Showing posts with label manual therapy. Show all posts
Showing posts with label manual therapy. Show all posts
Nov 18, 2014
Mar 19, 2014
Hey everybody! Today's post was written by my good friend Yuya Mukaihara. He was telling me about some success he was having using some Rocktape samples that I had given him so I asked him to write up one of the cases for my blog. So without further adou here it is:
I am one of Adam's classmates at Illinois State University and I work at a local HS. I am a Certified Athletic Trainer with CSCS, and NSCA-CT credentials. I have Graston Technique and Technica Gavilan IASTM certifications. I have also taken some PRI courses--Myokinematic Restoration, Postural Respiration, CCM, and I just finished Impingement & Instability this weekend. I use manual therapy, PRI, and corrective exercises in my practice but this case was an acute episode of left torticollis. So, I mostly used manual therapy to manage this case.
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| The athlete kind of looked like this... |
Background
Torticollis, also called as cervical dystonia or spasmodic
torticollis, is a condition of the neck that results in sustained involuntary
muscle contractions that may cause pain and neck rigidity.1,2 66% - 75% of the
patients experience pain, which is the main cause of disability in those
patients.1 It is more common
in women than men and occurs in 5 to 20 out of 100,000 individuals.2 Idiopathic
torticollis is considered as primary cervical dystonia due to no history of physical
examination or laboratory tests whereas the secondary cervical dystonia is due
to an abnormal developmental history.1
Currently, the
pathogenesis of torticollis and the anatomical origin of its symptoms are
unclear; however, an onset of idiopathic torticollis is often gradual and it
displays sustained co-contraction of agonists and antagonists of cervical
muscules.1,3 Commonly, it is
treated with a series of Botulinum toxin A injections into overactive
musculature.1 However, torticollis
can conservatively be managed by reducing pain and involuntary muscle contractions
with Kinsiotaping 4, manual therapy 5,6, and therapeutic
exercises.3
In this case report, I used Muscle Energy Technique (MET)
and Strain-Counterstrain (SCS) technique with an application of Rocktape to manage
acute idiopathic torticollis in a male high school basketball player while he
played playoff games.
Case Report
A 16 year-old basketball player came into the ATR 10 minutes
before his practice started, c/o of left neck pain and tightness that resulted
in his inability to look left. He stated that he started noticing tightness and
pain that gradually becoming worse in the afternoon. Any other symptom was
stated. It was in-season and was a day before his playoff game and he was
needed in practice because he was one of better players on the team.
- At resting with seated, his neck was rotated and side
bended to right a little bit.
- Active left cervical rotation was limited and was
about 15deg with pain in the left side. Full right rotation.
- Active left side bending was also limited and was
about 10 deg with pain in the left side. Full side bending.
- Palpable tightness over left cervical extensors,
upper trap and levetor scapula compared to right. He c/o pain with palpation of
these muscles.
- MMT to cervical flexion, extension, right rotation
and right side bending were 5/5 without pain. Left cervical rotation and left
side bending were 3/5 due to pain.
- No history of a car accident, head or neck injury, or
shoulder pathology. No history of medical conditions or surgery that should be
noted. No signs and symptoms other than tightness, pain, and limited ROM of the
c-spine.
Course of Treatment
Day 1, after a quick evaluation, he had to go to the
practice so I only had 10 minutes to treat him. I began with MET isometric
reciprocal inhibition on left rotation and side bending. I didn't target
specific muscle but general motions. I had him to rotate and side bend to the
right from neutral to gain motions on the left side by inhibiting these tight
musculature. There was not much improvement but he had to go to the practice.
15mins later, the player came back to me because he could not play due to pain. So, now I had a little bit more time to treat the athlete. I had him lay supine and checked his passive ROM. Passive left cervical rotation and side bending caused pain as did active, displaying limited ROM.
15mins later, the player came back to me because he could not play due to pain. So, now I had a little bit more time to treat the athlete. I had him lay supine and checked his passive ROM. Passive left cervical rotation and side bending caused pain as did active, displaying limited ROM.
I used SCS on his left upper trap and levator scapulae
because I suspected muscle spindle hyperactivity. After resetting the mechanoreceptors, he had
increased left cervical rotation and side bending.
After finding the most tender spot, I kept a pressure and started counting time. Then I slowly increased left rotation. Once he feels no tenderness under my finger, I stayed there for about 20-30sec and then increased a little further and repeated. At the same time, I added some side bending a little by little to gain the ROM.
After one session of this technique, his active left rotation was about 80% of his right rotation and side bending was about 30% of his right side bending. (active left cervical rotation about 75deg and side bend about 25deg).
Then, I performed a 1st rib MET on the left for one set of five isometric contractions to inhibit his left scalenes and to regain the function of left side bending.
Fortunately, I had a sample of Rocktape from Adam, so I put the player’s neck into flexion, right rotation and right side bending to place his left neck muscles on stretch then applied two strips of Rocktape.
After finding the most tender spot, I kept a pressure and started counting time. Then I slowly increased left rotation. Once he feels no tenderness under my finger, I stayed there for about 20-30sec and then increased a little further and repeated. At the same time, I added some side bending a little by little to gain the ROM.
After one session of this technique, his active left rotation was about 80% of his right rotation and side bending was about 30% of his right side bending. (active left cervical rotation about 75deg and side bend about 25deg).
Then, I performed a 1st rib MET on the left for one set of five isometric contractions to inhibit his left scalenes and to regain the function of left side bending.
Fortunately, I had a sample of Rocktape from Adam, so I put the player’s neck into flexion, right rotation and right side bending to place his left neck muscles on stretch then applied two strips of Rocktape.
One strip was applied from the occiput to about T3 level and
the other strip was applied from the mastoid process to scapular spine. My
intension to use Rocktape was to inhibit the hyperactive or hypertonic muscles.
I had some personal experience of inhibiting hypertonic muscle with Rocktape
previously.
After those interventions during 15 mins of treatment, he
was still limited to left sidebending with pain, but was able to complete the
practice with the team. He ended up keeping the Rocktape on for the next four
days.
Day 2, the day of the playoff game, he returned with full
left cervical rotation without pain and improvement on left side bending, which
was 80% of right side with minor pain. On that day, I used MET for left 1st
rib, upper trap, and levator scapulae with isometric autogenic inhibition. He
played the game without any complaint, and we won the game.
Day 3 and 4, he had no limitation on both left rotation and side bending and no pain. On that day, I used MET for 1st rib only. No deficit with RROM for flexion, extension, both rotation, and both sidebending. He completed a practice without any complaint.
Day 5, he had returned to play without treatment. He completed a practice without any complaint.
Day 6, he had no complaint from day 5. He played the playoff game without limitation
or complaint. We won the game.
Conclusion and Discussion
In conclusion, Rocktape and manual therapy were a lifesaver for this athlete,
his team, and me. Without them, I think he would continue to suffer from his
tight and painful neck muscles, which could have affected the dynamics of our
entire team and lost their first playoff game. Also, I was satisfied with the
immediate improvement of cervical motions, especially rotation, with SCS
technique. I wonder how an outcome would have been if I did not know SCS
technique and just provided a very traditional intervention, such as heat
modality and stretch. I need to thank my undergraduate program and faculty,
which brought a SCS technique expert from University of Oregon for us to learn.
Further, I think the tape maintained immediate effects of the SCS and MET techniques and even more so enhanced inhibition of those hypertonic muscles that caused pain. Overall, I was happy that he responded so quickly and positively to the intervention thus allowing him to return to play very quickly.
Further, I think the tape maintained immediate effects of the SCS and MET techniques and even more so enhanced inhibition of those hypertonic muscles that caused pain. Overall, I was happy that he responded so quickly and positively to the intervention thus allowing him to return to play very quickly.
References
1. Crowner BE. Cervical
dystonia: Disease profile and clinical management. Phys Ther. 2007;87(11):1511-1526.
2. Patel S,
Martino D. Cervical dystonia: From pathophysiology to pharmacotherapy. Behavioural Neurology.
2013;26(4):275-282.
3. Dool JVD,
Visser B, Koelman JH, Engelbert RHH, Tijssen MAJ. Cervical dystonia:
Effectiveness of a standardized physical therapy program; study design and
protocol of a single blind randomized controlled trial. BMC Neurology. 2013;13(1):1-8.
4. Pelosin
E, Avanzino L, Marchese R, et al. KinesioTaping reduces pain and modulates
sensory function in patients with focal dystonia: A randomized crossover pilot
study. Neurorehabilitation & Neural
Repair. 2013;27(8):722.
5. Godse P,
Sharma S, Palekar TJ. Effect of strain-counterstrain technique on upper
trapezius trigger points. Indian Journal
of Physiotherapy & Occupational Therapy. 2012;6(4):77.
6. Iqbal A,
Ahmed H, Shaphe A. Efficacy of muscle energy technique in combination with
strain-counterstrain technique on deactivation of trigger point pain. Indian Journal of Physiotherapy and
Occupational Therapy - An International Journal. 2013(3):118.
Jan 1, 2014
Happy New Year and welcome to 2014! This is my first post of the year and my 75th post overall. This is going to be a reflection on some of the things that I learned in the previous 365 days. I was inspired to write this post after reading many of Mike Reinold's similar posts over the last few years. I guess I learned a lot this year because this turned into an epically long post. Sorry.
Oct 18, 2013
Hey Everybody! Just wanted to take a moment to share a video that I recorded yesterday while in the clinic. If you have ever been here before you have probably heard me mention Ankle Dorsiflexion and I often find it to be restricted in a lot of people.
Well I use a lot of different techniques depending on the situation and I wanted to show you all one variation that I've been using with success.
The only separating factor with this technique is that I'm using two edge mobility bands simultaneously. Hope you all enjoy it!
Well I use a lot of different techniques depending on the situation and I wanted to show you all one variation that I've been using with success.
The only separating factor with this technique is that I'm using two edge mobility bands simultaneously. Hope you all enjoy it!
Sep 30, 2013
This is a quick video that I shot in the Athletic Training clinic the other day when working with a basketball player. This is a self-hip internal rotation mobilization that I have my patients perform on their own.
This helps to maintain the benefits gained from treatment and manual therapy when working with me in the clinic. Ideally, this would be done about once an hour for a single set of 10-20 reps but it can be hard to have a student-athlete comply with this and fit it into their busy schedules. I also have some of them do this before practice and lifting weights for temporary mobility gains.
This is done by the athlete applying an active-assisted hip internal movement while simultaneously providing slight distraction/traction. Check it out!
I have this athlete using an Edge Mobility Band in this video but they could also do this without the band. However, I feel that using the band is more efficacious due to the better hand-hold and compression provided by it.
In other news, I found an old but good video about pain by Lorimer Moseley on "Why Things Hurt". It is actually a pretty funny video and I am sad that I have only just now found this video. For some of you this will be old but for some of you it may be new. This guy's book is on my current to-read list.
Enjoy and Happy Monday!
This helps to maintain the benefits gained from treatment and manual therapy when working with me in the clinic. Ideally, this would be done about once an hour for a single set of 10-20 reps but it can be hard to have a student-athlete comply with this and fit it into their busy schedules. I also have some of them do this before practice and lifting weights for temporary mobility gains.
This is done by the athlete applying an active-assisted hip internal movement while simultaneously providing slight distraction/traction. Check it out!
In other news, I found an old but good video about pain by Lorimer Moseley on "Why Things Hurt". It is actually a pretty funny video and I am sad that I have only just now found this video. For some of you this will be old but for some of you it may be new. This guy's book is on my current to-read list.
Enjoy and Happy Monday!
Sep 2, 2013
Today's post is centered around a patient that I have been working with lately. This athlete is a sophomore collegiate runner that competes in middle distance running events.
History:
This patient is now a 19 year old male that began running in 4th grade. He was in a running club affiliated with his grade school and was soon running around 160miles a year. He began to suffer minor injuries during middle school and somebody had prescribed him orthotics. He struggled with stress fractures, hip pain, and plantar fascia pain all through middle school. Despite these issues, he still managed to run a 4:43 Mile as an 8th grader.
Throughout high school he continued to struggle with injuries such as hamstring strains/tendonosis, spinal stenosis and low back pain, chronic ankle instability and piriformis issues. He also struggled with plantar fasciitis/osis during this time as well.
Once this athlete got to college he tried to transition to minimalist footwear in attempt to "correct" his heel strike. He did not suffer at all until halfway through his first cross-country season when he had a week long flare up of pain that was similar to his previous plantar fasciitis/osis. He was fine again until the beginning of his first indoor track season. The pain became unrelenting despite being prescribed new orthotics and undergoing an expensive shockwave therapy procedure. The patient decided to just cross train and rest for the remainder of his freshman year as a collegiate runner.
This is where I entered the picture and had a few small conversations with this athlete regarding his plantar pain and I gave him a few exercises to perform on his own such as a self-mulligan mobilization with movement technique for ankle dorsiflexion and repeated end-range plantar flexion prior to runs. The patient used these few exercises all summer long until he returned for his sophomore year with good results but was not completely pain free.
I heard that he was still struggling with his plantar pain and offered to help him with a proper evaluation and treatment plan.
Aug 29, 2013
Today I will be reviewing the Edge Mobility Band which is part of the Edge Mobility System by Dr. Erson Religioso, DPT of The Manual Therapist. I have been following his blog for quite awhile now and from the start I was very intrigued by the magical blue bands that he kept using on his patients and in his videos.
I would watch his videos and read his blog posts about the increased function, mobility and decreased pain associated with using these bands as part of his treatment protocol. At the time I was unaware of the Voodoo floss bands so this was my first exposure to compression wrapping for anything other than edema prevention/reduction. I even tweeted at him back in April of this year to inquire whether a poor graduate student like myself could substitute a resistance band for his bands and get the same effect. He answered my tweet with complete honesty and told me that there was nothing magical about the Edge Mobility Bands. He stated that a simple resistance band should suffice.
While there may be nothing magical about these bands there is definitely something special about their construction and design considering that I wasted many hours trying to experiment with resistance bands instead of coughing up $24 bucks for two Edge Mobility Bands of my own. Most of those experiments led to cutting off the circulation of extremities, excessive body hair pulling, and the constant rolling and tearing of many thera-bands. It simply wasn't a feasible substitute for me but maybe it works or would work for somebody that is more coordinated, stubborn or cheap than me.
Jul 26, 2013
The weekend is finally here and that means you might have some more free time on your hands. If that is the case then here are some recent and interesting reads for you all. They are split up by genre! ;)
Eat.
Paul Jaminet of the Perfect Health Diet gives his take on the recent supplementation/vitamin debate.
Run.
Rehabilitate.
Jun 18, 2013
Hey all! New video for you all today that follows the same theme as my last blog post regarding foam rolling. I hope you all learn something and sorry for my amateur videography. I forgot to comment on it in the video but it is important to note that these gains in mobility are only temporary.
However, this treatment can and should (in this case, she as she is still restricted in terms of mobility) be combined with other treatments like joint mobs, Mulligan MWM's and repeated end-range plantar flexion. This will produce a synergistic effect and reapplication can help lock in the temporary gains.
However, this treatment can and should (in this case, she as she is still restricted in terms of mobility) be combined with other treatments like joint mobs, Mulligan MWM's and repeated end-range plantar flexion. This will produce a synergistic effect and reapplication can help lock in the temporary gains.
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