Before Dry Needling - October 2nd
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After Dry Needling - October 13th
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Dr. Mike Roberts, PT, DPT, CMTPT
Having worked extensively with CrossFitters over the years, I've had plenty of patients complain that they don't have the mobility to perform an overhead squat and that all of the daily stretching and foam rolling they do doesn't help. That no longer has to be the case! Wisconsin Orthopedic Physical Therapy offers a technique called Dry Needling to get you back in the game faster. Below are two videos of a fellow CrossFitter who had this exact problem. The video on top was before we performed dry needling to the pectoral muscles and addressing form at the hips and core, while the video on the bottom is only 11 days following. Watch the results!!!
Before Dry Needling - October 2nd
After Dry Needling - October 13th
There are many reasons outside of having "tight pecs" that may be limiting your overhead squats. This includes, but is not limited to lack of thoracic mobility, ankle mobility, and hip strength. The great news is - all of these can be fixed with physical therapy! Call us today if you are having trouble with overhead squats and want the same results as seen above!
Dr. Mike Roberts, PT, DPT, CMTPT
Zapped. Nuked. Cooked. Fried. Besides all these fun words you can use to describe yourself after a treatment of electrical stimulation, or “E-stim,” in therapy, what are the physiological benefits of being hooked up to this odd machine that makes you feel tingly? What is it actually doing within your body?
There are many different types of E-stim that we can manipulate using different frequencies, pulse durations, wavelengths, etc. The type of E-stim we use in your treatment depends on our goals for you. Let’s break it down in simple terms:
If you had a lot of soft tissue work done in our session (yes, those infamous thumbs!), you will likely be getting a setting called “Pre-mod.” This setting helps to reinforce what we worked on manually by increasing blood flow to the area, moving fluid out of the area (decrease swelling), and relaxing the muscle fibers by providing a gentle sensory stimulus.
If you have a very acute injury, such as a sprained ankle or a fresh surgery, we will likely use an E-stim setting called “Interferential current.” A current is sent between the electrodes to interfere with the natural pain signals your body is sending to your brain. This acts to “turn off” those pain signals and give you the sensation of pain relief. This is the same general idea behind a form of E-stim called “TENS,” which you may have heard of.
If you have a very weak muscle that is having trouble activating, such as your quad after an ACL reconstruction, we will use a setting called “Russian.” This setting stimulates your muscle fibers to contract—your quad will fire without you even trying! Besides being really cool to watch, this helps to retrain your nerves and muscles to communicate appropriately to regain your ability to fire that muscle on your own.
Hopefully this gives you a clearer picture of how those little pads work and why we use them in therapy. As you can see, E-stim serves as a useful adjunct to your treatment, but cannot resolve your problems on its own. High quality treatment consists of a well-rounded plan of hands-on manual therapy, therapeutic exercise prescription, neuromuscular re-education, and modalities like E-stim.
This is what you will get at Wisconsin Orthopedic Physical Therapy! Call us today at (414) 763-2941
Please first entertain yourself with this video below: https://www.youtube.com/watch?v=UKzq1upNIgU
Perhaps, if you are a CrossFitter, you have already seen it. Perhaps you have lived it, and have dealt with the embarrassment of exercise-induced urinary leakage firsthand. I’m curious to know what you think of this video. If you went to your gynecologist for help with this problem, would you be satisfied if she told you, “It is okay to pee during double unders?” So you are just supposed to let it happen and there is nothing you can do to stop it?
FALSE! Peeing during workouts is NOT okay, and it is not a normal and healthy response to exercise.
“But,” you may say, “I’ve had several children. It’s normal for me.”
FALSE. It doesn’t really matter how the dysfunction started—the fact is, it is a muscular dysfunction to pee during exercise, and it’s treatable.
When you perform a high intensity task such as double unders, your abdominal cavity is put under a lot of pressure, called intra-abdominal pressure. The body is designed to withstand that pressure without allowing things to fall out of it (literally). There are muscles that make up the bottom floor of your abdominal cavity, called your pelvic floor. When those muscles are not strong enough to counter the intra-abdominal pressure exerted by exercising, the pressure wins and you get leakage.
Think of it like the balloon model pictured. The abdominal compartment is made up of your diaphragm on top, pelvic floor on bottom, and transversus abdominis and spinal muscles around the front, sides, and back. When you increase pressure inside the area, these muscles must be strong enough to keep all that pressure inside without allowing things (like urine) to leak out.
So how do you strengthen your pelvic floor, you ask? Come to Wisconsin Orthopedic Physical Therapy! We do not accept or promote that having a leakage dysfunction during CrossFit activities is normal. Dr. Kristen Behl would love to teach you all about it, and help you develop these essential muscles to prevent this type of embarrassment in the gym forever!
Call and schedule an appointment today with Dr. Lauren Croal at 414-763-2941!
Here is an excellent, simple, easy-to-understand article describing what physical therapy is and its' benefits. Click below to read more!
When things get hard, giving up is easy to do. It is a temporary relief to a large problem. You know deep down that giving up is not the right thing to do, however. When things get difficult, especially when it comes to physical therapy, it is important to fight the urge to give up. Here's a nice article on what to do when you feel like giving up. Hopefully it encourages you to continue fighting, to staying strong, to come to your appointments, to do your Home Exercise Program, and to stay positive! Trust in your therapist!
Did you know that Wisconsin has direct access for physical therapy? This means you do not need a physician’s referral to see us! A recent study that was published in PT Journal last month performed a systematic review that compared health care costs and patient outcomes by direct access to referred physical therapy. The researchers found direct access provided the following:
Ojha, Heidi., et al. “Direct Access Compared With Referred Physical Therapy Episodes of Care: A Systematic Review.” PT Journal. 94 (2014): 14-30.
For those of you who do not know what CrossFit is, it is a mode of exercise that targets cardiovascular and respiratory endurance, strength, flexibility/mobility, stamina, power, speed, agility, coordination, and balance. The workouts change daily and can be performed by individuals at all fitness levels. Specializing in the shoulder, I have recently seen a handful of patients from the CrossFit community with pain in this region and thought I would address it.
Since CrossFit performs a variety of exercises that include Olympic and gymnastic movements, the shoulder can be placed in extreme positions that can put stress on important structures within the joint. Because I believe that CrossFit is one of the best modes of exercise out there, I want to educate you, not discourage you, from participating. I believe that if you have a better understanding of the shoulder complex, you can incorporate this knowledge into your workout routine to avoid injuries, and if injured, treat yourself immediately.
The first thing you need to know is a brief Anatomy 101 of the shoulder complex. Between the scapula (shoulder blade) and shoulder joint, is the subacromial space. In here, three structures are housed: the supraspinatus (one of the rotator cuff muscles), biceps tendon, and subacromial bursa. Making up the rest of the rotator cuff are two external rotators (infraspinatus and teres minor), and one internal rotator (subscapularis). The biceps tendon attaches at the labrum, which originates from the socket of the shoulder’s ball and socket joint and provides stability.
The most common condition I typically see with the shoulder is what we call subacromial impingement syndrome. This occurs when one of the three structures within the subacromial space is irritated and inflamed. There are multiple reasons as to why this can happen (and as a physical therapist, this is where I come in to diagnose and treat). Some of the most common reasons for this condition is due to poor thoracic mobility, weak scapular stabilizing muscles, decreased muscle length, poor posture/scapular positioning, and imbalances in rotator cuff internal and external strength. When one (or more) of these occur, we see tilting of the scapula, which closes the subacromial space.
For example, try this: slouch down and try to raise your arm forward as high as it will go. Now, sit up as straight as you can and perform the same motion. It’s a lot easier, right? That’s all because of scapular positioning. I’m sure my patients are sick of me using those two words all of the time in the clinic, but it is vital in preventing and treating these conditions. Now let’s relate this to the CrossFit world. Say you have a shoulder that has been aching (only a little bit so you think you can still perform today’s daily workout). Most of my patients who participate in CrossFit have massive deltoids, beautiful upper traps, and chiseled biceps, however muscles such as the lower trapezius, serratus anterior, and other vital stabilizing muscles are underdeveloped. Because of this, we begin to see tilting and poor scapular positioning. Now perform an overhead squat (let’s say 100 lbs) over your head. The subacromial space closes even more, putting increased stress and irritation on those structures.
Standard push ups, handstand push ups, push press, push jerk, kipping pull ups, hang power clean, hang power snatch, ring dips, overhead squatting, and many more are all great exercises, however are very stressful on the shoulder - if you don’t have proper scapular positioning and proper stabilizing strength throughout the rotator cuff and scapula. So the next time you are performing these, focus on where your shoulder blade is positioned and try to avoid what we call “winging” by keeping the shoulder blade “pinched back”.
I have also come along a program designed within the CrossFit community called Bulletproof Shoulders (http://www.youtube.com/watch?v=ACAz6HFj1xE) out of CrossFit New England (which I highly recommend you include in your routine) that target the scapular stabilizers that prevent “winging” while working out from occurring. If you do experience shoulder pain while working out - DO NOT WAIT. I have too many patients that come in to see me saying the same thing, “my shoulder didn’t hurt real bad and I figured it would go away within a day or two, so I worked through it.” I usually see them three months later with full blown subacromial impingement syndrome. I always recommend icing as soon as you can, as well as taking an NSAID (such as Aleve). The sooner you can decrease the inflammation, the sooner you will be back to participating in CrossFit symptom free. I provide free consultations for all injuries, so take advantage and call me if you start to experience any symptoms.
Knee osteoarthritis and meniscal tears are common conditions seen in many individuals, and for a long time have been treated with surgical procedures. In a recent study published in the New England Journal of Medicine, researchers found that physical therapy was just as effective as surgery in patients with these conditions. They concluded that functional improvements were the same after 6 and 12 months, which is encouraging news for many people with knee pain. There are many potential contributing factors for your knee pain, and a skilled orthopedic physical therapist can provide you with answers and treatments to relieve and possibly eliminate your discomfort. Call Wisconsin Orthopedic Physical Therapy today for a free consultation to see if your knee pain is appropriate for physical therapy!
Katz, Jeffrey N., et al. "Surgery versus physical therapy for a meniscal tear and osteoarthritis." New England Journal of Medicine 368.18 (2013): 1675-1684.
Where should I go for physical therapy? That’s a question many people ask themselves when they have aches and pains or receive an order from their doctor.
Well, two studies recently published confirm why you should choose Wisconsin Orthopedic Physical Therapy. The first study published in the May issue of Orthopedics, looked at factors contributing to patient satisfaction with postoperative physical therapy. They concluded that duration of therapy, number of co-patients per session, continuity of care with the same therapist, and the amount of hands-on time with their therapist, were significantly correlated with high patient satisfaction. The second article, recently published in The Journal of Knee Surgery, looked at patient dissatisfaction during their rehab experience. The researchers found that dissatisfaction was correlated with shorter mean duration of each session directly spent with their therapist, a higher number of therapists seen, and an increased number of co-participants during their sessions.
To maximize patient satisfaction, physicians should identify institutions, such as Wisconsin Orthopedic Physical Therapy, whose therapists are willing to spend adequate hands-on time during one-on-one sessions with a single provider.
What do patients and physicians need to know about Wisconsin Orthopedic Physical Therapy:
Johnson, Aaron J., et al. "Patient Dissatisfaction with Rehabilitation Following Primary Total Knee Arthroplasty." Journal of Knee Surgery EFirst (2013).
Issa, K., et al. "Evaluation of Patient Satisfaction With Physical Therapy Following Primary THA." Orthopedics 36.5 (2013): e538-42.
I’ve had many patients who have been told they need surgery for their rotator cuff, but they might be in jobs or situations where taking 2 to 3 months off is not an option. When I tell them that physical therapy may not only improve, but resolve their symptoms, they are sometimes skeptical. I’ve had great success with these patients, and I’ve had many who were able to avoid surgery completely. In a recent study in the Journal of Shoulder and Elbow Surgery, researchers looked at the effectiveness of physical therapy in treating full-thickness (atraumatic) rotator cuff tears. After studying over 450 patients, the researchers found that patients reported significant improvements at 6 and 12 weeks. They also found at a 2 year follow-up that physical therapy was effective and resulted in 75% of the participants not needing surgery. With the combination of manual therapy and therapeutic exercise by a skilled physical therapist, you can experience the same benefits these patients received. Are you having shoulder pain? Or have you already gotten the results of an MRI saying you have a rotator cuff tear? Call today for an appointment and begin decreasing your pain and improving your overall function and quality of life!
Kuhn, John E., et al. "Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study." Journal of Shoulder and Elbow Surgery (2013).
Michael Roberts, P.T., D.P.T., believes that evidence based practice, one on one care, and patient education are essential to return his patients to their desired level of function.