Monthly Archives

August 2017

Manual Therapy

By | Pain Relief, Physical Therapy | No Comments

Manual Therapy is the art of knowing what tissue needs to be moved in which direction combined with the science behind the biomechanics of the body. Manual therapy may include soft tissue mobilization, joint mobilizations, joint manipulations, and teaching self-mobilization exercises. But it also includes the knowledge of WHICH tissues to move to obtain optimum results. Manual therapy, or hands on treatment, is the backbone of Physical Therapy for EveryBODY because of the research supporting the long term effects on pain inhibition.

Soft tissue mobilization has been shown to decrease the expression of inflammatory genes and increase the expression of genes involved in healing. In animal models, soft tissue mobilization has been shown to increase oxytocin (happy, happy, joy, joy) in the plasma. Don’t you want to volunteer for those studies?!

Joint mobilization and manipulation has been shown to increase pain thresholds, improve muscle activation, decrease muscle tension, increase pain free motion, and affect the chemicals that float around your brain and make you feel good. Any way you slice it, getting those joints moving right is good, good stuff.

Teaching self-mobilization exercises is important so YOU can continue your treatment at home. 1) You get the benefits on your body as noted above and 2) YOU become empowered to help control your pain.

In all honesty, after 17 years as a Physical Therapist and obtaining my PhD in Orthopedic Manual Physical Therapy it all comes down to this – empowering YOU to manage your pain through education regarding self-treatment and appropriate exercise leads to the best long term results. If you are interested in finding out more, please feel free to contact Amy at (360)367-0970 or

Decreasing Chronic Pain

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One hundred million adults in America suffer from chronic pain. This is greater than the number of individuals affected by diabetes, cancer, and heart disease combined! The evidence on chronic pain and what decreases symptoms or improves outcomes for this population is plentiful. However, clear and decisive answers on what should be done to decrease chronic pain have not been found. The research is indicating that a multimodal approach is required to treat each patient individually with their personal beliefs, goals, and expectations.

There has been one modality that repeatedly decreases symptoms – EXERCISE! Research has found that adults who participate in higher levels of physical activity have more effective pain modulation. In fact, exercise can decrease the perception of pain even if you are not exercising the painful region. Say that you have low back pain and decide to go ride a recumbent bike. Your back is supported so the bike riding does not increase your symptoms AND your leg movement helps to decrease you perception of pain. (In addition, you burn calories, improve heart health, and release endorphins which are all good things.) This is called exercise induced hypoalgesia and has been shown to affect a multitude of chronic pain conditions. Five systematic reviews concluded that walking improved pain for individuals with chronic musculoskeletal pain, low back pain, knee osteoarthritis, and intermittent claudication.
Now, you may have tried exercise for your chronic pain and found that it increased symptoms. There is one caveat found in the literature – not all exercise is created equally. Some conditions respond better to cardiovascular exercise while others have been shown to improve with strengthening. Understanding the original source of pain generation as well as the current systems affected by chronic pain are all important in designing an optimal exercise program. If you have any questions regarding the optimum exercise for you, please feel free to contact us here at Physical Therapy for everybody at (360)367-0970 or

Education & Self-Management of Pain

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The research indicates what Physical Therapists have long known – education is the key to rehabilitation! Education becomes even more important as we discuss chronic pain. Every PT has stories of patients they were able to treat quickly, who had good long term results. We thrive on those patients and we are just as happy as they are with their results! But when patients have struggled with a chronic condition for years, they tend to develop abnormal motor patterns (see previous post) and poor pain responses. Therefore, most chronic pain patients have better long term outcomes with education along the way to help them manage their symptoms through the years.|

Education is key and commonly termed “explaining pain”. This is incredibly important in chronic pain since the nervous system pathways that maintain chronic pain do not function in a way that we commonly understand. Acute pain indicates tissue injury and is the body’s response to protect the damaged tissue. With chronic pain the nervous system is no longer responding to acute injury and the “protection” it offers is no longer helpful, but detrimental to healing. Therefore, it is important to gain an understanding of how pain is produced, why pain can persist when tissues are healed, and how pain can be seen as a truly biopsychosocial phenomenon.

Self-management plans are implemented to help each patient achieve THEIR goals. These plans help to give each patient control over their pain and over their ability to return to their chosen activities in life. Although these plans are always patient specific, they generally include several of the same ingredients. First, reasonable goals and timelines for achieving them need to be established. Next, graded exposure and pacing are implemented to optimize sleep (because when you are sleeping is when you are healing!). Targeting stress reduction and finding useful strategies for relaxation for each patient is key to decreasing the load on the nervous system. Another component is helping each person find ways to modulate their own pain which may include use of heat and/or cold therapy at home.

Chronic pain requires a health care ally to walk with you and find the strategies that work best for YOUR body. If we can help you, please feel free to contact us at (360)367-0970 or

To brace your abs or not to brace your abs?

By | Pain Relief, Physical Therapy | No Comments

As we are talking about chronic pain in this series of blog articles, it is critical to talk about how our body chooses to move in response to pain.  Let’s take an example of a sprained ankle.  When someone sprains their ankle they may start to walk with their foot turned out to the side.  This is a conscious or subconscious effort to protect the ligaments that have been damaged on the outside of the ankle.  However, this can cause more pain up the chain – in the knee, hip, low back, or even the shoulder.  What starts out as a movement pattern to protect an injured area turns into a movement pattern that causes pain in other places of the body.

Currently, we have four hypotheses to explain why these motor strategies occur.  The Suboptimal Tissue-Loading Hypothesis states that we tend to change our movement patterns over time due to habit or energy minimization.  Over time this suboptimal loading causes pain because it exceeds the tissue tolerance.  The Pain/Injury Interference/Inaccuracy Hypothesis describes altered movement patterns in response to a real or perceived threat of injury.  The Protective Response Hypothesis describes a change in the nervous system to remove or reduce the threat of pain which changes the motor behavior.  While the Conditioned Response Hypothesis states that pain may be experienced in association with movement in the absence of nociceptive discharge due to pain “memories”.  These four hypotheses often interact with each other and each person can move through different theories as they progress through an injury.

Understanding these hypotheses and how they are affecting an individual are critical to the rehabilitation of an injury.  Each motor strategy has a unique treatment regimen for optimal results.  We can help you to understand where your body is and develop a program to improve motor strategies to assure complete healing.  Please contact us at (360)367-0970 or for more information.