Massage Therapist Certification

Often I see some massage therapist’s with a nationally certified credential behind their name. What does this mean and is it important to look for when searching for a therapist?



Nationally Certified in Therapeutic Massage and Bodywork, NCTMB as seen written behind a massage therapist name, sets high standards for massage and bodywork practitioners. It protects consumers and employers by ensuring that certified practitioners have the necessary skills and knowledge to perform their job – and that they are committed to upholding NCBTMB’s Standards of Practice and Code of Ethics. NCMTMB is an independent, private, organization established to set high standards of ethical and professional practice through a recognized credible credentialing program.

A nationally certified massage therapist represents the highest professional credential in the field. This therapist has completed a minimum of 500 hours of instruction, demonstrates mastery of core skills, abilities and knowledge, and has passed a standardized exam. This credential will help gain the therapists’ recognition and visibility, and will also increase employment opportunities.

So, is it important when searching for a good massage? Yes, I feel that it is a good thing when doing research for a therapist, yet it’s completely up to that individual. I personally have received great treatments from non-nationally certified therapists. Yet, it does show continued advancement in the profession.

Brian A. Hrindo, LMT, NCTMB

Winter Warm-up

What is the best way to get in shape for winter sports? Where can I find a sample winter warm-up program to get started?
By: Rebecca L. Deal, MSPT
A winter warm-up program designed to best prepare your muscles to hit the slopes must contain three components: stretching, strengthening, and balance training. A basic five-minute stretching session prior to winter activity is important for several reasons. Stretching is the key to injury prevention. Muscles tighten in response to the frigid Tahoe temperatures. A stretching warm-up helps counteract the muscle tension caused by cold weather, acting to elongate the tightened muscle fibers. A correct warm-up raises body temperature, increases blood flow, and promotes oxygen delivery to the muscles. This increase in blood flow leads to higher energy levels, which helps to prepare the mind and body for upcoming exercise.
A proper winter strengthening program helps develop motor programs that allow for optimal performance with adequate endurance. When evaluating which major muscle groups are involved in skiing and require proper strengthening, consider which muscles are most exhausted after a long day on the hill. Quads? Hamstrings? Calves? Core? Hip flexors? Quadriceps and hamstrings are reciprocal muscles that work together, contracting to hold the prolonged squatted riding position. Calf muscles steer the edges of the skis and allow for optimal maneuverability. Core muscles are engaged to assist with balance reactions on uneven terrain. Hip flexor muscles are constantly activated for forward progression of the skis.
Uneven terrain like snow and ice challenge proprioception (the perceived position of a joint in space). Practicing balancing on uneven surfaces in a gym where conditions are safe can help the joints learn to anticipate and react to prepare for an unanticipated event on snow. Practicing where conditions are safe can help increase confidence and may convince you to challenge yourself that much harder next time your are on the slopes without fear of injury. To learn more about specific stretching, strengthening, and balance training techniques, be sure to attend the next free ski clinic offered at North Tahoe Physical Therapy on November 20th at 6pm. Call the clinic at (775)831-6600 or visit our website at www.northtahoept.com for additional details.

What the are most important elements to getting in ski shape?

Ask the Professional
November 19, 2008
Jane O’Brien, PT, MSPT North Tahoe Physical Therapy clinic
What are the most important elements to getting in shape for ski season?
The first thing that comes to mind for getting in “ski shape” is strengthening. I believe everyone would agree that strengthening of the lower extremity or leg muscles is top on the list. The legs are doing most of the work during a ski or snowboard run, so, focus strength training here. The muscles to emphasize are the quads (front of the thighs) the hamstrings (back of the thighs), the calf muscles, and the glutes. It is very important for one to gain strength of the proximal leg muscles, those closest to the trunk, typically called the hips. The stronger one is in the hip region, the less strain will occur across the knee joint.
A great exercise for the whole lower extremity is the squat. This uses the buttocks, the quads, the calves and the hamstrings. Also great are lunges and leg presses. These exercises directly correlate to the motions used in telemark skiing and downhill skiing. Bicycling is a wonderful outdoor activity for lower extremities. Lastly, calf raises (going up and down on tip toes) is great for balance and calf strength.
Besides strength, flexibility is highly important for all activities. A tight muscle is more likely to tear or be strained because there is no slack in the system. Stretches create length in the muscle and allow for freedom of motion.
While everyone agrees that training the lower extremity muscles is highly important, I also want to emphasize the importance of training the trunk or core muscles. The trunk is the “power center” of the body. These muscles include, among others, the abdominals, the iliopsoas, the glutes, hamstrings, and the spinal extensors. A strong core helps with speed, balance, strength, and power, quickly changing directions, improvement of skill level and prevention of injury. A training program needs to consist of trunk flexibility and strength conditioning. Having a strong and flexible core allows one to twist, turn and stabilize the body during the downhill journey. According to Douglas Brooks, MS, who wrote Effective Strength Training, the trunk is the base or foundation of the body. A body is only as strong as its weakest link. A body needs a strong base from which to direct its energy. If the core is weak, it leads to poor performance or worse, injury.
For more details on the top ten ways to get in shape for ski season, go to www.northtahoept.com and download our free report on “ Top Ten Ways to Get in Shape for the Ski Season.”

Physical Therapy Hows & Whys

Ask the Professional
October 21, 2008
Jane O’Brien, MSPT
North Tahoe Physical Therapy
Is Physical Therapy a good way to get started on an exercise program if you have been inactive for a long period of time or is a personal trainer a better option?
It is always best to consult with your doctor before beginning an exercise after prolonged inactivity. Your doctor will perform a complete physical and determine if you will be at risk or if you are safe to begin an exercise program. If the MD gives you the “Go Ahead”, physical therapy is your best option for proceeding.
The PT will evaluate your body before developing an exercise program. Tests may include an assessment of muscle strength in your arms, legs and core. He or she will assess your flexibility, your ligamentous stability, your range of motion in your joints, your endurance level, and your current fitness level. The PT will measure our blood pressure and your heart rate at rest and determine an appropriate activity level for your exercise program. He or she can tailor the program towards your specific fitness goals, for example, weight loss, improved endurance, strength gains, toning or others you may have in mind. If you wish, the PT can also measure your body fat level and develop a plan to reduce that level.
One benefit of beginning a fitness program with a PT is that you are being medically monitored. As you proceed with your fitness program, the PT will assess your heart rate and blood pressure before, during and after activity. Your exercises will be adjusted accordingly. If you have any previous injuries, alert the PT so that area can be protected in your program to prevent a flare up. Additionally, the PT can add exercise to your program to rehabilitate the injured area.
One last advantage of a fitness program which is performed under the direction of a Physical Therapist is the price. A medically guided program may be covered under your health insurance. This means that you may only need to pay for your copayment or coinsurance. If, however, you do not have insurance, many Physical Therapists provide personal training to their clients. The cost may be slightly higher than the fee a personal trainer may charge (about $10-$20 on average). But, the Physical Therapist is a medical professional who has either a Masters or a Doctor of Physical Therapy degree and is trained in the biomechanics of the body, muscle structure and function, injuries and rehab, anatomy and physiology, orthopedics, and strengthening and conditioning.
North Tahoe Physical Therapy works with many clients for reconditioning programs both through insurance and on a cash payment basis. We also offer personal training and Pilates exercise programs. Call us or stop by at 889 Alder Avenue, suite 105, Incline Village, NV 89451. 775-831-6600 Visit us on the web at www.northtahoept.com.

$35.00 Therapeutic Tune-Ups

For Immediate Release

Contact:
Jane O’Brien, MSPT
North Tahoe Physical Therapy
775-831-6600
775-831-6697
ntptclinic@sbcglobal.net
www.northtahoept.com

North Tahoe Physical Therapy Announces $35 Therapeutic Tune-ups as a Cost Effective Way to Treat Minor Aches, Pains and Strains

Incline Village, Nevada August 1, 2007
Therapeutic Tune- ups are a low cost way to treat minor aches or pains before they become more severe. There is no insurance involved which means that the client does not need to see the MD first for a prescription before they can get treatment from a Physical Therapist. This saves not only time but money. Direct access means that the client can simply walk in or call for an appointment time with the PT and get treated, often on the same day.
Therapeutic Tune-ups are appropriate for someone who twisted an ankle on a hike, someone who awoke with a kink in their neck, or someone who strained their shoulder playing with their children. These would be the people who think, “If I could just have someone rub my neck or treat my shoulder today, then the problem can be nipped in the bud before it gets bad.” NTPT provides Therapeutic tune-ups Monday-Friday 8-5:30 for $35.
“Many people either do not have insurance benefits or they have a very high deductible. Thus, Physical Therapy can be cost prohibitive”, said Jane O’Brien, MSPT, owner and director of North Tahoe Physical Therapy. “We have created a service which allows for a client to receive a 15 minute treatment for minor aches, pains, and strains for a very cost-effective price. “ Our Therapeutic Tune-ups serve 2 purposes: one is to enable a client to receive treatment shortly after they recognize the need. “Often, a shorter wait between injury and treatment means a quicker recovery,” said O’Brien. The second purpose is to recognize an injury that requires more intense medical attention and direct the client in the appropriate direction. For example (x-rays, physician, etc). For additional information on Therapeutic Tune-ups, contact North Tahoe Physical Therapy at 775-831-6600 or visit our web site www.northtahoept.com.

Massage and Chronic Pain

Can massage help me with chronic pain that I have had for years?
By: Brian Hrindo, LMT
Therapeutic and deep tissue massage and bodywork can not only relieve acute symptoms but can also affect a change in chronic pain that you may have been experiencing on and off for years. In some cases, massage is the most beneficial tool used to deal with these ongoing discomforts.As with anything, it may take several sessions to relieve symptoms of chronic pain. You didn’t develop these pains overnight, so they may take more than one session to relieve. As you begin to treat your condition, it may be important to be treated several times before you can transition to a less frequent schedule for health maintenance. Please be sure to share specifics with your massage therapist to develop the best plan for you.Massage therapy is particularly effective in treating the chronic pains experienced as a result of exercise, fibromyalgia, and job related discomforts (i.e. working at a computer, sitting or standing for long periods of time). I have the experience and training to facilitate your bodies healing process and look forward to ridding your body of the pain and discomfort that keep you from enjoying a healthy lifestyle in Lake Tahoe. Massage should not only be looked upon as a commodity, but as preventative maintenance on your body’s tissues and subsequent organs which is one of the best ways to stay out of your doctors’ waiting rooms.

Massage and Soreness

ASK THE PROFESSIONAL
I just had a massage yesterday, why am I so sore today?
Chances are it was the bodywork you experienced the day before, and it’s perfectly okay. Yes, soreness can be an after-effect of the treatment and it is common to experience it. Soreness or tenderness can result from the pressure used to release the restrictions in your body’s tissue, and also can be a result of under-hydration either before or after the treatment. If the body is not being properly hydrated after the session to flush out the toxins, such as lactic acid, they may be re-deposited into the muscular system causing tenderness. A great approach would to be properly hydrated prior to your treatment by drinking 2-3 glasses in the hours before your appointment. Water is necessary for the liver to filter out the toxins and chemicals from our body, food, and medications.
A professional massage is more than an ordinary back rub. The reason that massage therapy is so effective is that it physically breaks up the restrictions in the muscle tissue causing pain. It is very much like doing a workout. If the muscles are not used to it, they often respond with some soreness. This should only last a day or two, if it does last longer, speak with your therapist about adjusting the treatment. However, just as with exercise, when your body adjusts to having this type of workout your physical response will also be less intense. As a therapist, I want to know how the body is feeling after the soreness does subside.

Hip Replacement Care

My relative is getting ready to come home from the hospital after a total hip replacement surgery. What do I need to know to set up my home and make them most comfortable during their recovery?

By: Rebecca L. Deal, MSPT

After a standard posterior approach total hip replacement, most surgeons instruct the patient (and all involved caregivers) in three major hip precautions. Familiarizing yourself with these three rules will allow you to promote a speedy and safe recovery for your family member:

1. Avoid hip flexion more than 90°- Lifting the leg out in front beyond 90° puts excessive stress on the posterior joint capsule of the hip as it attempts to heal. Exercises that require excessive hip flexion such as marching and straight leg kicks are not recommended after a total hip replacement surgery until the medical professional instructs the patient in the proper form.

2. Avoid hip adduction- If a line were drawn down the middle of your body from head to toe, the affected hip cannot cross over this midline. This rule is particularly difficult to abide by when rolling over in bed. Using a pillow between the patient’s knees can prevent them from crossing the midline.

3. Avoid internal rotation- Do not allow the patient to turn the toes on their affected leg inward. Again, placing a pillow between their feet can prevent the patient from being able to internally rotate their hip.

Depending on the surgeon, physical therapy can begin soon after the patient awakes from the surgery. Specific questions should be directed to the doctor or physical therapist directing the patient care. As the caregiver, remember you are an important part of the rehab team and helping to communicate with the medical professionals can best promote a safe and speedy recovery for your loved one.

10 Steps to an Ergonomic Office

10 Steps to an Ergonomic Office
By: Rebecca L. Deal, MSPT

Where do you spend the majority of the time during your typical work day? If your answer is sitting in an office chair staring at a computer, it is time to evaluate your work station with regards to your health. Setting up a desk that minimizes prolonged postural stresses can prevent work-related episodes of low back pain. To set up your own ergonomically designed work station, follow these 10 simple steps:

Sitting Posture- When sitting in your chair, it is important to maintain three spinal curves: an inward curve in your low back, an outward curve in the mid-back, and another inward curve in the neck. Shoulder should remain relaxed but kept back in a retracted position. Your head should be kept level with the chin tucked in for the ideal desk posture.

Seat Settings- Adjust your office chair for optimal posture and comfort. For computer work slightly recline the back of the chair. Although some office chairs have lumbar settings, a separate lumbar support pillow is best. A small towel rolled and put in the small of your back works great to maintain the inward lumbar curve. When sitting against the back of the chair, there should be approximately two inches between the edge of the seat and the back of the knees.

Bending in the Chair- To bend over to reach an object out of a low drawer or pick up an object from the floor it is imperative to maintain the inward curve in your low back. Scoot to the edge of the seat and extend one leg out in front of you. Place one hand on the desk surface to assist with balance and bend from the hips. Using your hips as the hinge for this bending motion helps protect the low back.

Turning in the Chair- No Twisting!! When it is necessary to reach into the cabinet behind you or respond to a co-worker in the cubical next to you, it is important to avoid twisting motions that put excessive forces on the spine. Instead, move your body as a single unit in the direction you intend to go with the hips and feet pointed in the same direction.

Foot Rest- Optimal leg position is a 90° angle at the hips and knees. A 90° angle is best obtained using an appropriate height foot rest. Prevent “slouching” by sliding the office chair under the desk as far as possible while making sure to have adequate leg room.

Wrists over Keyboard- Chronic incorrect wrist positioning while typing can lead to the common office injury of carpal tunnel syndrome. To avoid carpal tunnel syndrome, use a wrist rest to position the wrists straight. Keep both of the elbows bent approximately 90° and supported by the desk surface. Adjusting the keyboard to maintain the straightened wrist position can help prevent the excessive wrist extension which leads to carpal tunnel injuries.

Monitor Position- The computer monitor should be angled to be level with the eyes in order to maintain proper head and neck posture. When attempting to type written material, use a document holder to position items at eye level.

Reaching across the Desk- Arrange the work area to eliminate tasks of repetitive reaching. Keep frequently used items close while storing rarely used supplies in a lower drawer. Repetitive lifting can irritate rotator cuff muscles and should be avoided without proper conditioning.

Talking on the Phone- When conducting business on the phone, do not support the receiver between your neck and shoulder. It is best to use a head-set or speaker-phone features to maintain proper neck alignment while talking on the phone for long business conversations.

Take Frequent Rest Breaks for Exercise- To take the strain off your back and prevent fatigue, change positions often. Alternate job tasks that require different postures when possible. The goal for all office workers is to take a break for one minute every hour to stretch and mobilize all the major joints of the body.


So if you’re up for the challenge of setting up your own ergonomically correct work station, print this list out, tape it to the bottom of your monitor and take the time to save your spine from the work-related aches and pains. For additional work station consultation advice or further questions, contact the physical therapy team at North Tahoe Physical Therapy.

For a Good Night's Sleep

For A Good Night’s sleep… According to one Physical Therapists perspective
Jane O’Brien, MSPT
North Tahoe Physical Therapy
889 Alder Avenue, Suite 105
Incline Village, NV 89451
775-831-6600
Have you ever awoken from a long night of sleep feeling sore, stiff, or in pain? Sleep is supposed to be the body’s way of recovering, resting and rejuvenating the body. Many people find that the 6-8 hours they spend sleeping is anything but restful.
As a physical therapist, I inquire of my client’s sleep position. I find that they are often sleeping in the wrong position. I rarely advocate sleeping on one’s stomach due to the extreme neck rotation combined with extension required in order to achieve this position. This small change in sleep position from the stomach to the side or back can relieve a tremendous amount of neck pain. If you must rest on your stomach to fall asleep, put a pillow under the chest to lift the trunk and allow for the neck to drop into flexion and rotation. One should also remove the pillow from under the head.
Pillows can be used to support the spine during sleep. Side sleepers can place a pillow between the knees to keep the hips from rolling forward and to keep the pelvis level. Back sleepers can place a pillow under the knees. This will allow the back to rest flat against the bed. A rolled towel can be placed inside of the pillow case to support the neck arch just as a contoured pillow would do. Lastly, one can buy pillows designed for side sleepers or for back sleepers in bedding stores. The firmness of these pillows differs to provide the proper amount of support for the cervical spine.
The mattress is an important component of a proper nights sleep. Imagine if you had to stand for 6 hours on a pair of shoes such as flip flops which do not support your arches. Later that day, you may have foot, leg or low back pain. If you had to sit on a chair for work all day that was leaning to one side and too tall for you, your body would ache after the work day. Now, think of sleeping on an old bed that is sinking in the middle or perhaps it is too soft. This bed cannot support the curves of your spine. Your muscles must work all night to give you that support. If you have not replaced your mattress in 4 or 5 years, it may be time to consider a change. Also, remember to flip the mattress as directed by the manufacturer to promote proper wear of the mattress. Firmness of a mattress is dependent upon taste to a degree. A mattress that is too firm may cause a backache while one that is too soft will not provide support. It is up to the sleeper to determine the density that will both create comfort and support.
For more self Help tips, be sure to check out our Web site at www.northtahoept.com or stop in for a complimentary consultation

RICE to Control Swelling

How do I best control swelling after a knee surgery?
By: Rebecca L. Deal, MSPT
Physical therapists often use the acronym RICE to educate patients in the principles of controlling the inflammatory response to injury or surgical trauma:
R: rest- Resting the leg after surgery allows the traumatized tissue structures to relax. Surgical procedures involving a bony repair require eight weeks of non-weight bearing status to allow the bone to heal. After a ligament repair, gentle weight-bearing exercises are allowed under the supervision of a physical therapist. Although an individualized home program is encouraged, excessive exercise is not advised.
I: ice- Cold modalities affect blood vessels through the process of vasoconstriction to decrease joint effusion. Choices include an ice pack, an ice water circulating cooler, or an ice cube massage. An ice bag works best over large, general areas and should be administered 15-20 minutes, 2-3x/day. Ice cooler units circulate cold water for a 15 minute treatment. An ice massage takes only 5-7 minutes and works best over bony prominences.
C: compression- Using an Ace bandage or a surgical sleeve to provide constant pressure around the knee joint prevents inflammatory by-products from collecting in the knee joint or draining into the lower leg during weight-bearing activities. The Ace wrap should be applied from top to bottom encompassing the entire knee joint.
E: elevation- Positioning several pillows under the heel prompts the inflammatory fluid to return to the bloodstream and flush back towards the heart to reenter the circulatory system. The key to elevation is to ensure the leg is above the level of the heart (lay flat on back with leg up). Combining the four RICE principles and resting the leg while compressing the joint with an ice bag in an elevated position for 20 minutes after exercise is the ideal situation to control swelling after a knee surgery.

Rotator Cuff Surgery and Repair

How long does it take a rotator cuff tendon to heal after a surgical repair?
By: Rebecca L. Deal, MSPT
A surgical rotator cuff repair requires a tendon reattachment into a bony anchor in the shoulder. The bone site of tendon reinsertion requires eight weeks to heal. Physical therapy, although specifics depend on the surgeon’s rehab protocol, usually begins three-five days after the surgery and continues for up to twelve weeks in three distinct phases until all prior shoulder function returns.
During phase one, the first eight weeks of physical therapy, while the bone is still healing, rehab is focused on symptom control and the return of symmetrical range of motion (ROM). Educating the patient to ice, encouraging the use of an arm support to rest the irritated tendons, and introducing the Codman pendulum exercises are all common strategies for controlling shoulder symptoms. ROM activities are limited in phase one to passive stretching (the patient must keep the muscles relaxed while the therapist stretches the rotator cuff muscles).
After the surgical repair site has healed and the patient has full ROM, emphasis shifts in phase two to shoulder strengthening. Strength work focuses on both rotator cuff muscles and the interscapular muscles to promote the return of normal shoulder biomechanics. Rotator cuff strengthening begins with isometric contractions and progresses to eventual strengthening with weight or Theraband resistance.
Phase three involves proprioceptive training for the upper extremity to ensure proper reaction time and future injury prevention. During week twelve of physical therapy the patient performs final assessment to determine if they can safely return to all activities of daily living before formal discharge from physical therapy. Once discharged, the patient is encouraged to maintain shoulder flexibility and strength with an independent exercise program.

Do I need diagnostic tests and results before I start PT?

Ask the Professional June 13, 2008
Jane O’Brien, MSPT

Do I need to have an X-ray or MRI and get the results before I start Physical Therapy?
Diagnostic tests are always helpful when assessing a client’s dysfunction, but they are not necessary prior to starting Physical Therapy. During the initial examination, the physical therapist (PT) will take the patient’s history to assess the nature of the problem. She will perform an examination of the client consisting of inspection of the body for posture and deformity, palpation of the tissues involved checking for tension, pain and inflammation. She will look at active and passive movements of the dysfunctional area. Additional clinical tests will be performed by the PT to help determine a diagnosis. The results of this comprehensive evaluation will indicate the nature of the client’s problem and lead to the development of a treatment plan.
Diagnostic tests can be used to validate the clinical exam results. They can provide clarity to any uncertainties regarding the dysfunction that the exam could not pick up. Many times, clients begin therapy without having had diagnostic tests and find that therapy alleviates their symptoms. If the problem is corrected, there is no need to have diagnostic tests after the fact. If the problems continue, X-rays or MRI may be ordered to determine how to redirect their treatment. The common thought is not to delay the healing measures by waiting to receive tests but to start therapy early, shorten the healing time and add diagnostic tests later if needed.

Pelvic Floor Dysfunction and Physical Therapy

Pelvic Floor Dysfunction and Physical Therapy
Jane O’Brien, MSPT
North Tahoe Physical Therapy June 11, 2008

The term pelvic floor refers to the sling of muscles, ligaments, and fascia which spans from the front of the pelvis at the pubic bone to the posterior pelvis at the tail bone. The purpose of the musculature is to support the pelvic organs (uterus, colon, and bladder), allow for control of the outlets (urethra and rectum) and provide tone for sensation for the sexual functions. It is important for this area to have proper muscle tone. Excess tone of the muscles can cause difficulty sitting, pain during intercourse, hip and low back pain or retention. Diminished tone may lead to incontinence, organ prolapse and possibly decreased sexual response.
Commonly, people associate pelvic floor dysfunction with incontinence. However, there are a myriad of diagnoses that fall under this category such as overactive bladder, pelvic pain, prolapsed uterus, painful periods (dysmenorrhea), interstitial cystitis, coccyx pain, painful intercourse, and many others. Symptoms may limit a man or woman’s ability to perform daily activities, cause a change in exercise habits and create embarrassment. Problems in this area are often not discussed with medical professionals and therefore, go untreated.
Many physical therapists have specialized training that can benefit men and women with issues of the pelvic floor. These therapists utilize every aspect of their physical therapy training to evaluate patients and to provide intervention to overcome these dysfunctions. Treatments may consist of a combination of many techniques. Exercises such as “Kegels,” which are geared for this area, greatly enhance muscle function when performed properly. Relaxation techniques may be utilized to assist with decreasing tone and pain. Manual techniques, such as Myofascial Release and soft tissue massage are often used to relieve tension. Biofeedback is used to increase awareness of proper muscle recruitment or to quiet overactive muscles. Electrical stimulation may be used to recruit and train pelvic floor musculature or to relieve pain. Joint mobilizations are often utilized to restore pelvic alignment and motion. In addition, patient education can assist with prevention of dysfunction.
Physical therapy for the pelvic floor dysfunction is relatively new and not widely known by many medical professionals in the USA. There are only a handful of Physical Therapists who are trained in Pelvic Floor therapy in Northern Nevada. But, Pelvic Floor Dysfunction is common. Just consider the number of commercials from the pharmaceutical industry promoting drugs aimed at treatment of these issues. Numerous surgeries are advocated as an answer for many pelvic floor issues. Many are unsuccessful. Physical Therapy can provide tremendous relief for Healthcare consumers who want to take control of their symptoms and overcome them without the use of longterm drugs or surgeries.
When choosing a physical therapist for treatment of a pelvic floor dysfunction, it is important to inquire of their training, experience and outcomes with this area to ascertain if they are qualified to treat this area. The Section on Women’s Health of the American Physical Therapy Association offers training and mentoring leading to a certificate program called the Certificate of Achievement in Pelvic Physical Therapy (CAPP). Approximately 150 PT’s have received the CAPP to date. To find a Physical Therapist who is trained to work with Pelvic Floor Dysfunction, one can contact the Section on Women’s Health of the American Physical Therapy Association. The web site is http://www.womenshealthapta.org/. The website provides articles and resources for consumers to learn more. One can also log onto www.northtahoept.com for further information and treatment options.
Jane O’Brien, MSPT is a physical therapist at North Tahoe Physical Therapy who provides services for the pelvic floor, orthopedics and pain. She is a candidate for the CAPP expecting to complete her certificate in summer 2008.

Heat vs Ice

When should I use heat or ice for a specific condition?

Submitted by Rebecca L. Deal, MSPT at North Tahoe Physical Therapy

There are two issue to consider when deciding between heat and cold therapy after an injury. First, consider the timing of the injury. If the injury is in the acute phase (1-2 days) and still showing signs of inflammation, ice is the most beneficial treatment. After swelling has resolved and the injury passes into the sub-acute and chronic phases of healing, switching to heat treatments is advised.

Second, the affected area and placement of the heat/cold modality must be analyzed. Crowded joint spaces, ligaments and tendon attachment sites that are susceptible to swelling and increased joint fluid with conditions like rotator cuff tendinitis or a torn knee meniscus require ice. Cold modalities work to decrease inflammation allowing more joint space and removing the fluid restrictions to range of motion. Muscles respond well to heat. Heat sources to sore muscles act to decrease muscle tension and eliminate muscle spasms.

Sometimes an injury scenario presents itself and the timing and placement issues conflict, leaving you again confuse between ice and heat modalities. What do you do for an acute muscle condition or chronic joint pain? The timing issue takes precedent over the placement so acute muscle pain needs ice, while chronic joint pain requires heat. If it is just too difficult to decide ice versus heat, consider a contrast heat/cold schedule. A contrast schedule alternates between heat and cold modalities in succession to both eliminate inflammation and provide symptom relief.

Certificate of Acheivment in Pelvic Physical Therapy

The Certification of Achievement in Pelvic Physical Therapy is offered by the Section on Women's Health of the American Physical Therapy Association. The Section on Women's Health offers three levels of Pelvic Physical Therapy courses. These courses provide evidence-based education for the learner to acquire skills and knowledge to provide Physical Therapy interventions for male and female clients of all ages with pelvic floor dysfunctions, including pelvic pain, urinary incontinence, endometriosis, and many other conditions. This certification prepares the learner for the Women's Health specialization Exam. The requirements are attendance at the SOWH Pelvic Physical Therapy classes level 1,2,3, pass the competency skills tests for each level, pass didactics tests for each level, and submit a case report. Experienced therapists who have completed previous training in pelvic physical therapy can apply for the transitional CAPP. I qualify for the tCAPP.
I have nearly completed the requirements for the Certificate of Achievement in Pelvic Physical Therapy. I just received my certificate of completion for the Level 3 class I took in March 2008 in Portland. I received a 94% on my post test. All that is left to do is to complete my Case Study and submit it. This could take some time as it involves both evaluating and following a client through their pelvic floor therapy, writing the requirements for the case study, and having it accepted. I expect to complete this process in the next 6 months. I'll keep you posted!Jane

11:52:00 AM
by North Tahoe Physical Therapy
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Pelvic Floor Dysfunction

Commonly, people associate pelvic floor dysfunction (PFD) with incontinence. However, there are a myriad of diagnoses that fall under this category such as overactive bladder, pelvic pain, prolapsed uterus, interstitial cystitis, coccyx pain, painful intercourse, and many others. Symptoms may limit a woman's ability to perform her daily activities, change or limit her exercise habits, and create embarrassment. Problems in this area are often not discussed with medical professionals, and therefore, go untreated.

Physical therapy can greatly benefit the pelvic floor. Exercises geared for this area greatly enhance muscle function. Relaxation techniques may be utilized to assist with decreasing tone and pain. Manual techniques, such as Myofascial Release and soft tissue massage are often used to relieve tension. Biofeedback is used to increase awareness of proper muscle recruitment or to quiet overactive muscles. Electrical simulation may be used to recruit and train pelvic floor musculature. In addition, patient education can assist with prevention of dysfunction.

When choosing a physical therapist for treatment of a pelvic floor dysfunction, it is important to ascertain if she is qualified to treat this area. Be sure she has taken coursework specifically for PFD. Ask her how many clients she has treated for your issue. Ask outcomes of treatments. Ask if she can help you gain relief of your symptoms and improve your lifestyle.

PFD is common, but not normal. You do not need to simply accept your symptoms as a process of growing old or due to childbirth. You can take control of your symptoms and often relieve them completely.

Jane O'Brien, MSPT works with clients ( male and female) who have Pelvic Floor Dysfunction at North Tahoe Physical Therapy. contact her at 775-831-6600 or visit the web site at www. northtahoept.com

Stay Physical, With Therapy

Stay Physical, With Therapy

Ask five people what physical therapy is and I'll bet you a Spring Pass you get five different answers. The beauty is that physical therapy is very different depending on what the individual requires to optimize health and quality of life. A good therapist customizes treatment to reach a patient's goals and improve quality of life. This means that the process should be very different for a competitive skier and a deconditioned elder, even if both have knee injuries. Physical therapists are trained to identify limitations or dysfunction on many levels and problem solve in a way that best serves the patient.
Many don't realize that for those entering the field today, a Master's of Science or Clinical Doctorate (DPT) is necessary to qualify for the licensing exam. In addition, the American Physical Therapy Association is advocating for all educational programs to be DPT accreditated by 2020, generally 6-7 years of college education. All this training is geared toward evaluation and treatment sensitive to each individual's needs. This includes integration of a variety of body systems affecting one's health. Musculoskeletal, neurological, cardiovascular, respiratory, integumentary, digestive/urinary, and emotional health are all part of this assessment process.
The advantage to this background is that a physical therapist can gear treatment toward the larger picture of health. An injured shoulder is not a separate entity, but a piece of the puzzle affecting daily activity, mental health, recreation, occupation, and social life. It is most therapists' intention to see this spectrum and work toward improvement through treatment, lifestyle changes, patient education, and home exercise. For the patient with pain, the treatment approach should include identifying the problem, working toward relief, and then preventing future pain. The injured athlete may need guidance in pacing his/her progression for optimal recovery. The client with neurological dysfunction and balance deficits should be instructed on home environment modifications to prevent falls. These are very different situations with different needs. Also, taken into account are individual characteristics. Factors including fear, attitude, motivation and bodily awareness must be recognized. Responsibility also lies on the therapist to educate the patient so they understand their body and can help prevent future impairments. To work with the patient and understand this broad approach will create the best outcomes.
What many don't realize is that one doesn't have to be suffering to benefit from therapy. Wellness promotion can be the sole purpose with prevention of future ailments being the primary goal. For someone that has had a heart attack and isn't quite sure just how to improve their fitness, physical therapy can be a great place to start. For the office worker with slight aches and pains, education in ergonomics and stretching to prevent carpul tunnel or thoracic outlet syndrome may be indicated. Unfortunately, our society has valued reaction instead of prevention in healthcare for much too long. Most problems are more successfully treated early in their course than later when dysfunction has escalated and negatively impacted physical activity or movement patterns.
Furthermore, every patient has the right to choose the physical therapist they utilize. As with any profession, some people work well together and some don't. Communication is the key to successful treatment to ensure that both understand the plan of care and how the patient is reacting physically and emotionally. Specialists in physical therapy may also better serve you. Training and expertise in many fields are part of physical therapy and can be overlooked. Physical therapists who are specialists in Women's Health, pediatrics and geriatrics, wheelchair evaluation, orthotics and brace fitting, Myofascial Release, and other manual therapies can help manage specific problems or pain. This can supplement or prevent a need for medication or more invasive medical options. If it's important to you, a bit of research may give you other alternatives.
To those young people looking for direction and wondering what occupation to pursue, I encourage an investigation of the field of physical therapy. Options are numerous with this degree. Sports physical therapy or rehabilitation from athletic injury is often the only mental picture people get when they think of this field. In actuality, one can work in hospitals, schools, with animals, in education, in research, or as specialist, among other options. It's an exciting time in our history to be involved with healthcare as technology changes, research diversifies, and health trends evolve. If working with a broad range of people and studying the human body and its condition interest you, physical therapy may be a good fit. With permission, shadowing a physical therapist for a day can be a good opportunity to learn more.
For more information, visit the APTA website, www.apta.org, or, contact a clinic with your questions. Be well and enjoy the day.

Submitted by Andrew Emery, PT at North Tahoe Physical Therapy 775-831-6600

Orthopedic Massage

Orthopedic Massage
By Brian Hrindo, MT

Orthopedic Rehabilitative Massage is an advanced form of bodywork in the current mainstream health care community. This type of massage is indicated for post-surgery, chronic pain, overuse, and repetitive stress injuries. It is indicated for people of all ages and body types. This deeper (more pressure, deeper layers) type of massage is very useful when patients/clients are in some sort of discomfort or pain and is useful (and in some cases more results with) as preventative medicine, which seems more important in this day and age. It compliments treatments by physical therapists, chiropractors, acupuncturists, osteopaths, and medical doctors.

This advanced style of bodywork requires more training from therapists specifically in the areas of anatomy, physiology, and pathology of injury. This work can be applies to any body part ranging from the neck all the way down to the feet. You will find practitioners of this work in multiple work settings, whether it is in a physical therapy or chiropractic clinic or day or resort spa. But if you decide to receive this type of therapy, please do your research. Not every massage therapist is qualified or for that matter good. So do your homework, find out the massage therapist’s history, education, and experience in body work. At North Tahoe Physical Therapy we are constantly increasing our understanding of how to address pathology, as continuing education is required for all licensed therapists.

Orthopedic Massage is a form of manual therapy that specializes in the treatment of musculoskeletal pain and dysfunction. In addition to the benefits of traditional massage such as relaxation and increased circulation, orthopedic massage has several other treatment goals. These include increasing the range of motion, decreasing and managing pain, and normalizing musculoskeletal function. The therapist works to dissolve adhesions in muscle and connective tissue, lengthen connective tissue, balance muscle function by strengthening weak muscles and releasing tight ones, as well as normalize the position of soft tissue, restore joint function, release entrapped nerves, and facilitate normal neurological function.

What to expect from Orthopedic Massage

You may ask, why a deeper more rehabilitative massage as opposed to your traditional Swedish massage? I prefer to label what I do as body work as opposed to massage. For a few reasons; when people think of massage they tend to correspond it to your every day Swedish massage, “which is nice to get”. Yes, I am doing tough “massage strokes”, but I am providing the body the therapy is desperately needs to return it to normal working order. I provide this type of work when everything else fails with traditional massage therapy and the pain and dysfunction persists. Also, I will incorporate other therapies such as Myofascial Release, myofascial stretches, manual traction, muscle energy techniques, and craniosacral therapy. So it is not necessarily massage strokes.

A session typically lasts from ½ hour to 1 hour. The work will be both gentle and deep. For lasting results, the therapist will want to see the patient 2-3 times a week initially, as frequency is the key. During the course of a session, the therapist will evaluate the entire body and address the body as a whole, to see how is responding to the injury. The therapist will then specifically address the area of trauma to increase the fluidity in the tissue and range of motion in the effected joints. This can be done by a postural evaluation, checking passive range of motion, or movement analysis.