PHYSIOTHERAPY INSTRUMENT MOBILISATION (PIM)

6th November 2011, a public holiday which the Muslim in Malaysia were celebrating Hari Raya Qurban, but me and some of my colleugues will have to control our lazy mood, to attend a workshop on  Physiotherapy Instrument Mobilisation (PIM).
A drizzling rain in the morning, and I was 10 minutes late to the venue, and the class were already started with some theory about the tecnique, which I manage to catch up later.

                                                       

PIM, a mechanical assisted joint mobilisation utilise a technological instrument and the treatment principal are according to physiotherapy principles, including the concept of physiotherapy model of joint mobilisation and manipulation, Mulligan's concepts of mobilisation with movement and positional faults. According to the speaker, these technique has being accredited by the Australian Physiotherapy Association as complying with their high standards of continuing professional(physiotherapist) development.

Manual therapy is a hard work - PIM technique using the mobilising device substitutes  high velocity and lower forces generated tools, ensuring effective joint mobilisation. One question raised, what would you prefer, an effective dose controlled repeatable reliable 2 second instrument application or 4 sets of  grade IV Passive Accessory mobilisations with clinician's thumbs? 

These is very true, because I started practicing since 1996, and in some busy days, my thumb already given me some sign of retirement ( oh no, I am too young to talk about retirement ...), this tools, seems to be a good option for me to rest my thumb's MCP( metacarpal phalangial joint), especially for small joint such as TMJ, cervical, acromio-clavicular, carpal and tarsal joint, very excellent result.

Furthermore, this instrument mobilisation enable the clinician to give fast and effective manual therapy, saving not only the clinician's thumb, but the energy and time for treating more patients in a day with less fatigue. 

From patient's feedback, PIM is less painful, compared to my fingers (are you sure?), and most of the time, patient no need to expose, with light clothing is desirable, and it showed quite an exciting clinical outcomes, which is what the clinician want.

Well, overall the workshop was so enjoyable, all the participants kept 'gun' here, 'gun' there, and I gun on my Right wrist's carpal joint, which already given me some problem due to joint mobilisation, and the result was satisfactory, my wrist extension improved after my self treatment.

Look at our lovely, sweet face and the powerful firing 'gun'....

squatting, 2nd from left - me....

A number of studies have investigated instrument mobilisation for its effectiveness and found it to be equivalent to manual mobilising techniques in reducing pain and improving function in patients. Ongoing research in to the basic science of instrument mobilisation and clinical trials have quantified intervertebral motions, electromyographic and neurophysiological responses to instrument mobilisation. 

Last and not least, allow me to express my appreciation to Mr Tim Mann and his lovely wife, Pam, who came all the way from Australia to conduct the workshop. Hope to see them soon for --- PIM 2nd part.

Penang Bridge International Marathon 2011

THE WORKSHOP OF 'DRY NEEDLING FOR MYOFASCIAL PAIN'

The workshop of " myofascial pain and dry needling - head/neck/shoulder girdle" at The royal London hospital for integrated medicine hospital.

It was not the first time, but it was a pleasure to meet Dr Robert Gerwin again for his myofascial pain workshop. Dr Robert Gerwin, a Board- Certified neurologist form Washington State, Medical Director of Pain and Rehabilitation Medicine in Bethesda, an associate professor in the Department of Neurology at John Hopkins University School of Medicine. He had the opportunity of training in the diagnosis and management of myofascial pain syndromes under the renowned Dr Janet Travell, and now runs a multidisciplinary pain clinic specialising in this field.  


Dr Gerwin is the author of over 30 peer reviewed articles, reviews, book chapters and consensus statements. he reviews articles for over a dozen medical journals. He is on the editorial board of the Journal of Musculoskeletal Pain, co-editor of the book Clinical Mastery in the Treatment of Myofascial Pain, along with Lucy Whyte Ferguson. 

Dr Gerwin demontrasted on a participant during the course.

The topic of these workshop was regarding myogenic headache ( headache origin from muscular pain.) and facial pain.

Decades ago, it was believed that, headaches are causes by intercranial pressure pain ( the increase of pressure in the brain), but nowadays, a lot of the medical professional that working on muscles or myofascial, having a revolution thinking that majority of headaches causes by the muscle surrounding the neck and the head.

Headache caused by a trigger point in the sternocleidomastoid muscle( a pair of muscles that located in front of neck) was described by Dr Travell 1955. Dr Janet Travell explained further that headache caused by trigger points in the trapezius muscle, the sternocleidoastoid muscle(both are neck muscle), and the muscles of mastication(muscle surrounding the jaw), and noted the contribution of mechanical stress,including a variety of postural stresses, on the development of trigger points that could lead to headache (Travell J : Mechanical headache. Headache 7:23-29 , 1967).

Referred pain pattern from the sternocleidomastoid muscle.

There are evidences shown the involvement of myofascial in headaches. E.g;

Olesen, the first to estimate tenderness in the pericranial muscles during a migraine attack , and found that temporal , masseter( muscle over the face) and neck muscles were tender (Prevalence significance of muscletenderness during common migraine attacks. Headache 21:49-54, 1981) , (Electromyography of pericranial muscles during treatment of spontaneous common migraine attacks. Pain 14:137-147 , 1982) & (Pericranial muscle tenderness and pressure-pain threshold in the temporal region during common. Pain 35:65-70 , 1988).

He also studied pericranial muscle tenderness in chronic tension type headache and correlated lower pressure pain thresholds and increased pericranial electromyographic activity with chronic tension-type headache (Muscular factors are of importance in tension-type headache . Headache 38:10-17 , 1998).

Jensen studied 735 subjects from the general population , and found 22 with chronic tension-type headache. Muscle pressure pain thresholds were lower in person , particularly females, with chronic tension-type headaches, than the general population (Pathophysiological mechanisms of tension-type headache , in Copenhagen : Foreningen af Danske Laegestuderendes Forglag , 1998, p 68).

Discussion and thinking during practical session.

Every time after the workshop is a hard time for me, because I need time to digest all the knowledge which being delivered during the workshop, but, honestly, I really learn a lot, and have no regret to travel all the way from Malaysia to London, UK for it.

No time tO excersice ... nO excuse ......




4 minutes Computer & Desk Stretches Sitting at a computer for long periods often causes neck and shoulder stiffness and occasionally lower back pain. Do these stretches every hour or so throughout the day, or whenever you feel stiff. Also, be sure to get up and walk around the office whenever you think of it.

4 minutes Computer & Desk Stretches Sitting at a computer for long periods often causes neck and shoulder stiffness and occasionally lower back pain.
Do these stretches every hour or so throughout the day, or whenever you feel stiff. Also, be sure to get up and walk around the office whenever you think of it.

 

Flat Feet (Pes Planus)

A true flat foot is rare. Generally, a flat-footed person is only suffering from a functional flat foot caused by excess pronation. Excess Pronation causes the foot's arch to collapse & elongate giving the appearance of a flat foot. A functional flat foot is quite common and generally exhibits symptoms ranging from sore/tired feet to general leg fatigue and body aches.

VASYLI products are designed to control excess pronation (the common cause of functional flat feet and thereby restoring the foot's arch to normal)

BALL OF FOOT PAIN 1

(Metatarsalgia)

This condition commonly occurs with women, however many men suffer from pain in the ball of the foot. Sometimes a callous develops in the centre of the foot and footwear may wear out in a similar fashion.

This condition causes a burning sensation in the ball of the foot and can become very painful. Ball of Foot Pain (Metatarsalgia) commonly occurs from rotation and dropping (plantarflexion) of the metatarsal bones along with excess pronation and weakening of the soft tissue (ligament & muscle) structures.

VASYLI products align the central three (3) metatarsal shafts using a inbuilt 5mm met raise to correctly position and maintain the Metatarsal bone position. By balancing the weight distribution over the five (5) metatarsal bones, this helps remove excess weight & friction which commonly causes the callous and burning sensation.

BALL OF FOOT PAIN 2

(Morton's Neuroma)

Commonly assocciated with Metatarsalgia (see previous ccondition), this condition is generally caused by entrapment of the interdigital nerve lying between the third and fourth metatarsal bones. Ball of Foot Pain (Morton's Neuroma) exhibits similar symptoms to Metatarsalgia, but may also cause numbness, tingling and discoloration of the third and fourth (lesser) toes.

VASYLI products may greatly assist in the early stages of Morton's Neuroma when damage to the nerve sheath is minimal. VASYLI products re-aligns the metatarsal shafts and prevents interdigital nerve jamming. Severe fibrosis of the interdigital nerve may require surgery. However, VASYLI products may prevent further problems post-operatively.

Back Pain (Lumbo-Sacral Pain)

As the feet roll over and the legs internally rotate the pelvis is forced to tilt forward, resulting in increased curvature of the lower back.

In turn , this causes tightness and stiffness of the lowerback muscles.

VASYLI products help align the body posture by controlling the feet, reducing internal rotation of the legs and forward pelvic tilt, therefore easing lower back pain.

Knee Pain (Patello-Femoral Pain)

This type of knee pain is commonly caused by rolling over of the foot - 'excess pronation'. As the foot rolls over, the lower leg (tibia) internally rotates, putting forces on the knee cap and weakening the muscle structures, causing knee pain.


By re-aligning the lower limb and preventing the feet from rolling over, VASYLI products reduce internal rotation of the leg and takes away this common cause of knee pain.

TIRED , ACHING LEGS

Tired/arching legs are commonly caused by strain and stretching (traction) on the calf muscles at the back of the legs. This occurs when the feet roll over ('excess pronation') and the legs rotate internally.

In turn, this placess stress and strain on the muscle structures of the legs.

VASYLI products control 'excess pronation' - decreasing internal rotation of the leg and traction stretching on the calf muscles, thereby taking away this common cause of tired/aching legs.

Heel Pain (Plantar Fasciitis)

Heel pain is commonly caused by rolling over of the foot ('excess pronation'). As the foot pronates, the arch collapses and the muscles and supporting structures are forced to stretch and elongate. This puts stretch (traction)and strain on the ligaments running from the heel to the toes.

In turn, the heel bone may 'respond' by developing a bony growth right in the centre of the -the heel spur.

VASYLI products re-align the foot , reducing the stetch (traction) forces on the ligament - taking away this common cause of heel pain.

 

Anatomy of the Foot

The foot consists of 26 bones. (28 if you include the two sesamoid bones under your 1st metatarsal). The great toe ig generally longest in the most feet, however it is common for the 2nd toe to be longer than the great toe. (this is commonly referred to as 'the greek foot')

The main join of concern in biomechanics is the Subtalar Joint which is the joint between the Calcaneus (heel bone) and the Talus.

The proper function of these joint is crucial to a correct and 'pain-free' gait.

VASYLI

" In my many years of Podiatry practice I have treated over 50,000 patient. It is my experience and that of other practitioners that many aches and pains occur from poor posture of the foot and leg. I have written this to help you understand the cause of these common complaints and how to provide relief through orthotic treatment. "

The human foot was originally "designed" to travel on soft , natural surfaces like earth and sand. Unfortunately , instead of soft earth , we now spend every day walking and standing on unnatural hard, flat surfaces like pavements and floors.

These surfaces force our feet to roll over to gain ground contact and our arches to flatten. Rolling over of the foot - or 'Excess Pronation' is believed to affect over 50% of the population !

Interestingly, altough the foot rolls inwards, often the shoe will wear excessively on the outside edge of the heel. This is because the foot normally 'lands' on the outside edge first and consequently rolls over causing excess pronation as a compensatory motion.

Just like the tyres on a car, poor alignment of the feet can cause wear the tear to other parts of the body. 'Excess Pronation' often disrupts normal knee function and hip alignment and increases forces on the muscles in the lower back. Subsequently, 'Excess Pronation' can cause a wide range of common complaints.

 

The answer is to treat the CAUSE of these complaint - not just the symptoms. In other words, by restoring the lower limb's natural angle we can align the feet and body posture to their neutral position and take away the cause of these problems.

VASYLI International manufactures a wide range of unique, patented orthotic footwear & footcare products. VASYLI products are invented by a Podiatrist and the result of many years of biomechanical research. They are specifically designed to re-align the feet to their natural position and to improve body posture, relieving many chronic complaints in the process.

El portátil en casa. Vodafone

El portátil en movilidad. Vodafone

Myofascial Trigger Points

Most Common Cause of Chronic Pain and Limited Range of Motion Put simply, myofascial trigger points are painful, hyper-irritable areas in muscles that cause pain, stiffness, limited range of motion and sometimes other symptoms. They can refer pain to other parts of the body - sometimes very far from their original location. As a result they are often misdiagnosed. Myofascial trigger points are a very common problem that can lead to severe pain and other puzzling symptoms, which are often misdiagnosed.

Trigger points are always created in certain places in a muscle and always refer pain to the same areas. However, because there are hundreds of muscles in the body, there are hundreds of possible locations for trigger points. Also, trigger points in one muscle tend to create trigger points in other nearby muscles. Myofascial trigger points are classified as either active or latent (inactive). Latent ones do not cause pain, but can still reduce range of motion. An active trigger point is easy to recognize by pressing on it, because it feels very painful. Often it is also palpable as a small "knot".

What Causes Trigger Points Repetitive movements and prolonged use of the same muscles are common causes of trigger points. However, a sedentary lifestyle is also a risk factor. As a result pretty much any job can cause trigger points, whether it involves physical labour or prolonged sitting or standing. Poor posture promotes trigger points, but the reverse is also true.

Myofascial Trigger Points and Headaches

Migraines and Tension Headaches May All Have a Common Cause .
Headaches are often classified into
 migraines,
 cluster headaches,
 tension headaches and
 cervicogenic headaches.
Headaches can be very disabling and worrisome, causing fears about a brain tumor or other serious condition.
Traditionally these headaches have been thought to have different causes and they are usually treated differently. However, many doctors in US now, believe that myofascial trigger points (hypersensitive areas in muscles) may be a factor in all types of headaches. Even if you don't think you have such trigger points, you may be wrong.


Trigger Points and Headaches
Many migraineurs have noticed soreness in their scalp or facial muscles and people diagnosed with tension headaches are often aware of having a stiff neck or shoulder trouble, but often the trigger points can be in a muscle you would not associate with headaches at all.
The most insidious thing about myofascial trigger points is the way they can refer pain - always in a predictable pattern, but most doctors don't know these patterns. A trigger point in the back, shoulders and chest can manifest as headaches, even in the absence of pain in the affected muscle.


Treatment
Myofascial trigger points are luckily treatable. Studies show that various trigger point treatments can significantly reduce headache frequency, intensity and duration.
Once you find the trigger points you can apply acupressure or self-massage into them.
In one study trigger point acupuncture proved as effective as the common prophylactic drug metoprolol (a beta blocker) in migraine prevention, but was better tolerated

Physiotherapist

Who is physiotherapist?
-A physiotherapist or physical therapist is a health care professional who specialises in maximising human movement,function and potential.

What is physiotherapist work for?

-A physiotherapist may work with someone after injury,accident or surgery, so that patinet regain their independence and return to work faster, or may work to prevenr injury for instance with sporting clubs or overuse syndrome in the workplace , such as neck pain or low back pain.

What is physiotherapy treatment?
-Physiotherapy is scientific and evidence-based medical treatment, including a wide range of treatment methods,basically divided into


i)   Physical assessment: assessment on physical joint and muscular system's mobility, joint alignment. From the assessment, Physiotherapist develops a clear plan of action for its future management, and estimation of number and frequency of treatments needed and outline actiivities for home and work to help your problem. Relief can be dramatic and long lasting.
ii)  Manual therapy : hands on treatment e.g. soft tissue manipulation,joint mobilisation , spinal manipulation.
iii) Electrotherapy to reduce pain and inflammation; e.g. interferential currect, low frequency current, ultrasound therapy, spinal traction.
iv)  Exercise therapy ; stretching and strengthening exercises , core muscle stability exercises.
v)   Education; advice on suitable exercises, foot wear and posture care.


What can patient expect from physiotherapy treatment?
-After physiotherapy treatment you should have less pain,feel more mobile,flexible and comfortable in your movements.
-Sometimes, there mayeb some mild treatment soreness because physiotherapists may mobilise the stiff joint and moblilisation may stretch on the tight soft tissue, e.g. tendon,ligament,capsule,which may produce after treatment soreness.
-However,it may take period of time to recover,because,to loosen the tight joints or tissue with conservative method may need some times.


Conditions for physiotherapist treatment?
-Physiotherapist can work with you to achieve better and more cost-effective care. Some of the areas where physiotherapist can help are;
-Treating and reduce disomfort in patient who have acute or chronic musculoskeletal pain,
Including ::
*Low back pain and neck pain.
*Joint pain including osteoarrthritis of hip.knee.shoulder,elbow.
*Prolapsed intervertebral disc or slip disc,spinal stenosis,sciatica pain.
*Cervical or lumbar spondylosis.
*Soft tissue injuries e.g. Frozen shoulder,wrist De quervain syndrome, heel pain(plantar fasciitis)
*Sport injuries e.g. shoulder rotator calf injury,tennis elbow,golfer elbow,wrist injury,sprain ankle,others tendinitis and ligament injuries.