Cutting the Cost of Your Treatment

At Premier Physical Therapy Clinic I aim to keep our fees as low as possible, providing you with professional and effective care at the best value for money around. I will always do my best to reduce your number of visits and thereby keeping your expense to a minimum. If a persons symptoms are chronic and may take more visits than average, I will reduce the cost of the treatments by €10 after the third visit. 

Insurance Refunds – save up to €25 per session

The cost of treatment can be as low as €15 depending on your health insurance cover. Vhi, Aviva Health, Irish Life Insurance, Laya Healthcare, and the Garda Medical Scheme may cover some of the cost of Physical Therapy. Check your policy to see what you may be entitled to.

I am a member of The Irish Association of Physical Therapists, so treatments are usually covered by VHI, Laya, Aviva and all other major private health insurance providers. Coverage may vary depending on your plan and your insurance company, therefore, please check your provider and policy to see how much they will reimburse and the amount of visits they may cover prior to your treatment. 

 Tax Relief – added savings.

As an example, if your treatment cost is €50 (full fee) and your health insurance policy reimburses you €25, then you may be able to claim a tax relief on the outstanding €25. Tax relief is available on physical therapy costs (on referral from your G.P. or other relevant practitioner) and depending on your level of taxation, you may receive a rebate of up to 42%. Tax relief may be claimed by filling in the MED 1 form available from www.revenue.ie.

 Payment Terms:

All fees are to be paid on day of treatment, including patients with private medical health insurance. A receipt will be issued so you can re-claim part of the fee from your insurance provider.

CPD with John Gibbons 2 Day Course

I recently did a John Gibbons 2 day course in Dublin in May 2017; Spinal Manipulation and METs and the Vital Glutes and Psoas. John is registered Osteopath and author on manual therapy (Vital Gluts and functional anatomy of the pelvis and sacroiliac joint to name just two). He is highly regarded lecturer in Oxford University and world renowned therapist of 20 years. The man is a font of knowledge on Anatomy,Physiology, Dysfunction and Rehabilitation. He also has a great sense of humour which is good as it made the course more engaging and enjoyable. After doing the course I know it’s going to add a greater dimension to my treatment sessions both for my clients and on a personal level as I continue to learn.

John and Myself at his two day ‘Vital Glutes’ course

Back Pain Myths

While back pain can be very painful and worrying, it is very common and rarely dangerous. A total of 84% of people worldwide will experience back pain during their lifetime. It is equally common across all age groups; from young to old and doesn’t get worse with age. Therefore, it should not be seen as a result of ageing or “wear and tear”. Commonly people recover reasonably quickly, and most will recover without the need for treatment. Some people experience repeated episodes of back pain which can be distressing, but again these are rarely dangerous.

Here is a link to a recent Irish Independent article about back pain and the myths surrounding it:

http://www.independent.ie/life/health-wellbeing/health-features/10-myths-about-back-pain-and-how-to-cope-when-it-strikes-35330563.html

Source: Irish Independent (3rd Jan 2017)

Good Posture for Good Health

Good Posture Helps Reduce Back Pain

Correct posture is a simple but very important way to keep the many intricate structures in the back and spine healthy. It is much more than cosmetic – good posture and back support are critical to reducing the incidence and levels of back pain and neck pain. Back support is especially important for patients who spend many hours sitting in an office chair or standing throughout the day. We can also help ourselves by doing some exercises throughout the working day. Here are some simple exercises to keep mobile and ease tension in tight muscles:

1. Shoulder Rolls: Sit up straight and take a deep breath in as you raise one shoulder up towards your ear. As you exhale roll the shoulder back and down. Do this three times then repeat on the other side. Then do them both at the same time. Repeat three times. These will help release tension in your upper back and shoulders.

2. Neck Stretch: Sit up straight and use one arm to anchor yourself to the chair, while bringing the other arm up and over to the opposite side of your head as you gently let your head fall to that side. Hold for 10-15 seconds and repeat on the other side. This will help to lengthen your neck muscles, decreasing compression of the cervical vertebrae of your spine.

3. Chest Opener: Sit up in your chair and clasp your hands behind you. Take a deep breath in and roll your shoulders down and back. Hold for 10-15 seconds while taking a few deep breaths. For a deeper stretch, stand up with your legs a few feet apart and clasp your hands behind your back, take a deep breath in and bend forward as you exhale, allowing your arms to come up over your body. Hold for 10-15 seconds.

4: Wrist Stretch: Extend your arms in front of you. Use your left hand to pull the right wrist back. Hold for 5 seconds. Turn the right hand down now and use the left to stretch. Hold for 5 seconds. Repeat 3 times on each hand.

5: Glute Stretch: Sit with both feet planted on the floor. Bring the right ankle up to rest on the left knee. Lean forward and hold for 10-15 seconds. Repeat on the other side.

Ankle Sprains

Ankle injuries are some of the most common for athletes competing in running, soccer, or basketball, but can plague even casual hikers and joggers. To prevent ankle injuries that can send you limping to your nearest Scottsdale physical therapy center, there are a few things you should know.

First, it is important to understand how the ankle works. The ankle, or talocrural region, is the region where the foot and leg meet. It is composed of three joints (the talocrural joint, the subtalar joint, and the inferior tibiofibular joint) and three bones (the tibia, fibula, and the talus). The joint surface of all bones in the ankle are covered with articular cartilage and bound by the strong deltoid ligament and three lateral ligaments. The ankle distributes the weight of your body to the bones in the feet.

The most common injury to the ankle is a sprain or twist. This occurs when the ankle is rolled, twisted, or turned in an awkward way, causing the ligaments to stretch or tear.

To help minimize the chance of injury, try these 3 tips:

  1.  Balance training: By improving your balance, you are honing your body’s proprioception. This is your body’s ability to control itself in all types of positions. Balance exercises can be as simple as alternating standing on one leg for as long as possible. To increase difficulty, try standing on one leg and leaning as far to each side as possible or balancing with your eyes closed. These exercises can be aided by the use of a bosu ball or wobble board.
  2. Ankle strengthening: Weak muscles around the ankle area make you much more likely to suffer a sprain. Resistance range-of-motion exercises with a thera-band are a great way to strengthen the muscles in the ankle. Place the band around the top of the foot and curl the toes at the end of the movement to work the internal muscles of the foot. Complete three sets of 20 in each direction. Another way to strengthen the muscles in the ankle is through calf raises. These should be completed both sitting and standing to strengthen the Achilles tendon and calf muscles.
  3. Stretching: Stretching the muscles in the legs is important before and after strenuous physical activity. Try some of these stretches:
    • Gastrocnemius stretch – stand on a step with heels off the back of the step. Keep the knees straight and slowly lower the heels down below the level of the step until you can feel a stretch.
    • Soleus stretch – stand with one leg in front of the other close to a wall. Place your hands on the wall and lean forward. Bend both knees as if trying to touch the front knee to the wall while keeping the back heel down.
    • Shin stretch – cross left foot behind right, stand on the toes of your left foot, and bend the right leg to push your ankle towards the ground as if dragging your toes on the ground. Hold for 15-30 seconds and switch legs.
    • Peroneal stretch – sitting in a chair, cross one leg over the other knee so that the ankle sits on top of the knee. Using your hands, stretch the foot towards you. Hold and switch sides.

 

Riverdance China Tour 2012/2013

I am recently back from a Riverdance tour that took us to 24 different cities in China. The tour included performances at the world renowned Beijing Exhibition Centre Theatre and many other state of the art venues. We did 10,000 kms of touring with the climax of the tour taking place at the Shanghai Grand Stage just after the Chinese New Year. Thankfully there were no major worries from a Physical Therapy viewpoint apart from a few typically tired and overused muscles.

All About Arthritis

Arthritis

You will develop arthritis at some point in your lifetime. It can be very mild, causing a little stiffness as you age, or it can be extremely painful and debilitating. Fortunately, there are things you can do to prevent and manage this condition.

Arthritis is not actually a disease. Arthritis is a term used to describe joint inflammation (“arthro” = joint;  “itis” = inflammation). When inflammation is present, the joint is usually painful. However, not all joint pain is arthritis. Problems like trigger points, sprains, or tendinitis can cause pain, but the joint itself remains healthy.

Arthritis refers to problems with the joints. There are over a hundred different forms of arthritis and growing. The forms relate to wear and tear of the cartilage such as osteoarthritis (OA) which is by far the most common. It affects approximately 400,000 people in Ireland. The second most common form of arthritis is rheumatoid arthritis (RA) which is associated with inflammation in the joints. In Rheumatoid arthritis the body’s own tissues in the joints are attacked. About 1% of the adult population in Ireland is affected by Rheumatoid arthritis.

Osteoarthritis

Osteoarthritis

Doctors will often refer to this type of arthritis as degenerative joint disease, or if it affects the back, degenerative disc disease. It sounds scary, but it’s the most common and least serious type of arthritis. Osteoarthritis is simply wear and tear of the cartilage on the ends of the bones. One research study found that 37% of all adults have osteoarthritis in their hands or feet. Everyone over sixty-five years of age has it to some degree. However, because the cartilage is not sensitive to pain, you most often do not know you have it.

Stiffness is a key feature of osteoarthritis. Typically, your joints feel stiff in the morning and will loosen up after you move around for awhile. Sometimes the joints will make crackling or crunching sounds with movement. In the early stages, you will only feel pain after excessive activity. The pain is usually an aching sensation within the joint. You will seldom see swelling because inflammation in the joint tends to be minimal.

Rheumatoid arthritis

Rheumatoid arthritis is not nearly as common as osteoarthritis. It occurs in only about 1% of adults.

This type of arthritis is called systemic arthritis because it can affect many of your body systems. For example, it can affect your heart, lungs, nerves and skin. Whereas osteoarthritis usually develops as you get older, rheumatoid arthritis can occur at any age.

Usually the symptoms appear over a period of weeks or months and are accompanied by fatigue, fever, and diffuse pain. Subsequently, specific joints become inflamed and are painful, tender, swollen and red. Many joints become involved and both sides of your body are affected equally. There are periods when it goes into remission. It’s progressive however and overtime the involved joints often become somewhat deformed.

New Services and Skills

As a member of The Irish Association of Physical Therapists and like all primary healthcare professionals, we are obliged to make sure we keep our skills up to date. This is formally called continuing professional development (CPD) and has been revised recently to be in line with similar healthcare providers. Over the last year I have completed a number of courses that I hope will add to my ‘toolbox’ and improve my skills and outcomes as a Physical Therapist. I have used all of these skills over the last few months depending on the client and their presentation. Here is a few of them and a brief explanation of what it is and how it can help you.

Kinesiotaping

During the 2012 Olympic games, numerous athletes wore a bright colored tape on their shoulders, knees, and backs called kinesiotape. David Beckham, Lance Armstrong and Serena Williams are also fans of the tape. The Kinesio Taping method involves taping over and around muscles in order to assist and give support to muscles or to prevent over-contraction of muscles, depending on patient presentation. Kinesio Taping can easily be integrated into a patients’ existing treatment plan. It also can be used on clients with postural problems and tightness in typical areas (neck shoulders and back).

Dry Needling

Dry Needling involves multiple advances of a fine filament needle into the muscle in the region of a “Trigger Point” (muscle knot). The aim of Dry Needling is to achieve a local twitch response to release muscle tension and pain. Dry needling is an effective treatment for chronic pain of neuropathic origin with very few side effects. This technique is unequalled in finding and eliminating neuromuscular dysfunction that leads to pain and functional deficits.

The needle used is very thin and most subjects do not even feel it penetrate the skin. A healthy muscle feels very little discomfort with insertion of this needle. However if the muscle is sensitive and shortened or has active trigger points within it, the subject will feel a sensation like a muscle cramp -‘the twitch response’. The patient also may feel a reproduction of “their” pain which is a helpful diagnostic indicator for the practitioner attempting to diagnose the cause of the patient’s symptoms. Patients soon learn to recognise and even welcome this sensation as it results in deactivating the trigger point, reducing pain and restoring normal length function to the involved muscle. Dry needling is similar but not the same as acupuncture.

Spinal Mobilisation Course

Spinal mobilisation is the gentle manual manipulation of the joints in the spine to release the body’s own healing powers which then are able to restore the joints or tissue being treated to normal functioning. This is done in the right place at the right time in the right way. If done correctly it can improve the faulty functioning of body structures such as joints, muscles and tendons.

Shoulder Injury

Torn Labrum

The shoulder joint is a ball and socket joint, similar to the hip; however, the socketof the shoulder joint is extremely shallow, and thus inherently unstable. This means that the bones of the shoulder are not held in place adequately, and therefore extra support is needed to help the muscles stabilize the joint. To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a labrum that forms a cup for the end of the arm bone (humerus) to move within. The labrum circles the shallow shoulder socket (the glenoid) to make the socket deeper. This cuff of cartilage makes the shoulder joint much more stable, and allows for a very wide range of movements. The biceps tendon attaches to the labrum.

How can a labral tear occur?

The labrum can get torn from repetitive, high force movements such as, throwing hard or a tennis serve. Having an extreme stretch of the biceps tendon with exercises like dips or full range bench press can also lead to labral damage. Falling on an out stretched arm or having a hard impact at the shoulder can also lead to a labral tear. The labrum becomes brittle with age and can become more vulnerable to fraying or tears.

What are the symptoms of a torn labrum?

Symptoms of a labral tear depend on where the tear is located, but may include:
An aching sensation in the shoulder joint, Catching of the shoulder with movement, Pain with weight bearing on the arms, Pain and/or loss of range in shoulder internal rotation and reaching across the body.

What are the common types of labral tears?

SLAP Tears
A SLAP (superior labrum anterior to posterior) tear is a type of labral tear most commonly seen in overhead throwing athletes such as baseball players and tennis players. The torn labrum seen in a SLAP tear is at the top of the shoulder socket where the biceps tendon attaches to the shoulder, and when severe can be related to complete detachment of the biceps.

Bankart Lesions
A Bankart lesion is a labral tear that occurs when a shoulder dislocates. When the shoulder comes out of joint, the labrum is torn, and makes the shoulder more susceptible to future dislocations.

Posterior Labral Tears
Posterior labral tears are less common, but sometimes seen in athletes in a condition called internal impingement. In this syndrome, the rotator cuff and labrum are pinched together in the back of the shoulder.

How do I know if there is a labral tear?

A doctor or physical therapist can do movement tests to see if the labrum is irritable but the tests are not considered to be consistent. An MRI is often needed to confirm a labral tear. If a shoulder problem is not getting better a consultation with a physician who specializes in shoulders is advised.

What is the treatment for a torn labrum?

As with any shoulder injuries, initially, the movements which irritate the injury must be stopped and the inflammation controlled. At Premier Physical Therapy we will discuss the daily activities which may be irritating the condition. Icing is critical to control the inflammation in the early phase. Another priority in the early phase is to normalize the shoulder motion with safe stretches, including some to improve internal rotation. Then, a comprehensive shoulder-strengthening program should be undertaken, emphasizing the back part of the shoulder and the ability to keep the shoulder blade in good posture. It is important to progress at a cautious rate so as to not irritate the torn labrum. As the symptoms recede and the strength returns,the mechanics of irritable motions must be addressed. For example, technique refinement with swimming, throwing, weight training, or a work task might be done with coaching or video analysis. In severe cases of labral tears the conservative treatment won’t sufficiently resolve the problem and surgical intervention may need to be explored. Even if surgery needs to be done ultimately the conservative program will make the post operative-recovery faster. At Premier Physical Therapy we make you an active participant in your rehab and not a passive recipient of our care. We will teach you how to fix yourself with the above-mentioned approach and return to your every day activities.