Browsing: Physical Therapy

Spinal Decompression: Negative Pressure = Positive Results

A mother bends over to pick up her child and feels a sharp pain in her back. A business man is on his lunch break and is rear-ended at a traffic light, causing neck pain and hand numbness. What's the cause of their pain? A disc herniation.

Vertebral discs are found between the bones (vertebrae) that make up your spell. Healthy discs have two primary functions: to act as shock absorbers for the spinal joints; and to act as spacers between the vertebrae where your nerves exit the spinal column.

When discs start to break down (degenerate), move in your vertebrae decreases and the disks become dehydrated. As they dehydrate, the spaces between your vertebrae narrow at the area where the nerves exit. This disc narrowing can cause nerve compression and pain. Additionally, as the disks in your spine dehydrate and start to tear, the edges of the disks can bulge. This bulging can lead to a disc herniation, creating neck or back pain and, at times, numbness and weakness in the arms and legs.

While some disc herniation require surgery, only about 1% of back pain sufferers are surgical candidates. While surgery may be a possible solution as a last resort, a non-invasive, highly effective alternative does exist. Spinal decompression therapy can eliminate back pain without surgery.

This alternative therapy offers back pain sufferers a non-surgical option that may restore normal function to damaged spines. Spinal decompression melds modern technology with the proven techniques of chiropractic medicine. By using precision computerized equipment, a chiropractor is able to administrator targeted therapy to the exact areas that need treatment. Spinal decompression utilizes comfortable traction therapy to treat back, leg pain, neck and arm pain. During this procedure, by cycling through distraction and relaxation phases and by proper positioning, a spinal disc can be isolated and placed under negative pressure, causing a vacuum effect within the disc.

The vacuum effect accomplishes two things. From a mechanical standpoint, disc material that has protruded or herniated from the disc can be rolled back within the disc, taking pressure off the nerves. When this pressure is relieved by the vacuum effect created within the disc, symptoms such as arm and leg numbness are relieved. In addition, the vacuum effect stimulates blood supply to the disc, secondarily stimulating a healing response. These results in pain reduction and proper healing at the injured site.

Generally, most patients with slipped and / or bulging (herniated) discs, as well as those who have chronic neck and / or back pain, are good candidates for spinal decompression therapy. Patients may also find relief using this therapeutic procedure for other specific conditions including spinal stenosis, sciatica, facet syndrome, degenerative disc disease, spondylosis or even failed spinal surgery.

Spinal Decompression Therapy has been shown to have a 71-90% success rate and has been well received by patients suffering from a variety of conditions. Many people have suffered long-term debilitating pain due to car accidents, the physical nature of their careers or from playing their favorite sports. But with the advent of Spinal Decompression, long-term sufferers are beginning to see the light.

Click the link to for more information on Spinal Decompression Therapy .

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Using the Best Physical Therapy EMR As a Tool

With the invention of great technology comes great responsibility. Physical Therapists can benefit immensely from the implementation of an EMR software program used in the clinic. However, it's important to understand that it is a tool to help your company become more efficient and patient-friendly, not a solution ready to do all of the work for you. Surprisingly, many PT clinics would love to have a product that they could fire up and watch it do the work for them (who would not?), But the fact is, EMR software should be used to help you do the work better and faster.

Only YOU can give the face-to-face care

Even the best physical therapy EMR software can not give your patients the face-to-face communication and contact that you can. It is a great tool for educational resources and take-home tips and guides for practices. However, in terms of giving patients the care they need, your EMR software system should only be able to best assist you in personally raising patients.

Think about things in terms of legal ramifications

When searching for EMR software that can provide you with the most accurate and up to date physical therapy documentation, you'll want to find a solution that is not strict and allow for manual input from the Physical Therapist. If your EMR program only offers room for quick checkmarks in boxes, how are you able to have a detailed account of your patient history? You need EMR that will allow some leeway for your medical knowledge. If you were ever in a situation where you needed to present evidence, you may find yourself in a sticky situation with too much reliance on an EMR.

Have pride in your human expertise

The best physical therapy EMR will allow you to customize and fill it up with notes and case studies that are relevant to you now. Physical therapy documentation tools that doe everything for you will not allow you to grow as a physical therapist or allow your clinic to grow overall. With EMR that contains templates that allows room for extra note taking and space for feedback will give you and your patients the tools necessary to improve. Find a piece of equipment that works as a tool that you can manually update with your own knowledge and expertise and you'll notice it makes for a much more efficient and caring PT clinic.

Instead of looking for that EMR software that will do all of the work for you, try to find a product that will harness your expertise and experience to make your overall office more efficient. You should guide your EMR, not the other way around.

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The Healing Power of Adjustable Beds

An adjustable bed is more than just a luxurious bed frame. Electrical beds allow users to sleep at semi-elevated levels that align the body in a position of least resistance to gravity. There are many health benefits that result from this position, including a reduction in snoring, acid reflux, muscle tension, and arthritic pain. Based on studies that have been conducted, there are numerous ways to use these high-tech beds to deliver effective and safe healing benefits. Because of these studies, adjustable beds are now commonly seen in healthcare facilities such as hospitals and elderly care facilities.

The Therapeutic Effects Of An Adjustable Bed
The benefits one may attain from an adjustable bed are derived primarily from the device's ability to change shape. Both the head and foot ends of the bed may be either raised or lowered, helping individuals to adjust their sleeping position in such a way that provides maximum comfort. In a medical context, the ability of these unique beds to be raised or lowered delivers additional benefits that help patients to recover from surgical procedures quickly and comfortably. Some of those benefits include:

  1. Resting in an Upright Position: Adjustable beds can be manipulated so that the upper portion of the bed could be raised up to 90 degrees. This bed position may help increase maximal lung expansion for patients who have difficulty breathing. This is accomplished through redistributing the weight of the body so less pressure is exerted on the lungs and ribcage.
  2. Health Benefits of Sitting Up: Resting in an upright position could also help people who have gastroesophageal reflux disease (GERD). The raised position will make it more difficult for stomach content to flow back in the esophagus. Furthermore, these beds could also correct snoring problems. When we go to sleep, the tongue tends to relax and blocks the oropharyngeal opening making it hard for air to flow freely. This causes a vibration in the tissue that causes a loud snoring sound. Because adjustable beds could be raised, the tongue can be put back to a neutral position to eliminate snoring.
  3. Resting in the Trendelenburg Position: If a patient is going into shock, the whole body of adjustable bed could be tilted with the head part lower than the foot end by about 15 to 30 degrees. This floods blood towards the upper body and head areas, increasing oxygen and nutrient flow to the brain to effectively combat shock.
  4. The Head Flat / Foot Elevated Position: A bed configured with the head portion flat but the foot portion elevated can assist those people who have a problem with the cardiovascular and circulatory systems. The Heat Flat / Foot Elevated position helps by encouraging blood to return to the heart more easily. Fluids may cease to circulate and gather in the extremities if the patient is not sleeping with the feet elevated, resulting in edema. Elevating the lower body while leaving the head and body flat brings blood back to the heart with the help of gravity, helping to increase circulation overall.
  5. Enhanced Comfort and Rest: There is no doubt that electrical beds, and particularly beds with massage features, are created with the comfort of the user in mind. Rest and sleep is vital component of making a healthy medical recovery, and these beds deliver unparallel quality of both rest and sleep.

Adjustable beds assist patients in recovering from medical procedures by positioning the body at specific angles that promote blood circulation, reduce stress, and increase tissue regeneration. Adjustable hospital beds have a long time tradition of increasing both the quality and effectiveness of recovery time. These beds are undeniably an indispensable object for the welfare and benefit of many patients.

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Can’t Fail Recovery Tricks

Whether you're a runner, swimmer, or a gym fanatic at some point in your life you may experience an injury. Lengthy layoffs can be frustrating as they can interrupt your training schedule and they can be the catalyst for you to get repeated injuries if you do not use good recovery techniques. For example, if you break one leg on a chair and continued sitting on it, it would only be a matter of time before the other three legs were damaged. Your body is the same and will only compensate for a weak joint for so long. The quicker you can get back to full fitness the better, and with proper rehabilitation you can reduce the risk of altering your body mechanics and picking up other injuries further down the line. In order to help you back on the road to recovery we have looked at some ways that will help you recover quicker and we will advise you on how to use these techniques to recover from some of the most common injuries.

Illiotibial band Friction syndrome (ITB syndrome)
Illiotibial band friction syndrome is when you get a pain on the outside of the knee. It can be caused by your IT band becoming too tight, and the muscles in your hips becoming too weak. The IT band is a muscle that connects into the bum and down into the knee down the side of the leg. Steve Perry who is a physiotherapist says “Changing your running shoes” can be a key to recovering from this injury, as often it is a problem with the body's mechanisms that cause the problem. “ITB friction syndrome is caused by the intensity of the IT band so a thorough stretching program is also essential for a quick recovery.” The key muscles to stretch are your IT band, which is at the side of your legs; your quads, which are the front of the legs and muscles in the buttocks.

Patellar tendonitis
Patellar tendonitis is when you have pain in the knee because your knee cap is being pulled to the outside of the knee causing a clicking pain in the join. This injury will cause pain in the knee but it will be possible to still train with this pain if you use hydrotherapy. This is because the support from the water takes away any impact you would have on land. The temperature of the pool is 35 degrees which allows the muscle to relax and helps to reduce pain. “Hydrotherapy also increases blood circulation, reduces swelling and increases recovery time as you are able to run, jump and improve balance in the pool” says Steve Perry. This recovery technique is great for all types of lower body injuries and will allow you to maintain some type of fitness while being injured.

Tennis elbow (Lateral epicondylitis)
If you experience a pain on the outside of the elbow when you play a back hand in tennis or any other racket sport you probably have tennis elbow. Steve Perry advises that you “Stop doing what you are doing”, and this includes using a mouse at work, or typing. Next thing to do is stretch. An effective stretch to do is to “place your hand out in front of you with your elbow straight and grab your index finger and your little finger with your other hand and pull toward you”. You should feel a stretch in the forearm. You can also aid recovery to the forearm with a sports massage. Last thing to do is eccentric work (lowering phase of a lift). “Rest your arm over the bed or the edge of a table with a dumbbell in your arm, and then slowly lower the dumbbell until your arm is straight. Repeat 15 times.

Calf strain
You may overuse your calf if you do allot of running which could cause a calf strain. Steve Perry suggests that you rest it, compress your calf with ice, and elevate it for 48 hours. After 48 hours try to move the ankle so that your calf and ankle do not become stiff, you may do this by sitting on a chair with your feet on the ground and performing a calf raise (by performing a tip toe). “Only do this if it is pain free”. Also stretch out your calf but the stretch should not be painful, and the last stage should be to get a massage.

Shoulder impingement
You may experience shoulder pain if you play sports like tennis, badminton or swimming. If you have a shoulder impingement “you must stop any type of over head work immediately” says Steve Perry. You must also perform “shoulder setting exercises”, which is where you pull your shoulder blades together and slightly downwards. Once you have learned how to set your shoulders you than practice setting your shoulders with your hands on an unstable surface area like a Swiss ball (proprioception). This exercise requires a partner. For example, extend your arms and place it in the middle of a Swiss ball and then set your shoulders. Get your partner to move the ball, and as the ball moves it will cause your arm and then your shoulder blades to move from the set position, so try to maintain the set position with every change of the ball.

Neck pain
If you cycle or run you may experience neck pain and the way to tie this neck pain is to first of all stretch some of the muscles around your neck. One stretch you can do is to close your mouth and lean your head back as far as it can go. This will stretch the front of the neck. You can also lean your head to the side and place your hand that is on the same side your head is leaning towards the side of your head. Once these muscles have been stretched out then you need to learn how to set your shoulders using the same principles from the shoulder impingement and learn to keep your head in an upright position instead of leaned forward.

Lower back pain
It's wise to take any pain in the lower back seriously as this is the body's way of telling you that something is wrong. Lower back pain can be caused by a number of different things ranging from weak buttocks muscles, sitting at a desk, playing a sport that places strain on the back and many more. The first thing to do is to increase your core strength because the abdominals help to protect the lower back. Pilates is one of the most effective ways to recover quickly from lower back pain because it “focuses on the muscles of the lower abdominals and lower back” says physiotherapist and lumbo-pelvic-hip specialist Sally Critien “Real Pilates should only have 8-10 people in a class, and not 20-30 people “, because of the precision required in each movement. Try to look for private classes by private Pilates practitioners.

Lateral Ankle sprains
We all know that eating the right foods at the right time can help refuel and energize the body for optimum performance, but it can also help you to recover faster than a lateral ankle sprain. “Rest, appropriate stretches and extra Vitamin C and zinc will help definitively with the tissue repair and an awareness of the cause of the injury is critical” says Doctor David Thomas DC. “However, as always, optimum hydration and correct electrolyte balance is also critical not only to optimum performance but also to optimum recovery”.

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Recovering From Knee Surgery – What You Can and Can’t Do

After your knee surgery you will be advised by your orthopedic surgeon what you can physically do and what you have to refuse from. You will also be advised of your weight bearing status on the affected knee.

There are several things that most patients that have knee surgery can do. First of all walking and staying mobile will be important to keep your condition intact while you are recovering. What you have been given to walk with such as a cane or walker, will be either determined by your surgeon or rehabilitation professional.

Another important area that will be instituted by your doctor will be your exercise program. The exercises of course will depend again on the type of surgical procedure you have undergone. For instance if you have had ACL surgery exercises that place force on these ligaments such as forced extension will have to be avoided.

Flexion exercises however are encouraged with the help of a physical therapist to monitor them.

Staying disciplined with your exercise program will determine your overall success in your recovery. This is something you can do and must work on.

You can also use pain modalities such as heat or ice. Ice generally is used to treat pain and swelling after exercise or several days after the surgical procedure. Heat can be used prior to exercise to loosen the soft tissue surrounding your knee allowing your knee to move freely and to help relieve muscle spasms.

What you can not do after knee surgery is to begin walking too soon without using some sort of assistive device to less the amount of force you place through it. By not using your walker or cane as instructed you can cause an increase in pain and swilling which will delay your rehabilitation and, slow the healing process.

You can not speed up the recovery process. Your knee and the type of procedure you have gone through will have its own time line for a full recovery. By pushing the recovery too fast and cutting corners you set yourself up for a possible chronic pain issue and permanent disability.

You also want to avoid the temptation of stopping your pain medication before you are well into the healing process. Many people get caught in the trap of not taking their pain medication as prescribed due to constipation or fear of getting addicted. By reducing your pain medication too soon you allow the pain to get out of control affecting your rehabilitation and, your ability to rest and recover comfortably.

Following these simple recommendations above will allow you to recover in a successful manner assuring you a complete recovery.

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Strength Training After 50 For Your Health and Orthopedic Fitness

In today's world of healthcare and the costs increasing every year, it is imperative that you take responsibility for your health by not only eating good nutritional foods and getting plenty of sleep, but also including strength training in your routine. Strength or weight training after 50 is an important piece of the puzzle to help increase your chances of physical independence and, improving your quality of life.

Strength training has the ability to increase your mobility, maintain your body weight at a healthy level and reduce body fat. Strength training also helps reduce the risks and even reverse chronic medical problems such as type two diabetes and high blood pressure.

One of the biggest problems we all face as we age is a medical condition called sarcopenia also known as muscle wasting. This is a common phenomenon that begins to take place generally in the fourth decade of life and accelerates after the age of 75. It affects the type two muscle fibers in our bodies that are responsible for our strength and mobility. Physical activity alone is not the answer to stopping this natural event. You must include some type of resistance training to stimulate the muscle fibers that are responsible for strength and extremely our functional mobility.

By keeping your body stronger as you age, you also help reduce body fat that is seen often with older adults. By maintaining appropriate amount of muscle mass, you body will burn more calories therefore burning more fat. Muscle is a live active tissue and requires calories to operate. Muscle acts like your car engine when it is idling at a traffic signal. The engine does not stop because it is burning fuel constantly. In turn your muscles are doing the same thing. So the more muscle you have the more calories you are burning through out the day and at rest 24/7.

Strength training also helps to maintain your proper hormone levels in your body. The loss of hormone production is a part of the aging process however, strength training helps slow that process down allowing you to sleep better, increase your strength and stamina and improve your quality of life.

More muscle mass creates stronger bodies. Having more muscle on your body also protects your body from falls reducing the chance of breaking a hip for instance. Muscle provides protection for our bones and joints.

Stronger muscles in your back for instance improve your post keeping you upright when you walk. By strengthening your entire body you improve its efficiency and its ability to overcome many of today's chronic diseases that are prevalent in society today.

When weight training to strengthen the type two muscle fibers keep your exercise repetitions in the 8-12 range. Use a weight that you can handle properly using good form to prevent unnecessary injuries.

It is a good idea if you have not used resistance training in the past, to seek the advice from a certified personal trainer or a physical therapy professional to prevent injury.

If everyone in the United States began some sort of training training program coupled with eating cleaner you would see our medical costs in this country reduced considerably.

The choice is yours, getting older is not easy. Now is the time to go to battle against the age old war of physical decline as we age.

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Exercises to Perform After a Broken Femur Has Healed

Once your femur is fractured depending on the severity and location of the fraction, there generally is some damage involved in the surrounding muscles. The femur which is the longest and strongest bone in the human body will take a great deal of force to break it. There also can be vascular problems due due to the large network of blood supply to the bone itself and surrounding soft tissue.

The exercises to perform after a fraction of course will depend on what stage of the healing process you are in.

If for instance you are in the early stages you may still be working on exercises such as quadricep isometric contractions, heel slides, and abduction and adduction along with hamstring isometrics for example. These are generally completed in the supine or lying down position. You also more than likely also have been introduced do them if you received any type of physical therapy.

If your fracture is healed and you have started walking again your rehabilitation professional will graduate you into exercise that involve both open and closed chain exercises. Open chain exercises may consist of terminated hamstring curls, isolated leg extensions, and contained abduction and adduction. These exercises are progressed by using weight that is added to build strength and endurance in the surrounding muscles.

Another exercise that is highly recommended is stationary biking. This also is a strength builder but also great for muscular endurance and stamina along with increasing blood flow in the immediate area. Stationary biking also helps with your overall condition as more than likely your activity level was significantly curtailed during the healing process.

Later in your recovery phase again this is determined by your orthopedic doctor, you than progress to exercises such as leg presses, hamstring curls both laid and standing, partial mini-squats leading to full squats. You also will also want to complete exercises were you isolated standing on the affected leg. This will help not only in the strengthening of the thigh and hamstring muscles but also build proprioception and balance back into your leg and body.

Your hips also can be affected after a fractured femur. Strengthening your pelvic area will be important as well to be sure there is no muscle imbalances that could affect your gait and create other problem areas later in your recovery. Many of the exercises listed above will involve your hips to one degree or another.

Fractured femurs will take time to get completely rehabilitated. Progressing properly through the exercise protocol will be important to follow and maintain. If proper progress and dedication is followed you should be back to doing your prior level of activities.

Age and prior level of conditioning of course will also be strictly considered in the rehabilitation process.

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Novel Methods of Injury Rehabilitation: How to Heal Fast Starting From the Bottom Up

With time, we learn. Advances are made daily, but sometimes the original concept is better. Injury rehabilitation is a great example of both progression and regression. In this article, I will show you when “out with the old, in with the new” is good for lower body rehab, and when it's best to “get rid of the new, and go back to the old!” Here we go …

Treat Ankle Injuries with METH

Let me start by telling you about my experience with METH.

The date: Tuesday July 19, 2011

The place: my backyard

It was a hot summer day, and I decided to finally trim the branches that were rubbing against my shed. I hopped on the fence behind the shed, did what I had to do, then I jumped down. The distance was a little further than I expected, and I ended up rolling my ankle over some river rock.

At first, no pain. A few hours later, lots of pain! There was no time for discomfort, though. I had a slew of training sessions ahead of me. But as the night progressed, so did the swelling and pain! By the time the last person left I could barely move, let alone walk. That's when I took action.

The standard procedure for an injury like this involves anti-inflammatories and pain-killers along with RICE: rest, ice, compression, and elevation.

What did I do?

Almost the exact opposite!

No rest and no compression – I used movement with trafficking instead. According to Dr. Tim McKnight (2010), rest will lead to atrophy and weakness and may disturb balance and proper body positioning. Furthermore, compression can shut down blood flow to the area; whereas, traction will release the pressure and movement will encourage blood that is rich with healing factors, such as oxygen and white and red blood cells, to flow to the area. In addition, movement with traction reduces pain, improvements lymphatic removal of inflammation, improvements flexibility, and restores normal joint alignment.

Absolutely no ice – I used some moist heat instead. Again, the key is blood flow. If you want something to heal, it requires blood! Do not slow down this process with ice. However, I did use varying degrees of elevation through the process. I learned this procedure from Dick Hartzell, co-author of the book Do not Ice that Ankle Sprain . (Keep in mind that this procedure is for grade 1 or 2 sprains only.)

I term this approach METH: movement, elevation, traction, and heat.

Did I take anti-inflammatories and pain-killers? Well, yes and no. I took proteolytic enzymes (natural anti-inflammatories), and I took them by the boatload on an empty stomach.

The end result: no pain and full function the next day, full leg workout 2 days later, and medicine ball circuit at a local soccer field 4 days later. This injury was rehabilitated in mere hours, not days or weeks. I bet you if I used the RICE approach, it would have taken much longer!

Bottom line: Forget RICE, do METH instead of heal injuries fast!

Volume Training for Knee Rehabilitation

Now we'll cover knee injuries, specifically post-surgery rehabilitation of knee injuries … but first let's touch on a topic that is very popular in strength training, volume training.

There are many excellent volume routines out there. One of the most popular systems involves the 10 sets of 10 reps method, like the German Volume Training (GVT) protocol that was introduced in the July 1996 issue of Muscle Media 2000 . This type of routine is geared toward rapid and maximum hypertrophy – a lot of size in a short period of time!

Is it a new concept?

Not really. You will see this system scattered among the literature over the decades from various sources. For instance, in a paper originally published in the Russian journal Teoriya i Praktika Fizicheskoi Kultury , authors Vaitsehofsky & Kiselev (1989) discuss a protocol involving 10 sets of 10 pull-ups where the weight is reduced every second set (ie, additional loading is used to start such as 9kg, then down to 6kg, then 3kg, and then body weight to finish) or the grip is altered in the later sets to draw new, unfatigued fibers into work. Long-time Ironman contributor George Turner outlined a similar approach in his Real Bodybuilding audiotape series in the nineties.

What does this have to do with injury rehabilitation?

Well, think about it for a second. What are three things you need to reestablish after an injury, especially post surgery? If you said range of motion (ROM), muscle mass and strength, then you are correct. The quicker you can achieve these objectives, the quicker you can return to your activities of daily living and / or athletic endeavors. Intensity initially will be low because strength levels are low (pain and inflammation can inhibit strength), but in order to accomplish your objectives in short order, you must repeat a sufficient stimulant frequently. A volume training routine may fit the bill nicely if it is properly connected.

You with me so far?

Okay, let's take a Pulp Fiction moment and go off on a tangent.

The Famous DeLorme Scheme

If I asked what the most popular set / rep scheme in strength training is, most people would respond with 3 sets of 10 reps. It seems to be the universal training prescription, but where does it come from?

The concept stems from a 1948 paper by Dr. Thomas DeLorme and Dr. Arthur Watkins where they recommend 3 sets of 10 reps using a progressively heavier weight in the following manner:

Set # 1 – 50% of 10 repetition maximum
Set # 2 – 75% of 10 repetition maximum
Set # 3 – 100% of 10 repetition maximum

In this scheme, only the last set is performed to the limit. The first two sets can be considered as warm-ups. A few years later in their 1951 book Progressive Resistance Exercise, DeLorme & Watkins state: “By advocating three sets of exercise of 10 repetitions per set, the likelihood that other combinations may be just as effective is not overlooked.” Still, the majority of trainees today automatically adopt the 3×10 scheme as if it were written in stone.

The Not-So-Famous DeLorme Scheme

Now, let's take a little journey back in time to 1945 when the same Dr. Thomas DeLorme unleashed a powerhouse of a paper titled “Restoration of muscle power by heavy-resistance exercises” published in the Journal of Bone and Joint Surgery . Back then, far more than 3 sets were recommended per exercise with great results. The clinical observations made on 300 cases showed a “splendid response in muscle hypertrophy and power, together with symptomatic relief”, as DeLorme put it. Why change the system then? We'll explore that a little later, but first things first …

The 1945 DeLorme method consistent of 7-10 sets of 10 reps per set for a total of 70-100 repetitions each workout. The weight would start off light for the first set and then get progressively heavier until 10RM load was achieved. The workouts were short (on average about half an hour), but they were repeated frequently during the week. In GVT, for instance, each body part is trained once in a 5-day period. With the 1945 DeLorme system, the injured body part is trained once a day for 5 days straight! Of course, the difference is due to the direct relationship between intensity and recovery – the greater the intensity, the more recovery is necessary, and vice versa.

If you adopt this approach, will you be sore initially?

Yup!

Will the soreness subside after a week or so?

Yup!

Will you be ecstatic with the improved hypertrophy, strength, mobility, and function after just a few weeks while others are complaining that they can barely move and are in an extreme amount of pain?

Yup!

Now, here is where it is important to read the entire paper and not just the abstract. DeLorme insists that a pulley system (common with most selectorized machines today) must not be used. Instead, use an iron boot, plate-loaded machine, or simply ankle weights to overload the terminal end of knee extension. This method will increase the overload on the vastus medialis oblique (VMO) muscle, a prime stabilizer of the knee (weakness of this muscle can impair function and cause pain of the knee.)

Of course, there are many ways to skin a cat. Terminal knee extension can be performed as a more “functional” closed kinetic chain (CKC) movement (ie, standing with a band or cable attachment strapped behind the knee or by performing a low amplitude step-up) rather than the separated, open kinetic chain (OKC) option mentioned previously. However, DeLorme points out that weight-bearing exercises produce symptoms of pain, thickening, and fluid in knee joints that are controlled by weak, atrophied muscles. It may be best to implement CKC movements only after strength is matched in both limbs through the use of non-weight-bearing OKC movements.

Also, many patients are told to stop all activity until the pain goes away. I do not agree! I have talked about this issue many times in the past so I will not dwell on it much further; however, if you feel that you should rest the area, get some treatment here and there, and everything will return to normal, think again! You can do all the soft tissue work in the world to try to break down fibrotic tissue – the muscle will still be weak, atrophied, and hard! If you really want to make progress, stop “pampering” the muscle and start exercising with progressive resistance. DeLorme makes that quite clear.

Back to the question: Why change from as many as 10 sets to only 3 sets?

This is what DeLorme & Watkins (1948) had to say: “In the initial publications concerning progressive resistance exercise, 70 to 100 repetitions were advocated, the repetitions being performed in 7 to 10 sets with 10 repetitions per set. Figure to be too high and that in most cases a total of 20 to 30 repetitions is far more satisfactory. Fewer repetitions permit exercise with heavier muscle loads, thereby yielding greater and more rapid muscle hypertrophy. ”

That sounds reasonable, but before we go on let's establish two relationships:

  1. There is an inverse relationship between intensity and volume (ie, the higher the intensity, the lower the volume, and vice versa).
  2. There is an inverse relationship between intensity and frequency (ie, the higher the intensity, the lower the frequency, and vice versa).

If intensity starts to increase yet the frequency lasts the same, something has to give! At a higher intensity, one all-out 10RM set can be performed 5 days a week. It's really only a total of 5 sets spread through the entire week. (Yes, I know that there are 3 sets performed each workout, but as mentioned earlier the first two sets are merely warm-ups.) Contrast 5 sets to as many as 50 sets (although not all of those 50 sets are taken to the limit), and you'll quickly realize why the 1948 “3×10” method was considered superior to the 1945 “10×10” method, but hold on a second. DeLorme still experienced quite a bit of success with that original method, and I do believe that it still has merit and can provide a “more satisfactory” result if it is implemented in a specific manner.

Here it goes: If intensity increases and volume lasts the same, the variable that must decrease is frequency to allow for sufficient recovery. Using the 10×10 method may in fact be more superior if the frequency is altered as follows:

Stage # 1: 5 days a week (Mon, Tues, Wed, Thurs, Fri)
Stage # 2: 4 days a week (Mon, Tues, Thurs, Fri)
Stage # 3: 3 days a week (Mon, Wed, Fri)
Stage # 4: 2 days a week (Mon, Thurs)
Stage # 5: 1 day in a 5-7 day period

Now, how long each stage will last will depend on the individual and their injury, but the key is to make progress each week and once that starts to stagnate, it's time for the next stage. Think of it as progressive resistance meets regressive frequency! By Stage # 5, muscle strength, mass and ROM should be back to normal – this is the frequency used in most volume training routines.

Try this new twist to the original concept introduced by Dr. DeLorme over 60 years ago.

Here are some take-home points:

  • Read an entire study not just the abstract, and as much as possible check the references.
  • The 10 sets of 10 reps method is by no means a new method, nor is it meant strictly for bodybuilders. This form of volume training may be an excellent way to rehabilitate an injury.
  • The primary objective during injury rehabilitation is to restore muscle strength, hypertrophy and range of motion. Endurance training can be counterproductive to these objectives and should only be implemented when the strength of the limbs involved is approximately equal.
  • During injury rehabilitation, pursue active (not passive) treatment with the use of progressive resistance exercises conducted at regular intervals with maximum effort.

Captain Thomas L. DeLorme, MD, a retired orthopedic surgeon at Massachusetts General Hospital, developed some novel methods to speed up the rehabilitation of injured soldiers during World War II. A true pioneer in the strength game, Dr. DeLorme passed away on June 14, 2003 at the age of 85, but his concept of progressive resistance exercise lives on today.

References available upon request.

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Microcurrents In Motion – Accelerated Rehabilitation

One of the main aims of physical therapy is to increase mobility of injured muscles and joints. Whether through joint manipulation or stretching and range of motion exercises, such intervention is often painful to the patient and its results usually of short duration. Many newer and more sophisticated methods are now available to reduce patient discomfort and increase duration of improved motion from these maneuvers. The two most noteworthy methods to accomplish these aims are use of proprioceptive bodily reactions and microcurrent stimulation.

Proprioceptive techniques involve placing an affected muscle in a position that triggers the CNS to command that muscle to increase or decrease its tone in a desired manner. These techniques fall into two categories. The first category involves active joint movements, and include techniques such as isometric or resisted contractions and reciprocal inhibition, in which muscle spasms are released utilizing resisted contraction of the muscle that is the antagonist to the muscle in spasm. The second category includes techniques that passively position affected muscles in a comfortable position that allows return to normal resting tonus, and includes Strain-Counterstrain techniques. These proprioceptive techniques utilize the body's innate system of checks and balance to facilitate structural rebalancing, and hence, healing.

One of the most effective applications of microcurrent therapy is what I call “Microcurrents in Motion”. This is simply joint and muscle mobilization with simultaneous microcurrent stimulation to the area being treated, and is a wonderfully effective clinical tool. Microcurrents will usually quickly relax and reduce pain in an injured area, and since it makes any manipulation or mobilization procedure more comfortable for the patient. Many chiropractors and physical therapists have reported to me that in addition to making the patient more comfortable, these procedures also give longer carry over of increased mobility than mobilization without microcurrents. Appropriately proprioceptive responses are
modulated in part by subtle bio-electric direct currents in the body, and appropriate external stimulation acts as an “amplifier” or enhancer of the rebalancing process, especially in injured and compromised tissues.

Listed below are some specific applications of Miecrocurrents in Motion:

1) Placing microcurrent probes on origins and insertions of affected muscles while placing them in a stretch position.

2) Micro-interferential through the neck during cervical traction.

3) Micro-interferential through the low back during use of flexion-distraction table.

4) Microcurrent stimulation through affected muscles while performing strain-counterstrain techniques.

5) Microcurrent stimulation prior to manipulation to balance musculature.

6) Use of probes to stimulate distal acupuncture points while simultaneously asking patient to mobilize affected joints. I have found this to be especially effective with use of hand acupuncture points, such as Luozhen for impaired motion of the neck, and Ling Ku and Zong Bai for back problems.

The high rate of effectiveness of these methods, plus the increased comfort and compliance of the patient, makes traditional methods such as milliamp muscle stimulation and painful ROM exercises positively “stone age” for increasing motion in most patients!

For more information about microcurrent and light therapies visit http://www.eastwestseminars.com or call 1-888-803-7397

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Graston Technique Aids In Pain Relief

A 57-year-old man notices he is not getting the distance he used to with his golf swing because his low back is stiff. A 44-year-old runner has to cut her run short because of a missing muscle that does not seem to heal. An avid, recreational league tennis player has to finish her match serving underhand because her shoulder hurts when she serves above her head. What do all these injuries have in common? Scar tissue.

When a person is injured, the body lays down fibrous scar tissue in order to protect the injury. Scar tissue adhesions can occur from microtrauma, like repetitive motion injuries such as swimming, tennis or golf swings, or from macrotrauma, such as a torn muscle or blunt trauma from falling or in contact sports such as football and lacrosse. The scar tissue limits the range of motion, and in many instances causes pain, which introduces the patient from functioning as he or she did before the injury.

When viewed under a microscope, tendons and ligaments have dense, elongated fibers running in the same direction. When the soft tissue is damaged, it can heal in a haphazard pattern, resulting in restricted range of motion, scarring and pain. The scar tissue explains why many injuries feel “different” even after weeks or months of handsome healing.

A new soft-tissue therapy called The Graston Technique incorporates the ancient Chinese therapy of Gua Sha, cross-friction massage, and modern technology into a soft-tissue treatment that has been getting world-renewed attention. The stainless steel Graston Technique instruments have been utilized by more than 50 major professional and amateur sports organizations. Trainers, physical therapist, chiropractors and clinicians at these organizations are treating elite athletes every day and counting on the Graston Technique to get them injury free, allowing them to compete at the highest performance levels.

The Graston Technique's instruments are used to enhance the clinician's ability to detect scar tissue, adhesions and soft tissue restrictions in the affected areas. Skilled chiropractors and therapists use the stainless steel instruments to comb over and “catch” fibrotic tissues, which immediately identify the areas of restriction. Once the tissue has been identified, the instruments are used to break up the fibrotic scar tissue so that it can be absorbed by the body. Patients usually receive 2-3 treatments per week over 4-5 weeks; however, most patients have a positive response by the 3rd or 4th treatment.

A recent study found that the Graston Technique resolved 87 percent of all soft tissue conditions treated. It is equally effective in relieving pain and restoring function to acute and chronic injuries as well as assisting in post-surgical recovery. Graston has had amazing results with conditions as diverse as tennis elbow and sprain / strains to plantar fasciitis and neck and back pain. For more information, watch the video demonstration of the Graston Technique .

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On Label and Off Label Uses Of Microcurrent Devices

The FDA approves electrical stimulation devices for sale in the United States for “the symptomatic relief of chronic intractable pain and as an adjunctive treatment in the management of post surgical traumatic pain problems.” Manufacturers of microcurrent and other electrical stimul devices are only allowed to advertise and promote their devices for these approved uses. These are what would be called “on label” uses of the devices.

Medical devices and approved pharmaceutical drugs are often used by doctors for uses not approved by the FDA. These are called “off-label” uses. A high percentage of health care and esthetic practices use microcurrent devices for a wide range of off label uses, including non-needle acupuncture, treatment of macular degeneration and other eye diseases, facial rejuvenation, wound healing and fracture acceleration, TMJ syndrome alleviation and even relief of many internal organ and emotional disorders. These off-label applications are used with particular frequency by acupuncturists, who are used to using stimulation through the acupuncture meridian system for treatment of a host of physical and emotional diseases.

So the question is- are you within your legal rights to use your microcurrent stimulator for these off-label uses?

The term “IRB” refers to Investigational Review Board – a lengthy procedure required for providing new medical claims:

“Does FDA require IRB review of the off-label use of a monitored device?” YES, if the off-label use is part of a research project involving human subjects. NO, if the off-label use is intended to be solely the practice of medicine, ie, for a physician treating a patient and no research is being done. The FDA recognizes that off-label use by prescribers is often appropriate and may represent the standard of practice. ”

There is a provision in the Federal Food, Drug, and Cosmetic Act that allows a practitioner to use a cleared device for an unapproved or 'off label' use. “There are a number of restrictions that do apply in this case. only use the device “off label” in a legitimate lawyer-patient relationship. “off label” use.

This is very clear. If you are a licensed health care practitioner whose scope of practice includes electrical stimulation, you may use a microcurrent device for any safe off-label application that you deem appropriate in the doctor-patient relationship. You are NOT legally allowed to advertise these off-label uses.

This advertising restriction only applies to advertising the electrical stim device for an off-label purpose. You can advertise treatment of any disease that you are legally allowed to treat. For acupuncturists or doctors, that is just about anything.

So what about microcurrent facial rejuvenation treatments? According to the FDA guidelines, you technically should not advertise the use of a FDA-registered microcurrent device for facial rejuvenation services, although you are free to use it with your patients. Yet the FDA does allow estheticians to advertise the use of microcurrent devices that are not FDA-registered for rejuvenation. They are the same technology! In actual practice the FDA has not bothered health care practitioners using or advertising microcurrent devices for facial rejuvenation due to these ambiguities. I have personally spoken with many FDA workers at various departments about this subject, and they all basically punt on the subject as they do not want to have to deal with it. The best opinion I could get was that it is OK to use microcurrent and light devices for rejuvenation as long as no medical claims are made for the procedure.

It would certainly be a no-no to use the word “face-lift” in any advertising, but rejuvenation, toning, revitalizing and similar words are perfectly OK.

For more information about microcurrent and light therapies visit http://www.eastwestseminars.com or call 1-888-803-7397

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How to Look After a Fractured Shoulder

Caring for a fractured shoulder will entail that you first of all get clear instructions from your orthopedic surgeon and your rehabilitation professional on how to properly care for your injury. By following the instructions that are provided, you can save yourself a lot of discomfort or further injury.

Proper care for a fractured shoulder consists of keeping your pain levels within a reasonable level. This can be done by first of all taking your pain medication as prescribed. Many of the patients I see for various types of shoulder injuries are not compatible with their medications for various reasons. By not taking the pain medication as prescribed will slow down the healing process and cause you unnecessary pain and discomfort.

When you allow your pain to get out of control and it remains constant, it actually slows down your body's healing process. It also will make rehabilitation of your shoulder difficult when you are in pain. When you allow your pain to get out of control, your compliance in caring for your shoulder drops considerably.

Weaving your sling as directed by your doctor will also save you from suffering an increase in pain that can be caused by gravity pulling on the fracture site. It is important during the initial healing process to have the shoulder protected by keeping it elevated with the sling. By keeping your shoulder immobilized as instructed, you will help speed up the healing process. This has been an area I have witnessed where patient compliance can be very inconsistent.

During the care of your fractured shoulder part of the healing process and recovery will include physical therapy.

Your orthopedic doctor will provide your physical therapist and yourself with an exercise protocol to follow. It will be important once medically cleared, to begin gentle passive range of motion exercises to help regaining the mobility of your shoulder that was lost due to the immobilization. Once the mobility has improved you will also be instructed on general strengthening exercises to improve the ability of your shoulder to function properly during your activities of daily living.

During the rehabilitation process it is vital that you follow precisely not only the recommendations that your doctor has set forth but, also pay close attention to the information that is given by your rehabilitation professional.

Your ability to remain disciplined not only with the exercises but including the pain control tips during rehab will help you in achieving your prior level of function.

Finally during your care, the biggest problem I see in clients is the ability to remain patient through the healing and rehabilitation process. Like many orthopedic injections, we all begin to feel better and in our minds feel that the whole process of recovery should be going faster. This can be your biggest obstacle to slowing your recovery.

Allow yourself to fully recover by following the advice of the medical personal, take your pain medication as prescribed after the initial injury and allow the fact site to properly heal by protecting your injured shoulder.

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Physiotherapy – Questions for New Patients to Ask

Physiotherapy, also often called physical therapy, can help you heal after an accident makes it hard to move. This type of treatment can also assist you in managing disorders that you have had from birth, which means you may be able to move a little easier, with a little less pain than usual. No matter why you have to go to physical therapy, there are a few questions you should ask before you schedule an appointment. Finding out certain facts ahead of time can save you time.

One thing to check is that your insurance is accepted. Otherwise, you may have to pay out of pocket for your physiotherapy appointment. Most doctors list this fact on their website, but since this can change so often, it is best to call the office to confirm. You should also ask whether the office files the claim for you, which is a convenience that many practices now provide since filling out the paperwork on your own can be confusing and time-consuming.

Another insurance-related question to ask is what your co-pay is, although the front office staff may not be aware of this off the top of their heads. Luckily, you can contact your provider or check your coverage on the website to find out information like co-pays, co-insurance, and deductibles so you make sure to bring the right amount with you.

New patients always need to fill out a lot of forms at any doctor's appointment. This is why you are encouraged to arrive early to your visit, as it may get pushed back a little if you do not allow sufficient time for the paperwork. Since it requests about allergies, past treatment, and insurance information, there is usually no way to get started with the physiotherapy care before you fill out the proper forms. If you know you will be in a hurry on the day of the visit, find out if you can fill out the paperwork days before the appointment, such as by downloading it online, printing it out, and bringing it with you.

Finally, ask what you should wear to your physiotherapy visit. In most cases, you should wear loose fitting, comfortable clothes that you can work out in. However, you should take into account what body parts will be involved in the exercises. For example, if your arm is the only part being rehabilitated, then you probably do not need to think much about your shoes, while tennis shoes are best if your legs will be the focus. To be sure, simply ask the office staff before you come in. If you can not get in touch with anyone, just use common sense and think about what you would feel most comfortable in.

To avoid having to get your visit rescheduled, you should ask these things well in advance of your appointment. Otherwise, you may have to pay more than you expect, or you might be uncomfortable the whole time. Most physiotherapy practitioners should be happy to provide the answers you need over the phone or website.

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Finding The Help You Need – Whiplash Symptoms Explained

Overview on Whiplash Symptoms

One must know what a whiplash injury is. It is not exactly like being washed by a whip. Whiplash injury is actually a non-medical term for the injury caused by the acceleration and deceleration of the cervix (“Cervical-Acceleration-Deceleration or CAD.”) While CAD refers to the mechanism, “Whiplash Associated Disorders” is the term used for the injury itself and the so-called whiplash symptoms.

Whiplash symptoms usually begin to show right after a person experiences a collision from the rear of a motorcycle that he's riding in. Not only after motorcycle vehicles do whiplash symptoms happen, even on collisions on a car, a simple fall, assault, or any other collision that can cause impact may result into such cases. In fact, the whiplash problem was not called as such until 1928 – a few years after the invention of motorcycles and back then, it was still called “railroad spine.” When after a strong impact to the neck, the soft tissues on it will be damaged and these damages create the need for adequate rest and recovery.

The symptoms, like most muscular damages, are just few, simple, and very easy to notice. These symptoms and signs may occur right after the collision impact has occurred to even several minutes after it. One thing that you have to remember when you begin to experience whiplash symptoms is that the sooner you experience them after the impact, the more like it is to lead to some more serious damage.

The most predominant of all whiplash symptoms is the pain on the neck itself. Along with this pain would come a thoughtful swapping on the neck part which does not need to have to be painful when touched. The swelling on the neck would usually feel soft when you try to touch it. Further the symptoms include spasms on the muscles on the side or at the back of your neck. This means that either or both the side and back muscles of your neck should have involuntary contraction, which is not really usual on the neck muscles. A person experiencing whiplash symptoms may also feel headache during the period. Also, during that time, the pain that occurs at the neck extends even up to the shoulders or even down to his arm.

When these whiplash symptoms are experienced, you need not to worry too much because they can be easily taken care of by a qualified physician.

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Choose a Physical Therapy Office Only After Making Sure It Is Up-To-Date

You may need to get physical therapy for any number of reasons, but the most important thing is that you choose a good doctor so so you can get the results you are looking for. There are probably plenty of practices to choose from in your city, but the best one is going to be one that is known for being modern. Updated equipment and knowledge are both good things to look for, and there are a few ways to find these aspects.

One of the easiest ways to get to know how updated the office looks is to check out the website. If it looks like someone pays attention to it, constantly updating the information and making sure the design is modern and attractive, this is a good sign. If there is a calendar of events or recent reminders, check the dates and make sure they are within the last couple months, if not the last few days. A company that cares about its reputation and its ability to provide patients with the best service will usually market itself as such, and the best way to do this is with a modern website. If the doctor you are considering does not have one, or it is clearly neglected and outdated, the office may be the same way.

While you are checking out the physical therapy website, find out a little about the staff. The site should mention the doctor's history, so check out his or her education. There should be some mention of recent training or certification, even if the initial degree was several years ago. Someone who went to college decades ago is probably very experienced, but if his or her knowledge and philosophy has not changed much since then, it could be incorrect now since new ideas and facts are always emerging in the medical world. This is why many of the best doctors constantly update their information every few years with new classes and seminars. They also often make sure their staff members have the same new facts, so find out if continuous training is required for them, too.

Some components of physical therapy involve equipment, and if you want the best results, it should be modern. You do not want it to break during use, or not work properly, which will probably set you back when it comes to recovery. You can usually visit the office for a tour or consultation before you get any physical therapy, so ask about this kind of offer. Look around and make sure everything looks well taken care of and fairly new.

If you want to feel like you are in good hands, you should not have to wonder if the creaking equipment will break on you, or if your doctor has the latest information in the world of physical therapy. Fortunately, you can find out these facts before making an appointment, usually for free, so check out the website and office of the doctors you are considering before you commit to any of them.

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