For individuals dealing with chronic fatigue syndrome, can incorporating acupuncture with other treatment protocols help regain functionality and improve quality of life?
Acupuncture For Chronic Fatigue Syndrome
Research is looking at how acupuncture can help manage symptoms of chronic fatigue. These studies focused on specific acupoints and techniques and how they affected certain symptoms or abnormalities linked to the condition. The researchers found that acupuncture may help manage and alleviate some symptoms (Qing Zhang et al., 2019). However, they were still unable to determine the mechanisms of how acupuncture exactly works.
Symptom Relief
Various studies showed that acupuncture could improve physical and mental fatigue symptoms, including:
One case study showed improvements in groups of athletes who were put through a series of exhaustive physical exercises and short-term rest. One group of athletes was treated with acupuncture on selected acupoints while the others were given an extended rest. Analysis was applied to the metabolic profiles of urine samples collected from the athletes at three points: before the exercises, before and after the acupuncture treatment, or taking extended rest. The results indicated that the recoveries of disturbed metabolites in the athletes treated with acupuncture were significantly faster than in those who only took extended rest. (Haifeng Ma et al., 2015)
Researchers said studies involving acupuncture alone or in combination with other treatments appear to show that it is effective at lessening fatigue. (Yu-Yi Wang et al., 2014) However, further studies are needed to confirm the benefits. This is a significant change from a review that found limited evidence for the effectiveness of alternative treatments for relieving chronic fatigue symptoms. (Terje Alraek et al., 2011)
Another review of alternative therapies found acupuncture and certain meditation techniques showed the most promise for future investigation. (Nicole S. Porter et al., 2010)
Another study compared prednisone, a steroid, with an acupuncture technique called coiling dragon and an additional treatment called cupping. It suggested that acupuncture and cupping treatments surpassed the steroid regarding fatigue. (Wei Xu et al., 2012)
Another study found that needling with heat application or moxibustion produced better results than standard acupuncture regarding physical and mental fatigue scores. (Chen Lu, Xiu-Juan Yang, Jie Hu 2014)
From Consultation to Transformation: Assessing Patients In A Chiropractic Setting
References
Zhang, Q., Gong, J., Dong, H., Xu, S., Wang, W., & Huang, G. (2019). Acupuncture for chronic fatigue syndrome: a systematic review and meta-analysis. Acupuncture in medicine : journal of the British Medical Acupuncture Society, 37(4), 211–222. doi.org/10.1136/acupmed-2017-011582
Frisk, J., Källström, A. C., Wall, N., Fredrikson, M., & Hammar, M. (2012). Acupuncture improves health-related quality-of-life (HRQoL) and sleep in women with breast cancer and hot flushes. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 20(4), 715–724. doi.org/10.1007/s00520-011-1134-8
Mandıroğlu, S., & Ozdilekcan, C. (2017). Impact of Acupuncture on Chronic Insomnia: A Report of Two Cases with Polysomnographic Evaluation. Journal of acupuncture and meridian studies, 10(2), 135–138. doi.org/10.1016/j.jams.2016.09.018
Zhu, L., Ma, Y., Ye, S., & Shu, Z. (2018). Acupuncture for Diarrhoea-Predominant Irritable Bowel Syndrome: A Network Meta-Analysis. Evidence-based complementary and alternative medicine : eCAM, 2018, 2890465. doi.org/10.1155/2018/2890465
Ma, H., Liu, X., Wu, Y., & Zhang, N. (2015). The Intervention Effects of Acupuncture on Fatigue Induced by Exhaustive Physical Exercises: A Metabolomics Investigation. Evidence-based complementary and alternative medicine : eCAM, 2015, 508302. doi.org/10.1155/2015/508302
Wang, Y. Y., Li, X. X., Liu, J. P., Luo, H., Ma, L. X., & Alraek, T. (2014). Traditional Chinese medicine for chronic fatigue syndrome: a systematic review of randomized clinical trials. Complementary therapies in medicine, 22(4), 826–833. doi.org/10.1016/j.ctim.2014.06.004
Alraek, T., Lee, M. S., Choi, T. Y., Cao, H., & Liu, J. (2011). Complementary and alternative medicine for patients with chronic fatigue syndrome: a systematic review. BMC complementary and alternative medicine, 11, 87. doi.org/10.1186/1472-6882-11-87
Porter, N. S., Jason, L. A., Boulton, A., Bothne, N., & Coleman, B. (2010). Alternative medical interventions used in the treatment and management of myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia. Journal of alternative and complementary medicine (New York, N.Y.), 16(3), 235–249. doi.org/10.1089/acm.2008.0376
Lu, C., Yang, X. J., & Hu, J. (2014). Zhen ci yan jiu = Acupuncture research, 39(4), 313–317.
For individuals dealing with plantar fasciitis, every step can be painful. Can taking an integrative approach and utilizing acupuncture help treat this condition and accelerate symptom relief?
Acupuncture Plantar Fasciitis
Plantar fasciitis is when the supportive tissue running under the foot, from the heel to the base of the toes, becomes irritated and painful. The disorder can be difficult to manage, but there are alternative treatment options. Acupuncture plantar fasciitis therapy is one potential method of relief, alleviating pain, and returning the individual to regular activities. Acupuncture involves inserting extremely thin needles into points in the body to restore and balance the normal flow of energy and improve overall health. (Johns Hopkins University. 2024) In traditional Chinese medicine or TCM, the body comprises a series of meridians/channels that supply energy flow or qi/chi.
Facts
Plantar fasciitis is a common disorder affecting the foot. The condition occurs when the plantar fascia, designed to absorb the forces that travel through the arch of the foot, becomes overloaded. When the bottom of the foot is constantly subjected to high amounts of strain, it leads to ligament degeneration, pain, and inflammation. The most common symptom is heel pain, the first thing an individual experiences in the morning or after a long day of work and activities. Anyone can get plantar fasciitis, but those who are more prone to the condition include individuals with:
Acupuncture and its effectiveness are still being studied, but there is evidence suggesting that it is beneficial in plantar fasciitis treatment.
One review found significant pain improvements in individuals who had acupuncture for the condition compared to individuals who received standard treatments like stretching, orthotics, and strengthening. (Anandan Gerard Thiagarajah 2017) The same review also found benefits when comparing acupuncture to a placebo version of the treatment, further reinforcing the findings.
Another medical review found that acupuncture helped alleviate heel pain and improve daily function when combined with nonsteroidal anti-inflammatory medications/NSAIDs such as ibuprofen or naproxen. (Richard James Clark, Maria Tighe 2012)
Side Effects
While acupuncture plantar fasciitis therapy is beneficial, it is important to remember there can be potential side effects that can include:
Pain in the area where the needles were placed.
Bleeding in the area where the needles were placed.
Bruising or skin discoloration.
Allergic reaction or contact dermatitis/itchy rash.
The chances of a serious adverse side effect are relatively low when undergoing acupuncture on the foot.
Acupuncture Points and Sensations
The ways acupuncture works are not yet fully understood, but like other neuromusculoskeletal therapies, the process activates the body’s healing properties.
Inserting a needle into the body’s points stimulates the central nervous system.
This leads to the release of chemicals in the brain, spinal cord, and muscles that promote healing.
These same chemicals and reactions also reduce the body’s sensation of pain. (Teng Chen et al., 2020)
Number of Sessions
The amount of sessions that acupuncture takes to provide pain relief varies from person to person and case to case.
One review found that treating plantar fasciitis weekly with acupuncture produced significant pain relief after four to eight weeks. (Anandan Gerard Thiagarajah 2017)
This corresponds to another medical review that included a study showing significantly improved pain levels in individuals undergoing weekly acupuncture sessions for four weeks. (Richard James Clark, Maria Tighe 2012)
Individuals are recommended to consult a healthcare provider about personalized treatment plans and if they have a bleeding disorder, are on blood thinner medications, or are pregnant.
Thiagarajah A. G. (2017). How effective is acupuncture for reducing pain due to plantar fasciitis?. Singapore medical journal, 58(2), 92–97. doi.org/10.11622/smedj.2016143
Clark, R. J., & Tighe, M. (2012). The effectiveness of acupuncture for plantar heel pain: a systematic review. Acupuncture in medicine : journal of the British Medical Acupuncture Society, 30(4), 298–306. doi.org/10.1136/acupmed-2012-010183
Chan, M. W. C., Wu, X. Y., Wu, J. C. Y., Wong, S. Y. S., & Chung, V. C. H. (2017). Safety of Acupuncture: Overview of Systematic Reviews. Scientific reports, 7(1), 3369. doi.org/10.1038/s41598-017-03272-0
Chen, T., Zhang, W. W., Chu, Y. X., & Wang, Y. Q. (2020). Acupuncture for Pain Management: Molecular Mechanisms of Action. The American journal of Chinese medicine, 48(4), 793–811. doi.org/10.1142/S0192415X20500408
For individuals that are feeling unmotivated to work out and exercise can developing a fitness mindset help improve and maintain motivation?
Fitness Mindset Motivation
Learning to exercise as part of a regular workout routine can have a significant impact on health and well-being. In the beginning, individuals are all in, but as time goes on, mental blocks can interfere with workout motivation. Being flexible with oneself and fitness/health goals is part of the process, and overcoming mental blocks is key to maintaining motivation. It’s all about creating a fitness mindset to maintain confidence and motivation and enjoy the benefits of regular exercise.
Feeling Tired
When feeling tired, individuals should ask themselves if it’s physical or mental fatigue. If the exhaustion is not from lack of sleep, illness, or a physically demanding job, it is more than likely mental tiredness. Mental exhaustion can often feel physical, and a recommended cure is physical activity. Often, once an individual starts working out and gets over the mental fatigue, they feel better. (Juriena D. de Vries et al., 2016) Regular physical activity can increase energy levels and leave the body feeling less fatigued. (Bryan D. Loy et al., 2013) However, individuals need to make sure there is ample recovery time to repair and restore the body after working out.
Self-Talk
Sometimes there is a small voice that says to take a day off or perform an easier workout. It’s okay to be flexible, but most times, individuals need to be ready to stand up to the skip-the-workout voices and stay motivated.
Remove Obstacles
Remove obstacles that can distract from exercising.
Have the workout gear ready and exercise time pre-scheduled so there are no second thoughts.
If limited space is an issue, find compact equipment like a cordless jump rope that doesn’t require a lot of room.
Don’t Allow Relaxation Takeover
Individuals who plan to exercise after school or work shouldn’t go home, sit down, and relax watching TV before working out.
Individuals who may need a transition to work out should try something gentle but active, like stretching or doing a light chore.
Individuals who exercise in the morning should wear their workout clothes immediately, so they can’t second guess and can continue their workout.
Remind yourself of the reasons for committing to exercise.
Research shows that using second-person self-talk can help maintain motivation. Encouraging oneself with phrases like you can do this, you got this, or you are going to achieve your fitness goals improves the chances of obtaining the desired outcome. (Sanda Dolcos, Dolores Albarracin. 2014)
Fight Through The Doubt
Start with small steps. Ask if doubt is stopping you from starting. If doubt begins to arise:
Ask For Help
A colleague, friend, or partner can help reinspire motivation.
Tell them about the challenges of sticking with exercise.
Ask them to work out together.
Do What Is Possible
If working out for 30 minutes is too difficult, don’t worry about it.
Go for as long as possible and try for more the next time.
Working out can feel like a job, but it does not have to.
For example, individuals sitting or standing all day can approach the workout as 30 minutes to get out and move around.
Or, after getting the kids settled in, it is time to do something for yourself and exercise the stress away.
Healthy Reminders
Write inspirational fitness mindset notes and put them where they will be seen regularly.
These can be exercise goals; for example, I will exercise for 30 minutes because I want more energy, better sleep, strength, etc.
Train The Brain For Exercise
When the issue is motivation, the mind needs to be convinced to exercise. How to use mind-over-matter skills:
Rewards
When finishing a workout, rewards can help.
Exercise has its own rewards – more energy, improved mood, stress relief, and reduced disease risk.
Maybe a new pair of shoes, earbuds or headphones, workout equipment, or a massage will increase motivation.
Make A Deal
Continue to exercise for whatever amount of time, and if the desire to stop is still present, then stop.
Nine times out of 10, individuals will keep going.
Pretend
Make-believe can encourage the fitness mindset.
Pretending to be in a race, or in a movie, anything that makes the body want to move.
Set Achievable Goals
Making difficult goals can generate the fear of being unable to achieve them.
Aim for small achievable goals that go along with a bigger overall goal.
That way, there are more victories, and the motivation to keep moving is maintained.
Competition
Healthy competition can be a great motivator.
Competing with oneself for faster times, heavier weights, or more frequency can keep the inspiration going.
Social media and apps to compete with family and friends can also help.
Visualization
Athletes use visualization techniques of going through the game, match, and tournament to get themselves prepared and ready to execute what they’ve been practicing.
Individuals can do the same thing by picturing themselves going through their workout from beginning to end.
Exercise provides meditation time to think about problems and challenges.
Use the workout time to work through the problems and refocus strategies to solve them.
Process Goals
Choosing specific goals that are part of the workout process, like working out 3-4 times per week, is recommended compared to using outcome goals, like losing ten pounds.
Outcome goals can be out of the individual’s control; instead, focus on the steps to achieve the goals, which lessens stress and is a more controllable method of working out. (Kylie Wilson Darren Brookfield. 2011)
Changing lifestyle to include exercise is not easy. The most important step is having the right attitude. (Margie E. Lachman et al., 2018) Thinking about exercise as an obligation will discourage motivation. Instead, create a fitness mindset to treat exercise like a break from all the stress and a reward for the mind and body to a healthier life.
Home Exercises for Pain Relief
References
de Vries, J. D., van Hooff, M. L., Geurts, S. A., & Kompier, M. A. (2016). Exercise as an Intervention to Reduce Study-Related Fatigue among University Students: A Two-Arm Parallel Randomized Controlled Trial. PloS one, 11(3), e0152137. doi.org/10.1371/journal.pone.0152137
Bryan D. Loy, Patrick J. O’Connor & Rodney K. Dishman (2013) The effect of a single bout of exercise on energy and fatigue states: a systematic review and meta-analysis, Fatigue: Biomedicine, Health & Behavior, 1:4, 223-242, DOI: 10.1080/21641846.2013.843266
Dolcos S, Albarracin D. (2014). The inner speech of behavioral regulation: Intentions and task performance strengthen when you talk to yourself as a You. Eur J Social Psychol. 44(6):636-642. doi:10.1002/ejsp.2048.
Lachman, M. E., Lipsitz, L., Lubben, J., Castaneda-Sceppa, C., & Jette, A. M. (2018). When Adults Don’t Exercise: Behavioral Strategies to Increase Physical Activity in Sedentary Middle-Aged and Older Adults. Innovation in aging, 2(1), igy007. doi.org/10.1093/geroni/igy007
Renner, F., Murphy, F. C., Ji, J. L., Manly, T., & Holmes, E. A. (2019). Mental imagery as a “motivational amplifier” to promote activities. Behaviour research and therapy, 114, 51–59. doi.org/10.1016/j.brat.2019.02.002
Kylie Wilson & Darren Brookfield (2009). Effect of Goal Setting on Motivation and Adherence in a Six‐Week Exercise Program, International Journal of Sport and Exercise Psychology, 7:1, 89-100, DOI: 10.1080/1612197X.2009.9671894
For individuals looking to improve overall health and wellness, how can paying attention to non-exercise activities help burn more calories and improve metabolic rates?
Non-Exercise Activity Thermogenesis – NEAT
Non-exercise activity thermogenesis, or NEAT, describes the calories burned by daily movements and activities. These physical movements are not planned or structured exercises, workouts, or sports. It is also referred to as non-exercise physical activity or NEPA. Examples include activities like:
Cleaning
Cooking
Shopping
Playing a musical instrument
Small movements like fidgeting
When buying a few items, carry a basket instead of a shopping cart.
Take the stairs instead of the elevator or escalator.
While these movements might not seem like a lot, they can have a substantial impact on metabolic rates and calorie expenditures. A study followed over 12,000 women for 12 years and found that fidgeting can reduce the risk of death associated with excessive sedentariness. (Gareth Hagger-Johnson et al., 2016)
Calories Burned
The amount of calories burned varies from person to person. A study reported that the number of calories burned from non-exercise activity thermogenesis varies up to 2000 kilocalories a day between two individuals of similar size. (Christian von Loeffelholz et al., 2000). A number of factors can account for this difference, including environment and genetics. Individuals’ occupations and lifestyles can also influence non-exercise activity thermogenesis. For example, two individuals with similar body mass indexes or BMIs but different jobs, sedentariness versus activity, will burn different calorie amounts.
Improving Health
Non-exercise activity thermogenesis is thought to be one of the ways the body manages weight. When gaining weight, NEAT tends to increase, whereas when losing weight, NEAT decreases with individuals sitting more without moving as much. A research review noted that the benefits of non-exercise go well beyond the extra calories expended. (Pedro A. Villablanca et al., 2015). Increasing non-exercise activity thermogenesis reduces the risk of metabolic syndrome, cardiovascular issues, and other health problems. Plus, research shows that inactivity can negate the time and effort put into structured exercise. (John D. Akins et al., 2019). Combating sedentary behavior with non-activity thermogenesis helps increase the benefits of regular workouts.
Incorporating NEAT
There are small ways to incorporate non-exercise activity thermogenesis at work and at home. This could be using a standing desk or stability ball. According to the National Academy of Sports Medicine, a 145-pound person can approximately burn:
102 calories an hour while sitting at work.
174 calories if standing at work.
72 calories extra may not seem like a lot, but it can add up to more than 18,000 calories burned per year, leading to an approximate 5-pound weight loss.
If waiting in line or sitting in traffic, finding small ways to move, like tapping the hands or feet or moving the head to music, helps the body take advantage of non-exercise activity thermogenesis. Making more conscious efforts to move can go a long way in improving health.
Is Motion Key To Healing?
References
Hagger-Johnson, G., Gow, A. J., Burley, V., Greenwood, D., & Cade, J. E. (2016). Sitting Time, Fidgeting, and All-Cause Mortality in the UK Women’s Cohort Study. American journal of preventive medicine, 50(2), 154–160. doi.org/10.1016/j.amepre.2015.06.025
von Loeffelholz, C., & Birkenfeld, A. L. (2022). Non-Exercise Activity Thermogenesis in Human Energy Homeostasis. In K. R. Feingold (Eds.) et. al., Endotext. MDText.com, Inc.
Villablanca, P. A., Alegria, J. R., Mookadam, F., Holmes, D. R., Jr, Wright, R. S., & Levine, J. A. (2015). Nonexercise activity thermogenesis in obesity management. Mayo Clinic proceedings, 90(4), 509–519. doi.org/10.1016/j.mayocp.2015.02.001
Akins, J. D., Crawford, C. K., Burton, H. M., Wolfe, A. S., Vardarli, E., & Coyle, E. F. (2019). Inactivity induces resistance to the metabolic benefits following acute exercise. Journal of applied physiology (Bethesda, Md. : 1985), 126(4), 1088–1094. doi.org/10.1152/japplphysiol.00968.2018
Progress can be challenging for individuals in post total ankle replacement surgery. How can physical therapy help in recovery and restoring leg function?
Total Ankle Replacement Post Surgery Physical Therapy
Total ankle replacement surgery is a major procedure that takes time to recover. A total ankle replacement surgery or arthroplasty can benefit individuals with chronic ankle pain or disability. This procedure can significantly improve an individual’s overall pain and function with time. Physical therapy is essential to regaining movement in the ankle and restoring full mobility. A physical therapist will work with the individual to control pain and swelling, restore the ankle’s range of motion, train on walking gait and balance, and rebuild strength in the leg. This will help maximize the chances of a successful outcome after surgery.
Total Ankle Replacement
The ankle joint is the section of the lower leg where the shinbone/tibia meets the talus bone on the top of the foot. What can happen is the slippery surface/articular cartilage that coats the ends of these bones begins to thin or deteriorate. As the deterioration progresses, it can lead to significant pain, disability, and difficulty walking. (Cleveland Clinic. 2021) This is where a specialist may recommend total ankle replacement for the best results. Various conditions can be helped by this procedure, including:
During an ankle replacement procedure, an orthopedic surgeon removes the damaged ends of the tibia and talus bones and replaces them with an artificial covering. A polyethylene component is also secured between the two structures to support the smooth movement of the new joint endings. (Massachusetts General Hospital. N.D.) Following the procedure, individuals are typically placed in a protective boot or splint. The healthcare provider will recommend staying off the leg for 4 to 8 weeks to allow healing.
Physical Therapy
Outpatient physical therapy is usually initiated several weeks after the ankle operation. (UW Health Orthopedics and Rehabilitation. 2018) Physical therapy can last for five months or more, depending on the severity of the condition and injury. The physical therapist will focus on different areas to get the best results. (Cort D. Lawton et al., 2017)
Pain and Swelling Control
Post-operative pain and swelling are normal after a total ankle replacement. It is not unusual for an ankle to be swollen for even six to 12 months after the operation. (UW Health Orthopedics and Rehabilitation. 2018) The surgeon will normally prescribe medication to help manage discomfort early on, and physical therapy also plays an important role in addressing the symptoms. Treatments used can include:
Electrical stimulation – mild electrical pulses applied to the muscles.
Ice
Vasopneumatic compression, where an inflatable sleeve is used to create pressure around the area, is commonly utilized at the beginning of physical therapy to reduce pain or swelling.
Other modalities, such as stretching and targeted exercises, are combined with other treatments.
Range of Motion
Early after the procedure, the ankle will be very stiff and tight. This is due to several factors, including the inflammation and swelling after surgery and the time spent immobilized in a boot.
The physical therapist will employ various techniques to improve the ankle joint’s range of motion to rotate and flex.
The physical therapist may employ passive stretching induced by an outside force such as the therapist or a resistance band) to help improve mobility.
After multiple weeks of reduced movement and lack of bearing any weight on the ankle, the muscles that surround the ankle have often atrophied/weakened, which can impact balance.
When the individual can begin placing weight on the leg, the therapist will apply proprioceptive/sense of body position training to improve overall stability. (UW Health Orthopedics and Rehabilitation. 2018)
Balance exercises will be added to the home program and will progress from week to week.
Strength
The muscles in the leg, ankle, and foot become weak from the surgery and the time spent in a splint or boot. These structures have a significant role in balance, the ability to stand, walk, and go up or down the stairs.
Regaining the strength and power of these muscles is a critical goal of rehabilitation.
In the first weeks, the physical therapist will focus on gentle strengthening exercises.
Isometrics lightly activate the muscles but avoid irritating the surgical site.
As time passes and weight-bearing is allowed, these gentle moves are replaced with more challenging ones, like resistance bands and standing exercises, to accelerate strength gains.
Lawton, C. D., Butler, B. A., Dekker, R. G., 2nd, Prescott, A., & Kadakia, A. R. (2017). Total ankle arthroplasty versus ankle arthrodesis-a comparison of outcomes over the last decade. Journal of orthopaedic surgery and research, 12(1), 76. doi.org/10.1186/s13018-017-0576-1
Individuals in post-surgery recovery or dealing with illness or an injury can experience weakened muscles and endurance that can cause temporary loss of sleeping mobility and not being able to move around normally because of weakness, decreased range of motion, or pain. Can they benefit from physical therapy to help get back to normal functional mobility?
Sleeping Mobility
For individuals who are hospitalized or homebound from injury, illness, or surgical recovery, a physical therapist will assess various areas of functional mobility. These include transfers – from sitting to standing positions, walking, and sleeping mobility. Sleeping mobility is the ability to perform specific motions while in bed. A therapist can assess sleeping or bed mobility and recommend strategies and exercises to improve movements. (O’Sullivan, S. B., Schmitz, T. J. 2016) A therapist may have the individual use specific devices, like an over-the-bed trapeze or a sliding board, to help move around.
All of these movements require strength in different muscle groups. By checking out individual motions in sleeping mobility, a therapist can work out specific muscle groups that may be weak and require targeted exercises and stretches to restore mobility to normal. (O’Sullivan, S. B., Schmitz, T. J. 2016) Individuals visiting a therapist in an outpatient clinic or rehabilitation area may have the individual work on sleeping mobility on a treatment table. The same motions on the treatment table can be done in the bed.
Importance
The body is meant to move.
For individuals who cannot move comfortably on their bed, the body may suffer disuse atrophy or the wasting away of muscular strength, which can lead to increased difficulties. Not being able to move can also lead to pressure ulcers, especially for individuals who are severely deconditioned and/or remain in one position for a long period. Skin health may start to break down, leading to painful wounds that require specialized care. Being able to move around in bed can help prevent pressure ulcers. (Surajit Bhattacharya, R. K. Mishra. 2015)
Improvement
A physical therapist can prescribe specific exercises to strengthen muscle groups and improve sleeping mobility. The muscles include:
Shoulder and rotator cuff muscles.
Triceps and biceps in the arms.
Gluteus muscles of the hips.
Hamstrings
Quadriceps
Calf muscles
The shoulders, arms, hips, and legs work together when moving the body around the bed.
Various Exercises
To improve bed movement, physical therapy exercises can include:
Physical therapists are trained to assess these motions and functions and prescribe treatments to improve body movement. (O’Sullivan, S. B., Schmitz, T. J. 2016) Maintaining appropriate physical fitness can help the body stay active and mobile. Performing mobility exercises prescribed by a physical therapist can keep the right muscle groups working properly, and working with a physical therapist can ensure the exercises are correct for the condition and are performed properly.
Bhattacharya, S., & Mishra, R. K. (2015). Pressure ulcers: Current understanding and newer modalities of treatment. Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India, 48(1), 4–16. doi.org/10.4103/0970-0358.155260
For individuals having difficulty moving or functioning normally due to injury, surgery, or illness, can a chiropractic and physical therapy team help expedite recovery?
Friction Massage
Individuals may develop scar tissue or tissue adhesions that limit normal motion after injury or surgery. A pain management team may use various treatments and modalities and may incorporate friction massage as part of a rehabilitation treatment plan. Friction massage, also known as transverse friction or cross friction massage, is a technique used to help improve scar tissue and adhesion mobility to move better and decrease the negative effects. The therapist uses their fingers to massage the scar in a direction that is at right angles to the scar line. It is a specialized technique that breaks up tissue adhesions that are limiting normal movement in the skin and underlying tissues. (Haris Begovic, et al., 2016)
Scar Tissue and Adhesions
For individuals who require surgery due to an injury or an orthopedic condition, their doctor will cut into the skin, tendons, and muscle tissue during the operation. Once sutured and healing has begun, scar tissue forms. Healthy tissue is made up of collagen that is comprised of cells that are arranged in a regular pattern. Healthy collagen is strong and can resist forces when tissues are pulled and stretched. (Paula Chaves, et al., 2017)
During the healing process after an injury, the collagen cells are laid down in a haphazard pattern and form scar tissue. The random accumulation of cells becomes tight and does not react well to tension and stretching forces. (Qing Chun, et al., 2016) The body can form scar tissue after a soft tissue injury, like a muscle or tendon strain. (Qing Chun, et al., 2016)
If a muscle or tendon gets strained the body will generate new collagen during the healing. The new collagen is laid down in a random fashion, and scar tissue or tissue adhesions can form that can limit the normal range of motion. Healthy tissue stretches and glides as the body moves. Scar tissue is rigid. At the site of the scar tissue, there can be some movement, but it is tight, less pliable, and can be painful. If scar tissue or adhesions are limiting motion, cross-friction massage can improve tissue gliding and sliding. This process is referred to as remodeling.
Massage Objectives
The objectives and goals of friction massage to adhesions or scar tissue may include:
Stimulation of nerve fibers to decrease and relieve pain.
The entire area of scar tissue or adhesion should be treated.
If the scar tissue is in a muscle, it should be relaxed.
If the scar tissue is in a tendon sheath, that tendon should be slightly stretched during the procedure.
The therapist places two or three fingers over the scar or adhesion and moves their fingers perpendicular to the scar to smooth the collagen fibers down.
The fingers and underlying tissues move together.
The massage should feel deep and uncomfortable but not painful.
There may be some pain, but should remain within the individual’s tolerance.
If the massage is too painful, less pressure may be used.
After several minutes the therapist will assess the tissue mobility.
Specific stretches may be done to elongate the scar tissue or adhesions.
At-home exercises and stretches may be prescribed to maintain flexibility.
Contraindications
There are situations where friction massage should not be used and can include: (Paula Chaves, et al., 2017)
Around an active open wound.
If there is a bacterial infection.
Areas with decreased sensation.
If calcification is present in the muscle or tendon tissue.
The therapist will explain the procedure and inform of the goals and risks associated with it.
Adhesive capsulitis in the shoulder/frozen shoulder.
Joint contracture.
Ligament tears.
Scar tissue buildup after surgery or trauma.
Friction massage is a popular technique used in physical therapy, but some research suggests it is not any more effective than other rehabilitation techniques. One study found that static stretches and exercises were more effective than massage in improving tissue length and strength in uninjured soccer players. Other studies have supported this, but individuals may find that the massage helps improve injured tissues’ movement as well. (Mohammed Ali Fakhro, et al. 2020)
The main goal of any treatment in physical therapy is to help the individual regain movement and flexibility. Friction massage, combined with targeted stretches and exercises, can help individuals expedite recovery and get back to normal.
Chiropractic Care After Accidents and Injuries
References
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Chaves, P., Simões, D., Paço, M., Pinho, F., Duarte, J. A., & Ribeiro, F. (2017). Cyriax’s deep friction massage application parameters: Evidence from a cross-sectional study with physiotherapists. Musculoskeletal science & practice, 32, 92–97. doi.org/10.1016/j.msksp.2017.09.005
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