Enfield Health & Wellness Center
Enfield Health & Wellness Center

To whom it may concern:

Whenever my patients require physical therapy for acute or chronic conditions, I confidently refer them to Dr. Sadowski and his team for top quality patient care. The Team at Enfield Health and Wellness Center remains in close contact with the patient's provider and gives updates regarding this or her level of progression. This is very important to me and for the total care of my patients. I highly recommend this facility.

Arthur Skalski, MD, FACSG     
Enfield, CT

 

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Enfield & Suffield Connecticut Physical Therapy

The Health & Wellness Centers of Enfield and Suffield routinely mail newsletters to physicians to explain treatment options available through referral and to highlight the most current thinking in physical therapy. Here we have posted a few of these newsletters for your perusal. Contact us if you are a prescriber in or near Enfield or Suffield, CT and would like to be added to our postal mail list.

 

Physical therapy is widely advocated as the first-line approach, but there has been little evidence to help doctors tell patients what to expect from therapy and when. To help with these conversations, Dr. Hey Hwee and colleagues followed 30 consecutive patients to measure their response to their first few physical therapy visits. After two weeks of treatment, pain ratings dropped from a median of 8 to a median of 4 on a 0-10 visual analog scale. These results are in keeping with our experience with similar symptoms.

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Both physical therapy and surgery have been considered among first line treatments, but, for non-traumatic rotator cuff tears there has been little comparative evidence between treatment options. This past January, The Bone & Joint Journal published a randomized, controlled trial testing the hypothesis that rotator cuff repair surgery yields superior results. At 12 months, each treatment regimen caused clinically significant improvements, but there was no statistically significant difference between the groups. The direct cost of care in the physical therapy group averaged $3,285 per patient, and the direct cost of care in the repair group averaged $7,760.

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Many repositioning maneuvers now have versions adapted for self-treatment. This poses the question of whether self-treatment with training from handouts is equal to treatment delivered with the supervision of a suitably-trained health care professional. The handful of studies addressing this question suggest that professional assistance and training with these maneuvers adds to the effectiveness of treatment. The data suggests that some professional supervision is helpful if response rates are to exceed 60%. If patients are instructed to self-treat, Dr. Helminski and colleagues recommend that patients receive professional supervision twice (initially and at follow-up) to verify the accuracy of performance. They also point out that patients should be warned of the risk that the maneuvers can trigger an acute worsening of symptoms by causing horizontal canal migration and canalith jam.

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Prognostic studies in physical therapy are a current research priority as healthcare providers attempt to determine the most efficient care paths for individual patients. Researchers hope that clinicians will be able to use prognostic indicators to differentiate patients who are likely to spontaneously resolve their complaints versus patients who would benefit from greater intervention in the disease process. To this end, The Journal of Pain recently published a study evaluating prognostic indicators of chronic low back pain (LBP) in primary care with the longest follow-up to date. This study adds to a large body of evidence encouraging the healthcare community to discard the old notion that LBP serious enough to result in a primary care consultation is usually self-limiting.

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The therapists at the Health & Wellness Centers of Enfield and Suffield use a special technique called Kinesio Taping to provide protection for muscles and joints in a way that actually improves circulation. This technique has been connected with improved physical therapy results in focal dystonia, chronic low back pain, shoulder impingement syndrome, rotator cuff tendinopathy, and acute whiplash. Since your patient can wear the high-grade tape for more significant time spans, structures can be affected to enhance treatment for problems one might not think of such as posture imbalances, lymphedema, hematomas, fascial adhesions & scars, pathological movement patterns, and neurological conditions.

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Wright et al. identified five statistically validated predictors. The presence of just one of these predictors suggests an average response to physical therapy. The presence of two predictors doubles the likelihood of positive response. The presence of three predictors suggests a 99% likelihood of therapy success.

  • Unilateral hip pain
  • Age less than or equal to 58
  • Pain of 6 or greater on a 10-point scale
  • 40-m self-paced walk test time of 25.9 seconds or less
  • Duration of symptoms less than one year

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Your older patients prove particularly vulnerable to the negative sequela of rest. Among a test sample of healthy subjects age 67 and older, 10 days of bed rest resulted in more lean tissue loss than 28 days of bed rest caused in younger test subjects. For patients over the age of 70, bed rest is associated with a major, new disability in one-third of prolonged cases. Among elderly patients, when the negative effects of bed rest are not addressed assertively, injury or prolonged difficulties become more likely.

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Enfield Health & Wellness Center now incorporates a relatively new treatment for myofascial pain: dry needling. Myofascial pain (MP) is a common, painful disorder that causes or contributes to many pain complaints brought to doctors. The technique now has encouraging support in the scientific literature. One systematic review and multiple randomized controlled trials have concluded that dry needling achieves analgesic effect comparable to injections of substances such as lidocaine. A Cochrane review of 35 randomized, controlled trials concerning back pain concludes that dry needling appears to be a useful adjunct therapy. In cases of myofascial pain syndrome, there is some evidence that needling the associated paraspinal muscles, in addition to needling the trigger points in painful muscles, enhances the effects in terms of increased subjective pain reduction, improved range of motion, and better outcomes on the geriatric depression scale.

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Previous studies have found rehabilitation programs to have efficacy roughly equal to lumbar fusion when chronic patients are randomized into treatment groups. Hellum and colleagues recently attempted to compare the efficacy of a rehabilitation program to surgery with disc prosthesis. Their results were recently published by the British Medical Journal. At two-year follow-up, the researchers found the difference between rehabilitation and disc prosthesis surgery not clinically significant. Christian Hellum, orthopedic surgeon from the Department of Orthopedics at Oslo University Hospital, concludes that even with a patient group that has received physical therapy before, it is reasonable to consider additional rehabilitation programs.

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Temporomandibular joint disorders (TMD) are now ranked as the second most common musculoskeletal pain, behind only low back pain. While 42% of untreated TMD cases become asymptomatic over time, 58% have persisting symptoms after 2.5 years, and 33% have no improvement. The preponderance of controlled trials show positive results when the treatment includes posture assessment, exercise therapy, and manual therapy.

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Sarah Lamb and colleagues published a large study in the Lancet this past February. Patients receiving usual care cost 220% more than patients receiving physical therapy, and at one year, physical therapy patients were 50% more likely to have file closure. Best results are achieved when active physical therapy treatment for WAD begins within 96 hours of the injury.

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Sarah Lamb and colleagues published a large study in the Lancet this past February. Patients receiving usual care cost 220% more than patients receiving physical therapy, and at one year, physical therapy patients were 50% more likely to have file closure. Best results are achieved when active physical therapy treatment for WAD begins within 96 hours of the injury.

Click here to download full physical therapy article

 

 

 

This past April, Spine published a placebo-controlled, randomized, double-bind, study comparing spinal manipulation, the NSAID diclofenac, and placebo in the treatment of acute low back pain. Specifically, the spinal manipulation provided was high-velocity, low-amplitude (HVLA) manipulation. At 12-week assessment, both interventions proved superior to placebo. The HVLA group achieved better results than the NSAID group. The HVLA trended better in use of rescue analgesics and scored significantly better in quality of life measures, disability measures, and visual analog pain scales.

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In March, the New England Journal of Medicine published the first large, multicenter, randomized, controlled trial to examine the efficacy of arthroscopic partial meniscectomy plus physical therapy compared to physical therapy alone.  Between the two experimental groups, improvements from baseline do not differ significantly.  The authors suggest that their findings provide encouragement for offering non-operative strategies.

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This article analyzes the performance of the physical therapists treating low back pain and concludes that 79% of patients receive sub-optimal physical therapy treatment.  Physical therapy guidelines recommend an active approach for low back pain, from the acute phase forward.(2)  There should be an emphasis on helping patients improve activity levels.  Previous studies link an early, active approach to better outcomes with reduced costs.(3,4)  The tens of thousands of billing records reviewed by Fritz and colleagues suggest that 79% of LBP patients receive primarily passive therapies from their physical therapists for the first two weeks of therapy.

 

 

 

The consensus on when to refer to physical therapy for non-specific low back pain (LBP) is in a state of transition.  A study published in Spine last December reviewed the medical records of 32,070 patients with a new, primary care LBP consultation.(1)  They found that the median time from primary care consult to first physical therapy visit was 14 days, with 53% of physical therapy episodes starting within 14 days and 47% of episodes starting later.  Those patients who started physical therapy earlier showed statistically significant patterns toward improved outcomes and lower costs.

 

 

 

The new State of Oregon Evidence-Based Clinical Guidelines for the Evaluation and Management of Low Back Pain recommend spinal manipulation during the acute phase (<4 weeks). The recommendation comes with the highest level of recommendation achieved by any of the interventions listed - B. These new recommendations are a reversal of previous Oregon drafts that sent many patients to surgery without trying any form of physical therapy. Those lobbying for changes to previous versions argued that the analysis needs to look beyond short-term pain control to functional improvement and longer-term outcomes.

 

 

 

Last October, the American Journal of Epidemiology published the first prospective study examin-ing the correlation between regular NSAID (nonsteroidal antiinflamatory drug) use and hearing loss in women.1 Multivariate-adjusted relative risk analysis demonstrates that regular ibuprofen and acetaminophen use increases the risk of hearing loss in women by 8% to 24% as the usage rates range from two doses per week to six or more doses per week. These results add to those of a previous study demonstrating that men regularly using ibuprofen, acetaminophen, or aspirin increase their risk of hearing loss up to 99%.2 Regular NSAID use appears to have a greater effect on the hearing of men than of women, but both men and women are at increased risk.

 

 

 

Lymphedema is a painful, emotionally taxing condition suffered by more than half a million Americans.1 Irreversible lymphedema occurs when the lymphatic system is damaged to the extent that interstitial fluid production exceeds the lymphatic system’s capacity to filter and transport. In most cases of secondary lymphedema, surgery and/or radiation often did not cause all the damage necessary to create irreversible lymphedema. In many cases, these procedures only started the process. The subsequent swelling triggers an inflammation-like response that, when inadequately addressed, can permanently degrade the lymphatic system.

 

 

 

More than 50% of patients injured in motor vehicle accidents receive whiplash diagnoses. Patients with acute neck pain develop chronic neck pain in 15% to 40% of cases. Can pearls of wisdom from high quality research help America do better with this troubling diagnosis?

 

 

 

Inasmuch as patients with acute whiplash develop chronic neck pain in 15% to 40% of cases, prescribing every measure shown to improve whiplash outcomes may be justifiable. Indeed, multiple studies have demonstrated various physical therapy interventions to be effective at improving pain ratings, recovery speed, and ability, compared to usual care. However, this does not answer the more difficult question of cost-effectiveness. Is it better in terms of societal costs for patients to heal at their own pace with medications and advice?

 

 

 

The Vestibular Disorders Association reports that more than 12 million Americans suffer from a dizziness or balance problem that significantly interferes with their lives and that 40% of the population over the age of 40 will experience a dizziness disorder in their lifetime. Patients typically bring these complaints to their family practitioners or to the emergency department. If not successfully treated, the occasional disequilibrium can lead to fall injuries, auto accidents, work accidents, and fear of performing normal activities of daily living. When designing a treatment plan for patients with any type of vestibular disorder (peripheral or central), you can in-clude certified vestibular rehabilitation at the Health & Wellness Centers of Enfield and Suffield.

 

 

 

Histopathologic studies have long established inappropriate fibrosis and scarring, that lacks the parallel, longitudinal structure of a normal tendon, as consistent elements in various tendinopathies. One of the specialized approaches available at the Health & Wellness Centers fo Enfield and Suffield improves physical therapy results by specifically addressing the fibrosis and scarring usually associated with tendinopathies. The Graston Technique is an instrument-assisted, soft tissue mobilization technique utilizing ergonomically designed stainless steel instruments to detect and break down scar tissue and fascial restrictions.

 

 

 

In a systematic review published recently by the Lancet, Coombes et al. consistently found that peritendinous corticosteroid injections are sometimes effective in the short-term for tendinopathy but usually worsen out-comes past 13 weeks compared to other treatments.

 

 

 

In many cases, the Health & Wellness Centers of Enfield and Suffield will assert that a small number of visits to our practice will improve outcomes compared to teaching a patient an exercise regimen once or twice and sending him/her home. For the most part, this is accomplished through verification of correct performance, professional input on progression of intensity, and individualized manual therapy. Interestingly, Gail Deyle, DPT, tested this hypothesis in a randomized, controlled trial.

 

 

 

The physical therapists of the Health & Wellness Centers of Enfield and Suffield practice a relatively new manual therapy so effective that authors describing its physiology have referred to its results as the “Pain Release Phenomenon.” First described in the literature by Brian Mulligan in 1992,(1) an admirable body of re-search now attests to its effectiveness.(2-15) The Mulligan Technique, sometimes titled Mobilization With Movement, delivers immediate relief and recovery from local musculoskeletal pathology of mechanical origin.

 

 

 

Worldwide, the McKenzie Method® has consistently grown in recognition and has established itself as a scien-tifically proven foundation in spine care. Over the past two decades, literally hundreds of research papers sup-porting the use of the McKenzie Method have appeared in numerous peer review journals. Journals such as Spine, the Journal of Neurology, JMPT, Physiotherapy, and the New England Journal of Medicine have all fea-tured research demonstrating the faster results and low-er costs of the McKenzie Method.

 

 

 

A randomized, controlled trial published recently in Spine demonstrates that prompt intervention including manipulation, an individualized exercise program, and guided exercises produces faster and more cost effective results than “normal medical care” in cases of acute and sub-acute simple low back pain (LBP). Participants in the guided exercise group spent 35% less time off work (an average of 7 days) and showed significantly better results on pain assessments and health status assessments at one month and two months. Even though patients in Group 2 received injections and physical therapy and returned to work better prepared for the rigors of their jobs, participants in Group 2 reduced overall costs by $367 to $850 per patient.

 

 

 

Occupational low back pain (OLBP) is a different and more serious condition than non-occupational low back pain (LBP). OLBP ranks as a leading cause of workplace disability, representing at least one fourth of all costs due to work-related conditions. studies specifically measuring return to work after four weeks of normal medical care have found full return to work rates of 28% to 58%, calling into question the assertion that most “recover” in four to six weeks with minimal intervention. There is strong evidence that if a person misses four to twelve weeks of work, he or she will have up to a 40% chance of missing work for the ensuing year.

 

 

 

It is commonly held that low back pain (LBP) resolves spontaneously in the majority of cases, but the passive treatment this statement would suggest results in 280% higher recurrence or greater. In a randomized, controlled trial published in Spine, Julie Hides, PhD, and colleagues demonstrated with unusual specificity that LBP cases that would commonly be labeled as “resolved” have in fact not resolved.

 

 

 

The Vestibular Disorders Association estimates that 42% of the adult population reports episodes of dizziness or vertigo to their physicians and that in 85% of those cases, vestibular dysfunction causes the patient’s problems.  Left unaddressed, the occassional dizziness or dysequilibrium can lead to injury falls, auto accidents, work accidents, or fear of performing normal activities of daily living.

 

 

 

Every year, 17% of women and 14% of men present themselves to a healthcare practitioner looking for relief from headaches.1  Practitioners seeking to offer maximum, long-term relief to their patients can include headache treatment at the Health & Wellness Centers of Enfield and Suffield as part of their management strategy.  We offer headache assessment and management that provides expert care for orthopedic factors contributing to many recurring headache and migraine situations. 

 

 

 

Authors have suggested that, while this broad category may be useful in medical practice, it can be deleterious to clinical research, clinical guidelines, and, resultantly,  physical therapy practice. The assessment-based therapy treatment plan, delivered promptly after injury, produces results superior to strictly interpreted AHCPR “evidence-based guidelines.”

 

 

 

In this article, we explore a promising alternative to the misguided acute vs. chronic model and explain why most cases of low back pain should not be treated as an injury.  Low back pain (LBP) ranks as a leading cause of disability among Connecticut’s adults.  Despite increased attention to the problem over the past three decades, annual healthcare costs related to LBP continue to rise at rates exceeding inflation.  Research has shown some cost-effective approaches for prevention of low back pain and LBP disability, and these approaches are available to you through the Health & Wellness Centers of Enfield and Suffield.

 

 

 

 

 

 

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