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Sleep Better with These Tips for Bed Mobility

Sleep Better with These Tips for Bed Mobility

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?

Sleep Better with These Tips for Bed 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.

Bed and Sleeping Mobility

When a physical therapist checks mobility, they will assess various motions that include: (O’Sullivan, S. B., Schmitz, T. J. 2016)

  • Moving from sitting to lying down.
  • Moving from lying down to sitting up.
  • Rolling over.
  • Scooting or sliding up or down.
  • Scooting or sliding sideways.
  • Twisting.
  • Reaching.
  • Raising the hips.

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:

  • Upper extremity exercises
  • Lower trunk rotation
  • Glute exercises
  • Bridges
  • Leg raises
  • Short arc quads
  • Ankle pumps

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.


Optimizing Your Wellness


References

O’Sullivan, S. B., Schmitz, T. J. (2016). Improving Functional Outcomes in Physical Rehabilitation. United States: F.A. Davis Company.

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. https://doi.org/10.4103/0970-0358.155260

Get Stronger with Wearable Weights: All You Need To Know

Get Stronger with Wearable Weights: All You Need To Know

For individuals wanting to improve their fitness routine can incorporating wearable weights and knowing how to use them effectively help achieve health goals?

Get Stronger with Wearable Weights: All You Need To Know

Wearable Weights

Adding wearable weights allows individuals to use their body weight with added resistance. This can add strength training to a routine but can also be used during walks or runs to increase cardiovascular health and aid in weight loss. Research studies have found that wearing a weighted vest reduces body weight and fat mass. This is because heavier loads increase energy expenditure for the increase in physical workload. (Claes Ohlsson, et al., 2020)

Benefits

Wearable weights are easy to use.

  • Depending on the type, they are compact and can be taken on the go.
  • Wearing weights is an option for individuals with injuries or degenerative joint disease like arthritis that makes it difficult to hold or move weights.
  • Exercise has been proven to be a useful tool for treating osteoarthritis. (Lei Chen, Yan Yu. 2020)
  • There is no age limit for wearable weights.
  • Because many are only a few pounds, they are available to anyone from adolescents to the elderly.
  • Anyone can benefit from the different types of wearable weights.

Types

Three main types of wearable weights include wrist weights, ankle weights, and weighted vests.

  • Wrist weights can replace dumbbells in some cases.
  • They are typically between 1 to 10 pounds.
  • Ankle weights can provide extra resistance to leg motions.
  • They can be found from 1 pound up to 20 pounds.
  • Weighted vests provide a full-body challenge.
  • The weight choices for them vary, as most contain pockets where weight can be increased or decreased.

Using The Weights

Individuals can use wearable weights as a complement to strength and cardiovascular regimens. Beginners will want to start with lighter weights worn for less time. As the body becomes stronger, it’s important to increase the weight to see results.

Ankle Weights

  • Ankle weights can be used during a strength training workout to add resistance to lower body exercises.
  • As the body ages, it becomes more important to decrease the risk of falls by increasing lower limb and trunk strength.
  • Wearing ankle weights is recommended to build strength, especially in older adults. (Hiroyasu Akatsu, et al., 2022)
  • Individuals can wear them during a walk or run to increase the challenge.
  • They can be used for a high-level core workout.

Wrist Weights

  • Wrist weights can be used like dumbbells and worn during a walk or a run.
  • Research shows that walking with wrist weights can improve walking gait. (Hyung Suk Yang, et al., 2018)
  • Wearing weights on the wrists generates a higher energy expenditure, which allows one to add intensity to a walk or run without having to increase speed. (Catherine T. Campaña, Pablo B Costa. 2017)

Weighted Vests

  • Wearing a weighted vest during workouts will create a full-body challenge.
  • They can be used while walking or running and automatically add more difficulty.
  • Another way to utilize a weighted vest is to wear it while completing a regular workout.
  • Whether doing HITT, strength training, etc, individuals can wear a weighted vest.
  • The weight should be evenly distributed to prevent any injuries or functional disorders to the lower body.
  • Studies show no change in gait or an increased risk of injury when used correctly. (Christopher J. Gaffney, et al., 2022)

Individuals want to talk to a healthcare provider before beginning a new fitness program, and adding weights is no different, especially if there are any current or past injuries.


Is Motion Key To Healing?


References

Ohlsson, C., Gidestrand, E., Bellman, J., Larsson, C., Palsdottir, V., Hägg, D., Jansson, P. A., & Jansson, J. O. (2020). Increased weight loading reduces body weight and body fat in obese subjects – A proof of concept randomized clinical trial. EClinicalMedicine, 22, 100338. https://doi.org/10.1016/j.eclinm.2020.100338

Chen, L., & Yu, Y. (2020). Exercise and Osteoarthritis. Advances in experimental medicine and biology, 1228, 219–231. https://doi.org/10.1007/978-981-15-1792-1_15

Akatsu, H., Manabe, T., Kawade, Y., Masaki, Y., Hoshino, S., Jo, T., Kobayashi, S., Hayakawa, T., & Ohara, H. (2022). Effect of Ankle Weights as a Frailty Prevention Strategy in the Community-Dwelling Elderly: A Preliminary Report. International journal of environmental research and public health, 19(12), 7350. https://doi.org/10.3390/ijerph19127350

Yang, H. S., James, C. R., Atkins, L. T., Sawyer, S. F., Sizer, P. S., Jr, Kumar, N. A., & Kim, J. (2018). Effects of arm weight on gait performance in healthy subjects. Human movement science, 60, 40–47. https://doi.org/10.1016/j.humov.2018.05.003

Campaña, C. T., & Costa, P. B. (2017). Effects of walking with hand-held weights on energy expenditure and excess postexercise oxygen consumption. Journal of exercise rehabilitation, 13(6), 641–646. https://doi.org/10.12965/jer.1735100.550

Gaffney, C. J., Cunnington, J., Rattley, K., Wrench, E., Dyche, C., & Bampouras, T. M. (2022). Weighted vests in CrossFit increase physiological stress during walking and running without changes in spatiotemporal gait parameters. Ergonomics, 65(1), 147–158. https://doi.org/10.1080/00140139.2021.1961876

The Impact of Unhealthy Posture and How To Reverse It

The Impact of Unhealthy Posture and How To Reverse It

Many individuals attribute to some degree, their neck or back pain to unhealthy posture. Can knowing the causes and underlying factors help guide lifestyle adjustments and seeking medical rehabilitative treatment?

The Impact of Unhealthy Posture and How To Reverse It

Unhealthy Posture Causes

Numerous factors can cause individuals to practice unhealthy postures regularly.

Practicing healthy posture is a form of exercise where the muscles support the skeleton in stable and efficient alignment that is present in stillness and movement.

Injury and Muscle Guarding

  • After an injury, muscles can spasm to protect the body and help stabilize injuries and protect against further injury.
  • However, movements become limited and can lead to pain symptoms.
  • Prolonged muscle spasms lead to weakened muscles over time.
  • The imbalance between muscles guarding the injury and those still operating normally can lead to posture problems.
  • Musculoskeletal treatment with massage, chiropractic, and physical therapy can help restore optimal functioning.

Muscle Tension and Weakness

  • If certain muscle groups become weak or tense, posture can be affected, and pain symptoms can develop.
  • Muscle weakness or tension can develop when individuals hold a prolonged position day after day or when performing routine tasks and chores in a way that places tension on the muscles or uses them in an unbalanced way.
  • A study found how muscle tension, strength, and flexibility affect posture. Dariusz Czaprowski, et al., 2018)
  • Postural retraining and physical therapy adjustments can help strengthen the muscles and relieve pain symptoms.

Daily Habits

  • As individuals find ways to accommodate muscle spasms, weakness, tension, and/or imbalances, the mind and body can forget and abandon healthy posture.
  • The body then begins compensating using alternate, awkward, and counterproductive muscle contractions and stretching that compromise body and spinal alignment.

Use of Technology

  • Technology – whether sitting at a desk/workstation, using a tablet or cell phone, or working with several devices can gradually shift the body out of alignment. (Parisa Nejati, et al., 2015)
  • Individuals constantly looking down at their phone may develop a text neck, a condition in which the neck is held in flexion or forward tilting too long, which can lead to pain.

Mental Attitude and Stress

  • Individuals under stress or are experiencing stressful situations can begin to have posture problems. (Shwetha Nair et al., 2015)
  • Stress can contribute to over-contracting muscles, which can cause muscle tension, shallow breathing, posture problems, and pain symptoms.
  • Being aware of body position and correcting and adjusting posture can help to counteract stress. (Shwetha Nair et al., 2015)

Footwear Choice and They Are Worn

  • Footwear can affect body posture.
  • High heels shift the body’s weight forward, which can cause misalignment. (Anniele Martins Silva, et al., 2013)
  • Wearing down the outside or inside of the shoes faster from things like weight-bearing habits will imbalance kinetic forces that translate up the ankle, knee, hip, and lower back leading to pain symptoms in any or all of these joints.

Heredity and Genetics

  • Sometimes the cause is hereditary.
  • For example, Scheuermann’s disease is a condition in which adolescent males develop a pronounced kyphosis curve in the thoracic spine. (Nemours. KidsHealth. 2022)

Consult Injury Medical Chiropractic and Functional Medicine Clinic for an evaluation, and let us help you by developing a personalized treatment and rehabilitation program.


The Path To Healing


References

Czaprowski, D., Stoliński, Ł., Tyrakowski, M., Kozinoga, M., & Kotwicki, T. (2018). Non-structural misalignments of body posture in the sagittal plane. Scoliosis and spinal disorders, 13, 6. https://doi.org/10.1186/s13013-018-0151-5

Nejati, P., Lotfian, S., Moezy, A., & Nejati, M. (2015). The study of correlation between forward head posture and neck pain in Iranian office workers. International journal of occupational medicine and environmental health, 28(2), 295–303. https://doi.org/10.13075/ijomeh.1896.00352

Nair, S., Sagar, M., Sollers, J., 3rd, Consedine, N., & Broadbent, E. (2015). Do slumped and upright postures affect stress responses? A randomized trial. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 34(6), 632–641. https://doi.org/10.1037/hea0000146

Silva, A. M., de Siqueira, G. R., & da Silva, G. A. (2013). Implications of high-heeled shoes on body posture of adolescents. Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo, 31(2), 265–271. https://doi.org/10.1590/s0103-05822013000200020

Nemours. KidsHealth. (2022). Scheuermann’s kyphosis.

Break Up Scar Tissue With Friction Massage

Break Up Scar Tissue With Friction Massage

For individuals having difficulty moving or functioning normally due to injury, surgery, or illness, can a chiropractic and physical therapy team help expedite recovery?

Break Up Scar Tissue With Friction Massage

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.
  • Increase blood circulation to the tissues.
  • Working the affected tissue to break up scarring.
  • Collagen fibers tissue realignment.
  • Improve mechanoreceptor activity.

Massage Technique

Friction massage treatment follows a specific technique: (Paula Chaves, et al., 2017)

  • 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.

Diagnoses Treated

Diagnoses that can be treated with friction massage can include: (Paula Chaves, et al., 2017)

  • Muscle tears or strains.
  • For tendonitis or tendinopathy.
  • After a tendon tear.
  • 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

Begovic, H., Zhou, G. Q., Schuster, S., & Zheng, Y. P. (2016). The neuromotor effects of transverse friction massage. Manual therapy, 26, 70–76. https://doi.org/10.1016/j.math.2016.07.007

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. https://doi.org/10.1016/j.msksp.2017.09.005

Chun, Q., ZhiYong, W., Fei, S., & XiQiao, W. (2016). Dynamic biological changes in fibroblasts during hypertrophic scar formation and regression. International wound journal, 13(2), 257–262. https://doi.org/10.1111/iwj.12283

Fakhro, M. A., Chahine, H., Srour, H., & Hijazi, K. (2020). Effect of deep transverse friction massage vs stretching on football players’ performance. World journal of orthopedics, 11(1), 47–56. https://doi.org/10.5312/wjo.v11.i1.47

Advanced Sciatica: Recognizing Nerve Damage Symptoms

Advanced Sciatica: Recognizing Nerve Damage Symptoms

For individuals dealing with chronic sciatica, when pain and other symptoms significantly impact daily activities and the ability to walk, can a musculoskeletal healthcare provider help relieve and manage symptoms through a multidisciplinary treatment plan?

Advanced Sciatica: Recognizing Nerve Damage Symptoms

Chronic Sciatica

Sciatica is a common condition that results from compression of the sciatic nerve in the lower back or leg. Chronic sciatica occurs when symptoms last for 12 months or longer.

Advanced Sciatica Symptoms

Advanced or chronic sciatica usually produces pain that radiates or travels down the back of the leg. Long-term sciatic nerve compression can result in:

  • Leg pain
  • Numbness
  • Tingling
  • Electrical or burning sensations
  • Weakness
  • Weakness
  • Instability of the legs, which can impact the ability to walk.
  1. Severe nerve compression can progress to leg paralysis if the nerve is significantly damaged from chronic compression. (Antonio L Aguilar-Shea, et al., 2022)
  2. Sciatica can progress to nerve damage of the smaller nerves and travel into the legs and feet. Nerve damage/neuropathy can result in pain, tingling, and loss of sensation. (Jacob Wycher Bosma, et al., 2014)

Disabling Sciatica Treatment Options

When sciatica becomes disabling, affecting an individual’s ability to walk, more involved treatment is needed to bring relief. Many cases of chronic and disabling sciatica are caused by problems with the lumbar spine. Compression of the nerve roots that form the sciatic nerve can occur from bulging or herniated discs or spinal stenosis. If symptoms of sciatica persist beyond 12 months with little or no relief from physical therapy, non-surgical mechanical decompression, stretches and exercises, or pain management techniques, surgical procedures may be needed. (Lucy Dove, et al., 2023)

Lumbar decompression surgery encompasses several procedures to create more space in the lumbar spine and relieve nerve compression. Lumbar decompression surgery can include: (Mayfield Clinic. 2021)

Discectomy

  • This procedure removes a portion of a damaged disc between vertebrae to alleviate root compression from a bulging or herniated disc.

Laminectomy

  • This procedure removes the lamina, a portion of the vertebrae causing nerve compression, especially if there is a bone spur due to arthritic and degenerative changes in the spine.

Foraminotomy

  • This procedure widens the foramina, the openings in the vertebrae where the nerve roots exit to relieve compression.

Spinal Fusion

  • This procedure takes two or more vertebrae fusing them together with metal rods and screws for stabilization.
  • The procedure can be performed if:
  • An entire disc is removed.
  • Multiple laminectomies were performed.
  • One vertebra has slipped forward over another.

Daily Relief Management for Advanced Sciatica

Achieving relief from advanced sciatica symptoms at home can include regularly practicing methods like taking a hot bath or shower massage, and applying a heating pad to the lower back or glutes to relax tight muscles to help release the tightness surrounding the sciatic nerve.

  • Corrective or therapeutic exercises like sciatic nerve glides can help reduce tension along the nerve while low-back exercises that move the spine into forward or backward bending can reduce compression. (Witold Golonka, et al., 2021)
  • Medications like nonsteroidal anti-inflammatory drugs/NSAIDs, muscle relaxants, or nerve-pain medications may be recommended. (Antonio L Aguilar-Shea, et al., 2022)
  • Advanced sciatica may not be as responsive to conservative treatment methods, as the injury has set in and the nerve and surrounding tissues have become significantly restricted.
  • Sciatica symptoms lasting longer than 12 months require more involved treatment like injections or surgery to address symptoms effectively. (Antonio L Aguilar-Shea, et al., 2022)

Healing Chronic Sciatica

If the underlying cause can be effectively treated then chronic sciatica can be healed. Chronic sciatica often results from spinal conditions like herniated discs or lumbar spinal stenosis. These conditions narrow the space around the nerve roots that exit from the spinal cord and merge to form the sciatica nerve. Surgery is performed to open the space in the spine. (Mayfield Clinic. 2021) Sometimes sciatica is brought on by less common causes like a tumor or a spinal infection. In these cases, symptoms will not resolve until the underlying cause is addressed. Tumors may need to be surgically removed while infections require aggressive antibiotics to prevent spreading to other regions of the body. (Hospital for Special Surgery. 2023)

Pain Specialist Treatment Plan Development

Ongoing pain, numbness, tingling, and weakness are all symptoms that should be addressed with a healthcare provider. A pain specialist can help create a treatment plan that involves: (Hospital for Special Surgery. 2023)

  • Physical therapy
  • Therapeutic massage
  • Chiropractic decompression and spinal adjustments
  • Targeted stretches and exercises
  • Referrals to specialized healthcare providers
  • Injections
  • Medications

Sciatica Causes and Treatments


References

Aguilar-Shea, A. L., Gallardo-Mayo, C., Sanz-González, R., & Paredes, I. (2022). Sciatica. Management for family physicians. Journal of family medicine and primary care, 11(8), 4174–4179. https://doi.org/10.4103/jfmpc.jfmpc_1061_21

Bosma, J. W., Wijntjes, J., Hilgevoord, T. A., & Veenstra, J. (2014). Severe isolated sciatic neuropathy due to a modified lotus position. World journal of clinical cases, 2(2), 39–41. https://doi.org/10.12998/wjcc.v2.i2.39

Dove, L., Jones, G., Kelsey, L. A., Cairns, M. C., & Schmid, A. B. (2023). How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 32(2), 517–533. https://doi.org/10.1007/s00586-022-07356-y

Mayfield Clinic. ( 2021). Spinal decompression laminectomy & foraminotomy.

Golonka, W., Raschka, C., Harandi, V. M., Domokos, B., Alfredson, H., Alfen, F. M., & Spang, C. (2021). Isolated Lumbar Extension Resistance Exercise in Limited Range of Motion for Patients with Lumbar Radiculopathy and Disk Herniation-Clinical Outcome and Influencing Factors. Journal of clinical medicine, 10(11), 2430. https://doi.org/10.3390/jcm10112430

Hospital for Special Surgery. (2023). Sciatica.

Hospital for Special Surgery. (2023). Pain management.

Choosing the Right Pain Management Specialist

Choosing the Right Pain Management Specialist

For individuals dealing with chronic pain conditions can having a better understanding of pain management specialists help in developing effective multidisciplinary treatment plans?

Choosing the Right Pain Management Specialist

Pain Management Specialists

Pain management is a growing medical specialty that takes a multi-disciplinary approach to treating all types of pain. It is a branch of medicine that applies scientifically proven techniques and methods to relieve, reduce, and manage pain symptoms and sensations. Pain management specialists evaluate, rehabilitate, and treat a spectrum of conditions, including neuropathic pain, sciatica, postoperative pain, chronic pain conditions, and more. Many primary healthcare providers refer their patients to pain management specialists if pain symptoms are ongoing or significant in their manifestation.

Specialists

Healthcare providers specializing in pain management recognize the complex nature of pain and approach the problem from all directions. Treatment at a pain clinic is patient-centric but depends on the clinic’s available resources. Currently, there are no set standards for the types of disciplines needed, another reason treatment options vary from clinic to clinic. Experts say that a facility should offer patients:

  • A coordinating practitioner specializing in pain management and consulting specialists on the patient’s behalf.
  • A physical rehabilitation specialist.
  • A psychiatrist to help the individual deal with any accompanying depression or anxiety, especially when dealing with chronic pain. (American Society of Regional Anesthesia and Pain Medicine. 2023)

Other Medical Specialties

Other specialties represented in pain management are anesthesiology, neurosurgery, and internal medicine. A coordinating healthcare provider may refer an individual for services from:

A healthcare provider should have completed additional training and credentialing in pain medicine and be an MD with board certification in at least one of the following (American Board of Medical Specialties. 2023)

  • Anesthesiology
  • Physical rehabilitation
  • Psychiatry
  • Neurology

A pain management physician should also have their practice limited to the specialty they hold the certification.

Management Goals

The field of pain management treats all types of pain as a disease. Chronic, such as headaches; acute, from surgery, and more. This allows for applying science and the latest medical advances to pain relief. There are now many modalities, including:

  • Medication
  • Interventional pain management techniques – nerve blocks, spinal cord stimulators, and similar treatments.
  • Physical therapy
  • Alternative medicine
  1. The objective is to minimize and make symptoms manageable.
  2. Improve function.
  3. Increase the quality of life. (Srinivas Nalamachu. 2013)

A pain management clinic will go through the following:

  • Evaluation.
  • Diagnostic tests, if necessary.
  • Physical therapy – increases the range of motion, strengthens the body, and prepares individuals to return to work and daily activities.
  • Interventional treatment – injections or spinal cord stimulation.
  • Referral to a surgeon if indicated by the tests and evaluation.
  • Psychiatry to deal with depression, anxiety, and/or other issues that accompany chronic pain symptoms.
  • Alternative medicine to support and enhance the other treatments.

Individuals who do well with a pain management program

Individuals who have:

  • Back pain
  • Neck pain
  • Had multiple back surgeries
  • Failed surgeries
  • Neuropathy
  • Individuals determined that surgery does not benefit their condition.

A better understanding of pain syndromes by communities and insurance companies and increased pain studies will help increase insurance coverage for treatments and technology to improve interventional outcomes.


Chiropractic Care for Leg Instability


References

American Society of Regional Anesthesia and Pain Medicine. (2023). The specialty of chronic pain management.

American Academy of Pain Medicine (2023). About the American Academy of Pain Medicine.

American Board of Medical Specialties. (2023). The Most Trusted Medical Specialty Certification Organization.

Nalamachu S. (2013). An overview of pain management: the clinical efficacy and value of treatment. The American journal of managed care, 19(14 Suppl), s261–s266.

American Society of Interventional Pain Physicians. (2023). Pain Physician.

Unhealthy Posture – Is Your Rib Cage Compressing Your Pelvis?

Unhealthy Posture – Is Your Rib Cage Compressing Your Pelvis?

For older individuals experiencing posture problems, slumping, slouching, and upper back pain, could adding rib cage exercises help bring relief and prevent the condition from worsening?

Unhealthy Posture - Is Your Rib Cage Compressing Your Pelvis?

Improved Posture

It’s common to associate a collapsed upper back posture with age, but other factors can also contribute to the problems. (Justyna Drzał-Grabiec, et al., 2013) The rib cage and the pelvis are important to body structure and comprise much of the core. If these bone structures become misaligned due to unhealthy posture, the muscles that attach to them become tight, weak, or both, and the surrounding muscles have to compensate, causing a worsening of the condition and further injury.

  • Unhealthy postures can be caused by a rib cage that compresses down onto the pelvic bone.
  • As the upper back slumps or compresses, height can begin to decrease.
  • Posture awareness exercises can help lift the rib cage off the pelvic bone.

Rib Cage Exercises

This exercise can be done sitting or standing. A daily routine can help improve posture and relieve back problems and pain.

  • The sitting version helps keep the focus on doing the exercise right.
  • The standing version challenges body awareness, allowing the individual to feel how the rib cage and upper back movements affect pelvic and lower back posture.
  • To begin, it is recommended to start in a sitting position.
  • Once the basics are learned, then certainly progress to standing.

Exercise

  1. Position the pelvis so it is in a slight forward tilt.
  2. This forward tilt will exaggerate the low back curve slightly while tightening the lower back muscles in a good way.
  3. Establishing and maintaining this curve in the sitting position should feel natural.
  4. Inhale and exaggerate the upward lift of the rib cage.
  5. Inhaling causes the spine and ribs to extend slightly.
  6. Exhale and allow the rib cage and upper back to return to their natural position.
  7. Repeat up to 10 times once or twice a day.
  • For this exercise, use breathing to develop the rib cage’s lift and carriage incrementally.
  • Don’t max out on the spinal extension.
  • Instead, focus on how breathing/inhaling supports the movement of the ribs and upper back and develops the muscles from there.
  • Try to lift the rib cage equally on both sides as the body allows.

With practice, individuals will realize the healthy posture changes and increased distance between the ribs and pelvis.

Guidance and Variation

  • Perform the exercise with the back against a wall for upper back guidance.
  • Another variation of the pelvis and rib cage posture training exercise is to raise the arms.
  • This will create a different posture awareness training perspective.
  • Focus on rib cage movement when the arms are raised.
  • Does lifting the arms make the exercise easier, harder, or different?
  • To enhance posture improvement, stretch the pectoral muscles.

Yoga

Individuals looking for more ways to strengthen healthy posture should consider yoga.

A study published in the International Journal of Yoga suggests that a great way to activate the core may be to include a variety of yoga postures into the routine. (Mrithunjay Rathore et al., 2017) The ab muscles attach to various places on the rib cage and play a role in posture, alignment, and balance. The researchers identified two muscles, the external obliques, and the transverse abdominal, as key to a healthily aligned posture.


Core Strength


References

Drzał-Grabiec, J., Snela, S., Rykała, J., Podgórska, J., & Banaś, A. (2013). Changes in the body posture of women occurring with age. BMC geriatrics, 13, 108. https://doi.org/10.1186/1471-2318-13-108

Rathore, M., Trivedi, S., Abraham, J., & Sinha, M. B. (2017). Anatomical Correlation of Core Muscle Activation in Different Yogic Postures. International journal of yoga, 10(2), 59–66. https://doi.org/10.4103/0973-6131.205515

Papegaaij, S., Taube, W., Baudry, S., Otten, E., & Hortobágyi, T. (2014). Aging causes a reorganization of cortical and spinal control of posture. Frontiers in aging neuroscience, 6, 28. https://doi.org/10.3389/fnagi.2014.00028

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