Remember this simple mantra:
PoTSB TLC
-Po: Posture
-T: Tongue on the roof of the mouth
-S: Swallow correctly
-B: Breathe well
-TLC: Teeth apart, Lips together, and Calm your muscles and mind
PoTSB TLC further described:
Posture
-Preferably sleep on your back, definitely not on your stomach.
-Don’t get stuck sitting for long--move often! Remember variety is more important than one static, “perfect” ergonomic position. Sit in a chair, stand, kneel, sit on the floor, take microbreaks, etc.
Tongue on the roof of the mouth
-Anchor the front third of the tongue on “the spot” on the roof of your mouth. Find “the spot” by making a clucking sound.
Swallow correctly
-Tongue should already be at “the spot.”
-When you place a cup to your mouth, your tongue should not push against the cup.
-As water enters your mouth, let your tongue drop down to collect the liquid.
-Swallowing starts when you close your lips and the tip of your tongue goes back. to its resting position, or “the spot,” and helps stabilize the lower jaw. That is where a wave of the tongue starts on the alveolar ridge, where those bumps/ridges give your tongue some traction to push off and initiate the swallow.
-Next, your tongue segmentally squeezes and waves the fluid or food along the roof of your mouth from front to back toward the back of the mouth and esophagus, like a peristaltic wave.
-Your top back teeth should touch lightly on your bottom teeth, helping to stabilize the jaw.
-Your tongue then returns to anchor in its postural resting position on the roof of your mouth, allowing your head, neck, and jaw to relax.
-Your head and neck muscles and lips should not noticeably move or contract when you swallow.
Breathe well
-Breathe through your nose and diaphragm, keep your lips closed.
-Calm your breathing to 12 breaths/minute. Small/short breaths in and relaxed/slow breaths out.
Teeth apart
-Do not brace, clench, or grind your teeth.
-Teeth should only momentarily touch when swallowing.
Lips together
-Stretch your upper lip if needed. Keep your nasal pathways clear.
-Helps create gentle suction to keep the tongue to the roof of the mouth which in turn allows you to separate your teeth and keep your jaw muscles relaxed.
Calm your muscles and mind
-Reduce stress and exercise.
-Practice proper breathing again.
Stop Hurtful Habits:
-Do not brace, clench or grind your teeth
-Do not keep objects between your teeth, e.g. smoking, instruments, whistles, snorkels, pencils, toothpicks, your cheek, hair, etc.
-Avoid excessive biting, chewing, and licking: stop biting nails, cheek, gum, suckers, etc.
-Avoid external pressure on the jaw:
-Stop sleeping on your stomach at night. Sleeping on your back is best.
-Use a headset or speakerphone and don’t hold the phone between your ear and shoulder.
-Stop resting your head by putting your head under your chin.
-Food to avoid:
-Anything chewy, painful, or tiring
-Chewing gum and ice
-Hard and chewy candy
-Sinewy meat such as steak
-Crunchy raw vegetables
-Chewy bagels and hard or chewy bread
-Crunchy foods such as nuts
-Caffeine
-Mixed consistency foods such as ice cream with nuts
-Avoid full unsupported yawns or other full jaw opening activities. When yawning, keep your tongue on the roof of your mouth and hand below the jaw to help support it.
Partially adapted from the book: The TMJ Healing Plan by Cynthia Peterson and other sources
Another first for Movement! Recently Scott became the only MovNat Certified Trainer (MCT) in the Colorado mountain region. MovNat is a physical education & fitness system based on the full range of natural human movement abilities. These include the locomotive skills of walking, running, jumping, balancing, crawling, climbing & swimming. In addition we practice the manipulative skills of lifting, carrying, throwing & catching. How we move is how we train. More about MovNat can be found at: https://www.movnat.com/
We have found "Natural Movement" is one of the most powerful ways to help the rehabiliation process and to stay moving well throughout the lifespan. Contact us to learn more about integrating MovNat into your rehab or fitness programming.
New study highlights the successful use of Dry Needling to decrease pain following total knee replacement. Abstract and link below.
Pain Med. 2014 Aug 4.
Successful Management of Chronic Postsurgical Pain Following Total Knee Replacement.
Vas L1, Khandagale N, Pai R.
Abstract
We report reversal of chronic postsurgical pain (CPSP) along with functional restoration after total knee replacement (TKR) in two patients, using a combination therapy that included ultrasonography-guided pulsed radiofrequency (PRF) of nerves supplying the knee to provide pain relief, along with dry needling (DN) to relax myofascial triggers/bands that caused painful stiffness and restricted movement of muscles acting across the knee. Both patients showed demonstrable pain relief, as evidenced by changes in pain as assessed on the Numeric Rating Scale (patient 1: 4-9/10 [pre-treatment] to 0-3/10 [6 months post-treatment]; patient 2: 5-9/10 to 0-4/10), Oxford Knee Score (patient 1: 17 to 40; patient 2: 12 to 39), Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs score (patient 1: 16 to 0; patient 2: 18 to 0), and Patient Health Questionnaire-9 score (patient 1: 17 to 2; patient 2: 20 to 2). The selection of the PRF-and-DN combination for treating post-TKR CPSP was based on a new idea that CPSP is a neuromyopathic phenomenon involving both sensory and motor neuropathy. It has evolved from our experience of 8 years. Physiotherapy worked synergistically with DN, optimizing muscle performance and pain relief.
http://www.ncbi.nlm.nih.gov/pubmed/25132412
Unfortunately, in the Vail Valley, failed hip surgery is all too common. Oftentimes Physician generated protocols fall short and an advanced approach can offer hope. Linked here is a research article abstract describing success in such a case. Don't settle for anything short of Movement!!!
When you have neck pain, the muscles in your neck are often painful to the touch. The irritable, hard “knots” within a muscle or connective tissue that may cause pain over a large area are called trigger points. These painful areas can limit your daily activities and movement. Dry needling, also called trigger point dry needling, is a treatment that involves pushing a very thin needle through the skin to stimulate a trigger point. The needle may relax the tight muscle bands associated with trigger points. As a result, dry needling may be helpful in decreasing pain and increasing motion for patients with neck pain. In a study published in the April 2014 issue of JOSPT, a group of researchers measured the benefits of dry needling for patients with neck pain.
New Insights: The researchers studied 17 patients. All patients' neck pain began within 7 days of the start of the study. Half of the patients received trigger point dry needling treatment, and the other half received no treatment. The patients who received the dry needling had better results. Immediately after the treatment, their pain decreased by 33%. One week after the treatment, their pain was 66% less. Also, those patients treated with dry needling were better able to bend their heads forward and backward and to turn their heads toward the painful side of their necks.
Practical Advice: Trigger points can be a source of pain and may limit neck motion. Dry needling is a specialized treatment for trigger points that some physical therapists provide. In the short term, the findings of this study suggest that a single treatment of dry needling can decrease pain and improve motion. Dry needling is typically combined with other treatments, including exercises to further lessen pain and improve motion and the ability to perform daily activities. Your physical therapist can give you a thorough evaluation to help determine if you are a good candidate for this treatment as part of a program designed to reduce your pain and improve your function. For more information on the treatment of neck pain, contact your physical therapist specializing in musculoskeletal disorders.
Relaxing Trigger Points: Neck pain can result in trigger points in the muscles or connective tissues. Trigger points are irritable, hard “knots” that may cause pain over a large area (A). A potential treatment option is dry needling, which consists of pushing a very thin needle through the skin to stimulate the trigger points in the muscles or connective tissues (B). This research team found that trigger point dry needling decreased pain and increased motion (C).
Credit: This JOSPT Perspectives for Patients is based on an article by Mejuto-Vázquez et al, titled “Short-Term Changes in Neck Pain, Widespread Pressure Pain Sensitivity, and Cervical Range of Motion After the Application of Trigger Point Dry Needling in Patients With Acute Mechanical Neck Pain: A Randomized Clinical Trial,” J Orthop Sports Phys Ther 2014;44(4):252–260. Epub 25 February 2014. doi:10.2519/jospt.2014.5108. This Perspectives article was written by a team of JOSPT's editorial board and staff, with Deydre S. Teyhen, PT, PhD, Editor, and Jeanne Robertson, Illustrator.
Read More: http://www.jospt.org/doi/full/10.2519/jospt.2014.0502#.UzwHRBaMXFJ
If you have knee pain there are two major arguments grounded in medical research as to why you should see a PT to avoid unnecessary surgery and save you $$$:
1. Just as many “issues” are seen on knee MRIs in those without pain as compared to those with pain: http://www.bmj.com/content/345/bmj.e5339?view=long&pmid=22932918
2.“Fake” knee surgery as good as the real procedure: http://www.cnn.com/2013/12/26/health/knee-surgery-study/index.html | http://www.nejm.org/doi/full/10.1056/NEJMoa1305189?query=featured_home&
Keep in mind these studies have their limitations and do not apply to all people and to all knee injuries. That being said, the most common knee surgery, a partial menisectomy, is what was highlighted in the second study as being over-utilized and equally as effective as a sham procedure. Also note on the image from the first noted study above the incidence of meniscal tears on MRI. It is no wonder the surgery is unlikely to help! Oftentimes I see patients jump to imaging and surgery all too soon, hoping it will provide a quick fix. Sometimes it pans out, sometimes it does not and costs them. And this is true not just for knee pain. Fortunately skilled PT likely can how you move and lessen or eliminate the pain you are in -- all with less risk and for much cheaper than imaging and surgery.
Click on any of the below images to see how physically what the body can and cannot do influences your golf swing and how to fix it:
S-PostureC-PostureLoss of PostureFlat Shoulder PlaneFlying ElbowEarly ExtensionOver the TopSwaySlideLate BuckleReverse Spine AngleForward LungeHanging BackCastingScoopingChicken Winging
Key Points From NPR's: Pain In The Back? Exercise May Help You Learn Not To Feel It
-More than 1 in 4 adult Americans say they've recently suffered a bout of low-back pain. It's one of the most common reasons people go to the doctor. And more and more people are being treated for it.
-Many specialists say less treatment is usually more effective.
-There's evidence that many standard treatments for back pain — surgery, spinal injections and painkillers — are often ineffective and can even worsen and prolong the problem.
-Research suggests that 1 in 5 who have surgery for back pain end up having more surgery.
-Lots of people who are pain-free actually have terrible-looking MRIs. And among those who have MRI abnormalities and pain, many specialists question whether the abnormality is really the cause of the pain, and whether fixing it can make the pain go away.
-Research is showing that the pain often has nothing to do with the mechanics of the spine, but with the way the nervous system is behaving. "It's a change in the way the sensory system is processing information. Normal sensations of touch, sensations produced by movements, are translated by the nervous system into a pain message. That process is what drives people completely crazy who have back pain, because so many things produce discomfort." This is a different way of thinking about pain. Normally pain is an alarm bell that says, "Stop what you're doing right now or you may hurt yourself!" But for many people, that pain is a false signal. It's not about looming danger; it's actually caused by hypersensitive nerves.
-About 25% of patients with acute back trouble get stuck in an endless loop of pain. Chronic back pain is often due to persistent hypersensitivity of the nervous system.
-Physical Therapy can teach you to ignore your pain by gradually increasing the intensity of exercises designed not only to increase the strength and flexibility of the back, but also learn that it's OK to move normally again.
See the full article and listen to the show: http://www.npr.org/blogs/health/2014/01/13/255457090/pain-in-the-back-exercise-may-help-you-learn-not-to-feel-it
What is the History of Dry Needling?
It is important to recognize that the origins of Dry Needling are drawn from Western Medicine principals and scientific, research-based conclusions. The technique of Dry Needling has NO historical ties to acupuncture, which is based in Eastern tradition. Dry Needling effectively treats musculoskeletal pain and dysfunction while acupuncture aims to influence “energy” and “meridians.” The only similarity between the two is that they share a common tool, a fine needle. However, just because the same tool is used doesn’t mean the same job is being performed. For instance, a surgeon and a butcher share a common tool but I know who I would want cutting on me.
Injections into myofascial trigger points (hyperirritable spots in muscle) were first proposed by Medical Doctors Janet Travell and David Simons in the early 1940’s. These physicians injected various substances including corticosteroids, analgesics, saline, etc. into trigger points. Dr. Travell was well respected and actually became President John F. Kennedy’s White House physician. The wider use of “Dry” Needling started after a study in 1979 by a Czech physician, Karel Lewit, where it was emphasized that the “needling effect” is distinct from that of the injected substance (“wet” needling). Since then, numerous medical studies have found no difference between injections of different substances and Dry Needling in the treatment of musculoskeletal pain.
Digging a bit deeper, two main conceptual models of Dry Needling developed during the last few decades; most common are the radiculopathy and trigger point models. The radiculopathy model is based on empirical observations by the Canadian physician Dr. Chan Gunn, another pioneer of Dry Needling technique. To distinguish this approach from other methods of Dry Needling, Dr. Gunn named it intramuscular stimulation (IMS). The Gunn IMS technique is based on the premise that musculoskeletal pain is a result of peripheral neuropathy or radiculopathy, defined as “a condition that causes disordered function in the peripheral nerve.” According to Gunn's theory, denervated tissues develop supersensitivity. In the musculature, this manifests as muscle shortening, pain, and the development of taut bands with trigger points. Shortening of the spinal muscles, particularly the multifidi muscles, leads to disk compression and pressure on the nerve root, which subsequently results in peripheral neuropathy and the development of supersensitive nociceptors and pain. Thus, restricted flow of nerve impulses in all innervated structures—including skeletal muscle, smooth muscle, spinal neurons, sympathetic ganglia, adrenal glands, sweat cells, and brain cells—leads to atrophy, aggravated irritability, and sensitivity. According to the second model, the trigger point approach, a fine filament needle (AKA acupuncture needle) is inserted directly into a trigger point of the dysfunctional muscle that may be contributing to pain. In 1942, Dr. Janet Travell and colleagues first published the method of injections into trigger points. In 1979, Dr. Karel Lewit concluded that the effect of injections were primarily caused by the mechanical stimulation of a trigger point with the needle alone (not the medication being injected). Since then, Dry Needling has been widely used for the treatment of trigger points. More recent studies have found Dry Needling to be most effective when local twitch responses are elicited, probably because of rapid depolarization of the involved muscle fibers, which manifests as local twitches. After the muscle has finished twitching, the spontaneous electrical activity subsides and the pain and dysfunction decrease dramatically. Acupuncture technique does not aim to necessarily even pierce muscle tissue, nor cause this important muscle twitch response that is definitive of Dry Needling.
From origins in “wet” trigger point injections performed by physicians grounded in Western Medicine to the use of a “dry” fine filament needle by specialty trained physical therapists, the technique of Dry Needling has had a fascinating evolution. Now by omitting unnecessary medication (and side effects), Dry Needling has established itself as a treatment that is minimally invasive, cost effective and carries a low risk. The ffectiveness has been confirmed in numerous studies already and it will continue to change lives in the future.
Adapted from the Article: Dry Needling in the Management of Musculoskeletal Pain
Published in: Journal of the American Board of Family Medicine. Volume 23, Number 5.
Original Article Link: http://www.jabfm.org/content/23/5/640.full
"First move well, and then move often."
Before embarking on your New Year's resolutions, it is important to understand the "Performance Pyramid" and how it applies to your fitness routine. Some people think that performance only applies to athletes but really the performance applies to everyone, regardless of sport, age and level of activity. The goal at Movement Physical Therapy is to improve the way you perform with everyday tasks as well as sports and recreational activities. The Performance Pyramid is broken into three levels and illustrated clearly by one of my mentors, Gray Cook. If you can keep your pyramid appropriately balanced, you will not only perform better but be at a much lower risk of injury.
The Performance Pyramid tells us the foundation of human performance is "functional movement," which is the ability to have good range of motion and the ability to have sufficient muscular control/stability through that full motion. An example is the ability to adequately perform a deep squat with just your body weight. Just like when you’re building a house you need to have a solid base to build upon. You wouldn’t consider building your house on sand, would you? Would you then consider adding significant weight to a dysfunctional squat pattern?
The next layer of the pyramid is "functional performance." This is strength, power, muscular endurance and conditioning. Typically this is where most of your conventional workouts live. All these traits are dependent upon how well you control your own body movement (the functional movement base).
This person depicted by the pyramid to the right has plenty of strength, power or endurance. Or perhaps a combination of all of them but their functional movement capacity is poor. A person like this may appear to be in great physical condition but in reality, medical research is showing that they are at a significantly higher risk of injury--a ticking time bomb. Unfortunately, this time of year I see a lot of people whose Performance Pyramid looks this way. If this person were to only re-establish a strong functional movement base, their overall performance would reach new heights.
If you’d like to find out where you are in regard to the Performance Pyramid, please contact us or click here. This information can make the difference between reaching your goals and being injury-free and not this year.