What Role Does a Functional Screen Play in Evaluation and Treatment?

There’s a lot of talk out there on whether functional screens are useful what they can and can’t be used for, or if they should be used at all. We are on both sides of the fence on this one. We do use a functional movement pattern screen here with the One80 System, but it’s probably very different than what you’ve seen in the past.

What We Don’t Use Screens For

We don’t use screens to establish a diagnosis, they don’t dictate our treatment. They don’t ever find the root cause of pain, so that’s why they can’t tell us what to treat and what not to treat. They also don’t tell us what to do. So we don’t run someone through a screen see that they can’t squat and just give them corrective exercises. We need to screen before and after every visit. This is what shows us functional gains. We are functional practitioners that want to get our patients back to normal function. We are not just trying to cover up symptoms. We should be able to run through our screen in about a minute to find out what we need to know and move on to the next thing.

What We Do Use Screens For

The screen is just the first tool in our evaluation process, it gives us a gross snapshot of what the patient can and cannot do. Screens pick up the missing pieces that the patient might not have explained to us either in their history or in their subjective. They might have other surgeries or problems that they forgot about that when we do the screen it brings those problems out. It leads to further evaluation because now we set the table for what we are going to look at next. It helps lead their home exercise program design. Because it’s based on function and what they can or can’t do after the visit, we can send them home with things that are appropriate. This is so when they come back we are not redoing all of their progress.

A Typical Screen

A screen will usually start with shoes off, so there’s no compensation. We don’t use tape or braces. During the quick assessment, we look for certain things to happen in certain points, such as quality of motion and patient feedback. Screens are pretty easy to get through, and we get a lot of information that gives us a great pre and post-assessment of what our patient can and can’t do.

If you are experiencing pain and would like to learn how One80 Physical Therapy® can help you get back in the game of life, call (970) 593-9300 today for a FREE CONSULTATION. Let us show you why One80 is the opposite of everything you’ve tried before.

Loading Injured Patients: Good or Bad?

The typical patient that we see at One80 Physical Therapy® already has some type of injury that they are coming in for rehabilitation. We do have patients that we see for tune-ups, most of which are athletes. However, the overwhelming majority of our patients are coming in with an injury: post-surgical or post-accident. Our patient age ranges from 9-year-olds, up to 80-90-year-old medicare patients. So the question is when should we, and can we load these patients?

What it Means to Load a Patient

With a typical patient, we want to load them because what we are trying to do is get muscles to contract normally in order to let them function normally. Loading a patient is going to increase all of the co-contraction. For example, if we’ve got somebody who has knee pain, and we put them under a 25-pound load with either a kettlebell or dumbbell and they ariel squat pain-free. This tells us that if we get more muscles to kick in and more muscles to contract and facilitate, their motion begins to get better and they function normally.

How to do it Safely

So the quick answer to that question is yes, we want to load every patient that comes in as much as we possibly can. Of course, if we have somebody coming in with weight-bearing precautions, obviously we are going to heed those precautions. We rarely ever give patients exercises in either supine prone or quadruped because that’s not functionally loading them as they would be during their sports, their work whatever their activities of daily living are. We want to simulate ADL and sports specific activity as much as we possibly can, and that’s really hard to do without loading somebody. Just because somebody has pain without load doesn’t mean we can’t load them. After we treat them, their pain should be lower, their range of motion should be higher and their strength and stability should be better. We always want to load our patients as much as we possibly can.

If you are experiencing pain and would like to learn how One80 Physical Therapy® can help you get back in the game of life, call (970) 593-9300 today for a FREE CONSULTATION. Let us show you why One80 is the opposite of everything you’ve tried before.

Three Biggest Keys to Patient Success

Patient success is the number one priority at One80 Physical Therapy®. But we tend to do things a little differently than other physical therapists. Our three biggest points for success are educating our patients, using a science-driven treatment strategy and focusing on function, not symptoms.

Patient Education

This is the first stepping stone. It sets the foundation for our patients. It lays out our thought process and explains why it is probably the opposite of what they’ve tried in the past. We want them to understand what we’re evaluating so that they know that we are not focusing on symptoms. Understanding the root cause of their problem is a very big key that most physical therapists, chiropractors, massage therapists completely miss. We also want our patients to understand what we are doing when we are treating them, and how the treatment is going to target the root cause. Patient education is huge in what we do.

Science vs. Symptoms

This is where we introduce our actual treatment. We want to make sure we are focusing on breaking down the science of it all, instead of getting stuck on things like pain, lack of range of motion, or swelling. If we treat symptoms we might get our patients to feel better for about an hour after they leave. But when they come back we are starting all over again, because covering up symptoms doesn’t get to the root cause. It also doesn’t take into consideration physiology, anatomy and biomechanics. We also want our patients to understand that everyone, no matter what their orthopedic diagnosis is is a neuro patient. And if we treat them neurologically, they get much better faster. They also stay better for longer, orthopedically.

Focus on Function

Our last key is focusing on function. This is where our home exercise programs come in. We want our patients to know that we are doing specific exercises for specific reasons. That starts with educating them on why we are not trying to correct the problem with exercise. Because exercise is a focus on function, it acts as the reinforcement of the actual treatment process. While the patient might be doing their home exercise program 4-5 times a day, it’s only going to take about 5 minutes to do and they probably don’t need any equipment. They’re going to feel the difference in function, not just symptoms when they get done.

If you think One80 Physical Therapy® might be a good fit for you or you want more information, visit our sign up page. If you are experiencing pain and would like to learn how One80 Physical Therapy® can help you get back in the game of life, call (970) 593-9300 today for a FREE CONSULTATION. Let us show you why the One80 System is the opposite of everything you’ve tried before.

6 Reasons Why Athletes Come to One80 Physical Therapy®

Being an athlete isn’t easy. Participating in intensive in-season programs, off-season programs, regular practice, specialty practice all on top of their actual competition, takes a toll on the body. While these activities are crucial for athletes to perform, they can also lead to issues that limit the ability to compete.

The doctors at One80 Physical Therapy® are dedicated to the prevention and treatment of sports-related injuries like tendonitis, fractures, dislocations, sprains/strains, hypermobility, overtraining syndromes and pain in general. On top of injury-related issues, these specialists can also help athletes improve their performance levels.

Some common sports injuries treated with the patent-pending One80 System® include:

ankle sprains                 ACL tears                      piriformis syndrome

plantar fasciitis                tennis elbow                 impingement syndrome

muscle strains               neck sprains                 pars fracture

knee instability              meniscus tears              shin splints

low back pain               impingement                patellar pain

Achilles tendinitis           rotator cuff tears            groin pulls

shoulder instability        spondylolisthesis          sciatica

Here are the top reasons athletes should be treated with the patent-pending One80 System®.

1. Customized Care:

The doctors at One80 give every patient an extensive functional evaluation to determine the root cause of their specific issue. During the course of treatment, patients are seen for one on one manual therapy treatments and progressed through customized reinforcement exercises.

2. Science-based thought process and treatment strategies:

Rather than relying on symptom modification gimmicks used by conventional PTs, chiropractors, massage therapist, etc., One80 attacks the cause of the symptoms. This unique thinking gets athletes quick and lasting results.

3. Performance maximization and injury prevention:

One80 Physical Therapy® provides athletes with maximized MoStreBility. This is the combination of motion, strength, and stability and is what increases performance levels while decreasing the risk of injury. Athletes are also given expert advice on how to prepare for practice and play to reduce the likelihood of re-injury.

4. Return to play

Our goal at One80 is to help you restore normal function and return to play as soon as possible. Because our System is able to restore normal nerve-muscle communication, our patients recover quickly, and rarely spend time on the sideline.

5. Non-Surgical Treatment:

When possible, the doctors at One80 try to avoid surgery in favor of non-invasive methods like manual therapy, neuromuscular re-education, exercise prescription and patient education. With this line of treatment, many athletes are able to either avoid surgery or put it off until after their season is over.

In the case that surgery is warranted, One80 Physical Therapy®  is able to refer athletes to the surgeon best suited for their condition.

6. Education

The best tool we can give a patient is the knowledge they need in order to understand why an injury occurred, what we did to solve the problem and what to do in order to prevent future issues. Because what we do at One80 Physical Therapy is the opposite of conventional thinking, patient education paramount.

One80 Physical Therapy® is the premier sports medicine facility in Northern Colorado. With our team of doctors, an in-house sports performance gym and elite strength and conditioning coaches, we are the source for athletes to get better faster and stay better longer. If you are an athlete who is limited by pain, or looking to avoid breakdown while increasing performance levels, and would like to learn how One80 Physical Therapy® can help you, call (970) 593-9300 today for a FREE CONSULTATION. Let us show you why One80 is the opposite of everything you’ve tried before.

If Stretching is Out, What is In?

Dr. Stewart McGill, possibly the most regarded expert of spine biomechanics, and professor at the University of Waterloo in Canada, has stated that “static stretching deadens the muscle from a neural perspective – diminishing the stretch reflex and reducing peak strength and power.“ He goes on to state that active warm-ups actually facilitate muscle contraction, and have a positive effect on muscle function. This line of thinking isn’t shocking to anyone who has followed studies published in the Journal of Strength and Conditioning Research, the Journal of Orthopedic and Sports Physical Therapy, Strength and Conditioning Journal, The New England Journal of Medicine, just to name a few, over the past 20 years. Those studies have shown stretching to decrease vertical jump eight, increase 40 yard dash time, decreased single leg stance stability, and have no benefit on decreasing injury rate. One study done by the US military showed that recruits who entered boot camp with the most flexibility for the most likely to get injured and not finished boot camp.

The question is, what should someone do with this information? First, it helps to understand what muscle is, what it does, and why it gets “tight.“

  • Muscle is a contractile tissue.
  • When it contracts, it either stabilizes a joint or causes motion at a joint.
  • When muscles provide stability (like the muscles in your neck or as you read this), there should be equal contraction on all sides of the joint. When muscle contracts to cause motion (like bending your elbow to put food in your mouth), one group of muscles contract concentrically as the opposing muscles contract eccentrically. Notice, none of the muscles RELAX. If the muscle on either side relaxed, or misfired, joint mechanics would suffer, performance would decrease, an injury (acute or chronic) could also occur.
  • Muscles get “tight“ when they don’t to give/receive a normal input with the nervous system. Nerves regulate muscle tension. If a muscle is in a shortened position, and doesn’t have normal regulation from nerve, it will contract and get “tight.“ Things like fatigue, swelling, dehydration, malnutrition, and stretching can cause the nerve/muscle relationship to be impaired.

Second, stop stretching, and know what to do instead.

  • Isometrics help to engage muscle and “reset“ the nervous system input. When you watch a dog or cat wake up and “stretch“, they’re actually doing isometrics to get their muscles firing. Isometrics are easy to do, just think of flexing muscle that feel weak or tight, just like when you wake up.
  • Use an active/dynamic warm-up prior to exercise. This could include a light jog, high knees, lunges, skips, push-ups, crunches, band or dumbbell work, etc. Anything that involves movement in and out of different positions would fall into this category.
  • What about post workout cool downs? Just re-do your warm-up routine.

The take-home message here is that movements that engage muscle will increase range of motion, maximize athletic ability and decrease the risk of injury. This is a much better option than increasing range of motion by forcing muscles to relax, become weak and no longer function normally. So, get moving and leave stretching behind.

Five Reasons Why Yoga is a Great Idea.

At least once a week we have a patient ask if yoga would be a good idea to help reinforce what we do with The One80 System. They always seem surprised when we would say, “you bet!“ Most people think that yoga is synonymous with stretching, and since we recommend patients avoid stretching, yoga must also be a no-no. It is important to understand that stretching is forcing a muscle to passively lengthen. On the other hand, yoga (we are talking more specifically about flow or power practices like Vinyasa, Hotha, Asthanga and Bikram) is great because it;

  1. requires muscles to contract globally – in order to stabilize the upper extremities during warrior pose, the trunk and lower extremity musculature has to be facilitated. This makes yoga a great total body functional workout.
  2. is a multi joint exercises done in weight-bearing anytime you can load and unload multiple joints simultaneously, you are reinforcing functional patterns.
  3. requires a-planer motion – moving through more than one plane at a time, with emphasis on the transverse plane, will help decrease future injury.
  4. requires the student to get in and out of end range of motion positions – this increases range of motion, builds strength and maximizes stability (review our blog post on MoStreBility), while decreasing flexibility. That means function is increased and the risk of injury is diminished.
  5. they are portable – at One80 we like prescribing home programs that can easily be done with minimal equipment, space and time involved. Yoga is great because you can do short versions of your practice while on vacation, during business trips, or on off days at home as a recovery work out.

As with any type of exercise, the effectiveness of your yoga practice will depend on your studio, instructor and motor control. With The One80 System, we can help you maximize the your stability, proprioception, strength and biomechanics. If you need advice on where to go to find a great studio and instructor, we can probably help with that too.

5 Reasons Why Dry Needling is… Something We Don’t Use at One80.

Many patients who are new to The One80 System have tried trigger point dry needling treatments with little to no success. Others ask why we don’t offer it. Here are 5 reasons that address both situations.

1. Experts don’t know what trigger point dry needling (TDN) treats.

PTs and chiropractors that use TDN claim to be treating “trigger points.” A common definition for a trigger point is, “a hard and/or tender part of a muscle where the fibers are balled together causing local or referred pain.” This is actually different than a “tight muscle” where the length of the muscle belly is shortened. The problem is, although the theory behind trigger points has existed since the 80’s, not even the “experts” have been able to tell exactly what they are, what causes them, or if they really exist. If they don’t exist, or if we can’t find or clearly define them, how and why are people sticking needles in them?

2. Nobody agrees on what it does.

Speculation runs rampant on what actually happens when needles are stuck into muscles. Hypotheses suggest that needling techniques; stimulate fibers, may activate inhibitory interneurons, causes opioid mediated pain suppression, activate inhibitory systems to block noxious stimulus, disperse the excessive ACh in the tissue to relax muscle fibers, enhances the release of ACh from nerve terminals, cause micro-trauma and bleeding/inflammation to help promote healing, results in increased ACh receptors at the neuromuscular junction, releases various chemicals at the motor end plate… Does that sound like a treatment strategy or a guessing game?

3. Research has shown little to no efficacy.

Although a Google search will uncover plenty of case studies and testimonials claiming miraculous results with TDN, published studies differ. A systematic review of the literature with meta-analysis published in Physiotherapy in 2017 concluded that, “There is very low evidence to support the use of TDN in the shoulder region for treating patients with upper extremity pain or dysfunction.”

4. Let’s pretend we knew trigger points existed, knew how to find them, knew exactly what they were, knew what caused them, and we also could prove at the physiological level that TDN decrease pain and cause muscles to relax… would masking pain and forcing muscle relaxation be good?

Remember, at One80 we NEVER mask pain (that is what tells us there is a problem somewhere) and we NEVER force muscles to relax (because muscle can’t function normally when forced to relax). So, even if TDN did what clinicians claim it does, it would not address or reverse the root cause of your problem.

5. If the entire TDN thing is bogus, why does every PT clinic other than One80 do it? It all comes down to the equation TDN = $$$. Here is a line from a blog written by a clinician who works for one of the biggest providers in the TDN continuing education realm. “…while there is a paucity of evidence, TDN probably works in some instances-likely more to “meaning effect” and placebo than anything else, which of course is fine…” That’s right, even the experts in the TDN world know its nothing more than placebo. But, if PTs want to shell out thousands of dollars to learn it, and referring physicians want patients to get it, and patients will pay for it, does it really matter that patients don’t know any better? We think it does, and that’s why we don’t offer it.

Learn more about The One80 System, why it works, and how it is different, and earn FREE CEUs at http://promo.theone80system.com/videoseries

Taping Away the Pain, A Sticky Issue

Therapeutic tape has a long history in the world of physical therapy. In the 80’s and 90’s it was more commonly called McConnell tape. This tape was popular in the treatment of painful joints that were deemed weak and unstable, mostly knees and shoulders. The downfall of McConnell tape was two fold. First, it was proven bogus by many studies that showed that bones (patellas, scapulas, vertebra, etc.) could not be moved or held in place by tape. Second, and somehow more significant, it was uncomfortable, ugly and lacked a catchy name.

Fast forward to the marketing savvy 21st century, and tape is back! But, this time, its biggest limiting factors have been remedied. Now tape is colorful, comfortable and has cool names like “kinesio tape”, “rock tape” and “spider tape”. Along with the new look, the new tape now claims to improve performance, decrease swelling, remove lymph, reduce injury, and even re-educate nerves. As for any clinical proof for the old and new claims, that remains to be seen. But, who needs that when Olympic and professional athletes use it?

So what does tape really do and why to physical therapists, athletic trainers, chiropractors, physicians and coaches deem it so useful? To answer the first question, tape, especially when applied in a manor that wrinkles or pulls on skin, stimulates proprioceptors. These microscopic mechanisms include Merkel’s disks, Meissner’s corpuscles, Pacinian corpuscles and Ruffini endings. When these receptors are stimulated by tape (or braces, wraps, tights and/or sleeves), they override the pain response so you feel the tactile stimulus instead. As for the reason why it is used by health care professionals, it is a combination of falling for the latest trend, focusing treatment on pain relief instead of function, and marketing.

Unfortunately for patients, there have been many gimmicks over the recent years (tape, needling, shoe inserts, lotions, machines, etc.) that the medical “experts” have allowed to take over their practices. If all you want is symptom modification, don’t waste your time at physical therapy or the chiropractor. You can buy kinesio tape, braces, lotions, shoe inserts and many other gimmicks at your local sporting goods or grocery store. If you really want to recover from an injury, or prevent one, find an expert that identify and treat the root cause of your symptoms, rather than just cover them up.

Why MoStreBility Beats Flexibility and Mobility.

Over the past several years, the term “mobility” has become very popular in the exercise community. When it comes to pre-exercise warm-ups, the new and cool “mobility work” (based on foam rolling), has even come to rival the old-school standard of stretching. Although one term his hip, and the other is an old standard, they both shoot for the same results, more joint motion caused by less muscle contraction. Let’s take a look at the definitions of terms that mobility is based on, stretching, flexibility and mobility.

  • Stretching – according to one of the biggest publishers of human performance books, “The goal of a static stretching is to overcome the stretch reflex in order to coax a joint into a wider range of motion.”
  • Flexibility – defined by Gummerson as “the absolute range of movement in a joint or series of joints that is attainable in a momentary effort with the help of a partner or piece of equipment.”
  • Mobility – the ability to move or be moved freely and easily.

What should set off alarms to anyone in the medical and/or human performance field when reading the above is the use of the phrases “overcome the stretch reflex,” “coax a joint into a wider range of motion,” “absolute range of movement,” “with the help of a partner or piece of equipment,” and “moved freely and passively.”

As a professional that helps patients recover from and avoid injury, I understand that all joint movement should be a byproduct of normal neuromuscular facilitation, muscle should be reactive and resist external forces, the stretch reflex is a healthy protective mechanism, absolute range of motion should be dictated by joint stability and strength, forcing muscles to give into external forces provided by partners or equipment is dangerous, and joints that move freely and easily eventually break down.

Because they conventional medical model continues to follow the mantras above, The One80 System has developed a unique alternative,

Motion + Strength + Stability = MoStreBility.

See if the following sounds like a healthier and wiser replacement for flexability and mobility;

  • Motion – a change in position of an object over a period of time.
  • Strength – inherit capacity to manifest energy, to endure, and to resist.
  • Stability – the strength to stand or endure, a condition of equilibrium or study motion, to develop forces or moments that restore original condition.

When we combine these, we get to controlled motion over a period of time, while resisting external forces, storing of energy, and the ability to endure an event or restore the original condition. That is why MoStreBility is more effective and safer than flexibility and mobility, and is always the goal of The One80 System.