Thursday, May 23, 2019

Trigger Point Dry Needling Part Deux

Physical therapists routinely evaluate individuals for painful "trigger points' that can result in not only pain but, also limited movement and tolerance for activity.  If these areas of muscle hypersensitivity are not identified and then addressed therapeutically, they can result in a prolonged and sometimes chronic painful condition.  The "dry needling" component is simply a means of better allowing a technique to specifically zero in on and "reset" the muscle tissue that is hypersensitive.  As the name implies, dry needling involves the use of thin needles of varying length without anything "wet" going into or out of the body.  No medications or solutions are injected and most of the time no blood exits the body as the needles are a fraction of the size typically used for injections or for drawing blood.
The targets for these needles are trigger points which are taut bands (nodules) found within muscles that can be irritable and painful with pressure or palpation's and often times result from our body's response to injury.  When activated by pressure or irritated by injury or activity, they can reproduce an individuals pain at the site of the trigger point, or even in a seemingly unrelated location of the body, which may then result in a loss of motion or a decrease in function.  Since these identified areas of hyper sensitivity are ultimately the targets for part of our treatment regimen, it makes sense that dry needling is often called trigger point dry needling (TPDN).  Trigger points and muscle dysfunction (i.e. tight muscles or muscles that are not working properly) have been recognized since the 1950s and have been something physical therapists have been trained to correct with a variety of treatment approaches.  Stretching strengthening, therapeutic ultrasound, lasers, electrical stimulation, joint mobilizations, manipulation, as well as various techniques using thumbs elbows, and or tools have all been utilized and will continue to be used to address these problems.

Dry needling for trigger points was first used in 1979 when a physician found that using injections into trigger points to alleviate pain worked regardless of the medication used.  The needle actually seemed to be the source of the pain relief.  The rationale to explain how a skillfully placed needle into a muscle can result in a significant reduction of pain isn't completely understood.  Perhaps the needle causes a very specific and localized stretch to the taut fibers within the trigger point which then results in a 'twitch' response which ultimately renders the muscle to be less sensitive to movement.  Another theory is that there may be a localized increased chemical release or 'leak' of the chemical that causes a muscle to contract which may lead to incomplete relaxation of the affected area.  The needles may be enough of an irritant to the structure that is leaking the chemical that it releases more, resulting in a localized muscle twitch.  This may then use up the excess chemical which then ultimately helps to shut off the leak leaving behind a more relaxed muscle.  No matter what the exact mechanism is for why a needle in a trigger point makes it act differently, the result is a muscle that has been reset, no longer holding unnecessary tension or acting inhibited from performing its role in helping the body move.  This reset is often compared to the Control-Alt-Delete function on a computer effectively causing it to 'forget' whatever it was causing the problem!

Monday, May 20, 2019

What about the Lunge?

In sport, athletes display a high variance of movement potential. To build athleticism, strength trainers must select exercises that improve speed, power, and strength. In traditional strength training, the squat reigns supreme for improving lower body power and strength. But what about the lunge?
Since the squat directs force vertically, the lunge takes precedence in directing force horizontally. In running sports, acceleration and change of direction are paramount. Lunging can touch on athletic components that the squat alone cannot.

Why Lunge?
In looking at the athlete’s sporting demands, we see that movement happens in large part on one leg. This unilateral movement demands the athlete to have enough strength to both produce and resist force in the sagittal, frontal, and transverse planes.
Lunging variations serve to integrate and load multiple planes of movement that help the athlete’s proprioception and timing. Further, multi-planar lunging can help safeguard problematic and injury-prone areas like the groin, hips, lower back, hamstrings, and knees.
Although strength trainers cannot ultimately prevent injuries from happening, they can provide exercises that build multiplanar hip, knee, and ankle stability to make the athlete more robust and resilient. Since tight musculature and lack of mobility often contribute to injury potential, lunging provides an inbuilt mechanism for safeguarding against these risks.

The Lunge is Foundational
An assessment of the athlete at play is vital in determining which exercises to include in their training program. It is appropriate for a tennis player or fencer to train the lunging pattern, as their sports are almost entirely based on lunging and striking movements. However, swimmers, rock climbers, and gymnasts may not need the same training volume or intensity.

Since athletes from all sports must be able to move with precision, the lunge is as prudent as it is pragmatic. If the athlete is able to comfortably cross the midline of their body during cutting, acceleration, and deceleration, their chances of injury lessen while their performance increases.
In programming for strength and athletic performance, exercise selection ultimately comes down to the primary action of the athlete. Both bilateral and unilateral movements are important for the athlete, but the application of when and why to use each is paramount.

The Squat vs. Lunge
In human evolution, the squat is more of a rest position than an exercise, but that doesn’t mean that it shouldn’t be loaded for strength and power development. When loading the body with a barbell, kettlebell, or other implement, the squat trains the lower body’s maximum force development in the vertical plane
However, the lunge is advantageous for the athlete that must make a change of direction in sport. Further, athletes with prior injuries to the knees, low back, or hips may find loading lunging patterns easier than loading squats. In order to understand the necessity of lunging, we must look at the role the feet play in the squat and lunge:

Squat: The feet remain in a fixed position. The feet do not move during the movement.

Lunge: The feet move in a stepping motion in any direction. The feet return to the starting position or to a new position.
Since moving into a squat is a downward motion of the athlete, it’s wise to see how a bilateral squat can help improve an athlete’s overall power and vertical jump. However, lunging provides a stimulus for the athlete that must make a sudden forward thrust of the body like in sprinting, cutting, or attacking an opponent.

The Lunge Improves Athletic Ability
There are several progressions that I give to my athletes when learning to lunge. In order to progress, the athlete should demonstrate precision in each movement, loaded and unloaded.

Lunging Continuum
Split Squat  > Reverse Lunge > Walking Lunge > Forward Lunge > Power Lunge

Friday, May 17, 2019


During treatments, you need to do an ongoing evaluation of length/strength of muscles, relationships of body parts. I.e., which part moves most, which least; why? Which part is tighter causing abnormal positioning? 

Resting position (normal posture) gives strong clues as to which muscles are long, which are short, since resting position is a "balance" between antagonistic muscles. We need to lengthen muscles that are too short, and shorten supporting muscles that are too long, then use them habitually in that shortened position. This will counter balance the muscles that tend to get too long. It is ineffective to merely strengthen long muscles; they must be gotten to be shorter in their "resting" position by habitual positioning.

Need train movement to be correct through practice so correct part moves, correct part STABILIZES. (practice, use wall for support, mirrors for visual alignment.

Need correct postural habits which involves all the above, i.e. exercise must become a habit
  1.  Effects - refers to physiological changes
  2. Indication - refers to an advisable, safe, recommended, prescribed treatment based upon clinical signs and symptoms.
  3. Contraindication - refers to an inadvisable, potentially unsafe, not recommended treatment based upon clinical signs and symptoms.
  4. Precautions - It is "okay" to consider this treatment with caution.  there may be potentially negative consequences. Be aware and ready to discontinue treatment based upon effects (subjective and objective) signs and symptoms that occur during the treatment.
Common Abbreviations:
  • Rx - Prescription
  • Tx - Treatment
  • Dx - Diagnosis
  • PMHx - Past Medical History
  • BID - Bi Daily (two times a day)
  • PRN - As Needed
  • THR - Total Hip Replacement
  • c/o - Complaint
  • WBAT - Weight Bearing As Tolerated
  • WOD - Workout of the Day
  • AMRAP - As Many Reps As Possible
  • EMOM - Every Minute On the Minute
  • PR - Personal Record
  • 1RM - 1 Rep Max
  • Wednesday, May 15, 2019

    WOD Wednesday #103

    5 2-minute rounds of: - 15-cal. row
    - Max strict weighted toes-to-bars

    Rest 2 minutes

    Men use 8-lb. ball for T2B
    Women use 4-lb. ball for T2B

    In this interval workout, you have to use a hip-opening movement to earn time to perform a hip-closing movement. A moderate amount of rest is provided, allowing you to push hard in each round. Select a number of calories that will allow you about 60-75 seconds on the bar, and select a toes-to-bar variation that will allow you to perform at least 8-10 reps per interval.

    Intermediate Option5 2-minute rounds of:
    - 12-cal. row
    - Max strict toes-to-bars
    Rest 2 minutes

    Beginner Option5 2-minute rounds of:
    - 10-cal. row
    - Max strict hanging knee raises
    Rest 2 minutes

    Tuesday, May 14, 2019

    Balance, Balance, Balance

    Stance is the position of the feet and legs in standing. Stance has a primary impact on balance, along with movement and surface. Stances that require a small base of support, e.g., tandem, split, single-leg, etc., are more challenging to balance. Conversely, stances that have wide bases (feet apart) are easier on balance. Below is list of standard stances, in order of increasing levels of difficulty:

    Normal: feet about shoulder width apart.

    Feet Together: feet are positioned near each other in narrow stance, heels may touch.

    Split Stance: feet arranged with one foot forward and one foot back.

    To make balancing easier, widen the frontal plane distance between feet. Narrow the distance to make it harder.

    Narrowing the sagittal plane distance will also help make balancing easier. Conversely, widening the distance between the feet will make it harder.

    Tandem Stance: one foot directly in front of the other, like standing on a narrow balance beam.

    Modify tandem stance to make balancing easier; place feet so inside border of heel touches inside border of toe on opposite foot.

    Single-Leg Stance: standing on one foot.

    For patients unable to stand on one foot, modify single-leg stance by resting the opposite foot on the ground, stool, or wall.

    Functional carryover of arrow stances includes improved ability to stand in confined areas, such as, spaces between furniture, stored items, walls, etc. Split stance postures are also common when reaching deep into a pantry or fridge. Additionally, steadiness in single-leg stance is helpful when stepping over a tub, up/down a curb, up/down stairs, etc.
    The next time you want to increase the level of difficulty for balance training, try a new stance. Modifying stances is a great way to fine tune intensity, helping to ensure proper training at the 20:20 ratio for steadiness and unsteadiness. Don’t be afraid to take a stance, try a new stance, or change stances on balance – your patients will thank you. Happy balancing!

    Wednesday, May 8, 2019

    Product Review: XTERRA Fitness AIR650 AirBike Pro

    Product Details:
    The XTERRA Fitness Airbike Pro offers a tremendous range of workout solutions – the unlimited range of air resistance provides low resistance at slow speeds to high resistance at fast speeds. Simply put, it increases resistance the harder you work, so it’s great for everyone.
    This modern take on a classic modality is one of the most popular full-body workouts available. The XTERRA Fitness Airbike Pro offers a tremendous range of workout solutions – the unlimited range of air resistance provides low resistance at slow speeds to high resistance at fast speeds. Simply put, it increases resistance the harder you work, so it’s great for everyone. Few other full body workouts are as low impact, easy to use, and burn so many calories in such a small compact design. Whether you are looking to rehab an injury, shake up your WOD (workout of the day), or cross-train for your next race, the XTERRA Fitness AIR650 Airbike Pro has you covered.
    • RESISTANCE: Smooth, unlimited air resistance provides low resistance at slow speeds and high resistance at fast speeds – user controlled and great for anything from rehab to high intensity interval training
    • DRIVE SYSTEM: Industrial grade chain drive system operates as a fixed gear (direct drive) and is extremely durable and reliable
    • CONSOLE: Performance monitor LCD display is easy to read with all your necessary information - RPM, Speed, Time, Distance, Calories, Watt, Interval Prompt, and Heart Rate. Chest strap transmitter (not included) is required for heart rate display to function.
    • PROGRAMS: Quick mode program buttons include Target Time, Target Distance, Target Calories, Target HR, Interval 20-10, Interval 10-20, and Interval Custom
    • SEAT: Performance designed seat enables maximum exercise mobility while still providing support and comfort
    • HANDLEBARS: Ergonomic handlebars are designed with multiple padded grip options and are built to take the most intense upper body workouts
    • PEDALS: Wide, low profile pedals are anti-skid with dual sided molded pegs for an excellent grip
    • FOOT PEGS: Large foot pegs are knurled for better grip, allows user to rest their feet during targeted upper-body workouts
    • ADJUSTABILITY: Seat is fully adjustable (up/down/forward/back) to provide users with a proper fit
    • FAN: 9 heavy duty steel fan blades are completely enclosed in a 27” wire steel fan housing – added benefit is the fan keeps you cool during workouts
    • FRAME: Heavy-duty steel frame is extremely stable and backed by our lifetime warranty
    • POWER: No external plug-in required, console uses 4 AA batteries (included)
    • STORAGE: Large transport wheels allow for easy transport to any room in the house
    Product Review:
    Finally, a heavy-duty exercise bike designed directly for the use of athletes to rehab patients and everyone in between. The Xterra Fitness AirBike Pro reinvents and retools nearly every component of the traditional fan bike, from the frame construction to the crank, pedals, monitor and more.
    The great thing about the Xterra Fitness Air Bike is that it can work for a beginner, a rehabbing athlete, or a seasoned pro training at the highest levels of competition—no matter their sport, body type, or ambition. While fanbikes have existed for nearly half a century, modern advances in their design and function have made them increasingly in-demand among military personnel, pro and college sports teams, competitive cyclists and sprinters, and high performance athletes from the cross-training ranks. The key: you set your own pace. The resistance adapts to your own output, and the bike’s multiple, custom seat adjustments make for a more comfortable, customized ride.
    This bike has become an essential part of my daily routine. I've actually been using fan bikes for almost two years at my local CrossFit gym and fell in love with it there. Now I have one of my own so I can use it when I want, which is just about every day.

    There's nothing quite like it. Resistance increases the faster you pedal. There is no coasting. It's a workout from the first pedal to the last. And it's super simple. Some might be put off because of this. The monitor is an upgrade over the competition with all the the important information you need to monitor your work...time, calories, MPH, watts (watts are what you should be watching's the best indicator of how much work you're actually doing).

    It also has several simple programs built in including interval training, distance, calories, and heart rate. I like the interval programs. Research shows interval training is the best for your overall well being. I've taken to doing the 10-20 (that's 10 seconds work hard and 20 seconds rest) in the morning. You go through it 8 times which is a total of 4 minutes. I burn about 50 calories in that 4 minutes and I really feel it when I'm done. If you do interval training right and push as hard as you can during the intervals, you will get to that "breathless" state where the magic happens.

    In the physical therapy world, Dual Action Air Bikes are simply smart. Wind resistance is exponential, so the harder you pedal, or push/ pull your arms, the higher the resistance becomes. This naturally provides the right workout for both a novice exerciser and an elite athlete.  You will find the bike in heart centers, physical therapies, Cross Fit gyms, NFL training rooms, and millions of homes throughout the world.
    The bike was super easy to put together. I followed along with the directions that were included  and it probably took me all of 20 minutes. There are actually very few parts for you to assemble, and it's super helpful that all the screws are already in the holes that you'll tighten them in.

    Main Points to Consider:
    -   Effective for Any Ability
    Xterra Fitness Air Bikes resistance is controlled by the user, not the machine. You can control the intensity of your workout - The harder you push, pull and pedal, the more air you're moving and the greater the resistance. Cool-down and lower your heart rate by easing the intensity of your push, pull, and pedal stroke in order to decrease the resistance and amount of air moving.
    -  Full-Body Workout
    Pushing, Pulling, and Pedaling can all be done with a Xterra Air Bike. This activates muscles in your arms, chest, back, legs, and even your core for washboard abs! Quickly burn calories with a full-body workout where you control the intensity of your exercise regimen!
    -  Comfortable and adjusts to fit various heights
    The adjustable seat allows you to adjust the seat up/down, and forward/back. Simply loosen the pop-pin and pull out to adjust the vertical distance from seat to pedal. Next, loosen the seat lever to slide the seat closer or further away from the handlebars!
    -  Easy Transport and Storage
    Simply tilt the AIR650 forward and roll away using the 2 over-sized wheels from the front stabilizer
    -  Built to Last, COMMERCIAL GRADE!
    More robust than competitor Bikes and uses more durable moving parts. Xterra Fitness Air Bikes utilize the best technology in exercise bikes for a heavy-duty piece of equipment built to withstand anything you can throw at it!

    -  Easily Measure Performance and Progress
    Competition Ready: The Xterra Fitness Air Bike comes everything you're accustomed to and more! The console measures distance, watts, speed, and calories. The Large Console Display gives users an easy way to measure performance and track progress.  Everything you need in one, easy-to-read console with the ability to setup Interval Training, Target Training, Heart-Rate Training, and more. Polar-Heart Rate Chest Belts are compatible.

    The console also allows for switching between units of measurement: Meters or Miles and measures to the tenth of a Calorie so you know your exact progress. Our console is easier to use and more accurately reads changes in speed. We've also included the ability to SET or TARGET distance, calories, and time while the console counts down from your targeted goal so you know just how much longer to work for.

    -  How does it compare to other Air Bikes?
    The Xterra Fitness AIR650 Air Bike features increased durability by using higher quality parts throughout the frame. We've reinforced weak points of other air bike models to create the most durable and robust bike on the market. The frame weighs more than comparable models which leads to more stability.

    Purchase your XTERRA Fitness AIR650 HERE

    Monday, May 6, 2019

    Ached by Lower Back Pain? Stand up Straighter with Physical Therapy

    Lower back pain is a sensation all too familiar to millions of people. This ache can hinder many aspects of your life: working, spending time with friends and family, partaking in the activities you enjoy, and even just relaxing. The World Health Organization estimates that in the United States, 149 million days of work are lost due to low back pain. It is the leading cause of inactivity among adults, and it can result in other health issues if left untreated. It is also extremely common, appearing in 60-70% of people across industrialized nations.
    If lower back pain is plaguing your everyday life, it is important that you find relief as soon as you can. For more information on how we can help get you back to a pain-free life, call our office today.
    How can physical therapy help?
    Physical therapists focus specifically on pain and injury to help their patients regain function, comfort, and mobility. Physical therapy treatments are used to alleviate pain, promote healing, and bring restored function and movement to the painful area. When you come in for a consultation, your physical therapist will provide you with an extensive evaluation, discovering what form of treatment will be best for whatever orthopedic, neurologic, or cardiovascular condition you are facing.
    Physical therapy also consists of two categorized types of treatments: passive physical therapy and active physical therapy:
    Passive physical therapy
    The purpose of passive physical therapy is to help pain become more manageable, and hopefully to alleviate it altogether. Lower back pain can be a debilitating condition, impeding your physical abilities. Because of this, physical therapists work hard to reduce pain as much as possible. Passive physical therapy can include any combination of these specialty treatments, as deemed fit by your physical therapist:
    • Massage
    • Manual therapies
    • Hydrotherapy
    • Ultrasound
    • Dry needling
    • Heat/ice packs
    • Iontophoresis
    Some of these methods are used to reduce pain and swelling, such as heat/ice packs and massage therapy. Electrical stimulation, while it sounds intimidating, is a painless treatment that delivers minuscule waves of electricity throughout your nervous system. This also helps with pain relief, and it can also help in decreasing muscle spasms, as well as encouraging your body to produce pain-relieving hormones. Hydrotherapy is an aquatic-based treatment, in which patients will perform low-intensity movements in water, thus relieving any muscle pressure they may be experiencing and allowing their joints to move freely and comfortably. These techniques are more commonly used for the treatment of lower back pain than others, although any could be prescribed based on your physical therapist’s discretion.
    Active physical therapy
    The purpose of active physical therapy is to provide exercises that the patient can do on their own in the later stages of their physical therapy treatment. Once your lower back pain has subsided enough that your physical therapist believes you are ready for active physical therapy, he or she will set up and exercise schedule specific to your needs. This can include any combination of stretching, strength training, and stability training, and it is all geared toward helping you gain back your flexibility, range of motion, and muscle strength. These exercises will help provide support to the painful area and will guide you further in your recovery process.
    What will my visits look like?
    At your initial consultation, your physical therapist will ask you several questions regarding your medical history, lifestyle, and painful area(s). This information will assist your physical therapist in creating the best treatment plan for you and your specific needs, so you can be provided with long-term results.
    After your consultation, your evaluation process will begin. Your physical therapist will examine you by assessing your posture, coordination, strength, balance, flexibility, blood pressure, and/or heart rate, depending on your pain and symptoms. This evaluation will be both manual and visual.
    When you’ve completed your thorough evaluation, your physical therapist will then create your treatment plan, beginning with passive physical therapy and leading into active physical therapy. You may also be given exercises to do at home, during your time away from treatments. This is all done in order to reduce pain, avoid further injury, and provide you with the quickest recovery time possible