By John Vicchio, PT, CCTT
Breathing is unquestionably a key function of the human body. It sustains life by providing oxygen needed for metabolism and removing the by-product of these reactions, carbon dioxide. Breathing has other functions that affect motor control, postural stability and roles in maintaining homeostasis function (maintain internal stability such as balance and equilibrium) in the autonomic nervous system and circulatory system. When breathing becomes dysfunctional it affects people’s lives, challenging homeostasis, creating symptoms that most patients do not associate with their pain and compromising health.
The primary muscles of breathing are the diaphragm, intercostals (muscles running between the ribs) and abdominals, which allow the average person to take over 21,000 breaths per day. These muscles are located in the chest wall compromised of the rib cage/thorax and the abdomen, creating an effective respiratory pump. The respiratory pump can become dysfunctional due to many factors, which are altered and paradoxical motion between rib cage and abdomen called paradoxical breathing, thus increasing use of upper body muscles such as the scalenes, upper trapezius and sternocleidomastoids. Abdominal weakness and rib cage stiffness are common dysfunctions that we see at North Jersey Physical Therapy Associates (NJPTA).
At our clinic we evaluate and treat on how breathing affects postural stability and motor control. Muscles such as the diaphragm, transverse abdominals and pelvic floor muscles are important for motor control and postural support as well as for breathing. If their function is compromised there is an increased susceptibility to low back pain and injury.
At NJPTA, we take a unique approach in treatment, which includes an extensive assessment and treatment using manual therapy interventions, neuromuscular exercises (90/90 Diaphragm breathing, Buteyko breathing) and dry needling. These are all helpful tools in restoring and maintaining motor control/postural stability.
Below is an illustration of optimal breathing from Integrative Core Dynamics:
The American Physical Therapy Association (APTA) represents more than 80,000 members throughout the United States, and established the specialist certification program in 1978. The specialist certification program was created to provide formal recognition for physical therapists with advanced clinical knowledge, experience, and skills in a special area of practice, and to assist consumers and the health care community in identifying these physical therapists.
The American Board of Physical Therapy Specialties (ABPTS) coordinates and oversees the specialist certification process. One such designation, received by North Jersey Physical Therapy Association’s (NJPTA’s) Kathryn Haskins, is the Orthopedic Clinical Specialist certification. It is important to note that as of June 2014, according to ABPTS, only about 10% of PTs in the U.S. are certified as Orthopedic Clinical Specialists.
As an Orthopedic Clinical Specialist (OCS), PTs strengthen their knowledge in the following body regions:
Additionally, OCSs have increased their orthopedic practice dimensions in the following areas:
More focus and study is placed on knowledge areas and procedures that orthopedic clinical specialists use in their work, which are as follows:
NJPTA’s Kathryn Haskins has her doctorate in Physical Therapy, is certified in Dry Needling, and now in Orthopedic Clinical Specialty. These unique credentials enable her to provide the upmost in services for those suffering from conditions that may include, but are not limited to sports injuries and spinal disorders, in addition to pre- and post-orthopedic surgeries. By using dry needling, myofascial release, neuromuscular reeducation, manual therapy techniques and laser as well as key exercises, Kathryn and NJPTA are dedicated to bringing patients sustained pain relief and pain-free function.
To schedule an appointment with Kathryn or our other well-qualified PTs, please Contact Us.
By Carol Cote, PT, CCTT, CODN, CMTPT
On Friday, June 5, 2015, Dr. Kevin F. Muench, MDM, MAGD of Maplewood, NJ presented a new perspective on evaluating patients with TMJ to NJPTA physical therapists. NJPTA continues to stay abreast of rehabilitating the head, neck and jaw with dry needling, myofascial release, neuromuscular reeducation, laser and key exercises. NJPTA is grateful to Dr. Muench for his time and inspiring lecture.
In a later photo, Dr. Muench (left), Dr. Robert Eskow DMD, MSCD (middle) and Carol Cote, PT, CCTT, CODN, President and Director of NJPTA (right) further discuss different patient scenarios. NJPTA has two physical therapists board certified in CCTT (Certified Cervical Temporomandiular Therapy). There are only about 35 therapists within the U.S. that have this certification.
By Carol Cote, PT, CCTT, CODN, CMTPT
In the general medical population we make the mistake that muscles are under 100% voluntary control. This is partially true, however, the majority of our muscles are more automatic (i.e. autonomic nervous system) than voluntary (somatic nervous system). Our muscles are controlled by 2 nervous systems. The somatic nervous system is our voluntary nervous system. When we bend our elbow and move our bodies voluntarily that is done through the somatic nervous system via our motor cortex.
Our second auto pilot nervous system is our autonomic nervous system which is more about bodily functions that help us survive (heart beat, body temperature, blood pressure, digestion, etc). Muscles are innervated by both nervous systems. For example, breathing. We have voluntary control with our breath but breathing is more automatic than voluntary. Muscles of our spine, shoulder blades and pelvis are more autonomic than voluntary. Autonomic muscle control has to do with how we hold our body against gravity. Our brain is blind to gravity, reflexes (such as balance) and habits (motor activation patterns
and muscle memory). Holding our head up and balancing is automatic very much like breathing. When it comes to neck and back pain and muscles this problem is an involuntary muscle problem.
Dry needling works to change our autonomic motor control affecting our auto pilot muscle activation pattern by releasing the trigger points (involuntary muscle contractures) that exist in chronic soft tissue pain. Dry needling works faster than traditional manual therapy like massage and even joint manipulations, treatment strategy needs to address the right level of where the problem is. Dry needling works at the three levels of how our bodies process pain:
1. Peripheral (skin, muscle, bones, joints)
2. Spinal (spinal cord, nerve roots) and
3. Brain (motor and sensory cortex along with our thinking/decision making and emotional brain).
Dry needling is a key treatment strategy which works at all levels (voluntary and involuntary) all at once and allows for permanent sustained change.
By Carol Cote, PT, CCTT, CODN, CMTPT
Dry needling of trigger points has unprecedented results in patient care treatment protocols when addressing orthopedic, musculoskeletal, neuromuscular and chronic pain conditions. We at North Jersey Physical Therapy have fully integrated dry needling of myofascial trigger points as part of our rehabilitation treatment protocols that include manual myofascial release, neuromuscular rehabilitation and exercise. Some observations/results with dry needling are unattainable via traditional physical therapy.
Dry needling releases the muscles’ contractures (trigger points) in both muscles and myofascial bands in soft tissue pain while facilitating a more balanced muscle activation pattern. We believe dry needling when combined with manual myofascial release and active release treatment strategies creates a change in the motor cortex, cerebellum and sensory cortex. Dry needling facilitates a change in muscle tone, muscle memory and activation patterns while relieving muscle pain. There is frequently sustained pain relief and perceived lightness/proprioception to the movement.
The human brain learns movement by doing and feeling which becomes habit which then becomes more hard wired. For example, riding a bike is an example of a muscle memory habit. We don’t have to think about how to ride a bike once we’ve learned it (body felt learning). If however, our habits over work key muscles and tendons during our grip, elbow and wrist, tendonitis of the elbow develops as a result when wear and tear exceeds repair. Dry needling the muscles and fascial bands allows immediate release of painful trigger points while also creating an inhibitive influence not to over contract those
muscles that habitually (through muscle memory) get overused. The human brain is
linked to habit and we are unaware of this process.