Muscle IQ Physical Therapy

MUSCLE IQ PHYSICAL THERAPIST/OWNER

DR. HOWARD KNUDSEN                            

Doctor Howard Knudsen, a Provo physical therapist, was born in  Seattle, Washington in 1970. In the same year his family moved to Provo  and later settled in Orem. He graduated from Mountain View High School  in 1988 and ten years later received a doctor of physical therapy degree  from Creighton University in Omaha, Nebraska.

Dr. Knudsen suffered from back, neck, shoulder,  and hip pain for most of his life. It is because of this that he went  on dedicate his career to helping others with chronic conditions. And  this is also why he has such a great understanding of what patients are  going through and what happens to the body in a declined state of  health.

HIS FAMILY:                            

What it comes down to is skill-mastery... It is said  that it takes 10,000 hours of deliberate work to become a master, or  roughly 10 years of practice in your area of expertise. One year after  graduation, Dr. Knudsen spent 12 months in a fellowship program at the  Houston Spine Center at Scurlock Tower within the Houston Medical Center  training. He worked under a master PT with twenty years of experience.

He has traveled to Australia and Canada to  study with rehabilitation experts within two mini-residencies. His   continuing education has introduced him to the brightest minds in the   field of manual therapy. He has a passion for learning. He is always   working on skill-mastery and seeks inspiration as he develops more   effective treatment techniques for neutralizing pain and balancing the   body along with the mind.

Now in his eighteenth year of practice, he sees  things (in regards to the pain puzzle) more clearly. He enjoys critically analyzing different "new ideas" and treatments to see how   they fit into his understanding of the viscious cycle of chronic pain.                            

EDUCATION:                                                    

     Doctor of Physical Therapy at Creighton University in Omaha, Nebraska              Bachelor of Science at Idaho State University in Pocatello, Idaho                             

Training:                           

MUSCLE IQ PHYSICAL THERAPIST

DR. CHRIS KNUDSEN                      

Doctor Chris Knudsen, was born and raised in Orem, Utah. He is a graduate of BYU and received his Doctor of Physical Therapy degree from Creighton University, in Omaha, Nebraska, in May of 2000.  He spent 15 years practicing physical therapy in Lancaster, Pennsylvania, where he specialized in orthopedic physical therapy. He joined his brother's practice in June of 2016.

Dr. Chris Knudsen loves spending time with his wife, Amanda, and their four children. He loves to read science fiction books and is a big Star Trek and Star War fan. He and his wife love sitting on the couch with their laptops in the evening doing family history. How did he get started in physical therapy? "I had my first taste of physical therapy as a patient when I was 14 years old. I accidently fell while jumping over some trash cans late one night when I was out jogging. I hurt my shoulder and ended up having surgery to repair a torn labrum. I went to several weeks of physical therapy and was fascinated by all of it.  That is when I decided to become a physical therapist."

  HIS FAMILY:                                                        

Dr. Chris Knudsen has a treatment philosophy that centers on the patient. He enjoys helping people and listening to their stories.  After  18 years of treating patients, he says his favorite part of his job is when he gets to see his patients smile. They smile when they see that there is hope for them and they have the potential to be pain-free.

  EDUCATION:                                                     

   Doctor of Physical Therapy at Creighton University in Omaha, Nebraska              Bachelors of Science at Brigham Young University in Provo, Utah                                                                                                                                                ADDITIONAL TRAINING:                                              

Can I go to Muscle IQ before getting an MRI for my Low Back Pain?                                             

20 April 2018, Chris Knudsen, DPT

                                     (Part 2 of a 4 Part Series)                                    

Keywords:  Low Back Pain, Fascial Distortion Model, Muscle Strength Testing, Pain Relief, and MRI.

Thanks for clicking to read my second blog on the Muscle IQ Blog Page! Today’s blog is about Low Back Pain and getting an MRI.  When I had my first MRI 30 years ago my doctor showed me what was wrong with me and was able to explain why I needed to have surgery.  MRI’s are amazing.  What I like to tell my patients is that an MRI is great for showing your surgeon where to put the scalpel.  My surgery was a success and I had a great recovery.  That is how I was first introduced to Physical Therapy and was the reason I decided to become a physical therapist.                                    

There are reasons why you should get an MRI when you are suffering from low back pain.  Here are what I would consider the Top Three Reasons to get an MRI of your back:

                                     Severe low back pain and recent onset of loss of bowel or bladder control (Cauda Equina Syndrome?)  Germon T, Ahuja,S, Casey A, Rai A. British Association of Spine Surgeons standards of care for cauda equina syndrome. The Spine Journal 2015 15 (3), pS2-S4.

                                     Severe low back pain accompanied by a significant weight loss that was not expected. (Spinal Tumor/Cancer?)

                                     Severe low back pain with radiating pain, tingling and or numbness down one leg that shows no improvement with physical therapy (Lumbar Herniated disk)

Do I need an MRI before starting therapy at Muscle IQ?                                  

The most recent consensus is that “Imaging is not recommended unless alerting features of serious conditions are present.” Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010;19:2075–94 (Level of evidence 1A)  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997201/                                  

So, the answer is No, you do not need an MRI before starting physical therapy at Muscle IQ because during the first visit we will take a thorough past medical history and perform an evaluation that will identify whether you have any “alerting features of serious conditions” and send you on for the appropriate care.  During your physical therapy sessions we will also continue to monitor your progress and if things are looking wrong we will recommend you to appropriate further care.  If you are unsure what to do just give us a call.

Can a MRI predict how much low back pain I will have in the future?                                  

One reason to wait to get an MRI is that it is not a good predictor of future low back pain.  A recent study looked at 50 people over a ten year period.  Each person had an MRI of their low back and then another MRI 10 years later.  The people were asked about their incidents of low back pain during that 10 year period and the researchers concluded that there was nothing on the MRI that was able to predict which people were going to have episodes of pain and which people were not going to have episodes of pain.                                  

“baseline MRI findings were not associated with LBP history during the 10 years; therefore, our data suggest that baseline MRI findings cannot predict future LBP.” The associations between magnetic resonance imaging findings and low back pain: A 10-year longitudinal analysis.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5687715/                                  

The best course of action is to get started on the road to recovery as soon as possible.  If you are having low back pain give us a call at 1-801-310-0851.

LOW BACK PAIN IN PROVO                                    

                                     17 April 2018, Chris Knudsen, DPT

                                                    (Part 1 of a 4 Part Series)

Thanks for clicking to read my first blog on the Muscle IQ Blog Page.  Today’s blog is about Low Back Pain.  Twenty years ago, when I was attending Creighton University for my DPT degree I frequently heard people say that Low Back Pain was going to be the hardest diagnosis to treat.  (The easiest they said was treating a Total Knee Replacement, but that will be discussed in a future blog).                                    

What is it about Low Back Pain that is so difficult to fix?                                                                 

The Medical Model of treatment focuses on diagnosing the problem according to the disease model.  

                                     Public dependence on imaging. (I want an MRI).

                                     Giving patients exercises without knowing what is weak and expecting it to get better.

                                     Not treating the problem to completion.                                                    

Today’s blog will focus on how the Muscle IQ model differs from the Medical Model for diagnosing and treating low back pain.  According to the Medical Model, the most common diagnosis for low back pain is called Non-Specific Low Back Pain.  It is defined as low back pain not attributable to a recognizable, known specific pathology (eg, infection, tumour, osteoporosis, lumbar spine fracture, structural deformity, inflammatory disorder,radicular syndrome, or cauda equina syndrome).  Or in other words, they have no idea why this person’s back hurts, because it does not fit the “disease” model.

One thing that sets us apart at Muscle IQ is that we have a quick and effective way of categorizing why your back hurts and what we should do about it to help the pain..  The Model we follow is called the Fascial Distortion Model.  How does this differ from the Medical model of diagnosing and treating low back pain?

First, if there are so many people with non-specific low back pain, how do they know that the patients with the other types of back pain don’t also have back pain attributable to the same cause of pain as the non-specific low back pain.  Or in other words, why do they attribute all of your back pain to something they see on an MRI or x-ray, when it might be the same type of pain presented by patients with non-specific low back pain.  Is the pain that the patient is experiencing really coming from the image taken?  Or, the other disease based diagnosis?   

What is the Fascial Distortion Model?                                  

With the Fascial Distortion Model we take all medical history into consideration, and we watch for red flags.  But, instead of using a disease label for your back pain, we take the history from the patient, we listen to the patient tell us about the pain, and we watch their gestures.  The Fascial Distortion Model has six different types of fascial distortions that are each separately distinguishable by certain types of force injury descriptions, patient verbal descriptions, and patient gestures. What makes the model effective is that there are specific, unique treatments for each of the six different fascial distortions.  The most effective treatments are then used for that specific distortion.  This helps us improve the results we can get with our patients. (See Research Article Above).

Low Back Pain and Muscle Strength                                                              

1 May 2018, Chris Knudsen, DPT

(Part 3 of a 4 Part Series)                    

Keywords:  Low Back Pain, Fascial Distortion Model, Muscle Strength Testing, Pain Relief

Today’s blog is about Low Back Pain and Exercise.  My wife will ask me sometimes to treat her back after I get home from work.  Like many of my patients I see during the day, she wants to see quick results. “Doc, can you just fix me, PLEASE!”  Short term pain relief is possible.  But, long term pain relief requires strong muscles.  To get Strong Muscles takes more effort on the part of the patient, and more effort on the part of the therapist in order to ensure the proper exercises are being prescribed.

Chronic Low Back Pain                                    

Chronic low back pain by definition is low back pain that does not resolve easily on its own (chronic = lasts for more than a few weeks).  The same websites that give out “Great Home Exercises for Low Back Pain”, might on the same site also state that “Low Back Pain Has High Recurrence.” (http://europepmc.org/abstract/med/6223365) Insurance companies are happy if care is stopped as soon as possible. This helps keep costs down.  However, it does not keep the pain from coming back.   I have always believed that low back pain is usually under-treated.  Otherwise, it would stay fixed.

Three Reasons Low Back Pain Returns After Physical Therapy                     

Back Muscle Strength Not Measured Fully

Exercises were not specific enough to the problem

Rehab was cut short or stopped before strength returned to normal

Full Muscle Testing for the Low Back - Manual Muscle Testing

At Muscle IQ we test muscles in two different ways; Manually and Mechanically.  Every patient with low back pain receives a thorough evaluation of the muscle of the back.  Manual muscle testing is a simple and quick way for us to see whether there are muscles that are not responsive and quick to contract.  Many times we will identify muscles that are being inhibited, or where the muscle tone is being turned down, possibly as a protective mechanism from the injured area in the low back.  When we have identified muscles that are inhibited we can work on treatments that are specifically helpful in turning these muscles back on.  Muscles that have been turned off for a while are always deconditioned and weak. This is why we also perform mechanical muscle testing with our computerized David Medical Exercise Machines.

  Full Muscle Testing for the Low Back - Computerized David Strength Testing

The second way we test for Low Back Pain muscle weakness is through computerized isometric mechanical muscle testing using the David Medical Exercise Machines. The results show the amount of force generated by your back muscles in six different directions.  Because the testing is computerized, we also get to see how your scores compare to the average results of other people of the same age, size and gender.  (Click Here for More Info about the David Machine Testing)  

The Best Exercises for Low Back Pain!  Show Me The Numbers!

How can you tell whether an exercise is good for your low back pain?  What is the purpose of exercise?  An exercise is good for low back pain if it does not cause more pain and if it leads to increased motion and strength in the areas that were measured to be limited.  If you have low back pain, you should be given exercises that are specific to the weakness that were found during examination.  The right exercises will not be painful.  This is very important.  Pain during exercise can trigger muscles to be turned off.  The muscle tone can be inhibited by pain.  Also, the exercises, when repeated, will lead to increased strength.  At Muscle IQ we can show you your progress because we measure your back muscle strength and we can show you the numbers.  No other physical therapy clinic in Utah County measures muscles like we do.

Should I Stop Rehab When the Pain Stops?                                  

We discussed in an earlier blog that MRI results are not a good predictor of future episodes of low back pain.  We believe a good predictor of future low back pain is Muscle Strength.  So, it follows that you should focus your rehab efforts on returning to normal strength.  Strong muscles protect against re-injury and re-occurrence of low back pain.  Once you reach normal strength you can maintain that level of strength with a Home Exercise Program.  You put yourself at a disadvantage if you cut your rehab short, before seeing a return to healthy strength levels for an injured low back.

Low Back Pain -  Muscle Strength Summary