Warm ups are always important. They gradually raise your heart rate, and get you breathing a little faster. This sends more oxygen, energy, and nutrients to your heart, lungs, and muscles so they can perform at their best. Warm ups also get the aerobic energy system started, which takes several minutes. Getting it going before your activity also helps you perform better.

What's different in the cold?

Our bodies have a few tricks to stay warm in the cold. One of these is to narrow the blood vessels closest to the skin. That means that the more superficial muscles get less blood flow, making them more likely to be injured if you place too much demand on them before they're ready. The restriction in the blood vessels also makes your heart work harder. This doesn't mean you can't be active in the cold, it just means that you should take a little more time to get your body ready.

How to warm up

Start with something to raise your heart rate, maybe a brisk walk or light jog. Follow that with a dynamic warm up like walking or jogging while pulling your knees up high to your chest. Some high front kicks with straight knees will loosen your hamstrings. Walking lunges with an upper body twist will get your whole body moving. Your warm up should match the activity you have planned. If you're not sure how it should look, ask your physical therapist!

Consider your clothes

Dress in layers so you can adjust your clothing to your activity level. After you warm up, you might want to take off a layer to avoid getting too hot during your main activity. You can always add layers back when your activity level drops or the temperature changes.

Even though it's cold, cool down

We know it's tempting to rush inside to a warm blanket and hot drink, but don't skip the cool down. Keep moving with a walk or another form of active recovery so your heart rate can come down gradually. A cool down also helps your muscles to transition back to a relaxed state and can reduce soreness following your workout. Since your muscles are still warm, your cool down is the right place for static stretching.

The shorter days and lower temperatures don't mean that you're stuck inside for all of your exercise. Follow these tips and you can safely keep moving outside. If you'd like a customized warm up or cool down, or have questions about your exercise routine, your physical therapist is a great person to ask!

Haven't thought about having an annual PT exam? We're biased, but we think you should. You see your optometrist and dentist regularly because your eyes and teeth are important. You get an annual physical from your family physician. You might even be getting ready to see your accountant to get your yearly taxes done.

But what about the rest of your body? Have you lost range of motion, or strength? How's your balance and coordination? These all affect how you move. You might not notice small changes until you have problems like trouble lifting a heavy load, joint pain, or a sprained ankle from a stumble. An annual PT exam can catch problems early, then correct them before they lead to something bigger.

What to Expect

An annual PT exam is quick and easy. Your annual visit may include:

• A history of your injuries, as well as a health history
• Assessment of your strength, balance, flexibility, etc.
• A review of your movement goals (do you want to run a marathon? Get on and off the floor easily playing with your grandkids?)
• A review and update of your exercise program

How Important Is Moving Well?

There is strong evidence suggesting that movement is a valuable predictor of future health and resilience against disease. Moving well can keep you healthier and help you live longer. Here are some examples of the power of movement when it comes to predicting future health:

Gait Velocity

Gait velocity is how fast you walk. Studies have shown that if your typical walking speed is over 1 m/s or 3.3 ft/s, you're likely able to complete typical daily activities independently. You're also less likely to be hospitalized and less likely to have adverse events like falls.

Get On and Off the Floor

A series of studies suggest that if you can go from standing to sitting on the floor and back to standing without using your hands, you're a lot less likely to die than someone who can't. It's  called the sitting-rising test. You can find the instructions and examples with a quick internet search.

Notice that both gait velocity and the sitting-rising test aren't specific to any one thing. The risk of hospitalization in the gait velocity studies was hospitalization for any reason. Death in the sitting-rising studies was death from anything. So science says that moving well is incredibly important to your overall health. It's also important for your quality of life. We think moving well is just as important as your teeth, eyes, and taxes. If you agree, get that annual PT exam scheduled!

References

Why provide an annual physical therapy visit - https://www.apta.org/patient-care/interventions/annual-checkup

Physical Therapists' Role in Prevention, Wellness, Fitness, Health Promotion, and Management of Disease and Disability - https://www.apta.org/apta-and-you/leadership-and-governance/policies/pt-role-advocacy

Ability to sit and rise from the floor is closely correlated with all-cause mortality risk -- ScienceDaily

Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older - PubMed (nih.gov)

Keeping up with physical therapy during the holidays is tough. There are so many other things to do - cooking, parties, shopping, travel, and visiting with family and friends. But if you're in physical therapy over the holidays, there's a reason. You're having pain, or not moving as well as you want to. These issues place limitations on your life, which are going to affect your ability to do things - like cooking, partying, shopping, traveling, or enjoying time with friends and family. So even though keeping up with your PT this time of year is tough, it's important. That's why we're going to give you our best tips to help you through the holidays.

Plan

Some of what makes the holidays challenging is the crazy schedule. To survive this, you're going to have to plan ahead. We're not just talking about appointments on your calendar, either (although those are important). Here are some things to think about planning ahead:

Your PT appointments

Your schedule is busy during the holidays. So is your PT's. Plan and schedule your appointments in advance. You'll get the times and days that work best for you, and you'll already have your PT appointments in your calendar to plan other things around.

Your exercise

Hopefully you have a regular time to exercise. With the holiday mania about to shake up your routine, that time may no longer work. Think about when you're going to exercise ahead of time and you'll stay consistent.

Your diet

Healthy eating often gets derailed during the holidays. Putting low quality fuel into your body won't help you feel better. Think about planning what you're going to eat ahead of time. We're not saying to skip every holiday treat offered to you, but maybe think about which ones you really need to have, and which ones you can skip in advance. It makes saying "no thanks" to that third slice of fruitcake easier.

Modify

We're realistic. We understand that life isn't the same during the holidays as it is during the rest of the year. That's part of what makes this time of year special! With that in mind, our next set of tips focuses on making modifications to help you get through the holidays successfully.

Your PT Plan

When you planned your PT appointments out well in advance, you might have run into some challenges. Talk to your therapist about how you might be able to modify your plan of care through the holidays to make it all work. Maybe you're going to PT three times a week and you can only come twice a week for a week or two. Plan this sort of thing in advance with your PT and you can work together to come up with the best plan.

Your exercise

Exercise is so important, it made our list twice. Now that you know when you'll exercise, you might have to modify your routine to make it fit. Again, we recommend talking with your PT to see what you can do. Maybe your home exercise program can be modified so you can do everything in the kitchen during downtime when you're cooking up your holiday feast. Maybe you can reduce the number of exercises to focus on maintaining the gains you've made until things settle down.

Your schedule

In your planning in advance (see how important it is?) you might have found that your normal routine wasn't going to work. If your PT appointments or exercise time is usually right after work and you've now got commitments during that time, maybe you can move them to the morning before work. If you've been exercising outside, the shortened days may move you into the gym. Be flexible and consider temporarily modifying your schedule and your routine to make it work better during the holiday season. You can always go back to your previous routine after.

The holidays are a special time of year. Keeping up with your health and your physical therapy can be challenging during this time. But you don't have to fall behind. With some planning and flexibility, you can stay healthy, survive the holidays and head into next year with good momentum!

Physical Therapy Is For Everyone!

Physical therapists are highly trained health care professionals. They are experts in human movement who are trained to evaluate and treat all kinds of musculoskeletal issues with exercise and other techniques. Everyone moves and everyone can benefit from exercise, so physical therapists can help people through their entire lives!

Physical Therapy for Children

Physical therapists start treating some people very shortly after birth. Common reasons a baby might need PT include torticollis and cerebral palsy. Torticollis is a postural issue caused by a tight neck muscle. Babies with torticollis hold their heads tipped to one side. Cerebral palsy is a neurological disorder that causes difficulty with movement and coordination.

As children get older, some have trouble hitting their motor milestones - think of these as the "firsts" - sitting up, rolling over, crawling, standing, and walking. Physical therapists can help here too, using their expertise to help develop motor skills and coordination to get these children back on track.

Physical Therapy for Adolescents

In adolescents, sports injuries become more common. Whether it's an ankle sprain, or an ACL surgery, a PT can help. The rapid growth in adolescents can cause issues too. Things like growth plate fractures, growing pains, Osgood-Schlatter's disease, and Sever's disease are all common in adolescence and are related to the changes the body is going through.

Physical Therapy for Adults

As adults, a lot of us will have back pain - studies say up to 80% of us. Physical therapy is one of the first treatments recommended for back pain. Physical therapists also see adults for injuries - maybe from weekend warrior type sports injuries, overuse, or from an accident at work. Some adults also start to show symptoms of diseases like multiple sclerosis, or myositis which also benefit from physical therapy.

Physical Therapy for Older Adults

Later in life, people tend to have more health issues that impact their ability to move. Things like arthritis, joint replacements, strokes, and heart attacks are all things a PT can help with. Physical therapists also help people age better - keeping them moving with exercise programs that help reduce falls, or helping them make adaptations and modifications to keep them in their homes safely.

Movement is a constant in life. As movement experts, PTs can help people of any age. Some specialize in treating pediatric patients, and some specialize in treating geriatric patients, but all PTs have the expertise to help people move better.

References

https://www.cdc.gov/ncbddd/cp/facts.html

PT for pediatric ataxia - https://pubmed.ncbi.nlm.nih.gov/31392562/

Adult in workplace - https://pubmed.ncbi.nlm.nih.gov/32270086/

Adult myopathy (an example of something treated for adults, not geriatrics necessarily) - https://pubmed.ncbi.nlm.nih.gov/31115788/

The Role of a Physical Therapist in Healthy Aging - https://www.ncoa.org/article/the-role-of-a-physical-therapist-in-healthy-aging

How Physical Therapists Can View Normal Versus Abnormal Aging - https://www.foxrehab.org/pt-impact-older-adults-optimal-function

Don't Keep Injury Secrets!

Physical therapists are experts in dealing with injuries, but your PT can't help if they don't know about your injury!

You might be wondering who would keep an injury secret. The answer is - lots of people!

The first thing that comes to your mind might be an athlete, like a football player, or maybe a baseball pitcher. But athletes aren't the only ones that keep injury secrets. Performers like dancers keep injury secrets, and so do workers in all types of jobs.

Why would anyone want to keep their injury secret instead of getting it treated and letting it heal? Read on…

Stigma

Although there have been big improvements in the culture around sports, performing arts, and worker's comp, some people still have the old "no pain, no gain" attitude. To some people, reporting an injury is an act of weakness, or a way of letting the team down.

There can also be external pressure from coaches, parents, teammates, supervisors, or fans to keep playing or working.

Fear of Loss

With the focus on head injuries in recent years, athletes that get hit in the head know if they report concussion symptoms, they're coming out of the game. Workers who get hurt on the job fear loss of pay, or loss of their job. Performers who get hurt might fear that their replacement will outshine them on the stage and take their place.

Competitive Advantage

While the first two reasons can apply to athletes, performers, workers and most any other group that might be hiding an injury, this one is limited to athletes. If an opposing team knows a player is injured, and what the injury is, they might be able to take advantage of it. For example, if a football team has a running quarterback that has an ankle injury, it will change how the opposing defense plays. 

These reasons all make some sense, but they're also all shortsighted. Finishing a game, dancing tomorrow night, or working one more shift are never worth your long term health. Hiding a minor injury can turn it into a major one. It's never weak to report an injury and you're not letting your teammates, or coworkers down. If you're not up to your best, you owe it to the people counting on you to let them know. Letting a healthy player, performer, or worker take your place is the right thing to do. If you're injured, don't hide it! Let the right people know, then go to the right person for help - your physical therapist!

PT For Your Pelvis?

Nobody is going to be surprised to hear that Physical Therapists work with muscles. But we bet a lot of people would be surprised to learn that the muscles inside your pelvis are included. While the pelvic muscles don't get as much attention as the biceps or hamstrings, they can still cause problems that need treatment. Here are a few examples:

Urinary Incontinence

Urinary incontinence is the involuntary leakage of urine. More than 13 million people in the United States have this issue. There are different types of incontinence, but the most common are stress and urge incontinence.

• Stress incontinence is when leakage happens during coughing, sneezing, or laughing.
• Urge incontinence is a result of the bladder being overactive or unstable. People with urge incontinence often often have triggers that cause the involuntary loss of urine, such as hearing running water.

Pelvic Pain

This is defined as any pain that occurs either internally or externally in the pelvic or genital area. Both men and women can be affected, but it's more common in women.

What's the Cause?

Most incontinence is caused by issues with the pelvic muscles - either weakness or tightness. There can be other contributing factors like spasms that cause bladder contractions, or conditions like anxiety may increase the urge to empty the bladder.

Pelvic pain is also usually attributed to either tightness or weakness of the muscles of the pelvic floor. The pelvis is made up of three bones, forming three joints where they meet. These joints need to be stabilized by an outside force. The job of the muscles and ligaments in and around the pelvis is to  provide that stabilizing force. If the muscles are too tight, the joints will have an excessive amount of compression on them. Too loose, and the joints of the pelvis can experience shear forces. Both conditions result in pelvic pain.

What can PT do?

Because incontinence and pelvic pain are usually musculoskeletal conditions, physical therapy can offer a lot of effective treatments. Some examples include:

Exercise - strengthening or stretching of the pelvic muscles or the core can help correct imbalances, improve pelvic stability and reduce pain.

Biofeedback - This involves using sensors placed on the body while doing exercise to help the patient identify which muscle groups are working and bring awareness to areas of tightness or weakness.

Education - For incontinence,  learning how the bladder normally functions can help you to understand changes that can be made to improve symptoms. Learning about posture and how to improve alignment of the pelvis and the trunk can help to reduce pain and improve tolerance for positions like sitting and standing.

Manual Therapy - joint mobilizations, trigger point release, soft tissue massage, myofascial release, and other techniques can help improve mobility of the pelvic joints, decrease tone in spastic muscles, and reduce pain.

If you’re experiencing pelvic problems, a specially trained physical therapist can complete a comprehensive evaluation, help determine the cause, and design a customized treatment plan to help.

References:

1. Research (peer-reviewed)
   1. Geriatric incontinence - https://pubmed.ncbi.nlm.nih.gov/34519024/
   2. Assess Pelvic Floor Guide - https://pubmed.ncbi.nlm.nih.gov/34807882/
   3. Pediatric pelvic floor - https://pubmed.ncbi.nlm.nih.gov/10458431/
   4. Using PTs for Pelvic floor - https://pubmed.ncbi.nlm.nih.gov/35353916/
   5. Urinary Incontinence prevalence - https://pubmed.ncbi.nlm.nih.gov/35173077/
   6. Physical Therapy Treatment of Pelvic pain - Physical Therapy Treatment of Pelvic Pain - PubMed (nih.gov)
2. Articles and Content
   1. Pelvic floor muscles and training - https://pubmed.ncbi.nlm.nih.gov/35036386/
   2. Exercise in pregnancy (helping incontinence - one of the symptoms - https://pubmed.ncbi.nlm.nih.gov/34478617/

What Physical Therapy Can Do For Arthritis

Arthritis is a chronic condition that causes inflammation of the joints. It can cause pain, stiffness, and swelling. The hips, knees, hands, and spine are the most commonly affected joints. Arthritis is not a single disease but an umbrella term that includes a variety of different types. Some of the more common examples are osteoarthritis, rheumatoid arthritis, gout, psoriatic arthritis and ankylosing spondylitis.

While physical therapy might not be the first treatment you think of for arthritis, it probably should be. A lot of people with arthritis choose to use medication to manage their pain, stop activities that hurt, and wait for things to get bad enough to have a joint replacement. But this isn't a great plan - all medications have side effects, even over the counter ones. Reducing activity leads to muscle atrophy and even stiffer joints. Even though joint replacement surgery usually has good outcomes, it does come with its own set of risks and a painful recovery.

Physical therapy has been extensively researched as a treatment for arthritis, and demonstrates good outcomes. Physical therapists typically start with exercise as the base for arthritis treatment. Exercise helps to regain lost joint motion, decrease feelings of stiffness, and strengthen muscles surrounding the affected joint. These benefits are all somewhat obvious. What surprises many people is that exercise has been shown to be as effective as medication for pain relief in many types of arthritis, without the side effects.

Physical therapy has more to offer people with arthritis than just exercise though. Education helps people understand their condition, what to expect, and how to manage it. As experts in human movement, physical therapists are especially good at helping people modify the way they perform certain tasks or activities to reduce strain on joints affected by arthritis. They can also suggest ways to modify the environment at work or home to reduce pain and improve function. They may also suggest things like braces, orthotics, or other devices that can help maintain mobility and reduce pain. On top of all of that, PT has been proven to be a cost effective treatment, too.

With so many techniques that are proven effective in helping people with arthritis, physical therapy is a recommended first line treatment for many types of arthritis. Now that you have a better understanding of what PT can do, hopefully you'll think of PT first when you think of arthritis too.

References:

1. Research (peer-reviewed)
   1. PT for juvenile RA - https://pubmed.ncbi.nlm.nih.gov/1946625/
   2. PT for hip and knee OA - https://pubmed.ncbi.nlm.nih.gov/33034560/
   3. Systematic Review for Juvenile RA - https://pubmed.ncbi.nlm.nih.gov/28729171/
2. Articles and Content
   1. Effectiveness and Cost-Effectiveness of Physical Therapy for Knee Osteoarthritis-  https://www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/718
   2. Can physical therapy reduce arthritis pain? - https://www.medicalnewstoday.com/articles/physical-therapy-for-arthritis

As we head into the dog days of summer, the weather is heating up. For the nearly 5 million people in the United States with Fibromyalgia, they might experience a different kind of heat - the burning pain that typically comes along with this diagnosis.

What is Fibromyalgia?

Fibromyalgia is a chronic condition that can cause a wide range of symptoms throughout the body. It's usually diagnosed between the ages of 30 and 50, and 80% to 90% of the people affected are women.

The most common symptoms are:

• chronic pain all over the body
• fatigue
• memory problems
• sleep disturbances
• depression or anxiety.

How Does Physical Therapy Help?

Because of the wide range of symptoms, fibromyalgia can be a debilitating condition. It is not uncommon for people to begin avoiding activities altogether because of pain and fatigue. This begins a cycle of deconditioning that not only impacts the person's overall health, but also makes the symptoms of fibromyalgia worse. The cause of fibromyalgia is currently unknown and there is no cure, so physical therapy treatments are designed to reduce and manage the symptoms. This requires a multi-pronged approach. Common treatments include:

Education

The first step in treating fibromyalgia is often helping people understand what's going on, and what they can do about it. Research has shown that people who are knowledgeable about their condition have better outcomes, more confidence, and cope better.

Decrease Pain and Improve Range of Motion

Physical therapists are movement experts with a lot of tools and techniques to help with the pain and stiffness caused by fibromyalgia. A PT might use gentle manual therapy or massage, prescribe specific stretches, or a simple yoga routine. They might also use modalities like electrical stimulation, biofeedback or in states where it is allowed, dry needling.

Exercise

Once patients understand the condition and are able to move a little better with less pain, exercise often enters the treatment picture. Research has shown that low to moderate intensity aerobic exercise like walking, biking, or swimming is important in managing fibromyalgia symptoms. It can help with pain, fatigue, sleep disturbances, depression, and more. Physical therapists and patients work together to find the right type of exercise and the right intensity to best manage fibromyalgia. They often have to start slow, and make adjustments along the way.

Each physical therapy session is tailored to the needs of the patient and will vary depending on the severity of their symptoms. Despite there still being no cure for fibromyalgia, physical therapists can help with pain management, strength, mobility, fatigue and function to help patients find relief from their symptoms.

References:

1. Research (peer-reviewed)
   1. Exercises for Fibro - https://pubmed.ncbi.nlm.nih.gov/32455853/
   2. Manual therapy for fibro - ​​https://pubmed.ncbi.nlm.nih.gov/32604939/
   3. Aquatic PT for fibro - https://pubmed.ncbi.nlm.nih.gov/23818412/
   4. Effectiveness of exercise with fatigue, etc for fibro - https://pubmed.ncbi.nlm.nih.gov/32721388/
   5. Aerobic exercise for fibro - https://pubmed.ncbi.nlm.nih.gov/28636204/
2. Articles and Content
   1. https://www.choosept.com/guide/physical-therapy-guide-fibromyalgia
   2. https://www.everydayhealth.com/fibromyalgia/aquatic-therapies/
   3. Physical Therapists are poised to treat and manage Pain (AOPT) https://www.orthopt.org/uploads/content_files/files/Pain_Manual_Draft_FINAL_6.25.2021%281%29.pdf

If you've been to physical therapy, you likely got a home exercise program. Research says that if you do your home exercise program, you'll have a significantly better chance of meeting your goals and feeling better. Not doing your program increases the risk of recurrent injury or flare-ups with less positive outcomes long term. Even though they're important, adherence to home exercise programs is terrible. It's estimated that only 40 to 50% of patients do their exercises the way they're supposed to. What can you do to make sure you do your exercises and get the best outcomes? Here are a few ideas.

Plan ahead

Think about what's going to get in your way - your schedule, that you'll forget, or that you don't have the space or equipment that you need. Once you figure out the problems, come up with solutions. Put your exercises in your schedule, talk to your PT about equipment, or adjusting your program to fit the time you have. If you solve problems before they start, they're no longer problems.

Address pain and beliefs

You'll need to work with your PT on these. If your exercises cause pain, you're not going to do them. When your PT prescribes your exercises, try them out. If there's pain, ask your PT about modifications to make them more comfortable. The other thing might need addressed are your beliefs. If you believe that the exercises won't help, or that they're a waste of time, you won't do them. Again, work with your PT to understand why they're prescribing those exercises, and what they're meant to do. Once you know why you're doing those exercises, you're more likely to do them.

Get support

People who have social support are more likely to do their exercises. This is why CrossFit and group exercise classes work. Find a family member or friend to help you stay consistent with your exercises. Your PT can help here too. Have someone ask if you're doing your exercises, and how they're going. This will keep you accountable and more likely to do them.

Use Technology

If you like technology and gadgets, they can help you be consistent with your exercises. There are plenty of apps that can track your exercise. Seeing that streak of days you've exercised will motivate you not to break it. Smartwatches and activity trackers can fill the same role.

Doing your home exercise program will help you get the most out of PT. With a little planning and a little help, you can make sure you're one of the 50% of the people who do their home exercises consistently to get the best outcomes.

References:

https://pubmed.ncbi.nlm.nih.gov/32669487/

https://www.physio-pedia.com/Adherence_to_Home_Exercise_Program

It's no secret that prices have been going up. Gas is expensive. Food is expensive. The housing market is crazy. If you're looking for ways to pinch some pennies or stretch your dollars, physical therapy might be just what you're looking for.

Physical Therapy Saves Cost

A study that looked at the claims data of 472,000 Medicare beneficiaries with back pain found that when PT was the first treatment, costs were 19% lower than when people got injections first and 75% lower than for people who were sent straight to surgery. The study also found that in the year following diagnosis, people who got PT first had costs 18% lower than those who got injections, and 54% lower than those in the surgery group.

Another example happened in 2006 when Virginia Mason Health Center in Seattle teamed up with Aetna and Starbucks. They sent workers with back pain to see both a physical therapist and physician for their first treatment. Use of MRI dropped by 1/3, people got better faster, missed less work and were more satisfied with their care. The cost savings was so great that Virgina Mason was losing money on treating back pain, so Aetna ended up paying them more for PT treatments because they were saving so much money.

Physical Therapy First Means Fewer Visits…

A paper published in Physical Therapy looked at outcomes when patients went to a PT first vs. seeing a physician first for back pain. It found that patients who went to their physician first needed 33 PT visits on average, while those who went to their PT first only needed 20. Seeing a PT first saves money, but it also saves time.

It Also Means Better Outcomes

A study of 150,000 insurance claims published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit.

High quality research consistently shows that taking advantage of direct access and getting to your physical therapist quickly leads to better outcomes in fewer visits with lower costs. We think that's a deal worth taking advantage of.

References

1. https://ww1.prweb.com/prfiles/2010/11/03/4743604/0_ANovelPlanHelpsHospitalWeanItselfOffOfPriceyTests.pdf
2. https://pubmed.ncbi.nlm.nih.gov/33245117/
3. https://www.apta.org/news/2017/07/26/study-says-cost-savings-of-physical-therapy-for-lbp-are-significant#:~:text=Researchers%20say%20that%20not%20only,over%20treatments%20that%20begin%20with
4. https://academic.oup.com/ptj/article/77/1/10/2633027?login=true
5. https://newsroom.uw.edu/news/early-physical-therapy-benefits-low-back-pain-patients

When you think of physical therapy you might think of an injured athlete, someone recovering from surgery, or someone with a chronic medical problem. We're here to let you know that you should think of kids, too. Physical therapists are trained to work with patients of any age. Some even specialize in pediatrics. Here are a few things PTs can help kids with:

Coordination Disorders and Gross Motor Delays

Some children are delayed in hitting their gross motor milestones - things like sitting up on their own, rolling, standing, walking, jumping and running. Other children show difficulty with coordination - activities like hand motions to "wheels on the bus", feeding themselves with utensils, moving awkwardly or slowly, or even tripping or bumping into things a lot. Physical therapists can help encourage development of gross motor skills and coordination to help these kids get back on track.

Cerebral Palsy

This is the most common motor disability in childhood. The symptoms can vary from moving a little awkwardly to being unable to walk and needing assistance for almost all activities. There are also different types - the most common causes stiffness in the muscles, but other types affect control of movements, balance or coordination. No matter the type or severity of cerebral palsy, a physical therapist can help with things like stretching, exercise, bracing, and equipment like a wheelchair if needed.

Torticollis

Torticollis is a postural issue that usually becomes noticeable shortly after birth. Babies with torticollis typically hold their heads tipped one direction and rotated towards the opposite side. This is caused by a tight neck muscle. Research has shown that early referral to a physical therapist is a very effective treatment. The PT usually shows the baby's caregivers ways to gently stretch the neck, and activities to encourage the baby to move his or her head into a more neutral position.

Pelvic Floor Issues

People don't commonly think of pelvic floor issues in children, but you might be surprised at how common they are. The most common symptom is chronic constipation, but pelvic floor problems can also show up as urinary incontinence, bed wetting, or needing to go to the bathroom frequently. A physical therapist can help with education for the child and their family, exercise, and sometimes even the use of biofeedback to help the child learn to better control their pelvic floor muscles.

Pain and Injuries

Although kids have a list of problems specific to them, don't forget about regular old pain and injuries. Your physical therapist can treat an ankle sprain, painful joint, or athletic injury in a child just like they can an adult.

Sometimes kids and even babies need some help with movement. From now on, when you think of your physical therapist, don't leave kids out of the picture!

References

https://www.cdc.gov/ncbddd/cp/facts.html

https://pubmed.ncbi.nlm.nih.gov/29087112/

https://pubmed.ncbi.nlm.nih.gov/30277962/

https://pubmed.ncbi.nlm.nih.gov/31096249/

https://pediatricapta.org/consumers/

https://www.youtube.com/watch?v=fq62vwyrcXs

Heart disease is a leading cause of death and disability. This shouldn't be a surprise - it's been at the top of the list for years. You know that taking care of your heart is important. That means doing things like eating right, avoiding smoking, and exercising regularly. While all of those things can be difficult, today we're going to focus on exercise.

How Physical Therapy Can Help With Your Heart Health

Cardiovascular exercise is anything that makes you breathe harder and your heart pump faster. That could be walking, running, dancing, biking, swimming or hiking. It strengthens your heart and blood vessels. It can help control weight, lower blood pressure, reduce stress, and prevent heart disease.

If you're regularly going for a run or swimming laps, you don't need help from your PT. But 3 out of 4 adults aren't exercising regularly. If you'd like to get started, your PT may be just the person to help you. It's not uncommon to get injured, then never get back to your old routine. Your PT can help you deal with the old injury and design a plan to get you safely back to regular activity.

It's also not uncommon to try to be more active on your own, only to stir up pain somewhere like your back, hip, knee or shoulder. Your PT can help with that too. They'll figure out why you're having pain, help you correct it, and get you a plan to reach your goals.

Physical therapists can also help you safely increase your activity levels after major medical issues like a heart attack, stroke, or even cancer. Recent research has shown improvements in cardiovascular fitness, fatigue levels and even pain in cancer patients who participate in a personalized physical fitness plan from a PT.

Whatever your barriers to physical activity are, your PT can likely help you overcome them. As movement experts, physical therapists are trained to deal with a variety of conditions. They'll help you work around whatever issues you have so you can safely elevate your heart rate and keep cardiovascular disease away.

The ongoing COVID-19 pandemic is responsible for a lot of bad stuff. But, if you look really hard and maybe squint just right, there are a few less-than-terrible things to be found. The pandemic forced society to quickly adapt. It pushed forward the adoption of new technologies like Zoom and new ways of doing things, like working from home. There were changes in rules, regulations, and payment related to telehealth. A lot of patients and providers experienced their first virtual health appointment in the past 2 years, and many of them see the benefits. The pandemic forced the telehealth genie from the bottle. Now that patients and providers have seen the benefits, it's not going back.

Why telehealth is here to stay

Telehealth isn't going to replace in-person rehab, but it's likely going to complement it heavily. Research has shown that telehealth is as effective as in-person rehab for a lot of conditions. It's also shown high satisfaction rates from patients - up to 94% in some studies. For a lot of people, telehealth makes sense. Think about people trapped at home because of a snowstorm or those who are at high risk of falling on the ice. Before the wide adoption of telehealth, these patients didn't get to see their PT during the winter. Now, they can stay connected virtually and continue healing through the bad weather. Telehealth can also work well for busy people. Patients can check-in or have a visit with their PT on their lunch break, or while their kids are at practice.

Where telehealth could go

Even though there have been big advances in telehealth, we're still in the early phases. It's hard to predict how telehealth will be used in the future and how it will evolve, but expect it to look a lot different in 5 years. The software being used for telehealth will continue to get better. Expect a more engaging user experience with educational content and maybe some gamification - levels to achieve, points or badges to collect, or some other metric. Hardware will also continue to advance. Maybe the fitness tracker you already have will integrate into your telehealth app, letting your PT track your activity, heart rate, and other metrics. Remote stethoscopes, scales, and other medical equipment already exist and will continue to become more common as prices decline.

While telehealth has certainly seen a big advance because of the pandemic, most people still see it as an adjunct to in-person visits. Right now, telehealth tends to be used because it's more convenient than a visit in real life, not because it's better. With advances in software platforms and hardware options, telehealth could evolve into something just as good as in person rehab that makes high quality rehab available to everyone.

Research has shown that positive expectations increase the chances of a good outcome. It's the old self-fulfilling prophecy; your attitude determines your approach to situations. If you believe you'll be successful, you'll likely put in more effort. You'll be more willing to try new things, take some risks and keep trying after failures or setbacks. A negative attitude will likely mean that you'll take your first failure or setback as confirmation that what you're trying won't work or isn't possible and you'll give up. Why waste time and effort on something that's doomed to failure anyway?

Your Expectations Influence Your Results

There's some research to prove that positive thinking and expectations make a difference in rehab settings too. A review of 23 articles looking at outcomes for shoulder pain found a few interesting things. First, patients who expected to recover and believed that they had some control of the outcome, ended up doing better than those who didn't. Second, optimistic patients were found to have less pain and disability after completing rehab. Third, patients who believed they'd have pain and disability after surgery tended to have - you guessed it - pain and disability after their surgery. Research says that you tend to get what you expect.

So Do Your Therapist's

Your attitude is important, but what about your therapist's? There isn't much research specific to PT, but there is a study done in elementary schools that might give us some clues. Two psychologists - Rosenthal and Jacobs did a study showing that teacher expectations had an influence on student performance. They told teachers that randomly selected students in their classes were tested and found to be "late bloomers". These students were expected to show large improvements in academic performance during the school year. When the students were tested 8 months later, the students the teachers believed would improve the most, did.

Why? When teachers think students have a lot of potential to improve, they hold them to higher standards. They teach more complex materials, don't settle for simplistic answers and are more willing to spend time instructing and working with those students. It's pretty easy to see how this could cross over into a PT clinic. If your PT thinks you can get better, they'll probably put more effort into designing your program, spend more time with you and push you harder than someone they don't believe has a lot of room for improvement.

To have the best chance for a good outcome, you and your therapist both need to expect one. You probably will.

References

• De Baets L, Matheve T, Meeus M, Struyf F, Timmermans A. The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review. Clin Rehabil. 2019 Jun;33(6):980-991. doi: 10.1177/0269215519831056. Epub 2019 Feb 22. PMID: 30791696.
• Rosenthal, R, and L. Jacobsen. Pygmalion in the classroom: teacher expectation and pupils’ intellectual development. New York: Holt, Rinehart and Winston, 1968.

Last month we introduced you to Long COVID and all of the challenges it brings. This month we're going to talk about what physical therapists can do to help people living with Long COVID. Early in the pandemic, therapists started seeing people with what would later be known as Long COVID. They noticed that some of the symptoms people were describing overlapped with conditions they had treated before. Specifically, Myalgic Encephalomyelitis and Chronic Fatigue Syndrome also caused severe fatigue and delayed symptoms after activity. Because of this overlap, the current treatment for Long COVID is heavily based on what we know works to manage these diseases. Here are a few of those strategies.

Pacing

The first strategy that can help manage Long COVID symptoms is pacing. This is simply doing less activity than you have energy for. By keeping bouts of activity short with lots of breaks, pacing can help avoid severe fatigue immediately after activity. It can also avoid the delayed "crash" of PESE. A useful metaphor is to think of your energy level as a battery. When you do activities, you drain your battery. When you rest, you charge it back up a little bit. Physical therapists can help patients learn how much energy is in their "battery" and work to teach them strategies to conserve it. When used effectively, pacing can help patients with Long COVID accomplish more with less fatigue and less bouts of PESE.

Heart Rate Monitoring

Another strategy that comes from ME and CFS management is heart rate monitoring. With the huge number of wearable devices that monitor heart rate, this is becoming an easier strategy to use than ever. Heart rate monitoring uses your heart rate as a gauge of how hard your body is working. It's based on your resting heart rate, which should be taken after you've been lying down, relaxed for at least 20 minutes. First thing in the morning before you get out of bed is a great time to measure your resting heart rate. Once you have your baseline, the goal is to keep your heart rate within 15 beats of your RHR while you're doing activities. This keeps your heart rate below the threshold at which your muscles start to produce lactic acid. Build up of lactic acid is what gives you "the burn" when you're working out really hard. It also causes your muscles to fatigue more quickly - by keeping activity light enough to avoid lactic acid, we can also reduce fatigue.

Exercise

What about exercise? Sure, lots of people think about exercise when they think about PTs. But exercise can make some diseases worse. For people living with Long COVID, CFS, or ME, "toughing it out" or "pushing through it" won't make them stronger. It will cost them days of their lives - leaving them barely enough energy to get out of bed or complete basic tasks. For long-
term, sustainable recovery, the first goal of rehabilitation of these folks is to stabilize and manage their symptoms. Using pacing, heart rate monitoring and other strategies like breathing exercises can stop the fatigue cycle and start to get the body responding to activity more normally. Only then can we very gradually and cautiously introduce exercise into the mix, monitoring symptoms during and after activity to make sure we don't overdo it.

As we learn more about the pathology behind Long COVID's symptoms, rehabilitation will surely change and improve. But people who are living with Long COVID can't afford to wait until science figures everything out about their disease. Fortunately physical therapists have training and strategies that can help improve their lives right now.

You may have heard about people who got a COVID-19 infection and have symptoms for weeks or months after. This is now referred to as Long COVID. In this post we're going to dive into what Long COVID is, what the symptoms are and who it affects. Next month we'll talk about strategies that are helping people with Long COVID and where physical therapy fits in. Let's get started.

What is Long COVID?

Long COVID is generally defined as ongoing signs or symptoms lasting 12 weeks or more after a COVID-19 infection.

What is it like?

Like all things COVID-19, we don't fully understand Long COVID and new information is being discovered all the time. Long COVID tends to involve more than one system and currently has a list of over 200 possible symptoms. The most common are:

1. Fatigue
2. Post-exertional symptom exacerbation (PESE)
3. Problems with memory or concentration, often referred to as "brain fog"

Other common symptoms are shortness or breath, chest pain or tightness, insomnia, muscle or joint pain, depression/anxiety, and stomach problems like stomach aches, loss of appetite or diarrhea.

What's the fatigue like? Does rest help?

Long COVID fatigue is an extreme exhaustion that isn't relieved by rest or sleep. It's not fatigue after some physically demanding task. People experience exhaustion for no obvious reason. The fatigue is so severe that it impacts the ability to complete daily tasks.

What about this PESE thing?

Post-exertional symptom exacerbation is a disabling and often delayed exhaustion disproportionate to the effort made. Patients are referring to this as a "crash". PESE is very common in people suffering from Long COVID. 75% of people who have Long COVID have PESE after 6 months. The activity that brings on the crash is something that the person could easily tolerate before their COVID-19 infection. Things like taking a shower, walking, attending a social activity, or even being in a high sensory environment with flashing lights and loud noises may all now trigger a crash.

Who does Long COVID affect?

This is difficult to answer. We still don't understand what causes some people to have symptoms long after their initial infection. What we do know is that about 25% of people who get COVID have symptoms that last at least a month. Around 10% of the people who get the virus will experience Long COVID. Long COVID isn't related to how severe your initial symptoms were, or if you were hospitalized. It also doesn't appear to be related to your previous health as it affects children and people who were previously fit and healthy.

Now that you know what Long COVID is, in our next installment we'll talk about what's being done for it and how physical therapy helps.

When you think about a person going into intensive care, you probably picture someone who's very ill and likely fighting for their life. They may be on a ventilator or other equipment that's keeping them alive. When you're in that situation, surviving would be a win. But what happens after these people survive? Do they recover and go back to life as it was? What's the road to recovery look like?

Fortunately, medical advances have led to higher survival rates for people who end up in intensive care units - it's now between 71% and 90%, which is great. But, survival is not the end goal, and getting out of the ICU is not the end of the battle. Many patients show significant losses of physical, mental and cognitive abilities after discharge. It makes sense - if you don't use it, you lose it! This cluster of problems is called Post-Intensive Care Syndrome or PICS.

PICS is now recognized as a public health burden. Interventions against PICS need to start in the ICU. Then they need to continue after discharge.

Physical declines often include significant losses of strength, endurance, and mobility. These can lead to serious difficulty completing basic daily tasks like getting to the bathroom, preparing a meal, or walking to the mailbox. This may keep some people from returning home. For others, it means they need a caregiver to safely return to their previous setting. 50% of ICU survivors have limitations in daily activities 1 year later, so this is a serious and long-lasting problem.

Mental health is also a very real concern for ICU survivors. They show significant rates of depression - the mean is 28%. 24% of survivors have anxiety and 21% report PTSD. Again, these conditions have a real impact on the quality of life after leaving the ICU.

Last, declines in cognitive abilities are very common in ICU survivors. 77% have cognitive impairments at 3 months post-discharge and 71% have impairments 1 year out. Cognitive issues after discharge can include poor memory, slower thinking, problems making decisions, or difficulty concentrating.

Physical therapists play a significant role in the fight against PICS. PT typically begins while the patient is in ICU, focusing on getting the patient up and walking early. Patients begin a progressive exercise program as soon as it's safe for them. We expect a rise in PICS due to the number of people who COVID-19 has put into critical care and/or on a ventilator.

While we can't prevent every problem that critical illness causes, recognizing the losses that remain after discharge from the ICU is an important step. Physical therapists play an important role in combating the effects of PICS and helping people return to higher-quality lives.

Starting a career in physical therapy is like climbing a tree. Everyone starts with the same trunk, but pretty quickly, you have to make some decisions about which way you're going to go. What kind of people do you want to work with? Where do you want to practice? And how far up the tree do you want to climb? You'll get to grow professionally - learning more, getting better clinically, and maybe even improving your sales and business skills, but that's not all. Physical therapy gives you a chance to grow personally too.

Pick your people

You can pick the type of people you want to work with - sports physical therapists work with athletes, helping them recover from injuries and improve performance through exercise and hands-on techniques. Geriatric physical therapists work with elderly patients on mobility problems, pain or managing chronic conditions. Pediatric physical therapists work with infants and children providing developmental assessments and helping them improve their gross motor skills.

Pick your place

You can also pick where you work - there are physical therapy jobs in nursing homes, hospitals, outpatient clinics and schools. Physical therapists provide care wherever people need it. So far, we've only mentioned the more common places you'll find PTs - if you want to specialize further, you may find yourself working only in the ICU with critical care patients, in a factory doing industrial rehabilitation and ergonomics, in a women's health clinic, or even working in a preventative, public health role.

Grow professionally

Most physical therapy careers start in a general role, working with all types of different patients. If you work in a large health system, you may even rotate between settings. But as you find the type of people you like to work with and the setting you prefer, you have the option to improve your skills and focus on a specialty area of practice. Again, you have lots of options on how to do this. You could:

1. Take an internship position or join a fellowship program
2. Attend workshops or conferences
3. Read journals and textbooks
4. Collaborate with your colleagues and mentors
5. Take courses in other areas of medicine
6. Study abroad or take courses online

Grow personally

Your clinical skills aren't the only thing a career in physical therapy can grow though - you'll grow personally as well. You have to learn to have compassion and empathy when you work with ill or injured people. You have to work as a part of a team. You need sales skills - most people aren't going to want to make changes in their routines, or do the exercises you prescribe at home. You'll learn to work with people who have different opinions and different viewpoints from all kinds of cultures and backgrounds.

You may also have a chance to improve your business skills. You could advance out of the clinical setting and into a management role. Some PTs start their own practices, or a company in a field related to physical therapy like wellness, performance, injury prevention or population health for large corporations.

Wherever you start in physical therapy, you'll have a lot of options on where you end up. Chances are you'll explore more than one branch of the physical therapy tree. That's OK, having the chance to grow and change is part of what makes PT so exciting!

Stories about hiring difficulties are all over the news right and physical therapy clinics haven't been left out. An aging population with more chronic diseases has been pushing up the need for physical therapy for years. The pandemic has accelerated the problem. Clinics aren't only looking for PTs and PTAs either. Finding the right people to fill roles in billing, administrative and tech roles is difficult too. Many clinics also employ people like nutritionists, athletic trainers and fitness professionals. If you're looking for a new place to work or a change in career, a PT clinic might be a great setting for you. Here's a few reasons why:

Build relationships

Physical therapy is unique in the world of healthcare because of the time that patients spend in the clinic. People often come in 2 to 3 times a week for anywhere from a few weeks to several months depending on what they're coming in for.

When people spend that much time together, it's easy for great relationships to form. Often these relationships end up lasting a lifetime and have benefits that extend outside the clinic. Having a large and diverse network is never a bad thing and a PT clinic is a great place to build one.

Make a difference

Physical therapists work with people who have injuries or disabilities that affect their mobility, as well as those who have chronic illnesses like heart disease or diabetes. They help people heal faster and get them back to normal life, with a focus on function. That means PTs want to help people get back to meaningful things like going to work, recreational activities, hobbies, or playing with grandkids. Being able to return to things like that means a lot more to patients than lowering their blood pressure or improving their lab values. And it feels good to be a part of making that happen.

If you've never considered working in a PT clinic, it might be right for you. It's rewarding and a great way to build relationships, become valuable in the community, and make a difference in people’s lives.

During the COVID-19 pandemic, activity levels dropped for a lot of people. Between stay at home orders, gym closures and working from home, people became more sedentary. On top of that, there were shortages of equipment like dumbbells and bicycles, making staying active at home difficult even if you wanted to.

But this summer, things look different; vaccines are widely available, restrictions are loosening and people are looking to get active and enjoy the warm weather. That's all good news, but if you had a long break from activity, your body might not be ready to jump right back in. Here are a few tips to help you get more active without getting hurt:

Start slow
     - If you're a runner, think about a walk to run program
     - If you're a weight lifter, start with lighter weights and less reps.
     - Whatever your activity of choice is, start with short periods of activity and gradually work your way back up.

 Warm up and cool down
Warming up gets your heart and lungs ramped up and prepares your muscles and tendons for the increase in activity about to come. Include some light cardio like jogging, calisthenics, or cycling, followed by active stretching like butt kicks, high knees, or yoga.

Cooling down transitions your body back to a lower state of stress - it brings your heart rate and breathing down, decreases blood flow to your muscles and back to places like your digestive system, and helps you relax. It's also a great place for static stretches if you need some work on your flexibility.

 
Take a day off
Rest days let your body recover and keep you from getting burned out. Not enough exercise isn't good for you, but too much of a good thing can cause problems too.

Watch for early signs of injury
Some soreness for a few days after activity is normal, especially if you've had a long break. But there are a few common issues to watch out for as you return to activity:

     - Swelling or bruising
     - Joint pain, especially in the knees or shoulders
     - Foot pain, which could be a sign of plantar fasciitis
     - Muscle strains - particularly common in the hamstrings
     - Sprains - most common in the ankle

Any of these issues justifies a call to your physical therapist. Getting checked out early can prevent an injury that derails your attempt to return to activity. PTs see all of the issues just mentioned on a regular basis and can help safely guide you back into a more active lifestyle.

You know that physical activity is good for you. The benefits are well researched and the list is impressive. Here's just a sampling:

- Releases endorphins to make you feel good and fight depression

- Helps control weight

- Prevents diseases like stroke, diabetes and some forms of cancer

- Improves sleep

- Helps you live longer

Recent studies even show that physical activity strengthens your immune system, with a protective effect against COVID, and that staying active through middle age protects your brain as you age.

Physical activity is a wonder drug. If it was a pill, you'd buy it and take it every day. But even though activity is free, less than 25% of Americans meet the CDC recommendations for activity. We clearly need help.

Physical Therapists Are The Experts in Human Movement

To be active, you need to be able to move. Physical Therapists do more than help you recover from surgeries or major injuries. They are the experts in human movement. Sure, you could see a strength coach to lift weights, hire a personal trainer, go to a yoga class to work on your flexibility and balance, and see a chiropractor for adjustments. But that seems like a lot of people when a PT can help you with all of these things and more. Nobody knows more about human movement or looks at your health the same way a PT does. Your PT can help you with every aspect of movement including strength, range of motion, flexibility, endurance, balance and coordination.

As medical professionals they can help you with injuries or other issues. Your PT can work with your doctor to help use activity to manage things like diabetes, cholesterol levels or blood pressure instead of prescriptions. Your PT is also trained to work with people of all ages, so you can develop a long-term relationship and they can continue to adjust and modify your routine as you age or your goals change.

Stay Healthy For Life

Staying active has a long list of benefits both now and in the future. But chances are you're not moving enough to make the most of those benefits. Most people need help. Physical therapists are the most qualified professional in existence to help keep you healthy now and in the future. So don't think of your PT as someone you see when you need help with pain or an injury. Think of them as your partner and coach working to help you stay healthy for life.

COVID has certainly made the importance of health very clear and we have all seen how quickly things can change with an illness. While COVID is currently front and center in most people's thoughts, it isn't the only thing out there that can change your life. Heart disease, diabetes, strokes and cancer can all be devastating too.

Movement offers a defense

If you're looking to be more resilient and defend against these things, physical activity can do it. The dangers of being sedentary are well known and documented in the research. Excessive sitting and sedentary time have even been called the new smoking. For many of us, sitting and being inactive is part of our jobs. However, research has shown that getting in enough movement can counteract the negative effects of being sedentary.

A large study done in the U.K. found no association between the amount of time people spent sedentary and their chances of illness. But the authors didn't conclude that being sedentary is OK. Instead, they felt their findings were likely "attributable to a protective effect of the high volumes of daily walking." The study was conducted in London, where people tend to spend much more time walking or standing than average. The people in the study had daily walking times that were over double the average amount reported in the U.K.

Physical Therapists Are Unequaled Experts in Human Movement

While walking was the activity in this particular study, other research has shown that all kinds of movement can help protect your health. If you're looking to get those protective benefits for yourself you could choose to walk, bike, lift weights, dance or garden. If you're not moving as much or as well as you'd like, see your physical therapist. PTs are the most qualified professionals on the planet to help you move better and allow you to stay healthy and enjoy life. From designing a program to get you started or moving more to helping you recover from an injury, your PT is the right person to look to for help.

People usually see a physical therapist for pain or loss of function. Think of the person who has back pain, the injured athlete or the person who's had a stroke. They all want to improve how they move and complete tasks. Now, there is good reason to wonder if physical therapists will start seeing more people who are not in pain or having difficulty moving. Why would these people come to a PT? To improve their overall health and wellness.

There is strong evidence suggesting that movement is a valuable predictor of future health and resilience against disease. Physical therapists are movement specialists, so taking advantage of their expertise makes sense if your goal is to become healthier and live longer. Here are some examples of the power of movement when it comes to predicting future health:

Gait Velocity

Gait velocity is how fast you walk. Studies have shown that if your typical walking speed is over 1 m/s or 3.3 ft/s, you're likely able to complete typical daily activities independently. You're also less likely to be hospitalized and less likely to have adverse events like falls. 

If you'd like to test yourself, measure out a straight, flat course to walk between 10' and 30' long. You'll also need 5' or so at the beginning and the end for acceleration and deceleration. Walk the course at your typical speed and divide the length of the course by how long it took you to walk it (distance/time). That's your gait velocity. 

Get On and Off the Floor

A series of studies suggest that if you can go from standing to sitting on the floor and back to standing without using your hands, you're a lot less likely to die than someone who can't. It's  called the sitting-rising test. Here's how it works:

You start standing, and without support you sit down on the floor, then stand back up. You start with a score of 10. Every time you put a hand, knee, forearm or the side of your leg on the floor you lose 1 point. Putting a hand on your knee or thigh to help also costs a point. In a sample of over 2,000 people, they found that scoring less than 8 points made you twice as likely to die in the next 6 years when compared to people who scored higher. Score 3 or less and you're 5 times more likely to die in the same period. Overall, each point in the test is worth a 21% decrease in mortality from all causes. 

Notice that both gait velocity and the sitting-rising test aren't specific to any one thing. The risk of hospitalization in the gait velocity studies was hospitalization for any reason. Death in the sitting-rising studies was death from anything. So while we know that exercise and healthy lifestyle reduce your risk of specific diseases like heart disease or diabetes, it appears that being able to move may provide much more wide ranging protection than we previously thought.

TRICARE has decided to waive the cost-sharing requirement of up to three visits to a physical therapist for low back pain. They've said that the goal is to encourage more use of "high-value" treatments for low back pain. Understanding what they mean by "high-value" vs "low-value" treatment can help us see the direction healthcare payers are moving and how physical therapy is a part of that.
TRICARE tells us in their summary of this demonstration what they mean by high and low-value care: "Increasing the value of health care refers to improving patients’ quality of care and outcomes, improving patients’ access to care, and reducing overall costs of care. In contrast, low-value care refers to interventions that: are not proven to benefit patients; may harm patients; result in unnecessary costs; or waste health care resources."

High-value care

High-value care leads to better outcomes, is easy to access and is cheaper for both patients and insurers. We already know that physical therapy fits into this category, but if we look at other things that fall into this category, a larger theme starts to emerge. In 2017 the American College of Physicians released guidelines for treating low back pain that have been widely endorsed. Initial treatment recommendations include exercise, stretching, tai chi, yoga, progressive relaxation, heat or ice, cognitive behavioral therapy, and motor control exercise. These are all active treatments, where the practitioner and the patient are working together to improve. This is "well care" or "let me help you get better."

Low-value care

In contrast, low-value care tends to be "sick care" where the patient is a passive participant and the practitioner is saying "let me make you better." TRICARE puts imaging before six weeks without red flag symptoms, surgery for non-specific low back pain, opioids as the first or second-line treatment, and bedrest in the low-value category. We would also place spinal injections in this category for most people. They're expensive, only offer temporary relief, usually have a long wait before they're available and include the risk of serious infection and damage to surrounding soft tissues like skin, cartilage, and ligaments.
This isn't to say that imaging, surgery, or injections are always bad. For a small percentage of people with low back pain, they're the right thing. But, most people should start with treatments that have the best outcomes for the lowest cost. If those treatments tend to focus on empowering the person in pain to actively participate in their care rather than making them dependent on someone to "heal" them, that's even better. Physical therapists have known this and have been providing care that fits this model for years. TRICARE's demonstration that waives cost-sharing clearly shows that insurers are recognizing the value of this type of care and that they are actively moving in this direction.

TRICARE, one of the nation's largest insurers wants their members to get physical therapy for back pain. They think that treating back pain with PT is so important that they're willing to waive the cost to their members. That's a huge deal. When's the last time you remember an insurance company covering the entire cost of anything? Let's dive into back pain treatments and see why TRICARE likes PT so much.

You probably already know that back pain is a common problem. What you might not know is that the medical system isn't very good at treating it. "Non-drug treatments like physical therapy" are the first treatment recommended for back pain. Unfortunately, many providers don't follow this and treatments are often recommended based on opinion rather than research. This means insurance companies and patients often end up spending a lot of money for outcomes that are less than stellar.

Here's how it usually goes: You go see your doctor with back pain. They might give you medication, recommend rest, some stretches, send you for x-rays or an MRI. Next will likely be a referral to a specialist like an orthopedic surgeon. Chances are you won't be having surgery right away, so the specialist will either refer you to PT, or back to your PCP where you'll end up with a PT referral. The path will look different for each person, but the end result is usually the same - multiple failed treatments, imaging you probably didn't need and a delay of weeks or months to get to a physical therapist.

Multiple large studies have looked at the effects of early physical therapy on low back pain with impressive results. One of them was done in 2006 in Seattle by Virginia Mason Health Center. They teamed up with Aetna and Starbucks to send workers with back pain to see both a physical therapist and physician for their first treatment. Use of MRI dropped by 1/3, people got better faster, missed less work and were more satisfied with their care. The cost savings was so great, that Virgina Mason was losing money on treating back pain and Aetna ended up paying them more for PT treatments because Aetna was saving so much money.

Intel ran a similar program with their employees, getting people with back pain to a PT within 48 hours. Previously it took about 19 days for people to get to a PT. With the earlier access, patients completed their care in 21 days, compared with 52 days previously and costs dropped between 10 and 30%. Intel also found more satisfaction with care and a faster return to work.

The data is out there that proves physical therapy is the cheapest and most effective treatment for most people's low back pain. It's clear that people with back pain should start treatment with their physical therapist, but most don't. TRICARE's pilot program that waives copays for up to three PT visits aims to change that. If successful it will lead to lower costs for both TRICARE and their members while delivering better outcomes in less time.

Back pain is a huge problem in developed nations worldwide. It has or will affect most of us. The current estimate is that 80% of people will experience back pain at least once. It is the single biggest cause for disability, the third most common reason for doctor visits, and one of the most common reasons for missing work.

It's also expensive. Back and neck pain makes up the biggest healthcare expense in the US, totaling $134 billion spent in 2016. The next two most expensive conditions were diabetes — $111 billion in spending — and ischemic heart disease at $89 billion.

Diabetes and heart disease being so expensive to treat doesn't surprise most folks - they can both lead to other major problems, require long term medication, could require surgery, and both can be fatal. Back pain won't kill you, usually doesn't require long term medication, and usually doesn't require surgery either. Why is it so expensive?

The first reason is that it's so common. The second reason is that our current system isn't very good at treating it. Current recommendations include starting with activity modification, and active treatments like physical therapy. Research backs this up, showing better outcomes and lower costs with early PT. Unfortunately, only 2% of people with back pain start with PT, and only 7% get to PT within 90 days. At the same time, a study looking at about 2.5 million people with back pain in JAMA showed that 32.3% of these patients received imaging within 30 days of diagnosis and 35.3% received imaging without a trial of physical therapy. Both of these things go against current practice guidelines for treatment of back pain.

A new pilot program being rolled out by TRICARE, the insurance system used throughout the US military is waiving the payment owed by the patient for up to three PT sessions in an attempt to improve the use of what the Defense Health Agency calls "high value" treatment for low back pain. The theory is that once a person sees some benefit from PT treatment, they're likely to go back for more. This is the "try it before you buy it" approach - think of the 7-day free trial Netflix offers, free samples poured in wineries and craft breweries, or the folks you see standing around in supermarkets with food on toothpicks. TRICARE's data seems to indicate that it works just as well for healthcare as it does for other businesses. In a press release they state that once people attend one session of physical therapy, they're likely to go back for more, no matter what their co-pay is. But TRICARE found that higher co-pays could be a barrier to people trying that first visit. For the group of patients with the highest co-pays in the system, only 38% of the people prescribed PT attended the first visit. That's about half the rate of attendance found in the lowest co-pay group.

The fact that such a major insurer is looking into the value of PT is great news for everyone. If TRICARE can show that lowering the cost of PT for patients can improve outcomes and save insurance companies money, other major insurers will likely follow. This could improve the lives of millions of people every year while reducing the huge cost of treating low back pain for the country. That seems like a win for everyone involved.

Colder weather means some changes to how we exercise. Of course it's harder to motivate yourself to get outside for a run or bike ride when the temperature drops, and the shorter days compress our schedules, but there are changes in your body that affect your ability to exercise too. For many people with arthritis or other joint problems, cold weather brings more complaints of pain. To stay warm, our bodies narrow blood vessels to reduce blood flow to the skin, and more superficial muscles. That means that there is an increased risk of muscle strains in the cold. There is also an increased strain on the heart because of the narrowed blood vessels. This isn't to say that you shouldn't be active outdoors in the cold, it just means you may have to make a few changes to your routine. Here are a few to consider:

Warm up right

A good warm up is always important, but because of the tendency for joints to be stiffer, and blood flow to muscles to be reduced in the cold, it's even more important that you do it right this time of year. To start, do something to get your heart rate up a bit, maybe a brisk walk or light jog. Follow that up with a dynamic warm up rather than static stretches. This could include walking or jogging while pulling your knees up high to your chest. Maybe some high kicks in front of you with straight knees to get your hamstrings loosened. A walking lunge with an upper body twist can get your whole body moving. Cater your warm up to what you have planned in your workout. If you're not sure how it should look, ask your physical therapist!

Dress right

Dressing in layers allows you to adjust your insulation to your activity level. After you warm up, you might want to take off a layer to avoid getting too hot during your main activity. You'll have it there later to put back on when your activity level drops and you start getting too cold.

Don't forget about the sun either - just because it's cold doesn't mean the UV rays are gone. Sunscreen and sunglasses aren't just for the summer. A lip balm with SPF can protect you not only from the sun but from the wind too.

Stay hydrated

Drink water before, during, and after your workout. The temperature may be down, but you'll still sweat and you'll still lose water vapor in your breath. The drier air in winter lets your sweat evaporate more quickly, so it's easy to underestimate how much fluid you've lost.

Cool down

When you're done, don't rush to get inside and crawl under a blanket. Cool down properly. Keep moving with a walk or another form of active recovery to let your heart rate come down. After exercise is the right place for static stretching. You can also head inside for some foam rolling or self-massage.

The days being shorter and the temperatures being lower don't mean you're stuck inside for all of your exercise. If you follow these tips, you can safely keep moving outside. If you'd like a customized warm up or cool down, or have questions about your exercise routine, your physical therapist is a great person to ask!

Virtual physical therapy has quickly moved from a niche offering to the mainstream. Having more options is great, but it can also complicate decision making. Having an understanding of the benefits of both can help make clear which one would best help you meet your goals.

In Person Physical Therapy

The main advantage of traditional "brick and mortar" PT is that the therapist is in the room with you. That means they can move around to see how you're moving from different angles, physically adjust your position or movement as you exercise, and physically examine you - testing your strength, measuring your range of motion, etc. They can also use things like manual therapy, electrical stimulation or ultrasound when you're in the clinic. In person PT may work best for:

• New patients - the ability to physically examine you makes it easier for your PT to accurately diagnose what's going on
• Less active patients - if you're not used to exercising and moving, having someone physically present to coach you along can be a big benefit
• People with complicated or chronic conditions - if your back has been hurting for the last 5 years and you've been ignoring it, providing a diagnosis and treating it totally virtually will be difficult for your PT
• Less motivated patients - virtual PT requires you to do most of your exercises by yourself. If you need someone watching over you to make sure you do them, in person PT might work better for you

Virtual PT

The main benefit of virtual PT is convenience. Because virtual PT relies on you doing most of your exercise and treatment on your own, appointments can be shorter. This also means that motivation is a prerequisite to choosing virtual PT. The fact that you don't have to travel to the clinic makes it easier to squeeze a visit into a busy schedule. Virtual PT works well for:

• Athletes and others with good body awareness - being on your own for your home exercise program requires you to be in tune with your body and how it's moving
• People with common athletic injuries - things like tendonitis, sprains, strains, plantar fasciitis, and overuse injuries are commonly treated by PTs. Because of that, there is a template for treatment that is easily adapted to individual needs.
• People who are comfortable with technology - you don't have to be a technology whiz, but having some familiarity with skype, facetime, or zoom helps!
• Existing and returning patients - if your physical therapist knows you, it's easier to treat you virtually.

Both options have benefits and limitations. One or the other might be right for you and your needs, but they're not mutually exclusive. Combining the two can work well for many people. Doing an in person visit for your initial evaluation and perhaps a follow up visit or two will let your therapist provide an accurate diagnosis and get you started on your exercise program. Once you're comfortable with your exercise program, you can transition to virtual visits.

Physical therapists aren't just for people that are injured or have had surgery. Physical therapists can also help healthy people improve their fitness. Here are 5 reasons why you should consider seeing yours.

You Want a Baseline

When you see a physical therapist to improve your fitness, you'll get an assessment of your strength, range of motion, posture and movement patterns. This not only helps your physical therapist design a customized program just for you, it gives them a baseline to compare things to in the future should you start having pain or suffer an injury.

You Want Expert Guidance

Sure, other professionals could help with your fitness routine, but the fitness industry is not well regulated. Some certifications just require an online course and paying a fee. There are no licenses or other requirements to use many titles. Becoming a physical therapist requires at least a bachelor's degree and most PTs practicing today have a doctorate. Every PT has passed a national board exam and maintains a state license. That guarantees you that every physical therapist is a verified expert in human movement.

You Want to Prevent Injury

Physical therapists don't just work to heal injuries, they are also experts in preventing them. After a thorough assessment, a PT can help you design a program that will not only help you reach your fitness goals, but that can address any issues that increase your risk for injury.

You Want Unbiased Advice

Yoga instructors will want you to do yoga. Personal trainers will want you to come to their gym. Pilates instructors will want you to do Pilates. Strength coaches will want you to strength train. A physical therapist doesn't have a bias or vested interest as to what type of fitness regimen you choose. They are only interested in helping you reach your goals.

You Have a History

If you have some kind of history that affects your ability to exercise, a PT is the best person to help you design a fitness regimen. It doesn't matter if it's an old injury from athletics or work, back pain that comes up from time to time, COPD, arthritis or heart disease, a PT can help you safely work around it and meet your fitness goals.

While the coronavirus pandemic continues to be front and center in the news and in the thoughts of many people, other health issues have not gone away. People are still getting back and neck pain, overuse injuries and hurt while at work. Many of these people would benefit from seeing a physical therapist, but some of them are reluctant because of concerns over COVID-19. That's understandable, PT clinics are busy places, with lots of people coming and going, right? They used to be, but things are different now. Just like every other business and public place, PT clinics have made changes to allow them to continue to serve patients while keeping both patients and staff safe. Here are some common changes clinics have made to reduce the risk of COVID spreading among patients and staff.

Scheduling and patient flow

• Clinics have reduced the total number of people they see each day to allow for social distancing in the clinic
• Many clinics are using a staggered schedule to avoid people coming in at the same time
• Many clinics have implemented a "virtual waiting room" having people wait in their car and notifying them when their clinician is ready via a phone call or text message
• When possible, clinics may be using separate entry and exit points

Treatment

• Clinics may be screening patients and staff as they enter the building using questions, temperature checks, or other means
• Clinics may have designated areas for each clinician and their patients to reduce contact between different groups of people
• Equipment will likely be spaced out further than you're used to and there may be less of it to allow for more distancing between patients
• Many clinics are leaning more heavily on telehealth when appropriate for patients to reduce the number of patients physically present in the clinic

Physical therapists are medical professionals who were trained to deal with infectious diseases and keep people safe long before COVID-19 existed. By making changes throughout their workflows and patient experiences, physical therapy practices have reduced the risk of spreading COVID among their staff and patient populations, while continuing to deliver needed services to the public. If you are in need of PT treatment, but are hesitant to go into the clinic, give your PT a call and talk about what policies and procedures they have in place. To reduce or eliminate going into the clinic, ask about using telehealth either exclusively or in combination with in-person treatment. This is a time of uncertainty, but people are reacting with flexibility and creativity. Don't let concerns over COVID keep you in pain or from the treatment you need.

With in-person events neither safe nor permitted, two practices - one on the East coast, the other on the West coast - were not going to let COVID-19 limit their community engagement. Between the two practices, almost 600 people took on the challenge either alone or as teams to walk, hike, run, and even kayak 19 kilometers.  

The COVID-19 pandemic has impacted our practices in a multitude of ways: the delivery of services via telehealth, designing new clinic layouts, scheduling, helping fearful patients, managing loans and grants, furloughs, lay-offs, illness, childcare, and burnout. And yet, for the long-term recovery and success of our practices, marketing must continue. However, like every other element of our practices, our approach to marketing must evolve to meet the needs of the communities we serve.

Typically, private practices have a multi-faceted marketing approach. More often, this includes direct marketing to referral sources, a robust website, social media content, signage, advertising, events, and word of mouth initiatives. Due to the impact of COVID-19, many of the traditional approaches used to seek new patients were suddenly impossible. Either they were not allowed or would be insensitive to the needs of our communities. The realization that our practices will not survive without new patients has forced practices to truly review the effectiveness and return on investment of their marketing efforts.

Our industry understands that ongoing community engagement – even throughout a pandemic – is vital. It ensures that our patients, referral sources, and community partners trust that our practices would continue to provide resources and encourage movement. With social distancing guidelines due to COVID-19 in effect, there was an explosion of online exercise videos, blog posts, ZOOM classes, Facebook Live events – all to stay engaged with the community.

With this in mind, Performance Physical Therapy in Rhode Island, Massachusetts, and Peak Sports and Spine in Washington each decided to organize a virtual event. Both practices advertised and organized a 19K, where participants could enter individually or as teams. They could choose to complete the distance by walking, running, swimming, kayaking, or even dancing – any way to get them moving. Registrations were at a low cost, sponsorships were available, and social media engagement was encouraged. Together, the practices raised $14,500 to support respective local beneficiaries – The Rhode Island Foundation’s COVID-19 Response Fund, International Community Health Services, and Hopelink. All organizations worked to provide goods and services to those who were struggled due to COVID-19.

Most striking was the diversity of engagement opportunities these events provided for each practice. Referral sources, staff, former patients, insurance companies, local businesses, schools, and athletic teams all volunteered to participate.

Staff Engagement

A virtual event can help rebuild and strengthen a team that has been dulled by the enormity of COVID-19. Whether having staff participate individually, or as teams of coworkers, or with friends and family, coming together to share the experience can build your team’s culture, whether it be through in-person activities or social media. “Our team worked so hard to transition to telehealth, then to reopen the clinics within the same month. Exhausted and tired, our virtual 19K gave people a purpose and reason to get out and move with their friends and family on Memorial Day weekend,” says Michelle Collie of Performance Physical Therapy. “The photos of smiles and celebrations of various accomplishments were uplifting and rewarding for everyone, and it brought our team closer together.”

Patient Engagement

Online engagement with our communities has become exponentially important during the pandemic. Ali Schoos of Peak Sports and Spine Physical Therapy says that “sending e-newsletters and posting on social media with the goal of driving people to seek our services seemed insensitive during the pandemic, yet we still needed to stay engaged. Our virtual 19K over the July 4^th weekend coincided with the Black Lives Matter movement. As COVID-19 took a backseat in the news and on our minds, I made the decision to make our event about more than just the pandemic and its negative health consequences. It became about our community and recognizing that there is inequality in access to safe spaces, sporting equipment, recreational areas, fitness, and health care. We renamed it the Peak Virtual 19K for Unity to recognize the impact of COVID-19 and the need to get our community united in our response to health disparities.”

Community Engagement

For both Collie and Schoos, the virtual 19K provided an opportunity to reach out to community partners, gyms, physicians, insurance companies, local nonprofits, and referral systems to bring everyone together for the good of their respective communities. Between them, 75 sponsors donated, participated, and shared details of the event in their communities. The event has resulted in stronger community relationships as measured by requests to provide content for local sports stores, podcasts with local experts in health and fitness fields, a virtual presentation on ergonomics for people who are now working from home, and an increase in new patients.

These virtual events allowed both practices to engage with their communities in two important ways: providing an event to boost mental and emotional morale and helping people to understand further the importance of physical therapy in the health and wellness of their community. It also provided an opportunity to provide valuable associated content, like choosing the right running shoe, dynamic warm-ups, and stretching for success. Participants printed out bibs to wear and were encouraged to take photos and post them on social media with designated hashtags for the events. “on all of our social media platforms, we saw a 200% increase in engagement the week before and the weekend of our event.” Collie says.

The work involved in organizing a virtual 19K paid off for both practices! Not only was money raised for community-driven causes, but there was also overwhelming social media engagement that led to an increase in new patients. But most importantly, the long-term goal of spreading the message that physical therapists are the leaders in musculoskeletal health, fitness, prevention, and wellbeing will serve us well for the future.

The weather is hot, the gym is closed, and you've been relaxing - enjoying the lazy, hazy days of summer. Taking a day off here and there is no problem, but if you've been consistently missing your regular run, bike ride, or gym session and notice some aches and pains showing up, you might have the beginnings of deconditioning.

Deconditioning explained

Exercise creates many changes in your body - your heart begins to pump blood more efficiently, your muscles use oxygen more efficiently, they contract in a more coordinated manner, and your body gets more efficient turning food into fuel to name just a few. Deconditioning is the reversing of these changes. Exercise is a "use it or lose it" kind of thing, and deconditioning is the process by which we "lose it."

How long does it take to decondition?

As with most things related to a system as complex as the human body, it depends. According to the ACSM, two weeks without exercise can lead to significant loss of cardiovascular fitness. Two to eight months of detraining can erase virtually all of your gains. As you detrain, cardiovascular fitness tends to decline first, with muscle strength declining later.

Other factors are your age, and your exercise history. If you're younger, you'll probably lose fitness at a slower rate than someone older. If you've been consistently exercising for a long time, or at a high intensity, your losses will probably be slower than for someone who just started.

Reversing the losses

If you're just undergoing a period of increased time commitments at work or with family, using a shortened exercise routine can help minimize your losses. Even one session a week will help you keep most of what you've gained. Other options are to use shorter but more intense interval training sessions, or breaking up your activity into multiple short chunks during the day. If your layoff was longer, it may take just as long to retrain as it did to make the gains initially. If you're having those aches and pains due to inactivity or need help designing a safe program to either maintain your fitness or gain it back after a layoff, your physical therapist can help. Injury and illness are other common reasons for detraining. Your PT can not only help you recover faster, but they can also find activities to maintain your fitness while safely working around an injury or illness.

With health in sharp focus as a result of the pandemic, now may be a good time to look at the team of experts you have in place and see if there are any improvements you could make. You probably have a family doctor, dentist, and optometrist. Maybe you have some specialist physicians, a trainer, or a massage therapist. If a physical therapist isn't a part of your healthcare team, you're missing out on taking care of a big part of your health. To understand why you need a physical therapist, you need to understand what they do.

Physical Therapists Help You Do Things

The American Physical Therapy Association defines PTs as "health care professionals who diagnose and treat individuals who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives." So physical therapists help you do things that you have trouble with. That could be going for a hike, playing with your kids, or getting through a day of work without pain.

Physical Therapists Reduce Pain

Chronic pain is a huge problem worldwide. A big part of that is low back pain. Statistically, around 80% of people will have low back pain in their lifetimes. Physical therapists are trained to treat pain without surgery or medications. If you have back pain, an arthritic knee, neck pain, or an old injury that won't go away, a PT may be able to help.

Physical Therapists Keep You Healthy

The APTA goes on to say that "PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles." That means that a physical therapist can help you determine your risk for injury, choose the right fitness program, and improve the quality of your life by improving your health and ability to move.

Physical Therapists Can Help You Live Longer

It's well known that the risk of many of the leading causes of death can be reduced by exercise. Some of these conditions would include heart disease, cancer, lung disease, diabetes, and stroke. By helping you move better with less pain, finding the right exercise program, and helping you to make healthy lifestyle choices, a PT could help you live longer.

Physical therapists have a unique set of skills and expertise that can do a lot to improve your health and quality of life. If you don't have one, consider adding one to your healthcare team.

Because of the closures of physician's offices, stoppages of elective surgeries, and social distancing guidelines resulting from COVID-19, many people with pain or joint issues have had appointments or surgeries delayed. If you're one of them and you haven't seen your PT yet, you should. Here are some reasons why:

Early PT leads to better outcomes

Studies have shown that people who receive PT sooner have better outcomes, lower costs, are less likely to have surgery, use opioids or have unnecessary testing. Because back pain is so common, there is a lot of outcome data from people with back pain. A study of 150,000 insurance claims published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit. Unfortunately, only 2% of people with back pain start with PT, and only 7% get to PT within 90 days.

Early PT saves money

The rising cost of healthcare is well known and early PT is something that has been shown to reduce costs without reducing the effectiveness of treatment. A study published in the Journal of Orthopaedic and Sports Physical Therapy showed that patients who obtained physical therapy via direct access had significantly lower medical costs—an average of $1,543 less per patient than those who chose referral from a physician. They also had significantly fewer visits and spent significantly fewer days in care.

Surgery may not be as effective as you think

Many patients look to surgery as the fix for their pain, but surgeries aren't always as effective as patients believe. A large study looking at worker’s comp patients with back pain found that people who have surgery have a 1 in 4 chance of having a repeat surgery, a 1 in 3 chance of a major complication, and a 1 in 3 chance of never returning to work again. Recent large studies of arthroscopic surgeries for meniscal tears have shown no difference in outcomes between people who have surgery and those who don't. Other procedures with questionable effectiveness include kyphoplasty, vertebroplasty, and injections for nonspecific back pain.
So, if you were planning on seeing your PCP or a specialist for an orthopedic condition or pain and you haven't seen a PT yet, you should consider making PT your first stop. You could end up getting better faster for less money and you might avoid riskier treatments like opioids or surgery.

The COVID-19 pandemic seems to have stopped much of the world. Once busy streets and shops are empty, activities are cancelled and you may not even be going to work. One thing that the virus has not stoppe is pain and injury. Maybe you were seeing your PT when stay at home orders were issued. Maybe you've been having more pain and soreness in your back or neck because of all the time you've spent in front of the computer working at home, or maybe you hurt yourself over the weekend doing some yard work or exercising to relieve stress. How do you get the care you need without putting yourself or others at risk during this time of social distancing?

Telehealth

Technology like the internet, electronic medical records, online patient portals, smartphones and webcams open up treatment and intervention options that may be new to both you and your provider. Virtual platforms allow one-on-one interactions in real time. Patient portals allow uploads and updates of home exercise programs and educational materials. You may not be able to go to your PT, but your PT may be able to come virtually to you! Rules and regulations vary from state to state, and insurer to insurer. They are also being rapidly updated and changed to respond to the COVID-19 pandemic, so the best way to find out what is available to you is to contact your physical therapist and ask!

Virtual Visit Tips

• You'll need a device with a screen, camera and microphone. This could be a smartphone, tablet, or computer
• You may need a specific app - your therapist will tell you what you need and where to find it
• Choose a private space where you feel comfortable to conduct your visit. Make sure you have room to move, this is still a PT visit and movement is the whole point!
• Wear clothes that you can move in, and that your PT can see you move in. Very loose, baggy clothing makes it hard for your PT to see and evaluate your movement
• Collect any equipment you may have beforehand, so your PT knows what you have to work with. Examples might include resistance bands, foam rollers, yoga mats and blocks, etc.
• Be ready to get creative and have fun! For many patients and therapists, televisits are a new experience so expect to work together and try new things to find what works best for you.

How much thought have you put into the exercises you're going to use for your next workout? Did you choose them yourself, or did you find them on the internet or in a magazine? What's your workout designed for? Do those goals match yours? Are the exercises even safe for you? Using the wrong program can lead to wasting time in the gym, frustration, plateaus in progress and injury. Let's take a closer look at what goes into program design and the cost of getting it wrong.

Exercise Selection

There are many things to think about when choosing specific exercises. Machine vs. free weights, isolation vs. compound lifts, number of reps and sets, etc. Each one of these factors affects the results, so making the wrong choices could lead to wasting time working on the wrong things, limit your results or lead to injury.

Technique

If you choose the right exercises, but don't know how to do them properly you will again limit your results, or worse, end up injured. Poor technique leads to inefficient movement and limits the power your muscles can create. It also changes the load on your muscles, joints, and ligaments which can lead to pain and injury.

Volume

Volume is a way of thinking about how much work you're doing during a workout. Doing a few reps with a heavy weight or a lot of reps with a light weight could end up being the same volume. Same goes for running a shorter distance quickly uphill vs a longer run at a slower pace on flat terrain. If your volume is too great you won't recover well between workouts and create the possibility of injury. Too little volume and you won't see results.

Progression

If you've been doing the same exercises with the same weight and the same number of reps and sets, you're not progressing. Same goes if you jump on the treadmill for the same amount of time with the same settings each time. To make progress, things have to change and the program that works for your first 6 months won't work for you 2 years down the road.

Designing an exercise program is a complex challenge with a lot of factors to consider. Most people have a history of injuries and don't have perfect movement in every joint which further complicates things. If you're not making progress or just want to make sure your workouts are as effective as they can be, have your physical therapist take a look at your program. Your PT can help design an individualized program to help you reach your goals while keeping you safe and injury free.

This time of year, many people are focused on fitness so it's worth taking a look at what fitness really means. The dictionary defines fit as "sound physically and mentally, healthy." Using that definition, many "fitness" routines fall short of the goal. If you don't enjoy running and dread every workout, you're probably falling short of the "sound mentally" portion. Exercise should be enjoyable, reduce stress, and leave you feeling better, not worse.

No Pain no Gain?

Exercise should also leave you feeling better physically. If you can run a good time in a 5k, but have aches and pains for days after, you're not "sound physically." If you are increasing your PR in the squat rack, but your joint pain is increasing right along with it, you're not "sound physically" either. Sure, some muscle soreness and fatigue after a hard workout is normal. But if you're having pain that doesn't go away, sore joints, or trouble moving after exercise, you're probably developing movement dysfunction along with your fitness.

Movement Dysfunction

Go back to the dictionary and you'll find that dysfunction is "impaired or abnormal functioning." So movement dysfunction is impaired or abnormal movement. When someone has a movement problem like a sore joint, limited range of motion, or strength loss, the brain finds a way to get the body to do what it wants. That usually means moving in a way that is less than optimal. For a while, it works. But eventually it leads to injury. As a concrete example, think of someone who has trouble bending one knee doing squats. When one knee bends further than the other, it will cause one side of the pelvis to drop lower than the other. Now that the pelvis isn't level, the spine bends towards the high side to stay balanced. When that one side of the pelvis drops lower than the other one, it also usually rotates. Now the spine has to bend to the side and twist to keep you upright. This works for a while, but as weight gets added to the squat, and the repetitions add up so does the risk for a back injury.

Preventative Medicine

Pain during workouts, or pain and soreness that don't go away after can be warning signs of a movement dysfunction. If you're experiencing any of these, your physical therapist is a movement expert who can help. PTs are trained to analyze movement, and figure out the root cause of problems. They can then design a program to treat the cause and correct the abnormal pattern. There is no need to wait until you're injured to see your physical therapist. In fact, it's preferable not to. Getting minor problems fixed early means fewer visits to the PT, less pain, and not having your workouts put on hold by injury.

Your car needs regular maintenance, so you probably have a mechanic. Your eyes and teeth are important, so you see your optometrist and dentist regularly. You get an annual physical from your family physician. You might even be getting ready to see your accountant to get your yearly income tax done. What about your physical therapist? Do you and your family have one? If not, you should. Your body is a lot like your car. It's got multiple systems, all of which are complex, and all of which have to be working well for it to function. Physical therapists are experts in maintaining, diagnosing, and treating the movement system. Like the braking or ignition system in a car, most people only think of the movement system when it's not working the way it should.

Don't Neglect Your Movement System

Similar to the systems in your car, problems with your movement system are much easier to deal with if they're caught and treated early. This prevents small issues from becoming larger ones. For example, if you have a little bit of weakness, and balance that's not quite up to par, improving those early could prevent a sprained ankle, or a fall and a broken wrist.
An annual movement screen from your physical therapist can find small issues that you may not have noticed with your strength, balance, flexibility, or coordination. Many of these minor issues can be fixed with a few exercises at home, or with just a few visits.

What to Expect

A screen of your movement system is quick and easy. Your annual visit may include:
● A history of your injuries, as well as a health history
● Assessment of your strength, balance, flexibility, etc.
● A review of your movement goals (do you want to run a marathon? Get on and off the floor easily playing with your grandkids?)
● A review and update of your exercise program

As one year comes to a close and another begins, people begin to set goals and make resolutions. Losing weight, getting to the gym more often or getting into "better shape" are all common. These all require increasing your amount of physical activity. More activity is great for your health, energy levels, sleep, and mood. However, ramping up your activity level too quickly after a holiday season of eating, drinking and being merry can lead to pain, injury and disappointment if your body isn't ready for it.

Your physical therapist is an expert in human movement, and can help you safely reach your fitness goals. People think of PTs as the person to see after an injury, but a visit before you change your activity level could prevent injury in the first place. An evaluation by your PT will include assessment of your strength, range of motion, and functional movement patterns - think jumping, running, squatting, carrying. Some PTs even like to use a standardized assessment, such as the Functional Movement Screen.

Most common injuries from new fitness routines are caused by underlying weakness, range of motion deficits, or compensatory movement patterns. Your PT will find these during your assessment. They can then prescribe exercises or movements to address the issues found and get you safely moving into the new year!

The other common way people get injured working towards their resolution is with overtraining, or doing too much too soon. Physical therapists are also experts in exercise prescription and program design. Your PT can help you create a routine specific to your needs and goals that will progress appropriately and keep you out of trouble.

So stop only thinking of your PT after you're injured. In this case, it's true that an ounce of prevention is worth a pound of cure. Seeing your physical therapist before you start on your resolution can keep you on track, injury free, and help you reach your goals for the new year!

Medical diagnoses don't need much of an introduction. They're what you get from your doctor when you're sick. Examples would be influenza, diabetes, or hypertension. They describe the underlying problem that is causing your symptoms. 

When people feel sick, they know they need to go to the doctor and find out what's going on to get treated. We should treat movement the same way. If you're having pain when you move, can't do things you used to be able to - like get on and off the floor easily, or can't do things you want to do - like go for a bike ride or pick up a grandchild then you need to get a movement diagnosis. 

A movement diagnosis does the same thing as a medical diagnosis; it describes what's causing your difficulty with movement. Some examples would be difficulty standing from a chair secondary to decreased force production, scapular down rotation syndrome, or lower crossed syndrome. 

Diagnoses set the roadmap for treatment, so getting them right is crucial. Human movement is complex and is influenced by more than just your muscles and joints. According to the APTA, movement is impacted by the following systems:

     - Endocrine
     - Nervous
     - Cardiovascular
     - Pulmonary
     - Integumentary
     - Musculoskeletal

Because of the complexity and interplay between these components of the movement system, getting a movement diagnosis correct is often very difficult. Physical therapists are experts in human movement with doctoral level training and should be your first stop for movement issues. Not only can a physical therapist provide an accurate movement diagnosis, they will also design a treatment plan to correct the underlying issues and help get you moving well again. 

References:

http://www.neuropt.org/docs/default-source/default-document-library/movement-system-diagnosis-in-neurologic-physical-therapy-where-are-we.pdf?sfvrsn=0

https://journals.lww.com/jnpt/FullText/2018/04000/White_Paper__Movement_System_Diagnoses_in.9.aspx

http://www.apta.org/MovementSystem/

http://www.apta.org/MovementSystem/Template/

Physical therapists are experts in the musculoskeletal system, and typically use patient history and a good physical exam to come to a diagnosis and treatment plan. However, PTs are increasingly using diagnostic imaging as they become the practitioner of choice for musculoskeletal injuries. Many PTs have access to diagnostic ultrasound right in the clinic, and in some practice settings like the military, and certain ACOs, therapists have the ability to order imaging like x-rays, CT scans and MRIs.

The research indicates that PTs are effective in using their ability to order imaging when it exists. A study of 108 imaging orders by PTs providing musculoskeletal primary care in a direct-access sports physical therapy clinic found that advanced diagnostic imaging was ordered appropriately in over 80% of cases.

So, PTs are good at appropriately ordering imaging, but how does it improve treatment? A case study published in the July 2015 issues of the Journal of Manual & Manipulative Therapy gives a good illustration:
The patient was a very active dentist who had chronic mid and upper back pain. He had a known history of benign neural tissue tumors of his head and upper back region, but no specific diagnosis for his back pain had been provided. After examination, the PT decided to start treatment for the patient's back pain, but also order x-rays and an MRI of the symptomatic part of the patient's spine. The MRI showed a previously undiscovered meningioma, or benign tumor of the membrane that covers the spinal cord.

The benefit to this patient was that the PT could continue treatment without making referrals and waiting for someone else to order the images. Also, once the tumor was discovered, the PT could select exercises and manual techniques that would help the patient, but avoid putting stress on the area of the tumor. It also allowed the PT to educate the patient on fitness activities that would be safe and appropriate.

The case study has a quote that sums up the benefits of imaging combined with PT nicely: "Orthopaedic physical therapists have high levels of musculoskeletal expertise and extensive knowledge of typical patterns and behaviors of musculoskeletal conditions. These competencies and experiential knowledge enable them to appropriately recognize situations requiring additional diagnostic screening for non-musculoskeletal pathology. This case demonstrates how privileges to order musculoskeletal imaging studies assisted the physical therapist in providing optimal, patient-centered care. The physical therapist in this case was able to continue treatment without multiple referrals back to the medical provider to obtain imaging, and so provided more cost-efficient and convenient care."

Reference article and case study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5046964/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534847/

When most people think of diagnostic imaging, they think of X-rays, CT scans and MRIs, but the use of musculoskeletal ultrasound is becoming more popular for physical therapists. With most states having direct access laws, physical therapists are becoming primary care providers for musculoskeletal injuries. Despite a long history of therapists effectively using imaging in the military, and some managed care organizations like Kaiser Permanente in Northern California, in the United States PTs usually can't order X-rays, CT, or MRI scans. They can, however use  musculoskeletal ultrasound. 

A musculoskeletal ultrasound is very similar to the more common sonogram used during pregnancy. Both use sound waves to create an image of what's going on in the body in real time. Ultrasound can show a PT many structures in the body and can be used to help diagnose strains, sprains, inflammatory conditions like tendonitis or bursitis, nerve entrapments, and hernias.

Ultrasound is not popular with PTs just because they are limited in the ability to order other imaging. Research and clinical experience supports ultrasound as the preferred diagnostic test for many musculoskeletal injuries. Here are some benefits of ultrasound that support why:

• Ultrasound uses no radiation and has no known harmful effects on humans
• Real time imaging allows ultrasound to capture movement in the tissues, something x-ray, CT, and MRI can't do
• Ultrasound is widely available, and less expensive than most other types of imaging
• Ultrasound may provide greater detail of soft tissues like muscles, tendons, or joints
• Ultrasound can be used on people who can't have an MRI such as patients with pacemakers, and certain metallic implants
• Patients don't have to remain still for an ultrasound, meaning it can be easily used on people who are claustrophobic or nervous about other imaging types

With such a list of advantages, it seems that ultrasound is a great type of imaging technology. This is true, but it's not without a few drawbacks. These would include:

• Difficulty penetrating bones, and through large amounts of soft tissue, limiting the ability to see the deepest tissues in the body
• Ultrasound also has difficulty showing the internal structure of bones, making other techniques better for detecting suspected fractures
   

Most people think of heart rate or blood pressure when they think of vital signs. It is common to use numbers to quantify health and risk of disease. The American Heart Association encourages people to "know their numbers" referring to blood pressure, blood cholesterol, blood glucose, and weight. However, research is now showing the importance of moving properly for health. Let's take a look at some of the numbers you can use to quantify your movement health:

Walking Speed

Walking speed has been called the "sixth vital sign" in medical literature recently. It is easy to measure, and takes into account strength, balance, coordination, confidence, cardiovascular fitness, tolerance to activity, and a whole host of other factors. It has also been shown to be predictive of future hospitalizations, functional decline, and overall mortality. Normal walking speed is considered to be 1.2 to 1.4 meters per second.

Push Ups

Push ups are popular to build strength, but a recent study found that they can show us a lot about your heart too. Researchers found that men who could do 40 or more consecutive push ups were at a 96% lower risk for cardiovascular disease than were men who could do less than 10. The push up test was also more useful in predicting future cardiovascular disease than aerobic capacity measured on a treadmill.

Grip Strength

Hand grip strength has been shown to be strongly correlated with health. The stronger your hand grip is, the less likely you are to suffer from cardiovascular disease, respiratory disease, COPD, and all types of cancer. In the study, muscle weakness was defined as grip strength <26 kg for men and <16 kg for women. Grip strength below these numbers was highly correlated with an increase in disease.

Standing From the Floor

If you can't easily get down on the floor and back up your health might be in trouble, according to a study that looked at more than 2,000 people. The study asked people to go from standing to sitting on the floor and back up with as little support as needed. They found that if you need to use more than one hand to get up and down from the floor that you were 2 to 5 times more likely to die in the next 7 years than someone who can do it with just one hand, or even better, no hands at all.

Moving well is obviously important to overall health and longer life. These tests can give a snapshot of how you're doing. If you're having trouble with any of them, considering seeing a movement specialist - your physical therapist.

Think about the last time you made a big purchase, say $1,000 or more. Did you go out and buy the first thing you saw? Take one recommendation from somebody? Or did you research it, learn some things, compare it to other options, and select something that was right for you? Most people tend to be educated and research large purchases like cars, televisions, or the newest iphone. So why do we so often fail to do this with healthcare?

By becoming more educated healthcare consumers we can go from passive patients who take the first recommendation that comes from a practitioner to an active consumer who weighs options and makes choices. Here are some questions to talk through with your practitioner the next time a healthcare decision comes up.

What are the benefits or expected results?

When a treatment or procedure is recommended, the patient often assumes that it will make them "better." But what the patient expects and what the healthcare provider expects are often two different things. For example, a patient having back surgery expects to be pain free after surgery. The surgeon probably doesn't expect that to happen. Outcomes from back surgeries are terrible. A large study of 1450 patients in the Ohio worker's comp system showed that after 2 years 26% of patients who had surgery returned to work. Compare that to 67% of patients who didn't have surgery. There was also a 41% increase in the use of painkillers in the surgical group.

What are the risks and downsides?

Patients want to hear about the benefits of a treatment, but they often don't ask or care about the risks. To be an educated consumer, you need to. If one treatment has a 3% edge over another, but has a high risk of making you itchy or causing frequent headaches, do you want it? Going back to the back surgery study from before, the researchers found a 1 in 4 chance of a repeat surgery and a 1 in 3 chance of a major complication. With surgery you risk infection, blood clots, complications with anesthesia, and a whole host of other things. These risks need compared with other treatments. In the case of back pain, physical therapy is a valid alternative with a much lower risk profile. You might have some soreness with physical therapy, you might sweat some and be challenged with exercise, but the risks of PT compared to surgery are minimal.

What are the alternatives?

Don't feel bad asking about alternative treatments. If you were looking at  a certain car you wouldn't go out and just buy it. You'd at least consider the competitors and probably even test drive them. You should at least look at the other options in healthcare too. Maybe the first recommendation that your practitioner makes is the right one for you, but if you don't consider the alternatives you'll never really know.

Why this treatment over the other ones?

This is the question where the rubber meets the road. You've learned about all the options, now you can see if your practitioner is balancing the risks and benefits to make the right choice for you. Staying with the back pain example, research shows that more than 40% of people who seek care for back pain will not receive a treatment of known effectiveness. Back pain is also the #1 reason for opioid prescriptions, despite a 2016 recommendation from the CDC to avoid prescribing opioids for back pain, and opt for non-drug treatments like physical therapy. By asking for the rationale and carefully weighing options, you can avoid being one of the people who gets an ineffective treatment.

What's it cost?

This last question is becoming more important as patients bear an increasing share of the cost of healthcare. Even if you don't have a high deductible plan or hefty co-pays, by being financially responsible today, you'll probably see smaller price increases in your premiums down the road. That back surgery that we've been talking about? It'll likely cost between $60,000 and $80,000. So if we put the whole picture together, a patient who takes the first recommendation for surgery will have a $60,000 procedure that leads to a higher risk of disability, and a higher risk of long term painkiller use, while risking infection, and blood clots. Don't forget the 25% chance that you'll get to do it all again in a repeat surgery. Seems like a bad deal. An educated consumer would learn that physical therapy is a viable alternative to surgery with comparable outcomes, much less risk and lower cost. In fact, a large study of 122,723 subjects showed that people with back pain who got physical therapy in the first 14 days lowered their healthcare costs by 60%. It's easy to see why bargain shoppers love PT!

Youth sports injuries have been on the rise for years, and baseball players are not immune to this trend. 1 in 5 players between the ages of 9 and 15 will have an injury each year. The good news is that only 5% of these injuries result in surgery, or being unable to continue to play baseball. More good news comes when you learn that the majority of injuries are preventable with proper training and awareness.

Many of the injuries seen in baseball are common to other youth sports and include things like:

1. Sprains and strains
2. Fracture
3. Minor injuries like bruises, scrapes, abrasions, and muscle cramps

Keys to preventing these types of injuries are making sure that players have a proper base of strength and fitness to participate, adequate warm up before practice and games, and making sure that players have enough recovery time built into their schedules throughout the season.

Injuries Unique to Baseball/Softball

In addition to the common injuries above, baseball sees a large number of injuries due to overuse. These most commonly occur in the shoulder and arm, typically in a pitcher. Parents of athletes who pitch need to be aware of the risks of pitching and guidelines to minimize them. Studies have shown that pitchers who average more than 80 pitches in a game are 4x more likely to get injured. They have also found that pitching for more than 8 months out of the year, causes your injury risk to increase by 5x.

Tips to prevent pitching injuries

1. Pick a team to pitch for -if you play on multiple teams, choose oneto pitch for and play a different position on the other to reduce the chances of injury
2. Don’t play a position that requires a lot of throwing on your non-pitching days, like catcher
3. Take 2 to 4 months off each year from pitching to rest your arm
4. Keep your arm healthy and strong. The thrower’s ten was developed specifically for throwing athletes and is a good place to start.
5. Stop pitching if you feel pain, or fatigue. Throwing through problems will change your mechanics and put you at risk for serious injury
6. Follow the guidelines for rest days and total pitches below.

If you're 14 or under: 

15 and under can throw a bit more

Finally, you should aim to keep under the maximum number of daily pitches set by Little League Baseball and Softball:

Recent research is showing that surgery might not be needed as often as we think. A large review estimates that 10% to 20% of surgeries might be unnecessary and that in some specialties such as cardiology and orthopedics, that number might be higher. The reasons for so many unneeded surgeries being performed are varied, but the most common are that more conservative options aren't tried first, or lack of knowledge by the operating physician. 

Physicians undergo long and rigorous training programs to become surgeons, but if they don't work hard to keep learning, their knowledge often stops growing when they leave residency. Recent research is showing that certain common surgeries aren't any better than a placebo. Two such examples are kyphoplasty - a procedure for spinal compression fractures, and partial meniscectomy - a procedure used to treat tears of the meniscus in the knee. If a surgeon hasn't continued to learn, they won't know that these surgeries often don't offer any more benefit than a non-surgical treatment and will continue to perform them. 

Every surgery, even "minor" ones carry risks. These include complications from anesthesia, blood clots after surgery, delayed healing of the incision, infection, and unintended damage to nerves or other organs near the surgical site. Some of these risks cause discomfort for a period after surgery and go away, but others can result in permanent disability or even death. For some patients and conditions, surgery is a great treatment option, but with all the associated risks, when surgery can be avoided, it should be. 

For musculoskeletal problems like back and joint pain, sprains, and strains, seeing your PT before a surgeon can help keep you out of the operating room and get you back to life without surgery. Studies have shown that physical therapy is just as good if not better than surgery for a multitude of conditions and carries less risk. Some examples would include rotator cuff tears, meniscal tears, spinal stenosis, low back pain, and osteoarthritis. 

Physical therapy can't fix every problem, and for some patients surgery is the best choice. However, research is showing that surgery isn't a cure-all, and is sometimes just a very expensive and risky placebo. In most cases, starting with physical therapy is the right choice, and for many patients, PT is the only treatment necessary.

Strength training is an important type of exercise, but becomes even more important as people age. Without resistance training, we begin to lose somewhere between 0.5% and 1% of our muscle mass each year.  

With this loss of muscle mass comes higher levels of arthritis pain, more difficulty with things like getting out of a chair or going up steps, higher risk for falls and injuries, and eventually the possibility of loss of independence.  

Research has shown that people of any age can benefit from strength training, so just because you’re getting older doesn’t mean that you can’t get any stronger. When many people hear “strength training” they automatically picture someone straining under a heavy barbell. However, strength training can be performed with resistance bands, machines, dumbbells, barbells, and many other types of equipment. The key to strength training is that the resistance gets stronger as you do.  

The data we have also shows that increasing strength can reduce pain from arthritis, and make things like climbing steps, carrying groceries, taking a bath, and preparing a meal easier. Strength training can also help to reduce your risk of falls and maintain your independence.  

If you’d like to begin strength training and start reaping the benefits, your physical therapist can help you design a plan that’s both effective and safe. They can teach you the correct movements and monitor your progress, helping you increase your resistance the right amount at the right time.  

We’ve all heard that a proper warm up is important before exercise, and that skipping it can lead to injury. As physical therapists, one of the more common places we see people skipping warm ups or doing them improperly is at the golf course. For many golfers, the warm up is carrying the golf bag from the trunk of the car to the cart. For others hitting a bucket of balls at the driving range or taking some practice swings is a warm up.  

The golf swing is a complex, full body motion that puts a lot of force through the bones, muscles, and ligaments. Jumping straight into swinging a club without properly preparing those bones, muscles and ligaments puts golfers at risk for injury. A good rule of thumb to help you remember what a proper golf warm up looks like is that you can’t swing to warm up, you have to warm up to swing. 

A proper warm up happens right before you start golfing, so that means you’ll be doing it at the course. If swinging a club isn’t a good warm up, what does one look like? It’s a series of dynamic activities that raises your heart rate to 60% of your maximum. The easy way to figure this number out is to subtract your age from 220 to get your maximum, then multiply that by 60% to get your target heart rate for your warm up. So for a 55 year old, the maximum heart rate would be 165 (220-55) and 60% of that is 99 (165 x 0.6).  

Each exercise below should be done for about 1 minute on both sides of your body to keep symmetry and be done a pace to get your heart rate up to the target you calculated.  

Neck circles 

Drop your chin down to your collar bone, then rotate your head in a circle, bringing your ear to your right shoulder, up to the sky, to your left shoulder, then down at the floor. Repeat for 30 seconds and then switch directions. 

Neck Rotation 

Turn your head to the left and hold for 2 seconds, then to the right and hold for 2 seconds. Continue for 60 seconds. 

Torso Rotation with Club 

Stand in a 5-iron posture with your feet shoulder-width apart, and a slight bend in your knees and waist. Hold the club in front of your shoulders with crossed arms, and keeping your hips steady, rotate your shoulders from side to side.  The end of the club should point forward at the biggest point of the stretch 

Side Bends with Club 

Stand with your feet shoulder width apart.  Hold the club on your shoulders behind your neck. Keeping your back straight, bend to your left and hold for two seconds, then to the right and hold for two seconds. Make sure you’re not bending forward or backward as you bend from side to side. 

Shoulder Circles 

Do small shoulder circles for 30 seconds, first clockwise and then counter clockwise. 

Toy Soldiers 

Walk forward, kicking one leg and then the other out in front of you while keeping your back and knees straight. As you kick, reach your arm on the same side, aiming to touch your toes to your fingers. Keep your toes flexed toward your body as you kick. 

High Knees Walk 

Walk around where you are, and with each step, grab your leg just below the knee with both hands and pull it as close to your chest as possible, feeling a stretch in the glute. Hold the stretch for a second and then release and take the next step. 

Reverse Lunge Calf Stretch 

Stand with feet shoulder-width apart and step back with one leg. Keep your back knee straight with your heel on the ground as you bend your front knee and drop into a slight lunge. Hold for a moment and then switch legs, alternating legs for 60 seconds.  Hold onto a wall or chair if you need to. 

You might wonder where the static stretching is in this warm up. Research has shown that static stretching (holding a stretch for a long period of time) done before activity can actually hurt your performance. Static stretching is important as part of the cool down after activity, however. So before you head to the 19th hole, stretch and re-hydrate with some water.  

What is Parkinson’s? 

Parkinson’s affects about a million adults in the United States. It is a progressive nuerodegenerative disorder meaning that over time it does get worse, and that it’s caused by degeneration of neurons in the brain. The specific neurons affected produce a chemical called dopamine. Parkinson’s causes tremor, slow movement, loss of coordination, and muscle stiffness. 

While Parkinson’s does not have a cure, symptoms can be managed, and progression can be slowed allowing people with Parkinson’s to live a high quality and active life. 

What can be done? 

Currently, the primary treatments for Parkinson’s are medication and exercise. There are surgical options for people who have exhausted the medications available, or who suffer profound motor deficits. Additional studies are ongoing looking at medical marijuana and other complementary or alternative treatments as well.  

Medication 

It is important for people with Parkinson’s to work closely with their neurologist because each patient will require a different combination of medications.  

The first choice for many patients will be one of the levadopa drugs. This chemical is converted into dopamine in the brain to reduce symptoms like tremor, rigidity, and poor coordination.  

There are other drugs that may be used in place of, or in combination with levadopa to manage symptoms. Most patients will need ongoing assessments and changes in their medication regimen as their symptoms progress and change 

Exercise 

Research has shown that exercise can help with both motor and non-motor symptoms in people with Parkinson’s. The most important thing for people with Parkinson’s is to get started with exercise early in the disease process and to be consistent with exercise. Your exercise program should focus on a few different components: 

1. Flexibility exercises 

2. Aerobic activity 

3. Muscle strengthening 

Some types of exercise like Tai Chi, yoga, Pilates, biking, or dancing combine several of these elements. 

Your physical therapist will complete an individualized evaluation to determine the areas where you have the most trouble, then work with you to design an exercise program to address these areas. They can help you find beneficial types of exercise that you enjoy, which will help you stay consistent with your program and reap the most benefits.  

There are exercise programs specifically designed for treatment of Parkinson’s disease, including the LSVT BIG program. This is a program delivered by a specially trained physical therapist over 16 sessions that focuses on getting people to make bigger movements. The BIG program has been shown to improve balance, increase quality of life, and help people walk faster with bigger steps.  

While there is no one answer to manage symptoms and slow progression of Parkinson’s disease, working with your physician and your physical therapist using a combination of medication and exercise has been shown to lead to the highest quality of life.  

What is Urinary Incontinence? 

Urinary incontinence is the involuntary leakage of urine. 25 million Americans experience this condition, and ¼ of women between the ages of 18 and 59 have urinary incontinence. There are different types of incontinence, with the most common being stress and urge incontinence. 

1. Stress incontinence is when leakage happens during coughing, sneezing, or laughing.  
2. Urge incontinence is a result of the bladder being overactive or unstable. People with urge incontinence often often have triggers that cause the involuntary loss of urine, such as hearing running water.  

What Can Be Done? 

Physical therapy can be used to effectively treat urinary incontinence. A typical program consists of a combination of exercise and education. Exercise is used to improve the strength of the muscles of the pelvic floor, providing better support to the bladder and improving your ability to control the flow of urine. Education helps you learn how the bladder normally functions and changes you can make to improve your symptoms. Examples of these changes are making sure that you are adequately hydrated, avoiding “just in case” peeing, and dietary changes to avoid bladder irritants like spicy foods, citrus fruits, caffeine, and carbonated beverages.  

A common example of a pelvic floor strengthening exercise is the Kegel. Although this exercise is well-known and commonly attempted, it is frequently done incorrectly. Many people substitute muscles that are not part of the pelvic floor during a Kegel like the abdominals, glutes, or hip adductors.  

To perform a correct Kegel: 

1. Avoid contracting your abdominals or glutes
2. Tighten the muscles as if you’re trying to stop the flow of urine 
3. Then imagine a string pulling those muscles up towards your belly button.  

Physical therapy can help you take back control of your bladder and stop worrying about where the next restroom is. If you’re experiencing urinary incontinence, a pelvic PT can provide a comprehensive evaluation and develop a treatment plan specifically for you! 

Chances are, you or someone you know has had back pain. Each year 15% of the population has their first episode of back pain, and over the course of our lives, 80% of us will have back pain. Even though back pain is common, the medical community does a poor job managing it. Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too common. 

Let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy: 

Medication 

Low back pain is the #1 reason for opioid prescription in the US, however in 2106, the CDC recommended against the use of opioids for back pain in favor of “non-drug treatments like physical therapy.” 

Imaging 

Having an X-ray or MRI for back pain is common, however it’s rarely needed or helpful. Research has NEVER demonstrated a link between imaging and symptoms. As we age, degenerative changes on imaging is common. 

1. 90% of people age 50 to 55 have disc degeneration when imaged, whether they have symptoms or not 

2. In 2015 a study that looked at 1,211 MRI scans of people with no pain found that 87.6% had a disc bulge 

3. Just getting an image increases the chances that you’ll have surgery by 34% 

Surgery 

The US has sky high rates for back surgeries - 40% higher than any other country and 5x higher than the UK. You’d think that with all the back surgeries we do, we’d be pretty good at it but the outcomes are terrible! A worker’s comp study looked at 725 people who had spinal fusions VS 725 people who didn’t. The surgical group had: 

1. A 1 in 4 chance of a repeat surgery 
2. A 1 in 3 chance of a major complication 
3. A 1 in 3 chance of never returning to work again 

Physical Therapy 

1. Current clinical practice guidelines support manual therapy and exercise 
2. Research proves that early PT lead to better outcomes with lower costs, and decreases the risk of surgery, unnecessary imaging, and use of opioids 
3. A study of 122,723 people with low back pain who started PT within 14 days found that it decreased the cost to treat back pain by 60% 
4. Unfortunately only 2% of people with back pain start with PT, and only 7% get to PT within 90 days. 

Despite the data showing that PT is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. Almost every state has direct access, meaning that you can go directly to a physical therapist without a doctor’s referral. If you see your doctor for back pain, and PT isn’t one of the first treatment options, ask for it!

Your physical therapist can play a big role in helping you maintain or improve your balance as you age. Unfortunately, falls are becoming increasingly common in adults age 65 and over. Just because they’re common, doesn’t mean they’re inevitable though. Research shows that falls are caused by a variety of factors, and many of them can be improved. Let’s take a look at some of them and some tips to help you get back into balance.
 

Lower Body Weakness

As we age, without resistance training we lose muscle mass every year. Weakness in your lower body has been shown to increase your fall risk. A physical therapist can design an exercise program to help you strengthen your legs and lower body safely.

Inactivity

Another reason we lose muscle mass and our balance decreases is inactivity and deconditioning. People who have fallen in the past often have a fear of falling again, which leads them to do less. As their activity levels decrease, they get weaker and even more fearful of falling.

This downward spiral can be stopped with balance training from a physical therapist to build your confidence on your feet and allow you to become more active.

Group exercise classes are another great way to become more active, work on your balance and meet new friends at the same time. Ask your PT for recommendations for a class near you.
 

Vision Problems

Many people don’t realize that your body uses your vision for balance. If you want to prove this to yourself, try standing with your feet together with your eyes open, then compare that to doing it with your eyes closed. Visual problems can also make you miss things like bumps and changes in the surface you’re walking on, or objects that you could trip over.

If you’re having problems with your vision, see your eye doctor for an exam and recommendations on what can be done.
 

Medications

Certain medications can increase your risk of falling and impact your balance by making you sleepy, slowing your reactions, or causing weakness. Some examples of medications that can increase fall risk are certain types of antidepressants, blood pressure medications, and water pills.

Your physical therapist can help you work with your doctor or pharmacist to review your medications and consider changes to improve your balance and reduce your risk of falling.

When it comes to helping you improve your balance, and reduce your risk of falling, your physical therapist is an important part of the team. They can evaluate you to determine where your problem areas are, and design an individualized program for you. They can also refer you to other professionals who can help like your eye doctor and your pharmacist. If you’re starting to feel out of balance, your PT can help you stop falls before they start.

What is Osteoporosis?

Osteoporosis is a condition that causes degeneration and weakening of the bones. It is most common in women, but can affect men as well. It is also more common as we age, with 55% of Americans 50 or older affected.

Bone is living tissue and like all living tissues, old cells are constantly being removed and replaced by new cells. In normal bone, the removal and replacement of cells happens in a balanced process. In osteoporosis, bone is weakened when the removal of cells outpaces the addition of new cells.

Osteoporosis is often called a “silent disease” because there are often no symptoms until a fracture occurs.
 

How can Physical Therapy Help?

Your physical therapist will complete a comprehensive evaluation and develop a treatment plan to address your specific needs. In most cases, your PT will include weight bearing activities, or resistance exercises using weights or bands because these types of exercises have been shown to strengthen bones.

Your PT might teach you proper posture to decrease the stress on your spine and help reduce the risk of fracture. Another way to reduce unnecessary bone stress is to learn proper posture and alignment during daily tasks like reaching for items or bending to pick up an object.

To help reduce the risk of fracture from a fall, your PT might incorporate balance activities, or specific strengthening activities. 

If you already have a fracture, your PT can work with you to reduce pain. They can also assess you for things like braces or splints that may help you heal or improve your posture.

Every year one in four people over 65 falls. That means that millions of older adults fall every year, and 1 in 5 of those falls results in serious injury like broken bones or a head injury. Less than half of the people who fall will tell their doctor, maybe out of embarrassment or maybe because they assume that falling is a part of the aging process. But falling is not inevitable, and with some help from your doctor and your physical therapist, your chances of falling can be significantly reduced.

Research has shown that many risk factors contribute to falls. Some risk factors can be changed, like lower body weakness, difficulties with walking and balance, vision problems, use of certain medications, foot pain or poor footwear, and home hazards like throw rugs, extension cords, and uneven steps or floors.

A physical therapist can screen you for fall risk. They can also have a positive impact on many factors to reduce your fall risk through interventions like strengthening exercises, balance training, or teaching you to use a device like a cane or walker to keep you more steady when you’re walking. A physical therapist can also teach you how to make easy changes around the house that can reduce your risk of falling. Some easy examples would include:

Using night lights to help your vision at night
Removing throw rugs, extension cords, or clutter that you could trip over
Installing grab bars near the toilet or bathtub

A PT can help you work other professionals like your eye doctor if your vision is increasing your fall risk or with your doctor or pharmacist to review your medications to see if they could be making you feel dizzy, weak, or sleepy.

Falling is common in people over the age of 65, but that doesn’t make it a normal part of the aging process. If you have fallen, your chance of falling again is doubled, but by working with your physical therapist and the rest of your healthcare team, you can reduce your fall risk and maintain your independence.

Most people know that physical therapists often recommend exercise as part of their treatment. What most people don’t realize is how simple that exercise can be. Instead of complicated workouts, heavy weight lifting, or running for miles, physical therapists often surprise people when they recommend walking.

While it seems like an easy exercise, walking still has powerful health benefits. Walking 30 minutes a day, 3 times a week has been shown to improve cardiovascular endurance, and reduce blood pressure and weight. Lots of people are using activity trackers and apps to track steps during their daily activities, and this too has been shown to have benefits. These include reducing disability and pain associated with conditions like knee osteoarthritis. While many people aim for 10,000 steps per day, research shows that as little as 6,000 steps a day can reduce pain and disability while boosting cardiovascular health.

If you’re thinking about starting a regular walking program or just increasing the amount of walking you do throughout the day, it’s important that you do it the right way. The general recommendation for building any physical activity is to take whatever amount of the activity you do in a week and increase it by 5% or less per week. A good general starting place would be 3,000 steps per day, and an example program following the 5% rule might look like this: 
 

If you’re not sure if you’re ready to walk the recommended 6,000 steps a day, you can always visit a physical therapist for a review of your medical history and baseline testing to find out what a safe level for you to start at would be. A PT can also help you design a program to safely meet your goals.

One last thing to consider is footwear. Although walking is less stressful than running, it’s still important to take care of your feet. Shoes designed for running work well to cushion and support your feet when walking too. If you need help picking the right pair, a PT can help and so can the staff at a good specialty running store.

Most people know that physical activity is important. In fact, not getting enough has been linked to illnesses like heart disease, stroke, diabetes, Alzheimer’s, high blood pressure and lung disease. So the important question is not if you need to be doing some form of physical activity to protect against diseases like these, but how much is enough?

The US Department of Health and Human Services answered that question for us in 2008 with their recommendations for physical activity. To improve or maintain health, adults over 65 need to do 2 types of physical activity: aerobic exercise and strengthening. 
 

Aerobic Exercise

To meet the recommendations for aerobic exercise you should try to be active daily, and perform your aerobic activity for at least 10 minutes at a time. Each week you should aim for

150 minutes of moderate intensity activity
OR
75 minutes of vigorous intensity activity.

The general rule is that 1 minute of vigorous activity is equal to 2 minutes of moderate intensity activity, so a combination of moderate and vigorous activity can also be used to satisfy the recommended 150 minutes each week.

Some examples of moderate intensity aerobic activity would be:

Walking
Water aerobics
Riding a bike on a level surface
Doubles tennis

Vigorous intensity activities include:

Running or jogging
Riding a bike fast, or on hills
Singles tennis
Hiking uphill
 

Strengthening

Muscle strength is important for all daily movement, and in older adults it can help to maintain strong bones, as well as reduce the risk of falling. The recommendation for strengthening is to work each major muscle group twice a week.

Examples of strengthening activities include:

Carrying heavy loads
Lifting weights
Exercises using your own body weight like push ups, sit ups, or squats

For each exercise you should try to perform:

At least one set
8 to 12 repetitions in each set

Your resistance should be heavy enough that the last repetition is hard to complete.

These guidelines are general recommendations and do not take into account previous injuries, medical conditions, or limitations that individuals may have. Your physical therapist is an expert in exercise and physical activity who can help design a program to maintain or improve your health while considering your past medical history, limitations, and goals. Your PT can teach you safe exercise technique, and help you safely progress your program as you get fitter to continue making improvements in your overall health.

Now that spring has arrived, temperatures are starting to rise in many parts of the country. And that means the transition from heating our homes to cooling our homes is right around the corner. No matter what method you use to cool your home during the warm spring and summer months (central air conditioning, window units, or fans and dehumidifiers), each spring you cross your fingers that your approach still works. If not, you might be calling an expert for a tune-up, or in extreme circumstances, you might need a complete overhaul.
 

Just like an AC system that has probably been dormant for many months of the year, a body that hasn’t been physically engaged on a regular basis may have trouble getting started again. And yet, this time of year, the warm temps draw many people to city and suburban streets, tracks and trails, ready to take that first run of the season. A good percentage of these spring runners haven’t kept up their strides throughout the winter. It should come as no surprise that a 4-mile run for a previously inactive person is going to stir up a few aches and pains.

Especially as we age, our ability to move undergoes changes. But whether we’re talking about a college student or a retiree, returning to an activity without proper planning is a recipe for disaster. That’s where physical therapy comes in. Physical therapists are trained to treat injuries and ease pain, but they can also help their patients prevent injuries and safely prepare to participate in new activities.

Think of physical therapists as “movement consultants” who can ensure that your body is physically ready to tackle a new challenge—or resume a favorite leisure activity. Here’s another example to illustrate what we’re talking about: Let’s say that you play in an adult soccer league and you’re preparing to play in your first game of the season in a few weeks. You probably hung up your cleats when the last season ended months ago, but expect to pick up just where you left off. But it’s simply too much to ask for your 2019 debut on the field to be on the same level as the last game of the previous season, when you likely had reached peak performance.

This is a good time for your PT to step in and help you shake off the rust. The rehab professional can customize an exercise plan to help you slowly return to sport and avoid an injury that could sideline you for the whole season. Or like cleaning the filters before firing up your air conditioner for the first time this year, the rehab expert can help to ensure that your body is prepared to return to its former activity level following a hiatus.

We all feel like life is spinning out of control at times, but if you have dizziness, that spinning feeling is for real. A physical therapist can help with many common forms of vertigo and dizziness. In this article we’ll take a look at two examples of conditions that cause dizziness commonly treated by PTs.
 

BPPV
 

Benign Paroxysmal Positional Vertigo (or BPPV) is the most common cause of vertigo, a false sensation of spinning. BPPV is a mechanical problem in your inner ear that causes a feeling of spinning with certain head positions or movements. BPPV is caused when some of the small crystals normally embedded in gel in your inner ear get dislodged and end up in the semicircular canals of your inner ear. These canals are filled with fluid and sense head motion. The crystals disrupt the normal function of the canal, which sends an abnormal signal to your brain. Your brain interprets this signal as head movement, even though your head is still, causing you to feel dizzy.

Your therapist can take you through a series of motions to determine which is the problem ear and which canal the crystals are in. After that a specific maneuver involving head motion allows gravity to pull the crystals out of the semicircular canal. Usually symptoms can be greatly improved in 1 to 3 treatments, but some patients continue to feel mild dizziness or sensitivity to head motions even after the crystals are removed from the canal. Your therapist can also evaluate this and prescribe home exercises to correct this problem.
 

Cervicogenic Dizziness
 

This is a condition that causes dizziness, but is related to problems in the neck. This is a much more rare condition than BPPV, and does not cause a true spinning sensation. There is no specific test for cervicogenic dizziness, so it’s important to get a thorough evaluation from a qualified professional like a PT to rule out other problems that may be causing your dizziness.

In most cases the dizziness improves with treatment of the neck pathology alone using things like exercise, manual therapy, and education on proper posture. For the patients who don’t improve with treatment of the neck alone, adding vestibular rehabilitation often improves symptoms. Vestibular rehabilitation may include eye exercises, balance exercises, or graded exposure to what makes your dizzy.

Treatment of vertigo and dizziness is a specialized form of physical therapy that requires specific training. If you’re experiencing dizziness or vertigo, getting a full evaluation by a qualified PT is a great first step to stop yourself from spinning out of control. They can diagnose the specific cause of your dizziness and design a treatment plan to address it.

Exercise has great benefits for your physical health - it can strengthen your muscles, improve your cardiovascular system, and reduce your risk of diseases like stroke and diabetes. But, did you know that exercise can have benefits for your mental health too?

Why exercise lifts your mood

Exercise causes your brain to release chemicals including endorphins, adrenaline, serotonin and dopamine. These chemicals all work together to make you feel good. In addition to the chemical changes in your brain, exercising can lead to a feeling of accomplishment and relaxation of your muscles, also helping you feel good. 

Exercise and depression

Exercise on it’s own is not a cure for depression, but research has show it can be as effective as medication for mild to moderate depression. In fact, the most commonly prescribed antidepressants are SSRI drugs, which work by increasing the amount of serotonin in your system. As mentioned above, exercise also increases the amount of serotonin in your system, so the effect on depression shouldn’t be a surprise. 

Make time for yourself

Many people believe they are “too busy” for exercise. Being “too busy” for something really just means that you’re prioritizing something else above it. By placing exercise high on your priority list, you’re prioritizing yourself. This is a great way to help boost your mood and your confidence, because you’re taking a portion of your day for yourself.

Choose physical activity you enjoy

While any physical activity will help release endorphins and serotonin, choosing something you enjoy can help boost your mood even further. In addition, by using physical activity that’s fun for you, you’ll be more likely to be consistent. Consistently exercising is important for getting the most benefit out of it. 

Dealing with the pain and limited mobility associated with an injury or illness can be stressful for so many reasons. You might have questions like, “How long will I be sidelined?” and “What do I need to do to get better?” Or maybe you’re worried about how you’ll pick your children up from school, walk to the train for your commute or prepare meals for your family.

These are all perfectly normal concerns. Luckily, there are some ways that you can gain control over the situation and ensure that you return to the activities you care most about—especially if physical therapy is part of your plan.

What you can do before your very first appointment—and during physical therapy—to take control of that injury-related stress? First and foremost, it’s important to come prepared for physical therapy. And no, I’m not talking about dressing appropriately and arriving on time (or even better, 15 minutes ahead of your scheduled appointment). That stuff is important, of course, but there’s one thing you can do in the days leading up to your appointment that will set you up for success.

Any guesses? I’m talking about starting a list. What kind of list? Well, every time that you feel pain in the affected area or notice an activity that is harder than it was pre-injury, add it to the list! And the more specific you are, the better. Here’s an example to help drive this point home: Let’s say that you’re recovering from a moderate meniscus tear and you have an appointment with your physical therapist in three days. Take notes on how your knee feels first thing in the morning after you’ve been off your feet. How does your knee react when you stand up from a chair—does it feel unstable? Or do you find that you need to clutch the back of the couch on your way to the bathroom? Sharing each of these details helps your physical therapist understand your limitations beyond the injury printed on your intake form.

Now let’s take that list a step farther and add some details about the activities that you typically participate in on a regular basis. Let’s say that you normally play a weekly round of golf, spend your mornings weeding your garden or meet up with friends for a four-mile walk two evenings a week. These activities have become an important part of your life so let’s make sure that they’re factored into your list, perhaps in the “what you hope to get out of physical therapy” category.

Painting a clear picture of how active you are—and what types of activities and sports you participate in—can help your physical therapist design an individualized treatment plan and to better help you on your road to recovery.

Have you been to physical therapy lately for an injury? Did you find anything else that helped maximize your time in rehab or that improved communication with your physical therapist?

Osteoarthritis (OA) is one of the most common joint disorders, especially in adults over the age of 60. Two of the most commonly affected joints are the hip and the knee. Common symptoms are morning stiffness, where you feel like you need to get up and moving for 20 or 30 minutes before you “limber up”, creaking or popping sounds from your joint, as well as pain and swelling which is typically worse towards the end of the day.

For a lot of people, the thought of knee or hip arthritis leads right to joint replacement surgery. While total hip or knee replacement surgery is an effective treatment for severe pain and disability related to OA, it’s not for everyone and certainly shouldn’t be the first line of treatment. Hip and knee replacements are major surgical procedures and are accompanied by significant risk. On top of that, both require months of recovery and rehab, and neither is a guaranteed solution with data showing that between 1 in 5 and 1 in 10 patients are not happy with the outcome after total joint replacement.

So if replacement isn’t the first and only option, what else is there?

Exercise
Many studies have shown exercise to be beneficial in reducing pain and disability resulting from OA. Exercise can help regain range of motion and reduce stiffness around the joint. It also helps strengthen the muscles surrounding the joint which reduces the stress placed on the joint during activities.

Manual Therapy
Manual therapy is a hands on approach that can including joint manipulation (a quick thrust, often accompanied by a “pop” or “crack”), joint mobilization (more gentle, graded movements of the joint), and soft tissue mobilization (various forms of massage). These techniques have been shown to be effective in treating OA, especially when combined with exercise.

Weight Loss
Significant benefits have been shown in overweight patients with OA who have shown a 10% weight loss. We take thousands of steps in a day, and each step puts stress through our hips, knees, feet, and other joints. When you consider reducing that force by a few pounds a few thousand times a day, a little weight loss can add up to a big difference!

These are three effective and conservative treatment options that your physical therapist can use to help decrease the pain that you’re feeling from arthritis. With a through evaluation, your PT can determine which options will best help you meet your goals and get back to whatever level of activity you’re aiming for. On top of these options you PT can also consider things like bracing, and help you consider options your physician might be able to provide like injections or medications.

Just because joint pain is starting to slow you down, doesn’t mean you have to live with the pain, face surgery, or give up your independence. Conservative treatment options from your physical therapist are an effective way to treat osteoarthritis and can help get you more active with less pain!

Between work, family commitments, and running errands, it’s understandable why weekend warriors cram all their physical activity on Saturday and Sunday. Unfortunately, this pattern of 5 days of inactivity, and being active on the weekend often leads to injury.

The most common types of injuries seen in weekend warriors are:

Muscle strains such as hamstring strains
Ligament sprains, most commonly in the ankle
Tendonitis, especially in the Achilles
Low back pain
Shoulder pain

To decrease your chances of injury, there are some things you can do. The biggest step you can take is to avoid going from no activity to full out competition. Try to maintain a basic level of fitness through general aerobic activity, strengthening, and stretching throughout the week. If you know what type of sport you’ll be participating in, adding in some sport-specific conditioning is a good idea. 

In addition to maintaining a basic level of fitness, here are a few other tips specifically for the weekend warrior:

Build your activity level slowly If you’ve taken a layoff over the winter, build up slowly to your first 5k, or the spring softball season

Give yourself time for a proper warm up A dynamic warm up is best, including some jogging or other aerobic activity to get your heart rate up, along with some high knees, braiding, butt kicks, or toy soldiers will get your body ready for activity

Stretch when you’re done Research has shown that static stretching before activity probably doesn’t have much benefit, but stretching after has been shown to reduce soreness and help recovery

Make sure your technique and equipment are up to par Poor equipment can put you at higher risk for injury. If your technique is off, especially in sports like golf or tennis, you can be at higher risk for injury. A visit with a physical therapist or coach can help correct issues. 

Don’t push through pain Some soreness after an increase in activity is normal, but if it doesn’t go away, gets worse, or is severe, get it checked out. 

If you’re having pain, suffered an injury, want help designing a training program to get you ready to compete, or just want a physical to make sure you’re ready for activity, a visit with a physical therapist is a good idea. 
 

When you kick off a new project at work, chances are you spend a fair amount of time setting and reviewing goals. These goals help you—and those you’ll be working with—get a clear sense of what you’re looking to achieve and begin to map out a plan of attack. Along with specific goals, you also probably find it helpful to set some key milestones to ensure that you stay on task and to prevent your motivation from waning.

These same principles apply when going to physical therapy for an injury. Communicating what you hope to get out your therapy sessions can help your physical therapist to individualize the treatment plan and design an exercise program that aligns with your goals. The idea is to move from “I’m here because my knee hurts” to “I’d like my knee to feel better so I can get back to doing X, Y and Z.”

Let’s talk about a concrete example to illustrate goal-setting in action: A father of three ruptures his Achilles tendon while playing a game of pickup basketball after work. When he lands in rehab, he explains to his PT that he’s due to walk his oldest daughter down the aisle at her wedding in a few months. This gives the PT a specific goal—and a timeline—to aim for. Of course, not every patient has a goal tied to such a momentous occasion. It can be as simple as carrying your groceries to your car unassisted or lifting your grandchild into a high chair. Either way, it’s important to have goals—and to communicate them clearly to your physical therapist.

Your PT wants you to get better but without the right guidance from you, he might default to following a checklist and design a program that unknowingly misses your goals. Only you know precisely what you want out of PT: If you have a wrist injury and getting back to your knitting hobby is important to you, then be specific! Another patient could come in with the same injury but have completely different goals, so guide your PT to help you achieve what’s most important.

Proper communication ensures success, and that means you can’t passively participate in your care and simply listen to what the PT recommends. Instead, communication needs to be a two- way street. So next time you’re at physical therapy, speak up: Make sure that your PT knows precisely why you’ve made the appointment, what you hope to get out of it and why it’s important to you. This information not only helps your PT make important decisions about your care but also to think of new ways to keep you motivated during therapy.

If you find yourself making an appointment to see a physical therapist for a new injury or a nagging pain, make sure that you prepare in advance. Being prepared to answer this one simple question can help to ensure that rehab is a success: What brings you to physical therapy today? After all, you wouldn’t walk into a kickoff meeting at work without first giving some thought to the goals that you planned to share with your team, would you?

Recently we have seen a rise of diseases in children that in the past had only been seen in adults. Things like obesity, type 2 diabetes, and high blood pressure are being seen more frequently in children. One of the best ways to combat the rise of these diseases is to make sure that your kids are getting enough physical activity.

The Department of Health and Human Services has developed guidelines recommending that youth ages 6-17 participate in 60 minutes or more of physical activity 7 days/ week. This is total activity time, so 1 hour, 2 30 minute sessions, or 4 sessions of 15 minutes each in a day would all satisfy this recommendation. Most of this activity should be at either moderate or vigorous intensity.

An easy way to distinguish vigorous vs moderate intensity exercise is as follows:

Moderate intensity allows you to talk but not sing during or right after activity

Vigorous intensity allows you to say only a few words at a time

As part of the 60 minutes daily, it is recommended that children participate in muscle strengthening activities 3 days/wk and bone strengthening activities 3 days/wk. Some activities that would fit into these categories are listed below:

Muscle Strengthening Activities

Games like tug of war 
Climbing playground equipment
Push ups, pull ups, or sit ups
Activities like crab walking, bear walking, or wheelbarrow with a partner

Bone Strengthening Activities

Hopscotch
Jumping rope
Skipping
Sports that include jumping like basketball or volleyball

To get and keep kids participating, physical activity should be fun and incorporated into playful activities that are age appropriate. Being involved in physical education in school is important, especially if children are not involved in extracurricular activities that meet the requirements.

Summer camps can be a great way to keep kids active during summer vacation.

For more information check out:

https://health.gov/paguidelines/midcourse/youth-fact-sheet.pdf

https://www.cdc.gov/healthyschools/physicalactivity/facts.htm

Turning the page on the new year is a chance to wipe the slate clean—and to be better versions of ourselves. And when it comes to what we want to improve, goals that fall in the health and wellness arena top all other New Year’s resolutions. In fact, three of the top four resolutions in a 2018 YouGov poll were health-related: eat healthier (1), get more exercise (2) and focus on self-care, e.g., get more sleep (4).

There are three types of people who choose a goal from the health and wellness category as a New Year’s resolution: the resolution newbie, the resolution master and the resolution flunkee. Let’s see which category you most identify with—and how focusing on the right strategy can help you get healthier in the new year.

Resolution Newbie. Maybe this is your first time making a commitment to your health and wellness. Good for you! Did a recent event like a health scare or loss of a loved one make you see the light? Or perhaps you want to be more active to enjoy activities with your grandchildren or to carry your own bag on the golf course. Whatever your goals are, taking that first step is a big one so you’ll want to be sure that you’re prepared for the challenge. Particularly when exercising for the first time or returning to an active lifestyle after a long hiatus, it’s important to have the proper information and tools to be successful. And that means tapping the healthcare resources available to you: Clinicians like nutritionists and physical therapists can make sure that your body is prepared to take on new challenges and work with you to a design a program that will help you achieve your goals.

Resolution Master. Perhaps you fall into a different camp: You vowed to get healthy in 2018 and you achieved it! For 2019, your resolution is to continue the work you’ve begun. After all, living a healthy lifestyle is a lifelong commitment; it’s not something you do for a while and then revert back to your former habits. As you prepare to embrace the new year, are there any small tweaks you can make to advance your goals? Maybe you’re thinking about training for and running a half marathon, but don’t know where to begin. A physical therapy evaluation is a great place to start—PTs are trained to assess your movement patterns and identify any limitations or weaknesses. Based on that information, the PT can design a personalized exercise program to help you safely and effectively prepare for the grueling half marathon course.

Resolution Flunkee. Let’s say your plan for 2019 is to get in better shape and improve your overall health (we support that resolution!), but this isn’t your first rodeo. Your 2018 resolution was pretty similar but it’s one year later, and you’re in the same place you were on New Year’s Eve 2017. What stood in your way—was it time? Affordable options? Access to healthy choices and activities? If any of these barriers sound familiar, then along with your resolution, you need an action plan. Without planning ahead, you’ll find yourself staring down the year 2020 with the same goal in mind. But let’s not focus only on the negative—what went right last year? Maybe you made sleep a priority, which in turn helped you to make better food choices at breakfast but by afternoon, you found yourself choosing to energize with a soda and candy bar when all you probably needed was an apple and a 15-minute walk. Take some time to think about the previous year—good and bad—and take with you what you need, and leave the rest behind. Afterall, you can’t plan where you’re going without understanding where you’ve been.

Which resolution type are you?

You know exercise is important to your health. It helps you feel better physically, gives you energy, and helps you deal with the stress of your busy life. 

But what do you do when life gets too busy to take an exercise class, go for a run, or get to the gym?

It’s easy to start skipping exercise when life gets busy, but that leads to less energy, and aches and pains cropping up. This makes you feel like exercising even less, and leads to a downward spiral. That means that finding time to exercise when life is busy is even more important.

If you can find 8 minutes, you can maintain your strength even on your busiest day. 

Exercise doesn’t have to take lots of time. In fact, your 8 minutes don’t even have to be all together. You can break them up throughout the day. Doing one exercise for one minute every hour while at work counts just as much as doing 8 minutes of exercise after the kids are in bed and before you collapse on the couch. The following exercises use your body weight for resistance, so you don’t need any equipment. They also use many muscle groups at onces so you can maintain strength in your whole body in a short amount of time.

1. The plank; Lying on your stomach, with your forearms on the ground, elbows under the shoulders, and arms parallel to the body. Toes tucked under, engage your stomach muscles and lift your body up. Hold for 20 seconds, rest 5 seconds, and repeat 3 times.
2. Push up; (do on your knees if you need an easier version). 20 seconds of push ups, 10 seconds of rest and repeat.
3. Quadruped -Start on your hands and knees with your hands under your shoulders, and you knees under your hips. Lift and reach with one arm and the opposite leg, maintaining a stable core. Hold 10 seconds and repeat on opposite side. Repeat 5 times.
4. Bridge; Lying on back, with your knees bent, engage your abdominals and lift your hips. Hold 20 seconds, rest 5 seconds, and repeat 3 times.
5. Lunge; Stand tall and take a large step forward with the right leg, shifting your weight forward. Lower your body until the right thigh is parallel to floor and your right shin is vertical. (do not let the knee shift past right toe). Return to the start and repeat on the other side. Repeat 20 times.
6. Squat to heel raise; Feet shoulder width apart, core engaged and arms raised high above the head. Perform a squat and return to standing then rise onto your toes. Repeat 20 times.

#preventpain #staystrong

Payless recently conducted a very telling social experiment. You probably heard about the shoe chain’s stunt in the news but just to recap quickly, “The Payless Experiment” tricked consumers into buying their typically budget-friendly shoes at sky-high markups. To carry out the clever ruse, the discount retailer invited style influencers to a (fake) launch party for a new high-end label in one of Los Angeles’ glitziest shopping areas. The attendees believed that they were buying fashionable, high-quality footwear and therefore didn’t object to the three-figure price tags.

Aside from being a brilliant marketing ploy for Payless, what lessons does “The Payless Experiment” have for our current healthcare system, and specifically for patients suffering from low back pain? The experiment is a commentary on perceived vs. real value but also how easily people can be swayed into believing that something is reliable as presented. Think about someone who has had weeks of pain and dysfunction stemming from low back pain: she wants to find a solution that will relieve her symptoms. If a physician presents surgery as the best option—and she’s assured that her pain will go away—then it’s going to sound appealing, right?

Today’s consumer has so many choices when shopping for just about anything from apparel to healthcare. But while it’s customary to shop for the best price for a goose down jacket (without sacrificing quality), shopping around for the best solution (and value) for our ailments is less typical. Doing our due diligence in healthcare may ultimately bring us back to the first proposed solution, but it also may introduce us to solutions that we didn’t know existed.

In the case of low back pain, one such under-heralded solution is physical therapy. Physical therapy, yoga and acupuncture are gaining in popularity as equally (or more) effective and less costly than surgical procedures, injections, MRIs and pain relievers—and for good reason.

Physical therapists are trained to restore and improve patients’ mobility, reduce soft tissue pain, improve function and build muscle strength. They not only develop custom strategies to treat persistent or recurrent low back pain, but educate patients on the prevention of future issues. Some preventive techniques include adopting and following a regular exercise program and learning to lift correctly by keeping the object close to the body.

As the holidays kick into high gear, you likely have a long list of gifts to buy. I’m willing to guess that you have a strategy in place for selecting appropriate gifts for each recipient. As you match the right price point, size and color to each person on your list this holiday season, think about approaching your healthcare needs with the same level of scrutiny. After all, finding the right solution at the right price for our health needs contributes to improved long-term outcomes and better piece of mind.

Got back pain? You’re not alone. Eighty percent of Americans suffer from low back and neck pain at some point in their lives. Let that sink in. With such great odds that you—or someone close to you—will one day become a statistic, wouldn’t it make sense to arm yourself with preventive strategies and knowledge? Physical therapy is a good place to start.

By performing a thorough evaluation, a physical therapist can identify the muscular, postural and skeletal limitations that could one day lead to an episode of back pain. As part of the assessment, she will observe as you perform a series of exercises and then gather an account of your daily activity level and environmental factors like operating machinery or working at a desk 40 hours a week.

The PT will then use all of this knowledge to design a personalized exercise program and teach you a few APTA-approved strategies to prevent back pain:

• Use good body positioning at work, home and during recreational activities.
• Keep the load close to your body during lifting.
• Ask for help before lifting heavy objects.
• Maintain a regular physical fitness regimen—staying active can help to prevent injuries.

Lifestyle can play a big role in back pain. In fact, inactivity and incorrect body mechanics while participating in certain activities are two of the biggest contributors to back pain. In addition to the strategies listed above, it’s also helpful to pay attention to little things throughout your day that could add up to bigger problems down the line. Let’s go back to that desk job for a minute: How often do you get up to walk, stretch and move throughout the day? A good rule of thumb is to stand up or move every 30 minutes. You may get bonus points with your boss, too, as your productivity soars due to the increased activity.

While low back pain rarely becomes serious or life-threatening, it can be quite painful and interfere with our daily lives. Working with a physical therapist can help patients identify the factors that might contribute to back pain and help to develop a prevention plan. But the healthcare professionals are also a great place to turn when you’re seeking treatment for back pain or hoping to prevent a recurrence.

With such good odds that you could one day become a low back pain statistic, why not do everything in your power today to change your trajectory? Seems like another good reason to find an activity (or better yet, two or three activities) that you enjoy, make it a regular part of your day and stick to it!

Today’s physical therapy was successful by all measures: Your PT spent time listening to your symptoms, collected a thorough medical history, diagnosed your issue (tennis elbow), and sent you on your way with a bunch of exercises to do at home. During the appointment, you watched intently as the physical therapist demonstrated each home exercise and you understood the directions clearly at the time. There’s just one problem: Now that you’ve returned home, you can’t seem to replicate the exact elbow positioning that elicits the desired stretch. And the exercise handout isn’t helping.

To make matters worse, you’re headed out of town for the weekend and the PT clinic can’t accommodate you for an in-person appointment until next week. During that time, you have two options: Continue doing the exercise how you think it should be done and risk doing it incorrectly—and possibly doing harm—or not doing the exercise at all until you’re able to see your therapist.

Wouldn’t it be helpful if there was a way to show your PT what you’re doing—without leaving your house—so he could pinpoint the source of your problem and help you to adjust your movements for maximum benefit? That’s precisely the type of experience that telerehabilitation could bring to physical therapy. Being able to get timely and accurate feedback from a rehab professional can improve your chances of a quick and safe recovery.

Now you’re probably asking, “Why didn’t my PT tell me about this?” Well, telerehab is not (yet) a mainstream offering for physical therapy, but all signs indicate that more clinics will get on board in the coming years once they’ve tackled the regulatory and reimbursement issues. At some clinics, patients with certain diagnoses are given the option to schedule a “virtual visit” with their physical therapists. There also are a growing number of services that provide patients with a series of injury-appropriate videos—with clear demonstrations of the exercises that should be completed at home. This is just a sampling of the many ways that telemedicine will help to ensure that patients perform their home exercise programs correctly.

You’re probably familiar with the age-old notion that practice makes perfect, the very idea that proficiency of a particular activity or skill comes with regular practice. But in the case of rehabbing from an injury or illness, Vince Lombardi said it best: “Practice does not make perfect. Only perfect practice makes perfect.” And the hope is that telerehab is just what the therapists need to ensure that their patients adhere to their prescribed home programs and complete their exercises safely and accurately.

You’re sitting in your living room and glance at the clock: just five minutes until your physical therapy appointment is scheduled to start. You still need to lace up your shoes, grab your wallet, jump in the car and drive 10 miles across town. The walk from the parking alone will take five minutes! How will you ever make it on time?

With rapid advances in telehealth technologies, this scenario could soon become a thing of the past—at least for some of your physical therapy visits. Instead of racing out the door, it’s possible that soon you’ll be able to flip on a telerehabilitation system from your living room. While the arrival of telemedicine in the rehab world doesn’t mean that your care will be delivered entirely through a screen, it does mean that you’re likely to have fewer in-person appointments with your physical therapist.

While we still don’t know exactly what telemedicine will look like for physical therapy—or when it will become a mainstream offering—we do know that the benefits for both patients and clinicians are numerous. The #1 benefit that draws patients to telehealth services of any kind is convenience. Here are a few ways that televisits could make physical therapy appointments more convenient for patients:

1. Saves precious time. Time spent traveling from the home, office or school to the physical therapy clinic (and back again) can really add up. While the time saved by visiting with a physical therapist virtually varies from patient to patient, who doesn’t need extra time (even five minutes!) to fold laundry, complete a homework assignment or answer the boss’ email?
2. Puts more greenbacks in your wallet. Traveling to the outpatient clinic costs money— whether you travel by foot (sneakers and other appropriate attire), car (gas and parking), or by bus, train or rideshare service (fare). Other factors to consider are childcare costs and the wages lost by potentially missing work.
3. Keeps stress levels in check. The details involved in getting to a physical therapy appointment can be stressful, especially for those with competing priorities like childcare responsibilities or travel barriers like unreliable transportation.

In today’s world of e-retailers and smartphones, convenience is important to consumers. Today’s consumers can use an app to have groceries delivered to the home in less than an hour or ask a voice assistant to play their favorite songs without getting up from the couch. Naturally the demand for a similar experience is spilling over into healthcare.

Beyond the obvious advantages of cost savings and convenience, telehealth technology would allow PTs to observe, guide and educate patients to ensure that they complete their home exercise programs and other rehab-related goals on-schedule and safely.

To access the complete mareting toolkit associated with this article, including a press release, social media posts, and shareable images, visit the PPS Marketing Resources page.

Is the source of your low back pain a mystery? You’re not alone: Nine out of 10 patients don't know the primary cause of their back pain. The problem is that most people seek treatment after they’ve begun exhibiting symptoms of back pain. While this may seem logical on the surface, we’re here to tell you that there’s a better way.

The key is to go to a physical therapist before you begin to see the signs and symptoms of back pain. I’m sure that right about now you’re asking, “Why would I do that?” One, because physical therapists are trained to recognize the physical dysfunctions that may one day lead to back pain. And two, because eight out of 10 Americans suffer from low back pain at some point in their lives, so the chances are good that you could become a statistic one day.

Seeing a physical therapist on an annual basis is one of the most effective ways to prevent back pain from occurring in the first place. Doesn’t that sound like the better alternative? Great, now that you’re on board, let’s talk about what you can expect during that annual physical therapy appointment. The first time you go, your physical therapist will collect a complete picture of your medical history. During subsequent visits, it’ll be important to update your physical therapist about any changes to your health during the previous 12 months, but it won’t be necessary to review your entire medical history again.

Next, your physical therapist will perform an examination using a variety of tests and measures including a movement screen. A movement screen is a screening tool that’s designed to identify imbalances in your mobility and stability that may contribute to limited function or other impairments. This gives your PT the ability to see how your back, hips, core, shoulders, knees and ankles perform during a series of carefully selected exercises.

The information gathered during an examination helps your physical therapist to identify changes from one year to the next, a critical step in assessing your risk for back pain and a host of other debilitating conditions. If a problem is identified early enough, then your physical therapist is better equipped to discuss preventive measures instead of designing a treatment plan. And that’s how you identify the root cause of back pain and derail issues before they even begin. Mystery solved.

To access the complete mareting toolkit associated with this article, including a press release, social media posts, and shareable images, visit the PPS Marketing Resources page.

Recently we have seen a rise of diseases in children that in the past had only been seen in adults. Things like obesity, type 2 diabetes, and high blood pressure are being seen more frequently in children. One of the best ways to combat the rise of these diseases is to make sure that your kids are getting enough physical activity.

The Department of Health and Human Services has developed guidelines recommending that youth ages 6-17 participate in 60 minutes or more of physical activity 7 days/ week. This is total activity time, so 1 hour, 2 30 minute sessions, or 4 sessions of 15 minutes each in a day would all satisfy this recommendation. Most of this activity should be at either moderate or vigorous intensity.

An easy way to distinguish vigorous vs moderate intensity exercise is as follows:

Moderate intensity allows you to talk but not sing during or right after activity

Vigorous intensity allows you to say only a few words at a time

As part of the 60 minutes daily, it is recommended that children participate in muscle strengthening activities 3 days/wk and bone strengthening activities 3 days/wk. Some activities that would fit into these categories are listed below:

Muscle Strengthening Activities

1. Games like tug of war
2. Climbing playground equipment
3. Push ups, pull ups, or sit ups
4. Activities like crab walking, bear walking, or wheelbarrow with a partner

Bone Strengthening Activities

1. Hopscotch
2. Jumping rope
3. Skipping
4. Sports that include jumping like basketball or volleyball

To get and keep kids participating, physical activity should be fun and incorporated into playful activities that are age appropriate. Being involved in physical education in school is important, especially if children are not involved in extracurricular activities that meet the requirements. Summer camps can be a great way to keep kids active during summer vacation.

For more information check out:

1. https://health.gov/paguidelines/midcourse/youth-fact-sheet.pdf
2. https://www.cdc.gov/healthyschools/physicalactivity/facts.htm

To access the complete mareting toolkit associated with this article, including a press release, social media posts, and shareable images, visit the PPS Marketing Resources page.

Some health habits are instilled in us at a young age. For as long as you can remember, for example, you made annual treks in the family minivan to both the pediatrician and the dentist. As you entered adulthood, you probably transitioned to a primary care physician, and maybe even a different dentist better equipped to address adult needs. Anytime you’ve moved or switched insurance carriers, one of your first priorities has been to track down new providers. Now you may even choose to schedule visits more than once a year, when necessary. You probably figure that between the two healthcare professionals, all of your health needs are covered, right?

As it turns out, these healthcare professionals aren’t specifically trained to assess your musculoskeletal system, which is comprised of your muscles, bones, cartilage, tendons, ligaments, joints and other connective tissues. Then who is the right healthcare professional to ensure that these essential internal structures are working properly and helping to support, stabilize and move your body? A physical therapist.
At a yearly physical therapy “checkup,” your PT will gather your medical history and observe as you participate in screening tests and other assessments to establish a baseline of your physical abilities, fitness level and personal health. Physical therapists are educated on how your musculoskeletal system functions properly and are trained to identify dysfunctions before they grow into bigger problems.

To maximize the encounter with your physical therapist, it’s important to be prepared before your appointment. To ensure that you cover everything and address any issues you may be having, make a list that includes:
• Health issues like diabetes or high blood pressure • Current medications, including supplements • Physical fitness activities • New activities you’re considering • Fitness goals
The information exchange between you and your PT is critical to forming an ongoing relationship, and to ensuring that you’re functioning and moving at top form. By understanding what sports and recreational activities you’re currently participating in and the fitness goals you’re aiming to achieve, your PT will be better prepared to make recommendations and tailor a home exercise program designed to help you achieve your goals.

Making wellness a part of your everyday life and taking steps to ensure that your musculoskeletal system is functioning at top notch can be very empowering and rewarding. Why not begin—or continue—that journey with a physical therapist? Now that you know how to prepare for a physical therapy checkup, and understand what you can expect during the appointment, the next step is to call and schedule your annual visit.

To access the complete mareting toolkit associated with this article, including a press release, social media posts, and shareable images, visit the PPS Marketing Resources page.

It is becoming more popular for young athletes to specialize in a single sport. The advantages seem obvious. Putting in more time early and “outworking” the competition should lead to a better chance of success later right? Even though that seems to make intuitive sense, early specialization may not be giving kids the advantages parents think and comes with some risks.

The Advantages

The obvious advantage is skill acquisition. Baseball players use the off-season to work on hitting or pitching mechanics, basketball players work on their shooting, and tennis players might work to develop their serve. Specific skills like these do take time and repetition to develop. Athletes who spend more time developing them will likely have more skill. But what are the costs?

The Disadvantages

Focusing on specific skill acquisition comes at the cost of overall athletic development. Athletes who participate in many sports gain more athleticism and tend to have more strength, balance, speed, and agility.

Athletes who participate in a variety of sports give their bones, muscles, and tendons exposure to a wide variety of forces. Athletes who specialize early have more repetitive stress that puts them at a higher risk of injury.

Specializing early in a sport puts athletes at risk of burnout and psychological fatigue. When athletes participate in club sports, travel teams, or extra off-season practice for the wrong reasons or when they’re not fully invested mentally and emotionally, it can be detrimental. Athletes who suffer psychological burnout are much more likely to lose interest in their sport, or even worse - physical activity in general.

Lastly, research has not supported the idea that early specialization leads to long term success. In fact, it shows the opposite. A study of international athletes looked at the time that they began specialization. It found that the elite athletes played multiple sports during their developmental years (defined in the article as 11 and younger). Near-elite athletes specialized at a younger age. The study concluded that waiting to specialize until the athlete reaches physical maturity could be more likely to result in elite status. A study of Olympians came to the same conclusion. A 2014 survey by the USOC found that Olympians averaged 3 sports per year from ages 10 - 14, and 2 sports per year from 15 - 18.

Conclusion

Early specialization may lead to earlier acquisition of sport specific skills, but comes with multiple disadvantages:

1. Focusing on specific skills comes at the cost of developing general athleticism
2. Athletes who specialize early have a higher risk for injury
3.  Early specialization is associated with burnout
4. Elite athletes and Olympians tend to have been multi-sport athletes who specialized late, indicating that early specialization does not lead to long-term success

For athletes who aspire to play at collegiate or higher levels, specialization becomes necessary at some point. While the right time to specialize will vary from athlete to athlete, there are some guidelines.

1. An athlete’s age can be used to gauge how many hours a week they should be practicing a specific sport (A 12 year old should spend no more than 12 hours a week on a certain sport)
2. For most sports, waiting until an athlete has reached skeletal maturity is generally recommended
3. Specialization should happen when the athlete chooses to do so, without external pressures

To access the complete mareting toolkit associated with this article, including a press release, social media posts, and shareable images, visit the PPS Marketing Resources page.

Let’s talk about the last time you—or someone close to you—interviewed for a new job. Chances are that the first step was a phone screen with your potential employer, and when you passed that portion of the process with flying colors, you were then invited for an in-person interview. At that stage, the employer probably asked you to answer a series of questions and to demonstrate your skills through a test or two. The process is set up in a way that narrows down the options until the most suitable candidate is found. Makes sense, right?

Just as job recruiters screen applicants to find the best fit for an open position, your PT will ask you to perform a series of exercises so that she can observe and understand your body mechanics to uncover any issues or limitations. Used in combination with a full evaluation and assessment, these so-called movement screens are just one tool in identifying the most appropriate treatment or prevention program for you. But unlike that test you may have taken during a job interview, the screen is not testing your skills or abilities, it’s simply a way of identifying how your body functions during a variety of movements.

Now that spring is in full swing, it’s the perfect time of year to make an appointment with your physical therapist for a movement screen. The warmer weather means more time spent outdoors participating in sports and other recreational activities that may be physically demanding. A PT checkup that includes a movement screen will ensure that you’re physically able to engage in popular spring and summer adventures, whether it’s exploring in the woods, tending to your garden, or swimming at your family’s lake house.

Physical therapists perform movement screens for a variety of reasons, including:

• • To identify areas of strength and weakness
• • To uncover issues or rule them out
• • To determine readiness to begin a safe exercise program
• • To improve sport performance (for both novice and elite athletes)

A movement screen is something that you can have done whether you have a nagging injury or are simply ready to kickstart your activity level after a long hiatus. Gaining an understanding of how your body performs during basic exercises such as squats and lunges helps your PT ensure that you can safely jump on a bike or into a pool this summer. And just like an employer screens candidates to identify the one individual who is likely to thrive on the job for many years to come, a movement screen can help you develop a lasting and fulfilling relationship with the activities you enjoy most.

To access the complete mareting toolkit associated with this article, including a press release, social media posts, and shareable images, visit the PPS Marketing Resources page.

Basketball is the most popular youth sport in the US. A study by the National Athletic Trainers Association found that 22% of male basketball players have an injury that causes them to miss playing time each year. 42% of the time, that injury is to the ankle or foot, making this the most injured area.

Some other common injuries to basketball players include:

Lower Extremity

1. Muscle strains such as a groin pull, quadriceps, hamstring, or calf strain
2. Knee ligament injuries such as ACL, LCL, MCL tears or sprains
3. Ankle sprains, including high ankle sprain
4. Ankle fractures
5. Overuse injuries such as patellar tendonitis, IT band pain, shin splints

Upper Extremity

1. Falls, leading to fractures, dislocation, or sprains of the wrist, elbow, or shoulder
2. Jammed fingers

Head

1. Concussion as a result from a collision between head and the ground, usually from falling

Knowledge of the most common types of injuries gives us a place to start thinking about prevention. While not all injuries can be prevented, there are some things parents and players can do to reduce the risk of being injured.

1. Have an annual physical completed by a physical therapist or other qualified professional

   This should include baseline testing of strength, ROM, and a baseline concussion test

2. Make sure you have an adequate base of strength and aerobic fitness

   The annual physical mentioned above should identify areas needing addressed here. Your PT or other professional can help design a training a program to address your specific needs

3. Improve your balance and proprioception - this can help reduce the risk of the foot and ankle injuries so common in basketball

   This can be accomplished with off-season strength and conditioning as well as participation in injury prevention programs to work on jumping and landing skills

4. Avoid overuse injuries and burnout

   Taking time off throughout the season and the year will let the body recover

5. Hydrate adequately before and during practice and games

6. Wear properly fitted shoes

7. Be aware of the environment

   Especially when playing basketball on outside courts - the court may not be smooth and even everywhere.

To access the complete mareting toolkit associated with this article, including a press release, social media posts, and shareable images, visit the PPS Marketing Resources page.

You know exercise is important to your health. It helps you feel better physically, gives you energy, and helps you deal with the stress of your busy life.  

But what do you do when life gets too busy to take an exercise class, go for a run, or get to the gym? 

It’s easy to start skipping exercise when life gets busy, but that leads to less energy, and aches and pains cropping up. This makes you feel like exercising even less, and leads to a downward spiral. That means that finding time to exercise when life is busy is even more important.  

If you can find 8 minutes, you can maintain your strength even on your busiest day.  

Exercise doesn’t have to take lots of time. In fact, your 8 minutes don’t even have to be all together. You can break them up throughout the day. Doing one exercise for one minute every hour while at work counts just as much as doing 8 minutes of exercise after the kids are in bed and before you collapse on the couch. The following exercises use your body weight for resistance, so you don’t need any equipment. They also use many muscle groups at onces so you can maintain strength in your whole body in a short amount of time.  

1. The plank; Lying on your stomach, with your forearms on the ground, elbows under the shoulders, and arms parallel to the body. Toes tucked under, engage your stomach muscles and lift your body up. Hold for 20 seconds, rest 5 seconds, and repeat 3 times. 

2. Push up; (do on your knees if you need an easier version). 20 seconds of push ups, 10 seconds of rest and repeat. 

3. Quadruped - Start on your hands and knees with your hands under your shoulders, and you knees under your hips. Lift and reach with one arm and the opposite leg, maintaining a stable core. Hold 10 seconds and repeat on opposite side. Repeat 5 times. 

4. Bridge; Lying on back, with your knees bent, engage your abdominals and lift your hips. Hold 20 seconds, rest 5 seconds, and repeat 3 times. 

5. Lunge; Stand tall and take a large step forward with the right leg, shifting your weight forward. Lower your body until the right thigh is parallel to floor and your right shin is vertical. (do not let the knee shift past right toe). Return to the start and repeat on the other side. Repeat 20 times.  

6. Squat to heel raise; Feet shoulder width apart, core engaged and arms raised high above the head. Perform a squat and return to standing then rise onto your toes. Repeat 20 times. 

#preventpain #staystrong 

The posts on the Marketing Blog are intended for the use of physical therapists and physical therapy clinics. PPS members are free to utilize any content on this blog in their clinic's respective websites and newsletters. You can simply copy & paste from the blog itself or download the word documnent template from the Marketing Resources area of the PPS website. 

The joys of a family vacation can be overshadowed by the ‘pain’ of hauling excessive luggage, sleeping in a different bed and extended periods of sitting. Here are our favorite tips to keep you feeling your best while traveling so you can enjoy your destination.

Take breaks while driving

Every hour or two, stop and walk for a few minutes. It’s also not a bad idea to do some standing back extensions. Sitting places your spine in a flexed position, so moving it the opposite direction can prevent pain.

Support your back

If you’re going to be sitting for extended periods, like on an airplane, using lumbar support can keep you more comfortable. A lumbar roll, or small pillow works well placed between the seat and the small of back. Using a rolled jacket or blanket is another good option.

Choose the right luggage

Suitcases with wheels let you avoid lifting and carrying. If you’re flying, check your bags to avoid the overhead lifting. A backpack that can be worn on both shoulders makes a great carryon and is easier to handle than a bag you can only use one hand on.

Dress to move

Comfortable shoes and clothes let you walk when you have the opportunity. If you have down time, like waiting at the gate at the airport, or waiting for your hotel room to be ready, use the opportunity to take a walk instead of sitting.

Pillow talk

If you have a long flight, train or car ride where you plan to sleep, use a neck pillow. This helps you avoid sleeping with a twisted neck, then waking up in pain. If you’re worried about the comfort of the pillows at the hotel, don’t be afraid to bring your own.

Listen to your body

Vague discomfort is often a warning sign that you need to move!

Don’t take a vacation from exercise

Maintain your usual activity level. Research local exercise facilities before you head to a new town, take your running shoes, and travel with your theraband and foam roller. The more you can maintain your activity level, the less likely you are to end up in pain.

With these tips, you should be able to arrive at your destination feeling ready to enjoy your time with your family instead of in pain, stiff, or sore.

To access the complete mareting toolkit associated with this article, including a press release, social media posts, and shareable images, visit the PPS Marketing Resources page.

Chances are that you probably haven’t given much thought to how your neck and back are faring in the era of the smart phone, but studies show that you most certainly should. It’s practically a reflex these days to pull out our smart phones when we’re standing in line, sitting at the airport or riding the subway. And while it’s great that we rarely need to venture beyond our pockets for entertainment, our bodies are beginning to retaliate—and mourn the pre-texting days. So, what exactly are these contemporary conveniences doing to our bodies? A surgeon-led study that published in Surgical Technology International assessed what impact surgeons’ head and neck posture during surgery—a posture similar to that of smart-phone texters—has on their cervical spines. With each degree that our heads flex forward (as we stare at a screen below eye level), the strain on our spines dramatically increases. When an adult head (that weighs 10 to 12 pounds in the neutral position) tilts forward at 30 degrees, the weight seen by the spine climbs to a staggering 40 pounds, according to the study. 

How pervasive of a problem is this? According to the study, the average person spends 14 to 28 hours each week with their heads tilted over a laptop, smart phone or similar device. Over the course of a year, that adds up to 700 to 1400 hours of strain and stress on our spines. As a result, the number of people dealing with headaches, achy necks and shoulders and other associated pain has skyrocketed. Trained to address postural changes and functional declines, physical therapists are well-versed in treating this modern-day phenomenon, widely known as “text neck.”

Over time, this type of poor posture can have a cumulative effect, leading to spine degeneration, pinched nerves and muscle strains. Scheduling an appointment with a physical therapist can help people learn how to interact with their devices without harming their spines. The PT will prescribe an at-home program that includes strategies and exercises that focus on preserving the spine and preventing long-term damage.

Exercise is an important part of taking care of our spines as we age, but what we do when we’re not in motion matters, too. So next time you pick up your smart phone or curl up with your e-reader, do a quick check of your head and neck posture. Your body will thank you for years to come.

To access the complete mareting toolkit associated with this article, including a press release, social media posts, and shareable images, visit the PPS Marketing Resources page.

Are you among the millions of Americans who have high aspirations for how you’ll spend the extra time during your post-retirement years? Whether you plan to travel the world, pick up fly fishing, spend more time woodworking or sign up for a golf league, your physical fitness level will be a factor.

A 2010 study suggests that the fitness declines we typically attribute to advancing age are largely caused by living sedentary lifestyles—which are on the rise due to the prominence of desk jobs in the workplace and activity-limiting personal technologies including smart phones and voice-activated remote controls in the home. Still, this runs contrary to the widely held belief that any declines in our physical abilities are caused solely by biological aging. Do we really have control over how active we’ll be in our “golden years”?

In a word, absolutely. The study—which examined 900,000 running times of marathon and half-marathon participants aged 20 to 79—found no significant age-related performance declines in those younger than 55 years old, and only moderate declines among the older cohorts. In fact, more than one-quarter of runners aged 65 to 69 were faster than half of the runners aged 20 to 54.

And for those thinking that these runners must have been lifelong enthusiasts of the sport, the study revealed that 25% of runners aged 50 to 69 were relative newcomers—and had started marathon training within the previous 5 years. The researchers concluded that even at an advanced age, people in the “non-athlete” category who engage in regular training can reach high performance levels.

If this revelation is intriguing, then perhaps it’s time for you to get moving! If you aren’t currently active, then you likely have questions and concerns about where to start. And if you regularly engage in physical activities, then you’ve probably set goals that you’d like to achieve. Either way, there’s no shortage of tools and resources to help you live a more active lifestyle but one reliable place to start is with a physical therapist.

The benefits of beginning with a physical therapist consultation are many: PTs are trained to assess your abilities and limitations, consider your health concerns, demonstrate safe exercises and build a plan to increase strength, function and mobility. Whatever your passion is, physical therapy will help you be fit and injury-free so you may enjoy life’s many pursuits.

To access the complete mareting toolkit associated with this article, including a press release, social media posts, and shareable images, visit the PPS Marketing Resources page.

When the calendar year comes to a close, we often find ourselves physically and mentally depleted from the holidays and the end-of-the-year rush. It’s no wonder that three of the most common self-improvement resolutions uttered as the clock strikes midnight are: eat more healthily, lose weight and commit to a regular exercise program.

January is a great time to press the restart button and revisit our ongoing quest to be better versions of ourselves, and not just because the longstanding New Year’s Eve tradition tells us to. Each year, however, Americans struggle to turn the goals they’ve set out for themselves into long-term change. In fact, according to Statistic Brain Research Institute, of the 41% of Americans who make resolutions each year, just 9.2% successfully achieve their objectives.

When it comes to committing to a regular exercise program, don’t become a statistic! For those looking to make exercise a regular habit, enlisting help in achieving your goals is one way to ensure success. You might consider recruiting an exercise buddy (to make you accountable), using a calendar app to schedule workouts (to dedicate time in your day) or consulting a healthcare professional (to supervise your program and keep you safe).

Physical therapy is a great resource for those interested in beginning a new exercise program or overcoming a nagging injury. Rehab professionals are trained to assess limitations and dysfunction, teach proper body mechanics and prevent—and treat—injuries. Your physical therapist will ask about any issues you’re encountering, evaluate your functional abilities, gather a thorough medical history and discuss your fitness and activity goals.

One rule of thumb is to start slow—particularly if you’re trying a new form of exercise or haven’t been active for some time. And once you start to form the habit of regular activity, mix it up by engaging in multiple activities rather than focusing on one. Many lingering injuries occur because of overuse or repetitive stress, most often at the hands of participating in one activity—such as running or biking—exclusively.

If you’re experiencing pain, inflammation or weakness, make an appointment to be evaluated by a physical therapist. The movement specialist will assess and identify the cause of the nagging injury and teach you how to modify your behavior to distribute stress to different parts of the body and reduce the repetitive nature of your movement patterns.

But that doesn’t necessarily mean putting your resolution to exercise regularly on hold. Your PT can work with you to identify an appropriate fitness program, including the safest frequency, intensity and duration of each workout session. The best part? There will be no excuses because you’ll have all the tools you need to be make this your most fit year yet.

To access the complete mareting toolkit associated with this article, including a press release, social media posts, and shareable images, visit the PPS Marketing Resources page.