Unfortunately, the health insurance and Medicare systems have distorted the way health care practitioners can provide care and still remain profitable. In the case of Physical Therapy, most practitioners have to see multiple patients per hour and utilize modalities and technicians/assistants in the provision of care in order to remain profitable. In almost all cases that I’ve seen, this unfortunately diminishes the quality of care provided.

This scenario will only get worse as our population ages and our nation’s budget problems become even larger over time. Reimbursement for Physical Therapy services is bound to get lower and lower, and those PT practices who directly bill insurance and Medicare will have to see more and more patients each hour to stay in business. It’s a downward spiral, and I refuse to be a part of it.

It is so rewarding to go to my clinic every day knowing that I will spend a full hour with every patient and have the time to get significant results in each session. I can still provide the paperwork for my patients to send self-claims to their health insurance, many of whom do; but because I have taken myself out of the system in this way, I am able to provide the highest quality care and get my patients better much faster than average. It’s wonderful.

A clinical approach utilizing skilled, specific hands-on techniques, including but not limited to manipulation/mobilization, used by the physical therapist to diagnose and treat soft tissues and joint structures for the purpose of modulating pain; increasing range of motion (ROM); reducing or eliminating soft tissue inflammation; inducing relaxation; improving contractile and non-contractile tissue repair, extensibility, and/or stability; facilitating movement; and improving function.

When we look at the two words in the term “Manual Therapy,” I can see why many are defining it much more simply as “hands-on therapeutic techniques.”  In no way am I dumbing down the term or its definition.  I simply want to convey that it is being defined in a very broad sense by a growing number of practitioners out there; and that there are important consequences to this trend.

When I search the Internet for information about people practicing and providing “Manual Therapy,” I am often amazed at the wide variety of practitioners who utilize the term and identify themselves as “Manual Therapists.”  Since this obviously will not change, it is important that consumers know that the people utilizing the term come from an incredible range of educational and clinical training backgrounds.

When I personally use the term “Manual Therapist”, I am specifically talking about a licensed Physical Therapist with advanced training (and preferably certification) in Manual Therapy.  Manual Physical Therapists are healthcare practitioners who not only have the training and skills to impart highly effective techniques with their hands, but also the education and training to evaluate and determine/diagnose the true cause of a person’s pain.

This is simply not the case if you are visiting a licensed Massage Therapist, regardless of whether or not they use the term “Manual Therapy.”  I have seen and even personally received hands-on therapeutic techniques from a variety of different professionals, including Massage Therapists, Chiropractors, and even Personal Trainers, but that does not mean I would define any of them purely as a Manual Therapist.  Nor does it mean that I am discounting the effectiveness and need for these professionals.  I utilize them myself regularly and refer my own patients to them quite often.

I’m simply posting this information to help clarify a term that is being used in a wide variety of ways by a number of different professionals. If you are a consumer looking for Manual Therapy, my suggestion would be to search for a licensed Physical Therapist with a certification and/or residency in Manual Therapy.  These credentials can only be given by educational institutions  that have strict oversight from proper credentialing organizations.

You can also be assured that these practitioners have undergone rigorous training in the diagnosis and treatment of issues from head to toe and have spent years in both the classroom and clinic to obtain their licensure and credentials.

1. How specific Hip muscle weakness can lead to different types of injuries
2. How anyone can test themselves to see if they have these issues
3. Some simple exercises that can be done to strengthen the muscles and avoid injury

(Please excuse the sound quality/background noises) Click Here to see the presentation handout referred to in the videos.  It includes some images and tips for the tests and exercises taught in the presentation. And here is Part 2 of the presentation, in which I opened it up to questions from the group…

My hope in posting these videos is that any ATX TRAINING members who missed the presentation can still benefit from the information and avoid injury as you work toward your goals. This information is certainly relevant to anyone who walks or runs for exercise, so all who find themselves at this page should feel free to enjoy the videos/handout and leave any questions you have in the comments below or contact me directly.

If you are not part of this program and have a goal of losing 20, 50, or 100lbs, I highly encourage you to get involved with RunTex ATX TRAINING. It’s an inspiring and motivating group making amazing changes in their lives and their community.

So what can be done for this condition? There are specific manual physical therapy techniques that can help resolve the joint capsule irritation and surrounding muscle spasms quite quickly. Joint tightness can also be identified in the evaluation process and effectively treated with hands-on mobilization. A home program of appropriate stretches and range-of-motion exercises are also very helpful. Here is a video showing the results that good Manual Therapy can provide for someone with this type of neck pain.

The take-home point is that this issue can usually be treated quite quickly, and it does not have to be a debilitating condition that lasts for weeks or months. If you are in the Austin area and are having neck pain like that described in this post, please feel free to call us (512-947-3705). We are happy to answer any questions you may have.

The good news is that many injuries can be avoided altogether if the predisposing factors are identified and resolved beforehand. For this reason I made a short video to help you do a quick “screen” your own movements to identify the potential for injury.

This short self-evaluation will not identify every possible injury predisposition … that would require an incredibly long video. It covers some of the most common things that bring people into my clinic (that can be identified with a self-evaluation). It will take you less than 10 minutes to complete and could save you months of pain and missed workouts.

If this self-screen reveals any injuries waiting to happen, let me know and we can resolve it before it becomes a big issue (512-947-3705). If you found this article and aren’t in the Austin area, see a good Physical Therapist in your area and make sure you stay active in 2012.

Know of others who may want to avoid injury this year? Click “Like” below and share it with your friends.

Excluding the young athletes I treat, the vast majority of my patients have a job that puts them in a chair at a desk most of each day. Many of you are very health conscious, and you attempt to combat the effects of this inactivity by the hitting the gym or doing something active at least a few days a week; and that’s Great! But read on

The New York Times recently published a summary of the research on this topic, and I’m afraid to say that our assumptions have not been correct. Excessive sitting has harmful effects, even if you exercise for an hour or more every day. I like the analogy they give in the article: you can’t reverse the effects of a pack-a-day smoking habit by jogging. Of course you will be better off with regular exercise, but it will not stop 8-hours of sitting each day from taking its toll, and potentially shaving years off your life.

The scientists explain the scenario in this way:  (paraphrased from the NYT article) When you sit in a supportive chair, electrical activity in the muscles drops … which leads to a cascade of harmful metabolic effects. Your calorie-burning rate immediately drops to about one per minute. Insulin effectiveness drops within a single day, and the risk of developing Type 2 diabetes rises. So does the risk of being obese. The enzymes responsible for breaking down lipids and triglycerides (fats) plunge, which in turn causes the levels of good (HDL) cholesterol to fall

“But Jarod, I can’t quit my job and walk around all day! What am I supposed to do with this information?” Luckily, there are things you can do to increase your ongoing muscular activity while at work and minimize the harmful effects described in this research. It comes down to making more small movements each day than you would when simply sitting in a desk chair.

One easy technique would be to set a quiet alarm/pop-up on your phone or computer to remind you to stand up and briefly stretch every 20-30 minutes. Here are free apps for the Iphone and Android phones that will help

A much more effective approach is to sit on a an exercise ball rather than a chair. This demands a constant low level activation of your core and leg muscles; even on the balls with stable bases and low back support like this one. If you are 5’7’’ or taller, you will likely need to get a 65 cm ball to use rather than the 52 cm ball it comes with

This may seem like a strange recommendation, but I urge you to read the research on this topic and maybe you’ll considering trying it. If nothing else, it will encourage weight loss and core strength gains, so why not?

One year prior to meeting ‘Mr Smith,’ an avid runner, he had strained his right lower back lifting a heavy box. The discomfort from that injury faded over the next couple months, and since the symptoms were getting progressively better he decided he would not get checked out by a healthcare practitioner.

Once his pain was gone, he resumed his daily run and progressed back to five miles per day. Within 2-3 months, he began to notice a mild pain in his right knee after his morning jogs. It wasn’t long before this pain was present during his runs as well, and within a few weeks he could no longer run. His Orthopedic specialist referred him to Physical Therapy with a diagnosis of Patellar Tendonitis. After a few treatments, Mr. Smith’s symptoms began to improve, and he started some light jogging. Two months, many Physical Therapy treatments, and a cortisone injection later, Mr. Smith was still not able to progress beyond a two-mile jog without pain. The ultrasound, leg/hip stretching and strengthening, and massage of the painful area had all helped but had not solved the problem.

When I saw Mr. Smith the first time, and watched the way he stood, walked, and ran, I noticed a very slight lean/shift of his trunk to the right. This prompted me to ask about his back, and any injuries/pain he may have had in the past. By the end of the evaluation, and after ruling out a few other factors such as leg-length differences, it was clear that his tendon irritation was due to repeatedly overloading his right leg. This overload was due to the fact that the injured myofascia in the low back had remained tight even though the pain faded over time, and it caused him to shift his weight slightly to the right. The overuse manifested as an irritation of the patellar tendon, though it actually could have come up as pain in a variety of other areas. The Orthopedist was correct. Mr. Smith did have inflammation and irritation of his patellar tendon. Treatment of this area was effective to a point, but was not addressing the underlying cause of the overuse. A few Manual Physical Therapy treatments to release the myofascia in his right lower back, and Mr. Smith was back to running 5 miles pain-free.

The moral of the story is that even if an injury ‘fades’ quickly, it does not mean that it didn’t leave behind a problem. Though the true source of musculoskeletal pain may often be in the same place symptoms are experienced, it is also quite common for it to exist in a different part of the body.

So how does this happen? There are a number of examples, but for the sake of brevity I’ll just choose one for today …

Let’s say you strain your hamstring at the gym or on a run. Depending on the specifics of the trauma, it is theorized by some that a number of changes in the myofasica could have occurred. One such change could be a twisted fascial band that was formerly a flat sheath of fascia (or at least part of the sheath is twisted). How does a strong longitudinal-force through the muscle cause these distortions to occur? That’s a great question. I could go on with more theory, but the truth is that I’ve never hooked up a camera inside the hamstring and recorded the traumatic event. Such real-time documentation is impossible for obvious reasons, though there is plenty of post-traumatic ultrasound imaging that shows soft tissue changes with injury. What I can say is that these fascial changes can be palpated, and when they are treated with specific manual techniques to reverse the aforementioned ‘twists,’ the results are undeniable.

Returning to our original question, it is important to know that tiny nerve endings and blood vessels exist pretty much everywhere in the body. Fascia is lined with, and pierced by them. Imagine twisting a towel that was lined and pierced with these tiny nerve endings. At a certain point, the twisted towel would become tight enough that it was compressing the nerves. This illustrates, in a very simple manner, one way that fascial distortions can have an effect on the nerves in the area, causing pain and dysfunction.

Fasia is “the soft tissue component of the connective tissue system that permeates the human body. It interpenetrates and surrounds muscles, bones, organs, nerves, blood vessels and other structures. Fascia is an uninterrupted, three-dimensional web of tissue that extends from head to toe, from front to back, from interior to exterior… After injury, it is the fascia that creates an environment for tissue repair.”

- Paoletti, Serge (2006). The Fasciae: Anatomy, Dysfunction & Treatment. Seattle, WA: Eastland Press. pp. 151–161.

Important to note is that when Fascia is distorted from its normal arrangement, it restricts the movements of the above-mentioned structures, creating abnormal movement compensations and resulting in dysfunction and often pain. These changes in fascia can have a wide variety of causes … everything from a one-time trauma/injury, to repetitive overuse, surgical procedures, and even poor posture.  Luckily, in most cases, Fascia can be manipulated back to a normal or at least more normal arrangement very quickly. When this occurs, there is usually an immediate improvement in range of motion and pain levels.