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Thursday, February 27, 2014

"Why won't this Pain go away?"

In the field of physical therapy, there's been a growing trend of two groups of thought regarding pain:

1) the classical "structural" point of view (i.e. poor postural alignment leading to pain)

2) the neuroscience/pain science view where pain is a brain output.

And yet a third group is emerging that is somewhat of a "middle path" that is both #1 & #2.

The middle path isn't as popular, perhaps since being in the middle isn't as charged as polar opposites. Some people need identity (the "charge") through their tightly held beliefs which separates them from any opposing view.

Gratefully, I see the middle path is growing more each day since seeing both sides of a coin allows us to experience the Whole coin.

And this is Understanding.....


Below is a post I made on my personal FB page:

Pain is a brain output. In other words, it's a thought, and like all thoughts, pain is a limiting belief based upon past experiences and conditioning.

Our thoughts separate us from Reality and what we perceive as reality.

In this respect, pain is more of the Messenger.

It's not simply that the pain you experience is "all in your head". It's so much more than this. It can be from that "herniated disc" that an MRI revealed, or it can be related to that "forward head posture" from sitting eight hours a day, and it can also be so much more than a structural "fault".

It's a call to pay Attention. The Messenger is telling us to pay Attention to something that we've neglected or were too distracted to attend to.

But what do we tend to do to the Messenger?

Blame it, kill it, avoid it, or run away from it. In other words, refuse to Listen to It.

What is it that we do not want to hear?

Perhaps the Truth to who we are?

I don't know.


Friday, February 21, 2014

Got ITB issues?

Common gluteus minimus trigger point referral patterns

Often times when someone says they have "ITB issues", it's not so much that the iliotibial band (ITB) is at fault as it is it's a compensation for something else that's going on. And although there can be a lot of other possibilities to why the ITB can be affected, it can be as simple as some stubborn trigger points in the gluteus minimus muscle of the hip joint.

As you can see in the picture, the red areas represent the common referral pattern of a gluteus minimus trigger point (denoted by the "x") which coincides with the full length of the ITB.

Now you can simply treat the trigger point for some temporary relief (if that's what is causing your symptoms), but it's probably a better idea to address the movement pattern impairment that started the trigger point in the first place. One can think of a trigger point as the nervous system's way to create soft tissue stability in an unstable function.

Always a great idea to get assessed ;)

Wednesday, February 5, 2014

My Kneecap Keeps "Popping" Out

Dislocated patella
It's very common when presented with a history of one's kneecaps "popping out" for a doctor to refer the patient for physical therapy with a prescription of "Knee Strengthening/Quadriceps Exercises" and "ITB Stretching".

The medical term for this situation is "patellofemoral instability", where the patella (kneecap) has a tendency to sublux (or even dislocate) as it glides over the femur (thigh bone). I like to explain this to patients as if a train (your kneecap) is coming off of its tracks due to poor alignment.

Your patella derailing off your femur

Why does this happen?

Despite what conventional wisdom would tell you that it's weak muscles around the knee that cause the instability, it's actually a bit more involved. The usual suspects in conventional thinking to "blame" are a "weak" vastus medialis obliquus (VMO) and a "tight" iliotibial band (ITB).


 

In reality, the cause is more functional in that you can think of the knee joint as the middle man in-between the hip/pelvis above and the foot/ankle below. And like all middle men, they react to what's going on with the opposite ends of the chain.

When the patella subluxes, or "goes out of place", it's usually lateral of the femur. In not so severe cases, because the soft tissue structures involved are still contained, the patella usually glides back into place with a straightening and bending motion of the knee (i.e. it falls back into its track)

When the pelvis is in a less than ideal position, it will affect the function of the hip joint which will affect the function of the knee joint below. Likewise with the positioning of the foot and ankle can affect the knee joint above.

You can think of the pelvis/hips as the steering wheel, the knee and the foot/ankle as the wheels. What happens when your steering wheel is out of alignment? More wear & tear of the wheels.

Here's a typical clinical presentation:

The pelvis on the same side of the involved knee is either rotated too far forward or backward, with either way, there's a compensation at the knee where the femur (thigh bone) either wants to roll inward excessively or can't roll inward enough. Either way, the vastus lateralis (VL) quadricep muscle can be overly worked to maintain  a stable amount of internal rotation of the femur. Because the ITB covers the VL, it commonly is mistaken as the "culprit". And because the VMO wants to do the opposing motion of external rotation of the femur, it is often "out-classed" by the VL.

Can you see now why doctors prescribe "quadriceps strengthening" and "ITB stretching" for patellofemoral situations?

Everything's connected
The moral of the story is that everything is connected and with patellofemoral instability situations, I find what works is addressing what's going on above (more than below) the knee joint. Obviously every case is unique and I could go on about many other possible relationships, but what it comes down to is what is the primary driver, or the "Mother", behind the clinical presentation and the only way to find out is through a thorough clinical evaluation along with a barrage of assessment/reassessments of function.

So the next time you're in the Greenwich Village and/or Union Square neighborhood, consider coming by Michael Jocson Physiotherapy for a check up. You'll be glad you did.....
:)

Tuesday, January 21, 2014

Michael Jocson Physiotherapy now accepts insurance!



For 2014, I've decided to get involved with insurance companies again. It's been awhile and I chose not to "ever do this again", but as they say, time heals. With the advent of the Affordable Care Act, aka Obamacare, times have changed and so do we, no matter how much we try to fight it.

Here's a list of the insurance companies that I've presently contracted with (and currently awaiting for my enrollment to activate; this is why I'm not listed on their website provider directories yet since it takes 30-60 days) as an in-network provider:

Medicare (pending)
United Healthcare (pending)
Oxford Freedom (pending)
1199 (pending)
Multiplan (pending)
PHCS (pending)
Beech Street (pending)
Magnacare (pending)
GHI/Emblemhealth (pending)
No-Fault
Workers Compensation

*Until pending notification from the specific insurance company, I am considered an out-of-network provider (if applicable)

I can also work with you as an out-of-network provider if your insurance plan applies. The way this works is once we verify your out-of-network benefits (deductible, max visits, percentage plan pays, etc), you pay me my rate for each visit; I provide you with a receipt and CMS-1500 claim form in which you submit/mail to your plan. Your plan sends you a check for the percentage they cover (typically anywhere from 50-80% of the total charges).

So except for me being a nice guy, I'm actually a pretty decent therapist and now that I work with insurances, I am much more accessible to those who thought they could "never afford me". The bottom-line is that I truly love what I do and I am here to serve you, the patient, the Individual.

Wednesday, January 1, 2014

Happy New Year from Michael Jocson Physiotherapy!


With 2014 being the second year that I opened my practice in Union Square, I am offering the following specials:

- "Three for Two", or 3 sessions for the price of 2 regularly priced session.

- Treat & Train Monthly Membership Program - up to two sessions a week for a month.

- 10% discount when you sign up for a three month commitment ($240 savings)

Also, if your job offers a Health Savings Account program, you may be able to use it towards payment of my physical therapy services (not personal training).

Got questions? Contact me at mjocs@aol.com 

As you can see, it's now easier than ever to see me. No more waiting on the fence. "Physical therapy" and "Personal Training" catered for the Individual's needs. They're in quotes because I'm not your typical physical therapy and personal training practice ;)

Be Kind....
Be Awesome....



Wednesday, November 6, 2013

New Ligament Found in the Human Knee? So What?

The Anterior Lateral Ligament (ALL)
All over the internet on social media websites such as FaceBook and Twitter there's a popular buzz about a new found ligament "discovered" in the Human knee. This was from a study by some Belgium surgeons who found a consistent presence of the ALL in all but one of forty-one cadavers.
In reality, a Dr. Paul Segond, a French surgeon was the first to document a description of the ligament back in 1879. Obviously, like the conquistadores of Europe "discovering" the Americas, this "discovery" is more like a renaming. In the Belgium study, it states that probably about 97%-100% of us have this ligament. Previously many have thought of it as an oblique band of the lateral collateral ligament (LCL) or a lateral extension of the knee joint capsule.

What does this new "discovery" mean?

Honestly, nobody really knows. But there's some speculation that the ALL has a role in anterior cruciate ligament (ACL) injuries and its potential role in limiting internal tibial rotation as seen in positive pivot shift testing. For now we can just guess based upon our current understanding of the biomechanics of the knee along with the rest of the body.

My Take On This:

If the ALL checks internal tibial rotation and if it's injured, like all ligamentous injuries, the common approach is to facilitate the agonist muscle around the ligament to check further stretching/tensioning of the ligament. For example, the ALL limits internal tibial rotation and the biceps femoris contributes to the opposing external tibial rotation movement; so it makes sense to condition the muscles that externally rotate the tibia: biceps femoris, TFL, vastus lateralis. Theoretically, if the ALL limits the tibia moving internally on the femur, it can also limit the femur moving externally on the tibia and addressing the muscles that internally rotate the femur may also help stabilize an injured ALL: TFL, ischiocondylar adductor magnus, anterior gluteus medius/minimus.

But regardless of these specific muscles that directly affect the transverse plane of the knee and counters the internal tibial rotation tension that the ALL restricts, you'd also want to assess the function of the popliteus:
Popliteus
The popliteus actively contributes to unlocking the knee, internally rotating the tibia, and externally rotating the femur. Its actions of rotating the tibia internally and rotating the femur externally actually create more tension on the ALL. And what muscle do I see pretty much all the time being facilitated and loaded with gnarly trigger points post-knee surgeries? The popliteus, of course. Disengage the popliteus and you decrease the tensional load on the ALL. Pretty simple, huh?

But if you really want protect the ALL, ACL, the menisci, the patella-femoral joint and all the other structures around the tibia-femoral and tibia-fibular joints, assess what is going on up north at the pelvis. The pelvis-femur complex is like the steering wheel and everything below are like the wheels. If your steering is out of alignment, your wheels get much more wear and tear for every mile driven. This is a whole other story and blog post altogether but it is highly recommend to address the function of the pelvis and hip complex in three planes of motion.

Hopefully you got something out of this post and perhaps it helped spark some outside of the box thinking. Please share this with others since no one else appears to be writing about the ALL other than it's some "new" ligament discovered.
;-)


Friday, November 1, 2013

November 2013 Specials

For the month of November, 2013, our special this month is a "Get 3 for the Price of 2" where you get three sessions for $350.00 (about 33% savings). Also, for new patients/clients, save $15 off the normal hourly session rate ($160/hour). Contact me at mjocs@aol.com if you're interested.