Bluegrass Doctors of
Physical Therapy, PLLC

Concierge Manual Physical Therapy and Interventional Dry Needling Experts

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Quick Blog about working out....AT WORK!

Posted on February 7, 2017 at 7:55 AM



 

Mini Workouts You Can Do At Work!

What does exercise have to do with running a successful healthcare business?

More than you think. Everyone knows exercise has significant health benefits, but what about its cognitive benefits?

Research shows that regular exercise dramatically improves job performance and productivity. According to a study cited in Harvard Business Review, it "enables us to soak in more information, work more efficiently, and be more productive." Here are some of the perks:

Improved concentration

Sharper memory

Faster learning

Prolonged mental stamina

Enhanced creativity

Lower stress

Although many healthcare professionals know and preach the benefits of exercise, finding the extra time to do it themselves can be a challenge. They're already overstretched and overworked as it is, running a successful healthcare business and taking care of family responsibilities. But, there is a solution!

Make short bursts of exercise part of your daily routine. A few minutes every couple of hours isn't going to sabotage your schedule or quality of patient care. In fact, it will increase your energy and focus, so you can deliver the level of care and service your patients and customers deserve.

 



Other Ways To Sneak In Exercise At Work

 

Do a set of 20 push-ups every morning when you wake up.

While you’re waiting to use the bathroom at work, do 30 squats.

Set your timer to go off every 30 minutes to an hour. Then, run up and down the stairs or do push-ups for 1 minute.

Ride your bike to work.

Grab a fellow employee and take a walk around the block or the parking lot.

Park farther away, so you increase the number of steps you walk.

Take the stairs instead of the elevator.

For your next meeting, have a walk-and-talk around the block or parking lot.

Have a daily or weekly push-up challenge with everyone at the office.

Before each meeting, have everyone do 30 squats or 30 push-ups.

Run up and down the stairs for 3 minutes 3 times a day.

Switch out your office chair for a stability ball.

All It Takes Is A Few Minutes A Day

 

Research shows it can take as little as 10 minutes a day to see results. You may not become the next Ironman, but you and your medical team will be in better shape to deliver quality care and superior service.




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.

 

Bluegrass Doctors of Physical Therapy Picked as Top 16 Providers in Louisville

Posted on November 14, 2016 at 4:35 PM

https://www.expertise.com/ky/louisville/physical-therapists" target="_blank">/www.expertise.com/ky/louisville/physical-therapists


Please Check out the Link Above For more information and how Bluegrass Doctors of Physical Therapy was selected.



Thanks to everyone who has supported us over the last few years. We hope to continue elevating your healthcare experience each and every day!  

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. 

Female Athletes read this!

Posted on July 20, 2016 at 9:55 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]

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

Replace CPR?

Posted on July 13, 2016 at 8:35 AM

Can new devices match Heimlich to stop choking?

Published July 13, 2016

The Wall Street Journal

The Ache: Nearly 5,000 people a year die from choking in the U.S., according to the nonprofit National Safety Council.

 

The Claim: Two new easy-to-use devices work like plungers to suck out obstructions in the airway, providing another option if standard treatment—such as abdominal thrusts developed in 1974 by Henry Heimlich—fail to clear the airway, say the companies who sell them.

 

The Verdict: A recently published laboratory study showed the LifeVac, from LifeVac LLC of Springfield Gardens, N.Y., dislodged simulated obstructions. So far there haven’t been any scientific publications detailing lives saved with the LifeVac or another device, from Dechoker LLC, of Salisbury, N.C.

 

More on this...

96-year-old Heimlich uses namesake maneuver on choking woman

Autistic NYC boy says 'SpongeBob' taught him Heimlich

The ubiquitous choking poster gets a makeover

Both the Dechoker, $89.95, and the LifeVac, $69.95, have a plastic mask that provides a seal over the mouth and nose while suction is provided. The Dechoker looks like a large syringe, while the LifeVac’s plunger is shaped like a small accordion. In both devices, one-way valves allow air to only travel out of the mask and not into it, which avoids pushing the object deeper in, says LifeVac Chief Executive Arthur Lih.

What we do in the spine and extremities affects our brain.

Posted on July 7, 2016 at 9:35 AM

Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex: A Brain Source Localization Study


LINK: 

 

http://www.hindawi.com/journals/np/2016/3704964/



Above is a title of a new article looking at what happens we apply joint manipulation in the spine, on the brain. Amazing. Again, this is yet another article that shows interventions that are applied to the spine and extremitieis affect our BRAIN. This in time could induce neuroplastic changes. Good stuff! 


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