ML830 Cold Laser

Are you looking for an effective and alternative treatment option that can relive pain and help your body heal itself from chronic injuries?  Then you might consider low level laser therapy (LLLT) or cold laser therapy.

The application of cold laser sends light (photons) into injured tissues.  The photons emitted can penetrate two inches beneath the skin surface without being absorbed by the skin, fat or blood, thus targeting deeper tissues.  Once the photons penetrate injured tissues, they stimulate and energize the cells to repair and strengthen itself.  In short, the body converts laser light into a form of energy that it can harness for self repair and healing.

Cold laser has been used for over 40 years in other countries, and has been FDA approved in 2002 for safe use in the United States.  Cold laser has endless applications because of its approach to healing.  Its low intensity does not burn like other high powered surgical lasers.

The benefits of laser treatment are pain reduction, reducing inflammation and increasing tissue healing time.  It is effective in treating many conditions that limit people from leading healthy and active lifestyles such as Arthritis, Neck and Back Pain, Headaches, Shoulder Rotator Cuff Pain, Carpal Tunnel Syndrome, TMJ Pain, Tendonitis and Bursitis, Plantar Fasciitis, Fractures and many other conditions.

Most treatment sessions last between 15 – 30 minute intervals, and most conditions may take up to 5 – 8 treatments before significant improvement is noticed. Countless people are reaping the benefits of cold laser and eliminating their dependence on pain medication, delaying and avoiding surgery, decreasing and eliminating pain, and returning to a healthier and active lifestyle.

Kerri Walsh- 2008 Olympic Beach Volleyball

The exciting thing about the practice of manual therapy, is the ability to incorporate other treatment techniques to restore pain free movement.   If you watched the 2008 Olympics in Beijing China, chances are that you noticed the intricate patterns of taping that adorned some of the athletes, especially the volleyball players.  The taping technique used is unique, in that it allows one to remain active with a muscle injury.

The taping technique used is known as Kinesiotaping, and is used as an adjunct to treat injured muscles and joints by enhancing the body’s own natural healing process through the activation of its neurological and circulatory systems.  Unlike athletic taping where a joint is immobilized and activity limited, Kinesiotaping allows for freedom of movement during the healing phase, making it a very favorable intervention.

This taping method was developed in Japan 25years ago by Dr. Kenzo Kase.  The goal of Kinesiotaping is to support injured muscles, correct joint problems, improve circulation and activate the analgesic system of the body.  Next time you have a muscle injury that results in pain with activity, ask your therapist whether you can benefit from Kinesiotaping to reduce your pain and promote healing and restore function.  Remember, Kinesiotaping works.

Hasheem Thabeet- 2009 Junior UCONN Basketball

AAOMPT Executive Committee Position Statement:

It is the Position of the AAOMPT Executive Committee that dry needling is within the scope of physical therapist practice.

Support Statement:

Dry needling is a neurophysiological evidence-based treatment technique that requires effective manual assessment of the neuromuscular system.  Physical therapists are well trained to utilize dry needling in conjunction with manual physical therapy interventions.  Research supports that dry needling improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor endplates, and facilitates an accelerated return to active rehabilitation.

This has been approved as an official position of the AAOMPT Executive Committee.  In October at the AAOMPT Annual Conference in Washington, DC the AAOMPT Membership will have the opportunity to determine if this should be accepted as a Position of the AAOMPT Membership.  As an FYI, this process is very similar to how the APTA process works wherein, there are official positions of the APTA Board and official positions of the Association that come from the APTA House of Delegates.  In some cases the APTA Board will pass a position statement and in time the House of Delegates may pass the same or similar position statement.

Symptomatic lumbar degenerative disc disease develops when a disc weakens (often due to repetitive strain), is injured, or deteriorates from aging. As a result, the disc is unable to hold the vertebrae as it should and the lack of stability can cause back pain.

The review details the different treatment methods for symptomatic lumbar degenerative disc disease, including physical therapy with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and concludes that, in most patients with low back pain, symptoms resolve without surgical intervention. The review also concludes that physical therapy and nonsteroidal anti-inflammatory drugs are the “cornerstones” of non-surgical treatment.

Physical therapist intervention includes strengthening of core muscle groups, including the abdominal wall and lumbar musculature, which can have positive effects in patients with this condition. According to APTA spokesperson Julie Fritz, PT, PhD, ATC, clinical outcomes research scientist at Salt Lake City’s Intermountain Healthcare and associate professor at the University of Utah, physical therapists have several treatment options that can help patients with LBP whether due to degenerative disc disease or a variety of other causes.

Exercise and manual therapy including spinal manipulation, have been shown to benefit many patients.2, 3. In addition, patient education to remain active and use appropriate body mechanics is beneficial. Physical therapists are trained to identify which of these treatment strategies will be most effective for an individual patient, which further improves the effectiveness of care.

In previous systematic reviews of the literature, it was found that exercise has been shown to improve function and decrease pain in adult patients with chronic LBP and that physical therapy was beneficial for the treatment of acute LBP.2, 3 In another systematic review, NSAIDs were found to provide LBP patients with short-term symptomatic relief.4

“Receiving care from a licensed physical therapist can further improve the odds that a patient can maintain their quality of life and avoid surgery,” said Fritz. In addition to building the core muscle groups, hands-on therapy to mobilize the spine has been shown to be particularly effective. 5, 6  “Spinal manipulation can be an important component of physical therapist treatment for low back pain. Supplementing exercise with spinal manipulation is also beneficial for many patients.”

Physical therapists can help patients develop a safe and effective exercise program that is tailored to an individual’s specific needs and goals. “Surgery should be the last option, but too often patients think of surgery as a cure all and are eager to embark on it,” said Luke Madigan, MD, an attending physician at Knoxville Orthopaedic Clinic, Knoxville, TN, and the lead author of the literature review.

Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility - in many cases without expensive surgery or the side effects of prescription medications. APTA represents more than 70,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Its purpose is to improve the health and quality of life of individuals through the advancement of physical therapist practice. In most states, patients can make an appointment directly with a physical therapist, without a physician referral. Learn more about conditions physical therapists can treat and find a physical therapist in your area at www.moveforwardpt.com.

1Andersson GB: Epidemiological features of chronic low back pain. Lancet 1999; 354:581-585.

2Hayden JA, van Tulder MW, Malmivaara A, Koes BW: Exercise therapy for the treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005;(3):CD000335.

3Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG: Spinal manipulative therapy for low back pain. Cochrane Database Syst Rev. 2004;(1):CD000447.

4vanTulder MW, Scholten RJ, Koes BW, Deyo RA: Nonsteroidal anti-inflammatory drugs for low back pain: a systematic review within the framework of the Cochrane collaboration back review group Cochrane review. Spine 2000:25:2501-2513.

5Childs JD, Fritz JM, Flynn TW, Irrgang JJ, Johnson KK, Maikowski GR, Delitto A: A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med. 2004; 141(12):920-928.

6Chou R, Huffman LH: Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline.; American Pain Society; American College of Physicians; Ann Intern Med. 2007; 147(7):492-504.

[Last updated: 02/23/09 | Contact: public-relations@apta.org]

PNF stands for Proprioceptive Neuromuscular Facilitation. It originated in the late 40’s by Dr. Kabat and Maggie Knott to provide tools to help patients gain efficient motor function (Adler 1993).  A simpler translation of PNF is the use of sensory receptors in the skin to stimulate nerves and muscles, to allow for easier and more efficient movement patterns.  PNF is a specific treatment approach used to improve movement, coordination, stability, strength, endurance and overall function.  It can be used to treat any body part from the cervical spine to the foot.

Pain is an inhibitor of effective and coordinated muscle performance and it can be a sign of potential harm (Hislop 1960, Fisher 1967).  This is always addressed during every treatment session.  During a session, a patient assumes a position that allows for the most effective movement of a specific body part.  The therapist uses manual contact to initiate and facilitate a specific movement pattern. This treatment approach requires active patient participation and involvement making it functional.  It also allows for integrative manual therapy skills to be incorporated into the treatment session.  This approach requires one on one therapist attention since it is tapered to each individual patient.

After a couple of sessions, patients see a significant improvement with postural and movement patterns needed in everyday activities.  They also develop easier and less painful movement patterns, thus allowing them to return to activities they were doing before their injury pain free.  This makes PNF a highly cost effective and efficient tool in today’s medicine, where patients are looking for ways to decrease pain and improve function in fewer treatment sessions and with the best outcomes.

Their findings about the potentially important “scaffolding” role of this poorly understood muscle has been published on line in advance of the January issue of the Journal of Bone and Joint Surgery.
“The multifidus muscle was formerly thought to be relatively unimportant based on its fairly small size,” said Richard L. Lieber, Ph.D., Professor and Vice Chair of UC San Diego’s Department of Orthopedic Surgery and Director of the National Center for Skeletal Muscle Rehabilitation Research, based at UC San Diego. Lieber is also Senior Research Career Scientist at the Veterans Affairs San Diego Health System. “Our research shows that it’s actually the strongest muscle in the back because of its unique design. It’s like a long, skinny pencil packed with millions of tiny fibers.”

The researchers discovered that the multifidus has a unique packing design consisting of short fibers arranged within rods, and that these fibers are stiffer than any other in the body. Using laser diffraction methods that they developed to measure muscle internal properties during back surgery, they demonstrated that the multifidus’ unique design serves a critical function as a stabilizer of the lumbar spine. These findings could have implications for surgery, according to Steven R. Garfin, M.D., Professor and Chair of UCSD’s Department of Orthopaedic Surgery.

“It is important to identify what each individual muscle does, and this is just a start, showing that the multifidus contributes significantly to spinal stabilization,” said Garfin. “The more we know about what muscles do, the better we can devise therapeutic interventions such as physical therapy to target specific muscles.”

Garfin explained that currently surgery to treat spinal disorders could actually disrupt the multifidus muscle, which could lead to decreased stabilization and lower back pain. Minimally invasive spine surgery techniques strive to minimize surgical trauma to these muscles in order to best preserve their function.

The lower back, or lumbar spine, can be vulnerable to many pain-causing injuries or disorders because the lumbar vertebrae carry the most body weight and are subject to the most force and stress along the spine. Muscular instability is a risk factor in many injuries and consequent chronic lower back pain, according to Lieber. “The multifidus back muscle keeps us vertical and takes pressure off the discs,” said Lieber. “When muscle function is poor due to back problems, support is lost.”

He explained that many muscles get weaker as they are extended. But the researchers discovered that, unlike all other muscles, the multifidus actually becomes stronger as it lengthens, when the spine flexes.
“The length of the sarcomere—the structure within the muscle cell where filaments overlap to produce the movements required for muscle contraction—is shorter in the multifidus than in any other muscle cell,” explained study’s first author Samuel R. Ward, P.T., Ph.D., Assistant Professor of Radiology at UC San Diego School of Medicine. “But as it gets longer, for instance as a person leans forward, the multifidus actually strengthens.”

Contributing authors to the study include UCSD researchers Choll W. Kim, M.D., Ph.D., Carolyn M. Eng, B.S., Lionel J. Gottschalk, B.S.; and Akhito Tomiya, M.D., Ph.D. Tohoku University School of Medicine, Sendai, Japan. Research was supported by the Department of Veterans Affairs Rehabilitation, Research and Development; the National Institutes of Health and DePuy Spine of Raynham, MA.
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Adapted from materials provided by University of California - San Diego, via EurekAlert!, a service of AAAS.

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A Physical Therapist’s Perspective:

This report should be of interest to any physcial therapist that treats low back conditions because it provides evidence of the role that the multifidus muscle plays in stabilization of the spine. Although, I have issue with the statement that “the multifidus muscle was formerly thought to be realtively unimportant based on it’s fairly small size”. Physical therapy researchers discovered over a decade ago the importance of the multifidus muscle in spine stability and its relation to low back pain. For this reason many physical therapists have advocated the importance of proper rehabilitation following any lumbar spine surgery that disrupts the multifidus muscle.  In addition, much of recurrent and chronic low back pain can be attributed to spinal instability. Thus, there has been much focus in the clinical field of physical therapy to perform exercises that retrain the multifidus in conjuciton with the transverse abdominus and pelvic floor muscles. To read more about the role of motor control exercises for spine related problems read this news release- Report Shows Motor Control Exercises Reduce Persistent Low Back Pain

Tamer S. Issa, PT, DPT, OCS

Tim Flynn, PT, PhD, president of the American Academy of Orthopaedic Manual Physical Therapy, expressed confidence that, “This study broadens the base and depth of evidence that manual physical therapy is the first line treatment for patients suffering from neck and arm pain.” He continued, “Year after year the physical therapy profession continues to produce high quality randomized, controlled trials that demonstrate conclusively that our profession provides better outcomes for less money, while also being substantially safer than other medical interventions. Wake up America, to a new day without pain.” If you have neck or back pain or the aches and pains of musculoskeletal problems contact your local physical therapist today.

Tallahassee, Florida, August 18, 2008 – A recent investigative report1 published in the New York Times highlights the alarming increase in methadone prescriptions for the treatment of chronic spinal pain.  The result has been a shocking increase in methadone related deaths.  Physical therapists can play a role in providing patients and physicians with an alternative to dangerous pain medications like oxycodone and methadone.

Methadone was once limited to use in addiction treatment centers to replace heroin, but today it is frequently given out by physicians to manage spine and joint pain.  The Drug Enforcement Administration noted that from 1998 to 2006, the number of methadone prescriptions increased by 700 percent.  “Many legitimate patients, following the direction of their doctor, have run into trouble with methadone, including death,” noted pain specialist Dr. Howard A. Heit from Georgetown University.  Florida alone, which keeps detailed data, listed methadone as a cause in 785 deaths in 2007, up from 367 in 2003.

“These are senseless deaths,” said Dr. Timothy Flynn of Regis University in Denver, CO, and President of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT).  “Patients should be aware that these medications are not the best option to reduce the symptoms of spinal pain. Research has shown that early movement and treatments like exercise and spinal manipulation offer strong benefits to spine pain and disability.”  “The medical management of spinal pain in this country is a failure,” continued Flynn, “we too often initiate prescription drug therapy before choosing safe and effective alternatives.”  Flynn suggests that patients seek out physical therapists as a first-line treatment for these conditions.

A February 2008 report published in the Journal of the American Medical Association reports that from 1997 to 2005, pharmaceutical expenditures for the management of low back pain increased by 171% while the rate of good outcomes fell.  “All the imaging we do, all the drug treatments, all the injections, all the operations have some benefit for some patients,” said Richard A. Deyo, a physician at Oregon Health & Science University in Portland and a coauthor of the report.  “But I think in each of those situations we’ve begun using those tests or treatments more widely than science would really support.”

For more on the benefits physical therapists can provide in the management of spinal pain, contact your nearest physical therapist or visit the American Academy of Orthopaedic Manual Physical Therapists website at www.aaompt.org.  AAOMPT represents physical therapists by promoting excellence in orthopaedic manual physical therapy practice, education and research.

Dr. Richard Deyo, MD, MPH will be the key note speaker at AAOMPT’s Annual Conference in Seattle this November.  The conference theme will focus on pain management and physical therapists’ role in this important area of care.

Tallahassee, Florida, June 23, 2008 – A recent study published in the British Medical Journal1 reports that spinal surgery for patients with sciatica offers a short term benefit, but by 6 months that benefit disappears and no difference is seen between patients who had surgery and those receiving physical therapy.  The study suggests that the benefits of surgery are only short-term and conservative treatments such as physical therapy may offer the same outcome.
Sciatica often resolves quickly, but in some patients it persists.  Previous to this study, only limited evidence existed that could guide patients about when or if that resolution was going to occur.  In this study, patients had the option of opting for early surgery, or prolonged conservative management under the guidance of a physical therapist.  The surgical group showed improvement in symptoms for only a brief period following surgery.  But, by 6 months, and up to 2 years following surgery, the difference between the groups having surgery and those that didn’t disappeared.
“The significance of this study is that patients may be able to avoid surgery if they realized they can expect a similar improvement in symptoms if they use other ways to manage the pain for 6 months,” said Dr. Timothy Flynn of Regis University in Denver, CO, and President of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT).  “Patients should be aware that surgery is not the only option to reduce the symptoms of sciatica.”
The study’s authors conclude that since the early benefits of surgery are gone by 6 months, when deciding to have surgery for sciatica, well informed patients, and not physicians, should decide if and when they opt for surgery.
The results of this study, coupled with the findings of another study published earlier this year suggest expensive treatments for low back pain may not be the best approach.   Less expensive conservative options like physical therapy may be the preferred choice for patients with low back pain.
“The best course of treatment for low back pain is to make sure it is addressed early and does not progress to leg pain, or become a chronic condition,” continued Flynn.  “Research has shown that early movement and treatments like exercise and spinal manipulation offer strong benefits to this group of patients.”
These treatments include hands-on physical therapy to mobilize the spine and exercises designed to alleviate low back pain.  Flynn suggests that patients seek out physical therapists as a first-line treatment for these conditions.