Physical Therapy Month Spotlight—Dr. PJ Christopherson, DPT

Dr. PJ and family: Sarah, Cooper, Declan & Micah

It would give us no greater pleasure than to shine the spotlight on EVERY one of our providers in October, otherwise known as National Physical Therapy Month, but that ain’t going to happen.

This is a blog, not a book.

So we are choosing to introduce you to PJ Christopherson, and not just because of what he brings to our practice.

He had us with the first sentence that came out of his mouth.

“Yeah, I really tried to talk myself out of going into the PT profession. Because of my mom.”

Wait, what?

A Shawano native, Christopherson grew up with physical therapy. No, this is not an injury story. His mother, physical therapist Jean Darling, has been a fixture in the community’s health and fitness scene for a lifetime. Suffice to say Christopherson had significant exposure to all things PT.

“My mom lived and breathed physical therapy, so I was around it a lot,” Christopherson said. “But for some reason—and I’m not sure what that reason was—I thought of doing something else. Maybe I just didn’t want to pick something because my mom did.”

Christopherson nevertheless found himself gravitating to the health field. His high school anatomy class was an early inspiration; later, an introductory course on health careers at UW-La Crosse revealed the variety of career opportunities beyond PT that were available to him.

Following completion of the course, a turning point.

“Not sure I’d call it closure, but I had this acceptance that PT could actually be something I could see myself doing,” Christopherson said. “Maybe it was on my radar all along.”

Fast forward, Christopherson would earn his bachelor’s degree in Exercise & Sports Science and then (of course!) his Doctorate of Physical Therapy, both at UW-La Crosse. Newly engaged, Christopherson and his wife Sarah moved to the Milwaukee area, where she attended graduate school and he began his career at a small private physical therapy practice.

Not that he didn’t consider other options, including one at Advanced PT, the very place where his mom practiced and thrived.

“Fresh out of school I actually interviewed with (Advanced PT president and co-founder) Rob Worth for a job,” Christopherson said. “At that point, I felt like branching out a bit, doing my own thing.”

A year later, the couple—he from Shawano and she from La Crescent, MN—had the desire to get back to a smaller community. A job at Advanced PT’s Ripon clinic became available, so the Christophersons found themselves headed right where they hoped they’d be.

Now Clinic Director, Christopherson divides his time serving patients in several capacities. He works with his patients at the clinic on Eureka Street, which also happens to be the near-site clinic for the Ripon Area School District (RASD). Advanced supplies PT services to all RASD employees and is part of the care team delivering high-quality, low-cost care to the district since they recently transitioned to a self-funded health care plan.

The relationship began when the district’s primary care physician needed space. His arrival at 402 Eureka Street resulted in conversations (Advanced PT assists several districts with their healthcare via direct contracts) that led to the establishment of the near-site clinic with a range of providers, part of the district’s overall strategy to reduce costs by offering health services to employees free of charge.

“Being part of this means we can really help people on a community-wide level,” Christopherson said.

Christopherson also finds himself as part of the industrial team at Advanced, providing onsite physical therapy, injury management and rehabilitation services to employees at a manufacturing company in a nearby community.

“With these relationships, we’re more than just a provider of services,” Christopherson said. “We’re part of these communities, growing with them and making them stronger.”

Speaking of growing, the Christophersons are the proud parents of three young children; recently they moved to a larger house to accommodate the needs of the family and the extra space they were looking for. They both love where they live (Sarah is a home health occupational therapist), a beautiful area of closely knit communities with small-town values, thriving and upbeat downtowns, a wide variety of recreational opportunities and the convenience of being close to larger metropolitan areas.

“My Milwaukee friends joke that I live in the middle of nowhere,” Christopherson said. “No way. I live in the middle of everywhere!”

Compared to his Milwaukee experience (he also completed a physical therapy internship with the Milwaukee Brewers, providing orthopedic evaluations for prospects at their spring training facility in Arizona), Christopherson finds his current schedule just as jam-packed, perhaps even more so.

He wouldn’t have it any other way.

“I’m in the clinic four days, then one day a week I’m onsite, so I see a little bit of everything, neck to jaws, knees to ankles to shoulders, vertigo patients,” he said. “If you walk in the door, I will see you for X, Y or Z.”

That ability to treat a wide variety of patients is perhaps a gift from his mother, whose resume is ridiculously robust. The fact that he chose to follow in her footsteps makes her very happy, which has upsides when you have a three, two and one-year-old.

“Mom comes down from Shawano every week to babysit,” he said. “That’s been a game-changer.”

—

To learn more about Dr. PJ and/or the Ripon clinic, click here.

Providing Experiences for the Next Generation of Professionals

Getting people back to what they love is the job of an athletic trainer. Ensuring there are plenty of high-caliber graduates ready to serve active populations is the job of universities and colleges, whose programs provide interactive learning environments that will prepare students to enter the profession.

Advanced Physical Therapy & Sports Medicine (APTSM) plays a vital role in the process.

“It’s important we offer internships and job shadowing opportunities for those on the path to becoming athletic trainers,” said APTSM’s Traci Tauferner. “The field is projected to grow 25% by the end of the decade.”

While there is a broad range of settings for the athletic trainer—physician practices, professional sports, clinics specializing in sports medicine, occupational health, and performing arts, to name a few—the vast majority of graduates will enter the field’s most traditional setting: schools.

That’s where Tauferner started out after earning her athletic training degree at UW-Oshkosh. With a robust resume developed since her graduation—she’s the Director of Industrial & Tactical Medicine at Advanced—Tauferner now devotes time both to her administrative duties as well as to the onsite therapy services she delivers at multiple locations.

Tauferner is committed to bringing attention to industrial athletic training, especially as the need for athletic trainers to prevent, evaluate, manage, and rehabilitate conditions faced by workforces—directly at companies and municipalities—continues to grow.

“Achieving injury prevention and cost control in this day and age for the industries and tactical groups we serve is not just a desired outcome,” said Tauferner. “In many cases, it’s a matter of survival.”

More than 55 Wisconsin companies and organizations utilize Advanced PT’s hallmark program of onsite wellness solutions. APTSM’s dedication to workplace health and safety has contributed to recognition at local, state, and national levels.

That kind of focus includes providing learning opportunities for those interested in pursuing a career in the field, and Tauferner is passionate about students understanding the paths available to them.

“It’s important for us to provide these experiences for the next generation, especially so in the bourgeoning industrial and tactical realms, as fewer than 5% of graduates are going into those sectors,” she said.

The connection between APTSM and Tauferner’s alma mater remains strong, as evidenced by UW-Oshkosh student Cade Littleton’s recent experience.

Littleton, a senior in the Masters of Athletic Training Program, spent the summer working through four specific rotations: clinical, hospital, professional team, and industrial/tactical.

Littleton said a few football injuries (“some hip and shoulder pain, but nothing huge like a blown ACL”) led him to seek treatment. Though his high school didn’t have a traditional athletic trainer, a nearby orthopedic group supplied the small school with a physical therapist, and Littleton found himself fascinated by the PT’s skills.

“I was just very interested in what he did, so much so that I actually job shadowed him for one of my classes,” said Littleton. “That set me on the PT path, but once I got to school and got a little more experience with athletic training, I became drawn to that, to work with a younger and highly active population.”

To meet the requirements of the program, one of Littleton’s rotations had him paired with Tauferner.

“This was actually the third time I had met Traci,” said Littleton. “I met her following a presentation she did on mental health, then at the WATA (Wisconsin Athletic Trainers’ Association) conference this year.”

For two weeks Littleton followed Tauferner’s schedule (“yeah, she starts early”), which included stints with the tactical groups she services.

“It was cool to see the firefighters and police officers and how they handle things at their own facilities,” said Littleton. “It was a lot different than my traditional experiences.”

With those tactical groups, Tauferner gave Littleton the opportunity to do full evaluations; she provided guidance, talking Littleton through treatment options and giving him the chance to “do his own thing.”

“Traci allowed me to do a lot more hands-on than I expected, so that was really cool,” he said.

He also learned about Tauferner’s use of and advocacy for modern cupping techniques.

“Just how she used cupping and explained it so it made sense to the client was very interesting,” said Littleton. “That helped me a lot because I’m still a student trying to figure this stuff out.”

Asked about key takeaways following the rotation, Littleton doesn’t hesitate.

“The experience pushes me to continue to learn, to ask questions, and to demand respect as Traci does.”

Littleton admitted he’d like to replicate the demeanor Tauferner exhibited throughout their time together.

“Traci’s vibe is straight confidence,” said Littleton. “The setting doesn’t matter.”

Summer rotations are complete, Littleton is now working with UW-O’s athletic trainer for 2023 football season. Set to graduate next May, Littleton is currently leaning towards working in the high school or college setting, but he’s not ruling anything out.

“I’m not 100% sure yet,” said Littleton.

If uncertain about his job setting, Littleton expresses a clearer view in the geographic sense.

“I’m up to moving,” he said. “I’m not a huge fan of winter.”

—

If you or a student you know is interested in experiencing what Advanced does every day, contact us today!.

Trail Blazer to Trailblazer

Ray Mack is inducted into the St. Francis High School Hall of Fame by Dr. Deborah Kerr, Superintendent of Schools, on December 9, 2022

Many physical therapists have an injury story that contributes to a career path.

But most don’t include a connection to a legendary Wisconsin team whose mad dash to a national championship helped make March Madness what it is today.

Ray Mack of Advanced Physical Therapy & Sports Medicine vividly recalled a high school football injury from six decades ago that led him from athlete to athletic trainer.

“As defensive end, it was my job to get crushed first on a student body left,” Mack said. “Hurt my back and that was it. To continue participating in sports, I decided to become a student athletic trainer.”

And the rest, they say, is history. A history that includes the improbable journey with the Marquette Warriors basketball team from 1973 through 1977.

Understand that at the time of Mack’s injury, circa 1970, athletic training was in its infancy: it was the coaches who primarily handled injuries to their athletes. Outside of football hotbeds like Texas, the presence of athletic trainers was few and far between.

The year after Mack’s injury, he became the student trainer at St. Francis High School and would continue for the remainder of his high school career.

“I wanted to continue participating in sports and I had the aptitude for the health and medical stuff,” said Mack.

As a result of his performance, the St. Francis football coach obtained a scholarship for Mack to Marquette University as a student athletic trainer, which also allowed him to attend physical therapy school there. He covered multiple sports at the university including soccer, wrestling and cross country/track. Ray was also one of the first student athletic trainers for the new Marquette University's Title IX women’s sports program.

It was Division 1 college basketball, however, that powered the engine that was Marquette sports.

“I was blessed to be part of the national championship at Marquette in 1977 under legends Al McGuire, Hank Raymonds, Rick Majerus, and Bob Weingart,” said Mack. “All Hall of Fame members.”

While many know the names of the coaching legends, Mack highlighted Weingart’s impressive resume, which included 38 years as Marquette’s head athletic trainer as well as trainer for the USA track team in the 1972 Olympics.

“He was the man at Marquette,” said Mack. “Working with Bob was both an honor and an opportunity.”

It was during Mack’s senior year stint as the Warriors student athletic trainer when he was told he couldn’t continue with the basketball program during his second semester, as he was being sent to New York for his physical therapy residence—exactly when Marquette would make their run to college basketball’s ultimate prize.

Though Mack didn’t exactly appreciate the timing of the move, he later came to appreciate the wisdom of the choice his advisors made, sending him to areas that took him well beyond his identified niche in sports medicine.

“As a function of that experience, I became through my VA tenure an amputee specialist and a medical surgical clinic specialist,” said Mack. “It broadened my horizons dramatically.”

After 45+ years as a physical therapist, Mack continues to treat patients, specializing in the non-operative treatment of orthopedic-related injuries of the spine/pelvis and extremities. His personal interests are as vast as his medical pursuits and include photography, website development, history, learning theory and aquatics.

Oh, throw in mustaches and Hawaiian shirts too.

Mack described his work as an athletic trainer and physical therapist not as an occupation but a vocation, something he was meant to do in life. And while there is plenty to look back upon, there’s much more ahead.

“I'll do this for as long as I feel like I can contribute and make a difference.”

Near-Site Care for School Districts

Advanced Physical Therapy & Sports Medicine's location at 402 Eureka Street is part of a multi-specialty clinic delivering high quality, low cost services to Ripon Area School District employees in 2023.

Only a generation ago, you’d be hard-pressed to find a school district in Wisconsin self-funding their health insurance.

Oh, how times have changed.

About 40% of school districts statewide are now self-funded, and that number continues to trend upwards. With self-funding, employers pay for claims out-of-pocket as they are presented instead of paying a pre-determined premium to an insurance carrier for a fully funded plan.

In essence, the employer becomes the insurance company.

One of the most recent to join the ranks is the Ripon Area School District (RASD), which will go self-funded in 2023. They will add a near-site medical clinic as well, with multiple care providers including a primary care physician, cardiologists, an orthopedic surgeon, and physical therapists available free to RASD staff.

Advanced Physical Therapy & Sports Medicine, a leader in direct contracting and onsite/near-site physical and occupational PT care, will supply the physical therapy at the near-site clinic.

School districts must be laser-focused on the cost of health care, generally the second biggest budget outlay after salaries. With rising health care costs, districts know that money has to come from somewhere, and the simple truth is this: when revenue doesn’t increase and the cost of health care and operations does, those dollars will come from just about every student-centered program in the district.

Becoming wise consumers of health care is on every district’s and employer’s agenda—looking at data, doing their homework, finding the best care at the best cost—so money that is saved can go to the education of students, facility needs, or employee cost of living increases.

To learn more about the money-saving steps being taken in Ripon and other districts across the state, read Bethany Gengler’s article from the Ripon Commonwealth Press here:

https://www.riponpress.com/news/ripon-area-school-district-will-make-switch-to-self-funded-insurance/article_873ec986-605e-11ed-a2af-17529821152a.html

Content Link Block

Select a page and create a visual link to it. Learn more

Blog

October is National Physical Therapy Month!

By Adam Wirtz, PT, DPT

In celebration of Physical Therapy month, I thought it would beneficial to share some facts about our profession:

Physical therapists (PTs) are movement experts who optimize the quality of life through prescribed exercise, hands-on care, and patient education.  PTs and the licensed physical therapist assistants (PTAs) may team up to provide care across the lifespan to anyone of any ability.

There are many benefits to physical therapy. Some of these include the following:

Ø It can maximize your movement. PTs can identify, diagnose, and treat movement problems.  Pain-free movement is essential for good quality of life, your ability to earn a living, and your ability to remain independent.

Ø Personalized care that meets your specific needs.  PTs design individualized treatment plans to address each patient’s needs, challenges, and goals.  PTs and PTAs improve patient mobility, manage/decrease pain and other chronic conditions, recovery from injury/surgery, and aim to prevent future injury and chronic disease.

Ø Accessibility.  PTs and PTAs provide care in a variety of settings, including hospitals, private practices, outpatient clinics, homes, schools, sports and fitness facilities, work settings, and nursing homes.  During these uncertain times during the pandemic, choosing to see a PT first can help to reduce patient traffic in physician offices.  This can allow physicians to focus more on caring for patients that are more critically ill or are at risk of becoming critically ill from COVID-19 or other illnesses such as influenza.  It also means that you do not have to risk being around patients at a hospital or clinic that may possibly be ill with a contagious pathogen.

Ø Active participation in care.  PTs and PTAs empower and motivate people to be active participants in their care.  They also work in collaboration with other medical professionals to make sure patients receive high-quality care.

Ø Reduces the use of opioids.  In certain situations, when dosed appropriately, prescription opioid medications can be an appropriate part of medical care.  However, current CDC guidelines are urging medical providers to consider safer alternatives to opioids like physical therapy for most long-term pain.  Opioids have several risks including depression, overdose, and addiction, plus withdrawal symptoms when stopping use.

Ø Avoid surgery.  Before undergoing expensive or invasive surgery, consider physical therapy first.  There is mounting evidence that physical therapy can be as effective or in some cases even better than surgery for conditions such as meniscal tears and knee osteoarthritis, rotator cuff tears, spinal stenosis, and degenerative disk disease.

Now that you are aware of some of the benefits of PT, let’s address the topic of direct access.

Did you know that you have the freedom to choose your own physical therapist?

Ø  Currently, you may be evaluated by a PT without a physician’s referral in all 50 states and the District of Columbia.  In addition, all 50 states and the District of Columbia allow some level of treatment by a PT without a physician’s referral.  This is referred to as “direct access” to physical therapy services.

Ø  Some insurance policies may require you to see a primary care provider or physician prior to seeing a physical therapist.  Also, some insurers may limit your access to preferred providers only.  Contact your insurance company to make sure you are aware of any of these policies.

Ø  If you have Medicare as your primary insurance, you are able to see a PT for an evaluation without a physician’s referral.  The PT would then send the plan of care to the patient’s physician for signature.  Once this is signed treatment can be continued.

Ø  Your physician may refer you for physical therapy that is provided in the physician’s office, or to a facility in which the physician has a financial interest.  However, you are not obligated to attend PT in any specific facility or location.  You can choose where you would prefer to attend physical therapy and which licensed physical therapist you would like to see if you have a preference.

Now that you know all about the benefits of PT and your ability to choose your physical therapist, the next time you have an aching knee, a bum shoulder, a sore heel, or an injured lower back, consider finding a physical therapist first to help you get back to moving well!

Our clinics are low traffic, safe environments that allow for continuity of care for those individuals that may not be able to get into their doctor’s office, especially during the COVID-19 pandemic.  We have implemented deep cleaning protocols and patient screening procedures to minimize the risk of infected individuals entering our clinics.

You can find a physical therapist by checking out our website at www.advancedptsm.com

A Return to Physical Activity & Sports During COVID-19

Kyle Schumacher, PT, DPT, LAT

COVID-19 has turned our world upside down. Sadly, it has taken many lives and negatively impacted many others. It prematurely ended the Winter sports season, canceled the Spring sports season, closed down gyms, studios, and weight rooms, and left people scrambling to purchase at-home exercise equipment.

It’s been about five months since our lives were upended, and unfortunately, the virus isn’t going anywhere. Agree or disagree, the state begins to re-open and along with that - gyms, studios, weight rooms, exercise classes, and sports participation. Whether you saw the inches around your waist grow or rushed to purchase every piece of in-home exercise equipment before it vanished, you more than likely are not in the same shape you were months ago. As a healthcare professional, I want to stress that it would not be wise to rush back to the same intensity, sets, reps, and the weight you were doing at the end of February.

Here at APTSM, we want to emphasize a smart, thoughtful, and phased approach to return to exercise and sports participation to decrease the risk of injury and help the body acclimatize to the environment. Planning should include a gradual return taking 6+ weeks. Also, take into account the temperatures have changed drastically since March, and the body needs to accommodate exercising outside of climate-controlled space to avoid heat illness.

Gradual Return (1, 2)

-        Start with an activity level around 25-50% of your pre-pandemic level, including your training frequency, volume, and intensity.

-        Focus on low to moderate intensity for the first couple of weeks.

-        Adjust workload/volume by about 10-20% each week

-        Take frequent rest breaks during sessions

-        As the body adjusts, add frequency or duration

Environmental Acclimatization (3)

-        Allow your body to gradually get used to the heat over 10-14 days

-        Avoid 2-days for the first 5 days of outdoor exercise

-        Keep practices and workouts to less than 3 hours per day

-        Sports using protective equipment should gradually add pads over the 14-day period

-        Two-a-days should not begin until day 6. The first practice should not exceed 3 hours and should be followed by a 3-hour break. Total practice time should not exceed 5 hours.

-        Complete the full acclimatization period

Hopefully, these recommendations will help guide you in your return to physical activity/exercise and sports. Please do not hesitate to reach out to one of our APTSM locations for further guidance or recommendations. You can also schedule an injury risk assessment with one of our healthcare professionals at the APTSM – Champion Center for a total body screening and assessment and performance training classes.

1.       Caterisano, Al, Decker, D., Snyder, B., Feigenbaum, M., Glass, R., House, P., Sharp, C., Waller, M., Witherspoon, Z. “CSCCa and NSCA Joint Consensus Guidelines for Transition Periods.” Strength & Conditioning Journal, June 2019 - Volume 41 - Issue 3 - p 1-23

2.       Clarkson, Priscilla M., and Monica J. Hubal. “Exercise-Induced Muscle Damage in Humans.” American Journal of Physical Medicine & Rehabilitation, vol. 81, no. Supplement, Nov. 2002

3.       Casa DJ. Csillan D. Pre-season Heat Acclimatization Guidelines for Secondary School Athletics. Journal of Athletic Training. 2009; 44(3):332-333.

Blood Flow Restriction (BFR) Training

Kyle Schumacher, PT, DPT, LAT

You may have seen it in Men’s Health, Forbes, on ESPN, your local news channel with professional athletes or witnessed in it in person at the gym. Bands, straps, or cuffs being applied or wrapped around the person’s upper arms or upper thighs to try and cut off some of the blood supply to the limb while they do some sort of exercise. Why would someone do this? Does it work? Is it a fad? Is it safe? BFR is gaining popularity throughout the performance (gym, fitness center, weight room) setting and rehabilitation setting. This post’s main focus will be on its application in the rehab setting.

What is it?

Personalized BFR is the application of a cuff/tourniquet system around the upper arm or upper thigh which is then inflated to your specific pressure to occlude a portion of the arterial blood flow into the extremity and the venous outflow of blood from the extremity. This practice has been going on for ages, but within the last 5-10 years, it has been gaining popularity through extensive research. This is designed to only be performed for a short period of time approximately 5-6 minutes while an exercise is performed. The system is then deflated for 1 minute, and then re-inflated for another exercise. Typically, one session consists of about 5 exercises or about 30 minutes with a one minute deflate between each exercise.

Why would someone use BFR?

If you’re suffering from an injury, preparing for surgery, or recovering from surgery, usually you’re in pain. Typically, when you’re in pain, it hurts to move the involved extremity, so you don’t. This usually leads to weakness or atrophy, spasm, and more pain. The last thing you even want to think about doing is exercising or trying to get stronger. In order to see strength or hypertrophy in an extremity, you have to be able to exercise or lift heavy around 70% of your 1 rep max (RM). That is almost impossible for someone to do a week out of most injuries or surgeries. With BFR, you’re able to achieve those strength and hypertrophy gains at only 20% of your 1 RM. This allows us, as rehabilitation professionals, to begin strengthening and hypertrophy phases much sooner in the rehab protocol.

How does it work?

The exact mechanism on how BFR affects the body, specifically the muscle tissue, is still being extensively research, but it is thought that this is achieved through multiple factors:

-        Cellular swelling: BFR produces an influx of fluid into the muscle cell that threatens the cell’s ultrastructure forcing it to kick in muscle protein synthesis to keep the cell from dying.

-        Anaerobic metabolism & Systemic Response: BFR limits the amount of blood reaching the muscle tissue above and below the cuff causing the body to try and create energy in the absence of oxygen. This leads to increased production of metabolites (i.e. lactate and hydrogen) which trick the brain and body into producing more growth hormone thus kicking muscle strengthening and hypertrophy into overdrive.

Is it safe?

Personalized BFR has been performed on thousands of individuals in peer-reviewed literature with little to no side effects. Numerous studies have looked at BFR in conjunction with low load exercise and its associated with venous thromboembolism (i.e. a blood clot). The totality of studies seems to reveal minimal adverse events pertaining to blood clots after using BFR and clinically reported events have not been reported. BFR may not be suitable for everyone. It should be carefully applied in those with varicose veins as there has been a case of rupture of a vein following BFR training. One should get clearance for their physician to perform BFR training if: they are on blood thinners, have a history of blood clots, have a presence of a stent or port. It is contraindicated in those who have an infection in the limb or open wound, active blood clot, active cancer, and sickle cell anemia. Typically, a rule that could be followed is if the individual is allowed to have surgery where a tourniquet will be applied and used, they should be able to perform BFR.

Can I just use knee wraps, a blood pressure cuff, or some other advertised device to do BFR?

The safest pneumatic tourniquet devices are those that are certified with the FDA and indicated for personalized BFR. These devices are able to calculate each individual’s limb occlusion pressure (LOP) and what percentage to exercise underneath that LOP. What does this mean: the tourniquet will measure how much pressure it takes to fully occlude blood going into and coming back out of the limb. Once that pressure is measured, the system will then be able to calculate how much pressure needs to be applied to maintain your personalized exercise pressure. BFR with low load is usually performed around 80% of one’s LOP in the leg and 50% of one’s LOP in the arm. Therefore, the device will find the individual’s LOP and the person will exercise at either 80% or 50% of that and the whole time the device is continuing to measure the blood pressure to maintain that level of occlusion. Anyone not using a device certified by the FDA for BFR leaves the individual susceptible to liability in the event of an adverse event.

Who should use BFR?

Clinically, BFR has been applied to numerous diagnoses with positive results: Achilles tendon repair, pre and post-operative knee reconstructions (ACL, PCL, MCL), UCL (Tommy John) reconstructions, total joint replacements, rotator cuff tears and repairs, muscle strains, tendinopathies, cartilage repairs, fractures, and the list can go on. So no, it is not just for the professional or collegiate athlete, it is appropriate for the weekend warrior, the individual who has general deconditioning, the baby boomer following a knee scope or rotator cuff repair, the high school basketball player with jumper’s knee, or the grandparent following a total hip or knee replacement. As long as the person does not have an absolute contraindication listed above, and in conjunction with clearance from their physician, BFR can be applied to most cases where strengthening and hypertrophy are encouraged and needed.

Blood flow restriction training is gaining in popularity in the area, and could possibly become the standard of care as more and more research proves its efficacy, safety, and faster positive outcomes. As more and more people start to become exposed to it as a rehab modality, educate yourself and all involved in its application for maximum benefit and safety.

**APTSM does NOT currently offer this treatment, as it is still in the research phase. This blog is strictly informational and meant to serve as a conversation piece. BFR should ONLY be performed by a licensed physician or physical therapist-- do not try this at home. Please contact us if you have any further questions regarding BFR and the treatments we currently offer.

Blog: Direct Access

By Andy Taber, PT, DPT

As I have grown in my career as a physical therapist, I have been lucky enough to practice in a time of reform. Direct Access has allowed for greater autonomy for both patients and therapists alike in the state of Wisconsin. With that being said, it still surprises me how many patients are not aware of the choices they have when seeking medical care, and in particular, physical therapy! As an advocate for my profession, I always try to be proactive in educating and informing patients of their rights when seeking medical treatment.

Under current Wisconsin law, Direct Access allows physical therapists to evaluate and treat patients without a referral from a doctor.

Historically, one of the main barriers between injured patients and proper PT services was the necessity of a doctor’s referral prior to any appointments. This extra step often prevents patients from seeking treatment from a qualified physical therapist. Indeed, each year, over 100 million Americans suffer from wellness and mobility impairments, and yet only 10% actually make their way to a physical therapy clinic. With the implementation of Direct Access, however, the process is streamlining. By placing the power directly into the hands of consumers and clinicians, direct access provides a new avenue through which a patient can receive evaluation and treatment for a host of injuries or conditions.

Put simply, Direct Access grants the patient the ability to “refer themselves” to their desired physical therapist, who may then provide evaluation and treatment without the sign-off of a physician. This may seem like a small deviation from the standard medical referral model, but in actuality, it could potentially have a profound effect on eliminating much of the bureaucratic red tape that the previous referral system was built upon. Some key benefits of this reform are as follows:

1. Direct Access eliminates the burden of extraneous visits to physicians. The referral requirement can cause delays and denials of services provided by physical therapists. These delays in care result in higher costs, decreased functional outcomes, and frustration to patients!

2. It promotes more efficient treatment by eliminating sometimes unnecessary and frequently expensive diagnostic testing, like MRI’s and X-Ray’s.

3. Direct Access can lead to both a better treatment experience and outcome for the client. Patients who visited a physical therapist directly for outpatient care had fewer visits (27%) and lower overall costs on average than those who were referred by a physician while maintaining continuity of care within the overall medical system and showing no difference in health care use in the 60 days after the physical therapy episode.

Direct Access also allows for patients to be treated sooner rather than later. Sometimes, injuries are not addressed until weeks, or even months, after originating. This may be due to patients having a difficult time getting in to see a specialist or reluctance in seeking treatment due to uncertainty on which doctor to see. Have you ever tried to “ride out” pain because you didn’t want to spend the time or money on doctor’s visits, specialists, procedures and medications? There is a better way to manage and treat your pain! In Wisconsin, the Direct Access law allows most people with most insurances to see a physical therapist without a prescription or referral from a doctor.

Physical Therapists are experts on the musculoskeletal system, including:

• Pain from muscle injuries

• Joint pain like arthritis

• Nagging back or neck pain

• Sports injuries

• Recovery from broken bones or fractures

• Post-operative rehabilitation

• Vertigo and other balance issues

• A host of other pain resulting muscle, bone and joint problems.

Physical therapists are also trained to ask the right questions, explore all possible causes, offer a clinical diagnosis and let you know if a customized PT plan is right for you - or if you should seek additional insight from a doctor or specialist. Now, most patients can see a physical therapist the same day of an injury, if desired! Treating injuries sooner will not only help speed up the healing process, but it may also decrease the financial burden of medical diagnoses that linger for longer periods of time. Research has shown that early physical therapy treatment decreases overall medical expenses in the long run, for a particular diagnosis!

If you are currently suffering from a recent injury or a nagging issue that’s been around for several weeks or months, feel free to stop by and speak with one of our therapists at Advanced Physical Therapy and Sports Medicine to determine how we can help you on your road to recovery!

Please visit our website at www.advancedptsm.com

Flip Flops!

If you wear flip flops into my clinic you get my ceremonial response!

I take them and throw them out onto the lawn in front of our clinic space ….  Seriously I do eventually go out and retrieve them and we have a little laugh.  There are however, some sound reasons I dislike the favorite summer footwear of the ladies and gentleman who come to see us.

   Many of the patients we see are seeking help for foot and ankle related pain or difficulty wearing certain types of shoes. The flip flop, while being easy to slide on and off and comfortable for our poor foot who has been trapped in a hot restrictive boot all winter, does not offer what a good sandal or supportive shoe offers.

   Ask yourself, why do we wear shoes? Our friends who are a part of the barefoot running trend question this all the time. But especially here in the mid-west there are reasons to wear shoes:

1)     Protection of the bottom of the foot: the shoe offers an interface between our soft tissues on the bottom of the foot (some have softer than others …. hence the term “tenderfoot “from the westerns of my childhood) and the surface we are walking on.  We walk and or run on hot, sharp, uneven or even toxic surfaces. So for this function the flip flop does provide a very thin layer of protection.

2)     Protection of the toes and top of the foot:  There is a reason folks wear steel toed work boots in industrial settings and why there is the sign in the restaurants: no shoes no shirt no service. Wearing flip flops while mowing the lawn or doing gardening for example, where your foot encounters all kinds of nasty sharp, hot or chemically irritating things is, as my father would say …. “Not real smart. “

3)     Sun protection: A recent in-service to our staff by a local dermatologist pointed out that we as therapists should screen for Melanoma (skin cancer) on the toes as well as more common areas such as the ears neck and face. This reminds us to protect the exposed tops of the toes to the dangers of sun exposure, which honestly, I never thought about.

4)     Shock absorption:  Depending on who you read, 2-5 times your body weight is transferred from the ground through your heel and foot. A cushioned shoe along with a healthy foot and leg absorb much of this shock and dampen it. The flip flop, especially a well-worn one offers very little shock absorbing qualities.

5)     Support: Our feet are a complex system of bones, muscles, tendons and the nervous system that senses as well as activates the motors that drive us through life. A proper fitting shoe helps to stabilize the foot and control excess motion by the shape of the shoe, and by controlling the heel bone which is the key that locks and unlocks the foot. The flip flop just sits under the heel; it doesn’t wrap around the heel nor does it control the heel.

6)     Lastly in order to hold the flip flop on your foot so it is under the foot when your heel contacts the ground you need to pull down with your toe flexors (this is the flip sound) In a regular shoe or a sandal with heel strap, the sole remains in contact with the bottom of the foot through the swing phase due to the foot being enclosed in the shoe /sandal.  This is the only time the toe flexors are on constantly instead of on and off through the gait cycle. This can create a muscle imbalance that can lead to the foot being held in a positon leading to hammer, claw or mallet toes. Also in order to be sure the sole is under the heel at heel contact (the flop sound) a person alters their stride which can impact the entire leg and lower body alignment.

   So am I going to tell my patients “You are not allowed to wear flip flops ever?” If I did, I may get run right out of the clinic.   Instead I suggest that much like cheesecake and my diet, limit flip flop wear in your shoe wear “diet. “  

So if you must wear flip flops here are my suggestions:

1)      Choose a hybrid flip flop, one that has a heel strap

2)     Use flip flops only for short bouts of walking (across the beach versus hiking down the Grand Canyon)

3)     Replace flip flops regularly to maximize shock absorption.

4)     Never wear flip flops to do lawn mowing, household cleaning or other more dangerous tasks.

5)     Sunscreen tops of toes (don’t grease the bottom of the foot however)

6)     Pack a “back up “pair of shoes to switch to at the first signs of heel, arch or toe pain.

7)     Limit wear time to short trips. If you are shopping, hiking, or touring; wear a sandal.

References: 

Zhang, Xiuli, Max R. Paquette, and Songning Zhang. "A comparison of gait biomechanics of flip-flops, sandals, barefoot and shoes." Journal of foot and ankle research 6, no. 1 (2013): 45.

Salathé Jr, Eric P., George A. Arangio, and Eric P. Salathé. "The foot as a shock absorber." Journal of biomechanics 23, no. 7 (1990): 655-659.

Photo Credit: Composita on Pixabay