Our Physical Therapy Blog

Posts for tag: manual therapy

A common medical diagnosis in the physical therapy world is osteoarthritis (OA). A recent study performed by Bunzli et. al. identified some common misconceptions about knee OA that appear to influence a patients’ acceptance of nonsurgical, evidence based treatments such as exercise and weight loss. The study showed that once participants in the study were diagnosed with “bone on bone” changes in their knee, many disregarded exercise based interventions believing that such treatment would cause further damage.

The truth here is that degenerative changes throughout our bodies are completely normal. Many of these changes begin in our second decade of life. The term “-itis” would indicate that there is an inflammatory component possibly causing a person pain but recent evidence has shown that this isn’t always the case. Beals et. al. found in their study that if you were to take 100 athletes, almost 30 of them would have asymptomatic cartilage tears in their knees. And if you have kept up with our blog series, you already know that diagnostic imaging is not the end all be all when confirming a diagnosis (or ruling it out).

By now you may be asking yourself, “what if I have pain while I’m exercising with my osteoarthritic knees?” Well here are some pro tips from us:

  1. Monitor your pain DURING exercise. 0-3 out of 10 pain is pretty low and should be considered a “safe zone.” 4-5/10 is acceptable but 6-10 pain levels are excessive and the exercise should be altered to accommodate your situation.

  2. Monitor your symptom response over the next 24 hours following exercise. Pain and discomfort should settle quickly after cessation and back to baseline levels within 24 hours.

  3. Monitor the trends in your signs and symptoms. If you pain and discomfort are improving over time (4-6 weeks) then this is a good thing. Your body is adapting and you may even notice you feel stronger rather than always hurting.

As modern medicine moves forward and providers try to find effective ways of decreasing healthcare costs, offering simple solutions like an exercise based program and changing your nutritional habits to help manage weight would be easier solutions versus expensive and painful surgical replacement procedures. Now of course always consult with your medical provider should you decide to take on such programs as each persons’ case is unique to their own situation. If you have any questions please ask us!

Tommie Baugh, PT, FAAOMPT

By Olivia Hulme, PT, DPT
May 01, 2019
Category: Uncategorized

Are your “hamstrings tight”? Is stretching making your symptoms worse? Did you know that it might not actually be your hamstrings limiting your flexibility or causing pain?

There is a big nerve running down the back of your thigh alongside the hamstring muscle group called the sciatic nerve. It can get irritated with trauma, repeated wear and tear from poor movement patterns, compression, or quick and/or prolonged stretching. Similarly, a reported symptom of short or “tight” hamstrings could be caused from overuse, body alignment, quick/sudden stretch movements, or direct or indirect trauma (Valle, 2017).

So how do you know which is the culprit and how to go about treating it?? Good thing you have great therapists at AMTA to help you figure out this differential diagnosis!

We have several tools in our tool box to figure out if your symptoms are nervy or from the hamstrings, one of those tools being the Straight Leg Raise Test. This test can measure the hamstring flexibility, and rule in or out nerve involvement.

Now I know what you’re asking yourself, how do we treat a nerve injury vs. a hamstring injury?

First thing is first. Nerves do not like to be stretched or compressed. This is why stretching your hamstrings at the gym is making your symptoms worse. We describe nerves like the consistency of dental floss, which…can’t be stretched. Treatment will consist of nerve glides to glide the nerve along its pathway, break up any adhesions, and sooth the nerve. These adhesions, or sticky spots, bind the nerve and create tension, which have decreased the flexibility of your leg.

If the straight leg raise test does not indicate nerve involvement, then it’s safe to say the hamstrings may be the limiting your flexibility. However, that will require even more investigating to decide if there is a potential strain, tendon pathology, short muscles, referred pain from a stress fracture, etc.

So before you go cranking away on stretching those poor “hammys”, come see us at Austin Manual Therapy Associates.

Olivia Hulme, PT, DPT

On a daily basis, the few questions I get asked more often than “How old are you?” or “How long have you been doing this?” are, “Should I get a steroid injection?” or more frequently, “Why did the steroid injections not help with my ____ pain?” The utilization of corticosteroid injections for musculoskeletal pain management dates back to the 1950s, but recent research reveals that negative effects to surrounding tissues outweigh the trivial benefits. In the clinic, most people are aware of this pain management option and many have first hand experience. However, it is less common that consumers understand how injections work, adverse effects associated with injections, and more importantly, what is efficient at resolving their pain. The goal of this entry is to provide current research to equip health consumers with the knowledge necessary to make confident, informed decisions about their treatment options.

In the literature, steroid injections are documented to treat a broad array of painful conditions: joint pain associated with arthritis, soft tissue pain (muscles, bursas, tendons, and ligaments), and nerve pain like carpal tunnel syndrome (Brinks et al. 2010). Injections are used for a large range of conditions because they serve one purpose: to attempt short term pain reduction via anti-inflammatory processes and immunosuppressive properties at the cellular level (Pekarek et al. 2011). In other words, injections temporarily halt inflammation, which is the first phase of normal tissue healing similar to how band-aids reduce bleeding. Unfortunately, injections do not address the cause or reasons for re-occurring inflammation. Patients typically notice a greater pain reduction, if any, with an initial injection followed by diminishing returns with subsequent encounters. Literature shows that injections have little or no effect on mitigating pain in chronic conditions. This often leads to frustration because injections are frequently administered after a condition has already become chronic (symptoms for 3 months or longer). Unlike band-aids, injections stimulate tissue breakdown with the gamble of having no effect on pain, or even worse, increased pain or sooner surgical procedure. Therefore, corticosteroid injections should only be cautiously considered for pain control during acute conditions (Mittal et al. 2018).

Injections actually cause further damage to the very tissues they are expected to treat. Specifically, a systematic review identified adverse events of extra-articular (outside the joint) corticosteroid injections ranging from minor to fatal infections, numerous tendon ruptures, and local skin and fat pad atrophy (Brinks et al. 2010). A single injection directly into a ligament results in reduced tensile strength for up to a year post injection (Pekarek et al. 2011). Similar findings are evident in cartilage tissue with intra-articular (inside joint) injections. A recent study compared intra-articular corticosteroid injections versus a placebo solution in 140 patients suffering from knee osteoarthritis over 2 years. This study examined the effects on pain and cartilage health measured by MRI. The results were alarming. No significant difference in knee pain ratings between the groups were identified and the corticosteroid group had significantly greater cartilage loss - a sign of progressing osteoarthritis and the very reason people seek injections (Mittal et al 2018). Corticosteroid injections made these patients worse! Clinically, I find that patients get injections to avoid pain and/or surgery, despite the evidence stating the exact opposite.

There needs to be a paradigm shift. Corticosteroid injections should never be a first line of defense to pain and certainly not a “lets just see if it helps” option. There are numerous studies illustrating that exercise alone is superior to injections. Many even prove exercise alone to be equal, if not better, than injections combined with exercise for managing musculoskeletal pain. So why are steroid injection still commonly used for pain management? A meta-analysis by Mohamadi et al. proposed, “their wide use may be attributable to habit, under-appreciation of the placebo effect, incentive to satisfy rather than discuss a patient’s drive toward physical intervention, or for remuneration, rather than their utility (2016).”

Musculoskeletal pain that gradually develops is associated with poor, repetitive movement patterns that apply abnormal stress to muscle, tendon, ligament and cartilage tissues. This is the root cause of reoccurring inflammation and pain. Just as band-aides would never heal a scrape if the scab were repetitively scratched off, injections will not heal tissues in the body if the faulty movement pattern is not corrected. Don’t expect an injection to heal a movement impairment. Stop insulting your tissues, learn to move efficiently, and let the tissues heal.

Here at Austin Manual Therapy, we specialize in soft tissue/joint mobility, specific exercise for tissue healing, and restore efficient movement patterns for a lifetime of reduced pain. If you or someone you know is struggling with pain, work with one of our experienced therapist to stop the tissue bleeding and get you moving in the right direction.