identify which tool can be effective is each case. 

AlterG - the anti-gravity treadmill

The video presents a range of patients with different diagnoses using the AlterG - the anti-gravity treadmill:

1. A Parkinson's patient walking safely, allowing her to stay mobile and improve her condition

2. An overweight patient enjoying running for the first time and losing weight

3. A triathlete recovering from an injury and competing again

4. An injured cop recovering from an injury, enabling him to return to his job

I just came across this product. It seems to me that it would benefit these kinds of patients since it allows pain free movements that they would otherwise not be able to do - a fact good for both the musculoskeletal and the neurologic rehab process. This fits very well with the functional rehabilitation a Physical Therapist should focus on.

The Mulligan concept

Mobilization with Movement manual therapy techniques were discovered and developed by Brian Mulligan F.N.Z.S.P. (Hon), Dip. M.T., Wellington, New Zealand. This simple yet effective manual approach addresses musculoskeletal disorders with pain free manual joint “repositioning” techniques for restoration of function and abolition of pain.

Explore this Official International Web site to find more about the Mulligan Concept.

The McKenzie Method

The McKenzie Method is not merely extension exercises. In its truest sense, McKenzie is a comprehensive approach to the spine based on sound principles and fundamentals that when understood and followed accordingly are very successful. In fact, most remarkable, but least appreciated, is the McKenzie assessment process.

Assessment. Unique to the McKenzie Method is a well-defined algorithm that leads to the simple classification of spinal-related disorders. It is based on a consistent "cause and effect" relationship between historical pain behavior as well as the pain response to repeated test movements, positions and activities during the assessment process.

A systematic progression of applied mechanical forces (the cause) utilizes pain response (the effect) to monitor changes in motion/function. The underlying disorder can then be quickly identified through objective findings for each individual patient. The McKenzie classification of spinal pain provides reproducible means of separating patients with apparently similar presentations into definable sub-groups (syndromes) to determine appropriate treatment.

McKenzie has named these three mechanical syndromes: Postural, Dysfunction and Derangement.

Postural: End-range stress of normal structures

Dysfunction: End-range stress of shortened structures (scarring, fibrosis, n.root adherence)

Derangement: Anatomical disruption or displacement within the motion segment

(All three mechanical syndromes – postural, dysfunction, and derangement – occur in the cervical as well as thoracic and lumbar regions of the spine.)

TRX bodyweight training

We are aware of the TRX training. I believe it is something simple, clever and very efficient a Physical Therapist can use in many cases. Here is a very nice example of how it can be applied and combined with bodyweight training.

"Since the dawn of time, humans have used their own bodyweight for resistance training. Using your own bodyweight as a training tool enables you to develop strength, increase mobility, bolster endurance, burn fat and build lean muscle virtually anywhere. Bodyweight training predates any fitness fad, but it continues to be a staple in the training menus of top trainers, coaches, athletes and experts. On this page you’ll find a wealth of resources related to TRX and bodyweight training".

Physiotherapy advice following abdominal surgery

Beautiful manual for enhanced recovery physiotherapy programme following abdominal surgery.

Individuals undergoing abdominal surgery are at an increased risk of developing a chest infection or a blood clot in the days following their surgery. Fortunately there are a number of simple exercises and measures that can be taken to help reduce the risk of this. You will be seen by a physiotherapist once you have had your surgery who will discuss these exercises with you.

The effects of your anaesthetic teamed with the pain of your incision and surgery may result in you taking a more shallow breath than you would normally. This pain may also make you feel less inclined to sit out of bed and walk around the ward. Physiotherapy aims to get you taking deeper breaths, enable you to cough up your phlegm if there is any and encourage you to get back on your feet.

Care for patients after major abdominal surgery

This booklet has been designed by the physiotherapy service for patients undergoing major abdominal surgery, who require physiotherapy during their stay in hospital. We hope that this will help answer some of the most frequently asked questions.

Sleeper stretch for the posterior glenohumeral capsule

When I first learned about the sleeper stretch technique for the posterior glenohumeral joint I asked myself "why would anyone want to put so much stretch on a body structure that is so thin and sensitive, since we know that the posterior part of the glenohumeral joint lacks the ligaments that are at the anterior part of the capsule?". Then I found out that I am not the only one that has the same doubts about this technique. These 3 very interesting articles at Mike Reinold.com worth reading:

The Correct Way to Perform the Sleeper Stretch

The sleeper stretch is one of those exercises that unfortunately gets abused.  As I have said, I don’t really like the sleeper stretch and I do not use it often – go back and read why I don’t use the sleeper stretch.  The stretch is probably overused and often times used used so aggressively that it may actually be doing more harm than benefit.

But I do see the need for the sleeper stretch for certain individuals.  Just like everything else, there is a time and a place to use it, but when something is very popular, it probably gets overused.  Plus, the sleeper stretch has been shown to be effective in restoring posterior shoulder tightness in overhead athletes.  So there is definitely some validity to it’s use, especially if done safely, but more on this below.

Read more

3 Reasons Why I Don’t Use the Sleeper Stretch and Why You Shouldn’t Either

Ah, the sleeper stretch.  Pretty popular right now, huh?  Seems like a ton of people are preaching the value of the sleeper stretch and why everyone needs to use it.  It’s so popular now that physicians are asking for it specifically.

I don’t like the sleeper stretch and I rarely use.

There, I said it, I felt like I really had the get that off my chest!  Every meeting I go to I see more and more people talking like the sleeper stretch is the next great king of all exercises.  Then I get up there and say I don’t use it and everyone looks at me like I have two heads!  Call me crazy, but I think we probably shouldn’t be using as much as we do.

Read more

Alternatives to the Sleeper Stretch that May Actually Work Better

It is no secret that I am not a huge fan of the sleeper stretch, I have written about why I don’t use the sleeper stretch that often in the past.  While I do realize that there is a need for it at times if you know how to perform the sleeper stretch correctly, I also think there are alternatives to the sleeper stretch that may be safer and even more effective.

To begin, let me ask the question – what is it we are trying to achieve by performing the sleeper stretch?  It is probably to work on shoulder internal rotation or cross body horizontal adduction mobility (we’ll refer to the later as posterior shoulder mobility).  So let’s explore what else we can do to work on those areas.

Read more

Osteoarthritis grading system - Kellgren and Lawrence

Top Left - Grade I

Top Right - Grade II

Bottom Left - Grade III

Bottom Right - Grade IV

Photos source: synoviscone.com

The Kellgren and Lawrence system for grading osteoarthritis is based on xrays and consists of Normal, Grade I, Grade II, Grade II and Grade IV.

It measures the presence of typical features of osteoarthritis:

Joint space narrowing - bone is visible on xray but the articular cartilage that covers it is not. A normal joint therefore appears to have a space between the bones. Any decrease in space implies a reduction in cartilage cover.

Osteophytes - small bony projections that form around joint margins. Thought to be a result of the body trying to increase joint surface area to decrease pressure. They are responsible for limiting range of motion and can cause pain.

Sclerosis - this means 'hardening' and is a sign of osteoarthritis, seen as increased white areas in the bone at the joint margins.

• Grade I: doubtful narrowing of joint space and possible osteophytic lipping

• Grade II: definite osteophytes, definite narrowing of joint space

• Grade III: moderate multiple osteophytes, definite narrowing of joint space, some sclerosis and possible deformity of bone contour

• Grade IV: large osteophytes, marked narrowing of joint space, severe sclerosis and definite deformity of bone contour

You can read more here. A very nice blog dedicated to knee osteoarthritis.

A very nice pdf file with some general guidelines for assessment and treatment publishes by the Brigham and Women's Hospital can be found here.

(these sources were suggested to me by my classmate Bita Lotfaliei)

Total hip replacement rehab protocol

Ellis & Badenhausen Orthopedics, PSC is dedicated to providing the Louisville community with the highest quality of orthopaedic service. We will ensure that patient care remains the focus of our medical practice by maintaining an experienced staff and by keeping on the forefront of medical technology and research.

The following protocol should be used as a guideline for rehabilitation progression, but may need to be altered pending the nature and extent of the surgical procedure, healing restraints or patient tolerance.

Nordic walking and osteoarthritis

For the aftercare stage of patients with osteoarthritis operation in the hip or the knee, the physical therapist should advise the patient on maintaining the targets they have achieved, for instance by giving them tips on engaging in healthy physical activity behavior in their everyday life or, if useful, by helping patients enter regular community exercise or sports programs, or supervised group exercise programs, such as tai chi, Nordic walking or other exercise programs (KNGF Guidelines for osteoarthritis of the hip and knee).