Sunday, January 3, 2016

5 TIPS TO KEEP YOUR SHOULDER (AND NECK) HEALTHY

By: Mark Z. Jamantoc, PT
About the Author

Here are some quick ways to keep your shoulder healthy and prevent (or improve) discomforts caused by possible impingement issues. Patients are always asking me for specific stretches to improve neck and shoulder. Here are some great ways to do them. As always, this article will not replace medical advice coming from your doctor or your physical therapist. This was written for educational purpose only.



1. Stretch the Pecs. The chest muscles are mainly composed of pectorals: Pectoralis major and Pectoralis minor. I wanted to give special attention to the Pec minor since it has attachments to the 3rd, 4th, 5th ribs and the coracoid process of the scapula. Thus, when the pectoralis minor is tight, it causes a multitude of issues for the shoulder (and sometimes the front of the neck area as well).
File:Pectoralis minor.png

Pectoralis major and minor stretch by Brent Brookbush:


2. Stretch your neck and top of the shoulders. As the neck is connected to the shoulders, when I evaluate the neck, I never ignore the shoulders. The key muscles are the scalenes and the upper trapezius, both of which have huge influences on the top ribs: 1 and 2. When these muscles are tight, they can pull the 1st and 2nd ribs out and cause some major issues in the neck and the shoulder and may cause some symptoms resembling thoracic outlet syndrome. A study showed that a subluxed 2nd rib can actually resemble an impinged shoulder. It is important to stretch a major muscles that surround this region.

Here are a few quick stretches that you can start incorporating daily:

Scalenes:

Alternative chest stretch

Levator scapula stretch

Posterior shoulder stretch

Upper trapezius stretch

Triceps stretch

STRETCH THE LEVATOR SCAPULAE. I see so many shoulder patients that have tight levator scapulae muscles, hence I am giving this muscle a bit more attention here. More often than not, I would find the C1 to C4 on that side hypomobile because of the pull of this muscle and therefore, can cause some major neck pain or symptoms. After all, it is attached to the transverse processes of the first four cervical vertebrae.

Here is a great video by my friend Brent Brookbush, DPT, MS, PES, CES, CSCS, ACSM-H/FS, owner and president of Brent Brookbush Institute of Movement Science on a dynamic stretch for the levator scapulae muscle. This is actually one of my own personal favorites.

3. DON'T FORGET THE ARMS. That would be your Biceps brachii and Triceps brachii muscles. Studies have shown that working on these antagonistic muscles while you're strengthening your rotator cuff WILL help with shoulder strength and ultimately, scapular stability. I was one of those who were guilty enough in the past to not give these muscles a workout routine as a patient's homework.

4. DO YOUR Y's and T's WITHOUT A STABILITY BALL. That's right. I see these all the time in clinics for strengthening the upper back muscles, specifically the postural muscles: scapular retractors, the lower trapezius. Working these babies improve the scapular stabilizers. Working on these unilaterally at a stable surface will fire your rotator cuffs more versus being on the stability ball where your body and brain are trying to focus on two things at once - not a great way to isolate, if I might add.

 

5. FULL CANS VERSUS LATERAL RAISES. According to Mike Reinold, PT, the deltoids are accessory muscles and will be used anyway when you work on the suprapinatus. So he recommends this over the lateral raises. Lateral raises may contribute to some impingement in the shoulder joint. On a related note, doing that traditional "empty can" exercise has been discouraged by a few authors in the past. You can read Mr. Reinold's study on comparing Empty Can and Full Can HERE

In a pubmed study, the conclusions state: Supraspinatus activity is similar between 'empty can' and 'full can' exercises, although the 'full can' results in less risk of subacromial impingement. Infraspinatus and subscapularis activity have generally been reported to be higher in the 'full can' compared with the 'empty can', while posterior deltoid activity has been reported to be higher in the 'empty can' than the 'full can'.

RELATED READING: YOUR NECK PAIN COULD BE A LATS PROBLEM


FIND US ON:

Saturday, January 2, 2016

3 THINGS TO KNOW ABOUT KNEE PAIN AND ORTHOTICS

By: Mark Z. Jamantoc, PT
It is not unusual to hear a diagnosis of Osteoarthritis on the knee. You may even hear your doctor say, “your knee is bone-on-bone now and that is why you are in pain." These patients would eventually get a referral to Physical Therapy in conjunction with perhaps, some type of NSAIDS (Non-steroidal Anti-inflammatory Drugs) or pain medication and/or a suggestion for a knee brace. But the question I always get in my clinic is: do braces really help?



This article will not replace education on correct exercise and form. It will also not include other forms of treatment for knee pain. I wanted to keep this article as short as possible for my patients and other busy clinicians so I mainly focused on specific studies and summarizing them with the intent of putting together a general idea whether or not knee braces actually work. In addition, I have included some information on whether or not wearing shoe orthotics such as Superfeet (which is what I recommend and carry in my clinic) would be helpful for knee pain.


To be honest, as I was looking online for research, there isn’t much out there for evidence and higher quality studies about this. On the latest issue of the Journal of Orthopedic and Sports Physical Therapy, Callaghan, Parkes and Felson examined the Effects of knee braces on quadriceps strength and inhibition in subjects with Osteoarthritis (4). This was a research study as a secondary analysis of a randomized controlled trial. The study had 108 participants who had at least 3 months of Patellofemoral pain and were randomized into 2 groups: those that wore a flexible knee support (brace) and a group with no knee support (no brace). The main concern of this study is not about preventing pain, however, but to see if wearing the knee brace had deleterious effects on the quadriceps muscle group strength. The results showed that it did not inhibit the strength of the quadriceps, which leads us to the first concept:

1.     Wearing a flexible knee brace does not inhibit quadriceps strength nor does it inhibit the muscle. The main concern for most clinicians and trainers out there is that wearing the brace might weaken the surrounding muscles. The potentially negative effects of the muscle can be measured by a maximum voluntary contration (MVC) and arthrogenous muscle inhibition (AMI). AMI uses supramaximal electrical stimulation (ES) to assess voluntary contraction. Also please note that to date, this is the first ever-published study on the effects of bracing on muscle inhibition (4). Other studies might start to surface in the future but to date, this may be the most useful tool for us in the clinic.

2.     Wearing a flexible knee brace may help improve pain in those with Osteoarthritis. There is evidence that in patients with OA (Osteoarthritis) braces in the form of flexible knee braces does help improve knee pain. In a systematic review on the Efficacy of Knee Braces and Foot Orthoses in Conservative management of Osteoarthritis by Raja K and Dewan N (2) in a Pubmed published study, they concluded that knee braces and foot orthoses were, in fact, effective in decreasing pain, joint stiffness and drug dosage. Furthermore, they also improved proprioception and balance. In a 2010 study, Role of bracing in the management of Knee Osteoarthritis (3), the authors concluded that braces are recommended for treating Osteoarthritis but must be adapted to the symptomatic knee. This should be added in conjunction with conservative methods like exercises that your Physical Therapist prescribed as well as manual therapy.
FLEXIBLE KNEE BRACE

3.     Foot orthoses may help improve knee pain and stiffness. In a study done by Johnson and Gross in 2004 Effects of Foot Orthoses on Quality for individuals with Patellofemoral Pain Syndrome (1), they found statistically significant improvement in knee pain and stiffness 2 weeks following the start of foot orthotic intervention. They further concluded that custom-fitted orthosis may improve patellofemoral pain symptoms in patients demonstrating excessive foot pronation. In a clinical commentary done by Gross and Foxworth in 2003 (5), they generally found that patients who have patellofemoral pain and who demonstrate excessive foot pronation benefit from foot orthoses that address directly the alignment problem that may be driving their foot pronation. These patients may have other problems related to this such as tightness of the Iliotibial band, tight quadriceps muscle group, tight hamstring muscle group, weakened external rotators, and tight tissues around the knee cap.


So what does this tell us? 


If you were a trainer, how will you create a program to avoid knee pain for your clients? Based on these readings, and based on your assessment, you might be able to suggest a flexible knee brace that is over-the-counter and create an exercise routine centered on decreasing the valgus on the knee, proprioceptive and balance exercises (See USEFUL LINKS below), and a good flexibility regimen for major leg muscle groups like the quadriceps, hamstrings, and hip muscles. As a therapist, use your judgment and clinical decision-making skills in recommending the right brace for the client. Keep in mind that they may not actually need it. The brace may not be a one-size-fits-all resolve but I am hoping that knowing these studies will help you decide what’s best for your client.
Useful links:




SUPERFEET SHOE INSOLES – the only insoles I carry in the clinic at this time.

EXAMPLE OF FLEXIBLE KNEE SLEEVE I USE IN THE CLINIC - call our clinic for information on ordering (541)-459-8459

FIND US ON

Reference:
1. J Orthop Sports Phys Ther 2004;34:440-448. Effects of Foot Orthoses on Quality for individuals with Patellofemoral Pain Syndrome

2. Am J Phys Med Rehabil. 2011 Mar;90(3):247-62. Efficacy of knee braces and foot orthoses in conservative management of knee osteoarthritis: a systematic review.

3. Curr Opin Rheumatol. 2010 Mar;22(2):218-22. Role of Bracing in the Management of Knee osteoarthritis.
4. Journal of Orthopaedic & Sports Physical Therapy, 2015 Volume: 46 Issue: Pages: 19–25  DOI:10.2519/jospt.2016.5093. Effects of knee braces on quadriceps strength and inhibition in subjects with Osteoarthritis
5. Journal of Orthopaedic & Sports Physical Therapy, 2003 Volume: 33 Issue:11Pages: 661–670 DOI:10.2519/jospt.2003.33.11.661 The Role of Foot Orthoses as an intervention for Patellofemoral pain

Sunday, February 15, 2015

ACL REHABILITATION: Pre- and Post-Op shows promising results even 2 YEARS after.

Pre- and Post-ACLR Rehabilitation Shows Benefits 2 Years After Surgery

This is a really good article I read online regarding a two year follow up with individuals who underwent ACL reconstruction.  Many of my athletes have expressed some form of concern as well as some mild paranoia of whether they will be able to participate in the future as competitively as they have prior to being injured.


A study of individuals who undergo anterior cruciate ligament reconstruction (ACLR) shows that patients who participate in both pre- and postoperative rehabilitation not only get a head start on recovery, but also experience markedly better outcomes than patients receiving usual care even 2 years after surgery. The study was e-published ahead of print in the British Journal of Sports Medicine.

Patients completed the KOOS—a knee-specific self-assessment instrument of injuries linked to posttraumatic arthritis—preoperatively and again 2 years after reconstruction surgery. Researchers found that patients who underwent a 5-week preoperative rehabilitation program, followed by a yearlong progressive rehabilitation program after surgery, reported what authors describe as "significantly better" scores than their usual-care counterparts at both measurement points.

Patients in the rehabilitation cohort were recommended to achieve 90% quadriceps strength, hamstring strength, and hopping performance prior to surgery. This is HUGE! The fact that they have recovered the quads strength means the stability will be there long term. The postoperative rehabilitation varied by surgical circumstances and patient functional status, and was divided into 3 phases that began with quadriceps contractions and range-of-motion exercises and progressed to heavy resistance strength training, plyometric exercises, and sport-specific drills.

Researchers found that the rehabilitation program not only set the stage for better short-term outcomes, but also showed positive results long afterwards. "Compared to usual care, [the rehabilitation cohort] had superior preoperative patient-reported knee function, and still exhibited superior … function 2 years after the surgery, with 86–94% of patients scoring within the normative range in the different KOOS subscales," authors write.

Authors recommend that treatment strategies that include progressive pre- and postoperative rehabilitation for ACLR patients "be considered in the standard treatment protocol," but acknowledge that more research needs to be conducted to identify which parts of the rehabilitation programs are most responsible for the improvements.

Sunday, January 18, 2015

Anti-inflammatory Diet and Gluten-Free Food List

Here are a couple quick charts I use in the clinic for alkalizing foods and gluten-free foods. Please feel free to share with friends or give this link to them.

-->
NUTRITION FOR AN ANTI-INFLAMMATORY BODY
DOWNLOAD PRINTABLE FORMAT HERE. 

For most people, including children, the ideal diet is 75% alkalizing foods and 25% acidifying foods. Athletes should aim for 80% alkalizing foods.
ALKALIZING FOODS
ACIDIFYING FOODS
VEGETABLES
FRUITS
GRAINS
FATS AND OILS
Asparagus
Apple
Amarath
Avocado oil
Beets
Apricot
Barley
Canola oil
Broccolli
Avocado
Buckwheat
Corn oil
Brussel Sprouts
Banana
Corn
Lard
Cabbage
Cantaloupe
Kamut
Olive oil
Carrot
Cherries
Oats (rolled)
Safflower oil
Cauliflower
Currants
Rice
DAIRY
Celery
Dates / figs
Rice cakes
All cheeses (cow, goat)
Chard
Grapes
Rye
Butter
Chlorella
Grapefruit
Spelt
PROTEIN
Collard greens
Lemons
Wheat
Beef
Cucumber
Limes
Wheat cakes
Clams
Garlic
Honeydew Lemon
NUTS & LEGUMES
Lamb
Eggplant
Nectarine
Cashews
Lobster
Kale
Orange
Brazil nuts
Mussels
Kohirabi
Peach
Peanuts
Oyster
Lettuce
Pear
Peanut butter
Pork
Mushrooms
Pineapple
Pecans
Rabbit
Mustard greens
All berries
Tahini
Salmon
Onions
Tangerine
Walnuts
Shrimp
Peas
Watermelon
All legumes
Scallops
Peppers
PROTEIN
PASTA (WHITE)
Tuna
Pumpkin
Eggs
Noodles
Turkey
Rutabaga
Whey protein
Macaroni
Venison
Spirulina
Chicken breast
Spaghetti

Sprouts
Yogurt
OTHER

Squash
Almonds
Beer

Maitake
Chestnuts
Wine

Daicon
Tofu (fermented)
Spirits

Dandelion root
Flax seeds
Distilled vinegar

Shitake
Pumpkin Seeds
Wheat germ

Kombu
Sunflower seeds
Potatoes

Reishi
Sprouted seeds
Most tomatoes

Nori
OTHER
Sugar substitutes

Umeboshi
Veggie juices


Wakame
Fresh fruit juice


Spices, seasonings and herbs
Fresh and mineral water



Green Tea




-->
SHORTLIST OF GLUTEN-FREE FOODS 
- DOWNLOAD PRINTABLE FORMAT HERE.

Wild fish and shellfish

Grass-fed meats
Organic Poultry
Organic nuts

Organic cheese
Organic eggs
Virgin olive oil

Organic flax seeds, flax oil
Wild rice
Organic rice
Organic rice cakes
Organic rice flour (and other gluten free flours
Organic vegetables

Organic fruits
Peppercorns
Tamari sauce

Yogurt
Cider vinegar
Organic millet

Organic quinoa
Organic jelly, jams, marmalade
Organic honey

Tea (check herb teas)
Coffee

 MJ 2015


Follow by Email