Dry Needling

Ease Nagging Shin Splints While Continuing To Run

Shin Splints seem to be one of the biggest nagging complaints I hear from a variety of runners.

While many times some simple warm up and strengthening exercises can help. Often times the discomfort continues to linger, and as mileage accumulates things can start to become more and more of an issue.

On Track Physio provides alternative solutions to address this very injury. We have seen this issue many times before and won't waste your time with exercises or stretches that you are already doing. 

As a collegiate track athlete myself, I know exactly what you are dealing with. I can talk with you about strengthening, stretching, and running form. But I also recognize that sometimes certain muscles tend to respond well to some TLC treatment. 

We offer cupping and dry needling as a treatment of choice, which tends to work well if you already have the basics down.

The pictures below show the recovery modalities we use which on contrary to popular belief are actually quite comfortable (or at least should be! You do not need to aggressively dig into these already aggravated tissues to get reults). 

Contact us today to see how we can help you continue doing what you love!

B39myBoCQAA_eOo.jpg
Photo-Jan-31-4-23-23-AM.jpg

Ann Arbor, Mi

Greg S.jpg

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Alfredson Protocol for Achilles Tendinopathy

If you have ever experienced an achilles injury or dealt with chronic achilles re-injuries or tendinopathy chances are your physician may have recommended something called the Alfredson Protocol.

This is an aggressive loading program with the intent of building back the strength and capacity back up in the tendon so that it can withstand normal daily movement as well as the activity levels your more than likely looking to regain. 

The Alfredson Protocol consists of 2 exercises performed for 3 sets of 15 reps that would be repeated 2x per day (which is a total of 180 reps every day). 

This is one of the exercises below. There are ways to make this activity easier or more challenging depending on the clients symptoms, strength, and skill level.

Now I know what you are thinking....thats a lot of reps, and that is probably going to hurt!

The reality is that this is a protocol which is standardized for research purposes. Many people do not do well with this aggressive approach. This approach is modified or altered depending on location of achilles pain as well. The exercises for mid achilles tendon pain are different than insertion (or at base of heel).

Having seen numerous achilles tendon cases before, we at On Track Physio have found that while this strengthening approach certainly works, we also need a menu of exercises to choose from which allows the client to perform the activity comfortably. 

Depending on your case and presentation we may also recommend less repetition or utilizing a heavier weight. This very much depends on the person.

Likewise, to make things even more comfortable, we have found that utilizing soft tissue techniques in conjunction with this will allow you to perform the exercise more comfortably. Below is a picture of cupping, which applies a distraction force to the tissue. This sensation seems to work better than compressive massage techniques possibly because achilles tendinopathy tend to be a repetitive compression based injury. In some instances we will perform dry needling, but not always.

20180423_121427.jpg

The more comfortable you are able to perform the exercises, the more likely we can continue to progress the exercises and perform them on a daily basis. On a daily basis is a very important part of this process, which is why once we determine the correct exercise for you, it's just a matter of doing it. We do not need to see you very often, we just need YOU to do the exercise daily and remove or modify the aggravating factors (something we will also help you do). Our goal is never to stop you from being active, however we may need to modify things slightly so that it gives the tendon a chance to recover.

To learn more about how we can help you with this process, apply for a free discovery session.

Ann Arbor, Mi

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Shoulder and Tricep Pain

Nagging shoulder pain can be a real pain to put up with throughout the day!

It impacts just about everything you want to be doing from reaching overhead, putting your seatbelt and jacket on to just name a few. It also can prevent you from performing you normal workout and fitness exercises as well.

In this case study from On Track Physio we are going to look at shoulder pain as well as tricep pain that caused a grabbing or catching pain in shoulder, as well as pain in elbow upon full extension of arm.

When we examined the shoulder he had pain with overhead motion as well as reaching across the body. Resistance testing indicated a few particular muscles in the shoulder that we wanted to address via soft tissue work as seen in video below.

We then followed this up with specific exercises that he was able to perform at home as opposed to visiting the clinic multiple times per week. Within less than 6 visits he has back to his normal fitness program with minimal to no limitations in the shoulder and confident to continue on without treatment.

At On Track Physio we don't waste time performing meaningless "filler" activities. We pick the most efficient treatment based upon our assessment to get you back to your goals the FASTEST.

If you are interested in Dry Needling we offer a discounted trial session $37 to see if you like it. 

To try your first session of Dry Needling, click here!

Ann Arbor, Mi

Greg S.jpg

About the Author: Dr. Greg Schaible is a physical therapist/strength coach specializing in athletic performance. He attended The University of Findlay, graduating in 2013 with his Doctorate of Physical Therapy (DPT). As a Track and Field athlete, he was as a 5x Division II All-American and 6x Division II Academic All-American. Greg is the owner of On Track Physiotherapy in Ann Arbor, Mi. You can stay up to date with helpful information and news on Facebook.

Sciatica, Back Pain, and Associated Leg Pain

Sciatica, back pain, and associated leg pain can be really annoying to deal with. It can make simple tasks like sitting, sleeping, or walking a nightmare. Fortunately, we’ve had a lot of great success with these folks so thought I’d share a couple examples.

Often these issues can be difficult to treat (especially if you have been dealing with them for an extended period of time) but we like a challenge!  Always being mindful of how the location of the pain extending down your leg can be a dead give away as far as what area to target in treatment.

There are other ways to narrow down the location of the problem as well:

  • The muscles will be painful to palpation at a specific vertebral segment and may even refer pain down the leg when palpated with deeper pressure.
  • Reflexes may be diminished.  A slow or non-existent patellar tendon reflex corresponds with lumbar spinal nerve L4.
  • Muscles may test weaker on the affected side which may indicate an injury to a particular spinal level or nerve.  An example of this would be weakness in the calf muscles (can’t lift up on to the toes) which are controlled by the first two sacral nerves (S1 and S2 on the chart).

So below are a couple great examples of a number of these factors all lining up and how quickly the pain and loss of function can be addressed.

Case Study #1

The patient in this case had left sided low back pain and pain running down through the back of her hip and leg to the mid-calf.  She felt a ‘pop’ in her back and immediate leg pain as a result of pushing and twisting trying to put a heavy object in the back of her truck.  She is an avid runner but even standing and walking significantly increase her pain after 10 minutes.

Exam

So here is what I found:

  • Symptoms following the S1 and 2 dermatomes down the back of the left leg
  • Increased muscle tone/spasm at the S1 and S2 levels of the spine, and these muscles are tender to palpation.
  • ‘Springing’  or pushing down on the S1/S2 vertebrae reproduced the symptoms into the back of her hip/upper thigh.
  • She could do only 12 calf raises on her left leg while doing 25 on the right side (this muscle corresponds with S1 and S2 nerves).
  • Achilles reflexes normal (S1 reflex)

It’s nice when everything points back to a specific level or two like that.  Doesn’t always work that way but when it does it makes me much more confident that we can knock this out quickly.

Treatment

In this case I chose to use dry needling to address the muscles at the S1 and S2 spinal levels on both sides of the spine.  Once the needles were placed I attached an electrical stimulation unit and she just relaxed for 10 minutes.  Dry needling in conjunction with e-stim are shown in the research to decrease tone within the muscles as well as alleviate pain through a number of local and global factors.

The patient was instructed in two exercises that had multiple purposes:

  • decrease pain through relaxation of the over worked muscles of the back and anterior hip
  • facilitate improved stability through the lumbar spine and pelvis

Results

The patient had near full resolution of symptoms for two days after the first session.  Her exercises relieved her pain at home and she could walk as much as she wanted.  She tried to run on the third day but was unable due to pain.

We repeated the same dry needling + e-stim treatment during the second visit and followed it up by progressing her exercise program.

The patient cancelled her appointment the next week as she reported being completely pain free and back to running.

Case Study #2

The patient in this case presented to our clinic with pain shooting into the front of his hip and groin as well as down the front and side of his thigh.  He also reported minor back pain but it was nothing compared to the pain in his leg.  The patient reported having this pain on and off over the past couple years especially when exercising but recently it was much more constant and severe.  In the past he had been diagnosed with IT Band syndrome (pain laterally in the hip and thigh might make you think that), and more recently with a hip flexor strain (could also make sense now that he was having more pain into the front of the hip and groin).

Exam

  • Minimal tenderness to the ‘hip flexor’ muscles anteriorly, slight weakness with manual muscle testing but no pain (probably not a hip flexor strain).
  • Moderate tenderness and active trigger points in the lateral hip musculature that referred pain down the lateral thigh to the knee (could be part of IT Band syndrome).
  • Springing of the lumbar vertebrae at L2 and L3 reproduced the typical symptoms  he felt into his anterior hip/groin as well as lateral thigh (Bingo!)

Treatment

Dry needling was performed at the levels of L2 and L3 along with electric stimulation for 10 minutes, and followed up with IASTM to decrease tone and improve mobility of the superficial fascia and muscles of the mid and lower back.

A couple exercises were given to maintain, and hopefully even improve, the mobility gained through the spine and hips as a result of the dry needling and IASTM.

Results

The patient reported a significant decrease in the anterior hip and groin symptoms as well as a moderate improvement in lateral hip and thigh symptoms.

During the second treatment session I decided to treat the muscles of the lateral hip as well since they also referred pain into the lateral thigh.  This was done with by dry needling + e-stim just like we had done in the low back.

By the third treatment session a few days later the patient was reporting a significant reduction in lateral hip and thigh symptoms as well.

Final Thoughts

It took a few more treatments to completely resolve this patient’s symptoms but it’s nice to see an immediate decrease in symptoms to know that you are treating the right areas.  With a thorough evaluation process it wasn’t hard to figure out that the patient’s symptoms were primarily coming from his spine which was quite a different diagnosis than what was previously thought.

If this sounds similar to you or would like some assistance in your recovery, then click the link below to receive a FREE discovery session.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi.

Follow On Track PT and Performance on Facebook.

Dry Needling For Hip and Knee Pain

Ann Arbor, Mi - At On Track Physical Therapy and Sports Performance we strive to find new and innovative ways to treat pain and get you moving again.  Dry needling is one of those treatments and can potentially works wonders for hip and knee pain.

The Vastus Lateralis (VL) is one of the four muscles that make up your quadricep and is the most lateral.  Trigger points in this muscle will often refer pain to the lateral knee.  Check out the photo below of the VL and corresponding trigger point referral patterns.

Vastus_Lateralis_TP_39_s.jpg

Even without active trigger points, the VL is often in a state of high tone which can significantly limit hip mobility in certain directions.  With it’s attachment all along the IT band, it can also create greater stress on the knee joint through that IT band.

In the video you’ll see the limitations in our patients hip adduction (her knee should hit the table when I try to lower the leg across midline).  Her right hip does this easily.  This is a fairly standard PT test, known as the Ober test in most circles.  In the video you’ll see how dramatically dry needling the Vastus Lateralis with a few minutes of muscle stimulation can change her hip mobility.

Just a quick note on the video.  This was originally created by my mentor Joe Heiler at Elite Physical Therapy in Traverse City for the website Sports Rehab Expert which is read by other PT’s, Athletic Trainers, Chiropractors, etc.  Sorry for all the medical talk but you’ll get the idea with the huge change in range of motion following the dry needling treatment.

Here are some of the common diagnoses you’ll hear from your doctor that will respond well to dry needling:

  • IT Band Syndrome
  • Runner’s Knee (distal IT band syndrome)
  • Patello-Femoral Pain Syndrome/Patellar Mal-Tracking
  • Hip Bursitis

There are many other ‘diagnoses’ that can benefit from improved hip mobility but those above are what we would see most frequently.  For those that are needle-phobic, we can get similar results using IASTM and other manual therapy techniques, it’s just often not quite as dramatic.

There are also a number of specialized motor control and strengthening exercises that need to be used following this treatment to maintain this new mobility.  Just because she can move her hip now on the table doesn’t necessarily mean its going to move that well when she is standing, walking, or running.  Strength must also be established in that new range.

Hope that was helpful to see plus you get a bit of a glimpse at what we do here at On Track Physical Therapy and Sports Performance.

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.

Shoulder Rehab Part 2

In Part I, I discussed why physical therapy of the shoulder using traditional rotator cuff exercises does not always work .  Traditional methods of shoulder rehab often train the muscles of the shoulder in a way that they are not really used in normal everyday function.  If you haven’t caught that article yet, I suggest you read that one first. In this article I want to address a couple other pieces of the puzzle:  motor control and regional interdependence.

There are many cases in which a certain movements may look dysfunctional in a standing position, but may actually be completely functional in other positions where the patient is more unloaded like lying on their back, stomach, side lying, on hands and knees, or even in kneeling.  In these positions there are fewer joints and segments to control and in most of these cases less gravity to deal with.

Unless the movement pattern is tested in multiple positions, it is not possible to know with any certainty that the movement is limited because of a true mobility issue (think joint restriction or ‘tight’ muscle) or if it is because of a lack of motor control.

Here is a great example looking at a functional reaching pattern behind the back.  In standing, you should be able to reach up behind your back and touch the bottom of the opposite shoulder blade as in the picture below:

Previously I had a patient come in that could only reach to just below her belt line.  She had been given stretches to increase that movement but they really hurt her shoulder to perform.  If you’ve ever had a shoulder problem or therapy after a shoulder surgery then this exercise will look very familiar:

When I had her lie down on her left side, she could reach all the way up her back and touch the opposite shoulder blade!  So why could she not do it in standing but had no pain and no difficulty lying on her side?

By going to a more unloaded position in side lying, the other joints of the body are taken out of the equation, and there is much less to have to control.  In this position she could be successful.  This is a great example of poor motor control, not a loss of shoulder range of motion.  So of course the first question she asked me is why did she spend the last 4 weeks in therapy and at home trying to stretch out her shoulder?

During the evaluation is was also discovered that she had some loss of mobility in her neck.  Because the neck movements were not painful, these were addressed first using some IASTM soft tissue work to her upper trapezius, levator, and rhomboids.

 Another soft tissue treatment modality we offer at  On Track Physical Therapy is   Dry Needling .

Another soft tissue treatment modality we offer at On Track Physical Therapy is Dry Needling.

Here is where that term – Regional Interdependence – comes into play.  In simple terms, regional interdependence is the interplay between different regions of the body.  In this case its easy to see how limitations in the neck can affect the shoulder since there are a number of muscles that run between the spine and shoulder girdle.  In other cases it could be dysfunction even further down the spine, the pelvis, hip, and beyond that could affect alignment and function at the shoulder.  Without the proper evaluation, it would be nearly impossible to find these relationships.

Once her cervical mobility was restored, we immediately went to corrective exercises to improve motor control of the neck and shoulder girdle.  These were fairly simple non-painful exercises that allowed her to successfully work through her neck limitations in a more unloaded position (hands and knees in this case).

Following that first treatment she could reach behind her back and nearly touch her opposite shoulder blade!

When the patient returned for her next visit, she had maintained her neck mobility and behind the back reach without shoulder pain.  We progressed to kneeling and standing motor control exercises, and by the end of the treatment she could touch her opposite shoulder blade without difficulty.

Needless to say, this patient was quite happy with the results.  Sometimes it is as simple as being in the right place at the right time with your treatment.  

Sports Specialist Physical Therapy Clinic| Ann Arbor, Mi | FREE Discovery Session|

About the Author: Dr. Greg Schaible is a physical therapist and strength coach specializing in athletic performance. He attended The University of Findlay as a student athlete. As an athlete he competed in both Indoor and Outdoor Track & Field where he earned honors as a 5x Division II All-American and 6x Division II Academic All-American. In 2013 he completed Graduate School earning his Doctorate of Physical Therapy (DPT). Greg is the owner of On Track Physical Therapy in Ann Arbor, Mi. Follow On Track PT and Performance on Facebook.