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Graston Technique is Changing the Field of Pain Management Quickly reveals painful scar tissue and eliminates it! The Graston Technique, originally developed by athletes, is changing the way clinicians and patients view treatment of acute and chronic soft tissue injuries. The Graston Technique is an innovative, patented form of instrument-assisted soft tissue mobilization that enables clinicians to effectively break down scar tissue and fascial restrictions. The Technique utilizes specially designed stainless steel instruments to specifically detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation. Research conducted by Graston Technique trained clinicians at Ball Memorial Hospital and Ball State University, Muncie, Indiana, found that the controlled micro trauma induced through the Graston Technique protocol, increased the amount of fibroblasts to the treated area. That amount of inflammation to the scar tissue helps initiate the healing cascade. The structure of the tissue is rearranged, and damaged tissue is replaced by new tissue. Other clinical studies continue to document the success of the Graston Technique, generally achieving better outcomes when compared to traditional therapies, and resolving injuries that have failed to respond to other therapies. Currently, over 30 professional and amateur athletic teams use Graston Technique to keep their elite athletes in top form. Get the edge the pros use! To learn more, go to www.grastontechnique.com. ATM2 Is The New Weapon in the Arsenal Against Back and Hip Pain Painless exercise machine helps re-educate muscles When the human body is injured, muscles splint and brace the area of injury. Long after the area has healed, this altered muscle behavior can persist and become a problem in and of itself. These so-called "pain motor programs" are a current hot topic in the research of spine, hip and knee pain. At the forefront of this new trend is the ATM2, from Back Project Corp. The ATM2 helps to stabilize the spine, removing that task from the "to-do" list of overworked muscles, and enabling them to work without pain. Training the muscles in this stabilizing environment, allows them to revert to their normal firing activity that existed before the pain. This seemingly simple therapy is painless and the effects are immediate in improvement of pain and restricted range of motion. The benefit is culmulative over a few visits, and preliminary research indicates that most spine and hip pain conditions resolve with 50% fewer necessary treatments than with ordinary treatment methods. Below is a reprint of a recent case study from the October 2006 issue of the peer reviewed journal BioMechanics. Low back pain treatment launches resistance movement By: Clare Lewis PT, MSPT, PsyD, MTC Low back pain is a major public health problem. LBP affects 80% of the general U.S. population at some point with sufficient severity to cause absence from work. It is the second most common reason for visits to primary-care doctors, and is estimated to cost the American economy $75 billion every year. Lifetime incidence of LBP ranges from 60% to 90% with a 5% annual incidence.1 One of the problems for practitioners treating LBP has been the need for empirical proof of the efficacy of intervention. As effective treatments for LBP have been quite elusive (especially for patients with chronic pain), many techniques and interventions have been attempted.2 A fairly new treatment technique that has been generating excitement among practitioners using it is the concept of active therapeutic movements (ATM), which are short, full-strength movements against an isometric resistance in the direction of a previously painful movement. The ATM concept was discovered by accident by a physical therapist while treating a back patient. A device called the ATM2 was developed to most effectively implement the ATM concept. Despite the effectiveness of the ATM2 reported by some physical therapists, chiropractors, and team trainers, no clinical studies have been published. This case study was undertaken to begin generating empirical data concerning the effectiveness of the ATM2. Case study To recruit a subject for this case study, a notice was placed in a local daily newspaper, advertising a treatment for LBP. Inclusionary criteria included any kind of movement impairment due to low back pain and age between 18 and 75. Exclusionary criteria were pregnancy, smoking habit, current pain medication protocol, and current care protocol for the problem. The objective of the trial was to compare lumbar muscle activation levels in a normal relaxed stance and in an upright, anatomically correct position before and after an ATM-concept treatment using the ATM2 system. Equipment used included the ATM2-Pro, by BackProject, and the MyoVision sEMG with the Baseline 3D sEMG protocol. A 60-year-old woman was chosen from among several respondents as a preliminary subject. She was cleared by her physician to participate in the trial and on screening was deemed appropriate for the study and signed an informed-consent agreement. The subject was a part-time teacher who indicated that she began to have LBP in late December of 2005. She could not recall any incident or injury to her low back but indicated that she had been doing her customary four to seven-mile walks three times a week and thought maybe her pain had something to do with the cold weather prior to its onset. She also suggested that lifting her grandchild might have set off her back pain, although she never felt any pain at any time while lifting her grandson. She thought maybe carrying her water bottle while walking was to blame so she tried alternating her carrying side but her LBP persisted. She described her pain as tense, achy, and cramping. The pain was located about two inches above her waist. It came on after five to 10 minutes of walking and did not appear to be affected by flat versus hilly terrain. She described her pain level as a nine (out of 10) that eased immediately when she stopped walking. She denied any sleep disturbance and the only other activity that she indicated caused her back to ache was sitting, but only occasionally and only after sitting for a long time (a couple hours or more). The subject was quite fit. Besides walking, she regularly did Pilates, had built a home with Habitat for Humanity in Africa the previous summer, and a couple years previously had completed Avon's Walk for Breast Cancer, which involves walking 60 miles in three days. The subject denied any prior history of LBP and indicated that other than taking medication for hypothyroidism, her health was excellent. The subject was evaluated on Jan. 23 to determine which direction of lumbar movement most closely reproduced her complaints. Backward bending reproduced her LBP, so it was determined that she would be set up on the ATM2 facing the unit (Figure 1). With this setup, the subject could perform the ATMs into the direction of her pain. Subject's backward bending motion was also measured at this time and she was determined to have 17 degrees of extension. Before performing the movements, the subject was prepped for application of surface electrodes (skin was cleaned with alcohol, shaved, and abraded). Five sEMG electrodes were used on the patient's back, one placed on either side 1 to 2 inches from the spine at L1 and L5 and the fifth, a ground, placed near the bottom of the scapula (Figure 2). The subject was instructed to stand in her normal relaxed stance with her back to the wall, but not touching it for about 15 seconds, then transition to an anatomically correct position by leaning flat against the wall, with her back, hands, and head touching the wall for an additional 15 seconds. The subject was next strapped into the unit and the straps were ratcheted tight until she was able to bend backward without any pain. The movement is rendered pain-free as a result of the passive repositioning and stabilization facilitated by the ATM2 system. She performed 10 ATMs. While still held by the device, she completed the 10 hip extensions for each leg that were also prescribed. After she finished all movement repetitions, the belts around her pelvis were gently loosened and she was asked to walk around for a moment. She was then asked to repeat the backward bending movement free of the ATM2 and she reported that her pain level had gone from a nine of 10 to a zero of 10. Her backward bending was measured again and determined to be 22 degrees of extension, a 29.4% increase from her pretreatment measurement. Her pain-free state lasted for a couple of days, even after a walking trial of two and a half miles. The subject was seen two more times, once in January and once in February. At each session she repeated the protocol exactly except that at the final intervention she did not perform the hip extension movements but instead (still in the holding position), she performed 10 flexion movements to each side (about 45 degrees ). Results The patient underwent three interventions, with one week between each intervention. After each treatment, measurable improvement was documented. Session 1. Prior to the first intervention, notable differences in muscle activation levels were observed between subject's left and right sides in both the normal stance and anatomical posture. Postintervention, sEMG results indicated immediate calming and normalization of muscle activation levels during normal stance, but no significant changes in the anatomical posture (leaning flat against the wall). Session 2. Prior to the second intervention, significantly less difference in muscle activation levels than prior to the first intervention were observed between left and right sides in the normal stance. No significant changes were observed in the anatomical posture. Postintervention, sEMG results indicated immediate calming and normalization of muscle activation levels during the normal stance, but again no significant changes in the anatomical posture. Session 3. Prior to the third intervention, significantly less difference in muscle activation levels were observed between left and right sides in the normal stance than before the second session. There were still no significant changes observed in the anatomical posture. Postintervention, normal stance remained low and normalized, but sEMG results indicated immediate calming and normalization of muscle activation levels during the anatomical posture. The subject reported that after the first intervention and with each successive intervention she was able to increase her walking mileage without any increase in pain. When contacted by phone for follow-up at the end of March, she reported that her pain was very mild and noticeable only because she was now being asked about it. She reported that she had returned to her prior level of walking, which is five to six miles at a time, including hills. She stated that she was very pleased with the results. Discussion and conclusion Although ATM2 has come to be widely used by healthcare practitioners as a treatment for LBP, no clinical studies have been published to establish the efficacy of the unit. This case study was conducted to begin to establish empirical evidence of the device's efficacy. Results indicated that for this case study, the subject had an overall decrease in LBP significant enough to allow her to return to full activity. In addition, the subject's ROM improved and recorded sEMG levels decreased. At the end of the study trial EMG readings indicated a normalization of muscle activation levels in the anatomical posture while normal stance activation levels remained low and normalized. Based on the results of this case study, the ATM2 appears to be an effective treatment for LBP with objective measures to quantify the results. Clare Lewis, PT, MSPT, PsyD, FAAOMPT, MTC, is an associate professor of physical therapy at California State University, Sacramento. References 1. Hills EC. Mechanical low back pain. eMedicine Web site, www.emedicine.com/pmr/topic73.htm. Last updated 4/8/05. 2. Nourbakhsh MR, Arab AM. Relationship between mechanical factors and incidence of low back pain. J Orthop Sports Phys Ther 2002;32(9):447-460. Whiplash Treatment Requires Advanced Training/Expertise Avoid Years of Chronic Neck Pain, Get Help From an Expert Few injuries bring as much opinion to mind as whiplash injury. Most of us know folks who have had minor auto collisions and had no problem, while others were significantly injured. Seemingly mild neck injuries can alter muscle function in the neck and shoulders, resulting in slowly worsening pain syndromes months down the road. If you wait until then to seek treament, your insurance company will likely balk at payment. You can relieve the pain and hassle by getting treated by someone who has specialized training in neck trauma. Dr. Snell has post-graduate training in neck injury and whiplash injury from the prestigious Spine Research Institute of San Diego. This training insures that your condition will be well managed from diagnosis to discharge. His experience with these cases means that you have someone to help you navigate the confusing path of insurance coverage and treatment. We can also recommend quality legal counsel and reputable body shops if you like. Your family medical doctor is an expert in many matters, but receives next to no training in management of these cases. What's worse, because of the daunting paperwork imposed on physicians, many don't want to see these patients, leaving patients with few choices. Choose carefully! 9% of the US population has chronic neck pain related to whiplash injuries. Don't be a statistic, get help from an expert, so you can get better fast. Frequency Specific Microcurrent 7 time Tour de France winner, Lance Armstrong, used FSM to help him recuperate faster after racing! For years, sports medicine has used localized electrical current to block pain in professional athletes. What medicine has now discovered is that smaller amounts of electrical current can be used to stimulate healing on a more basic cellular level. The body can utilize very small amounts of current (millionths of an amp) to stoke the healing fires within each individual cell: increase cell wall permeability, stimulate critical protein production and promote ATP (natural biochemical energy) availability. Beginning from this cellular level, applications of microcurrent can trigger a dynamic restorative sequence and reverse the damage of years: healing each cell and fiber; banishing fibrosis and restoring circulation to complete the task. What is truly remarkable is that this process works quickly. There is minimal discomfort and usually a rapid result. Current in amounts so tiny it cannot be felt, is delivered through the finger tips of black graphite gloves. This allows the therapist maximum sensitivity in reaching the trigger point or other tissue for treatment. What is noticed most often is a sudden release of stress and tension in the damaged muscles as they are healed. In many situations the results are immediate and dramatic. Most patients have experienced reduced symptoms and some have returned to normal function. The use and expansion of microcurrent technology continues to open new doors of relief for patients with painful muscle conditions that were previously considered untreatable. These include: TMD Carpal Tunnel Syndrome Chronic Lower Back Pain Shoulder & Neck Pain Whiplash Work Related Injuries Oregon law entitles injured workers to seek chiropractic care without need of physician referral! Work related, or occupational injuries, require experitise in case management to achieve optimal results. Key to this process is working with a doctor who understands the legal issues, is willing to work with your employer to get you back to work ASAP, and can assess your work environment to tailor your treatment. Research suggests that injured workers who return to work sooner, even if they have to work at a reduced capacity, have fewer long term problems than those who are advised to avoid work. Dr. Snell understands these occupational health issues and will work closely with your medical physician to make sure you get the care you need. KEY TO THE RECOVERY PROCESS IS THE TIME BETWEEN THE INJURY EVENT AND THE TIME WHEN CARE IS SOUGHT. IF YOU HAVE BEEN INJURED ON THE JOB, RESEARCH SHOWS THAT THE SOONER YOU GET CARE, THE SOONER YOU WILL BE BACK AT YOUR DAILY FUNCTIONS! CALL US SOON TO GET HELP! Why Do Knees Hurt? At patient request, below is a reprint of Dr. Snell's article in the June, 2006 Portland Southeast Examiner At this time of the year, as the weather changes, people in this part of the country renew their New Years resolutions to exercise more. Programs like Portland Fit are active in gradually preparing aspiring runners for the Portland Marathon, and folks in the office start recruiting members for Hood-to-Coast teams. Unfortunately, these aspirations frequently are dashed against the painful reality of muscle and joint pain that stops those athletes in their tracks. Two of the more frequent areas of pain that we see in our clinic are achy knees and feet. In the next two issues here, we’ll explore these barriers to activity and detail new research into effective treatments or knee and foot pain. Few painful conditions are cited as frequently for lack of physical activity as knee pain is. Often, those with knee pain assume that this pain is part of growing older, or that it is an arthritic condition which they can do little about. Research over the past several years challenges this notion. While arthritis of the knee certainly occurs, many now think that it is over diagnosed. The recent revelation of the health risks associated with the pain relief medications commonly prescribed for arthritis points out the need for accurate diagnosis before subjecting patients to those risks. So if the pain isn’t due to arthritis, then what causes it? Pain in the front of the knee, around and under the kneecap, used to be called chondromalacia patellae, and was assumed to be arthritis under the kneecap. Years ago, some surgeons pointed out that the fibrous bands on each side of the kneecap (retinacula) contained irritated small nerves in their knee pain patients. It was assumed that another condition called patellofemoral syndrome (PFS) was the cause of this irritation. PFS is a tracking misalignment of the kneecap as it passes over the bones of the leg. When aberrant biomechanical forces on the kneecap, pull it too much in the wrong direction, the kneecap can rub on the underlying retinacula. Over time, scar tissue develops around the nerves in those retinacula, causing the painful symptoms prevalent in anterior knee pain. Some of the most frequently heard complaints are that the pain is worse going up and down stairs. Other patients find squatting motions, or standing up after sitting for a while, are aggravating. Correcting this scenario involves thorough assessment of the muscles of the leg to look for imbalances of strength and for restrictions to proper motion. These restrictions may occur in the muscle itself or in the fascia surrounding the muscle. Graston Technique® instruments can quickly find these restrictions and remove them. This helps to restore proper function AND to remove the cause of the pain. Following the treatment with home stretching and exercise completes the therapy, reducing the need for ongoing treatment A Pain in the Sole: Plantar Fascitis At patient request, below is a reprint of Dr. Snell's article in the July, 2006 Portland Southeast Examiner This time of year, we often see a spike in the number of foot pain cases in our clinic. As the weather warms, more people long to feel warm sand between their toes at Cannon Beach or cool grass beneath their feet playing Ultimate Frisbee in Laurelhurst park. Others ramp up their training in preparation for Hood to Coast or the Portland Marathon. Often, after these unaccustomed events, folks will awake the next morning to a rude surprise when their foot hits the floor. The most common complaint from patients with plantar fasciitis is that " it feels like a stone in my shoe " when their foot first touches the floor in the morning. The plantar fascia is a broad, elastic structure stretching from the base of the toes to the heel bone (calcaneus) in the foot. It functions as a sort of tie beam for the arch of the foot, and with the help of local foot muscles, should help to keep the arch elevated when weightbearing. Trouble occurs when the plantar fascia is stretched beyond its elastic limit and tears a bit. Often, other factors in a person’s foot and leg make the structure more likely to suffer such an injury. If a person tends to roll their foot too far inwardly when walking or running (called overpronation), the arch will tend to collapse a bit, chronically stretching the plantar fascia. Tight calf muscles also frequently play a role, as they pull the heel bone upwards at the Achilles tendon, thereby putting more tension on the plantar fascia. Indeed, home treatments involving ice application, calf stretches and arch supports in one’s shoes are sometimes enough to resolve acute plantar fascitis. Sometimes, the condition is more stubborn and becomes a chronic source of pain. Whereas, the initial injury in plantar fascitis causes inflammation and pain, current research suggests that beyond 2-3 weeks from the injury date, inflammation is rarely the cause of the pain. This research shows that the pain at that point is more of a “learned” process by the local tissues in which the body essentially becomes more adept at feeling pain more easily in these areas. Therefore, treatments that focus on controlling inflammation, like corticosteroid injections or even taking ibuprofen, may not be the best interventions. This research has been around for more than 25 years, but only seems to be trickling down into clinical practice these days with the advent of evidence based practices. Treatments for these stubborn, chronic cases may need to be multi-faceted to achieve lasting results. It helps to identify activity and lifestyle issues that may complicate healing. Rarely, a case may need specific blood and serum analysis to rule out certain types of arthritis. In my practice, I have found that most chronic plantar fascitis responds well to very deep tissue mobilization with Graston instruments to initiate another true inflammatory condition. This procedure allows the breakup and removal of old scar tissue that may be a source of pain. The resultant new deposition of collagen is then guided with appropriate exercise and stretching to prevent future pain recurrence. Above all, the focus is to restore the patient to a condition which allows them to keep moving and stay healthy. An interesting opinion article from British Medical Journal in 2002 provides more information and references regarding the need to change current thinking on chronic tendonitis conditions. If you’re interested, find the free article “Time to Abandon the ‘Tendintis’ Myth” at bmj.bmjjournals.com. Be well. Dr. Phillip Snell is a chiropractic physician and may be found at Hawthorne Wellness Center, 503-235-5484.