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.

Dry needling is an effective and efficient therapy method for the treatment of myofascial trigger points.  Trigger point dry needling is performed by medical doctors, physical therapists, nurses, chiropractors, and dentists that are specifically trained in the technique. The approach is based on Western anatomical and physiological principles. The technique utilizes fine solid acupuncture needles to release trigger points in muscle, but in all other aspects it is different than traditional acupuncture. Other terminology used to describe similar techniques to dry needling includes intramuscular stimulation (IMS) and twitch-obtaining intramuscular stimulation.

Dr. Janet Travell first described trigger point injections in the early 1940’s. Injections are performed by injecting trigger points primarily with saline or analgesics. Through the years it has been shown that it is not the substance that is being injected that is providing the therapeutic benefit, but rather the mechanical stimulus of the needle hitting the trigger point. When a needle tip hits a trigger point, a characteristic ‘local twitch’ is noted by the clinician and the client. This local twitch is involuntary. It has been shown that the elicitation of local twitch responses is the most important aspect in obtaining a successful therapeutic outcome for trigger point deactivation. There are a number of hypotheses as to the reasons why dry needling works. Dry needling and the subsequent local twitch responses may mechanically disrupt the contracted nature of the trigger point. Dry needling stimulates certain sensors in the body which modulate pain signals. Dry needling and the subsequent local twitch responses can cause local biochemical changes and result in an increase of blood flow in the trigger point area.

The benefits of trigger point release through dry needling include a decrease in the tightness and the pain associated with a particular muscle. Often times an immediate improvement is noted. Dry needling is tolerable for most, but not all people. A limited amount of muscle soreness is to be expected for 1-2 days, after which the soreness resolves. Dry needling is never used as an isolated treatment; it is followed by myofascial release and soft tissue work to minimize soreness and to maximize connective tissue flexibility. Other important aspects of musculoskeletal improvement of pain and function requires addressing possible contributing factors which includes the presence of joint or spinal dysfunction, postural imbalances, poor coordination of movement and poor posture and body mechanics with activities of daily living.

Not all medical professionals are trained in the assessment or treatment of myofascial trigger points. Trigger point dry needling requires highly specialized training. One must be adept at finding trigger points before one can attempt to treat them. If you have suffered of pain or tightness of muscular origin, I would urge to consider the possibility of trigger point dry needling as a treatment option. It has made a world of difference in many people’s lives.

 Tallahassee, Florida, Feb. 14, 2008 – Health care expenditures for patients with spinal conditions are rising without an associated increase in health status, according to a February, 2008 research report appearing in the Journal of the American Medical Association. The study suggests Americans may be wasting their money for treatments as the overall proportion of people with impaired function increased from 1997-2005, despite a 65% increase in expenditures to treat spine conditions. Physical therapists offering spinal manipulation, exercise, and advice can provide an effective alternative for patients with back and neck problems, often at a lower cost.

“I think the truth is we have perhaps oversold what we have to offer,” said Richard A. Deyo, a physician at Oregon Health & Science University in Portland and a coauthor of the report. “All the imaging we do, all the drug treatments, all the injections, all the operations have some benefit for some patients. But I think in each of those situations we’ve begun using those tests or treatments more widely than science would really support.”

What science does support is the effectiveness of physical therapy for affecting outcomes in patients with spinal conditions. “Research has consistently shown the value of particular physical therapy interventions for patients with back and neck problems,” said Dr. Timothy Flynn of Regis University in Denver, CO, and President of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT). “Specifically, spinal manipulation and exercise have repeatedly been shown to be effective in managing patients’ current pain and preventing future episodes.” Particularly discouraging in this recent report was an increase in pharmaceutical expenditures of 171% during the study period. This suggests that physicians are over-utilizing an ineffective treatment for spine pain. “You have drugs, you have surgery, or you have us,” explained Flynn. “The reality is that very few treatments have shown the ability to truly affect patients with spine conditions. Physical therapists can do just that.” These treatments include hands-on therapies to mobilize the spine and exercises designed to alleviate low back pain. Flynn suggests that patients should seek out physical therapists as a first-line treatment for these conditions. A separate study in 2006 demonstrated that patients with back pain were experiencing an increase in the rates of imaging and injections, meanwhile realizing a significant under-utilization of physical therapy.

For more on the benefits physical therapists can provide in the management of back and neck problems, 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.

“There are many options for evaluation and treatment of low back pain,” said Amir Qaseem, MD, PhD, MHA, senior medical associate in the American College of Physicians Department of Clinical Programs and Quality of Care, and an author of the guidelines. “We wanted to review all the evidence and develop guidance for clinicians and to give our patients a realistic sense of what they can expect when they visit a clinician for low back pain.  In particular, clinicians should consider the addition of non-pharmacological therapies with proven benefits.”
“This recommendation comes as no surprise to physical therapists,” said Dr. Timothy Flynn from Regis University, Denver, and President of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT). “Research has consistently shown the value of particular physical therapy interventions for patients with low back pain.  Specifically, spinal manipulation and exercise have repeatedly been shown to be effective in managing patients’ current pain and preventing future episodes.  We are glad to see that the American College of Physicians and the American Pain Society recommend physical therapy as a safe and effective alternative to drugs for patients with back pain.”  Physical Therapists can help patients with low back pain by performing thorough examinations and designing an evidence-based treatment program to meet their particular needs.  These treatments can include hands-on therapies to mobilize the spine and exercises designed to alleviate low back pain.
For more on the benefits that physical therapists can provide in the management of low back pain, contact your nearest physical therapist or visit the American Academy of Manual Physical Therapists website at: http://www.aaompt.org.

ALEXANDRIA, VA, September 18, 2007 — For the nearly 100 million Americans who are overweight or obese, physical activity must be a crucial component to weight loss and better health, which is the focus of October’s National Physical Therapy Month, the American Physical Therapy Association (APTA) announced today.

According to a recent study conducted by the Trust for America’s Health, a research group that focuses on disease prevention, obesity rates continued their climb in 31 states last year. Health officials say the latest state rankings provide evidence that the nation has a public health crisis on its hands. Last year, The Centers for Disease Control and Prevention cited evidence that found that more than 22 percent of Americans did not engage in any physical activity in the previous month.

A lack of exercise is a major contributing factor to obesity rates. “People who are overweight or obese must follow an appropriate exercise program that includes aerobic conditioning and avoids exercise that can lead to injury,” notes Terry Michel, PT, DPT, DSc, CCS, a physical therapist at Boston’s Mass General Hospital. “Physical therapists will typically recommend a low-impact form of weight training, such as exercise bands that help avoid excessive joint stress, and modified yoga stretches and Tai Chi for promoting flexibility and relaxation,” she adds.

Physical therapists develop fitness plans for both adults and children that promote the ability to move, reduce pain, restore function, and prevent disability. For those who are overweight or obese, physical therapists balance the progression of the exercise prescription with the need for joint protection and safety during exercise.

“We are no longer looking at just adults who have diseases resulting from obesity,” says physical therapist Susan S Deusinger, PhD, professor and director of the Program in Physical Therapy at Washington University School of Medicine. “Rather, physical therapists need to regard obesity as a primary concern for intervention,” she adds. Previous research** conducted by Dr Deusinger confirmed recent rising health concerns on college campuses. Her study of 300 undergrads at Washington University in St Louis found that 70 percent of the students had gained an average of 9 pounds between their freshman and sophomore years, and most were still not meeting recommended guidelines for healthy eating and exercise behavior.

“To say the least, the results of this study are cause for concern,” notes Deusinger. “People are dying from the effects of obesity, and it’s not just our parents and grandparents anymore; it’s our friends, siblings, and colleagues. No one is immune from the dual epidemics of obesity and sedentary behaviour.”

Connie Cushing, PT, MS, a 17-year-veteran physical therapist at Children’s Hospital in Birmingham, Alabama, is a member of a practice team that focuses on overweight and obese children and teens at the Hospital’s Center for Weight Management. Along with a psychologist, physician, nurse practitioner and nutritionist, Cushing evaluates each child individually (both before they enter and leave the Center). As a result, Cushing can determine whether the patient is at risk for joint and musculoskeletal problems, as well as implement what the collective team learns regarding other commonly seen issues such as diabetes or asthma. “Patients often have multiple, pre-existing medical conditions that can affect their ability to exercise and what specific exercises they are capable of doing,” notes Cushing.

“For the younger children at the Center we recommend restricting television viewing and video game playing and encourage family games that can be played both indoors and outdoors at home,” says Cushing. “It becomes a bit more complicated with teens, as we need to factor in what their interests are, both in and out of school; if they work better in groups or individually; and if they prefer being outdoors or indoors. Based on their profile, we determine a list of goals and the best ways to achieve those goals. We’ve also found that having teens keep daily logs of their physical activity provides great incentive.” She adds, “The goal of the Center is not solely weight loss. Our ultimate goal is for these kids to make lifestyle changes. Yes, we want them to lose weight, but we also want them to eat better, sleep better, and to feel better physically and emotionally.”

Consumers can find information about the fight against obesity and about National Physical Therapy Month, whose theme is “Physical Therapy: The Science of Healing. The Art of Caring,” by visiting APTA’s Consumer Web page at www.apta.org/consumer.

Physical therapists are health care professionals who diagnose and treat individuals of all ages, from newborns to the elderly, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan of care using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. Physical therapists also work with individuals to prevent the loss of mobility by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

The American Physical Therapy Association (www.apta.org) is a national organization representing 70,000 physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can access “Find a PT” to find a physical therapist in their area, as well as physical therapy news and information at www.apta.org/consumer.
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** Racette SB, Deusinger SS, Strube MJ, Highstein GR, Deusinger RH. “Weight Changes, Exercise and Dietary Patterns During Freshman and Sophomore Years of College.” Journal of American College Health, vol. 53 (6); pp. 245-251, May/June 2005.

“No pain, no gain” is not true when one has been injured. When one is recovering from an injury it is not wise to exercise with pain. When one is performing their rehabilitation program, one should only exercise in a pain-free range. If there is always a bit of pain present, as it is true after an injury or surgery, then you should never do exercise that creates more pain or increases your pain response. The increase of pain perception is the body’s way of letting you know you are overdoing things and that some tissues are not able to handle the stress that is put on them. The soft tissues (tendons, ligaments, muscles, and fascia) involved become weak and over-stressed.

Pain is a subjective feeling that we all have experienced at one time or another. We expect that we are going to experience pain after an injury or trauma. However, if there is no presence of pain during exercise we may think that there is nothing to worry about. This may not always be the case. Pain during exercise is the body’s way of telling us whether we are exercising too hard or overstressing our bodies. But just because pain is not present, does not mean that we may not be doing harm. For instance, a sedentary or deconditioned individual may not experience a pain response during exercise. However, then one day they find they have back pain or neck pain due to a lack of muscle endurance or some other musculoskeletal problem. For this reason, many people move into pain patterns without any apparent reason or trauma.

In summary, exercise should be performed without any increase in pain. Therapeutic exercise is utilized to promote healing, increase metabolism, and introduce gentle controlled loads so that the soft tissues can adapt to normal forces. Periodic maintenance through exercise can prevent non-traumatic pain patterns from occurring. It is important to give plenty of feedback to your physical therapist or other health professional so he or she can monitor and make any adjustments to your exercise program.

The impact of chronic pain is devastating for the individual as well as for society. Persons with chronic pain suffer physical, psychological, and social detriments. Many say that their pain disturbs their ability to sleep and their productivity at work. It interferes with the ability to participate in daily home, leisure, and recreational activities. It can negatively interfere with sexual relations as well as relations with family and friends. Chronic pain sufferers describe feeling anxious, irritable, or depressed as a consequence of their pain. In severe cases, pain sufferers describe feeling helpless and alone. Chronic pain may be the single most costly medical problem in the U.S.

Annual costs for medical expenses, lost income, and lost productivity are estimated to exceed $50 billion. The International Association for the Study of Pain defines pain as: “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described by the patient in terms of such damage.” Acute pain is indicative of inflammation and tissue damage resulting from injury, illness or recent surgery. It is short lived and usually subsides after the underlying cause and subsequent inflammation has resolved.

On the other hand, chronic pain can last for months or years. Chronic pain may start as a progression of acute pain after an injury or illness, even perhaps after the original problem has resolved. It can also be as a consequence of ongoing sources of pain related to medical conditions such as low back pain, cancer, arthritis, headaches, neuralgias, neuropathies and other pain disorders. In chronic pain, constant firing of pain signals occurs in the nervous system.

Over time, this persistent bombardment of pain signals can actually change the structure and function of the central nervous system thereby lowering the threshold of pain. For example, an individual’s perception of a normal painful stimulus can actually be perceived as extremely painful or an individual’s perception of a non-painful stimulus can actually be perceived as painful. These are only some of the examples of the complexities of chronic pain.

A skilled physical therapist will initially evaluate and treat involved painful nerves, muscles, and joints to decrease pain and improve function. This may lead to a decrease number of pain signals firing in the central nervous system and hopefully contribute to breaking of the pain cycle. Physical therapy can also be helpful in managing chronic pain by restoring normal movement patterns, developing a realistic exercise program, and providing education regarding goal setting, pacing of activity and other self management techniques.

Although the general medical approach to chronic pain is to manage the problem, there are occasions in which the underlying cause was not addressed but once treated may result in a significant improvement in one’s pain. An example of a chronic pain condition often overlooked is Myofascial Pain Syndrome, which describes pain due to sensitive knots in muscles called ‘Trigger Points’.

Despite the fact that chronic pain is a medically complex problem and can influence all facets of an individual’s life, a multidisciplinary treatment approach can alleviate one’s suffering in the management of the condition.

“Fortunately,” according to Dr. Timothy Flynn from Regis University, Denver, and board member of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT), “there are alternatives.” Dr. Flynn said that by “using an innovative treatment approach consisting of manual physical therapy and specific exercise based on recent high quality research, patients with knee arthritis frequently report a 20-40% relief in their symptoms after only two or three sessions of manual physical therapy and exercise.” He added that “these improvements are usually maintained for up to one year.”

Similar results were observed in a recently published follow-on trial in patients with knee arthritis, Flynn said. “At one year, patient improvements were maintained and patients who received a combination of manual physical therapy and exercise were less likely to be taking medications for their arthritis.” “Evidence also suggests that patients with hip arthritis experience similar benefits from manual physical therapy and exercise,” he added. “The research is clear. Individuals with hip and knee arthritis should see their physical therapist first, before trying dietary supplements, prescription drugs, or surgery,” suggested Dr. Flynn. “A physical therapist can help you alleviate the pain in your knees and hips and show you how to prevent that pain from coming back.”

To read a synopsis of the study in “Annals of Internal Medicine,” go to: www.annals.org and search for Vol. 146, No 8, 17 April 2007. For more information about the benefits of physical therapy and how it can help you alleviate knee and back pain associated with osteoarthritis, eliminate your use of supplements or prescription drugs, and prevent costly and painful surgery, go to: www.aaompt.org, or contact your local physical therapist.