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"Surgery, or not surgery?" Recently one of my clients had to make the biggest decision of her life. She will have to make up her mind and accept a fusion surgery on the cervical spine. The risk of paralysis with or without surgery is the biggest concern for her, not to mention the risk of infection, active bleeding and possibly expensive medical bills. Her MRI did show spinal stenosis with 4 intervertebral disks herniations, which match the constant spasm and very limited range of the neck and shoulders. She started to notice the weakness of the legs with mild tripping imbalance accidents. She almost cried when we talked about the possible surgery before further rehab. Constant spasm with tingling of the limbs usually indicates some impinging problem of the peripheral nerves close to the spine.  I strongly suggest anyone with a similar presentation go for professional help immediately. Compared to the expensive medical bills for surgery, the cost to see your PCP or an

My patient L said "I have treated my body poorly in the past. Now I want you to fix it."  After an MRI of the shoulder, she was diagnosed with 3 of the 4 rotator cuff muscles of the right shoulder, labrum tear. She had a very limited active range of motion and could not tolerate sleeping on the right side and overhead motions in the kitchen or laundry. The key information is that she waited and ignored her shoulder symptoms for so long. All the connective tissues inside the joints had been torn to a certain level. This is a sad story because it could be treated in time with less pain and avoid the trouble in the long term. After 6 weeks of treatment, her pain of the shoulder was much less with a better overhead motion of the right shoulder at about 90-110 degrees. She was able to do housework with cooking and laundry with lightweight without pain. I am surprised about her recovery with the evidence of the 3 out of the 4 rotator cuff muscles/tendons ruptured. That

What is Cobb's angle, why it is important to know about it? www.PTcares.com You might hear of the diagnosis of Scoliosis-- the increased abnormal curve of the spine. One of the key findings to judge the progression of the curvature is Cobb's angle. Why it is important to measure the Cobb's angle of the spine every 1-2 years? Your pain, muscle spasm and internal organs function might be associated with your spine condition. Generally speaking, the development of the curve should be controlled within 5 degrees per year. Before you start feeling discomfort and pain, your body already started to compensate to a certain degree. The compensation will not last forever. It might be easier to correct the abnormality in the early stage before the cartilages worn out, joints fused, muscles became tight and weak, and bad habits developed. Will physical therapy with muscles retraining and spine mobilization help the curve and it's syndromes? Yes! Manual therapy with therape

How to prevent disk herniation of the back? WWW.PTCARES.COM One of my client Sherri was diagnosed with L4/5, L5/S1 disk herniation after on and off back pain for 3 years. She had been through some exercises in the past but still with on and off symptoms. Recently she had an accident of bending over to pick up her shoes and ended up with significant back pain. She got an MRI and had the above diagnosis confirmed. She walked into the clinic with limping gait and sat down with only the left hip on the chair. She had significant difficulty in moving in and out of bed, car, and chairs. The numbness and tingling and pain was shooting from the back to her right butt and down to the toes. She could not function well as mother and could not walk to another office to discuss work with her colleagues. She cried for a while and asked how she could do to prevent the disk herniation of the lumbar spine. I paused for a few seconds because there are so many things that might contribute to the r

Dry Needling by a Physical Therapist: What You Should Know I got questions about DN a lot recently. So here is a useful link to learn about Dry needling. https://www.moveforwardpt.com/Resources/Detail/dry-needling-by-physical-therapist-what-you-should A licensed PT with DN training will help you to deal with tightness, pain, and headache. My personal feeling about Dry Needling was not as great at the very beginning, mainly because of the limited evidence we have now.  But after seeing the change of my clients after DN, I recommend DN to all providers and clients. The baseline is the anatomy. Now I see the DN technique as a new approach to get to the deep and sensitive muscles. Usually, I will have to do a lot stretching and adjustment of the spine before the "angry tissues" will relax. That means more pain during the process and less compliant with my client. Now with DN approach, I can pinpoint the compensated tissues quickly. I mean genuinely PINPOINT 

What are pelvic floor muscles and why they are important for you? www.PTcares.com So you heard about the pelvic muscles training after giving birth or during the pregnancy. But what are these muscles and why you need to know about them? It doesn't matter if you are female or male. Yes. Men have pelvic floor muscles also.  : ) Researchers also suggested that correctly use of the pelvic floor muscles also help sex performance and reduce the frequency and intensity of the lumbar pain. As you can see in the above picture, there are so many muscles work together to close the openings at the bottom of the trunk.  That's the main function of these muscles--to protect your internal organs from dropping down by gravity. The pelvic floor muscles also work with diaphragm, belly muscles and back deep extensor muscles to form the "Core" muscles of the trunk, which is super important for our daily performance. Your doctor might suggest you get some core tr

What is Patellofemoral Pain Syndrome (PFPS, ) in the knee?  What to do about it? www.PTcares.com Anterior knee pain is one of the most common complains in an outpatient rehab clinic. It has several other names also, jumper's knee,  runner's knee, patellar tendinitis or tendinopathy. Just like other conditions, it is important to knee the mechanism of irritation associated with pain. There is a concept of primary and secondary impairments when many joints, tendons, and muscles are involved. The pain is simply a protection mechanism of our body to inform our mind that something is wrong. So the pain is not a bad thing. Don't kill the messenger, right? As I explained in the last post about the knee dislocation, the kneecap was supported by quad muscles, patellar ligament, and retinaculum on both sides. When the balance was not well maintained statistically or dynamically, the bones of the joint ---patella bone and femoral bone might rub each other with a lot of pressure

What is TMJ dysfunction or Jaw pain? How to fix it? TMJ irritation/pain is a very common complaint after injury or MVA. A lot of my clients did not know that PT can help. So today let take a look at the TMJ anatomy and treatment options. The TMJ is a joint on the jaw allowing mouth open movements. There is an articular disc inside the joint, which could be the source of the pain after injury. Similar to other joints of our body, the TMJ might also develop into arthritis with overuse activities. Things that might contribute to the TMJ irritation: 1. Direct injury with violence, MVA 2. Chewing gum or food mostly on one side 3. Leaning on one side of the jaw with hand 4. Sleeping on the belly with head turning to the left or right side in bed 5. Chronic grinding or clenching of teeth at night 6. Excessive hypermobility of joints Tricks to check if you have a TMJ issue: 1. Open your mouth in front of a mirror and check if you jaw shifts toward sides or maintain in the ne

4 factors that contribute to the kneecap dislocation www.PTcares.com Kneecap is a bone in the front part of the knee joint, also is known as the patella. Many young athletes have dislocation accidents followed by pain, swelling, and significant functional limitations. My friend's 18 years old son, Tom, has been diagnosed with Patellar Femoral (PF) joint dislocation. As a bike-riding lover, Tom was sad to be told by his PCP to stop the biking for 3 weeks after the accident. He had X-ray done and was suggested to go to see an Orthopedic surgeon for suggestions and see an experienced PT for quadriceps training.  Tom's mother asked me this question, "Why and how to deal with the kneecap dislocation?" So today I will share with your the 4 factors that contribute to the kneecap dislocation. 1. The shape of the distal femur bone. There is a groove in the distal femur bone that accepts the kneecap while the joint is moving into flexion or extension. When the shape of

Why you should not wait for too long before seeing a medical professional after injuries? www.PTcares.com One of my clients told me that she waited for 5 months before coming in to see a physical therapist after her car accident. Her neck had a lot of pain, stiffness and muscle spasm. After 2 visits in 2 weeks, her neck was much better, and she stated: "I wish I could talk to someone like you immediately after the car accident." With her permission, I am here to share with you the story of her accident and why you shouldn't wait for too long to see a professional after the injury. My client's name is Kay. She had car accident back in Oct 2017 with a T-bone hit from the passage's side. She got a police report and felt ok when the ambulance sent her to the ER of a local hospital. Her X-ray was negative without fractures but with the reverse curve of the cervical spine---neck bone is straighter than usual. She gradually developed a headache, neck and upper bac

WWW.PTcares.COM My 4 years old son had left knee pain after a near falling accident in the Exp lora. After a brief exam, I did not find any problems with the knee, so I turned my attention to the hip. He had some difficulty of left hip extension with a very slightly posterior tilt of the left pelvis. I worked on the hip joint with hip extension and mild~moderate anterior tilt of the left pelvis in the prone position. He started to giggle and fight against the mobilization and ended up with a mild popping of the left SI joint. He then was able to walk, jump and do all kinds of crazy motions. Knee pain could be the first sign of a hip pathology! I had a similar experience when I practiced as an ER physician years ago. In that case, an MRI of the hip joint confirmed the diagnosis. Next time your kid reports knee pain, you should ask your pediatric doctor or your physical therapist about the hip. Today I want to share with you another phenomenon I observed in t

WWW.PTcares.com One of my clients was diagnosed with Rotator cuff muscles injury.  She asked me about the rotator cuff muscles and why they are contributing to the shoulder pain and neck pain.  Today we will talk about the function of rotator cuff muscles. There are 4 rotator cuff  muscles: Supraspinatus Infraspinatus Teres Minor Subscapularis The primary function of the rotator cuff muscles is to maintain the stability of the glenohumeral (GH) joint, which is part of the shoulder complex.  As you can see, there are 3 bones in the shoulder complex: Scapula, clavicle and humeral bone. When the rotator cuff muscles are weak and could not maintain the humeral head close to the glenoid of the scapula, the humeral head might not glide smoothly and impinge surrounding tissues, causing connective tissue problems, such as tendinitis, bursitis, capsulitis, or rupture of tendons or ligaments. When the connective tissues and muscles around the sho

WWW.PTcares.COM By Dr. Wu Doctor of Physical Therapy Do you have dizziness for couple seconds when you turn your head to left or right? Do you have trouble getting in and out of bed or your vehicle? Are your symptoms getting worse after a falling or car accident? If you answer at least one "Yes" to the above 3 questions, you probably have a condition called "BPPV."  Today I will share with you more information about this unique condition and treatment options. What is BPPV ? BPPV is the abbreviation of  Benign Paroxysmal Positional Vertigo. As you learn from the name of the condition, it is benign--not life- threatening, sudden onset position related vertigo.  The vertigo is related to the functional organ located in the inner ear. There are 3 input systems for balance sensation. 1. Vision 2. Vestibular system --inner ear 3. Somatosensory --sensation input from joints One of the theory for the vertigo is that the inputs from the above 3 systems a

www.PTcares.com Posterior Cruciate Ligament is a cross ligament in the knee, which provides stability of the knee joint.  Injury of the PCL is a typical sports injury. In this post, we will review PCL anatomy, function, and 4 common mechanisms. There are 2 primary functions of the PCL. 1. resist knee flexion, avoid excessive posterior translation of the tibia or anterior translation of the femur bone. 2. resist extremes of varus, valgus and axial rotation.  4 most common Mechanisms of PCL injury 1. D irect blow to anterior tibia or  Dashboard injury 2.  Severe hyperextension of the knee 3.   Falling and landing on the proximal tibia   4.  Large axial rotation or valgus-varus applied torque What not to do? Without the protection of PCL, your knee might not be stable enough for vigorous workouts. Avoid any exercises the apply direct loading to the proximal tibia. Such as: 1. Rapid deep squatting 2. Leg press with hyperextension of the knee jo

www.PTcares.com My 17 years old female athlete patient finally gets rid of the back pain and leg discrepancy after 6 visits. She asked me why previous chiropractic approach on the hip and back did not help her for more than 3 weeks. My answer to that question was simple. After adjustment of the alignment, the muscles around the lumbar and pelvic needs to be able to hold the bones in the perfect position with functional activities. That is what was missing for most of my clients when they worked with other professionals. As you can see the right knee in the photo below, my client might report knee pain as the main issue. Legs discrepancy might contribute to back pain, hip pain, and knee pain. Manipulation techniques have been proved to be useful and effective for lumbar, pelvic and hips malalignment.  The long-term benefits of the exercises and self-adjustment technique should also be addressed for the maximum long-term outcome. Pelvic floor muscles are crucial to maintaining t

Why and how relaxing techniques might help to decrease your neck pain? www.PTcares.com Neck pain is one of the most common complains from my clients.  Today I want to share with you some useful relaxing techniques to decrease your pain. Before we get into more details of the methods, let's take a look the tissues around the neck. The neck connects the head and the upper trunk of the body. Many muscles are designed to balance the neck from all directions. As I pointed out in the last post , the neck bones are supported by joint articulation shape, connective tissues/ligaments, and muscles. The neck pain might be related to any of those structures. The key word here is "balance." If the head is placed ahead of the shoulders, the above structures will have to do a lot of work to stabilize the neck. The muscles might be tired due to the prolonged positioning in an unbalanced posture. When the muscles cannot support the neck, more stress will go to the joints and the c

What to do and not to do after the AC joint injury? Time Heals All Wounds, or Does It? www.PTcares.com OK. Let's face it. It is going to be painful and inconvenient after the AC joint injury. Based on the degree of the separation, you might be told to stay put and take it easy for a while by ED/family doctors. You might refuse to accept the surgery because you don't like to be cut open or you just want to try conservative approaches first. You are having the difficulty of putting on and taking off your shirts and pants and shoes, even socks. In other words, you are limited temporarily. Here is the tricky question: Time Heals All Wounds, or Does It? I am here to provide you more information and help you make the decision. Time heals NOTHING. It's what you do with that time. Why? All the joints in our body are balanced by muscles, ligaments, cartilage, bones shape, and your habit of doing. There is a chance that you might feel less irritation with time.

www.PTcares.com Recently a friend of mine had a falling accident in a playground and was Diagnosed as " AC joint separation". She reached out to me and asked the above questions. I spent time chatting online and I realized she had not clue what was going on and what to do about it. I decided to share some information here in case you need some help. What is AC joint? The  acromioclavicular joint , or  AC joint  is a  joint  connecting the acromion and the clavicle as showed in the following picture.  What is AC joint's function? Along with other ligaments, It stabilizes the shoulder girdle and maintain appropriate muscle tone of the neck, shoulder and para-scapular muscles.  What happened during the injury? When you fell, you landed on the shoulder and directly hit the acromion of the scapula and increased the shear force to separate the AC joint. Sometimes the violence might be strong enough to separate the coracoclavicular ligament, which is also ve