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Categories: Physicians & Surgeons, Osteopathic Manipulative Treatment, Physicians & Surgeons, Physicians & Surgeons, Family Medicine & General Practice, Physicians & Surgeons, Gynecology, Physicians & Surgeons, Ophthalmology, Physicians & Surgeons, Orthopedics, Physicians & Surgeons, Pediatrics, Physicians & Surgeons, Surgery-General

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Phone: (724) 494-1468

Address: 30 Warrendale Bayne Rd, Warrendale, PA 15086

Website: http://myofascialtherapy.massagetherapy.com

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Advanced Bodywork, Massage and Yoga

General Practitioners

Osteoporosis
Headaches
Arthritis
Between September 2007 and December 2009, all consecutive patients with shoulder pain referred to a primary care practice for physical therapy were potential study participants. The patients were self-referred or were referred by general practitioners, orthopedic surgeons, neurologists or physiatrists. Patients were eligible if they had had unilateral nontraumatic shoulder pain for at least 6 months, were between ages 18 and 65 years and had a clinical presentation that did not warrant referral for further diagnostic screening. Excluded from the study were patients who previously had been diagnosed with shoulder instability; shoulder fractures; systemic diseases such as rheumatoid arthritis, Reiter's syndrome, or diabetes; or whose medical history or physical examination suggested neurological diseases or other severe medical or psychiatric disorders. Patients with signs and symptoms of a primary frozen shoulder were also excluded. Because the questionnaires were in the Dutch language, patients had to understand written and verbal Dutch. The lead investigator (CB) checked all available information from referral letters and additional information from the patients. All eligible patients were invited to participate in the study. The patients were informed of the study before the first assessment and signed a written, informed consent statement.
Fibromyalgia
About 23 million persons, or 10 percent of the U.S. population, have one or more chronic disorders of the musculoskeletal system. 1 Musculoskeletal disorders are the main cause of disability in the working-age population and are among the leading causes of disability in other age groups. 2 Myofascial pain syndrome is a common painful muscle disorder caused by myofascial trigger points. 3 This must be differentiated from fibromyalgia syndrome, which involves multiple tender spots or tender points. 3 These pain syndromes are often concomitant and may interact with one another.
Plantar Fasciitis
Medical Weight Loss
Sedation and cognitive side effects (such as confusion or memory problems) may limit its use. Topamax often decreases appetite, which leads to weight loss; this is unusual among headache preventives. The starting dose is 25 mg. once or twice daily; this may be pushed to 100 mg. once or twice per day. 100 mg. daily is the usual dose. It is usually well-tolerated in lower doses and may be effective as a mood stabilizer for some milder bipolar patients. GI upset may occur. Acute glaucoma has been a rare side effect.
Pediatric Care
Infants should have a daily intake of 400 to 1,000 IU (10 to 25 mcg) of vitamin D, and children and adolescents should have a daily intake of 600 to 1,000 IU (15 to 25 mcg) of vitamin D, consistent with the recommendations of The Endocrine Society (99). Given the average vitamin D content of breast milk, infant formula, and the diets of children and adolescents, supplementation may be necessary to meet these recommendations. The American Academy of Pediatrics currently suggests that all infants, children, and adolescents receive 400 IU of supplemental vitamin D daily (19).
Primary Care
Two research assistants (MO and MB; see Acknowledgements), each with 30 years of clinical experience in primary care practice and more than 5 years of experience in identifying and treating MTrPs, performed the physical examination, including the assessment of passive range of motion (PROM) of the shoulder and the MTrP palpation of the shoulder muscles. The total number of shoulder muscles with active and latent MTrPs was counted. The research assistants were blinded to the patient treatment allocations during the entire study period. The assessments were made at intake, prior to randomization and at 6 and 12 weeks. For every patient, only one observer was active. A detailed medical history was completed, which included demographic variables and potential prognostic factors [ 54, 55 ] and a set of self-administered questionnaires regarding outcome measurements, including the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire, the Visual Analogue Scale for Pain (VAS-P), the RAND Medical Outcomes Study 36-Item Short Form Health Survey (RAND-36) and the Beck Depression Inventory, Second Edition (BDI-II). A third research assistant (IS; see Acknowledgements) transferred the collected data to a worksheet. After the data from the worksheet were transferred into the statistical software packages Systat 12, SigmaPlot 11 and SigmaStat 3.11 for Windows software (Systat Inc., Richmond, CA, USA), the lead investigator (CB), who was blinded to the patients' treatment allocation until all statistical tests were performed, analyzed the data. Blinding of the patients and the treating physical therapists was impossible because of the treatment characteristics.
Family Practice
PAMELA G. ROCKWELL, D.O., is a clinical assistant professor in the Department of Family Medicine at the University of Michigan Medical School. Dr. Rockwell also serves as the medical director of the Family Practice Clinic at East Ann Arbor Health Center, which is affiliated with the University of Michigan Medical School. She received her medical degree from Michigan State University College of Osteopathic Medicine and completed a family practice residency at Eastern Virginia Medical School in Norfolk.
Constipation
Infectious Diseases
Electrocardiogram
Constipation is common. Starting dose is 1/2 of a 240 mg. ER tablet, increasing quickly to one 240 mg. tablet per day. May be pushed to 240 mg. twice a day, or decreased to 120mg. or 180 mg. per day. With doses higher than 240 mg. daily, an EKG needs to be done.
Diarrhea

Ophthalmologists

Glaucoma

Endometriosis
Pelvic Pain
Pregnancy

Kidney Stones
The risk of forming kidney stones is increased by the use of Topamax. Bicarbonate levels should be monitored, as Topamax may cause a dose-related metabolic acidosis.
Colon Cancer
Inflammation Research (2010), include supplying bone calcium to body organs and the lowering of elevated inflammatory markers linked to heart attack, diabetes and colon cancer.

Neurology
Chapter 6: Triggers and Thresholds. There’s more to triggers than red wine, cheese, chocolate, and the tyramine-containing foods list. These may be factors, but migraines can also come from bones and joints. Consider the connection between TMJ, the bones of neck, cranium, hips, feet, and postural strain from furniture, musical instruments, and more. Consider also alcohol and tobacco, antacids and their resulting opportunistic infections, sleep disruptions, the neurology behind barometer headaches, and the fashion migraine from posture, clothing and accessories.
Carpal Tunnel Syndrome
Pain felt down the arms, even numbness is often misdiagnosed as "carpal tunnel". Very often the pain and numbness is caused by trigger points in the neck and torso. Cutting into the wrist will not fix the problem!
Multiple Sclerosis
The Linus Pauling Institute recommends that generally healthy adults take 2,000 IU (50 mcg) of supplemental vitamin D daily. Most multivitamins contain 400 IU of vitamin D, and single ingredient vitamin D supplements are available for additional supplementation. Sun exposure, diet, skin color, and obesity have variable, substantial impact on body vitamin D levels. To adjust for individual differences and ensure adequate body vitamin D status, the Linus Pauling Institute recommends aiming for a serum 25-hydroxyvitamin D level of at least 80 nmol/L (32 ng/mL). Numerous observational studies have found that serum 25-hydroxyvitamin D levels of 80 nmol/L (32 ng/mL) and above are associated with reduced risk of bone fractures, several cancers, multiple sclerosis, and type 1 (insulin-dependent) diabetes.

Attention Deficit Hyperactivity Disorder (ADHD)
When prescribed for headache patients, stimulants (dextroamphetamine, meth-ylphenidate, phentermine, Adderall«, Vyvanse«) may be beneficial for various comorbidities, such as attention deficit hyperactivity disorder (ADHD), depression, and fatigue. In addition, stimulants do not cause the weight gain that is seen with a number of other current headache preventives. Amphetamines have been shown to possess intrinsic analgesic properties, primarily through brain catecholamine activity. They also intensify the analgesic effects of certain opioids. Stimulants have been utilized to counteract the sedation encountered by opioids. An excellent review article on stimulants as adjuncts for opioids concluded that, “The evidence suggests that amphetamine drugs may enhance the effect of opioids and, at the same time, decrease somnolence and increase cognitive performance.”
Stress Management
Mary Jo has worked in the healthcare field for over 34 years and has taught workshops on trigger point therapy and stretching, stress management, migraine prevention, and treatments for Fibromyalgia and Chronic Pain support groups.
Depression
Mental Health
Psychiatry
Insomnia
Anxiety

Endocrinologist

Diabetes Care
Endocrinology
Journal of Clinical Endocrinology & Metabolism indicate that vitamin D 3 also produced a 2- to 3-fold increase in the storage of the vitamin, compared with vitamin D2.
Hypothyroidism
Thyroid

Ultrasound
Et al. defined a latent MTrP as "clinically quiescent with respect to spontaneous pain; it is painful only when palpated. A latent MTrP may have all the other clinical characteristics of an active MTrP and always has a taut band that increases muscle tension and restricts range of motion" [ [ 26 ], page 4]. Palpation is still considered the only reliable clinical method of diagnosing MTrPs. Previous studies have shown that trained physical therapists can reliably detect MTrPs by palpation [ 37, 38 ]. Although magnetic resonance elastography and ultrasound imaging studies have shown potential in allowing clinicians to visualize MTrPs, their clinical usefulness has yet to be established [ 31, 32 ].
MRI
Archives, one by Shah and colleagues and another one by Chen and colleagues, present groundbreaking findings that can reduce some of the controversy surrounding myofascial trigger points (MTPs). Both author groups recognize the ubiquity of this disease and the importance to patients of health care professionals becoming better acquainted with the cause and identification of MTPs. The integrated hypothesis is the most credible and most complete proposed etiology of MTPs. However, the feedback loop suggested in this hypothesis has a few weak links, and studies by Shah and colleagues in particular supply a solid link for one of them. The feedback loop connects the hypothesized energy crisis with the milieu changes responsible for noxious stimulation of local nociceptors that causes the local and referred pain of MTPs. Shah’s reports quantify the presence of not just 1 noxious stimulant but 11 of them with outstanding concentrations of immune system histochemicals. The results also strongly place a solid histochemical base under the important clinical distinction between active and latent MTPs. The study by Chen on the use of magnetic resonance elastography (MRE) imaging of the taut band of an MTP in an upper trapezius muscle may open a whole new chapter in the centuries-old search for a convincing demonstration of the cause of MTP symptoms. MRE is a modification of existing magnetic resonance imaging equipment, and it images stress produced by adjacent tissues with different degrees of tension. This report seems to present an MRE image of the taut band that shows the chevron signature of the increased tension of the taut band compared with surrounding tissues.
Radiology
4 is a ground-breaking first. Although previous authors have investigated muscle by using magnetic resonance elastography (MRE), this is the first study that specifically examined imaging of the MTP phenomena. Chen focused on the imaging of taut bands of MTPs because of the high prevalence and clinical importance of that disease. The possibility of imaging taut bands promises to open up a whole new chapter in the MTP saga. Finding a taut band by palpation requires considerable skill that is a combination of innate palpation skill (something many clinicians were not blessed with), authoritative training, and critical clinical practice as is required for any advanced medical skill, such as heart surgery. Finding just the tender spot of an MTP is much simpler. If the clinician makes use of the published pain patterns of individual muscles, the patient’s pain complaint gives a running start as to which muscles to examine. When range of motion is painfully limited, the patient can usually point to the painful muscle; this provides more help to the practitioner. The muscle with an MTP is usually similarly painful when contracted in the shortened position. Then all the clinician must do is poke the suspected muscle(s) with a finger to find an exquisitely tender spot. Rheumatologists are quite practiced at this kind of procedure to diagnose fibromyalgia and are perplexed by taut bands for identifying MTPs. A request to the local radiology department equipped with MRE (and a number are already) is all that would be needed to confirm the diagnosis for the benefit of all, including the third-party payer and payment. This indeed shows promise for the dawning of a new day for the disease of MTPs.
Chemotherapy

Sciatica
Help for conditions such as Fibromyalgia, "Carpal Tunnel", Repetitive Motion Injuries (RMI, RSI), Chronic headaches and migraines, jaw pain (often called TMJ or TMJD), heel and leg pain, "sciatica" and many other conditions with medical-sounding names that they just tell you to take pain meds for......
Whiplash
Consistent with a whiplash injury, many upper back and neck muscles were involved, two most prominently. One, the trapezius (illustration A) refers a very familiar pain pattern up the back of the neck and into the temples. The sternocleidomastoid (SCM for short) was the other. (Illustration B) These muscles check-reins excessive forward and backward motion of the head, which often happens in an auto accident, even more so if hit from behind! The common diagnosis is "whiplash injury" or "cervical sprain/strain".
Orthopedic Surgery
Hip Replacement
Acute sports injuries caused by acute sprain or repetitive stress (e.g., pitcher's or tennis elbow, golf shoulder), surgical scars, and tissues under tension frequently found after spinal surgery and hip replacement may also predispose a patient to the development of trigger points. 12

Plastic Surgeons

Botox
Migraines and muscle tension headaches have long been thought to be separate conditions. This has been disproven by elimination of migraines by Botox injections and by discovery of a direct muscular connection between the neck and the dura, the tough tissue surrounding brain and spinal cord.

Calluses
Lesions
Muscle lesions (e.g. trauma, RSI) can cause ruptures of the sarcoplasmatic reticulum which leads to an uncontroled release of calcium ions from the sarcoplasmatic reticulum. This in turn causes persistent sarcomere contractions. Many contracted sarcomeres and muscle fibres cause the taut band. Taut bands are palpable and can be visualized by ultrasound and MRI. On the one hand prolonged contractions have an increased energy demand and on the other hand they compress vessels, which leads to a decreased energy supply. The result is an energy crisis. Due to the lack of ATP there is also a decreased reuptake of calcium ions into the sarcoplasmatic reticulum which perpetuates contractions. As a result there is a local release of bradykinin and CGRP which lower the threshold of nociceptive endings. Many studies confirm the energy crisis theory. The integrated hypothesis is an expansion of the energy crisis theory and is the most accepted model for the explanation of trigger points. It postulates that the energy crisis process takes place in the vicinity of motor endplates. This leads to an incresed release of acetylcholine and therefore perpetuates the vicious circle of prolonged contraction.

Physical Therapists

Sports Medicine
It's usually a form of overload on the muscle. That is very common in life, we all over do things, we all fall a few times in our lives. Childhood injuries to sports injuries, heavy lifting or packing, raking leaves of shoveling snow. Repetitive strain injuries (RSI) almost always are really trigger points.
Physical Therapy
Findings: It seems that mechanical pain sensitivity is a consequence and not a causative factor for TTH. Recent evidence modifying previous knowledge about relationships between muscle tissues and chronic tension-type headache, suggests a potential role of myofascial TrPs in the genesis of the pain. In fact, active TrPs reproducing the headache attacks are present in both episodic and chronic TTH in a similar percentage, supporting an etiological role of active TrPs in TTH. Further, spatial and temporal summation of TrP activity is present in TTH. An updated pain model suggests that headache perception can be explained by referred pain from TrPs in the craniocervical muscles, mediated through the spinal cord and the trigeminal nucleus caudalis rather than tenderness of the muscles themselves. Different therapeutic strategies, i.e., pharmacological, physical therapy, psychological, and acupuncture, are generally used for the management of TTH. All these therapeutic interventions are also targeted to inactivating TrP activity.
Frozen Shoulder
Tennis Elbow
* Carpal Tunnel and other arm pain and numbness, Thoracic Outlet Syndrome, tennis elbow, golfers elbow, trigger finger, texter's thumb, aching and heaviness of the arms. Most other
Shoulder Pain
Heel Pain
Back Pain
Manual Therapy
Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibers and the formation of trigger points. Patients may have regional, persistent pain resulting in a decreased range of motion in the affected muscles. These include muscles used to maintain body posture, such as those in the neck, shoulders, and pelvic girdle. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and low back pain. Palpation of a hypersensitive bundle or nodule of muscle fiber of harder than normal consistency is the physical finding typically associated with a trigger point. Palpation of the trigger point will elicit pain directly over the affected area and/or cause radiation of pain toward a zone of reference and a local twitch response. Various modalities, such as the Spray and Stretch technique, ultrasonography, manipulative therapy and injection, are used to inactivate trigger points. Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms.
TMJ Dysfunction

Flat Feet
* Heel and foot pain, Plantar Fasciitis, knee pain, shin splints, fallen arches, ankle pain, Restless Leg Syndrome
Heel Pain
Foot Pain
Plantar Fasciitis
They're everywhere. I think most people that I see have neck and back pain as their main complaint. People who work or play on computers have them in their neck, arms and shoulders. The diagnosis of plantar fasciitis or foot pain is almost always due to trigger points at the calf muscles.

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