PROGRESSIVE PHYSICAL THERAPY

1. PROGRESSIVE PHYSICAL THERAPY An Advanced Approach to Rehabilitation by Nick Liatsos PT, CSCS, CN

2. Traditional Approach • Physical Therapy • Hot Pack, • Stim, • 2-3 visits per week • Anti-Inflammatory drugs • Cortisone shots • Unnecessary surgery

3. NSAIDs Advil Aleve Ibuprofen Lodine Fenoprofen Toradol Tolmetin Cox-2 Inhibitors Celebrex Vioxx Bextra Not an Advocate of Pain Meds

4. Medical Management of Pain and Inflammation “Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for non-steroidal anti-inflammatory drug (NSAID)-related GI complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures for all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated.” This does not include deaths from renal failure or hepatotoxicity. Am J Med. 1998 Qutab, A. 2005

5. Cont’d… • Many NSAIDs exacerbate joint destruction, decrease ligament-bone healing response, cause renal failure, and other numerous adverse effects • Many safer treatments and comprehensive approaches are available. • Effective symptom suppression robs doctors and patients of the impetus to create health-promoting change • Just because the pain is reduced, this does not mean that the underlying problem is diminished

6. A new approach…

7. Progressive, Multi-Step Approach to Healing • Microcurrent • Low-Level Laser • Manual Therapies • Therapeutic Exercises • Nutrition = The “Liatsos Method”

8. “Anything that can be done with a drug can also be done with a frequency, without side effects.” - Dr. James Oschman 2009

9. Frequency Specific Microcurrent • Albert Abrams, MD (1863 – 1924) started treating with Microcurrent in 1916 with great success – called it Oscilloclast • 1934 - Dr. Morris Fishbein, former president of AMA and chief editor of Journal of American Medical Assoc. mandated that only drugs and surgery would be used by medical doctors. He stated all electromagnetic therapies would be viewed as quackery and “unscientific”. Most all devices were destroyed and doctors who disagreed were prosecuted. • Some units and frequencies were somehow hidden from destruction • Today it is FDA approved.

10. Importance of Specific Frequencies • Everything resonates with it’s own specific frequency • Example: When you hit a “C” note on a piano, all other C strings in that piano will vibrate in resonance • When you introduce the appropriate frequency to the injured or diseased cell, the cell matrix can be repaired and healing results. • Chinese medicine has known for thousands of years that emotions like frustration, anger, irritability… can settle in an organ and cause dysfunction. Microcurrent therapy can treat these interferences of energy, restoring proper function.

11. How does Microcurrent Therapy work? • Normal healthy tissue conducts bioelectricity through the healthy cell and tissue membranes which act as capacitors with a charged layer on either side. There is also an uncharged lipid bilayer between the two charged membranes. Inflammatory changes result in a bioelectric current resistance at the injury site which further delays healing. • Microcurrent Therapy (FSM) helps normalize bioelectrical resistance by breaking through the resistance barrier and normalizing cell membrane function. This enhances the body’s own restorative properties and accelerates healing. Tissue repair is accelerated most likely due to the increase in ATP production, increased protein synthesis (intracellular flow of nutrients) and waste product removal (extracellular flow of waste materials). Oshman, 2003 Rowley, et al., 1974 Manley, 199, Cheng, 1982

12. The Research • Research by Ngok Cheng, MD (1982) showed microamperage of 50 – 500 microamps increases ATP production in cells by 500%, increases rate of protein synthesis by 70% and waste product removal (cell transport of amino acids) by 40%. • Bourguigonon (1987-1989) used similar research to show enhanced tissue repair, protein and DNA synthesis, improved insulin binding (sensitivity) and increased intracellular calcium uptake • Currents above 750-1,000 microamps actually reducesenergy production (1,000 microamps = 1 milliamp) • All other PT modalities currently use milliamp currents

13. Inflammation Reduction • Research done by Vivienne Reeve, PhD showed that inflammation and swelling on mice was reduced by 70% with Microcurrent. No anti-inflammatory drug ever tested in animal research ever produced more than 45% reduction in swelling. • What would happen to your client’s performance if post exercise inflammation and muscle soreness could be eliminated?

14. Low- Level Laser Erchonia Laser This FDA approved technology initiates increased micro-circulation and enhanced tissue regeneration. Stimulates cell renewal with no side effects ever reported. The overall effect is decreased pain and inflammation, and increased range of motion.

15. Manual Therapies • ART™ • Myofascial Release • ELDOA

16. Combing Microcurrent w/ART

17. Myofascial Stretching & ELDOA

18. Fascia “By it’s action we live, and by it’s failure we shrink, or swell and die. It is in the fascia that we must look for the cause of disease and the beginning of healing action” A.T.Still, DO Father of Osteopathic Medicine

19. Myofascial vs. Conventional Stretching • Myofascial stretching is different than conventional forms of stretching. • It targets the fascial sheaths and chains that surround and connect the muscles with the ligaments, tendons, and visceral attachments of the body.

20. What is Myofascial Stretching? • By definition it is the stretching of a muscular chain within a fascial chain. Fascia is the connective tissue that envelopes, shapes and connects every muscle in the body. It connects with and impacts with other muscles, bones, ligaments, tendons, nerve fibers, and visceral organs through the fascial attachments and runs along fascial chains throughout the body. As such, it plays an important role in carrying kinesthetic information back to the brain for the proper formation of posture. It helps determine the range of motion of all the lumbar and cervical vertebrae. Stretching this tissue helps restore and maintain the proper functioning of the spine but requires a specific form of exercise called myofascial stretching.

21. Cont’d… • Myofascial stretching involves positioning the body in specific postures and contracting muscles so that the specific myofascia (myo meaning “muscle”) is elongated. This makes it a motor control exercise with a specific stabilization component to it. It makes the client aware of posture and spatial awareness, kinesthetic awareness, while attempting to release a fascial restriction within the respective chain. By placing the myofascial chain under tension we can stretch the local fascial structure but also impact the distal structures that are connected with it such as the visceral organs. During this stretch you might not feel a stretch in the target muscle but in the distal myofascial restriction. It makes it an easier way of observing imbalances in a client’s mobility. This is a radically different type of stretching from the static stretching that is usually taught by most personal trainers, strength coaches and health care professionals – but the difference in results is remarkable.

22. Myofascial Stretching Tips • To be performed after strength training, energy system work, or competitive event • Never to be done before the above • All stretches to be held for 2-3 reps of 30 seconds each. • These are static stretches. No bouncing.

23. Psoas Major & Iliacus

24. Ilio-PsoasMyofascial Stretch Beginner stretch Advanced stretch w/increased hip extension

25. What is ELDOA? • ELDOA is the French acronym for EtirementsLongitunaux avec DecoaptationOsteo- Articulairewhich translates to LOADS (Longitudinal Osteo Articular Decoaptation Stretching) in English.  The ELDOA were developed by Guy Voyer, DO and a group of therapists in France over 20 years ago.  There is an ELDOA for all levels of the spine and sacroilliac joint.  The effects of the decoaptation (decompression) of the specific level results in reabsorption of the intervertebral disc, postural normalization, decompression of the disc and facet joint, and improved kinesthetic awareness of the myofascial chain.

26. ELDOA is an excellent restorative exercise to be performed at the end of a training session and most importantly within 1 hour of bedtime. The only equipment needed is an empty wall and some floor space to lie down.  All ELDOA are performed for at least 60 seconds to achieve desired effect.

27. Most Important ELDOA • The most important ELDOA is the L5 – S1 level which is where the lumbar spine articulates with the sacrum. This lumbosacral articulation represents the support of the vertebral column on the pelvis.  A significant amount of spinal flexion takes place at this mobile segment, thus making it a weak link from all of the heavy training. running and jumping an athlete participates in.  Guy Voyer states, “The strength of the myofascia is as strong as the weakest link.” • ELDOA works to provide decompression at the Lumbar 5 and Sacrum 1 level. This is accomplished by fixing the inferior segment, L5, and mobilizing the superior segment, S1. The position is created to place the myofascial chains under tension.  Once these tensions are maintained with proper awareness, the specific level undergoes a decoaptation or decompression.

28. Relaxed L5 – S1ELDOA

29. Strength Training

30. No clear direction with LBP Some experts think that “core” strengthening and stabilization techniques are important while others think that a traditional strength based program is optimal. SO WHICH IS IT!?!?

31. Case Study for Lower Back Injury • Patient: Bryan Berard – NHL Defenseman • Condition: L4- L5 Microdiscectomy in March of 2006 L3-L4 Microdiscectomy in October 2006 • Therapy: He was given traditional physical therapy and core exercises in off season and was in camp for start of next season. Returned to play in Sept. 2006 however started to develop severe L thigh and hip flexor pain (80%) along with LBP (20%). MRI (+) for L3-L4 disc herniation. 2nd Microdiscectomy in October 2006. Patient flew out for Microcurrent treatments 5 days after surgery. Pt. received multiple Nerve injury and Disc Acute protocols for 9 days. Pt. also received specific pompage and gentle ART during these treatments as well. The team ordered him back to work with their trainers and PT. He did not return to play and was out the entire season.

32. Case Study Continued… • In April 2007 he hired me to be his physical therapist, strength coach, and nutritionist with the goal of returning to the NHL as an active player. • Evaluation: After evaluating his condition with the Klatt test to determine he had LB weakness, VMO weakness, and Quadratus Lumborum weakness. He had marked decreased hip internal rotation on left and B psoas ???? tightness. I had my work cut out for me!

33. Case Study Strength Program: • Weeks 1-4: • Structural Balance training protocol including: • Program A • A1 Petersen step ups 4 sets, 12-15 reps • A2 Leg curls with Toes Inward/DF 4 sets, 6-8 reps • B1 Split squats w/front foot elevated 4 sets, 10-12 reps • B2 45° back extension 4 sets, 10-12 reps • Manual techniques used to facilitate posterior chain musculature • Manual resistance on sets 2-4 alternating left & right rotation. • C Single Leg Calf raise 3 sets 10-12 reps, no rest between legs • Voyer Lower ab circuit 5 sets 10 reps 10 second rest between sets • Manual techniques used to facilitate lower rectus abd. work

34. Strength Program Cont’d… • Program B • A1 DB Side Step ups 16-18 box 4 sets, 10-12 reps • A2 Leg curls with Toes Inward/PF 4 sets, 6-8 reps • B1 DB Walking Lunge 4 sets, 12 reps • B2 Swiss Ball hip extension and curl 4 sets, 10-12 reps • C1 Single Leg Calf Raise 3 sets 10-12 reps no rest between legs • C2 Toe Raises on Hammer or Step 3 sets 12-15 reps • D Reverse Sit ups on flat bench 3 sets 12 reps • Manual techniques used to facilitate lower rectus contraction

35. Strength Program Continued… • All workouts started with 5 minutes on treadmill and 5 minutes of a dynamic warmup. All sessions ended with illio psoas and obterator internus myofascial stretches followed by General spine ELDOA and L5 S1 ELDOA. • Athlete performed 2 upper body workouts per week and always finished off with 45 degree lateral flexion 3 sets 12 reps followed by side bridge/front bridge combo. Manual facilitation and perturbation was used during these combos. • Patient also given 7 myofascial and ELDOA stretches to do on his own every night before bed.

36. Strength Program Cont’d… • Patient received Microcurrent treatments 3X’s per week along with full body ART sessions 2X’s per week. • Sacroilliac joint pompages were done prior to the ART session to increase tissue elasticity and to prepare the fascia for release techniques.

37. Program Conclusion… • Weeks 10-16 • Patient progressed to back squats • A1 Manta Ray Back Squat 5 sets, 4-6 reps • A2 Leg curls with feet neutral 4 sets, 6-8 reps • B1 Manta Ray Barbell Split Squats 4 sets, 8-10 reps • B2 Glute-Ham Raise 4 sets, 8-10 reps • Manual techniques used to facilitate posterior chain musculature • Results: Athlete made it back to the NHL with no LBP or nerve pain at all. Scored #6 overall in training camp and was very pleased with results. He made it through the entire season without any missed games from the lumbar injuries. He maintained his strength with abbreviated off season workouts and sled work as well. The myofascial stretches and ELDOA were performed daily.

38. Nutrition & Healing

39. Nutrition and Healing To Reduce Pain and InflammationRemove the “Sensitive 7”: • Dairy • Wheat • Sugar • Corn • Soy • Eggs • Peanuts

40. Nutritional Support • Optimize GI and Liver health • Avoid Trans Fats and High Fructose Corn Syrup • Introduce Paleo/anti-inflammatory diet • Optimize fatty acids and eicosanoids synthesis • Vitamin D • Introduce Chondro-support • Proteolytic enzymes for acute/chronic pain

41. 5 Take Away Messages: • Always continue educating yourself on the latest advancements in your field. • FSM and Low Level Laser are effective modalities in increasing ATP production and decreasing pain. • Hands on therapy is still one of the most powerful tools in rehabbing injuries. • You don’t need physio-balls, Airex pads, Bosu Balls, or foam rollers to rehab patients! Use whole body routines addressing structural imbalances. • A dehydrated, smoking or malnurished patient will not get better.

42. Thank you.Nick Liatsos, PTHealthPro Physical Therapy30 Boston St, Ste. 10, Lynn, MA 01904100 Everett Ave, Unit 7, Chelsea, MA 02150www.HealthProPT.net