Welcome to Health News

December 13, 2010 – 11:00 AM

Ed Deboo, PT, along with two other Bellingham Physical Therapists were profiled in the “Northwest Health” magazine.

“Ed Deboo, PT, doesn’t want to fix people. He wants them to fix themselves. ‘I don’t want you to come in and watch you ride my bike,’ he says.‘I help to facilitate the healing process and remove roadblocks, but you own your own health.’

To read the entire article and view the pictures, please click here to download the NW Health PDF

What’s new in the literature?

I will often come across an article that I think my patients would be interested in. I have included a short summary and then cited the source if someone was interested in the entire article. Enjoy!

By IPTS | Posted in General | Comments (0)

Come and support Elizabeth at the “Wine, Women, & Song” benefit

November 4, 2011 – 5:48 PM

As many of you already know, my beautiful wife is multi-talented: not only is she an incredible Physical Therapist, but she also has an amazing voice.  She belongs to a local woman’s choir, Bellingham Sings,  and they are having a fundraiser on November 17th at the Lairmont Manor.  Additional details below:

THURSDAY, NOVEMBER 17, 2011 @ 7:00-9:00pm
Wine, Women & Song
Bellingham Sings Fundraiser at Lairmont Manor

Mark your calendars for the return of Wine, Women & Song, our popular, musical, fundraiser hosted at Bellingham’s elegant Lairmont Manor. From 7:00-9:00pm, you will enjoy an assortment of fine wine, delectable sweet and savory, after-dinner snacks, wonderful company, and loads of fantastic music performed by Whatcom Sound Jazz Singers, and Allegra Women’s Choir, in this beautifully, intimate setting. Please join us!

7:00 – 9:00pm
Lairmont Manor, 405 Fieldston Road, Bellingham, WA –

Tickets: $20, available at the door, from any singer, or by phoning 360-676-1024.

Elizabeth has graciously volunteered my services to help service the wine so I hope to many of you there!

Cheers,

Ed

 

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Emerging controversy in spine surgery research

August 7, 2011 – 10:55 AM

Imaging this scenario:  You’ve been suffering from chronic back pain for many months and you’ve tried multiple therapies, injections, medications, etc to no avail.  The next step is to go and consult with the neurosurgeon who recommends a fusion of the vertebral segments that they determine are the source of your pain.  They outline all the risks, chances of improvements, and potential time of rehabilitation.   After much deliberation, you decide to have the fusion surgery.  Back in the day when you had a spinal fusion, the bone used to fuse the vertebrae together was actually harvested from the patients own iliac crest (hip bones). 

Now, this is where the fun begins. Medtronics, the words largest manufacturer of medial devices, developed a bone morphogenetic protein, BMP-2, that has since become the standard of care.  Back in August of 2010,  John Fauber, of the  Milwaukee Journal reported that  ”in 2002 the FDA approved a product that many thought would revolutionize spinal surgery — recombinant human bone morphogenetic protein-2, or BMP-2, which could almost magically create bone where none existed”.  This eliminated the need for harvesting bone from the patients own iliac crest, thereby reducing complications and expediting recovery.  Great, winners all the way around….not quite so fast…

When Medtronics produced RCT (random controlled trials) demonstrating the superiority of their product over the old way of harvesting bone, there were many problems that were over looked at the time:

  • 9 of the physicians that were involved in the research studies had financial stakes in the company, creating an obvious conflict of interest.
  • The company sponsored research exaggerated the negative effects of the previously used methods of harvesting bone from the patients iliac crest while at the same time downplayed and under reported the complications from their product, BMP-2.

Many surgeons, not aware of the flawed research procedures, began using MMP-2 on a regular basis, to the tune of 500,000 fusion procedures alone in the US.  The result is that many tens of thousands of patients may have suffered adverse effects from surgeons unknowingly using BMP-2. According the the Back Letter, Vol 26, No.8, August 2011,  “Complications can include back and leg pain, disc space collapse, infections, and retrograde ejaculations and associated infertility-as well as implant displacement, catastrophic airway problems, cancer, and perhaps even death”.

So where does the field of spine research go from here to prevent something like this from happening again?  The US Senate has launched an investigation in to how research is conducted and are patients given the full picture before they consent to a procedure. 

The bottom line is that a system needs to be adopted to produce unbiased, scientific research that can safely help the millions of people with chronic back pain.  

Ed Deboo, Physical Therapist,  Bellingham, Washington

By IPTS | Posted in Spine Health | Tagged , , , , | Comments (0)

Relationship between Carpal Tunnel Syndrome and neck range of motion

May 26, 2011 – 1:37 PM

Carpal Tunnel Syndrome (CTS) is a painful condition of your arm that is mainly characterized by a variety of symptoms in your hand, including numbness, tingling, loss of grip strength, and pain at night.  The “carpals” are the bones in your hand and they form an arch or tunnel that houses many structures, including the median nerve.  It is believed that the median nerve is “compressed” within this tunnel, resulting in the aforementioned signs and symptoms.  Common treatment includes local stretching and nerve glide exercises directed mainly at the carpal region and, if that is unsuccessful, then a surgical “release” of the retinaculum is performed with variable success. 

As a manual structural therapist, I have always had a  different take on carpal tunnel syndrome.  First, let’s talk about the make up of the median nerve:  the median nerve is made up of nerve roots that exit the spinal column at the levels of C5-T1 that pass just under the clavicle and then travel down the arm (see picture below, courtesy of Grant’s Anatomy).   You can see the thick, canvas like tissue at the wrist.  This is what is “released” in surgery.

Since the median nerve roots come out of the middle and lower neck, it makes good sense to first look at the mobility of the cervical spine to determine if there is any segmental vertebral joint restrictions that may be playing a role in the arm symptoms.  I just read a research article from some Physiotherapists in Spain that give this treatment approach some scientific credibility.  To summarize the article:

71 women with diagnosed CTS had their cervical (neck) range of motion tested to see if they also demonstrated restrictions proximally (the area that the median nerve is formed from).

Conclusion:  Women with mild to severe CTS all exhibited less cervical spine range of motion compared to women of the same age without CTS.

My take home message is this:  if you have CTS and are being treated, make sure your practitioner is also addressing your cervical spine, clavicle, and explaining the role of the neck in your hand symptoms.  Good luck!

Ed Deboo, Physical Therapist

Bellingham, Washington

Nerve: median nerve
Diagram from Gray’s anatomy

 

 
   
   
   
 
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Finally, some good news for those with Fibromyalgia:walking works!

May 19, 2011 – 10:12 PM

Many of my Fibromyalgia patients have multiple complaints of musculoskeletal pain, especially back and neck pain, that can make even routine daily activities seem daunting.  I just read an encouraging article by a group of Swedish researchers who found that high intensity Nordic walking for 20 minutes twice a week “significantly boosted function without any exacerbation of pain”.  The only difference between Nordic walking and “regular” walking is the use of walking sticks/hiking poles.  When you use walking sticks to ambulate, you tend to take longer strides, use less energy, and involve your upper body more.

Summary of the study:  67 women diagnosed with Fibromyalgia where placed in to two groups:

Group 1:  low intensity walking without walking sticks only once a week for 20 minutes.

Group 2:  Nordic walking (used two walking sticks/hiking poles).  This group started each session with low intensity walking followed by a series of 2 minute intervals of higher intensity walking including both flat and hilly surfaces for a total of 20 minutes 2 times per week.

According to the researchers “after 15 weeks, the women in the Nordic walking group experienced improved function, decreased activity   limitation, and improvements in fatigue levels compared with the control group”.

This is promising on many levels.  You have often heard me preach the importance of daily exercise and walking is something that we can all do, anywhere we are at, without the use of expensive gear or equipement. A quick search for hiking poles on Amazon.com showed multiple pairs for about $25, not a big investment. 

 The results of this study are preliminary and we cannot make vast, sweeping judgements.  However,  I will be recommending this program to my Fibromyalgia patients as an alternative to steady state walking to get them to exercise and hopefully improve their quality of life. Good luck!

Ed Deboo, PT,

 Bellingham, Washington

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Changing attitudes towards the treatment of osteoarthritis

April 14, 2011 – 2:10 PM

A fellow basketball player friend of mine originally hurt his back and hip  in high school, about 25 years ago.  He was playing 2-3 times per week, but I hadn’t seen him in awhile until I ran into him at a social function.   Well, over the years his lower back and hip has progressively become more painful and he’s been unable to play basketball. Subsequently his weight has ballooned, his attitude had gone south, and to top it off, he now has high blood pressure.  So off he goes to the orthopedic specialist who takes an x-ray and promptly tells him that he has the hip of a 65 year old (no offense to those 65 year olds reading this), he needs to stop playing basketball because it will cause further arthritis, take an anti-inflammatory, and start a walking program for exercise.  No mention of any physical therapy, acupuncture, massage, or water therapy program and, more importantly, no hope of returning to basketball.

He asked me what I thought and my first question to him was whether or not he still enjoyed playing basketball.  His response was a resounding “yes, I love playing but I’m afraid I’ll never be able to play again”.  In response to his Eyore like answer, I gave him my suggestions:

1. Get your hip and back looked at by someone who will do a comprehensive bio-mechanical analysis of his gait and running technique, not just give you hip stretches that you can find on the internet. (FYI: upon evaluation, we found that his ankle on the opposite side of his painful hip was severely restricted, placing more stress on the opposite hip with running, jumping, etc)

2. Tell yourself everyday in the mirror that you will return to basketball, you must believe it.

3. Until you can do it on land, take up deep water running to keep the movement strong without the gravitational impact.

4. Get some body work done either by your Physical Therapist, massage therapist, or local Rolfer.  In addition, try a course of acupuncture.

5.  Start a strengthening program with body weight resistance and free weights, no machines.

6. Lose weight, no excuses, just do it.

7. Try Glucosamine/Chondroiton for 6 weeks

The results?  He’s had to limit the number of days in a week that he can play, but he’s BACK, doing something he loves, how great is that?

Sobering stats:

  • According the the American Arthritis Foundation, 27  million Americans have osteoarthritis that effects their quality of life. 
  • 632,000 joint replacements are performed each year in the US.
  • obesity is one of the main culprits of advancing osteoarthritis.

The mainstream medical community is finally understanding that the best thing for arthritis is to get moving!  Gone is the old attitude of rest and medication.  Studies have shown that reducing weight, starting a strength training program, and performing range motion/stretching exercises can significantly improve your quality of life as compared to medication alone.  Good luck!

Ed Deboo, Physical Therapist, Bellingham Washington

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Shoulder stretching: posterior capsule

March 16, 2011 – 5:04 PM

Stretching of the posterior capsule is critical for normal shoulder health and function.  Check out the video for more education..

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Back strengthening exercise: Multifidus strengthening on hands and knees.

March 16, 2011 – 4:55 PM

If you’ve seen me in the clinic, you know one of my favorite back strengthening exercises is the quadruped, alternating arm and leg lifts with a 3-5 second hold.  Make sure you are stable before you began your 3-5 second hold.  Much research has been done on the multifidus musculature and for many of those with lower back pain, that muscle is almost non-existent.  Therefore, strengthening this area is a big step in the right direction to help manage lower back pain.  Check out the video below.

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Pain under your shoulder blade? Try stretching your subscapularis

March 15, 2011 – 3:29 PM

The subscapularis is a muscle under your shoulder blade that is often tight with those individuals that have a painful arm or shoulder.  Since the subscapularis plays a big role in stabilization of the shoulder, tightness is often associated with an impingement that can effect the bursa and the rotator cuff.  Check out the video below to figure out how to stretch it. Plus, impress your friends with a big word they haven’t heard of before….

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The birth of a new website

March 12, 2011 – 5:13 PM

As many of you know, my treatment specialty is Osteopathic manual structural therapy and exercise prescription.  However, over the years I have had patients that have requested just an exercise program to help manage their pain, be it neck, back, or shoulder, because they cannot afford to attend PT.   Many cannot attend therapy because they either have too high of a co-pay/deductible or may not even have health insurance at all.   Lately, with the ever changing world of health insurance and larger deductibles, the number of request for just exercises that people can do to help manage their pain independently has swelled.  Although the web has a wealth of information about exercise prescription, not all of it is current or very comprehensive, leaving the reader with many unanswered questions.

I was asked if I could put together affordable, comprehensive, online exercise programs for different areas of the body that would be available for an instant download from any computer.  After taking about a year to put it all together, I have finally launched a new web site, www.exercisesforpainfreeliving.com. The first program I have put together involves the treatment of shoulder pain. Since the shoulder is very mobile, strengthening of the shoulder complex is imparitive for normal function.  Posture also plays a huge role in the function of the shoulder and therefore, exercises to improve posture are essential.   The program contains patient education, written exercises with pictures, and video demonstration of the exercises.  The program has been divided into three phases, based upon how severe the symptoms may be and a special section to help deal with a frozen shoulder.

The goal of the new web site is to be able to educate and empower people with specific exercises to help them manage their pain independently, even if they cannot come into the clinic for treatment. So check out the new website, tell me what you think, and also if you have any additional suggestions for future exercise programs.  Cheers, Ed

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Core Training and it’s effect on athletic performance, injury prevention, and injury treatment

March 3, 2011 – 12:28 PM

Core training (mid line musculature) has been added to many exercise programs and the virtues of this type of training have been detailed in many media outlets, magazine articles, and also by health professionals, myself included.

However, I read an interesting article by John M Cissik, MBA, PT from the Texas Women’s University in Denton, Texas, who checked on the actual evidence of these claims in the literature.  What he found was that the evidence to support these claims is “lacking, contradictory, or taken out of context”. 

Let’s look at the 3 main areas of “benefit” from core training and then take a critical look at the literature:

Performance Improvement:  Research review in this area has, at best, produced “mixed results” with some studies showing improvement in field tests and others not.

Injury prevention:  Most of the literature in this area deals with core training and the prevention of lower back pain.  The nature of lower back is too complex to conclusively say that core training can actually “prevent” lower back pain. 

Injury treatment:  Again, most of the research is with lower back pain and it’s response to exercises including core training.  Several studies have found a positive correlation between strength training and the reduction of lower back pain.  However, the studies have many detractors who disagree with the methodology and therefore, do not take stock in the results.

So what does this all mean and how has it changed my approach to core training for myself and my patients?  The results of this literature review highlight the difficulty of studying exercises and directly relating them to performance and injury prevention/treatment.  To take performance and injury treatment and reduce them down to a simple series of exercises is far too simplistic as there are a multitude of factors that play a role in each. 

Remember, in the human developmental process, movement came first, then stability and strength! Babies are born with great flexibility, but almost no strength as even lifting their heads is difficult.  How does that translate to injury prevention/treatment and performance?  If you have ever been a patient at our clinic, you would know that finding the movement loss first is critical since you cannot strengthen tissue that is in “guarding” or “protective” mode.  Bottom line, continue with the core strengthening exercises, remembering that they are only a component of the entire fitness plan and look for areas of immobility or asymmetry and get them corrected!  Good luck and keep moving.

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