“Could my child have a concussion?”

It’s alarming how many times I’ve been asked this question. Concussions in kids are not always as apparent as they are in adults. Did you know a child can suffer a concussion without ever having a blow to the head?

 

If you have any questions about concussions or questions about physical therapy, give me a call.

Ayrsley Town Rehabilitation (ATR) provides performance-enhancing, preventative and rehabilitative programs and services that maximize functionality and promote well-being in patients of all ages and abilities.

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Independence From Pain Through Physical Therapy

Physical therapy can be your answer to independence from joint and muscular pain. Chris Stulginsky from Ayrsley Town Rehab explains how treating the underlying cause of pain is the only way to be truly pain free. No more just treating the symptom, solve the problem that’s causing the pain!
Ayrsley Town Rehabilitation (ATR) provides performance-enhancing, preventative and rehabilitative programs and services that maximize functionality and promote well-being in patients of all ages and abilities.

Visit us online to learn more at: http://ayrsleyrehab.com/

Generic “One Size Fits All” Home Exercise Programs Can Cause More Harm than Good

Often after a visit to a medical office for pain, patients are provided with a list of exercises, a pamphlet or brochure or worse, they find a “one size fits all” exercise “cure” on the internet. Many feel these are often sufficient replacements for a skilled physical therapy evaluation and subsequent treatment, with the notion that strengthening or exercising the painful area will improve the pain in function.

The leading experts in the therapy, movement and performance field will tell you that this assumption is incorrect.

Physical therapists, with a foundation of anatomical structure, neurological pathways, and motor control are the recognized functional experts the in healthcare industry. With the proper education and approach they can easily explain to you not only what is hurting, but why it is hurting. With the proper approach, they will look at the entire kinetic chain. Many times, the pain is not the problem; it is a symptom of movement dysfunction elsewhere, putting more stress on the area that is experiencing pain. Direct, “one size fits all” programs for a painful area rarely lead to a decrease in pain and often can make symptoms worse and lead to an unsatisfied patient.

The Problem in Theory:

All too often patients receive a home exercise program with the “one size fits all” approach with the painful area being the sole focus. These programs often disregard an injury with individual characteristics resulting in improper recovery, decreasing their ability to return to prior level of function and often result in reoccurrence. The number one cause of re-injury is a result of insufficient or improper rehabilitation. Generic home exercise programs are not sufficient nor are they proper for comprehensive rehabilitation for an individual with pain.

Here are 5 reasons why a stand-alone Home Exercise Program can be ineffective.

1. A home exercise program is not self-care program; it is a component of one. Many incorrectly assume the terms are one in the same. Often important components such as patient education workplace, and home modification to name a few, are not included, to the detriment of the patient. Just as a grade school homework assignment reinforces what is taught in class:

Home Exercise Programs are NOT synonymous with physical therapy, they are an adjunct.

2. The body is designed to compensate and often does without the knowledge of the person performing the exercise. With a “one size fits all” home exercise program these issues often go unaddressed and result in compensation, decreasing the effectiveness of the exercise. Additionally, improperly performing home programs reinforce incorrect motor patterns resulting in additional stress on structures that are not designed to handle the force. The  work of Richard A Schmidt, PhD. tell us that tells us that it takes 300 repetitions to create a bad habit, and 3000 correct repetitions to undo it. That is the human condition.  Exercises given without compensation safeguards can quickly have detrimental results to one’s movement patterns and pain.

3. Generic programs are limited to a specific painful area and ignore other affected areas of the body. The “one size fits all” exercise program usually only addresses the site of pain with the assumption that the pain is the problem. In most cases the pain is the symptom of movement dysfunction elsewhere. The entirety of the kinetic chain, which is the interaction of muscle, nerves and joint to create movement, is often ignored. When this occurs, people with foot pain, for example, develop knee, back or hip pain because their functional requirements of other areas have increased, but have gone unaddressed. In this same light, if a non-painful dysfunction at the thoracic spine creates issues at the shoulder blade and in turn shoulder pain, shoulder exercises are not going to address the problem.

4. There is often no progression, increasing the chances of re- injury. Without progression, the structures are improperly prepared for the functional demands of everyday life and the end result is some level of pain, be it reoccurring or new.

5. It is an incorrect assumption that if an individual has a program that addressed the structures involved in a specific movement that motor patterns will take care of themselves. Generic orthopedic programs that do not address movement patterns may improve isolated strength, but will not improve the dysfunction that caused the injury.

The Problem in Practice:

Just this week we had a patient who had been in chronic pain for a while. She performed exercises that was a “one size fits all” and her pain had gotten worse. The patient had shoulder pain, so she was provided the “shoulder exercise program”.  The patient’s shoulder was painful, but as a result of rounded shoulders and weak shoulder blade stabilizers, not because of decreased shoulder strength. Yet, repeated the very mechanical issue that caused the pain. This program did not address the tight chest muscles and weak scapular stabilizers which were the primary causes of the painful shoulder.

All too often this occurs, resulting in an unsatisfied patient who remains in pain. There are many limitations to performing a general program. To start, the proprioceptive mechanism, which is what tells am individual where their body is in space, is not well tuned, making it nearly impossible for an individual to self-correct. Good pure movement is often altered in the non-painful population, let alone a painful one. Many won’t correct a problem unless they know there is one in the first place, if they don’t know there is a problem, the correction won’t happen.

The “one size fits all” approach is counterintuitive to all other aspects of medicine, and yet it seems to be the “go to” approach for orthopedic pain. Two people with similar health problems are rarely going to be prescribed the same prescription medicine, with regard to frequency and dosage. People are different; so it stands to reason that many factors should be taken into account. Returning to the scenario above, shoulders are not created equally, and yet, the “one size fits all” approach was the “cure.”

If you have received or given an exercise program, you should ask yourself these questions:

Does it include self-treatment education on proper use of modalities, home and workplace modification?
Does it have safeguards against compensation to protect functional movement from becoming dysfunctional?
Does it focus on multiple areas vs .one?
Does it include motor pattern correction?
Is it being performed correctly? How do I know?
Is it too easy? Is it too difficult? How do I know?
If you do not know the answer to one or more of these questions, a physical therapist will be able to answer them for you or your patient.

ATR Thoracic Spine Stretch for Golfers

Chris Stulginsky of Ayrsley Town Rehab in Charlotte, NC demonstrates a quick & effective stretch for the thoracic (middle) spine to improve mobility for golfers.

Chris is certified by Titleist Performance Institute and can help you take your golf game to the next level!

Ayrsley Town Rehabilitation (ATR) provides performance-enhancing, preventative and rehabilitative programs and services that maximize functionality and promote well-being in patients of all ages and abilities.

http://ayrsleyrehab.com/

Want to improve your golf swing? See a physical therapist!

With the days getting longer many take it as an opportunity to hit a bucket of golf balls after work, or to try to get out early one day to “squeeze in 9 or 18”.

As many golfers start playing more frequently, it is almost inevitable that they become frustrated with flaws in their game. Often one hears golfers saying, “I blocked the ball there” or “I was quick with my hands on that one”. Typically the frustrated reaction to a poor shot or round is, “I need some more time on the range”, “I need to get with my pro”, or “I need to look at a driver”. While practicing more, modifying your equipment and working with your pro can help, if your body won’t move enough to make  the adjustment or correction, other venues will probably continue to result in frustration. Additionally, this could result in injury or lead to a dysfunctional learned motor pattern that could have detrimental effects to one’s enjoyment of the game.

Your body is, after all, the only piece of equipment you never stop using on the golf course.

While the golfer may see a block, hook, early extension or reverse spine, a physical therapist certified by the Titleist Performance Institute (TPI) sees lead hip tightness, a lack of trail side shoulder stability or decreased thoracic spine mobility when they watch a swing.

Understanding how these dysfunctional motor patterns impact how golfer uses and performs with his or her golf club is imperative for improvement. Many people cannot perform basic functional movements, let alone produce a consistent golf swing on a foundation of a dysfunctional movement. Adding a physical therapist to your golf support team can help you assess and change the limitations of the body, making the lesson with your pro, or time on the range with your new wedge more efficient and beneficial.

With Adam Scott’s recent victory at The Masters, golf fitness has been on the national stage. Scott’s frequent appearances on the The Golf Channel’s, “Golf Fitness Academy presented by TPI” and his work with his Titleist Performance Institute team have helped him take his game to the next level.

Locally, Charlotte Country Club has started a “TPI Prep School”.  Director of Instruction, Rich Albright and Director of Custom Fitting, Allen Avakian have teamed up with TPI certified physical therapist, Chris Stulginsky in offering “Prep School” to the members.

“We wanted to connect body mechanics with the golf swing.  Each player’s body reacts differently to the body’s movement requirements for an effective golf swing.  When the body limits the movements within the golf swing, it is hard to hit the golf ball consistently”, said Rich Albright, Director of Instruction. “We saw each student gain efficiency in their ability to swing the golf club.

Both professionals also saw the personal benefits as it translates to their golf game as well,  Avakian pointed out, “personally, the program has helped to increase range of motion as well as ease of motion. My sense is that this increased mobility along with better stability will help in maintaining rhythm and tempo.” Albright added that, “[the program], had a direct impact on my back and my ability to rotate better during the swing.”

So many think that the program or physical therapy itself can be working with resistance band or stretching to improve flexibility. In fact they work a great deal on stability so one can build increase potential energy when they swing or on the motor control of functional opposites to make for a more consistent swing. With the properly trained eye, one can easily expand their program, and simultaneously make it more efficient and effective.

The program at Charlotte Country club has been a success leading the club to add another session says Avakian, “the feedback is leading us to start another session in the month of May.”

How to: Simple Home Screen for Nerve Tension

Often, when people have back pain, they also have tingling and numbness down their legs. This could be coming from the back but it could also be amplified if you have nerve tension which is the tightness of your nerves down the legs. You can do a simple at home screening as shown above to determine if you have nerve tension.  If someone does indeed have nerve tension, this can only be helped by proper physical therapy and corrective exercise.