As part of OSTC's commitment to excellence, the professional staff is constantly seeking out and learning new techniques to help our patients.  This March, Thomas Patrey flew to San Francisco to attend a continuing education course to learn about the "Mulligan Concept."  

The Mulligan concept was developed by New Zealand Physical Therapist, Brian Mulligan F.N.Z.S.P. (Hon), Dip M.T.  This simple technique involves applying a sustained joint glide while the patient performs a pain-free movement. The goal of a Mulligan Technique is P.I.L.L., (pain-free, immediate and long lasting). One of the main ideas of the Mulligan Concept is "Mobilization with Movement" or "MWM.  This involves re-positioning of a body part to a pain free zone to help it move.  MWM generally involves the extremities of the body and is indicated for use when a body part is restricted or has painful movement.  Benefits of the Mulligan Concept involve decreased pain and increased range of motion.  

When asked what he liked best about the Mulligan Concept, Thomas replied, "The greatest thing about it is that this technique can decrease your pain to help you complete your physical therapy exercises, and get patients back to normal daily activities."

The biceps tendon connects the biceps muscle in the upper arm to the elbow. The tendon acts like a tough connective tissue. The inflammation of this tendon is bicep tendinitis. Physical therapy can help reduce pain and regain mobility.

Causes

Some of the causes of biceps tendinitis include:

• a fall that injures the shoulder
• excessive weight lifting
• overuse from recreational and sports-related activities
• a sudden twisting motion of the shoulder

Symptoms

1. Pain at the front of the shoulder joint that extends down the arm i.e. the biceps muscle.
2. Weakness in the shoulder
3. Decreased range of motion of the shoulder joint
4. A visible change in the shape and appearance of the front of the arm

Biceps tendinitis is the type of condition that feels like an inconvenience at first, but it is not something that should be brushed aside. This condition has the potential to escalate, causing severe pain and reduced movement in the elbow joint. This can impact the patient's quality of life and interfere with day-to-day tasks like holding a pen, working at a computer, lifting things, driving, cooking and cleaning.

A pain relief intervention plan involving collaboration between your physician and physical therapist is crucial for long-term healing. In fact, physical therapy helps in the prevention and the post-surgical rehabilitation of the shoulder and elbow joint.

A therapist can create a carefully designed recovery andrehabilitative routine. This routine may consist of several treatment procedures and techniques available to help facilitate healing of the biceps tendon and mobility in the shoulder and elbow joints. If you or someone you know has symptoms of biceps tendinitis or any health issue that limits strength and movement, we can certainly help. As your preferred physical therapists, we promise to use our professional judgement, experience and interest in your well-being to help you get 'back in the game' as quickly as possible.

Once a diagnosis is confirmedby your physician, conservative treatment involves rest, ice and progressive physical therapy. Medical treatment may involve the use of over-the-counter pain relievers such as ibuprofen and aspirin. A physician may also recommend prescription pain killers. In extreme cases, surgery may be required. An orthopedic surgeon can relieve swelling by opening the lining around the tendon and removing the inflamed tissue. Physical therapy plays a significant role in post-surgical recovery.

Prevention Tips

If you are engaged in ongoing, repetitive arm activity at work or home, make sure to rest periodically and do the following:

• Massage the shoulder, arm and elbow
• Stretch the muscles surrounding the shoulder and elbow
• If your arm is tingling, feeling numb or aching, it is time see your physician. If ignored, the condition can become painful and disabling.

Treatment

• Your physical therapist will help you avoid motions and positions that cause pain.
• Once the pain subsides, manual therapy and therapeutic exercise begin. The therapist will create a plan for:

• • Muscle strengthening
  • Joint mobility
  • Postural retraining
  • Supporting the shoulder and arm in a sling
  • Ergonomic intervention
  • Facilitating a safe home environment

Blood flow restriction (BFR) training is a training strategy that involves the use of cuffs or wraps placed around a limb during exercise.  The pressure is increased enough to restrict venous return, while allowing for arterial blood flow.  The person is then asked to perform high rep exercises with a very low weight. 

Blood flow restriction may sound scary, but the risks are no more than general weight lifting. Study after study proves that this training technique is useful in helping athletes and patients gain strength, power, muscle size and reduce muscle atrophy following surgery.

So why does BFR work?  Resistance training with low load weight training and BFR shows greater post-exercise muscle protein synthesis, higher growth hormone elevations, and more robust molecular signaling responses than conventional resistance training with a similar load.  

At OSTC, therapist often use BFR to help athletes maintain muscular strength after ACL or Meniscal Knee surgery.  This allows athletes return to their sport sooner!