Thrive Physical Therapy in Richmond

Physical Therapy and Fast Pain Relief

New Low Back Pain Treatment Guidelines Released by ACP: Pharmacological Intervention ill Advised

The American College of Physicians has revised it’s treatment guidelines for lower back pain recommending conservative treatment and avoiding use of Corticosteroids and Narcotics.  Pharmacological intervention was determine to be either ineffective of ill advised as a result of increased chance of adverse side effects.  Conservative interventions including spine manipulation, motor control training, and various other movement therapies were considered equally or more successful with reduced risk of harm or adverse side effects.  See more…     Here are a few of their key recommendations from the research article

Recommendation 1:

Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation)

Recommendation 2:

For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation)

Recommendation 3:

In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients. (Grade: weak recommendation, moderate-quality evidence)

If you are suffering from pain, injury, or weakness why suffer a moment longer?  We can help.  Give us a call at 804 320-2220 today!

Learning to THRIVE!

We are committed to improving our clinical skills in order to help you THRIVE!  We meet formally once per month as a group to share ideas, learn, and to improve our treatment skills.  We believe life long learning and working to excel is a key to developing a healthy team and thriving in life!  What have your learned today?  What areas of your life can you work to improve?  What do you want to accomplish today to grow?!

practicing-skills

Having pain, injury, or weakness? We can help!  Give us a call today! 804 320-2220

Why Exercising First Thing in the Morning is a Key to THRIVING!

I have been giving this advice for some years now to our patients and I believe it is a critical component to being successful in the rehab process and THRIVING in life.  There are many advantages to working on corrective exercise and general exercise early in the day.  First completing your therapeutic exercises first thing in the morning increases mobility, improves alignment, and wakes up your core and hips.  The more mobile, well aligned, and the better our core/hips are functioning the more efficiently you will move throughout the day which reduces pain.  Efficient movement feels good and improves our well being physically and mentally.  To quote Gray Cook from functionalmovement.com  “Move well. Move often”.  Second, it increases your metabolism and mental acuity.  Studies have shown that after exercise, cyclists perform better on memory and mental processing tests.  I can attest to this personally as I am much more productive and excited about the day when I get out and exercise first thing.  Third, cardiovascular exercise produces endorphins, which is one of the most powerful pain reducing substances that we know of and also promotes feelings of well being.  A healthy daily dose of endorphins goes a long way towards dissipating stress, reducing pain, facilitating positive thoughts, and improving our health.

Now for the less apparent benefits. Taking time to exercise first things gets you up moving and sets a precedent.  The first thing you have done at the start of the day is something for your benefit.   Regardless of what happens through the day you have done something positive for yourself.  Taking care of yourself and improving your health first makes it easier for you to do for others and improves your ability to be fully present.  Think of it this way, “first put the oxygen mask on yourself and then on your child/loved one”.  If you want to be strong, healthy, and happy it is necessary to takes steps regularly towards that aim.  With this choice events of the day are less likely to prevent you from getting to your exercise program.  So part of the benefit is mental, and the other is practical as it is more likely to get done.  Next, getting up and moving exposes you to life and chance something good will happen.  As most of you know I am a cyclist.  I have been out early on the bike and have seen things that I would not have experienced otherwise.  I have seen a baby deer playing like a human child with its family along a trail, fog coming up over Rockett’s Landing as the sun comes up, and a homeless person sleeping in a tent under a bridge to name only a few.  This has given me a chance to appreciate unexpected beauty and to be thankful that I have a roof over my head and loved ones who care about me.

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23rd Street Climb where Peter Sagan launched his World Championship winning attack back in September! While riding up it this morning (much slower than racers did it in September) I thought about how special it was to have the Worlds in Richmond and to have shared it with our son and as a THRIVE group outing.
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One of my favorite views of the city from Libby Hill while out on morning ride. I remembered how I took my wife here first time she came to visit Richmond years ago.

When it comes to being healthy and pain free, take the necessary steps that will move you to a better place physically and mentally.   Look at your health globally and consider, “what did I do today to make myself healthier?” After all it’s your thoughts that shape your life experience, health, and happiness.   Be disciplined get up, get out, and exercise!  Expose yourself to what you might not have seen or experienced otherwise.  What did you see today? What did you think about?

 

Having pain, injury, or weakness? We can help!  Give us a call today!

Understanding Chronic Pain and How to Eliminate It

Recent research into chronic pain states has revealed a variety of interesting facts. Pain is our body’s protective mechanism to prevent injury. For example, when you place your hand on a hot stove, you feel immediate pain, which prompts you to quickly pull your hand away, hopefully in time to prevent a burn! Likewise, when a person has continued to irritate a condition by repeated injury or continued repetitive stress, his or her nervous system can become “sensitized”, meaning the body learns to carry a pain signal because the circuit has been continually reactivated. The degree of stimulus needed to activate the signal gradually lessens to the point that non damaging stress to the body can result in pain. Your body’s protective mechanism becomes less accurate in assessing what is damaging and what is not.

Emotions, beliefs, stress level, and fears can help or hurt the healing process. Negative thoughts, called “catastrophizing “ in medical literature, include such behaviors as worrying about something serious being wrong, fears of what this could mean in the future, or focusing on your pain level. When catastrophizing, a stress hormone cortisol level is increased, pain thresholds are lowered, and circulating inflammatory mediators in the blood are increased (R.R. Edwards et al. / Pain 140 (2008) 135–144). The result is you hurt more and your body’s inflammatory response is increased. Your alarm system becomes hyperactive, and usual daily activities can become painful, prompting the individual to be less active. This can lead to fear of movement/activity, disuse, and de-conditioning, making your tissues less healthy and, therefore, less tolerant of stress, thus perpetuating the cycle. This can be a slippery slope, leading to decreased quality of life and/or depression.

For anyone experiencing pain over time, part of the rehab process is to address and encourage not only healing of unhealthy tissues but also calming the individual’s nervous system. There are good resources available to better understand this process including a book called “Explain Pain” (Butler D. and Moseley L. Noigroup Publications; in 2003). We have found that education and understanding are key components in successfully assisting individuals through the rehabilitation process. All injuries, not just long term chronic pain states, frequently have components of abnormal pain physiology that contribute to their perpetuation. We have found the following general advice helpful to our patients in resolving acute and chronic pain:

1. Understand what is contributing to the perpetuation of your pain and what you can do to minimize it. Are you overstressing your tissues throughout the day with bad postural habits and a poorly setup workstation? If so, change it and improve the situation. View the following link to correct your work station and sitting alignment http://www.youtube.com/watch?v=cHelFza49K8
2. Understand what happens to a nervous system that suffers chronic pain. Know that your body’s “alarm system” may not be an accurate assessor of what is damaging to your tissues. Discuss with your therapist how to tell the difference between good and bad pain.
3. Try to ease your worry that something more serious may be wrong. Talk about your concerns, fears, and symptoms with your therapist. If there is something that warrants further investigation he or she can help direct you. Worry is only helpful if it causes you to take a necessary action. Otherwise, it increases your inflammatory response and pain level for no good reason.
4. Do not focus on your pain. I am not saying to always ignore your symptoms, especially when you have done something that may have exacerbated your condition. However, constant vigilance of your pain level has been shown to decrease your pain threshold and increase your body’s inflammatory response, making you feel worse. Divert your attention elsewhere and enjoy your day.
5. Try to stay in the moment. If you are having pain, do your best not to project into the future how you will feel later today, tomorrow, or how it may impact you as time passes. Be confident you will heal and that your symptoms will pass. A positive attitude and belief that you will do well is one of the most important factors contributing to how well you will do in the future.
6. Remember, part of eliminating pain and working through the rehab process is to make you healthier from a global perspective. What are your specific needs and biggest deficits? Do you need healthy diet? More sleep? Do you do dissipate stress poorly? Do you exercise regularly? Do you have personal relationships that need attention? Are you in a stressful work setting? Poor organization skills, etc.? Work on your areas that need attention. A helpful book that everyone should read in this area is Spontaneous Healing, by Dr. Andrew Weil
7. Breathing and meditation activities have repeatedly been shown to reduce stress, improve health, and reduce pain states. Discuss this with your clinician.
8. Get more sleep than you think you need.
9. Do something for youself that you enjoy everyday.
10. Do something kind for someone else every day. You will get more benefit from it than they will.
11. Try to laugh as much as you can! It reduces stress and things seem to hurt less when you do.
12. Try to learn something new every day. When your focus is elsewhere pain is less.
13. Do some form of cardiovascular exercise regularly that will not exacerbate your condition. It is theorized to dissipate inflammation and is the strongest producer of natural endorphins (happy chemicals) we know of that are helpful in reducing pain.
14. Work on your prescribed exercise program and movement strategies learned in physical therapy. This is a key component! The cliché is true that you will get out of it what you put into it.
15. When adding new physical activities, do so in a slow, graded manner. This allows your tissues and nervous system to adapt without setting off the alarm system causing pain.
16. Have a plan and carry it out.
17. You have the key to healing yourself. Professionals are your guide through the process!

By Clarke Tanner PT, MPT, CMPT, ATC, CSCS

If you are experiencing pain, take action to eliminate it! We can help. Let us help you get back to the activities you enjoy. Call 804 320-2220 and setup an appointment today.

THRIVE PT is a specialized manually based orthopedic, spine, and sports physical therapy practice that provides individualized care to its patients. All of our therapists have specialty training, advanced certifications in orthopedic manual therapy, and extensive post graduate course work, and are highly qualified to help you reach your therapy goals. Our methods include hands-on corrective treatment, movement training, dry needling, and therapeutic exercise provided exclusively by your therapist. Our objective is to teach you how to move efficiently and painlessly and to educate you on how to stay healthy. We can help you achieve your goals to lead a healthy, active life--in a word, THRIVE!

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