Delaying Physical Therapy Can be Costly

Gunnar Mossberg

Tuesday, August 14, 2012


Up to 80 percent of people will at some point experience acute low
back pain, and in most cases it will resolve on its own within four to
six weeks, but with a high recurrence rate. However, recent large
studies have shown that early start of physical therapy treatment may
lead to less need for additional health-care treatment down the road.

A new study led by physical therapist Julie M. Fritz, published in the
medical journal Spine, used a national database of employer-sponsored
health plans, where 32,070 patients had newly consulted a primary care
physician for low back pain. Those who were referred to a physical
therapist within 14 days of consultation were compared to patients who
had their physical therapy referral delayed until 15 to 90 days after
initial consultation with a physician.

During an 18-month follow-up, the researchers found that early
physical therapy treatment was associated with reduced likelihood of
subsequent surgery, injections, physician visits, opioid use, advanced
imaging, along with a corresponding reduction in related medical costs
relative to delayed treatment by a physical therapist. The total
health-care cost was $2,736 lower in the early treatment group.

Another recently published study, taken from data from the Centers for
Medicare and Medicaid Services, looked at 439,195 patients who
received treatment for acute low back pain, and who received physical
therapy in the acute phase (less than 4 weeks) versus in the chronic
phase (more than 3 months). This study also showed less subsequent
medical services among patients who received physical therapy early
after an episode of acute low back pain, versus later on. Fritz
suggested that early physical therapy may promote a greater sense of
self-reliance in managing low back pain and confidence in a positive
outcome. It may also prevent patients’ dependency on additional health
care services and medications.

Although the literature has shown evidence of moderate benefit of
exercise therapy for chronic and sub acute low back pain, a systematic
review has shown strong evidence that exercise can reduce the future
occurrence of back problems in adults.

Gunnar Mossberg, PT, MOMT, DPT, has practiced physical therapy in San
Diego since 1982


Early proper treatment can be crucial to be preventive of chronic
illness behaviors.

--
Hyunsuk Oh, DC, CCEP, CKTP, ART®, GT®

Dr. Hyunsuk Oh graduated from Life University in Marietta, Georgia. Dr. Oh currently holds licenses to practice chiropractic in Maryland and Virginia. He is a member of the Maryland Chiropractic Association, American Chiropractic Association and International Chiropractic Association. Dr. Oh has undergone extensive training and has earned the designate of Certified Chiropractic Extremity Practitioner (CCEP) from the Council on Extremity Adjusting. He has also obtained  certification as a Golf Rehabilitation Specialist through Blanchard Institution. Dr. oh has achieved Advanced Certification in the Graston Instrument Assisted Soft-Tissue Mobilization (GISTM) technique (or Graston Technique), a highly advanced and efficient technique developed for treating soft tissue pathology.  He also has achieved Advanced Certification in the SASTM (Sound Assisted Soft-Tissue Mobilization).   Dr. Oh is also a full body licensed provider of Active Release Techniques (ART).  This technique is highly effective for treating a whole host of soft tissue and nerve entrapment issues.   ART is a favorite technique of triathlon participants, volleyball players, marathon runners, and athletes of all sports. Dr. Oh is also a Certified Kinesio® Taping Practitioner (CKTP®). The Kinesio® Taping Method is one of the most sophisticated taping techniques in the world.  It allows for facilitation, inhibition, and functional corrections of the musculoskeletal system.

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Neuropathy and Spondylosis

Chiropractic Care Can Help Patients with Neuropathy and Spondylosis

We all see patients with chronic pain that may not be related to a
direct inflammatory process, and the examination reveals no hard
neurological signs (diminished reflexes, etc.). Gunn states that there
are functional and/or structural alterations within the central or
peripheral nervous systems, i.e., neuropathy. Neuropathic pain is
associated with abnormal nerve function and/or hyperactivity at some
level in the pain sensory system.

Neuropathic Pain Begins in the Spine and Has a Gradual Origin

The most common cause of neuropathy is spondylosis. He states that
"the spinal origin of neuropathic pain is not always obvious because
spondylotic degeneration follows a gradual, relapsing and remitting
course that is silent. Pain can arise with no history of trauma, and
laboratory, radiological and other tests are unhelpful." Spondylosis,
which refers to the structural disintegration and morphologic
alterations in the intervertebral disc and pathoanotomic changes in
surrounding structures, can eventually cause simultaneous damage to
the nerve roots (radiculopathy) and cord (myelopathy). Gunn speaks of
a prespondylosis which may be symptomless until trauma occurs. A
neuropathy may appear. With an acute injury to a healthy nerve there
is no prolonged discharge of pain signals, whereas, the same injury to
a neuropathic nerve affected by a prespondylosis can cause a sustained
discharge. This may explain why people with spondylosis and no
symptoms can have minor injury and the pain can exist beyond a
reasonable period.

Spondylosis Increases with Age and is More Common among Middle Aged People

Because spondylosis increases with age, spondylotic pain is more
common in middle-aged individuals. They have accumulated an "injury
pool" or an accumulation of repeated major and minor injuries to a
segment leading to unresolved clinical residuals, which may or may not
produce pain. The most important manifestation of neuropathy, besides
sensory and autonomic findings, is the motor sign of muscle shortening
from spasm resulting in ropey bands in muscle, which may eventually
become fibrotic or focal areas of tenderness called trigger points.
Gunn states that in radiculopathy, these tender spastic muscles can be
found throughout the myotome, contralaterally, and in paraspinal
muscles. Gunn feels that shortened muscles can mechanically stress
muscle attachments leading to tendinitis, epicondylitis, and in
muscles crossing a joint which can increase joint pressure, upset
alignment, cause facet joint pressure, and precipitate pain in the
joint, eventually causing degenerative changes. He even believes that
shortening in paraspinal muscles acting across a disc space can
compress a bulged disc irritating the nerve root. Pressure on the
nerve root will cause more spasm and result in further nerve root
compression.

In radiculopathic pain, tender muscle bands will appear in myotomal
muscles supplied by both the anterior and posterior primary rami. For
pain in the knee, Gunn would seek the tender bands not only in the
quadriceps femoris muscles but also in the paraspinal muscles at the
same segmental levels (L2-L4). He states that while back pain is most
common at L5-S1 levels, more often than not, higher segmental levels
are involved, frequently reaching dorsal and cervical levels.

By Warren Hammer, MS, DC, DABCO

As we can see this article soft tissue treatment can help relieve the
pressure from nerve root which could cause ridiculer pain.
The treatment of this condition should be emphasized on not only
chiropractic manipulation for joints also soft tissue treatment for
surrounding structures including soft tissue and fascia.

For more information and health tips, visit the Laurel Chiropracticwebsite and “like” us on Facebook.  

Dr. Hyunsuk Oh graduated from Life University in Marietta, Georgia. Dr. Oh currently holds licenses to practice chiropractic in Maryland and Virginia. He is a member of the Maryland Chiropractic Association, American Chiropractic Association and International Chiropractic Association. Dr. Oh has undergone extensive training and has earned the designate of Certified Chiropractic Extremity Practitioner (CCEP) from the Council on Extremity Adjusting. He has also obtained  certification as a Golf Rehabilitation Specialist through Blanchard Institution. Dr. oh has achieved Advanced Certification in the Graston Instrument Assisted Soft-Tissue Mobilization (GISTM) technique (or Graston Technique), a highly advanced and efficient technique developed for treating soft tissue pathology.  He also has achieved Advanced Certification in the SASTM (Sound Assisted Soft-Tissue Mobilization).   Dr. Oh is also a full body licensed provider of Active Release Techniques (ART).  This technique is highly effective for treating a whole host of soft tissue and nerve entrapment issues.   ART is a favorite technique of triathlon participants, volleyball players, marathon runners, and athletes of all sports. Dr. Oh is also a Certified Kinesio® Taping Practitioner (CKTP®). The Kinesio® Taping Method is one of the most sophisticated taping techniques in the world.  It allows for facilitation, inhibition, and functional corrections of the musculoskeletal system.

Graston Treatment for Olympian Micheal Philps!

Graston Technique Helps to Normalize Your Body from Damage Due to Overuse

When the body does not get appropriate recovery time, damaged tissue
is not able to rebuild stronger than it was before. The body remains
in a state of breakdown, and the accumulation of micro tears in
tissues will eventually result in an overuse injury. Graston technique
helps to normalize your body through breaking scars from micro
tears in tissues for your perfect recovery.

Graston Technique is part of an integrated whole body recovery treatment program; we use in conjunction with other methods of chiropractic care to ensure athletic patients can train harder and recover faster.

U.S.A. Olympic Champion Uses Graston Technique for Sports Recovery

By: Selene Yeager, August 12, 2012

MICHAEL PHELPS: THE GREATEST AMERICAN HERO

AFTER THE SCANDALS AND THE SETBACKS, THE GREATEST SWIMMER EVER IS RECHARGED, RELAXED, AND READY TO TAKE HIS FINAL SHOT IN LONDON. THE INSIDE STORY OF HOW A SKINNY KID FROM BALTIMORE ASSEMBLED THE BEST BODY OF WORK—AND BODY—IN U.S. OLYMPIC HISTORY.

BY SELENE YEAGER,

AUGUST 2012 ISSUE

Age: 27 Height: 6'4" Weight: 195 lb Hometown: Baltimore Most athletes follow a regimen that builds endurance, strength, and power over the course of a year. Under coach Bob Bowman, the mastermind of the long-term view, Michael Phelps mapped out a 16-year plan for world domination—the entire duration of his career. In the years before the 2004 Athens Games, Phelps focused on building a massive aerobic capacity, logging 50 miles a week in the pool. Leading up to his record-smashing performance in Beijing in 2008, he added four days a week of weight-intense dry-land training—Keenan Robinson, Phelps' trainer, rotates through a bottomless bag of routines to keep Phelps at the top of his game—and 10 pounds of water-slicing muscle. Fourteen gold (and two bronze) Olympic medals later, he's all about power as he prepares to storm London. In addition to knocking out four sets of five pull-ups while wearing a 40-pound vest, "I'm doing more Olympic-style lifts, like power cleans and snatches and plyometric push presses and box jumps, to get explosive power for jumping off the block and pushing out of turns," Phelps says. "At this point in my career, everybody has caught up. So I'm fine-tuning the little things that add up to make a huge difference."

DETAILS: So what do you do for recovery? Michael Phelps: My trainer, Keenan [Robinson], uses Graston tools, these little metal crowbars. He carves them into my shoulder blades, my back, my knee, my hamstrings—wherever I'm really tight—to loosen things up. It's pretty intense. Obscenities fly out of my mouth the whole time, and I'm usually bruised for two days after it. I also use ice tubs. And when I'm back home, I sleep in an altitude chamber set to about 8,000 feet. All these things help me to be close to my best every time I jump in the water.

Michael Phelps' Workout Tips

ON THE IMPORTANCE OF RECOVERY "Compared to Beijing, I think the biggest thing is just trying to find ways to recover faster. Going into the weight room three times a week, it can be harder to swim, it can be harder to get up and to feel fresh and do this. So it's like you have to find different exercises or different routines that you go through." Here are some of Phelps' activities.

Graston Technique® A modern yet medieval-looking form of soft-tissue manipulation in which the practitioner, in this case Phelps' strength trainer, Keenan Robinson, uses a series of stainless-steel instruments to comb over muscles, find adhesions, and break down scar tissue and stretch connective tissue and muscle fibers. "He takes those little crowbars and carves them into my shoulder blades and I go crazy, letting obscenities fly the whole time," Phelps says. "I bruise for two days. It's pretty intense." But it works. "We used it before a mid-season meet in Missouri in 2007," Robinson recalls. "He was locked up through his rhomboids and lats and external rotators. We went in there and worked it out and he broke the world record in the 200 butterfly. It's amazing."

Note to patients: While Phelps treatment results in some discomfort and bruising, this is not a typical response for GT

For more information and health tips, visit the Laurel Chiropractic website and “like” us on Facebook.  

Dr. Hyunsuk Oh graduated from Life University in Marietta, Georgia. Dr. Oh currently holds licenses to practice chiropractic in Maryland and Virginia. He is a member of the Maryland Chiropractic Association, American Chiropractic Association and International Chiropractic Association. Dr. Oh has undergone extensive training and has earned the designate of Certified Chiropractic Extremity Practitioner (CCEP) from the Council on Extremity Adjusting. He has also obtained certification as a Golf Rehabilitation Specialist through Blanchard Institution. Dr. oh has achieved Advanced Certification in the Graston Instrument Assisted Soft-Tissue Mobilization (GISTM) technique (or Graston Technique), a highly advanced and efficient technique developed for treating soft tissue pathology.  He also has achieved Advanced Certification in the SASTM (Sound Assisted Soft-Tissue Mobilization).   Dr. Oh is also a full body licensed provider of Active Release Techniques (ART).  This technique is highly effective for treating a whole host of soft tissue and nerve entrapment issues.   ART is a favorite technique of triathlon participants, volleyball players, marathon runners, and athletes of all sports. Dr. Oh is also a Certified Kinesio® Taping Practitioner (CKTP®). The Kinesio® Taping Method is one of the most sophisticated taping techniques in the world.  It allows for facilitation, inhibition, and functional corrections of the musculoskeletal system.