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  • KurtPT
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    Hi Dennis,  Sorry your surgery didn’t fix the problem. I’m an orthopedic PT with 28 yrs of experience, so-owner of  3 clinics in northern WI. I see cases similar to yours fairly often (sadly). I suggest you search;  trigger points, Travell and Simons, Dommerholt, Gerwin, Shaw among others for information on trigger points and the many referred symptom patterns related to them. A recent patient of mine had a diagnosis of CTS confirmed by EMG, severe right and moderate left wrists. Contrary to her surgeon’s opinion she suggested trying PT. I released many points in the upper back and forearms over the next ~4 weeks and she was symptom free. Actually she stated she couldn’t wait to go back to tell her surgeon.  If you look into the concept of trigger points and their referred patterns you’ll get a glimpse of what we see on a regular basis. I’d be happy to discuss this with you in detail if you like.

    Kurt Klemm PT  Cert MDT  CEAS 

    in reply to: Postal Workers #39201

    KurtPT
    Participant

    Hi Brent, As an orthopedic PT I see a lot of people with foot pain with various etiologies. Metatarsalgia just means apin in the area of the metatarsals. In the case where there’s no obvious bony anomaly the muscles are likely the cause. If the client hasn’t had proper treatment of the muscle inflammation to restore tissue health first, any positioning with orthotics etc won’t be enough to solve the problem by itself. If you could find and orthopedic PT or other practitioner who could release the soft tissues of the foot (and likely lower leg also) I think you would see a notable difference. We see a lot of folks on referral from  podiatrist who want their patients to have the soft tissue work and instruction in proper stretching to relieve soft tissue problems in the feet. Hope this helps.

                                                  Sincerely,

                                                   Kurt Klemm PT, Cert. MDT, CEAS


    KurtPT
    Participant

     

    The type of symptoms Dennis is talking about are similar to those we treat daily with great success. Read the first 80 or so pages in the text written by Travell and Simons and you’ll note the exact pattern of symptoms he’s reporting may be from specific muscles in the scapular area. In their text T&S list common diagnoses that are often actually muscular trigger point problems and this is what we see regularly in the clinic and treat successfully, in many cases after the symptoms have been present for years or even decades. Check out the referral patterns in the text and you may be surprised to see the similarity to CTS,TOS, sciatica and others. Not everything is muscular but it is often overlooked and easily treated. A brachial plexus problem should be exposed with testing and hopefully would have been by now. Trigger points develop as a result of various stimuli including static muscle use as you stated, trauma (including surgery) —basically any pain source will do it over time.  I think it would be a mistake to assume an entrapment as we see paresthesias  ( and T&S thoroughly document them) on a daily basis from trigger points. Hopefully he’ll find a practitioner that will do a comprehensive eval  and fix him.

     

                                          Appreciate your thoughts,   Kurt

    in reply to: Back Pain Complaints – Cement Truck Driving #39175

    KurtPT
    Participant

    Hi Brent,  You might consider looking at the booklet by Robin McKenzie, "Treat Your Own Back". It would certainly help to specifically evaluate them but a middle aged male that sits a lot will often feel "stiff’ as a result of increased disc pressure. This usually begins at 35-40 yo and older but sometimes earlier. The booklet describes in detail self-correction exerecises to reduce the disc pressure. To maintain the reduction a lumbar roll/support would be needed. In a few cases (although less so for a male of that age) if the patient had an increased lumbar curve as their normal spine position a lumbar roll wouldn’t be indicated as it might exacerbate the problem. Good booklet–there’s also one called "Treat Your Own Neck".  The problem you described is often seen in trick drivers in general and those who sit a lot. It’s harder on the indivdual that first sits a lot to pre-load the disc and then gets out of the truck and does lifting etc without unloading the disc (via the self-treatment exercises).  There’re really asking for trouble ad the disc is just waiting to get irritated.  The self treatment really works well and then follow up with the lumbar support.

                                               Hope this helps,

                                               Kurt Klemm PT Cert. MDT  CEAS

                                         


    KurtPT
    Participant

    You may be right Mark but a good therapist as you have mentioned should be able to evaluate the upper quarter for any possible trigger point involvement. We relieve upper extremity symptoms including the hand on a regular basis that are caused by points in the scapular area—note the referred symptom patterns documented by Travell and Simons.  Might be worth looking into.

                                       Kurt

    in reply to: office chair for LBP #39171

    KurtPT
    Participant

    Hope you’ve solved your problem by now but if not


    If you have an increased lumbar lordosis and that is the actual symptom generator you should be careful about a chair that would tendf to accentuate that position. Not everyone needs "more lumbar support" or assistance in exagerating that position. As a certified spine therapist one of the general areas we need to determine is if the patient would benefit from more or less of a certain position or direction of movement in the spine. If you’re already in a lot of extension you may not need to be positioned more in that direction. For the same reason not everyone would benefit from a lumbar cushion when they ride in a car. I’d be happy to discuss it further if you have questions.

                                   Sincerely,

                                    Kurt Klemm PT Cert. MDT  CEAS

    in reply to: Swissball as seat #39170

    KurtPT
    Participant

    Hi Rami,  Swiss balls are effective for a specific purpose, that of a training tool for muscles—stabilization/core strength etc. The idea being that if you destabilize the indivdual in a specific way you can expect certain muscles to have to work harder to stabilize the person. In a training or exercise environment it’s great. As a platform to work from it doesn’t make sense as we’d rather have stability/support so the muscles don’t have to work as hard. For example, if I had a pitcher with an ankle problem I might work them out on a wobble board /BAPS to strengthen certain muscles and improve reaction times. But I wouldn’t put them on the wobble board on the mound to destabilize them while they’re pitching. A good training tool isn’t necessarily good during the activity. As a certified spine therapist I can tell you there are a number of possible causes of back pain, either spinal or muscular as general catagories—be happy to talk with you about specifics if you want. In our practice nearly all spine problems can be resolved with the correct intervention, often with not much more than the right exercises especially if there’s no major trauma involved.

                                              Sincerely,
                                               Kurt Klemm  PT Cert. MDT   CEAS


    KurtPT
    Participant

    Hi Dennis, As you can see from the posts there are a lot of possibilities for you to consider. I’m an ortho PT with 26 years in the clinic and would like to suggest another possible reason. Many patients we see have primary or secondary problems with trigger points—a soft tissue anomly from various irritations such as overuse or trauma or actually any pain source. The muscle develops ischemia and resulting irritation that leads to pain. This often includes referred symptoms of pain and/or paresthesias in the upper or lower extremities. This is all documented well by Travell and Simons–google it and you’ll get plenty of info. I’d be happy to share more detail with you if you’d like. Because muscles react to any pain stimulus these symptoms can be a part of any trauma or overuse situation and the referred symptoms (according to Travell and Simons and my experience )  often mimic other diagnoses such as CTS,TOS, HNP, sciatica and many others. There’s a more complete list in the textbook. Need to find a therapist that can specidically evaluate trigger points. 

                                       Sincerely, 
                                       Kurt Klemm PT Cert. MDT  CEAS

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