Welcome Rachael!

 





As a new addition to the Rock Valley family, I thought I'd better introduce myself in RVPT "blog-world" as well.  I am so excited to join this team of extraordinary professionals, and look forward to meeting and helping many new faces in the Peoria community.



I grew up in Indianapolis, IN where my interest in physical therapy was sparked; this is what drew me west to Peoria to attend Bradley University.  Although I had not intented to stay in this area after obtaining my Doctorate (DPT) degree in 2010, I was blessed to meet my husband while at Bradley, and we have decided to call Peoria "home."  With him growing up in a small town south of Springfield, IL, this is a perfect middle ground for us in many ways.

In our spare time, we enjoy spending as much time as we can outdoors with a variety of recreational activities.  We also love to travel to see friends and family as often as possible.

Professionally speaking, my background is two years practicing in a rural community north of Peoria where I treated a wide variety of diagnoses and age-groups.  I have also developed a niche interest Vestibular Rehabilitation, treating individuals with complaints of dizziness and imbalance, and have advanced training in this area.

Posterior Tibialis Tendon Dysfunction

The posterior tibialis tendon crosses the inside of the ankle joint, and works to control foot position during stance and walking.  Posterior tibialis dysfunction is the major cause of acquired flat foot deformity.^1,2

Nearly 60% of patients with a rupture of the posterior tibialis tendon had 1 or more of the following symptoms: hypertension, obesity, diabetes mellitus, previous surgery or trauma in the medial aspect of the foot, or exposure to steroids.¹

 

There are two main classifications within this disorder process:

Stage I: The tendon is of normal length, pain and swelling at medial foot
Stage II: Elongation of tendon, patient is unable to stand on toes of affected limb

What is the rehab role?

A study by Kulig et al examined the effectiveness of a 12 week program with custom -made orthotics in addition to stretching with or without an exercise program in adults with Stage I or II PTTD.  The study found that all interventions were effective in reducing pain; however the custom made orthotics along with eccentric exercises group had the most improvement in all subscales of foot functional index scores.³

A study by Alvarez et al found treating patients with Stage II PTTD with short articulating orthotics in combination with a high repetition ankle strengthening program showed significant improvements in VAS, single-support heel rise, ambulation distance, and strength.⁴

While being more expensive, custom articulating orthotics have been shown to provide best foot kinematics in gait, when compared to OTC or solid custom AFOs.⁶

Rehabilitation guidelines:^3,4

• Early stage (up to two weeks): Unload the tendon using orthotics, gastroc/soleus stretching, and build ambulation tolerance.

• Middle stage (2-8 weeks): Recruit tibialis posterior, eccentric strengthening

• Late stage (8-12 weeks): Progress toe walking to 150ft, progress ambulation distance to 2 miles, increase reps in HEP.

References:
Geideman WM, Johnson JE. Posterior Tibial Tendond Dysfunction. J Orthop Sports Phys Ther. 2000;30(2):68-77.
Trnka HJ. Dysfunction of the tendon of tibialis posterior.  J Bone Joint Surg [BR]. 2004;86-B:939-46.
Neville C et al. Choosing among 3 ankle-foot orthoses for a patient with Stage II posterior tibial tendon dysfunction. Journal of Ortho and Sports Phy Ther. 2009;39(11):816-824.

Alvarez RG et al. Stage I and II posterior tendon dysfunction treated by a structured nonoperative management protocol: an orthoses and exercises program. Foot & Ankle Internationional. 2006;27(1):2-8.

Kulig K et al. Effect of eccentric exercise program for early tibialis posterior tendinopathy. Foot & Ankle International. 2009;30(9):877-855.

Franettovich M et al. A physiological and psychological basis for anti-pronation taping from a critical review of the literature. Sports Med 2008;38(8):617-631.

ASTYM

The ASTYM system is an evidence-based rehabilitation process designed to effectively treat chronic tendon disorders, scar tissue and fibrosis.


The goal of the ASTYM treatment is to stimulate the body’s healing response, resulting in the resorption and remodeling of scar tissue and the regeneration of degenerative tendons. This effective therapy incorporates a customized program of stretching and exercise, which positively influences the alignment of the new collagen.

For some of you who may have heard of this technique, through personal experience or observation, there are some common misconceptions that we would like to clarify.  Please read-on as we unravel the myths surrounding this effective rehab process:

Myth:  All soft tissue injuries are treated equally regardless of the underlying cause.

Fact:  Chronic, long-standing repetitive injuries must be treated differently than acute injuries.  The absence of cardinal signs of inflammation should necessitate that an alternate approach should be taken.  Interventions used for a tendinosis that attempt to address inflammation where inflammation is absent will be unsuccessful.

Myth:  ASTYM is just “scrapping” people with tools.

Fact:  ASTYM tools are designed and used to promote controlled capillary leakage promoting phagocytosis of inappropriate tissue and stimulation of fibroblasts.  Although to the lay person treatments appear to be scrapping tissue, provider training and testing ensure the  proper tool pressure, direction, and angulation give the sought after effect.

 

Myth:  ASTYM is most effective when done without exercise.

Fact:  Exercise, including strength and flexibility,  in conjunction with ASTYM treatment is necessary to promote proper collagen fiber alignment and alleviate impairments caused by chronic dysfunction.

 

 

References:

Kannus P and Jozsa L. Histopathologic changes preceding spontaneous rupture of a tendon. Journal of Bone and Joint Surgery. 1991; 73-A(10):1507-1525.

Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy. 1998; 14(8):840-843.

Gehlsen GM, Ganion L, Helfst RH. Fibroblast Response to Variation in Soft Tissue Mobilization Pressure. Med Sci Sports Ex 1998; 31(4):531-535.

Wilson JK, Sevier TL, Helfst RH, Honing EW, Thomann A. Comparison of rehabilitation methods in the treatment of patellar tendinitis. J Sports Rehab, 2000;9:304-14.

Walking Speed

There is significant evidence to suggest that people with decreased walking tolerance, strength, and balance are actually dying sooner.  There is also significant evidence that sitting time, alone, increases risk of death.  Walking speed is a powerful indicator of functional status for patients with varying diagnoses; however, it is not routinely assessed by the medical community.

The functional requirements for community-living, aging adults are identified as follows:

·         1203 feet (366.7 meters) to complete an errand in the community

·         Gait speed of 1.2 m/s or 2.68 mph to cross a street safely

·         Need to carry an average of 6.7  lb. package

How do we measure walking speed?

We can time how long it takes a person to travel a 20-meter distance, by using only the middle 10-meters of this area, to allow for acceleration and deceleration.

 

What does the research have to say?

A significant increase in mortality existed among subjects with increased time to perform the 400 meter walk test.  (948 men and women; this was further adjusted for depression, education, smoking, BMI, sedentary, chronic disease.)^2,3  For each additional minute of longer performance time, risk of death increased 35%.⁴

Walking speed, walking less than 400 meters, and decreased lower extremity strength are strong predictors for nursing home placement.  Loss of leg strength is the strongest single predictor for subsequent institutionalization, stronger than disease diagnosis. ^5,6

A change in gait speed by .10 m/s (.22 mph) has been shown to be a meaningful change in community dwelling older adults, hospitalized male veterans, and patients with a hip fracture. A 2011 study in the Journal of American Medical Association found that a change of .10 m/s (.33 mph) increased survival over a 10 year period.⁷

How can we help?

The staff at Rock Valley Physical Therapy can help to identify a decline in function, using this measure along with other special testing.  We will then work with you to establish a program that is consistent with your pace of life & desired activity level, restoring your mobility and independence.

References:

Shumway-Cook A, et al.  Environmental demands associated with community mobility in older adults with and without disabilities.  Phys Ther.  2002;82:670-681.

Chang M, et al.  Incidence of loss of ability to walk 400 meters in a functionally limited older population.  J Am Geriatr Soc.  2004;52:2094-8.

Vestergaard S, et al.  Characteristis of 400-meter walk test performance and subsequent mortality in older adults.  Rejunenation  Res.  2009;12:177-84.

Newman AB, et al.  Association of long-distance corridor walking performance with mortality, cardiovascular disease, mobility limitation, and disability.  JAMA.  2006;295:2018-2026.

Guralnik JM, et al.  Validation and use of performance measures of functioning in a non-disabled older population: MacArthur studies of successful aging.  Aging.  1994;6:410-419.

Judge JO, et al.  Step length reductions in advanced age: the role of ankle and hip kinetics.  J Geritol A Biol Sci Med Sci.  1996;51:M303-M312.

Studenski S, Perera S, Patel K, et al.  Gait speed and survival in older adults.  JAMA.  2011;305(1):50-58.

Fritz S, Lusardi M.  White paper: “Walking speed: the sixth vital sign.”  J Geriatr Phys Ther.  2009;32(2):2-5.

 

Welcome Alicia!

We would like to welcome Alicia Kuhns to the Rock Valley family.  She will be assisting Cheryl at the front desk, by serving as our front line on Fridays. 

Alcia is from Decatur, IL and currently resides in West Peoria.  She enjoys spending time with family and friends, as well as coaching middle school volleyball.

Headache

Headaches originating from the cervical spine are believed to account for approximately 15-20% of all chronic and recurrent headaches.¹  The International Headache Society (IHS) defines cervicogenic headache as “pain referred from a source in the neck and perceived in one or more regions of the head and/or face².”

 
 

Individuals with cervicogenic headache have been shown to exhibit restricted neck motion, palpable upper cervical joint dysfunction, and impaired muscle performance of the deep neck flexors.³
 

Limited upper cervical spine rotation with the neck flexed has been shown to differentiate individuals suffering from cervicogenic headache from those suffering from migraine headache.⁴

 

 

How can we help?

Based on the available current best evidence, the combination of exercise and manual physical therapy has been shown to be beneficial in reducing symptoms of headaches.  Jull et al.⁵ showed that a physical therapy program that combined manipulative interventions with endurance training for deep neck flexor endurance resulted in significantly reduced frequency, intensity, and duration of headaches.  These improvements were maintained at twelve month follow-up.  Hall et al. ⁶ showed that regular performance of a patient self-mobilization exercise resulted in significant improvements in headache symptoms.  These benefits were also maintained at twelve months.

 

Effective Interventions: 

·         Deep neck flexor endurance training

·         Self-mobilization

·         Postural education

·         Manual physical therapy



References:

Nilsson N.  The prevalence of cervicogenic headaches in a random population sample of 20-59 year olds.  Spine 1995;20:1884-1888.

The International Classification of Headache Disorders:  2^nd Edition.  Cephalgia 2004.24:9-160.

Jull et al.  Cervical musculoskeletal impairment in frequent intermittent headache, Part 1:  subjects with single headaches.  Cephalgia  2007.27:793-802.

Zito G, Jull G.  Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache. Manual Therapy 2006;11:118-130.

Jull et al.  A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache.  Spine 2002;27(12):1835-1843.

Hall et al.  Efficacy of a C1-C2 self-sustained natural apophyseal glide in the management of cervicogenic headache.  JOSPT  2007;37(3):100-107.

American Gastroenterological Association (2005, January 16). Study Shows Long-term Use Of NSAIDs Causes Severe Intestinal Damage.ScienceDaily. Retrieved January 31, 2011, from http://www.sciencedaily.com­/releases/2005/01/050111123706.htm

Hall  T, Briffa K.  Reliability of manual examination and frequency of symptomatic cervical motionsegment dysfunction in cervicogenic headache.  Man Ther 2010;15:542-546.

Gadotti I, Olivo S, Magee D.  Cervical musculoskeletal impairments in cervicogenic headache: a systematic review and a meta-analysis.  Physical Therapy Reviews  2008;13(3):149-166.

Injury Prevention and Management in the Soccer Athlete

It has been quite some time since we posted on our blog. That means it has been busy at the clinic. We wanted to share with everyone in the Peoria area athletic community that we are hosting a presentation on June 8th entitled, "Injury Prevention and Management in the Soccer Athlete." This will be a joint presentation between us and Joe Terry, PT, CSCS of the Human Performance Lab. Feel free to forward this information to coaches and parents who might be interested. As physical therapists and strength coaches, sports-specific rehabilitation and injury prevention have been a primary focus. We hope to educate the soccer community on injuries most commonly seen in the sport, functional testing, and preventative training.

Date: June 8th, 2011

Time: 7:00 - 8:30 PM

Location: Rock Valley Physical Therapy (9901 N. Knoxville)

Amy Johnson, PT, OCS/ Luke Acklie, PT, OCS, CSCS/ Joe Terry, PT, CSCS

Description: The presentation will consist of two lectures with the first lecture discussing the management of common injuries in the soccer athlete. The second lecture will focus on injury prevention in the soccer athlete from the sports enhancement perspective. There will be time devoted for a question/answer session after each presentation. For more information or questions, please contact the clinic at 309-243-1989.