Nearly 8 of 10 Americans will experience lower back pain at some time in their lives. Persistent low back pain is a common, incapacitating, costly, and a difficult to treat condition. Many patients might benefit significantly from an individualized, multidisciplinary, team-based model of care that includes access to licensed complementary care practitioners (e.g., chiropractors, massage therapists, and acupuncturists) in addition to conventional care providers, as demonstrated in a study published in The Journal of Alternative and Complementary Medicine, a peer-reviewed journal from Mary Ann Liebert, Inc. The article, “A Model of Integrative Care for Low-Back Pain,” is available free online at The Journal of Alternative and Complementary Medicine website.*

David M. Eisenberg, MD, and colleagues from Harvard Medical School and Brigham and Women’s Hospital (Boston, MA), Group Health Research Institute (Seattle, WA), and Brown University (Providence, RI), compared conventional therapy alone – defined as “usual care” – to the combination of an integrated program of complementary and alternative medical (CAM) therapies plus usual care. They report significant differences between the two randomized patient groups in outcomes which included pain, functional status, and difficulty performing routine, self-identified challenging activities.

CAM therapies were provided by a trained team of healthcare practitioners and included acupuncture, chiropractic, massage therapy, occupational therapy, physical therapy, mind-body techniques, and nutritional counseling. Usual care consisted of treatments provided by subjects’ primary care physicians and typically included non-steroidal anti-inflammatory drugs (NSAIDS), physical therapy and bed rest as needed, education, and changes in activity levels.

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Mary Ann Liebert, Inc./Genetic Engineering News. (2012, April 26). “Treatment Of Lower Back Pain Could Be Improved By Adding Complementary And Alternative Medical Therapy.” Medical News Today. Retrieved from
http://www.medicalnewstoday.com/releases/244570.php.

(Richmond, Virginia) – Sheltering Arms, Central Virginia’s premier physical therapy rehabilitation provider, is pleased to announce the appointment of Lisa LaFata Powell as chairman of its Board of Directors.

Ms. Powell has been prominent in the Richmond area for decades, starting as an anchor and reporter at WTVR-TV from the middle 1980s until the middle 1990s.  Since leaving WTVR, she has worked as not only a freelance journalist but also an adjunct member on the faculty at the University of Richmond and Virginia Commonwealth University.

Ms. Powell is extremely active in the community, giving her time to multiple organizations.  She has served on Sheltering Arms’ board since 1999 and has also served on the board at Children’s Hospital, the Richmond SPCA, Theatre IV Children’s Theatre, The Daily Planet and the National Conference of Christians and Jews (Richmond Chapter).  In addition, she has given her time to the Christian Children’s Fund, Make Women Count, Big Brothers/Big Sisters and many other local organizations.

Ms. Powell will serve a two-year term as chairman of Sheltering Arms’ board. She resides in Hanover County with her husband, Lewis, and three children.

About Sheltering Arms

Sheltering Arms helps patients find the Power to Overcome the obstacles of illness and injury with a complete range of physical rehabilitation and wellness services.  To learn more about Sheltering Arms’ two hospitals and nine outpatient clinics visit http://www.ShelteringArms.com, call 1-877-56-REHAB, or connect with Sheltering Arms on Facebook. (www.facebook.com/shelteringarms) or Twitter (www.twitter.com/SheltArmsRehab).

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  Media Contact:

Stephanie Sulmer

Director of Public Relations

804-342-4329 / ssulmer@shelteringarms.com

Products to treat common issues in sports orthopedics and fitness, and return athletes to play.

by: Shannon R. La Spina, PT, DPT

Article Originally published in www.ptproductsonline.com

Therapy balls are an excellent source for a high-level core training program.

In an average physical therapy clinic, where a high-level athlete with ankle pain can be followed by a new runner with knee pain, knowing what to use in treating sports injuries is paramount for an effective training program and quick recovery. In my clinic, Sheltering Arms’ Maple Outpatient Center, Richmond, Va, typical subjective complaints of insidious-onset pain include knee pain while squatting, low back pain while playing a beloved sport, and ankle pain while running, to name a few. When it comes to joint, muscle, and fascial dysfunction, nontraumatic onset pain can usually be boiled down to four key areas.

1) HIP WEAKNESS AND UNILATERAL INSTABILITY
Patients with patellofemoral pain syndrome often show weakness of the hip external rotators and hip abductors,1 and recently an earlier dissipation of such pain has been documented, with a focus on early hip strengthening versus the historical focus on quadricep strengthening.2 Any asymmetry in hip girdle strength will likely cause eventual back/knee pain with the excessive joint forces created during athletic activities. Positive exam findings indicative of such weakness include knee pain, excessive hip internal rotation while performing a unilateral single-leg squat, weak hip abduction and/or hip internal or external rotation, and a pelvic drop during the stance phase of running or walking. A slow-motion video gait analysis, with both coronal and sagittal plane views, is very helpful in detecting biomechanical faults. A Thera-Band, from Hygenic Corporation, Akron, Ohio, is good for beginning strengthening in the hip girdle, with the BOSU ball, from Canton, Ohio, and DynaDisc from Exertools, Petaluma, Calif, helpful in advanced unilateral stability training.

Performing quadruped exercises on the Swiss ball allows for greater core engagement and increased range of motion.

2) CORE WeAKNESS AND LOW BACK PAIN
Core stability and strength largely affect the amount of strain on the lumbar/sacral spine during any mobility, especially in a fitness/sports setting. Without core strength, or the simple awareness of core engagement, patients place excessive strain on their lumbar spine and unknowingly set themselves up for probable injury. Teaching awareness of the core muscles is always a challenge, and therapy balls are a great adjunct to treatment in these cases. Simply sitting on the ball to perform pelvic tilts and circles is a challenge for many athletes, and it will often assist in lumbo-pelvic dissociation far better than when the patient is supine, or even in quadruped. Core exercises on a Swiss ball have been shown to activate core muscles more than traditional floor abdominal exercises,3 and for $30 or less patients can purchase a ball for home and be discharged with a high-level core program that is a fraction of the cost of a gym membership. Medicine balls are also a good adjunct to therapy and provide resistance in dynamic core work.

3) FOOT MECHANICS

A Thera Cane can help relieve muscle spasms in the upper back.

It is paramount to assess the patient’s feet with all complaints of pain in the back or lower extremity. Assessment of pain or injury in the low back and the lower extremities needs to begin from the ground up, and often the actual dysfunction lies in the joints above or below the painful site. A thorough mechanical assessment of the hind, mid, and forefoot will reveal areas of hypo- or hypermobility, and therapeutic taping can assist in restoring normal foot mechanics, either to stabilize or to maintain mobilizations performed in the clinic. Leukotape, BSN Medical, Charlotte, NC, with or without Hypafix, Smith and Nephew, London, UK, is useful in stabilizing a displaced navicular, cuboid, or distal tibiofibular joint, post mobilizations. I frequently use standard athletic tape with a modified lo-dye technique to correct overpronation and to determine whether the patient is appropriate for orthotics. Over-the-counter orthotics such as Superfeet, Ferndale, Wash, or Powerstep, Cincinnati, are affordable and typically provide patients the support they need to maintain normal alignment and allow a normal ground reaction force to the knee and hip.

4) IMPAIRED POSTURE AND SHOULDER PAIN
General shoulder pain has been shown to respond favorably to therapeutic exercise for rotator cuff strengthening,4 and several factors are often involved in symptom onset. Mechanical shoulder pain is often seen with repetitive throwing or weightlifting activities, causing tight anterior chest muscles and rounded shoulders, which places excessive strain on the glenohumeral joint and rotator cuff tendons. This is also typical for the adolescent population, who tend to carry very heavy backpacks and present with lower and upper back pain as a chief complaint. The Thera Cane, Denver, a self muscle-release tool, is excellent for loosening trigger points and common areas of muscle spasm that lead to upper back and shoulder pain, and they can be purchased for around $30. Foam rollers may also be effective in treating mechanical shoulder pain. Used horizontally, foam rollers allow thoracic mobilization, and when used vertically, they can aid soft-tissue release to paraspinal musculature. A simple but highly effective product I often use is the humble tennis ball, which is useful in self-release of the periscapular muscles, upper trapezius, and suboccipital muscles.

Lastly, validated outcome measures are a very helpful tool in assessing change in functional limitations, especially among an athletic population. In a study of physical therapists’ use of outcome measures,5 the majority of participants (>90%) who used such measures believed they enhanced communication with patients and helped direct the plan of care. Outcome measures are helpful in goal setting and provide the clinician an accurate view of the real limitations. They also provide to the patient objective feedback about progress, which provides motivation and security in knowing the treatment plan is working.

Foam rollers allow thoracic mobilization when used horizontally.

CASE STUDY
A 47-year-old female presented to our clinic with a 1-year history of ankle pain that progressively worsened with walking and had forced her to stop running 1 month prior to her PT evaluation. She was a new runner and worked at the local animal shelter in a job that required lots of walking, squatting, and lifting. Initial ankle motion measures showed a lack of full ankle dorsiflexion on both sides and decreased right hip internal and external rotation strength, as well as a significant loss of right hamstring strength.

Joint mobility testing showed hypomobility in the hind and midfoot on the right side, as well as a plantar-flexed first ray and cuboid subluxation on that side. Her initial score on the Foot and Ankle Ability Measure (FAAM) was 57%. Impairments were also seen in her gait pattern, with decreased dorsiflexion in midstance and decreased push-off on both sides. Goals were set to increase her ankle ROM, decrease pain levels to allow performance of work duties, and return to running 1 mile without pain limiting. Treatments consisted of manual mobilizations to increase motion in the hind and midfoot and reposition a subluxed cuboid, use of ultrasound and the Game Ready, CoolSystems Inc, Alameda, Calif, for pain and inflammation. A home exercise program of gastroc-soleus stretching and foot intrinsic and anterior tibialis strengthening, as well as a basic hip-strengthening program, were also included as treatment.

Thera-Band was used for four-way ankle strengthening, and the patient also purchased over-the-counter orthotics after responding well to use of tape to simulate an arch support. By the end of therapy, she had increased her FAAM score to 98% and scored a 95% on the Lower Extremity Functional Scale. The patient was discharged to a continued home program for high-level hip and hamstring strengthening, unilateral squats, and continued focus on lower-extremity stretching. By the end of therapy, all muscle groups tested at a 4/5 level or higher, and 4 months after completing therapy the patient was able to compete in four different road races without pain.

Physical therapy involves considerable patient education, and among the general fitness population knowing what products to use in the clinic, and recommend for home use, can help patients to faster and more effective outcomes.

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Shannon R. La Spina, PT, DPT, is a staff physical therapist for Sheltering Arms and works at the organization’s Maple Outpatient Center in Richmond, Va. She is an American Physical Therapy Association (APTA) Credentialed Clinical Instructor and Leadership Education in Neurodevelopmental and Related Disabilities (LEND) Pediatric Fellow, and specializes in manual therapy, pediatrics, and gait analysis.

REFERENCES

1. Ireland ML, Wilson JD, Ballantyne BT, Davis IM. Hip strength in females with and without patellofemoral pain. J Ortho Sports Phys Ther. 2003;33:671-676.
2. Dolak KL, Silkman C, Mckeon JM, Hosey RG, Lattermann C, UHL TL. Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: A randomized clinical trial. J Ortho Sports Phys Ther. 2011;41:560-571.
3. Escamilla RF, Lewis C, Bell D, et al. Core muscles activation during Swiss ball and traditional abdominal exercises. J Ortho Sports Phys Ther. 2010;40:265-276.
4. Ginn KA, Herbert RD, Khouw W, Lee R. A randomized, controlled clinical trial of a treatment for shoulder pain. Phys Ther. 1997;77:802-809.
5. Jette DU, Halbert J, Iverson C, Miceli E, Shah P. Use of standardized outcome measures in physical therapist practice: Perception and applications. Phys Ther. 2009;89:125-135.

We make our eye movements earlier or later in order to coordinate with movements of our arms, New York University neuroscientists have found. Their study, which appears in the journal Neuron, points to a mechanism in the brain that allows for this coordination and may have implications for rehabilitation and prosthetics.

Researchers have sought to understand the neurological processes behind eye and arm movements. For example, when you reach for an object, what goes on in our brains so that our eyes and arms are in sync? Such coordination is central to the way different systems of the brain communicate with each other, and these undertakings are surprisingly complicated – due to differences in weight, for instance, the arm takes longer than the eye to move.

The question is vital to rehabilitation – a better understanding of these neurological processes may help address the needs of those who have suffered brain injuries and struggle to coordinate movements among different parts of the body. In addition, new insights in this area could lead to more advanced neural prosthetics, which are artificial extensions to the body that restore or supplement function of the nervous system lost during disease or injury. Currently, these devices are somewhat primitive given our relatively limited knowledge of how the brain works to coordinate movement.

In their study, the NYU researchers examined the neurological activity of macaque monkeys while the subjects performed a variety of tasks that required them to either reach and to simultaneously employ rapid eye movements or to only use rapid eye movements, also known as saccades.

The resulting readings revealed significant coherent patterns of firing of neurons in the brain’s posterior parietal cortex (PPC) when both the eyes and arms were required to move for the same task, but not for tasks that involved only saccades. The patterns of firing were found in regions of the PPC that are specialized for moving either the eye or the arm.

Coherent patterns of firing may be due to these different brain areas communicating when coordinating movement, the research team concluded.

“We think we have a mechanism for coordination,” explained Bijan Pesaran, a professor in NYU’s Center for Neuroscience and the study’s senior author, adding that the finding is only a step and additional study is likely to reveal a more complex process. “Our findings show it is the patterns of activity in a specific region of the brain just prior to both saccades and reaching that are important.”

In addition, their data showed a coordination of movement between the eyes and arms.

“The brain adjusts timing of eye movements, depending on how long it takes to start moving the arm,” Pesaran explained. “Our study is asking how information flows between the arm and eye movement systems, and it shows how coherent patterns of neural activity are important to this communication.”

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The study’s other co-authors were Heather Dean and Maureen Hagan, postdoctoral fellows in NYU’s Center for Neural Science.
The research was supported by grants from: the National Science Foundation; the National Institutes of Health; NYSTAR; the Sloan Fondation; the McKnight Endowment Fund for Neuroscience; and the Burroughs Wellcome Fund.
New York University

In a new study published in the March issue of Radiology, functional magnetic resonance imaging (fMRI) shows that cognitive rehabilitation changes brain function and improves cognitive performance in patients with relapsing-remitting multiple sclerosis (MS).

“These results prompt the use of specific computer-based rehabilitation programs to treat deficits in selected neuropsychological domains in patients with relapsing-remitting MS,” said the study’s lead author, Massimo Filippi, M.D., professor of neurology at the San Raffaele Vita-Salute University and director of the “BrainMap” interdepartmental research program and the Neuroimaging Research Unit, Department of Neuroscience, Scientific Institute San Raffaele, Milan, Italy. “They also suggest that fMRI might provide useful metrics to monitor the effects of rehab in MS.”

MS is a nervous system disease affecting the brain and spinal cord. MS damages a material called the myelin sheath that surrounds and protects nerve cells. This damage disrupts messages between the brain and other parts of the body, leading to symptoms such as muscle weakness, coordination and balance difficulties, numbness, problems with vision, memory loss and other cognitive issues. MS affects women more than men and often becomes symptomatic between the ages of 20 and 40.

In relapsing-remitting MS, the most common type, patients experience a series of attacks followed by partial or complete disappearance of symptoms. The interval between relapses can range from weeks to years.

Cognitive impairment affects a large proportion of patients with MS in the areas of attention, information processing, executive functions, memory and visual-spatial abilities. Cognitive dysfunction impacts a range of activities, including work, driving and social integration.

For the study, Dr. Filippi and colleagues recruited 20 patients with relapsing-remitting MS. Patients were randomized into two groups of 10. The first group received a 12-week program of computer-assisted cognitive rehabilitation of attention and information processing and executive functions, and the second (control) group received no cognitive rehabilitation.

Aspects of the rehabilitation program included a day-planning task, which employed realistic simulations of a set of scheduled dates and duties to address the patient’s ability to organize, plan and develop solution strategies; and an attention task requiring the patient to simulate driving a train, carefully observing the control panel of the train and the countryside while encountering several distractions at increasing levels of difficulty.

All of the patients underwent neuropsychological assessment and MRI exams at baseline and after 12 weeks. As compared to their performance at baseline, the patients in the treatment group improved in tests of attention and information processing and executive functions. The fMRI results showed modifications in activity in several brain regions in the rehabilitation group, compared to the non-rehabilitation group. These fMRI modifications were correlated with cognitive improvement.

Analysis after cognitive rehabilitation found no structural changes in the gray matter or normal-appearing white matter of the brain in the treatment group.

“The findings demonstrated that computer-assisted cognitive rehabilitation in patients with MS results in an improvement of the trained cognitive functions,” Dr. Filippi said. “However, the structural integrity of the brain’s gray matter and white matter showed no modifications in these patients, suggesting an impairment of structural plasticity.”

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DOE/Sandia National Laboratories. “Improving Neural Control Of Prosthetics For Amputees.” Medical News Today. MediLexicon, Intl., 23 Feb. 2012. Web.
24 Feb. 2012. <http://www.medicalnewstoday.com/releases/242004.php>

(Richmond, VA) – Sheltering Arms, Central Virginia’s premier physical rehabilitation healthcare provider, today stepped onto the big stage of Super Bowl advertising by releasing its first spot developed specifically for the big game.

The advertisement, which runs thirty seconds, will premier during WWBT-TV’s coverage of the Super Bowl.  It utilizes a series of voice-overs of individuals telling how they’ve learned The Power to Overcome disability, thanks to working with Sheltering Arms.  The words said by the individuals in the spot are transcribed in graphics, which at the end of the commercial form the Sheltering Arms logo.

“The graphics in the ad are incredible, and it grabs you on a very visceral level,” said Sheltering Arms Director of Marketing and Public Relations Stephanie Sulmer.  “We feel it is right up there with the national spots in terms of creativity, and at the same time it educates viewers about how we help people get back to living their lives and doing the things they enjoy.”

The past year has been a groundbreaking one for Sheltering Arms.  Last spring, the organization launched an unique and innovative program with cutting-edge technologies called the iWALK Recovery Center, which continues to receive both national and international attention.  In the next few months, Sheltering Arms has plans to launch more exciting programs that will help people regain their lives.

“We don’t want to be the “best kept secret” in Richmond, and that’s why we chose the Super Bowl as our advertising platform,” said Sulmer.  “We want everyone to know about Sheltering Arms and how we help patients to find the power to overcome their disabilities and setbacks resulting from illness and injury.”

Sheltering Arms worked with Studio Center’s Richmond office to produce the commercial.

About Sheltering Arms
Sheltering Arms helps patients find the Power to Overcome the obstacles of illness and injury with a complete range of physical rehabilitation and wellness services.  To learn more about Sheltering Arms’ two hospitals and eight outpatient clinics visit http://www.ShelteringArms.com, call 1-877-56-REHAB.

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If you missed the first showing…it is OK!
Encore Presentations of NEW Sheltering Arms Documentary are Airing soon!
This new documentary features real patients seen in our recent commercials. Inspirational moments are expressed through stories of incredible people finding the Power to Overcome at Sheltering Arms. Spread the word!!!
Showtimes
Saturday, January 28th at 2pm on Channel 8
Sunday, January 29th at 6am on Channel 12
Saturday February 4th at 1pm on Channel 12

See the trailer!

Tune in on Sunday, January 22nd at 2pm on WRIC Channel 8 for a new documentary about Sheltering Arms! See the in-depth inspirational stories behind the patients featured in our recent commercials!  Share with your friends!