Physical Therapy

Flute Player’s Pulled Neck Muscle Treatment

Clara, a flute player, came in for therapy on Tuesday morning reporting that she was in too much pain to play her instrument and could not function normally during the day. She was exceptionally busy the previous week playing upwards of 8 hours a day and performing three concerts in one week. On the Monday morning after this week, the day before her first treatment, she was drying her hair and pulled a muscle in her neck. She felt a sharp pain that resulted in an immediate loss of motion. She was un-able to play her flute that day due to intense pain. Clara had had no previous episodes of neck injury but commented that she plays flute, so she has some “inherent neck tension.”

She immediately went to seek medical help. She made an appointment with an internist for that Monday afternoon. The physician told her to make an appointment with an orthopedist. This usually takes about 2 weeks. In the meantime, she was instructed to apply ice and take Advil. Clara made the appointment but was not satisfied with waiting. She was also told by the physical therapist at Juilliard that no appointments were available until the following week. It is essential for a working musician to be able to receive immediate treatment and begin practicing again.

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Consistency and Commitment to One Treatment

If you are suffering from an injury, have pain or discomfort in your body you should do the appropriate research to find “the right” treatment and physical therapist to cure your ailments.

In other words, lets say you have injured your shoulder/rotator cuff and all basic movement such as raising your arm above your head, putting your t-shirt on or shampooing your hair hurts. You have done your research and found that there are many options of treatments, such as message therapy, acupuncture, traditional physical therapy and alternative physical therapy. Keep in mind you could research forever and in a city like New York there is a world of options.

A friend can give advice and make recommendations for treatments, but only you can know what you feel and what works for your body. Allow your self the time to listen to your body and commit to one style of treatment, try to avoid going to various practitioners and receiving different sessions because both the practitioner and you, the patient, will lose the notion of which treatment really worked and which did not. At a certain point you will not have the ability to judge which treatment had the best effect on your body.

Once you found a practitioner/specialist that is helping, you should commit to the treatment for an extended period of time. It is not beneficial to jump from treatment to treatment or from modality to modality. You should have at least 10-20 appointments, in order to reap the benefits. The idea is for you, the patient, to walk away feeling really good.

You really need to give your shoulder the time to heal and be patient with yourself and the treatment. After a number of sessions you should see improvements in your shoulder and feel the benefits in your body. Remember to be kind to yourself and acknowledge that recovering from a shoulder injury is not easy and can be frustrating, but that with a dedicated alternative physical therapist working with you, you will get better and be happier.

Alternative Physical Therapy

In traditional Physical Therapy programs a student is taught 10-15 conventional approaches to be utilized in Hospitals and Medical Centers. These facilities have very strict rules regarding modalities permitted to be used for treatment. For this reason teachers and professors mostly teach traditional therapies and modalities which in turn are FDA approved for Hospitals. An interesting point to emphasize is that all machines used for physical therapy in a hospital need FDA approval. In turn the insurance companies have assigned codes to each therapy and they will only approve the treatment/machine with the proper code number. Most code numbers were done 30-40 years ago and it now takes 5 or more years to get a new code number which discourages a hospital or medical center to venture into new territory for physical therapy because they will not get paid for a long time.

In a private practice the physical therapist can use any modality that he or she thinks could work for the patient. A physical therapist that is working independently of medical centers, hospitals and insurance companies has the flexibility to utilize a variety of techniques and no limitation of time.

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Discovering the Source of Pain and Connecting to the Body

body-pain

Pain in any part of the body is a sign that the body of out of “tune.” For instance one can complain of pain in the knee, but the x-ray, MRI and even manual testing show that there is nothing wrong with the knee.  So the question becomes why is this person complaining of knee pain? In this case we need to look at the body parts that are directly related to the knee such as the back, hip and ankle.  One must analyze the hip and ankle to understand what is occurring in the knee.

A person with a limited range of motion and flexibility in the back, hip and/or ankle requires the knee joint to work twice as hard, eventually causing discomfort, then tension and finally pain in the knee. If the issue is not addressed simultaneously in the back, hip, knee and ankle it can lead to inflammation of the tendons, sprained ligaments and inevitably major problems in the knee.

In order to resolve the problem in the knee, one should have a number of body tuning treatments on the back, hip and ankle as well as perform movement exercises at home.

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Student Musicians’ Injury Treatment

I spoke with a client of Dr. Shmuel Tatz’s named Sarah, recently in the office after her treatment.  She is a violinist at Mannes conservatory, which is part of the New School; the campus is on the upper West side.  She came to Shmuel initially for about 3 months of treatment and by the end she showed significant improvement.

Most importantly, she is now able to play again with ease and more comfortably. She feels much better overall.  She gave a glowing review of Shmuel’s abilities, “He is wonderful, he is the best, he is better than everyone else I’ve seen.”

She is never sore after a treatment and is able to play at events and concerts the same day, which is a concern for musicians I’ve learned. In many cases musicians in physical therapy may have to schedule therapy on days they don’t play, because you don’t want to be sore from a treatment on the day of a performance.

The young student said that her school does not have any formal support programs in place to help musicians who are experiencing pain from playing their instruments.  She wished that they did have this option available, as many need physical therapy services.

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How to Choose the Best Physical Therapist

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In general patients should be aware that having a physical therapist license does not mean one automatically gets good results. The patient should always do their research before choosing the appropriate physical therapist and then request the full attention and the best possible treatment. Many of the patients that I currently treat have gone to other physical therapists before eventually coming to see me.

Rarely do I receive a patient with an ailment in the body that has been treated by a physical therapist that has spent the appropriate time working on them. By this I mean if one has tendinitis in the shoulder or knee, the physical therapist should concentrate on the tendon using a hands on technique for about a half hour, applying the right amount of force, without causing too much discomfort. The patient should never feel so much pain that they want to jump off the table or tense another part of their body, but they should feel a release and relief during the session. One should see the physical therapist’s hands moving slowly and intensely, not hurting the patient but listening to the body and tendon in order respond and aid in the healing process. There should be communication and understanding between patient and physical therapist. The goal of the physical therapist should be to change the position of the tendon and put it back into the right place. This is not an easy task nor does it happen in one treatment. The most important part of the process is to work with an experienced and talented physical therapist.

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Physical Therapy: Treating the Problem, Not the Symptoms

Everyone experiences muscular or skeletal problems in their lives, no matter what their lifestyle. A dancer will have back problems, as will a couch potato, albeit through very different mechanisms. These aches and pains are part of life. What is worrying however is the number of people who choose to ignore these signs from their bodies and continue as if nothing is wrong, or even worse, mask the pain with drugs so they can continue doing the things that caused the pain in the first instance.

The Sticking Plaster Approach

It is very easy to take painkillers. Just wash them down with a glass of water and the pain will subside within a few minutes. But it is worryingly common for people to become addicted to these painkillers through continued use. As the cause of the pain is not being treated, it persists. Moreover, it gets worse as the individual continues performing the same movements that initially caused the injury. They increase the dose to deal with the extra pain then, when OTC drugs no longer hide the pain, they move on to harder prescription medication and the cycle starts again. By this point they cannot dance, play, run or perform without the use of the painkillers and addiction has set in. At some point even the strongest painkillers will no longer mask the pain so the person will just be left with a drug addiction and pain. Alongside their addictive properties, pain relievers such as oxycodone and codeine have a number of nasty side-effects that could lead to coma or death even in otherwise healthy individuals. Eventually, if the individual does realize they have a problem, they may phone a help line or check into rehab to mitigate the problems. Unfortunately, the injury and its pain that started the whole thing will still be there, waiting for real treatment.

What these people really need is physical therapy. The actual manipulation and massage of the muscles or joints that are causing the pain will, with time, actually treat the injury not the symptoms.

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Surgeries to Avoid: Knee Arthroscopy for Osteoarthritis

Reasons to think twice before going under the knife

With this procedure a surgeon places a tiny camera in the knee, then inserts small instruments through other incisions to repair torn or aging cartilage. Studies show the operation works well when patients have in fact torn their meniscal tissue, but it is no more successful than noninvasive remedies in treating osteoarthritis of the knee. In a 2008 study, 178 patients with osteoarthritis received either physical and medical therapy without surgery, or therapy plus surgery. After two years the two groups had nearly identical outcomes, reporting less pain and stiffness and more mobility.

Alternatives to surgery

If you have knee pain, “start with the least harmful and invasive treatment and work your way up the ladder,” says Colin Nelson, a senior research associate at FIMDM. This includes lifestyle changes such as exercise, as well as medication and cortisone injections.

by Karen Cheney, AARP The Magazine, July/August 2011

Surgeries to Avoid: Complex Spinal Fusion for Stenosis

Reasons to think twice before going under the knife

With spinal fusion, a surgeon places bone grafts that “weld” two or more vertebrae together to prevent motion and stop pain. The procedure is often used to treat back pain from spinal stenosis, which occurs when the soft tissues between the vertebrae flatten out, creating pressure on the spinal cord or nerves that go to the back, arms, neck, shoulders, and legs. There is little consensus on how best to relieve pain from stenosis, so doctors tend to develop their own preferences, says Richard Deyo, M.D., professor of medicine at Oregon Health and Science University.

Not all surgeries are worth the risk. — Getty Images/Uppercut RF

Not all surgeries are worth the risk. — Getty Images/Uppercut RF

Their top treatment choice increasingly seems to be fusion. Deyo recently studied the records of more than 30,000 Medicare patients who underwent surgery for stenosis of the lower back and found that complex fusion procedures (in which surgeons place bone grafts between multiple vertebrae) had increased an astounding 1,400 percent between 2002 and 2007.

The risks are significant: Those who underwent complex fusion were nearly three times more likely to suffer life-threatening complications than those who underwent less invasive surgery. Previous studies have also found that most fusion patients experience no more relief from their chronic back pain than those who had physical and behavioral therapy. “There is even some evidence that [complex fusion surgery] is worse than other surgeries,” says Floyd J. Fowler Jr., Ph.D., senior scientific advisor for the Foundation for Informed Medical Decision Making (FIMDM). “The vertebrae right above and below the fusion have to do a lot more bending, and it puts stress on your back above and below.”

Alternatives to Surgery

Before considering any type of back surgery, make sure you have exhausted more conservative measures, including physical therapy, cortisone injections, acupuncture, and medications. “Probably less than 5 percent of all back pain requires surgery,” says Arnold Weil, M.D., clinical assistant professor of rehabilitation medicine at Emory University School of Medicine in Atlanta.

by Karen Cheney, AARP The Magazine, July/August 2011

Herniated Disc Pain Relief: A Sister’s View

In June of 2013, my sister began seeing Dr. Shmuel Tatz. She has been suffering for years with a herniated disc. The misguided treatment had later brought on other issues causing her pain throughout her body. With very little relief from other physical therapists we were not sure what to expect from Dr. Tatz. On our first visit she explained her injury and they kept the conversation between them to a minimum. He knew exactly where her pain was and was able to alleviate the numbness in her big toe instantly. This was surprising since she had been complaining about this for almost a year to other physical therapists. I have watched many physical therapists work with her over the course of 6 years and have yet to see anyone like Tatz. With very little words he understands and can point out her pain without her having to explain what she is feeling. After so many years of her having to explain her pain, she got tired of the charts and having to constantly describe what she was feeling. It just felt as if none really understood her pain. After that first visit my sister felt understood, without having to go into so many details about what she was feeling. He told her that every time she left there she should feel a difference.

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