Open Forum 2/2010
February 15, 2010 
14 Comments
Hey everyone, it is that time of year again when I swamped! Let’s use this week as another open forum, which have always been popular in the past. Comment on this post and ask any question or start any discussion you would like! Have a new website you want to promote? Comment here. Have a difficult patient that you want to some help with? Comment here. Have a new technique you have been using that you want to share? Comment here? I’ll leave this open for the week, so please join in and ask questions and comment on one another’s responses!
I’ll start some discussion off with a couple of things I want to learn from you:
- What does everyone think of the use of PRP? What types of patients have you seen – lateral epicondylitis? Patellar tendonitis? How did they do? Did you feel any different results were obtained?
- When you cast for orthotics, do you prefer the person weightbearing or nonweightbearing? Why?
I have a number of patients that develop tender or trigger points in infraspinatus following RC surgery. I've tried ultrasound, combo ice and ultrasound, ice massage, massage and using a tennis ball. Any other suggestions?
Sorry meant combo estim and ultrasound
Mike,
When taking a look at the sleeper stretch, a patient is basically placed in a side-lying Hawkins-Kennedy impingement position. Why exactly would this be a superior stretch over a simple post/post-inf capsular stretch and other than the post cuff, does it get a stretch on the inf capsule? Thanks.
I would like to explore that IR stretch more too. I really like it; wondering if the position is stabilizing the scapula adequately to allow the stretch to happen most effectively. For the trigger points in the infraspinatus following RC surgery, I would do deep tissue mobilization…are you trying to gain IR or address symptomatically? (how long post repair?)
@Bob – I like to use some manual soft tissue functional mob techniques that I have learned through IPA (Institute of Physical Art). Get pressure on the trigger point/restricted tissue and go through a cascade of techniques developed by Greg Johnson, PT head of the IPA. I get some of the best results with utilizing the patients own movement, probably similar to Mulligan type techniques MWM (have never taken a Mulligan course, so can't say specifically). The tennis ball and foam roller tricks also are good home ex for patient to improve soft tissue mobility. Continue as well to get at thoracic mobility and scapular kinematic training as I'm sure you have, as this is usually key with these patients. I personnally usually haven't gotten very good results with modalities with these, other than some ice or heat.
I would also like to know if anyone has ideas for a good maintenance exercise program for managing a chronic cervical spine problem: ie what exactly are cervical stabilization exercises? In this time of spine surgeries being more of a last resort, how can I help patients not have frequent recurrences (besides the usual posture, body mech, etc)?
Re Jennifer's question about cervical stabilization maintenance: I am obviously biased toward yoga as an excellent means of long-term maintenance of strength and posture. As a PT, I like to make sure that my patients know neutral position, how to find/isolate longus coli and how to keep the shoulders and jaw relaxed. Then they can incorporate all of those fundamentals into strength-building yoga postures such as planks, reverse table top and triangle postures. It is a lot more fun and sustainable than just doing isolated neck exercises. I would make sure to refer patients to a reputable yoga teacher (if they want to go to classes) and I always insist that no matter how experienced the patient is , that they always return to a beginner-level or gentle class so that they can take time to really think about how to incorporate the fundamentals they learned in therapy.
Has anyone had experience with the class IV laser. Have had amazing results with decreasing capsular tightness and trigger point management. Question is: Since this is a very expensive unit, is it practical in the physical therapy setting based on laser reimbursement.
thank you Lisa, sounds great!
Hi there
I am not a PT but visit here to pick up what I can to help my understanding of sports medicine.
I also have a blog that covers sport science, performance enhancement, and coaching. I would appreciate any comments.
Thanks for this chance to put it out there:
http://pursuitofperformance.blogspot.com/
Any recommendations on computer documentation software for PT Clinic?
@ DANE – Depends on what you are looking for. Who is doing your billing? You or and external group. If you, I would look at TheraWriter. Pretty easy to use and has billing capability. If a third party, they may have a software that they are integrated with. I have a third party and I have found that because we are integrated with them through our software, our reimbursement is higher than others in our area.
Good luck
Loyal reader to this blog (among others that are linked and referenced off this blog).
Thank you for the opportunity to share with the readers the opening of our new PT clinic (www.momentumpt.com) in Milford, MA.
Kudos to Mike for an amazing reference. Thank you for sharing your unique perspective!
Anyone have an opinion or know anything about orthotics for young kids (2 years). I do fabricate them for adults when indicated but I was taught that unless there was a functional problem or suspicion of a neuro problem leave them alone for this population. I have a 2 year old referred for orthotics. Her hips are clear and her knees seem ok. She has a little forefoot valgus but I'm thinking its way too early to do anything? Thoughts? What do I tell the doc?