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Rolfing: What is it, and can it help with chronic back pain?

Categories: Other Physical Injuries

By Melissa D. Carter. Posted on .

“Rolfing” is a massage therapy that involves manipulation of the body and movement education.  Founded by Ida Rolf, a biochemist over 70 years ago in New York City, the Rolfing Institute explains that Rolfing is a “holistic system of soft tissue manipulation and movement education that organizes the whole body in gravity.”   Rolf theorized that, while skeletal muscles often work in opposing pairs in concert, with one contracting and the other relaxing, the fascia, or connective tissue, often get bound up and restrict opposing muscles from functioning.  When an injury occurs, Rolf theorized, the fascia tightens around that injury, somewhat like a cast or band-aid. Even after the injury heals, the fascia stays in that rigid position, often causing chronic pain and discomfort. Rolf sought to separate the fibers of the jumbled fascia manually, to loosen them and allow effective movement.

The theory was born out of many modalities, including osteopathic medicine, chiropractic medicine and yoga.  The main premise is that the body must be secure so that it can use gravity for support, to then allow each segment of the body to relate properly to the other. 

 The Rolfing massage technique involves an attempt to reposition tissues under the skin by manipulating connective tissue, keeping in mind the body’s relationship to gravity.   Balancing the entire body and increasing movement, Rolfing is intended to resolve chronic problems, such as pain and tightness, by releasing tension patterns and realigning the legs, torso, shoulders, arms and head.

The “Rolfer” and the patient must work together to change the body’s form, balance and function.  The Rolfer slowly lengthens the body’s fascia and repositions it by manipulating the connective tissue.  Many patients praise Rolfing for restoring mobility where years of tension and holding once hindered joints.

Long ignored as a fringe therapy, Rolfing has recently been getting serious attention from researchers. The National Institutes of Health provided a grant for the First International Fascia Research Congress in 2007, which brought together therapists, scientists, and doctors.

More recently, Eric Jacobson, a research associate at Spaulding Rehabilitation Hospital in Boston and a lecturer at Harvard Medical School’s department of global health and social medicine, received an NIH grant to study the therapy’s effect on chronic low back pain, which affects 16 million American adults. Other research has shown the therapy reduces the pain of fibromyalgia.

Meditation and Chronic Pain

Categories: Other Physical Injuries

By Melissa D. Carter. Posted on .

A recent Brown University study proposed that meditation can help patients manage their chronic pain.[1]  The study analyzed the intimate connection in mindfulness between mind and body, as meditation training begins with a highly localized focus on body and breath sensations.

Meditation and Chronic Pain

The study’s researchers state that the repeated concentrated sensory focus enhances control over localized alpha rhythms in the primary somatosensory cortex, where sensations from different parts of the body are mapped by the brain.  By learning to control their focus on the present somatic moment, researchers say, meditators develop a more sensitive “volume knob” for controlling spatially specific, localized sensory cortical alpha rhythms, thus enabling optimal filtering of sensory information.  Meditators learn to control which body sensations they listen to, and also how to regular attention so that it does not lean toward negative physical sensations, like chronic pain.

The study team used a brain imaging technology called magneto encephalography (MEG) to show that alpha rhythms in the cortex correlate with sensory attention and that the ability to regulate localized alpha brainwaves on a millisecond scale is more distinct in people who have had standardized mindfulness training than in those who have not.  The team also used a computer model that simulates the electrical activity of neural networks and predicts how the alpha rhythm is generated.  One prediction from this study is to explain how gaining control of alpha rhythm not only enhances sensory focus on a particular area of the body, but also helps people overcome persistent competing stimuli, such as chronic pain signals.

The study proposes that training chronic pain patients in the standardized mindfulness techniques of focusing on and then focusing away from pain, should result in MEG-measurable, testable improvements in alpha rhythm control.

“By this process of repeatedly engaging and disengaging alpha dynamics across the body map, according to our alpha theory, subjects are re-learning the process of directly modulating localized alpha rhythms,” they wrote.



[1] Frontiers in Human Neuroscience, “Mindfulness starts with the body: somatosensory attention and top-down modulation of cortical alpha rhythms in mindfulness meditation,”Catherine E. Kerr, Matthew D. Sacchet, Sara W. Lazar, Christopher I. Moore and Stephanie R. Jones.


CURVEBALLS AND KIDS: How Can Parents Protect Their Young Pitching Athletes From Serious Arm Injuries?

Categories: Other Physical Injuries

By Melissa D. Carter. Posted on .

With the first day of summer on our heels, most little league championships have concluded and young baseball players are done for the season.  Unless you, like I, have a TOK (totally obsessed kid) that plays post little league pitcherseason Allstars, followed by summer ball league, sprinkled with summer baseball parties and topped with pitching sessions with dad in the yard.  We are All-Baseball, All-The-Time.

At one particular little league championship this spring, an 11-year old pitching dynamite on the mound was destroying our team.  He was throwing curve ball after curve ball, striking out one batter after the next.  He was fierce.  He was feared.  The championship was on the line, and he was a Hero.  That is, until his 11-year old arm gave out on him and he collapsed on the mound, grabbing his ravaged elbow, screaming in pain.

According to the Division of Sports Medicine at Children’s Hospital Boston, the “Little League elbow” is on the up-tick, and they are seeing 12-14 year olds in droves with injuries caused by throwing curve balls.

Sports medicine physicians seem to agree that pitchers under the age of 13 are simply not physically capable of absorbing the torque and strain on the elbow caused by throwing a curveball.  The ulnar collateral ligaments that connect the lower and upper part of the arm are too underdeveloped to survive the strain.   The American Sports Medicine Institute says, “don’t throw curve balls until you can shave.”[1] ASMI Executive Director Lanier Johnson added, “The kid who throws all those curve balls in the Little League World Series is a hero. But does he ever get a change to earn a college scholarship or sign a major league contract? Do you want to take a chance on your son or daughter to get a college scholarship? Do you want to be a hero at 13 or 14 but never much else after that?”[2]

Dr. Lyle Micheli, director of the Division of Sports Medicine at Children’s Hospital Boston, believes the curveball is best not thrown until a pitcher is at least 14. He also said kids shouldn’t attempt to throw a slider, a pitch that puts even more stress on the elbow, until 16.[3]

Little League International and Little League Baseballs have tried to minimize the risk to young pitchers by mandating a pitching count limit and innings’ pitched limit per game.  They have not, to date, mandated an age requirement or restriction on curve balls.  “It doesn’t mean we’re advocating throwing breaking balls,’’ Stephen D. Keener, president and chief executive of Little League International.  “We don’t promote it. We just think it’s very difficult to regulate it out of the game, and there is no data to show that throwing breaking balls is at the root of arm injuries.’’[4]

Timothy Kremchek, an Ohio orthopedic surgeon and the Cincinnati Reds team physician, disagrees.  “They have an obligation to protect these 12-year-old kids and instead, they’re saying, ‘There’s no scientific evidence curveballs cause damage, so go ahead, kids, just keep throwing them.’’’[5]

While there is no Little League rule banning the destructive pitch, parents should remain vigilant to protect their children from serious injury, and heed the warnings by the medical profession concerning this growing trend among young pitchers.  Without Little League oversight, parental knowledge is instrumental in protecting young athletes. These injuries are totally preventable, and awareness is key.

Dr. Kremcheck offered the following tips to parents and their eager, baseball loving children, on appropriate measures to minimize serious injury to pitchers:

  1. No curveballs until aged 14-16;
  2. No more than 300 pitches per week, be it games or practices; and
  3. Good coaching: ensure your child has a knowledgeable, experienced pitching coach teaching proper techniques.

If you are someone you know has suffered a traumatic, preventable, injury while participating in a sporting event, we have trained, knowledgeable and experienced attorneys in the area of sports injury law that are able to consult with you.






[5] Id.


Recent Survey Results on Distracted Driving

Categories: Auto Accidents

By Melissa D. Carter. Posted on .

The US Department of Transportation’s National Highway Traffic Safety Administration (NHTSA) released survey results on April 5, 2013 showing that Americans continue to use electronic devices while driving, despite laws and evidence that such distractions cause lack of focus while driving and can lead to collisions, injuries and even death.

The survey revealed that, at any given daylight moment, approximately 660,000 drivers are using cell phones, or some form of electronic devices, while driving.  This number of users has held steady since 2010, despite awareness and anti-texting while driving laws.  The NHTSA also found that more than 3,300 people were killed in 2011, and 387,000 were injured in collisions involving a distracted driver.[1]

US Transportation Secretary Ray LaHood states, “There is no way to text and drive safely.  Powering down your cell phone when you’re behind the wheel can save lives – maybe even your own.”

Click here to view a short documentary created by EndDD concerning teen distracted driving:

To prevent distracted driving, the Department of Transportation recommends drivers:

  • Turn off electronic devices and put them out of reach before starting to drive;
  • Be a good role model for young drivers and set a good example;
  • Talk with your teens about responsible driving;
  • Speak up when you are a passenger and your driver uses an electronic device while driving;
  • Always wear your seat belt; the best defense against other unsafe drivers.




Tablets As An Essential Rehab Tool for TBI Survivors

Categories: Other Physical Injuries

By Melissa D. Carter. Posted on .

iPad (2)There is no doubt that smartphones have revolutionized how we work, travel, stay connected and, well, live.  More than just finding the closest Starbucks, or finding the quickest route home during rush hour traffic, the latest smartphones and tablets have also revolutionized therapy for survivors of traumatic brain injury.

For TBI patients, rehabilitating short term memory is a difficult struggle that plays a major role in rehabilitation.  Many TBI survivors cannot recall basic details to get through the day without significant assistance, and cannot retain memory beyond a few minutes in time.  TBI survivors frequently rely on copious notes with lengthy details to simply navigate a single task in a given day.  Many rely on caregivers for cues and reminders to help them with daily tasks, such as remembering to take medication, or assistance with completing the preparation of a simple meal from beginning to end.

A new study suggests that tablets, such as Apple’s immensely popular iPad, can actually assist TBI survivors with short term memory rehab.   The Royal Centre in Sydney, Australia trained 21 TBI patients to use personal digital assistants (PDAs) instead of relying upon diaries and human reminders, for help with tasks and alarms that were pre-loaded into the calendar.  The patients received multiple alarms for reminders throughout the day for medications, and other pre-arranged tasks to help the patients handle their days.  Pictures of friends and family members were loaded into the PDAs to help patients put names with faces.  At the same time, another group of patients continued on without PDAs and relied upon the traditional diary method.  At the conclusion of the two-month study, the patients using PDAs had a greater level of improved memory function over those working with diaries only.[1]

In addition to improved memory functions, devices like the iPad and their applications, commonly called “apps,” have assisted TBI victims who struggle to communicate verbally.  Here is a list of 27 life-changing apps for TBI patients for the iPhone and iPad:

And for the android:

As research develops and continues to show progress in TBI recovery, insurance companies may start treating these devices with great deference and may start to cover them for patients undergoing rehabilitation for traumatic brain injury.



New Protections for Baseball Pitchers

Categories: Brain Injury

By Melissa D. Carter. Posted on .

Mention traumatic brain injury and student athletes, and few people think about baseball.  However, balls struck off aluminum bats can reach speeds close to 100 mph, causing serious risk of injury to the pitcher.

In October, 2012, Major League Baseball announced that it is looking for ways to protect pitchers from line drive injuries to the head, such as the injury to Tigers starting pitcher Doug Fister from a line drive during the World Series.  MLB is considering a variety of head gear for pitchers, including cap Kevlar liners.

Little league is ahead of MLB, with many youth leagues across the country requiring young pitchers to wear protective head gear while on the mound.  In 2010, high school pitcher Gunnar Sandberg was sidelined when a line-drive traveling at over 100 mph struck his skull, causing a life threatening traumatic brain injury.  A year later, Gunnar returned to pitching, wearing a 5 pound helmet to protect his skull.  President of Little League Baseball, Stephen Keener, is hopeful that this will catch on with younger players.

The youth pitching helmet was first designed by Easton-Bell as part of a movement to reduce traumatic brain injuries to student athletes.  The helmet is made from expanded polystyrene, a lightweight material adept at absorbing energy:

baseball helmet

Fire Prevention 101: Keep Your Family Safe

Categories: Personal Injury Resources

By Melissa D. Carter. Posted on .

October marks the month of national Fire Prevention and Awareness.  The risk of serious injury and death from home fires is real.  In 2011, 384,000 homes across the country required fire department emergency responses, which claimed the lives of 2,640 and injured 13,350 others.[1]  Most victims of fires die from smoke or toxic gases and not from burns.[2]  85% of all US fire deaths in 2009 occurred in homes.[3]  Of the home fires that cause death, 40% had no smoke alarms.  The main reason that smoke alarms fail to operate during home fires is missing or disconnected batteries.

Landlord Responsibility to Promote Fire Safety

In Washington, as in many states, a landlord of a residential unit must ensure that all units have smoke detection devices.[4]  The smoke detection device must be designed, manufactured and installed inside the dwelling unit in conformance with nationally accepted standards and per Washington state rules and regulations promulgated by the director of fire protection.  While a tenant must maintain the smoke detector and test/replace batteries periodically, the owner alone is responsible for installation.  The landlord must also ensure the smoke detector’s performance whenever a unit becomes vacant and before re-letting it.

A landlord who does not comply with this law is subject to civil penalty and may be liable to any tenant who is injured from smoke or fire due to the lack of a functioning smoke detector.

Keep Your Home Fire Safe

  • Cooking Safely: never leave cooking food unattended on the stove.  Keep all flammable objects, such as potholders, towels, and clothing, away from flame.  Also keep the handles of pots turned in.
  • Smoking: try to quit.  If you must smoke indoors, never smoke in bed or leave a burning cigarette unattended.  Never smoke while drowsy or under the influence of alcohol or medications.  Don’t empty hot ashes into a garbage can.  Keep ashtrays away from furniture and curtains.
  • Staying warm: stay safe.  Keep any space heaters three feet away from any flammable objects, including curtains, furniture and bedding.
  • Alarms.  Install smoke alarms on every floor of your home, including the basement.  Install smoke alarms in all sleeping rooms, especially those occupied by a smoker.  Test smoke alarms once a moth using the test button.  Test and change your batteries every six months.
  • Escape plan.  Determine a home fire escape plan.  Have at least two exits for every room and agree on a meeting place outside with all household members.  Practice your escape plan twice a year with everyone in your home.

For more information on fire safety, go to:

For the duties of a landlord and tenant regarding smoke detectors go to:

Learn More About Home Fire Prevention


  1. Ahrens M. The U.S. fire problem overview report: leading causes and other patterns and trends. Quincy (MA): National Fire Protection Association; 2003.
  2. Ahrens M. Home structure fires. Quincy (MA): National Fire Protection Association; 2011.
  3. Ahrens M. Smoke alarms in U.S. home fires. Quincy (MA): National Fire Protection Association; 2009.
  4. Centers for Disease Control and Prevention. Deaths resulting from residential fires and the prevalence of smoke alarms – United States 1991–1995. Morbidity and Mortality Weekly Report 1998; 47(38): 803–6.
  5. Centers for Disease Control and Prevention, National Center for Health Statistics (NCHS). National vital statistics system. Hyattsville (MD): U.S. Department of Health and Human Services, CDC, National Center for Health Statistics; 1998.
  6. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2010). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). Available from:  [Cited 2010 Sept 21].
  7. Finkelstein EA, Corso PS, Miller TR, Associates. Incidence and Economic Burden of Injuries in the United States. New York: Oxford University Press; 2006.
  8. Flynn JD.  Characteristics of home fire victims. Quincy (MA): National Fire Protection Association; 2010.
  9. Hall JR. Burns, toxic gases, and other hazards associated with fires: Deaths and injuries in fire and non-fire situations. Quincy (MA): National Fire Protection Association, Fire Analysis and Research Division; 2001.
  10. International Association for the Study of Insurance Economics. World fire statistics: information bulletin of the world fire statistics. Geneva (Switzerland): The Geneva Association; 2009.
  11. Istre GR, McCoy MA, Osborn L, Barnard JJ, Bolton A. Deaths and injuries from house fires. New England Journal of Medicine 2001;344:1911–16.
  12. Karter MJ. Fire loss in the United States during 2010,. Quincy (MA): National Fire Protection Association, Fire Analysis and Research Division; 2011.
  13. Parker DJ, Sklar DP, Tandberg D, Hauswald M, Zumwalt RE. Fire fatalities among New Mexico children. Annals of Emergency Medicine 1993;22(3):517–22.
  14. Runyan CW, Bangdiwala SI, Linzer MA, Sacks JJ, Butts J. Risk factors for fatal residential fires. New England Journal of Medicine 1992;327(12):859–63.
  15. Runyan SW, Casteel C (Eds.). The state of home safety in America: Facts about unintentional injuries in the home, 2nd edition. Washington, D.C.: Home Safety Council, 2004.
  16. Smith GS, Branas C, Miller TR. Fatal nontraffic injuries involving alcohol: a meta-analysis. Annals of Emergency Medicine 1999;33(6):659–68.

[2] Hall 2001.

[3] Karter 2011.

[4] RCW 43.44.110; See also Moratti ex rel. Tarutis v. Famers Ins. Co. of Washington, 162 Wn. App. 495, 254 P.3d 939 (2011).

Common Treatment Modalities for Facet Joint Injuries

Categories: Other Physical Injuries, Personal Injury Resources

By Melissa D. Carter. Posted on .

Almost everyone is familiar with the injury term “whiplash” as a result of spinal trauma.  What, however, is a facet joint injury, and what are the common treatment methods to reduce or alleviate the pain?

The facet (zygapophyseal) joints are the articulations or connections between the vertebraes in the spine and occur in pairs at each vertebral level. The facet joints work with the corresponding disc to link the vertebrae directly above and below to form a working unit that lends stability and weight-bearing capacity while permitting flexibility and movement of the spine.  The facet joints have a synovial lining, covered with hyaline cartilage.  These joints contain nerves, the medial branches, that transmit pain back to the spinal cord.  Injuries to the spine can inflame the facet joints, or cause the cartilaginous surfaces to wear away, causing back pain in the vicinity of the inflamed joint as the friction increases within the joint space.  On occasion, the pain is located several inches away from the inflamed joint, or even into the limbs.

Treatment of facet injuries includes physical therapy, acupuncture, spinal manipulation, massage, heat and medications to reduce pain.  Anesthetic and steroidal injections under fluoroscopic (x-ray) guidance are another common diagnostic tool that can provide very good therapeutic results in combating a facet joint injury.  Immediate alleviation of pain following a facet injection confirms the pain source.  If conservative treatment modalities provide only temporary relief, radiofrequency neurotomy can provide a longer lasting result.  Under this procedure, a radiofrequency probe deadens the small nerves that supply the facet joint to reduce pain.

A less traditional modality which can have very good results, but not always covered by insurance plans, is prolotherapy.  Prolotherapy involves repeated injections of a solution of concentrated dextrose (pharmaceutical-grade sugar water) and local anesthetic into the injured facet joint.  Prolotherapy is thought to encourage the body to naturally produce connective tissues, collagen and cartilage, in the injured area to reduce pain by stimulating the immune system to bring fibroblasts and chondroblasts to the pain area and to rejuvenate it.[1]


Bicycle Safety Tips For Your Child

Categories: Bicycle Injury

By Melissa D. Carter. Posted on .

Bicycle friendly cities like Seattle see die-hard cyclists that proudly brave the wind and rain in the dark days of winter.  With summer finally here, though, the cyclists hitting the street increases dramatically, as does the risk for bicycle collisions.   This risk is even greater with children, who are less capable of making quick decisions and are less visible to motorists.   Here are some tips on bicycle safety and children.

A Properly Fitted Helmet Can Save A Life

Helmets protect your biggest asset: your brain.  A cheap investment in a helmet can save your child’s life, but take the time to ensure that the helmet fits properly.  Per the National Highway Traffic Safety Administration (NHTSA), following these easy steps will help you fit and wear your helmet to maximum safety:

Step 1[1]: Size.  Measure your child’s head for approximate size.  Try the helmet on for a snug fit.  While the helmet sits flat on the top of the head, make sure that the helmet doesn’t rock from side to side.  In your child’s helmet, remove the padding when your child’s head grows.   Remember to select a helmet that fits your child’s head now, not one to “grow into.”

Step 2: Position.  The helmet should sit level on the top of your head and low on the forehead; one to two fingers above the eyebrow.  The helmet must cover the forehead.

Step 3: Buckles: Center the buckle under the chin.  Tighten for snugness so no more than one finger can fit under the strap.

Step 4: Side Straps: Adjust the straps on both sides to form a “V” under and in front of the ears.  Lock the slider.

Step 5: Final Fitting: Open your mouth wide: does the helmet pull down?  If not, tighten the chin strap.  Make sure the helmet does not rock back and forth or forward into the eyes.  If so, re-adjust the side straps and chin strap.

Also, be sure to replace a helmet whenever it has been involved in a crash, even if it appears unharmed.

Helpful Safety Tips

Before your child‘s feet hit the pedals, check the equipment to ensure that the tires are properly inflated and that the brakes work.  Make sure that your child wears bright, neon or fluorescent colors while riding (day or night) to increase visibility.  Consider installing light reflectors on the bike and helmet.  Even with these precautions, a child should avoid riding at night at all times.

Per the NHSTA, the safest place for adults to ride is on the street, following the same rules of the road as motorists.  Washington law requires that bicyclists always ride with the flow of traffic.[2]  However, children under 10 years old are not mature enough to make decisions necessary to ride safely in the street.  Children under 10 are much better off riding on the sidewalk.  When riding on the sidewalk, a bicycle rider has all of the rights and responsibilities of any pedestrian.[3]  Have a discussion with your children about alerting nearby pedestrians on sidewalks that they are approaching, watching for vehicles exiting driveways, and entering the street at corners, instead of between parked cars.   A bell or horn can be a very helpful tool for your child’s bike, as well a fun one, too.



[1] Bicycle Helmet Safety Institute:

[2] RCW 46.61.100.

[3] RCW 46.61.755

Settling Your Motor Vehicle Property Damage Claim After An Auto Collision

Categories: Auto Accidents, Personal Injury Resources

By Melissa D. Carter. Posted on .

Under the Insurance Fair Conduct Act (IFCA), your automobile insurance company must settle your vehicle damage claim in good faith.  Your insurer must:

  • make a good faith effort to communicate with the repair facility of your choice;
  • not arbitrarily deny your repair estimate;
  • not require you to travel unreasonably to obtain an estimate, repair your car or obtain a loaner car;
  • provide you with a copy of the estimate it prepares, or disclose reasons for denying your estimate;
  • provide a list of repair facilities within a reasonable distance of your principally garaged area;
  • consider any additional (related) damage the repair facility discovers during repairs;
  • limit deductions for betterment/depreciation to parts normally subject to repair and replacement during the life of your vehicle;
  • not recommend that you make a claim under your own collision coverage, if liability and damages are reasonably clear, solely to avoid paying claims under the liability insurance policy.[i]

If your vehicle is rendered a “total loss” after a collision, then your insurer must follow this established protocol:

  1. Replacing the loss vehicle: replace your vehicle with a comparable one that is available for inspection within a reasonable distance from where your vehicle is principally garaged.
  2. Cash settlement: based on the actual cash value of a comparable vehicle.
  3. Appraisal: resolve appraisal disputes per the policy terms.
  4. Settlement requirements: When settling a total loss vehicle per subsections (1) through (3) above, the insurer must:

a.  communicate its settlement offer to you by phone or in writing;

b.  base all offers on itemized and verifiable dollar amounts for vehicles that are currently available, or were available within ninety days of the collision, using appropriate deductions/additions for options, mileage or condition;

c.  consider relevant information supplied by you;

d.  provide you with a true and accurate copy of any “valuation report;”

e.  include all applicable taxes and fees.[ii]

Finally, your insurer shall not refuse to settle any property damage claim under your automobile policy based upon your refusal (or delay) in responding to your insurer’s demand that you submit to an independent medical examination in connection with your Personal Injury Protection (PIP) claim.


[i] WAC 284-30-390

[ii] WAC 284-30-391