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Can Cupping Therapy Help Dizziness? - themanualtherapist.com



Cupping therapy can be described as a technique that uses cups placed over the skin to create negative pressure through suction.  It has been in use all over the world for centuries for many musculoskeletal and some non-musculoskeletal conditions.  The treatment approach has created more buzz in the Physio world for the past few years for musculoskeletal conditions, mostly pain.

I believe the pictures of Olympic swimmer, Michael Phelps, in 2016 games was the reason the modality was brought to the attention of the most of the western world.   Therefore, it struck a chord with the sport and active crowd!

There are two types of cupping methods, dry and wet. Dry cupping is noninvasive with no bloodletting. Wet cupping is invasive and includes bloodletting.  The current western approach by physios / chiropractors and massage therapists use the dry cupping method.

Our profession has then created many variations of cupping approaches.  Some clinicians leave them in place for a period of time with the patient still.  Some clinicians move the cups over the skin themselves through different planes.  Some clinicians even leave them in place for a period of time on patients but have the patient move in a therapeutic manner.

The question that I have never encountered before is the title of this blog: “Can Cupping help Dizziness?”

To answer that question from the medical research, I take the reader to a case report by Almusleh and Ansari in 2020 entitled “Integrating Cupping Therapy in the Management of Sudden Sensorineural Hearing Loss: a Case Report” in the journal, Cureus.  You can access it free here. 

I find it interesting to read literature outside our profession as it broadens the mindset of what others can do.  It is the same reason I get any PT student to observe local chiropractors, acupuncturists, podiatrists, running shoe store owners, etc as we tend to get stuck in our own ways that exercise fixes everything!

If you read the title, you will realize that the authors were mainly writing about the effects of wet cupping for sudden sensorineural hearing loss that failed conventional medical treatment, but within the report, you will see this statement on dizziness changes:

DHI {Dizziness Handicap Inventory} score was improved from an initial 52 score to 0 (no handicap at all)

And this conclusion:

In our case, WCT {wet cupping therapy} improved the feeling of fullness after the first session and improved hearing loss, tinnitus, and dizziness after the completion of the WCT treatment regime (12 weeks).

We don’t recommend every patient with dizziness to get wet cupping from the report by any means!  However, I think it does show a link between many symptoms: dizziness, hearing loss, tinnitus and pain.  It also shows a manual therapy approach can be helpful for these conditions, including dizziness.


You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the author and his wife, a Vestibular Specialist, teach a 2-day course.  Pertinent to this blog post, the second day provides the most up-to-date evidence review from multiple disciplines to treat through the “Physio Blend”, a comprehensive approach to treating neck pain and dizziness / vertigo symptoms.

If you would like to host a course for your staff (either a vestibular, neuro, sports or ortho clinic), please do not hesitate to contact me at harrisonvaughanpt@gmail.com for prices and discounts.

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Authors

Harrison N. Vaughan, PT, DPT, OCS, Dip. Osteopracic, FAAOMPT    

Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts

Danielle N. Vaughan, PT, DPT, Vestibular Specialist  

Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts


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5 Squat Training Progressions - themanualtherapist.com

The Motion Guidance Clinician Kit is one of my favorite in clinic and at home tools for patient's to get visual feedback on their motion and motor control. My colleague over at MG recently posted a great video on how to progress your patients on squat training using the Motion Guidance.

Research Review: Treatment for Non-Specific Low Back Pain - themanualtherapist.com


Treatment for non-specific low back pain


INTRO:
Non-specific low back pain (NS-LBP) is a leading cause of pain and disability worldwide. Among the therapeutic interventions for NS-LBP, it is not clear which intervention offers the best benefit–harm balance. Uncertainty in the management of NS-LBP is reflected in the often discordant guideline recommendations.

Gianola et al. (2021), explored the relative efficacy of currently available treatments for acute and subacute mechanical NS-LBP in terms of benefit and harm.

METHODS:
Systematic Review

46 RCTs included n=(8765)
Risk of bias was:
  • Low in 9 trials.
  • Unclear in 20.
  • High in 17.

Primary outcomes were pain intensity and disability.
Secondary outcomes were any occurrence of adverse events.

Follow-up times:
  • Immediate-term (closest to 1 week).
  • Short-term (closest to 1-month).
  • Medium-term (closest to 3–6 months).
  • Long-term (closest to 12 months).

RESULTS:
Most Effective for pain decrease:
Exercise, heat wrap, opioids, manual therapy, and (NSAIDs).

In the long term, for pain decrease:
The most effective treatment was cognitive behavioral therapy.

Similar findings for disability decrease as with pain.

Mild or moderate adverse events were reported in:
  • opioids (65.7%).
  • NSAIDs (54.3%).
  • Steroids (46.9%).

CONCLUSIONS:
  • After first line of care, NS-LBP should be managed with nonpharmacological treatments which seem to mitigate pain and disability in the first week.
  • Pain and disability reduction were best achieved by heat wrap, manual therapy and exercise at immediate-term of follow-up.
  • Among pharmacological interventions, pain and disability reduction were best achieved by NSAIDs and muscle relaxants at immediate-term of follow-up.
  • Paracetamol had no benefit over inert treatments at any follow-up assessment; evidence was largely uncertain.

SOURCE:
Gianola et al. 2021. Effectiveness of treatments for acute and subacute mechanical non-specific low back pain. BJSM.


Dalton Urrutia, MSc PT

Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics. 
Want to learn more or contact him?
Reach out online:
@Grapplersperformance

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Intermittent Fasting and PT - themanualtherapist.com


Fasting, or intentional restriction of food intake, has been around for thousand of years. Much of the roots of fasting comes from religious or spiritual ceremonies; today, fasting is often done for the aspects of improving health and longevity, with some still continuing the religious or spiritual purpose. The data on fasting is robust and doctors of physical therapy (DPTs) need to be aware of the benefits, risks, and the how-to of fasting. Let's get started!

Many various forms of fasting exists. Strict or pure fasting includes the abstinence of food altogether. Time restricted fasting or feeding is where a person restricts feeding to a certain number of daytime hours and uses sleep to help create a partial fast. In other words, a person may eat only from 11am to 7pm, while fasting from 7pm to 11am. Some might consider this a form of intermittent fasting, but the true definition of intermittent fasting is where person will consume food ad libitum one day while restricting food the next. Intermittent fasting (IM) has shown much promise in both animal and human studies.

Hoppers and Me

I know a lot about intermittent fasting. I have two peer-reviewed publications on IM, with a focus on longevity and reproduction. Our organism we studied were lubber grasshoppers -- I know, it's a bit funny but they jump and are pretty. Grasshoppers are a great model organism to study because they live on average 80-120 days once in adults stage, they don't need a huge environment, and we can measure lymph (blood), eggs, and other details easily. In summary of our findings, intermittent fasting significantly increases lubber's lifespan (by adding 20-80 more days) and doesn't interfere with egg production. All of these are great findings!

 

Other studies confirm similar findings in worms, rats, and even some primates. Understanbly, examining humans with IM can be tough, as we live longer and have varied environments...so we don't have long-term data on humans yet. But what are the underlying mechanisms for the improvements seen?

Mechanisms

To understand the mechanism of why IM helps, it is important to understand some of the theories as to why we age. Many theories exist as to why we age. Some of these include both programmed and error theories such as:

  • Free radical damage
  • Programmed senescence 
  • Immunological factors
  • Cross-linking theory
  • Rate of living (metabolism)
  • Soma vs reproduction trade-off
  • Combination of theories

Intermittent fasting appears to interact with several of these theories of aging. First, reducing food intake can reduce free radical damage from toxic foods like alcohol and highly processed foods. Second, IM may modulate the immune system by stimulating the gut biome and reducing the intake of potentially immune-stimulating substrates in foods (e.g. insulin-like growth factors in cow's milk). Third, IM lowers a person's thermic effect of food and metabolism, thus reducing a person's rate of living. Lastly, IM is a form a calorie restriction, one of the only mechanism scientists have found to extend lifespan.

Less calories = less weight gain = less chronic disease

Human Studies and Implication for PTs

Having such robust data on hoppers and mice is great, but what about humans studies and the impact to physical therapy practice? A well-done systematic review outlines some of the following benefits for humans who undertake IM:

  1. Improved stress response
  2. Lowered cholesterol
  3. Lowered blood pressure
  4. Improved insulin response

Understanbly such benefits could help many of patients in cardiac rehab, neuro physical therapy, and PTs working with diabetes. Some of this data focuses on time-restricted feeding, which many authors consider a form of intermittent fasting. Regardless, reducing food intake for a part or a whole day can confer substantial benefits to our patients.

What about musculoskeletal disorders and IM. Interestingly those who undertake IM during Ramadan, a Muslim fasting holiday, patients with rheumatoid arthritis (RA) and spondyloarthritis (SA) may see significant pain reduction and symptom improvement. The authors argue that IM may "may attenuate the inflammatory state by suppressing pro-inflammatory cytokine expression and reducing the body fat and the circulating levels of leukocytes." As such, PTs working with RA, SA, and other autoimmune patients may want to discuss IM with their patients and possibly seek a registered dietician (RD) referral for help.

Longevity may be a talking point for some authors, but the data is limited in humans at this time. Physical therapists should focus their efforts on educating patients on IM and seeking assistance from trained MDs and RDs as IM does carry some risks.

PTs should be aware that IM is not appropriate:

  • For those with a high caloric need such as in pregnancy or advanced sport
  • For those with history of eating disorders
  • For those feeling weak, tired, extremely hungry, or sick.

In the end, DPTs have advanced training in the neuromusculoskeletal systems; however, understanding IM and implementing a IM program involves careful planning, education, and preparation. Seeking the care of a RD or trained MD (not all MDs are competent in nutrition science let alone IM) is essential!

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 If you like what you see here then know there is more in our 3 board-approved continuing education courses on Nutrition specific for Physical Therapists. Enroll today in our new bundled course offering and save 20%, a value of $60!



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5+ Exercises for Multiplanar Training - themanualtherapist.com



Athletic performance comes down to your ability to master multi-planar movements.

Sports occur in all planes of motion: sagittal (forward/reverse), transverse (rotational/twisting), and frontal (lateral/side-to-side). Hence: multi-planar.

Neck Disc Bulges Can Heal Themselves - themanualtherapist.com



Cervical Disc Herniation: Spontaneous Regression


BACKGROUND:
Spontaneous regression of herniated lumbar disc has been well established in the literature, but, not for cervical discs.

3 Proposed Mechanisms for Spontaneous Regressions of Discs:
  1. Dehydration and shrinkage of the herniated nucleus pulposus.
  2. Retraction of the protruded disc.
  3. Recognized as a foreign body, leading to an inflammatory response, and subsequent disc resorption.
Sharma et al. (2021), published a case study and reviewed 75 cases of spontaneous regression of herniated cervical discs from the literature.

CASE STUDY:
  • 24-year-old male.
  • 3 weeks of severe neck pain.
  • Right upper arm radicular pain.
  • Right C7 distribution weakness/numbness. 

MRI showed a right paracentral disc extrusion at the C6-C7.

The patient chose to try conservative management, including:
  • NSAIDS
  • Analgesics
  • Muscle relaxants
  • Cervical collar
  • Physical therapy
After 4 weeks, all symptoms vastly improved. 

The follow-up MRI 3 months later revealed significant spontaneous regression of the C6-C7 disc extrusion.

LITERATURE REVIEW:
75 Cases included 

Predominant symptoms included:
  • Neck pain and/or radiculopathy (91%).
  • Myelopathy (9%).
Herniations were:
  • Paracentral or foraminal in 61 cases (84%).
  • Central in 12 cases (16%).
  • At C5-C6 (31 cases)
  • At C6-C7 (22 cases)
Average time of spontaneous regression was 9.15 months.

CONLCUSIONS:
Successive MRI studies documented the spontaneous regression of herniated cervical discs over an average of 9.15 months. 

Conservative therapy is a viable initial treatment strategy over surgery.

SOURCE: 
Sharma et al. 2021. Spontaneous regression of herniated cervical disc: A case report and literature review. Surgical Neurology International. 12(141).

Dalton Urrutia, MSc PT

Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics. 
Want to learn more or contact him?
Reach out online:
@Grapplersperformance

Learn more online - new online discussion group included!


Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. 
  • NEW - Online Discussion Group
  • Live cases
  • webinars
  • lecture
  • Live Q&A
  • over 600 videos - hundreds of techniques and more! 
  • Check out MMT Insiders
Keeping it Eclectic...

Nutrition Beyond Weight Loss: Diet Impacts Neural, Immune, and Psychological Systems - themanualtherapist.com


By Dr. Sean M Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DN

The field of nutrition science continually expands. Once seen through only a metabolic and nutrient lens, nutrition science now interconnects with immunology, neurology, and psychology. How these fields of study interact are becoming amazingly complex but may help to shed light into various therapies and prevention for many common chronic conditions. How these various areas of clinical practice interact with nutrition makes it apparent that the practicing physical therapist needs to be aware of how foods interact with human physiology and biochemistry. 

Immunonutrition

Nutrition certainly impacts immunology. From colds to rheumatic flares, diet can certainly mediate certain physiological processes that can drive or promote disease states. Nutrients play a vital role in disease prevention. Water helps to hydrate our eyes and mouth to prevent infections. Vitamin C helps to boost white blood cell count, which may help in the prevention of common colds; it also facilitates the absorption of iron and prevents rickets. 

One major area of exploding research is the gut-microbiome. PTs should be aware of the billions of microbes that live in our gut and on our skin. These small bugs can interact with our bodies' ability to modulate the immune system (e.g. stimulate T or B cell aggregation), which can be seen in various rheumatoid arthritis (RA) and lupus studies. Fasting can positively impact patients with RA, while patients with lupus may benefit from diets low in sugar, high in omega 3 fatty acids, and rich in phenols.

In short, diet can help modify the gut biome, which can possibly mediate changes in disease state. All of these are solid reasons why a Doctor of Physical Therapy should be screening patients for potential nutrition-related issues. Diet is intricately connected with our immune systems, which can make or break our PT outcomes!

Neuronutrition

Our diet can impact our brain, nerves, and spinal cord. Don't think so? Try skipping your coffee today and see how your head feels...diet can and does modulate the nervous system in various ways.

Studies have shown that a poor, Western diet high in fat, sugar, and processed foods can mediate low-levels of chronic inflammation. Such inflammation has been linked with a phenomenon known as inflammaging, or advanced aging in flight of excessive inflammatory exposure. Inflammaging may explain how some individuals may present with cognitive decline, chronic tendon and joint pain, and cardiovascular disease. Such disease states are likely preventable and reversible, depending on the length of the condition and the applicable treatment methods. 

It's not all bad news regarding diet and neurology. Diets rich in polyphenols from blueberries may help to improve balance in older adults, and may reduce the odds of Alzheimer's development by scavenging for free-radicals. Vitamin D, from the sun or supplementation, may help to increase muscle mass in older adults and help prevent some falls. Food can drive inflammation, mediate other physiological responses, as well as interact with the gut biome. The interaction with the gut biome and the brain is known as the gut-brain-axis, which we will discuss in depth in the next section.

Some of these findings have clear implications for neuro certified clinical PT specialists (NCS) and geriatric certified clinical PT specialists (GCS). Just as nutrition can modulate the immune system it can also directly impact the nervous system. PTs need to be educated on the interaction of food and nervous system.

Psychonutrition

Psychological disorders can alter the treatment response to physical therapy. As DPTs, how many clients have you seen successfully beat chronic pain when they are very depressed -- very few, right? In other cases, some of us have seen how psychological disorders can alter the posture (anxiety), reception of PT treatments (bipolar or memory issues), or pain response (depression). Psychological factors also dovetail in with social and economic factors, making it one powerful modifier to the response of physical therapy management. Diet does impact psychology and one popular nutrition term used for such study is psychonutrition

How does nutrition factor into this? First, we understand more about how the gut talks to the brain (and vice versa). The gut-brain axis is a neural, endocrine, and immune system pathways that directly and indirectly communicate from the brain to the gut. Much of the "talking" is via neurotransmitters, short chain fatty acid production, and autonomic nervous system stimulation. The gut microbiome does much of the "talking" between the brain and gut, with the small gut bugs producing 90% of the body's serotonin in the gut vs the measly 10% the brain makes. WIth such a contribution of serotonin it's no wonder how diet can impact psychology! Food impacts the gut microbiome by shifting the type and amount of certain bacteria, fungi, or archaea, which all interact with our body in different ways. Probiotics have been studied for their mood and psychological impact, positively helping patients with depression, anxiety, and other mood disorders. 

Second, diet directly modulates moods their various chemical and nutrients. Alcohol depressives the nervous system, which might either temporarily elevate or depress a person's mood. Chocolate studies have highlighted how certain compounds, like phenethylamine, may stimulate the release of dopamine, the feel-good neurotransmitter. In these cases, it's more clear how food directly impacts the psyche. 

Physical therapists working with various patient populations will likely run into ways diet interacts with a patient's psyche. While some of the methods for modulating the psyche from food are very clear and direct, more research is needed to understand the complex interactions of the gut-brain axis. Regardless, the impact food has the psychology of a patient is one more facet that the DPT needs to be cognizant of.

Conclusions and PT Considerations

It's apparent that diet has intricate interactions with our immune, nervous, and psychological systems in a myriad of complex ways. Researchers are piecing apart, and looking for synergistic pathways, these interactions and systems in hopes of improving health and wellness. Physical therapists can also do their part by paying attention to patients' diet, screening for nutrition issues and substance abuse, and referring patients to dietary specialist (like RDs) for concomitant care when appropriate. Becoming more aware of nutrition science, taking nutrition continuing education courses, or enrolling in a nutrition certification program are also ways of staying current and offering best-practice. In the end, the future of PT may be one where a patient's gut biome is modulated with a probiotic strain while undergoing the "usual" exercise and education so commonly seen in PT practice. More to come!

 Earn Your CNPT Credential

If you like what you see here then know there is more in our 3 board-approved continuing education courses on Nutrition specific for Physical Therapists. Enroll today in our new bundled course offering and save 20%, a value of $60!






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Hey guys! I'll be travelling for a few weeks, so new posts will still be happening but maybe not 3 times a week! To kick off the summer, EDGE Mobility System is having our annual summer sale! Everything is 15% off and Eclectic Approach Online Seminars are 25% off! Save now! Here are 5 new products being featured at EDGE Mobility System



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  • the most comfortable, easy to use neck traction device on the market - no pumps or strings attached (literally)
  • 6 tools in one for a complete rehab experience in one amazing foam roller!
  • Wrist/Forearm/Finger stretcher (~$30 value) - Helpful for stretching the wrists and hands to decrease pain, improve function, and increase flexibility - especially for regular cell phone and computer users.
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  • Peanut roller (~$20 value) - Useful for getting around bony landmarks like the spine, shins, and neck.
  • Myofascial releaser (~$99 value) - Specifically used for relieving stress in the muscles of the hip that cause back pain, hip pain, disability and immobility. It can also be used to target hard to reach muscles like the iliacus or psoas muscles.
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Have an amazing holiday everyone! Please share our sale with your friends and colleagues! Click below to go to our Best Sellers Collection!





Learn more online - new online discussion group included!


Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. 
  • NEW - Online Discussion Group
  • Live cases
  • webinars
  • lecture
  • Live Q&A
  • over 600 videos - hundreds of techniques and more! 
  • Check out MMT Insiders
Keeping it Eclectic...