TREATMENTS
Robin uses a full spectrum of treatments to help your body restore normal function and heal itself. A combination of techniques are often required to ensure complete restoration. These include:
INTRAMUSCULAR STIMULATION (IMS)
PHYSIOTHERAPY
ACUPUNCTURE
PILATES
WHAT TO EXPECT FROM YOUR TREATMENT
Robin’s goal with every patient is to stop the pain cycle so you can resume regular activity – even after months of persistent pain.
As a new client, your pain or injury will be carefully assessed in a number of ways. You can expect a thorough case history to be taken and a related physical assessment. Based on the outcome of your initial assessment, a personalized treatment plan will be created.
UNDERSTANDING THE PAIN CYCLE
Many patients arrive at the clinic with longstanding, chronic pain, which has set the pain cycle in motion.
A shortened, tight muscle does not function properly, putting great strain on the tendons attached to them and the joints that they move and so a chronic cycle of pain begins. Left untreated, this cycle can contribute to degenerative changes such as tendonitis and osteoarthritis.
To stop the pain cycle a combination of treatments are used to effectively strengthen ligaments and allow your contracted muscles to return to their normal resting length after which, blood flow returns to the muscle and nerve signals are received properly.
INTRAMUSCULAR STIMULATION (IMS)
Intramuscular stimulation (IMS) draws on both the traditional practice of acupuncture and the recent advances in physiotherapy and medical research. IMS uses fine needles to treat tight muscle bands that are responsible for many chronic and painful conditions.
People who suffer from chronic neuropathic pain often try one treatment after another but find only temporary relief. Neuropathic pain that shows no obvious sign of tissue damage or inflammation, such as chronic muscle pain and a host of other soft-tissue complaints, is difficult to treat with traditional methods.
Neuropathic pain explained
Neuropathic pain typically occurs when nerves malfunction following minor irritation. Nerve conduction becomes exaggerated and the body often misperceives its messages as painful ones. The most common cause of irritation to nerve roots is spinal degeneration or spondylosis. Nerves fan out from the spine and irritation of a nerve root can be responsible for pain or soft-tissue changes in any part of the body.
Muscle shortening
When muscles receive exaggerated signals from super-sensitive nerves, they contract and remain contracted. These contracted muscles put great strain on the tendons attached to them and the joints that they move. Chronic muscle shortening contributes to degenerative changes such as tendonitis and osteoarthritis. Super-sensitivity cannot be operated on and muscle shortening from the super-sensitivity cannot be readily stretched out. Painkillers and anti-inflammatory medications only mask the pain.
How IMS helps
The goal of IMS is to release shortened muscles, which press on and irritate the nerves. Super-sensitive areas can be desensitized and the persistent pull of shortened muscles released with IMS. IMS is particularly effective for deep muscles that can be difficult or impossible to reach with other forms of treatment. The effects of IMS are cumulative – needling stimulates a certain amount of healing, until eventually the condition can more fully recover, pain dissipates and muscles loosen.
Experiencing IMS
The treatment involves dry needling the epicenter of taut, tender muscle bands and/or near the spine where the nerve root may have become irritated and super-sensitive. Insertion of the dry needle into your skin is often not felt, and if your muscle is normal the application is painless. If your muscle is super-sensitive and shortened, you will feel a cramping grabbing sensation in your muscle sensation as the needling causes the abnormal muscle shortening to intensify very briefly and then release. This is a distinctive type of discomfort caused by the muscle grasping the needle, which then disappears and is followed by a feeling of relaxation in the muscle. For an effective treatment effect to occur, it is important to experience this "grabbing"sensation.
For more information on IMS:
Training and current research:
Patient information and precautions:
www.physiotherapyalberta.ca/.../patient_information_ims_trigger_point_dry_needling.pdf
PHYSIOTHERAPY
Physiotherapy treatment helps restore mobility, strength and function through the advanced understanding and study of anatomy and pathology. Robin Bone’s physiotherapy treatments aim to improve flexibility, strength, posture and biomechanics (patterns of movement).
Treatment includes hands-on therapy, exercise and education.
Manipulation/Mobilization
As part of your treatment, Robin may elect to use a technique called manipulation. This is defined as a “skilled passive movement to a joint with therapeutic intent” (Stanley Paris, 2004). If done appropriately, it is a safe and effective method to restore the normal motion of a hypo-mobile (stuck) joint, and to decrease muscle tone and pain in the area. Sometimes a pop or click is heard at the time of the manipulation. This is thought to reflect a release of gas around the joint.
Before the manipulation is performed, you will be asked specific questions and various safety tests will be performed to ensure that manipulation is a safe and appropriate technique for you. The technique will be explained and you will be asked for your consent to proceed. Following the technique, the motion will be reassessed to determine the effectiveness of the treatment.
Manipulation is not a suitable treatment for individuals suffering from symptoms related to osteoporosis, vascular compromise (e.g. previous stroke), rheumatoid arthritis, cancer, multiple sclerosis or similar conditions.
Exercise programs
Exercise prescription is a key component to any physiotherapy treatment. Whenever an injury affects the soft tissues (muscle, ligament, tendon, and fascia) and joints there is normally a loss of strength and/or flexibility. Some of this will return naturally as we become more active as the injury heals. However, there is often residual weakness and loss of flexibility. Since these tissues control the alignment and stability of the joints, there is the potential for uneven forces across the soft tissues and joints. Such imbalances cause subtle changes to our movement, leading to increased stress and predisposing our bodies to injury.
Alignment and movement patterns are carefully addressed in elite athletics, yet little attention is given to these factors in everyday activities. Typical examples include office workers repeatedly turning to the same side when working between a computer and a telephone, or a mother who always carries her baby on the same hip. Postural alignment is fundamental to normal movement patterns. Where alignment is faulty, optimal movement is difficult to impossible and mechanical injury is likely to occur.
Therefore, when you are recovering from injury or managing everyday aches and pains, Robin will seek to correct alignment and movement patterns to alleviate muscle and joint pain and to prevent further injury. To do so, we carefully assess your musculoskeletal system and prescribe specific exercises tailored to your needs.
ACUPUNCTURE
Acupuncture is an ancient form of Chinese medicine involving the insertion of solid filiform acupuncture needles into the skin at specific points on the body to achieve a therapeutic effect. The needles alone create the beneficial effects of acupuncture.
Acupuncture is used to encourage natural healing, improve mood and energy, reduce or relieve pain and improve function of treated areas. It is safe and effective and is often successfully used as an alternative to medications or even surgery. Relief is often obtained with acupuncture when traditional medical therapy has failed.
How it works
Needles are inserted at acupoints, which are areas of low skin resistance, in order to restore balance to the body, thereby reducing dysfunction of the organs and corresponding symptoms. These points may include auricular acupuncture points in the ear.
Acupuncture studies have shown that the stimulation of acupoints produces analgesic effects similar to that of morphine. It is a very useful method of treatment in pain reduction, improving blood flow, reducing inflammation and boosting the immune system, as well as regulating the endocrine system (hormones).
What can acupuncture treat?
Many conditions can be treated with acupuncture from acute to chronic pain. Neuromusculoskeletal conditions: sciatica, low back pain, neck pain, facial and TMJ (jaw joint) pain, headache, migraines, neuralgias, arthritis and stroke.
Experiencing acupuncture
Acupuncture needles are very fine. They are sterile and used once only and then disposed of medically. The needle insertion is generally painless, however, a slight sensation may be felt.
After insertion, the needle is manually stimulated to achieve the desired result of a deep, heavy ache. The failure to achieve this usually means poor results.
The needles are inserted at the area of the condition and also distally at points along the hands and feet, and are left in for 15-20 minutes. In addition, these needles can be stimulated by an electro-current, which is attached to the needles causing a pulse to be felt throughout the treatment. This regime can also be augmented by moxibustion (an herb that heats the channel) and by suction cups to improve circulation at the local level.
It is fundamental to pilates to perform exercise with flow, exercise that focuses on concentric and eccentric loading the joints through their available range, in order to, improve inner and outer range of movement and lengthening of the antagonist muscle. It improves alignment and rotation control, as well as, improving altered recruitment strategies that may have adapted because of sustained postures, repeated movements, pain or injury.
Pilates instructors pay close attention in the teaching and the execution of an exercise. The high standard prevents movement faults and may even prevent actual injuries.
Pilates teaches clients about neutral alignment of the spine and neutral alignment of peripheral joints. The client is taught how to find neutral spine in supine, sitting and standing and learns about neutral joint position in the periphery. When the spine and peripheral joints are in ideal alignment there is less stress/strain on the joints and connective tissue and the muscles are in an optimal length tension relationship. Any aberration in posture, or in motor control will ultimately result in greater accumulation of stress in the system than an optimal posture.
Pilates focuses on neuromuscular re-education or retraining muscle recruitment patterns. That is, pilates focuses on recruitment from the centrally, from core stabilizers, to the periphery. Pilates utilizes low load exercise to bias the neuro-muscular system. To exercise at low threshold loads with posture and alignment controlled, a client can effect change and develop strategies which are eventually hoped to become automatic.
Co-ordinating movement with breath also taps into the motor control system because we are able to alter and control our breath to assist in stability of the core.
Pilates offers ongoing care, teaches clients how to challenge pain cycles, negative beliefs and fear avoidance behaviour. Most importantly the cognitive challenge with performing the exercises helps to teach clients how to perform their exercises independently at home without the fear of injury.