Get Rid of Shoulder Pain Faster with Caring, Professional Physical Therapy Help in Brentwood

Whether you’re an athlete who has just suffered a shoulder injury that is causing you considerable pain, you were a little too ambitious at the gym and it seems you’ve damaged your shoulder, or for some reason you have shoulder pain which isn’t going away, it’s time to find the shoulder pain physical therapy help in Brentwood you need.

Here at Letgolts Physical Therapy in Brentwood, you’ll find the professional physical therapist who will help to rid you of your shoulder pain. There are a number of benefits to coming and seeing us. Your physical therapist will get right to work diagnosing the problem and providing you treatment needed to efficiently reduce and then eliminate your shoulder pain. With us at Letgolts Physical Therapy, you’ll also enjoy the most state-of-the-art equipment for better, more successful treatment.

Get rid of shoulder pain faster with physical therapy help in Brentwood from Letgolts Physical Therapy. To learn more about how we can help you with your shoulder pain, simply browse through our website, https://letgoltsmethod.com. If you’re in need of physical therapy help in Brentwood you can trust, then make an appointment with us today by calling 310-979-8525 or you can use the simple form found on our website.

Suffering From Lower Back Pain, We Can Help!

Lower back pain can be the result of a number of things. But whether you’ve sustained an injury from sports, perhaps your pain is the result of sitting down for long periods of time, or it’s possible that you have an internal problem that is causing the pain, it’s time to find out what the problem is and get the help you need so that you can rid yourself of the pain. So, if you have lower back pain and live in the Los Angeles area, then now is the time to schedule an appointment with us at Letgolts Method Physical Therapy.

lower back pack Los Angeles

Here at Letgolts Method Physical Therapy, you’ll meet the friendliest and most professional people who are committed to helping eliminate your pain. No matter the root cause of the lower back problem, your physical therapist will provide you with the right treatment options which will help you to reduce and then eliminate the pain. It’s also good to know that here at Letgolts Method Physical Therapy, we view surgery only as a method of last resort.

If you’re suffering from lower back pain and live in the greater Los Angeles area, then it’s time to make an appointment here at Letgolts Method Physical Therapy. You can learn more today about how we can help you when you browse through our website, https://letgoltsmethod.com. If you have any questions or you’d like to get started with scheduling an appointment, then give us a call today at 310-979-8525 or you can use the simple form found on our website.

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Fed Up with Your Knee Pain? Find Los Angeles Physical Therapy Help Today

It can be easy to forget just how important your health is; that is, until you develop a nagging health issue. If you’re someone who has developed a nagging pain or discomfort in your knee or knees and are getting fed up with the pain, then it’s time to find the knee pain help in Los Angeles needed to get your life back.

Here at Letgolts Method Physical Therapy, we can help stop the pain so you can get your life back on track without any knee issues. Whether you’ve injured a knee performing some physical activity or sport or you’ve just noticed some creeping discomfort in a knee or both knees, your physical therapist at Letgolts Method Physical Therapy will provide the effective treatment needed to stop the pain, no matter the specific issue or cause.

If you’re fed up with your knee pain, then find the Los Angeles knee pain help you need today here at Letgolts Method Physical Therapy. You can learn more about how we can help you with your knee pain or other lower body or upper body pain or discomfort when you browse through our website, https://letgoltsmethod.com. If you’re ready to make an appointment, then please call us today at 310-979-8525 or you can use the contact form found on our website.

Stop Lower Back Pain and Start Enjoying Life with Physical Therapy Services from Dr. Letgolts Method Physical Therapy

Can you really continue living like this? If you’ve been suffering from lower back pain which doesn’t seem to be going away anytime soon and instead seems to be getting worse, then now is the time to take action. Lower back pain help along with a wide range of physical therapy services is available in the greater Los Angeles area found here at Dr. Letgolts Method Physical Therapy.

It’s our mission here at Dr. Letgolts Method Physical Therapy to help our patients get rid of their pain in a non-invasive way. No matter how long you’ve had your lower back pain or why you think you have the pain, it’s time to speak with an experienced Physical Therapist who will be able to accurately diagnose the problem and then put you on an individualized treatment program that will reduce and then eliminate the pain for good. You deserve a life free from lower back pain, and we at Dr. Letgolts Method Physical Therapy will help you enjoy just that.

Stop your lower back pain and start enjoying life with Dr. Letgolts Method Physical Therapy in Brentwood, Los Angeles. You can learn more about how we can help alleviate your lower back pain when you browse through our website, https://letgoltsmethod.com. If you’re ready to schedule an appointment with us or you have any questions, then please call us today at 310-979-8525 or you can use the contact form found on our website.

How To Get The Best Result From Your Hip Or Knee Replacement Surgery

How To Get The Best Result From Your Hip Or Knee Replacement Surgery

By Allen Letgolts, Doctor of Physical Therapy

There are well-established protocol treatments for after joint replacement surgery, but many miss essential elements needed for full recovery. Despite a successful surgery,, many people still experience pain and lack mobility even many months later. They often blame the surgery, but the true cause is usually incomplete or inadequate rehabilitation.

Most large joint damage happens over a long time, and is due to structural issues or prior injuries causing compensations. Of the many structural issues, the most common are pronation and a difference in people’s leg lengths. These cause uneven load on the joints. Over the years, that causes uneven wear, arthritis, and uneven muscle strength. Addressing these common underlying issues involves orthotics and/or heel lifts and re-alignment and retraining of muscles and joints. This is usually not part of post-surgical rehabilitation protocol.

But prior injuries also impact joint health. An old sprained ankle that never healed properly. The twisted back that still flares up occasionally. These can cause improper knee movement, which can grind down the joint over time. Addressing a current or old injury involves manual manipulations to restore normal function of the joint.

It’s not only the underlying issues you have to address, if full recovery is your goal. It’s also the compensations that those issues caused. When a joint doesn’t function properly, itself is damaged, but due to damage it will also causes damage in other joints. When you have a structural issue or a prior injury, your body will automatically adapt and change the way it moves to avoid pain. Since this internal “passing the buck” simply shifts the uneven loading to elsewhere in your body, the trick is to identify the compensations, understand why and how they occur, and then address them.

Diagnosis of the cause of damage and resulting compensations is critical to post-surgical recovery. This is done by taking a careful history and doing a biomechanical analysis. The therapist should be able to explain clearly what the problem is and the proposed solution. Make sure to request that these issues be addressed in your post-surgical rehabilitation for best results.

Dr. Allen Letgolts DPT has been in private practice in Brentwood for over 20 years.

Leg Length Difference/Discrepancy

Ever had hips adjusted only for them to go out of alignment again? If so, then you likely have a structural leg length discrepancy (SLLD). While this may not seem like a big deal as SLLD is USUALLY negligible up to a point and doesn’t cause short-term problems by itself, it has a bottom-up effect on the body that can worsen over time, especially when coupled with other factors (e.g., stiffness, external trauma, stress from physical activities). When someone’s problems are chronic and unilateral (one-sided), they can often be traced back to a leg length discrepancy.

Due to the oblique angle of the pelvis, when one leg is longer than the other, it pushes the pelvis on that side up and back, which causes the opposite hip to “drop” and rotate forwards—in order to stand facing straight, the torso will rotate in the opposite direction.

Since most SLLD’s involve a longer left leg, for explanation purposes, we’ll assume the left is always the longer side. When the left hip is higher than the right, the body tends to weight shift to the right—notice how the midline is much closer to the right leg in the image. In order to keep the center of gravity over the base of support, the lower back will curve to the left (this is a bit subtle in the image).  The upper back will then side-bend to the right, raising the left shoulder higher than the right. Finally, in order to keep the eye-line horizontal and remain upright, the head will tilt back to the left.

In general, this altered curvature of the spine causes the IT band, QL, obliques, scalenes, and levator scapulae to become tighter on the left than the right. On the right the hip flexors, piriformis, adductors, pectoralis and serratus anterior become tighter than the left, while the obliques, middle trap, and serratus posterior become weaker (reverse everything for someone with a longer right leg). Occasionally, this compensation pattern can also be altered by prior injuries or structural scoliosis.

Final point:

The only way to truly determine whether someone has SLLD is to measure the leg itself, from the greater trochanter of the femur to the fibular malleolus, and correlate it with the expected compensation pattern.

Pronation Part VII – How to Address Pronation II – Casting for Orthotics

As mentioned in our last post, many pairs of orthotics are made incorrectly and don’t address the main issue with pronation. Properly made orthotics must have support for the ball of the foot in order to properly address one’s pronation and the issues caused by it. If you haven’t already, go check out our previous pronation posts to get the relevant background information for this post!

Most issues with incorrectly-made orthotics can be traced back to the casting method—i.e., the method used to create the molds of the feet (which are then used to make orthotics). Many methods involve someone stepping into impression molds or onto pressure plates. The problem with this is that the individual is in a weight bearing position, which completely misses the reason behind pronation.

We cannot stress enough that pronation occurs because the ball of the foot must come down to the ground when weight bearing. Therefore, methods requiring someone to be in a weight bearing position will not result in accurate molds of the feet, as they won’t be in a subtalar neutral position. Proper casting methods require people to be in non-weight bearing positions in order to make orthotics properly. That said, many methods involving sitting positions also tend not to result in accurate foot molds: they often rely on active/passive dorsiflexion of the foot to hold the “neutral position” without accounting for the side-to-side rotation that occurs with pronation.

In our clinic, casting is done in a prone (lying face down) position. That way, the feet aren’t loaded and can be properly set (and held) in subtalar neutral while the casts are made. As seen in the video below, strips of plaster are used to encase the feet, which are held in subtalar neutral as the plaster sets. Based off of these molds, the orthotics will then be made with the proper amount of support to keep the ankle in subtalar neutral.

Pronation Part VII – How to address pronation – casting

One last, but very important, thing to remember about orthotics: since pronation is important for shock absorption, orthotics should still allow for some pronation to help with shock absorption, but not so much that the foot is constantly thrown out of neutral alignment.

Pronation Part VI – How to Address Pronation I – Orthotics

When people pronate, they’re often told to strengthen the foot muscles to “build an arch” that sets the foot in a neutral position. However, this assumes that pronation is the same as flat feet, which it is NOT. If you haven’t already, check out our previous pronation posts to get up to speed!

Remember, the issue with pronation is not with the arch, but with forefoot varus when the ankle is in subtalar neutral and the ball of the foot coming down to the ground when weight bearing. Therefore, training the muscles to create an arch helps minimally, as someone with forefoot varus will still pronate when the ball of the foot comes down. Even if the foot muscles can build an arch approximating subtalar neutral and are trained, they cannot maintain it 24-7: muscles eventually fatigue, causing the foot to pronate and the arch to collapse again—when dynamic movement is incorporated, that arch is even more likely to be lost.

So what corrects for pronation? The answer is orthotics: custom insoles made to keep the foot in a subtalar neutral position. This is achieved by supporting both the arch and the ball of the foot, such that it no longer drops when weight bearing—something that cannot be compensated for with foot musculature OR an arch support alone (pronation is a structural issue).

Many orthoses are actually just arch supports, but these don’t help much and may actually make the problem worse! Without support underneath the ball of the foot to maintain the forefoot varus position, pronation still occurs when weight bearing: the foot rolls over the arch support, which can further exacerbate one’s problems. Imagine shoving a rock underneath your foot and walking on it all day!

As seen in the photo, a pronated foot [1] still pronates on an orthotic that’s just arch support [2] because the ball of the foot is unsupported. However, with the properly made orthotics [3], the ball of the foot is supported so the foot no longer pronates and can maintain a subtalar neutral position. That said, there are some (rare) cases of calcaneal or midfoot instability (WITHOUT forefoot varus) that do benefit from arch supports alone. It all depends on the foot structure!

Pronation Part V – How Pronation Affects Low Extremity Movement II – Knee Flexion

Pronation 5_how pronation affects lower extremity movement_knee flexion

When the foot pronates and knee is rotated internally, any movement that requires flexion (bending) will occur at an oblique angle, as seen in the video above (the pronated foot is shown on the left, while the corrected foot is shown on the right). In other words, the knee does not move directly over the ankle, but rather off to the medial side (towards the midline of the body). Due to this oblique angle, people who pronate tend to excessively torque the knee—the degree of which depends on the degree of pronation. This puts additional strain on the anterior (front) and medial aspects of the knee, which may not be a significant issue when it comes to everyday activities such as walking, but it plays a huge factor in exercise and athletic performance.

Due to the additional torque on the knee caused by pronation, athletes in sports that involve explosive, rotational, and lateral movements—on top of rapid changes in direction—may be more prone to injuries. Since some individuals (particularly the young and/or fit crowd) may be able to compensate for their pronation, not necessarily everyone who pronates will experience symptoms of pain. However, regardless of injuries and/or pain, pronation can certainly affect athletic performance.

Having a “corrected” foot placed as close to subtalar neutral allows the knee and ankle to track properly, which translates to the optimal movement mechanics, as no energy is wasted in generating power. This significantly affects athletic performance, even in absence of injuries. When the knee doesn’t tract properly, more force is required to generate the same power and control the movement. This further exacerbates any issues caused by one’s pronation and can contribute to hip and knee stability. When the ankle and knee are properly aligned, the body is able to properly stabilize these structures and move more efficiently.

Pronation Part IV – How Pronation Affects Lower Extremity Movement I – Gait

In our first post regarding pronation, we discussed how pronation affects static posture. Today we’ll discuss how pronation affects dynamic movement, particularly the lower extremities. As the foot pronates and the midfoot rotates medially (inward), the knee also rotates internally. This alone may not seem like a big deal when dealing strictly with posture, but the real damage is occurs during movement.

When people pronate they tend to stand with their feet pointed outwards due to their internally rotated knees. In order to stand in a way that takes stress off the knees, the feet must point outward: if the feet are parallel, the knees will be at an oblique angle towards the midline, which is uncomfortable for most people. Therefore, to keep the knees pointing straight forward, the toes must turn out.

Pronation 4_how pronation affects lower extremity movement_gait

As a result, people who pronate tend to roll around the ball of the foot instead of rolling through it when they walk. As seen in the video, the pronated foot begins to roll inward (during the mid-stance phase of the gait cycle) before the heel leaves the ground, whereas the corrected foot remains stable. As the foot remains stable at the ankle and midfoot, it can then move through the ball of the foot instead of rolling around it (during the heel-off phase of the gait cycle). Due to this change in gait a person can develop any combination of the following issues: bunions, plantar fasciitis, neuromas, Achilles tendonitis, lateral ankle pain, knee pain, IT band or piriformis syndrome, low back or neck pain and poor posture and balance.