Now more than ever consumers have to make educated decisions and be their own advocate when it comes to choosing their healthcare provider. If you need services such as physical therapy or chiropractic care and you haven’t done your homework, you could end up spending both time and money you don’t need to. In these tough times when many are struggling financially, patients should seek out care that is both effective and efficient. What many don’t realize is that there are vast differences in treatment approaches amongst different providers which can make all the difference in treatment length and cost of care when it comes to successful resolution of your injury or ailment. You can’t assume that just because providers have the same degree or initials after their name that they are using the same techniques or following the same protocols. This is a very important distinction.

Here are some tips for choosing your healthcare provider:

1. Ask friends and family. There is nothing better than good testimonials from others when making your decision.

2. Check the clinic websites. The website should provide you with the backgrounds of each provider as well as the clinic’s treatment approach.

3. Interview the provider. I am speaking to folks by phone and responding to e-mails prior to seeing them in my office. This is a great way for patients to get preliminary questions answered and get a feel for the provider. If the provider is not willing to do this, I would be concerned.

We at the Advanced Injury Treatment Center located in Bedford, NH (www.aitcnh.com) strive to separate ourselves by providing by the highest level of care in manual medicine and rehabilitation. Our mission is to restore the highest level of function in the shortest period of time saving you both time and money. The treatment is always one-on-one and with the same provider to optimize continuity in care. We are a small, privately-owned clinic whose success is largely based on satisfied patient to patient referrals.

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.

At the Advanced Injury Treatment Center in Bedford, NH, we evaluate all contributing factors to a patient’s back pain.  That may entail excessive hamstring tightness, poor foot mechanics, or weak gluteal muscles to name a few.  Long-term relief of back pain requires a treatment plan that addresses all of an individual patient’s biomechanical faults.  Treatment may consist of Graston Technique or Active Release Technique to lengthen chronically tight soft-tissue, joint manipulation to restore joint mobility, and exercise prescriptions to strengthen weak/inhibited muscles.  Low back pain can be resolved but it takes a thorough treatment plan and a motivated patient.  Like I tell every patient, “if I see you back here in 3 months with the same symptoms, what have we really accomplished?”

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.

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.

First of all, the condition of tennis elbow is also called lateral epicondylitis which is an inflammation of the common extensor tendon that attaches to the outer part of the elbow (lateral epicondyle).  This condition can happen as a result of a macrotrauma or microtrauma.  Most patients fall under the 2nd category which is another way of saying it’s a repetitive stress injury or RSI.  RSI’s usually develop as a result of performing a repeated action to an area that may not be conditioned well enough to handle the load or stress from that repeated action.

In mild cases of tennis elbow, patients will usually be able to experience relief of symptoms with rest, ice, compression and support through either a brace or elbow wrap.  However, most patients will often develop an increase in symptoms that may be present even when they are not playing tennis.  Perhaps they notice difficulties with activities of daily living like brushing their teeth, or reaching into the refrigerator for milk or even shaking a person’s hand! It’s during these situations where it is important to look at the big picture on what CAUSES tennis elbow.

If the inflammation of the extensor tendon (forearm extensor muscles) is the problem, then what causes that tendon to become inflammed in the first place?  The answer usually requires a fair amount of detective work to figure out what the greatest contributor may be to cause the inflammation in the first place.  For example, the overload on that tendon may be coming from a weakness in the area, a lack of flexibility, joint space compromise (bone spurs, worn cartilage), rotator cuff or shoulder muscle imbalance and not mention the racquet and technique component.  Things like improper grip size, racquet weight, racquet balance,racquet head size,  string type, string tension AND swing technique can also play a major role in the complexity of tennis elbow.  Of course, we can’t forget the biochemical component as well.  Lack of proper hydration and a poor diet can also affect the healing rate of the tendon as well as how the inflammatory cycle is regulated for that person.  Diet can determine whether or not chemical reactions in the body are happening at an excessive rate or not happening at all.

Therefore, it is important to look at tennis elbow in three ways – the physical component, the equipment component and the biochemical component.  The greatest results in managing this condition will usually come when all three areas are investigated and treated for optimal results.  For example, someone with tennis elbow may not experience full relief unless they properly stretch and strengthen their elbow and shoulder – modify their equipment and stroke to improve the efficiency of movement and reduce the likelihood of improper elbow loading – and tweak their diet to properly hydrate their body and fuel their muscles with protein to control the inflammatory cycle.  Only then will a person reach their best results.

Often times, a person dealing with tennis elbow may feel like they will never be able to play the sport they love because of the chronic nature of this condition.  However, it’s never too late to have your elbow, equipment and nutrition assessed by the proper professionals to see if perhaps previously attempted treatments failed because the treatment only focused on the physical aspect only.  Personally, I have treated hundreds of elbow complaints and I always reach the best results once we properly manage all three components.

So, the next time you feel that twinge or ache in your elbow after a few sets of tennis – think about what you can do to improve the three areas we mentioned above.  Then think about how much fun the sport of tennis could be if you never had to worry about whether or not your elbow was going to “act up” on you.  The game of tennis gives you plenty to think about without you having to worry about elbow pain.  Stop living with the pain and visit your local tennis professional and local sports injury clinic like Advanced Injury Treatment Center to help you get back to the court quickly and without that nagging pain in your arm.