Treatments come in a variety of options. Opioids (oxycodone, hydrocodone, etc.) are often prescribed as treatment for an episode of pain patients are experiencing. If you haven’t been the recipient of these directly, there’s a good chance you know someone who has. They’ve been widely prescribed as they had always been considered both safe and effective. However, in the wake of an opioid epidemic, we want to remind our patients that there are safe and effective treatments that let you avoid the drugs – and without the side effects, That said, there are instances where these types of drugs are appropriate – post surgery or serious injury – and with proper management may be used safely. However, we want to use this platform to highlight our approach to more conservative treatments that can effectively alleviate pain.
As physical therapists, chiropractors, and massage therapists, we look to provide that first-line treatment for acute and chronic injuries alike – including: manual therapy; joint mobilizations; massage and soft tissue release; targeted therapeutic exercise; and health education. Let’s take a closer look at these distinct areas.
Joint Manipulation and Mobilization
Manipulation and mobilization are used throughout musculoskeletal health by chiropractors, physical therapists, and some osteopathic doctors. Despite popular belief, the aim of these treatments is not to put a bone back in place. Treatments like this work with the nervous system to affect pain (through release of endorphins), muscle tension (through reduction in pain and thus reduction in spasm), and proprioception (your brain’s sense of your joint position). In my opinion, 95% of cases require exercise to reinforce the effects of the manipulation. In other words, mobilization and manipulation gives your body a window to exercise with less pain so that you can correct the issue at fault and increase muscle tone. However, it does not correct the underlying cause of the pain independently. These are powerful pain relieving tools that can be employed to aid in your recovery from pain, especially in the spine.
Generally massage is thought of as a relaxation and stress reducing technique, but it can also be used as a powerful pain relieving and recovery tool. Therapeutic and sports massage are given in order to improve recovery through reduction in muscle tone and improvement in blood flow. Relaxation in muscle tone allows the muscle to receive the adequate nutrition is desperately needs to heal. Think of a muscle as a sponge; when it is squeezed out (overactive) it is not able to receive the water (blood) it needs to function. We see this happen often in cases of back pain associated with sustained postures, and receiving occasional massages would help alleviate this chronic paid in a more effective and cost-effective treatment. Massage also releases endorphins through a healing touch and targeted techniques, which helps to ease pain and creates a relaxing therapeutic environment for the body to heal. Your chiropractor or physical therapist may also use targeted soft tissue techniques to promote healing and pain reduction.
Therapeutic exercise is used widely by physical therapists and chiropractors as well. Movement encourages the body to release endorphins, reduce tissue tension through increased blood flow, promote healing through cellular processes, and prevent chronic pain from fear of movement. Exercise can be used as a means for tissue to adapt and heal to specific stresses it will encounter through daily activities. We use therapeutic exercise not only as a pain relieving mechanism, but also as a way to introduce stress to healing tissues in a controlled manner. If the tissue is not properly loaded over time, it can be substantially weaker than it was prior to the injury causing recurrent injuries. The best example of this phenomenon is chronic ankle sprains. Without proper rehabilitation, ankle sprains are likely to keep occurring as the body is unable to fully heal the tissue prior to sustaining a second, third, or fourth injury. Another common misconception is with arthritis. Many people stop moving because the arthritis is causing too much pain. On the contrary, our joints need to be loaded in order to provide nourishment to the joint surfaces. Without movement, joints can continue to degrade and become more painful. Remember, movement is your friend and is ultimately what will keep you feeling happy and healthy for years to come.
Education about a particular condition should not be taken for granted. It is the responsibility of your healthcare provider to educate you on your conditions, the treatment options, and expected recovery prognosis. Please don’t hesitate to ask your provider questions – fully understanding your condition is a key element to complete recovery. Education about pain can also be invaluable for the patient, which is why our office strives to provide pain education to help contextualize thoughts and beliefs about pain. Sometimes education is the stepping stone to preventing a patient from progressing to a chronic state of pain. For this reason, our office doesn’t just treat your condition, we help you understand it.
As you can see, there are many alternative treatment options for pain relief – and with far fewer side effects – than prescription drugs. It is important when seeking care for pain, that you explore all options landing on an course of treatment. Second opinions can often be helpful when you are unsure if a certain treatment is right for you. Trying a more conservative option first may save you time and dangerous side-effects from other riskier alternatives.
Our office uses all of the above techniques, and when necessary, uses other techniques including modalities and dry needling. Our goal is to provide our patients with the most comprehensive, evidence-based treatments to ensure the fastest and most complete recovery path from injury. We ensure that each patient is treated individually, as every patient has different needs from the healthcare system. Still have questions? Give us a call to learn more. We’d love to help you become the strongest version of your best self!
Bryan Esherick PT, DPT
Healthy School Lunch
Don’t sacrifice healthy for easy. Try these quick lunch tips to help you save time during hectic schedules while packing all the nutrition your kids need. Good nutrition is important for growing minds and growing bodies. A good lunch can be a part of better athletic AND academic performance for your children. Cafeteria school lunches tend to be focused around limiting costs for the school and not necessarily the healthiest options for kids. But making lunch can be a time consuming part of the day, on top of being just one. more. thing.
Try these quick lunch tips to help you AND the kids!
- Buy fresh produce. Sunday night prep can be 30 minutes: wash, peel and cut all carrots, celery, broccoli, cucumbers, etc. and store in large ziplock bags for the week for a quick grab-and-pack.
- Create your own lunchables. Sliced cheese/ham and crackers in a reusable container, grapes and carrots in another, hummus and pretzels for non-meat eaters, and you’re set! You can use peanut butter (or almond, cashew) for some added protein.
- Avoid sweet drinks. My kids would finish a juice pouch and eat nothing else. Keep juice and sweet treats at home as an after-school-treat. They’ll look forward to that! High blood sugar will cause a crash when they had back into class.
- Provide ample food storage. Having sandwich and snack size reusable containers on hand makes packing a lunch so much easier for little ones.
- Pack a note. Wouldn’t you want a note from Mom/Dad? (I would!) A silly joke or a ‘have a crazy day!’ can help your child (or spouse!) get through the rest of the day.
Enjoy healthy and happy lunching!
If you have more questions about a healthy diet, please don’t hesitate to email me at [email protected]
Concussions. They can have lasting effects later in adulthood, so prompt treatment is essential to mitigate long-term effects. While the end of summer draws near, and fall sports get underway at the start of a new school year, it’s important for parents, trainers, and coaches to remain vigilant in watching for signs and symptoms of concussion in young athletes.
Here some tips to help you recognize concussions:
- Your child isn’t acting quite like themselves: Look for changes in your child’s usual mood, cognition, ability to pay attention, and energy level. When your child isn’t acting like he/she normally does following a game, it’s a safe bet they may have suffered a concussion.
- They sustained a jarring hit: Any hit, whether it is to the head or body, has the possibility of causing a concussion. Hits to the head are obviously related to concussions, but hits to the body can also cause concussions through whiplash-like mechanisms.
- Nausea or sensitivity to light or sound: These are some very common signs seen following a concussion.
- Dizziness while using their phone or watching TV: This can be caused by a sensory issue within the vestibular system. Also watch out for dizziness or imbalance while driving and walking in busy areas.
- IF YOU SUSPECT A CONCUSSION SEEK MEDICAL ADVICE: Waiting to seek medical advice can have an impact on the overall time it takes for your child to recover. Seeking medical advise as soon as you suspect your child may have a concussion is key.
One of the best things that you can do for your athlete as a parent or coach is to be sure that they have baseline testing consisting of physical, cognitive, and equilibrium tests prior to participation in practice and games. Should an injury occur, baseline testing allows the coach and trainer to know when it is safe to allow the athlete to return to sport after an injury has occurred. Also be sure that the testing for your athlete is comprehensive, and not performed only using the IMPACT computer-based test that doesn’t take into account the other functions of the body that may be impacted through concussion.
When seeking medical advice, remember that advice can come from a variety of medical practitioners including medical doctors, physical therapists, athletic trainers, etc. Medical examination usually consists of some tests and measures to determine the severity of the injury. Examination is necessary to rule out other serious pathologies, including a brain hemorrhage. Usual care for a concussion is a brief period of rest (1-3 days), followed by a graded return to sport and school, and then rest. Rest is essential for the brain to heal itself in the early stages, although activity should be resumed as quickly as possible while maintaining little to no symptoms. Physical therapists can help by determining a safe level of activity for the athlete and developing a sport specific training plan. Before your child returns to sport, ensure all testing compares to baseline, that physical activity has been progressed, and that your child is symptom-free with sport specific training.
By following these key steps after sustaining a concussion, your athlete can return to sport as quickly and safely as possible.
Note: This blog is not considered medical advice that should be used if you suspect a concussion in your child. If you believe your child may have suffered a concussion or would like to receive baseline testing, contact our clinic at 434-293-3800.
Want to do better in school? Get more, restful sleep! We all know sleep is important but we might think of it more as an “eat your vegetables” important kind of way. In reality, we should be thinking about it more in a “this could impact my life, hopes and dreams” kind of way. That’s exactly what researchers are finding as we learn more and more about sleep and the value it brings.
Sleep is vital for so many functions and processes in the body: memory, cognitive function, blood pressure, hormone regulation (cortisol, insulin, leptin, grehlin, testosterone), healing, muscle recovery, immune system, etc., etc.,. And, it is especially important for children. Sleep deprivation can significantly impact a child’s performance in school.
So, how do you know if your child is getting enough rest? Here’s a good rule of thumb:
- Children aged 6-13 should be getting 9-11 hours of sleep each night
- Teens should be getting 8-10 hours
While these are good gauges to check patters in your household, that’s just a starting place. Behavior can be a great clue.
Signs of sleep deprivation are similar to symptoms of ADHD. They include:
- easily distracted
- difficulty focusing
- difficulty learning new concepts
- feeling “fuzzy”
- increased appetite
Most likely, we could all make a few adjustments to get a better night’s sleep.
The best rules work for both children and adults:
- keep a consistent, daily bedtime
- avoid eating within three hours of bedtime
- discontinue screen time at least an hour before bed
- can the caffeine after noon
- maintain a set bedtime routine for children
With these simple tips, you and your little ones will be sleeping sounding and reaping the benefits in no time!
Sam Spillman, DC
Here are some backpack tips to lighten the load:
- Choose a backpack that has two wide straps with good padding to distribute the load evenly.
- Adjust the height. Tighten straps so the bag is centered on the back, ideally above the lower curve of the spine.
- Use both straps. The one-shoulder method may be cool, but it adds serious pressure and throws body alignment out of whack.
- Weigh the bag. It should weigh no more than 10% of the child’s weight. If your child regularly has to carry more than that then you should get them one of those rolling backpacks that they can pull.
- Have your child checked. If your kid complains of back pain-even if it seems minor-talk to your doc. No amount of achiness is normal, and a physician can recommend strengthening exercises to help ease it.
My grandfather was a farmer in the heart of Cornell chicken country. He raised dairy cows, chickens, and corn in upstate New York and when he retired, he continued farming the most delicious corn – and even became adept at growing brussels sprouts – on the few acres behind his house.
Back in the day, Cornell chicken was widely popularized by Cornell University’s poultry science and agricultural program as an inexpensive protein alternative to beef. And Cornell’s very own Robert C. Baker actually invented the barbecue recipe now famous in Cornell chicken recipes – like the one my grandfather perfected. However, Baker’s real claim to fame was his invention of the chicken nugget, which he actually invented while at Penn State but only gained appreciation after he joined the faculty at Cornell. He would travel all over the country sharing his love of poultry and demonstrations of his recipes.
At one point, Cornell had approached my grandfather inviting him to be one of their instructors at the agricultural school but his love of farming kept his focus. I must say I’m glad it did because my grandfather’s Cornell chicken recipe is a summer classic, and brings back some of my fondest childhood memories.
This Fourth of July I’ll be grilling up a batch of my grandfather’s signature summer fare, complete with corn-on-the-cob for the side – though I’ll be getting my corn from the local farmer’s market. Give it try!
What you’ll need:
- 1 egg
- 2 cups of apple cider vinegar
- 1 cup of vegetable oil
- 3 tbsps salt
- 1 tablespoon of black pepper
- 1 tablespoon of poultry seasoning
What to do:
- In a bowl, beat the egg and whisk in oil followed by the vinegar and then the seasonings.
- Marinate whole chicken, or chicken pieces, for 24 hours.
- Throw it on grill and cook to an internal temperature of 165 F.
Research. It’s the core of success. In our clinic, we pride ourselves on evidence based practice. But what does that really mean to the patient? Evidence based practice combines three things: clinical experience; research; and patient preference or values. So how do the articles we read from the research that’s done in universities filter down to affect our actual patient care?
One way we use research is to apply what we read to inform our thinking.
For an example, the Journal of Orthopaedic and Sports Therapy published this article that looks at using the drop vertical jump task as a way to predict an ACL injury. What we learn is that this task isn’t a good indicator of predicting a possible injury. So many variables are involved in athletic injuries that it is very difficult to predict an injury from just one factor.
However, we also learn that increasing the cognitive demand on an athlete when performing the vertical drop jump task, makes the activity more difficult – and therefore, likely increases an athlete’s risk of injury. While this isn’t a perfect simulation of what might be happening on a soccer field or basketball court, it can help guide our rehabilitation of patients.
The result? We’re adding increased cognitive demands in the rehab process for our athlete patients before returning to sport.
Just another example of how research informs on how we care for our patients, through evidence based practice, in the “real world.”
While there have been several mornings that have felt like winter instead of spring, spring is indeed upon us! What comes to your mind when you think of spring? Mine is sunshine, being outdoors without a coat and my of course seasonal spring vegetables! Now is the time we will find a variety of vegetables at the farmers market. Having an abundance of fresh and local vegetables is a great time to play around and experiment in the kitchen. Having a variety of vegetables in the diet is very important for health! Your GI tract will be healthier as it will have more diverse and beneficial gut bacteria and you will also be providing your body with more micronutrients that are critical for good function. Challenge yourself this spring to try several new vegetables, or using the vegetables in a different way.
Below I have highlighted some of my favorite spring vegetables.
This delicious sauce can be used for chicken, fish and pork either as a marinade or just on top after cooking.
2. Add chopped rhubarb, wine, ginger and honey.
3. Season and cook over low heat for 8 to 10 minutes until the rhubarb is cooked and the sauce is reduced.
Charlottesville is where my heart, and home, is… now. But it wasn’t always the case. As a native of Pittsburgh, I enjoyed opportunity to gain my education on the east coast – earning my bachelor of science in biology with a minor in nutrition from the Indiana University of Pennsylvania, before ultimately graduating from Lynchburg College with a clinical doctorate in Physical Therapy.
Lynchburg boasted far greater weather than Indiana, PA, and I found myself taking up more outdoor activities – hiking, biking, exploring Virginia and all that it has to offer. I knew then, Virginia was for me. As I wrapped up my time in Lynchburg, I took an internship at UVA’s hospital for the summer. My fiance, then girlfriend, was living in Charlottesville at the time and as we took in the sights of Charlottesville – hitting up the shops, restaurants, and events around town – I quickly realized this was where I wanted to make my home.
A few years later, and we find ourselves residents of one of the most charming towns I’ve ever been in.
From the events constantly going on; the character of the people around us; the nature trails; outdoor sports; wineries; and breweries – I couldn’t imagine living anywhere else.
– Bryan Esherick PT, DPT
It has almost become cliché to say that runners should strength train. So then I ask are you a runner who is strength training consistently (2-3 times a week)? If the answer is “hmmm, no,” you might not fully understand all of the amazing benefits we get from strength training. Let me break it down for you.
Benefit #1: It Makes You Faster
Proper strength training has been shown to improve running economy, or the ability to run faster while using less energy. Let me put it this way, if you could run a 7-minute mile with the same amount of effort it takes you to run an 8-minute mile right now, you would take that deal right? Of course you would. Faster runners spend less time on the ground and produce more force when they strike the ground. You can improve your force production and ground contact time through various exercises, drills, speedwork and plyometrics that can actually train the neuromuscular system to fire faster. Make sure you are complementing your runs with all of this ancillary work. Take that deal!
Benefit #2: It Reduces Injury Risk
A strong body is crucial to tolerate the repetitive load of running. Many overuse injuries can be avoided with the addition of strength training and a variety of functional, rotational, and multi-directional movements to your regimen. I like to explain it this way: if you have an overuse injury like plantar fasciitis, you know the plantar is working too hard. Rest is an answer, sure. But come on, you and I both know you aren’t taking more than a day off without losing sanity! If you are able to strengthen the posterior chain (glutes, hamstrings, calves) to carry more of the load that your plantar is currently taking, you will reduce the use of your plantar and improve its function.
Benefit #3: It Enhances Recovery
This is probably my favorite fun fact that many runners don’t realize. When done correctly, lifting heavier loads produces a positive hormonal response that can rev-up the recovery process AND significantly reduce the risk of over-training. Lifting heavy will improve your overall strength, and metabolism; but what’s more I guarantee you will sleep really, really well at night.
All In All…
When done correctly and consistently, strength training and other ancillary work like drills and faster running can make you more efficient, reduce risk of injury, and enhance recovery. You will feel stronger on your runs and in races, and you will be able to tolerate higher training loads and have more energy.
Make strength training a priority and your body and mind will thank you!
Ann Dunn, M.S., CPT
BCPT Guest Blogger