Physical Therapy and One Very Special 8-Year Old Patient

Every profession has high-lights and low-lights, Physical Therapy is no different and often, the two extremes get blended together in many cases. I’ve asked one of our Physical Therapists, Aurora D. Smith, to tell you about one of those patients who makes us love what we do each day. Here is her story:

As a Physical Therapist, I see many patients that inspire me to continue to learn more about my profession and myself as an individual. I have treated a variety of medical diagnoses over the span of more than 10 years in this field. Recently, I have had the pleasure of getting to know an amazing young girl that has a beautiful spirit. She makes me think of butterflies… Her name is Paulina and she has gracefully dealt with issues that would be difficult for a “well adjusted” adult to handle well. Paulina is 8 years old.

On October 10, 2012, Paulina was diagnosed with a brain tumor. It took approximately one year from the time that her optometrist recommended an MRI because the doctor felt that there was an issue of vein diameter during a routine examination. They were smaller than normal. So it began… for Paulina, Rosa, her mother, and grandmother in tow (she is at every physical therapy appointment). Eventually it was confirmed. She had a tumor approximately the size of a golf ball sitting on the pituitary gland. By the end of October, she had a port and then underwent chemotherapy in November.

Rosa, Paulina’s mother, states that they are a close knit family and the entire extended group was brought together in this time of need on the eve that her parents received this life changing diagnosis. Her mother was understandably feeling “helpless” without a clue of what to do next. “I wanted to take it away from her,” she states when asked about her feelings that day. It has been a strain on the family unit in many ways, but her mother says, “we just kept God first and Paulina always had a good attitude and rarely complained.” I know that to be true – when we have sessions together, she will ask in a chipper voice: “what’s next!? How many?” and that alone puts a smile on my face. She truly is a treasure!

At present time, Paulina’s cancer is in remission. While there is uncertainty, this family and this very special little girl have decided to live life to the fullest. But who of us does not live uncertain of what the future holds? When I see her smile, it makes a lot of sense to me that we embrace the moments that we have and all of the golden nuggets along the way. She is an example of what makes my profession incredibly worthwhile.

Aurora D. Smith, PT, MS
Physical Therapist

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I am Aurora D. Smith, PT, MS originally from Columbia, SC. I am a graduate of Wake Forest University with a bachelor’s degree in Health and Exercise Science. At Wake Forest University, I had the opportunity to continue my dance studies while pursuing academic interests, and was subsequently was offered the opportunity to dance professionally with the Charleston Ballet Theatre upon graduation. I enjoyed a brief yet fulfilling career as a professional ballet dancer for 2 years prior to attending the Medical University of South Carolina to pursue a career in Physical Therapy.

Having a love of science and movement, it was the perfect fit for me! I graduated in 2002 with a Master’s in Rehabilitation Science and began my career working in an outpatient clinic located in Sumter. SC. Since that time, I have worked in a variety of settings and have extensive experience with ergonomics, work hardening, work conditioning and performing functional capacity evaluations. I have furthered my education with several manual therapy courses through the University of St. Augustine. In my spare time, I enjoy reading, visiting museums and travel to interesting and exotic places!

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Knee Pain Doesn’t Always Mean Surgery

As discussed in the video, chronic knee pain doesn’t always mean surgery. Our patient, Rosa Underwood’s* experience demonstrates how physical therapy helped resolve her chronic knee pain, even though she had been advised that surgery was her only option.

Patient Spotlight: Rosa Underwood*

The Issue: I had severe knee pain, constant arthritis pain in my right knee that was affecting my quality of life. The limited mobility affected my ability to shop, play with my grandchildren, garden, enjoy myself in general. I was fearful of being stigmatized professionally because of my limping and the possibility of not working due to needing knee surgery. I was miserable.

How was your physical therapy treatment? The physical therapy felt immediately empowering! I felt that I had an active role in getting better and the better I understood how muscles functioned the more I realized I was not helpless, that a lot of my pain was due to extra stress being put on my knee because of how I moved at many joints and that my knee was not going to crack in half.

The moment things changed: Chris found that I was compensating by clenching my jaw, he treated that and my knee pain decreased significantly. I thought, “What just happened?” My knee pain was decreased significantly, and I was able to garden that weekend kneeling with very little pain, I have not been able to do that in months.

The difference over the past few weeks is incredible… I am walking longer, my attitude is hopeful, I don’t describe my pain as severe…I play with my grandchildren and enjoy myself again. I have not worn a knee brace or wrapped my knee since. My doctor is pleased with my progress and so am I! The ATR team is truly outstanding!

The Therapist’s take: Rosa had significant movement restrictions in her knee, ankle, and hip which piled on top an existing arthritic condition. Her Gluteal muscles were not firing much, and her knee was not able to get straight. It is a common compensation pattern, inhibited gluts put more pressure on the muscles that surround the knee. We tested her glut, it was strong, but she was clenching her jaw. Retesting with a relaxed jaw decreased the glut strength drastically. Palpation revealed increased tenderness at her right masseter, and quick, patient-directed release resulted in the gluteal muscles firing again so they tested strong with a relaxed jaw. With the gluts back on line, it took pressure off of the knee and the patient’s squat test improved dramatically. This is a great example of how the pain is rarely problem, it is the symptom of dysfunction. This is why we examine and treat function, treating structure alone without addressing function rarely leads to long term success.

*Use of quotations and names are with permission of patient

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.

Patient’s Report 35% Pain Relief with New Laser Treatment in Charlotte Physical Therapy Clinic

In May of 2009 Ayrsley Town Rehabilitation debuted the ML830 Laser in their clinic, over the last five months, patient have reported, on average of a 35% reduction in pain with the laser and the implementation of preferred provider protocols.

PRLog (Press Release) – Sep. 30, 2009 – In May, Ayrsley Town Rehabilitation (ATR), a physical therapy clinic in southwest Charlotte, introduced the ML 830 Laser in their clinic. According to the results of the company’s internal study, patients treated with the ML830 Laser have reported a 35% reduction of pain after a 10 minute treatment.  “It has gotten to the point, where I am no longer surprised by the results,” said Christopher Stulginsky, PT who is not only the managing partner of ATR but also the regions only certified premier provider according to the distributor’s website.  “We have had success with people of all ages and with multiple body sites and conditions. Most of our success has been with carpal tunnel, arthritis pain, post surgical rehab, with people who have been in car accidents, and those who have back pain.” Stulginsky has also had success with adolescent sports injuries as well. “They always seem to like the idea of being treated with something that Olympic and NFL athletes use.”

For more information about this and other treatment programs at Ayrsley Town Rehabilitation please contact them at 980.939.1580.

Additionally, the 830 Laser can be used over orthopedic hardware, pacemakers and over adolescent growth plates without side effect, which is not necessarily the case with traditional ultrasound and electric stimulation.  “The laser, which is the first on the market approved by the FDA, uses light to assist the local lymphatic response, it does not use heat or electricity, which can be contraindicated in certain scenarios,” said Stulginsky, who continued, “people need to know this information, they need to know what they have available to them. It is the only way to navigate healthcare today, to be armed with knowledge and explore their options.”

Many patients have been successfully treated at ATR since they opened their doors last October. Amelia is one of them and certainly agrees with Stulginsky’s assessment. She is a grandmother of one and recently had surgery for a torn rotator cuff, “I was going to have to wait for a while before I could get my surgery. I thought there was no point in going physical therapy, and that I couldn’t without a referral.  One day I was just in so much pain, a client recommended Chris to me, and I realized he could see me without a referral; he started working with me and helped the healthy muscles stay strong and help manage my pain with the laser.  I had not slept well it quite some time, but after one laser treatment I slept through the night. I am way ahead of schedule after my operation; I attribute that to Chris, seeing him before surgery and the use of the laser,” said Amelia.

Keith is a full time barber and  works at a local restaurant on the weekend, he has gone to ATR for treatment. “All day I am cutting hair, I can feel it in my forearm and wrist. I need for my hands to work. That laser thing is amazing. I feel relief within the first few minutes.”  Keith was also in a car accident many years ago, and after a busy weekend at the restaurant, he feels his old injury.  “Just the other day, after working on the weekend, I could barely stand up to cut hair, Chris was able to get me in and help lower my pain so that I could get through the day”

Annie is a chronic pain patient with severe osteoarthritis, multiple bulging discs, radiculopathy, entrapped nerves at L4 and L5 with trochanteric bursitis and peripheral neuropathy. She has tried many different treatments including medication, acupuncture and steroid injections.  “After my first treatment I cried in the bathroom the next morning because for the first time in many years I was not experiencing that horrible grinding pain.”

For more information about this and other treatment programs at Ayrsley Town Rehabilitation please contact them at 989.939. 1580.

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Ayrsley Town Rehabilitation (ATR) was opened by Christopher Stulginsky and Alex Gomez in October of 2008 in The Town of Ayrsley, a New Forum community in southwest Charlotte.

Christopher Stulginsky, PT is the managing partner and treating physical therapist at ATR. Christopher is a 2003 graduate of the masters in physical therapy program at The Rangos School of Health Sciences at Duquesne University in Pittsburgh, PA. After graduation he spent 4 years as a travel physical therapist working throughout the United States. His travel background afforded him the opportunity to learn various techniques and about different technologies that were being used around the country. Additionally, Christopher has worked in multiple settings and multiple institutions including: The Johns Hopkins Hospital in Baltimore, MD; Friday Harbor Physical Therapy in Friday Harbor, WA; Mercy Hospital, West Suburban Sports and Rehab Clinic and Westlake Hospital’s Outpatient Back and Spine clinic in Chicago, IL.

Charlotte Clinic Offers Affordable Payment Options for Treatment as Deductibles Reset in New Year

With the new year, comes a reset in insurance deductibles, with high cost deductibles, many avoid treatment, which makes situations worse. This Charlotte clinic offers options to patients for manage the costs of their health care needs.

 PRLog (Press Release) – Jan. 27, 2010 – As the calendar has flipped to 2010, individuals who have medical insurance once again encounter and, are understandably concerned about their high medical insurance deductibles.  Insurance deductibles vary from insurance plan to insurance plan and in most cases they are a number negotiated between insurance company and their employer. The deductible is the amount that the employee is responsible for before the insurance coverage begins.

With some plans the deductable is a total medical deductable, with some there is a total family deductable, and with other plans there is a separate deductable for different medical services.  It is understandable that after a busy and usually expensive holiday season, individuals put off medical treatment because of the deductable of their plan.

Ayrsley Town Rehabilitation feels that high cost deductibles should not interfere with those who want and need pain relief.  “There is no reason that just because the calendar has changed that treatment should stop or be avoided. Pain does not stop after the new year, why should treatment?” says Chris Stulginsky, PT who is the managing partner of Ayrsley Town Rehabilitation in the Steele Creek area of Charlotte, NC.

In order to help patients navigate a climate with high insurance deductibles or a situation where there is no insurance at all , Ayrsley Town Rehabilitation offers discounted private pay rates as well as discounted multiple treatment rates all of which can be applied to the patient’s deductable. “We have plans in place to make things affordable for patients, most people are hesitant to even contact a medical facility to ask about payment possibilities, we encourage everyone to call and ask, we can help find what  option is best for each individual,” said Stulginsky.

“It is something for both patients and providers to consider as we continue to give our patients the best total care that we can.”

For further details on this or many other affordable pain relief programs at Ayrsley Town Rehabilitation please contact Chris Stulginsky, PT at 980.939.1580.
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Christopher Stulginsky, PT is a 2003 graduate of the physical therapy program at the Rangos School of health Sciences at Duquesne University in Pittsburgh, PA. He is a certified member of the Prehab Network and a Certified Provider in use of the ML 830 Laser, the first cold laser approved by the FDA for pain. He has worked at The Johns Hopkins Hospital in Baltimore, MD and in various Sports Medicine clinics around the country. Currently, he is the managing partner or Ayrsley Town Rehabilitation, a physical therapy clinic in Charlotte, NC.

Local Clinic Introduces New Aquatic Program

Ayrsley Town Rehabilitation offers first aquatic therapy pain relief and therapy program in the Steele Creek section of Charlotte, NC.

PRLog (Press Release) – Jun. 23, 2010 – Charlotte, NC:

(Steele Creek) – On June 1, 2010, Ayrsley Town Rehabilitation started offering aquatic physical therapy to the healthcare consumers of southwest Charlotte.

“Aquatic therapy is a great way to decrease pain,” states Chris Stulginsky, PT of Ayrsley Town Rehabilitation.

“It is the closest thing we can get to being weightless, it unweights the joints and allows people to do more and work on true solutions for their pain relief. Because they are able to move more easily, clients strengthen their muscles to take pressure off of the joints over time.”

Myrtle Williams, a client who participates in the aquatic program agrees.  “I can do more in the pool then I can on the land, it helps me move around better without the pain. I can exercise without soreness the next day.”

Stulginsky continues on, “The aquatic program assists us in providing comprehensive pain solutions. It is an added plus to our already established Back Pain, Fibromyalgia, Orthopaedic Rehab and Prehab for Pregnancy Programs. Though it varies from plan to plan, in most cases the therapy is covered by health insurance, including Medicare.”

Stulginsky adds, “The aquatic program is another component to assist us in addressing the pain and rehabilitation needs of the people of south Charlotte and the Lake Wylie corridor.”

Summer Foot Pain is Preventable

As the weather gets nicer many change their footwear and increase activity. This often results in foot and ankle pain. With simple preventative exercises, individuals can reduce chances of experiencing this pain & get treatment if it does get worse.

PRLog (Press Release) – Apr. 24, 2012 – With the days getting longer and the weather getting warmer, summer is right around the corner. As a result, many will be spending more time outside exercising, doing yard work and enjoying,  “shorts and flip flop weather”.

“Who doesn’t love this time of year?” says Chris Stulginsky, physical therapist and owner of Ayrsley Town Rehabilitation.  “It’s a great time to get outside with your family and friends to enjoy the weather; however foot and ankle pain often follows.”

There are many ways to work to prevent these types of injuries with very little effort. “Alternating footwear, and performing stretches, like a standing gastrocnemius stretch and standing soleus stretch, are very important.”

Many of these problems are preventable, but despite one’s best effort, they still may start developing pain in the foot and ankle.

“When the pain is interfering with your life, it is very important that these types of maneuvers are performed correctly. They may seem easy on the paper your doctor has given you or on the internet; however, I would say, almost everyone we see needs some level of correction,” stated Stulginsky.

The body’s desire to do things efficiently is a positive in many ways, but in a case where pain has set in it often results in compensation and improper technique. “Many times we find our patients are not performing their exercises correctly and are reinforcing the very issues that are cause a great deal of their pain. Additionally, dysfunction in the hip and knee often change the way the foot hits the ground and also contributes to the pain,” says Stulginsky.

Many disorders, such as plantar fasciitis, tarsal tunnel, tendonitis and heel pain, all present very similarly and are typically treated with footwear modification and potentially with injections. One commonly over-looked component is the nerve in that area, which needs to be treated with a specific and targeted treatment plan.

The nerve is one component that can affect all of these areas. It commonly presents symptoms in one area but and is radiating from problems in other areas.  “Just like muscles and tendons, nerves get tight as well,” says Jackson Bellis, DPT who is the newest addition to ATR’s clinical team. “We have found that using nerve mobilizations with our patients is gentle, effective and can have fast results.”

Recently, Roger Goforth presented to the ATR team with a diagnosis of tarsal tunnel. “I was in excruciating pain. Things I took for granted all my life such as showering, walking barefoot and getting dressed were difficult.”

The tarsal tunnel runs along the inside of the ankle and provides sensation to the entire bottom surface of the foot. This area typically gets squeezed between the tissue behind the ankle bone on the inside of the leg.

“With the use of gentle neural mobilizations and a technique we call a tarsal trace we have significantly diminished Mr. Goforth’s pain,” says Bellis.

When performed by a skilled clinician, neural mobilizations are effective because both the nerve and the surrounding tissue get relief from issues causing inflammation.  The neural tissue becomes hypersensitive, and as a result, it is harder for the nervous system to perform and recover.

Goforth is a believer. “After 3 treatments I was able to walk and stand barefoot with very little pain for the first time in a year. The results have been nothing short of amazing.”