Length of Care

I recently treated a patient who came to me with a 2-3 year history of neck pain. The patient reported that she had tried a different type of treatment prior to this and did treatment on a regular basis for 2 years. This treatment plan was necessary is what they explained to her. She reported that she would feel better after treatment but overall there was not much progress being made.

One must question, how long should I seek treatment for before I start to see overall progress. Now that answer obviously varies for every patient and type of injury but I am fairly certain that if you haven't seen overall progress in 2 years, then that type of treatment is not the answer for you.

I typically like to see some overall change in the patients progress in 4-6 weeks and if I am not seeing any change in progress, then I will refer the patient to a different type of treatment or practitioner.

As a patient, you should be asked what your goals are and what your expectations are. If you are not satisfied with your progress or if you are not sure what the expectations are, then you might need to seek another opinion.

Article from NY Times on Pain and Love

Love and Pain Relief

By TARA PARKER-POPE

Love really can be a drug, according to new research that shows feelings of intense love can relieve pain.

Researchers from Stanford University studied the link between love and pain by scanning the brains of 15 college students who all professed to being deeply in love. The eight women and seven men were placed in brain scanners that tracked their body’s response to pain — in this case a heated probe placed on the palm of the hand.

Glow Images

Then the researchers studied the brain’s pain response under three different conditions. In one scenario, the study subject looked at a picture of an acquaintance. In another, the student looked at a picture of his or her beloved. And because other research has shown distraction also can relieve pain, the student was given a distracting word task — in this case, they were asked to name sports that don’t use balls.

Looking at a picture of a loved one reduced moderate pain by about 40 percent and eased severe pain by about 10 to 15 percent, compared to viewing the picture of an acquaintance. The distraction task also provided similar levels of pain relief, but researchers noted that the analgesic effects of love and distraction occurred in different pathways of the brain. Love-induced analgesia was associated with the brain’s reward centers, while the pain relief resulting from distraction occurred mostly along cognitive pathways, the researchers said. The findings were published online in the journal PLoS ONE.

Other studies have shown that romantic love activates the brain’s dopamine system, much as addictive behaviors like gambling or drug use do. Researchers speculate that looking at a photo of a romantic partner prompts the dopamine system to interact with other brain systems that release natural opioids, or painkillers, in the body, similar to those credited with the “runner’s high” that can occur with exercise.

The findings add to scientists understanding of how the brain responds to discomfort and could lead to new treatments for people suffering from chronic pain. Dr. Sean Mackey, chief of the division of pain management at Stanford and senior author of the study, said the findings support the theory that pain patients may find some relief by seeking out pleasurable activities.

“Find things to give you pleasure in life, whether it be through the one you love or going and listening to great music or reading a good book,” Dr. Mackey said. “It suggests that activating this intrinsic reward system ultimately can reduce your pain.”

Dr. Mackey said the research should also help doctors better assess the condition of their patients, particularly those who are finding relief “that doesn’t involve a pill or procedure.” In his own practice he now not only encourages pain patients to seek out distractions but to also focus on pleasurable activities.

“It’s caused me to change the education and how I talk with my patients and how they understand it,” he said.

Dr. Mackey says he also now pays more attention to the role that a relationship may be having on a patient’s health.

“When patients are doing markedly better and I find out they are in a new passionate relationship, I may be less likely to think it’s the new medication I put them on,” he said. “I realize that maybe it has nothing to do with me.”

Exercise and Burning Calories

As most of us all know, obesity is a HUGE problem in this country literally and figuratively. The amount of calories we take in should be close to the amount of calories that we burn. In order to burn calories our bodies must be active. My research project in physical therapy school was to determine if there was a different in calories burned between doing one bout of 30 straight minutes of aerobic exercise vs. two 15 minute bouts vs. three 10 minute bouts. The study showed that there was no significant difference. So, if you are unable to exercise for 30 minutes straight due to time, stamina, pain, etc, then try and be active throughout the day. Take a walk in the morning, or lunch, or after dinner. Also add in resistance training because this also helps burn calories.

A quick thing to remember is 3600 calories is equal to 1 pound of body weight. So if you take out 500 calories a day and burn 500 calories a day then you would lose 1 pound in roughly 3-4 days. This is obviously just one example. Most people may have to go at a slower rate.

Keep active everyone! Holiday season is right around the corner, so let's finish the year strong!

Pain and Fear

Pain and Fear. These often are associated with each other and for good reason. Pain is not a fun thing to go through and when you are in pain, you often are fearful to do something that will make it worse. This causes most people to stop doing things and stop moving. I see this everyday as a physical therapist. Now, its one thing if you are training for a marathon and you develop a pain in your knee and you need to back off a bit. It's another thing however if you begain to develop pain in your knee and you stop going up and down a flight of stairs or you stop going for your daily walk.

The best advice I can give is that if you are having pain and you are fearful of doing your normal daily activities then you should consult a doctor and/or a physical therapist because the longer that you stay in pain, most likely the worse your fear will get.

Remember increased activity does not always mean increased pain!

Cheers!

Spinal Manipulation....Not Just for Chiropractors

Over the last several years there have been challenges in the various state legislatures against the physical therapy profession via legislation promoted by chiropractors attempting to prohibit qualified physical therapists from performing spinal manipulation - a technique that has been part of the PT scope of practice since its inception.

Spinal manipulation is not designated as being under the exclusive domain of any one specific profession or group of practitioners. Physical therapists, chiropractors, medical doctors, and osteopathic physicians are all educated and trained to employ manipulation within the scope of their respective licenses and in a manner that protects the public's health, safety and welfare. It is inappropriate for one profession to attempt to "own" a specific technique or dictate clinical practice through such legislation.

This was a statement by the APTA (American Physical Therapy Association). I believe that a patient can benefit from a manipulation if they fall under the clinical prediction rule. If your neck or back hurts or feels still, schedule an appointment with a physical therapist that is skilled in manual therapy. Not only will you get "hands-on" treatment but you will also receive exercises and education to help this problem from recurring.

Cheers,

Steve

Disc Pathology

Disc pathology (herniated, bulging, protruding, slipped) is very common. The age group that this affects mostly is between 20-50. Many studies show that disc pathology can comprise around 60% of all low back pain. This doesn't have to scare people however. Most discs will heal through the bodies own defense and healing mechanisms within 4-6 weeks. There are certain positions or movements that can put the lower lumbar discs under more stress.

A famous study done in the 70's showed that bending forward increased the stress on the discs tremendously, and bending forward and picking up something was even more, followed by bending forward with a twist, and then bending forward with a twist with a weight etc. So what does this mean? The obvious which most people know is to bend with your knees when picking up something heavy. The not so obvious is the classic stretch people do where you simply stand with your knees locked and try and touch your toes. DONT DO THIS IF YOU HAVE LOW BACK PAIN! It will only put increased pressure on your discs! A better way to stretch is to do the child's pose (go on hands and knees and sit your butt back to your heels and stretch your arms out in front) or lay on your back and bring one leg up with your hands behind your knee and knee slightly bent to stretch your hamstrings! Hope this is helpful! Please respond with any questions or comments.

Cheers,

Steve

One Way to Save Workout Time

Let's be honest. We all start out the week or the New Year and say to ourselves that we are going to go to the gym and exercise more. Then for most of us at least time becomes one of the limiting factors. We all would like to exercise for at least an hour a day but it is very challenging to do this.

Many people have been taught for whatever reason that they need to do 3 sets of X number of repetitions when doing resistance training. A study done by the ACSM (American College of Sports Medicine) found that doing 2 sets vs 1 set produced 25% improvement in strength but 3 sets vs 2 sets only produced a 3-4% difference. So don't sweat the 3rd set!!! This may not save you a ton of time but every little bit helps!

Also, one last tip. When doing core strengthening, studies show that holding the position is more effective than repetitions. So when doing crunches for example, try holding the crunch for maybe 10 seconds and do 6 reps. Also try not holding your hands behind your neck so it will work on strengthening your neck muscles as well.

Cheers!

Steve