Cost effective continuing education for medical professionals.

Are you running out of time within your 2 year time periods to get 30 CEU’s? Well look no further. You no longer need to break the bank to recieve CEU credits. You can sign up for Medbridge continuing education courses which provide in depth research and evidenced based practice treatment for neck, back, shoulder, sacroiliac , sport related, neurologically impaired population patients that you will commonly encounter in any treatment setting. The classes are available either as live or online courses with printable course material that you can keep and use within your clinic.

So what are you waiting for? Sign up today and use my link https://www.medbridgeeducation.com/r/C7C9FE3 and start your clinical education now!

Physical therapy Jobs + Travel + Bonus pay positions.

Pediatric Specialty

The ARC of Essex County   

is looking for a PT to join its Shapiro Center Early Intervention Program Team. The offer therapeutic services to kids from birth to 3 y/o who have developmental delays and disabilities.

Benefits of Working with them:

• Make your own schedule 
• Competitive hourly rates
• Make a positive impact on a child’s life

If interested call them at 862-210-8053 or email at shapiro@arcessex.org  

Outpatient Setting  

Prosynergy Physical therapy is looking for a part/full time PT. Multidisciplinary clinic. . Population: pediatric-geriatric & vestibular cases, MVA commonly seen.

Polish speaking is a plus. Experience with Web PT documentation is a plus +, new grads are welcome to apply.
Contact Agnes Mika MSPT- 908-709-7300. info@prosynergypt.com

Travel PT/ Contract positions *BONUS PAY available*

Therapy Staff LLC 

Therapy Staff, LLC is always hiring qualified therapists at competitive salaries. They offer full-time, part-time, contingent, and travel opportunities in a variety of clinical settings including outpatient clinics, hospitals, and skilled nursing facilities. They have the BEST pay packages available for you too.

• Highest paying staffing company in the nation
• Full benefits option (including medical, dental, vision, and 401k, see attached)
• Weekly pay via direct deposit
•  PT, OT, SLP, COTA, PTA job placements also available nationwide
• Access to an experienced team of staffing specialists with thorough knowledge of the job market
• A support system of team members behind you every step of the way. We will not place you on an assignment and forget about you! We are with you through the good and the bad, and always available to help when needed.

If interested contact Samantha McIntosh at 734-329-5318 or at samantha.mcintosh@therapystaff.com 

 

 

Myofunctional therapy: What is it and how can it be cured?

What is it?

Myofunctional therapy is commonly used to treat pain and muscle length imbalances associated with crooked teeth, teeth misalignment, swallowing problems, mouth breathing, and thumb sucking. This is also referred to as orofacial myofunctional disorders (OMDs) which involve any disorders of the muscles and functions of the face and mouth.

Typically, this disorder develops since, people continually exhibit bad habits that affect the length, tension, and overall strength of the muscles of the face and mouth that inhibits them from performing the job that they are designed to perform.  For instance, in order to swallow it involves the muscles of the throat, face, mouth and tongue to work in unison. “When a person swallows normally, the tip of the tongue presses firmly against the roof of the mouth or hard palate, located slightly behind the front teeth. The tongue acts in concert with all the other muscles involved in swallowing. The hard palate, meanwhile, absorbs the force created by the tongue. Because a person swallows 500-1000 times a day, improper swallowing can cause a variety of problems. When a person swallows incorrectly, the tip and/or sides of the tongue press against or spread between the teeth. This is commonly called a tongue thrust. Constant pressure from resting or incorrectly thrusting the tongue away from the hard palate may push teeth out of place. An OMD may lead to an abnormal bite – the improper alignment between the upper and lower teeth known as malocclusion. This problem may lead to difficulties in biting, chewing, swallowing, and digesting of food.” [1]. So in this example, if your tongue is habitually not on the roof of your palate then, it can lead to uncoordinated swallowing, front teeth misalignment, speech problems (lisps & difficulty articulating sounds), sleep disordered breathing and decreased jaw strength.

How can physical therapy help?  

Treatment will use evidence based practice techniques in an individualized program to correct speech production by activating the muscles of the face and mouth to

1. Increase and/or refine speech sound repertoire
2. Increase expressive vocabulary skills
3. Increase ability to combine words
4. Increase ability to express wants, needs, and thoughts [2]
5. Familiarize children with the feeling of making pressure consonants
6. Teach children to use nasal occlusion independently (if necessary) [3]
7. Set up individualized home program with families to continue use of therapy in home environments

8. • Elimination of damaging oral habits (digit sucking, nail biting)
   • Reduction of unnecessary tension and pressure in the muscles of the face and mouth.
   • Strengthening of muscles that do not adequately support normal functioning.
   • Development of normal resting postures of the tongue, jaw, and facial muscles.
   • Establishment of normal biting, chewing, and swallowing patterns.

9. Swallowing therapy involves: [3]

   Education regarding appropriate chewing patterns
   Practicing forming  food into bolus.
   Increasing self-awareness of the masseter (chewing) muscles
   Maintaining correct placement of tongue when swallowing
   Sequential positioning of the tip, mid-portion, and back of the tongue.

 

 

 

 

 

References

1. WHAT IS MYOFUNCTIONAL THERAPY?. (2015). Retrieved from https://aomtinfo.org/myofunctional-therapy 
2. Intensive Treatment Sessions – Kids Creek Therapy. (2016). Retrieved from https://www.kidscreektherapy.com/pediatric-therapy-services/intensive-treatment-sessions/ 
3. Myofunctional Therapy – Tongue thrust. (2018). Retrieved from https://tonguethrust.weebly.com/myofunctional-therapy.html

 

 

 

 

 

 

 

 

 

Migraine Headaches: Where can I find a cure?

Let’s be honest we have all had that terrible Monday morning headache that absolutely ruins our mood and productivity level for the day. It seems like no matter what NSAID or over the counter medicine we take for the headache it seems to continue on relentlessly. So where can you turn to for relief when these headaches strike? This article will explain just that!

 

What classifies as a migraine headache? 

 

A migraine headache is characterized by the occurrence of an intense, throbbing pain on one or sometimes both sides of the head. Most people who suffer from these types of migraines can experience very severe and debilitating types of headaches. “Most people with migraine headache feel the pain in the temples or behind one eye or ear, although any part of the head can be involved. Besides pain, migraine can also cause nausea and vomiting and sensitivity to light and sound. Some people also may see spots or flashing lights or have a temporary loss of vision.” ^[1]  A migraine can be triggered at any particular time of the day but, they often occur predominantly in the morning. The pain caused can last anywhere from a few hours or up to one or two days. Sadly, some people get migraines once or twice a week while others experience it once or twice a year. It is more prevalent in women than in men. “About 3 out of 4 people who have migraines are women. In particular, women who are between the ages of 20-45 years old who have more job, family and social duty stress. Migraine pain and symptoms affect 29.5 million Americans.” ^[1] A migraine is also composed of three stages which are prodrome, aura, and attack. Prodrome is the first stage that occurs a day or two before the migraine actually starts. Symptoms include mood changes, depression to euphoria, constipation, neck stiffness, frequent yawning, food cravings, increased urination and thirst. Aura is the second stage which some people don’t experience at all.  Symptoms of aura include flashes of light, issues with speech, hearing noises, music, uncontrollable jerking movements, weakness, touch and motor skills. Just about anyone is susceptible to developing these migraine headaches. “Annually about 6% of men, 4% of children and 18% of women suffer from migraine headaches.” ^[5]

 

What causes migraine headaches? ^[1,4]

The exact cause of the migraine is unknown. Many researchers believe that migraine is due to the abnormal changes in levels of substances that are naturally produced in the brain. When the levels of these substances increase, they can cause inflammation. This inflammation then causes blood vessels in the brain to swell and press on nearby nerves causing pain. Also possessing a family history of migraine or of disabling headache also increases your risk of having migraine headaches. Researchers do believe instead that these migraines are triggered by exposure to a combination of the following factors:

v Lack of or too much sleep

v Skipped meals

v Bright lights, loud noises or strong odors.

v Hormone changes during the menstrual cycle

v Stress and anxiety or relaxation after stress

v Weather changes

v Alcohol (red wine mostly)

v Excessive or Withdrawal of Caffeine intake

v Food that contain nitrates (ie: hot dogs and lunch meats)

v Foods that contain MSG (monosodium glutamate), a flavor enhancer heavily used in fast food, broths, seasonings, and spices

v Foods that contain tyramine (ie: aged cheese, soy products, fava beans, hard sausages, smoked fish, and Chianti Wine

v Aspartame (ie: Nutrasweet and Equal sweeteners)

 

It helps if you start to keep a headache diary. Every day you have a migraine headache you write down what time of day your headache started, where you were and what you were doing when the migraine started, what you ate or drank 24 hours before the attack, and the exact start and end dates of your period. These details will help your doctor pinpoint what exactly triggers your headaches.

What are the types of migraine headache? ^[2,3]

There are 8 types of migraine headaches.

1)    Migraine with Aura (Complicated Migraine)

v About  ¼ of people who experience migraine also experience aura which involves a series of sensory and visual changes that can range from seeing black dots and zig zags to tingling numbness on one side of the body, or an inability to speak clearly. Aura sets in shortly before or during a migraine, and can last anywhere from 10-30 minutes. Aura is the second of migraine’s four stages, and anyone who experiences it will confirm it is an unmistakable warning sign that the severe head pain is on its way.

2)    Migraine without Aura (Common Migraine)

v Pulsing or throbbing pain on one side of the head, photophobia, phonophobia, pain that is made worse by physical activity and nausea and vomiting are all classic symptoms of migraine without Aura.

3)    Silent or Acephalgic Migraine

v Also known as migraine without head pain. This type of migraine can be very alarming as you experience dizzying aura and other visual disturbances, nausea, and other phases of migraine, but no head pain. It can be triggered by any of a person’s regular triggers, and those who get them are likely to experience other types of migraine, too. The International Headache Society classifies this type as typical aura without headache.

4)    Hemiplegic Migraine

v If you have ever had a migraine that felt more like a stroke, it was probably a Hemiplegic Migraine. People who experience this type of migraine develop weakness on one side of the body, often with visual aura symptoms and a “pins and needles” sensation, or loss of sensation, on one side of the body. It can last for as little as a few hours to several days. Similar to typical aura without headache, Hemiplegic Migraine doesn’t always include the severe head pain.

5)    Retinal Migraine/ Ophthalmoplegic Migraine              

v When a headache causes you to temporarily lose vision in one eye, it is a Retinal Migraine. Most common in women during their childbearing years, the blindness can last anywhere from a minute to months, but is usually fully reversible. This is a specific type of aura that accompanies a migraine, and it’s a condition we know very little about. What we do know is that Retinal Migraine may be a sign of a more serious issue, and those who experience it should make a point to see a specialist.

6)    Chronic Migraine

v If you have a headache of more than 15 days a month, you’re probably suffering from chronic migraine. Many of the days often feel like typical migraine, but there may be considerable variability in the severity of the symptoms and head pain on any given day. Some days patients may mistake the pain for a “tension-headache” or “sinus headache” if the pain is less severe. Many patients with chronic migraine also use acute headache pain medications on more than 10-15 days per month, and this can actually lead to even more frequent headache.

7)    Vestibular Migraine

v Vestibular Migraine or Migraine Association Vertigo (MAV) is a disorder which involves a problem with the coordination of the sensory information sent to your brain from the eyes, muscles & bones, and the vestibular organs inside the ears. Nearly 40% of all migraine sufferers experience some vestibular symptoms during their lifetime, such as dizziness, sensitivity to light/sound and stiffness of the neck, however, people who suffer from vestibular migraine specifically, experience a whole gamut of other symptoms, including, but not limited to; Severe dizziness,Vertigo, Other motion problems in the head, eyes or body, Diminished eye focus, Photo-sensitivity (light), Phono-sensitivity (sound), Tinnitus, Nausea and vomiting, Ataxia (loss of control over bodily movement), Neck pain, Muscle spasms in the upper spine area, Confusion, Disorientation ,Anxiety/panic.

8)    Basilar Migraine

v Basilar migraine is a rare form of migraine that includes symptoms such as loss of balance, double vision, blurred vision, difficulty in speaking and fainting. During the headache, some people lose consciousness. These are very frightening sensations for the migraine sufferer, and often people describe the feeling of terror and fear that they are about to suffer a stroke. Basilar migraine occurs when the circulation in the back of the brain or neck is affected. It usually affects young women but is sometimes seen in children too. “The migraine in children is generally shorter in duration than in adults with less pronounced symptoms like cyclic vomiting, abdominal symptoms or paroxysmal vertigo rather than head pain” ^[5]

How are migraines diagnosed? ^[4]

You will have to consult with a neurologist who specializes in diagnosing migraine headaches. The doctor will also order a blood test to show if there is any infection in the patient’s brain or spinal cord, if there are toxins in the system or if there are any blood pressure problems. An MRI will be used to detect for the presence of tumors, stroke, infection, bleeding in the brain, and other brain abnormalities.  A CT scan detects the same things the MRI can just displayed in a cross-sectional view. A spinal tap may be ordered if they suspect bleeding in the brain, infection or another underlying problem.

 

What are my treatment options?

1)    Pharmacological Management ^[5]

v Serotonin 5HT1B/D agonists (triptans) are the first line therapy for those who suffer from moderate to severe disability. Other triptans are rizatriptan, zolmitriptan, sumatriptan, naratriptan and frovatriptan.

v Ergots, dihydroergotamine, butalbital-containing analgesics or other analgesic combinations, isometheptene mucate, NSAIDS, and opoids

v Prophylactic Medication: Beta Blockers, Tricyclic Antidepressants, Antiepileptic Drugs, Calcium Channel Blockers.

2)    Surgical Management

v Surgical removal of the corrugator supercilia muscles, transection of the zygomaticotemporal branch of the trigeminal nerve, and temple soft tissue repositioning along with injection of 25 units of Botulinum Toxin type A (Botox) have been proven to decrease pain.

3)    Physical Therapy- Conservative treatment

v A physical therapist will evaluate and thoroughly examine you to determine what type of migraine headache you have based on your signs and symptoms. They will then develop a personalized exercise program that will help alleviate and diminish reoccurrence of your symptoms. A physical therapy treatment plan will include general strengthening, stretching, habituation exercises, balance and gait training.

 

Research of Physical therapy Patient outcomes ^[6]

39 patients who suffered from chronic and vestibular type migraine headaches were treated with a custom designed physical therapy exercise program of 5 visits over 4 months.  Certain tests and measures were used to chart improvement and decrease in incidence of falls. After performing specific stretching, strengthening, balance and gait training activities the patient scores significantly reduced thereby leading to a 78% decrease in falls and occurrence of severe dizziness.

Physical therapy management ^[7]

v Stretching of the Pericranial muscles such as the suboccipital and paraspinal muscles

v Manual therapy/ Spinal Manipulation

v Modalities (Cold packs)

v Exercise

v Thermal Biofeedback and Neurofeedback- Neurofeedback is the use of frequency-based biofeedback that uses an EEG to give clients information about their brainwaves and subtly teaches people how to alter their brainwave activity eventually helping them to abort migraines independently. This helps the patients to self-regulate and reduce muscle tension, slow the rate of breathing, and warm their hands and forehead.

v Relaxation techniques

v Massage therapy

 

 

 

 

xoxo S

 

 

Bibliography

1)    Goadsby, P., & Hutchinson, S. (2017). Migraine. womenshealth.gov. Retrieved 25 January 2018, from https://www.womenshealth.gov/a-z-topics/migraine

2)    What type of headache do you have? Different migraines and headaches. (2017). American Migraine Foundation. Retrieved 25 January 2018, from https://americanmigrainefoundation.org/understanding-migraine/what-type-of-headache-do-you-have/

3)    Types of Migraine. (2015). The Migraine Association of Ireland. Retrieved 25 January 2018, from http://www.migraine.ie/types-of-migraine/

4)    Migraine Headaches 101: Common Symptoms, Causes, and Treatment. (2018). QuickcareorER.com. Retrieved 25 January 2018, from http://quickcareorer.com/migraine-headaches-causes-treatment/

5)    Mueller, L. (2007). Diagnosing and Managing Migraine Headache. Journal Of The American Osteopathic Association, 107(11), 10-16. http://dx.doi.org/10.1002

6)    Whitney, S., Wrisley, D., Brown, K., & Furman, J. (2000). Physical Therapy for Migraine-Related Vestibulopathy and Vestibular Dysfunction With History of Migraine. The Laryngoscope, 110(9), 1528-1534. http://dx.doi.org/10.1097/00005537-200009000-00022

7)    Migraine Headache. (2017). Physiopedia. Retrieved 25 January 2018, from https://www.physio-pedia.com/Migraine_Headache

 

 

 

 

 

 

 

 

 

 

 

Abdominal Discomfort, Pregnancy, Low Back pain, Pelvic pain, and Abdominal Weakness are they all related?

The simple answer is yes they are all related! These symptoms are common complaints among every hard-working American Citizen. However, all of these can be related to one key problem Diastasis Recti Dysfunction. Now if you haven’t heard of this term before it is okay. In fact, the Diastasis Recti plays a key role in abdominal musculature stabilization and strength. Diastasis Recti Dysfunction involves “a separation of the rectus abdominis muscle along the band of connective tissue that runs down the middle of the rectus abdominis known as the Linea Alba”. [6] This separation is commonly seen during the 2nd and 3rd trimester of pregnancy. Of course, this is due to the fact that your adorable baby needs additional room to grow inside the tight abdominal wall. Also, the hormone Relaxin, that is heavily secreted during those trimesters, make ligaments and connective tissue more lax during pregnancy. Now ladies the pregnancy process is beautiful so don’t panic. A small amount of widening of the abdominal midline is normal. “In fact, a diastasis recti occurs in about 30% of all pregnancies. Although some women’s midlines spontaneously close to less than a 2 finger-width after labor”. [6]  The problem begins when the “midline separation is more than 2 to 2.5 finger widths or 2 centimeters.” [6] This problem not only affects pregnant and post partum women but, it can also affect men and children.

How does it develop in men?  

Many males develop this after having prostatectomy surgery via the Da Vinci Robotic method which involves making an incision along the midline of the abdominal area. Weight lifting using improper body mechanics or posture and performing sit-ups vigorously can lead to diastasis recti. If you have gained weight in a short period of time it can add additional pressure on the abdomen causing separation to occur. Lastly, if your mother or father has suffered from this condition you are at higher risk for developing this.

 

How does it develop in children?

When we are born our abdominal muscles are separated in the beginning. “Usually around 3 years old after the development of the nervous system, the abdominal muscles come together but don’t fully close since, the belly button in the connective tissue are just starting to join the outermost abdominal muscles (rectus abdominis)”. [5] This in turn makes the muscles more susceptible for separation and opening. In addition, the way kids are being taught in school to strengthen their core by performing abdominal crunches increases their risk for developing diastasis recti since, it ultimately adds more stress on the abdominal area. “If a child has separated abdominal muscles, his or her developing spine and organs won’t be supported. Diastasis Recti has also been linked to Central Coordination Disorder (CCD), a condition that results in delayed motor development”. [5]

Signs and Symptoms of Diastasis Recti  [6,1,4]

• Abdominal discomfort with certain movements, such as rolling over in bed, getting in/out of bed, and lifting heavy objects.
• Umbilical Hernia
• Pubic Symphysis pain
• Sacroiliac joint pain
• Low back pain
• Pelvic floor dysfunctions, such as urinary, fecal and flatulence incontinence and pelvic organ prolapse
• Severe Abdominal weakness and visible abdominal skin drooping
• Constipation
• Trouble breathing

Risk Factors

• Obesity
• Multiple Birth pregnancy
• Abdominal wall laxity from previous pregnancy or abdominal surgery
• Increased BMI

How can I be sure that I have this? [6]

1. Lie on your back with your knees bent, and your feet on the floor.
2. Place your fingertips of one hand at your belly button and while your abdomen is relaxed, gently press your fingertips into your abdomen.
3. Lift the top of your shoulders off the floor into a “crunch” position.
4. Feel for the right and left sides of your rectus abdominis and take note the number of fingers that fit into the gap.
5. You will want to test this again approximately 1-2 inches above and below your belly button to determine the length of the gap.

How can I correct this problem?

Thankfully there are some basic exercises that can be performed at home to help decrease the abdominal separation and increase core strength and decrease pain.

For men: [1]

Exercise One

• First lie down on the floor with both legs bent and both feet on the ground.
• Put both of hands on the lower stomach and point fingers downwards.
• Breathe in and out in a steady stream.
• Slowly lift the head and shoulders off the ground.
• Press down on the lower abdomen using hands and fingers.

Exercise Two

The more you strengthen the muscles that are involved in diastasis, the more difficult it is to divide the muscular tissue.

• Lie on the ground on the back with knees bent and feet on the floor.
• Tighten the muscles in the lower abdomen and lift your hip at the same time.
• Do 10 reps or as directed.

Exercise Three

This is the third exercise for diastasis recti in men and do as instructed:

• Lie down on the floor, knees bent and feet on the floor.
• Inhale and when exhaling, slowly straighten out one leg and slide it down on the floor.
• Straighten your leg as far as you could. Then inhale and bring the leg back to its starting position. Repeat with the other leg.

Exercise Four

• Sit on the floor and put both hands on the abdomen.
• Take small breaths and slowly contract abdominal muscles, pulling them toward the spine.
• Hold this position for 30 seconds while keep your breathing under control.
• Do this exercise 10 times per day.

Exercise Five

• Lying down with knees bent and feet on the ground.
• Lift head slowly with chin downward the chest.
• Slowly contract the abdomen towards the floor and hold it for 2seconds.
• Lower your head to the starting position and hold it for 2 seconds.
• Repeat this exercise 10 times

For Women [3]

Research has shown that pregnant mothers who engaged in a 90 minute exercise class over 6 weeks made improvement by performing the following exercises:

First, make sure your abdomen is drawn in at the umbilicus to spine with all exercises to engage transverse abdominis muscle (a key abdominal stabilizing muscle). In order to perform this, try to suck your bellybutton in towards your spine.

While keeping that muscle engaged perform pelvic tilts in supine, standing, all fours and sitting

In sitting and using upper extremity exercise bands perform military presses, lateral raises, chest press and overhead pull sitting.

While laying on your side perform hip abduction, hip flexion, hip adduction.

While laying on your back, perform a bridge.

Take a towel or bed sheet and wrap it around your waist and cross it at the largest gap area. Hold the sheet nice and tight, making sure the sheet is in between the rib and hip bones and perform a mini sit up.  Perform this 30-60 times per day.

 

Make sure to AVOID performing any of the following activities as they can create further separation of the abdominal muscles:

• abdominal sit-ups
• crunches
• oblique curls
• double leg lifts
• upper body twisting exercises
• exercises that include backbends over an exercise ball
• yoga postures that stretch the abs, such as “cow” pose and “up-dog” pose
• pilates exercises that require the head to be lifted off the floor
• lifting and carrying heavy objects
• intense coughing without abdominal support

Now these exercises may be enough to begin strengthen your abdominals gradually but, not everyone responds the same way to exercise as others. This is simply due to the fact that when we are in pain we tend to substitute and avoid performing an exercise the right way to minimize the onset of pain. These compensatory movements only lead to more damage in the long run. Therefore, you can schedule an appointment at Bella Physical Therapy where a specialized Pelvic Floor Physical therapist can evaluate you and develop a customized exercise program just for you.

 

Exercise responsibly my friends,

❤ S

 

Cited References:

 

1. Causes and Treatments of Diastasis Recti Among Men. (2017). New Health Advisor. Retrieved 25 December 2017, from http://www.newhealthadvisor.com/diastasis-recti-in-men.html
2. For Medical Professionals – The Dia Method ®. (2017). The Dia Method ®. Retrieved 25 December 2017, from https://thediamethod.com/for-medical-professionals/
3. Gillard, S. (2013). Diastasis Recti Abdominis in Pregnant Women. Fitbackandbumps.co.uk. Retrieved 25 December 2017, from http://www.fitbackandbumps.co.uk/diastasis-recti-abdominis-in-pregnant-women/
4. Move Forward Physical Therapist Guide to Diastasis Rectus Abdominis. (2017). Physical Therapist Guide to Diastasis Rectus Abdominis. Retrieved 25 December 2017, from http://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=f8a7ad12-eadf-4f42-9537-e00a399c6a03
5. Tupler, J. (2014). Diastasis Recti in Children?. Diastasis Recti in Children?. Retrieved from https://saferide4kids.com/blog/diastasis-recti-in-children/
6. Wright, M. (2014). How to Fix a Diastasis Recti. As The Pelvis Turns. Pelvic Health & Rehab Center Blog. Retrieved from https://www.pelvicpainrehab.com/female-pelvic-pain/2306/fix-diastasis-recti/