I have recently been thinking quite a bit about the importance of joint mobility, not strictly for function, but for joint health. In manual therapy, assessment of a given joint in the body always consists of consideration of joint mobility. Is there enough mobility? If not, why not? Does the joint itself have a motion restriction? Or is there perhaps some tissue outside the joint, like a tight muscle, that is limiting mobility? While it makes sense that a certain degree of motion is important for functional tasks, like bending your knee a certain amount to ascend stairs, mobility is also critical for joint health. (more…)
Although tinnitus, or ringing in the ears, can be a sign of serious brain pathology, tumors, and hearing loss, this condition can also be often diagnosed by your physician as idiopathic tinnitus. Such a diagnosis indicates no known or verifiable cause to the ringing in your ears. Ruling out the more concerning problems through brain imaging, neurological testing, and hearing tests is helpful, but often leaves the patient with no real answers about how to decrease or eliminate the annoying sound. One theory regarding the source of idiopathic tinnitus centers on the musculoskeletal system as a trigger for ear ringing. (more…)
Community Education Series – free and open to the public – join us!
“Conquering Neck Pain: Self-Help Techniques & Treatment Options”
Presented by David Coletta, MPT, CMPT, Certified Manual Therapy Specialist
Wednesday, December 3, 2014
Bozeman Public Library Community Room
What You Will Learn:
- How neck pain develops and becomes chronic.
- What the anatomic sources of neck pain are.
- How a specialized physical therapist utilizes manual therapy, patient education, exercise, and dry needling techniques to treat neck pain.
- How improving posture can alleviate neck pain.
- Which exercises are most effective in self-treatment of neck pain.
- Other self-treatment techniques.
- There also will be time at the end of the seminar to speak with David regarding your specific neck problem.
David Coletta, MPT, CMPT has specialized in the treatment of back and neck pain, spinal issues, whiplash, headaches, TMJ/jaw pain, and postural dysfunctions for over 15 years. David received his masters in physical therapy from Mount St. Mary’s College in Los Angeles, California. He enjoys finding long-term solutions for his patients — solutions that involve a fine-tuned combination of manual manipulative therapy and a targeted exercise program that address even the most difficult patient presentations. A considerable amount of David’s training from leading physical therapy clinicians has occurred through the North American Institute of Orthopedic Manual Therapy (NAIOMT). He has completed advanced certification in manual therapy (CMPT) with NAIOMT and has received advanced training in dry needling techniques for the spine and extremities. David is also a Certified Clinical BikeFit Pro Fitter.
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
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.
If 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
My Personal Bout with Acute Neck Pain: The Onset ~ Part 1 of 3
Evaluating and treating individuals with neck pain has been my specialty over the past 15 years. I have literally treated over a thousand people suffering from this affliction. Recently, neck pain became a much more personal issue, as I experienced the sort of agony which some of my patients deal with. For the past 20 years, my neck has been intermittently stiff, with the occasional inability to turn my head for a day or two and what felt like an acute muscle spam, but there has been nothing of serious concern. This was different. While still in bed, I opened my eyes in the morning and noticed neck stiffness when turning over. Could this be one of those mornings where there would be trouble turning my head? Better to get up slowly. I sat up and immediately felt a rush of nauseating pain sweeping into my low neck and then shooting into my left shoulder blade. I don’t have time for this I thought. Into the shower for some hot water on the neck and down the hatch with 600mg of Ibuprofen. I drove to work applying traction to my neck with both hands and steering with my elbows and knees. A smarter man would have just stayed at home and called in sick. But I had patients that depended on me.
Luckily, this was my short day of the week at work. My neck pain steadily grew worse and by 2PM I was stuck with my head down and turned to the right, avoiding the worst ache. I utilized a home traction unit from work and had to go very slowly and gently not to aggravate my symptoms. That night, I managed about 2 hours of sleep, constantly readjusting to avoid pain.
The next morning, I called a physician friend of mine and he prescribed me a round of oral steroids. After 3 days, my neck pain slowly started to improve and within 1 week I was 75% better and training on my road bike for short periods. Unfortunately, this progress did not last.
8 days after the initial onset, my symptoms suddenly returned in the morning and were even worse. At this point I had to be honest with myself about the serious nature of my neck problem. My symptoms included weakness in the left arm, severe pain behind the left shoulder and into the shoulder blade, severe neck pain, numbness in the left hand, and I could not extend my neck or turn to the right. This was a very familiar presentation, a cervical radiculopathy. It had to be a disc bulge in my low neck that was inflaming and compressing one of the spinal nerves. Megan Peach, DPT, here at Excel PT did a great job at treating my acute problem, but my presentation was too severe to benefit from PT at that time. I decided to make an appointment with a local orthopedic specialty physician.
My Personal Bout with Acute Neck Pain: Recovery ~ Part 2 of 3
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.
My Personal Bout with Acute Neck Pain: Lessons Learned ~ Part 3 of 3
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 links below to access Flyer info for Nov. 14th Neck Pain and Dec. 5th Skiing & Snowboarding Injury Prevention Seminars:
Excel Physical Therapy Participates in a Research Study on Cervicogenic Headaches
Seeking Research Study Participants
Headaches can cause lost time from work, visits to multiple physicians, and a general loss in quality of life. The major categories include migraine headaches, tension headaches, TMD headaches, and cervicogenic headaches. While cervicogenic headaches are not the most common type of headache, the prevalence in the general population is estimated at 15%.
Cervicogenic headaches are defined as one sided, or one side dominant, head pain, which is caused by a neck problem. Other symptoms include stiffness in the neck, decreased range of motion in the neck, increased headaches with neck movements or poor cervical postures, and a possible history of trauma. Although physical therapy can be effective in treating tension headaches and TMD related headaches, cervicogenic headaches have shown, in multiple studies, excellent response to manual therapy. Mechanical joint and muscle restrictions in the neck lead to a referral of pain into the head (cervicogenic headache). Manual therapy based physical therapy utilizes hands-on techniques to restore muscle and joint mobility, eliminating the head pain.
Interestingly, research indicates that manual therapy success in treating cervicogenic headaches does not depend on chronicity. Cervicogenic headache patients can benefit from manual therapy treatments whether the symptoms have been present for 20 days or 20 years! As a manual physical therapist for 15 years, my success rate with treating cervicogenic headaches has been very high. Our research from this study hopes to clinically show which manual therapy techniques are the most effective for treating cervicogenic headaches.
Excel Physical Therapy is enrolled as a clinical site in a national research study to determine the best manual therapy techniques to treat cervicogenic headaches. There are several other clinical sites throughout the United States also collecting data on real patients being treated in a physical therapy environment. Mobilization or manipulation of the neck and upper back are the two manual therapy variables in this study. Mobilization is a joint “popping” technique and mobilization is a joint “stretching” technique.
The Treating PT at our clinical site is skilled and trained in performing both spinal mobilization and manipulation. One treatment group will receive only manipulation and the other treatment group will receive only mobilization and exercise. We anticipate that both groups will benefit from the manual therapy treatments, but the magnitude of improvement is part of our research question. Both groups will have 6 physical therapy visits over 2 to 4 weeks.
We are looking for patients to be part of this study – To be included:
patients must have one side dominant head pain, pain in the neck or the base of the skull that is felt to project into the head, and at least one headache per week for at least 3 months.
Patients cannot be included in the study if they have a history of stroke, high blood pressure, high cholesterol, diabetes, heart disease, peripheral vascular disease, smoking, or whiplash injury to the neck in the last 6 weeks.
Patients are not being offered free treatments in this study. As with all of our patients, cost for physical therapy services will follow our normal fee schedule and we are happy to bill your insurance or provide you with a payment plan. In most cases, a doctor’s prescription is not required to receive physical therapy services in Montana. Excel Physical Therapy is a preferred provider for many insurance companies as well.
Please contact me if you meet the criteria for this study or if you have any questions.
David Coletta, MPT, CMPT -Treating Physical Therapist
david at excelptmt.com (insert the @ sign in your email message)
"I really can't think of any improvements. You guys are great!" --T.K., Bozeman PatientView more testimonials from Excel PT clients »