Monthly Archives: October 2014


One of my middle aged female patients with a history of high blood pressure mentioned her right hip hurts. She said it felt like lead with pain and burning sensations.

When heaviness is the primary symptom of leg problems, or of relatively high severity, the cause is usually a dysfunction of the vascular system such as Lymphedema, Varicose Veins or Chronic Venous Insufficiency. This should be evaluated first if you suspect it may apply to you. If there is severe swelling in the leg there is possibly a blood clot in an artery or deep vein thrombosis.

If what you experience is pain that typically begins toward the hip region and travels down the affected leg, sometimes down to the foot, you most likely have sciatica.

Sciatica usually affects only one side of the lower body. Often, the pain extends from the lower back all the way through the back of the thigh and down through the leg. Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes. Pain varies from annoying to disabling. The sensation ranges from tingling or burning to a deep, sharp shooting pain. The painful sensation often starts or worsens with movement, coughing, laughing, or sneezing.

You might experience pain in one region of the leg and numbness in another. Some may experience a weakening in the leg or foot accompanied by sciatica hip pain. The weakness may become so severe that mobility becomes difficult.

Herniated or slipped discs remain the most common contributing factor. The discs lie between each vertebra and consist of a tough exterior and a gel like interior to provide shock absorbing cushioning. If the outer covering of the disc ruptures, the gelatinous interior oozes through the disc and compresses the sciatic nerve.

Common causes of sciatica include: narrowing of the spinal canal in the lower back, degenerative disc disease and Spondylolisthesis (a condition in which one vertebra slips forward over another one.)

Physical therapy exercises incorporating strengthening and stretching are a central component of almost any sciatica treatment plan.

Treatment may include McKenzie-based mechanical diagnosis and therapy, muscle energy techniques, mobilizations, spinal stabilization and core strengthening exercises, nerve slides/glides, or traction. Often people will respond to moving in a certain direction. Some people with sciatica feel better with exercises moving in a backwards bending position, some in a bending forward position. Occasionally exercising in a neutral spine position is necessary. Sometimes we have a patient who responds best to rotating or shifting the hips sideways. The best therapy treatment for someone with sciatica varies greatly from person to person secondary to the many reasons the sciatica may be present.

At the Healing Center of Scottsdale, we offer a unique treatment program with the ATM2 device. ATM2 stands for Active Therapeutic Movement which is based off of Mulligan theory, a joint mobilization technique.

Jeff Juraska, PT

Cervical Fusion Surgery

The other day I was chatting with a woman who told me her husband, who played pro football for 10 years, was wondering if he should get another opinion before neck fusion surgery. It seems he has already had two laminectomies as treatment for spinal stenosis in his low back which seemed to be successful.

He had already discussed this with two neurosurgeons who recommended an anterior cervical fusion. His wife was concerned because he’s been getting “nerve flashes” daily and a bit light headed at times. He continues to work out and play golf without a problem.

Football players are no strangers to injury. High-velocity collisions can lead to cervical disk herniations, which in turn cause symptoms such as neck pain, radiating pain in the upper extremities, and coordination problems. Conditions that result in spinal instability require stabilization.

The benefits to be obtained must be weighed against the potential risks in any surgical procedure. NFL players treated surgically had a higher return-to-play rate and a longer career after surgery than those treated non-surgically. However, Defensive backs had a poorer prognosis than players in other positions.

Anterior cervical discectomy and fusion (ACDF) is a procedure used to treat neck problems such as cervical radiculopathy, disc herniations, fractures, and spinal instability. In this procedure, the surgeon enters the neck from the front (the anterior region) and removes a spinal disc (discectomy). The vertebrae above and below the disc are then held in place with bone graft and sometimes metal hardware. The goal is to help the bones to grow together into one solid bone. This is known as fusion.

This procedure should not be performed if the patient has diffuse multilevel neoplastic disease, severe osteoporosis or infection of soft tissues adjacent to spine. There may be other reasons why a particular patient is not good candidate for this procedure.

After the surgery, physical therapy would help to address the areas that were not surgically repaired. It is important to focus on strengthening and stretching areas to compensate for the fused components which don’t move.

At the Healing Center of Scottsdale, we offer a unique treatment programs that will address cervical neck pain and low back pain to prevent further re-occurring conditions.

Jeff Juraska, PT

Hip Pain With Rash

A 59 year old male patient came into the office saying he almost couldn’t stand up because of hip pain when he first woke up. He mentioned that about a month ago he had a rash on the back of calf the same leg that the hip pain is in.

I told him a bullseye shaped rash is often an indicator of Lyme disease. If you were out hiking in the woods or in tall grass during that time, you possibly could have been bitten by a deer tick and developed Lyme disease. This can produce multiple joint pain throughout the body, mostly in knees and elbows but change between joints. It is possible to have conditions presented as orthopedic issues from Lyme disease. Be sure to tell your doctor if you were hiking or travelling in wooded areas.

Another common reason for hip joint pain is Osteoarthritis. Osteoarthritis is associated with ageing. The exact cause is unclear. As osteoarthritis develops, you experience loss of cartilage, bone spurs around the joint, and muscle weakness of the extremity. As people age, they can expect symptoms including mild to severe pain in a joint, especially after overuse or long periods of inactivity, such as sitting for a long time; creaking or grating sound in the joint; Swelling, stiffness, limited movement of the joint, especially in the morning; Weakness in muscles around the sore joint; even deformity of the joint.

Obesity, genetic factors, injury to the joint surface, occupations and physical activities that put stress on joints and neuromuscular disorders, like diabetes, increase your chance of developing osteoarthritis.

The goal of treatment is to reduce joint pain and inflammation and to improve joint function. During your assessment and evaluation for physical therapy it is important to screen out the low back for inter-vertebral discs problems, which are a very common source of pain in the low back. Improper gait and posture can put abnormal stress on the discs and the material between them that acts as a cushion. Bone degeneration increases with age. Pain can affect the facet joints of your lower back along with surrounding soft tissues when you have degenerative arthritis.

Persistent pain indicates the need for a Physical Therapy evaluation to provide a customized treatment program. Traction and joint mobilization, if indicated, along with stretching, strengthening and stabilization of the tissues are typical physical therapy treatments for low back pain.

If your pain is spreading it could possibly be the condition called “sciatica” which can be resolved by similar low back pain treatments.

At the Healing Center of Scottsdale, we offer a unique treatment program with the ATM2 device. ATM2 stands for Active Therapeutic Movement which is based off of Mulligan theory, a joint mobilization technique.

Jeff Juraska, PT

Upper Back Pain

A female patient, 38 years old, was recently experiencing pain in the upper right hand side of her back. She said for about two days, every time she moved in a certain way it hurt. Especially when bending down.

One common cause of constant aching visceral pain is gall bladder, which can present as right upper shoulder or back pain. Upper back pain may also be triggered by sports, improper lifting, bending, or twisting. When pain develops suddenly or related to direct trauma, stop all strenuous activities to prevent aggravation of the injury and increasing the damage. Muscle spasms may develop as strained muscles swell after injury. If related to trauma bruising may occur. Rest and gentle stretching will help the muscles relax.

If the pain is in both sides of the upper back, tight pectoral muscles can be the cause. Both the pectoral minor and pectoral major, can pull your shoulders forward, throwing off the mechanics of all the other muscles, creating a tight capsule of the shoulder joint.

I have seen this in my clinic where it presents similar to arthritis, however slow and gentle pectoral stretches, and eventually stretching the latissimus dorsi muscles will begin to alleviate the snapping, crackling and popping. Another muscle that should be looked at with similar problems would be the levator scapulae muscle which affects both your neck and shoulder biomechanics.

Bad posture is also a common cause. Over time, poor posture from hours in front of the computer will strain the upper back muscles. Most back pain is related to muscle strain rather than injury to the spine.

Under most circumstances applying ice will reduce swelling and pain and will accelerate your healing. Once initial pain has eased a rehabilitation program of upper back strengthening exercises and stretching is recommended to help prevent re-injury and pain.

At the Healing Center of Scottsdale, we offer a unique treatment program with the ATM2 device. ATM2 stands for Active Therapeutic Movement which is based off of Mulligan theory, a joint mobilization technique.

Jeff Juraska, PT