Provider Spotlight: Bill Rein Helps the complex PT Patient

In order to know more about Bill Rein and one of his favorite topics, we needed to get past his least favorite.

“Yeah, I don’t really embrace talking about myself. So let’s get that out of the way,” Rein began.

Just did.

Once acknowledged, Rein spoke (quite willingly, by the way) about his passion for treating patients with chronic, persistent pain issues. He traced it back to the beginning.

“All of the professors and mentors I had were excellent working with their hands, but more than that they were great clinical decision-makers,” said Rein. “I wanted to model my career after those people.”

At Rein’s first job, he had the good fortune to work with a Fellow of the American Academy of Orthopedic Manual Therapists, a provider who completed stringent post-graduation specialization programs in the field of neuro-musculoskeletal disorders and the use of hands-on treatments of muscles, tendons, ligaments and joints.

“I worked with him for two years, and he kind of pushed me in a direction to treat spine conditions, neck, back, headaches, the sacroiliac region. I really took a liking to that,” said Rein.

That pushed Rein to earn his specialty certification as an Orthopedic Clinical Specialist (OCS). After 2,000 hours of direct patient care in orthopedics and a rigorous exam showing they have expertise in diagnosing, treating, and preventing orthopedic conditions, the OCS brings that additional level of understanding to their patients.

And that’s what Rein did. Still, there was some frustration.

“I felt I was getting four out of five patients to where they needed to be, but it was that fifth one that kept me up at night,” said Rein. “So I needed to keep searching for ways to help those I wasn’t able to treat effectively, patients with chronic issues who had been seen by multiple healthcare providers and still weren’t getting the relief they sought.”

So Rein kept at it.

Doing a lot of reading, engaging in a lot of research on his own, and teaching as part of his orthopedic residency, Rein’s work delivered him to the place he is now, where treating the most complicated patients has become his passion.

“There's something about the shared collaboration, trying to figure out with patients exactly what is going on and how we can help them, and where we, the medical establishment, may have missed the boat in treating their pain,” said Rein.

Rein feels he can take the vast majority of those challenging patients and find something that he can offer them that will help. That’s not 100%, though.

“There are still patients where physical therapy just isn’t going to work,” said Rein. “But I feel confident that I can offer things to them even if it’s just in the way of explaining what they are going through, to plant the seeds that might help them to not have to get an injection, or be on medication, or have a surgery later on, if I give them the tools they need now.”

And he strongly believes in a team approach.

“I feel very comfortable collaborating to get patients the help they need, facilitating connections with providers—a physiatrist, an orthopedic physician, a primary care specialist—who excel in these cases,” said Rein.

Rein estimates that about a quarter of his patients have chronic conditions.

“There's someone on my schedule pretty much every day that has a persistent pain condition,” he said.

Rein’s interviewer (me) admitted to having low back issues for much of his life. Is that considered chronic pain?

“I’m definitely not saying the low back issues you just described, which are fairly common, haven’t been debilitating and life-affecting for you,” said Rein. “But that's very different than the patient who's had fibromyalgia for 30 years, has severe headaches every day, and low back pain with pain radiating down the legs and is barely able to move. That’s a more challenging population.”

It’s a challenge Rein embraces.

“It’s about taking the emotion out of the pain experience, looking at it objectively, being a detective with you and trying to figure out how your body is working. When you connect the dots, it’s a very powerful thing.

Bill Rein serves patients at Advanced PT’s Appleton West location on Casaloma Drive.

He received his master's degree in Physical Therapy from the University of Wisconsin-Madison and subsequently earned his Board Certification in Orthopedic Physical Therapy. Additionally, Bill is certified in ASTYM (augmented soft tissue mobilization) and Trigger Point Dry Needling (Level 3).

His professional interests involve seeing patients who have shoulder, knee, and spinal issues.

Essential Exercises to Prevent Low Back Pain

By Joe Hanel, LAT

Back pain can be quite complex and a real hassle.

Whether you strained your back lifting something, sat for too long, or woke up with that all-too-familiar ache, back pain can really slow you down.

But here’s the good news—there are things you can do to help!

When back pain hits, it's important to take action.

Rest is a good starting point, but recovery requires more. You need to stay active and work on strengthening your back to help it heal and stay strong.

And remember, not all advice about back pain is accurate.

Let’s clear up some common myths:

• Myth 1: "If My Back Hurts, I Should Rest All Day."

  • Resting a little can indeed help when your back hurts. But too much rest can make your back worse. When you don’t move, your muscles can weaken, and stiff muscles can lead to more pain. Gentle exercises within pain limits can help reduce pain and keep your muscles strong.

• Myth 2: "Lifting Heavy Things Always Causes Back Pain."

  • Your back is strong and resilient. Lifting heavy objects can hurt your back if you do it the wrong way too many times in a row for an extended period, but learning the right technique can actually strengthen your back. The key is to lift with your legs, not your back. Keep your back flat, bend your knees, and use your leg muscles to lift. If you do find yourself out of position, it’s not the end of the world but you’ll want to focus on your form with each lift if your job requires repetitive lifting tasks.

• Myth 3: "Only Old People Get Back Pain."

  • Back pain can happen at any age. While it’s true that it becomes more common as we age, kids and teenagers can experience it, too, especially if they carry heavy backpacks, play sports, or spend too much time sitting. Everyone needs to care for their back, regardless of age.

  • It’s estimated that up to 80% of Americans will experience lower back pain at some point. Low back pain and disability impact up to 62% of our industrial workforce. Low back pain can also affect our police, firefighters, and emergency response at similar rates.

So, what can you do to prevent low back pain?

Over the years, I have treated LBP patients in many ways, trying lots of different approaches and hoping something provides them relief.

I have found that preventative exercise is the best way to prevent recurrence for many of those I have treated. Often, it may not be a lower back injury or tightness causing their discomfort, so it is important to address core strength and hip mobility while examining the lower back.

Check out this exercise progression, for example:

Start with a warm-up:

1. Single knee to chest stretch: Lay on your back with knees bent, draw in belly button to engage core. Birng one knee up to your chest and hold for up to 30 seconds; switch sides.

2. Rotation stretch/knee rock: Lay on your back with knees bent. Draw in belly button to engage core. Slowly rock knees to one side and hold for up to 30 seconds; switch sides.

3. Lumbar rotation stretch: Lie on your back, then bring one knee toward your face so that your hip is flexed to 90 degrees. With the opposite hand, pull it sideways toward the floor to feel a stretch in the lower back/buttock. Keep your shoulders flat on the ground during the stretch.

4. Back bridge: With head and shoulders relaxed tighten abs and glutes. Push through your heels to raise your hips, hold for 3 deep breaths and repeat.

Move to some strengthening Exercises:

5. Contralateral Extension: Activate your lower abdominals by bringing your belly button inward and by activating your pelvic floor muscles (inner thigh). Maintain steady abdominal breathing while you lift one arm and opposite leg up towards the ceiling keeping your chin tucked in. Return and repeat with the other arm and opposite leg.

6. Bird Dog (band optional): On all fours, draw in belly button then extend one arm then the other, then one leg then the other. Focus on keeping your back flat and staying balanced. Hold in extension for 1-3 sec. then switch sides.

If that’s too easy, try moving one arm up and the opposite leg up at the same time. Focus on keeping your back flat and staying balanced. Hold in extension for 1-3 sec. then switch sides. This movement should be slow and controlled.

By working up with core strength and hip and spine mobility, you'll keep ahead of lower back tightness and pain.

—

Disclaimer: As a reminder, these exercises are for educational purposes only and should not be taken as medical advice. If you have a complex history of lower back pain, are unsure if these exercises are right for you or have pain while doing an exercise, it is recommended that you connect with one of our skilled clinicians to assess further. It may be recommended that these exercises or a different series are accompanied by manual therapy, trigger point dry needling, and therapeutic cupping to ensure that you achieve your goals and eliminate your lower back pain for good.

CranioSacral Therapy: Understanding the body’s response to trauma

“It’s not something that’s considered mainstream,” he said. “But it can be very powerful.” 

So, the discussion about cranial sacral therapy begins with Dennis Kaster, a longtime physical therapist at Advanced PT. 

Kaster has as much experience as a PT practitioner as just about anyone on the Advanced team. He confirms what his online bio states, that he has a great deal of experience in the areas of the spine, chronic pain, hand injuries, sports medicine, industrial rehab, and various manual therapies. 

One of those manual therapies is cranial sacral therapy (CST). This alternative treatment releases tensions deep in the body to help reduce pain, relieve dysfunction, and improve whole-body health and performance. Dr. John Upledger pioneered and developed CST in the mid-seventies at Michigan State University. It’s a gentle technique Kaster has used with patients for decades.  

Describe gentle. 

“When I went through training,” Kaster said, “the instructors described CST this way: ‘You’re using the same amount of pressure you’d use to bend the Legs of a fly.’ It’s that subtle.” 

CST focuses on the connection between the cranium or skull and the sacrum or tailbone to relieve tension within the body’s connective tissue, called fascia. Kaster uses it frequently with his patients suffering from chronic pain. Many of those patients are women who have suffered physical or sexual abuse.  

“There’s a lot of trauma in their past, a lot of post-traumatic stress disorder,” said Kaster. “Probably half my caseload relates to migraines and headaches, and many of those patients have PTSD. 

Because CST isn’t mainstream, few people have been trained in the practice, and people looking for the relief it can offer can’t find clinicians to do it. Kaster says that he gets people all the time who come from a distance to see him. 

“I see patients in Stevens Point and other areas,” Kaster said. “One of my patients travels from Minneapolis to see me because she can’t find anyone there who does it.” 

So how is it done? 

For a typical PT visit (about 40 minutes), Kaster will use the technique when appropriate or combined with other approaches (such as manual therapy, functional exercise, and other interventions)

With the CST portion, Kaster is looking for a “rhythm or pulse,” feeling for the movement of the body’s connective tissues and any restrictions encountered.  

Cranial sacral therapy has differing results for patients. At times, the technique has little or no effect. With others, it’s life-changing.  

Kaster describes the technique as simply another tool in the toolbox.  

“I assess people to see if they have tightness and restrictions,” said Kaster. “For many people with headaches, any type of neck, low back, mid-back pain, tension, post concussions, chronic pain, CST can be a powerful tool.” 

By releasing the restrictions in the craniosacral system, Kaster says, you’re engaging the body’s innate healing processes, which has benefits for a wide range of physical challenges faced by his patients.

Kaster says another huge component of the technique is SomatoEmotional Release (SER), which expands on CST principles to help people rid their bodies of the residual effects of past injuries and negative experiences.  

Also a gentle process, SER facilitates the release of negative energy and allows the body to heal. Kaster describes it as working through layers of an onion. But the gentle process can bring forth some very emotional memories. 

“It’s important that the patient is working with a counselor before using SER techniques, as things can be brought to the surface that patients aren’t ready to deal with,” said Kaster. “But I’ve found it helps people to heal and get over deeply buried emotions, which is important because psychological trauma will manifest itself into physical conditions.” 

Kaster recognizes that some medical professionals will refer to CST and SER as “voodoo medicine.” That’s not his worry.   

“I’ve got 35 years of experience and a heck of a lot of training in it, and it’s helped so many of my patients,” said Kaster. “Like I said, perhaps not mainstream, but so very powerful.” 

If you have questions about Craniosacral Therapy or want to see if it’s a good fit for your treatment plan, please use our online submission form.

—

About the Author:

Dr. Dennis Kaster is a physical therapist at Advanced PT’s Stevens Point North clinic on Division St. He has been happily married to his wife Adrienne, who is also an extraordinarily talented physical therapist, for almost as long as they have been practicing. They love cycling, hiking, and traveling. They also love helping people feel better, which brings them joy.  

Recover Smarter with Blood Flow Restriction (BFR) Training

Can restricting blood flow really help you get stronger?

Well, sort of! Let us explain.

Blood Flow Restriction (BFR) training is a powerful tool athletes and individuals use to maintain strength and prevent muscle loss during rehab or recovery from surgery.

BFR involves applying a tourniquet-like system (similar to a strong blood pressure cuff) to the arm or upper thigh, reducing the flow of oxygenated blood to the muscles. When combined with low-intensity exercises, BFR tricks your body into working just as hard as you would during normal weightlifting or practice.

Benefits of BFR Training:

• Maintain muscle size and strength after surgery

• Reduce pain from muscle strains

• Safely build strength and endurance while recovering from an injury

• Achieve the same results as regular training with 20-30% less weight and effort

• Release endorphins and other natural healing substances, similar to regular exercise

Is BFR Safe?

Yes! BFR training has been proven safe and effective for most individuals cleared for exercise.

However, people with Factor V Leiden (a condition that increases clotting risk) should avoid BFR.

If you have cancer, a bone fracture, an infection, or are pregnant, consult with a healthcare provider before trying BFR.

In most cases, there is no increased risk of blood clots or deep vein thrombosis (DVT) associated with BFR.

What to Expect with BFR Training:

During a BFR session, as your muscles fatigue, you may feel a lactic acid burn, similar to what you'd experience during an intense workout.

Afterward, you might experience delayed onset muscle soreness (DOMS) for 24-48 hours, especially if you're new to exercise. This is normal and tends to decrease with repeated sessions.

When paired with a comprehensive treatment plan—including manual therapy and functional exercises designed with your physical therapist—BFR can be a valuable tool for recovery and strength building.

BFR training is available at our Appleton East, Champion Center, and Green Bay East locations.

Dr. Gerad Donahue and Dr. Blake Van Maanen, who contributed to this article, serve patients at our Clinic within the Champion Center on Champion Dr. in Grande Chute, WI.

Tendonitis 101: What Every Industrial Worker Should Know to Stay Pain-Free

Tendonitis is a prevalent condition characterized by inflammation of a tendon, the thick fibrous cord that connects muscle to bone.

It typically results from overuse or repetitive stress and can affect various tendons throughout the body, including those in the shoulders, elbows, wrists, knees, and ankles. In a previous blog post, we discussed some stretching and strengthening exercises and ergonomic concepts an industrial worker can utilize to help avoid tendonitis.

But what if you’ve already developed the condition?

This article explores the average recovery timeline and general treatment strategies for some of the most common cases of tendonitis industrial workers develop, helping you understand what to expect and how to manage this condition effectively.

Common Types of Tendonitis for Industrial Workers:

Click here to learn more about Tennis Elbow

1. Tennis Elbow (lateral epicondylitis): This condition involves the tendons on the outside of the elbow, usually caused by repetitive wrist and arm motions.

2. Golfer’s Elbow (medial epicondylitis): Affects the tendons inside the elbow, often from repetitive gripping or wrist flexion.

3. Rotator Cuff Tendonitis: This condition impacts the tendons in the shoulder, typically due to overhead activities or lifting.

4. Trigger Finger or Trigger Thumb (stenosing tenosynovitis): This condition occurs in the hand when the tendon sheath becomes irritated and swollen. It is often caused by repetitive use of the thumb or fingers, such as gripping or pinching.

5. Achilles Tendonitis: This condition affects the Achilles tendon, which connects the calf muscles to the heel bone. It is often caused by excessive running or jumping. Heavy, stiff work boots can also irritate the Achilles tendon.

Recovery Timelines

Recovery from tendonitis varies depending on the severity of the condition, the tendon affected, and the effectiveness of the treatment plan. However, general timelines can be outlined as follows:

1. Mild Tendonitis: For cases caught early and involving minimal damage, recovery can range from a few weeks to a couple of months. With proper rest and treatment, individuals often return to their normal activities within this timeframe.

2. Moderate Tendonitis: If the condition is more established and involves moderate inflammation and pain, recovery may take 2 to 6 months. This duration includes time for therapy and a gradual return to activities.

3. Severe Tendonitis: For severe cases beyond 6 months, it’s not uncommon for a tendinitis to transition to a tendinosis. This means there are actual physical changes and degradation within the cellular structure of the tendon. Depending on your symptoms, this may require intensive therapy or other medical intervention. Moral of the story here: if you’re having pain, don’t wait and see if it improves. Act ASAP!

General Treatment Strategies

Effective treatment for tendonitis involves a combination of self-care measures, medical interventions, and physical or occupational therapy. Check with your employer to see if they sponsor any on-site or near-site programs for seeing an athletic trainer, physical therapist, or occupational therapist.

Here’s a breakdown of common approaches:

1. Rest and Activity Modification:

o Rest: Avoid activities that exacerbate the pain. Giving the affected tendon time to heal is crucial.

o Activity Modification: Adjust your activities to reduce stress on the tendon. This might involve changing techniques or using different equipment. It’s essential to keep your body moving during this time, so find something that you like to do that doesn’t increase your pain.

2. Moist Heat:

o Apply moist heat: Apply moist heat (e.g., a moist heating pad) to the area for 5-10 minutes twice a day. The moist heat will promote soft tissue healing and increase the flexibility of the muscles surrounding the area.

3. Medication:

o Consult with your medical provider regarding medication usage. In general, nonsteroidal Anti-Inflammatory Drugs (NSAIDs) may be helpful; however, movement within pain-free limits may be equally as effective if done appropriately.

4. Physical Therapy or Occupational Therapy

o Stretching and Strengthening Exercises: An experienced physical therapist or occupational therapist can guide you through exercises to improve flexibility and strengthen the muscles around the affected tendon.

o Manual Therapy: Techniques such as massage, mobilization, therapeutic cupping, or trigger point dry needling may reduce pain and improve function.

5. Supportive Devices:

o Braces or Splints: These can help support the affected tendon and prevent further strain during the healing process. Consult your employer about which ones you may or may not be allowed to wear at your job.

6. Injections or Surgery:

o Things like corticosteroid injections, platelet-rich plasma and surgery may be an option if other interventions have not been helpful. When treating these conditions, seeing a PT or OT first has been proven to save you time and money.

Conclusion:

Understanding the recovery timeline and treatment options for tendonitis can help manage expectations and guide effective management of the condition.

Early intervention and adherence to a comprehensive treatment plan are essential for a successful recovery.

If you experience persistent or severe symptoms, let’s chat!

The best post-race recovery strategy

Dr. Rob Worth at the 2023 Fox Cities Marathon

Written by: Dr. Natalie Ullrich.

Happy race week to everyone participating in the Fox Cities full, half or 10k/5k races!

Congratulations, you have done the hardest part by just making it to race week.

You did your long runs in 90-degree weather, spent countless hours of your week training, and probably learned many lessons along the way.

On race day, remember all your hard work to be there, and have a great time! 

Here are some pieces of advice to make your post-race recovery more enjoyable.  

1.Don’t skip the post-race cool-down!

Even though you may be tempted to sit (or lie) down right after the finish to relieve your exhausted legs, an active cool-down is integral to the recovery process.

Walk for at least 10-15 minutes before resting. This will give your heart rate time to gradually lower and your blood flow time to normalize, which may help improve overall cardiovascular and respiratory recovery.

Unfortunately, research has found no link between an active cool-down and delayed-onset muscle soreness, but an active cool-down is still essential to improve acute post-race comfort. Walk a leisurely lap around Riverside Park before heading to the post-race snack tent! 

2.Fuel your run

Make sure you have a nutrition and hydration plan going into the race, and stick to it! Whether you like eating whole foods or prefer gels and chews, your body must replenish its energy stores and electrolytes. Fueling correctly during the race will help make your run more enjoyable help you feel better after the race, and speed up your recovery over the next several days.

(Pro tip: On hot days, don’t skip the pickles or bananas on the course; they can help you prevent cramping during and after your run.)

3.Prioritize post-race nutrition

Aim to eat something carbohydrate-heavy within 30 minutes of the race and prioritize carbohydrates and protein for the rest of the day. This is important to restore depleted muscle glycogen and repair damaged muscle tissue. It is common to lose your appetite for several hours after a hard effort, but try to eat small amounts often to refuel your body.  

(This is where we’re supposed to tell you that healthy food choices are the best, but we all know that all you want is a bag of chips…and in moderation, that’s okay, too.)

4.Keep moving a little bit and often for the rest of the day.

Whether you plan on heading to a brewery to celebrate or lying on the couch to binge-watch a new show, stand up and walk often throughout the day. I recommend that my patients get up at least every hour to walk and gently stretch. It is normal to feel progressively stiffer and more sore throughout the day, and you may notice a significant increase in soreness and stiffness when you get up the next morning. Do a similar amount of short and frequent movement throughout the day after your race.  

5.Take a gradual return to running and exercise.

This is very person-dependent on when it is appropriate to return to running. Still, as a general rule of thumb, you should no longer have any significant muscle soreness and should be able to jog without any pain.

Most people can do a recovery run within 3-7 days after the race, but some may need several weeks. If you cannot run, stay active by walking and doing low-impact cardiovascular exercises such as biking, swimming, or elliptical exercise.

Suppose running-related pain does not improve within a few weeks after the race. In that case, you may benefit from a physical therapy evaluation to address this and get you back to running ASAP! 

Good luck, everyone. Have fun, and remember that we’re here to support you in any way we can after the race!

—

About the Author: Dr. Natalie Ullrich is a physical therapist at our Neenah clinic on Commercial St. She loves working with runners and helping them prepare for, perform during, and recover from their races.

Tips and Tricks for Preventing and Managing Tendonitis

You wake up on a Monday morning with some forearm and elbow soreness.

You did a lot of yard work this past weekend- raking, pruning, and using the weed wacker. And last week, at work, you had to use several hand tools that required a lot of gripping and moving your wrist around.

You think back to several years ago when you dealt with a lot of pain and other issues with that same part of your arm…something they called “tennis elbow?

Boy, you’d really like to avoid another case of that!

So what should you do?

—

Tendonitis is a common experience . It is a musculoskeletal condition when a tendon, the thick fibrous cord connecting muscles to bones, becomes inflamed. Repetitive motions, overuse of muscles, or improper ergonomics can cause it. However, with proper awareness and preventive measures, minimizing the risk of tendonitis and effectively managing its symptoms is possible.

Recognizing Early Signs of Tendonitis:

Early detection of tendonitis symptoms is crucial for timely intervention. Industrial workers should be vigilant of the following signs:

· Pain or tenderness near a joint, usually where the tendon attaches to the bone

· Swelling or inflammation around the tendon

· Stiffness or difficulty in moving the joint

· Gradual onset of discomfort, especially after repetitive tasks

· Weakness in the affected muscle group

Stretches and Strengthening Exercises:

Regular stretching and strengthening exercises can help industrial workers maintain flexibility and muscle strength, reducing the risk of tendonitis. Here are some recommended stretches and strengthening exercises for the wrist and elbow.

Wrist/forearm/elbow:

o Wrist Flexor Stretch:

• Extend your arm in front of you with the palm facing down.

• Use your other hand to gently bend your wrist upward until you feel a stretch in the forearm.

• Hold the stretch for 2-4 rounds of 20-30 seconds each.

o Wrist Extensor Stretch:

• Extend your arm in front of you with the palm facing down.

• Use your other hand to gently bend your wrist downward until you feel a stretch in the forearm.

• Hold the stretch for 2-4 rounds of 20-30 seconds each.

o Forearm Strengthening Exercise:

• To focus on the muscles on the inside of your forearm, hold a light dumbbell or a resistance band with your palm facing up.

• Slowly curl your wrist upward against the resistance, then lower it back down.

• Perform 2-3 sets of 10-15 repetitions.

• Do this same technique, starting with your palm facing down to target the muscles on the outside of your forearm.

Modify your work:

Correct ergonomics and tool usage are essential for preventing tendonitis in industrial settings. Workers should adhere to the following guidelines:

1. Maintain neutral wrist positions while gripping tools whenever possible to reduce strain on tendons.

2. Take regular breaks to rest and stretch muscles during repetitive tasks.

3. Use ergonomic tools with padded handles and adjustable grips to minimize joint stress. Using anti-vibration gloves may also help decrease the demands on tendons while using power tools that create a lot of vibration.

4. Avoid excessive force or sudden movements when using tools, as this can strain muscles and tendons.

Preventing and managing tendonitis requires a proactive approach focusing on early recognition, regular exercise, and proper ergonomics.

By implementing stretching and strengthening routines and following correct ergonomics, you can reduce the risk of tendonitis and maintain optimal musculoskeletal health.

Please note that these exercises above are general recommendations. They should not take the place of advice from a medical professional.

If you would like a program developed specifically for you and your needs by one of our physical therapists, occupational therapists, or athletic trainers, contact us today!

In addition to elbow and wrist stretching, strengthening, ergonomic modifications, your plan may include things like manual therapy, trigger point dry needling, therapeutic cupping, functional exercise and so much more.

—

About the author:

Megan is our Sports Medicine Coordinator and a key player on our Industrial and Tactical Medicine Teams. She has utilized this preventative exercise and ergonomic strategies to help all the athletes she works with within all realms.

References:

• https://www.ptandrea.com/blog-posts/ergonomic-principles-and-hand-care-techniques

• https://www.medicalnewstoday.com/articles/324489

• https://www.researchgate.net/figure/Recommendations-for-hand-tool-handle-design-5_fig10_234056130

• https://www.harborfreight.com/anti-vibration-mechanics-gloves-x-large-58696.html

• https://steemit.com/sledge/@lindawilson/high-quality-sledgehammers-make-a-high-impact

Conquering Carpal Tunnel: A Guide to Conservative Treatments

Carpal tunnel syndrome (CTS) is like an uninvited guest in your hand, but it doesn't have to stay forever. Several simple treatments can help manage CTS and make your hands feel better. Here’s how you can take control of your recovery.

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome arises when the median nerve, responsible for sensation and movement in your thumb, index, middle, and half of your ring finger, gets compressed within the carpal tunnel in your wrist. This compression can lead to tingling, numbness, weakness, and pain in the hand and wrist.

What causes the compression?

It could be a combination of things: inflammation, awkward or sustained working positions, repetitive movements, operating heavy machinery, muscular strength, and mobility imbalances throughout the forearm, upper arm, and even the neck.

Combating CTS: A Multi-Pronged Approach

Conservative treatments aim to reduce pressure on the median nerve and alleviate CTS symptoms. Here's a look at some effective options:

1. Splinting: Wearing a wrist splint, particularly at night, immobilizes your wrist in a neutral position. This helps rest the median nerve and reduce pressure within the carpal tunnel.

2. Activity Modification: Mindfulness in daily activities can significantly improve CTS symptoms. Identify tasks that aggravate your symptoms and make adjustments. This may involve taking frequent breaks, using proper posture, and incorporating ergonomic tools into your workspace, keeping your wrist in neutral while you work, or changing your workspace to set yourself up for success.

3. Manual Therapy: Mobilization and manual therapy to the transverse carpal ligament and surrounding structures, trigger point dry needling to the flexor or extensor mass, depending on where the restrictions or limitations can be found, and nerve mobilizations/ gliding for the median nerve.

4. Therapeutic Exercises: Gentle hand and wrist exercises prescribed by a physical or occupational therapist can improve flexibility, nerve mobility, and overall hand function.

Wrist flexion stretching, wrist extension stretching, median nerve glides, grip strengthening, and upper extremity strengthening exercises may be appropriate depending on the severity (how intense they symptoms are and how they impact you), irritability (how much activity is required to provoke the symptoms) and nature (what other factors besides activity impact your experience) of your symptoms.

*Disclaimer: Exercises are for education only and should not be used in place of a PT or OT evaluation or free injury screen by one of our skilled PTs or OTs.

5. Functional Exercise: Using the fundamental strength and mobility built with therapeutic exercise to perform combined movements that mimic your job tasks, life outside of work, or hobbies that you may have.

The Takeaway: Early diagnosis and intervention are crucial for successful CTS management. By implementing conservative treatments at the first signs of CTS, you can prevent further nerve irritation and regain control of your hand function.

Consulting a physical or occupational therapist is vital for proper diagnosis and crafting a personalized treatment plan to conquer carpal tunnel and reclaim pain-free hand use.

—

About the author: Ron Lawrence is a physical therapist and strength and conditioning specialist at our Shawano Clinic on Green Bay St. and with our Industrial Medicine Team. He holds advanced certifications in Dry Needling and Nutrition. He is an excellent resource for any work-related or non-work-related aches you may have!

3 Tips to Improve Your Desk Setup

As a physical therapist, I have had the opportunity to work with and support office workers in learning how to set up and use their workstations ergonomically for optimal support and comfort. I’d like to share some of the pearls I have learned.

We have all heard the saying, “Everything in moderation.” One may choose to start eating healthier and choose one less dessert at a party or cut back on the size of that favorite mocha latte. Someone with a love of shoes may decide to create a shoe budget to keep spending in moderation. In the same way, moderation also applies to physical activity and body posture. Runners prepare for a race by following a training plan that allows the body to have periods of rest to prevent repetitive injury. With stationary activities, it is just as important to have periods of movement. Designed to move, our bodies feel the impact of lack of movement. Sitting for prolonged periods can lead to reduced blood flow, stiffness, discomfort and fatigue (both mental and physical).

These simple tips will help you moderate stationary activity in order to work healthier and more efficiently in an office setting.

1. Sit Smart:

Seating Choice – office chairs with adjustable height, seat depth and lumbar support offer an individual fit to support the spine and legs.

Showing how to assess seat height, seat depth and lumbar support.

Key Seating Adjustments

Seat Height – choose a height that places the thighs parallel to the floor or slightly higher. This creates a stable base of support. If adjusted too low the hips can become stiff and if adjusted too high one may slide forward and slump.

Seat Depth – adjust to fully support the thighs, but still leave the width of a couple fingers between the front edge of the seat and the back of the knee. This is very important to distribute body weight evenly and not impede blood flow at the back of the knee.

Lumbar Support – adjust to support the curve of the lower back. This not only supports the back but also promotes healthier upper body and leg postures. In some cases, even with an adjustable lumbar support, individuals find they may need more. Rolling up a towel or purchasing an additional lumbar cushion is a simple fix.

2. Be Aligned (With Your Desk/Workstation)

Showing proper alignment with your desk

Desk Height – if able to adjust desk height, adjust so that while typing the forearms are parallel to the floor and wrists are at the same level or slightly lower than the elbows. This will keep the wrist in neutral postures and help reduce the risk for development of carpal tunnel. If the desk height cannot be adjusted, hopefully it is just a little high. To solve this problem, add a footrest and raise the chair. If too low, look for a different desk.

Keep It Close – to prevent leaning forward and slumping as well as unnecessary reaching, adjust the keyboard and mouse to be close to the edge of the desk; adjust monitor(s) to be centered in front of you, about an arm’s length away, and at a comfortable height to view the screen without needing to tip the head up or down.

3. Sit (or Stand) in Moderation

Schedule Movement Breaks – whether it is a sticky note or a phone or calendar reminder, plan to move every hour. A lap around the office, a water refill break, a longer walk during lunch break, a trip to the printer, and even 1-2 minutes of standing and shifting weight or marching in place help break the stationary cycle. If you have an adjustable desk and can stand while you work, remember it is just as important to move and avoid locking in a stationary standing posture for a long time.

Eye Breaks—Remember that our eyes need a break as well. Periodically look away from the computer screen and focus on something else in a different direction. This can reduce eyestrain and related tension headaches.

If our bodies are supported in healthy postures and given opportunities to move, we will reap the benefits of working comfortably with more energy and focus. If you haven’t already, take the time to adjust your office workstation and plan movement every day properly.

Remember to sit smart, be aligned, and of course, everything in moderation!

About the Author: Dr. Renee Anderson, PT, DPT, is heavily involved with our Industrial Medicine program and helps at our clinics in Shawano and Green Bay.

How to Decrease fatigue and reduce stiffness in 5 minutes.

Feeling sluggish or stiff at work?

Try these 5-minute breaktime exercises to boost circulation, reduce fatigue, and alleviate stress!

These short and simple exercises can be done during breaks to relax overworked muscles and activate those not used as often. This will improve your ability to perform your job with focus and reduce aches and pains. Dynamic stretches and postural reversals are critical to this process.

Dynamic stretches held for just 0-5 seconds increase blood flow and improve flexibility and strength.

Postural reversals, done throughout the day, counteract the effects of prolonged postures. Incorporate these exercises into your daily routine and feel the difference immediately! 

Dynamic Stretches:  

Dynamic stretches assist with restoring physical functioning & flexibility, elevating the core body temperature, increasing circulation, accelerating energy production, and improving speed & strength.

Increased blood flow to your tissues helps delay muscular fatigue. 

Perform each exercise until the muscles feel warmed up, avoiding any movements that cause pain.* Progress slowly and always move through a pain-free range. Stop when you feel a gentle pull. They are most effective if they are done a few times per day.

• Head Circles - Rotate the head to make circles. Complete in both directions.  

• Arm Circles - Lift arms away from the body. Move in a circle. Complete both directions.  

• Wrist Circles - Bend elbows. Move the wrist in a circular direction. Complete in both directions.  

• Squat-to-Fly: Stand with feet hip-width apart and push hips back as if sitting on a chair. Cross arms in front of your chest. Bend your knees to lower yourself into a squat. Stand up while uncrossing/opening your arms as wide as you can. Squeeze your shoulder blades together.  

• Toe-Touch to Side-Bend - Stand with feet hip-width apart. Try to touch your toes, and stop when you feel tension. Return to an upright position and lift one arm above your head. Reach to the opposite side. Re-center. Bend towards the toe and then reach towards the opposite side.  

• Butt Kickers - Stand with feet hip-width apart. Bend your right knee and lift your heel toward your butt. Lower your right leg and do the same on your left side.  

• Lunges: Stand with your right foot in front and your left foot in back. Move your hips forward while bending your front knee to tolerance. Repeat on the opposite side.  

• High-Knee with a Twist - Lift knee upwards towards the chest while rotating trunk. Bring opposite elbow to knee at the same time—alternate sides.   

This is an example of a program we use for our industrial clients; however, these are great for office workers too!

Postural Reversals:  

Postural Reversals involve placing your body in the opposite position or motion. They can be done throughout the day and only take a few seconds to accomplish. Postural reversals are more effective for combating muscular tension from prolonged postures than stretching alone.

• If you’re Standing, perform 5 squats every 30 minutes of continuous standing.  

• If you’re twisting your wrists a lot, draw circles with your wrist for 3-5 reps in each direction.  

• If you’re gripping a lot, Make a tight fist and then spread your fingers out as wide as possible, returning to the starting position with 3-5 reps total.   

• If you’re forward-bending a lot, Stand hip-width apart and reach up towards the sky for 5-10 seconds. Slightly bend or curve your spine backward, using your hands to support your lower back as needed.   

• If you’re Forward Reaching a lot, Stand hip width apart, arms out to the side, elbow bent at 90 degrees into a “Happy Cactus” position, perform 3-5 reps for every 15 minutes of work.  

• If you’re sitting a lot, stand and complete 25 high knees every 30 minutes of sitting. We can do this in place or march forward.  

• If you have low back discomfort while seated, arch your back and round your back for 5-10 reps as needed.  

You can perform these exercises wherever you have adequate space or surface support, as needed. 

Dynamic stretches and postural reversals boost circulation and reduce muscular fatigue. Incorporate these into your daily routine and feel the impact on your physical and mental health. 

*Disclaimer: Please note, these exercises are general recommendations. They should not take the place of advice from a medical professional. If you would like a program developed specifically for your or your workforce by one of our physical therapists, occupational therapists or athletic trainers or feel like you could benefit from manual therapy, dry needling or cupping to compliment these exercises, contact us today!

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About the author: Megan is a Physical Therapist Assistant at our Fond du Lac and Ripon Clinics. She is also heavily involved with our Industrial Team. She uses similar exercises to help workers thrive during their workday and prevent injuries for jobs requiring prolonged postures/positions and repetitive work.