Spine

Advanced Training News...We're at it again!

By David Coletta, MPT, CMPT
david@excelptmt.com

David Coletta, MPT, CMPT, physical therapist and owner of Excel Physical Therapy of Bozeman and Manhattan, recently completed a seven day advanced spinal manipulation training from the North American Institute of Orthopedic Manual Therapy (NAIOMT). The course was held at Andrews University in Berrien Springs, Michigan, and was taught by Erl Pettman, PT, MCSP, MCPA, FCAMPT, a world leader in the development and education of safe and effective spinal manipulation.

  • At Excel PT of Bozeman and Manhattan, we are dedicated to providing our patients with the highest level of physical therapy treatment. Our physical therapists focus on evidenced-based practice, rigorous continued education in specialized areas of treatment, and weekly research-based study to allow our patients to quickly and effectively achieve the best results. To further ensure preeminent physical therapy services and patient care, each of our patients are directly treated by our licensed, specialty certified physical therapists – without interaction from assistants or aides.

Proper Computer Ergonomics for a Healthy Neck & Back

By David Coletta, MPT, CMPT
david@excelptmt.com

Proper Computer Ergonomics for a Healthy Neck & Back

Using computers have become a normal part of most people’s daily lives.  For many of us, sitting at a desk top or laptop computer can last several hours every day.  Do you suffer from neck pain, upper back pain, or headaches?  Could poor posture at the computer be a contributing factor to such complaints? A 2012 study (Cho et al) found that 254 surveyed Chinese office workers, between 25 and 40 years old, working 3+ hours per day at the computer, had a 71%-76% prevalence of neck pain and a 60%-64% prevalence of upper back pain.       

 How often do we find ourselves stuck in postures such as this?  Poor positioning, most often producing a forward head, causes undue stress on the neck and upper back muscles and joints.  Over time, the soft tissues cannot bear the burden without developing tightness and inflammation.  Such complaints lead to pain and a visit to the physical therapist, massage therapist, or doctor in search of relief.

 A proper desktop set-up starts with a higher quality supportive computer chair, which securely supports the lower back lordosis, has great deal of adjustability, and comes with padded arm rests (forearm rests on padding).  A large computer screen, with the top edge placed just above eye level, is optimal.  The keyboard and mouse should be easily accessible to the hands so that the elbow can rest under the shoulder.  The ultimate goal is to have the ear, shoulder, elbow, and hip almost in a perfect vertical line.

 Posture Photo 2 3-28-2014If the top of your desk is too high, then your keyboard and mouse can be placed on an adjustable external tray that is secured underneath this surface.  Obtaining proper ergonomics can be a good deal more challenging with a laptop computer, but purchasing an external keyboard and mouse or a laptop stand can be helpful.  These and other computer ergonomic products can be found online at ergopro.com

 

If you have specific questions about how to improve your computer ergonomics, contact David Coletta, MPT, CMPT at Excel Physical Therapy, 406-556-0562 in #Bozeman, Montana.

David Coletta's Personal Bout with Acute Neck Pain: Recovery Part 2

By David Coletta, MPT, CMPT
david@excelptmt.com

My Personal Bout with Acute Neck Pain: Recovery ~ Part 2 of 3

Recovery

As a physical therapist specializing in treatment of the spine, I had a great deal of experience with the physicians at Bridger Orthopedic & Sports Medicine.  This seemed like a good place to seek advice and help for my agonizing condition.   I called Christine, a patient care coordinator at Bridger, and she was kind enough to get a same day appointment for me with Dr. Speth and Bryce Wiley, PA-C.  They performed a very thorough evaluation and determined that I most likely had a cervical radiculopathy.  I was in for a cervical MRI the next day and Bryce called to inform me that the imaging revealed a left C5/C6 disc bulge with compression on the C6 nerve root.  There was also some cervical arthritis present in the mid to low neck.

Again, the patient care coordinators (Christine & Shane) quickly scheduled me for a cervical steroid injection with Dr. Slocum at the surgery center, just below Bridger Orthopedics & Sports Medicine.  Dr. Slocum was kind enough to come downstairs between seeing patients and perform a transforaminal steroid injection in the neck.  During the procedure, I took the opportunity to dissect what was going on.  Some of my patients go through spinal injections and they will often ask me if it is painful.  Now I was about to find out.  I’m sure the experience is different for all people, but my procedural pain was considerable, though quite brief.  Dr. Slocum injected around C6 on the left and for about 5 to 6 seconds I felt all of the pain that I had experienced over the last week and a half condensed into my neck, shoulder blade, and arm.  Within a few minutes there was some relief.  Dr. Slocum explained that the injection could take 1 to 2 weeks for the full positive effect, but I would experience an initial decrease in pain within the first day, which might not last.

The next morning I woke up and felt 90% better.  I could move my neck, lie down comfortably on my back, and work on patients without concentrating on my own pain.  Slowly, by the next day this reduction in pain slid backwards to about 50% better.  I had a problem.  Two days later, I was to be on a flight to Chicago for a much anticipated PT continuing education course.  Bryce prescribed me another round of oral steroids and more hydrocodone for pain relief.  I made it to Chicago, wearing a soft cervical collar on the airplane to support my neck. 

I arrived at my continuing education course tired, now only 40% better, and unable to sit during the presentation.  I was truly blessed to be traveling with Jason Lunden, one of our sports specialist PTs from Excel PT, and sitting next to another experienced PT named Effie.  During the first break she looked at me and asked if I was OK.  She got the full story.  Effie said “I can help you.”  I immediately explained how serious this problem was and that I probably was not appropriate for hands-on PT treatment.  She assured me that her specialty was in spine.  Sounds familiar.  Effie performed left sided cervical and upper thoracic joint mobilizations, soft tissue techniques to the shoulder blade and shoulder muscles, and traction to the neck.  These techniques were more aggressive than I would have chosen for my patients, but I was willing to try anything and I trusted her.  After 10 minutes of treatment, my pain was reduced greatly and I practically fell asleep on the table.

Effie treated my neck again on the following 2 days of class and, by the time I returned home to Bozeman, the symptoms were improved to 75% of normal.  I continued under the care of Megan Peach, at Excel PT, and I reached 95% improvement over the next month with physical therapy treatments 2x/weeks.  The remaining 5% of symptom reduction and full strength in the left arm took 2 to 3 more months of performing my exercises independently.  

Click Here to read David’s Personal Bout with Acute Neck Pain: Lessons Learned ~ Part 3 of 3

Click Here to read David’s Personal Bout with Acute Neck Pain: The Onset ~ Part 1 of 3

David Coletta's Personal Bout with Acute Neck Pain: Lessons Learned Part 3

By David Coletta, MPT, CMPT
david@excelptmt.com

My Personal Bout with Acute Neck Pain: Lessons Learned ~ Part 3 of 3

Lessons Learned

I believe that there was a silver lining or a purpose to why I experienced this cervical radiculopathy.  As health care practitioners, we sometimes lose perspective on the severity of what our patients are dealing with.  The terrible pain, decrease in function, and loss of sleep will be hard to forget.  I gained valuable familiarity with the use of a Saunders Cervical Traction Unit and other treatments that are best for an acute and sub-acute radiculopathy.  I also became more personally familiar with the use of different medications to treat this condition.

Perhaps the most valuable lesson learned was an appreciation for how important good physical therapy and excellent physician specialty care are.  I would not be where I am today without the tremendous care from Megan and Effie (my physical therapists), Dr. Slocum, and the doctors at Bridger Orthopedics and Sports Medicine.  Hands on manual therapy, exercises, diagnostic imaging, and epidural steroid injection were all very helpful to me.

This ordeal has helped me to be a better physical therapist when treating the neck.  I value the experience over any class or formal education in my past.

Click Here to read David’s Bout with Acute Neck Pain: The Onset ~ Part 1 of 3

Click Here to read David’s Bout with Acute Neck Pain: Recovery ~ Part 2 of 3

Effects of High Heels on Body

By Tiffany Coletta
tiffany@excelptmt.com

Now we love a good pair of heels too, but we saw this information and wanted to pass it on.  Perhaps worn more in moderation…. “Ever wondered the effects of high heels on your feet and body? Often painstakingly selected to complete outfits, high heels put stress not just on feet, but on ankles, knees and backs, contributing to the approximately $3.5 billion spent annually in the United States for women’s foot surgeries, which cause them to lose 15 million work days yearly.”

https://i1.wp.com/www.mainstreetphysio.ca/blog/wp-content/uploads/2013/08/HighHeels18.jpg?resize=588%2C1111

 

SOURCE: American Academy of Orthopaedic Surgeons, American Apparel & Footwear Association, American Orthopaedic Foot & Ankle Society, Mayo Clinic, Society of Chiropodists and Podiatrists, “Women’s Shoes and Knee Osteoarthritis,” by D. Casey Kerrigan, Jenn.

"Pregnancy & Exercise: Rewards, Risks & Recommendations" Seminar June 5th, 2013 6:30pm

By Megan Peach, DPT, OCS, CSCS
megan@excelptmt.com

Community Education Seminar ~ free and open to the public

 

“Pregnancy & Exercise: Rewards, Risks & Recommendations” presented by Megan Peach, DPT, CSCS

  • Wednesday, June 5, 2013  6:30-7:30pm
  • Bozeman Library Large Community Room
  • Come dressed to move!

 

 

  • Discover the benefits and risks of aerobic and resistance exercise during pregnancy.
  • Learn how to exercise safely with specific exercise recommendations to do during pregnancy.
  • Ask Our PT: Q&A with Megan after the talk. 

Megan specializes in manual treatment of spinal dysfunction, as well as knee and shoulder pain. After receiving a Bachelor of Science in exercise science from Montana State University, Megan earned a doctorate in physical therapy from Duke University. Post-graduation, Megan became a Certified Strength and Conditioning Specialist and is currently a member of the National Strength & Conditioning Association. Shortly thereafter, Megan completed the Kaiser Permanente Residency program in advanced orthopedic manual physical therapy in San Francisco, California. Megan’s philosophy for physical therapy treatment embraces educating patients about the tools they need for enhancement of proper body movements during work and play to promote a pain and injury free active lifestyle.

Megan is an expectant mom herself and enjoys outdoor activities such as rafting, backpacking, photography, and especially loves hiking with her husband and great danes.

Join Excel PT on twitter #excelptmt and facebook for more details and community education series seminar updates.

Posture: “Sit Up Straight, Don’t Slouch!”

By Tiffany Coletta
tiffany@excelptmt.com

Posture: “Sit Up Straight, Don’t Slouch!”

“Sit up straight, don’t slouch!” Those words echo in my head close to the spot where I can almost feel the slap on the back of my head from my mother’s hand as she reminded me to sit up straight at the dinner table.

As a physical therapist, I can now appreciate the benefits of maintaining appropriate posture. Almost daily, I see patients with neck, back or shoulder pain. The majority of these patients have noticeably bad posture. We all do. It’s a constant battle between aging, our bodies and gravity. We must work to maintain appropriate posture or our bodies “slouch” into the easiest position, succumbing to the force of gravity and our office chair.  

From a mechanical standpoint it all makes clear sense. Keep in mind, that it is scientific fact, that our entire body is related. One system affects the other.  If our shoulders are “slouched” forward as we sit at our office desk, our neck must then extend to compensate so that we can continue to view the computer or look forward. The vicious cycle continues to take its toll. The muscles across our chest get short and tight, adapting to this poor posture. In return, the muscles between our shoulder blades and on our back become elongated and weak, further adding to the problem. This affects the mechanics of our shoulders. It also alters the mechanics of our middle and low back.

Simply put, poor posture places additional stress on your spine and the muscles, ligaments, and other soft tissue surrounding it. There is a solution however! Sit up straight. Here are few recommendations to sit properly and some simple exercises you can do on your own to address your posture.

 

1)      You may have to alter your work station to make it more posture and ergonomically friendly.

2)      Try a towel roll for lumbar support

  • Make a towel roll with a (6-8) inch diameter
  • Place behind low back
  • Sit up with shoulder blades down and in your back pockets

3)      Stretch the muscle across the front of your chest.

                  

4)      Strengthen the muscles across your back.

      

 

Make all of these simple exercises a habit!

 

A statesman who keeps his ear permanently glued to the ground will have neither elegance of posture nor flexibility of movement.   Abba Eban

 

Adam Groves, DPT specializes in the treatment of back pain, neck pain, whiplash, general orthopedic conditions, and vestibular or balance disorders. He received his doctorate of Physical Therapy degree from the University of St. Augustine for Health Sciences in St. Augustine, Florida. Training under the instruction of Dr. Stanley Paris at St. Augustine’s highly regarded manual therapy program, Adam developed his specialized, comprehensive treatment approach.

Prior to completing his doctoral education, Adam received his Bachelors of Science in Education, with a major in Exercise Science from the University of Tennessee. There he worked as a student athletic trainer with men’s athletics, and focused on physical wellness, conditioning and athletic performance.

 

Lumbar Spinal Stenosis in the Aging Spine

By David Coletta, MPT, CMPT
david@excelptmt.com

Lumbar Spinal Stenosis in the Aging Spine

Lumbar Spinal Stenosis (LSS) is a clinical diagnosis made by taking a careful history, utilizing physical tests, and analyzing spinal imaging, such as MRI.  Symptoms of LSS include low back pain and weakness, cramping, pain, or fatigue in one or both legs.  Such symptoms are brought on usually by walking and relieved by sitting or forward bending.  MRI evidence of LSS will reveal a narrowing of the central spinal canal and/or narrowing of the intervertebral foramen on either side of the spine.  In both cases, spinal nerves become affected, leading towards neurogenic claudication.  Neurogenic Claudication is a condition where the stenosis, or site of narrowing that leads to compression, causes disturbed blood flow to the spinal nerves.  Eventually, the spinal nerves become dysfunctional in their attempt to control the muscles of the lower extremities, and the above symptoms ensue.

Symptoms of LSS include low back pain and weakness, cramping, pain, or fatigue in one or both legs.

Studies reveal that as many as 80% of subjects, age 70 or older, have MRI evidence of LSS.  However, many of the same subjects do not have the clinical condition of LSS, because they don’t suffer from the physical complaints that match this diagnosis.  The stenosis that is found with the imaging can be considered a normal part of aging in the spine.  The discs and joints in the low back will naturally break down, causing bone spurs and disc bulges.  Such protrusions into the passageways of the spine don’t always lead to symptoms that are the hallmark of LSS.

As a physical therapist, many of my older patients will arrive with an MRI that will show severe degenerative breakdown of the lumbar spine.  Sometimes they will also have a prescription from their doctor with diagnosis of LSS.  But a careful physical therapy evaluation is always done to determine if the clinical condition of LSS truly exists or does the patient have low back pain or leg symptoms coming from a degenerative or arthritic lumbar spine, with neurogenic claudication.  The physical therapy treatment will be somewhat different in either case.

Physical therapy interventions to treat LSS include hip stretching and back strengthening exercises, cardiovascular exercise, joint mobilization to the lumbar and thoracic spine, and patient education to alter aggravating activities.  Another important part of treating LSS patients is reassurance.  Research reveals that patients with mild to moderate LSS will improve with time.  Another study showed that long-term results, comparing physical therapy to lumbar spine injections in LSS patients, were equal when looking at pain reduction and functional mobility.  If you suffer from LSS, then physical therapy can be a safe, cost effective, and conservative place to start on a path towards improving your quality of life.

 

If you suffer from Lumbar Spinal Stenosis, then physical therapy can be a safe, cost effective, and conservative place to start on a path towards improving your quality of life.

Jeff Moore and Jason Lunden to speak at Montana APTA Spring Conference

By Tiffany Coletta
tiffany@excelptmt.com

Excel Physical Therapists, Jeff Moore, DPT, MTC will present “Spinal Manipulation: An Evidence-Based Intervention” and Jason Lunden, DPT, SCS will present “Rehabilitation of the Injured Runner: An Evidence-Based Approach” in Billings, Montana on April 17th, 2011. 

 

Their presentation will be attended by the Montana American Physical Therapy Conference Members which includes physical therapists from all over the state.

 

Click on the following link to access the MAPTA Spring Conference Brochure which outlines both Jason and Jeff’s presentation points and biographies:

MAPTA Edu_2011_Spring

Spinal Manipulation: Does It Help Neck and Back Pain?

By Tiffany Coletta
tiffany@excelptmt.com

Spinal Manipulation: Does It Help Neck and Back Pain?

Spinal Manipulation is a widely used tool to treat patients with neck and back pain, and for good reason. Evidence for the effectiveness of utilizing manipulation in certain subgroups of patients with spine pain is strong.  In 2004, one of the largest randomized controlled trials ever performed looked at whether spinal manipulation, spinal manipulation with exercise, or just exercise alone was best to treat patients with low back pain1.  The result suggested that not performing manipulation resulted in significantly worse outcomes.  The situation is similar in the neck.

 

This year a study was published comparing patients who received an exercise and stretching program versus patients who received the same program but also received two sessions of thoracic spine (upper back) manipulation2.  At the conclusion of the study 37.5% of patients in the exercise and stretching group were considered a success where as 81% of patients in the group that received manipulation were successes.

 

Overall the body of evidence to support spinal manipulation continues to build very rapidly. Next time you experience neck or back pain, ask your health care provider if spinal manipulation may help to more quickly and fully resolve your symptoms.

 

1. UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ. 2004; Dec 11;329(7479):1381. Epub 2004 Nov 19

2. Cleland JA, Mintken PE, Carpenter K, Fritz JM, Glynn P, Whitman J, Childs JD. Examination of a clinical prediction rule to identify patients with neck pain likely to benefit from thoracic spine thrust manipulation and a general cervical range of motion exercise: multi-center randomized clinical trial. Phys Ther. 2010 Sep;90(9):1239-50. Epub 2010 Jul 15

 

Jeff Moore, DPT, MTC

jeff@excelptmt.com

"On a scale of 1-10, I give a 12 rating. The whole team deserves special recognition and Megan is excellent." --Bozeman Patient's Dad

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