A recent National Health Interview Survey determined that 50.2 million adults (20.5%) in the US reported pain on most days or every day, with the most common pain locations in the back, hip, knee or foot. Other, more persistent pain diagnoses include fibromyalgia, orofacial pain, complex regional pain syndrome, TMJ dysfunction, headaches and joint pain stemming from Ehlers Danlos Syndrome or hypermobility.  

If you are struggling with chronic pain, Bethesda Physiocare is here to help. Contact us online or call (301) 656-5613 to learn about treatment options and which could work best for you.

At Bethesda Physiocare, We Listen.

Not all Physical Therapists are created equal. Physical Therapy schools often lack the curriculum that addresses symptom management of the Chronic Pain population. At Bethesda Physiocare, our physical therapists strive to provide specialized care to Chronic Pain Patients utilizing the latest and best evidenced-based interventions in existence. We are not here to provide cookie cutter exercises that anyone can do at home. We are here to support you in a journey of breath work, lifestyle management, movement, exergaming, and dry needling, as applicable. We think outside of the box and take pride in our work.  Here at Bethesda Physiocare, we have helped thousands of patients find relief from their chronic pain. Our most common patient statement is, “you all actually listened to me.” 

How We Treat Chronic Pain 

Our Physical Therapists are highly trained in a multitude of Chronic Pain Management techniques, each bringing his or her own style into each session. We have often succeeded when “Traditional” therapy has failed.  These techniques may include:

• Breath Work
• Yoga/Pilates Movement
• Manual Therapy
• Dry Needling
• Exergaming (you won’t even know you’re exercising!)
• Taping
• Posture Training
• Work-space Modifications

What to Expect from Your Chronic Pain Appointments at Bethesda Physiocare

On your initial visit, our Physical Therapist will conduct an intake of your Chronic Pain History and how you’ve tried to manage your pain through the years. Our focus going forward will be on creating a plan with you that allows you to move more freely with reduced pain. At Bethesda Physiocare, our therapists want you to be educated about the mechanisms of chronic pain, especially in regards to the central and peripheral nervous system. Empowering our patients with knowledge is a trademark of our physical therapy sessions at Bethesda Physiocare. Contact us online or call (301) 656-5613 today to learn more about treatment options.

One of the most commonly used joints in the human body is the temporomandibular joint.  This is the hinge joint that helps us chew, talk, yawn, and much more. The TMJ is located on both sides of your face and consists of the mandible, which is the lower portion of your jaw, and the top portion of your jaw attached to the skull via temporal bones.  When working correctly, the TMJ allows you to move your jaw side to side, up and down, and forward to back. However, when it is not working correctly, it can alter your everyday quality of life.

If you suffer from TMJ pain, Bethesda Physiocare is here to offer you treatment options and find what works best for you. Contact us online or call (301) 656-5613 today to arrange a consultation.

What is TMJ Pain?

When the TMJ is not working appropriately, one may experience pain in one’s teeth or jaw, clicking, locking, grinding, headaches, disorders within the neck and shoulders, dizziness and vision changes, tinnitus and ear pain, and overall facial fatigue. Many may not know their symptoms are not normal. Their dentists may be the first to acknowledge this before they come in for specialized treatment.  Even so, many patients try to tough it out, thinking their issues will resolve on their own. However, without proper guidance and treatment, symptoms can linger for months to years.

The temporomandibular joints are located on each side of the jaw, connecting the jawbone to the skull. According to the National Institute of Dental and Craniofacial Research, there are three main classes of TMJ disorders or pain including:

• Disorders of the joints, including disc disorders
• Disorders of the muscles used for chewing (masticatory muscles) 
• Headaches associated with a TMJ disorder

Causes of TMJ Pain

Several factors may contribute to TMJ disorders, including general stress, genetics, hormones, environmental factors, chronic pain, motor vehicle accidents, postural abnormalities, and connective tissue disorders such as Ehler’s Danlos syndrome and others.  But these factors can be addressed with proper treatment from a healthcare professional who treats musculoskeletal disorders.

What Does Treatment Include?

At Bethesda Physiocare, all of our physical therapists treat the temporomandibular joint. After a thorough initial evaluation to determine the particular cause of your individual issue, we will create an individualized plan of care. Treatment consists of manipulation of the joint and exercises to perform at home. There are various manual techniques, including myofascial release, soft tissue massage, and dry needling, we can use to enhance your outcomes. We also provide appropriate therapeutic exercises to perform here at this clinic and others that you can safely perform at home. Providing neuromuscular re-education is also key in training this complex joint to perform the best it can. The main purpose of TMJ care is helping to restabilize your jaw and enhance its function to allow you to get back to your life.

Additionally, other treatments may include:

• Jaw exercises (for flexibility and range of motion)
• Trigger point therapy
• Cranial manual therapy
• Massage
• Oculomotor therapy
• Neuro-dynamic mobilizations

Learn How Bethesda Phsyiocare Can Help with TMJ Pain

If you have been experiencing pain or clicking in your jaw, you may have a TMJ disorder. If so, it is crucial to assess your symptoms immediately so that a professional can quickly and effectively provide the best course of treatment. Contact Bethesda Physiocare online or call (301) 656-5613 to make an appointment today and take the first step toward a pain-free life.

Are you suffering from chronic pain? If so, you might be considering physical therapy as part of your chronic pain treatments. PT effectively manages chronic pain and can help you reduce your reliance on medication. At Bethesda Physiocare, we provide personalized one-on-one physical therapy to help relieve your chronic pain and get you back to feeling your best. Read more to learn how physical therapy can help with chronic pain.

If you suffer from chronic pain, Bethesda Physiocare is here to help. Contact us online or call (301) 656-5613 today to learn more about our physical therapy services.

What Is Physical Therapy

Physical therapy is a healthcare discipline that offers a non-invasive and effective treatment option for those suffering from chronic pain. Therapists are trained to assess and diagnose pain and develop a treatment plan that addresses the underlying causes of pain. Some techniques to help reduce pain and improve function are:

• Exercise
• Manual therapy and dry needling
• Education

What are the Benefits of Physical Therapy in Chronic Pain Management

Improve Range of Motion and Flexibility

Physical therapy incorporates exercises that target the affected area and help to stretch and strengthen the muscles and joints. These exercises can also improve posture and balance, which can help to reduce the risk of falls and further injury.

Helps with Muscle Tension and Stiffness

Manual therapy is another important part of chronic pain treatment. This involves the therapist using their hands or dry needling to manipulate the muscles and joints in the affected area. This can help reduce muscle tension and stiffness, improve joint mobility, and increase blood flow.

Manage Chronic Pain

Pain science education is an important part of physical therapy for persons with chronic pain. Many patients have misinformed ideas about their diagnosis and prognosis or may have received outdated instructions from other clinicians. Pain science education helps people with chronic pain to gain better control over their pain and start moving again without fear of pain or re-injury. 

Improve Overall Fitness and Quality of Life

Exercise and physical activity are essential for maintaining a healthy body and mind. It helps to increase strength and flexibility, improves cardiovascular health, and can help people to maintain a healthy weight.

Improve Sleep and Reduce Stress

Chronic pain can make getting a good night’s sleep challenging, and stress can worsen the pain. Physical therapy can help to improve sleep by reducing pain and tension and helping to promote relaxation.

Educate Patients on Ways to Manage Their Pain 

A physical therapist can teach patients exercises and stretches that can be done at home to help manage pain and prevent further injury. They can also advise on lifestyle changes, such as diet and stress management, that can help reduce pain.

Leading Physical Therapy Clinic in Bethesda, MD

Physical therapy is an effective treatment option for those suffering from chronic pain. If you are suffering from chronic pain, it is important to speak with your doctor about PT as a treatment option. A physical therapist can work with you to develop a customized treatment plan that addresses your specific needs and goals.

Don’t let chronic pain control your life any longer. Visit Bethesda Physiocare in Bethesda, MD, for the region’s premier physical therapy treatment. Our industry-leading physical therapists provide a wide range of services, including chronic pain management and Ehlers-Danlos syndrome treatment. Contact us online or call (301) 656-5613 and take the first step toward relief today.

To become a skilled musician or singer, hours upon hours of practice are necessary. But that practice can also end up hurting a musician or engrain bad habits that limit a singer’s range. The key to success in singing, playing an instrument, and even breathing is ensuring your body has the appropriate posture.

If you are a musician in Bethesda in need of posture training, Bethesda Physiocare is here to help. Contact us online or call (301) 656-5613 to schedule an appointment today.

The first thing many people associate with singing is the vocal cords. However, the key to optimal song is ensuring you’ve created the proper posture within your whole body, head to toe, as you sing. Spinal alignment is important in getting a diaphragmatic expansion and ensuring improved breathing. Slouching can cause poor chest expansion placing the diaphragm at a disadvantage when trying to sing. It is hard to hold that note without enough air in your lungs to back it up. It is a fact that if you try singing slouched versus in better spinal alignment, you will see that your voice sounds significantly better; try it out! You truly become the instrument when posture and breathing techniques are utilized well. 

Musicians can suffer from injuries to muscles, tendons, ligaments, and nerves as a result of their art. For instance, flute players can develop arm and elbow pain from the repeated finger movements required by their instrument. Piano players can suffer from low back pain if they do not focus on their posture while tickling the ivories. The dangers of injury for musicians may include diagnoses of carpal tunnel syndrome, lateral or medial epicondylitis, lumbar or cervical radiculopathies, compression fractures, scapular instabilities, headaches, TMJ disorders, low back pain, chronic pain, and much more.

Typically injuries to musicians, regardless of the type of instrument, occur from a combination of having an asymmetrical posture and performing repetitive motions.  Often patients will say, “If I take a break, then the pain/fatigue goes away.” However, as time passes, symptoms tend to linger longer and do not go away as easily as they did initially with just a break. This is primarily because the underlying postural issue was not addressed or mitigated.

Musicians develop habits around how they play, and unintentional subtle changes in posture can occur. If a musician does not consciously work to either improve their posture while playing, include stretching, and/or correct issues after a session, then their body may eventually head toward severe injury.

Violinists are known for having scapular instability and overuse of the upper trapezius and pectoralis muscles, creating a slouched posture with spinal asymmetry. It is common to see even the best violinists struggle to keep their necks as straight as possible when playing. Some will unintentionally also clench their TMJ muscles on the left, setting off a chain reaction toward injury.

As a former violinist, I understand this struggle, but there is good news, you can counteract these adverse playing habits. A physical therapist can help determine any problem areas that have arisen from poor instrument-playing habits. Various stretching and strengthening techniques can help resolve these asymmetries, whether as simple as stretching tight muscles in the left side of your neck by doing a right-side bend or strengthening your scapular stabilizers to reduce scapular winging from repetitive bowing motions.

The physical therapist’s goals align with the musicians in that they also just want to help reduce pain, restore function and help the musician perform at their best. Besides teaching patients about appropriate exercises, the therapist will also perform various manual techniques to help reset the joints and muscles so that they can work well together again. At evaluation and at follow-up sessions, physical therapists may also want to see how your body is influenced by your instrument- with and without your instrument. So, feel free to bring in your instrument to help us pinpoint your specific concerns.  With the proper care and instruction, physical therapy can help you continue playing your instrument of choice for as long as you want.

As always, it is important to consider your posture during all other activities of the day, as mentioned in previous blogs, not just with singing or playing your instrument. For posture training in Bethesda, contact us online or call (301) 656-5613 today!

Those who are diagnosed with pelvic floor myalgia experience difficulty in controlling the muscles that lie on the pelvic floor. This condition can ultimately lead to many other issues with one’s physical health. It is ideal to have this condition treated to prevent further discomfort and address many modifiable symptoms of pain, sexual function, and bowel/bladder health.

If you or a loved one require treatment for pelvic floor myalgia, Bethesda Physicocare in Bethesda, Maryland, can help. Contact us online or call (301) 656-5613 to learn more about our services.

Causes 

While research is still being done, this condition is linked to several other conditions or events that weaken the pelvic muscles, including but not limited to the following:

• Childbirth
• Traumatic injury to the pelvic region
• Abdominal Surgery
• Pelvic surgery
• Nerve damage

Symptoms

If you are experiencing symptoms of pelvic floor myalgia it is important to let a doctor know immediately. Some symptoms include:

• Urinary issues (painful urination or urge to urinate)
• Constipation or bowel strains
• Lower back pain
• Pain in the pelvic region
• Discomfort during sexual intercourse
• Pressure in the pelvic region
• Muscle spasms in the pelvis

Treatment

There are many ways that pelvic floor tension myalgia can be treated. If you are diagnosed, a doctor will follow up with you to discuss the best methods of treatment. It is important to note that Kegel exercises or similar techniques that require you to contract the muscles may not always help in this condition.  It is necessary for a trained physical therapist to assess the muscles and determine what treatment plan is necessary.  

Medication

A professional can prescribe a muscle relaxant to help mitigate the symptoms of pelvic floor tension, myalgia, dysfunction, or any pain. These medications may help prevent the muscles from contracting.  However, trigger points in the muscles are a local phenomenon to that area and may not respond to muscle relaxers.  In that case, pelvic floor physical therapy is recommended.

Self-Care

A professional may also recommend that you practice certain methods of self-care in order to ease strain or pressure on the pelvic region. To avoid and reduce strain on the pelvic floor muscles, it is important to avoid pushing or straining when using the bathroom.

Relaxation Techniques

Techniques such as yoga or stretching can help relax the pelvic floor muscles. Even whole-body relaxation can help, as it is often used in conjunction with pelvic floor relaxation. The technique involves progressive relaxation of the body’s muscles ranging from the face and neck down to the feet.

Diaphragmatic Breathing

The diaphragmatic breathing method involves slow and deep breathing in and out from the belly as opposed to breathing from the chest. Very similar to yoga and other techniques, diaphragmatic breathing is very important when releasing strain from the pelvic floor muscles.

Applying Heat

Applying heat with a heating pad or taking a warm bath can ease and soothe the muscles in the pelvis. You can use a heating pad on mild settings over clothes over the pelvic floor. It is recommended to leave the pad for 15 to 20 minutes at a time. The position to use the pad is lying down with a pillow under both knees.

Physiotherapy

A trained specialist can provide specific methods to promote pelvic floor relaxation. Therapy techniques may include:

• Desensitizing painful areas using physical touch
• Massage
• Pelvic floor stretches
• Progressive strengthening
• Biofeedback instruments
• Postural re-education
• Dry Needling
• Treating coexisting conditions such as problems with pelvic joints, tailbone, or lower back problems

Surgery

A doctor will always start treatment by recommending the least invasive methods, but surgery may be necessary in certain conditions.  A proper evaluation with a physical therapist can help assist the decision making process of whether or not surgery is necessary.

Get the Treatment You Need with the Professionals at Bethesda Physiocare

No one should have to endure pain from conditions such as pelvic floor tension myalgia. If you are ready to treat your body with the right method of care, our physical therapists can help. Contact us online or call (301) 656-5613 to learn more about how we can help you.

Although physical therapists in Maryland legally cannot provide advice about nutrition and healthy eating – the Maryland PT Board has ruled that this is not in the scope of physical therapy – we would like to share a few interesting studies about eating highly-processed food (HPF). As physical therapists, we are concerned about the health of our patients, and with the holidays coming up, we feel that the new findings are worthy of sharing.

As you may know, the Surgeon General issued a report in 1988 describing tobacco products as addictive based on three primary scientific criteria. According to the Surgeon General, tobacco can 

1. cause highly controlled or compulsive use
2. cause psychoactive, including mood-altering effects via their effect on the brain 
3. reinforce behavior. 

More recently, it has become clear that tobacco products trigger strong urges or cravings, which is another indicator that tobacco can lead to addiction. 

Researchers Gearhardt and DiFeliceantonio published an alarming study that highly-processed food meets the same four criteria and should be considered addictive, similar to tobacco! 1 Even though food addiction was first described in 1956, 2 it is still not recognized in the Diagnostic and Statistical Manual of Mental Disorders. Many people eat primarily HPF as it is cheaper than healthier foods, readily available, and heavily marketed to adults and children. Did you know that about 14% of adults and 12% of children suffer from food addiction? 1 Highly processed foods are technologically engineered to rapidly deliver carbohydrates and added fat, which triggers addictive behaviors. 

Many highly processed foods can lead to food addiction, such as carbonated soft drinks, sweet or savory snacks, chocolate, candies, ice cream, cakes, cookies, bread, and pizza (among many others). 3 To check whether your favorite food or snack is highly processed, check the list of ingredients. Ultra-processed foods contain a combination of ingredients you would probably not use in your kitchen, such as high-fructose corn syrup, hydrogenated or inter-esterified oils, hydrolyzed proteins, or classes of additives designed to make your food look more appealing and delicious, such as artificial flavors, flavor enhancers, colors, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents. 3 There is no question that HPFs can trigger compulsive use, which can contribute to serious health issues, such as diabetes, obesity, and cardiovascular disease. While it may sound unbelievable, HPFs and their components increase dopamine in a part of the brain called the striatum at a similar magnitude as nicotine! Even after undergoing gastric bypass surgery, 20-50% of people who had this surgery start gaining weight again, which can be attributed to consuming HPFs! 4 Minimally processed foods (MPFs), such as fruit, vegetables and legumes, do not cause these problems as few individuals become addicted to veggies, but most people prefer candy, cake, ice cream, and pizza. Even after eating a full meal, there is always room for chips or dessert.

Gearhardt and DiFeliceantonio advocate for stricter guidelines to curb the devastating impact of HPFs. Obviously, that is not going to happen in the very near future. In the meantime, you may want to check the labels and lists of ingredients of the food you are going to eat during the holidays. Maybe a good New Year’s resolution is to drastically reduce your intake of HPFs, even if that means no more daily frozen meals, cookies, sodas, etc. 

1. Gearhardt AN, DiFeliceantonio AG. Highly processed foods can be considered addictive substances based on established scientific criteria. Addiction. 2022.
2. Randolph TG. The descriptive features of food addiction; addictive eating and drinking. Q. J. Stud. Alcohol. 1956;17:198-224.
3. Monteiro CA, Cannon G, Levy RB, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22:936-941.
4. Li Z, Pan Y, Zhang Y, Qin J, Lei X. Dietary experiences after bariatric surgery in patients with obesity: A qualitative systematic review. Obes. Surg. 2022;32:2023-2034.

At Bethesda Physiocare, our physical therapists are well-trained in the management of complex chronic pain conditions.  Treating chronic pain requires a thorough understanding of the biological, psychological, and sociological factors that can influence one’s symptoms.  Ultimately these biopsychosocial factors can manifest as three types of pain, known as nociceptive pain, neuropathic pain, and nociplastic pain.  

Many of the patients we treat at Bethesda Physiocare demonstrate components of all three types of pain.  This is especially true of patients with Ehlers-Danlos Syndrome, pelvic pain, orofacial pain, and chronic back/neck pain.  Let’s look at how these types of pain manifest and how physical therapy can help.

Suffering from chronic pain? Our team of Bethesda physical therapists can help. Call (301) 205-5477 today to schedule an appointment.

Nociceptive Pain  

The International Association for the Study of Pain (IASP) defines nociceptive pain as “pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors.”  Nociceptors are receptors in the body responsible for sending signals to the brain of potential damage or injury.  

Clinically this presents as pain arising from receptors in muscles, fascia, joints, viscera, and other connective tissues.  The good news is there are a variety of physical therapy techniques that can decrease nociceptive pain, including dry needling, fascial manipulation, joint mobilization, and therapeutic exercise. 

Neuropathic Pain  

This type of pain is caused by a lesion or disease of the somatosensory nervous system.  Many patients are misdiagnosed with a variety of orthopedic conditions when the true culprit is actually an irritated peripheral nerve.  At Bethesda Physiocare, our therapists are expertly trained to diagnose neuropathic pain through a variety of assessments and measures, including neurodynamic testing.  We have successfully treated many failed cases of tennis elbow, plantar fasciitis, frozen shoulder, and carpel tunnel syndrome, to name a few, by utilizing neurodynamic testing and treatment techniques. 

Nociplastic Pain

Nociplastic pain arises from altered nociception despite no clear evidence of tissue damage causing the activation of peripheral nociceptors or disease or lesion of the somatosensory system.  While there may be components of neuropathic or nociceptive pain present, often, these patients have an exaggerated level of pain due to changes in their nervous system.  This can then lead to increased fear of movement and exercise.  

Our experienced clinicians have had many successful cases of decreasing nociplastic pain by teaching patients to access their endogenous pain-relieving chemicals using externally focused exercise and exergaming. 

Contact Bethesda Physiocare to Learn More

If you are struggling with chronic pain, we encourage you to reach out to our skilled team of Bethesda physical therapists. We can identify the many factors that are causing your symptoms and utilize a range of effective techniques to successfully alleviate your pain. Call Bethesda Physiocare today at (301) 205-5477 to get started. 

Working at a desk, playing video games, and spending time on smartphones and tablets all impact our posture.  Sitting in one position may not seem unsafe initially, but one can think of it as a 0 mph injury. We start off in a good natural posture, but as we get more immersed in our work, game, or activity, we tend to get closer to the screen. Joints, muscles, ligaments, tendons, and fascia all get impacted by this awkward position.

Ultimately the folks who spend more time doing these activities have complaints of pain, weakness, headaches, numbness/tingling, and an overall stiffness and decreased range of motion in various joints in their body.  Poor sitting postures include having a forward head, rounded shoulders, and tightness within the chest and neck. One common ailment from poor posture is compression between the first rib and the collarbone or within musculatures such as the scalenes or pectoralis minor which is also known as thoracic outlet syndrome. This can lead to neuropathic-type pain in the arms.   Another very common area affected is within the gluteal muscles leading to pain in the bottom from muscle weakness and neural compression.

Why These Activities Can Lead to Pain and Injury

Our vertebrae are strong when stacked appropriately upon each other. But this requires proper posture while sitting and standing. For every inch the head moves forward, the weight of the head on the spine increases by an additional ten pounds. That’s like balancing a small sack of potatoes on your head for every inch it is out of place. 

Further, when we sit, gravity and the weight of our head pull us down toward the surface we sit on. Not only can this cause cervical instability by straining the ligaments of the neck, but it also can lead to decreased protection of the brain and spinal cord, especially in those who are hypermobile. But that’s just the start. Poor sitting posture can also cause issues across other regions of the body. Everything from an increase in tension headaches, TMJ pain, and weakness to decreased overall balance, decreased gastrointestinal mobility, and an overall reduction in lung capacity from poor ribcage mobility. 

But injury and pain aren’t the only potential issues arising from poor posture. Postural abnormalities can literally change your body over time, leading to long-term impairments. Poor posture can cause discs to collapse, cause muscles to get shorter or longer, and warp joints by changing their shapes. The effect on joints is particularly dangerous and can cause ailments such as bone spurs and osteoarthritis. 

Our bodies are wonderful for moving around but aren’t so great at being sedentary. The longer someone is sedentary, the harder it is for them to become mobile, creating a vicious cycle that can be hard to break out of, especially when the cause is our job or favorite pastime. 

How a Bethesda Physical Therapist Can Help

Fortunately, with the help of the proper physical therapist, these issues can be corrected without the need to change careers or cut out favorite recreational video games and screen time activities. With appropriate postural re-education from a physical therapist, these 0 mph injuries can be alleviated and avoided altogether. Best of all, physical therapists know how to encourage good posture using the many positions we find ourselves in daily.  Effective core stabilization exercises should be performed with functional life movements such as sitting, standing, kicking, running, walking, lifting, reaching, and more. Not only does this protect the joints and preserve one’s alignment, but it also makes sense with our busy and ever-changing lives!  

That being said, some life changes to incorporate nonsitting tasks are also important. This could include walking, jogging, hiking, dancing, etc. When you do have to sit, try to remember to maintain your feet on the floor, knees about hip-width apart, and support your low back against the back of a chair. If that’s not possible, you can use bolsters or pillows to aid the support, but remember to keep it neutral. Be sure to take plenty of breaks, ideally at least every 30 minutes, get up, stretch out, drink some water, walk, etc. 

Contact Bethesda Physiocare Today to Learn More

Hope these postural tips help to prevent that 0 mph tragedy from happening to you. For those who want more advice on this topic, don’t hesitate to seek physical therapists for more great suggestions, and keep an eye out for my next blog for more insight into posture. On that note, Happy Physical Therapy month to my peers! Feel free to reach out to us by contacting us online or calling (301) 923-4877

Written by Ancy Alford, PT, DPT, CMTPT/DN — Physical Therapist at Bethesda Physiocare, Bethesda, MD