Bluegrass Doctors of
Physical Therapy, PLLC

Concierge Manual Physical Therapy and Interventional Dry Needling Experts

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TMJ and Daily Life

Posted on November 9, 2018 at 3:50 AM

Don’t let TMJ (temporomandibular joint) dysfunction hijack your life. When it comes to managing chronic pain, small steps can make a big difference.


Sometimes Less is More

 

If you’ve had temporomandibular disorder (TMD) for any length of time, you are probably willing to try almost anything that promises a better quality of life. Keep in mind that an episode of worsening TMJ pain is often caused by inflammation around the joint itself. Sometimes, a few simple changes are all it takes to reduce the inflammation and stop the pain for a while.

 

Have you Tried and Failed?


We’ve all seen TMD handouts telling patients to eat soft foods, to use ice packs, and to avoid extreme jaw movements. These are well-intentioned ideas, but do they make sense in your daily life? Do you keep an ice pack in the office? Are you willing to subsist on a nursing home diet? Can anyone really avoid yawning?


TMJ Pain Relief for the Real World


Five Easy Ways to Relieve TMJ Pain Right Now:


1. Give up the gum habit.


Some people with TMJ dysfunction believe their symptoms might actually improve if they chew gum; after all, if jaw muscles get tight and sore, they should be exercised, right? Wrong. Unless you have taken a vow of silence and never eat solid food, your jaw muscles are getting enough of a work out already. If you absolutely must chew gum, be sure to chew for no more than three minutes before tossing it.


2. Try a quick and easy DIY massage.


Gently massaging the masseter—the powerful muscle that opens and closes your jaw--can relieve jaw tension and muscle pain. You may find it simpler to employ a set of therapy balls to do this massage. (Click here for a video tutorial.) This gentle technique is easy to learn and reduces muscle tension. It can improve chronic pain from conditions like TMD.

 

3. Fight pain with acupressure/Trigger point pressure.


Acupressure is a great way to help relieve TMD pain. Acupressure uses the same body points as acupuncture to activate the healing process. While acupuncture activates these points more strongly, you can try acupressure on your own. There are a host of online resources for finding acupuncture points. You may be surprised to discover that some of your most effective points for TMJ relief are nowhere near your jaw.

 

4. Relax your jaw.


Are you clenching right now? Whenever you notice tightness or pain, try to lower your jaw very slightly until your teeth stop touching. This is easily done with your mouth closed, so no one will notice. If your tongue is pressing upward on the roof of your mouth, this is the time to let it drop back down. The goal is to keep your teeth from touching, and to keep your jaw relaxed, for most of the day. With practice, you may be able to drastically reduce TMJ pain caused by clenching.


5. Check your posture. 

Is your head on straight? If you’re not sure, have someone take a picture of you from the side while you sit or stand as upright as possible. If your ear is not in line with your shoulder, you may suffer from forward head posture. Along with the spinal misalignment mentioned here, forward head posture can contribute to TMJ pain. To help correct your posture, try this simple exercise: lie down on the floor—or stand tight against a wall--and tuck yourchin to your chest as if you are trying to make a double chin. Repeat. This exercise strengthens the muscles in your neck and can help relieve TMD pain.




March 2018 Newsletter

Posted on March 2, 2018 at 10:20 AM

What is Musculoskeletal Ultrasound?

Ultrasound imaging uses sound waves to produce pictures of muscles, tendons, ligaments and joints throughout the body. It is used to help diagnose sprains, strains, tears, and other soft tissue conditions. Ultrasound is safe, noninvasive, and does not use ionizing radiation.

 

What is Ultrasound Imaging of the Musculoskeletal System?

Ultrasound is safe and painless, and produces pictures of the inside of the body using sound waves. Ultrasound imaging, also called ultrasound scanning or sonography, involves the use of a small transducer (probe) and ultrasound gel placed directly on the skin. High-frequency sound waves are transmitted from the probe through the gel into the body. The transducer collects the sounds that bounce back and a computer then uses those sound waves to create an image. Ultrasound examinations do not use ionizing radiation (as used in x-rays), thus there is no radiation exposure to the patient. Because ultrasound images are captured in real-time, they can show structures under the stresses they endure with normal movement. It is this unique property that allows us to see compromises of ligaments and tendons quite easily.

 

 

What are some common uses of the procedure?

Ultrasound images are typically used to help diagnose:

• Tendon tears, or tendinitis of the rotator cuff in the shoulder, Achilles tendon in the ankle and other tendons throughout the body.

• Muscle tears, masses or fluid collections.

• Ligament sprains or tears.

• Inflammation or fluid (effusions) within the bursae and joints.

• Early changes of rheumatoid arthritis.

• Nerve entrapments such as carpal tunnel syndrome.

• Benign and malignant soft tissue tumors.

• Ganglion cysts.

• Hernias.

• Foreign bodies in the soft tissues (such as splinters or glass).

• Dislocations of the hip in infants.

• Fluid in a painful hip joint in children.

• Neck muscle abnormalities in infants with torticollis (neck twisting).

• Soft tissue masses (lumps/bumps) in children.



 

Mindful Observation

This exercise can be simple but powerful by helping you start to appreciate seemingly simple elements of your environment.

 

The exercise is designed to connect us with the beauty of the natural environment, something that is easily missed when we are rushing around in the car or hopping on and off trains on the way to work.

 

1 Choose a natural object from within your immediate environment and focus on watching it for a minute or two. This could be a flower or an insect, or even the clouds or the moon.

2 Don’t do anything except notice the thing you are looking at. Simply relax into watching for as long as your concentration allows.

3 Look at this object as if you are seeing it for the first time.

4 Visually explore every aspect of its formation, and allow yourself to be consumed by its presence. Notice the color, shapes, textures, movements, and sounds.

5 Allow yourself to connect with its energy and its purpose within the natural world.

Throughout the month of March give your mindful observation a try. When waiting for a friend or family member practice this observation. Don’t forget about your breathing and continue to practice the mindful breathing you practiced last month.




 

 

Reciprocating Gifts.

Posted on September 15, 2017 at 10:00 AM

Great Tumblers a patient made us. We are so fortunate to work with such a great group of people!

TMJ the hard case!

Posted on August 24, 2017 at 10:15 AM

Temporomandibular joint dysfunction

 

 

Introduction

The temporomandibular joints (TMJ) connect your lower jaw to your skull. There are two matching joints, one on each side of your head, just in front of your ears. They let your jaw move up and down and from side to side.

The abbreviation "TMJ" refers to the joint but is often used to refer to any problems with the joints. Such problems include:

Popping sounds in your jaw

Not being able to completely open your mouth

Jaw pain

Headaches

Earaches

Toothaches

Other types of facial pain

Most people with TMJ problems have pain that comes and goes, but some have chronic (long-term) pain.

 

Signs and Symptoms

TMJ problems often cause the following symptoms:

Pain, particularly in the chewing muscles or jaw joint or an ache around your ear

Limited movement or locking of the jaw

Pain in the face, neck, or shoulders, or near the ear

Clicking, popping, or grating sounds when opening your mouth

Trouble chewing

Headache

A sudden change in the way your upper and lower teeth fit together

Also, sometimes earaches, dizziness, and hearing problems

 

What Causes It?

Sometimes TMJ dysfunction can be caused by an injury, such as a heavy blow, to the jaw or temporomandibular joint. But in other cases there may not be a clear cause. Other possible causes include:

A bad bite, called malocclusion

Orthodontic treatment, such as braces and the use of headgear

Wearing away of the disk or cartilage in the joint

Stress or anxiety. People with TMJ problems often clench or grind their teeth at night, which can tire the jaw muscles and lead to pain.

 

Who is Most At Risk?

The risk for TMJ problems may be higher with these factors:

Gender: more women than men seek treatment

Age: people ages 30 to 50 have the most problems

Children and adolescents with arthritis

Grinding teeth, clenching jaw

Malocclusion (bad bite)

High stress levels

 

What to Expect at Your Provider's Office

 

Your health care provider will check muscles in the area of the TMJ, and will:

Look for asymmetry or inflammation in your face

Listen for joint clicking or scraping sounds

Test the range of motion in your jaw

Look at your teeth for evidence of jaw clenching or teeth grinding

If you are having any neurological symptoms, such as numbness, your provider will give you a neurological exam. Your provider may also order imaging tests, such as an x-ray, computerized tomography (CT) scan, or magnetic resonance imaging (MRI) scan to look for degenerative disease or disk problems.

 

Treatment Options

 

Prevention

Reducing stress and keeping yourself from grinding your teeth or clenching your jaw may help prevent TMJ problems or lessen the symptoms.

 

Treatment Plan

In many cases, you can treat TMJ dysfunction at home. Your doctor may:

Ask you to change your eating habits: cut food into small pieces, avoid too much chewing, and stop chewing gum.

Give you exercises that stretch the muscles around your jaw.

Your doctor may also recommend:

If your bite is out of alignment, your dentist may suggest you wear a biteplate over your teeth to help bring your upper and lower jaw into alignment.

If you grind your teeth in your sleep, you may be asked to wear a night guard over your teeth.

If stress is causing you to clench your jaw, your doctor may suggest stress reduction techniques or cognitive behavioral therapy to help you manage anxiety and tension.

 

Drug Therapies

Your doctor may recommend the following medications:

Nonsteroidal anti-inflammatory drugs (NSAIDs): to relieve pain. These drugs include ibuprofen (Advil, Motrin) and naproxen (Aleve).

Minor tranquilizers or muscle relaxants at bedtime to reduce spasms and pain.

Injections of a local anesthetic.

Corticosteroid injections, for severe cases.

Botox (botulinum toxin A) injections: can reduce muscle spasms

 

Surgical and Other Procedures

In some cases, removing fluid from the joint may help reduce pain, especially for people whose jaws lock. When other measures have failed, surgery may be needed to repair or take out the disk between the temporal bone and the jaw.

 

Complementary and Alternative Therapies

A comprehensive treatment plan for TMJ dysfunction may include a range of complementary and alternative therapies (CAM). Work with a health care provider who has experience treating TMJ and be sure to tell all of your doctors about any medications, herbs, and supplements you are taking. Treatments, including physical medicine, may help.

 

Nutrition and Supplements

The following nutritional tips may help prevent or reduce symptoms of TMJ dysfunction:

Eat soft foods high in flavonoids, such as cooked fruits and vegetables. Flavonoids are plant-based antioxidants that may help decrease joint pain.

Avoid saturated fats, fried foods, and caffeine. These foods may increase inflammation.

DO NOT chew gum.

 

Some supplements that may help:

Glucosamine: may reduce pain and help rebuild cartilage in the joint, which helps improve range of motion. Some studies show that glucosamine helps reduce pain in people with arthritis, which involves painful joints. One study found that glucosamine worked as well as ibuprofen (Advil, Motrin) for relieving pain and other TMJ symptoms. Glucosamine is often combined with chondroitin sulfate. Glucosamine may increase the risk of bleeding, especially if you also take blood thinners like warfarin (Coumadin), clopidogrel (Plavix), or aspirin. Some doctors think glucosamine might interfere with medications used to treat cancer. Ask your doctor before taking glucosamine and chondroitin.

Vitamin C: is also used by the body to make cartilage. It may improve range of motion in your joints, including your jaw, although there are no scientific studies investigating vitamin C for TMJ problems. Vitamin C supplements may interact with other medications, including chemotherapy drugs, estrogen, warfarin (Coumadin), and others.

Calcium and magnesium: may help the jaw muscle relax, although there are no scientific studies using them for TMJ problems. Magnesium and calcium interact with several medications, herbs, and supplements. They can also affect your heart and blood pressure, so be sure to tell your doctor before you take them.

 

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects, and can interact with other herbs, supplements, or medications. For this reasons, take herbs with care, under the supervision of a health care provider.

Cramp bark (Viburnum opulus) and lobelia (Lobelia inflata) may help reduce muscle spasms, although there are no scientific studies to support using them for TMJ problems. Rub 5 drops tincture of each herb into joint. Use on the skin only and do not apply to broken skin. DO NOT take these herbs by mouth (orally).

 

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of TMJ dysfunction based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Causticum: for burning pains

Hypericum perforatum: for sharp, shooting pains

Ignatia: for tension in the jaw

Kalmia: for face pain, especially with other joint pains or arthritis

Magnesia phosphorica: for muscle cramps

Rhus toxicodendron: for pains that feel better in the morning and in dry weather, and worse after movement or in wet weather

Ruta graveolens: for pains from overuse or injury

Physical Medicine

Contrast hydrotherapy, which is alternating hot- and cold-water applications, may:

Lower inflammation

Provide pain relief

Speed healing

Use hot packs and ice wrapped in a clean, soft cloth and apply to area. Alternate 3 minutes hot with 1 minute cold. Repeat 3 times for 1 set. Do 2 to 5 sets per day.

 

Acupuncture

Very good evidence suggests dry needling can treat TMJ dysfunction. Several well-designed studies found that needling therapies can relieve pain long term for TMJ problems.

 

Manipulation

There is some Evidence that Cervical manipulation as well as manipulation to the TMJ as well can help with TMJ dysfunction and restore range of motion

 

Craniosacral Therapy

This therapy is a very gentle form of body work. Practitioners use their hands to get rid of restrictions in the craniosacral system, the fluid and membranes surrounding the spine and brain. Although there are not many studies, some people say they feel better after craniosacral therapy. Find a practitioner who has training and experience with TMJ problems. You can interview several practitioners before deciding which one is right for you.

 

Massage

Some types of massage and chiropractic manipulation may help:

Reduce muscle spasms

Provide pain relief

Prevent symptoms from coming back

 

 

Biofeedback

Biofeedback teaches you how to reduce muscle tension through relaxation and visualization techniques. At first, sensors are placed on your jaw, and a machine shows the amount of tension in your muscles. Using relaxation and visualization techniques, you learn to reduce the amount of tension around your jaw while the machine provides instant feedback so you can see how you are doing. Once you have mastered the technique, you can do the relaxation and visualization techniques anywhere, without the machine.

Improving posture

Two types of movement therapy can sometimes help treat TMJ problems: the Alexander technique and the Feldenkrais method.

The Alexander technique teaches you how to properly align your head, neck, and spine, and move your body. It can help relieve tension in your head and jaw muscles, which may reduce the symptoms of TMJ dysfunction.

The Feldenkrais method teaches you to recognize bad posture habits and movements that cause your body to tense. It is a gentle therapy aimed at making you more aware of how your body moves, and helping you develop an inner awareness of your body. Feldenkrais is popular with dancers and musicians, who often do repetitive motions that can lead to overuse injuries.

 

Prognosis and Possible Complications

About 75% of people with TMJ problems who follow a treatment plan with more than one treatment find relief. In rare cases, long-term teeth clenching or grinding, injury, infection, or connective tissue disease may cause degenerative joint disease or arthritis. If you have severe grinding, a nighttime bite guard worn inside your mouth may help.

 

Following Up

You may need to see your health care provider regularly to make sure your treatment plan is working for you.

 

Do not reuse needles!!!!!!

Posted on April 5, 2017 at 10:15 AM

Here is a microspcopic view of a filament needle at various stages of "use". Many people "re-use" their needles to save money. Needles are Cheap (relatively speaking)...people aren't. Get a NEW NEEDLE. 




Updated evidence on Fibromyalgia

Posted on December 17, 2016 at 9:05 AM

The global burden of chronic pain has reached epidemic proportions; furthermore, it is estimated that 136 million Americans are currently suffering with chronic pain.1 Despite this large number, the diagnosis and management of conditions such as Fibromyalgia Syndrome (FMS) remains poorly understood, widely criticized, and routinely mistreated by physical therapists and medical physicians alike. The use of dry needling is described in the literature as a novel and potentially effective intervention for treating FMS. Despite the evidence supporting neuronal plasticity and centrally-mediated changes in chronic pain, the traditional conservative interventions for FMS have exhausted light exercise, gentle mobilization, and/or electro-thermal modalities, with little more than poor patient outcomes. Perhaps it is time to change the way we treat chronic pain and utilize the best possible evidence to guide us in delivering the highest quality of care for conditions such as FMS.

A large body of evidence supports that exercise has little to no benefit in patients with FMS, and further, that chronic muscle pain appears to worsen with exercise.2,3 McVeigh et al found 85% of patients with FMS reported increased fatigue and pain following exercise.4 Therefore, perhaps the repetitive movement or “more exercise for everyone” model does not fit all categories or patient conditions.

The concept of neuroplasticity, or the structural and functional cortical changes related to chronic pain states, has been described by multiple sources.7,8 Neurophysiologic changes have been identified at multiple levels of the central nervous system including the spinal cord, brainstem, and cortex.9,10,11,12 Coghill et al found specific brain areas of increased activation in chronic pain states including the anterior cingulate cortex, primary somatosensory cortex and prefrontal cortex.9 Yu et al reported specific disruptions in functional connectivity at enkephalin producing pain control centers of the periaqueductal gray in chronic pain conditions.13 Moreover, the mechanism of hypersensitivity has been found to largely occur at the dorsal horn involving wide-dynamic-range neurons (WDR).14 WDR neurons are regulated by diffuse noxious inhibitory controls (DNIC) via the subnucleus reticularis dorsalis in the caudal medulla.14

Patients with FMS are thought to have defective DNIC systems; that is, the WDR neurons, which are responsible for innocuous and noxious stimuli, develop increased receptive fields, thus increasing the region of perceived pain.14 Disrupted brain circuitry has been described by Loggia et al who articulates that decreased activation of the periaqueductal gray area in the midbrain accounts for decreased descending pain modulation in patients with FMS.15 Two studies reported augmented pain processing in patients with FMS via disruptions of cortical areas responsible for the anticipation, attention, and emotional manifestation of pain.16, 17

The role of myofascial trigger points in FMS has been largely utilized in identifying the diagnosis. The biochemical properties of myofascial trigger points, including localized acidity and the increase in inflammatory mediators, may contribute to peripheral changes in patients with FMS.18 That is, sustained peripheral nociceptive input may sensitize dorsal horn neurons and supraspinal structures leading to hyperalgesia, allodynia, and referred pain.19

Peripheral and centrally-mediated changes associated with dry needling have been described in the literature; furthermore, dry needling to specific distal points in the upper or lower extremities has been found to activate sensorimotor cortical networks and deactivate limbic-paralimbic areas.20, 21 Deactivation of limbic areas following dry needling is thought to affect the sensory, cognitive, and affective dimensions of pain.20 Studies utilizing fMRI have demonstrated that dry needling at specific distal points activates the descending pain centers including the PAG.22 Moreover, dry needling with electric stimulation has been shown to activate enkephalinergic inhibitory interneurons, thereby modulating central pain.19 In addition, dry needling has also been found to reduce pain by peripheral mechanisms. One recent study found peripheral opioid receptors contribute to the anti-nociceptive effects of electrical dry needling via activation of cannabinoid CB2R receptors.23 Moreover, the stimulation of ATP release and the subsequent activation of adenosine A1 receptors via electrical dry needling is thought to sharply reduce inflammatory and neurogenic pain.24

The use of dry needling to target solely trigger points within muscles has been challenged.25 Several authors have articulated that the effectiveness of dry needling lies in the mechanical disruption of the integrity of dysfunctional endplate at the neuromuscular junction.19 That is, dry needling to the endplate region is thought to cause increased discharges, decrease acetylcholine stores, and thus reduce spontaneous electrical activity.19 However and importantly, not all patients with fibromyalgia have trigger points, and not all patients with trigger points develop FMS.26 Some investigators have distinguished the “tender points” associated with fibromyalgia from trigger points—i.e. tender points may lack taught bands.27 Given that skeletal muscle in patients with FMS has been shown to have altered oxygen utilization,28 perhaps dry needling can be useful to help improve muscle vascularity and oxygenation, and hence reduce sustained peripheral nociception.29,30

Nevertheless, the efficacy for the use of dry needling in patients with FMS is limited; that is, to date, there are few high methodologic quality studies on the topic. Two recent systematic reviews provide conflicting evidence for the use of acupuncture (i.e. the insertion of needles without injectate without the intent of moving qi along traditional Chinese meridians) in FMS—i.e. both concluding further high quality research is needed before definitive conclusions can be made in regards to efficacy.31,32 In a randomized controlled trial, Deluze et al found electroacupuncture provided significant improvements in pain perception and sleep quality (limbic system) in patients with FMS.33 Additionally, a recent systematic review and meta-analysis found that dry needling may be effective in the immediate and short-term in patients with upper quarter myofascial pain syndrome.34

 

 

 

 

 

 

 

 

REFERENCES

1 Tsang A , Von Korff M, Lee S, Alonso J, Karam J. Common Chronic Pain Conditions in Developed and Developing Countries: Gender and Age Differences and Comorbidity With Depression-Anxiety Disorders. Pain. 2009;10(5): 553.

2 Fricton J. Myofascial pain. Baillière’s Clinical Rheumatology. 1994;8(4): 857-880.

3 Mengshoel AM, Vollestad NK, Forre O: Pain and fatigue induced by exercise in fibromyalgia patients and sedentary healthy subjects. Clin Exp Rheumatol. 1995;13: 477-482.

4 Vierck, C, Staud R, Price D. The Effect of Maximal Exercise on Temporal Summation of Second Pain (Windup) in Patients With Fibromyalgia Syndrome. Pain. 2001;2(6): 334-344.

5 Hebb, D. O. Organization of behavior. New York: Wiley. Journal of Clinical Psychology. 1950;6(3): 307-307.

6 Melzack R, Wall P. Pain Mechanisms: A New Theory. Science. 1965; 150(3699): 971-978.

7 Melzack, Ronald, Terence J. Coderre, Joel Katz, and Anthony L. Vaccarino. Central Neuroplasticity and Pathological Pain. Annals of the New York Academy of Sciences. 2001; 157-74.

8 Wand, Benedict Martin, Luke Parkitny, Neil Edward O’Connell, Hannu Luomajoki, James Henry Mcauley, Michael Thacker, and G. Lorimer Moseley. Cortical Changes in Chronic Low Back Pain: Current State of the Art and Implications for Clinical Practice. Manual Therapy. 2011; 15-20.

9 Coghill R, McHaffie J, Yen Y. Neural correlates of interindividual differences in the subjective experience of pain. Proceedings of the National Academy of Sciences. 2003;100(14): 8538-8542.

10 Sandkühler J. Understanding LTP in pain pathways. Molecular Pain. 2007;3(1): 9.

11 Tinazzi M, Fiaschi A, Rosso T, et al. Neuroplastic changes related to pain occur at multiple levels of the human somatosensory system: A somatosensory-evoked potential study in patients with Cervical Radicular pain. The Journal of Neuroscience. 2000; 20(24): 9277–9283.

12 Benoist J, Gautron M, Guilbaud G. Experimental model of trigeminal pain in the rat by constriction of one infraorbital nerve: changes in neuronal activities in the somatosensory cortices corresponding to the infraorbital nerve. Experimental Brain Research. 1999;126(3): 383-398.

13 Yu R, Gollub R, Spaeth R, Napadow V, Wasan A, Kong J. Disrupted functional connectivity of the periaqueductal gray in chronic low back pain. NeuroImage: Clinical. 2014;6: 100-108.

14 Van Wijk G, Veldhuijzen D. Perspective on Diffuse Noxious Inhibitory Controls as a Model of Endogenous Pain Modulation in Clinical Pain Syndromes. The Journal of Pain. 2010;11(5): 408-419.

15 Loggia M, Berna C, Kim J et al. Disrupted Brain Circuitry for Pain-Related Reward/Punishment in Fibromyalgia. Arthritis & Rheumatology. 2014;66(1): 203-212.

16 Gracely R, Petzke F, Wolf J, Clauw D. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis & Rheumatism. 2002;46(5): 1333-1343.

17 Burgmer M, Pogatzkizahn E, Gaubitz M, et al. Altered brain activity during pain processing in fibromyalgia. NeuroImage. 2009;44(2): 502-508.

18 Shah JP, Danoff JV, Desai MJ et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil. Jan 2008;89(1): 16-23.

19 Cagnie B, Dewitte V, Barbe T, Timmermans F, Delrue N, Meeus M. Physiologic effects of dry needling. Current pain and headache reports. Aug 2013;17(8): 348.

20 Chae Y, Chang DS, Lee SH, et al. Inserting needles into the body: a meta-analysis of brain activity associated with acupuncture needle stimulation. J Pain. Mar 2013;14(3): 215-222.

21 Biella G, Sotgiu ML, Pellegata G, Paulesu E, Castiglioni I, Fazio F. Acupuncture produces central activations in pain regions. Neuroimage. Jul 2001;14: 60-66.

22 Hui K, Liu J, Marina O et al. The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. NeuroImage. 2005;27(3): 479-496.

23 Su T, Zhang L, Peng M et al. Cannabinoid CB2 Receptors Contribute to Upregulation of β-endorphin in Inflamed Skin Tissues by Electroacupuncture. Molecular Pain. 2011;7(1): 98.

24 Goldman N, Chen M, Fujita T et al. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nat Neurosci. 2010 July; 13(7): 883–888.

25 Dunning J, Butts R, Mourad F, Young I, Flannagan S, Perreault T. Dry needling: a literature review with implications for clinical practice guidelines. Physical Therapy Reviews, 2014; 19(4): 252-265.

26 Castro-Sanchez A, Aguilar-Ferrandiz M, Mataran-Penarrocha G, Sanchez-Joya M, Arroyo-Morales M, Fernandez-de-las-Penas C. Short-term effects of a manual therapy protocol on pain, physical function, quality of sleep, depressive symptoms, and pressure sensitivity in women and men with fibromyalgia syndrome. Clin J Pain. 2014;30: 589-597.

27 Chae Y, Chang DS, Lee SH, et al. Inserting needles into the body: a meta-analysis of brain activity associated with acupuncture needle stimulation. J Pain. Mar 2013;14(3): 215-222.

28 Melzack R, Stillwell DM, Fox EJ. Trigger points and acupuncture points for pain: correlations and implications. Pain.1977;3: 3-23.

29 Cagnie B, Barbe T, De Ridder E, et al. The influence of dry needling of the trapezius muscle on muscle blood flow and oxygenation. J Manipulative Physiol Ther. 2012;35(9): 685–91.

30 Sandberg M, Larsson B, Lindberg LG, et al. Different patterns of blood flow response in the trapezius muscle following needle stimulation (acupuncture) between healthy subjects and patients with fibromyalgia and work-related trapezius myalgia. Eur J Pain. 2005;9(5): 497–510.

31 Mayhew E, Ernst E. Acupuncture for fibromyalgia—a systematic review of randomized clinical trials. Rheumatology. 2007;46 (5): 801-804.

32 Bai J, Guo Y, Wang H, et al. Efficacy of acupuncture on fibromyalgia syndrome: a Meta-analysis. J Tradit Chin Med. August 2014; 34(4): 381-391.

33 Deluze C, Bosia L, Zirbs A, Chantraine A, Vischer TL. Electroacupuncture in fibromyalgia: results of a con- trolled trial. BMJ. 1992;305: 1249-1252.

34 Kietrys DM, Palombaro KM, Azzaretto E, et al. Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. J Orthop Sports Phys Ther 2013;43: 620-634.

 

New Book! Highly recommended.

Posted on October 26, 2016 at 11:50 AM

I have just read a wonderful book, provided to me by one of my patients. It details many causes of dysautonomia. It has a patient side and a physician side which discusses the topics of each chapter in clear language from both a lay perspective and professional perspective. Wonderful resrouce to anyone who is struggling with chornic pain, "wonky" symptoms (my word...;) ) or anything that just seems to confound many practioners. Almost eveyr person who has had some type of chronic pain has some form of sensitization. I have experienced this myself with abdominal pain. There is hope though and we can begin to reverse aspects of this disorder. 


Take a look at the link below for more info. Of course we at Bluegrass Doctors of PT will always be resources to our patients on this topic. 



https://www.amazon.com/Dysautonomia-Project-Understanding-Autonomic-Physicians/dp/1938842243

Cupping our way to victory?

Posted on August 8, 2016 at 8:00 PM

If you have watched any of the Olympics as of late, the big buzz is Michael Phelps Circular bruises. Almost covered more intensly than the events themselves. He undergoes a procedure called Cupping. Cupping has been around for centuries. Used in various cultures around the world it is thought to improve blood flow (reducing stagnation), improve Chi, (energy) and liberate toxins from an area that is haing pain or dysfunction. There are many ways to utilize myofascial cups to aid in pain reduction and to improve tissue texture. We can lengthen fascia, and improve flexibility as well as reduce pain. The mechanisms that are truly happening are a bit ore enigmatic but are thought to involve actually causing a localized inflammatory response to allow a chronic injury to heal appropriately and thus pain can be alleviated. 

However, one does not have to come out looking like he/she had a hot date with an octopus to get benefit from this technque. At Bluegrass Doctors of PT we utilize cupping techniques that most often do NOT leave bruises. Unlike Dry Needling this technique is non invasive, completely safe with relatively no contraindications. It is a wonderful adjunctive therapy, to needling, Laser therapy, manipulation and exercises. It however, in my opinion is not a stand alone technique.

Follow us on Twitter, and Facebook. #OlympicCupping. 

To all female athletes!

Posted on July 20, 2016 at 9:50 AM

Wearable Reduces ACL Injuries in Female Study Subjects

Published on July 11, 2016

http://www.dreamstime.com/royalty-free-stock-photo-uefa-female-soccer-championship-2009-italy-hungary-image10426435

Technology may offer a way to control the significantly higher occurrences of ACL injury among young women who play soccer. A new report shows that using a wearable neuromuscular (WNM) as part of a training protocol helped substantially reduce ACL injuries in recent testing.

 

According to the study, presented recently at the American Orthopaedic Society for Sports Medicine’s (AOSSM) Annual Meeting in Colorado Springs, Colo, athletes who used the devices in combination with a regular training program showed functional improvements.

 

“Our study showed that training with a wearable neuromuscular (WNM) device improved postural control in athletes, without limiting performance,” says Michael John Decker, PhD, from the University of Denver in Denver, in a media release from AOSSM. “Moreover, no athletes in the study experienced an ACL injury during training or over the course of the following season.”

 

In the study involving 79 elite youth and collegiate female soccer players (ages 12 to 25), participants trained with a WNM device that applied bilateral, topical pressure to the medial quadriceps and hamstring muscles. The preseason training program with the device lasted 7 to 9 weeks, and consisted of strength and conditioning exercises and on-field team practices.

 

“Research has shown female soccer players have a three times greater risk of ACL injury compared to males, yet only a small portion of soccer coaches are currently utilizing ACL injury risk reduction programs,” Decker states in the release. “We hope these devices offer coaches a practical means to overcome participation barriers, opening the door for more organizations and teams to implement similar programs.”

 

[Source(s): American Orthopaedic Society for Sports Medicine, Science Daily]

Can't Sleep?? Come in and see us.

Posted on July 16, 2016 at 8:40 AM

In the past 10 years, computers and cellphones have become one of the most important factors in our lives, and one which has a tremendously negative impact on our muscles. Muscle tension may be one of the causes of sleep disturbance. Tension in the shoulders and neck can affect blood circulation to the muscles. This research uses a dry needling treatment to reduce muscle tension in order to determine if the strain in the head and shoulders can influence sleep duration. All 38 patients taking part in the testing suffered from tinnitus and have been experiencing disturbed sleep for at least one to five years. Even after undergoing drug therapy treatments and traditional acupuncture therapies, their sleep disturbances have not shown any improvement. After five to 10 dry needling treatments, 24 of the patients reported an improvement in their sleep duration. Five patients considered themselves to be completely recovered, while 12 patients experienced no improvement. This study investigated these pathogenic and therapeutic problems. The standard treatment for sleep disturbances is drug-based therapy; the results of most standard treatments are unfortunately negative. The result of this clinical research has demonstrated that: The possible cause of sleep disturbance for a lot of patients is the result of tensions in the neck and shoulder muscles. Blood circulation to those muscles is also influenced by the duration of sleep. Hypertonic neck and shoulder muscles are considered to impact sleeping patterns and lead to disturbed sleep. Poor posture, often adopted while speaking on the phone, is one of the main causes of hypertonic neck and shoulder muscle problems. The dry needling treatment specifically focuses on the release of muscle tension.



Check out the full article here! 

http://www.waset.org/publications/10004906