​It has become common practice for patients with low back or neck pain (with or without arm/leg numbness or tingling) to have an MRI. However, recent studies have shown that having an MRI does not lead to an improved ability to determine a diagnosis and does not help you to get better any faster than if you did not have the MRI.1,2 In fact, these tests can actually result in unnecessary treatments, having worse pain or being in pain for a longer period of time than you would if you didn’t have the MRI, and can cost you more money than if you avoid the MRI.
 
So how can having an MRI result in more pain? 
 
Based on research, roughly 2 of out every 3 people without any pain have “abnormal” MRI findings.3 These findings in pain-free individuals consist of bulging and/or herniated discs, stenosis (narrowing of the spinal canal), and arthritis, just to name a few.3 
 
Yes, that is right, 2 out of every 3 people without pain have MRIs that show something “wrong”. Having an MRI often results in more confusion for all involved parties when trying to determine your diagnosis. This means you may be told that you have spinal conditions that are actually normal in pain-free individuals. The following table reveals higher incidence of surgery, injections, and visits to spine specialists and the ER for patients who have had an MRI before receiving physical therapy care, and these differences were unrelated to the severity of the patients’ symptoms.4 

So how can we know that the findings from an MRI have anything to do with your current pain? 
 
We often can’t, and it actually doesn’t matter. The cause of low back pain cannot be identified in > 80% of patients.5 Most back pain goes away within 1 month, and many times this doesn’t even require any treatment.6 When treatment is needed, physical therapy is often enough to help you overcome your symptoms in a short period of time, even in those cases when there is numbness and/or tingling down the arm or leg.  
 
Let’s discuss an example to explain how your symptoms can worsen by having an MRI.  You develop sudden onset back pain with tingling in your left calf and foot. Your physician prescribes medication and orders an MRI, which reveals a bulging disc on the left side. You should now know that 50% of pain-free 40 year olds have bulging discs and this percentage rises steadily with age. While waiting to get the MRI results, valuable time has passed that could have been used to initiate appropriate treatments designed to help you overcome your pain. 
 
What should I do if I am currently experiencing, or start to experience back or neck pain?
 
Seeking out the correct physical therapist is likely your best option, as we are musculoskeletal experts and have the ability to perform a competent physical examination in order to determine whether or not you actually need an MRI. If we determine that you don’t need an MRI, we can use the information gathered during our assessment to provide treatments that are proven to decrease your pain and disability. Current research shows the 2 most important factors to getting better the fastest are: 1. Getting treated as soon as possible after the onset of pain, and 2. Getting the appropriate treatments.4 Remember that in New York State you are allowed to go directly to your physical therapist without a referral from your physician. 
 
Give us a call today if you are having any pain and we’ll get you back on track.   Physical therapists that are Fellowship or Residency trained in evidence-based practice make up only 5% of clinicians in the country due to this advanced level of training. All of our clinicians here at PRO-Active Physical Therapy have their Doctorate in Physical Therapy and are Fellowship or Residency trained.
 
Call us today for more information about this topic.
 
PRO-Active Physical Therapy, North Syracuse, NY.  315-458-2552.
 
 
 
References:

1. Fritz JM, Brennan GP, Hunter SJ. Physical therapy or advanced imaging as first management strategy following a new consultation for low back pain in primary care: associations with future health care utilization and charges. Health Serv Res. 2015. Epub ahead of print.
2. Jarvik JG, Gold LS, Comstock BA, et al. Association of early imaging for back pain with clinical outcomes in older adults. JAMA. 2015;313(11):1143-1153.
3. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Spine. 2015;36(4):811-816.
4. Childs JD, Fritz JM, Wu SS, et al. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Services Research. 2015;15:150.
5. Nguyen TH, Randolph DC. Nonspecific low back pain and return to work. Am Fam Physician. 2007;76(10):1497-1502.
6. Atlas SJ, Deyo RA. Evaluating and managing acute low back pain in the primary care setting. J Gen Intern Med. 2001;16(2):120-131.

An ankle injury produces pain, swelling and discoloration.  Following the “RICE” protocol (Rest, Ice, Compression, and Elevation) can help minimize these symptoms.  It is always a good idea to seek medical intervention to ensure there are no fractures.

The next step for a quick return to the field is Physical Therapy. Physical Therapy will improve range of motion, strength, and stability of the ankle.  Physical Therapy will also improve balance and proprioception. Proprioception is the ankles' ability to tell the brain what position it’s in, in space.  Improving balance and proprioception is important in reducing the risk of re-injury.

Following these steps will promote a speedy and safe return to the playing field.  Most insurances offer direct access for Physical Therapy, meaning that you can see the Physical Therapist of your choice WITHOUT a prescription.

Contact your favorite MyHometown Physical Therapist with any questions or to schedule an appointment.

Blog Post by:  Debra Donohue, PT
Westside Physical Therapy

A Hand Therapist could be either an occupational or physical therapist, who through advanced study and experience, specializes in treating individuals with conditions affecting the hands and upper extremity. All Orthopedic PT’s are qualified to see patients with hand and arm dysfunctions, however more complicated issues might best be seen by CHT’s, Certified Hand Therapists.

A Certified Hand Therapist has a minimum of five years of clinical experience and has successfully passed an examination of advanced clinical skills and theory in upper extremity rehabilitation. Every CHT is required to demonstrate professional development and competency by re-certifying every five years.

Using specialized skills in assessment, planning and treatment, hand therapists provide therapeutic interventions to prevent dysfunction, restore function, and/or reverse the progression of pathology of the upper limb. The goal of therapy is to enhance an individual’s ability to execute tasks and to participate fully in activities of daily living.

If surgery is needed, a hand therapist can also help with a patient’s recovery. This may include assistance with helping wounds heal, preventing infection, scar management and reducing swelling.

Hand therapy is not limited to your hand. A hand therapist also specializes in treatment for your shoulder, elbow, wrist, and fingers. These treatments can help to relieve arthritis pain, improve your sports abilities, and build strength and dexterity. Exercise equipment used in Hand Therapy include squeeze balls, theraputty, power webs, wrist weights, grippers and more. These will be combined with the modalities typically seen in PT, such as ultrasound, electrical stimulation, moist heat and paraffin.

Heidi Hathaway, CHT is employed with Kuss Physical and Aquatic Therapy in Central Square, NY. Call us today for an evaluation and let us help you Get a Grip!! 315-668-0123

My Home Town PT is also a great resource for finding a Certified Hand Therapist near you. 

Most of the time when it comes to orthopedic issues health care professionals tend to focus on one area, the area of complaint.  If the pain is at the knee the problem must be at the knee, so I should treat the knee.  In a percentage of cases this works, but not in all cases.  In cases where problems get better but not all the way or when an injury fails to respond as expected, looking at the body as a whole for dysfunction may be the answer.  

Postural Restoration is a treatment approach to the body as a whole improving postural symmetry, orientation, stability and control.  The Postural Restoration approach was developed by Ron Hruska Jr., MPA, PT.  He developed a series of retraining exercises targeted to correct overpowering postural and movement patterns.  In most cases treatment will start at the pelvis and hips and then move up into trunk, shoulder blade and arm.  Programs are developed individually for each person to target their own personal asymmetries.  

What type of asymmetries are therapists looking for?  Visually we may see curvatures of the spine, uneven shoulder height, one lower extremity turning out more than the other, over or under developed muscles compared from side to side and many others.  Also, testing flexibility, strength and ROM will reveal imbalances across the body and resting postural position.  The final asymmetry a Postural Restoration trained therapist will look for is an imbalance in respiration.  

Breathing is the most important musculoskeletal activity we do.  The body will compensate anywhere it needs to in order to maintain respiration.  When our posture becomes asymmetrical it can negatively affect the orientation of the diaphragm.  Improper position of the diaphragm will limit ability to get full inhalation and exhalation.  Typically, compensation for a diaphragm that is not working properly can occur through the cervical or shoulder musculature.  With the neck now assisting in respiration it can create pain or dysfunctional movement.  A proper breathing pattern is an important part of postural restoration exercises.  

In summary, think of the human body like any other machine.  Imagine your car’s alignment is off which causes your tire to wear unevenly and then to finally blow.  You could try and patch the tire and when that fails replace the tire, but does that fix the real problem.  How long until the new tire fails.  Sometimes a tire blows because we drive over a nail, but other times there may be an underlying issue.  If you’re experiencing a muscle or joint problem that has improved, but not completely or continues to reoccur consider Postural Restoration and looking at the impact the rest of the body is putting on your injury.  

For more information, please contact  Mary Lou Corcoran Physical and Aquatic therapy 315-637-4747.

Vestibular dysfunction is a condition experienced by millions of Americans every year. It can occur spontaneously or after a traumatic incident and be very debilitating, producing symptoms of vertigo, dizziness, nausea, loss of balance and headaches. Vestibular dysfunction is broken down into 2 categories; central and peripheral.

Central
Central vestibular dysfunction involves a dysfunction of areas of the brain that process information coming in from various sensory organs allowing one to maintain their balance. For one reason or another, the incoming messages are processed incorrectly. This can result in dizziness, loss of balance, headaches, and eye pain.

Peripheral
Peripheral vestibular dysfunction involves structures of the inner ear, particularly the semi circular canals and the vestibule, which are filled with fluid. Problems arise when small crystals break loose and fall into the semi circular canals or build up on small hair cells in the vestibule. This results in abnormal nerve impulses being sent to the balance centers of the brain giving the false impression of movement. One would experience a feeling of the room spinning with head movements, position changes, or even sitting still. This is often referred as BPPV or Benign Paroxysmal Positional Vertigo.

Although these symptoms may be severe and debilitating, physical therapy can be very successful in treating vestibular dysfunction. Therapists will examine eye and head movements, position changes, and physical structures to determine which component(s) of the vestibular system are involved. Treatment for central dysfunction usually involves exercises designed to desensitize the individual to the problem movements. Treatment for the peripheral dysfunction involves moving the individual through different positions to flush the crystals out the semi circular canals or break them loose from the hair cells. When you decide to have physical therapy treatment for vestibular dysfunction, make sure the therapist has had specific training in vestibular rehabilitation.

Carey and Daley Physical Therapy has several therapists with training in vestibular rehabilitation. For more information call (315)652-4323.

The three primary principles inherent with the use of water therapy that help to maximize recovery are : 1. Decreased  pressure on your joints and spine through buoyancy of the water   2. The ability to adjust resistance or assistance of an activity via the 3 -Dimensional pressure resistance of water itself and 3. The temperature of pool which can be raised or lowered to stimulate muscles or relax muscles to maximize pain relief allowing increased activity ad function.

Multiple scientific studies have proven the efficacy and benefits of using water to improve joint mobility, strength, function , endurance and relieve pain in patients referred to physical therapy. 

If you are in pain, have touble moving your joints or need to strengthen your muscles but can't tolerate typical gym or land exercises, water therapy may very well be an answer for you to achieve these goals. 

Achieve Physical Therapy and the MyhometownPT  group has a Physical Therapist near you that can offer an evaluation to help determine if water therapy is right for you.

What is it and what can you do for it?

Do you experience pelvic pain, low back, or hip pain? Do you leak urine or stool?  Do you have pain with intercourse? Did you know all of these issues can be caused by problems with the pelvic floor muscles?   The pelvic floor muscles, or the “kegel” muscles, are muscles in the pelvis that assist in sexual appreciation, urinary and bowel function, and provide support to pelvic structures.  When these muscles are not working properly, it is called pelvic floor dysfunction.

Pelvic floor dysfunction affects both males and females and can cause a variety of symptoms related to bladder, bowel, and sexual function as well as pain in the pelvis, low back, and hips.  Patients with pelvic floor dysfunction may experience urinary urgency and frequency, pain with urination, difficulty emptying their bladder, and leakage of urine or stool. Symptoms might also include constipation, straining, or pain with bowel movements.  Pain may also be present during and after intercourse.  In addition to these symptoms, patients with pelvic floor dysfunction sometimes have medical diagnoses such as prolapse, interstitial cystitis, endometriosis, irritable bowel syndrome, prostatitis, vulvodynia, and pudendal neuralgia. Pelvic floor dysfunction can cause a variety of symptoms, all of which can be difficult to discuss and significantly impact quality of life.            

Fortunately, there is effective treatment for pelvic floor dysfunction. Physical therapists with special training can perform internal vaginal or rectal examination of the pelvic floor muscles in addition to a traditional assessment of the low back and hips. Many people assume symptoms such as urinary leakage are caused by “loose” muscles. While the pelvic floor muscles can become lengthened, they can also become too tight (or shortened).   It is important to determine whether the muscles are shortened or lengthened because treatment for each is very different. Based on examination findings,   a physical therapist can develop a treatment program that is specific for each patient.  Treatment might include pelvic floor muscle relaxation exercises, internal and external muscle release, education on ways to manage your bladder and bowel habits, and strengthening exercises for the pelvic floor, hip, and core muscles.

If you experience urinary symptoms, bowel symptoms, pain with intercourse, and/or low back, pelvic or hip pain, you might have pelvic floor dysfunction.   Do not be afraid to discuss your symptoms with your healthcare providers.  If you have any questions or if you would like to make a physical therapy appointment, please contact Mauro-Bertolo Therapy Services at (315) 699-1009 and any of our four specially trained physical therapists would be happy to talk with you.