Movement Dysfunction

 

SI Joint Dysfunction… Under or Over Diagnosed?

Post by Maggie Gebhardt PT, DPT, OCS A patient of mine recently forwarded me this article. I found it interesting because as a Physical Therapist, we are told more often than not that the SI joint is overly diagnosed by us PTs. So after reading this article I was wondering…which is it? If doctors are not diagnosing it enough and PTs are diagnosing it too much, what’s the problem? Where is the disconnect? I think the happy medium is that with a thorough examination and evaluation both the SI joint and lumbar spine should be screened for possible involvement. Oftentimes I have found with my own patients that it is not nearly as black and white as we clinicians want it…

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Exercises To Prevent Lower Back Pain

What Exercises for My Core Can Help Prevent Lower Back Pain? Brian Yee PT, MPhty, OCS, FAAOMPT First – generally there are different roles of muscles in your trunk. Typically the smaller ones closest to your spine are considered ‘local’ muscles. Such muscles as the transversus abdominis, diaphragm, pelvic floor, and lumbar multifidus provide segmental control of your lumbar vertebra. Real-time ultrasound imaging can be used to visualize the proper contraction of these muscles as we cannot see these muscles from the superficial skin. So first step in core stability is to ensure that the smaller muscles are engaging properly. Then you have ‘global’ muscles which are the larger muscles – such as rectus abdominis, obliques, paraspinal muscles. These muscles…

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What Can I Do to Prevent an ACL Injury?

Brian Yee PT, MPhty, OCS, FAAOMPT An ACL injury is usually due to the knee going into excessive valgus (knee turning inwards) and/or some type of rotary /pivot force. Many people focus on training the musculature around the knee such as the quad and hamstrings. This does help, but one must also consider the stability of the joints above and below – which would be the hips and ankle/foot complex.The knee can be viewed as a junction between two different stilts. If the hip is not stable or has excessive mobility, or the foot / ankle is not supportive such as excessive flat feet or stiff ankles from an old ankle sprain – it can place excessive valgus force at…

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What Can I Do For Plantar Fasciitis?

Brian Yee PT, MPhty, OCS, FAAOMPT Pain in the arch or heel of your foot is commonly diagnosed as ‘plantar fasciitis’. However, there are several reasons that can cause pain at the bottom of the foot. Plantar fasciitis: Usually due to an over-stretched arch. Treatment by taping, manual therapy, orthotics, and use of night splints can provide short-term relief. Long term prognosis is based not only treating the plantar fasciitis itself, but also restoring proper mechanics of the entire leg. Nerve Pain: The tibial nerve, which is a branch of the sciatic nerve can cause symptoms in the bottom of the foot. The key to treatment in nerve injuries is to determine why and where the injury occurred and treat…

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Play Golf? Avoid Lower Back Pain With These Stretches.

Brian Yee PT, MPhty, OCS, FAAOMPT There are numerous studies that have come out recently that show the loss of lead leg internal rotation of the hip in the golf swing has a high prevelance of low back pain in golfers. This is due to the lead leg in the golf swing acting as your swivel / finishing point in the swing. With limitations in the hip, the back has to work harder to finsh the swing.  You should work on the foam roll to loosen the lead leg hip musculature, knee to chest and pirformis stretches can also help. Standard back stretches can help alleviate your back after golf, but consider the causitive reasons why your back is hurting…

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Will I Need Physical Therapy After Hip Replacement Surgery?

Brian Yee PT, MPhty, OCS, FAAOMPT It is recommended that you work with a skilled Physical Therapist after hip replacement surgery. The Physical Therapist will coordinate with the operating surgeon to improve your hip range of motion, strength, and progress your weightbearing and walking on your hip appropriately. They will also demonstrate to you safe and proper movement with your hip with functional activities such as sitting to standing, getting in / out of cars, and progress you back to your other functional and recreational goals.   _________________________ Medical Disclaimer: Motion Stability has created and compiled the content on its websites for your information and use. This information is not intended to replace or modify the medical advice of your…

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How Does Posture Affect Back Pain?

Brian Yee PT, MPhty, OCS, FAAOMPT The way you sit and stand significantly affects your back. Especially for prolonged duration, the tissues around the spine experience what clinicians call ‘creep phenomenon’. Think of a cold piece of taffy. As you hold it, warm it up, and then hold it by its ends, it slowly stretches and lengthens. Very similarly, the tissues in the back can due the same thing. The fascia, muscles, nerve, joints all experience increased strain when the spine is statically held in one position for a long duration of time. When you then place yourself in a poorly sitting or standing posture, that then accentuates the amount of tissue loading that is placed on the spine and…

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How Can a Weak Core Lead to Back Pain?

Brian Yee PT, MPhty, OCS, FAAOMPT According to Panjabi’s model, we can view spinal stabiilty based on 3 key elements:1. Passive Structures: The spinal column itself and the ligaments, fascia and other static tissues that hold it together. 2. Active Structures: The muscles that surround the trunk and pelvis ‘actively’ contract to provide muscle support. 3. Cognitive / Motor Control: The brain has a way to coordinate how muscles will be used to anticipate how the spine is used with functional activities. The passive structures and the spine itself is limited in its ability to stabilize the spine, especially in dynamic function or prolonged positions such as standing or sitting. The brain thus needs to coordinate the proper timing of…

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How Is Rehabilitation Used to Treat Neck and Back Pain?

In Physical Therapy we treat neck and back pain by the following interventions: 1. Examination: Take a thorough subjective and physical examination to determine the causes and severity of pain. The examination helps determine what specific interventions need to be done. Each patient is unique in the medical history and interventions should also be individualized to the patient’s progress. 2. Reduce Pain: Especially in more severe pain complaints, it is important to reduce the symptoms to allow for the patient to simply feel less pain. This can include manual therapy to decrease muscle spasms, restricted joint mobility, or decrease nerve irritation. Modalities such as ultrasound, electrical stimulation and traction can also be used. 3. Restore Motion: As pain decreases, it…

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What Is The Right and Wrong Way to Bend Over?

Brian Yee PT, MPhty, OCS, FAAOMPT Proper bending requires a fluid ‘lumbopelvic rhythm’. This means the hips and spine should coordinate to be able to touch the ground. Ideally there should be a 2:1 ratio hip movement to spine movement.  What we see typically in the clinic is that patients have significant restriction of what we call ‘hip hinging’ as the patients hips have restricted motion, thus requiring increased movement from the spine..with repetitive and excessive movement at the spine it creates greater torque to the spine. The other scenario we commonly see are patients who have fear to move their spine and essentially ‘lock’ their spines in slight hyper-extension and try to bend entirely from their hips. This creates…

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Motion Stability