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>

Rotator Cuff Surgery: What You Need to Know Before and After

Rotator cuff injuries are one of the more common injuries seen at Continuum Wellness Physical Therapy.  The severity can range from mild inflammation and irritation from overuse to a full blown tear that requires surgery.   Nearly 2 million people each year have rotator cuff pain and ⅓ of them require surgery.[1]  One study found that 20.7% of people in their group had complete rotator cuff tears and the prevalence increased with age.  Risk factors included: increased age, previous trauma, dominant arm and being male.[2]  Once surgery is required, most people are unaware of what to expect after they have the procedure and during their rehabilitation process.

First we need to explain what the rotator cuff is.  It is a group of four muscles (supraspinatus, infraspinatus, teres minor and subscapularis) that attach the shoulder blade to the ball and socket of the shoulder.  Their primary responsibility is to stabilize the ball and socket joint.  They also assist the shoulder in rotating in and out, hence rotator cuff.  Symptoms of a rotator cuff tear include: pain over the top of the shoulder or down the arm, weakness and difficulty raising your arm over your head, loss of range of motion.

Rotator Cuff Muscles

Once you have surgery for a torn rotator cuff, it is very important to follow instructions from your surgeon and physical therapist.  The surgery site is very vulnerable and any movement or use of the arm not specified by your PT can damage the surgery.  You will be required to wear a sling, usually 6-8 weeks, depending on the nature of surgery and severity of your tear as well as the direction of your surgeon.  At this time your physical therapist will be performing gentle stretches to your shoulder, help reduce pain and maximize healing.

Once you are out of the sling you are allowed to slowly start moving your arm on your own and your exercises will start to include active and passive range of motion and gentle strengthening until you are discharged.

Here is a typical physical therapy protocol for a rotator cuff repair[3]

Phase I (maximal protection)

This phase lasts for the first few weeks after your surgery, when your shoulder is at the greatest risk of reinjury. During this phase, your arm will be in a sling. You will likely need assistance or need strategies to accomplish everyday tasks such as bathing and dressing. Your physical therapist will teach you gentle range-of-motion and isometric strengthening exercises, will provide hands-on techniques such as gentle massage, will offer advice on reducing your pain, and may use cold compression and electrical stimulation to relieve pain.

Phase II (moderate protection)

This next phase has the goal of restoring mobility to the shoulder. You will reduce the use of your sling, and your range-of-motion and strengthening exercises will become more challenging. Exercises will be added to strengthen the “core” muscles of your trunk and shoulder blade (scapula) and “rotator cuff” muscles that provide additional support and stability to your shoulder. You will be able to begin using your arm for daily activities, but will still avoid any heavy lifting with your arm. Your physical therapist may use special hands-on mobilization techniques during this phase to help restore your shoulder’s range of motion.

Phase III (return to activity)

This phase has the goal of restoring your strength and joint awareness to equal that of your other shoulder. At this point, you should have full use of your arm for daily activities, but you will still be unable to participate in activities such as sports, yard work, or physically strenuous work-related tasks. Your physical therapist will advance the difficulty of your exercises by adding more weight or by having you use more challenging movement patterns. A modified weight-lifting/gym-based program may also be started during this phase.

Phase IV (return to occupation/sport)

This phase will help you return to sports, work, and other higher-level activities. During this phase, your physical therapist will instruct you in activity-specific exercises to meet your needs. For certain athletes, this may include throwing and catching drills. For others, it may include practice in lifting heavier items onto shelves, or instruction in raking, shoveling, or housework.

Rotator Cuff Tears

In general, physical therapy for a rotator cuff repair can last up to 6 months.  Most people in our clinic report feeling 100% (returning to sport and daily activities with minimal symptoms) after about a year.  Once you are discharged from PT, you will be given a home exercise program so you can continue strengthening your shoulder so your likelihood of re-injury is reduced.

The rehab process for a rotator cuff tear is a very long and frustrating process.  Most people don’t expect the process to be as painful and demanding as it really is.  Another thing most patients don’t realize is how immobile and dependant on friends and family they are for 6-8 weeks after surgery.  Be sure to have a good support system of friends and family that will help you with chores, driving, hygiene and other daily activities.

If you think you have symptoms of a rotator cuff injury or even a tear, stop by any Continuum Wellness Physical Therapy for a free screening.  We will do a complete screen, free of charge, of your shoulder and help determine what type of injury you may be dealing with.  We can give you an exercise program, advise you on self treatment, recommend PT if necessary and help you find the right specialist for a more complete diagnosis.

[1] (2013). Rotator Cuff – A Nation in Motion. Retrieved January 27, 2016, from http://www.anationinmotion.org/value/rotator-cuff/.

[2] Yamamoto, A. (2010). Prevalence and risk factors of a rotator cuff tear in the … Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19540777.

[3] (2011). Physical Therapist’s Guide to Rotator Cuff Tear. Retrieved January 27, 2016, from http://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=95bd746b-b25f-46f5-8373-fb56c9f6b46a.

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.