Tamer Issa, PT, DPT, OCS will be a presentor of a pre-conference workshop and breakout sessions at the American Academy Orthopaedic Manual Physical Therapists annual conference.

October 6-7, 2010

Pre-Conference Workshop

Intramuscular Manual Therapy: Trigger Point Dry Needling — A Novel Approach to Relieve Muscle Pain, Restore Muscle Function

Intramuscular manual therapy is increasingly becoming the treatment of choice for trigger point deactivation and for treatment of segmental spinal dysfunction. Physical therapists worldwide are becoming educated and clinically trained in this technique through post-graduate workshops and even in entry-level programs. In the United States a growing number of states, the American Academy of Orthopaedic Manual Physical Therapists, and the American Physical Therapy Association have acknowledged that trigger point dry needling is within the scope of physical therapy practice. This pre-conference workshop will introduce clinical examination and treatment of myofascial trigger points with emphasis on Intramuscular manual therapy.
Presenters: Edo Zylstra/Tamer Issa

October 9, 2010

Breakout Session

Trigger Point Dry Needling/Intramuscular Manual Therapy: Advancing Clinical Practice Towards Vision 20/20

Trigger Point Dry Needling(TDN)/Intramuscular Manual Therapy(IMT) is a relatively new treatment technique quickly increasing in popularity in the United States as physical therapists, advancing their clinical practice, seek new, more effective and innovative ways to treat their patients with increased efficiency and improved outcomes. With Vision 20/20 quickly approaching, how will therapists continue to differentiate their practice to fit into the Doctoring profile that will be expected with this Profession’s future goals and its involvement in the progression of medical/health care in this country.

Trigger will be defined and it’s history of use will be described as it pertains to mainly the United States and what future role we can expect it to take in the next 10 years as we move towards Vision 20/20. Progression of the use of this technique in the US and abroad will be discussed. The research of this technique will be presented as to the current thought of its affects on the body but also the potential affects yet to be fully identified. Application to current diagnoses and types of injuries will be discussed. Discussion on insurance coverage, billing and how physical therapy is adapting to its ever expanding scope of practice, and how physical therapy should be consistently valued among third party payers and the public.
Presenters: Edo Zylstra/Tamer Issa

Tamer Issa, PT, DPT, OCS

Dr. Issa is the owner of ISSA Physical Therapy in Rockville, MD and is an instructor for Myopain Seminars, based in Bethesda, MD. He received his DPT degree from the University of St. Augustine for Health Sciences in 2006 and a B.S. degree in Physiotherapy from the Hogeschool Enschede in the Netherlands in 1998. Dr. Issa is a board-certified Clinical Specialist in Orthopaedic Physical Therapy and is certified in Myofascial Trigger Point Therapy. Dr. Issa has published articles and book chapters on the topics of orthopaedic manual therapy, chronic headaches, trigger point dry needling, myofascial pain and fibromyalgia differential diagnosis.

Bad habits such as the way you stand (posture) or the way you position yourself (body mechanics) can contribute to the onset of low back pain.  Poor posture and body mechanics change the optimal alignment of the spine over time leading to a process of degeneration.  Often, the process can and will result in weakened discs, inflamed joints, irritated nerves, and painfully tight overworked muscles.  Maintaining proper posture during lying, sitting and standing positions has a significant affect on reducing the stress and strain on the spine which are associated with pain and injury.  Learning how to move properly during common daily activities such as bending, lifting, turning, and reaching is also critical in preventing low back pain.  Many of you may have experienced the ill effects of poor body mechanics during activities such as moving furniture, lifting children, or snow shoveling.

A healthy back needs to be strong and flexible.  Daily exercises aimed at stretching and strengthening muscles and maintaining the flexibility of your spine will help to accomplish this.  One highly recommended exercise for your back is regular walking.

There are many other useful self care tips and techniques that can be learned to keep your back healthy.  Here are a few: maintain an optimal body weight, wear the right shoes, shift positions often at home and work, choose the right bed, use lumbar support for sitting, self-massage, or better yet get someone else to give you a massage.

A physical therapist can help develop an exercise program that is right for you while teaching you the skills you need to move safely and keep your back healthy.  If you are interested in taking care of your back to prevent the onset of low back pain or to address a current back pain problem you should consider seeing a trained physical therapist.

The long term effects of poor sitting posture have been associated with numerous painful conditions relating to the function of muscles, joints, ligaments, nerves, connective tissue, circulation, respiration, and digestion. Common associated diagnosed conditions include temporomandibular joint dysfunction, headaches, neck pain, shoulder pain, repetitive strain injuries, mid and low back pain, thoracic outlet syndrome, and myofascial pain syndrome. More importantly, poor sitting posture may adversely affect activities of daily living and overall energy level at work and home.

The concept that there is a single ideal posture is misleading. This idea does not take into account that people are proportioned differently or for example the multiple positions a worker needs to sustain to accomplish a task in varying situations. Factors that influence our postures include the environment surrounding us, our personal habits and attitudes at a certain point in time. There is no “perfect posture.” Posture is dynamic. Functionally, our bodies are reacting to and working against gravity and other stresses to maintain balance. Good sitting posture maintains the three normal curvatures of the spine. The lumbar (lower back), thoracic (mid-back), and cervical (neck) transform the spine into a flexible unit allowing the body and head to be erect with minimal muscular effort.

Prolonged static sitting position will eventually lead to feelings of stiffness, soreness, achiness and pain as body tissues become overloaded. The most commonly seen improper sitting posture is “slouching”; characterized by a rounded lower back, humped upper back, rounded shoulders, and a forward head position. The resultant alignment leads to biomechanical dysfunctions of the spine and the extremities, which include muscle imbalances, connective tissue restrictions, altered mechanics of the shoulder and spinal joints, increased vertebral disc compression and narrowing of the space in which arteries and nerves pass. In essence, poor posture allows one to become vulnerable to injury and is one of the factors which hinders healing and adequate resolution of associated painful conditions.

In most cases, it is not too late to experience the positive outcomes of improving one’s posture.  Physical therapy evaluations incorporate a postural assessment to define the severity of the postural problem, to identify contributing factors, and to recognize the possible relationship to someone’s given pain and dysfunction. Treatment of postural dysfunctions may involve regaining the normal length of shortened muscles, mobilizing stiff extremity and spinal joints, strength and endurance training of postural muscles, addressing environmental/ergonomic factors, and education of postural awareness and correction. Awareness is the key to the success of postural reeducation. Just like your body has adapted to poor posture over a number of years, you can allow your body to adapt once again to its natural structural state.

Well much of the country has experienced record snowfall this season and of course with that comes digging out of the snow.  Snow shoveling can contribute to a host of injuries to the spine, shoulders and muscles of the body.  Most of the problems are as a result of excessive bending and twisting while carrying a heavy load.  Here are some tips to avoid pain and injury from shoveling snow.

The Basics:

Think of snow shoveling as a form of exercise, so as with any exercise prepare your body for what you are about to do.

• Don’t begin shoveling snow after eating, smoking or consuming caffeinated beverages.
• Warm-up your body with some gentle movements and stretches as you would before any exercise.
• Dress appropriately.  Ensure that you have good footwear to avoid unnecessary slips and falls, dress in layers, wear gloves that will keep the hands warm and dry, and wear a hat the will keep your head dry.
• Stay hydrated.  Drink plenty of water before, during and after.
• Stop if you are hurting or you feel pain of any kind.  Don’t make a problem worse by trying to work through the pain.  The exception is the feeling of muscle fatigue, which is to be expected.
• Take plenty of breaks.  Don’t try to finish the job all at once.  It’s better to divide the work in several segments, especially if you are dealing with large amounts of snow.
• Know Heart Attack Warning Signs: chest discomfort, discomfort in other areas of the upper body, shortness of breath with or without chest discomfort, breaking out in a cold sweat, nausea or lightheadedness.  Please call for help immediately if you are experiencing these symptoms.

The Form:

Proper body mechanics is critical to avoiding pain and injury from snow shoveling.

• Use the right shovel.  Ergonomic shovels that have a curved shaft allow for better leverage and are easier on the body.  Plastic shovels are typically lighter than metal ones.
• Proper grip is important.  Don’t keep your hands too close together.  Placing your hands further apart improves the leverage, which will allow you to work more efficiently.
• Maintain proper spine alignment.  It is critical that you keep your back straight and head in line with your spine.  Your ear, shoulder and hip should always stay in line.  To attain proper spinal alignment while bending, you should bend your knees, stick your hips back, keep your back straight and tuck your chin slightly in.
• To shovel snow: keep feet apart, bend the knees, lift the shovel by straightening your knees and not by straightening your back.  If you need to move the snow, walk your feet to where you would like to dump the snow.  Never bend at the waist and twist to move the snow to the side.  Never thrown snow over your shoulder.
• Push whenever you can.  Pushing the shovel with one leg in front of the other, knees slightly bent and back straight is always better than lifting the snow.
• Lighten the load.  Don’t try to move heavy amounts of snow.  It’s better to minimize the load.

Remember to take frequent breaks and stop if you feel pain.

If by chance you do end up injuring yourself, consult a physical therapist for a consultation so that your pain and functional limitations are kept to a minimum.

BJ from from Wichita State University won the top prize of $1000 in Evidence In Motion’s 30 Second Elevator Pitch 2008 Competition!

The International Headache Society has classified hundreds of different types of headaches into two categories: primary headaches and secondary headaches.  Primary headaches are the most common headache type and have a single cause.  They include migraine, tension-type, cluster and others. Secondary headaches are classified according to their causes.  Examples of secondary headaches are headaches attributed to temporomandibular joint (TMJ) disorders and cervicogenic headaches, which are attributed to mechanical disorders of the neck.  Both are treated by various clinicians including osteopaths, dentists, chiropractors, massage therapists, and physical therapists.

Sources of headaches are often a combination of factors, including musculoskeletal, psychological, neurovascular, nutritional and chemical imbalances in the brain.  Some headaches relate to or are indicative of a disease process; some are life threatening and others benign.  Thus, a thorough medical evaluation is necessary with any onset of a new or ongoing headache.  Most researchers agree that there is a musculoskeletal component in tension-type, cervicogenic, and TMJ disorder related headaches.

A thorough physical therapy examination attempts to determine the type of headache and to define the neuromusculoskeletal factors contributing to it.  Muscle tension, joint dysfunction of the neck and jaw, poor posture and stress are factors that can be addressed and treated by a skilled physical therapist trained in manual therapy.

The muscles of the face, head, neck and may contain tight bands and contraction knots called myofascial trigger points.  Trigger points found in these muscles typically refer pain to the head, causing headaches.  Manual physical therapy addressing muscle tension involves the release of those trigger points, stretching the involved muscle and soft tissue, and restoring normal muscle function.  Trigger point release can be accomplished by manual techniques and dry-needling.  Dry-needling is a technique in which a thin acupuncture needle is used to deactivate the trigger points and proves to be highly effective.

Dysfunction in the spinal joints of the upper neck and of the TMJ can directly cause headaches or can trigger migraine or tension-type headaches.  Treatment of spine dysfunction may include mobilization/manipulation of the spine or jaw and the performance of stabilization exercises of the neck and shoulder girdle.  In the case of TMJ dysfunction, referral to a dentist may be indicated for splint therapy and other dental interventions.

Prolonged poor posture of the head, neck and shoulders leads to the overloading of muscles, which in turn results in the development of trigger points and altered mechanics of the spine and TMJ.  Physical therapy treatment may include education for postural correction and prescription of a postural strengthening program.  In cases where stress is a contributing factor — which it almost always is — treatment would include education with relaxation and breathing techniques.

If you are a headache sufferer and you are looking for a way to manage your headaches beyond using medication, talk to a manually trained physical therapist about possible conservative treatment options.

ALEXANDRIA, VA, February 9, 2007 — The American Physical Therapy Association (APTA) has endorsed the BackTpack®, an innovative carrying system that uses the vertical force of gravity to ensure proper alignment of the skeleton, developed by physical therapist and APTA member Marilyn Miller von Foerster, PT.

School student wearing the BackTpack.

“Physical therapists are acutely aware of the postural problems children face when trying to adapt to a heavy load, such as arching the back, bending forward, or leaning to one side,” said R Scott Ward, PT, PhD, president of APTA. “The backpack was designed so that children and adults may be better able to maintain correct posture while carrying a load,” Ward said. “We are pleased to be able to endorse a product that can contribute to the effort to prevent back pain and improve balance.”

The BackTpack® is available in sizes for children and adults from 4′0″ to 6′3″ tall. Its vertical design allows for proper posture, and the side pockets and cell phone and pen pockets offer better balance, easy accessibility, and overall convenience when standing, sitting, or walking.

“It is crucial for lifelong spinal health to practice good posture habits, especially during the years of rapid and permanent skeletal development,” Miller von Foerster noted. “I am pleased to be able to use my education and training as a physical therapist in this way and to offer the BackTpack® as a new tool to help people of all ages achieve improved posture and reduce the incidence of back pain.”

Miller von Foerster, who has helped patients with back conditions for 35 years, is a native Oregonian and received degrees from the University of Oregon, Duke University School of Physical Therapy, and San Francisco State University. For more information on the BackTpack®, visit www.backtpack.com.

Physical therapists (PTs) 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.

The American Physical Therapy Association (www.apta.org) is a national organization representing nearly 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. For more information about the meaning of APTA’s product endorsement, visit www.apta.org/productendorsement.

Available at ISSA PHYSICAL THERAPY in a number of different styles, sizes and colors.

The BackTpack is perferct for traveling.

Great for parents on the go.

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.