Archive for the ‘IMS’ Category

ARE YOU OUT?

How many times I’ve heard a client say: “I have one leg shorter than the other,” I can’t count.

Or there’s, “my hips are out and the therapist tugs on my leg to fix it.”

What exactly are us therapists doing when we pull your leg? What we’re up to is actually a form of manipulation that’s supposed to target the sacroiliac joint (SIJ), where the tailbone (sacrum) meets the pelvis, wing-like bones (innominants). 

I will admit this was a technique I used frequently to help correct my client’s pelvis misalignments. 

I’ve even had it done to my own. The trouble with this is when clients tell me they need to keep having it done, because it keeps going out. 

WHY ARE YOU OUT? 

The pelvis (sacrum or tailbone and the pelvic bones or innominants) has two forms of stability. 

1. STATIC STABILITY, which comes from the shape of the bones and how snugly they fit together as well as the tough ligaments like duct tape holding them firmly in place.

2. DYNAMIC STABILITY, which comes from the muscles and how they pull on the pelvic bones. 

WHAT MUSCLES?

Muscles can have an effect on your pelvis including the muscles at the front of the thigh (quadriceps, tensor fascia lata), the inner thigh muscles, the back of the thigh muscles (hamstrings), the buttock or gluteal muscles, the back muscles, and even some of the shoulder muscles (the lattissimus dorsi, which is a huge muscle coming from the front of the shoulder down into the lower back). 

CHECKING THE PELVIS

I check the alignment of the pelvis on most of my clients who come in for an assessment. 

I had one client who came in for a calf strain as she was training for a half-marathon.  After releasing the calf tightness and following the line of muscle tension up the hamstring to the pelvis, I soon discovered she had significant muscle tightness and stiffness in the left upper thoracic spine (mid-back between the shoulder blades). 

The stiffness was one-sided, so I asked if she had ever been in a car accident (one where because of the shoulder strap crossing over one shoulder only, there may have been a twisting trauma). 

In fact, she had…20 years ago. 

IS THE PELVIS STUCK OR IS IT JUST MUSCLE?

One of the things I learnt from physiotherapist Dianne Lee http://dianelee.ca/ (be sure to check her website for more educational information) is how to better determine what muscles might be contributing to the problem at the pelvis.

Why are you out? This is the question I ask myself. So, I feel how the joint itself is sliding and gliding. Sometimes I feel a stiffness like I am pushing against a brick wall (the joint itself is stuck). Other times (which is actually most of the time) I feel a resistance that resembles trying to push against a mattress spring. This to me is indicative of a tense muscle causing the joint to lose its mobility. In any case, the treatment technique is different. 

With the stiff joint, I will manipulate it (which might be tugging on your leg). With restriction from muscles, I use Intramuscular Stimulation (IMS) http://istop.org/.

COMMON TRAINING ERRORS

One of the biggest training mistakes I see is over-working of the quadriceps (front thigh muscles).  People run, bike, play hockey, then go to the gym and blast the quadriceps more with squats, squat jumps and lunges. 

Tension in the quadriceps builds and has the tendency to pull the pelvis bone (wing innominant) forwards. This then puts strain on the back opposite (antagonistic) muscles, the hamstrings, which can then contribute to a hamstring strain or pull. 

You can see what I’m getting at. It’s all about muscle balance.

DO I NEED STABILITY EXERCISES?

In my honest opinion, everyone can benefit from exercises that focus on stability around the pelvis. It connects the lower half to the upper half. 

There are people who have injured the strong ligaments (after childbirth is one example) that support the pelvis and need to work on regaining the muscle stability. 

There are specific tests we can do to determine if you will benefit from these exercises and if you need extra support (core shorts are what I use).  

When retraining the pelvic muscles, PT Dianne Lee distinguishes the inner core from the outer core. 

Hold tight for more on this in my next blog entry.

So for now, if you are someone who continually needs to have his/her leg tugged on to re-align the pelvis, it’s time to look at whether the SIJ is too loose and needing extra stability or whether it’s a matter of muscle imbalances around the hip and pelvis (or up at the shoulder) that need to be released and stretched. 

It’s time to look for the why (see my earlier blog on our “bullies”) rather than treating the symptom (victim).

IF YOU’RE MOTIVATED:

Read more from physiotherapist Dianne Lee: http://dianelee.ca/

Find out more about IMS: www.istop.org/

Read Wendy’s earlier blog on discovering our bullies: http://bit.ly/qjUCY0

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.

As a physiotherapist who has always been very manual therapy oriented, the discovery of IMS (Intramuscular Stimulation) changed my practice the most. I was once told that I could get 90 per cent of people feeling better just with my skills I learnt in school, and therapeutic use of myself. But for the other 10 per cent, I would need more skill. My last preceptor (the person who guided me on my clinical student placements), told me to get my hands on as many people as possible. I know this sounds highly inappropriate but, conations aside, this was great advice.

NATURAL HEALING

When we injure ourselves, there is a natural healing process. What this means is that the damaged tissue will repair itself given enough time. Why then would anyone need to come to see a physiotherapist? What people are not always aware of is it’s not always just the tissue damage that’s the problem. 

SCAR TISSUE

There is the formation of scar tissue that if not mobilized (through movement) as it heals will get tight and scarred down. The massage therapist who was working on me the other day mentioned how tight my left buttock was. I related this to my piriformis syndrome from prior nerve irritation in the lower back. She told me it felt more like scar tissue, like someone might have after a fall.  Immediately I thought back to Grade 5 when I was trying to hang upside down with my feet in the rings, only to discover that my feet were too small as I toppled to the ground landing half on the mat and half off the mat. How could I forget the pain in my buttock at the time?  Of course being a kid, I just went on with life. 

I know the benefit of deep tissue release work to areas where there is scar tissue damage. My partially dislocated shoulder continues to improve with massage therapy to it.  Of course I am doing the work from my end as well, with stretching and strengthening work. 

MUSCLE REACTIVITY

The other thing that seems to happen with an injury is muscle tissues go into a protective shortening (most people would consider this a spasm).This protective response is controlled by our nervous system. What these bands of tissue feel like to me are ropy knots in the muscle that are tender and/or painful to light massage and do not go away fully (and may get worse) with deeper scar tissue massage work. 

THE ROARING MUSCLE

When the engine of your car is revving too high, you punch the gas and the revolutions drop.  When your computer is malfunctioning, you turn it off and turn it back on.  This is what we call rebooting. When the engine of your muscles are revving too high is when I use IMS to reboot the muscle. An acupuncture needle (more like a filament) is inserted into the muscle, and the muscle that is reactive will jump or twitch. After IMS, muscles feel very fatigued and may be sore like you have done a workout.  What I tell people is it’s like we have shut down the muscle and are rebooting it. 

REBOOT TIME

 If a client goes out and performs the aggravating activity right away while the muscle is rebooting (generally no less than 48 hours but it can take up to a week), it will become over active again. What I find is it’s not quite as bad the next time though. Nobody really wants to stop the activity they are doing (unless of course it is work or vacuuming) but sometimes if you don’t stop, treatment really just feels like maintenance, without any full resolution.  I am guilty of this, but have been better lately. 

EFFECTIVENESS

IMS is not for everyone, and there are still times that a joint needs to be mobilized (wiggled free) or manipulated, scar tissue needs to be released, the whole system needs to be relaxed.  What I have found is I perform IMS on approximately 90 per cent of my clients, and would estimate it’s effective on 90 per cent of those clients. I continue to utilized my other manual therapy skills, educate the clients, and provide exercise instruction.  I also refer to other health care practitioners. 

REBOOT YOUR BOOTIE

If you’re suffering with a pain that just won’t go away, perhaps a “sciatic” pain in the buttock or down the leg, neck and upper back tension with or without headaches, a rotator cuff shoulder impingement, achy knee joints, hip pain, consider IMS to help reboot your tight muscles, taking compression stress off the joints, or simply allowing the joints to move as they are supposed to because the muscle imbalance is no longer present.

IF YOU’RE MOTIVATED:

Make sure to check out this link: http://www.istop.org/

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.

The hip joint is a ball and socket joint like the shoulder. It allows movement in multiple directions.  But because it is a weight bearing joint it requires more stability than the shoulder. The socket part of the joint is deeper. It is surrounded by a rim of tough, thick ligamentous tissue that adds support. It also has several very strong ligaments (attaching from one bone to another). 

DID YOU KNOW  

Not all pain in the butt is coming from the butt? 

Piriformis syndrome (http://en.wikipedia.org/wiki/Piriformis_syndrome is a common diagnosis for people with pain in the buttock (gluteal) area.  A tight piriformis muscle is often looked at as the cause of sciatic pain (pain, tingling, and/or numbness down the back of the leg). This is because the sciatic nerve (which is comprised of the L5, S1, S2 nerves from the back) travels closely to the piriformis muscle (actually through it in 10 per cent of the population according to a study that I read when I was in school). 

THE QUADRICEPS CULPRIT  

One of the clinical findings that I have discovered since using IMS to release tight faciliated (overactive) muscles is the significance of the quadriceps muscles (front of the thighs) in contributing to hip pain and buttock pain.  The quadriceps is a group of four muscles at the front of the thigh.  The Rectus Femoris attaches to the front of the pelvic bone and also has an attachment to the hip bone.  My thinking is that when the quadriceps are overly tight and tense it can pull the pelvis forwards which then ends up putting tension on the other muscles attaching to the pelvis.  Also it may pull the ball of the hip forwards, creating an impingement (pinching) at the front of the hip.  

ARE YOU TIGHT? 

Stop reading and lie down on the floor. Okay finish reading this part first so you know what to do and then lie down to do this.  Bring your knee up towards your chest and then inwards towards your opposite shoulder (right knee to left shoulder).  Where do you feel the tightness?  Is it in the butt or in the groin?  If it is in the groin, that would mean there is an impingement happening.  

So you don’t have any pain but you do get the groin pinching with the above test. Why do anything about it now if it does not hurt?  If it is not broke don’t fix it right?  

WRONG!!!  

ARTHRITIS or just muscle tightness?  

“Artho” means joint and “itis” means inflammation.  If you watched some of the videos, this is where I have you put your hands together and press them against each other and rub.  Then I ask “What do you feel?”  Friction and heat. If you kept doing it then they would get red and sore because they would be getting inflammed from the rubbing.  

When a joint is not resting in the proper position or not moving properly because of muscle imbalances, it may cause abnormal rubbing of the two joint surfaces, which would contribute to rubbing, wear and tear and inflammation.  It might not start to hurt until it gets to the inflamed stage.  

ARE YOU MOTIVATED? 

People are motivated to get things looked at when there is pain. They are not motivated to seek preventative treatment.  But if you are reading this I would recommend that you consider having a Preventative Assessment done to look at where your muscle imbalances lie.  Get someone to look at those areas where you are just having a bit of discomfort when you do certain activities.   

If you want someone who does IMS then go to www.istop.org to find a practitioner in your area.  You can also look for physiotherapists who have there advanced manual therapy (FCAMT), although there are good practioners out there who have not done this training.  Ask around. 

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter  sites by hitting the links there. To book an appointment at Start Line, call the clinic at 250-746-7463.

Once upon a time there was a young active teenager who was having problems with her knees.  She liked to bike, play basketball, play soccer and hockey. She went to the doctor who diagnosed her with “chondromalaciapatella.”  http://www.mayoclinic.com/health/chondromalacia-patella/DS00777

The doctor told her not to bike or do jumping exercises and started her on a knee strengthening program (“VMO” or “Vastus Medialis Oblique”  muscle). 

WHY STRENGTHEN THE VMO?

http://en.wikipedia.org/wiki/Vastus_medialis

The thinking is if the VMO muscle (inner thigh) is weak or not firing properly, it creates an abnormal pull around the knee cap. 

It is true that the VMO can stop working after trauma or swelling as a protection to the knee.  It is true that sometimes it needs to be retrained.  But it is not true in all case of knee pain.

THE STORY CONTINUES

The young girl continued to have knee pain. But to be honest she never did stop being active.  Years later she discovered her thigh muscles were not weak but  tight.  What happens when the quadriceps get tight is that the knee cap (patella) gets compressed down into the thigh bone (femur).  The two cones will rub together creating compression and friction.  When you use the quadriceps during running, squatting, climbing stairs, getting into and out of a chair, or biking, the muscle tenses and creates more compression pain.

STRETCHING

The young girl was not very flexible. She has, however, been blessed with short fast twitch muscle fibers that gave her a lot of strength but not flexibility (or so she thougth). She did play sports that worked the quadriceps. She also had an injury to her left quadriceps during a soccer game (kneed right in the muscle). It did not seem to matter how much she stretched, she never got more flexible.

There is no consistent research on how best to stretch and the actual effectiveness of stretching on injury prevention and recovery.

THE BREAKDOWN

Eventually in her early 30′s while playing indoor soccer, both quadriceps went into spasm. What a sight to see her trying to continue to play soccer without being able to kick the ball (three women on the field  needed to continue to play, so she could not let the team down). The recovery took over six weeks. What she realized was that she could no longer sit on her heels and lean back to get her shoulders to the floor (stretching the quadriceps). What ever flexiblity she had was now worse.

THE TREATMENT

What I have been finding cllinically is that by releasing the tight ropy bands of muscle fibers in the quadriceps (using the Intramuscular Stimulation technique), the flexibilty of the quadriceps improves and the knee pain seems to diminish or resolve. A client with a two-year history of knee pain (patellofemoral diagnosis) who could not squat at all, and who could not walk without pain, is back to running. She is also able to fully squat.  She still does have some symptoms going up and down stairs. 

The quadriceps are not the only muscle to consider.  The hamstrings (back of the tight) are an antagonist (opposing) muscle to the quadriceps. If the hamstrings are tight, the quadriceps have to work harder to overcome the tension from the hamstring. You might even need to look at the calf muscles which cross the knee joint and can contribute to knee pain. 

MORE THAN MUSCLE IMBALANCES

It may not just be muscle imbalances around the knee that is causing the pain.  Sometimes even afer releasing the muscle tightness pain continues. What else could be going on? 

1.  Meniscal Injury: 

The meniscus is the rubber “washer” that rests between the bones of the knee (femur and tibia). There are two of them (medial or inner knee and lateral or outer knee). These are within the knee joint and are susceptible to tearing with twisting injuries to the knee. The most common finding on examination that I have noticed (and reported in literature) is tenderness and swelling at the joint line. Typically there is pain on twisting of the knee especially under load (weight bearing or compression).  There may also be a “catching”, “locking” or even a “giving way” of the knee.  These can heal without surgery (mine did), but may also require surgery. 

2. Osteoarthritis:

The meniscus is often confused with the cartilage.  The cartilage is actully the shinny covering on the bone. I like to compare it to a “shelac” or “tephlon.”  It does not have any nerve fibers and offers a smooth surface to the bone. This can be damaged (Osteoarthritis) with trauma to the knee (impact injuries). I have had clients who have ongoing pain from the “arthritis” of the knee even after the muscles have been released. Some of these individuals have benefitted from acupuncture. There are also those who ask about the use of chondroitin. I have not personally read the articles and research on this, but have been told it’s been shown to be effective. It might be something you have to look up yourself. 

3. Joint stiffness:

I have occasionally found that there is full range of motion of the knee, but when I add the twist to the knee when fully bent there is a stiffness or tension. Sometimes just releasing the right muscle corrects the problems, but not always.  Then I will use my hands to mobilize (wiggle) the joint. Once the motion feels normal again, I recheck the painful activity (usually they can’t get into a full squat without the knee pain), to see if it worked. 

4.  I did have one recently where it was actually a stress fracture to the end of the thigh bone (femur). I did not pick this up but knew very quickly that I was not able to locate the problem. I thought it might have been the meniscus or tendonitis of the inner thigh muscles. 

THE REST OF THE STORY

The young girl (older now), has remained active. She still is not as flexible as she would like, but she does not have nearly the discomfort in her knees with exercise as she has in the past. In order to fully get her back to running full time, further treatment is needed for her back (history of disc pathology with sciatic pain) and pelvis (loss of dynamic muscle stability possibly from the injury to the nerve that supplies the muscles of the  pelvis, hip and leg.

IF YOU’RE MOTIVATED:

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the links there. To book an appointment at Start Line, call the clinic at 250-746-7463.