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Providing Effective Information to the Physician

June 2000


Volume 2000 Issue 1

Treating Pain With StrainCounterStrain by Christina Shatney, PTA

the stomach. With a slight adjustment in bending to the side opposite of tenderness the tender point will be turned off. After a 90-second hold and a slow movement back to neutral, the pain will have decreased by two-thirds.

In a recent three-day seminar I was educated in Strain CounterStrain(SCS), a technique used to decrease “inappropriate proprioceptor activity that maintains somatic dysfunction” (Jones Strain-CounterStrain, 1995). It is a non-traumatic technique which has no contraindications and is also slow and passive.

It is a technique that added with an existing armamentarium can be very valuable in decreasing the length of time needed to see changes. In an era when insurances are asking health care providers to work within a time frame and a budget, SCS is an effective tool for continuing to provide quality care to our patient.

SCS is a progressive manual therapy technique specifically addressing muscles in a state of over stimulation, resulting in shortening of fibers. The theoretical framework for this technique is by passively shortening the over stimulated muscle while at the same time lengthening the antagonist. This will result in a decrease in firing of the 1a afferent neuron. In return, a decrease in excitation of the gamma neuron will result in decreased activity in the extrafusal and intrafusal muscle fibers. It works through the discovery of tender points. A tender point can be classified as a tense, tender, edematous muscle and fascial tissue 1 cm in diameter, with no referral pattern. Dr. Lawrence Jones has discovered close to 200 tender points that correlate with a specific dysfunction. 50% of those points were found anteriorly, representing posterior pain in the patient. Tender points are not just subjective. The operator can feel changes in tissue tension and therefore position a patient in a posture of maximum ease and relaxation, without relying on a patient's report. Relaxation changes can go from two-thirds to complete within two degrees. Going beyond the point will result in immediate tension. While treatments are done once a week to each tender point found, about 6 points maximum are done per session. This allows a period of adjustment and may in turn shut off other tender points. Educating a patient in this technique for home use does not have to be difficult. A patient with back pain may have a tender point in the abdomen at the area of the iliacus. Explain to the patient the origin and insertion of this muscle and how it may be causing low back pain. The patient can place a pillow under the buttocks, cross the legs at the ankles and flex the legs towards The Able Body Newsletter is published by Family Physical Therapy Services, Inc., 176 S. River Rd., Bedford, NH 03110-6925, 603-644-8334. Send all requests to this address, Attention: Editor.

Ultrasound Update by Rhonda Fletcher, PTII The therapists at Family Physical Therapy strive to provide the highest quality of care available. They do this by maintaining current through continuing education on new techniques and modalities as well as keeping abreast on new information available on older modalities. Ultrasound is one such older modality. Recently the NH Chapter of the American Physical Therapy Association sponsored a lecture titled “Therapeutic Ultrasound Update” by Joseph A. Gallo ATC, P.T. I was fortunate to attend this lecture and a summary follows. Physicians and therapists have seen patients improve from therapeutic ultrasound for years. Many people are curious as to just what ultrasound is and how it works. Ultrasound is a mechanical physical agent that has both thermal and nonthermal effects. Therapeutic ultrasound has a frequency between 750,000-3,000,000 Hz. Sound waves are generated by the reverse piezoelectric effect. AC current passes through a piezoelectric crystal causing it to expand and contract. The vibration of the crystals results in the mechanical production of sound waves. The sound waves can be continuous or noncontinuous which is called pulsed. Pulsed ultrasound is used for its nonthermal or mechanical effects. Some of these effects include increased cell membrane permeability and vascular permeability. Therefore, when used in conjunction with appropriate medications (phonophoresis), it can aid in decreasing inflammation and swelling. These nonthermal effects are thought to increase collagen synthesis. Cont. on page 2

Ultasound, cont. from page 1 Continuous ultrasound has thermal effects such as: (1) increased cell metabolism; (2) alteration in sensory and motor nerve conduction velocity; (3) increased tissue temperature (up to 5 cm); and (4) increased soft tissue extensibility, decreased pain, and decreased muscle spasm. Ultrasound used as an adjunct to a therapy plan of care can therefore be helpful with many conditions such as: • Muscle spasm post whiplash, trauma or surgery • Promotion of tendon healing after rupture or surgical repair • Reduction of pain from plantar warts • Increase of soft tissue extensibility for soft tissue tightness • Increase of tissue temperature (up to 5 cm) for relaxation of hypertonicity • Decrease of musculoskeletal pain • Inflammatory conditions The therapists at Family Physical Therapy would be happy to assist your patients achieve their rehabilitation goals. If you have any questions regarding how or if ultrasound or other therapy techniques may assist your patients, please feel free to contact our office so we may discuss your needs directly.

Reducing Costs without Sacrificing Care by Cathy Leer, PTII, MBA, Director of PT While reducing costs is an ever-present concern, excellent patient care is critical for positive results. We strive to provide both. Using evaluation methods that correctly identify patient problems and the actual source(s) of pain and/or dysfunction, we believe that we can address problems faster, decreasing the overall duration of treatment and associated costs. Our full array of treatment techniques, emphasizing hands-on care, can provide your patients with the results we are all striving for. Equally important to our success is providing personalized care to the patient. By "personalized", we mean typically 45minute, one-on-one treatment sessions customized to the patient's needs. Home exercise programs are designed for the patient to perform independently at home so that we may spend the majority of treatment on manual techniques and those aspects of treatment which are highly specialized. We also strive to gain the patient’s trust and confidence. The associated positive outlook and our expert care directly affect the outcome of any treatment approach that we may pursue.

INSERVICES As part of our practice of keeping you informed about the latest treatments in physical therapy and our expanding resources to meet you and your patients' needs, we welcome your questions. Our clinicians are willing to answer any questions that you have and meet with you at your convenience to present inservices to your staff. Simply call us at 644-8334 to set up a convenient time.

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We are open Monday through Friday, with early morning and evening hours available. FPTS is an approved provider for: Medicare, Blue Cross Blue Shield, Healthsource, and most independent third party insurance carriers. Direct insurance billing is provided for your convenience.

We are open Monday through Friday, with early morning and evening hours available. FPTS is an approved provider for: Medicare, Blue Cross Blue Shield, Healthsource, and most independent third party insurance carriers. Direct insurance billing is provided for your convenience. Family Physical Therapy Services, Inc. 47 Constitution Dr. Bedford, NH 03110

Specializing in General Orthopedic Physical Therapy

Family Physical Therapy June 2000 Newsletter