Latest Physical Therapy News

Dry Needling in Denver: What is Trigger Point Dry Needling, also known as TPDN, TDN, or IMS (Intra Muscle Stimulation)?

February 14, 2018

Have you ever wondered what those nasty little knots are that appear in your muscles and cause you pain?  They may be active trigger points in your muscle or connective tissue. Physical therapist that are trained in treatment of trigger points through trigger point dry needling. Trigger point dry needling can treat these points to provide relief of even chronic pain symptoms. The term ‘dry needling’ was coined to differentiate it from ‘injection needling’ where a substance (medication or otherwise) is injected into tissue with a hypodermic syringe.

Trigger points occur when there is too much electricity trapped in the muscle fibers.  This can happen through injury, misuse or overuse of a muscle. Trigger point dry needling is a technique where acupuncture needles are inserted into a myofascial trigger point, muscles or connective tissues to help release trapped electricity and, essentially, deflate the trigger to relieve pain.  It is known that the use of trigger point dry needling activates a ‘local trigger response’, an involuntary spinal cord reflex, although some of its biochemical and neurophysiological effects are still being studied.

While trigger point dry needling utilizes the same solid filiform needles, typically .16-.31 mm in thickness, that the Traditional Chinese Medicine of acupuncture utilizes, its science and research is based off western medicine principles and large body of research of the human muscular system.  The effects and mechanisms of dry needling are complex though research suggests that the local twitch response elicits a response from the brain in the area of pain or discomfort. There is a growing body of scientific evidence that supports the positive effect inserting a needle has on the electrical and chemical communications that take place in our nervous system, including the natural release pain relieving chemicals as well as the transmission of pain signals in our spinal cord. 

Trigger point dry needling can also be utilized as a diagnostic tool for physical therapists as the local twitch response would not be stimulated within healthy muscle tissue.  Trigger point dry needling may be heavily utilized near the beginning of a treatment plan as a means to break the cycle of pain.  After the technique is applied to a particular area, the muscle then needs to undergo re-education through exercise to help it learn how to work normally again.  This will help reduce recurrence of these trigger points, and help provide long term relief from pain.

Why does trigger point needling work?

The most widely accepted theory as to the reason trigger point dry needling works to help treat muscle spasms and reduce further muscle damage is that a muscle spasm creates a cycle of pain which further inhibits blood flow, oxygen and nutrients to the muscle tissue.  By introducing a needle and disrupting this cycle, the muscle is allowed to relax and repair itself while allowing further treatment using standard physical therapy practices.

This is a technique that should only be performed by someone who has been trained, and your physical therapist may be that person.  Physical therapists will typically utilize trigger point dry needling as a single tool within its larger treatment plan for any given condition.  Release of trigger points may provide relief from pain that has been present for short or long periods of time.  Some patients may feel soreness immediately following and even a few days after in the area of treatment and some may even see signs of bruising.  Most of the symptoms of trigger point dry needling are mild and will only last a few days, depending on the patient and in comparison to the pain usually experienced caused by the condition, the pain will be much less.

What can be treated by trigger point dry needling?

Trigger point dry needling can help with a variety of common conditions including headaches, shoulder pain, neck pain, back pain, knee pain, sciatica, Achilles tendonitis, plantar fasciitis, tennis elbow, golfers elbow, hip pain, gluteal pain, muscle strains, ligament strains, muscle spasms, jaw pain, sore muscles, tight muscles and more.

How is trigger point dry needling different from acupuncture?

As mentioned above there are some similarities between the Ancient Chinese Medicine of acupuncture and trigger point dry needling including the disposable, sterile needles used in each, however acupuncture largely is used as a method to treat ailments internally such as stress, insomnia and digestive problems.

With a session of acupuncture the needles inserted into a patient are done so along meridian lines and often left in for around 30 minutes.  The meridians lines represent the body’s organ systems.  By inserting needles along the meridian lines, acupuncturists attempt to rebalance and restore energy flow throughout the body.

In comparison, trigger point dry needling can oftentimes be finished in a few minutes depending on the condition, size of area and complexity of the problem.

Example of trigger point dry needling successes

Recent patient experiences include individuals suffering from muscles spasms in a patient’s back caused from a strain in one of the major shoulder muscle groups.  The strain of this muscle cause the body to use muscles which were much weaker causing them to contract beyond a point of function.  In order to restore function to the area, trigger point dry needling was done to these muscles.  Once the patient had relief from the pain, additional strengthening therapy was prescribed in order to teach the muscles how to properly function.

Who licenses and regulates dry needling in Colorado?

In Colorado, the Department of Regulatory Agencies and State Physical Therapy Board has regulated the use of trigger point dry needling in 4 CCR 732-1.  In the United States, Medical Doctors, Osteopaths, Physical Therapists, Chiropractors, Naturopaths and Acupuncturists are utilizing Dry Needling.

If stretching, massage, or just plain ignoring the pain has not worked for you, consider trying trigger point dry needling. Consult Body Image Physical Therapy to understand and discuss if trigger point dry needling may be a good option for you and your condition.

Another Year…Another Elephant to Eat

January 17, 2018

So how long is your list of promises to yourself this year?  I know why I sometimes veer off my path when pursuing this list.  It contains large promises that quickly mold themselves into an elephant sized task list. Then, with the best of intentions, I make my plan of attack that includes  eating that entire elephant in one bite.  What’s the old saying? Something about one bite at a time, I think.

Promises we make to ourselves about our health may tend to become that elephant.  Whether we are too fat or too thin, eat too much or too little, or when we just eat the wrong things for the wrong reasons, making those large promises to ourselves may create a task that is just too big to tackle all at once. So how do we take the first bite?

Taking the First Bite and Establishing Routines

Just take the first bite, chew well, swallow, and repeat.  The repeating part is the hardest and the most important. Building a routine means sticking to a routine. It is physical and mental training that takes time to establish. On the other side of the coin, breaking down our current routines is an equally challenging task.

So what’s the solution here? Instead of tearing down the old and building up our day to days from scratch, we can make smaller, more palatable alterations to our routine. Perhaps instead of promising to start in the gym 5 days per week, how about we begin, this week, with 1 or 2 days, and a specific program in hand so that we are more efficient and effective when we walk into the gym.

The same applies to our diet. Don’t promise yourself that you are going to eat salad for every meal for seven days a week for the whole year, if it’s a promise that you are likely to break. It’s going to be hard to keep that promise when it’s the weekend and you’re driving by your favorite restaurant or if the smell of bacon is in the air. If you aren’t consistent, you aren’t developing a lasting positive habit. Try starting with a plan that includes cutting out snacks, eating salads for lunch, and sticking to a smaller portioned dinner.

Your goals should be relative to your current lifestyle. Take your existing plan and make moderate improvements. Once these improvements have been ingrained and comfortable, it is time to implement the next step toward your goals. A plan that takes 3 months to bolster is far more sturdy than a plan that falls apart after 3 weeks.

Finding the Right Path to Your Goals

There is more than one way to eat healthy. There is more than one way to get exercise. Sure, there are some hard rules when it comes to health and different practices typically will carry their own pros and cons. However, you can reach your fitness and health goals by a number of different paths. Ultimately, the best path is often the one that you are most comfortable with.

It seems like there is always some new diet trend popping up or some new power food that is all the rage. Soy milk, almond milk, skim milk, cashew milk - what milk is the best for you!? Do you cut out calories, carbs, meat, or fat? The sea of available (and sometimes contradictory) nutrition information can make trying to eat healthy more convoluted that it need to be. Some generally agreed upon things are the benefits of reducing and/or eliminating processed sugars, alcohol, and tobacco. Many other parts of these specific diet plans like the atkins, ketogenic, vegetarian, etc. seem to be in hot debate.

All of these diets have worked for different people. While there is science behind the potential benefits and consequences of each, the common factor of success is sticking to the plan. Consistently controlling and moderating your eating habits will eventually provide you results, no matter what form that diet takes.

This same principle applies to how you get your exercise. People often equate fitness with running on a treadmill and lifting weights. Many people enjoy such activities and consider it a hobby. Maybe the gym is not for you.  How about biking, hiking, walking, climbing, yoga, skiing, snowshoeing, walking in the mall, or taking a class? 1 mile…1 floor of the mall…1 class…1 bite.

There are certain considerations, of course. Are you trying to bulk up, trim down, or just improve wellbeing? What existing injuries and physical limitations do you have? Do you need a more convenient activity? The bottom line remains, especially in Colorado, there are many options worth exploring. Exercise and fun do not have to be mutually exclusive.

Thinking of Your Goals as Resolutions

New Year’s resolutions can be a very effective way of jump starting your often procrastinated and abandoned self promises. It helps to give a definitive start date to your efforts. Once these efforts are underway, it is time to drop the “New Year’s” off of “New Year’s resolutions”.

This will help you establish a long term mindset. Just because you’ve slipped does not mean it is time to abandon your plan. If you’ve made it a few months into the year, don’t let that vindicate your desire to pick up bad habits again. If either of these situations occur, you will probably find yourself making the same New Year’s resolutions year after year. Instead, try to imagine to pride and satisfaction of having improved your health for the whole year.

If you are not sure what you can do to meet your goals for the year, have old injuries, or pain that is not just muscle soreness after activity, you may need to seek assistance in building the right program specifically for you.  Trainers working together with physical therapists to build this program will help ensure your success.  Need help? Call us: 720-870-8900.  We are well versed in elephants.

Had Joint Replacement and Still in Pain? Physical Therapists in Denver Can Help

December 20, 2017

Total joint replacement is a surgery that has provided pain relief for many people who have suffered with hip, knee or shoulder discomfort and pain.  Ads often times show patients who have undergone total joint replacement mid-run, smiling and--for all intent and purposes-- enjoying life again. The decision to undergo a complex procedure is not one to take lightly, but as physical therapists in Denver, we are happy to see someone make that decision to have the surgery when all signs are pointing toward a life limiting disability without the replacement.

Reasons for Replacement

Dealing with pain associated with joint movement is a symptom that could be the indication of something far more serious. Causes of joint pain can be anything from arthritis to infection even cancer in extremely rare cases.

For those who are experiencing chronic pain that is not caused by illness or infection, the most likely cause of said pain is essential the joint wearing down which has caused the bones to rub against one another.
The bones of the joint are typically covered in a substance called articular cartilage near their ends that allow them to easily glide against each other. In between the bones is another substance called synovial fluid which acts like oil in a car to lubricate the joint further. If either the cartilage, or fluid is damaged or diminished, problems can develop and lead to stiff and painful joint movement.

What Happens When a Joint is Replaced

Typically when people think of joint replacement, the knee and hip are what come to mind, but there are other less common areas where replacement surgery can help. The shoulder, ankle and even the finger joints can all be replaced to better help the patient live a regular, functional life.

When a joint is replaced by a surgeon, what essentially happens is the worn or damaged parts are removed and replaced with prosthesis that are fitted to the area and allow the joint to behave as it normally would in a healthy individual.
  • Before
    • Since joint replacement involves anesthesia, except for finger joint replacement which can be done as an outpatient procedure, your surgeon will require a physical examination. In some cases they may require more examinations to be performed such as blood tests, X-rays, and MRIs.
  • During
    • Depending on the area which is being replaced, you will be placed either under general anesthesia or have a spinal block, which numbs the lower half of your body and is typically for knee and hip replacements. During the procedure, your surgeon will remove the infected or damaged areas and fit your bone to the prosthesis which will replace the joint.
  • After
    • Once your surgery is complete, you’ll be taken to a recovery room where you’ll be monitored as the effects of the anesthesia wear off. From there you’ll be placed in a hospital room where you’ll be under supervision for the first few days afterwards to ensure no complications arise. Complications include:
      • Infection
      • Blood clots
      • Joint Stiffness or further pain if your body rejects the prosthesis
      • Dislocation
      • Loosening
One of the biggest risks after surgery is blood clots developing. In order to combat this you’ll be required to walk or move the area the day of, or after your surgery. You may also be required to take blood thinners and have a compress on the area to further deter clots from forming.

Physical Therapy to Ensure Your Back to 100% Functionality

The overall objective of the surgery is to help return the recipient to full activity without the underlying joint pain they have experienced for so long by ensuring that the bones connected to the joint in question don’t rub against each other.  

So the question is, if it is such a wonderful procedure, then why do some people still have pain and dysfunction after going through the discomfort of the surgery? The answer sometimes can be that something needs to be addressed by the surgeon, but more often than not, the answer tends to be a little more simple.  There is generally still work that the patient has to do post-operatively to make the joint replacement a total success.  

In physical therapy, we see the end result of many years of limited use of the limb in question; decreased range of motion, decreased muscle tone and strength, and an overall loss of ability to balance.  When a joint is painful, we just do not use it fully anymore, leading to all of these issues.  The replacement of the joint surfaces takes away the pain of bone rubbing against bone, which generally is the most direct cause of the pain, inflammation and swelling.  Once the new joint is in, now attention has to be turned to regaining all that was lost over the time when the joint was used on a limited basis.  

Unfortunately, just walking, riding a bike or swimming will not get back full motion, strength, or full functional capability.  Some people are just glad to have the majority of the pain resolved with the surgery, and simple functional capability returned, and really are not interested in anything beyond that.  
A much larger number of people, however, want to regain what they have lost over the years of joint dysfunction.  Your physical therapist is trained to test for loss of not only muscle strength, but also joint mobility and balance.  A program is then designed for each individual, taking into consideration what they personally have lost along the way.  

The lesson here is this….You may not be stuck with whatever you were left with post operatively, no matter what the surgery.  There are exercises specifically aimed at functional return for every body part, including those areas you thought were going to be an issue forever.  Not sure? The physical therapists in Denver at Body Image PT can discuss your issues and compile information and a schedule for you to regain more function in your limbs. Whether it’s knee pain or your experiencing chronic pain associated with your surgery, the skilled team at Body Image PT can help. Call today at 720-870-8900.  

What does posture have to do with shoulder pain or headaches?

November 29, 2017

We’ve all experienced the aggravating effects of shoulder pain; whether it’s sharp and caused by movement or the kind that radiates and aches all day.  Bad posture, whether it is caused by your environment or has been a habit, can have a significantly detrimental effect on your shoulder joints that can lead towards recurring pain and even headaches. Physical Therapists are well acquainted with shoulder injuries and pain, and have developed methods towards strengthening and conditioning the area to help patients live happier lives.  

Body Image Physical Therapy in Denver has made it its mission to provide not only exceptional care to patients in need of physical therapy, but to educate the community in ways they can improve their overall health as well. When addressing shoulder pain, it is often the case that symptoms felt for most of one’s life can be resolved or improved with physical therapy. With retraining or correction of one’s muscle function, shoulder pain and headaches could be a thing of the past.

Shoulder Injuries

Known as the part of the body most prone to injury, the shoulder girdle, which consists of the clavicle and scapula, is an area that needs to be properly maintained with conditioning and strengthening. While shoulder injuries are more common in those who are active in overhead sports such as swimming, tennis and volleyball, people of all ages can experience injuries and fractures in this part of the shoulder. Even after an injury has healed, working with a physical therapist in Denver is recommended to help the area regain any strength lost during the healing process. You don’t want a shoulder injury to affect your health down the line, so it’s best to tackle the problem head-on as soon as your are healed.

Shoulder impingement is a common issue in the physical therapy setting, and means it has become painful to lift the arm overhead due to a series of mechanical shifts in the shoulder itself.  It can be especially aggravating  when it seems to happen suddenly and without provocation.  The truth generally is that it probably evolved into a problem over time either due to repetitive motions, or poor posture utilizes muscles that have become overworked. When the shoulder is traumatized, or is being used incorrectly, the group of soft tissues about the shoulder tends to shift the skeleton, causing a pinching (impingement) of the soft tissues between the bones in the shoulder. This can take years to develop, and can lead to chronically inflamed soft tissues, or damage to the rotator cuff.

Poor posture, combined with shoulder trauma of any kind can lead to a chronic inflammatory state about the shoulder girdle which can lead some to develop recurring headaches.  Is it ever too late to be able to correct this? It is really never too late, but all of the steps have to be thoroughly completed to ensure a fully successful resolution of the pain, and full return of function.  

Treating Shoulder Pain With Improved Posture

Regardless of the actual diagnosis, if you cannot lift your arm up overhead without pain, it generally means that something in that complex environment about the shoulder needs attention. An over the counter anti-inflammatory medication, along with ice, may help reduce the acute inflammation, and  thereby reducing the pain. But this is never a good long term solution, as the problem will crop up again with less and less provocation if you just try to cover it up. At the end of the day--you still have the issue of why it happened in the first place.  

Remember the constant reminders from your parents telling you to sit up straight and stop slouching? That is where we need to begin.  Correcting your posture while sitting, standing or exercising, is the cornerstone in the process of eliminating this shoulder issue. Posture is cultivated by repetitive motions done without frequent breaks. This means that someone who slouches all day at a desk without any breaks to move around and stretch is essentially locking their posture into one that their musculoskeletal system wasn’t designed for.

Understanding what needs to be changed in terms of your posture is important towards regaining full motion in all directions in the shoulder as well as correctly strengthening those muscles. Doing so alone is possible, though consulting a physical therapist is highly recommended for those looking to address shoulder injury, pain or just to correct their posture. Working with a physical therapist in Denver could be your solution towards pain-free shoulder movement and even fewer headaches.   

Headache Connection

Frequent headaches (not for everyone, but it can commonly occur with this shoulder issue) can be due to the head being positioned too far forward in poor posture. This causes strain in the neck and shoulder muscles, creating spasms, trigger points, pain in the neck, and possibly headaches. While some have been told frequent headaches are a result of genetics or stress, this oftentimes turns out not to be the case. Even though who have suffered trauma, such as head injury or concussions can experience improvement through physical therapy and fitness training.

A good start to improving your posture and therefore the pain being felt is sitting up straighter, getting the inflammation under control, and find out what muscles are too weak to hold you properly. Working with a physical therapist with craniosacral work can alleviate the strain on certain muscles while strengthening the right ones to help improve circulation and tension experience in the neck and shoulder. We have amazingly resilient systems in our body, so whether you have had this problem for days or years, the body is generally willing to adapt to correction with the right input.

If you have been suffering from a shoulder injury or pain, or you have been relying on medication to tackle your headaches, consider physical therapy in Denver to help alleviate your symptoms and re-educate your body to better handle the stresses of your environment. Body Image Physical Therapy has made it it’s mission to help those in the community through therapy and education to live healthier and more fulfilling lives. Ready to tackle it? Fill out the Quick Contact Form at the bottom of our website or call us for an assessment at 720-870-8900.

Aurora Physical Therapist: To Sit or Not to Sit…That is the Question

November 3, 2017

What is the best position to work in at our desks? Do we sit in a chair, kneel on a kneeling chair, sit on a exercise ball, stand in place, or use a treadmill desk? How about a combination of all of the above? How often do we do each position? Is this good for everyone? It can all be quite confusing. We have many patients at Body Image Physical Therapy in Aurora who deal with pains contributing from and/or while working at their computer desks.

In recent years, there has been a rising popularity of standing desks and other alternatives to sitting methods. These alternatives to the traditional work chair aim to bring passive benefits to your health throughout your work day. People argue that spending an extended time in traditional desk chairs is sedentary and unnatural for human biology. The idea is that humans evolved as hunter-gatherers who are meant to be moving more consistently.

A number of studies have been conducted to try and determine exactly how long hours of sitting can be detrimental to your wellbeing. Some of the findings suggest that sitting causes issues related to your back, posture, weight, insulin levels, longevity, and even certain types of cancer. While there is dispute among the validity and extent of some of the conclusions drawn by various studies, it is generally believed that taking some regular level of break from the typical sitting position is positive for your health.

Taking breaks from sitting can often be incorporated somewhat naturally into the workplace. For instance, you could walk over to your colleagues to talk to them rather than email or call them. If you are talking on a cordless phone or headset, you may want to pace around the room over the course of the conversation. Plan regular water breaks where you walk around a bit while getting hydrated. Take the stairs when feasible. If you are unable or infrequently able to do these things, then try to plan short breaks specifically for walking or stretching once or twice an hour. You can tell your boss these types of breaks have often been shown to increase productivity.
If you are looking to incorporate more than occasional sitting breaks, there are a few fairly common substitutes for your average desk chair. Here are a few tips and considerations as you negotiate this maze of options:
  1. Kneeling chairs really only work for a small percentage of people. They claim to be better for your back and neck while burning more calories by engaging your core. However, kneeling for extended periods of time can cause it’s own issues and isn’t necessarily better for your back or neck. In general, I do not recommend this, especially if there has ever been knee or hip issues.
  1. If you sit in a chair, you do not have to have an expensive chair to have it work for you. It needs to be adjustable in all directions, have a built in lumbar support that fits your lumbar curve, and, when possible, armrests that fit so that you can truly rest your arms on them as you drop your hands onto your keyboard. Try to monitor your posture when possible to avoid craning your neck or bending over your keyboard. Follow these tips on how to sit at a computer to minimize some of the common strains of desk work.
  1. Exercise balls should really only to be used only part of the time, not full time for most people. It is a lot of work to sit properly on a ball. It also has to be the right height for the desk and keyboard to keep stress on the body low. Exercise balls keep you moving and engage you physically, reducing back problems and burning more calories. I generally recommend that a ball be used only 10-15 minutes out of the hour. If you are using a exercise ball with a ring on the floor, or with a seat back on it, then the purpose behind using a exercise ball has been lost. The ball has to be able to move to be useful.
  1. Treadmill desks seem to work for those who can do two things at one time. Obviously walking is an low exertion exercise that yields several benefits to the body. However, walking engages gait control which places demands on the brain. For most people, walking will deter their ability to focus on more intensive tasks. It would not be recommended for anyone with balance or vestibular issues or for anyone who has experienced foot/ankle, knee, hip or spine issues. Your core needs to be strong as do the hips/pelvic muscles.
  1. Now to speak to the newest and most prevalent trend… the sit to stand desks. This is a great idea in theory. It still requires the user to have a decent core as well as the awareness of knowing how to stand properly. It allows people to change the position of their body quickly and conveniently. The ability to stand for a while instead of sitting should be beneficial for most people; it just needs to be done properly, just like how sitting has to be done properly. Read these tips for using a standing desk.

There is little doubt that continuously sitting or remaining in any singular position over a long period of time is not ideal for health and fitness. The point really is that changing positions frequently, getting up and moving around on a regular basis is just a good idea regardless of how you are positioned at your desk throughout the day. The same positioning does not work for everyone, and your needs might change from year to year.

If you need help because nothing is comfortable…you may need to be in physical therapy.  At Body Image Physical Therapy, we help rehabilitate patients with a variety of disorders, aches, and pains. We educate our patients, so they understand what we are doing and how they can help themselves. Give us a call to see if we can help!