This study conducted at The Advanced Injury Treatment Center was just published in the peer reviewed Journal of Manipulative Physiological Therapeutics.  I would like to thank the above co-authors for all the help.  I couldn’t have done it without them.

ABSTRACT
Objective: The purpose of this prospective case series was to describe the outcome of a set of patients with plantar
fasciitis treated with Graston Instrument Soft Tissue Mobilization techniques (GT) and a home stretching program.
Methods: Ten patients with a primary report of plantar heel pain completed self-report questionnaires including the
Global Rating of Change Scale (GRC), the Numeric Pain Rating Scale, and the Lower Extremity Functional Scale.
Patients were treated with GT directed to the triceps surae, soleus, plantar fascia, and medial calcaneal tubercle.
Participants received a maximum of 8 treatments over a time frame ranging from 3 to 8 weeks at a frequency of 1 to 2
sessions per week. Each patient was instructed to perform the stretching program at home 3 times daily. Patients
completed all outcome measures at baseline, sixth visit (GRC), and at discharge or the eighth visit. The number of
successful outcomes on the GRC was examined using a binomial test. Dependent t tests were used to examine if a
significant difference existed in secondary outcome measures of pain and function.
Results: The subjects had a mean duration of symptoms of 32.4 weeks (SD, 31.1). Patients were treated for
an average of 6.9 visits (SD, 1.3). There was a statistically significant difference between the number of patients
who did and did not achieve a successful outcome (P = .047). There was also a significant improvement
from baseline to follow-up for the Numeric Pain Rating Scale (P = .002) and Lower Extremity Functional
Scale (P = .017).
Conclusions: The group of patients selected for this case series who were treated with GT and home stretching
experienced clinically meaningful improvement. (J Manipulative Physiol Ther 2011;34:138-142)
Key Indexing Terms: Plantar Fasciitis; Physical Therapy; Pain
Heel

In order to understand the benefit of strength training for the distance runner you must recognize the physiological demands that running places on the body. Unlike most sports, which require strength, speed, and power to be successful, distance running is primarily limited by the delivery and use of oxygen. This then brings us to the question: “Does strength training actually help increase endurance?” Currently there are no studies showing that strength training actually increases oxygen delivery from lungs to muscles. However, the way that strength training can make you faster is by improving your running economy. This means by increasing your muscular strength you will also increase your muscular power, which is the product of force (strength) and speed. The key to a runner’s strength training is to get his/her muscles to increase their rate of force production so that they can have stronger muscle contractions in a shorter time.

Current research supports that power training and plyometric exercises are most effective for enhancing economy and endurance performance by increasing muscle power production. This means that runners should be strength training like football players. Heavy weight training focuses on the strength component of power, and plyometrics training focuses on the speed component. The result is you will be stronger, quicker, and more powerful, translating into better running economy.

The bottom line is, if you have already increased your running volume and intensity as much as you can, or cannot handle the physical stress of more miles, strength training and plyometrics can help get you to that next level. If you are planning on adding strength training to your program, be sure to focus on high-intensity, low-repetition exercises. Examples include squats, hamstring curls, calf raises, power cleans, and dead lifts. Also, use specific periods of the year to focus on endurance training or strength, speed, and power.

The Advanced Injury Treatment Center in Bedford, NH specializes in the diagnosis and treatment of soft tissue injuries. We are also certified strength and conditioning specialists (CSCS). We utilize techniques such as Active Release Technique, considered to be the gold standard of soft tissue management systems, as well as Graston Technique, to break up scar tissue and enhance your recovery time from an injury. Advanced Injury Treatment Center can also assist in strength and conditioning program design, based on the needs and demands of your specific sport.

The weight of the pack and its contents should not exceed 10% of the child’s body weight.  Excessive weight causes the child to compensate their posture to carry the load.  This creates increased mechanical stress on the spine which can lead to muscle spasm, disc compression, joint irritation and ultimately pain.  Some studies have also shown that as little as 20% of body weight can begin to cause changes in a child’s breathing.  If the weight of your child’s pack cannot be reduced to a safe range than you should strongly consider a pack with waist belt.

Second to the actual weight is proper wear and fit of the pack.  Slinging a pack over one shoulder completely defeats the purpose of an ergonomically designed backpack.  The shoulder straps should be tightened so that the pack is snug to the child’s back as this will help evenly distribute the load and keep the contents from shifting.  Also, always place the heaviest items in the pack closest to the child’s back and lighter ones on the outside.  

If your child is still experiencing pain or discomfort after making these changes than they should be evaluated to rule out an underlying spinal disorder.  The Advanced Injury Treatment Center in Bedford, NH specializes in the diagnosis and conservative treatment of back and neck pain.

Traditional treatments include steroid injections, NSAIDs, and physical therapy modalities such as ultrasound and iontophoresis revolve around reducing inflammation. Is it no surprise that these treatments generally don’t work? You are being treated for something that doesn’t exist! So the question is how we get blood supply to this area that is now fibrotic “scar tissue” and start the process of healing. The answer to this question is Graston Technique combined with eccentric exercises. Graston Technique is a highly affective soft tissue treatment which utilizes stainless steel tools to break up scar tissue. It works on a tendonosis by initiating inflammation and therefore stimulating the healing process. Eccentric exercises focus on the lowering end of the movement or “negative” to load the tissue and aid in proper remodeling of the tissue. These two treatments combined makes for highly successful treatment outcomes with time and do diligence.

The Advanced Injury Treatment Center is the only clinic in the Southern NH area offering this form treatment. If you are currently in treatment and getting limited results, or waiting for the pain to just go away, call us and set up an appointment. Our mission is to provide the highest quality of care and get you back to activities you enjoy in the shortest time possible!

The shoulder is one of the most complicated joints in the human body and this unfortunately makes it very prone to injury during resistance training. Some basic background of anatomy, physiology, and biomechanics of the region can go a long way in preventing injuries. This knowledge will help you understand the “Risk/Reward” ratio that is inherent in all forms of exercise. By this I mean that we want to place a specific and controlled stress on targeted tissues while minimizing excessive strain on other areas. I find that too often certain exercises are performed which greatly increase risk of injury when safer alternatives are available.

So what is a rotator cuff anyway? Many people envision it as an actual cuff of ligaments but it is 4 small muscles that stabilize the shoulder joint. The supraspinatus, infraspinatus, teres minor, and subscapularis lie deep to the much larger deltoid. Imbalance of the primary movers (pec/deltoid) and underlying stabilizers (rotator cuff) ultimately leads to impingement syndrome, anterior instability, and tendinopathy of the rotator cuff muscles.

What you can do
- Never perform lat pull-downs behind the neck!!
- Work rotator cuff/scapular stabilizers at least once a week
- Limit range of motion with chest press and fly
- Maintain proper posture and scapular retraction with upper body exercises
- Posterior capsule and chest stretches
- Consider alternatives for exercises that put shoulder at high risk

HIGH-RISK EXERCISE ALTERNATIVE
Upright Row Reverse Fly, Shrugs, Cable Pull (D2)
Close-Grip Straight Bar Bench Dumbbell Bench
Military Press High-Incline Dumbbell Press
Dips Any Tricep Exercise
Front Raise Thumb-Up Front Raise

Just following a few of these suggestions can go a long way in preventing unnecessary shoulder injuries. However, if you do find yourself experiencing shoulder pain then I strongly recommend an evaluation with an AITC health care professional located in Bedford, NH. We can properly diagnose your problem and then make appropriate treatment/rehab suggestions to get you back in action.

Scar tissue forms mostly in muscles, tendons, ligaments, fascia and joints. These dead fibrotic tissues can also be called adhesions. Scar tissue is formed from sustained muscle contraction (posture), repeated contraction (repetitive motion), a traumatic event (muscle strain) or secondary to surgical procedures. All of these mechanisms reduce blood flow to the tissue resulting in “hypoxia” or lack of oxygen. The body produces free radicals secondary to hypoxia which results in the production of tough, dense scar tissue in the affected area. This scar tissue binds up and ties down tissues that need to move freely. As scar tissue builds up, muscles become shorter and weaker, tension on tendons can cause tendonitis, and nerves can become trapped. This can cause reduced range of motion, loss of strength, and ultimately pain. If a nerve is trapped by this fibrotic tissue you may also feel tingling, numbness, and weakness.

So the question is what to do about scar tissue. There are two treatment approaches that are highly effective in the reduction of scar tissue. The first is a manual approach called “Active Release Technique”. I have found ART to be extremely effective especially with deeper structures. ART uses active motion with sustained pressure to break up scar tissue. The second approach is instrument assisted soft tissue mobilization such as Sound Assisted or Graston Technique. These techniques utilize specifically designed tools which are often easier on the therapist and can be more effective on superficial structures.

The Advanced Injury Treatment Center in Bedford NH is the only clinic in the greater Manchester area that utilizes both of these highly effective treatment techniques. If you have had limited success in the past or are currently in treatment and not progressing, we can help. You no longer have to “just live it.”

The fact that NSAIDS actually delay and hamper the healing of all soft tissues including muscle, ligaments, tendons, and cartilage is overwhelming supported in numerous studies. In one study on muscle strains, a popular NSAID essentially wiped the entire inflammatory proliferative phase of healing (days 0-4). At day two there were essentially no macrophages (cells that clean up the area) in the area and by day four after a muscle strain, there was very little regeneration as compared to the normal healing process. The muscle strength at this time was about 40 percent of normal. Another study confirmed that at day 28 after an injury the muscle regeneration was still delayed.

The key question regarding the healing of sports injuries is what therapy speeds up the healing time by increasing fibroblastic cells (cells that lay down new tissue). The current literature supports a treatment called Graston Technique. Graston Technique is a treatment used to break down scar tissue and initiate healing by increasing fibroblastic proliferation. I have personally seen some amazing outcomes with even in the toughest of cases such as a chronic tendonosis. There are five certified practitioners in state of NH, two of which work out of The Advanced Injury Treatment Center in Bedford, NH. I personally have been using this technique for approximately 6 years and find it to be incredibly effective for resolving soft tissue dysfunction.

I hope this blog sheds some light on what not to do when you suffer an injury. Remember the next time that you go for the bottle of Advil that it will ultimately slow down the healing process and delay your return to activity. I would also recommend being evaluated by a healthcare professional if symptoms persist. Our goal at the Advanced Injury Treatment Center is to get you back to activity in the shortest amount of and enjoying the lifestyle you deserve!

There are two main types of hamstring injuries, and each affects a different part of the hamstring group. The injury I most often see in my clinic is a strain that occurs at the tendinous insertion on the ischial tuberosity at the pelvis. This commonly occurs in tri-athletes, and marathon runners who will complain of pain in the lower buttock region that increases with sitting and when the injured leg strikes the ground. The second type is more in younger athletes is caused by a sudden motion, such as an explosive sprint, jump, or a kick. In this type of injury, the strain occurs at the muscular portion of the hamstring, resulting in pain, swelling, and bruising in the middle of the back of the thigh.

An understanding of the biomechanics of running makes it easier to understand how these injuries occur and how to prevent them. There are two phases of running: the stance phase and the swing phase. The stance phase consists of foot strike, mid stance, and toe off; and the swing phase consists of follow through, hip flexion and leg descent. During the eccentric contraction, muscle fibers will slowly elongate to slow down a particular motion, while a concentric involves shortening of the muscle fibers to lift an object or move a limb in a particular direction. During leg descent and foot strike, the pelvis flexes forward and the leg extends, the hamstring muscles are eccentrically contacted to slow both of these particular movements. When the eccentric load exceeds the strength of the muscle fibers, tearing of the hamstring fibers occurs, resulting in a strain injury.

The Advanced Injury Treatment Center utilizes a comprehensive treatment approach to hamstring injuries. Deep tissue procedures including Active Release technique and Graston Technique are used to free up soft tissue motion of the hamstrings and surrounding musculature. Implementation of proper strength and flexibility training of the hamstring musculature and the nearby muscles surrounding the pelvis and thigh will reduce the risk of injury. Focus on strengthening the abdominal and gluteus maximus musculature is important in the prevention of a hamstring strain because these muscles aid the hamstrings in decelerating flexion of the pelvis during heel strike. Flexibility of the hip flexors and low back musculature is also important in the prevention of a hamstring strain injury. Tight hip flexors and low back musculature causes excessive flexion of the pelvis during foot strike placing increasing strain on the hamstrings. Tightness in these muscles also inhibits strengthening of the gluteus maximus and abdominal musculature. Advice on how to progress training runs more appropriately also aids in reducing the risk of injury.

This line of thinking has become the standard for how most people deal with chronic injury or chronic pain.  Avoidance therapy is certainly an easy answer when a person is in pain, but experience has shown that it’s never too late to do something about chronic injury or pain.

Most times, the avoidance of an activity will cause the area in question to weaken over the course of time mainly because of disuse.  This can complicate the issue because now the person loses some of the range of motion, stability and ultimately the strength of that area.  Rather than avoiding the activity, a person should try to work around the injury by working with the right professional and either modifying the movement or performing a series of pre and post activity exercises to “warm-up” the area before activity.

In addition, there are many soft-tissue techniques that can help kick start the healing process in an area by increasing local blood flow, breaking down old scar-tissue and stimulate the growth of new, more pliable and stretchy connective tissue.  One technique that has been proven effective in treating chronic injury is Graston Technique (GT).  GT is an advanced soft-tissue mobilization therapy which relies on the use of 6 stainless steel instruments to effectively break down scar tissue and stimulate the healing process in an area.

This technique has revolutionized the way chronic injuries are now treated.  Recently I had a patient come into the office with an 8 year history of frozen shoulder, or adhesive capsulitis.  After 11 sessions of GT, the patient had gained 80% of her range of motion and had full strength which allowed her to play tennis again for the first time in 8 years!!

So it’s never too late to deal with chronic injury.  For more information about GT, please visit their website and see a short slideshow that illustrates how this technique can help get you moving the way you were designed to move.

GT: www.grastontechnique.com