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Laser Therapy on Tennis Elbow

There are about as many treatment recommendations out there for proper laser therapy on elbow tendinitis as there are stars! How in the world do you know what works? Well I can tell you what works for me…and to my patient’s that’s all that matters. Just give it a shot…Here we go.

It’s all about the dose and diagnosis. I prefer very high doses with Class 4 laser with a certain number of joules per cm/2. I always do the cervical nerve root first with 600J. Then scalenes and brachial plexus/pec major minor with an additional 1,500J. Next is the supraspinatus with 600J then the actual elbow and forearm with 1,500J. Now you may be saying that’s too much dosage. Wrong! (at least in my clinical opinion) I keep the dose to about 500J per 50cm/2 and expanding higher for deeper tissue. That’s the target range. It’s all about absorption.

Just give this a try next time and see what happens. Of course if you have a Class 3 cold laser this is impossible to do since these dosages can’t be obtained anytime this century. The important thing is to get laser into the area. So anything is better than nothing. I do not recommend any particular brand of laser. Just use one!!

Why do I hit all these areas for tennis elbow? That is for another blog post.

Perry Nickelston

www.painlasercenter.com

The VMO Connection

Remember the VMO? The small little muscle in your thigh that can cause a huge problem in the knee. Ah, the Vastus Medialis Obliques brings back memories from anatomy class. But how many of you evaluate it with knee complaints? Trigger points in the VMO can cause a myriad of signs and symptoms. Most notably patellar pain and deep aching in the knee. Particularly when in a seated position. When evaluating chronic knee pain, ensure you check the VMO for active/latent trigger points. Perfrom MFR, ultrasound, or my preferrd modality (laser therapy) I recommend 600Joules of energy into the entire VMO muscle. Laser first and then perform soft tissue work and manipulate last. You may find an internal/external tibia. Oh and don’t forget to check the hip. Takes anywhere from 4-6 visits for resolution of chronic problems.

Perry Nickelston, DC
973-800-6570
www.painlasercenter.com

Shoulder Pain? Think Hip…Really?

Remember that wonderful system of the body which interconnects all layers of muscle tissue? Sure you do? Think hard…it will all come rushing back to you. Hint: It starts with an F. Right! Fascia. I am here to tell you this is the ‘missing link’ to resolving chronic pain, not just in the shoulder. So the power clinical tip of the day is this..whenever you treat shoulder pain or dysfunction ALWAYS look at the hip structure. Assess the gluteus medius, minimus, piriformis, TFL, iliopsoas and latissimus dorsi attachments…don’t forget the hamstrings by the sacrotuberous ligament. Why are you looking at these places? FASCIA. Restricted fascia and trigger points in these muscles will prevent proper scapular abduction leading to overload and movement dysfunction of the glenohumeral joint. So the moral of this story is ‘STOP CHASING PAIN’, begin fixing problems. Big difference. Have fun! It works.

Dr. Perry Nickelston, DC

973-800-6570

www.painlasercenter.com

Small things matter!

In this world of fast paced, instant satisfaction mindest, and infrequent face to face communication (e-mail anyone?), now more than ever it’s the small personal things you do for a patient that makes all the difference. Trust me, they will remember. And when it comes time for them to recommend your services to a loved one…it’s the personal touch that did it! So, how small is small? Well to be honest, there really is no such thing as small…because they all reap BIG benefits later. Here are ten small ways to make a lasting impression…Try them, you will be amazed at what you see. If you already do them…bravo! You are ahead of the game. :1. Address patient’s by their last name and request permission to use their first name. For example, ‘Hi Mr. Smith welcome to our office. May I call you John or do you prefer Mr. Smith?’2. Call them after your first treatment to check up on them.3. Send a HANDWRITTEN welcome note after their first visit. No e-mail!!4. Offer them Spring Water while they wait to see you. Mini-bottles.5. Compliment them on their progress.6. Thank them for choosing you as their doctor. Show appreciation.7. Send a thank you note for every referral.8. Ask questions about their favorite hobby.9. Walk your patient out to reception and say how great is was to see them.10. Give them a small little token give at milestones of care. It’s the small little behaviors that make all the difference. Your secret weapon to the big goal is taking small steps. Now go forth and do small!! Dr. Perry Nickelstonwww.painlasercenter.com973-800-6570 

Iliofemoral Joint Dysfunction

Have you hit a wall with resolving back pain? Try looking at the hip. The hip is an often over looked cause of chronic back pain. Let’s see how. Dysfunction of the Iliofemoral Joint usually results from muscle imbalances in the tensor fascia latae, gluteus medius/minimus, hip external rotators (piriformis, quadratus femoris, gemellus, and obturator, or even the rectus femoris. Tightness or inhibition in any of these muscles can alter the entire kinetic chain. Superior glide of the femoral head in the acetabulum can result in decreased dynamic caudal glide of the femoral head during frontal plane hip abduction. This can result in capsular dysfunction and inhibition of the glutues medius. This results in referred trigger point pain to the lower back and also over use of the lumbsacral junction. Oh what a tangled web from just muscle tightness.  So if progress in adjusting the lower back hits a road block. Look to the hip. Do some trigger point work and release the hip via manipulation. Sit back and watch the results. Now that’s the best part. Watching people get better.                                              Dr. Perry Nickelston     www.painlasercenter.com        drperry@painlasercenter.com        973-800-6570 

Power of Testimonials

Here is a litle secret for you: In order to build value you must establish credibility…the easiest way to establish credibility is via testimonials. Why do you want to build value? It’s how you sell your services to a new patient. Yes, you must ’sell’ yourself and ’sell’ chiropractic if you want to stay in business very long. It’s hard to take care of patients with chiropractic if you can’t get them in your door…and here is the catch…KEEP THEM THERE!So make it a point to gather testimonials from all of your patient’s and strike while the iron is hot. Meaning…when they start feeling better and are so excited that you could help them. This is usually within the first month of care. I suggest video testimonials. Take a quick snippet of film asking them questions and post it on your website…even YouTube…with your patient’s written consent of course. Watch what happens…I think you will be amazed at how easy it is to convince someone that chiropractic can be the answer for them. Better yet, YOU can be the answer and not the doctor down the street.Dr. Perry Nickelston, DCwww.painlasercenter.com973-800-6570drperry@painlasercenter.com  

Hip Mobility

If you ever have difficulty resolving a chronic lower back issue don’t forget to check for proper hip mobility issues. There is usually a lack of motion in unilateral and sometimes bilateral hips. Lack of motion cause inhibition to the gluteus medius and minimus with referred trigger point pain. Test for capsular mobility with Faber Test and compression you may see a lot of external rotation in the supine position. I find AIS (Active Isolated Stretching to be a great active way to loosen the hip with mobilization. Have patient foam roll or teenis ball at home to increase movement and break up scar tissue. You just might find that lower back come around when the Kinetic Chain improves.

Dr. Perry Nickelston

www.painlasercenter.com

drperry@painlasercenter.com

Open Up The Shoulder

One of the key secrets to freeing up cchroic shoulder probelms is by cncentrating on increasing thoracic spine and rib cage moblity. This is a key neglected area in a  lot of rehab programs. Below are two of my favorite ways to open up the spine with stretching and get your cleints on the fast track to feeling better. Don’t forget to submit for therapeutic exercise codes and the Foam Rollers. Thoracic spine soft tissue work. Using a Foam Roller lie back on the floor and put the foam roller under the thoracic spine. Have the patient hug themselves so their shoulder-blades shift to the side. Keep feet flat and glutes off the floor. Roll back & forth. Stay away from neck and lower back. Lean on the left and right sides to exert more pressure. This should be done on a daily basis. For patients that can’t tolerate the foam roller use ‘The Stick’ as a replacement therapy. Thoracic Spine Soft Tissue Work with Tennis Balls. Same exercise as the first one with the foam roller but using 2 tennis balls inside a sock or wrapped in athletic tape. Perform sit-ups with the thoracic spine between the 2 tennis balls. Head goes against the floor on each rep. Crossed-arm grip. Elbows up. Move the tennis balls up every 3 reps. Stay away from the lower back & neck.   Show patients how do these on a daily basis and watch the changes. Dr. Perry Nickelston, DC1-973-80-6570 www.painlasercenter.com drperr@painlasercenter.com 

Saliva Testing

Saliva Hormone Testing is an accurate and simple way to assess the current levels of steroid hormones.  Steroid hormones in saliva reflect the portion of circulating hormones in the bloodstream that are unbound by serum binding proteins (free or bioavailable) and therefore are able to enter tissues throughout the body. Conditions that may be assessed include adrenal exhaustion, often misdiagnosed as hypothyroid, but may include a hypothyroid condition as well; systemic hyper- or hypo-excitability, whether of suspected neural or hormonal origin, including suspected thyroid, pancreatic and sex hormone disorders; states of immunodeficiency; and states of abnormal physiological response to any of a variety of stimuli including foods in the normal diet. Take our online survey and determine if you have a hormone balance problem. It can change your patients’ life. Investigate further to learn how adrenal fatigue can cause chronic pain issues.

Dr. Perry Nickelston, DC

www.painlasercenter.com

drperry@painlasercenter.com 

1-973-800-6570 

 

Hormone Control

Take time to learn about hormones for controlling weight and influencing health. Here is a good start. Some you might already know…others may be a new lesson. Enjoy

Insulin: This hormone is made by the pancreas; its function is to lower blood sugar after meals. In the presence of insulin, you will not be able to burn fat. Sugar triggers insulin. Optimal concentrations of insulin are required for normal growth during postnatal life. Insulin stimulates protein synthesis and inhibits protein breakdown. Without insulin, normal responses to GH are not seen and protein breakdown is severe. Insulin promotes growth primarily by shuttling nutrients (glucose and some amino acids) inside cells, providing energy and the building blocks for protein synthesis.

Note that insulin and GH must both be present at the same time for normal growth to occur. This is because insulin and GH each shuttle a DIFFERENT compliment of essential amino acids inside cells, and of course all of the essential amino acids must be present at the same time for protein synthesis (and thus growth) to occur. Neither insulin nor GH alone is sufficient to support normal growth - it takes optimal levels of all the body’s hormones to produce optimal health and optimal fat loss.  Excess insulin cannot create muscle mass, but it will promote fat storage. It’s not the calories in sugar that make you fat - it’s the insulin response. READ THAT AGAIN!

Glucocorticoids: Glucocorticoids (primarily cortisol) promote optimal function of a wide variety of organ systems, but do not have direct growth promoting actions. Excess GC’s inhibit growth by the catabolic effects of cortisol (increased protein breakdown).

Normal levels of GC’s  permit optimal function of the other hormones. The concept here is that glucocorticoids act to stimulate (or maintain) optimal levels (amounts) of metabolic enzymes, whose activities in turn are regulated by the other hormones. GC’s sort of set the stage and make sure all of the machinery is in place.

Cortisol functions to make sure the key regulatory enzymes are present in sufficient amounts to allow allosteric regulation (enzyme regulation via small effector molecules such as metabolic intermediates) and enzyme regulation by other hormones. Also, cortisol is important in maintenance of glucose levels and resistance to stress, which intuitively would seem important for normal growth.Cortisol is a hormone produced by the adrenal glands and has been referred to as the “stress hormone.” It is also affectionately referred to as “The FAT STORAGE HORMONE” because of its ability to mobilize fat oddly enough around the mid-section.

During periods of elevated stress, Cortisol levels are increased. Cortisol is a catabolic hormone, which means it allows the body to cannibalize its own tissue. It does have an important purpose. The gradual breakdown of tissue allows you to continuously build new, healthy cells. Cortisol also makes certain that if the body’s energy needs suddenly go up due to an extreme stress, or if due to trauma eating is a challenge, there are plenty of amino acids floating around to be converted into glucose and used as fuel.

Thyroid hormone is present in two forms, known as T3 and T4 {triiodothyronine (T3) and thyroxine (T4)} T4 and T3 are derivatives of the amino acid tyrosine with three (T3) or four (T4) atoms of iodine. These two hormones have many effects on the body. Among the most prominent of these are:

  • an increase in metabolic rate (seen by a rise in the uptake of oxygen)
  • an increase in the rate and strength of the heart beat

Most of the circulating hormone is in the form of T4 that is converted to the more active T3 form inside target cells. Thyroidectomy (removal of the thyroid gland) has nearly as devastating an effect on growth as does hypophysectomy (removal of the pituitary gland - the body’s source of GH). Restoration of T3 and T4 promptly reinitiates growth. T3 and T4 have little if any growth promoting effect in the absence of GH however. T3 acts to promote the actions of GH at three levels: GH synthesis, GH secretion and GH action. Plasma concentrations of GH are very low in the absence of T3 or T4. This action is independent of GHRH (growth hormone releasing hormone) and appears to be exerted directly at the level of gene transcription. Failure of proper thyroid function is almost always a result of liver toxicity. 80% of thyroid function is controlled by the liver.

It is vitally important to detoxify the liver before a thyroid system can be normalized.Controlling all of the above hormones is key when looking to maximize muscle gains and /or fat loss. The premise behind our program allows you to do this more effectively than most diets. Learning about these hormones and how they work and relate to each other is a good step in helping to plan your own diet and training regimen.      

Dr. Perry Nickelston, DC

www.painlasercenter.com

drperry@painlasercenter.com