Chronic Pain
Common Diagnoses: Fibromyalgia, Complex Regional Pain Syndrome, Chronic Back Pain, Chronic Neck Pain, Osteoarthritis
Pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” according to the International Association for Study of Pain (IASP). Pain associated with a recent injury or surgery typically responds in a predictable manner within an appropriate time frame dependent on the original injury. Chronic pain, however, is not so predictable. According to The Pain Toolkit.org: “Pain that continues for a period of 3 months or more and may not respond to usual medical treatment. It can be disabling and frustrating for many people to manage. It can also affect relationships with their family, friends and work colleagues. Sometimes people with persistent pain are told by their healthcare team after assessment: I am sorry. But I’m afraid you have a chronic or long term pain problem and there is not much more we can do to help you. You will have to learn to live with it.”
The good news is that exercise programs can be used to provide pain relief and restore function in patients with chronic pain. Our therapists will custom design a plan of care helping you deal with your pain while restoring function, strength, and endurance based upon your individual goals. Our therapists routinely provide both land and aquatic exercise programs for individuals with chronic pain.
Shoulder Pain
Common Diagnoses: Rotator cuff tendonitis/tendinopathy, Impingement, Muscle Strain, Rotator cuff tear, Biceps tendonitis/tendinopathy, shoulder instability, post-acute shoulder dislocation management, post-operative shoulder conditions including rotator cuff repair, SLAP repair, suprascapular nerve release
The shoulder has the greatest mobility of all the joints in the human body. The great mobility of the shoulder allows for lifting the arm in multiple directions including overhead, behind the back, and across the body. The movement of the shoulder is actually shared with 3 different joints including the acromioclavicular joint, sternoclavicular joint, and the glenohumeral joint. While the shoulder is a very mobile joint, shoulder pain and dysfunction is very common. Shoulder pain is a common condition affecting up to 25% of our population. The most common group affected appears to be the working class with the average age of the person experiencing shoulder pain being 46 years old.
Due to the complex nature of the shoulder a thorough therapy examination is crucial in determining the proper treatment of shoulder pain. During your initial examination for shoulder pain your therapist will look at your shoulder flexibility and strength, and will also look at your posture and other parts of your body that can refer pain to your shoulder region.
Based upon your shoulder’s clinical presentation your therapist may choose some of the following to address your individual needs:
Exercises may be selected to for your shoulder based upon many factors including pain, flexibility, strength, staging of injury, time since surgery (if applicable). Your therapist may select stretching exercises to improve your motion, stability exercises to improve control of your shoulder, and even return to work/sport programs to safely return you to the highest level of activity without limitation
Manual therapy: Manual therapy is often used to treat stiff and painful shoulders. Your shoulder may have motion restrictions that will benefit from joint mobilizations to reduce stiffness. Therapists often times use manual therapy techniques to reduce guarding and improve flexibility of the musculature surrounding the shoulder. Your therapist will decide upon the appropriate manual therapy techniques based upon your individual clinical presentation.
Other forms of treatment for the shoulder may include: modalities to reduce pain and improve muscle activation, taping to reduce pain, and other forms of treatment depending on your shoulder needs.
Elbow Pain
Common Diagnoses: Golfers elbow (medial epicondylitis), Tennis Elbow (lateral epicondylitis), bursitis, ulnar nerve entrapment, arthritis, OCD, pitcher’s elbow, cubital tunnel syndrome, elbow fracture, dislocation
The elbow is a joint that undergoes high levels of stress during daily activity. The elbow is important in positioning and controlling the hand during daily life, work, and sports. The elbow is susceptible to overuse injury and trauma.
Similar to other body parts, a thorough examination of the elbow is important to determine what therapy plan of care is needed to restore function. Your individualized plan of care for the shoulder may include some of the following:
Exercises are often used in therapy to address weakness and improve flexibility for the elbow. Progressive resistance exercises are also used to promote healing of elbow injuries and allow a safe return to each patient’s prior level of function.
Modalities: Modalities including iontophoresis and phonophoresis are often helpful in reducing pain and inflammation in the early stages of injury
Manual therapy: Studies have found that mobilization and manipulation to the elbow region is beneficial in reducing pain and improve grip when appropriate. Therapists often utilize soft tissue mobilization when working with the elbow.
Wrist/Hand Pain
Common Diagnoses: Carpal Tunnel, Tenosynovitis, Fracture, De Quervains, Complex Regional Pain, Post-operative conditions, Mallet Finger, Dupuytren’s contracture, arthritis
The wrist and hand is dynamic body part including the radius and ulna along with 27 other bones. The combination of the many bones along with neural structures, muscles, and ligaments allow precise control of the region during tasks such as writing, typing, and eating. The region also allows for powerful grip while performing heavy lifting during work and recreational activities.
The types of wrist and hand dysfunction vary greatly. Common conditions include overuse injuries, nerve injuries, traumatic injury to name a few. While the type of conditions afflicting the wrist and hand may vary greatly, therapeutic plans of care are often utilized to restore function. Therapy for the wrist and hand may include some of the following:
Splinting: Splints are often used in the care of the wrist and hand following injury or surgery. Our therapists are trained in making customized splints for each patient when needed.
Exercise is often used in the wrist and hand to regain flexibility and strength. Practicing the fine motor control demands of the wrist and hand is the best way to regain function and recover from injury and or surgery.
Low Back Pain
Common Diagnoses: Degenerative Disc Disease, Disc Bulge/Herniation, Lumbago, Pelvic Pain, Pain during Pregnancy, Post-Partum Pain, Sacroiliac (SI) Joint Pain, Sciatica, Spondylosis, Spondylolisthesis
Low back pain is the leading cause of activity limitation and missed work throughout much of the world. The cost of care for individuals with low back pain has also become enormous, and the number of people experiencing low back pain continues to rise.
The good news is physical therapy can help your low back pain. Low back pain is one of the most common reasons patients come to physical therapy for these reasons. Studies have shown that individuals with low back pain may save up to $2700 in cost of care by attending physical therapy to address the pain and loss of function.
Physical Therapy for low back pain may include the following
Manual Therapy: Research has shown that patients attending therapy who receive a manual therapy get better results. Therapists often utilize manual therapy to reduce pain and improve motion for patients with low back pain. Examples of manual therapy may include a variety of techniques such as joint mobilizations for the lumbar spine and hip, soft tissue mobilization for muscles and fascia, and instrument assisted soft tissue mobilization.
Therapeutic Exercise: Studies have found that patients with low back pain typically demonstrate weakness and decreased motion that can be addressed with exercise. Our therapists will tailor a specific exercise routine based upon your evaluation to meet your needs. Examples of therapeutic exercise may include trunk coordination and endurance exercises, exercises with a directional preference based upon your motion limitations and presentation, and progressive programs to get you back to your pre-back pain level of activity.
Neck Pain
Common Diagnoses: Neck Pain, Cervical Headache, Pinched Nerve, Disc Degeneration, Spondylosis, Radiculopathy, TMJ (while not technically a neck condition TMJ is often closely linked to neck pain), Whiplash, Cervical Strain
Neck pain is a very common condition affecting many people in our country. Individuals experiencing neck pain may have difficulty sleeping at night, looking over their shoulder, looking up, and even experience headaches. Studies have shown that up to 70% of our population has experienced neck pain during his or her lifetime. Reports also find that up to 30% of those experiencing neck pain will develop chronic symptoms. Unfortunately, a clear pathoanatomic reason for the neck pain is difficulty to define. A trained Physical therapist can help classify neck pain as either being a mechanical problem or a nerve root issue.
A physical therapy plan of care may include some of the following based upon the presentation of neck pain:
Manual therapy: Studies continue to find that a combined approach of manual therapy and therapeutic exercise provide superior results to manual therapy or exercise alone. Therapists often utilize manual therapy to reduce pain and improve motion for patients with neck pain. Examples of manual therapy may include a variety of techniques such as joint mobilizations for the neck and upper back, soft tissue mobilization for muscles and fascia around the neck, and instrument assisted soft tissue mobilization.
Therapeutic Exercise: Therapists routinely prescribe exercises in conjunction with manual therapy to reduce patient pain by improving flexibility and endurance of the muscles of the neck and upper body. Our therapists will prescribe specific stretching routines to address flexibility limitations based upon the findings of the initial evaluation. Strength and endurance exercises for the neck have also been found to decrease pain in patients with neck pain.
Ankle/Foot Pain:
Common conditions: Altered foot posture, Overuse syndromes: Plantar fasciitis, tendonitis, shin splints, etc. Post-surgical recovery from: fractures, bunion correction, ligament repair, etc. Recovery from a ligament sprain or muscle strain.
Both the foot and the ankle are composed of many different muscles, tendons and ligaments that perform various movements. When any of these become over-stretched, torn or tight, it can cause pain and/or other complications.
As we walk, the ankle and foot work together to transmit the impact of the ground up through our lower leg to the knee joint. The foot specifically works as our “mobile adaptor”; meaning, the position of our foot changes as we walk to adjust to the type of surface we are walking on and appropriately absorb the force of the ground. The ankle is a combination of hinge joint, serving to move the foot up and down, and a “complex” joint that moves in three different directions; allowing us to move our foot around in a circle.
Treatment for these conditions would likely include therapeutic exercise, manual therapy and potentially therapeutic ultrasound:
Therapeutic exercise would focus on restoring appropriate muscle strength, flexibility and balance responses to the foot and ankle.
Manual therapy can involve the therapist using their hands or small tools to stretch tight tissue, mobilize a joint to improve its range of motion, etc.
Therapeutic ultrasound is performed over a specific area of tissue that is either tight or irritated. When tissue is tight, ultrasound can be helpful in loosening the tissue to help it stretch and to allow the joint to move more freely. If tissue is irritated or inflamed, ultrasound can be helpful to reduce swelling and inflammation.
Claudia A Knight, Carrie R Rutledge, Michael E Cox, Martha Acosta, Susan J Hall; Effect of Superficial Heat, Deep Heat, and Active Exercise Warm-up on the Extensibility of the Plantar Flexors. 2016; 81 (6): 1206-1214. doi: 10.1093/ptj/81.6.1206
Parkinson’s Disease:
Overview: Parkinson’s Disease is a chronic progressive disorder occurring when the substantia nigra diminishes. The disease impacts the way patients move during functional activities such as walking and balance. While modern medicine does not offer a cure, physical therapy offers a fighting chance.
Please view the attached video of a person walking before & after treatment: http://s3.amazonaws.com/lsvt-global/videos/11711/lsvt_bigwalk_2.0.mp4
Treatment: Bradley Whiteside Rehabilitation offers a specialty program specifically designed for individuals with Parkinson’s Disease. We have 2 therapists certified in the LSVT BIG approach to treatment. The LSVT program consists of 16 sessions over a single month, each an hour in duration. From the LSVT BIG website: “This protocol was developed specifically to address the unique movement impairments for people with Parkinson disease. The protocol is both intensive and complex, with many repetitions of core movements that are used in daily living. This type of practice is necessary to optimize learning and carryover of your better movement into everyday life!”. With this approach, we aim to extend the health of a person with the disease.
Ebersbach, Georg, et al. “Comparing exercise in Parkinson’s disease—the Berlin BIG Study.”Movement disorders 12 (2010): 1902-1908.
Stroke:
Overview: The CDC reports approximately 4 million people experience a stroke each year. A stroke or cerebral vascular accident (CVA) occurs when the brain tissue is damaged from a lack of nutrients. Disruption of nutrients to the brain may result in CVA via a ischemic stroke or hemorrhagic stroke. Both types of strokes cause damage to the brain by interfering with nutrient delivery to vital brain tissue. An additional type of CVA, a “mini-stroke” or a transient ischemic attack (TIA) is a temporary loss of blood flow to brain tissue. The loss of nutrients to the brain may result in temporary or long lasting weakness, hemiparesis, and other effects of the CVA.
Treatment: Physical therapy focuses on optimizing processing power through the principle of neuroplasticity. The idea behind neuroplasticity is that the brain can adapt to perform tasks in novel ways. Therapy attempts to retrain pathways to re-learn tasks. Recovery is challenging but the key to recovery is repetition of goal-oriented, intentional tasks.
Pediatrics:
Children can experience a range of injuries and conditions that may require therapeutic services to overcome. Our licensed occupational and physical therapists specialize in treating pediatric clients in a fun, playful way in a customized room just for children. Family members play a key role in our team-based approach and are involved every step of the way.
Common conditions treated include: brachial plexus injuries, cerebral palsy, complications from cancer, developmental delays, fine and gross motor skills (including hand-writing), muscle/joint pain, NICU follow-up, orthopedic injuries, sensory integration, sports injuries, torticollis, and wheelchair/equipment needs. Autism, Down Syndrome, Sensory Processing Disorder, ADHD/ADD, Genetic Conditions
Torticollis is a fairly common condition that we treat. A baby with torticollis has tightness on one side of their neck that limits how far they can move their head. They may also experience flattening on one side of the back of their head because they prefer looking to one side and not the other. Physical therapy is proven helpful in treating this condition as we gently stretch the tight muscles, encourage better positioning of the neck and head, and perform specific activities to help the baby strengthen the muscles in their neck and be able to turn it in all directions. We partner with parents in treating this condition by providing exercises to do at home as well.
Carolyn Emery; The Determinants of Treatment Duration for Congenital Muscular Torticollis. 2016; 74 (10): 921-929. doi: 10.1093/ptj/74.10.921
Common Deficits Treated in Pediatric Occupational Therapy: sensory processing issues, fine motor development delay, handwriting problems, inability to complete self-care, poor motor planning, difficulty with play and socialization, visual motor delay, decreased attention span and inability to attend to tasks
Each child we see is unique. As occupational therapists, our role is to help these children become successful with their “occupations” or different roles in life. This will look different for each child and will include different areas of their life, such as play, self-care, school, and socialization. An example of this would be a child that is experiencing handwriting difficulties at school. This is more than likely linked to issues with visual motor skills and sensory processing difficulty with tactile sensations.
Therapeutic Activities: Visual motor integration skills are a combination of visual and fine motor skills that allow a child to complete tasks such as copying letters from the board or copying shapes. If a child is having difficulties with visual motor integration, the occupational therapist will construct creative activities for the child to complete in order to sharpen these skills. To the naked eye, these activities will appear as play, but they will be providing a just right challenge in order to help the child gain the skills they need to be successful in the classroom.
Sensory Integration Therapy: Children use their senses to interpret information and interact with the world around them. Sensory registration difficulties are present when there is trouble organizing sensations. If a child is experiencing proprioceptive problems, they are not able to accurately process where their body is in space. This may appear as clumsiness, being distracted, or awkward movements. They may also have difficulty knowing how much force to exert when completing tasks such as writing, which can contribute to illegible handwriting. In sensory integration therapy, the occupational therapist will construct activities that provide proprioceptive input to the joints in order to improve sensory registration. During sensory integration, the child is an active participant, so that they can control the input they are receiving to their tolerance. This may look like jumping, obstacle courses, crawling, and a variety of other playful activities.
Lymphadema
Lymphedema is a medical condition that results in swelling. Swelling can be caused for many reasons including: infections, injuries, venous insufficiency and cancer. It may be present in any area of your body, arms, legs, head, neck and trunk. If you have swelling that is causing problems such as sores that are hard to heal, or making it hard for you to move or walk, or use your arm, you may benefit from treatment. Studies have shown that this Physical Therapy treatment is the best, most cost effective way to treat swelling.
Most swelling can be treated with a gentle, effective, hands-on treatment called Complete Decongestive Therapy (CDT).
It is a combination of treatments that include:
A very gentle special type of massage is done called Manual Lymphatic Drainage (MLD) that reduces swelling and helps wounds to heal.
Compression Therapy – Specialized bandages are used to help decrease swelling. Once swelling is reduced, compression garments that are designed for the swollen area are used to help you keep your swelling under control.
Special Exercises are done to help decrease swelling.
Training is given to you on the importance of skin and nail care to help prevent serious infections and help wounds to heal. Training is also given to you to help keep swelling under control.
See your doctor first to make sure you don’t have a serious medical condition, then ask for a referral to Bradley Whiteside Rehabilitation for Lymphedema Therapy from Nationally Certified Lymphedema Therapist.
Bradley Whiteside Rehabilitation – Physical & Occupational Therapy 1225 Broadrick Drive, Dalton, GA 706.272.6199
