Ankle sprains and avoiding long term issues

Have you ever sprained, or rolled, your ankle which resulted in pain, swelling and possible bruising? You then rested, iced and compressed it as you were told?  After an ankle sprain, the use of an ankle support for every day weight bearing activities is important for protection and to avoid re-injuring the ankle. Ice with elevation and compression are also important things to do early on. Ligaments take a minimum of 6 weeks to be somewhat stable (and only if they are nurtured correctly) and most often there are injured tendons and/or muscles involved that also take time to heal.  However, studies support the importance of moving the ankle, foot and knee (yes, knee) in very specific directions beginning in the acute stage of recovery to prevent excessive scarring and joint stiffness, atrophied muscles and to prevent much proprioceptive loss (our ability to make micro adjustments in ankle positioning to stay balanced).  Class IV laser kickstarts tissue regeneration and reduces swelling and can be done immediately. In addition, soft tissue manipulation, neuromuscular re-education, taping and balance are just a few things that should be implemented right away. These things will so often get you back to “normal”, with good strength, range of motion, and without pain on stairs, walking uneven surfaces and/or getting back to impact sports. Be sure you are not guessing as to what you need to be doing on your own as further injury can result. To be safe, have a Physical Therapy evaluation who will do a whole lower quarter assessment and guide you through what to do at home and to instruct you on contraindicated movements, as well.

Effects of Class IV Laser on Fibromyalgia Impact and Function on Women with Fibromyalgia



This study evaluated the effects of Class IV laser therapy on pain, Fibromyalgia (FM) impact, and physical function in women diagnosed with FM.


The study was a double-blind, randomized control trial.


Testing was completed at the university and Rheumatologist office and treatment was completed at a chiropractic clinic.


Thirty-eight (38) women (52±11 years; mean±standard deviation) with FM were randomly assigned to one of two treatment groups, laser heat therapy (LHT; n=20) or sham heat therapy (SHT; n=18).


Both groups received treatment twice a week for 4 weeks. Treatment consisted of application of LHT or SHT over seven tender points located across the neck, shoulders, and back. Treatment was blinded to women and was administered by a chiropractic physician for 7 minutes.


Participants were evaluated before and after treatment for number and sensitivity of tender points, completed the FM Impact Questionnaire (FIQ) and the pain question of the FIQ, and were measured for function using the continuous scale physical functional performance (CS-PFP) test. Data were evaluated using repeated-measures analysis of variance with significance accepted at p≤0.05.


There were significant interactions for pain measured by the FIQ (LHT: 7.1±2.3 to 6.2±2.1 units; SHT: 5.8±1.3 to 6.1±1.4 units) and for upper body flexibility measured by the CS-PFP (LHT: 71±17 to 78±12 units; SHT: 77±12 to 77±11 units) with the LHT improving significantly compared to SHT. There was a time effect for the measure of FM impact measured by the FIQ, indicating that FM impact significantly improved from pre- to post-treatment in LHT (63±20 to 57±18 units), while no change was observed in the SHT (57±11 to 55±12 units).


This study provides evidence that LHT may be a beneficial modality for women with FM in order to improve pain and upper body range of motion, ultimately reducing the impact of FM.

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Efficacy of 780-nm laser phototherapy on peripheral nerve regeneration after neurotube reconstruction procedure (double-blind randomized study).

Efficacy of 780-nm laser phototherapy on peripheral nerve regeneration after neurotube reconstruction procedure (double-blind randomized study).

Author information

  • 1Division of Peripheral Nerve Reconstruction, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.



This pilot double-blind randomized study evaluated the efficacy of 780-nm laser phototherapy on the acceleration of axonal growth and regeneration after peripheral nerve reconstruction by polyglycolic acid (PGA) neurotube.


The use of a guiding tube for the reconstruction of segmental loss of injured peripheral nerve has some advantages over the regular nerve grafting procedure. Experimental studies have shown that laser phototherapy is effective in influencing nerve regeneration.


The right sciatic nerve was transected, and a 0.5-cm nerve segment was removed in 20 rats. A neurotube was placed between the proximal and the distal parts of the nerve for reconnection of nerve defect. Ten of 20 rats received post-operative, transcutaneous, 200-mW, 780-nm laser irradiation for 14 consecutive days to the corresponding segments of the spinal cord (15 min) and to the reconstructed nerve (15 min).


At 3 months after surgery, positive somato-sensory evoked responses were found in 70% of the irradiated rats (p = 0.015), compared to 30% of the non-irradiated rats. The Sciatic Functional Index in the irradiated group was higher than in the non-irradiated group (p < 0.05). Morphologically, the nerves were completely reconnected in both groups, but the laser-treated group showed an increased total number of myelinated axons.


The results of this study suggest that postoperative 780-nm laser phototherapy enhances the regenerative process of the peripheral nerve after reconnection of the nerve defect using a PGA neurotube.

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Phototherapy in peripheral nerve regeneration: From basic science to clinical study.



This review summarizes the continuous study of low-power laser radiation treatment of a severely injured peripheral nerve. Laser phototherapy was applied as a supportive factor for accelerating and enhancing axonal growth and regeneration after injury or a reconstructive peripheral nerve procedure. In nerve cell cultures, laser phototherapy was used to stimulate activation of nerve cells.


Low-power laser radiation was used for treatment of peripheral nerve injury using a rat sciatic nerve model after crush injury, neurorrhaphy, or neurotube reconstruction. Nerve cell growth and axonal sprouting were investigated using laser phototherapy on embryonic rat brain cultures. The outcome in animal studies facilitated a clinical double-blind, placebo-controlled, randomized study that measured the effectiveness of 780-nm laser phototherapy on patients suffering from incomplete peripheral nerve injuries for 6 months to several years.


Animal studies showed that laser phototherapy has an immediate protective effect, maintains functional activity of the injured nerve, decreases scar tissue formation at the injury site, decreases degeneration in corresponding motor neurons of the spinal cord, and significantly increases axonal growth and myelinization. In cell cultures, laser irradiation accelerates migration, nerve cell growth, and fiber sprouting. A pilot clinical double-blind, placebocontrolled, randomized study showed that in patients with incomplete long-term peripheral nerve injury, 780-nm laser radiation can progressively improve peripheral nerve function, which leads to significant functional recovery.


Using 780-nm laser phototherapy accelerates and enhances axonal growth and regeneration after injury or a reconstructive peripheral nerve procedure. Laser activation of nerve cells, their growth, and axonal sprouting can be considered as potential treatment of neuronal injury. Animal and clinical studies show the promoting action of phototherapy on peripheral nerve regeneration, making it possible to suggest that the time for broader clinical trials has arrived.

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The Effectiveness of Therapeutic Class IV (10 W) Laser Treatment for Epicondylitis

Background and Objective

Photobiomodulation has been shown to modulate cellular protein production and stimulate tendon healing in a dose-dependent manner. Previous studies have used class IIIb lasers with power outputs of less than 0.5 W. Here we evaluate a dual wavelength (980/810 nm) class IV laser with a power output of 10 W for the purpose of determining the efficacy of class IV laser therapy in alleviating the pain and dysfunction associated with chronic epicondylitis.


Sixteen subjects volunteered for laser therapy, or an identically appearing sham instrument in a randomized, placebo-controlled, double-blinded clinical trial. Subjects underwent clinical examination (pain, function, strength, and ultrasonic imaging) to confirm chronic tendinopathy of the extensor carpi radialis brevis tendon, followed by eight treatments of 6.6 ± 1.3 J/cm2 (laser), or sham over 18 days. Safety precautions to protect against retinal exposure to the laser were followed. The exam protocol was repeated at 0, 3, 6 and 12 months post-treatment.


No initial differences were seen between the two groups. In the laser treated group handgrip strength improved by 17 ± 3%, 52 ± 7%, and 66 ± 6% at 3, 6, and 12 months respectively; function improved by 44 ± 1%, 71 ± 3%, and 82 ± 2%, and pain with resistance to extension of the middle finger was reduced by 50 ± 6%, 93 ± 4%, and 100 ± 1% at 3, 6 and 12 months, respectively. In contrast, no changes were seen until 12 months following sham treatment (12 months: strength improved by 13 ± 2%, function improved by 52 ± 3%, pain with resistance to extension of the middle finger reduced by 76 ± 2%). No adverse effects were reported at any time.


These findings suggest that laser therapy using the 10 W class IV instrument is efficacious for the long-term relief of the symptoms associated with chronic epicondylitis. The potential for a rapidly administered, safe and effective treatment warrants further investigation. Lasers Surg. Med. 45:311–317, 2013. © 2012 Wiley Periodicals, Inc.

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The sacroiliac joint (SIJ) …do you have pain here?



It is common to feel pain in the lowest part of the back with an irritable SIJ. In addition, the SIJ can refer to the buttocks, front of hip and groin, outer thigh and sometimes to the outside calf area. Problems in this area come from long-term poor postural habits, trauma due to falls, multiple births, autoimmune conditions, to name a few. Except for cases of severe hypermobility, the SIJ moves no more than a few degrees.

With an acute injury it can often be easy and quick to fix but how many people have had manual manipulations over and over again but continue to have the same pain? Are we “moving” the SIJ with manual therapy/manipulations? A study that looked at movement of the SIJ before and after manipulation used a system called Roentgen Stereo Photogrammetric Analysis (Tullberg, 1998) to measure miniscule changes in the joint. Though the position of the SIJ felt symmetrical to touch, there was no real change between the two bones. Subsequent studies have stated similar outcomes of insignificant joint changes. Numerous studies effectively confirm that the SIJ can be the primary source of pain as confirmed by a pain-relieving injection into the joint. Clinically, patients often report temporary relief of pain with SIJ manipulation and this can be a great tool. However, the soft tissue system cannot be ignored if long term improvements are expected. Weakness, pain and swelling cause compensatory movements and thus the muscles, tendons, ligaments, nerves, the joint capsule, and/or fascia must be addressed.

What to do for a painful SIJ? As everyone is unique, a thorough head-to-toe evaluation of movements and posture is critical. Treatments include any and all of the following: hands-on manipulation of joints, myofascial release, exercises, education on proper everyday movements including squatting, sitting and standing, modifying shoe wear, modalities such as Class IV Laser and Trigger Point Dry Needling.


Got a headache yet?


What is wrong with this all too common picture? The wrong muscles are working hard to hold the head up, important neck muscles for posture and stability are snoozing when they should be working, spinal joints (facet) are sitting in a compromised position, and it won’t be long before nerves send signals that disks, muscles, ligaments and joints are unhappy.

Studies, and the International Headache Society, show that about 15% of all headaches are cervicogenic in nature which means they originate from joints or soft tissues in the neck. Sensory nerves from the upper cervical spine (neck) relay information to something called the trigeminal spinal nucleus that is related to some headaches. Though this can happen from trauma such as car accidents, it is also common with sustained poor postures such as this one here.

What to do about it? Seek professional advise on postural changes that include correcting the way muscles are being misused in the neck and learn how to “stack” the joints in the neck appropriately. Strong evidence supports that joint mobilizations, myofascial release, trigger point dry needling and the right exercises alleviate this type of headache, as well.

What is big deal with trekking poles (nordic poles) for walking?

I find myself encouraging many of my patients to buy trekking poles so they will be more comfortable, safe and stable while walking for exercise. I also receive great feedback from those who heed my advice. It may be obvious that the use of these can improve safety on uneven surfaces and, thus, increase confidence for some people to just get out there and walk.

Research suggests that these poles also help decrease the load to lower extremity joints. For those with knee osteoarthritis, the impact to the whole knee, and inner region in particular, can be reduced and therefore improve pain levels with walking (Fregly et al, 2009). Another study showed up to 24% lower load onto the metatarsal heads (balls of feet) while using 2 poles (Hudson 2014). The lower back and hips are also mildly unloaded compared to walking without poles.

Proper fit and use is essential as overuse injuries can occur, as well. For example, if wrists or shoulders become sore with use then it is important to have a  physical therapist or health care provider assess footwear, gait and pole type. Additionally, there are Certified Nordic Walkers  who lead classes and can make it more fun to do as a group.

Patients in my clinic have gotten off the proverbial couch, walked more regularly, and felt more comfortable doing so. This is reason enough for me to continue to be an advocate for nordic poles.

New website, new Physical Therapy practice

Welcome and thanks for visiting my blog and website. My goal here is to share information regarding common injuries, injury prevention and to provide clinical pearls to encourage us all to live healthier lives. You can be sure I’ve done my research before I share with you here.

This blog is in no way meant to diagnose and/or treat an injury but to give good information that you can take with you in your quest for getting and staying healthy!

Stay tuned!