injury prevention

A Physical Therapist's Guide to Snow Shoveling Safety

Hello, everyone!

As a physical therapist, I’m here to share some important tips about snow shoveling. It’s a common winter chore, but if not done properly, it can lead to some aches, pains, and or injuries. So, let’s dive in!

Choosing the Right Shovel:

The first step to safe snow shoveling is choosing the right shovel. Look for one with a curved handle. This can help you keep your back straighter while shoveling.

Also, a smaller blade will require you to lift less snow, reducing the strain on your body.

Warm-Up Exercises:

Before you start shoveling, it’s important to warm up your body.

Try marching in place or walking for a few minutes.

Follow this with gentle stretching exercises for your back, arms, and legs to prepare them for the activity ahead. 

Your Physical Therapist can help you identify any specific stretches or areas to stretch that would benefit you most.

Proper Lifting Techniques:

When you’re shoveling, remember to lift with your legs and not your back.

Stand with your feet hip-width apart for balance and keep the shovel close to your body. Bend from the knees, not the back, and tighten your stomach muscles and buttocks as you lift the snow. Avoid twisting movements. If you need to move the snow to one side, reposition your feet to face the direction the snow will be going.

Potential Risks and Injuries:

Improper snow shoveling can lead to various injuries. These include strains and sprains, particularly in the back and shoulders. In severe cases, it can cause heart-related illnesses like heart attacks.

Remember, it’s a strenuous activity that raises your heart rate and blood pressure. Always listen to your body and stop if you feel pain or discomfort.

Watch for Overexertion:

Overexertion is a serious concern when shoveling snow. Be sure to take frequent breaks and drink plenty of water. If you feel any signs of overexertion, such as dizziness, sweating excessively, or shortness of breath, stop shoveling immediately and seek medical attention.

Conclusion:

Snow shoveling is a necessary part of winter for many of us, but it’s important to do it safely. By choosing the right shovel, warming up, using proper lifting techniques, understanding the risks, and watching for overexertion, you can keep yourself safe this winter season.

If you have any questions, please contact your physical therapist for further guidance.

Stay safe and warm out there!

Orchestrating Care: Advanced PT at Lawrence University

 

The team behind the Lawrence University Conservatory

 

As the physical therapist serving music students at her alma mater, Amber Lisowe knew what question was coming first. She answered it before it was even asked.

“No, I don’t have any musical skills. None whatsoever.”

Her patients at Lawrence University don’t really care. They are less concerned with any musical predisposition she might share with them and more interested in the skills she brings diagnosing and treating their musculoskeletal issues.

And those issues can be considerable.

“These students are practicing and playing for hours, every day,” said Lisowe. “Imagine being in these athletic positions, using your arms and hands, your back, for that long.”

Her use of the term “athletic” is deliberate.

“There are a lot of similarities between collegiate musicians and their counterparts on the field,” Lisowe said. “Both are passionate, and both deal with injury.”

While Lisowe might deem her history of musical pursuits minimal, her athletic undertakings were anything but. A multisport athlete in high school, Lisowe went on to play basketball at Lawrence. As with many athletes who follow the path toward a career in the medical sciences, Lisowe was familiar with injury.

“At Lawrence, I tore my ACL,” said Lisowe. “Twice.”

The first happened early in her freshman season, a devastating blow but one she was determined to overcome. An ACL tear is a season-ending injury with a rehabilitation period of 9-12 months, but Lisowe was passionate about her sport and getting back to it as quickly as possible.

There’s a period of mourning, Lisowe says, that can last until you’re back on the hardwood. The rehab process means you don’t get back to practicing on the court for a full five months. By this time, any concerns of re-injury were the furthest thing from her mind.

“I’d already done running things in therapy, some jumping and cutting, so by the time you get a ball in your hands, your body just kind of takes over and falls into those routines,” Lisowe said. “When you’re back to playing competitively, your focus has shifted from thinking about the leg itself to the dynamics of the game.”

Lisowe would tear her other ACL in her senior year.

“With the first injury, I knew I could work hard and return for my sophomore season. This time there was no next season for me. Definitely a big thing,” she said.

Those serious injuries led to firsthand physical therapy experiences, which in turn kindled Lisowe’s burgeoning interest in the field. Following Lisowe’s time at Lawrence (she graduated with her Bachelor of Arts from Lawrence in 2014), she went on to earn her Doctor of Physical Therapy degree from Rosalind Franklin University of Medicine & Science. She joined Advanced Physical Therapy soon after to work in their Neenah clinic.

The opportunity for Lisowe to work with Lawrence University Conservatory of Music students happened when LU’s longtime physical therapist, Advanced PT’s Phil Sorensen, looked to cut down on his hours. Lisowe jumped at the chance to return to Lawrence.

“Coming from a smaller town, Lawrence was such a great place for me to find myself,” said Lisowe. “The growth and experiences I had there, the friendships I made, really helped shape who I am today. Athletics got me on campus, but the academics and everything Lawrence offers is what really drew me in.”

Lisowe now finds herself at Lawrence one hour a week, providing physical therapy sessions for her student-patients. She sees a range of musicians—freshmen to seniors, flute to clarinet, oboe to piano—with a variety of orthopedic issues.

“A lot of what I do is helping them to manage their pain, figure out what’s causing it, getting them stronger and finding the best positions to hold their instrument,” she said. “There’s not a certain group of people that appear to be more at risk. I enjoy training and teaching them all.”

Sorensen, who worked with LU’s music students for nearly a decade, describes the experience there as unique.

“There’s just such joy there. These students will walk out of a session and begin playing their horn, and stuff like that. It’s just a really cool atmosphere. It makes you young again.”

Lisowe too recognizes the special nature of the gig, one that gives as much as it gets.

“I just love being back here. I think it was meant to be,” she said. “I love being able to make a difference for such a diverse group of talented individuals.”

Mentioning the variety of students she helps, Lisowe notes the common trait all these musicians possess. And despite being “non-musical,” it’s a characteristic she shares with them, as demonstrated throughout her athletic career.

“They are all very motivated to get better so they can continue doing what they love,” said Lisowe.

Click here to learn more about Amber and Phil and the clinics they serve at in addition to their responsibilities at Lawrence.

The impact of Athletic Trainers in Industrial Medicine

Heidi demonstrates a simulated pull during a post-offer test to assess the employees ability to perform their job duties.

Advanced PT’s Heidi Bohl had the opportunity recently to share her experiences as an industrial athletic trainer to college students on the AT track in South Carolina. The college seniors who comprised her audience have been the beneficiaries of a number of presenters who highlighted a variety of topics related to pursuing a career in athletic training, but this was their first exposure to industrial athletic training.

While there are many paths open to those earning an athletic training degree, the majority make their debut in organized athletics (secondary schools, colleges, etc.). Already employed at the YMCA when she joined Advanced Physical Therapy & Sports Medicine, Bohl was initially hired for on-call work, covering for full-time athletic trainers to provide care to high school and middle school athletes as well as to club team participants.

Bohl enjoyed the work but made clear to her audience the importance of considering options and thinking about what is most important to each individual as they continue their education and pursue their career goals

“The schedule of a high school athletic trainer isn’t necessarily conducive to raising a family,” Bohl said. “My husband and I knew we wanted kids, and I wanted to be home for them.”

Bohl continued with part-time efforts at both jobs until her position at the YMCA was eliminated due to COVID; to replace those missing hours, she looked to the bourgeoning field of industrial rehabilitation, where companies hire providers to deliver healthcare services onsite to their employees.

It just so happened her current employer was a leader in the delivery of industrial onsite services. And because of the growth in that area, Advanced was looking for additional providers.

“Rob Worth (President of Advanced PT) knew me through the PRN work I had done, and we discussed the kinds of services Advanced was performing at companies,” Bohl said. “We both thought it would be a great fit for me.”

Advanced PT works with over 60 industrial companies, who employ physical therapists, physical therapy assistants, occupational therapists, occupational therapy assistants, and, of course, athletic trainers from Advanced to deliver the services necessary to keep employees at their best. The idea driving the model is simple yet profound: reduce the time and money lost to a company by reducing employee injury.

“We look at the employees at our companies as industrial athletes,” said Bohl. “Our presence onsite allows them to work safely at their job and enjoy life outside of work.”

Bohl’s skill set is vast, and good thing, as there are a multitude of areas on which to focus, including early intervention services, job testing, injury prevention, ergonomics, and wellness initiatives, to name a few. Programs are customized by the employer; they choose what best fits their needs and objectives.

After three years in industry, Bohl now dedicates all her hours to a single employer. She’s available onsite, naturally, but she’s also available by phone, text and email when not onsite to discuss injuries and determine plans of care.

“We promise opportunities for access to care within 24 hours if we aren’t onsite, which includes access to orthopedic providers we partner with,” said Bohl. “That kind of rapid response is a win-win scenario for employees and the employer.” Typically, companies utilizing the onsite model will see a reduction in OSHA recordable injuries by at least 50%, along with significant reductions in healthcare costs from both work-related and non-work related injuries. Bohl covered a lot of information in her thirty-minute presentation, but she saved a few minutes at the end for questions.

“Can you discuss the importance of developing rapport with the employees and understanding the company culture?”

“It’s vital,” said Bohl. “You have to know your employees and know how to interact with them. I provide services at a concrete and construction company. My dad was a general contractor. My uncle does concrete for a living. This is just a natural fit for me.”

If students didn’t understand the concept of variety in the world of industrial athletic training at the beginning, they sure were on board at the end.

“You’ll be on the floor, moving from area to area, employee to employee, encouraging people to come talk to you if they have questions, then you’ll head back to meet with the employees who made appointments to see you. Afterwards, you’ll be at a safety meeting sharing data and ROI; following that, it’s time to perform a jobsite analysis and then an ergonomic evaluation,” said Bohl.

After a busy day that included many of the aforementioned tasks plus the Zoom presentation to prospective industrial athletic trainers located a thousand miles away, Bohl was back at her full-time job, the primary focus of which revolves around getting her children to and from a plethora of practices, games and competitions.

She has a vast mom skill set too.

Baseline Concussion Testing

Untitled design (24).png

Ben Benesh, PT, SCS

What is a concussion?  The Center for Disease Control and Prevention (CDC) definition:

“A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.”

According to a Pediatrics study from 2016, it was estimated that between 1.6 and 3.8 million sports concussions occur annually in the United States. Concussions can happen in sport during a violent head to head collision in football or taking a charge and hitting the back of your head in basketball. They can be sustained during a whiplash-type injury in a flyer during a competitive cheer stunt or when a young athlete takes a volleyball spike to the head or face. Besides the obvious appropriate post-concussion management for these athletes, a proper baseline concussion test is key in the successful return to school and sport.

High school-age athletes are baseline concussion tested as a Freshman and again as a Junior. They are usually tested in school by their athletic training team. The group that needs the most attention are the elementary and middle school-aged children, that do not have access to athletic training staff, and do not have school-based concussion baseline testing. These kids are still playing sports, including collision type sports that put them at risk for a concussion. Over the last 7 years of treating patients following a concussion, I have seen plenty of soccer and football athletes, but have also treated basketball players, volleyball players, wrestlers, competitive cheer athletes, and even swimmers! In order to treat these patients as effectively as possible following a concussion, baseline testing is crucial.

In healthy athletes, baseline concussion testing includes concussion education, past head injury medical history, baseline ImPACT neurocognitive computer testing, baseline vestibular/oculomotor screening and assessment, and baseline balance assessment. These objective measurements will be saved and used following a concussion to determine if your athlete is back to “normal” following injury and can safely return to their sport they love to do.

In this crazy time dealing with the COVID-19 pandemic, sporting events are delayed or canceled and then rescheduled without notice. The training schedule may not be as consistent or as intense as previous years as kids are quarantined or had exposure to COVID-19 or coaches are unable to secure facilities to practice. Parents are often not even able to watch their children play sports because of spectator restrictions in gyms. All of these reasons make this year unique. But the truth is, concussions still happen during a pandemic and we need to be best prepared to give our young athletes the best care possible if they sustain a concussion.

Please contact us for more information or to schedule your Baseline Concussion Test at our Appleton North or Community First Champion Center clinics!

Baseline Concussion Testing (1).png

References

https://www.cdc.gov/headsup/basics/return_to_sports.html

McCrory et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. BJSM April, 2017

Elbin et al. Removal From Play After Concussion and Recovery Time. Pediatrics August, 2016

Speed and Agility Training

spot-runs-start-la.jpg

David Reybrock, MPT

Speed and agility are primarily associated with athletes training for sport; but it also occurs in our everyday activities. We are all athletes in one form or another. Whether you are in a sport, involved in recreation, participate in regular exercise, walk a dog, or play with your children; speed and agility training can help enhance your movement skill acquisition and functional mobility.

As movement specialists, Physical Therapists can use speed and agility training to provide stability by varying speeds of motion and body position.  Everyone can benefit from improved balance, quicker feet, and faster reaction time.  Speed and agility in youth can be used for injury prevention, promote exercise participation, and improve physical fitness.  Speed and agility in elderly can be used to improve coordination, prevent falls, and maintain independent living.  Adding speed and agility to an exercise routine or treatment program can help you move more efficiently and effectively.  

What is Speed, what is Agility?

Speed is defined as the ability to move the body in one direction as fast as possible. Training for speed requires strength in the arms and legs to propel your body forward. The muscles in the back of the thigh and leg create triple extension- forceful extension of the hip, knee, and ankle joints. The gluteus maximus muscle of the hip; hamstring muscles of the knee; and gastroc-soleus muscles of the ankle are the muscles used to run faster.

Agility on the other hand, is the ability to accelerate, decelerate, stabilize, and quickly change directions with proper posture. Agility training focuses on performing a variety of movements in a quick manner. It is not simply going as fast as you can, but rather adjusting movements while going as fast and as steady as possible. Training for agility requires good balance and a strong core to support the body as it moves through all three planes of motion.

The combination of speed and agility training should be used to develop movement skills that include acceleration, deceleration, dynamic balance, and change of direction. In developing these skills, appropriate stability, mobility, and sequencing of movement patterns is important for training athletes and treating patients in physical therapy.

Here are some examples of speed and agility drills that can be used to train athletes and treat patients to be able to speed up, slow down, and change direction more efficiently:

Sprints or walking. Run or walk as fast as possible from a standing still position. The distance will vary based on ability and sport specificity. Add change of speed, stop and pivot turns, head movement, inclines or declines to incorporate agility.

High knees wall drill. With arms extended forward and hands on a wall for stability, alternate knees to hip level up and down as fast as possible. For agility, remove hands from the wall and perform with opposite arm swing and change of speed.

Static balance. Sit on a stability ball, stand with a wide or narrow BOS, or single limb stand.

Dynamic balance. Seated balance with arm and leg movement. Tandem forward walking, side-stepping, and carrying objects while walking.

Cone drill example:

Pro-Agility: 20-yard line sprint, 5-10-5
Purpose: Improve the ability to change direction by enhancing footwork and reaction time.
Procedure: Place each cone 5 yards apart. Start in a two-point stance at the starting line, the center cone. Sprint to the end line and touch with your hand. Turn back and sprint to the far cone (10 yards) and touch the line. Turn back and sprint 5 yards through the start line to the finish.

first.jpg

Image- https://mishockpt.com/speed-and-agility-training/

Agility Ladder drill example:

2 feet out, 1 foot in.

feet.png

Image- https://i.pinimg.com/564x/97/db/15/97db15d22b150e4585a1caa89056b39a.jpg

Plyometrics: Jump, leap, and hop.


References:

Clark, M.A., Sutton, B.G., Lucett, S.C. (2014). NASM Essentials of Personal Fitness Training, 4th Edition, Revised. Burlington, MA: Jones and Bartlett Learning.

Osteoarthritis of the Thumb CMC Joint

NL Blog photo.jpg

Written by: Tammy Vanevenhoven PT, DPT, CHT

As the season of fall hovers over us and the leaves begin to fall, the temperatures outside continue to fall as well. For those who suffer from arthritic hands stiffness and pain, it can quickly be felt by the changes in the temperature. Osteoarthritis is the most common of all joint diseases. It often affects the larger weight-bearing joints of the hips and knees, but it also commonly affects the smaller joints of the hands; especially the base of the thumb called the CMC joint (carpometacarpal joint). The CMC joint of the thumb is considered a saddle joint that allows the thumb its vast ability to grasp objects of various shapes and sizes, to open doors, jars, and packages, etc. It also allows pinching-- a more precision type movement for writing, buttoning, using scissors, picking up small objects or turning a key. We need our thumbs as they contribute to 60% of our hand function.

Signs and Symptoms of CMC joint arthritis are:

*pain at the base of the thumb after activity

*pain with active movement of the thumb especially with pinch

*morning stiffness

*joint tenderness to palpation

*crepitus (crunching noise in the joint) with thumb movement

*joint deformity with bony nodules felt at base of thumb

*weakness of hand grip (opening a jar, sealed packages, etc.) or with pinch (writing, buttoning, turning a key, etc.)

How is CMC joint arthritis diagnosed?

Usually a standard radiographic x-ray will show joint space narrowing, bony changes such as spur formation, and joint erosion. Based on the x-ray, the arthritic changes are usually classified as mild, moderate, or severe joint destruction.

What can be done non- surgically to help the painful arthritic thumb?

A certified hand therapist (CHT) or an occupational therapist can be of great help in alleviating pain in the arthritic thumb by fabricating a thumb spica splint that stabilizes the base of the thumb while still allowing use of the thumb tip for light pinch and grip activities. Stiffness can be reduced by using a paraffin bath that is composed of paraffin wax and mineral oil which is then melted to a therapeutic warm temperature which molds around the bony prominences of the hand to help soothe pain and improve movement of the joint. Your hand therapist will also educate you on joint protection by recommending built up handles on objects that are difficult to grip such as tools, scissors, writing and eating utensils. Key adapters can also be placed on your keys to allow ease with key pinch. An electric can opener can also be used to avoid stressing the arthritic thumb with a manual can opener. Protecting the hands from the cold weather is very important. Wearing mittens and using warming packs if you like to be outdoors will help keep your hands from getting stiff and painful while you cross country ski, ice fish or while taking a winter hike.

What does the surgery for CMC joint replacement entail?

CMC joint arthroplasty is the most common joint replacement of the arthritic hand. The beak ligament reconstruction, or the LRTI, is the most common surgical procedure performed. The hand has, thankfully, many muscles that perform the same function. They are called “spare parts.” The eroded CMC joint is removed and one of these extra tendons of the hand/wrist is sacrificed and bundled up to fill in the joint space at the base of the thumb. Patients are placed in a cast and often external pins are inserted for extra immobilization.  At four weeks the cast and pins are removed, and the patients are placed in a forearm-based thumb spica splint and sent to therapy to see a certified hand therapist or an occupational therapist that specializes in treatment of the hand. Therapy includes gentle progressive range of motion to restore normal movement of the thumb, fingers and concurrent wrist; which becomes stiff from being in the cast. Swelling control and pain management are treated by working on scar mobility to avoid tendon adherence. Hypersensitivity often occurs from the surgeons having to retract the superficial radial nerve to perform the operation. Therapists can ease this sensitivity by performing desensitization exercises to calm the nerve pain. Restoring functional hand strength while appreciating joint protection and education of patients for life-long care for the arthritic thumb are just some of the various ways your hand therapist can help.

If you would like more information in treating your arthritic hands you can call Advanced Physical Therapy and ask to speak to a certified hand therapist or occupational therapist that can assist you in answering your questions. APTSM New London phone: (920)982-0100.