Sensory Awareness workshop

Marlene and Paul Zweig, MD, are going to come again this year from Colorado to visit us to offer a one day course in Sensory Awareness,  on Sunday November 14,  from 10am to 4:30pm at our clinic. Cost is $60. Call us to register. On Saturday they offer similar work at the Chapel Hill Zen Center.

For information on Sensory Awareness go to: www.SensoryAwareness.org

Pain in the shoulder, arm and hand: The silent culprit

A common condition I have treated over the past several years has been arm and hand pain originating for the neck and upper back.  Often patients will report no mechanism of injury to the arm or hand and are confused as to why their elbow and hand are hurting.  They may remember waking up one morning with stiffness in their neck or an inability to move their neck in one particular direction.  These neck symptoms may have improved over the next few days, but then they started to notice the arm and hand symptoms.   Other complaints patients may experience are pain at night, changes in sensation in the arm, forearm, and specific fingers of the hand.  Specific postures may be associated with provoking the symptoms:  sitting at a computer, looking down to read a book and driving.

My role as a physical therapist is to identify where the symptoms are stemming from.  Pain that is originating from the cervical spine and radiates into the arm, elbow and or hand is termed cervical radiculopathy.  This type of condition is possible because the nerves which supply motor control and sensation to our upper extremities originate from the cervical and upper thoracic spine.  Impingements and obstructions of nerve regions will cause symptoms to be felt in more distal joints.  This is why when we hit our “Funny Bone” we feel numbness in our 4^th and 5^th fingers; it is not that we hit a bone, but we hit our Ulnar nerve which is located one the medial side of our elbow.  Sometimes a cervical component to a patient’s pain may be overlooked.  Common conditions which may have a cervical component are lateral epicondylitis “ Tennis Elbow”, medial epicondylitis “Golfer’s Elbow”, Carpal Tunnel Syndrome and tendonitis of muscles in the shoulder, forearm.  From listening to a patient’s history I can discern where to start my evaluation.  If the patient reports a history as in my first example, I will consider the neck and spine as the most likely cause.  If the patient reports a trauma to the shoulder, elbow or hand, then I will consider those regions as the most likely cause.  Regardless of the history, a thorough screening of the neck and upper extremity is necessary to rule out possible suspects.

Recent research has allowed physical therapists to better diagnose a cervical spine origin for pain in the upper extremity.  In a 2003 article in the Journal Spine, a group of researchers looked at 82 persons with symptoms of either carpal tunnel syndrome or cervical spine radiculopathy.  The authors performed a rigorous diagnostic work up of each patient including nerve conduction studies, needle EMG, historical intake questions, self assessment questionnaires, neurological screening including reflex testing, sensation testing and resisted muscle testing, 5 provocation tests and measurements of neck range of motion in all directions;  they left no stone unturned!   The authors concluded that using a cluster of tests gave a higher probability for determining the source of a person’s pain than any one test.  The tests identified were: Restricted neck rotation range of motion towards the involved side of less than 60 degrees, Positive reproduction of arm pain with a neural tension test, Positive reproduction of arm pain with a compression test known as Spurling’s Test and Reduction of referred arm pain with manual traction.   If 4 of 4 tests were positive then the probability of having a cervical spine radiculopathy increased to 90%!  If 3 of 4 tests were positive then the probability increased to 65%.  These findings have allowed physical therapists to more accurately determine the cause for a patient’s pain, thus allowing proper determination of the best treatment intervention.  In a time of increasing health care costs, use of this type of research can save money in avoiding more expensive testing such as needle electromyography.

The course of physical therapy for a cervical radiculopathy is to centralize or decrease the frequency, duration and intensity of symptoms in upper limb.  This can be achieved through taking stress or compression off the involved nerve tissue.   Specific manual treatments associated with relieving muscle tension, increasing circulation to affect healing and restoring joint mobility in the middle and upper thoracic spine can be effective at centralizing symptoms.  Specific exercises designed to promote range of motion, inhibit muscle tone and correct posture also help achieve this goal.  Patient education is paramount to helping centralize symptoms.  Sometimes specific exercises will be initially limited to repeated movements in only 2 or 3 directions to allow time for tissue healing to occur.  As symptoms become less irritable, then further progressions can be made.  If pain is the patient’s primary complaint then modalities to decrease inflammation and the acuteness of the condition will be the focus of physical therapy.  Referral to a primary care physician may be needed if conservative efforts to manage pain and inflammation are not helping.  From past experience, I usually allow 2-3 visits to determine benefit.  If a patient is having significant pain at night, then referral may be made at our first visit.

Matthew Harwood PT, DPT

Postural Restoration classes for beginners

Finally, we can announce that the beginner classes are scheduled. The evening class with Susan Henning will be happening on Wednesday evenings at 6pm.  This class is already full. The morning class with Joe Belding will start on Monday, October 4th at 9am. For this class there are still a couple of openings.

Both classes will be for 8 weeks, beginning and ending with an assessment. Cost is $ 120.00.

Please call us at 919 932 7266 or email : myadvancephysicaltherapy@gmail.com

Knee Pain

How do we approach knee pain, based on a Postural Restoration understanding of the knee?
We are talking here about a gradual development of knee pain that now demands your attention, not an identifiable sport injury or accident. Your knee hurts when you walk, squat, climb stairs, run, whatever.

In addition to examining the knee for joint or muscle injury, we are very interested in finding out why there are abnormal stresses causing pain at the knee, which may have led to injury. Abnormal stress is often the result of poor alignment of the knee joint bones and muscles, and of an inefficient, poorly balanced movement pattern. We assess the low back, the pelvis, hips and feet, for position and for appropriate muscle activity.

When the cause of pain is injury, inflammation, pain and weakness must be addressed and corrected. However, even in cases of injury, it is important to include correction of postural alignment in the treatment plan in order to minimize stress to the joint, to promote more rapid healing, and to ensure healthy movement patterns for the future.

advance Physical Therapy

Michael is a science teacher and has a very inquisitive mind. The other day he wondered why there is a ‘d’ missing in our name. We should be ‘Advanced Physical Therapy’. He has been coming for a while and readily admits that we really are  advanced in comparison to other places, on a higher level of understanding and treatment. So why not call us ‘advanced’ ?

Well, yes. But…  We intend to advance physical therapy. However, as in any practice the more you advance the more you see what still needs advancing. Even though our physical therapy is advanced, it is not finished,  it needs a lot more advancing. And that is what we intend to do:                              Advance Physical Therapy

Running Shoe recommendations 2010

Every year the Postural Restoration Institute compiles a list of good running shoes. Here is the latest:

Copyright 2010 © Postural Restoration Institute™
RUNNING SHOES
PRI Recommendations: (in alphabetical order)
1. ASICS 2150 (S-M)
2. ASICS Cumulus (S-M)
3. ASICS Evolution (S-M-L)
4. ASICS Foundation (M-L)
5. BROOKS Defyance (S-M)
6. BROOKS Dyad (M)
7. BROOKS Glycerine (S-M)
8. NEW BALANCE 850 (M-L)
9. SAUCONY Echelon (M-L)
10. SAUCONY Stabil (L)
Underline = neutral shoe considerations for orthotics
Italics = light lateral calcaneal give
Qualities of a good shoe:
1. Solid heel counter
2. Excellent calcaneal support (no lateral heel give)
3. Patient can feel arches of shoe
Sign of a good shoe:
PRI tests are negative (pick a few):
Adduction drop, SLR and HGIR (frontal, sagittal, &
transverse planes)

If you are a runner and have questions, ask Jean, one of our Physical Therapists who  is  trained in Postural Restoration.

Top Ten Recommendations for Runners

These Recommendations are reproduced from the website of the Postural Restoration Institute to celebrate springtime

Lori Thomsen, PT, PRC

Hruska Clinic – Restorative Physical Therapy Services

1. Keep your hamstrings strong, especially on the left. (4 & 5)

2. Avoid overstretching your hamstrings (90o straight leg raise at the hip with the

knee straight). Have the ability to stand and bend over and slightly touch toes

(palms to the floor is too much).

3. Occasionally walk slowly up the stairs backwards to keep your glutes

symmetrical. (1 & 4)

4. Properly stretch your Achilles tendon, your toes, and your low back.

a. Heel to floor in the squat position (8)

b. Ankle stretch with shoes on and knees bent (7)

c. Pull great toe up

5. Concentrate on striding out with your right leg and left arm when running. (6)

6. Try to find and feel your right arch when running to assist with shifting to the

left. (4)

7. Perform Standing Resisted Wall Reach to stretch your back, latissimus, and

pectoral musculature. (3 &

8. Stand and shift your body weight over your left leg regularly, keeping weight

shifted through you heel. (4)

9. Keep your left lower abdominals “alive” by performing sidelying activity. (2)

10. Wear correct footwear. Wear shoes that support your heels and that have good

arch supports. Avoid wearing flip flops, sandals and wearing shoes that are

untied during the running season.

Copyright © 2007 Postural Restoration Institute™

New Introductory Postural Restoration Class Starting on April 26th

New Introductory Postural Restoration Class starts on Monday, April 26th at 6 pm to 7 pm. This is an 8 week series, beginning and ending with an objective assessment. It is taught by Susan Henning, PT, PRC.  Space is limited to at the most 8 people. It costs $120. Please call 932 7266 to register.

Stroke Recovery Treatment

Scoliosis

Scoliosis is a case in point. It is so complicated, involving the pelvis, back, ribcage, breathing, etc, that it can serve as a  test for a good bio-mechanical understanding of the body.

I only know of two approaches that try to get to the causes of scoliosis, the Schroth Method and Postural Restoration. All other attempts deal  with the symptoms of scoliosis and they don’t need a thorough understanding of it.

Katharina Schroth suffered from scoliosis herself and she developed an exercise program based on her intuitive understanding of what helped. The Schroth Clinic in Germany, since the middle of the last century, has been very successful, even with older people with significant curves.

Postural Restoration provides a bio-mechanical understanding of the causes of scoliosis and the very precise exercises  are based on that understanding. The exercises help diminish the curvature, particularly among young adults or teenagers. The main difficulty is to get teenagers to do these exercises religiously on a daily basis.

The younger the people and the less pronounced the curve, the easier it is to re-balance the body and get rid of the curve. However, young teenagers are the hardest to motivate.

One of  our therapists, Susan Henning, is hoping for or dreaming of a regular screening  at schools for scoliosis, because the imbalances and the suffering that follows for a whole lifetime, could be avoided.