MENU
(855) 783-4778 Request An Appointment Pay Now Locations

Plantar Fasciitis a Clinical Study

by | Jul 11, 2019 | Health Tips

by Logan Swisher, SPT

Background:

Plantar fasciitis is the inflammation of the plantar fascia and a very common cause of heel pain. The plantar fascia is a thick band of tissue that runs from the heel bone to the toes and supports the arch of the foot. The pain is usually most noticeable when first standing up and walking or after walking, running, or standing for long periods; and may decrease after light activity. Plantar fasciitis can be a very frustrating diagnosis due to the fact that most people have to be on their feet at sometime during the day which further exacerbates their symptoms.

Participants:

66 total participants

-32 in dry needling group

-34 in the steroid injection group

Methods:

This study was a single-blind, randomized clinical trial. The participants placed into the dry needling group received dry needling for 30 seconds of the intended site. The participants in the steroid injection group received an injection at the intended site and the needle was immediately withdrawn. Patients gave a baseline measurement using the visual analog scale (VAS) and were followed up with at 3 weeks, 6 weeks, 3 months, 6 months and 1 year.

Results:

Baseline visual analog scale (VAS) scores to rate pain were taken in both groups before treatment. When scores were retested at 3 weeks, the dry needling and the steroid group both improved, although the steroid group demonstrated greater pain relief. This trend continued until the 3 month follow-up where the steroid began to demonstrate a gradual increase in pain. The dry needling group continued to demonstrate a gradual decrease in the VAS score at every follow-up. In conclusion, the steroid group got more effective short term relief while the dry needling group more significantly lowered their VAS score overall and were able to maintain their decrease over a 1 year follow up.

Clinical Application – Plantar Fasciitis:

This study demonstrated that steroid injections can make a rapid improvement in plantar fasciitis pain peaking at 3 weeks while dry needling showed a gradual decrease in pain that lasted up to the 1 year follow up. Here at PTFirst, we will work with you and your doctor to find the optimal treatment combination to reduce your pain. If dry needling does not interest you as viable treatment option we have many other treatments which include manual therapy, stretching, exercise, ultrasound and taping among others.

Article treatment of plantar fasciitis:

Rastegar, S., Baradaran Mahdavi, S., Hoseinzadeh, B., & Badiei, S. (2018). Comparison of dry needling and steroid injection in the treatment of plantar fasciitis: A single-blind randomized clinical trial. International Orthopaedics, 42(1), 109.

The optimal desk ergonomics setup for your computer

by | Jun 24, 2019 | Health Tips

by Logan Swisher, SPT

Finding the optimal desk setup

Many of us spend hours of our workday in front of a desk/computer. While some people have no difficulty with this, others find that their desk set up contributes to their pain. Proper desk ergonomics can help you stay comfortable at work and reduce the risk of pain from static postures.

 

  1. Start with feet flat on the ground. A footrest may be used if you cannot reach the ground.
  2.  Maintain a 90°-120° angle at the knees and hips. There should be a small distance (two fingers width) between the back of the knees and the front of the chair.
  3. You should be seated all the way back in the chair with lumbar support from either the chair or towel roll.
  4. Shoulders should be relaxed and elbows bent between 90°-120°.
  5. Wrist position should be in neutral and forearms should be supported by the arms of the chair or desk.
  6. Screen should be at eye level or slightly lower with a 10°-20° screen tilt backward.
  7. Screen distance is recommended to be an arm length (20’’-30’’) or a distance where you can comfortably see the screen without changing your posture.
  8. Remember to take frequent breaks when working in a position for an extended time. If possible, try to alternate between a seated and standing desk.

 

Before making any permanent changes, try household items like towels, pillows and boxes to find the best setup. Here at PTF we will work with you to optimize your desk setup so you can reduce your pain and maximize your efficiency.

Effect of Laser Therapy on Chronic Osteoarthritis of the Knee in Older Subjects

by | Jun 18, 2019 | Health Tips

By Sidney Jones, SPT

Background

Osteoarthritis (OA) is a common degenerative joint disease that is usually associated with pain, limited range of motion, muscle weakness, difficulty with activities of daily living and impaired quality of life. The knee is the most common joint in the body affected by osteoarthritis. Low-level laser therapy has been studied and used for pain control, anti-inflammatory effects and its healing efficacy. The purpose of this study was to determine the effects of adding low-level laser therapy (LLLT) to an exercise training program on pain severity, joint stiffness, physical function, isometric muscle strength, knee range of motion, and quality of life in older subjects with knee OA.

Participants

Men and women between 60-72 years old with chronic osteoarthritis according to the American College of Rheumatology (ACR) criteria grades II & III and knee OA according to the Kellgren-Lawrence grade. Participants also had to have the ability to stand independently and willingness to participate in the study.

Methods – laser therapy treatment

Group1: 18 subjects 7 males & 11 females were treated with a laser dose of 6 J/cm² over 8 points around the knee. Each point received energy of 6 J/point for 60 seconds.

Group 2: 18 subjects 6 males & 12 females were treated with a laser dose of 3 J/cm² on 9 points around the knee. Each point received energy of 3 J/point for 50 seconds.

Group 3: 15 subjects 5 males & 10 females participated as the control group. Procedure was identical but without emission of energy.

Exercise Training Program

All participants in each group participated in the same exercise training program for 30 to 45-minute sessions 2 times a week for 8 weeks. The program included stretching the quadriceps, hamstrings, adductors, and calf muscles. Strengthening exercises included knee extension, straight leg raises and quadriceps setting. All participants were instructed to practice these exercises as a home program.

Each participant was evaluated pre and post 8 weeks of physical therapy interventions on:

  • Pain intensity with Visual Analogue Scale (VAS)
  • Physical function with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
  • Knee range of motion, active knee flexion range of motion was measured with long arm universal goniometer.
  • Isometric strength of knee flexor and extensor muscles was measured using Handheld Dynamometer

 Results

The best improvements in VAS, WOMAC pain, knee range of motion and physical function were seen in patients who were treated with 6 J/cm² then 3 J/cm² and then placebo group. Mean values for WOMAC significantly reduced, which means improved physical function. Isometric strength of the quadriceps and hamstring muscles increased significantly in each group after interventions. The largest increase in isometric strength of the quadriceps and hamstring muscles and knee flexion range of motion was seen in patients who received 6 J/cm² followed by 3 J/cm² and then the placebo group. Mean values of knee flexion range of motion increased significantly after physical therapy interventions in each group with significant differences among the 3 groups.

Discussion about adding laser therapy

The current study suggests that adding LLLT to exercise training program could be an important modality for treating older adults with OA than exercise training alone. The active laser groups either 6 J/cm² or 3 J/cm² had a significant reduction of pain intensity in VAS and WOMAC, increase in physical function, increase in isometric quadriceps and hamstring muscle strength, and increase in range of motion after treatment of knee OA.

Conclusion

Adding LLLT to an exercise training program is more effective than exercise training alone in treatment of patients with chronic knee OA and the rate of improvement may be dose dependent, as with 6 J/cm² or 3 J/cm².

PTF Approach to adding laser therapy 

Here at Physical Therapy First, we perform a complete evaluation and based on those findings we design a treatment plan that best addresses our patient’s needs. Our goal is to provide quality patient care and as this study suggests, multiple interventions can and should be used to treat knee osteoarthritis simultaneously. At Physical Therapy First, laser therapy and strengthening are options along with several other interventions such as soft tissue mobilization, stretching and providing our patients with a home exercise program to maximize outcomes.

Original Article about Laser Therapy

Youssef, E. F., Muaidi, Q. I., & Shanb, A. A. (2016). Effect of Laser Therapy on Chronic Osteoarthritis of the Knee in Older Subjects. Journal of Lasers in Medical Sciences,7(2), 112-119. doi:10.15171/jlms.2016.19

How does my health insurance actually work?

by | Jun 12, 2019 | Health Tips

By Lillian Wynn, PT, DPT 

Health insurance can be a very confusing and complicated thing to navigate. We try very hard to work with all of our patients to understand what their coverage is so we can be honest up front with how much PT will cost you.

This is by no means a complete list of everything you need to know, but we are hoping it will help answer some of your questions about how things work.

Health Insurance Premium

This is the amount of money that you pay to your insurance company every month to buy coverage. The amount varies depending on which health insurance company you have, how much coverage you are paying for, and how many people you are paying for.

Network

Health insurance companies and health care providers also sign contracts with each other to determine if you are ‘in network’ or ‘out of network’. Oftentimes your coverage is different depending on whether you are in or out of network

Health Insurance Deductible

Not everyone has a deductible. This is the amount you must pay ‘out of pocket’ before your insurance starts helping pay for things. How much deductible you have varies depending on which health insurance company you have, how much coverage you are paying for, and how many people you are paying for. If you have a high deductible plan, you often qualify for a Health Savings Account (HSA).

Co-pay

This is the amount that you owe out of pocket at each doctor’s visit. This is IN ADDITION to your monthly premium. If you have a deductible, this may still apply after your deductible has been met. The amount of your copay depends on which health insurance company you have, how much coverage you are paying for, how many people you are paying for, and which type of doctor you are seeing.

I still have questions about:
  • My premium
  • Which plan I have
  • Whether I qualify for an HSA

Please call your health insurance company at the number on the back of your card

I still have questions about:
  • If PT First is ‘in network’
  • If I’ve met my deductible
  • What my co-pay or out of pocket cost is
We can help, feel free to give us a call!

I had an ankle sprain, why are you strengthening my hip?

by | May 26, 2019 | Health Tips

By Logan Swisher SPT

Ankle Sprain – Background:

Lateral ankle sprains are a significant burden on U.S healthcare with estimated costs of $6.2 billion annually. They can be associated with long-term consequences such as decreased health-related quality of life, decreased physical activity and post-traumatic ankle osteoarthritis. Some patients with a history of lateral ankle sprain develop chronic ankle instability; which is commonly marked by repetitive ankle injury, balance and mobility deficits, and perceived instability of the ankle.  Other patients with a history of lateral ankle sprain do not develop the subsequent characteristics of chronic ankle instability. Studies have shown that lateral ankle sprain copers have more favorable ankle range of motion, ankle strength, joint stability and postural control as compared to those who develop chronic ankle instability.

Dynamic postural control is the ability to maintain your balance while moving any part of your body (ie catching a ball, jumping, carrying, etc). Patients with chronic ankle instability tend to have limited dynamic postural control. In clinical practice, a star-excursion balance test (SEBT) is a simple measure of dynamic postural control. This study aimed to examine the differences in SEBT performance and hip strength in those with chronic ankle instability, lateral ankle sprain copers and control groups.

Participants:

84 participants total:

-30 chronic ankle instability

-29 lateral ankle sprain copers

-25 control

Methods:

Single-blinded, cross-sectional, case-control study design was utilized. One physical therapy clinic assigned patients to their appropriate group, and then after treatment, results were collected and analyzed. All participants were tested for leg length, SEBT, and isometric hip strength.  Averages of SEBT and isometric strength were taken from three trials respectively.

Results:

This research revealed that individuals with chronic ankle instability had lower SEBT score decreased hip strength compared to lateral ankle sprain copers and control groups. This indicates that dynamic postural control and isometric hip strength is compromised in individuals with chronic ankle instability.

Ankle Sprain – Clinical Application:

Physical therapists treating patients with chronic ankle instability should include exercises to target hip muscular strength deficiencies which may in turn have a positive effect on dynamic postural control performance.  Here at PT First we approach a patient globally and work to incorporate any insufficiencies found during examination into a well-rounded, dynamic rehabilitation program.

Original article – ankle sprain:

McCann, R. S., Crossett, I. D., Terada, M., Kosik, K. B., Bolding, B. A., & Gribble, P. A. (2017). Hip strength and star excursion balance test deficits of patients with chronic ankle instability. Journal of Science and Medicine in Sport, 20(11), 992-996. doi:10.1016/j.jsams.2017.05.005

 

Running with Knee Osteoarthritis-Part 3

by | Apr 28, 2019 | Health Tips

By Lillian Wynn PT, DPT
Physical Therapist

Background

40% of American adults (110 million people) report walking or running as part of a regular exercise routine.  Reports and ‘common knowledge’ about running and its impact on our joints are often conflicting. This is the third of three blog posts designed to look at current medical research regarding running on aging joints.

Article summary

PARTICIPANTS:

This paper is a systematic review and meta-analysis, so the authors compiled research on knee osteoarthritis (OA) and running, and summarized the findings in order to provide a concise recommendation based on the general consensus of research. Articles were included if they: were level I-III evidence, written in English, used physician diagnosed OA with clinical and/or radiographic findings, and running was compared to non-running. Articles that compared running to other forms of exercises were not included in this study.

METHODS:

Literature searches were performed, and 1,907 articles were reviewed. Of those, 25 met their inclusion criteria. Statistical analysis was performed on those 25 studies to come to a meta-analysis, which summarizes and confirms the general recommendations based on significant research.

CONCLUSIONS:

The authors concluded that recreational running was in fact associated with lower levels of OA when compared to sedentary individuals. Competitive running was associated with higher levels of OA than recreational runners. Overall, sedentary subject demonstrated the most symptomatic OA. The study also argues that this simply compares runners to non-runners. So the only conclusion that can be drawn is that running is better than being sedentary. More research should be done into seeing if running vs other forms of exercise is the best for of exercise.

 PTF approach

Here at PTF, we want to keep you active in the activities that matter to you. If walking and running are important to you, and you feel limited by your knees, an evaluation could be useful. There are many factors besides osteoarthritis that could be contributing to your knee pain while running. PTF does a complete evaluation and then designs a treatment plan individual to you and your body to keep you moving.

Original Article

Alentorn-Geli, E., Samuelsson, K., Musahl, V., Green, C., Bhandari, M., Karlsson, J. (2017). The Association of Recreational and Competitive Running with Hip and Knee Osteoarthritis: Systematic Review and Meta-analysis. J Orthop Sports Phys Ther, 47(6), 373-390. doi:10.2519/jospt.2017.7137