“Pinched Nerve”

  • Pinched nerve is a term we have all heard but what is it really?
  • Chip Review @ (14:56): Trader Joe’s – Everything but the Bagel (Thanks Kate)
  • Trivia question of the week @ (12:28): What city was the first capital of the United States?
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Brief overview of the episode:

We’ve all heard the term pinched nerve before. But what does it really mean? It is not an official diagnosis but it does clearly present a set of symptoms. A “pinched nerve” is a loose term that describes radicular symptoms. This is pain and possibility numbness, tingling and weakness. This most often due to compression at the nerve root but can also occur distally along a nerve. Carpel tunnel and hitting your “funny bone” are both examples of a pinched nerve.

Most often a pinched nerve occurs due to a compression of the nerve root. Which is can be due to a number of changes. Most common are degenerative changes and this is why people 50 year and older are most affected. A pinched nerve occurs in about 85 out of 100,000 US adults. Making it a fairly common diagnosis.

One of the best ways to experience relief is by getting the area moving. This can be a few degrees of movement but so long as there is some movement taking place progress is being made.

 

Other episodes you might enjoy:  

Spine Surgery Overview: Episode 80

Stenosis: Episode 36

Radicular Pain: Episode 22

 

Clubfoot

  • Clubfoot is a rare congenital defect that occurs in about 1 in 1000 births. In this episode we discuss treatment and how clubfoot can have affects across the lifespan.
  • Chip Review @ (14:56): Ripples by Old Dutch – Appetizers on the Go – BBQ Pulled Pork Wrap
  • Trivia question of the week @ (12:28): Where is the deepest hot spring in the world?
  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.
  • Thanks for listening!!

 

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Brief overview of the episode:

             Clubfoot is a rare, affects 1 in 1000 births, defect with no known specific cause. What is known is that children can develop this while in utero or shortly following birth. Presentation is of a severely inward turning of the foot. This can be so significant that the foot is turned upwards.

             With clubfoot the tendons of the Achilles and inverts of the foot are shorter than they should be. In most cases this can be treated with a combination of stretching, taping, bracing, splinting, casting and in 90% of cases some kind of surgery.

              Surgery is most commonly a procedure called a tenotomy. During this procedure a small cut is made in the Achilles followed by a case or splint to allow the tendon to stretch.

              Treatment for clubfoot is best done early and often with a baby. There can unfortunately be cases that go untreated or undertreated and result in more significantly structural changes that can only be correct with extension surgery later on in life. Unlike many orthopedic injuries clubfoot affects babies and as a result it becomes a family process to address the aforementioned issues.

 

 

Other episodes you might enjoy:  

Calf Tear: Episode 94

Foot & Ankle Health with Dr. Mohammad Rimawi: Episode 40

Fall prevention & Balance: Episode 19

Piriformis Syndrome

  • Piriformis syndrome is a common diagnosis for pain in the buttock. It is often attributed to issues related to the sciatic nerve but that’s not really the cause. In more than 80% of cases it has to do with some kind of trauma or repetitive motion not an anatomical difference of the piriformis muscle and sciatic nerve.
  • Chip Review @ (17:35): Yaokin – Mr. Cabbage Taro – “Sauce Flavor” (Hugh Thank you to Steve-O)
  • Trivia question of the week @ (15:12): How much poop does a rhino make in a single defecation?
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Brief overview of the episode:

Piriformis syndrome is the literal pain in your butt. Other symptoms include low back pain, numbness, difficulty walking, pain with sitting/squatting/standing/bowel movements and tenderness. Sometimes this is called deep gluteal syndrome, extra-spinal sciatica or wallet neuritis.

The reason that the piriformis muscle is so famous is because it can have a unique arrangement with the sciatic nerve. There are 6 other muscles in this area that can also play a role and that is why primary piriformis syndrome makes up less than 15% of cases.

Secondary pirifomris syndrome is by far more common. This is usually due to some kind of trauma, muscle holding, gait patterns or other issue further down or up the kinetic chain. That will then present as pain in the buttocks.

Women are affected 6x more than men. This seems to be due to an increased q angle as this impacts the relationship between the quadratus femoris and the OS Coxae.

Most people you experience piriformis syndrome will get better with short-term activity modification and exercises. Surgery is not often recommended even in cases of primary piriformis syndrome.

Other episodes you might enjoy:  

Lumbar Strain: Episode 123

Lateral Shift: Episode 106

Sciatica: Episode 34

Corticosteroids

 

  • Corticosteroids are used to treat a range of issues. From asthma, lupus and organ rejections too rashes and inflammation. They have been hailed as a wonder drug and for some people they are but there are some side effects to we aware of.
  • Chip Review @ (11:50): Feast & Fury – Habanero Hickory BBQ
  • Trivia question of the week @ (09:28): How many black keys are there on a traditional piano?
  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.
  • Thanks for listening!!

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Brief overview of the episode:

Corticosteroids are used to suppress inflammation and immune response. They are commonly used to treat lupus, asthma, arthritis, autoimmune disease, as an anti-rejection medication, Addison’s disease, and for diagnostic purposes. Glucocorticoids are natural produced by the adrenal glands from cholesterol with Cortisol being the basis for corticosteroids.

Most people are familiar with cortisone, hydrocortisone and prednisone but there are many other versions all used to treat different areas. Corticosteroids can be administered in an number of routes, oral, pill, cream and injection. Oral is the most common.

Prednisone is the most common oral corticosteroid. This form of administration means the corticostroids travel around the entire body. Which leads to a great potential for side effects because more systems are involved. Thankfully short-term use is not typically associated with any meaningful issues. Long-term use does however present some issues.

Some of the more common and concerning side effects include, glaucoma, skin thinning, diabetic issues, bone health issues, immune system suppression (when that is not the desired use) and both high and low blood pressure.

When corticosteroids are used and monitored appropriately there is little concern for significant side effects.

Other episodes you might enjoy:  

Neuropathy: Episode 118

Rhizotomy: Episode 116

Role of Modalities in PT: Episode 90

Osteopenia/Osteoporosis

 

  • Osteopenia is the early stage of osteoporosis. Both are the loss of bone mass and result in a weakening of the bone leading to increased risk of fracture.

  • Chip Review @ (08:24): Kettle Brand – Parmesan Garlic

  • Trivia question of the week @ (06:03): What is Canada’s most populated city?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

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Brief overview of the episode:

            Osteoporosis translates to pores bone. This is a condition that is affecting about 3 million Americans right now. More women than men are affected. Osteopenia is the early stage. Where bone density is beginning to deteriorate but has not yet reached a critical stage.

            The reason these two conditions are a concern is become weak bones have a greater opportunity to fracture. These can occur without trauma when the condition is sever enough. Most people who are affected by osteoporosis will present with back pain, stopped posture and loss of height. All of these symptoms are a result of fracture to the spine.

            The good news is that both osteopenia and osteoporosis can be treated to some extent. Medications, diet changes, and exercises are the prime methods. Physical therapy can help with the exercise portion.

            Bones respond to something called “Wolf’s Law” this law states that bones respond to stresses placed on them. When there is low stress the bone loses density. When there is higher stress the bones gain density. This is why exercises is such a valuable tool when treating osteopenia/osteoporosis.

 

Other episodes you might enjoy:  

Stretching: Episode 25

Dr. Mike Pascoe Interview: Episode 12

Stress Fractures: Episode 43

Neuropathy

  

  • Neuropathy occurs when peripheral nerves are damaged. This can happen for a number of reasons ranging from diabetes, infections, chemotherapy and drug or alcohol abuse.

  • Chip Review @ (08:05): Kroger – Prime Rib & Horseradish

  • Trivia question of the week @ (06:02): Which is Canada’s most populated city?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

 

 

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Brief overview of the episode:

            There are upwards of 20 million American dealing with neuropathy. This is a condition that can affect sensory, motor and autonomic nerves, usually of the feet and hands. It can present in 3 forms, mononeuropathy, multiple –mononeuropathy and the most common version poly-neuropathy.

            With each version symptoms are typical fairly similar, loss of sensation, pain, weakness, coordination issues and possibly bowel and bladder problems. Most people who are affected are 60 years old or older. But this is a condition that can affect anyone.

            Some causes of neuropathy include diabetes, infections, toxin exposure, poor nutrition, alcoholism and kidney failure. Typically pain is the first symptom. This can be sharp, throbbing, aching or burning. As symptoms progress typically pain lessens but numbness and sensation changes worsen.

            Treatment for neuropathy usually begins with treating the underlying cause. So managing diabetes, infections and kidney failure is highly beneficial. Physical therapy plays a role in working to up train limitations to help with balance and falls prevention.

 

 

Other episodes you might enjoy:

Radicular Pain: Episode 22

Radicular Pain: Episode 22

Fall prevention & Balance: Episode 19

Upper Trapezius vs

Levator Scapulae

  • The upper trapezius is often getting the blame for neck pain, headache and scapular issues. But the levator scapulae plays an important role in each of those as well.

  • Chip Review @ (08:25): 1 in 6 Carolina Kettle – Down East Carolina BBQ (Thank you Kate)

  • Trivia question of the week @ (06:29): What is the loudest animal on earth?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

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Brief overview of the episode:

             Upper trapezius and levator scapulae are both muscles that sit between the shoulder and the neck. They are involved with the scapula (shoulder blade) and cervical (neck) motions.

            The upper trap is well known, levator scap no so much. But levator scap plays a bigger role in cervicogenic headache and forward head posture.

 

 

Other episodes you might enjoy:  

Cervicogenic Headache: Episode 10

Cervicogenic Headache: Episode 10

Cervicogenic Headache: Episode 10

 

 

 

Rhizotomy

  • Rhizotomy is a procedure that has been used for years to treat spasticity, especially in children. In recent years it has been used to help with the treatment of chronic pain resulting from the facet joint.

  • Chip Review @ (09:14): Red Rock Deli – Sweet Chili & Sour Cream (Michael Westover)

  • Trivia question of the week @ (07:23): The New Yardbirds are better known as?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

 

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Brief overview of the episode:

            Rhizotomy is a procedure that has been around for a long time. Historically it was used to treat spasticity in children with cerebral palsy. Rhizotomy has been used to treat multiple sclerosis. In the outpatient orthopedic realm rhizotomy is a treatment option when facet joint pain is present.

            Facet joints are small joints in the spine. Coming out behind the facet joints are the dorsal root of the nerve at that level. The dorsal root is responsible or carrying sensation to the brain. An ablation is performed (burning) of the dorsal root that prevents pain signals from being transmitted to the brain. If pain signals don’t make it to the brain then you won’t perceive discomfort and should allow for typical daily and work activity.

 

 

Other episodes you might enjoy:  

Pain: Episode 29

Discectomy: Episode 81

Discectomy: Episode 81

Discectomy: Episode 81

 

Fibromyalgia

  • Fibromyalgia (FM) is a complex condition that can limit all facets of life for a person with it. The exact cause of FM is not fully understood and therefore medical treatments have been slow to develop and those available have varying levels of success.30 Pharmacological treatment is common for FM, however literature is beginning to surface that suggests the effects of physical therapy (PT) management may be as effective or perhaps more effective at reducing the symptoms.31 The effectiveness of PT management is based in large part upon the person with FM buying into the plan of care that unfortunately at times may make symptoms worse.

  • Chip Review @ (16:57): Lay’s Nashville Hot Chicken (Thank you Lizzie and Matt)

  • Trivia question of the week @ (13:14): What is the most densely populated US state?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

  1. Pogatzki-Zahn EM, Englbrecht JS, Schug SA. Acute pain management in patients with fibromyalgia and other diffuse chronic pain syndromes. Curr Opin Anaesthesiol. 2009;22(5):627-33.
  2. Rossy LA, Buckelew SP, Dorr N, Hagglund KJ, Thayer JF, McIntosh MJ, Hewett JE, Johnson JC. A meta-analysis of fibromyalgia treatment interventions. Ann Behav Med. 1999;21(2):180-91

 

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Brief overview of the episode:

           As a PT, it is important to realize that FM causes chronic pain and fatigue and that many patients will not be able to tolerate as many interventions or treatments as we would like to provide. However, treatment tolerance will improve with gradual exercise progression. 19 It is paramount that in the beginning, the PT works at a pace that the person with FM is comfortable with. As the person with FM starts to see and feel benefits from PT management, the difficulty and level of the interventions can be increased to levels that may be beyond the patient’s comfort to reach a therapeutic dose.
            The positive effect of aerobic exercise, specifically aquatic exercise, described by Assis et al and Munguía-Izquierdo et al, on the symptoms of FM is profound. 8,14 Many times people with FM, as was the case with PF, come to PT as a last resort. Being able to show them evidence that supports PT management for FM will help relieve the feelings of hopelessness that are common in the FM community and instantly build some level of trust in the physical therapist. For PF, deep water running or aquatic therapy are treatments that will improve aerobic capacity and decrease pain and fatigue thus improving her quality of life.
  1. Assis MR. Silva LE, Alves AMB. A randomized controlled trial of deep water running: clinical effectiveness of aquatic exercise to treat fibromyalgia. Arthritis & Rheumatism. 2006; 55, (1):57-65
  1. Munguía-Izquierdo D, Legaz-Arrese A. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89(12):2250-7.
  1. Busch AJ, Barber KA, Overend TJ, Peloso PM, Schachter CL. Exercise for treating fibromyalgia syndrome. Cochrane Database Syst Rev. 2007;(4):CD0037

 

 

Other episodes you might enjoy:  

Radicular Pain: Episode 22

Pain: Episode 29

Nutrition for Recovery with Amanda Turner: Episode 44

 

Myofascial Tools

  • This episode is a listen request from Luke. We discuss and comment on specifc evidence related too myofascial tools like foam rolls, Theracane ®, Theragun ® and Instrument assisted soft tissue mobilization (IASTM).

  • Chip Review @ (15:36): Deep River – Sweet Maui Onion

  • Trivia question of the week @ (13:25): What are heliotrope and puce?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

 

To Subscribe, Review and Download select your preferred hyperlink below 

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Brief overview of the episode:

             Myofascial tools have become more and more prominent for self-treatment but also within the clinic. How do these tools help you? The evidence is fairly mixed on their value but what is known is that if something helps you and it gives you value then it has a place within your preparation and recovery toolbox.

 

 

 

Other episodes you might enjoy:  

Radicular Pain: Episode 22

Radicular Pain: Episode 22

Pain: Episode 29

 

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