The Hands-on Approach—Manual Therapy (cont.)

Muscle Energy Technique & the Stanley Paris Technique

As physical and occupational therapists, our approach is to be “hands-on” with patients, to create personalized treatment plans and to achieve the best results.  At Advanced Physical Therapy Center, we utilize several different types of manual therapy techniques.  In previous posts, we touched on a couple other manual therapy techniques. In this post, we would like to feature Muscle Energy Technique (MET) and the Stanley Paris Technique (mobilization of the joints).

What is MET and what does it do?    

Muscle Energy Technique (MET) is a direct hands-on therapy originally developed by Dr. Fred Mitchell, Sr., Osteopathic Physician.  It utilizes the patient’s own gentle muscle contractions and body positioning to normalize joint motion.  It can be used to lengthen a shortened contracted or spastic muscle; to strengthen a physiologically weakened muscle or group of muscles; to reduce localized edema to relieve passive congestion and to mobilize an articulation with restricted mobility.

Who can benefit?

People who are restricted in their movements or have recently experienced a trauma.  Conditions include:

  • Back pain
  • Sciatica
  • Scoliosis
  • Muscle shortening
  • Pelvic imbalance
  • Somatic dysfunction
  • Limited range of motion
  • Headaches
  • Edema


What is The Stanley Paris Technique (mobilization of the joints) and what does it do?

 Joint mobilization is a treatment technique used to manage musculoskeletal dysfunction.  Mobilizations are used to restore joint play that has been lost due to injury or disease.  Stanley Paris, PT, PhD, FAPTA, FNZSP was the first to introduce manipulative physical therapy into the United States, and he is one of the most recognized figures in physical therapy today.  APTC therapists use a variety of his mobilization techniques.

Who can benefit?

Joint mobilization can be performed on any articulation in the body from the temporomandibular joint to the spine and from the fingers to the toes.  Therefore, it can be used on any patient where range of motion is lacking in a joint.


Creating Success Stories – One Patient at a Time

In March of 2016, Kevin Ronan woke up with pain going down the side of his back.  As the days progressed, he noticed his back was getting weaker and weaker, to the point that he couldn’t stand up.  He went to his doctor, but his doctor was baffled.  After several tests, his doctor couldn’t find what was causing the back pain and weakness.  Then the pain moved to the other side of Kevin’s back.  Being worried about her husband, Kevin’s wife, Katherine, took him to the emergency room.  Kevin was later sent home after being treated for what they thought was pneumonia.  The symptoms worsened from there.  The weakness Kevin felt in his back started moving into his right leg. That is when he was sent in for surgery.  In May, the surgeons found an epidural abscess on Kevin’s spine.  Infectious disease doctors from all over the area tried to figure out what caused the abscess.  No one could figure it out.

Kevin endured months of inpatient rehabilitation.  During this time is when doctors told him that he would never walk again.  “I remember thinking to myself, ‘I can’t be in a wheel chair the rest of my life.  I’ve got to prove them wrong.  We are going to fight this.’  So, they decided to send me to physical therapy.  I tried a couple of places, but I wasn’t getting results.  My wife started looking for new places for me to try, and we came across Advanced Physical Therapy Center,” stated Kevin.

Kevin Ronan

From left to right: Dane Potochny, MPT; Kevin’s wife, Katherine; Kevin; and Holly Clark, PTA

Kevin started physical therapy with Dane Potochny, MPT and Holly Clark, PTA in November.  As his visits went by, Kevin started getting the strength back in his legs.  Once wheelchair bound, Kevin can now walk around APTC’s gym three times with a walker.  “When Kevin came in he was unable to stand.  He is now able to walk with a walker and starting to go up and down stairs.  It’s great to see his determination and progress!” stated physical therapist assistant, Holly Clark, when asked about working with Kevin.  “Kevin is an extremely driven individual and has worked hard to go from immobility to ambulatory,” said Dane, Kevin’s physical therapist.

When asked about how physical therapy has changed his condition, Kevin replied, “I can lift my legs up into the bed without help.  I can put on my socks and shoes by myself.  I can get in and out of the car, and no one needs to help me.  I am taking showers on my own now. I am so happy!  I couldn’t do those things before I came here.”

When asked about his experience with his therapy team, Kevin responded, “Dane and Holly are excellent to work with.  I love them both.  They push you just enough to get you where you need to be without making it too hard or discouraging.    I wish I would’ve come here first instead of the other physical therapy clinics, but I am here now and doing well.”

Kevin has taken an early retirement and lives with his wife in Fenton.  He sees Dane and Holly for his therapy twice a week.  His next goal is to walk independently all the time with his walker.  “I am feel like I am so close to my goal.  If I keep working with Dane and Holly, I know I will get there,” said Kevin.


The Hands-on Approach—Manual Therapy (cont.)

Low-Back-Pain-BLUE_02Continuing in our series on the topic of manual therapy techniques, the next we would like to discuss is spinal mobilization.

Spinal mobilization has been a therapy that has been used for centuries dating back to the time of Hippocrates and the physicians of ancient Rome.

What is spinal mobilization?

Mobilization is a hands-on manual therapy designed to restore joint movement, power and range of motion.  The therapist gently coaxes joint motion by passive movement within or to limit a joint’s normal range of motion.  The therapist’s movement of the joint is very precise and is limited by the amount of joint play.

What part of the spine can be treated?

Any part of the facet joints and the articulations between the bones may become stiff causing joint dysfunction.  Therefore, any part of the spine can be treated with spinal mobilization.

What type of patient can benefit?

Any patient that has joint dysfunction, which can be caused by poor posture, muscular imbalance, trauma, spinal disease or congenital problems.    

What is the benefit of spinal mobilization?    

The goal of mobilization is to restore normal joint function, including the surrounding soft tissue.  The benefits are decreased pain, increased range of motion and reduced muscle spasm.


The Hands-on Approach—Manual Therapy

Physical therapy is more than the use of machines or modalities.  It is much more.  A crucial component of physical therapy is the use of manual therapy techniques.

Manual therapy is a specialized form of physical therapy delivered with the hands as opposed to a device or machine. In manual therapy, practitioners use their hands to put pressure on muscle tissue and manipulate joints in an attempt to decrease back pain caused by muscle spasm, muscle tension, and joint dysfunction.

One in particular type of manual therapy that has shown positive results for our patients is myofascial release.

What is it?    

Myofascial release techniques blend massage and gentle stretching to release restrictionsmyofascial-release in the fascia.

What does it do?

Myofascial release relieves pain and restricted movement caused by constricted fascia due to injury or holding patterns in the body.  It also helps to increase circulation, increase venous and lymphatic drainage, strengthen the immune system, and improve nerve function.

Who can benefit?

We use myofascial release to treat a wide variety of conditions.  These include but are not limited to:

  • Low back, thoracic, and cervical pain
  • Sprains and strains
  • Carpal Tunnel Syndrome (CTS)
  • Plantar fasciitis
  • Headache
  • TMJ dysfunction
  • Repetitive stress injuries (RSI) and injury to joints
  • Arthritis

What can you expect from treatment?

A patient may begin to feel better after a single session.  It generally takes three or more sessions before seeing relief of specific symptoms.  Most patients are surprised by how gentle myofascial release is, and they find it to be a very relaxing form of treatment.



Life After Cancer: It’s More Than Just Survival

In 2015, it was estimated that 98,280 women would be diagnosed with a gynecologic cancer and some 30,440 will die from the disease.  For men, prostate cancer is the second most common cancer in America after skin cancer.  About 1 out of 7 men will be diagnosed with prostate cancer during his lifetime.  Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 2.9 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.  Also, the number of people living beyond a cancer diagnosis reached nearly 14.5 million in 2014 and is expected to rise to almost 19 million in 2024.  This is due, in large part, to advances in medical technology and research.  Most people think that when you are a cancer survivor, survival is all you need to think about. But, there are many side-effects and issues that can arise from cancer treatments and the disease itself.  Cancer can have a negative impact on your pelvic and sexual health, causing issues, such as incontinence, constipation, pelvic pain, and sexual dysfunction.

levitt-sara-dsc_6-9-1-16-bhphotoSarah Levitt, MPT, PRPC is our pelvic floor rehabilitation practitioner, and she has seen, first hand, the issues these patients are dealing with.  She recently attended a continuing education course in the treatment of oncology-related issues through the Herman & Wallace Pelvic Rehabilitation Institute.  This course was designed to give practitioners, like Sarah, an understanding of the impact of pelvic and gynecological cancers have on the health and quality of life in our male and female patients.  It also gives an insight into the important role we play as members of the oncology multidisciplinary healthcare team.

As a pelvic rehabilitation practitioner, Sarah, has expert skills in the evaluation and treatment of pelvic dysfunctions, but oncology-related dysfunctions create unique challenges.  Some of these challenges may be injury to the lymphatic system, anatomical excisions, tissue injury from radiation, and systemic issues from chemotherapy.

Through this course, Sarah has gained an understanding of the diagnosis and treatment of pelvic and gynecological cancers and the long term implications of these treatments; especially in relation to pelvic floor and lymphatic function, cancer related fatigue, and bone density issues. The course covered common female gynecologic cancers including ovarian, uterine, cervical, vaginal, and vulvar cancer; as well as common male pelvic cancers, such as prostate, testicular, penile, bladder, and colorectal cancer.  The course provided instruction on specific interventions for the lymphatic system including, but not limited to, genital lymphedema and evidence-based approaches for treating cancer-related fatigue and osteopenia/osteoporosis.  Sarah is also able to provide strategies for clinical and home-based programs that will address conditions, such as sexual dysfunction and pelvic pain.

It is also important to understand the psychological effects of cancer on sexual function and health.  Because of the training she received in this course, Sarah is able to address those issues and keep an eye out for when a patient should seek additional support and guidance from a mental health provider.

Here is an informative article on how pelvic radiation can affect a woman’s sexual health. 

Sarah is eager to help patients like these as it is much needed.  If you would like to contact Sarah or schedule an appointment with her, please contact our Clarkston office at (248) 620-4260.


Don’t Dread That First Step Out of Bed in the Morning

Plantar Fasciitis

Have you ever woke up feeling good, fully rested, but as soon as you place your foot down to step on the floor, you have a aching or stabbing pain in the bottom of your foot? You know you didn’t injure it, but then as the mornings go by, it seems to happen every morning.  This condition is called plantar fasciitis.  It affects 1 out of 10 people in their lifetime.  A person is more likely to get it if they are a woman, overweight or has a job that requires a lot of walking or standing on hard surfaces.  It can be seen quite often in walkers and runners, especially if they have tight calf muscles.

foot-painPlantar fasciitis is a condition that occurs when the long fibrous plantar fascia ligament that travels along the bottom of the foot develops tears in the tissue.  This results in pain and inflammation.  People usually complain of pain close to where the fascia attaches to the calcaneous or heel bone.   They also may describe it as a burning, stabbing or aching pain in the bottom or heel of the foot.  Most people feel that it is worse in the mornings.  This is due to the ligaments tightening up in the middle of the night.  Once they climb out of bed and place pressure on the ligament, it becomes taut and painful.  The pain usually decreases as the tissue warms up.

There are many treatment options available, such as NSAIDs and orthotics.  Physical therapy is a great alternative due to the fact that it not only has shown to reduce pain significantly, but also helps the pain from recurring.

At Advanced Physical Therapy Center, we teach proper body mechanics to help improve gait and teach the patient exercises that stretch the surrounding muscle tissue.  We offer laser light therapy and cold therapy to reduce inflammation.  Massage is another piece of the therapy component that helps to relieve tension in the plantar fascia.  We use the Graston Technique to break up adhesions and release restrictions. Lastly, we will tape the foot to allow the foot to rest and increase healing.

About 90 percent of people with plantar fasciitis improve significantly after two months of the initial treatment of physical therapy.  We treat plantar fasciitis at all our locations. To schedule an appointment or free consultation to see if we can help you, give us a call. Click here to see all our locations.  

Exercises for Plantar Fasciitis Patients

Intrinsic Foot Stretch

Intrinsic Stretch:

  • In a sitting position and keeping the leg steady, pull the foot toward you so that the bottom of the foot is stretched
  • Hold this for 30 to 60 seconds and release, repeat five times
  • Do this exercise three times per day, especially in the morning before first step

Soleus StretchSoleus Stretch:

  • Place hands on a wall for support
  • Stand with one leg in front of the other, feet pointed forward and your back straight
  • Bend knees, drop your buttocks toward floor
  • Gently lean into the wall until you feel the stretch in your lower calf
  • Hold and repeat several times



What a Pain in the Neck!

How many times a day do you look down to check your phone?  How many times are you leaning closer to your computer at work to get a closer glance of the screen?  You are probably doing it multiple times, if not all the time, throughout the day.  Those little movements can add up to a big pain in the neck.  Neck pain can occur in any part of the neck – muscles, bones, joints, tendons, ligaments, or nerves.

Mature woman with neck painMuscle strain or tension is the most common cause of neck pain.  The problem is usually over-use, such as sitting at a computer for too long as mentioned above.  Sometimes you strain your neck muscles from sleeping in an awkward position or overdoing it during exercise.  There are other causes of neck pain that you may or may not have heard of:

Radiculopathy – A pinched nerve, often from a herniated, or slipped disc.  This causes pain down the arm that’s often described as an electrical feeling.

Myofascial Pain – Generally an aching pain in muscles that tends to be associated with poor posture.  Patients can become sore in different parts of the body like the neck and arms, and often patients report they have difficulty sleeping or feeling restored from sleep.

Spinal Stenosis – A narrowing of the nerve openings either around the spinal cord or nerve roots that can cause symptoms similar to a pinched nerve.  The pain is described either as an aching or an electrical feeling down the arms or legs.  It can cause weakness as well.

Tendon, Ligament and Soft Tissue Pain – Localized pain or tenderness when an area is stretched or its muscles are overused.

Spinal Instability – Increased motion between the vertebra, usually resulting from an injury in the neck ligaments and muscles.  The pain can cause tingling in the neck or arms.

Non-Spinal Causes of Neck Pain Pain imitating a neck injury, but from another cause.  Shoulder and elbow injuries and gall bladder disease are examples of problems that can refer pain to the neck area.

Repetitive Strain Injury – An injury that occurs from a chronically used part of the body, either in a normal or abnormal way.

If you are experiencing any of these symptoms, you definitely want to talk to your doctor about physical therapy.  The use of physical therapy and exercise is integral to almost all forms of neck pain treatment.  Sometimes physical therapy and exercise are the first lines of treatment, other times it may help manage chronic pain, or provide rehabilitation after surgery.  Physical therapy and exercise are perhaps the most mainstream of all non-surgical treatments for neck pain.  And unlike other conservative treatments, physical therapy can also help prevent and or lessen future occurrences.

What can you do to keep neck pain away?

Take frequent breaks.  Don’t sit in one place for a long time.  Get up and move!  Instead of emailing someone, walk to his or her desk to relay the message.   Arrange items at your desk so they are less convenient to reach.

Maintain good posture.  Adjust the seat of your computer or desk chair so your hipsergonomics are slightly higher than your knees; your head and neck will naturally follow in the correct position.  Traveling in a car, airplane or train?–Place a small pillow or rolled towel between your neck and a headrest to keep the normal curve in your neck.

How are you sleeping?  Avoid sleeping with too many pillows or falling asleep on the couch with your head on the armrest.

On the phone a lot?  Use a speakerphone or headsets.  Do not cradle the phone in your neck.

Exercise.  Treat your body to a consistent regimen of stretching and strengthening to balance your muscle groups.  This protects your neck as well as helping your whole body.  Walking at any pace is excellent exercise for your neck.  The rotation of the spine provides a great natural workout for the neck muscles.