Fibromyalgia Facts

Fibromyalgia (FM) is a common and complex chronic pain disorder that affects an estimated 10 million Americans, mostly women. FM is a syndrome rather than a disease. Unlike a disease, which is a medical condition with a specific cause or causes and recognizable signs and symptoms, a syndrome is a collection of signs, symptoms, and medical problems that tend to occur together but are not related to a specific, identifiable cause. FM is characterized by chronic widespread pain, multiple tender points, abnormal pain processing, sleep disturbances, fatigue and often psychological distress. Fortunately, FM is not a serious life-threatening illness and can be diagnosed properly by a physician who is knowledgeable about this condition.The National Fibromyalgia Association (http://www.fmaware.org/) is a nonprofit organization that provides educational information and support for Fibromyalgia patients and their family members; it is an excellent resource for gathering more information on this elusive disorder

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The tender point locations of fibromyalgiaMense S, Simons DG. Muscle Pain. Lippincott, Williams & Wilkins; 2001.


When should I see a doctor?
As with many other medical problems, proper diagnosis is half the cure. People with FM tend to look healthy on the outside but feel miserable on the inside, and therefore it is important that a physician knowledgeable about FM be the person to make the appropriate diagnosis. Many physicians are still not well educated about the diagnosis of FM and may be too quick to give a diagnosis of FM. It is important that you first have standard laboratory tests performed – before a diagnosis of FM is given – in order to rule out some other medical problems that could be the cause of widespread pain and fatigue.Many other medical problems can mimic the symptoms of FM including anemia, Lyme Disease, rheumatoid arthritis, low thyroid, diabetes, vitamin and mineral deficiencies, and other chemical imbalances. Sometimes the key symptoms of FM - widespread pain and fatigue – can be caused by reactions or side effects to common medications such as statins for high cholesterol, some blood pressure medications, and even some anti- depressant medications. Your doctor should be able to rule out these other causes of widespread pain and fatigue with standard laboratory tests. The diagnosis of FM should only be given after a thorough physical examination and laboratory tests fail to detect another medical problem. As noted above, FM is a complex pain disorder that requires a multifaceted treatment approach including the following components:

Pain management with various medications

Gentle exercises

Sleep management

Nutritional guidance

Psychological and emotional support

Complementary therapies such as chiropractic, acupuncture and massage.

There is no single cause or single treatment for FM, and each individual with FM requires an individualized treatment approach using a combination of the above therapies. It is normal to worry about the cause of your pain and the impact it may have on your life. Talking with your healthcare provider about these worries and concerns can be helpful. Although the pain of FM can be debilitating at times, you and your healthcare provider can find many ways to relieve the symptoms and get you back to your normal activities.


When should I see a doctor?

Keep in mind that staying active with your normal activities is the best thing you can do to limit the effects of fibromyalgia on your life. You may have to modify the way that you perform certain activities of daily living, slow down your pace and intensity of physical exercise. However, you need to keep moving and exercise within the limits of your abilities. Many FM patients find that gentler forms of exercise are better tolerated, such as Tai Chi and Yoga. Avoid intense or aggressive forms of exercise, such as high impact aerobics or heavy weight lifting.Proper sleep hygiene is an extremely important component to the successful management of FM. You should avoid excessive amounts of caffeine and alcohol, as these substances can alter your normal sleep cycle. Regular exercise can be a helpful aide in promoting good sleep. It is important that you try to maintain a normal bedtime and time to awaken in the morning; keeping to a routine sleep cycle is very helpful. Some patients will require certain medications for improving their sleep, which should be discussed with an appropriate licensed healthcare provider. Emotional stress and depression tend to afflict many FM patients. Taking classes in stress management, mindfulness meditation, yoga, and relaxation therapy may be very helpful in the self-management of these emotional states. Some FM patients will have severe depression and/or anxiety that need to be treated with therapeutic doses of anti-depressant or anti-anxiety medications often in conjunction with a licensed psychologist or psychiatrist. It is important to note that this does not mean FM is a psychiatric condition; patients will simply find it easier to cope with their FM symptoms when their mental health needs are addressed. Many FM patients experience specific areas of muscle pain, in addition to the overall sense of widespread pain and fatigue. For these discrete areas of muscle pain known as myofascial trigger points, various types of massage or manual therapy can be very beneficial. As a rule, most FM will not respond well to heavy or aggressive types of deep tissue massage. Instead, FM patients should consider lighter forms of massage that do not involve deep friction or stripping of the tissues. Deep breathing and relaxation, along with massage, can aide in the relaxation of tight painful muscles.

Rehabilitation
The FM patient can benefit from the assistance of a trained rehabilitation specialist who understands that FM must be addressed with more gentle types of exercise than other patients with musculoskeletal pain. It is important for both the FM patient and their rehabilitation specialist to understand that “hurt does not mean harm”. FM patients can expect to experience a modest amount of post-exercise soreness, but this should not be excessive or debilitating. As a rule, exercises should be performed at a very low intensity and gradually increased to a level that is tolerable for the FM patient. Mild aerobics and strength training are indicated for the treatment of FM, with many patients reporting that yoga and tai chi exercises are excellent adjuncts to a standard rehabilitation program.One simple way to get started with an exercise program is begin a daily walking program. You could start by walking just 5 minutes the first day, and gradually keep adding 2-3 minutes per day until you are walking 30-40 minutes a day. When the weather is bad, you can substitute the use of a stationary bicycle indoors. Keep track of your time on the bicycle and set a goal of reaching 30-40 minutes. Some fibromyalgia patients prefer to exercise in the water, by treading water, swimming a few laps, or taking a beginner’s water aerobics class. One benefit of pool based exercise is the fact that the buoyancy of the water takes a lot of pressure off your joints.The type of exercise you choose is up to you. It's important that you start exercising and keep doing it. Exercise relieves much of the pain fibromyalgia causes. Some people even find that exercise makes all their pain go away. You will also feel better if you have some control over your own care and well-being, by doing things to help yourself get better.

Sources from Clinicalrehabspecialist.com

FAI – What is it & why we are seeing more of it?



On September 13, 2011, in Controversies, Hip, Overuse Syndromes, by Craig Liebenson
Femoral-Acetabular Impingement (FAI) is an increasingly popular diagnosis for patients with stubborn hip problems. Hip replacement surgery has been a great advance, but recently the hope for it being a panacea has been dashed. Now, surgeons are diagnosing FAI in many aging athletes & weekend warriors. What is it? How do we diagnose it. And, how can we treat it?

WHAT IS IT?
FAI is a wear & tear injury from repetitive strain.

HOW CAN WE DIAGNOSE IT?
There are no specific diagnostic tests for it, however groin pain is one signature of it’s presentation. According to the revolutionary hip surgeon from Colorado Dr Philippon “A positive impingement test was defined as groin pain with 90 degrees of hip flexion and maximal internal rotation.”.
He also states that the Faber Test can be positive – limited & painful abduction & external rotation.
X-rays may show bony reaction on the femoral head or neck, and on the acetabular rim.
MRI can reveal fraying or tears of the cartilage and labrum.

FAI has to be distinguished from Hip Dysplasia (HD), and a Labral Tear (LT).

HD is present if the hip socket -acetabulum – is too shallow for the ball – femoral head. It is a congenital condition. This can be associated with tearing of the labral and articular cartilages. There should be laxity & instability.

A LT can be visualized on an MRI and can occur with AFI or HD. Like FAI, pain with hip flexion, internal rotation and adduction are hallmarks. The MRI finding of a LT does not mean there is a clinical problem since is it is present in many asymptomatic individuals.

Since tears can be asymptomatic and dysplasia occurs with instability when we have restricted or painful motion FAI is a reasonable working diagnosis.


HOW CAN WE TREAT IT?
Surgery is not the first choice, but last resort. Conservative care should always be considered

option 1.
Activating the posterior chain in order to “check” uncontrolled or excessive hip flexion is a key.
Integrated core activity with lower quarter control is a “no brainer”.

Frontal plane stability
Visualization training for movement education of the hip
Regarding acetabulo-femoral amnesia this is inspired by Eric Franklin’s movement education work. Most people have no idea where their hip is. When they learn it’s actual location it becomes much easier to train the hip hinge and activate the posterior chain. This is an example of the neuro-matrix whereby an new neural signature is created via motor control training.

WHAT IS THE ROLE OF MUSCLE IMBALANCE?
It is unlikely that FAI caused by muscle imbalance, however muscular compensations such as gluteal inhibition are typically present. Pr Janda put our attention on the gluteus maximus (posterior chain), gluteus medius (lateral chain) & abdominal wall (anterior chain) with his revolutionary work from the 1960′s. Today, our terms have changed – posterior chain, frontal plane stability, and functional core control, but it the same faulty movement patterns which Pr Janda the Father of Rehabilitation Medicine spoke about.


HOW CAN REHAB BE PROGRESSED TO RETURN TO SPORT & SELF-CARE?
First, identify quad dominance. Check where the patient “feels” squats, lunges, balance reaches, etc.. Most patients only feel their anterior thighs. This is our trigger to commence a posterior chain facilitation program. There are “many roads to Rome”. Find what works best. I am not about methods, but principles. If you know the goal you will find the means.

A few ideas though would include – 2 & 1 LDLs; functional reaches; 2 & 1 leg box squats; reverse lunge steps; Rear foot elevated split squats; monster walks, and bridges.

Second, ensure integrated core-lower quarter control. Planks; Supine foam roll marching with med ball chest press; 2/1 Hamstring bridges & curls with the gym ball; Kolar dying bug vs the wall; and Nordic or Russian eccentric hamstring lowers.

Third, determine if lateral hip stability is present check single leg balance for pelvic unleveling. Then, look at single leg squats to see if pelvic unleveling leads to medial knee collapse occurs. Third, check side lying hip abduction to determine if there is gluteus medius insufficiency or asymetric strength. Training can include clam shells; lateral band walks; kettlebell carries, posterior-lateral balance reaches (5:00 or 7:00).

If these 3 fundamental components can be mastered, then to maximize functional stability plyometric control must be ensured. This is essential for athletes as a functional test of improved stability resulting from the initial rehab. If the stretch-shortening cycle is sluggish overload will occur at the “weakest link” – achilles, anterior knee, or hip. Start with 2 legs jump squats; scissor lunges; and 360 degree jump squats. Progress to lateral hops, diagonal X-Hops; and single leg hop and holds.

For functional training once plyometric stability is ensured begin to build power by utilizing triple extension exercises such as Waterbury’s High Pull.
The key is to train for power by finding the athlete’s 10 RM then train only as many reps as can be performed at top speed without breaking form. The 1st set might by 6-7 reps. When performed as part of circuit of perhaps 3 exercises with each successive set the reps performed will drop before speed or form decays. 5 sets are ideal and if the initial RM was chosen wisely a Russian Reverse Pyramid of training will have occurred naturally. For instance, Set 1 – 6 reps; Set 2 – 5 reps; Set 3 – 4 reps; Set 4 – 3 reps; Set 5 – 2 reps. Grand Total of reps might be 15-20 reps. To increase power start by finding the 7-8 RM, so Set 1 at top speed is likely to be only 5 reps. Individualize this to the patient’s capabilities and demands.

Sources from craigliebenson.com

The Web of Life

Just beneath your skin lies a complex network of connective tissue called fascia. It helps you move well, stand straight and play hard. Keeping it healthy might be one of the fastest — and most overlooked — ways to improve your health and fitness.

Features,
There’s a good chance you’ve never heard of fascia: the stretchy, mesh-like substance that interweaves through and around your musculature, surrounds and supports your organs, and shrink-wraps your entire internal structure like a second skin.But if you were able to peek beneath your epidermis, you’d probably be surprised to see that this messy, elastic white stuff

— made of collagen fibers, and similar to the material that makes up your ligaments and tendons — is virtually everywhere.Unlike muscles and bones, though, fascia has historically been given so

little attention by therapists, trainers and other fitness pros that it’s not even on the standard gym-wall anatomy chart.“From an anatomical perspective, fascia is often seen as ‘the gunk you cut through to get to the good stuff,’” says corrective exercise specialist Anthony Carey, MA, owner of Function First in San Diego, Calif., and a leading fascia expert.In recent years, however, some forward-thinking trainers and therapists have begun to recognize that this seemingly inconsequential webbing plays a far more important role in everyday functioning than was once believed.Building on ideas outlined by anatomy teacher and bodyworker Thomas Myers in his book Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists (Churchill Livingstone, 2009), these therapists have begun to devise ways to improve the quality and elasticity of the fascia directly through bodywork, stretches and targeted exercises.Among these novel methods are Kinesis Myofascial Integration (KMI) — an approach to Rolfing developed by Myers — and Fascial Stretch Therapy (FST), founded by the husband and wife stretch-therapy team of Chris and Ann Frederick. These methods can significantly enhance the benefits of a stretching and strength program, making you stand taller, run faster and play harder. At the same time, fascial work often provides relief from chronic back and joint pain where many more conventional, muscle-based stretching and massage methods fail.“Everybody needs to start incorporating the fascia into their conception of the musculoskeletal system,” says Myers. To his way of thinking, however, that may mean a fairly substantial shift in the way we think about how we’re made and how we move.So if you still think “the foot bone’s connected to the ankle bone,” get ready to expand your thinking.

Facing the Fascia
Anatomy textbooks will tell you that the musculoskeletal system consists of thousands of separate parts: a couple hundred bones held together by more than 600 muscles and a near-countless number of ligaments and tendons. But Myers and Carey both assert that these divisions are largely artificial, created not by nature but by an anatomist’s scalpel.“The fascia links the entire muscular system, not just muscle to bone but muscle to muscle, along with all the structures in the body, like organs, ligaments and tendons,” says Carey. “Whether you’re exercising or treating pain, it doesn’t make sense to treat it like a machine with separate parts because of this head-to-toe continuity.”Seen from this perspective, Myers contends, “You don’t have 600-some-odd muscles, as we’ve always been taught: You have a single muscle with 600-odd stopping points, all linked by the fascial web.”Far from the haphazard mesh that the first anatomists perceived, this fascial network is now described by researchers as sensitive, dynamic and extraordinarily adaptable. “There are 10 times as many more nerve endings in your fascia as there are in your muscles,” says Myers, making fascia far more susceptible to pain and sensation in general than your muscles are. “Most sports injuries are in fact failures of fascial structures, not muscle tissue.“We say ‘muscles attach to bones,’” he continues, “but muscle can’t attach to anything. It’s formless, like hamburger. It’s the fascia that goes over and around and through your muscles that organizes that tissue into linear pulling machines.” When you perform a biceps curl, for example, the fascia of the biceps muscle shortens, tugging on your tendons and drawing your hand closer to your shoulder. And when you perform a quick, athletic movement — a layup in basketball, for instance — it’s the whip-fast elastic action of the fascia in your legs that transfers the force of those contracting muscles into the floor and launches you off the hardwood.Through decades of experience as a bodyworker and an extensive study of anatomy, Myers began to notice that the fascial webbing appeared to be organized into distinct meridians, or “trains” — dense bands connecting multiple muscles and spanning multiple joints, tacked down at numerous bony “stations” along the way. If you were to think of the entire fascial network as a suit of clothing, these “anatomy trains” would be a series of elastic straps, suspenders and seams that give it structure and shape. Myers has found about a dozen of these fascial superhighways, which seem especially effective in understanding human movement and treating pain and dysfunction. Some run the length of your body, head to toe; others spiral the torso, shoot over the top of your head, and run down the middle of your back.Like guy-wires on a well-rigged boat, a balanced, harmonious tension among these myofascial meridians helps support fluid, effortless movement. Too much chronic tension or slack in key meridians can, however, lead to poor posture and pain — and not always in the places you expect. Trace the fascial lines through the muscles and across the skeleton, and it’s possible to see, for instance, how shoulder pain might be caused by dysfunction in your opposite ankle, or how “tight hamstrings” might actually be caused by tension in the soles of the feet.According to Myers’s model, it is through these myofascial lines, moreso than through individual muscles, that the body adapts to and reinforces alignment and movement. Says Carey, “Fascia adapts to every move you make — good, bad or indifferent.” Over time, a competitive rower, for example, might develop thicker fascia in her back and shoulders to support the repetitive movement of pulling oars. The fascia in the front of the rib cage of your typical desk jockey, on the other hand, may become thick and short to reinforce a habitually caved-in posture. And injuries, even minor ones, often result in fascial “patches” in the muscles that can cause restricted motion, leading to compensations in gait and movement. These might remain long after the injury itself has healed.“Injured or poorly adapted fascia can start to act like glue, binding to muscles, other fascia, even your ligaments,” says Carey. In a sense, your entire individual life history — exercise habits, injuries, common sitting and sleeping positions — is written in your fascia. Depending on these and other behavioral factors, fascial adhesions can subtly accrue over years and decades, leading to movement inhibition and sometimes chronic pain.“Certain things in our bodies become tight, certain things become weak, and before you know it, our joints and limbs begin to make subtle twists and turns, making us a human game of Jenga,” jokes Sue Falsone, vice president of physical therapy at Athletes Performance and Team Sports in Phoenix.

The Tangled Web

So, think you might have a few kinks in your fascia? In a sense, if you’re already exercising and stretching regularly, you’re ahead of the game. “Muscles and fascia are so interwoven that you can’t affect one without affecting the other,” says Falsone.Nevertheless, standard, static stretching and muscle-isolating exercises, while beneficial in some ways, often have little effect on deeply ingrained fascial tension, especially if, like most people, you spend a large portion of your day sitting down.“If we spend months, years, even decades sitting at a desk and think that a few hours in the gym per week are going to undo all that, we’re probably fooling ourselves,” says Carey. Stretching a muscle with bound-up or poorly adapted fascia is a bit like trying to stretch a knotted bungee cord: You’ll get much better results if you get the knots out first.Some of the best methods for untying these knots take a therapeutic approach, in which a practitioner works with an athlete or client on a massage-style table. Other methods have the client participate more actively, moving and stretching him- or herself in fascia-friendly patterns.“Table work helps a client find more pliability and elasticity throughout the body,” says Carey. “Exercises help the client integrate the new range into their daily lives.” (For suggested exercises, see the Anatomy Trains at Work sidebar.)Although KMI and FST are among the first treatments to fully integrate Myers’s anatomy-trains concept into their methodology, other treatments have had measurable impact on the suppleness of the fascia, including active release therapy, resistance flexibility and strength training, and even self-myofascial release with foam rollers and other implements. As Myers’s research gains wider recognition, it’s likely that massage therapists, bodyworkers and trainers in other fields — from yoga to Feldenkrais — may well begin to emphasize fascial relationships in their teachings as well. (For more on Feldenkrais, read “The Feldenkrais Fix.")Myers’s KMI approach, which builds on the Structural Integration model developed by Ida Rolf (of Rolfing fame), takes the form of about 12 structured, progressive hands-on sessions with a KMI-certified practitioner. Initially, the practitioner takes photos and makes detailed observations about the client’s carriage and posture, noting especially where his or her fascial meridians appear shortened or contracted. From that point, each session focuses on a specific area of the body, starting with more superficial muscles, working gradually inward toward the core as the sequence progresses, and, finally, incorporating fully integrated movement.Throughout the treatment, the practitioner manually works out the fibrotic knots and scarring in the fascial tissues, restoring balance among the meridians by applying direct, sometimes fairly intense, pressure directly along the affected fascial lines. Although treatment can be painful at times, the results often feel terrific. Many people report marked improvements in everyday activities like sitting and standing, and even more impressive strides in active pursuits.

Flexibility Reclaimed
Forty-seven-year-old Nancy Di Benedetti, from Calgary, Alberta, began her KMI treatments with therapist Nadine Samila with the goal of touching her toes. “After the first session I was already walking differently. And after 12 sessions not only was I able to touch my toes, but I actually started skiing again,” she says.Chris and Ann Frederick bring to bear many of Myers’s principles in their Fascial Stretch Therapy (FST) system, which takes an unusually gentle approach to athletic flexibility training. “When you stretch too quickly or intensely, as many athletes do, the muscles go into a protective mode, contracting and resisting,” says Ann. “To get around these protective mechanisms, you’ve got to romance — not attack — the nervous system for optimal results. If the client is in a relaxed, calm state, his or her muscles and connective tissue will be much more responsive to the work. So you can’t yank on a muscle or deliberately push past a person’s comfort zone.”In practice, FST can be almost dancelike, as the practitioner slowly and rhythmically moves the client’s limbs in a series of slowly expanding arcs.These gentle, oscillating movements can elicit a soothing, parasympathetic response from the client’s nervous system, much like rocking in a chair or swinging in a hammock. “I never push the joints to their limits. I just gently test the boundaries of what’s possible for them at that moment,” says Carey. “A rhythmic tempo lowers apprehension, allowing the trainer to get past resistance in the fascia and into the muscles themselves.”This calm state also primes the client for learning new movement patterns, while at the same time, the broad, multidimensional movements stretch the entire fascial fabric in ways that conventional, single-plane stretching and many other types of therapy don’t.“I once worked on an insurance executive who had knee pain from years of high school and college athletics. His doctors were at a loss because the joints themselves seemed fine,” says Chris Frederick. “Through soft-tissue work and some well-chosen stretches, I was able to create space in his hip joints and relax the tension in his hip flexors, which took the pressure off his knees. And the pain he had had for 10 years was gone.”Frederick emphasizes that treating the whole person — rather than a single symptom or a single part of the body — can often mean paying attention to issues farther up and down the various meridian lines from the site of pain or dysfunction: “Where there’s pain,” he says, “ain’t usually where the problem is.”

DIY Anatomy Trains
Although working with a qualified therapist is the best way to deal with acute problems in the fascia, smart exercise choices involving the fascia can also help address some imbalances.One very effective option is to focus on full-body movements like Olympic lifts (and their regressions) and medicine-ball throws. Working with implements like battling ropes, Indian clubs and kettlebells, rather than trying to build or work different body parts in isolation, can also be helpful. Many of these movements require a dynamic transfer of force from the ground, through the body, and out through the arms or hands, in a pattern that simulates a wave. Done correctly, these wavelike motions parallel the sequential, muscle-to-muscle transfer of force that occurs along the fascial meridians just below the skin. As a result, they help reinforce healthy, integrated relationships among the myofascial meridians.You can approach flexibility training with a similar mindset: Rather than stretching one muscle group at a time, think about stretching an entire plane of the body at once, and of long movements that extend and spiral the body head to toe.Myers recommends stretching in multiple planes, adding rotation of the feet to a toe-touching stretch, for example, in order to more fully stretch the fascia across the hamstrings, calves and lower back. The asanas in yoga and the gentle oscillations of Feldenkrais are good examples of fascia-releasing work that helps enhance flexibility. (For more specific exercise and stretching choices, see the “Anatomy Trains at Work,” sidebar.)For greater suppleness throughout the fascial network, Myers also encourages people to incorporate bouncing of some kind in their workouts: skipping rope, jogging, jumping on a trampoline. “You lose elasticity in your fascia as you age. Kids exemplify that bouncy elasticity in their fascia, and bouncing helps you hold on to what you have.”Variety, however, may be your best safeguard against tightness and adhesions in the fascia, notes Myers: “If there’s one thing I could say to people who wanted to get fit or stay fit, it would be ‘Stop repeating yourself!’”Repetitive physical action — including forms of exercise like running or cycling — can leave its mark on the fascia, unnaturally tightening certain areas and eventually leaving you more susceptible to injury. The take-home lesson? Mix things up. Hike or cycle on uneven terrain, switch strength-training exercises frequently, and seek out new ways to move, through dance, sports, martial arts or other activities.For some time now, progressive fitness professionals have been emphasizing integrated forms of exercise, from dynamic flexibility work to full-body strength training to outdoor exercise and Eastern-style movement. In a sense, the anatomy-trains model represents the anatomical basis for this approach: Just as the fascia links the muscles together in interconnected chains, so integrated exercise and movement link the muscles functionally, through dynamic, coordinated movement patterns.In all likelihood, the more we can shift our perspective to see the body that way — as a whole system working together — the healthier we’ll be.

Anatomy Trains at Work
To experience the interconnectedness of your own fascial webbing, try some of the following exercises, and consider building similar moves into your workouts. Activities that include long, sweeping patterns, full extension of the limbs, and spiraling gestures through the torso (notably yoga, tai chi and Feldenkrais) can enhance awareness and foster optimum balance of your body’s major fascial lines. Many types of dance as well as racquet and ball sports, which require jumping, leaping, throwing and reaching, also have similar benefits.

"The World's Greatest Stretch"

• Stand and step forward with your left foot into a deep lunge position.

• Lean forward and place both hands on the floor, with your left knee outside your left arm and shoulder.

• Keeping your right leg straight and your back long (aim for a perfect line between your head and right heel), gently press your left elbow against the inside of your left knee for a two-count.• Still keeping your right leg fully extended, slowly straighten your left leg as much as possible, rocking your weight back onto the heel of your front foot. Hold for a two-count.

• Rebend your left knee and lift your torso from the bent-over position, assuming a standing lunge position with your right knee floating 2 inches off the floor. Hold for a two-count, then step forward with your right foot and repeat on the opposite side.

• Perform six to eight repetitions on each side.“The World’s Greatest Stretch,” recommended by Sue Falsone, vice president of physical therapy at Athletes Performance and Team Sports in Phoenix, mobilizes both front-of-the-hip and back fascial lines in their entirety, head to toe.Side

Bend with Rolling Feet

• Stand upright with your feet parallel and about shoulder-width-and-a-half apart.• Keeping your hips and shoulders square, reach your right hand directly overhead.

• Perform a side-bend to your left, reaching your right arm over your head and as far to your left as possible.

• Once in this position, roll both feet to the right, shifting your weight onto the outside edge of your right foot, and the inside edge of your left foot. Hold for 10 seconds and repeat on the opposite side.Although the standard side bend is traditionally seen as a stretch for the lats and obliques (the muscles on the sides of your torso), rolling the feet in this position — which inevitably intensifies the stretch — makes it clear that you are in fact extending a unified fascial line that extends along the side of the body from the outside edges of your feet all the way up to your ear.

A Better Hip Mobilization

• Lie flat on your back on a firm surface. Bend both knees with feet flat on the floor.

• Lift your right leg in the air.

• Take hold of your leg with both hands — behind your knee, on the outsides of your thigh, or wherever feels comfortable.• Keeping your neck relaxed and your head on the floor, gently pull your leg toward your upper body until you feel a gentle stretch.

• Maintaining your hold on the leg, gently rotate your foot, circling your leg to the outside, then to the inside of your torso.

• Continue to experiment with easy movements of your leg in whatever range and plane of motion feels comfortable for about two minutes, then repeat on the other side.Many people stretch their hips and hamstrings in one plane of motion: generally straight forward (as in, touch your toes). Since the fascia runs through and around the entire musculature, it can be more thorough to stretch in this multiplanar way: up, down, forward, back. And, avoiding the pain threshold can be more effective because you fly beneath the radar of the protective mechanisms of the joints, which tighten and shorten muscles when you stretch forcefully.

Snuffing Out Fascial Inflammation
Long-term inflammation and irritation in the fascia — the intricate web of connective tissue that holds your body together — is fairly common, and can sometimes aggravate and make worse certain arthritic conditions.What causes fascial inflammation? “No one knows for sure. It’s partly genetic, but it’s often related to overdoing one particular type of movement,” says Nadine Samila, a practitioner of Kinesis Myofascial Integration (KMI) and Myofascial Release Therapy (MRT) from Calgary, Alberta.Inflammation and tightness in the iliotibial, or “IT,” band (the thick fascial strap that runs along the outside of your thigh), for example, is common in avid runners. “A tight IT band can pull the kneecap off its track, which irritates the knee joint and can eventually lead to arthritis,” says Chris Frederick, PT, coauthor of Stretch to Win (Human Kinetics, 2006). Similarly, habitual slumping and slouching can cause the fascia in the front of the chest to shorten and tighten, restricting freedom of movement in the arms and shoulders. Desk-sitters, for example, will often be unable to reach behind themselves comfortably from a seated position because the fascia in and around their pectoral muscles is so short and tight. As a result, the smaller, weaker muscles of the rotator cuff can get strained or injured, even during seemingly harmless movements. “I’ve had clients who have torn their rotator cuffs trying to reach something in the back seat of their car,” says Frederick.Perhaps the worst-case scenario of fascial inflammation is called compartment syndrome, which is a restriction of the fascia surrounding the muscles of the lower leg. It often occurs in seriously overtrained athletes and exercisers. Let this condition go on too long, says Frederick, “and you could even lose your leg.”But it’s plain old inactivity that causes the most fascial troubles. Healthy fascia is well hydrated and smooth, like the fine membrane that covers fresh, uncooked chicken. But the connective tissue in older and inactive people, explains Samila, “gets fuzzy and sticky, like cobwebs. It doesn’t move well. That’s partly due to age, but inactivity makes it much worse. We just don’t move enough!”The antidote? Move. As much as you can, and in as many different ways. “The more you move, and the more ways that you move,” says Samila, “the more you keep the fascia soft, hydrated, and healthy.”

Tennis Ball Trick

• Perform a standing toe-touch in bare feet, with your knees soft, and note how far down your legs you can comfortably reach without straining.

• Stand, and carefully roll the bottom of your right foot over a tennis ball, paying particular attention to spots where your feet are tender or sensitive. Hold on to something stable for balance if necessary. Continue for at least a full minute, then repeat on the left foot.

• Perform the standing toe-touch test again.Fascia Facts: After a quick foot massage, many people will feel as though their hamstrings suddenly got looser. The hamstrings are affected as the tennis ball helps loosen the Superficial Back Line as a whole, a fascial train that runs from the bottoms of your feet to your head, allowing many people to reach further on their second try.

By Andrew Heffernan, CSCS / November 2011

Soft (and Not-So-Soft)-Tissue Overview

In my opinion, quality chiropractic care begins with combining soft-tissue techniques with joint manipulation and rehabilitation exercise. Muscles move bones. If you are not addressing the dysfunction in the muscles, your adjusting is much less likely to have long-term success.
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This article, the first in a series on soft-tissue techniques, reviews some of soft-tissue methods I have been introduced to over the past 35 years.
One underlying theme when it comes to the various soft-tissue methods is that pain is a liar. The pain generator may be the local joint, or the nerves affected by disc pathology or impingement, but we need to look beyond that. "He who treats (only) the site of pain is lost" has been attributed to Lewit. Research proving that soft tissue is the source of a particular pain is difficult. Sometimes the pain generator can be identified, but the question remains, what is pulling on the pain generator?

Clinical confirmation that a particular soft-tissue restriction is significant to the patient's complaint is not so difficult. My usual protocol for difficult conditions is fairly straightforward. Find a functional test, a limited ROM, a difficult motion, that relates to the main complaint. In addition or as a substitute, find one or more tender points that are in the area of pain. Next, do your search pattern, whatever that is. You can use palpation, AK- style muscle testing, Barral's "listening," logic; whatever.

Find an area of soft tissue, either nearby or distant, that you suspect relates to the symptomatic area. You could do the "treatment test" in one of three ways:

briefly treat the soft tissue;
completely treat the soft tissue; or
hold the soft tissue in the direction you think will help.

Treatment could be Graston Technique, myofascial release, or just finding the barrier and holding the lesioned area toward the barrier or away from the barrier (indirect).
Having initiated the "treatment test," now go back to the original functional test or tender points and recheck them. Are they somewhat improved? If so, this area is significant to the patient's complaint. If not, find other areas you suspect may be involved.

The goal of this protocol is to individualize treatment to the patient, to their particular set of fascial patterns. There is good research suggesting that identifying a treatment that works during the clinical session helps make any therapy more effective.1-2

Soft-Tissue Techniques
Let's briefly review several soft-tissue techniques with which I am familiar. Keep in mind that this list is not complete; there are many brilliant therapists who have either invented or evolved different systems.

I divide soft tissue into low-force and higher-force methods. Although I tend to prefer to do most of my joint manipulation with low-force methods, I like and appreciate both low-force and higher-force soft-tissue methods. I suspect that they do different things.

Craniosacral therapy: Lower-force soft-tissue methods probably start with craniosacral therapy and variations on it. Cranial has many variations; it can be a therapy that focuses on the bones of the skull or it can be a therapy that feels for a particular rhythm, and disturbances of that rhythm. The rhythm is seen as the motion of the fluids, a cranial respiratory motion, and expansion and external rotation of the whole of the body, followed by a contraction and internal rotation of the whole body. This is thought to start in the cerebrospinal fluids and spread throughout the body.

Myofascial release: Another popular low-force fascial method is myofascial release. Popularized by John Barnes, PT, it uses a gentle, long three-dimensional release. You could it call it fascial stretching, but it is much more sophisticated than that.

Strain-counterstrain: Another low-force method is strain-counterstrain. This was developed by Lawrence Jones, DO, around 1955. The points are named after joints, but most of the points are in muscles, tendons, ligaments or fascia. It seems to be particularly effective on spots that are extremely tender to the touch. You fold and hold, or slack the tissue, until you find a position at which the point is much less tender. Then hold the positioning for 90 seconds while monitoring the point. When you are done, the tender point is usually gone. It is postulated that the original strain left the muscles spindles or GTOs in an aberrant set point, and that slacking the tissue helps reset them.

Visceral manipulation is another of my favorites, although not as well-known. Visceral was developed by a French osteopath, Jean Pierre Barral. He postulates that the fascia surrounding the visceral organs can become restricted, and developed sophisticated anatomically based techniques to release these restrictions. I find that I use this technique mostly for musculoskeletal pain, and that often, these visceral restrictions can be key soft-tissue lesions keeping the musculoskeletal system from healing. A related method is scar tissue therapy. Here, one would use slow three-dimensional myofascial release on old scar tissue. Again, the theory is that active scar tissue can have profound distant effects.3

Fascial release techniques can be divided into direct and indirect techniques. Direct techniques involve finding the barrier and doing your manual release toward the barrier, feeling the barrier recede and melt. Indirect techniques take the tissue in the direction of ease, away from the barrier. Counterstrain is always done indirect. The others mentioned above are usually done as indirect, but can also be done as direct methods. I've noticed that chiropractors tend to prefer direct techniques. This may be secondary to our training in high-velocity manipulation.
During the early years of my career, I focused on both low-force manipulation and low-force soft tissue. This changed when I was introduced to Graston Technique. Once it began to grow in the chiropractic profession, GT really changed the playing field. The concept of using instruments to perform soft tissue spread rapidly, throughout both the chiropractic and the manual therapy field. Gua sha, the Chinese medicine version of instrument-assisted soft-tissue manipulation, became more popular. The verb form, to Graston, although it has not yet made it to the dictionary, began being used by soft-tissue therapists.

I have continued to use Graston Technique, and the more generic instrument-assisted soft-tissue manipulation (IASTM), and have added other more direct, somewhat more physical methods of soft tissue. More direct, more physical methods would include FAKTR, active release technique (ART), Stecco's fascial manipulation, Rolfing and other deep-tissue methods. Any article on soft tissue should mention both Janet Travell, who popularized trigger-point therapy, and Raymond Nimmo, DC, a chiropractic pioneer who developed receptor-tonus technique.
There is good evidence that pressure changes tissues, both on the gross level and on a subcellular level. Breaking up fascial adhesions can be done with both low-force and higher-force techniques. Once you start to use deeper, higher pressures, you add an additional component. You can restart first-stage healing, re-initiating the acute self-limiting inflammation that is an important part of the healing that occurs after an injury. Pro-inflammatory techniques require further explanation to the patient, as the patient can be very sore for a day or two after treatment. These methods can be dramatic in starting the healing process for chronic soft-tissue injuries.

Active release technique (ART), developed by Michael Leahy, DC, is a popular technique within chiropractic, especially within chiropractic sports medicine. ART could be called pin and stretch, as the doctor holds the point or area, as the patient moves the limb or body. ART was one of the first soft-tissue methods I know of that incorporated active motion on the part of the patient during soft-tissue treatment.

FAKTR: Functional And Kinetic Treatment with Rehabilitation, including provocation and motion, is another deep-tissue method, developed by Tom Hyde, DC, and Greg Doerr, DC.4 It was originally presented as an advanced methodology for using Graston Technique.
What I love about FAKTR is how it blurs the lines between passive soft-tissue therapy and active care. The patient is not just having something done to them. FAKTR treatment is unique, as it is done during functional ranges and functional activities. An example would be treating the soft tissue of the shoulder and scapula during a baseball pitcher's pitching motion.
The diagnostic aspect of FAKTR involves using the kinetic chain, following the movement pattern throughout the body. Try to imagine how pulls on the fascia transfer aberrant motion patterns throughout the body. The goal, of course, is to truly resolve the injury, not just treat the pain or loss of motion.
The algorithm of FAKTR follows the outline I mentioned above. Of course, you would start with history and then do a functional screening. Treatment is diagnostic; go back and retest and retreat, and see what changes after the initial treatment. This five-step outline illustrates how FAKTR is really unique:
Take them into position of provocation; not just pain, but also imbalance, instability and/or restrictions (loss of ROM).
Find the motions of provocation (dynamic).
Add in resistance, isometric and/or concentric and/or eccentric. As you treat, you'll feel the texture of the tissues change.
Do your actual soft-tissue treatment while the patient is doing the functional motion, such as working on the various soft tissues as the pitcher goes through their pitching motion.
You can add in further proprioceptive and perturbation inputs, such as having the patient stand on unstable surfaces during treatment.
I really like this concept. It is all about creating increases in afferent input, magnifying the proprioceptive bombardment. I will admit that I tend to simplify it and do it on my treatment table most of the time. For example, when I am releasing the piriformis area, the patient is side-lying, and I will have them abduct their leg against my resistance, and then let the leg back down toward the table while I am doing my IASTM. It tends to feel more painful to the patient, but tends to release more completely.

These concepts can be applied to any age group and with almost any soft-tissue technique. You can even use the FAKTR concepts with passive modalities, such as laser or estim, making them more active and adding the increased proprioceptive input.
There is so much growth happening in the field of soft tissue, both within and outside of our own profession. I encourage you to help more patients and expand your toolbox by using more soft-tissue techniques.

By Marc Heller, DC

References
Tuttle N. Do changes within a manual therapy treatment session predict between-session changes for patients with cervical spine pain? Aust J Physiother, 2005;51(1):43-8.
Liebenson C. "The Role of Reassessment: The Clinical Audit Process." Dynamic Chiropractic, July 1, 2010.
Lewit K, Olsanska S. Clinical importance of active scars: abnormal scars as a cause of myofascial pain. Journal of Manipulative and Physiological Therapeutics, July-Aug 2004;27(6).
Thanks to Drs. Greg Doerr and Tom Hyde for the classes and conversations that informed this part of the article.

Graston techechnique

Soft-Tissue Injuries: Better, Faster Healing

Beyond “hands only”The early Chinese may have been the first to promote health through using “instruments” on the soft tissues of the body. Those first devices were made of buffalo horn and jade.

Interest in instruments to extend the “reach” of chiropractors, massage therapists, and others got a boost in the ’80s when David Graston suffered a debilitating sports injury. Graston’s disappointment with the rehabilitation methods of the day caused him to create several stainless steel instruments with various shapes and angled surfaces. These instruments were designed to augment hands-only approaches to healing.

Chiropractors and massage therapists have always worked their fingers into injured soft tissue to increase blood flow and break up restrictions. But fingers alone cannot detect restrictions at deeper levels, nor can they match the ability of the right instruments to treat the full range of restrictions.

Today, several companies produce hand-held devices used to perform what’s known as instrument-assisted soft-tissue mobilization (IASTM).


What do the instruments look like?

Most instruments are stainless steel. Others are made of aluminum or polymer.


Which parts of the body can develop soft-tissue injuries?

Soft-tissue injuries, such as strains and sprains, often affect the extremities—the legs or arms. Because “soft tissue” refers to anything that isn’t bone, neck and back injuries fall into this category, as well.

How do soft tissues become injured?

Athletes who suffer a traumatic injury will often need soft-tissue-specific rehabilitation to get back full range of pain-free motion. Many soft-tissue injuries, however, are the result of repetitive motion.

People who may suffer from such injuries include:

Assembly-line workers

Golfers and other athletes

People who spend long hours at a computer without regular stretch breaks

Mothers who hold their babies only on one hip

Students who overfill backpacks or who hang heavy backpacks over one shoulder

Sedentary people who allow their muscles to atrophy


Where do soft-tissue injuries originate?

A soft-tissue injury can occur anywhere that ligaments, tendons, muscles, or myofascia are found. Ligaments connect two or more bones and help stabilize the joints. Tendons attach muscles to bones. Ligaments, tendons, and muscles provide a natural brace to protect the bony skeleton from injury. A ligament can be injured, for example, by making a movement that would take a joint outside of its normal range.

What is a “healing cascade”?

When the body is injured, it works to repair itself through a three-phase “healing cascade” process of inflammation, proliferation, and maturation.
In the inflammatory (“acute”) phase, the body releases chemicals that start the healing process. This process continues through the proliferative phase, during which the body migrates materials it needs to create scar tissue at the site of injury.
During the maturation phase of healing, scar tissue forms in the soft-tissue injury site. In this phase, the injury becomes chronic. Scar tissue helps the body form a “patch” at the site of an open wound or internal injury. Scar tissue, however, is much less flexible than normal tissue. It restricts movement, leading to pain when, for example, an athlete with a sprained ankle tries to return to running.

Why is a second healing cascade important?

Most patients with soft-tissue injuries come to a doctor of chiropractic after injuries have become chronic (weeks, months, or even years post-injury). By that point, the body has completed most if not all of the healing tasks of the original healing cascade. A second healing cascade is needed to restart the healing process, bringing to the site, among other things, oxygen and nutrients.

How is a second healing cascade created?

Although healthy soft tissue is longitudinal (laid out all in the same direction) and flexible, the body lays out scar tissue in a haphazard fashion. Scar tissue is fairly rigid. Pain results when movement stresses scar tissue. The doctor of chiropractic presses his instruments into damaged tissue to help release restrictions created by scar tissue and get a chemical healing cascade started. The goal is the normalization of the tissue. “Normalization” probably does not mean that the instruments force the underlying tissue to re-form longitudinally. It refers instead to the release of restrictions. Treatment, which includes stretching out muscles, helps patients build flexibility and strength in the area.

What is a treatment like?

When doctors of chiropractic trained in IASTM use the instruments, they first spread a light gel film over the patient’s skin. Then, they press into and move the instrument around the site to locate restrictions. Treatment breaks down scar tissue and encourages the body to remodel the underlying tissue. During treatment, smaller capillaries in the area are broken. Bruising is a normal response, signifying that a healing cascade is underway.

How does treatment feel?

IASTM can cause minor discomfort. You may wish to arrange a signal that will tell your chiropractor that the degree of pressure has become too uncomfortable. Treatments are typically short—often just three to five minutes.
The level of discomfort typically is reduced with repeated treatments. Chronic soft-tissue injuries are not healed overnight, but your willingness to perform home stretches and exercises as prescribed by your chiropractor will hasten the process.

What side effects can I expect?

Redness of the skin, followed by bruising, is common. These side effects show that your practitioner has been working to get at troublesome areas and help start the healing process. You may also be asked to apply ice as part of your at-home treatment.
Doctors of chiropractic are trained to effectively address your musculoskeletal complaints. If you have further questions about soft-tissue injuries, your doctor can help.

Sources from "www.acatoday.org"

Herniated Disc and Sciatica Facts

Introduction

Herniated discs are probably the most common diagnosis for severe back pain and sciatica (leg pain). Discs are large cushions that lie between the individual vertebrae of our spinal columns.

The disc is composed of layers of ligaments (annulus fibrosis) arranged in a criss-crossing matrix that hold in a gel-like substance (nucleus pulposus), giving the disc its "shock-absorbing" ability. Sometimes the gel swells (which is called a disc protrusion or bulge).




A more problematic situation occurs if the gel pushes through its ligamentous wall (which is a disc prolapse or extrusion). Both situations can led to pressure or irritation of the vulnerable spinal nerve roots. This can lead to sciatica - an abnormal sensation felt anywhere from the buttocks to the feet.

For more that 70 years, orthopedists have believed that most lower back pain and sciatica were caused by herniated discs. The "dynasty of the disc" led to the typical medical advice of bed rest and medication. Gordon Waddell, a renowned British orthopedic surgeon, wrote in the journal Spine, "There is remarkably little scientific or clinical evidence to support the value of bed rest for low back pain or even sciatica." Bed rest is now known to cause prolonged pain, muscle weakness, joint stiffness, and depression.

If bed rest failed, surgery was the usual next step. Unfortunately, due to poor patient selection, many unnecessary surgeries were performed. Waddell said, "surgical successes unfortunately only apply to approximately one percent of patients with low back pain." According to Alf Nachemson, M.D., editor of the journal Spine, bulging discs are found and taken as an excuse to do a lot of surgery and percutaneous discectomy. Discs are made to bulge; that is a normal finding."

Edward Carragee, M.D. the Dean of Neurosurgery at Stanford University reported that disc bulges are present even in 20 year olds, BUT by age 30 there are more episodes of back pain in individuals whose spines had no abnormalities when they were 20 than in those with the bulges! He has also written in the journal Spine that the long-term results of surgery vs. conservative care for pinched nerves is no different.

Back and even leg pain can arise from the muscles, joints, or ligamentous structures of the spine. Whatever the cause, evidence is growing showing that rehabilitation not surgery is the treatment of choice for most lower back disorders.

When should I see a doctor?

Anytime a person has pain radiating down their leg they should see a doctor to find out the reason why. This is not something urgent unless there is buckling of one or both legs, incapacitating pain, progressive pain or numbness, loss of bowel or bladder control, or numbness around the genitalia or anus.

Pain Control/First-Aid

Goal: reduce pain, swelling and inflammation

• physical therapy (e.g. ice, electrical muscle stimulation)

• manual therapy (e.g. massage, traction) and manipulation

• anti-inflammatory/pain medication if necessary

What can I do for myself?

An important study from a leading orthopedic center in San Francisco demonstrated that more than 90 percent of patients with disc herniations responded to non-surgical treatment. Most of these patients had already been referred by neurologists for immediate surgery. Their treatment included simple pain control methods in combination with rehabilitation. According to Nachemson, "All the structures in the back fare better with early, controlled motion....if something is injured and you start to slowly move it under controlled conditions, then the structure heals quicker and better."

It is important to spare your spine if you have a pinched nerve. Slumping or bending forward from the waist are key sources of irritation of the disc. Prolonged sitting is another problem. Try not to sit for more than 20 minutes at a time without getting up and limbering your back. Because the disc is mostly water it swells at night when you are recumbent. Thus, the morning time is a critical time to keep your spine from bending forward while you brush your teeth, dry your feet and change.

Besides taking over-the-counter pain relievers of anti-inflammatories iceing your back at home is a key treatment. This can be performed for 20 minute intervals a few times a day.

Ways to increase your activity.

Walking is a safe exercise for pinched nerves due to herniated discs. If bending forward increases your leg symptoms, but bending backwards ONLY hurts in your back you may want to perform press-up and standing back extension exercises a few times a day. 10-12 slow repetitions are generally recommended. It is best to see a qualified health care provider to determine what exercise is best for you.


Rehabilitation

Goal: stabilize back through better flexibility, strength, and endurance

• education about lifting, sitting, etc.

• exercises to increase back and cardiovascular fitness

• encouragement to achieve and maintain a healthy back

Sources from : Clinicalrehabspecialists.com

Low Back Pain During and After Pregnancy Facts

Introduction
Low back pain (LBP) is a common problem during pregnancy and even more so afterwards. The pain can vary from a mild discomfort to severe and disabling. Serious causes of back pain are rare and easy for your doctor or chiropractor to diagnose. Most back pain is mechanical in nature and greatly subsides in just a few weeks.

When should I see a doctor?
LBP often gets better on there own as nature takes its course. Many women do just fine by staying active, coping the best they can, and modifying daily activities as to not re-agitate the tender tissues.

You should see a doctor when the pain is too much for you to cope with or there are specific activities important to you that you are having difficult undertaking. Back pain can occasionally be associated with pain extending down into the leg. This condition sometimes known as “sciatica” and you should see a doctor to diagnose it.

Health care providers are useful for making sure you don’t have serious disease and offering reassurance. Also they can help suggest possible ways to control your pain and advise you of ways to deal with the pain and get on with your life. It is normal to worry about the cause of your low back pain and the impact it may have on your life or the pregnancy. Talking with your healthcare provider about these worries and concerns can be helpful. You will usually find there is no serious cause of the pain and that there are ways to relieve the symptoms and get you back to your normal activities. Often the rehabilitation specialist will work hand in hand with your physician when appropriate.

Make sure you work with your healthcare provider to find ways to better manage and control the low back pain.

What can I do for myself?

There are several preventive measures one can take to help reduce the likelihood of developing low back pain or as self-care for back pain.

• Staying active: By staying active often times you can reduce minor episodes of low back pain from becoming more serious. The old notion of staying in bed until the pain is gone is no longer the best advice. The sooner you get moving again, the quicker you’ll progress through the pain episode and move on with your life.

• Lifting: If you have to pick up something try to bend at the knees, keeping your low back curved forward, not slumped. This is called the “hip hinge” and forces you to use your buttock and thigh muscles to take pressure off your back.

Incorrect lifting position with slouch Correct lifting position with hip hinge



• Sleeping: Try supporting under your knees with a pillow when sleeping on your back or between the knees when lying on your side.

• Specific stabilizing exercises: Often a rehabilitation specialist can prescribe specific exercises for back pain to help strengthen and stabilize muscles. As no two patients are alike, your rehabilitation specialist can help find what exercises are appropriate for you.



Ways to increase your activity.
Sometimes it may seem quite daunting to deal with activities which increase your LBP. Often times its frustrating because the activities you were first able to perform without pain are now giving you discomfort. Find out how long you can perform a specific activity without “flaring-up” your condition or making you worse off than when you started. Reduce the amount or time of activity by 20% so you’re able to perform the activity, but it does not take you to the “flare up” point.

Having a little discomfort is normal, though the duration of the activity should not make you worse off than before. Gradually increase the activity little by little, as not to reach the “flare-up” state. Slowly you will notice you’re able to do the activity longer without “flaring-up” the condition. Don’t be too upset if you have a “flare-up,” just reassess your activity level and continue on. Monitor the sciatic leg pain and tell your health care provider if it is either not improving or getting worse. It’s normal to have good days and bad days. Don’t be afraid to ask others for assistance. Your body has changed and it’s natural for symptoms to occur, but they should pass with time.


Here are some other examples of ways to modify your activity:

Staying active and doing your normal activities is one of the most important things you can do for yourself. You may have to modify the way you perform certain activities to keep from aggravating your back. Examples may be how you bend over to pick something up, getting off a chair or toilet, putting on your shoes or pants, sitting too long at work. Your rehabilitation specialist can help you with modifying activities which are giving you difficulty. Massage, manipulation and other modalities may help relieve the pain, but they are best used to getting you re-activated and moving on with your life. Sometimes ice or heat packs may give some relief. Some women find relief with braces or belts that support the increasing abdominal weight. Medication (even over-the-counter) is to be used only with approval by your physician. Ask your rehabilitation specialist about specific problems you may be experiencing.


Rehabilitation
When self-care and activity modification does not give you sufficient relief, see a rehabilitation specialist for help. These doctors and therapists are specially trained to bridge the gap between what you are capable of doing and what you want to do. This may consist of specific exercises prescription that helps improve areas where you are having some difficulty. Make sure and voice your thoughts, fears and concerns to your healthcare provider. Often specific procedures following the pregnancy such as “Caesarian births” or the use of an epidural may dictate a specific kind of exercise or therapy. Pain and “flare-ups” may happen from time to time. This is normal and you will learn “first-aid” approaches for this. However, the more important goal is to re-condition your abdominal and back muscles so you are more stable during your chosen activities.

By staying active, modifying activities, and getting information from your healthcare provider, one can greatly reduce the occurrence or duration of LBP episodes.

Sources from "clinicalrehabspecialists.com"

Low back pain

Low Back Pain Facts

Low back pain is a common ailment which most people (80-85%) suffer with it at some time in their lives. The causes of low back pain are poorly understood and can range from trauma, poor lifting and overuse/underuse of the muscles. 85% of the time the pain is mechanical coming from either the muscles, joints or ligaments. Fortunately, it is rare for the pain to be caused by a serious medical problem and such causes can be ruled out by a thorough history and examination from your healthcare provider.





When should I see a doctor?

Often low back pain episodes will get better on there own as nature takes its course. It’s important to stay as active as possible as the old adage of bed rest and trying to completely avoid pain is not the best advice. Most people do just fine by staying active, coping the best they can, and modifying daily activities as to not re-agitate the tender tissues.

You should see a doctor when the pain is too much for you to cope with or there are specific activities important to you that you are having difficult undertaking. Understand that low back pain is a very common problem and the chances that it is caused by serious disease are very rare. Health practitioners can help suggest possible ways to control your pain and advise you of ways to deal with the pain and get on with your life. It is normal to worry about the cause of your low back pain and the impact it may have on your life. Talking with your healthcare provider about these worries and concerns can be helpful. You will usually find there is no serious cause of the pain and that there are ways to relieve the symptoms and get you back to your normal activities.

Make sure you work with your healthcare provider to find ways to better manage and control the low back pain.

What can I do for myself?

Keep in mind that staying active with your normal activities is the best thing you can do to limit the effects of low back pain on your life. You may have to modify the way you perform certain activities to keep from aggravating the tender tissues. Examples may be how you bend over to pick something up, getting off a chair or toilet, putting on your shoes or pants, sitting too long at work. Pain medication, hot/cold packs, massage, manipulation and other modalities may offer pain relief, but they are best used to getting you re-activated and moving on with your life. Keep in mind that the pain is your own and the manner in how you deal with it and return to normal activities is the greatest thing you can do for yourself. Try to stay working as only in cases of particularly severe pain do you need to be off work. You may need to find restricted duties or reduced hours, but staying active is important. Staying active helps prevent long-term problems. If it has been several weeks since you have been back to work, you really should be planning with your doctor or therapist and employer how and when you can return. Here are some ideas to keep your low back pain from becoming a more long-term problem:

•Keep moving.

•Do not stay in a position for too long.


•Move before you stiffen up.


•Move a little more each day.

•Don’t stop doing things-just change the way you go about doing them.


Ways to increase your activity.


First ask what is it that I want to do? Is it walking further, going up stairs, shopping, etc.? Find out how long you can perform this activity without “flaring-up” your condition or making you worse off than when you started. This is individual to you. Reduce the amount or time of activity by 20% so you’re able to perform the activity, but it does not take you to the “flare up” point. Having a little discomfort is alright, though the duration of the activity should not make you worse off than before. Gradually increase the activity little by little, as not to reach the “flare-up” state. Slowly you will notice you’re able to do the activity longer without “flaring-up” the condition. Don’t be too upset if you have a “flare-up,” just reassess your activity level and continue on. It’s normal to have good days and bad days. It takes some patience, but it works.


Ways to Modify Your Activities

Sitting

Find a chair that is comfortable to you and supports the small of your back, you may have to experiment with several. Get up and stretch often.


Rising from a chair
Avoid slumping as in the left hand picture. Instead stick your chest out as in the right hand picture to protect your back. Getting up and down like this utilizes what is called “the hip hinge” to spare your spine. This can be incorporated in other lifting and bending activities as well.



Desk work
Make sure the height of the chair fits the desk. Arrange the keyboard monitor and phone so you do not feel strained. Get up and stretch often.

Driving
Adjust your seat from time to time. Try some support in the small of the back. Take regular stops and get out of the car for a quick break. Walk around and stretch.

Lifting
Think before you lift on the best way to move the load. Don’t lift more than you need to. Keep the load close to your body. Lightly tighten your stomach muscles to brace your back. Turn with your feet when carrying the load, don’t twist the back. Finally, be sure to “hip hinge” to maintain an upright spine as the picture above shows.

Carrying and shopping
Ask yourself if you need to carry at all. Keep the load close to your body. Split the weight of the load between two hands. Push carts with both hands.

Daily activities/hobbies
Don’t do any one thing for too long. Keep changing activities.

Sports
Continuing to play your normal sports is fine, but you may need to modify your game or decrease your intensity.

Sleeping
Some people find relief sleeping of a firmer mattress; possibly try a sheet of chipboard under the mattress. Painkillers an hour before you go to bed may help.

Sex
Sex is fine, but you may need to try different positions.

If your pain is not settling down or getting worse, you may need further assessment from your health care provider. Make sure you ask questions or voice your concerns about your pain to your healthcare provider.


Rehabilitation

If there are specific activities which you are having difficulty with, a rehabilitation specialist can help. Once serious causes are ruled out and the pain is under control, the rehab specialist examines where the dysfunction lies. First identify specific goals or limitations you wish to overcome that are agreed upon by both the practitioner and you. The rehab specialist will perform a functional evaluation to determine what you are able to do and what areas may be causing some trouble. Bridging the gap between what you are able to do and what you want to do is the essence of rehabilitation. This may consist of specific exercises prescription that helps improve areas where you are having some difficulty. Make sure and voice your thoughts and concerns with your healthcare provider. Pain and “flare-ups” may happen from time to time. This is normal and should not be the focus in care. Rather, try to focus on the exercises that are bridging the gap to your goals and what activities you want to do.

It is important that you maintain contact with your healthcare provider. If the pain is not settling down or is getting worse, you may need further assessment. Follow up visits provide you the opportunity to obtain more information and address any fears or concerns you may have with your low back pain.

www.clinicalrehabspecialists.com

Headache

Headache Facts

Introduction

Headache pain is a common problem which many individuals seek relief through health care assistance. While the pain is common, headache treatment and management can be an ongoing source of frustration for many individuals. There are many types of headaches with differing causes, presentations, durations and intensities. These may range from the common migraine, classic migraine, tension, cluster, temporal aritis, and sinus headache. While a headache’s presentation and symptoms may be similar or different from one patient to another, effective treatment strategies usually take an individualized approach to identify the cause for appropriate management.

The most common forms of headaches are tension and migraine headaches. Tension headaches are a non-specific headache which usually stem from overactive muscle tension in the head, shoulder and facial areas. Dull, achy, non-pulsating pain is often felt in the temples, TMJ, forehead and base of the skull. There is usually a correlation to daily stress and these headaches do not commonly associate with bouts of nausea, eye pain, facial numbness.

More than 28 million Americans suffer from migraine headaches which are generally more severe than tension headaches. Women are three times more likely to suffer migraine headaches than men. These headaches may be influenced by external factors such as alteration of sleep-wake cycle; missing or delaying a meal; medications that cause a swelling of the blood vessels; daily or near-daily use of medications designed for relieving headache attacks; bright lights, sunlight, and fluorescent lights; TV and movie viewing; certain foods; and excessive noise. Migraines often occur with nausea, visual pain or disturbances, facial and hand numbness, and sensitivity to light and sound. Migraine headaches usually last in bouts, lasting from a few hours to several days. Classic migraines differ from common migraines due to the aura (flashing lights, blind spots, or jagged lines in vision, smelling strange odors and difficulty speaking) that will precede the manifestation of the migraine by 10 to 30 minutes.

When should I see a doctor?

Understand that while headaches are quite common, they can greatly impact the quality of your life and limit your daily activities. Seek care from your healthcare provider when you are unable to manage or cope with your headache. Your healthcare provider will take a history to try and identify the cause of your headache and rule out sinister causes. Once “red flags” have been eliminated, treatment solutions are offered to control the pain and reduce future reoccurrence so you can get back to your daily activities. While serious pathology is a rare cause for most headaches, it is normal to worry about the cause of your headache pain. Often fears of more serious disease may be of worry to you. Talking with your healthcare provider about these worries and concerns can be helpful. You will usually find there is no serious cause of the headache pain and that there are ways to relieve the symptoms and get you back to your normal activities.

What can I do for myself?

Since headache occurrence can be frequent, often there are ways to cope with an episode and limit its effects. Some individuals keep a headache diary to track headache triggers such as specific types of food or stressful situations that can be avoided in the future. In the event of a headache, avoiding certain types of light, finding a quite place to rest, reducing light exposure with sunglasses or sitting in a dark room may help ease the pain. Some people find sipping strong coffee helps with the headache pain. Others find alternating a hot compress for several minutes on the forehead followed by a cold compress helps reduce the pain and repeating this cycle several times. Try different coping strategies and see what works best for you. Some over-the-counter medications may help you control the pain. Prescription medications may also benefit some individuals. Speak with your healthcare provider about such remedies to determine if they are appropriate for you.

Rehabilitation

If your healthcare provider determines that your headache is from a musculoskeletal origin a rehabilitation program may be ordered. This may consist of short term trial of spinal mobilization/manipulation, soft-tissue treatment, neck stability exercise training and/or sensory motor training all used to reduce headache intensity and prevent reoccurrence. Workplace and lifestyle advice is often incorporated to improve management skills. The Brugger relief position is excellent stress “micro-break” which relaxes over-tense muscles.

Neck retraction is another exercise that helps to increase neck stability and stretch overactive muscles at the base of the skull.

Keep in mind that while headaches can be unpleasant and greatly affect the quality of our lives, there are emerging treatment strategies that can empower the patient to effectively control a headache’s intensity and frequency. Speak with your healthcare provider about any fears and concerns regarding your headache pain and discuss a management plan that works for you.

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