“Is this a model or is it the real thing?”


I had the pleasure of meeting with one of our local orthopedic surgeons, Dr. Benjamin Bjerke, and the Zimmer-Biomet rep, Christina Escobar, to talk Mobi-C Disc Replacement technology and surgical technique developed by Zimmer-Biomet. Incredibly interesting.

Seeing the prosthesis, my first question was, “Is this a model or the real thing you are showing me?” It was much smaller than I anticipated!

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Secondly, I found the specificity of the patient suitable for this intervention impressive – someone with neck pain and or radiculopathy (pain down the arm originating from nerve root compression in the neck) without much cervical spondylosis (degeneration of the discs and joints in the neck) and good vertebral alignment. The Mobi-C can replace discs at one or two levels of the cervical spine between the third and seventh cervical vertebrae.

So lets take a look in more detail.

Anatomy and Pathology of the Neck

  • The cervical spine has discs between each bone that provide cushioning for movements and body loads. The discs and bones in a healthy neck allow bending from side-to-side and front-to-back, and turning left-to-right. Disc problems can start from over-use, an accident, or just the wear and tear of daily life.  When a disc degenerates it becomes thinner and provides less padding to absorb movement.  Degenerated discs can also bulge (herniate) and pinch the spinal cord or nerves, which causes loss of feeling, weakness, pain, or tingling down the arms and hands. Below  you can see the normal cervical spine anatomy and adjacent is a graphic of what a spine with pathology may look like:

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Treatment Options

  • Before artificial discs were available, patients would traditionally receive an Anterior Cervical Discectomy and Fusion procedure to alleviate the pain from a herniated disc. In a fusion surgery, the disc is removed and either a bone spacer or a plastic implant is placed in the disc space to restore disc height and remove pressure on the pinched nerves or spinal cord.   A metal plate and screws is placed on the front of the vertebral column to hold the implant in place.  The result – a segment that no longer moves, or is “fused”.  The potential downside of a fusion procedure, in addition to the loss of motion, is that it can create additional stress on the spinal levels above and below it.  This can cause degeneration at those levels and potentially result in another future surgery.
  • An artificial disc like Mobi-C is an option instead of a fusion that will also be placed inside the disc space to restore height and remove pressure on the pinched nerves. However, the Mobi-C device is designed to allow the neck to maintain normal motion and thus limit adjacent levels from degenerating, possibly preventing future surgeries.

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Since Mobi-C cervical disc replacements are preferred over fusions because they preserve movement in the spine, lets take a look at this video to see what happens in the spine when a patient with the Mob- C implanted flexes and extends his/her neck versus a two level fusion:

Cervical disc replacement procedures are anticipated to experience rapid growth in the near future, due to multiple factors:

  • A growing library of clinical evidence demonstrating the long term safety and efficacy of cervical disc replacement.
  • Cervical disc replacement is being shown as a superior treatment to fusion for use at two cervical levels.
  • Better outcomes of cervical disc replacement over fusion such as reduced re-operation rates, reduced adjacent segment degeneration rates and surgeries, as well as a faster return to work.
  • Most patients return to work within six weeks of surgery. In the U.S. Mobi-C clinical trial, the return to work time was 20.9 days shorter for Mobi-C patients compared to fusion patients for two-level surgery and 7.5 days shorter for Mobi-C patients compared to fusion for one-level surgery.

What about physical therapy after the Mobi-C disc replacement?

  • Wear a neck collar to lessen neck movement for around a week after the surgery.
  • Avoid heavy lifting, repetitive bending, and prolonged or strenuous activity for up to 6 weeks after surgery.
  • When your surgeon releases you to start physical therapy the physical therapist will do a comprehensive evaluation to assess your cervical, scapular and shoulder range of motion as well as cervical, arm and trunk strength. Based on the data collected, you will be given specific exercises to address any deficits to ultimately improve your function. You may start of with cervical isometrics and progress to upper thoracic and arm strengthening exercises as well as neuromuscular reeducation of the deep neck muscles. The physical therapist will also utilize soft tissue mobilization techniques to limit scar formation and address any myofascial pain and muscle trigger points, present from inactivity. You will need to participate fully by being totally compliant with the home exercise program you are given by the physical therapist at your very first visit.

Successful outcomes are determined by multiple factors which include choosing the right surgical procedure done by a skilled surgeon, following post operative activity limitations and brace use as well as being totally compliant with physical therapy instructions and exercises. It is a 3 person team that makes your recovery work: you (and your home supporters), the surgeon (and their staff) and the physical therapist (and their clinical team members).

Thank you to Zimmer-Biomet for help with supplying me with information and photographs.

Smoking, Health and Forest Fires.


Living in Reno, Nevada, we are frequently engulfed in smoke from forest fires around the area. Last year it was the big Yosemite fire, this year we were living under a blanket of smoke from the massive King Fire just east of Sacramento, California. Air quality was in the unhealthy range day in and day out. With clean air in the Truckee Meadows so dependent on the wind direction, we were praying for wind direction changes and the return of our Nevada blue skies.

Someone told me about a scene he saw at his work during the time we were blanketed in smoke. He left for lunch and walked past the smoking area outside the building. He saw two people smoking outside in the already smoky air and one waving her hand, cigarette in the other, “This smoke is killing me!” We humans are a funny bunch!

So I thought I would have some fun with that and take a photo. My disclaimer: I am not a smoker and never have been and boy did I learn something about smoking in the brief 10 minutes I had cigarettes going for the photograph!

  1. My tongue felt fury.
  2. My wife did not enjoy our first kiss.
  3. My clothes smelt of smoke immediately afterwards and this did not disappear until I washed them.
  4. I coughed immediately.
  5. I had to brush my teeth and take a shower right away.
  6. If I disliked it so much then it must be addicting as I struggle to believe those who have chosen to smoke don’t eventually bypass these sensations and thereby continue to smoke.
Smoking and our Reno Air Quality

Smoking and our Reno Air Quality

My Dad was a thoracic surgeon with a specialty in lung and esophageal cancer. As a consequence, I have always been very aware of the health issues related to smoking. I have never been addicted to anything (some who know me well may say I am addicted to exercise, talking to strangers and coffee!). I have seen numerous patients who smoke despite having significant reasons not to. For example, one person I recall had COPD, was on oxygen, had cardiovascular disease and had recently had a spine fusion (smoking delays healing) and was still smoking. Some of these smokers are in the healthcare profession too. Putting these factors together suggests to me that whether we like it or not, smoking must be incredibly addicting. Everyone who smokes knows it is bad for their health but they continue doing it. This begs the question: “What makes people change?”

People change because the pain of their present situation (smoking) is more than the pain of making the change (the withdrawals after stopping?). The pain of smoking depends on the individual and is different for each person. Some may see their wife pregnant and decide to stop smoking on account of the youngster about to be born. Some will have significant ongoing disease and still keep smoking (not painful enough yet). I have even spoken with someone who had simply given up as the disease process had gone too far.

I feel somewhat cheap talking about smoking cessation as I am not a cessation specialist nor am I a smoker who has kicked the habit. I have a real interest in why people change. This is the reason for my post. That being said, I recently met an incredible man. During his lifetime he stopped alcohol, methamphetamine, smoking and violence all cold turkey!

How is it he was so strong and quit all those things and many of us struggle?

Knee Pain! Osteoarthritis!


To my fellow Boomers out there ….. How are your knees doing?  We are an active sector of the population and we want to remain that way for the health benefits (and the fun!) thereof.  Knee pain due to osteoarthritis, whether one or both knees, has a dramatic impact on a person’s ability to continue with their chosen active lifestyle and, if it gets painful enough, may impact activities of daily living such as getting into and out of a car or a chair, cooking a meal or simply walking.

 WHY KNEE OSTEOARTHRITIS?

Osteoarthritis affects 25 million North Americans and is symptomatic in 13% of people aged 55 years and older.  It has been shown to be the most frequent cause of functional disability including being dependent on alternative forms of mobility due to the tremendous pain with walking.  Ouch!  The prevalence of osteoarthritis is rapidly increasing due to two main factors.  Firstly, the aging of the American population (that includes us!) is increasing the share numbers of people older than 55 years.  Secondly, the rapidly increasing obesity in our population is increasing the rate of joint degeneration.  One study reported 83% of males who had knee osteoarthritis were obese compared to 42% of males without it.  Wow!  Now there is a statistic that says a lot and leaves nothing to the imagination as to what we need to do to address the issue.

WHAT IS IT?

Osteoarthritis is the joints response to structural damage caused by mechanical problems.  It is the body’s attempt to repair a joint under unusual stress and often leads to a stable, pain free joint.  If this process fails (is insufficient for the magnitude of mechanical stress placed on the joint) the knee becomes symptomatic and hence functionally debilitating.

MECHANICAL STRESS YOU SAY?

Pathological mechanical stress of the knee joint may be due to:

  1. Increased overall load through the weight bearing joint surfaces (e.g. obesity).
  2. Reduced load bearing surface area thereby increasing the pressure (same force through a smaller area) exerted through the joint (e.g. misaligned joint: bandy or bow-legged).
  3. Repetitive impulsive loading of the joint (e.g. trauma, doing moguls).

Obesity increases the overall load through the joint and overwhelms the joint tissues resulting in osteoarthritis.  Being bandy or bow-legged reduces the weight bearing surface area in the knee joints (shifts it from throughout the knee to one side or the other of the joint) and results in excessive wear and tear of the joint on the outer or inner surfaces respectively.  Sustaining a serious injury to the knee in which ligaments are torn and the joint surfaces are banged together in the injury may initiate the osteoarthritic “repair” process as well.  Thus, when stress on the joint tissues exceeds their physiological tolerance breakdown ensues and osteoarthritis begins.

HOW CAN WE ADDRESS THE CAUSATIVE FACTORS?

Weight loss in an effort to attain a normal body weight for your frame is paramount in reducing the forces through the knees.  Walking results in a force through the knee equal to 3 – 4 times your body weight each step.  If you lose 20 – 50 pounds in an effort to attain your normal weight, you reduce the forces through your knees by 80 – 200 pounds each step you take!  Talk about happier knees!  An 11.2 pound weight loss over a 10 year period has been shown to reduce the likelihood of developing knee osteoarthritis by 50%.

For misaligned knee joints (those of you who are bandy or bow-legged) there are unloading braces to modify (increase) the load bearing surface and hence reduce stress to the one side of the affected knee.

In all osteoarthritic knee joints muscle weakness, joint stiffness and poor balance are factors.  Muscles around the knee joint serve to cause movement in bending and straightening the knee, can reduce mechanical stresses to the joint by absorbing loads applied to the limb (e.g. cushioning during landing a jump or when skiing) and stabilize the knee joint during daily tasks of walking, running, lifting and carrying to name a few.  Patients with knee osteoarthritis are 20% to 40% weaker in their quadriceps than people without the condition.  As the disease worsens the knee muscle activation patterns become less efficient and less specific and joint proprioception (the brain’s ability to know what is happening at the joint and react accordingly) is suppressed.  A well constructed, evidence-based physical therapy program will improve strength, range of motion and proprioception and result in improvements in physical function, pain and quality of life.  Modifying the mechanical problems causing the osteoarthritis together with addressing the inflammatory and pain aspects of the disease process through pharmacological intervention from your physician can result in an 86% success rate in improving your function.  Who would not like that!?

All our physical therapists at Custom Physical Therapy have undergone specialized training for treating osteoarthritis.  The therapists work as part of a team comprised of you the patient, your physician and the physical therapist.  Using physical therapy interventions to modify the mechanical factors impacting the progression of osteoarthritis together with the physician addressing the pharmacological aspects and the patient being compliant with an exercise and stretching program (see our very first post on this blog) as well as brace use, if prescribed, the team of patient-physical therapist-doctor minimizes the effect of the disease process on your function.

YOUR CALL TO ACTION!

  1. If you are overweight start a simple lifestyle change that entails weight loss (Call Joe Dibble, dietician at Sierra      Strength and Speed, for a consult.  He is really knowledgeable and practical.)
  2. Call Custom Physical Therapy so we can evaluate your      arthritic knees and set you up with appropriate treatment.
  3. Forward this post to someone you know who has sore      knees or you think may be interested in the information.

You are encouraged to call Custom Physical Therapy to talk to one of our accredited physical therapists about your knee pain.  You may be a candidate for this customized evidence-based program specifically developed to improve your function which deteriorated due to knee osteoarthritis.

Break a Leg? Literally!


I really enjoyed Laura’s blogging of her total knee replacement.  I think this is a great idea and one which can help other people who are potential knee replacement candidates get a sense of what the process looks like from a patient’s perspective.

Great job, Laura.  We all hope you are doing well.

Break a Leg? Literally!.

A quick survey!


I am interested in how people decide where to go for their physical therapy. Let us know how you pick your provider and watch the results.  Should be interesting.  Knowing this information will help Custom Physical Therapy’s efforts to provide better services to our patients.  Thanks for your efforts.

Tendinitis


Tendinitis is the inflammation of a tendon and of tendon-muscle attachments i.e. where the tendon attaches to the bone (insertional tendinitis).  It is an overuse phenomenon, can be excrutiatingly painful and functionally debilitating.  Treatment should focus on addressing the cause of the tendinitis, reducing the inflammation and the pain, and remodelling the tendon through a controlled exercise progression.

Most frequently seen diagnoses in our physical therapy clinic are rotator cuff tendinitis (supraspinatus tendinitis), posterior tibial and peroneal tendinitis (pain in the foot and ankle), tennis elbow (lateral epidondylitis), achilles tendinitis, patella tendinitis and iliotibial band syndrome. Interestingly, we have recently been seeing an increase in tendinitis of the guteus medius (hip abductor muscle).  We see golfer’s elbow (medial epicondylitis) less frequently than tennis elbow.

Despite tendinitis occuring in tendons all over the body, the approach to treating the condition remains the same for each structure involved.  You treat the tendonitis by following a specific intervention progression.  The exercises are different for the different tendons but the principle remains the same:

 

Treat the cause of tendinitis.

It does not matter what tendon is involved, the cause is most frequently overuse.  Overuse means the stress the tendon has had to endure, as a result of the force it is being asked to apply (both intensity and frequency), results in microtrauma to the tendon structure and hence inflammation.  If the tendon is not given rest, it does not have the opportunity to recover.  Examples of activities which can result in tendinitis include typing, repeated gripping on a production line, fly fishing, overhead lifting or repeated jumping.  Ankle sprains may cause tendinitis in the posterior tibialis and peroneal tendons of the foot.

So, the first line of attack is to decipher what the causative activities are and modify them.  For most rapid resolution, these should be stopped completely to avoid the continuous trauma to the tendon.  Sometimes this is not possible and a program of relative rest must be designed by the physical therapist:patient team.

 

Treat the inflammation.

Part of controlling the inflammation is reducing the stress on the tendon.  The physical therapist will address this with you in detail.  As mentioned above, rest gives the tendon the opportunity to recover from the microtrauma (as noted above).  Non-steroidal anti-inflammatories or even streroids may be prescribed by your physician at the same time.  Physical therapy interventions to control inflammation include ice in the form of an ice pack or even ice massage and, iontophoresis – the administration of an anti-inflammatory, dexamethazone, to the tendon utilizing electrical currenct to faciltiate the passage of the medication through the skin (Yes!  No needles!).

 

Treat the pain.

By following the above suggestions, pain should subside over time as the inflammation is controlled.  If the pain is severe enough your physician may subscribe analgesics (pain killers).

 

Remodel the tendon.

Here is where the work is!  Your physical therapist will teach you how to stretch the involved tendon as well as progress you through a specific exercise regimen which involves both concentric and eccentric exercises which will stress the tendon.  A concentric exercise is one in which the muscle contracts and shortens at the same time e.g. the bicep contracts to bend the elbow bringing the coffee cup to your mouth.  An eccentric contraction is one in which the contracting muscle is lengthening while it contracts e.g. the bicep contracts and lengthens as it controls the extending elbow to put the coffee cup back down on the table.  An eccentric contraction places more tension on the tendon than a concentric contraction and can thus promote tendon remodelling.  Eccentric exercises are more aggressive than the concentric type.

The goal of the stretching and strengthening progression is to stimulate tendon remodelling.  This improves the flexibility and tensile strength of the tendon.  This, in turn, improves the tendons ability to tolerate the original activity which caused the tendinitis.

 

Soft tissue mobilization?  Deep transverse friction?

What about soft tissue mobilization and deep transverse friction?  Soft tissue mobilization of the involved muscle belly and, indeed, of the surrounding musculature can be helpful in alleviating discomfort.  It is less aggressive than deep transverse friction and is definitely more comfortable.

Deep transverse friction is used to stimulate blood flow in the involved tendon and break up any adhesions which may have developed as a consequence of the microtrauma of the tendinitis.  It is done by applying significant pressure (up to 7/10 pain) over the tendon with the thumb or index finger and rubbing in a direction transverse to the direction of the tendon fibers.  Sound like fun!?  It is done in conjunction with the tendon remodelling exercises detailed above.

 

YOU CALL TO ACTION:

  1. Make sure you visit us early on in the process because it is much easier to treat than if you have had tendinits for more than a few weeks.  EARLY INTERVENTION!
  2. Make sure you specifically ask to be sent to physical therapy the very first visit you have with your doctor so you can be shown the specific exercises and enjoy the hands-on treatment from the physical therapist.
  3. Pass this on to someone you know who has tendinitis.
  4. Call us with any questions you may have: 775-331-1199.

Part 2: The Global Leadership Summit 2011.


Day 2 (see last week’s post for day 1 summary) of the Global Leadership Summit started with 3 incredibly different sessions highlighting 3 individuals who have done great things in their own sphere of influence while facing different obstacles. The message I came away with is this: We all face obstacles every day and it is how we view these challenges that makes us leaders and makes us accomplish great things.
The first speaker was the President and CEO of Compassion International, Dr. Wesley Stafford. Compassion International (www.compassion.com) is an organization that partners with church members all around the world to fight against poverty affecting millions of children around the world.  Children are helped through child sponsorship which allows individuals to link to a specific child in need through the kid’s local church. Their church serves as their safe haven in a very difficult and often dangerous environment.  His take home message:

 
1. Dedication to a cause, the one thing you find drives you to stay the course, to get up each time you fall down, is not easy and often may involve sacrifice.

Next up was Mama Maggie, the Mother Teresa of Cairo and Nobel Peace Prize nominee. She has spent more than 20 years serving the poorest members of Cairo. She works with kids living and sleeping and eating in trash dumps! She profiled families with nothing, absolutely nothing. Mama Maggie was quiet yet strong. She was the depiction of faith. She is a very strong leader as a consequence. She held the podium with ease in her calmness. Indeed, this is a woman who is the Founder and CEO of Stephen’s Children Ministry. What did I draw from her message?

 
1. Life can be hard but with faith we can all persevere.
2. The world around us needs people who are willing to give of themselves, to listen to others in need and to care.
3. We don’t choose where we are born but we do choose what we do with our lives.
4. Her guiding thought in parting:

 
“Silence your body to listen to your words.
Silence your tongue to listen to your thoughts.
Silence your thoughts to listen to your heart beating.
Silence your heart to listen to your spirit.
Silence your spirit to listen to His spirit.”

 
How does this relate to physical therapy? Clinicians need to be compassionate towards their patients. We must listen to them. There is not enough listening and too much “telling” in the healthcare environment these days. Patients must know they are going to get better if they give all they have got to the process. This means we need to have faith in what we do and who we interact with.

Next up was an interview with Michelle Rhea who, at 37 years old, was appointed Chancellor of the Washington D.C. Public School System. She founded StudentsFirst.org, a non-profit organization, with a mission to promote the interests of children in public schools.  Check out her web site: www.studentsFirst.org.  (She served as a consultant to Washoe County School District this past year, if my memory serves me correctly). Here are some of her words of wisdom:

 
1. You cannot lead if change isn’t happening.
I think this applies to all of us in leadership positions. Our job is to create change and take people through it by addressing their fears.  Physical therapists lead their patients from the challenging position of lacking function due to pain into a new place which frequently requires a change in habits.  It’s our job and we love it.
2. “I’d rather deal with anger then apathy!”
We see a lot of people who the healthcare system has failed. They have seen multiple physicians, had numerous expensive tests done, had various invasive interventions, had physical therapy which did not result in any benefit and are not happy with still being in pain months or even years later.  As with Michelle Rhea, I would rather deal with patients in this situation that have been angered and have taken charge of their care.  As I wrote in the blog posted on 18 July, 2011), patients often recognize that they need to get involved after the healthcare system has failed them.  I suggest you get involved by being educated and asking questions and demanding better care before you get angry.

Dr. Henry Cloud, a clinical psychologist, author and leadership consultant then took us on a journey through the different kinds of employees a leader may need to interact with. The categories may surprise you: The wise, the fool, the evil!

 
1. The Wise: They respond well to critique and appreciate the feedback which they use to better themselves. Strategies to help the wise? Talk to them, coach them and challenge them.
2. The Fool: They shoot the messenger, don’t own the problem and get angry following critique. Strategies? Get them to come up with their own solution to a problem or behaviour you need corrected within a set timeline. If this does not correct the problem after they have addressed it their way …… see you later.
3. The Evil: These people have organizational destruction in mind. Watch out for lawyers, guns and lots of costs.

Up next was John Dickson, author of the just published book, Humilitas: The Lost Key of Life, Love and Leadership.  He is the Director of the Centre for Public Christianity in Sydney, Australia.  His 5 points on humility seem easy so let’s make you think about your own humility and list them:

 
1. Humility is common sense.
He stated, what you know and can do is far less than what you don’t know and can do.
2. Humility is beautiful.
Think of a truly humble person and tell me that they are not beautiful. Think about someone who is not humble.
3. Humility is generative.
Truly humble people are in a place of flourishing.
4. Humility is persuasive.
To persuade someone you need to be trusted. To be trusted you must have a character full of humility.
5. Humility is inspiring.
I think of my hero, Nelson Mandela, a truly humble man of immense greatness. What of Mama Maggie!?
How are you doing with humility these days?

Patrick Lencioni, a very dynamic and funny speaker, kept us riveted on “Naked Service.” His book, Getting Naked, must be a very interesting read. Getting naked refers to allowing yourself to feel vulnerable by being who you are. We all have difficulties being ourselves sometimes for some reason and he listed some of them.

 
1. Fear of rejection.
Be vulnerable and go for it. Tell the truth.
2. Fear of being embarrassed.
“Do not edit yourself to manage your image.” Celebrate your mistakes as you learn from them. Ask lots of questions to gain understanding and hence educate yourself.
3. Fear of feeling inferior.
You must have a genuine desire to serve your clients. Honor your clients work. As a leader, be willing to do some of your employees’ dirty work.
Overall, you cannot enjoy success without the potential for some pain.
Finally, Edwin McManus gave a high energy talk entitled “Chasing Daylight.”  Think about this one.  Why do we wait for someone else to create a better future?  As leaders or, I might add, as members of the human race, we should cultivate human talent.  How can we interact with others to make them better people for no other reason than to help them have a better day?  He said something similar to Cory Booker (see last week’s post).  “There has never been an ordinary child born on this planet, ever! Most of us die ordinary!”

 
 OUCH!


 YOU CALL TO ACTION:
1. Look these speakers up on the internet and buy one of their books. You will not be disappointed.
2. How well do you “play yourself?”
3. How might you be more real to yourself?
4. Are you giving yourself “Naked Service” in your quest for better health, better happiness, a better life?

Pain? What is it really?


The International Association for the Study of Pain defines pain as follows:

“Pain is an unpleasant sensory and emotional experience associated with actual or potential damage, or described in terms of such damage.”

So what does that mean anyway?

  1. Pain doesn’t feel good.
  2. Pain is influenced by our emotional status.
  3. There may or may not be any trauma to the body.

Put differently, per Dr. Lorimer Moseley, Ph.D., a world-renowned pain researcher and clinician at the Prince of Wales Medical Research Institute in Sydney, Australia:

“Pain is the conscious correlate of the implicit perception of threat to body tissue.”

Huh?!

This suggests that pain does not originate in the tissue due to injury or a degenerative process.  Instead, it is a very complex interaction between the peripheral tissues (e.g. torn muscle, knee arthritis, lumbar disc herniation, whiplash injury, broken bone) and the brain. The brain processes information as follows:

  1. From your experiences in life – how did your family deal with pain when you were growing up?
  2. Cultural factors – Italian men have been shown to be stimulated by a blue placebo pill and sedated by a red one while men of other cultures in the study experienced the opposite.
  3. Social and work environments – if you enjoy your job and like your boss then less pain may be experienced than if you don’t.
  4. Your expectations as to what might happen as a consequence of the pain – if you do not have an adequate understanding of a particular injury you have sustained you might be concerned as to how you will return to work or your hobby/sport and thus experience more pain.

So pain is an output from the brain after the brain has processed all the above information as well as the nerve impulses coming from the injured area, called sensory input.  Once it has synthesized the need for an output you will then “be told by your brain” if something is painful or not. Think about the person I spoke to a few years ago who had a motor cycle accident and felt minimal pain when she stopped skidding along the highway and noticed her leg 20 feet away from her!  Why no pain then? The brain had compiled an appropriate response at that time that suggested she had more important survival needs and thus did not feel pain. When she was loaded into the ambulance and the emergency personnel took over (they were in charge of survival now) she began to feel pain.

So what kind of output from the brain results once it has decided there needs to be a response to the “painful situation?”

  1. Pain is produced which makes us do something to address the “dangerous”  position we are in.
  2. The sympathetic nervous system causes the fight or flight reflex.  Increases in heart rate occur.  Energy systems are stimulated.  We sweat. We are ready to take evasive action!
  3. Muscles are reactive and are set to fight or run away as well as protect the damaged area. If you have torn a hamstring muscle you know you cannot move due to spasms – a physiological brace per se!
  4. The endocrine system is mobilized and in so doing hormones circulate in the blood stream to help mobilize energy for use by the muscles and reduce other nonessential body functions such as intestinal motility.

The most recent research into pain has changed the viewpoint from one of a noxious stimulus causing pain (i.e. a peripheral origin of pain) to one of the brain being the decision maker as to what is painful and what is not (i.e. a central origin of pain). How complicated is that! It is not as simple as treating the injured tissue to relieve the pain. Pain needs to be treated from multiple angles with a multi-disciplinary approach.

YOU CALL TO ACTION!

  1. Check out Dr. Lorimer Moseley’s blog at : http://bodyinmind.org/resources/journal-articles/full-text-articles/reconceptualising-pain-according-to-modern-pain-science/
  2. What do you think of this new concept of how pain is generated? Post your ideas on this blog for others to read.
  3. Invite a friend who is struggling with pain to read this.
  4. Call us at any of our three clinics if you have any questions:

Sparks location: 775-331-1199

South Reno location: 775-853-9966

Northwest location: 775-746-9222

It is Your Right to Choose Your Physical Therapy Clinic.


At Custom Physical Therapy, we come across many people who are not aware that it is their right to choose where they do their physical therapy. We also see patients who do not know that they can (and should) request their doctor to refer them to physical therapy if they think they need it.

Most people are referred to us by their physician, physician’s assistant, nurse practitioner, case manager or chiropractor. These providers partner with us in your recovery. We work together, as your “recovery team”, to provide the needed interventions for your speedy recovery.
 What about you? How should you be involved in the decision-making process?

1. You must be an informed consumer of healthcare.

Thus this blog! We want you to use this blog as an information source, a place to discuss (POST) your questions with other members of the Custom Physical Therapy community and our clinicians. Learn! Learn! Learn! Being informed takes effort on your part. We are here to answer any questions either by phone, in person or after you post them on the blog. Your choice. Obviously, we cannot give you concrete medical advice through the blog but we can give you access to information that may be in our head! We can direct you to appropriate resources if need be. This is an invitation to you whether you are a patient of ours, a prior patient or someone who has not visited our three clinics at all.

2. Actively participate in your healthcare.

To do this you need to be informed sufficiently to ask questions. Yes, you need to ask questions. Lots of them! Ask questions until you understand what interventions are being proposed by your doctor, nurse practitioner, physician’s assistant, case manager, physical therapist or chiropractor. This new understanding you have allows you to accept or reject what interventions we propose. You can also request other interventions – as long as you, the patient, are informed, i.e. you have done your homework! Educate yourself then actively participate in your care.

3. Make sure you know who you want to treat you.

Which clinic you attend and which provider (physical therapist) you want to be treated by is your choice. As long as they are on your insurance provider list (in-network) you will be covered by in-network benefits and typically pay less out-of-pocket than if you see someone who is out-of-network. You can, however, go out-of-network if your provider of choice hasn’t signed a contract with your health insurance company. You may then have a higher out-of-pocket expense.
At Custom Physical Therapy we try to match your out-of-network out-of-pocket cost to your in-network cost. So, never think you cannot see us if we are out-of-network. We will check your benefits and let you know what your out-of-pocket cost will be before you schedule your first appointment.

When should you request physical therapy if your doctor or other healthcare provider does not recommend it to you?

For any musculoskeletal issue there is a high likelihood physical therapy will benefit you.  Afterall, we specialize in the rehabilitation of musculoskeletal problems.  These include, but are not limited to, low back pain, neck pain, headaches, shoulder problems (weakness, pain, stiffness), arm and leg problems, ankle sprains, and numerous other conditions.  If you are unsure, call us at one of our clinics and we will be honest with you and tell you if we are an appropriate route to get you back to full function.

Regarding low back pain, research has documented the longterm benefits of physical therapy when started within 2 weeks of the onset of low back pain. Treatment with medications only (anti-inflammatories, muscle relaxers and/or pain killers) and no physical therapy resulted in an 85% reoccurrence within 1 year of resolution of the episode of low back pain, which took 3 months on average to resolve. Medical management combined with physical therapy (specific exercises and manual therapy interventions) only had a 35% reoccurrence!  That’s a huge difference!  Worthwhile I would say! It is totally appropriate for you to request physical therapy at the initial visit to your doctor for your low back pain.

Another condition where you should specifically request physical therapy immediately is for an ankle sprain, even if it is a slight one. Chronic ankle sprains may occur if early rehabilitation is not pursued.  There is a greater likelihood of arthritis in the ankle joint each time you traumatize the joint by spraining it. Research on ankle sprains shows that one sprain leads to another and then another if the brain’s ability to control the ankle in unstable situations (known as proprioception) is not retrained.  This involves being instructed in specific exercises to enable the brain to “adjust” to the faulty information, due to the ankle sprain, arising from the muscles, ligaments and tendons which control the ankle joint.

IN SUMMARY:

  1. Be proactive with your healthcare and learn as much as you can.
  2. Ask questions to gain understanding.
  3. You choose who you see for physical therapy.
  4. You can and should request physical therapy when you think it is needed.

 YOUR CALL TO ACTION!

  1.  Post a question concerning your health on this blog. If we do not know the answer, we will find it for you from another expert in the field.
  2. Check out the videos on the blog and rate them. Why do you think they are good?
  3. What topics would you like to see covered in this blog?
  4. Ask a friend to do action 1 through 3 above.  This will get our information out to many others with your help.

See you for the next post!  Plan on once a week visits to this blog for new information!