By Jessica Williams

The healthcare system in our country has been broken for a long time – from managed care to government regulations, from ever-increasing health insurance premium, to high deductibles. Most small private physician practices were unable to keep up with burdening government regulations, low reimbursement from insurance company and high office overhead. As a result, they have been “bought out” by mega-health care systems.

It often takes weeks to get an appointment with your primary care provider (PCP) and months to see a specialist. The family doctors who know your whole family, as in the good old days, are hard to find these days. Waiting in your doctor’s office for 30 minutes to one hour beyond your appointment time is no longer a surprise. Your doctor is only allowed to have 15 to 20 minutes to see you, including the time to complete entering information into his or her computer for electric medical record. Now, you need some good news, yes, the good news is that there now are many Urgent Care centers in our local communities.

Now, you are sick. What should you do to seek medical care? What is your best option for all considered, including your pocket book? In general, that will depend on your medical condition. If it’s just an acute common condition such as cold, mild sinus infection, mild strain or sprain or a small cut that requires suturing, your local Urgent Care facility would be your best bet. You don’t need an emergency room (ER) in a hospital where you might have to wait for hours. ERs are for acute serious medical conditions such as chest pain, shortness of breath or trauma. On another hand, if you have been sick or not feeling well for a while, trying to treat yourself with over-the-counter medication to save on cost (this isn’t recommended), but not feeling better, you need to make an appointment with your PCP and put your name on their waiting list, hoping for a cancelation. However, if your condition gets significantly worse while waiting for your appointment, you need to call and let your PCP know what is going on with you. Hopefully, your PCP might try to get you in on an emergency basis. Alternatively, you may receive a referral for a specialist or emergency room depending on how urgent your condition. A call from your PCP to a specialist physician could make a big difference on how quickly you will be seen.

In another scenario, you have been sick for months or years, you have been seen by your PCP and multiple specialists, you have done all the relevant diagnostic tests, but all the tests come back normal. You are told that there is nothing wrong with you! However, you still feel miserable. That is the time to consider alternative options. Chinese Herbal Medicine is one of the options.

In today’s world, we have a lot of modern diagnostic technologies. It is hard to imagine these marvelous technologies even twenty to thirty years ago. Even so, this doesn’t mean we can detect every possible problem. For physicians and the healthcare industry as whole, our goal is to eliminate or reduce suffering. If our patients tells us they feel sick and miserable, we need to help them even without any abnormal findings from laboratory studies or diagnostic imaging. This help should aim to address the causes of their suffering, not merely temporarily mask what they are suffering. There are options if we as physicians keep an open mind. Chinese Herbal medicine is one of them.

Chinese Herbal Medicine takes a holistic approach to medicine with focus on rebalancing and supporting the body to improve and heal itself. Chinese medicine has been developed and practiced for thousands of years by ancient Chinese practitioners. It is a personalized medicine with diagnosis and treatment based on each patient’s response to what’s causing the problem. It uses natural material as its pharmacy. It has been practiced from generation to generation in China, Taiwan, Japan, Korea, Singapore and other Asian countries. Over recent decades, it has become a vibrant part of the healthcare system throughout the world.

So, whatever health problems you have, making the right decision to choose the right healthcare facility is an important step. This will enable you to get better effectively while considering cost, time and energy. The goal is to recover quickly from whatever you are suffering and survive the current dysfunctional healthcare environment.

By Shawn VanderBrook, PT, DPT, OCS

I am going to start this off with a simple, yet profound statement about the knee joint and how it works. Ready? The knee is the victim of the foot and hip.

These wise words from a patient’s professor sum up my philosophy of how best to address knee pain and dysfunction in the physical therapy world. It may sound a little strange to some of you, but I really want you to take this to heart, because this knowledge can help you manage your knee pain at any age and help anyone manage a multitude of knee injuries.

Let’s start with the structure of the knee. The knee is a “hinge” joint with a locking mechanism called the “screw home” that improves knee stability when standing fully straight. Due to this structure, the knee is not designed to be the primary control of the leg’s rotational motion. The knee’s main function is to bend backward and forward.

So what joints are the primary controls for rotational motion of the leg? Go back to our thesis statement: The hip and foot/ankle joints are the primary controls for rotational motion of the knees.

This is such an important concept to get across because it can completely change the way you have been addressing your knee pain. Injections, medications, and surgeries are all simply used to manage pain and only last a temporary amount of time. If no focus is paid to the hip and foot/ankle joint complexes, then everyone who is treating you is not providing long-term solutions.

The first and foremost way to address pain is to improve hip stabilizer strength. This means that you should be performing exercises to improve your body’s ability to keep the knee in proper alignment and prevent abnormal wear and tear in one side of the knee joint or the other. This can be achieved with simple exercises prescribed by a physical therapist, based on which muscles are the weakest at the hip.

The second way to address knee pain and abnormal alignment is to address foot/ankle position with multiple types of interventions if needed. One simple intervention is attaining proper footwear and orthotics (custom or over the counter) to ensure your foot has adequate support. Other interventions could include ankle stabilizer strengthening exercises and stability exercises to improve control of your foot position and decrease abnormal stresses acting on the knee. These exercises can again be prescribed following a thorough examination from a physical therapist.

Knee pain is far more complex than most health care professionals may admit. The knee joint is part of a team comprised of the joints above and below it. If the knee’s “teammates” are not doing their jobs, then the knee joint becomes the unhappy “victim.” The hip and foot/ankle joints must always be assessed and addressed with any knee complaint, otherwise individuals with knee pain can only lean on short-term fixes, such as injections or medications, instead of engaging with long-term solutions that fix the root of knee pain.

Don’t continue to struggle with knee pain; Take action today and meet with a physical therapist and engage in long-term solutions that can last a lifetime! 

By Laura L. Jacobs, DPT

Have you ever had a nagging ache, pain, or tightness that hangs around too long and keeps you from enjoying life? Physical therapists use many different techniques and tools to help people return to normal pain-free function: Land or aquatic exercises, manual techniques, and modalities such as ultrasound, laser, and electrical stimulation can all be part of a treatment plan. While many approaches are familiar to most people, not too many have heard of the Graston Technique.

Graston is a type of instrument-assisted soft tissue mobilization that improves range of motion while reducing pain, leading to a return to normal function. The Graston Technique utilizes stainless steel instruments to address fascial restrictions and soft tissue lesions, also known as stubborn injuries, and can help break down and realign scar tissue. It has been shown to increase blood flow and trigger your body’s natural healing response. When normal, healthy tissue is damaged, the body often heals it in a haphazard manner, leading to restricted movement and pain. These are the areas where the Graston Technique can be beneficial.

You may be wondering why tools that look like knives would be a good idea to treat pain or motion restrictions. Basically it means the therapist uses instruments to perform soft tissue work instead of their hands. This “technique has been proven through research and in the clinical setting to be very effective. I have been using the Graston Technique in my practice for about six years and have used it to successfully to treat a widespread of conditions, including plantar fasciitis, Achilles tendinitis, tennis elbow, and lower back pain.

The instruments help keep the therapist’s hands injury-free while setting patients on the path to healing. These instruments allow the therapist to detect things they normally wouldn’t be able to feel with just their hands, such as the vibration and texture changes in the underlying tissue. It’s a great technique because the patient can be involved. During treatment, patients are able to feel a grittiness in injured areas, and over multiple treatment sessions they are able to feel how it changes and smooths out. While undergoing treatment, patients are allowed and encouraged to keep performing normal activities as long as they are performed without pain.

There has been a lot of research performed on the Graston Technique that shows positive outcomes in the majority of all conditions treated when performed correctly and with good compliance from the patient. The technique sometimes gets a bad reputation for being painful and causing post-treatment bruising. Occasionally this occurs, but treatment can be adjusted to minimize this. If you have ever had a deep tissue or sports massage, you might have been a little sore or tender the next day. Graston is the same way.

Where on the body can you use the Graston Technique? I get asked that question often and my answer is “Pretty much anywhere!” The most common applications are for neck pain, shoulder pain, tennis elbow, carpal tunnel syndrome, lower back pain, hip pain, IT Band (iliotibial band), knee pain (such as runner’s knee or jumper’s knee), shin splints, ankle pain, and foot pain. It can also be used on old scars resulting from a knee replacement or a C-section. It doesn’t matter how old or new the injury is, treatment can be adjusted to aid in your rehabilitation.

One of the best features of this technique is that it can be used on all people of all ages and at all activity levels. Whether your goal is to run a marathon or play with your grandkids, there is a great chance this technique will get you back to living life the way you want to!

By Bob Gorinski, DPT

One of my favorite pastimes as a boy was turning over rocks in the various creeks and woodland streams near my home in southwestern Pennsylvania. I was in search of salamanders, crayfish, frogs and any other treasures that inhabited those areas.

I realized that I was quite limited in the size and number of rocks that I could move. Even 15 minutes of this labor of love began to feel like backbreaking work. I was sure that larger prizes lay under the larger rocks, if only my 10-year-old frame could move them.

It is counterintuitive that a person can move something without using their arms. But one day, I realized that if I could straddle a larger rock and get a solid grip, I could then actually stiffen my arms and torso but otherwise not really use them. The arms and torso were simply a conduit from my lower body to my hands. This way, my legs could do the heavy moving.

I was amazed. I quickly discovered that my rock turning limits had immediately quadrupled, and I did not tire nearly as easily. My creature-finding abilities soared (well, in my mind). I had unintentionally discovered the benefits of what adult physical therapy and strength coaches today call functional training.

For athletes and adults of all ages, functional training involves building strength in a manner that optimizes efficient, graceful movement among all body segments. Gaining muscle size may or may not be a sought outcome, but a combination of strength and flexibility is always a goal. Functional training makes use of open space and basic free weights such as barbells, dumbbells and kettlebells. This is opposed to training methods that involve the trainee usually seated on and supported by various weight training machines working one or two muscles at a time. In functional training, the body is usually exercised as an integrated unit and there is no machine-guided path to balance and stabilize the resistance.

As a side note, cardiovascular-type training such as treadmills, stationary bikes and ellipticals provide many health benefits, but these do not substantially change the coordination of body segments — literally how you move — when your body is called upon to pick up a bag of mulch or reach high overhead to catch a ball or pick an apple from a tree.

Functional training is not new. It was first used by old-time weightlifters and strong men who were part of circuses or simply strength hobbyists. Most people didn’t identify with that image, and the fitness industry responded by creating gyms and gym culture filled with many of the technology dependent training that rose to popularity in the 1970s through 1990s. In recent years, many if not most gyms have incorporated a functional training section that includes free weights, various semi-firm boxes and other basic (but effective) equipment.

Functional training provides great benefit without being taken to extreme levels often seen on TV, with world-class athletes pushing themselves to their limits. Even athletes are beginning to learn that tearing the body down to an extreme state leaves little room for recovery and growth.

What is relatively new in functional training, however, is the known benefit of individual evaluation and exercise prescription. While functional training has the ability to spark great improvement in our ability to move well outside of the gym, without the fixed guidance and safety nets that exercise machines have to offer, there are certainly more risks involved for those who jump into the wrong exercises for their body type and abilities, or use unrealistic progression (too much too soon). Some individuals benefit from four to six weeks of simple posture and flexibility work before they are able to safely perform squats or hold a weight overhead.

Qualified personal trainers will be able to assist you with a training program that is appropriate for you. See a physical therapist to address any areas of pain you have been dealing with before beginning a functional training program.

By Rachel Wilson

Do you often feel rushed, overwhelmed, or unfocused? Perhaps you have felt that there are not enough hours in your day or energy in your system to accomplish everything on your to do list. For many people, these feelings are all too familiar and may be signs and symptoms of chronic stress.

The daily effects of stress have a detrimental impact on our bodies and our minds, potentially leading to physical problems such as headaches, backaches, stomach and gastrointestinal distress, ulcers, high blood pressure, joint issues, and compromised immune system function. Stress can also cause psychological problems such as irritability, impatience, anger, sleep disturbances, fatigue, depression, and anxiety.

But what is happening internally when we experience stress? The answer lies in our autonomic nervous system. The autonomic nervous system has two major parts: the sympathetic nervous system and the parasympathetic nervous system.

The Sympathetic Nervous System (SNS) brings our bodies and brains into “fight or flight” mode. This part of the nervous system is responsible for the stress response. When activated, we release increased amounts of the cortisol hormone, norepinephrine, and adrenaline. Our learning, digestive, and reproductive systems are put on hold as our brains become hyper-focused on the perceived threat. This response is crucial for survival, but we were never meant to remain in this high state of alarm. The problem occurs when we respond to everyday situations, such as a frustrating traffic jam or an overflowing email inbox with the same intensity and system reaction that was designed to protect us from acute danger.

Fortunately, we have a counterbalance to the SNS known as the Parasympathetic Nervous System (PNS). This system is sometimes referred to as the “rest and digest” system. To move out of stress and toward optimum health, it is important that we regularly engage in activities that stimulate the PNS to keep the mind and body in a healthy, balanced state.

Stress-soothing activities include:

• Gentle yoga
• Breathing
• Mindfulness practices
• Body work (e.g., massage, reflexology, acupuncture)
• Gentle walking
• Listening to music
• Spending time in nature

All of these practices can offer us an opportunity to deeply repair and recover from the effects of chronic stress. We begin to break thought patterns that we must always do things or make things happen. We begin to practice acceptance and allowing instead of constantly pushing and striving.

Our bodies have a tremendous built-in capacity to heal and return to balance, if we tend to them properly and slow down enough to allow them to achieve a state of equilibrium.

David Spiegel, M.D., author of “Living Beyond Limits,” reports, “In medicine, we are learning that physical problems, such as high blood pressure and heart disease, can be influenced by psychological interventions, such as relaxation training. Indeed, the Food and Drug Administration issued a report recommending these non-drug approaches as the treatment of choice for milder forms of hypertension. Mind and body are connected and must work together, and this should be a powerful asset in treating medical illness.”

Judith Lasater, author of the restorative yoga guidebook “Relax and Renew,” states, “During deep relaxation, all the organ systems of the body are benefited, and a few of the measurable results of deep relaxation are the reduction of blood pressure, serum triglycerides, and blood sugar levels in the blood; the increase of the “good cholesterol” levels; as well as improvement in digestion, fertility, elimination, the reduction of muscle tension, insomnia, and generalized fatigue.”

Stress is inevitable, but relaxation is possible! Even an hour each week devoted to a calming and system-soothing practice will provide life-supporting benefits. Sign up for that yoga class, take a quiet stroll on your lunchbreak, or simply stop and take a few calming breaths. Your body and mind will thank you.

By Dr. Michael Bennese

Headaches are a common complaint at chiropractic clinics. Some causes are unknown but others are more readily categorized. Vascular headaches, such as migraine and cluster headaches, arise from causes related to blood vessels. Vascular headaches often include nausea and/or vomiting, and can be quite disabling and require rest in a dark, quiet place sometimes for a half or a whole day. Another type, tension headaches, usually result from tightness in the muscles in the neck and upper back. Tenison headaches can be caused by stress, work, lack of sleep, sinusitis, and trauma such as whiplash.

Chiropractic is a tremendous resource for headache patients. It is critical to obtain a thorough history, asking the patient how and when the headaches started. This may glean the actual cause of headaches, such as a car accident or injury.

After the history, we will ask about activities that increase or create the headache, which helps us understand how to best manage the headache patient. For example, when certain activities precipitate the onset of a headache, we will modify the work station or give specific, scheduled exercises to keep neck tension under control. We will also gather information about what decreases the neck pain and headaches, then recommend treatments that can often be done at home. For example, if a patient says that pulling on the neck feels great, we might recommend a home traction unit. The quality of pain (throbbing = vascular, ache and tightness = neck), intensity of pain (0-10 pain scale), and timing (worse in the morning vs. evening) help us track change after treatment is rendered, usually gathered once a month.

The physical examination includes checking a patient’s blood pressure, which can create headaches when high; viewing the blood vessels in the back of the eye to ensure there is no evidence of increased pressure against the brain; and checking the ears for infection or wax blockage, which can cause dizziness and/or balance loss. We will sometimes listen to the throat as well as the heart to see if there may be a blockage, a valve problem, or other issues.

We will evaluate neck muscle tightness (spasm) and range of motion, paying particular attention to the positions/directions that increase and decrease pain. We will assess nerve function by checking reflexes, sensation, and muscle strength, as well as correlating information like positions that decrease arm or leg pain since any position that reduces pain in the arm or leg must be incorporated into an exercise plan. We may take X-rays that include bending “stress” views to evaluate ligaments for possible tears or instability.

Thorough evaluation is necessary for successful treatment and management. Treatment approaches include: adjustments; soft tissue therapy such as trigger point stimulation or myofascial release; posture correction exercises and other exercises; education about job modifications; and co-management with other health care providers, if medication or injection therapy is needed.

By Rich Harris, MSc, CSCS, PTA, CES, CSAC

Aquatic therapy has tremendous rehabilitative potential for individuals of all ages, ranging from the treatment of acute injuries to overall health maintenance of many chronic diseases. Water therapy has been proven effective with a variety of conditions, including post-surgery rehabilitation, impaired balance, joint replacements, and chronic pain. Water provides physical properties that can help ease the rehabilitation process compared to land-based programs which can be inadequate for conditions such as osteoarthritis, fibromyalgia, joint replacements, anterior cruciate ligament (ACL) reconstruction, muscle weakness, gait disturbances, and neurological disorders.

Exercising in water provides benefits that land-based programs cannot offer due to the principles of hydrodynamics. The physical properties of water, such as viscosity, hydrostatic pressure, thermodynamics, and buoyancy, create tremendous biological changes as the result of water immersion.

Buoyancy for Unweighting

The buoyancy of water is created by submerging the body, which causes water displacement and the resultant force of buoyancy. To understand the benefits of buoyancy, consider that when the body is immersed in waist-high water to the umbilicus, approximately 50% of the weight of the body is reduced. Furthermore, when submerged to the chest, about 75% of the body’s weight is reduced.

The result of this buoyancy, especially for individuals affected by arthritis or joint-related pain symptoms, is the ability to move more freely in the water. Clients can perform movement and activities with considerably less pain than on dry land. Likewise, it allows the participant to move with greater ease due to the sensation of feeling lighter in the water.

Patients who suffer from osteoarthritis are able to walk and even jog in water, thus improving their range of motion, strength, fitness, and overall function. One study demonstrated that participants significantly improved knee and hip flexibility, strength, and aerobic fitness while performing aquatic exercise while rehabilitating from arthritis.

Gentle Resistance

Another attribute of water that creates an additional benefit to the therapeutic environment is hydrostatic pressure. Hydrostatic pressure is the pressure exerted by water on the body. This pressure improves circulation and provides more oxygen and nutrients to injured tissues as well as reduces edema from injured extremities. When moving or exercising in water, viscosity or the opposition of the water creates a sensation of drag or friction to the body that provides a gentle resistance that can be used to improve muscle strength. The greater the force the body applies to the water, the greater the resultant viscous force and therapeutic resistance provided. Therapeutic pool temperatures should be between 87 and 94 degrees in order to provide the most benefit regarding muscle relaxation, increased blood flow, and patient comfort to complement the other benefits of aquatic exercise mentioned previously.

Stepping Into Recovery

Underwater treadmills help accelerate the recovery process for patients by utilizing all of the aforementioned attributes that water provides. Patients have the option to walk or move in multiple directions or even jog in water while taking advantage of the many benefits water creates. Many patients are able to walk greater distances and speeds than they could by walking on land-based treadmills or outdoors on sidewalks or roads. Even older adult patients who have compromised balance or gait disturbances are able to walk safely and confidently without the fear of falling if the treadmill has side rails the patient can hold and use to help maintain their balance.

From a sports-related perspective, athletes can begin a more aggressive but safe rehabilitation process by running much sooner on an underwater treadmill than would be possible on land; providing them a head start toward returning to their sport. To illustrate this point, Vinit Patel (pictured) suffered an ACL injury while playing college football. He had ACL reconstructive surgery and with the approval of his surgeon, Patel began a running program on the underwater treadmill much sooner than a land treadmill would allow due to the many benefits of the aquatic environment. Buoyancy was particularly helpful in his case as it removed the stress of gravity from his newly constructed graft.

Moving Forward with Aquatics

Physical therapy clinics considering whether an aquatics program could be the next step in enhancing its services or expanding its client base have certain considerations to address, including the task of researching and identifying a full-size pool or modular unit that provides the needed features at an acceptable cost. Budgets and target clientele vary. For example, one clinic may need only a modular unit equipped with an underwater treadmill that accommodates a single user and fits within an existing gym area, while another clinic may have the resources to build out a new space with a below-ground pool equipped with a movable floor, underwater cameras, underwater treadmills, or resistance jets.

Ins and Outs of Pool Access

Clinics that install aquatic facilities will also need to address questions associated with how individuals will enter and exit the pool. This is especially important for clients who have limited mobility or motion-limiting pain, or who use wheelchairs or assistive devices. One solution is to install an ADA-approved pool lift. These are available from several manufacturers, which can be designed for above-ground or in-ground pools, and are equipped with features such as headrests, seatbelts, and flip-up arms.

The literature strongly supports participation in regular physical activity as a prevention strategy for improving health and preventing chronic disease. The Centers for Disease Control and Prevention (CDC) has recommended a weekly minimum of 150 minutes of physical activity to prevent the development of chronic diseases such as diabetes, hypertension, obesity, osteoarthritis, and cardiovascular disease. Many people affected by these conditions may find that the benefits of the aquatic environment allow them to be physically active and exercise more comfortably than land-based activity or exercise.

By Susan Rosso, DPM

Plantar fasciitis is the most common cause of heel pain. Approximately 1 million people are diagnosed with plantar fasciitis each year. It is debilitating at times, keeping people away from their ability to walk, exercise, and sometimes work.

The plantar fascia is comprised of three bands of dense connective tissue extending from the bottom of the heel to the base of the toes. Its action is to reinforce the arch of the foot when pushing off of our toes, giving us forward propulsion. Repetitive strain of the fascia results in thickening and fibrosis of the fascia, which causes pain. Plantar fasciitis is most commonly seen in patients between 45-64 years of age and in those with risk factors including flat feet, high arch feet, long distance runners, military personnel, occupations requiring prolonged standing, and obese or sedentary patients. Leg length differences also contribute significantly to unilateral heel pain. About 30% of patients will have bilateral foot pain.

Clinical symptoms include sharp, intense pain in the medial plantar heel upon first step out of bed or after periods of rest. The pain can worsen throughout the day with prolonged standing.

Physical examination will show pain with direct pressure to the medial plantar heel and quite often a reduction in range of motion of the ankle. An X-ray of the heel may show a heel spur, but most importantly, the X-ray is used to rule out a stress fracture or bone cyst within the large bone of the heel. Plantar heel pain may also have a neurologic origin from the lower back or tarsal tunnel impingement, and this must be evaluated clinically and/or with nerve conduction velocity studies (NCVs). Further imaging studies such as an ultrasound or MRI are sometimes used in cases of abnormal heel pain presentation.

Typically, plantar fasciitis is treated successfully with conservative treatment in 85-90% of cases. Initial treatment consists of rest, stretching exercises, ice, modifications of current shoes, non-steroidal anti-inflammatories (NSAIDs), night splints, and over-the-counter or custom orthotics. Corticosteroid injections may also be used to help reduce inflammation, especially with patients who are not responding to other forms of conservative treatment. Physical therapy modalities, especially ultrasound, can be very helpful in reducing inflammation and promoting healing, and the physical therapist can design and monitor a therapeutic stretching exercise program.

Platelet Rich Plasma (PRP) injections are a relatively new form of treatment and are showing relief of pain and return to function comparable to corticosteroid injections. Surgical options should be considered after 6-12 months of failed conservative treatment. Surgery consists of full or partial release of the plantar fascia through an endoscopic or open surgical approach. Endoscopy can provide for less risk of infection and less scar tissue development. Approximately 75% of patients undergoing surgery reported substantial or complete relief of symptoms. This gives a very successful outlook on achieving complete resolution of pain.

Plantar fasciitis is very treatable. If you are experiencing the symptoms discussed above, a thorough podiatric evaluation is the first step toward healing and resuming a full and active lifestyle.

By Shawn VanderBrook, PT, DPT, OCS 

Sciatica is a term thrown around by patients and doctors alike and is a common complaint across the United States. What is it? How does it occur? What are the main causes? How can I get rid of it? These are all questions that I hear regularly as sciatica is one of the most common injuries and diagnoses I see at my practice.

Sciatica is pain along the sciatic nerve which runs from the low back through the hips and down the leg. Patients typically only experience sciatica on one side of the body. Sciatica is very common: The general consensus is that 5-10% of patients with low back pain have sciatica and about 2.2% of the population experiences disc-related sciatica annually.

The primary cause of sciatica is a disc herniation creating pressure on lumbar nerve roots. The second main cause of sciatica is lumbar stenosis—a narrowing of spaces in your spine—causing increased compression on lumbar nerve roots. The third main cause is possible compression and irritation due to a strained piriformis muscle compressing the sciatic nerve. This is more commonly referred to as piriformis syndrome.

Sciatica is most typically diagnosed from symptoms such as obvious radiating pain down the leg, change in lower leg sensation, and increased symptoms while sitting on the symptomatic hip or on a hard chair. Once a patient believes they may be suffering with sciatica, they may need to seek out professional help if symptoms are not resolving.

A physical therapist can perform a physical examination to confirm the diagnosis. The main point of the exam is to determine if there is neural tension in the sciatic nerve and if the pain in the area served by the sciatic nerve is greater than any current low back pain. A therapist may utilize multiple tests, but the most common test used is the passive straight leg raise test that places a maximal amount of tension on the sciatic nerve. If the straight leg raise test is negative, then a patient most likely is not dealing with sciatica as the sensitivity of this test is estimated at 91% for ruling out sciatica.

Sixty percent of patients will have a resolution of symptoms within three months, but it may take one year for all symptoms to resolve or they may not resolve without interventions. A lot of patients at this point believe that imaging, injections, medications, or surgery should be their first line of defense. The current recommendation of the medical community is to first receive conservative care by a licensed professional, such as a physical therapist, for 6-8 weeks to help manage symptoms and to help patients maintain or improve current levels of activity.

Research shows there is no difference in recovery rate between bed rest or staying active with sciatica. As a result, remaining active with conservative care and education on managing symptoms is the current main recommendation. A patient will be only be referred to a neurologist if there are any major symptoms that include cauda equina (numbness in the genitourinary area/incontinence), other signs/symptoms of possible malignancy, and severe and progressing muscle weakness of the legs.

In conclusion physical therapy and conservative treatment is the recommended initial treatment for sciatica and should be pursued by individuals limited by painful symptoms. If you are struggling with sciatica, don’t hesitate to look for a local, qualified, and knowledgeable physical therapist to help you overcome your deficits and to keep you active as you recover from this common injury.

REFERENCES

Sciatica references: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1895638/
Tulder, V., Koes, B. W., & Peul, W. C. (2007, June 21). Diagnosis and treatment of sciatica. Retrieved July 26, 2018, from https://www.bmj.com/content/334/7607/1313
Piriformis syndrome: https://www.ncbi.nlm.nih.gov/books/NBK448172/

By Bob Gorinski, DPT

We rarely think about our shoulders until something goes wrong. We ask a lot of our shoulders, so it should be no surprise they are frequently problematic. Our shoulders move frequently, in all directions, and through an extremely large range of motion.
How can we care for and nurture our shoulders? We must be aware of four ways that we often sabotage our shoulders.

1. Reaching and lifting with poor form:

Shoulders function best when the top portion of the humerus (the upper arm bone) has margin to spin and glide in the socket formed by the shoulder blade (scapula) and collar bone (clavicle). If you lift and carry objects with the palm of the hand facing downward and your elbow out to the side, the humerus is less stable in the shoulder socket, and the rotator cuff muscles and bursa can easily get pinched between the moving bones.

Whenever possible, reach overhead and lift with the palm of the hand facing up and your elbow more toward the center of your body rather than out to the side.

2. Slumping when we sit:

The foundation of many shoulder issues is poor sitting posture. Much of adult life is sit-sit-sit-sit. And after that, we sit. Sitting itself is not stressful on the shoulder joint, but problems can easily occur when stiffness and poor alignment has developed over months and years.

The first key to good shoulder health is being aware of the poor posture that many of us apply to our bodies. Sit up tall. Stand up and move. Pull your head and shoulder blades back.

3. Weekend projects:

High-performing athletes diligently train their bodies and closely monitor use of their shoulders. In contrast, the average adult frequently dives into weekend painting, trimming, and cleaning projects with little physical preparation to protect their shoulders. Even with perfect posture and lifting technique, chances are slim that the shoulder muscles, ligaments, and tendons will hold up.

Be aware of the demands that weekend projects will place on the shoulders. Take time to prepare by stretching and strengthening the muscles of the shoulders and upper back.

4. Exercising our shoulders:

Exercise programs are one of the biggest risk factors for shoulder injuries. Many people with the best of intentions take on too much too soon, perform exercises that are simply not a good idea, or fail to address postural and alignment issues prior to performing typical upper body strengthening and stretching.

To minimize shoulder injury during exercise:

Stay off the machines. Most resistance exercise machines do not require you to activate the core muscles that support good posture and movement of the shoulder blades. If a machine, rack, or person has to hold the weight for you, it may be more than the shoulder is prepared to handle. In contrast, sitting or standing dumbbell presses are self-limiting. These exercises demand support from the stabilizing muscles in the torso and you will not attempt to shoulder more than you can handle.

Stretch what is tight but avoid indiscriminately stretching what’s already loose. Instead of aggressively stretching the shoulder joints, stretch the upper back and pectoral muscles.

Strengthen what is loose but not what is already tight. Most of us need more upper back strengthening work and less work on the chest and biceps as these muscle groups pull the shoulder blades forward.

Shoulder pain is the third most common musculoskeletal problem treated by physical therapists and our risk increases as we age. Protect your shoulders by practicing good posture, not pushing your body to do more than it safely can, and selecting exercises to strengthen and stretch your upper back and pectoral muscles.