An educational October 2013 publication for physicians by BenchMark Physical Therapy Inside: Resolving Plantar Fasciitis With Astym® Treatment Casey Kalb, PT, DPT, OCS Resolving Plantar Fasciitis With ® Astym Treatment A fter a year of corticosteroid shots, custom orthotics and splints, repeated stretching and other therapy interventions, Anne’s plantar fasciitis was still so painful that she could barely walk and feared surgery – an option her primary care physician recommended she avoid if at all possible. “I had done everything my physician and podiatrist recommended, spending whatever necessary to try and resolve the pain,” said Anne, a healthcare professional with BCBST. She recalls when she began Astym® Treatment with BenchMark Physical Therapy. “With each session, I noticed small improvements, as if the condition was melting away,” she said. Within her twelve prescribed sessions, along with a personalized strengthening and stretching program, Anne’s plantar fasciitis was resolved. THE TREATMENT Generally, chronic soft tissue problems are due to scarring or degeneration due to inadequate healing. Over time, the tissues are not able to withstand stress during normal tasks. The biggest problems come from scar tissue that forms inside the body around joints, muscles, tendons and/or ligaments. The body naturally lays down scar tissue in response to irritation or injury. The fibrous, strong scar tissue is meant to reinforce an area, but often it ends up restricting movement and causing pain. Astym Treatment is a rehabilitation program that stimulates the regenerative healing process of the body. This manual therapy technique is non-invasive and works quickly by stimulating the healing process, rejuvenating muscles, tendons and ligaments, and helping resolve scar tissue problems. According to Hannah Norton, PT, DPT, OCS, Anne’s therapist, “Many treatments don’t address soft-tissue dysfunctions such as adhesions and inappropriate fibrosis. Astym treatment directly addresses unhealthy soft tissue.” WHAT PATIENTS CAN EXPECT The process of stimulating healing can be uncomfortable but is well worth it, according to Anne who told Norton the treatment reminded her of the old Patty Loveless song, “Hurt Me Bad in a Real Good Way.” Today, she recommends the treatment to anyone suffering from plantar fasciitis or other tendon disorders. According to Norton, “Patients can expect some mild discomfort during the treatment and occasionally some mild bruising and treatment soreness the next day or so. Treatment soreness usually resolves quickly, and can be minimized by doing exercises prescribed by the physical therapist.” Patients are generally pleased to learn that they can maintain an active lifestyle. In fact, “a home exercise plan is integral to success of the treatment approach,” she adds. “The regular performance of 2-3 simple stretches 4 times per day (usually about 3-4 minutes total for the whole day) allows continued and measured stress to the tissue to encourage remodeling of the tissue. Changes in symptoms and mobility can be immediate following the initial treatment but often occur about three to four sessions into the plan of care.” According to Norton, the usual progression of visits is about ten utilizing the Astym prescription approach. Other manual therapy techniques are often employed concurrently to address joint mobility and dysfunction throughout the kinetic chain of the affected area. ADDITIONAL CONDITIONS Astym Treatment is effective on sprains, strains, and other acute and sub-acute soft tissue injuries. Some of the more common diagnoses that have demonstrated positive clinical results when treated with the Astym approach are chronic tendinopathies, post-op or post-injury scarring, joint and muscle stiffness, and pain and stiffness associated with early degenerative joint disease. “Any tendon or soft tissue injuries that don’t seem to be improving would benefit from a physical therapy evaluation for Astym treatment. If someone is diagnosed with conditions like Achilles tendonitis, tennis elbow, patellar tendonitis, or other “-itis” conditions, they may be candidates for this technique,” said Norton, who has advanced certification and over five years using the procedure. “Research is finding that many of the conditions we previously thought of as an inflammatory condition do not reveal signs of inflammation when we look at the tissues microscopically. The tissue condition is better identified as an “-opathy” due to degeneration and lack of proper blood flow.” Physical therapy with incorporation of Astym is a promising treatment to consider for these patients to regain pain free function. BenchMark is proud to provide this manual therapy technique at many locations in your region. Use our convenient Central Scheduling: P (866) 518-0283 / F (423) 278-9809 / www.benchmarkpt.com/referrals Our Advanced Certifications We will do all precertification and get your patient to the most convenient Mean Betterlocation Results Referral Form/Care Plan PLEASE TAKE THIS PRESCRIPTION TO PHYSICAL THERAPY Appointment Date: ___________________ Patient Name__________________________________________________________ Phone Number _______________________________________ Diagnosis _____________________________________________________________ Date of Birth _________________________________________ Surgery __________________________________________________________________ Surgery Date _____________________________________ Next Physician Appointment ______________________ Workers’ Comp. Ins. Co. ___________________________ Phone ___________________ In making the referral, the physician certifies the prescribed rehabilitation is a medical necessity. Dr. ___________________________________________________________________ Date __________________________________ (Signature) Physician’s Name ________________________________________________________________ (print or type) Phone _________ EVAL AND TREAT  PT / OT  CHT Continue Therapy __________________________  Frequency __________________________  Duration _______________ Special Precautions/Instructions ______________________________________________________________________________ ____________________________________________________________________________________________________________ TENNESSEE Athens Chattanooga - Citico Ave. Chattanooga - Downtown EXERCISES/TREATMENTS Chattanooga - Gunbarrel ❑ Active ROM ❑ Passive ROM Chattanooga - Hwy. 58 ❑ Lumbar Stabilization Cleveland ❑ Cervical Stabilization Clinton ❑ Progressive Resistive Exercise Crossville ❑ Mobilization ❑ Shoulder Rehab Protocol Crossville - Fairfield Glade ❑ Ankle Rehab Protocol Dayton ❑ Hip Rehab Protocol Dunlap ❑ Knee Rehab Protocol ❑ Rotator Cuff Program ❑ Home Exercise Program East Ridge Knoxville - Sequoyah Hills For your convenience, we doLenoir all pre-certifications. Etowah City Farragut Madisonville Greeneville Maryville Harriman Morristown MIDDLE TENNESSEE Hixson Murfreesboro Jasper Newport Dayton Brentwood (October 2013) Kingsport NorrisRhea County Hwy 7693 1595 Mallory Lane Knoxville - Alcoa Hwy. Ooltewah Suite 2 Suite 210 Knoxville - Chapman Powell TN 37321 Dayton, Brentwood, TN 37027 Knoxville East Towne Bank P.Red (423) 570-0907 P (615) -900-4838 Knoxville Northshore F.Signal (423) Mountain 570-0936 F (615) -900-4839 Smyrna Soddy Daisy Spring City Sweetwater Tellico Plains Shelbyville NORTH 1878 N MainGEORGIA Street Calhoun Shelbyville, TN 37160 Dalton P. (931) 680-9722 Fort 680-9797 Oglethorpe F. (931) Trenton Smyrna 8823 Production Lane Ooltewah, TN 37363 Evidence in a Minute Are Joint Injury, Sport Activity, Physical Activity, Obesity, or Occupational Activities Predictors for Osteoarthritis? A Systematic Review Level of Evidence: Prognosis, level 2a: Systematic Review with Meta-analysis the above risk factors. Sport specificity (without injury) and physical activity demonstrated inconclusive results. Background: Osteoarthritis (OA) affects up to 10% of men and 18% of women over the age of 60. OA progresses after 50 y/o and affects up to 50% of this population. This is the first comprehensive review of modifiable risk factors. Take Away Message: Early identification of those at higher risk for the development of OA of the hip, knee, and ankle provides a window of opportunity for healthcare providers to implement strategies to modify the risk before OA progression leading to more costly interventions. Purpose: Identifying these modifiable risk factors is critical for the development and evaluation of primary and secondary strategies to reduce the impact of OA on this population. Methods: 43 studies were included in a qualitative synthesis, 11 studies included in quantitative synthesis (meta-analysis). The focus of this study was placed hip, knee, and ankle OA. Subject age ranged from 20-95 y/o. Results: Previous joint injury and previous meniscectomy were considered clear and significant risk factors for knee (with or without ACL injury) and hip OA. Joint Injury, obesity, and occupational activity were found to be associated with knee and hip OA as well but to a lesser degree. Only 2 studies found a correlation with ankle OA and 1. Richmond, SA et al. Are Joint Injury, Sport Activity, Physical Activity, Obesity, or Occupational Activities Predictors for Osteoarthritis? A Systematic Review. J Orthop Sports Phys Ther 2013; 43(8):515-524. Epub 11 June 2013. doi:10.2519/jospt.2013.4796. Evidence in a Minute is brought to you by BenchMark Rehab Partners, including BenchMark Physical Therapy and Pro Therapy. More people choose BenchMark Rehab Partners for their care for several reasons including: • Our Orthopedic Manual Therapy • Our commitment to advanced certification for all of our therapists, including certification, board certification, and Residency in Orthopaedic Physical Therapy • Our patient outcomes that consistently exceed national standards. • Patient Satisfaction - 99.5% Satisfied or Very Satisfied • Functional Improvement - 92.3% Good or Excellent