Vertigo

Vertigo is a symptom that many people will experience in their lifetime.  There are many different causes of vertigo and some of them can actually be treated with physical therapy.  If you suffer from vertigo, hopefully you will find some of this information helpful and may be able to treat your symptoms yourself.  If not, go see your doctor or come in to Continuum Wellness Physical Therapy as soon as possible.

Vertigo is a term that is described as feeling like the room is spinning and turning.  About 50% of dizziness symptoms are inner ear related and 50% of those are termed BPPV or Benign Peroxysmal Positional Vertigo.[1]   This is a condition that is most effectively treated with physical therapy, with most people feeling significant and long lasted relief in 2-3 visits.

BPPV is caused by small particles, sometimes referred to as “crystals”, that come loose in your inner ear (from the Utricle) and travel into one of the three semi-circular canals.  The medical name for these crystals are “otoconia”.

vertigo1

Symptoms of BPPV include a sensation of spinning, dizziness, nausea and lightheadedness.  The cause of BPPV is usually related to a change in head position in regard to gravity.  This usually manifests itself when rolling over in bed or bending over and looking under something like a car or low shelf.  The most common cause of BPPV for people under 50 is a head injury.[2]  People 60 and over, especially those with osteoporosis, tend to get BPPV more than other people.

BPPV can be diagnosed with different tests performed by your doctor or physical therapist.  During testing, your head is placed in different positions and the doctor examines your eyes, looking for nystagmus, which is when your eyes jump in different directions.  Different head positions and different directions of nystagmus will tell us what canal is involved.  Your physical therapist will determine if you actually do have BPPV or if your vertigo and dizziness symptoms are caused by something else.  These could include low blood pressure, central nervous system, vestibular nerve irritation, Menieres disease (18% of inner ear dizziness[3]), inner ear infection and multiple sclerosis, to name a few.

vertigo2

Self treatment of a vertigo episode can be effective if you are familiar with the Epley maneuver, which is a series of movements and positions that allow the otoconia to travel back into the utricle.  The Epley maneuver has been shown to be around 80% effective in treating vertigo, especially when it involves the posterior canal.[4]

Here is an illustration of the Epley maneuver.

vertigo3

Here is a video of the Epley Maneuver:

If you ever have an episode of vertigo go see your doctor as soon as possible or come into Continuum Wellness Physical Therapy.  We will do a free screening and tell you if you are a candidate for PT for your symptoms.

Call now!

Gilbert: 480-503-2010

Chandler: 480-207-1077

Apache Junction: 480-983-0877

 

[1] “Outline of causes of dizziness – Dizziness-and-balance.com.” 2003. 16 Mar. 2016 <http://www.dizziness-and-balance.com/disorders/outline.htm>

[2] “BPPV – Dizziness-and-balance.com.” 2003. 16 Mar. 2016 <http://www.dizziness-and-balance.com/disorders/bppv/bppv.html>

[3] “Dizziness-and-balance.com: Disorder index.” 2003. 16 Mar. 2016 <http://www.dizziness-and-balance.com/disorders/>

[4] “Epley-CRP maneuver for BPPV – Dizziness-and-balance.com.” 2015. 16 Mar. 2016 <http://www.dizziness-and-balance.com/disorders/bppv/epley/epley.html>

What Is Electrical Stimulation?

Electrical stimulation is a treatment commonly used in physical therapy.  It can be used for many different conditions and for many different goals.  The most common uses for electrical stimulation are: short term pain relief and muscle re-education.  Today we will briefly discuss how Continuum Wellness Physical Therapy uses electrical stimulation and how it helps you quickly recovery from injury and help reduce your pain.

Briefly, we must say that electrical stimulation is not appropriate for everyone.  Your physical therapist will discuss with you if electrical stimulation is appropriate for you.  Typically, it is not appropriate for people with the following conditions: pacemaker, pregnancy, cancer, open wounds or sores, decreased or abnormal skin sensation.

e-stimulation

 

Muscle Re-education

It is well documented that muscles will atrophy (shrink in size) following immobilization.[1] [2]  This usually occurs after surgery or after a bone is broken and you have to be put in a cast or immobilized. [3] One goal of physical therapy is to maintain muscle size and strength as much as possible when immobilization is necessary.  Because movement and strength training is often not allowed for many weeks following surgery or immobilization, one treatment we use is electrical stimulation.

Traditionally this is called “Russian” electrical stimulation because it was first researched and utilized by the Russian performance researcher, Kots.[4]  In this treatment we place between 2 and 4 pads on the muscle or muscles we want to activate.  You will feel a tingling sensation in that muscle and a slight contraction.  This should not be painful at all.  When you feel the tingling and contraction you then try to voluntarily contract the muscle at the same time.  Usually you will hold the contraction for 5-10 seconds and rest while the stimulation turns off for 5-10 seconds.  This is typically performed for around 10 minutes.

In normal circumstances we continue to use Russian electrical stimulation until you are able to make a strong muscle contraction on your own.

 

Pain Relief

Transcutaneous Electrical Neuromuscular Stimulation (TENS) can also be used for pain relief.  There are mixed data on whether long term pain reduces with use of TENS.[5] [6]  There have been some studies that show use of TENS can help reduce acute pain, such as after surgery. [7] [8] [9]

TENS should be very a very comfortable buzzing and tingling sensation.  Most people really enjoy the treatment, which usually lasts for about 10 minutes.  Clinically, we have found that many patients have an immediate reduction in pain after treatment and also a reduction in muscle spasm.

There are different theories on why TENS works to reduce pain.[10]  We typically use settings that follow the “Gate Control Theory”, which states that sensation nerves conduct faster than pain nerves, so providing a constant sensory input with the buzzing and tingling of the TENS excites the sensory nerves and overrides the pain nerves’ signals to the brain.

At Continuum Wellness Physical Therapy we use many different treatments to help you recover from injury and help reduce pain.  If you have been dealing with pain for a long time or have a recent injury or surgery that is causing you pain, please call to schedule a free, no obligation screening.  We will discuss your condition and tell you if physical therapy is right for you.

 

Call now:

Gilbert: 480-503-2010

Chandler: 480-207-1077

Apache Junction: 480-983-0877

 

[1] Appell, Hans-Joachim. “Muscular atrophy following immobilisation.” Sports Medicine 10.1 (1990): 42-58.

[2] Lake, David A. “Neuromuscular electrical stimulation.” Sports medicine 13.5 (1992): 320-336.

[3] Gibson, JNA, K Smith, and MJ Rennie. “Prevention of disuse muscle atrophy by means of electrical stimulation: maintenance of protein synthesis.” The Lancet 332.8614 (1988): 767-770.

[4] Ward, Alex R, and Nataliya Shkuratova. “Russian electrical stimulation: the early experiments.” Physical therapy 82.10 (2002): 1019-1030.

[5] Sluka, Kathleen A, and Deirdre Walsh. “Transcutaneous electrical nerve stimulation: basic science mechanisms and clinical effectiveness.” The Journal of Pain 4.3 (2003): 109-121.

[6] Johnson, Mark I. “Does transcutaneouselectrical nerve stimulation (TENS) work?.” Clinical effectiveness in nursing 2.3 (1998): 111-120.

[7] VanderArk, Gary D, and Kathleen A McGrath. “Transcutaneous electrical stimulation in treatment of postoperative pain.” The American Journal of Surgery 130.3 (1975): 338-340.

[8] Hansson, Per, and Anders Ekblom. “Transcutaneous electrical nerve stimulation (TENS) as compared to placebo TENS for the relief of acute oro-facial pain.” Pain 15.1 (1983): 157-165.

[9] Arvidsson, Inga, and Ejnar Eriksson. “Postoperative TENS pain relief after knee surgery: objective evaluation.” Orthopedics 9.10 (1986): 1346-1351.

[10] “Transcutaneous Electrical Nerve Stimulation: Overview …” 2008. 16 Mar. 2016 <http://emedicine.medscape.com/article/325107-overview>

Neck Pain

Two of the major conditions we treat at Continuum Wellness are neck pain and headaches.  They can affect people from ages 15 to 100, are usually related, and can be very frustrating.  The most common type of neck pain we see is posture related.  Treatment consists of stretching and massaging tight muscles, strengthening weak muscles, improving the endurance of your posture muscles, and correcting ergonomics of your work space or computer desk.

Ergonomics

First, let’s talk about work stations and computers.  A lot of people work at a desk job for at least 8 hours per day and then come home to either work on the computer even more or sit on the couch and watch television.  Poor ergonomics of your workspace are a major cause of neck pain and are corrected fairly easily.  By looking at the picture below, you can see what good and bad ergonomics look like.  Some highlights include: feet touching the floor (use a foot rest if they can’t touch), elbows bent to 90 degrees and using the arm rest, back touching the back rest and eyes even with the top 1/3 of the screen.

 

ergo1 ergo2

 

A lot of the time, these simple workspace changes can really have a positive impact on your neck pain and headaches.  For a free brochure on ergonomics, email Michael.dickey@continuumwellness.com.

 

Stretching

stretching

Next we need to focus on stretching the tight muscles of your chest (mainly the pectoralis muscles) and neck (suboccipitals, upper trapezius and levator scapulae) that are tight and shortened. Treatment would also include some type of massage to help reduce knots, trigger points and tension.

 stretching2 stretching3

stretching4

Hold each one for 20 seconds, 3 times per day.

Strengthening

Lastly, we need to improve strength and endurance of your posture muscles.  These include your deep neck flexors and shoulder blade muscles.  A 1993 study found that women with headaches had statistically decreased strength and endurance of the deep neck flexors compared to women that didn’t have headaches.  (Watson & Trott, August 1993)  In another study from 2007, improving neck flexor activity helped improve posture and decrease neck pain.  (Falla, Jull, Trovor Russell, & Hodges, 2007)

The last picture is one that really hits home for a lot of people.  Take a look at how much work your neck is doing to hold your head up when you have a forward head and rounded shoulder posture.  Due to leverage, with even just mildy poor posture your neck has to hold up 20 more pounds than compared to normal posture.

strength

If you have been dealing with neck pain and have had little success with getting rid of it,  or your neck pain has started recently and isn’t getting better – come to any of our clinics for a free screening.  We will assess your posture, your range of motion and strength, and the tightness of your muscles at no cost to you.  We will then give you specific exercises to do at home, recommend formal PT or help find the right doctor for you.  Give any of our clinics a call to schedule your free screening:

Apache Junction: 480-983-0877

Chandler: 480-503-2010

Gilbert: 480-207-1077

5 Health Benefits of Running

The weather in Phoenix makes for perfect runs where you can see colorful sunrises or sunsets, commune with nature, and get healthier. The benefits of running are almost endless. It combats symptoms of depression and anxiety, improves cardiovascular fitness, and decreases stress.

It’s time to get out and go for a run and here’s why:

  1. Improved Cardiovascular Fitness. Your heart will keep pumping as long as you keep it healthy. Exercise increases blow flow, making the heart more efficient. Over time, your resting heart rate will decrease because the heart is delivering more blood in fewer beats.
  2. Increased Endorphins. Exercise is one of the most underutilized anti-depressants. When you’re running, happy hormones, called endorphins, are released. Some call it their runner’s high. It’s the feeling that stress is leaving your body and being replaced with feelings of positivity and happiness.
  3. Experience the Great Outdoors. Whether it’s a neighborhood trail or a hiking trail, running gets you out of the house and into nature. Check your community website for walking, running, and nature trails. Hike Arizona is a great resource for those looking to trail run.
  4. Clear Your Mind. To me, running is an opportunity to have uninterrupted quiet time. Some days it’s a meditation and other days it’s housecleaning of a cluttered mind. I just get in the zone and run until the stress leaves and I am refocused.
  5. Burn Calories. If you’re looking for an exercise that will burn calories, you need to try running. Just make sure that you’re eating the right kind of calories. Each meal should include protein, carbohydrate, and fruit or vegetable. Each snack should include protein. Yogurt or almonds are good options. And never skip breakfast. Your body needs fuel for your run.

Ready to run? Get up. Dust off the ol’ running shoes and let’s go!

If you’re experiencing a sports injury related to running, make an appointment with Runner’s Rehab AZ. Call 480-382-0134 or schedule an appointment online.

Tips for Road Running Etiquette

When was the last time you went running in your neighborhood? It’s a great way to clear your mind and re-focus especially after a busy day. Don’t let the clutter in your mind prevent you from being safe while you’re exercising. Here are my tips for road running etiquette to help you get started:

1. Run like a Salmon. One of the safest actions you can do as a runner is to run against the traffic, like a salmon swimming upstream. If it’s available and legal, I recommend running in a bicycle lane as opposed to the sidewalk. The black top is more forgiving than a sidewalk and you’re less likely to get injured tripping on driveways and curbs.

2. Share the Path. You’re not the only one out on the road. Make an effort to share the path by announcing when you’re passing someone. Say, “On your left,” to let them know you’re passing on the left. They can be sure to clear a path for you to pass. Pay attention because not everyone may hear you (see #5).

3. Race for the Finish Line. If you’re in a road race and new to running, stay in the back or middle of the starting pack. You might think being first out of the gate is best, but you’re actually creating an unsafe situation for the faster runners behind you. The fastest runners should be at the front of the pack otherwise they have to navigate around you as they pace.

4. Be Nice to Your Neighbors. Have you ever said hello to someone while you’re on a run and they don’t say hello or wave back? Running is good exercise but it’s also about being part of a community. And that community waves and acknowledges people that we pass on our runs. The next time you’re out, give a nod or a wave to the runners, walkers, bicyclists, and neighbors as you pass. It’s the nice thing to do.

5. Pump Up the Jam. While you might like musical inspiration on your run, it’s important to keep personal safety your highest priority. Keep the music at a volume where you can still hear and respond to traffic, bicyclists, walkers, or runners in your path. You wouldn’t want to miss a honking horn or an “on your left” especially if it saves you from getting injured or worse.

Staying safe while you’re road running is part of the overall experience. Strap on the running shoes and let’s enjoy the darn-near-perfect Phoenix weather!

Iliotibial (I.T.) Band Syndrome in Runners

IT Band Now that the weather is getting pleasant in Arizona, people are getting outside and exercising and maybe even training for some 5k runs, 10k runs or even a full marathon.  It is at this time that runners may start to notice some pain on the outside of the knee.  More than likely this is called Iliotibial (I.T.) band syndrome, which is the most common cause of lateral knee pain in runners.[1]

The I.T. Band is a thick band of tissue that starts as a muscle on the outer part of the hip and connects to your knee.  It is also interconnected through series of tissue called fascia from your outer neck muscles to the outer part of your foot. IT Band2

Causes of this type of knee pain include: running on uneven or slanted surfaces or the same direction around a track, increasing training mileage by more than 30% every 2 weeks[1], muscle tightness and weak hip abductors[2] (outer gluteal muscles).

Symptoms include pain, stiffness, tenderness to touch and swelling along the outer knee during running, going up or down stairs and after being seated or still for a long period of time.

At Continuum Wellness Physical Therapy, we recommend that patients rest and try to reduce acute inflammation with massage, ice and anti-inflammatories and follow up with one of our physical therapists.

In our experience, runners with IT Band syndrome typically have some kind of biomechanical dysfunction, flexibility issue, weakness or all three that need to be addressed in PT.  We perform an in depth functional evaluation to identify tightness, weakness and other dysfunction.

We then use hands on treatments to break up scar tissue, improve flexibility of muscles, tendons and fascia and help jumpstart the healing process.  Then prescribe specific stretching and strengthening exercises to be performed in the clinic and at home.  We safely and quickly progress you back to running pain free and make sure that you are only increasing your mileage by 10% every two weeks.

 

Call now to schedule your free, no obligation screening! 

Chandler: 480-207-1077

Gilbert: 480-503-2010

Apache Junction: 480-983-0877

 

Here are some basic hip strengthening exercises to help increase strength in your hip abductor muscles to help reduce risk of getting I.T. Band syndrome.

IT Band3

 

 

Clamshell with band

30 repetitions, once daily

 

 

 

 

IT Band4

 

Hip Abduction

30 repetitions, once daily

 

 

 

IT Band5

 

 

 

Resisted lateral walking

10 steps to left, 10 steps back

 

 

IT Band6

 

 

 

to right, 3 times each

Once daily

 

 

 

 

[1] INSIGHTS, N. (2014). How to Safely Increase Your Mileage. J Orthop Sports Phys Ther, 44(10), 748.

[2] Fredericson, M., Cookingham, C. L., Chaudhari, A. M., Dowdell, B. C., Oestreicher, N., & Sahrmann, S. A. (2000). Hip abductor weakness in distance runners with iliotibial band syndrome. Clinical Journal of Sport Medicine, 10(3), 169-175.

[1] Fredericson, M., & Wolf, C. (2005). Iliotibial band syndrome in runners. Sports Medicine, 35(5), 451-459.