Human Performance and Rehabilitation Centers, Inc.

Dry Needling: Let’s Get to the Point

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Therapy that includes the word “needle” is an attention-grabber, but for a growing number of patients, dry needling is a game changer for managing pain and increasing mobility.

We’ve seen great results using dry needling in a variety of patients, including a chronic migraine sufferer in her 50s who was able to stop taking the prescription drugs she’d relied on for years after just a few sessions. In another case, dry needling helped a high school soccer player hindered by severe hip and glute strain regain his performance and play without pain. We’ve also used the intervention in a breast cancer survivor in her 40s who was eager to regain arm movement after a double mastectomy and reconstructive surgery. Dry needling was an individual component of a complex therapy regimen, but a very important one. It helped our patient regain the ability to raise her arms above her shoulders and meet her goal of competing in a local charity dance event.

Because of its success rate and its ability to treat numerus pain-related conditions, dry needling has quickly become a popular therapy intervention across the country. Availability depends on state laws. HPRC was the first physical therapy provider in the region to offer dry needling several years ago, and we continue to be a leader in the field. Several of our PTs have become certified in this technique, completing 50 hours of additional training. Used in concert with manual therapies, this safe and effective practice is being used routinely across the U.S. to treat a range of common and unusual conditions.

How does dry needling work? What’s happening in terms of the body’s neuromuscular function is complex, but the short version is that small filament needles are carefully inserted into trigger points, areas we commonly refer to as “knots” in the muscle. They’re located below the skin’s surface within the muscle and connective tissue. Dry needling differs from acupuncture in that it’s based on medical principles supported by research, as opposed to an Eastern form of medicine that focuses on the body’s energy. Dry needling elicits a muscle twitch response that can be temporarily uncomfortable, but this is far outweighed by the benefits normally seen.

Before we begin dry needling, we locate trigger points through careful assessment and palpation. Trigger points occur when an overstressed muscle tries to heal itself, creating a ball of angry tissue that can trigger pain in other parts of the body. By inserting a needle into a trigger point, we force it to let go of that tension, effectively “resetting” the muscle and nerves and restoring their function. One of the most hopeful aspects of dry needling is that the targeted pain isn’t likely to return; there’s a good chance we’ve eliminated it long-term.

How to protect your child from an overuse injury

Bryce Gaunt, PT, SCS
Director of Physical Therapy
HRPC St. Francis Rehabilitation Center – Main Campus

Over the last 20 years, a growing number of children have become involved in youth sports. Keeping kids active is a positive trend, but in today’s hyper-competitive environment, it’s important to protect young athletes from overuse injuries.

An overuse injury results from excessive physical activity without adequate rest and recovery, and it occurs when the body’s workload is consistently greater than its level of fitness. Children who train and or compete intensely over time are more at risk for overuse injuries. This is especially true for the growing number of young athletes who play one sport year-round, what we call sports specialization.

We tend to think of kids as having unlimited flexibility and endurance, but they’re actually at higher risk for overuse injury because their bodies are still growing and developing and they’re doing so at constantly changing rates. Kids’ muscles, bones, joints and coordination are not yet mature, and they can’t handle the same kinds of trianing that a healthy adult might.

Consider the following:

• Overuse injuries account for half of all athletic injuries in children and teens.
• Young people are at nearly double the risk of injury when they participate in more hours of sports practice per week than their number of years in age, or where the ratio of organized sports to free play time is in excess of 2:1.
• Young people are more than eight times more likely to be injured if they train more than 16 hours per week.

There are many things we can do to safeguard against overuse injuries. Keep the following in mind:

• Appropriate training can decrease the likelihood of injury as much as 50%.
• Recovery is essential. Adequate rest and proper nutrition are key to helping a young body recover.
• Kids should participate in a wide variety of sports. This provides different stresses to the body, and improves athletic development through a wide range of movements.
• Training intensity should vary over the course of a year and include periods of high and low intensity.
• Proper stretching is key. Children tend to have excessively tight muscles due to their growing bones. A regular stretching regime can reduce injury risk.

Remember, the goal is to make sure that any kind of training is appropriate for a child’s fitness level and stage of growth and development. The workload must fit the body’s capacity to do the work.

Plantar Fasciitis:

Question:
My heel is very painful and my doctor told me I have plantar fasciitis, what does this mean and how can I treat it?

Answer:
The plantar fascia is a tight band of connective tissue that runs along the bottom of your foot attaching your heel to the ball of your foot. Plantar fasciitis is an injury or inflammation to this area, which typically results in heel pain. Patients with plantar fasciitis often report sharp stabbing heel pain which is worst with the first few steps in the morning or after prolonged sitting. The pain may also be more severe after you have been on your feet for a long time.

A physical therapist can evaluate your foot and develop a treatment plan to address your specific needs. The therapist will assess your range of motion, flexibility, strength, walking pattern, and balance. A treatment program of stretching, strengthening, modalities and manual therapy will likely help to relieve your pain and get you back to your desired activities.

Typically frequent stretching of the calf and/or foot is needed to help relieve pain and tension in the plantar fascia. A normal walking pattern is essential to avoid over-stressing other tissues throughout the body. Your doctor or physical therapist will likely recommend you wear supportive shoes as much as possible and may prescribe shoe inserts. Your physical therapist may need to help mobilize your soft tissue, and may use a variety of tools to accomplish this. Massage or tool assisted soft tissue mobilization to the bottom of your foot may be uncomfortable during the treatment, but you should feel better afterwards. You may need to temporarily decrease aggravating activities such as running while you heal. Taping techniques may be necessary to support your painful foot and supportive shoes are essential. Overall, while working with your physical therapist, you should experience a gradual decrease in the intensity and frequency of your pain.

The Things We Take for Granted

Dr. Oz brought women’s health into the limelight in April 2014 with an episode about Pelvic Floor Dysfunction (PFD). His segment introduced a very well-known pelvic floor physical therapist, Amy Stein MPT, from Manhattan. If you viewed or missed his segment you might be asking, “I need a physical therapist for my what?” Don’t fret, let me explain. The pelvic floor is a group of muscles, nerves, and soft tissue that attach from the pubic bone in the front of your body to the tailbone behind, similar to a hammock.

Physical therapists are well known and effective in treating all types of muscle problems. We treat muscle strain, spasm, weakness, and tightness. We treat muscles after injury and especially after surgery to regain their best function. Are you still asking, “Do I need a pelvic floor physical therapist?” The answer may very well be yes. The Massachusetts General Hospital website states one in three women will develop a pelvic disorder in her lifetime.

Physical therapists are teaming with doctors to effectively and conservatively treat many types of pelvic floor disorders.

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The muscles of the pelvic floor serve the important function of supporting the organs in the pelvis, and assist in stabilizing and supporting the spine. They also play a role in sexual function and pleasure, indeed important muscles! It is these muscles that help keep us dry or continent and must relax in order for us to empty the bladder or rectum, and stretch to deliver a baby. We take for granted that these muscles will function throughout our lifetime, but sometimes they just need help.

In May 2014, Moore Magazine had an article highlighting all the treatment options for one type of PFD, stress incontinence. A physical stress from above the bladder pushes down on the organs in the pelvis and the muscles just do not have enough oomph to push back. This is a muscle problem. The pelvic organs are not well supported due to muscle weakness. Does your bladder leak with sneezing, coughing, laughing or lifting things? Think again about that physical therapist.

In 1948 Dr. Arnold Kegel developed exercises for women to reduce bladder leakage, assist in vaginal laxity, and support mild pelvic organ prolapse. Pelvic floor muscles can be strengthened just like any other muscle with properly prescribed Kegel exercises. But, one size does not fit all! So, if you were ever told to practice Kegel exercises, you were on the beginning of the right path…possibly. I hear many women state, “Oh, I tried Kegel exercise and they didn’t work for me.” Unfortunately, up to 51% of women are not able to perform Kegel exercises through verbal instruction alone (Bump et all 1991). Properly prescribed, instructed (squeeze and lift) and practiced (repetitions determined by your ability to produce and hold a contraction) Kegel exercises do work. You don’t have to squeeze your thighs or hold your breath or clench your buttocks, but you do need to learn to isolate the hammock of muscles in your pelvic floor. You can learn to exercise these muscles with your regular gym workout, and no one will know the difference, except you. You will be more comfortable, dry and less anxious about finding a bathroom. Take a look at www.totalcontrolprogram.com or www.nafc.org for more info.

Kegel exercises are NOT all we do. Not all women or men need or should even try to do Kegel exercises. For various reasons, pelvic floor muscles can also become short and tight, and lose their ability to relax. Symptoms of tight muscles might be pelvic and low back pain, constipation, finding it hard to empty the bladder or bowel, or experiencing pain with intercourse. Physical therapy can help with that too. Manual techniques to soften and lengthen muscle tissue and reverse Kegel exercises help to restore function and reduce pain.

The muscles of the pelvic floor are especially vulnerable in women due to pregnancy and delivery, but are important in men’s health as well. Dysfunction has multiple causes and affects all ages. The National Association for Continence (NAFC) website reports it takes an average of 7 years before a woman will discuss her bladder problems with her physician. Ignorance is not bliss. Your doctor can guide your treatment. The GOOD news is pelvic floor dysfunction is treatable, and a physical therapist that specializes in the pelvic floor can offer conservative options.

In September 2014, The American College of Physicians released guidelines for non-surgical solutions for uncomplicated stress incontinence. These guidelines include pelvic floor muscle exercises, bladder training and weight loss as effective options, and recommended conservative options as a first choice of treatment.

A pelvic floor physical therapist specializes in understanding and treating the multiple problems of the pelvic floor muscles. We can help you find your muscles in your pelvis and learn to control them. We can help that got-to-go feeling with a bladder training program. A pelvic therapist will complete a comprehensive pelvic floor muscle exam, digitally examine the pelvic floor muscles, evaluate posture and examine the joints of the low back and pelvis and prescribe appropriate treatment options.

There is HELP and HOPE for your pelvic health problems! You will be grateful for those hidden muscles once they are no longer hiding from you!

The HPRC Brand, Competence, Service, Culture

HPRC celebrates its 60th anniversary in 2015! The company has not only witnessed change but has endured and survived change. Medicare did not exist when HPRC was founded. About the only thing that hasn’t changed in our 60 years is our brand. In fact, we believe the reason we have survived for so long and through so many changes in the healthcare landscape is because of our brand. The HPRC brand is about EXCELLENCE – excellence in the level of care we provide, excellence in the delivery of that care, and excellence in our culture and how we treat each other and present ourselves to those we serve.

The founder of our company, George M. McCluskey Jr., PT is singularly responsible for establishing HPRC’s brand of excellence. He founded our company with one idea in mind – to improve life, one patient at a time. One of his favorite quotes is from St. Francis of Assissi: “If you work with your hands you are a laborer. If you work with your hands and your head you are a craftsman. If you work with your hands, your head, and your heart you are an artist.” He encouraged all of us to be artists.

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Mr. McCluskey, or “Coach” as we called him, challenged and inspired us to grow professionally and advance our knowledge. He taught us to then use our success to make a difference in the lives of others. He taught us about relationships – the importance of treating everyone with respect and dignity regardless of their situation. He had very high expectations of all of us, and gave us the means to accomplish anything we dared. He eliminated our fear of failure and replaced it with a spirit that wasn’t afraid to dream. And we loved him for it.

At HPRC, as we plan for our future, we plan together. Whatever the climate may be, we know we can count on each other. We know who we are, what we do, and why we are here. We are about excellence – excellence in our competence, our service, and our culture. An African proverb says if you want to go fast, go alone; if you want to go far, go together. We vow to keep alive the lessons we learned from our founder, and advance our brand of excellence.

Brian S. McCluskey, Ph.D.
Chairman and CEO
HPRC, Inc.

Knee Osteoarthritis

I was diagnosed with osteoarthritis in my knee. What caused this and how can physical therapy help me?

Knee osteoarthritis is a very common condition causing pain, stiffness, and limited mobility. It occurs when the cartilage or padding in a joint deteriorates and wears away. Arthritis is a degenerative condition and joint damage progresses or worsens over time. Arthritic joints can be quite painful, stiff, and sometimes swollen. Many people with osteoarthritis report that their knee is the most stiff in the morning.

There are a variety of factors which increase your risk of developing knee osteoarthritis. Arthritis is much more common in older adults. There is also a genetic component to developing arthritis, so you are more likely to develop arthritis if others in your family have it. People who are overweight are more susceptible to developing osteoarthritis and the joint damage can progress more quickly in heavy individuals. Also, if you have injured your knee in the past you are more likely to develop knee osteoarthritis as you age.

If you have the misfortune of developing painful knee arthritis, a physical therapist can evaluate you and develop an appropriate treatment program. Your physical therapist should assess your strength, range of motion, balance, and the alignment of your body while you move. People with arthritis often benefit from strengthening, stretching, and instruction on how to move correctly to minimize further joint wear and tear. As your strength, flexibility, and alignment improve, you should find that it is easier for you to walk, move around, and participate in your desired activities.

Welcome Back Patrick!

HPRC, Inc. is having a good day.

Patrick Graham returns to work.
Patrick D. Graham, PT, MBA (pictured centered and seated), our President and COO, returned to work this morning after more than a year’s absence due to illness. Patrick is six months post liver transplant and is obviously doing remarkably well. His journey and story is one that miracles are made of. Needless to say, we are thrilled he has returned to us.

The past year has been challenging. Other than Patrick, HPRC lost two senior leaders and executives to retirement. Henry McRae and Joyce Duncan retired in June 2014 and February 2015, respectively, after remarkable careers and contributions to HPRC. Patrick’s return today marks a new beginning for our company, a new chapter.

As I reflect on the past year and what Patrick and the company have been through, I am reminded of several important lessons:

1) Failure is nothing to be feared. I don’t know who performed the first successful liver transplant, but I know one thing about them – they were not afraid to fail. You simply cannot achieve anything great in this life without failing first. As HPRC faces its future in the difficult landscape of healthcare, we must take strong and confident steps forward.

2) Live today. As I understand Patrick’s disease, the day he was born his liver began dying. He was destined to have a liver transplant at some point in his life. We often have our eyes focused so far in front of us that we forget to enjoy today. Our planning for tomorrow trumps the possibilities today offers. Patrick was born with a diseased liver, he was never promised a second one. He was fortunate. Enjoy the people in your life today.

3) Miracles happen. Patrick’s story is the story of a miracle. My theology is far too amateurish to explain his healing. I just know that legions of faithful people were prayerfully thinking of Patrick every day. His work is not complete.

Welcome back, Patrick Graham! Even in your absence, you taught us all.

Brian S. McCluskey, Ph.D.
Chairman/CEO
HPRC, Inc.

Student Blog

Upon entering the HPRC main office, I was bombarded with joy, excitement, and warmth, mostly my own, but I knew that I was in good hands. This is my first long-term rotation, building relationships with patients, seeing their growth, and facing their challenges. I have been nothing but thankful to my patients, my Clinical Instructor, and the organization for the experiences I’ve had thus far and those that are yet to come.

The training and education that I’ve received has proven to be valuable every day. I have been trained to view each person differently, evaluating their symptoms and impairments, and using the findings to reach their personal goals. Even after such a short period of time in clinic, I’ve grown to love this profession even more (which is reassuring after dedicating so many resources to my education).

So what makes a PT’s education and training unique? Physical therapy school is a professional program that focuses on human anatomy and ultimately how the body moves. We consider ourselves the experts in human movement, recognizing abnormalities that are either contributing to an injury or inhibiting a person’s function. This includes three years of continuous learning divided between the classroom and clinic. There, we are subjected to a combination of written and practical exams testing our knowledge and competency in skills. You grow to rely on your PT family, a group of adults gathered with the same passion of bettering people’s lives by utilizing our extensive knowledge of human anatomy, kinesiology, and proper motion.

It should also be known that all physical therapy students graduate with a DPT, or a doctorate of physical therapy degree. The emphasis on higher education has come to light by including differential diagnosis (acknowledging other causes with similar symptoms), pharmacology, among other courses. This is all in preparation of treating patients directly, without the gate of a physician. Every state has some form of direct access of offering services to patients. This assists in cost savings through the elimination of an extra co-payment.   In addition, direct access allows patients the opportunity to have an individualized exercise plan, addressing muscle imbalances, and to provide relief from injury.

While we like to think we are ready to practice right at the start of school, we need guidance and practice to develop our skills, exercise progressions, and patient handling skills. If you ever have the pleasure to work with a student, make sure to maintain open communication. If something is uncomfortable, doesn’t seem to be improving your overall function, or you have a question about your condition or therapy, express your concern. You will improve your therapy as well as future experiences for other patients who are too timid to express their concerns.

Just remember, you are helping to mold the newest member of the healthcare team. Every therapist has memories from their clinical experiences that will affect how they treat and in what specialty they will dedicate their time. Be patient and open. But, most importantly, be an advocate for yourself. This will lead to better overall care for our future patients.