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Core Stability and Strength

Here is a posting from my good friend Joe Heiler, PT. A brilliant clinician. Enjoy.

Core stability and core strength are terms that are often used interchangeably when speaking about training the trunk musculature and spinal stabilization. The fact is that they are quite different. Training for core stability requires resisting motion at the lumbar spine through activation of the abdominal musculature as a whole. Training for core strength allows for motions to occur through the lumbar spine in an attempt to work the abdominal or back musculature, often in an isolated fashion.   Looking at the functional anatomy of the lumbar spine, it does allow for movement in all three planes of motion but overall it is quite limited.

  • The lumbar spine can move quite a bit through flexion and extension but we know from experience to avoid repetition going the extremes, hanging out at one extreme or the other for prolonged periods, and to avoid high loads while trying to move through the lumbar spine.
  • Rotation at the lumbar spine is only supposed to contribute 13% of total spine rotation (Sahrmann, 2002), hence limiting rotation with training might be a good idea.
  • Lateral flexion occurs as well but limited. The total amount of lateral flexion allowed from L1-S1 is 27 degrees, while the thoracic spine is capable of contributing up to 75 degrees (Sahrmann, 2002). This also has a degree of rotation to it which again is not really designed to happen in the lumbar spine.

Think of the sports that require tremendous amounts of rotation. Golf and baseball (pitchers) come to mind. Two populations we see quite often with back pain. They get more than enough rotation and lateral flexion with every swing or throw so why add more? Throw out the stability ball crunches, superman exercise, crunches with a twist, side bending, etc. Teach them to resist these motions against a load, and how to maintain a stable spine through a golf swing or a pitch. Work on bird dogs, front and side planks, chops and lifts in tall kneeling and half kneeling, and don’t forget to deadlift.

Joe Heiler, PT

www.sportsrehabexpert.com

Perry Nickelston, DC

www.stopchasingpain.com

Tags: General by Dr. Perry
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Customer Service

Focus on great customer service.  When people are making more decisions than ever about what to do with their hard-earned dollar, you must convince them that getting rid of their ‘personal’ chiropractic care is not an option. Notice the word ‘personal.’ The more your care is personalized and customized, the more of a necessity it becomes. Focus on doing the ‘little things’ to make it even more personal: phone calls, regular and informative e-mails, periodic assessments and care plan goal setting, 100% focused attention during each session (PTC-Present Time Consciousness), educational handouts, etc. Give them an experience worth remembering. What motivates them to talk about your services to others? Wow them so they want to talk about you.

Perry Nickelston, DC

www.stopchasingpain.com

 

Tags: General by Dr. Perry
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Laser Parameters: What Really Matters?

When determining how to apply laser therapy for back pain there are a few key factors to consider. This is taken from my article published in Advance Physical Therapy Magazine this month.

Laser PowerPower affects penetration, dosage, and treatment time. More power offers deeper penetration, higher therapeutic dosages, and decreased treatment times. Lasers are classified by power. Class 3 ‘cold lasers’ are at maximum power output of 500mw from a single laser source. Class 4 lasers are anything over 500mw.You cannot make up for insufficient power by increasing treatment time. Depth of tissue penetration will not increase with more application time if you have insufficient power. Positive results require more than increasing time.                                         

65% of laser energy is absorbed in the skin and subcutaneous tissue layers with the following having a high affinity for absorption:

Hemoglobin in blood

Melanin in skin, hair, moles, etc.

Water (present in all biological tissue)

In order to overcome these factors one must start with large quantities of energy to reach the deeper target cells and myofascial structures with a required dose.

Optimal Dosage

Dosage is the single most important parameter for a successful outcome in laser therapy. Too little, or too much energy produces no effect. There is an ‘Optimum Window’ of therapeutic dosage. The matter of correct dosage is very complicated, since a number of factors must be taken into account including laser wavelength, power density, type of tissue, condition of tissue, acuteness or chronicity of the problem, skin pigmentation, treatment technique, and depth of target tissue.  

The primary factors in laser therapy that determine dosage is power and time.  DOSAGE = Power x Time While power is the amount of energy measured at the source of the beam, dosage is the amount of energy delivered to the skin and target tissue. Dosage may also be referred to as energy density or fluence. Its unit of measure is the Joule (J). Current industry dosage application requires 1- 4 J/cm2 for superficial, and 4-10J/cm2 for deeper conditions. 3   Therefore, a 50cm2 deep tissue area may require up to 750J for maximum effect. 

Optimal Wavelength

Light characteristics are determined by its placement along The Electromagnetic Spectrum.  Wavelength is calculated in nanometers (nm). The ideal range for therapeutic lasers is along the Invisible Red (IR) spectrum of 790-970 nm. IR beams penetrate deeper into the body for increased effects on cellular tissue.  Wavelengths in the Visible Red (VR) 600’s nm spectrum are ideal for superficial conditions and limited in deep penetration.4 Wavelengths above a 1000nm lose therapeutic value and crossover into surgical laser applications. Deep therapy applications such as spinal stenosis, disc herniations, hip derangements, trigger points of spinal intrinsic stabilizer muscles and neuropathic conditions are inherently more responsive to the Invisible Red (IR) wavelength.

Perry Nickelston, DC

www.painlasercenter.com

Tags: General by Dr. Perry
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