Month: November 2010

An interesting clinical pilot study was recently
published in The Spine Journal that looked at changes in lumbar
disc height before and after normal sitting with the use of
a seated unloading exercise intervention.

Fryer et al. (2010) used upright MRI to measure changes in height
and configuration of the lumbar discs after sitting and a chair-care
decompression exercise.

Their premise is that sitting is associated with loss of lumbar lordosis
disc compression and height loss which possibly increases the risk of
low back pain.  So they proposed a practical strategy for the sitting based
jobs to prevent lumbar flattening and perhaps low back pain.

MRI scans of the disc height were taken at various intervals:
before sitting, after 15 minutes of relaxed sitting, immediately after
the seated unloading exercise and again at the 7 minute mark after
the exercise.

Their limited anectodal findings indicate that the chair-care exercise
has an immediate effect on the sitting related low back pain through
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Below is a picture of the exercise:

it involves 5 seconds of unloading and 3 seconds of reloading

and repeating the sequence 4 times

Although the current study has several limitations this seated unloading
exercise may represent for the manual therapist a symptomatic and even
preventative intervention for sitting pain among sedentary workers.

Adapted from:
Fryer J, Quon J, & Smith F. Magnetic Resonance imaging and stadiometric assessment of the lumbar discs after sittingand chair-care decompression exercise: a pilot
study.  The Spine Journal 10 (2010) 297-305.

To Your Manual Therapy Success!

PLEASE COMMENT AND SHARE

Michael

Yes it does….

Gross et al. 2007 report in their
systematic review of 84 randomized controlled
trials (RCTs) that there exists strong evidence
of being able to control mechanical neck pain.

However, a multimodal approach including stretching
and strengthening exercises, and mobilization and
manipulation techniques, was significant in
improving function and decreasing subacute and
chronic mechanical neck pain.

There was moderate evidence to support the use
of intermittent traction as a manual therapy
technique. This is especially true when combined
with direct neck strengthening and stretching
exercises for chronic neck pain.

Acute pain was defined as pain lasting
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and chronic pain as being greater than 90 days.

Clinically, I have found that when I have
incorporated exercise with manual therapy techniques
of the neck, pain and mobility significantly improve.

Adding in exercises like deep neck flexor
strengthening, and stretches of muscles like
Levator Scapula, Scalene Muscle group and
Suboccipital Muscle groups have been very
useful for my clinical practice.

For more detailed information on this topic,
I highly recommend to read the following article:

Gross et al. Conservative Management of Mechanical
Neck Disorders: A Systematic Review. 
The Journal of Rheumatology 2007; 34:3

To Your Manual Therapy Success!

Please comment and Share.

Here is the final post for this series on elbow
muscle stabilization in facilitating the treatment
of Lateral Epincondylitis.

There are three important muscles to consider
retraining, especially after any Manual Therapy
Techniques have been performed to the elbow.

Elbow Muscle Stabilization Techniques:

Try these on yourself as you read along.

Anconeus Muscle Retraining Technique

Activation with tactile feedback,
Elbow flexed to 90 degrees, neutral, palpate
posterior/inferior to the lateral epicondyle.

Then resist extension with low effort in
pronation ( or supination)

Then perform eccentric elbow flexion and
during deceleration of elbow flex, anconeus activates.
Then stop midrange and maintain tension in anconeus.

Supinator Muscle Retraining Technique

Activation with elbow flexed to 90 degrees with a
neutral position, then resist low effort activation
of supinators.

Add deviation and move from radial to ulnar deviation
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Pronator Quadratus Retraining Technique

Activation with elbow flexed to 90 degrees with a neutral
position, then reisist low effort contraction of pronation
while palpating at anterior distal radius.

Have the client manually self distract the distal
radial-ulnar joint with their thumb on anterior distal
radius and index finger on posterior ulna.

Have them actively pull the 2 bones back together while
resisting pronation with a low effort isometric contraction
with the wrist in a neutral position.

Add a power gripping progression with a low effort
ball gripping motion in neutral wrist.  This has an effect
on the palmar fascia which is continuous with Pronator Quadratus.

 I have used these very successfully clinically and have found
them to be especially useful with distal radial-ulnar joint
dysfunction at the wrist.

You may want to include some of these techniques to compliment
your Manual Therapy practice. 

Please comment, share and let me know if you

have any success with using these

Elbow Muscle Retraining Techniques.

To Your Manual Therapy Success