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Every year, 17% of women and 14% of men present themselves to a doctor or family practitioner looking for relief from headaches.  Practitioners seeking to offer maximum, long-term relief to their patients can include headache treatment intervention strategies by referring a patient to a physical therapist.  A skilled physical therapist can provide an assessment of the patient’s condition and develop a plan of care.  An assessment will typically consist of posture evaluation, range of motion evaluation of the spine, jaw and shoulders and a neurologic exam.

The next component will consist of the physical therapist performing a manual examination.  This will consist of palpating muscles during passive movement to identify abnormal patterns of movement or “snags & nags”.  This manual examination by the physical therapist can also identify hypermobility indicating over-stretched muscles, weakness, and/or damaged connective tissues.  Palpation can also serve to assess trigger points, muscle spasms and hypertonicity.  Some other tests that the physical therapist may perform include orthopedic tests.  These specialized tests are used to assess referred pain and to isolate problematic joints, nerve roots and dysfunctional muscle patterns.

Once the physical therapist has ruled out diseases such as vascular disorders, infection, metabolic disorders or substance abuse, the remaining cases often present with a biomechanical component.  Various studies have demonstrated that biomechanical lesions of the cervical spine and/or shoulder can result in referred pain subjectively experienced in the anterior or posterior cranial muscles.  In addition, doctors have connected myofascial conditions of the head, neck and shoulders such as triggerpoints, hypertonicity, and spasms with stress headaches, cluster headaches and migraines.  Under chronic stress and/or poor posture, muscles can become adaptively shortened or lengthened and predispose patients for recurring headaches.  Studies have repeatedly demonstrated that physical therapy effectively manages certain types of headaches.  The positive results and outcome provided by a physical therapist usually last long after therapy and/or when medication has been discontinued.

The indications for referral to a physical therapist:

Headache pain not responsive to medical management.

Trigger points in the cervical, cranial, or shoulder muscles.

Spasm or hypertonicity in muscles of the head, neck or shoulders.

Reduced active range of motion in the cervical spine, shoulders or jaw (TMJ).

Complaints of myofascial pain associated with headaches.  (In some cases, the myofascial discomfort is secondary to a migraine.  Even in these case, a physical therapist can help because the myofascial dysfunction can cyclically worsen the migraine).

Poor posture (especially rounded shoulders, anterior head carriage, and slouch).

Pain described as a tight band around the head.

A history of neck trauma such as whiplash.

Headaches brought on by movement.

Headaches worsened by movement.

Radicular arm pain.

Conclusion:

If you are experiencing chronic headaches or muscle tension consult your primary health care provider.  Seek out a physical therapist who specializes in the use of manual therapy techniques for evaluation and therapeutic intervention.  Consider daily walking and enrolling in progressive swimming 1-2 times per week.  Most physical therapists will be able to resolve your headaches utilizing, targeted progressive exercises (strengthening & stretching), mobilization, manipulation and/or cervical traction.  The use of postural re-education, frequency specific microcurrent or electrical stimulation can also be extremely beneficial.  The use of breathing exercises for pain/stress management may also be included.  A home exercise plan and independent pain management program will also be included.  The use of ergonomic teaching will also be incorporated for work place strategies.  Finally there may be therapeutic equipment recommendations such as cervical pillows, resistance exercise bands and home traction devices.

Gary J. Maguire, PT

Physical Therapist

” I have never taken any exercise, except sleeping and resting, and I never intend to take any.  Exercise is loathsome.  And it cannot be any benefit when you are tired; and I was always tired.”

Mark Twain, in seventieth Birthday Address given in New York, December 5, 1905

Our times have changed since Mark Twain spoke so disparagingly of exercise.  Public awareness of the benefits of exercise is now commonplace.  The modern debates on fitness are no longer over whether or not you should exercise.  They are about how we should go about it.  We have the StairMaster, Total Gym  Suzanne Summer’s Thigh Master, Tony and his Gazelle, PX90, aerobics and most recently the evolution of the Elliptical. Today’s fitness seeker is bombarded with frequently conflicting views on exercise.  There are many approaches to exercise and a spectrum of paraphernalia to select from.  Just finding out how to exercise can be a chore in itself.  It shouldn’t be such a burden.  The basic principles of exercise are so simple that they should be obvious.

To begin with, consider that no two individuals, not even identical twins are exactly alike.  We have our own DNA, references and personalities.  This leads to the first obvious principle of exercise.

FITNESS IS INDIVIDUAL

When making this observation, a form of exercise works for another person but it may not work for you.  Our needs differ, as our background, socioeconomic factors, state of health, age and our gender.  We also have differing heredity, psychological make-up, interests or motivation.  Our body types also vary, creating different exercise tolerances and capabilities.  With so many differing needs, no single exercise can possibly meet everyone’s individual requirements or satisfaction.  When we look at running or jogging, for example, these activities are widely popular and are touted as the ideal exercise.  City parks, streets, and health clubs are alive with joggers and runners.  Some Marathons draw upwards of 18,000 runners.  We have 5K and 10K runs as well as runs for charity causes.  World records for running also continue to fall as athletes continue to push further into the barriers.

Are the benefits of running or jogging ideal?

While running and jogging are excellent cardiovascular exercises and build endurance which is a component of overall fitness, running or jogging is not a universal exercise.  These activities contribute little to muscular strength and may actually undermine it.  Excessive running or jogging can lead to a wide variety of musculoskeletal injuries (e.g. Plantar Fasciitis,  Achilles tendonitis, bone spurs, etc).  Running can also work against the joint and limb suppleness needed for other activities.

Weight training instead?

Weight training with all its equipment variations, shiny chrome exercise machines, Kettle balls, resistance bands, free weight, exercise balls, etc build muscular strength but do little to benefit the internal organs functions which are so vital to overall fitness.  None of these traditional forms of exercise is perfect and non are completely wrong.  What is best is to find the exercise that suits you and do just that.

Nature provides no shortcuts for exercise.

To become physically fit or maintain your current fitness, you must exercise.  For every one week of rest from an exercise program you lose four weeks of accomplished training.  The benefits you reap are determined by the type and amount of exercise you perform.  To keep is simple, you gain what you train for.  For most of us, these aspects of exercise and how we pursue it, how much time spent on exercising and the intensity, imposes real-time limits.  While often providing health care as a physical therapist I hear “There’s no place nearby to do it,” or “I don’t have the time for exercise”, which are common excuses, they are often legitimate.

While we live in a hurried lifestyle with work, commuting, raising children, etc there often is little time for anything else.  Busy students also fall prey to the same time crunch.  Time is often in short supply.  As a result exercise needs to be efficient.  It should provide maximum benefit for a minimum time investment.  All other factors such as intensity, duration and frequency will fall automatically into place if it is efficient.

To conclude, find an exercise that is ideal for you and approach it with efficiency.  Your most important investment is yourself.  In investing, you should be guided by your own personal requirements and not what others are pursuing with their exercise needs.  On today’s scene, ideals range from anorexic high-fashion models to the sharply defined shapes of bodybuilders or athletes of both sexes.  There is no one perfect form.  So the goal of true fitness is a personal one.

 

 

 

 

 

The jaw consists of the temporal bones of the skull and the hanging hinge bone called the mandible. They form two joints, one on each side of the face. Together they are known as the tempomandibular joint, or TMJ. The jaw initially
opens like a hinge and then slides forward like a sliding drawer. Within each joint is a little disc pad called a meniscus. Muscles work to open and close the jaw. Muscle tension, disc problems, poor posture or other dental problems can
create upper jaw pain while eating.
How the Jaw Works

When you bite down hard, force is placed on the object between your teeth and on the temporomandibular joint. The mechanical mechanism in the jaw is the lever and the TMJ is the fulcrum. More force is applied per square foot to the
joint surface than to whatever is between your teeth because the cartilage between the bones provides a smooth surface. This allows the joint to freely slide with minimal friction, according to The American Academy of Otolaryngology, Head and Neck Surgery.
Temporomandibular Joint Disorder

Temporomandibular joint disorder, or TMD, consists of a variety of conditions that affect jaw muscles, temporomandibular joints and nerves associated with facial pain. Symptoms may occur on one or both sides of the face, head or jaw, or develop after an injury. TMD affects more than twice as many women than men, according to the Academy of General Dentistry. Clenching or grinding your teeth, known as bruxism, can also lead to TMD.
Causes of TMD
Jaw pain can result from a variety of causes. It may occur locally within the TMJ, in the disc pad located within the joint capsule or in the ear. Pain from muscle spasms or soft tissue structures is also a source. The muscles of the jaw consist of the massater, temporalis or internal and external pterygoid. These can become out of balance and cause misalignment of the jaw. Other muscle imbalances in the neck and shoulders from poor posture can also affect the jaw.
Control of Jaw Muscles
Control your jaw muscles to reduce irritation on your teeth and joints. Start with your lips closed, teeth slightly apart and your tongue resting lightly on the hard pallet behind the front of your teeth. Breath gently in and out through your nose. Try opening and closing your mouth slowly with your tongue on the roof of your mouth. If your jaw deviates, gently use your fingers to guide it in a straight opening and closing movement. Use a mirror for monitoring.
Prevention/Solution
Reducing jaw pain while eating can be a simple problem occurring from posture, muscle imbalance or joint irritation. Physical therapy treatment can help to address these problems. If you have jaw problems from grinding or clenching your teeth, an oral specialist can fit you with a teeth appliance. This may not correct the problem but can reduce muscle tension and damage to your teeth. Psychological counseling may be necessary to deal with underlying stress that can create jaw irritation from clenching.

Reference

Resource
Keywords
TMJ pain, jaw pain, pain when chewing, jaw irritation, jaw problems, Gary, J., Maguire, PT, Physical Therapist, Physical, Therapist, Pain, Physical Therapy, Vancouver, WA

The following is an overview about Fibromyalgia presented by Gary Maguire, PT a
physical therapist .

Fibromyalgia Syndrome (FMS) refers to a complexity of symptoms involving diffuse musculoskeletal pain.  There are also other problems associated with Fibromyalgia such as cognitive impairment, fatigue, sleep disturbance and morning stiffness.  Unfortunately there is currently no diagnostic test for this condition.  Currently health care providers use a standard developed by the American College of Rheumatology (ACR).  Following a patient history about their onset of pain, trauma and emotional state the criteria for a diagnosis is as follows:

 

There needs to be an unexplained or spontaneous pain present for over 3 months along the spine and in all 4 quadrants of the body.  A quadrant of the body consists of dividing the body in half from head to your feet and across at the naval or waistline. A clinician then assesses if pain is present by palpation or moderate pressure over 18 designated tender point areas.  To qualify a patient as having Fibromyalgia they have to test positive for 11 out of 18 tender points.

 

The tender points are on both sides in muscles at the base of you skull or what is referred to as the occiput.  The next group is at the lower base of our neck area on both sides at the neck and shoulder line or the cervical vertebras of the 5th to 7th of the neck.  At the level of our upper shoulders over the middle of the trapezius muscles at the middle are the next two points on each side.  The shoulder blades or scapula each has a point.  This is located at the middle on the inside edge closest to the spine.  Half way from the top of the
scapula to the lower tip.

 

On our front chest on each side are the next two points. These are located where the collar bone meets the sternum at what is called the costochondral junction.
Over our elbows where the end of the humerus or upper arm bones are the next points on each side.  The point is 2 cm away from the outside tip of the bone or what is called the
epicondyle.

 

The buttock muscles or gluteals each have a point located in the middle and towards the outside.

 

Each thigh bone (femur) at the top closest to the hip or greater trochanter has a point located on the back side.

 

The last points on each side are in the back of the knee joint at the area referred to as the medial fat pads or the half way point where the knee bends.

 

When examining these tender points to assess Fibromyalgia there are limitations.  This has lead to controversy amongst the medical community surrounding the identification of FMS.  The positive outcome is the recent research into what is referred to as Central Sensitization (CS) and further understanding of pain mechanisms.

 

Further research is also providing a clearer understanding of connective tissue or fascia tissue and its relationship to the autonomic nervous system.  As musculoskeletal physiology evolves, our clinical ability to accurately identify and diagnose Fibromyalgia will greatly improve.  Recent research studies have lead to the identification of what are called myofascial trigger points or MTrPs. These trigger points or painful tissue points play a specific role in Fibromyalgia.

 

These myofascial trigger points have been identified in Fibromyalgia patients in recent clinical studies.  A myofascial trigger point is a taut band of skeletal muscle fibers that create a characteristic pain and referral pattern of symptoms when they are palpated or stimulated.

 

These trigger points can be active and painful.  They also can be quiet and do not cause any discomfort.  When active they can cause spontaneous pain locally and can also refer pain to other areas exhibiting a muscle twitch.  Then they are quiet they only become active and painful when pressure is applied to them causing pain or a tender bruising symptom.

 

One common characteristic of myofascial trigger points is the presence of spontaneous electrical activity (SEA).  This activity can be measured using medical equipment referred as an electromyography (EMG) while the muscle is at rest.

 

As a physical therapist who has successfully treated and resolved patient with Fibromyalgia one important component is to engage the patient in a progressive
swimming approach.

 

Due to over arousal of the sympathetic nervous system and its direct influence on the connective tissue and trigger point mechanisms, this approach is aimed at quieting and shutting off this over arousal or derailment of the sympathetic nervous system.

 

The sympathetic nervous system is part of our central nervous system (CNS) involved involving the autonomic nervous system.  With progressive swimming a patient can reduce the overall symptoms and with specific treatment techniques applied by a physical therapist this condition can be resolved permanently.

Gary J. Maguire, PT is a physical therapist who specializes in treating patients with chronic pain.  As a physical therapist for over 20 years I have successfully resolved chronic pain related problems utilizing neurophysiology treatment approaches.

Key Words

Gary Maguire, PT
Physical
Therapist
Gary J. Maguire, PT Physical Therapist
Vancouver,
WA
PT

The knee cap, or patella, attaches from the quadriceps muscle and has a ligament attached into the tibia bone. When the knee bends, the patella glides downward; it moves upward when the knee straightens. Patella dislocation happens when the knee cap slips sideways outside of the femur bone’s trough. Patella dislocation is often seen in women, and is very painful. It usually occurs after a sudden change in direction when your leg is planted, putting your kneecap under stress, according to MedlinePlus.

Hamstring Stretch

The hamstring muscles on the back of your thigh often shorten with sitting
activities. These muscles limit the patella from gliding through its full range
of motion. Stretch your hamstring while standing with your leg up on a chair
placed in front of you. Lean forward until you feel tension on the hamstring. Do
not bounce or force a stretch. Hold the stretch for 1 to 2 minutes to allow the
muscle to adaptively lengthen and not return to its shortened resting length.
Repeat several times per day. As a variation, lie on your back with your leg
straight up and use a towel around your foot to stretch.

Towel Roll

Roll up a towel to about to 3 to 4 inches in diameter. Sitting on the floor with your leg straight, put the towel under your knee. Squish the towel into the floor with your knee while contracting your thigh muscles. Hold as long as you can for up to 1 minute. Repeat the exercise 10 to 12 times. There should be no pain with the gliding of the patella. Slowly relax your thigh muscle.

Straight Leg Raise

Lie on the floor with your leg straight. Bend the other leg up until your foot is flat. Turn your foot out to a 45-degree angle. Raise your leg up to the level of the other leg’s knee, or 12 to 14 inches. Hold for 10 to 20 seconds, then lower your leg back to the floor as slowly as you can. Rest and repeat. Start with 10 to 12 repetitions and gradually build to 22 to 30 repetitions.

Reference

Resource

  • Children’s Hospital Boston:
    Dislocated Patella

    [http://www.childrenshospital.org/az/Site801/mainpageS801P0.html] Keywords
  • patellar tracking
  • knee cap pain
  • patellar tracking exercises
  • knee cap exercises
  • knee cap problems
  • Gary J. Maguire, PT
  • Physical Therapist
  • Physical Therapy
  • Vancouver, WA

Chosing the Right Physical Therapist to Help You with Your Rehabilitation by Gary J. Maguire, PT: Physical Therapist
It’s a physical therapy
paradox in today’s health care market due to insurance reimbursement. Over the past decade, more and more research has demonstrated how manual therapy treatment approaches performed by physical therapists enhance the outcomes for a broad range of conditions.
Physical Therapists utilize manual therapy to treat back pain, shoulder impingement syndrome (e.g. Frozen Shoulder or Rotator Cuff injuries), headaches, Carpal Tunnel Syndrome, neck pain, sports injuries, Fibromyalgia, etc. Over this same span of time, many physical therapy clinics have deemphasized manual therapies, opting to utilize profitable approaches requiring less on-on-one time.

When choosing a physical therapist for your recovery from surgery, a sports related injury or work injury determine if the physical therapist you are referred to or selecting utilizes manual therapy as part of their rehabilitation
approach.

What is Manual Therapy?

The term manual therapy performed by a physical therapist refers to a host of approaches wherin the physical therapist uses his or her hands to achieve specific motion in targeted joints and/or soft tissue to improve or restore proper biomechanical motion. A physical therapist who utilizes manual therapy also may include higher velocity thrusts for greater mobilization of a restricted joint due to scar tissue, stiffness or soft tissue restrictions.

Manual therapy also provides the benefit of stimulating mechanoreceptors which are positive nerve stimuli in the joint and assist in reducing nocioceptor information or inappropriate nerve pain stimuli. The mechanical benefits include stretching joint capsule tissue, tendons and ligaments to overcome what is termed hypomobiity (restricted motion).

In general a physical therapist uses manual therapy to focus on healing injured tissue through the effects of motion. WIth manual therapy, a physical therapist can introduce therapeutic motion to tissues or joints much faster than would be possible through voluntary motion alone.

A physical therapist who combines motion manual therapy with therapeutic exercise, functional movment and medical therapeutic equipment on a regular treatment basis will improve and increase a patient’s recovery faster than without utilizing this specialized approach.

As you select a physical therapist you should inquire about their level of specialized training and ascertain if they are a skilled manual therapist?

Physical Therapy Research &
Guidelines:

Peer review journals and current guidelines show the benefits of manual therapy performed by skilled physical therapists in the treatment of back pain, headaches, sports injuries, carpal tunnel syndrome, Fibromyalgia and more.
One study by Bang et al reported in the 2000 Journal of Orthopaedic and Sports Physical Therapy compared two treatment approaches for shoulder impingement syndrome. The first treatment approach was physical therapy directed strengthening and stretching exercises.

The second type of physical therapy provided the same exercises plus passive
joint mobilizations involving skilled manual therapy applied by a physical
therapist. While both groups showed significant improvements in only three
weeks, the group receiving manual therapy reported twice the pain decrease on a visual analog scale and more than twice the improvement on functional ability questionnaires. The researchers demonstrated that even when exercise, stretching and other voluntary movements are effective, manual therapy provided by a physical therapist can significantly shorten a patient’s recovery
time.

Another good example reported in the 1999 New England Journal of Medicine by researchers Anderson et al., concluded that there was more effectiveness of adding manual therapy to reduce a patient’s low back pain. In the study, group one received a standard therapy approach including anti-inflammatory medications, muscle relaxants, ultrasound, heat & cold packs, and electrical stimulation provided by a physcical therapist.

In the second group, patients received the same treatment for low back pain and also received manual therapy techniques provided by a physical therapist. Both groups showed improvement in a reduction of pain, but the patients receiving manual therapy from the physical therapist had less than half the need for pain medication and 75% less muscle relaxant usage.

This study demonstrated that manual therapy provied by a qualified physical therapist can positively affect treatment outcomes even when added to a treatment plan including pharmacological therapies and therapeutic modalities.

In conclusion, when selecting a physical therapist to assist you with recovering from an injury determine their level of clincial expertise and if they have specialized training in manual therapy and the amount of time allowed for its use in your physical therapy appointment.

Gary J. Maguire, PT

Key Words:

Gary J. Maguire, PT, Physical Therapist, Vancouver,
WA, Pain, Manual Therapy, Low Back Pain, Fibromyalgia, Sports, Medicine,
Physical, Therapist, stretching,Chosing the Right Physical Therapist to Help You
with Your Rehabilitation by Gary J. Maguire, PT: Physical Therapist

Welcome to WordPress.com. This is your first post. Edit or delete it and start blogging!

>

It’s a physical therapy paradox in today’s health care market due to insurance reimbursement. Over the past decade, more and more research has demonstrated how manual therapy treatment approaches performed by physical therapists enhance the outcomes for a broad range of conditions.
Physical Therapists utilize manual therapy to treat back pain, shoulder impingement syndrome (e.g. Frozen Shoulder or Rotator Cuff injuries), headaches, Carpal Tunnel Syndrome, neck pain, sports injuries, Fibromyalgia, etc. Over this same span of time, many physical therapy clinics have deemphasized manual therapies, opting to utilize profitable approaches requiring less on-on-one time.

When choosing a physical therapist for your recovery from surgery, a sports related injury or work injury determine if the physical therapist you are referred to or selecting utilizes manual therapy as part of their rehabilitation approach.

What is Manual Therapy?

The term manual therapy performed by a physical therapist refers to a host of approaches wherin the physical therapist uses his or her hands to achieve specific motion in targeted joints and/or soft tissue to improve or restore proper biomechanical motion. A physical therapist who utilizes manual therapy also may include higher velocity thrusts for greater mobilization of a restricted joint due to scar tissue, stiffness or soft tissue restrictions.

Manual therapy also provides the benefit of stimulating mechanoreceptors which are positive nerve stimuli in the joint and assist in reducing nocioceptor information or inappropriate nerve pain stimuli. The mechanical benefits include stretching joint capsule tissue, tendons and ligaments to overcome what is termed hypomobiity (restricted motion).

In general a physical therapist uses manual therapy to focus on healing injured tissue through the effects of motion. WIth manual therapy, a physical therapist can introduce therapeutic motion to tissues or joints much faster than would be possible through voluntary motion alone.

A physical therapist who combines motion manual therapy with therapeutic exercise, functional movment and medical therapeutic equipment on a regular treatment basis will improve and increase a patient’s recovery faster than without utilizing this specialized approach.

As you select a physical therapist you should inquire about their level of specialized training and ascertain if they are a skilled manual therapist?

Physical Therapy Research & Guidelines:

Peer review journals and current guidelines show the benefits of manual therapy performed by skilled physical therapists in the treatment of back pain, headaches, sports injuries, carpal tunnel syndrome, Fibromyalgia and more.
One study by Bang et al reported in the 2000 Journal of Orthopaedic and Sports Physical Therapy compared two treatment approaches for shoulder impingement syndrome. The first treatment approach was physical therapy directed strengthening and stretching exercises. The second type of physical therapy provided the same exercises plus passive joint mobilizations involving skilled manual therapy applied by a physical therapist. While both groups showed significant improvements in only three weeks, the group receiving manual therapy reported twice the pain decrease on a visual analog scale and more than twice the improvement on functional ability questionnaires. The researchers demonstrated that even when exercise, stretching and other voluntary movements are effective, manual therapy provided by a physical therapist can significantly shorten a patient’s recovery time.

Another good example reported in the 1999 New England Journal of Medicine by researchers Anderson et al., concluded that there was more effectiveness of adding manual therapy to reduce a patient’s low back pain. In the study, group one received a standard therapy approach including anti-inflammatory medications, muscle relaxants, ultrasound, heat & cold packs, and electrical stimulation provided by a physcical therapist.

In the second group, patients received the same treatment for low back pain and also received manual therapy techniques provided by a physical therapist. Both groups showed improvement in a reduction of pain, but the patients receiving manual therapy from the physical therapist had less than half the need for pain medication and 75% less muscle relaxant usage.

This study demonstrated that manual therapy provied by a qualified physical therapist can positively affect treatment outcomes even when added to a treatment plan including pharmacological therapies and therapeutic modalities.
In conclusion, when selecting a physical therapist to assist you with recovering from an injury determine their level of clincial expertise and if they have specialized training in manual therapy and the amount of time allowed for its use in your physical therapy appointment.

Gary Maguire, PT

Key Words:

Gary J. Maguire, PT, Physical Therapist, Vancouver, WA, Pain, Manual Therapy, Low Back Pain, Fibromyalgia, Sports, Medicine, Physical, Therapist, stretching,Chosing the Right Physical Therapist to Help You with Your Rehabilitation by Gary J. Maguire, PT: Physical Therapist

>Exercises to Prevent Knee Cap Dislocation
Gary J. Maguire, PT

The knee cap, or patella, attaches from the quadriceps muscle and has a ligament attached into the tibia bone. When the knee bends, the patella glides downward; it moves upward when the knee straightens. Patella dislocation happens when the knee cap slips sideways outside of the femur bone’s trough. Patella dislocation is often seen in women, and is very painful. It usually occurs after a sudden change in direction when your leg is planted, putting your kneecap under stress, according to MedlinePlus.

Hamstring Stretch
The hamstring muscles on the back of your thigh often shorten with sitting activities. These muscles limit the patella from gliding through its full range of motion. Stretch your hamstring while standing with your leg up on a chair placed in front of you. Lean forward until you feel tension on the hamstring. Do not bounce or force a stretch. Hold the stretch for 1 to 2 minutes to allow the muscle to adaptively lengthen and not return to its shortened resting length. Repeat several times per day. As a variation, lie on your back with your leg straight up and use a towel around your foot to stretch.
Towel Roll
Roll up a towel to about to 3 to 4 inches in diameter. Sitting on the floor with your leg straight, put the towel under your knee. Squish the towel into the floor with your knee while contracting your thigh muscles. Hold as long as you can for up to 1 minute. Repeat the exercise 10 to 12 times. There should be no pain with the gliding of the patella. Slowly relax your thigh muscle.
Straight Leg Raise
Lie on the floor with your leg straight. Bend the other leg up until your foot is flat. Turn your foot out to a 45-degree angle. Raise your leg up to the level of the other leg’s knee, or 12 to 14 inches. Hold for 10 to 20 seconds, then lower your leg back to the floor as slowly as you can. Rest and repeat. Start with 10 to 12 repetitions and gradually build to 22 to 30 repetitions.
 
Reference
Resource
Keywords
  • patellar tracking
  • knee cap pain
  • patellar tracking exercises
  • knee cap exercises
  • knee cap problems
  • Gary J. Maguire, PT
  • Physical Therapist
  • Physical Therapy
  • Vancouver, WA

>It’s a physical therapy paradox in today’s health care market due to insurance reimbursement. Over the past decade, more and more research has demonstrated how manual therapy treatment approaches performed by physical therapists enhance the outcomes for a broad range of conditions.

Physical Therapists utilize manual therapy to treat back pain, shoulder impingement syndrome (e.g. Frozen Shoulder or Rotator Cuff injuries), headaches, Carpal Tunnel Syndrome, neck pain, sports injuries, Fibromyalgia, etc. Over this same span of time, many physical therapy clinics have deemphasized manual therapies, opting to utilize profitable approaches requiring less on-on-one time.

When choosing a physical therapist for your recovery from surgery, a sports related injury or work injury determine if the physical therapist you are referred to or selecting utilizes manual therapy as part of their rehabilitation approach.

What is Manual Therapy?

The term manual therapy performed by a physical therapist refers to a host of approaches wherin the physical therapist uses his or her hands to achieve specific motion in targeted joints and/or soft tissue to improve or restore proper biomechanical motion. A physical therapist who utilizes manual therapy also may include higher velocity thrusts for greater mobilization of a restricted joint due to scar tissue, stiffness or soft tissue restrictions.

Manual therapy also provides the benefit of stimulating mechanoreceptors which are positive nerve stimuli in the joint and assist in reducing nocioceptor information or inappropriate nerve pain stimuli. The mechanical benefits include stretching joint capsule tissue, tendons and ligaments to overcome what is termed hypomobiity (restricted motion).
In general a physical therapist uses manual therapy to focus on healing injured tissue through the effects of motion. WIth manual therapy, a physical therapist can introduce therapeutic motion to tissues or joints much faster than would be possible through voluntary motion alone.

A physical therapist who combines motion manual therapy with therapeutic exercise, functional movment and medical therapeutic equipment on a regular treatment basis will improve and increase a patient’s recovery faster than without utilizing this specialized approach.

As you select a physical therapist you should inquire about their level of specialized training and ascertain if they are a skilled manual therapist?

Physical Therapy Research & Guidelines:

Peer review journals and current guidelines show the benefits of manual therapy performed by skilled physical therapists in the treatment of back pain, headaches, sports injuries, carpal tunnel syndrome, Fibromyalgia and more.
One study by Bang et al reported in the 2000 Journal of Orthopaedic and Sports Physical Therapy compared two treatment approaches for shoulder impingement syndrome. The first treatment approach was physical therapy directed strengthening and stretching exercises. The second type of physical therapy provided the same exercises plus passive joint mobilizations involving skilled manual therapy applied by a physical therapist. While both groups showed significant improvements in only three weeks, the group receiving manual therapy reported twice the pain decrease on a visual analog scale and more than twice the improvement on functional ability questionnaires. The researchers demonstrated that even when exercise, stretching and other voluntary movements are effective, manual therapy provided by a physical therapist can significantly shorten a patient’s recovery time.

Another good example reported in the 1999 New England Journal of Medicine by researchers Anderson et al., concluded that there was more effectiveness of adding manual therapy to reduce a patient’s low back pain. In the study, group one received a standard therapy approach including anti-inflammatory medications, muscle relaxants, ultrasound, heat & cold packs, and electrical stimulation provided by a physcical therapist.

In the second group, patients received the same treatment for low back pain and also received manual therapy techniques provided by a physical therapist. Both groups showed improvement in a reduction of pain, but the patients receiving manual therapy from the physical therapist had less than half the need for pain medication and 75% less muscle relaxant usage.
This study demonstrated that manual therapy provied by a qualified physical therapist can positively affect treatment outcomes even when added to a treatment plan including pharmacological therapies and therapeutic modalities.

In conclusion, when selecting a physical therapist to assist you with recovering from an injury determine their level of clincial expertise and if they have specialized training in manual therapy and the amount of time allowed for its use in your physical therapy appointment.

Gary Maguire, PT

Key words:
gary maguire, pt, physical therapy, physical therapist, manual therapy, low back pain, motor vehicle accident injuries, work-related injury, Fibromyalgia, Myofascial Pain Syndrome, Carpal Tunnel Syndrome, Sports Injuries, ACL, Rotator Cuff, Frozen Shoulder, Knee Pain, Ankle Sprains, Tendonitis, Tendinitis, neck pain, headaches, http://garymaguiremspt.blogspot.com/ , Vancouver, WA, physical, therapist

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