Summer 2010

By Jim Harrison, PT

Jacksonville Orthopaedic Institute

Stretch, Summer 2010

Graston Technique and Soft Tissue Restrictions

By Jim Harrison, PT

Often individuals will experience injury or other insult to the soft tissue of their musculoskeletal system, the result is scar tissue formation. Scar tissue formation can cause the binding or adhering of layers of fascia to muscle, facia to tendons or ligaments, or muscle to muscle. Under normal circumstances these layers of tissue move smoothly over one another, however scar tissue formation changes all of that. When scar tissue forms these tissues stick together, range of motion is restricted, and pain is experienced.

This is not a new discovery. This has long been understood and treated by clinicians over the years. Generally, manual forms of treatment with the clinician using his/her hand(s) have been the methodology employed. Within the last 15 years another technique has been developed, researched, and is now gaining popularity in the medical community. That technique is Graston Technique or GISTM. This technique uses 6 surgical grade instruments to treat soft tissue adhesions or scar tissue. At JOI
we have a number of clinicians and the necessary instruments to perform the technique.

A typical treatment involves a warming up of the specific tissues to be treated. This can be accomplished by external heat application via hot packs or ultrasound. Cardiovascular exercise using a stationary bike, for instance, can also be employed for the same purpose. Once the body part is sufficiently warmed up, the clinician will use a scanning instrument to locate the lesions. Once located, the lesions are treated. Often the clinician will utilize some of the other instruments to treat the lesions. The treatment usually lasts about 6-8 minutes per lesion. Once the treatment is finished, the patient will follow a typical physical therapy or occupational therapy treatment routine. This will involve stretching and any other exercise regimen that is deemed appropriate for his/her specific problem. Once the exercises have been completed the session is finished by cold application.

Treatments are performed twice a week and not on consecutive days. A patient can expect to feel some minor discomfort during the procedure. The pressure applied can elicit the discomfort or sometimes the scar tissue being treated can be very deep within the tissue layers and greater application of force is needed to reach those tissues. Additionally, some bruising can be expected, which is why the treatments are not performed on consecutive days. The patient can expect to see some positive results within 3 or 4 visits.
The overall benefit to patients is that patients can enjoy rapid recovery from their injuries or surgeries and resume their activities sooner with less discomfort.

Strength Training Myths in Children

By Fred Baldwin, DPT

With recent studies showing that over 15% of children in the United States between the ages of 2-19 are considered obese, many parents are looking for ways to get their kids active. Unfortunately, some parents do not consider strength training as an option. Years of myths have led to the belief that strength training will cause more problems than benefits. Let’s take a closer look at the three most common myths about children and strength training.

Myth #1: My child is too young to begin strength training. Children, as young as 6 years old, have shown an increase in muscle strength and in motor skills, like running and jumping. When a child shows the maturity to accept and follow instructions, strength training can be considered.

Myth #2: Strength Training will stunt my child’s growth. This is an old wives’ tale about strength training damaging children’s growth plates and stunting their growth. If specific guidelines are followed, strength training can actually help reduce the risk of damage to growth plates, joints and soft tissues. Research has shown that if strength training is done properly, it will help increase bone density.

Myth #3: Strength training can cause injury. True! But this can happen with strength training at any age. When children are taught with proper training and correct form, the chances of straining muscles decrease. A child’s workout routine is not just a smaller version of an adults program. Children can build strength with exercises that use body weight as resistance. Pushups, pull-ups, and sit-ups are all good exercises to start a child’s strength routine without even getting close to weights.

When it comes to getting your child active, remember that the benefits of strength training out weigh its negatives only when performed with proper technique and supervision.

The Many Benefits of Yoga

By Constanze Scrone, DPT

The practice of yoga originated in India around 5000 years ago. The word yoga is a Sanskrit term meaning union, specifically union of body, mind, and spirit. The benefits of yoga are numerous. This article will focus on the manifold physical benefits. The central focus of any yoga practice is the breath and allowing optimal flow of prana (Sanskrit word for energy) through proper breathing. Depending on the type of yoga being practiced, asanas (Sanskrit term for postures) will be of a flowing nature or will be held for a few breaths with deepening into the posture with each exhalation. Over time, this will lead to improvements with flexibility.

Another focus of any yoga practice is alignment, which will serve to optimize the flow of prana (energy). With so many of our daily activities (reading, driving, eating, computer work) we regress into a cashew-type posture with our heads peaking out like a turtle. If prolonged, these malalignments can lead to pinching and shortening of structures such as nerves and tendons. No wonder doctor’s offices are filled with patients complaining of shoulder, neck, and back pain. Through yoga, postural awareness is improved, flexibility of tightened structures is enhanced and strengthening of weakened postural muscles is achieved by holding asanas (postures) in proper alignment.

Yoga practices also include balancing the body to maintain asanas (postures). Various degrees of difficulty can be practiced, often influenced by the type of yoga one is doing. For example, with ashtanga yoga great strength and balance is required to get into and to maintain some of the advanced asanas.

Purification of toxins is another physical benefit of any yoga practice through the focus of proper breathing techniques. Further, some types of yoga encourage purifying sweat by producing intense internal heat and/or practicing in a heated room.

Remember to always talk to your yoga instructor or a physical therapist if you have any physical limitations or injuries so that proper adjustments can be made. It is of keen importance not to ignore or push through physical limitations as this may prolong or cause further injury. Remember to leave your ego at the door and have fun!

Dealing With the Ultra-Sling

By Julia Guthart, OT, CHT

So you’ve had shoulder surgery. You wake up after a nice nap at home to find a black Velcro contraption attached to your body. This is not your ordinary sling, this is the ultra sling with attached pillow. You may be required to wear this sling for 6 to 10 weeks depending on your type of surgery. The following are some tips for living after shoulder surgery with your sling.

The ultra sling is made up of four main parts: the sling, the abductor pillow, the shoulder strap and the waist strap. The sling is the portion with the most skin contact and where your forearm rests. The abductor pillow positions your arm away from your body which is important for decreasing downward stress on your repaired shoulder. The shoulder strap attaches to the sling and supports your arm weight. The waist strap attaches to the abductor pillow and keeps the sling from twisting too far behind you and too far in front of you. A double sided piece of Velcro attaches the sling to the abductor pillow.

How do you take a shower, eat, get dressed, sleep and use the bathroom after shoulder surgery and while wearing this sling?

Showering: Remove the ultra sling as follows. Undo waist strap. Undo shoulder strap and with your other arm remove your forearm from the sling. Settle your arm next to your body. Get in shower. Do not use operated arm for washing. Perform all bathing with non-operated hand/arm. Do not wash your hair with operated arm. To get under your operated arm pit, lean forward and let gravity move your operated arm away from you. Wash arm pit with non-operated hand. Some physicians may direct you to wear a “shower sling” while showering. This is a fabric sling without a pillow to support your operated shoulder while showering. Just let it get wet and then hang it up to dry for the next time.

Eating: Sometimes after shoulder surgery your surgeon may not want you to eat with the operated arm. You will need to use your other arm for feeding yourself. Cutting up food is a no-no too. You will need help cutting meat. This is especially important when you go back to your workplace. You do not want to have to ask someone to cut up your food for you like a baby! Pack sandwiches or choose finger foods.

Dressing: Getting dressed and undressed is a little tricky at first. It is recommended that you have help with socks and tying shoes at first. Use slip on shoes when possible. Pants with elastic waist are preferred also at the beginning due to their ease for pulling on and off. Front button shirts one size larger than your normal size are recommended. When you put on a shirt, put your operated arm through the sleeve first; then the non-operated arm. Remember you are not allowed to lift that operated arm up to put through the sleeve hole; instead put the sleeve hole where your operated arm is, gathering the sleeve and pushing it past the elbow, then reaching around with your non-operated arm for the other sleeve. When removing the shirt, undress the non-operated arm first, then pull the sleeve off the operated arm. Button the top buttons one-handed. In the summer months it is recommended to wear a sleeveless t-shirt or tank top. You can cut the operated side and shoulder seams, then re-attach with Velcro or safety pins, for ease of on and off. Ladies use a tank top instead of a bra at first and wear a button front shirt over your tank top for adequate coverage.

Sleeping: YES, YOU HAVE TO SLEEP WITH YOUR SLING ON. Sleeping in a reclined position is more comfortable due to post-operative swelling. Use a chair recliner or you may purchase a foam wedge and put this on your bed. Use your pillow on top of the wedge. Also, use a roll-type pillow or rolled up towel to support behind your operated arm and sling. You don’t want to wake up flat on your back with your elbow on the mattress. It is very uncomfortable.

Using the bathroom: If it was your dominant side that was operated on, you may want to use flushable wipes to help make your uncoordinated reach more efficient.

Other tips for warm weather: Use a pillowcase or towel inside the sling portion, and change it out daily. This helps with perspiration and cleanliness of the sling. The sling is washable and dryable; however, that process takes a couple hours. Using a sock with the toe portion cut out and placing it over the neck part of the shoulder strap helps with cleanliness, too.


Where is Telemedicine frequently used?

All JOI Physicians, Physical Therapists and Occupational Therapists now offer Telemedicine services for virtual visits from the convenience of your home. If you feel that it is best to stay in your own home during this time, we can still provide orthopaedic Telehealth services for you. Through the download of the free Zoom app on the your phone, tablet or laptop. Our physicians and Telehealth for Physical Therapy can evaluate you and provide the care you need.

JOI Fracture and Injury Care

JOI Physicians are currently offering ASAP Fracture care. Make an appointment by calling (904)JOI-2000. This is a new option for patients who would like to avoid the emergency room if they have suffered a fracture or soft tissue injury. To learn more about this service, read this article about fracture and injury care.


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