Tarry Butner, physical therapist and co-owner of Garrett Orthopedic Physical Therapy and Rehabilitation (GO PT) attended an intensive 2 day seminar, Mechanical Diagnosis and Therapy of the Extremities on February 21-22 held at Wake Forest Medical School in Winston-Salem, North Carolina. The McKenzie Extremity course is the latest in a series of courses offered by The McKenzie Institute-Center for Postgraduate Study in Mechanical Diagnosis and Therapy. Robin McKenzie has applied the principles he developed for the spine to the extremities. Tarry is one of the first to complete this newly offered course.

In 1998, after completing McKenzie's original four course spine series, Tarry was credentialed in the McKenzie Technique for the Spine earning the title Certified in Mechanical Diagnosis and Therapy of the Spine (Cert MDT).

The intensive 2-Day McKenzie course consists of lecture, case studies, clinical reasoning, problem solving and heavy emphasis on assessment and treatment of patients. The goal of this course is to provide knowledge, skills and abilities to:

• appropriately apply the McKenzie Method of Mechanical Diagnosis and Therapy to patient extremity problems
• distinguish between the McKenzie Syndromes (Postural, Dysfunction, and Derangement) as applied to the extremities, and provide appropriate treatment regimens for each of the syndromes and sub-classifications
• identify when the application of external forces or external stabilization is required for the resolution of symptoms using McKenzie's "progression of forces" concept
• assist patients to design and apply the therapeutic processes on their own to maintain treatment goals
• distinguish non-mechanical disorders and provide appropriate advice

The effectiveness of the McKenzie Method for managing spinal pain is well documented. The McKenzie Institute has expanded its teachings to the human extremities. The same logical assessment process to determine the mechanical causes of a patient's extremity symptom/pain is used so that the patient can respond to an effective self-treatment regime. Using the newest McKenzie Extremity Approach, more patients can look forward to better health and better living, with less pain.

McKenzie's thorough assessment process will determine responders and non-responders with extremity problems. After a proper mechanical diagnosis is made, an appropriate treatment plan can be structured to meet the patient's individual needs. McKenzie therapists can educate the patient with an understanding of the problem and the role of movement in their rehabilitation process.

A great number of people have persistent or recurrent musculoskeletal problems that are either resistant to treatment or respond only temporarily. Patients have a significant role to play in their own rehabilitation. Only patients can influence the state of their tissues repeatedly, regularly day after day. A key component is patient education and teaching appropriate exercises and fuctional behaviors so that healing is not disrupted and the environment for recovery is optimal.

If you encounter a patient in your practice that could benefit from the McKenzie Extremity Approach, call GO PT for an evaluation and we will schedule your patient's appointment within 24 hours.

Carol Voelkel, physical therapist at Garrett Orthopedic Physical Therapy & Rehabilitation, attended a seminar, Physical Therapy for Urinary Incontinece on March 6th at St. Agnes Hospital in Baltimore, Maryland. Lorraine O'Neill, PT, presented the class.

Urinary incontinence affects 13 million Americans. Is is reported that 89% of this population can reduce or resolve their symptoms with therapeutic exercise and education.

The course was intended to teach skills for evaluation and treatment of patients with stress and urge incontinence. The approach utilizes external palpation (over light clothing) for evaluating the strength of the pelvic floor musculature. Some patients feel more comfortable with the option of an external evaluation rather than an internal approach.

Following the initial evaluation, patients are educated in lifestyle changes that will positively impact their incontinence. If there is muscle weakness, patients will be given an individualized home exercise program to restore the strength of their pelvic floor muscles. For patients with urge incontinence, they will be instructed in a bladder-retaining program utilizing a weekly diary.

We find that the more we can educate patients regarding the anatomy and nature of their condition, the more control that they have over the problem. Our goal is to give them the tools necessary to help themselves with this common but easily treatable condition.

If you encounter a patient in your practice that could benefit from our Urinary Incontinence Treatment Approach, call GO PT for an evaluation and we will schedule your patient's appointment. If you have any questions about the program, please do not hesitate to call us.

Sonya Hinebaugh, Physical Therapist Assistant at Garrett Orthopedic Physical Therapy and Rehabilitation—GO PT becomes certified as a Pilate's instructor. She recently completed the two day mat certification seminar held in Pittsburgh, Pennsylvania. The seminar included the latest research on the multifidus, and transverse abdominus muscles that stabilize the body core.

Pilates focuses on building a healthy, injury-free body through controlled and concentrated movement. It centers the body with breathing awareness while maintaining dynamic spinal stabilization. Since 1920, Joseph Pilates, the father of Pilates, has developed a series of 500 rehabilitation exercises using the body as a whole, not dividing it into separate parts. Pilates emphasizes flowing precise movements requiring the use of the body's "Powerhouse" or the core of the body-the deep abdominals, buttocks, and lower spinal muscles. The series of rhythmic exercises promote elongated and toned muscles, enabling the rest of the body to move freely.

In Physical therapy, Pilates speeds the recovery of soft tissue injuries. Pilates acts as a bridge between physical therapy and physical fitness where exercises are customized for each patient from the elite athlete to the elderly individual with many persons in between. Additional patient benefits include:

• Improved balance, strength and flexibility
• Increased circulation and coordination
• Create flat abdomen and a strong back
• Prevents injury by practicing more efficient patterns of movement
• Increased core strength and postural alignment
• No impact exercise—easy on the joints
• Reduce stress and tension through deep stretching

Patients of all ages, aptitude and fitness levels can benefit from Pilates-Based Rehab with injuries and disorders such as, but not limited to:

• Chronic neck and back pain
• Sciatica
• Shoulder impingement/tendonitis
• Hip bursitis
• Ankle injuries
• Osteoarthritis
• Total knee/hip replacement
• Multiple sclerosis
• Parkinson's disease
• Fibromyalgia
• Post delivery or post C-section
• Pregnancy

Due to the muscle fiber orientation, the transverse abdominus cannot biomechanical contribute to extension or lateral flexion of the spine. An EMG study has shown that patients suffering from low back pain have a delayed onset of muscle activation in the stabilizers while other research shows that low back pain is a motor control problem in the deep muscles related to segmental joint stabilization.

Brett Rice, Physical Therapist at Garrett Orthopedic Physical Therapy & Rehabilitation—GO PT recently attended a course in, Manipulation and Adverse Neural Tissue Tension at Concentra Medical Center in Balitmore, Maryland. The course is one of the 18 courses being taken by Brett as part of a 2.5 year post-professional fellowship program in orthopedic manual therapy. The orthopedic manual therapy program is credentialed by the American Physical Therapy Association and approved by the American Academy of Orthopedic Manual Therapists.

The extensive 2.5 year program in Orthopedic Manual Therapy puts a strong emphasis on advanced evaluation and treatment skills. The real strength of the program is the clinical curriculum where a sound framework of clinical reasoning and decision-making is taught. The curriculum includes anatomy, biomechanics, exercise physiology, therapeutic exercise, radiology, research and pharmacology.

Brett has completed the first year in the program and has taken the following courses:

• Foundation of Orthopedic Manual Therapy
• Evaluation and Treatment of Lumbar Spine
• Evaluation and Treatment of Cervical Spine
• Evaluation and Treatment of Thoracic Spine
• Adverse Neural Tension
• Medical Exercise Therapy

The Manipulation section of the course was an introduction to joint manipulations, utilizing high velocity low amplitude thrusts. The course consisted of evidence and research on efficacy of joint manipulation. The safety concerns, indications, contraindications, and absolute contraindications of joint manipulation were extensively discussed. The course provided extensive hands-on training in the assessment and treatment utilizing joing manipulation for the Cervico-Thoracic Junction, Thoracic Spine and Ribs.

The Adverse Neural Tension (ANTT) section of the course integrated the use of manual therapy techniques such as soft tissue mobilization, joint mobilization, and joint manipulation with the use of neural tension treatment. The course objectives included:

• Introduction of the concepts of Adverse Neural Tissue Tension
• Be able to perform neurodynamic tests including upper and lower limb neural tension test
• Understand the theoretical meaning of positive tension signs
• Be able to provide a variety of treatment techniques for adverse neural tension pathology

If you encounter a patient in your practice that could benefit from Orthopedic Manual Therapy, call GO PT for an evaluation and we will schedule your patient's appointment within 24 hours.