Tag Archives: manual therapy

Osteopathic correction of lumbar and sacrum

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Left on right sacral torsion correction

LEFT ON RIGHT SACRAL TORSION CORRECTION 7/17/16

This is an osteopathic manipulation technique for a sacral dysfunction.  More specifically a sacrum that is rotated left on the right oblique axis.  This dysfunction can cause intense pain in the low back and/or down the legs.  This is one of the problems people often have if they have had therapy or chiropractic care in the past without much help.  Unless the dysfunction is corrected, the pelvis and lumbar spine will never move appropriately and pain may never go away.  Manual therapy is very helpful in correcting these dysfunctions.

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Preparing for Right FRS at L5 correction

RIGHT FLEXED, ROTATED, SIDE BENT L5 (R FRS L5)

When a sacral torsion is present, their is also ALWAYS a dysfunction at the L5 vertebrae.  This is due to how the sacrum and lumbar spine interact with each other.  The picture shows the set up for the right FRS L5.  This has to be corrected out before the torsion is corrected.  Again, an easy diagnosis and treatment for someone trained in osteopathic treatment techniques specializing in manual therapy.

 

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Right ERS dysfunction set up for treatment

RIGHT EXTENDED, ROTATED, SIDE BENT L3 (R ERS L3)

This is another dysfunction that can occur at the lumbar spine.  Instead of the spine having an FRS dysfunction, it can also have an ERS dysfunction.  These dysfunctions are also easily corrected by manual therapy and can also occur in the presence of a sacral torsion and an FRS in the lumbar spine.  When the ERS is at L5 vertebra, their is often a posterior unilateral sacral nutation also present.

 

Piriformis syndrome

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FIXING PIRIFORMIS SYNDROME NOT ONLY WITH PHYSICAL THERAPY, BUT MANUAL THERAPY 5/6/16

Have you ever had pain in your rear end, or a tingle down the back of your leg that tends to get worse with pressure on the back of the leg, such as with sitting or even with walking? This can be occurring due to a condition called piriformis syndrome. The piriformis muscle is located in the rear end area and functions to extend, externally rotate, and abduct the hip. It is involved in providing stability to the hip. The sciatic nerve can run underneath or directly through the piriformis and can also be involved if the piriformis muscle becomes dysfunctional.

What can be done to help alleviate the pain from piriformis syndrome? Strengthening and stretching of the piriformis and hip is a typical treatment in physical therapy along with modalities such as electrical stimulation and ultrasound. This may or may not be helpful. What needs to be looked at is WHY the piriformis is dysfunctional. The piriformis becomes dysfunctional due to over use that occurs from abnormal function of the hip and low back. When the glute max and glute medius hip muscles are inhibited and aren’t doing their job because of somatic dysfunction of the low back, the piriformis is one of the muscles that becomes overworked to help stabilize the hip and pelvis. This creates the overuse syndrome of the piriformis, and since the sciatic nerve runs underneath or through the piriformis muscle it can be aggravated causing sciatica down the leg.

Training in osteopathy and manual therapy is imperative to getting proper diagnosis and correction of the pathology. This is due to the spine needs to be looked at for abnormal movement mechanics that causes the glute max and medius muscles to shut down. Explained earlier, when these muscle shut down the piriformis becomes overused, dysfunctional and painful. What will be done at wrightphysiotherapy is the spine dysfunction will be diagnosed and treated using manual therapy. This will let the glute max and medius muscles start working correctly, and then the appropriate exercises will be given to maintain the corrections and to strengthen the system promoting the continued appropriate function of the muscles. When this is done, the piriformis muscle use lessens, letting it relax and calm down. This reduces irritation and the symptoms go away. Unless hands on manual therapy is performed, the body has a very hard time allowing symptom reduction to occur. Manual physical therapy at wrightphysiotherapy is the best option for pain reduction fast!

Knee pain

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UNRELENTING KNEE PAIN 4/23/16

Knee pain is very common and can be difficult to treat if the physical therapist is not sure what to look for during the evaluation process. I have found that people with knee pain have some common problems. They have weakness in the hip on the same side of the knee pain along with quad weakness. You also have to be aware of the specific muscle tightness’s that can occur. The rectus femoris, hamstrings and IT band can often times be tight and they need to be appropriately addressed. So far this is pretty easy to figure out, but the evaluation needs to go much deeper. This is why a manual physical therapist is often needed when someone has been unsuccessfully treated for knee pain in the past.

What I would do is start at the lumbar spine and sacrum and work up to the lower thoracic spine looking for any vertebrae that are moving abnormally. When the spine is not moving the way it should, muscles in the body become inhibited and other muscles have an increased tone and will not work appropriately creating an imbalance. If the spine is not addressed, these muscle groups may never function the way they should and the knee pain may never go away. The spinal somatic dysfunctions can be easily corrected by a manual physical therapist. Hip capsular mobility may need to be addressed and then appropriate strengthening exercises and stretches can be given to restore the body’s normal balance, and the pain usually goes away in a short period of time.

Most of the time the spine will never be addressed in the typical insurance based physical therapy setting due to time constraints, therapists not having the appropriate knowledge of the spine, or not even being sure if they are allowed to work on the spine when someone comes in for knee pain. This is why the pain lingers and may never go away. Wright Physiotherapy is a better choice and is why I do not use an insurance based treatment model. Because I am a cash based physical therapist I will treat and fix what needs to be fixed. You will get better quicker and in 2-4 visits the pain will be much improved or gone. If you or anyone you know has knee pain, set up and appointment and I can address it.

Rotator cuff pathology

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ROTATOR CUFF PATHOLOGY 4/12/16

As a physical therapist I see a lot of shoulder pathology. This can be pain anywhere in the general shoulder area, lateral arm, or deep inside the joint. Generically, patients think they have a rotator cuff problem when they have shoulder pain, which it can be, but often times it is much more complicated than that. Let’s say someone has a non-traumatic shoulder pain. Meaning pain is occurring in the shoulder without having any kind of accident or trauma. The question has to be asked, “Why is the pain occurring and what can be causing it?” The shoulder joint needs to be looked at for range of motion (rom) and how it moves. Is it restricted or can it move through a full range? Usually the rom is restricted due to capsular tightness and this needs to be addressed. The rotator cuff muscles tend to be weak. The scapula is usually not moving in a normal upward rotation, and this can be due to inhibited low trap muscle and serratus anterior muscle. Posture is often times poor with a tight pec minor muscle and levator scapulae on the same side that has an increase in tone. All of these issues cause a poor functioning shoulder from abnormal movement mechanics, and leads to pain over time without an accident or trauma.

As a manual physical therapist what would I do that you would not get from going to typical physical therapy? First I would perform osteopathic manipulation of the thoracic spine that is causing the inhibition of the low trap and serratus anterior. Then the increased tone of the pec minor and levator scapulae would be addressed with manipulation and myofascial work. Followed by joint mobilization to specifically stretch the shoulder joint capsule to start to normalize rom. I would then finish off the treatment by giving rotator cuff strengthening, postural strengthening, and at home stretching. Usually 2-4 visits of this will completely resolve the issue over the period of a 4-6 weeks. If you have shoulder pain and would like to be treated quickly and efficiently, please give me a call or email me at my website wrightphysiotherapy.com.

Treating low back pain

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WHAT DO I LOOK FOR WHEN TREATING LOW BACK PAIN? 4/10/16

Low back pain is very common in today’s society. Most people have dealt with low back pain themselves or at least know multiple people with low back pain. It can be very debilitating and life changing, especially if the pain does not go away. Treatment for low back pain in physical therapy is usually mediocre at best due to the difficulty in being able to properly diagnose where the pain is being generated. Pain can come from the discs, nerve roots, facet joints, and abnormal muscle use. Having a good understanding of how the spine moves and functions, and how abnormal spinal movement affects the body is key to successful treatment in physical therapy.

What do I look at when evaluating a low back? I look for specific weakness in the glute max and med muscles. They are very important in lumbar spine and pelvic stability. The hip flexors are often times very tight, therefore specific manual therapy releases have to be performed along with stretching. Transversus abdominal and deep low back muscle called the multifidus also need to be retrained appropriately. I also look at very specific movement of the individual lumbar spine vertebrae, thoracic vertebrae, and sacrum. If the vertebral segments are not moving the way they should, osteopathic manipulation is performed to help correct the movement. I use a lot of osteopathic manipulation (OMT) called muscle energy techniques (MET). Uncorrected vertebrae will cause muscles to shut down and not do their job. This is where the skill of a movement expert and manual therapist comes into play to be able to find and correct the abnormal spine movement or lack of movement. The abnormal spine movement is called a somatic dysfunction which will be discussed in another blog. Using those basic guidelines is how I have been able to be very successful in fixing low back pain be it chronic or acute. Acute low back pain is much easier to fix with usually only needing 1-2 treatments over a 2-4 week period. Chronic low back pain is more difficult to fix but can usually be done over a 6 week period and a total of 4-6 visits. Come give physical therapy at Wright Physiotherapy a try and you will be amazed at your new pain-free way of life! Go to the contact page and send me an email to schedule an appointment or give me a call.

Physical therapy using manual therapy for treatment of pain.

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Hands on manual therapy using osteopathic manipulation techniques is the most effective way to treat orthopedic pain!  The philosophy of osteopathy is to treat the body using manipulation to get the body to function as efficiently as possible, and then work on appropriate strengthening exercises to prevent the pain from returning.  For example, with low back pain the movement of the individual vertebra in the low back need to be improved for normal function and then appropriate core strengthening and stretching needs to be done to allow the body to heal efficiently.