The importance of activity and motion in daily life can’t be overstated. At RiedPT we understand the impact that these small changes can make in the recovery of wide range of conditions. Consider a low back pain patient that is struggling with disc pain. Conventional medical advice would tell them to rest, stay off their feet, and minimize movement. Many studies are showing, though, that the pressure applied to the disc and through the lumbar joints themselves is actually increased in sitting positions. In a study by Wilke in 1999, researchers found that intradiscal pressure significantly increased during supported sitting vs standing, and increased again with sitting unsupported (hunched forward).

  There are a wide variety of treatments that are appropriate for disc patients to decrease symptoms and improve function, but another part of the recovery over time is dependent upon what you do with most of your hours, movements, exercise, and positions during the day. At first glance it may sound like standing is ALWAYS better than sitting based on the previous study, but this isn’t always the case either. In another study by Callaghan in 2001, researchers compared tissue forces, muscular activation, and load of the low back during different positions. They found that although standing appears to be a good rest from sitting given the reduction in passive tissue forces, the constant loading in one position would probably not provide as much relief for muscular activation levels as one with dynamic movement.

  So all that to say…the best position for you is one that is dynamic and always changing. Some sitting, some standing, some stretching, some walking, etc. Your spine (and all parts of your body) benefit from movement in terms of pain reduction, fluid dynamics, blood flow, tissue oxygenation, and calming effects on muscle and nerve tissues. So when your therapist goes over ergonomics and varieties of positions that may help you during your day, remember that they all have a purpose, and when in doubt, get moving.

 Chronic pain, defined as pain every day for at least the last 3 months, affects over 11% of our nation’s population and is the number one cause of first use and continued use of opioid pain medications like hydrocodone and oxycodone among others. It’s no secret that our healthcare system and thought processes about chronic pain need some attention considering the recent call to action on the topic by both our current and previous presidents. It’s interesting, too, that we spend by far more than any other country on healthcare and pharmaceuticals, but our outcomes for improving pain and function are not as high.

  One type of treatment for countless pain issues is physical therapy. More than just strengthening and stretching, physical therapy has proven itself over and over again as a way to combat and educate about chronic pain.  Countless studies have shown the positive benefits of being treated by a physical therapist in dealing chronic pain and curbing use or preventing the original need for opioid meds. A very interesting and recent study that made tabloids last month was one by Frogner and colleagues that analyzed over 150,000 health insurance claims from 2009 to 2013.  They found that patients who saw a physical therapist before trying other treatments had an 89 percent lower probability of eventually needing an opioid prescription, a 28 percent lower probability of having any advanced imaging services, and a 15 percent lower probability of making one or more ER visits.

  So what does this mean to you? There are a lot of great insights from a study of this magnitude, but the number that stands out the most is 89 percent . Out of 150,000 patients, nearly 90 percent who saw a physical therapist first didn’t have to get pain medicine as strong as opioids…ever. That’s a wild statistic for our nation’s patients, insurers, and those that determine healthcare policy and law.

  At RiedPT, we want you to know that if you are struggling with chronic pain, talk with your doctor about referral to physical therapy sooner rather than later. If you or someone you know has an upcoming surgery or had a traumatic injury, remind them of the potential of physical therapy to restore motion, strength, and pain free movements…without the side effects that your risk with stronger pain medications.

 Over the last 10-15 years there has been a gradual increase in popularity of a technique called dry needling. It is shared among many different healthcare professions and varies some in technique between providers.  The term sounds less than appealing, but has been shown very effective for a variety of neuro-musculo-skeletal conditions, and many people often wonder what it is, why it’s used, and if it works. The name originates from overseas where occasionally injections are referred to as wet needling, and anytime a monofilament needle is used without medication to affect various tissues it’s referred to as dry needling.

  Dry Needling varies slight from traditional Chinese acupuncture due to the underlying theories, diagnosis, and treatments chosen. In traditional Chinese acupuncture the same needles are used, but the goal is to move and balance energy, or Chi, along varying meridians in the body. Although in western practice with dry needling we do utilize many of these same points, our goal is to affect the target tissues specifically in a variety of different ways.

  These changes and affects on the tissues can be broken down into mechanical, chemical, and neural changes, both locally where you are having pain or dysfunction, and systemically in the entire body. On a chemical level dry needling helps release a variety of cells and messengers in the blood that combat the pain response. Many of these are chemically the same as pain medication that you take in the pill form, like endogenous (opioids and serotonin). Other cells are brought into the area to help clean up debris and tissue (macrophages), others to trigger a healthy immune response (T cells), and lastly other cells assist by helping lay down new tissues appropriately (Fibroblasts).

  Research shows dry needling can affects tissues on a mechanical level as well, stimulating production of new capillary formation, which we call neovascularization, and can with enough use create a lasting change in nitric oxide levels which also represents increased blood flow.

  Possibly the most interesting of changes, though, happens on the neurological level. The areas in the brain associated with judging pain responses appropriately as well as interpreting sensation and feedback for resting muscle tone and activation patterns seems to be stimulated at increased levels with needling of certain local and distal points.

  All together these tissue changes make dry needling is a fascinating tool, and when used appropriately with a variety of other treatment techniques it can be a huge boost to your recovery and treatment of pain symptoms.

 In physical therapy, we use a variety of tools for improving patient outcomes. Sometimes what works well for one patient may not be as appropriate or effective for another. However, there is a commonality between successful interventions and functional improvements and that is a Positive Attitude.

  Positive Mental Attitude or PMA is the state of optimism or hope in a situation which attracts a positive change. One study of 167 people reports, 94% of the people agree that PMA can aid in recovering from illness and 77% agree PMA can even prevent illness. It is no wonder that many researchers have shown interest in how our mindset affects so many systems in our bodies, called psychoneuroimmunology. We know the body is composed of millions of chemical reactions happening all the time and that our attitudes affect our chemical make up the reaction processes.

  The research strongly supports a correlation between positive attitude leading to positive outcomes and negative attitude leading to poorer outcomes. Many times in the clinic negativity and stress can cause a patients' body to react by changes in vitals, increased stress hormones, decreased sleep, increased tension in tissues, poor posture, and heightened sensitivity to pain.

  A study on how expectations impact post-operative improvements states, PMA can affect patient outcomes through, “triggering of a physiologic response, acting to help motivate patients to achieve better outcomes, conditioning the patient psychologically to observe certain types of symptoms and ignore others, changing the understanding of the disease, or acting in concert with anxiety to heighten or reduce symptoms.”

  So the next time you visit your physical therapist, remember to approach the treatment with a Positive Mental Attitude and know the recovery process is a process; it takes time. Stay positive!

Blood flow restriction training, or BFR, is one of the most recent treatment techniques circulating the US. BFR techniques were developed in Japan and have been used by health care professionals and fitness professionals world wide since 1997.

   BFR is the technique of adding a band of pressure around the upper portion of arms or legs, in order to reduce venous blood flow leaving the working muscles and reduce the arterial blood flow coming in during low load exercises. The amount of pressure is calculated by acheiving 80% arterial occlusion for legs and 50% arterial occlusion for arms. Even with this amount of occlusion, many research studies have not found any increased risk of blood clots using BFR.

   Blood flow restriction training can be helpful to a variety of populations in the healthcare field. Athletes, post-operative patients, elderly patients, patients with elevated pain levels, and even patients in the ICU can all benefit from this approach. When used in the early stages of rehab, it combats muscle wasting by increasing muscle protein synthesis and reducing risk of muscle atrophy. One study found low load BFR training at 20% of maximum effort produced a 41% increase in quad strength compared to high load training at 80% of maximum effort produced a 36% increase in quad strength, demonstrating BFR as an effective intervention for strengthening with significantly decreased amounts of stress on the tendons and joints.

   Overall, BFR has been shown to significantly improve muscle hypertrophy and strength similar to that of high intensity training while only performing low load exercises. BFR is a safe technique that has been researched for many years. In summary, using BFR can create a more effective treatment that can be more tolerable than heavy-load rehabilitation.