Manipulation: beneficial for low back pain
Manipulation can be a quick and effective treatment for low back pain.
What is a manipulation? A manipulation is a quick thrust (high acceleration, low amplitude thrust) applied to a specific joint in the body in order to increase the amount of motion at that joint. The manipulation causes a neurophysiological response, helping to decrease local pain and muscle tone.
Who should receive manipulation? Individuals with a fixated or “stuck” joint. A fixated joint is one that will not move in a certain direction and often leads to pain and dysfunction. This fixated joint could be causing a problem locally or somewhere else along the kinetic chain. This individual must be cleared for all contraindications prior to manipulation.
How can this help me as a patient with back pain? It has been shown that individuals with back pain can benefit greatly from manipulation immediately and several months after the intervention. The results from the study below by Janette Morton indicate that patients who received manipulation in addition to an exercise program experienced less pain immediately and 3 months after treatment compared to the group that performed exercise only. Not only did the group that received manipulation experience less back pain, they also demonstrated improved range of motion in their low back as well as improved ability to perform every day tasks.
Who can do this for me? Physical therapists are trained to perform these precise movements in a specific manner in order to produce the best benefit with little harm. Some physical therapists are trained in more advanced methods of manipulation. These therapists are considered manual therapists and should be certified. The team members at GOfit are both certified manual physical therapists!
Janette E. Morton (2013) Manipulation in the Treatment of Acute Low Back Pain, Journal of Manual & Manipulative Therapy, 7:4, 182-189, DOI: 10.1179/106698199790811546
How to treat the likely culprit of lateral hip pain; gluteal tendinopathy
There is a very common cause for pain on the outside of your hip. Most of the time its from your muscles and tendons.
In the last blog post, we discussed gluteal tendinopathy: why it happens, whom it affects, aggravating factors, and briefly how to treat it. Today we will delve further into treatment strategies for gluteal tendinopathy as suggested by the authors:
Grimaldi A, Fearon A. Gluteal tendinopathy: integrating pathomechanics and clinical features in its management. J Orthop Sports Phys Ther. 2015;45(11):910-922.
Ideas to reduce lateral hip pain:
1. Reduce compression of the gluteus medius and minimus tendons; ie. avoid repetitively adducting the hip (bringing the hip close to the midline of the body) or maintaining it in this position. For example, avoid sitting with the legs crossed or lying on your side without a pillow between your legs.
2. Avoid hip stretches into hip adduction while the hip is flexed or extended. So lay off of your pigeon stretch or figure 4 stretch for the time being.
3. Use dry needling or trigger point release techniques in lieu of stretches to address affected muscles
4. Avoid aggravating activities for the time being such as excessive stair climbing or running hills during training.
Ideas to rehab: Exercise should be focused on slowly progressing tensile loads in non-aggravating positions.
1. Start with sustained low intensity isometric contractions into hip abduction to activate the gluteus medius and minimus muscles for pain relief. Resistance can be progressed as tolerance is improved. This may be done on your back, standing, or side lying with a pillow between the legs and you can provide your own isometric resistance.
2. Next, resisted exercises are employed for hypertrophy of the muscle and tendon remodeling. This should be done 3 times per week and the workload should begin at a moderate level and progress if you are able to tolerate this well. Weight-bearing exercise is key because it helps activate the gluteus medius better. A good exercise would be side stepping with a resisted band tied around the legs.
3. Physical therapists need to assess movement patterns and control of the pelvis during the aggravating task and retrain these motions.
4. Physical therapists should assess the spine and knee for contributing factors and treat as needed.
Please call GoFit Physical Therapy to help treat your hip pain. We are here to answer any questions you may have: (443)699-4771 info@gofit-pt.com
Trochanteric Bursitis? Probably not...
Trochanteric bursitis is a diagnosis that is thrown out there way too often. It is pretty rare and there is a much more common reason for the pain your experiencing.
Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal tendinopathy: a review of mechanisms, assessment and management. Sports Med. 2015;45(8):1107-1119.
Today’s blog post highlights gluteal tendinopathy and it’s relationship to physical therapy. Tendinopathy is defined as a disorder of a tendon, which is the tissue connecting the muscle to bone. This post summarizes some key points directly from the article listed above.
Previously most lateral hip pain (pain on the outside portion of the hip) had been over diagnosed as trochanteric bursitis. Now, it has been established that oftentimes lateral hip pain is not coming from the bursa, but instead from gluteus medius and minimus tendinopathy. These muscles are two of the three gluteal muscles and these two sit on the outer portion of the hip. It is thought that the gluteal tendinopathy arises because of altered compression and tension to the tendons. When the tendon is not provided with the correct amount of loading, whether it be too much or too little, the tendon begins to break down. The gluteal muscles are then unable to function as they would normally, potentially leading to pain.
It is proposed that the positioning of the hip can lead to increased compression of the gluteal muscles. If the hip is constantly in an adducted position (with the leg coming into a position closer to midline of the body), the gluteus medius and minimus tendons are continually compressed and placed on tension causing atrophy. Additionally in this position, the gluteus medius and minimus muscles do not have a mechanical advantage to activate when needed, so other muscles take over.
Who typically suffers from this condition? Women > men, ages 40-80 years old
Aggravating factors: Crossing the legs when sitting, side-sleeping, walking, going up and down stairs, moving from sit to stand
How to treat it: Control the load placed on the gluteus medius and minimus tendons. Specifically avoid activities with high tensile and compressive loads, and work to modify movement patterns (ie. train the body to avoid adducted positioning of the hip). This can be done in physical therapy. In fact, physical therapy has been shown to be more effective at improving this condition long term than corticosteroid injections.
Return to Sport after ACL repair - How many athletes are actually ready?
Most athletes are returning to their sport way too soon after ACL repair. Find out if you are really ready.
Young Athletes Cleared for Sports Participation After Anterior Cruciate Ligament Reconstruction: How Many Actually Meet Recommended Return-to-Sport Criterion Cutoffs? Toole, Ithurburn, Rauh, et al. Journal of Orthopeic & Sports Physical Therapy, 2017.
This is an interesting article that highlights what we see often in sports; athletes returning too soon to their respective sport following an ACL tear. When athletes return to their sport too soon they are at a greater risk of a re-tear and are less likely to perform at their previous level. This study looked at how many young athletes actually met the recommended return to sport criteria when they were cleared to return by their surgeon and rehabilitation team.
The authors had several tests that they used to determine return to sport readiness. These were quadriceps and hamstring strength at greater than or equally to 90% of the uninjured leg, single leg hop tests at greater than or equal to 90% of the uninvolved leg, and a self reported knee function scale.
The outcomes are pretty staggering. Of the subjects in the study, only 13.9% of athletes that were cleared to return to sport by their surgeons and rehab team actually met the recommended criteria. The research also shows that those who returned to their sport without meeting the recommended criteria were less likely to maintain their level of participation.
So what does this mean? Unfortunately this means that a great majority of athletes are being cleared to return to their sport way earlier then they should be. This also means that most surgeons and physical therapists are likely not performing any reliable tests to determine if their patients met standards to return to sport.
How GOfit can help: If you have had an ACL injury and you are still having pain and/or difficulty returning to the activity that you love, we have the ability to objectively evaluate your function and develop a treatment plan specifically for you.