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Pain Relief

Should I get a cortisone injection?

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Has your doctor recommended a cortisone injection to help relieve your shoulder pain?

Are you wondering why you would get a cortisone injection and what they do?

Then let’s start there! Your doctor may recommend that you have a cortisone injection if you have a painful muscle or joint that is inflamed. The cortisone is injected directly into the muscle or joint and decreases the inflammation. You see, cortisone is a powerful anti-inflammatory. By decreasing the inflammation, the pressure in the muscle or joint will also be decreased. Once the pressure is decreased you will feel a decrease in the pain.

Decreased inflammation = decreased pressure + time = decreased pain

Do cortisone injections really work?
While the theory for cortisone injections is sound the research tells another story. A recent study concluded that “corticosteroid injections provide – at best – minimal transient pain relief in a small number of patients with rotator cuff tendinosis and cannot modify the natural course of the disease”. Which means that the cortisone injection may help decrease pain in the short term but will not provide the long term benefits needed to heal a rotator cuff issue.

A different study from the Annals of Internal Medicine compared 3 steroid injections with Physical Therapy treatment. This study found that both groups reported a 50% improvement in pain and disability after one year. However, the steroid injection group had more return visits to their primary care doctor and a higher request for additional steroid injections. Basically, Physical Therapy was able to provide the same benefits while decreasing the number of doctor visits after treatment and decreasing the need for drugs.

Are there any side effects from a cortisone injection?

YES! It has long been known that steroid injections lead to degeneration of the soft tissues of the area it is injected into, potentially leading to tendon tears in the future. That cortisone injection you get today to deal with a rotator cuff tear leads to a weakening of the rotator cuff muscles which increases the risk of further tears in the future.

AND, the medical community is starting to question if cortisone injections into joints actually leads to an increased risk of arthritis. A recent report in Radiology observed patients who had previously received steroid injections and found that some of the patients exhibited further joint damage on medical imaging tests. This study is concerning to those who have been told they need to have an injection to decrease pain from arthritis.

PLUS, there are other potential side effects from a cortisone injection including muscle weakness, slow wound healing, and high blood pressure. Just to name a few! The cortisone is injected locally but travels throughout your body and can cause problems to other systems.

Would you prefer a completely natural way to treat your shoulder pain?

Physical therapy offers a more holistic approach to treating your shoulder pain. It is true that there isn’t a one-size-fits-all solution. Our treatment model is entirely based around addressing the root cause of your pain instead of just providing temporary relief. This allows us to be non-invasive, movement-based, and entirely customized to YOU.

If you have been told that you need a cortisone injection to deal with your shoulder pain we would like you to get informed about other options. We offer a completely natural route to get your shoulder moving again. Want to find out how? Then schedule a FREE 20 minute Discovery Visit to talk with one of our specialists now.

Sciatica in 2020

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When I graduated from Physical Therapy school 20 years ago there were 3 indisputable facts:

  • The brain stayed the same throughout your life.
  • The disks in your spine never healed.
  • Nerves could not regenerate.

Oh, what a difference 20 years can make.  Research has taught us:

  • The brain can make new pathways and even repair itself.
  • Disks in your spine DO heal!
  • Nerves often regenerate AND your body can form new nerves.

These 3 factors are critical in our understanding of how to treat sciatica in 2020.

You see, the sciatic nerve is the big nerve that travels down the back of your thigh before splitting just above your knee to cover your calf area.  Along the way there are many places the sciatic nerve can have pressure put on it or get stuck.

The sciatic nerve is like a long hose that starts in your low back and goes down into your toes.  The information that is sent through the nerve is like the water flowing through the hose.  If the hose gets “kinked” it becomes more difficult for the information to travel down along the hose.

This can result in pain, tight muscles, feelings of numbness or tingling, difficulty walking, difficulty sitting, or inability to sleep due to not being able to find a relieving position.

Sciatica pain brings many people to my door as they are looking for a way to be able to do what they want to do without this constant pain.  Some people travel for work and have become afraid to travel because they don’t know if they can even make it through the airport.  Some people are teachers who can’t stand as needed to teach their students.  I have worked with engineers who are unable to focus on their work due to pain with sitting.

As you can see the sciatic nerve can affect many different aspects of life and each person may have a different limitation placed on them.  How can this be if it is the same nerve that is being affected?

Well, the sciatic nerve travels a long path and different people get a “kink” in different areas of the hose.  That is why a complete discussion and evaluation of your symptoms is so very important.  There is not one way to treat the sciatic nerve that works for everyone.

However, there is one specific way that will work for you.  We just need to uncover the truth behind your sciatic nerve pain and understand the treatment path that will work for you.  Every BODY is different and everybody deserves to be treated in the best way that works for them.  Not for your neighbor, family member, or the way Dr. Google recommends.

If you are ready to start finding specific treatments that will work for you and your body, we are here to be your guides along that path.  PT4EB was designed to offer you the time, space, and one-on-one care to focus on your body and your goals.

Medical Bills

Please Call Me!

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The picture above is the bill from my husbands’ recent trip to the Emergency Room (ER).  He had a painful toe that started to get REALLY bad quickly.  He called the doctor to make an appointment and they said he hadn’t been in recently so he would have to wait 3 weeks.  When my husband explained how bad the pain was they said he should go to the ER.  So, he did.  Turns out it was an ingrown toenail that was getting infected.  He was treated very well and the toe was completely taken care of.  I am grateful for the level of care he was provided.

But, I am not grateful for the bill that came out of it!

The bill you see above is ONLY for walking into the ER.  We have also received a bill from the doctor.  And, of course, there was the co-pay.

I was very angry when I found out he had gone to the ER and NOT called me first.  If I couldn’t fix it I am sure I could have found a doctor who would have seen him that day.  Yes, it may have been expensive but I am sure it wouldn’t have cost as much as that trip into the ER.

(Side note – he was also offered a prescription for Codeine which is a narcotic but that is a rant for another day.)

Now, I am grateful that we have doctors who are skilled in medical emergencies who can literally pull people back from the brink of death.  I am grateful that they work the long hours in the ER and keep their skills honed for such an emergency.  We do need ER’s for those life threatening emergencies.  But, we need options for those really scary pain situations where we don’t know what’s going on.

One Saturday morning I had just finished eating breakfast when my phone started ringing.  It was one of my favorite patients and I immediately answered.

“What’s up?”

She was crying and had difficulty getting her story out to me.  She had been plugging in her vacuum to do her Saturday morning housework and her back exploded in pain.  She was stuck perched on a chair and afraid to move.  She didn’t know what to do.

Should she call 911?

Have her husband take her to the ER?

She was afraid.  This was really bad.

We spent about 30 minutes on the phone that morning.  I suspected that she had ruptured a disk (this later was confirmed).  Once we got her breathing back to normal I explained what I thought had happened.  I gave her a 72 hour treatment plan.  I explained what she was going to feel during those 72 hours.  I told her what she could and could not do.  And, I did tell her that if her symptoms did not proceed EXACTLY how I described that she should head directly to the ER.

72 hours later she was in my clinic and said “How did you know?  Everything went EXACTLY how you described!”

I know because I know how disks behave.  I know the signs and symptoms of a disk herniation.  I know the initial treatment techniques.

I also knew her body. Since she was a current patient (being treated for her neck) I had put my hands on her.  Based on my previous knowledge of her body and what she described to me I was pretty certain about what had happened.

That patient made a full recovery and is now living pain free in her back AND neck.

I offer this free phone consultation to any of my patients – current or previous.  If you suddenly find yourself in excruciating pain feel free to call me.  I am happy to talk with you and see if we can come up with a treatment plan over the phone.  If I am uncertain about what is going on and feel that you need to see a medical doctor, I will tell you that.

My goal is to help my patients make the best decisions for their health.  To help them avoid unnecessary surgeries, procedures, and medications.  So everybody can get back to moving pain free and living the life they choose to live.

If that means we need to spend 30 minutes on the phone discussing your pain, I will do it.  If you find yourself searching on YouTube for exercises to help alleviate your pain, please call me.  Put down the YouTube and pick up the phone.  Let’s find answers that will work for YOUR body.

Movement is Life

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You need to be able to bend over to work in your garden, pick up your grandchild, or do yoga.

You need to be able to squat to give a child a hug at their level, to do home renovation projects, or tie your shoelace on the side of the trail while you are out running.

You need to have foot flexibility to walk so you can go hiking with your friends, take the dog out for a potty walk, or keep up with the kids while they are riding their bikes.

You need to have shoulder motion to play basketball, do Pilates, or paint a wall in your house.

You need to have neck motion so you can check your blind spot while you are driving, lay on your stomach while you are sun bathing, or use your “third eye” to watch the children.

Movement is required for life.  Movement is required to be able to do the things we want to do every day.  They may not feel like amazing things but they are the things that you want to do.  The activities that make up your life.

Perhaps you are a stay at home mom who spends your day reaching down for little ones, picking up their toys, standing while preparing meals, or hauling all of their stuff everywhere.  Those are all movements and they are required for your life.

You may work in an office which requires you to drive to work where you are walking between meetings, standing for discussions, typing to communicate with your team.  Those are all movements and they are required for your life.

Retirement brings a whole new set of movements depending on what that looks like for you.  It may be renovating your forever home, outfitting a boat for sailing around the world, or loading up the fifth wheeler to travel the US.  Those are all movements and they are required for your life.

The tissues in our body need movement to get stronger, to become more flexible, and also to heal.  Muscles need heavy weight applied in order to grow and become stronger.  Bones need the muscles pulling on them to regenerate and avoid osteoporosis.  Spinal discs require rotation to bring in fresh nutrients to remain healthy.

Just as you need motion to live your life, your body needs motion to maintain your life.  If you stop moving then you stop living.  Your body has a harder time healing itself as it becomes more difficult to get the proper nutrition to the proper locations.

Movement is life.  Movement allows you to live the life you love.  Movement teaches your body to adapt thereby allowing you to do the things you love.

If you are not moving, you are not living your life to the fullest.  If you are not moving, you are not helping your body to heal itself.

When a muscle is tight it holds on to all the extra stuff that is meant to be pumped out on a regular basis.  This makes it harder to bring in fresh nutrition for the muscle to feed on.  As you challenge that muscle with your daily activities, it starts to hold on for dear life.  No amount of ice or heat will cause it to release.  It simply can’t because it has gotten into this holding pattern.

That muscle may be compressing a joint.  The joint needs movement in order for the cartilage to get its nutrition.  When cartilage becomes dry it leads to arthritis.  Arthritis leads to pain and decreased movement.

Or that muscle may be compressing a disc.  Spinal discs are like sponges that absorb nutrition when the pressure is released.  If they are constantly compressed they cannot receive the needed nutrition.  This causes degenerative disc disease.  It comes down to a lack of movement.

Movement is life.  Movement allows the tissues in our body to heal. Movement allows us to do all the things we value doing in life.

How is your movement?  How is your life?

If you are having difficulty with movement please reach out to us.  We are movement experts that love seeing you achieve the movement you need for your best life.

Where headaches are born

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Have you ever had a headache that started at the base of your skull and wrapped itself over your head finally lodging behind your eyeballs?  Those headaches really hurt.  And, it seems like they can last forever.

But where do they come from?  Headaches that start at the base of the skull actually start in the upper neck.  You see, there are two special vertebrae in your upper neck that are different from all the other vertebra.

First you have C1.  AKA: The Atlas because it holds up the entire world.  Well, it holds up your head which feels like the entire world.  C1 is special because it is shaped like a ring which allows it to move more than the other vertebra.

Next you have C2.  AKA: The Axis.  The entire world (or head) spins around C2.  That’s why it’s called the axis. C2 has a part that sticks up so that C1 can rotate around it.

This intricate design can get out of place, causing increased pain that translates into headaches.  Specifically, headaches that go up over the top of your head and lodged behind your eyeballs.

The good news is that there is help for these types of headaches.  You can finally stop having to deal with the pain and frustration of never knowing when the next headache is going to strike.

Now, you might be thinking to yourself, I don’t have neck pain.  I know.  These headaches usually do not have neck pain associated with them.  In fact, when we start working on the source of my problem my patients often tell me that they didn’t know there was pain there.

As we get C1 and C2 playing nice with the rest of the spine, the headaches can clear up for good.  No more need to take pain medication on a regular basis.  No more missing out on activities because of your neck pain.  No more wondering why you keep getting these headaches.

Are you ready to put an end to your headaches and get on with your life?  Please feel free to contact us and find out more about how we can help eliminate your headaches.

Chewing on another cause of headaches

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Have you ever had a headache that started in your jaw?  Maybe you have noticed that you wake up with a headache the morning after eating a big meal.  Perhaps you grind your teeth at night and wake up every morning with a headache.  Some people chew gum all day long, causing jaw and head pain.

Have you ever wondered how jaw pain is related to headaches?

First, let’s do a brief demonstration.  I want you to take your pinky fingers and place them inside your ears with your pinkies facing forward.  You don’t have to shove them all the way in just enough that the pads of your fingers are inside.  Next I want you to open and close your jaw.  Do you notice that when you close your jaw a bony part butts into your pinky finger?  That is the TMJ (TemperoMandibular Joint)!

Congratulate yourself on finding your TMJ!

Now, the part that moves is your jaw bone also known as the mandible.  This is the “mandibular” in temporomandibular.  The part that stays still is the temporal bone.  You put the two together and you have the temporomandibular joint.  See, they really didn’t get that fancy when they named this stuff.

The part that stays still is connected to your skull.  This is one way that TMJ pain can radiate into a headache.  Often this pain will be described as “temple pain”.  People will point to one or both sides of their temples and say “it always hurts here”.  This is a common sign of TMJ pain.

There is also a big muscle called the temporalis muscle.  It helps you to do things like close your jaw and chew your food.  This muscle can be found by placing your hands flat on the sides of your head.  Open and close your jaw and you will feel this muscle activating.

This muscle covers the side of your head and can cause pain to travel up the side of your head.  People with this type of pain often point along the sides of their faces, up to the top of their head.  They describe the pain as going behind their eyeballs.  People with this type of TMJ pain often say their pain increases after eating.

What if you have pain that starts in the back of your neck and comes up over your head to the front?  This type of pain often starts from the upper neck.

Is it still related to the TMJ?

Often, yes.  You see, there are many small muscles that cross from the TMJ to the upper neck.  They are coordinated to work together to allow for very small motions in your upper neck and jaw.  So when the jaw starts becoming a problem, the upper neck will feel the effects too.  And the upper neck will send it’s pain up the back of the head, over the top, and down into the front.

So there you have it.  The TMJ can cause headaches along the temples of up the side of the head.  Further, the TMJ communicates with the upper neck which tends to send it’s headaches up the back of the head, along the top, and down into the forehead.

Do you suffer regularly from the headaches types described above?  Are you ready to find the real reason behind your pain and get rid of it once and for all?  Please contact us and we will get you scheduled for an absolutely free 20 minute consultation to see if we are a good fit for each other.

What not to wear

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Recently, I had a memorial service to attend right after treating patients.  So I wore my dress and flats while I was treating.  That afternoon, while I was standing at the memorial service, I felt my back tighten up.  “Oh well, it will be fine” I though like every other person does.

That evening I tried to avoid my low back pain by walking around the house and getting some things done.  I went and ran an errand at the mall to get more steps in.  My thought was – “move more and my low back pain will settle down”.  What I did NOT do was take off those flats.

The next morning I rolled out of bed and tried to stand up straight.  As I hobbled on my aching feet, holding my back and trying to stand up straight, I was reminded that it was not fine.  There are consequences for improper footwear and low back pain is at the top of the list.

Here’s the thing – I usually wear very supportive shoes all the time.  Especially when I am going to be working with patients.  I thought that I could get away with one day of wearing improper footwear and not have it bother my back.  I thought that doing it wrong, just this once, would not cause increased low back pain.  I thought these shoes were good enough to get me through my day.

What I am learning is that since I have hit the big 4-0, my body has less tolerance for these deviations.  My body requires me to work out daily.  My body requires regular stretching to maintain its performance.  My body requires me to not sit for more than 60 minutes while I am working on the computer.  And my body requires me to wear supportive shoes.

I have many people ask me what brand of shoes they should wear for work.  That is a complicated question as everyone has a different foot structure.  Also, your daily work requirements are different than your neighbors.  But I would be happy to discuss what works for me.  Feel free to send me an E-mail at amy@physicaltherapyforeverybody.com

One key way to decrease your low back pain?  Wear supportive shoes!  I have an order for new ones on the way as we speak.

 

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So, you have a herniated disc

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There are few things in life as painful as a herniated disc.  But it’s not just the pain that is difficult to deal with – it’s also the fear.  What is going on in my spine and am I going to live?  That may sound extreme but herniated discs are extreme.  They can cause extreme fear, extreme panic, extreme frustration, and extreme pain.

The first time I herniated my disc was in college.  I was in Air Force ROTC (don’t ask, long story) and we were doing physical training.  All of a sudden, I felt a ball of glass explode in my lower right spine.  Okay, I know that a ball of glass didn’t explode in my spine but that is absolutely what it felt like.

Of course, training must go on so I got up and went for a 3 mile run.  Each step caused a mini explosion of the glass shards in my right spine.  And I was one of the lucky ones.  My pain never touched my sciatic nerve and went down into my leg.

For many people, the disc herniates and then it irritates the nerves in the area.  The nerves are located close to the spine and right next to the disc.  When the disc herniates, the material inside the disc leaves the fibers of the disc and is hanging out right next to the disc.  This can cause increased pressure on the nerve which responds by sending pain down into your leg.

What are your initial steps when you have a herniated disc?

  1.  Breathe – Easy for me to say when the glass shards aren’t flying around my spine, right?  I know.  But it’s really important to breathe slow and steady.  Holding your breath increases the pressure on your spine which is not what you want right now.  I now it is incredibly painful right now but I promise it’s going to get better.
  2. Grab an ice pack and your favorite chair, floor, or bed.  You need to rest for the first 24-48 hours.  Find a comfortable position (as comfortable as possible) and an ice pack.  You might want to grab some magazines or the remote control.  You are going to be there for a day or two.
  3. Small movements matter. During the first 24-48 hours it is important to keep the area moving in small PAIN FREE ways.  This can mean trying to stand up straight while you walk to and from the bathroom.  Rolling your shoulders to get some movement in your upper spine.  Sitting and rotating your spine from side to side.  Don’t go crazy right now but keep those small movements.
  4. Get help. Once you can walk to and from the bathroom pain free you are ready to get some help.  A Physical Therapist will help you get back to moving pain free.  Yes, you will get back to all those activities you loved doing before.

Yes, the pain will go away.

Yes, we can help you figure out your path on this journey of healing.  Please fill out this simple form and we can get you started healing and back to living life on your terms.

Hip pain – it’s not just for “old” people anymore!

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Let’s admit it – we expect pain as we age!

When we are young, our bodies seem to be able to get away with anything. We can run, jump, play, fall off our bikes, jump on a trampoline, and basically run ourselves ragged without any further complications. We go to bed and wake up feeling fine the next morning – and we run out to do it again! This is the joy of youth.

However, what happens when our young ones start complaining of a pain that will not go away? We take them to the doctor to start figuring out what is wrong and how we can help them.

In the case of hip pain, long term pain that does not go away with rest can often lead to a consultation with an orthopedic surgeon. The surgeon will often have X-rays or an MRI taken to assess how the bones inside the hip look. In the past 10 years, this has led to a new diagnoses or CAM or PINCER hip morphology. This means that there is a bony abnormality that is causing the hip to “pinch”, which is what brings about the pain in younger people as they tend to be more active. Of course, if the problem is a bone issue, surgery is what is recommended to fix it.

This increase in hip surgery in our younger population has become extremely concerning to myself and many other Physical Therapists. That is why there are now studies assessing hip strength, hip motion, and how the hip moves while also looking at the bony structure of both hip joints.

A recent study in the Journal of Orthopaedic and Sports Physical Therapy (JOSPT) was looking at that specific issue. The study assessed sub-elite football (soccer) players for pain, motion, strength, and motion analysis. They also took an X-ray to see what each hip actually looked like.

What they found was that the hip structure looked the same on X-ray between the painful hip and the pain free hip. Both of the hips had the same structure but only one hip had pain! Both the hips had the same bony changes that would be classified as needing surgery. However, sub-elite athletes were able to continue their sport and only have pain in one hip. Where they did see a difference between hips was in how the person was walking and the muscles they used while jumping.

This study shows that your hip pain may not be caused by how your bones look on X-ray. The pain may be caused by how your muscles are functioning while you walk, work, and play. Therefore, I strongly urge you to consider visiting a Physical Therapist to see if changing how you move through space can change your hip pain. It may help you to avoid surgery and the painful recovery that follows. Plus, you may be able to get back to your sport, your work, or your life more quickly!

Sub-elite Football Players with Hip-Related Groin Pain and Positive Flexion, Adduction, and Internal Rotation Test Exhibit Distinct Biomechanical Differences Compared with Asymptomatic Side. JOSPT: 48(7):584-593.

Chronic Pain Review

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Thank you for walking with me through this blog series on chronic pain. I hope you have found it useful in discerning the optimum path for your health and wellness. This post is a general review of what we have covered.

Chronic pain includes pain that has not resolved in a normal, timely manner. In general, it is pain that lasts longer than 3-6 months although we have seen that it is actually a change in the pain state. Chronic pain is mediated through changes in the peripheral and central nervous systems. This means that the tissue injury model of acute pain no longer applies. Acute pain is directly related to a trauma to the tissue and has a normal progression of resolution. This can be greatly aided by Physical Therapy to prevent it from coming back or to address any related issues. For instance, I have had patients who successfully treated an acute injury with a steroid injection only to have the pain come back 6-12 months later. That is often due to the fact that the comorbidities surrounding the initial injury were never addressed. However, chronic pain that has been sustained for a long period of time is no longer related to a specific tissue injury. That injury was the trigger that set into motion a change in the nervous system that needs to be addressed in a new way.

Chronic pain must be addressed at multiple levels simultaneously. I have had patients who “try” one form of therapy at a time to see what works and what doesn’t. Although I agree with this scientific approach for acute pain, it does not stand up to the current understanding of chronic pain. A scientific approach for chronic pain is to add one treatment at a time. I have begun working with other health care professionals in the area to maximize outcomes for patients. When I work with a chiropractor, I focus on the exercise portion of treatment to improve the patient’s ability to “hold” manipulations and decrease their need for adjustments. When I work with a massage therapist, I focus on joint mobilization to ensure proper tissue length and exercise for patients to maintain the benefits of massage. Although I feel medications in general are over prescribed, I help assist medical doctors in ascertaining the benefits of prescribed medication to the treatment plan being carried out in Physical Therapy.

Chronic pain truly takes a village that is focused together on the goals of each patient. Every body responds differently to an intervention and this needs to be constantly reassessed. This is why I opened my company in the first place. To give each patient one-on-one access to one provider so they can be followed through a successful treatment regimen. The input I receive from each patient directly influences the treatment they receive that day. Education is always emphasized and I encourage my patients to ask as many questions as they can.

If I can be part of your team, please feel free to contact me at (360) 367-0970 or amykonvalinpt@gmail.com.