What Is Cupping

What Is Cupping

What is cupping?  Is that with the glass and the fire?, or some variation of this, is probably the first question we get asked by our patients when we discuss introducing cupping to their physical therapy.

“Cupping” is a term that is used in several professions. When most people think of cupping they usually do picture glass cups that have had the air inside them heated so that they create a vacuum when applied to the skin. This technique has its origins in ancient Eastern medicine and is still used by many practitioners in that field today. As a PT and a PTA, we don’t use glass cups and fire, instead we use a soft silicone cup and create the vacuum by compressing the air out of the cup before applying it to the skin. In our scope of practice, cupping is a form of manual therapy for trigger point and myofascial release and we use a combination of soft tissue mobilization, stretching, and negative pressure to lift, separate, and stretch underlying soft tissues.

What do you do with it?

Dynamic techniques involve moving the cup over the area of musculoskeletal tension or restriction in a gliding motion. Static cupping involves placing a cup directly over a trigger point or adhesion and left in place for a short time. This technique may be used in combination with “active release” movements performed by the patient when tolerated to increase effectiveness. When we introduce you to cupping for the first time, we’ll start by placing the cup on a non-painful body part and letting you see how it feels.

How is this going to help me?

Benefits of cupping include decreasing pain caused by soft tissue restrictions, improving scar tissue mobility and adhesions, and improved blood flow to treated areas. While other manual trigger point and myofascial release techniques such as foam rolling involve a compressive force being placed over the muscle tissue, cupping provides a decompressive force, which may be more effective for patients who are not responding to more traditional techniques.

Will it hurt? Will I have big circles all over my body?

Like other trigger point techniques, cupping does involve treating areas of the body which patients may note are tender or painful to the touch, so cupping may be initially uncomfortable, which is why we show you on a non-painful spot the first time. It is important to give your therapist feedback when using this technique so that they may adjust the cup position, amount of suction, cup size, or technique being used if needed. Patients may note discoloration in the treated area after cupping ranging from light red/pink to a darker purple. The greater the suction created with the cup, the more restricted the tissue, and the longer cupping is performed – whether dynamic or static – the more blood is drawn to the surface, which causes more discoloration. This will usually fade within a few days to a week, however because of this effect people with bleeding disorders or who are on anticoagulant medications are not appropriate candidates for cupping therapy. Treated areas may present with some mild soreness, however post treatment discomfort is usually temporary. Again, it is important to provide your therapist with feedback during your treatment as well as your response afterwards to ensure that cupping is an appropriate intervention for you.

Overall, cupping is an effective addition that can be used to improve your outcomes during physical therapy with other manual techniques and exercise. For more information, reach out to Mark or Kelly at our Severna Park location 410-315-9080.

Fall Injury Prevention

Summer is ending and Fall is on the way! Soon many of us will be taking on the tasks of winterizing gardens and raking up leaves. Yardwork can be strenuous, and if your body is not prepared for the physical activity you have an increased chance of injury. Reduce your risk with these tips:

  1. Warm up! Just like in sports, you don’t want to begin without stretching. Do gentle stretches for your calves, hamstrings, trunk, and shoulders, holding each stretch for about 30 seconds and performing 2-3 times on each side, to get yourself ready.
  2. When mowing or raking, keep your head up and your back straight to maintain good posture. If you are looking down at the ground, you are automatically starting to bring your spine into a flexed posture, putting additional strain on your muscles and on the intervertebral discs.
  3. Stagger your feet when raking – put one foot forward and the other back, then reverse after a few minutes. This will allow you to shift your weight from one leg to the other instead of straining your back.
  4. Lift with your legs! Bend your knees, hinge at your hips, and keep objects close to your body to prevent strain on your back. Use a partner to help heavy objects when available.
  5. Use your body weight to push items like lawn mowers and wheel bowers, not just your arms and back.

 

Sources:

  • medbridgeeducation.com
  • https://www.google.com/url?sa=i&source=images&cd=&ved=2ahUKEwjD2PvPpKPkAhUi1VkKHeV1CiAQjRx6BAgBEBA&url=https%3A%2F%2Fwww.healthymoves-pa.com%2Fblog%2Fraking-leaves-without-back-pain%2F&psig=AOvVaw1-jSLjXmbqLeNqsdGJ-wfP&ust=1567003369452033
  • https://www.google.com/imgres?imgurl=x-raw-image%3A%2F%2F%2F9a84deb49fb46fc0d37d1082edf8cbfca1086d03b6e2c59acdf4b89ce72ecdf9&imgrefurl=http%3A%2F%2Fwww.mccc.edu%2F~behrensb%2Fdocuments%2F210wk3BodyMechanics.pdf&docid=KFDSEGIQGm2DPM&tbnid=wG-0n7TehJpFtM%3A&vet=10ahUKEwjdjaOcpaPkAhVNSN8KHRvKBjAQMwhqKAkwCQ..i&w=460&h=300&bih=730&biw=1408&q=lifting%20body%20mechanics&ved=0ahUKEwjdjaOcpaPkAhVNSN8KHRvKBjAQMwhqKAkwCQ&iact=mrc&uact=8

What Causes Muscle Cramps? How Do I Get Rid Of Them?

Muscle cramps are painful, involuntary contractions of a muscle. They occur commonly in a variety of different people. They are generally harmless and subside quickly. However, many people want to avoid them due to the pain and discomfort they impose on day to day life.

Here are a few things that may predispose you to getting muscle cramps.

  1. Dehydration
  2. Low level of electrolytes- specifically Magnesium, Potassium and Calcium
  3. Exercise or a prolonged hold of one position
  4. Certain medications
  5. Pregnancy
  6. Underlying medical conditions that decrease blood supply to skeletal muscle
  7. Compression of nerves- pinched nerve root or spinal cord damage
  8. Dialysis

Many people have heard that you should drink 8 ounces of water 8 times per day. But according to the Mayo Clinic, the amount of water you need per day depends on your weight, gender, activity level and the climate in which you live. (5) The best thing to do is to pay attention to your level of thirst and level of activity, and drink enough water to meet your needs. It is also important to ensure you are taking in enough electrolytes. According to Earp et. Al, the most important electrolytes for reducing muscle cramps are Sodium (Na) Potassium (K) and Magnesium (Mg). (2)

Exercise and muscle injury can also cause cramps. This often occurs after holding one position for a long period of time. You can decrease the occurrence of exercise-induced muscle cramps by stretching before and after exercise. You can also use a hot pack to help the muscle relax.

If you think your muscle cramps could be related to another medical condition such as compression of nerves or dialysis, you should talk to your doctor about potential medical treatments. Certain medications can also increase the occurrence of muscle cramps (4). Muscle cramps during pregnancy may be related to electrolyte imbalance (1). Pregnant women should ask their doctor about appropriate treatments for their specific case.

There are many causes of uncomfortable muscle cramps. Identifying the cause of your muscle cramps can help to reduce their occurrence and make your day a little better.

Works Cited

  • Department of OBGYN, Faculty of Medicine Chulalangkorn University Bankok, Thialand. Oral Magnesium for Relief in Pregnancy Induced Leg Cramps: a Randomised Control Trial.
  • Earp, and Sterns. Electrolyte Beverage Consumption Alters Electrically Induced Cramping Threshold.
  • “Muscle Spasms | Charley Horse .” MedlinePlus, U.S. National Library of Medicine, 8 May 2019, medlineplus.gov/musclecramps.html.
  • Sawada. Effect of Furosemide on Muscle Cramps in Patients with Liver Cirrhosis.
  • “Water: How Much Should You Drink Every Day?” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 Sept. 2017, www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/water/art-20044256.

Benefits of Stretching

There are many benefits to regular stretching such as it can help increase your flexibility, range of motion, circulation, posture, and enhance performance in physical activities as well as decreasing pain, stiffness and even stress. In order to see results, stretching has to happen on a regular basis. I always like to give the example of asking “do you brush your teeth every day? If you don’t brush your daily, what will happen? In correlation, stretching has to be a part of your daily routine just as brushing your teeth is”.

Stretching keeps the muscles flexible, strong and healthy and we need that flexibility to maintain a range of motion in the joints and without it, the muscles shorten and become tight. When muscles are tight, it can put you at risk for joint pain, strains, and muscle damage.

Keeping our muscles long, lean, and flexible with regular stretching will prevent exertion from putting too much force on the muscle itself. Healthy muscles also help a person with balance problems to avoid falls.

Find a Physical Therapist who can assess your flexibility and muscle strength to create a stretching program to fit your needs.

Make sure when you are stretching you are performing a static hold for 30 seconds. Don’t bounce while you stretch because it can cause injury and you should feel tension during a stretch but not feel any pain.
If you have any questions we can help you at Chesapeake Bay and Aquatic Physical Therapy. We also provide Manual Stretching Boutique services. Stretch your way into 2020! Give us a Call!!!

Stretch

Remedies for Lower Back Pain

About 80 percent of adults experience low back pain at some point in their life. It is the most common cause of job-related disability and a leading contributor to missed days at work.

Most low back pain is acute, or short term, and lasts a few days to a few weeks. It tends to resolve on its own with treatment at home and there is no remaining loss of function.

Bed rest should be limited for those experiencing back pain. Individuals should begin stretching exercises and resume normal daily activities as soon as possible, while avoiding movements that make the pain worse. Evidence suggests that bed rest alone may make back pain worse and can lead to secondary complications such as depression, decreased muscle tone, and blood clots in the legs.

Below is a list of some common exercises given to those experiencing low back pain:

1) Supine hamstring stretch

Setup

  • Begin lying on your back with your legs straight, holding the end of a strap that is looped around one foot.

Movement

  • Use the strap to pull your leg up toward your body until you feel a gentle stretch in the back of your upper leg. Hold this position.

Tip

  • Make sure to keep your other leg straight on the ground during the stretch.
  • Hold 2 times for 30 seconds each. Perform 2 times a day, 7 days a week.

2) Supine piriformis stretch

Setup

  • Begin by lying on your back with both knees bent and feet resting flat on the ground. Cross one leg over the other so your foot is resting on your knee.

Movement

  • Grab your leg just below the knee and slowly draw it towards your opposite shoulder until you feel a stretch in your buttocks.

Tip

  • Do not allow your back to twist or bend excessively during the stretch.
  • Hold 2 times for 30 seconds each. Perform 2 times a day, 7 days a week.

3) Posterior pelvic tilt

Setup

  • Begin lying on your back with your knees bent and your hands resting on your hip bones.

Movement

  • Slowly tilt your pelvis backward, monitoring the movement with your hands. Then return to the starting position and repeat.

Tip

  • Make sure to focus the movement only on your pelvis, and keep the rest of your back still during the exercise.
  • Hold for 5 seconds. Perform 20 times, 7 days a week.

4) Lower trunk rotations

Setup

  • Begin lying on your back with your feet flat on the floor and your arms straight out to your sides.

Movement

  • Lower your knees to one side, return to center, and repeat on the other side.

Tip

  • Make sure to activate your core muscles and keep both of your shoulders in contact with the ground throughout the exercise.
  • Hold 10 seconds. Perform 10 to each side, 7 days a week.

5) Bridging

Setup

  • Begin lying on your back with your arms resting at your sides, your legs bent at the knees and your feet flat on the ground.

Movement

  • Tighten your abdominals and slowly lift your hips off the floor into a bridge position, keeping your back straight.

Tip

  • Make sure to keep your trunk stiff throughout the exercise and your arms flat on the floor.
  • Hold for 5 seconds. Perform 20 times, 7 days a week.

Sources:
Medbridge
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet

How To Stay Compliant With Your Home Exercise Program

During your physical therapy care, your therapist will design a home exercise program tailored to your needs, pain complaints, muscle weaknesses, and areas of inflexibility. Your therapist will provide you with advice on proper form with each exercise, how to progress each exercise at home, and a schedule for performing each exercise. A print out with a picture and written instructions of each exercise is often provided as well. These programs are important to follow through with in order to maintain the gains made in physical therapy with your flexibility, strength, posture, and reduction in your pain. However, one of the most common excuses we hear from patients of why they aren’t following through with their home exercise program is they are “too busy” or “don’t have enough time.” Here are some ways to fit your exercise program into your daily schedule no matter how busy you are and stay consistent!

1) Set goals for yourself. Challenge a family or friend to a certain number of workouts each week. Set up rewards for yourself for hitting your goals. Competition is a good motivator!
 
2) Schedule a day and time for your exercise program. Just like you schedule a physical therapy appointment, set out a specific day and time to perform your home exercise program. Treat each workout like an appointment you can’t miss. The more times you meet your scheduled workout day and time, the more consistent you will become. And then your exercise program will become a part of your normal routine!
 
3) Hire a personal trainer or join an exercise class at your local gym. Workout with a friend. Some people are more consistent when they have another person motivating them. You may also have more fun doing your workout with a friend or family member.
 
4) Visualize your progress. Track your participation with your home exercise program on a chart in your home or on an app on your phone. Seeing your progress and dedication can be a great motivator.
 
5) Performing some of your exercise over none of your exercises is best! Even on days when you don’t feel like exercising or you are “too busy”, doing some of your exercises is better than not doing any exercise!
 
6) Sprinkle your exercises throughout the day if you are unable to carve out one specific time to do them all if you are still “too busy.” You don’t need to do all of your home exercises at one time during the day. Do some of your neck stretches while sitting in traffic in your car. Do some of your exercises while sitting at your desk at work. Do some of your exercises during commercials while watching TV. Do your heel raises when brushing your teeth or washing dishes at the sink. Squeeze in 1 or 2 exercises wherever you can during the day.

Making your home exercise a priority in your day will benefit you by maintaining the gains made during your course of physical therapy. It may also help you maintain your functional mobility and independence for longer periods of time between episodes of physical therapy care.  Visit Chesapeake Bay Aquatic & Physical Therapy in Maryland.

What do foam rollers do besides hurt a lot?

As an orthopedic physical therapist, I use foam rollers during the treatment of many of my patients. They do often complain that the foam rolling hurts at the time of the treatment, but they also say they feel better after using the foam roller. This makes it possible to convince my patients that they should continue foam rolling even after they are discharged from physical therapy. Foam rolling makes it possible for my patients to independently maintain the gains they made while working with me in PT.

So what good do foam rollers do?

Well, a survey of 685 sports and orthopedic physical therapists identified the top four benefits of foam rolling:1

1. Decreased pain (after you’re done using them)

Pain and fatigue are often associated with trigger point soft tissue damage. There are many studies that have shown that massage is helpful in alleviating the pain caused by this soft tissue damage. This is because massage increases blood flow at the areas where pressure is applied, which aids in healing of the tissue. Foam rolling is a technique you can use independently to get similar results to a deep tissue massage. And it’s a lot cheaper too. The average foam roller costs about $20.

2. Decreased muscle stiffness

Muscle stiffness can actually be measured by something called mechanomyography. This is a test that monitors the temporospatial summation of electrical activity at the motor unit (a building block of the musculoskeletal system that is composed of one motor neuron and the skeletal muscle fibers which it innervates). Mechanomyography has been used in several foam rolling studies to demonstrate decreased muscle stiffness after foam rolling. However, this effect lasts an average of only 15 minutes.2

3. Increased range of motion

Several studies have explored the change in range of motion (ROM) at a specific joint, after foam rolling was performed to a muscle group adjacent to that joint. One specific study found that hip flexion ROM improved by 23 degrees on average from baseline measures, after foam rolling and statically stretching the hamstring muscle group.3 This was compared to an improvement of only 12 degrees of improved hip flexion ROM after static hamstring stretching alone. The group of subjects who only foam rolled their hamstrings and did not stretch, had an average of only 6 degrees of improved hip flexion ROM. So, if you have tight hamstrings, I recommend making the time for both foam rolling and stretching. You might feel a little more pain than you would like, but you will see results!

4. Improved athletic performance

According to a study on collegiate male athletes, foam rolling performed in conjunction with a dynamic warm-up can lead to objective improvements in speed, power, strength, and agility.4 This study showed improvements in 1 rep max bench press and 37 m sprint test after a dynamic warm-up and total body foam rolling, versus just a dynamic warm-up. A dynamic warm-up is a series of movement drills that gradually increase from light to moderate intensity. These may include squats, pushups, jump squats, high knees, etc.

Ok, foam rolling sounds great! How do I use a foam roller?

  1. Research suggests that you should foam roll each muscle group for 30 seconds to 2 minutes daily at a self-selected rhythm.
  2. Foam rollers can be used on many different muscle groups, and it is beneficial to perform total body foam rolling. However, if you have time limitations, it makes sense to foam roll the muscle groups that feel the most stiff or painful to you on that day.
  3. You can use a foam roller either before or after your workout. If foam rolling before your workout, you should use it in conjunction with a dynamic warm-up. If foam rolling after your workout, you should follow your foam rolling with static stretching on similar muscle groups in order to maximize gains in joint range of motion.
  4. Foam rollers apply the greatest amount of pressure at more proximal muscle groups (closest to your center of mass). On average, about 29-50% of your body weight is actually applied to the muscle group you are foam rolling. If you feel too little pressure, you can lift one leg up off the ground to increase the compression at the targeted area.
  5. Here are some examples of how to foam roll specific muscle groups:

 

Here is a video tutorial for foam rolling different muscle groups:

What kind of foam roller should I get?

There are many different types of foam rollers that you can buy. There are different lengths, densities, and surfaces of foam rollers available on the market. In my experience, foam rollers with higher density tend to last longer, and will give you a longer duration of use. This includes foam rollers labeled as “high density,” and those with a plastic insert in the center of the roller. However, you have to be comfortable with consistently using the foam roller you get. If you have a lower pain tolerance, you should avoid the spiky, deep-tissue massage option, and opt for the lower density foam. I generally recommend the 36-in length foam rollers in order to allow more room for movement without rolling off of the foam.

 
Want to learn even more? Here is a great summary on the benefits of foam rolling:

Plantar Fasciitis and Physical Therapy

The hallmark sign of plantar fasciitis typically is sharp, severe pain in the foot immediately upon getting out of bed in the morning. Plantar fasciitis is one of the most common sources of foot pain, and more specifically heel pain in the U.S.

This band of connective tissue serves as a major defense component in the over flattening of your foot’s arch. When this part of your body becomes inflamed or sustains small microscopic tears, PAIN and limitations in weight-bearing function can occur.
Who suffers from Plantar Fasciitis?

With 10% of the population in this country experiencing this persistent pain it falls into a cluster of common orthopedic issues affecting a wide spectrum of people. This diagnosis is prevalent in active runners but also affects individuals who may be overweight and exerting excessive force on the lower extremities.
Proper Diagnosis

Undoubtedly you have heard your co-worker, BFF, or next door neighbor tell you all about his or her “Sciatica”, “Rotary cup tear”, or “Plantar Fasciitis”. The important thing to remember when digesting this diagnosis and deciding how to go about treating it is to first acknowledge that the internet (and your cousin’s mailman’s ex-boss) is full of information and misinformation. So as always let’s look at what the CURRENT research and science say……
What are the most effective treatments?

In 2014 JOPST (Journal of Orthopedic & Sports Physical Therapy) published a comprehensive update on clinical practice guidelines for the treatment of plantar fasciitis. This reassessment of the guidelines formally proposed in 2008 rated various treatment’s effectiveness on a letter grading scale with A being the strongest and F being the lowest.

Manual therapy, stretching, taping, foot orthoses, and night splints all received grades of A’s in their effectiveness. Physical agents such as low-level laser therapy, phonophoresis, and ultrasound received C grades. Electrotherapy and dry needling received the lowest grades with ratings of D and F respectively.
How about steroid shots?

If conservative treatments are not effectively reducing pain symptoms after several months, other options may be explored. Typically imaging tests are unnecessary but an X-ray or MRI may be suggested if a compressed nerve or stress fracture is suspected.
Or Antiinflammatories?

Pain relievers like Ibuprofen may reduce some of the inflammatory response in the foot and cortisone/steroid injections may be administered. These options typically will only provide temporary relief. It may be detrimental to have multiple steroid injections as they can actually reduce the integrity of the plantar fascia and weaken it.
Why choose physical therapy for plantar fasciitis?

Despite the strong evidence for conservative treatment of plantar fasciitis, physical therapy is often under-utilized by patients and their physicians. In a study published this past February researchers looked at a database of over 800,000 individual cases of plantar fasciitis and discovered that only 7.1% of these individuals were prescribed physical therapy.

If you suspect you have plantar fasciitis and it is limiting your daily functional activity consult with a physical therapist. He or she can help both with manual treatment and developing a guided and progressive exercise program. With the state of Maryland being a “direct access” state you may be able to see a physical therapist initially without requiring a visit with or script from your physician.

Greg Chrest, DPT, Reisterstown Clinic Director

Greg graduated from Elon University in 2011 with a Doctorate of Physical Therapy after completing his undergraduate degree in 2006 where he majored in exercise sports science with a minor in psychology. He worked as a Personal Trainer in Charleston, South Carolina where he was able to focus on his love of adult fitness along with getting people of all ages interested in exercise and living a healthy lifestyle. His special interest is continuing to cultivate his manual therapy skills along with sports medicine and management of chronic pain. Growing up in Bel Air, Greg is a die-hard Oriole and Raven fan and spends his free time training for triathlons and road races, playing the guitar, and sharing time with his family and friends.

Click here to contact Greg Chrest

Chesapeake Bay Aquatic and Physical Therapy perform injury assessment at no cost to you or your insurance. If you suspect you have plantar fasciitis contact us for an appointment.
REFERENCES

Fraser et al, titled “Utilization of Physical Therapy Intervention Among Patients With Plantar Fasciitis in the United States” (J Orthop Sports Phys Ther 2017;47(2):49–55. doi:10.2519/jospt.2017.6999).

Martin RL, Davenport TE, Reischl SF, et al. Heel pain—plantar fasciitis: revision 2014. J Orthop Sports Phys Ther 2014;44(11): A1-A23.

“Plantar Fasciitis”. Mayo Clinic Staff. https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/diagnosis-treatment/treatment/txc-20268820. November 16, 2016.