Trigger Point Dry Needling.

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I just spent a weekend in sunny Arizona.  I was inside the whole weekend!  Some of you may think think that is horrible.  But I was learning!  I am now certified to perform Dry Needling.

What is Dry Needling?

Dry Needling is a physical therapy technique to help reduce pain and other symptoms.  In dry needling, a physical therapist uses acupuncture needles to stimulate an immune response in a certain area. We start by inserting an acupuncture needle or needles around the trigger point, and then along the myotomal (nerves responsible for muscle contraction) and/or dermatomal (nerves responsible for sensation of pain) pattern toward the spine.  Needles may also be inserted at the spine. The action of these needles creates a lesion in the surrounding tissues, stimulating the body’s own immune response.  An increase in blood flow to the area results from the needling!

It is important to note that acupuncture and dry needling are different. Acupuncture is based on Traditional Chinese Medicine and has a focus on correcting Xi.  Dry Needling is based on scientific neurological principles.

Joel with Dry Needles

Joel with Dry Needles

Be sure to call and set up an appointment in either Redmond (425-883-9630) or Mercer Island (425-883-9631).  For further information check out Advantage PT on the Web!



Maintaining your balance

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English: Vrksasana, the tree position, a Yoga ...

English: Vrksasana, the tree position, a Yoga posture. (Photo credit: Wikipedia)

Is balance an issue for you? You are not alone!

I see many patients with balance problems, and not all of them are using canes, walkers, wheelchairs, crutches, or other aides to keep them upright.  Some of them feel they are moving and balance just fine on their own.  And maybe that’s true.  But I find it much more common that someone creates a way to balance so there is no need to realize that balance is poor.

The leading reasons for poor balance are; hip weakness, poor core stability, ankle instability, and joint hyper/hypomobility.

By keeping the muscles and joints of the low back and lower extremities in good condition with exercise and movement, we can prevent developing balance problems later in life.

Did you know that by moving, you innately need some balance?  Walking and running are basically just alternating balancing on one foot as well as moving forward at the same time.

In order to keep your balance long into life, you can try these exercises to keep you upright.

Here is an exercise to practice your balance:

You can make this harder by adding a pillow under your foot or closing your eyes, or both!!!

This second exercise will strengthen your hips to help your balance:

Spinal Mobility

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Most of us know that as we age, it is important to keep moving.  Whether that is full on, hardcore exercise, or gentle walking is not important.  What is important is to keep every joint in the body mobile.  This includes not only the joints of the extremities:

  • Toes
  • Ankles
  • Knees
  • Hips
  • Fingers
  • Wrists
  • Elbows
  • ShouldersThe lumbar region in regards to the rest of th...

But also the joints of the spine.  The spine consists of 7 cervical vertebrae each with 4 or more joints, 12 thoracic vertebrae with 6 or more joints and 5 lumbar vertebrae with 4 or more joints.  The spine has over 120 joints, which can tighten with bad posture, overuse, pregnancy, and/or poor technique with exercise.

We are trained as early as pre-school to sit still.  If you look at children today, most are hunched over a desk or table to learn (class), study (homework/library), eat, or play some sort of game.  This continues into adulthood as we tend to work at a desk or watch TV.  All of this time spent in one position can lead to degenerative changes in the joints of the spine.

We need to move.  Spinal mobility can be improved by standing up and moving around.  I recommend to my patients to get up at least once per hour and move around the office and do some back bends and neck rotation exercises to help keep the spine limber. (click here for some neck exercises)

When your spine is tight, it can lead to the muscles of the spine getting tight as well.  This muscle tightness can lead to back and/or neck pain, shoulder pain, and even headaches and TMJ (temporalmandibular joint) pain.

If you are concerned about back pain and joint mobility, your Physical Therapist can help design a program for you to stay mobile as well as provide manual therapy to increase joint mobility of the spine.


Are You at Risk for Shin Splints?


English: DEERWOOD, Md. (Feb. 7, 2009) Lt. j.g....

English: DEERWOOD, Md. (Feb. 7, 2009) Lt. j.g. Gina Shaw treats shin splints by wrapping her leg in ice after her 8 Kilometer run after competing in the 2009 Armed Forces Cross Country Championship. The women’s cross-country team finished second behind the Air Force. (U.S. Navy photo by Mass Communication Specialist 2nd Class Jhi L. Scott/Released) (Photo credit: Wikipedia)

A common complaint among runners is Shin Splints.  In all honesty, this type of injury happens to more than just runners.  Anyone who has a mild to major increase in activity level is susceptible to shin splints. Shin splints (medically known as Medial Tibial Distress Syndrome) can limit the amount of activity a person can do.  If you have ever had shin splints before, you know exactly what I am talking about.  The pain is excruciating!  So now that the summer is coming to an end, maybe you are trying to increase your amount of activity before the clouds and storms come in representing the change in seasons.

Some factors that increase your risk to shin splints are:

  • Improper footwear
  • Overpronation of the foot/ankle
  • Muscular weakness
  • Muscular tightness
  • Decrease joint mobility
  • Poor training quality/form
  • High foot arches

I am sure that everyone can fit into this list in at least one category.  I know that I fit into at least two fo them.  Does that mean you will get shin splints?  No!  Does it mean you should address pain in the front of your lower leg (shin) if you have it?  Yes, of course!  Here are a few tips to help avoid shin splints

  • Try to stay on softer surfaces for running
  • Replace running shoes around 300-400 miles
  • Limit distance increases to 10% or less each week
  • Include lower impact activities (cycling, elliptical, rowing, swimming, etc.)
  • Stretch the calf muscles (gastrocnemius and soleus)

If you do get shin splints, Advantage PT therapists can help get you back to full training faster!!  Email us with any questions (


Back to School

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Hey everyone.  School is starting up, and that means that summer is slowly coming to an end!  Fall sports are starting and everyone is returning to the grind. Did you know that one of the riskiest things for children at school is a backpack?  A backpack that is overloaded or worn improperly can cause damage to the spine and the surrounding musculature.  It is extremely important to watch for the risks of backpacks. Our website has some wonderful advice from the APTA on how to wear a backpack.  Here is a list of some of the more important considerations:

  • Wear both straps.  This distributes the weight more evenly across the back and promotes symmetrical posture
  • Make sure the backpack fits. The pack should sit evenly in the middle of the back and not sag.

Left: Improper wearing of a backpack. Right: Proper wearing of a backpack.

When looking to make a new purchase, some features that are beneficial are a padded back, a waist belt, compression straps, and reflective material.

It seems that today, many children are burdened with heavy packs.  Here is how you can tell if a backpack is too heavy:

  • Pain with use
  • Tingling or numbness down the arms
  • Red marks on the shoulders


One of the new “fads” is to have roller bags for school gear.  This can cut on the wear and tear to a childs back.  The drawback to this is that the pack is heavier itself and can cause injury when carrying it over unever surfaces. It is also important to not the size of the roller.  If you or your child have to lean to reach the handle, this can lead to some assymytry in the spine due to extra bending to one side (lateral flexion).

If you feel that you may want a backpack assessment or are having pain due to a backpack or a purse, call your physical therapist.


Prevent and Treat IT Band Symptoms

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Many people who are active feel sore knees either during or after participation in exercise and sports.  Unsure if they did anything to cause injury, most people just rest and then resume activity.  The IT (iliotibial) band can be a major culprit in some of these injuries.  The IT Band runs down the side of your leg from just above your hip all the way to your knee.  A tight IT band can pull the patella to the outside and cause some havoc with patellofemoral gliding.  At the same time, a tight IT Band can increase pressure over the greater trochanter and its bursa causing trochanteric bursitis.  Being able to keep the IT Band supple can help to stop both knee pain and some hip pain.

How do you keep the IT Band supple?  There are really two ways that work, and it is best if you perform both of them together. A strong hip will help create better alignment of the leg reducing the load on the ITB.  A majority of my patients demonstrate strength deficits in the gluteus medius muscle with is a strong supporter of pelvic alignment during ambulation.  Other hip dysfunctions due to weakness may result in walking or running with your leg rotated away from midline and the toes pointing more outward than forward.  Remember, strong and stable hips will help keep the IT Band from getting to tight.

Sometimes people are really tender along the IT band.  You can check yourself by applying gentle pressure along the side of your leg between your hip and knee.  If this is the case, the strengthening exercises below will help you out, but you will need to perform some “stretching” type of exercises as well.  I have found that even with a tight IT Band, it is a difficult muscle to perform a stretch to, but it is possible for some people.  What I find to be most effective to loosen the tissue is a self massage with a foam roller or a self roller.

Here are two exercises to help you on your way to stronger hips!

Side Lying Leg Raise



You can always use a foam roller to help massage out the ITB.  If this is not progressing the way you would like, please call us at Advantage Physical Therapy and schedule an appointment


Knee Pain

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Upon returning to exercise, it is common to feel pain in the front of the knee just below the knee cap (patella).  This is a very common complaint among my friends and in my practice.  In physical therapy and orthopedics, this type of pain is generally referred to as patellofemoral pain.  It is related to the way the patella tracks in the femoral groove.  There are many reasons for this to occur:

English: Right knee.

English: Right knee. (Photo credit: Wikipedia)

  • Weakness of the hip abductors
  • Tightness of the illiotibial band (IT Band)
  • Poor foot control
  • Tightness of the lower extremity musculature (hamstring, quadriceps, and gastroc-soleus complex)
  • Poor form in exercise

Because there are many causes for this anterior knee pain, it is important to get a proper and correct diagnosis from a physical therapist.  If you have pain in the front of your knee, your physical therapist can design a program to help you beat the pain and return to your exercise program.

This month’s Sports Health: A Multidisciplinary Approach has an article that talks about how exercise (done properly) is the best intervention for patellofemoral pain. (Read the Abstract here)

In my practice, I find that a majority of patients require training of the gluteus medius, which is the major hip abductor muscle.  This muscle can become weak due to positioning of the leg during exercise.  If you look at your feet when they move, are they turned outward?  If so, this is the body’s way of compensating for a weak gluteus medius, and forces the tensor fascia latae (TFL) and ITB to do a lot of the work, thus changing the position and angle of the knee bending during gait and squatting/lunging movements.

Here are a few exercises that can be performed to target and strengthen the gluteus medius:


Sidelying Hip Abduction:


Bridging with Band:


Single Leg Balance:


Wall Slides/Squats:


It is important to remember that, although these exercises may help your knee symptoms, a physical therapist can help treat the cause and individualize a program for you.  Please contact Advantage Physical Therapy to set up an appointment!!!


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