Squishing Holiday Humbugs via Exercise

Bah Humbug!

With the holiday season in full swing, many people are experiencing excitement, joy, and happiness as talk of Christmas cookies, family gatherings, and Clark Griswold fill the air. “SQUIRREL!!!!!” 

However, on the flip side of all these warm fuzzy feelings can often be the chilly reality that everything isn’t so great. You’ve had to spend your vacation savings fund to buy Christmas presents, you agreed to show up to 9 different Christmas gatherings, and you spent all day putting lights on your house that don’t work. Or the wind blows down the reindeer and sleigh you just put up in your front yard.  True story, happened to me. 

So what do you do when the holiday stress sets in? Instead of stress eating, turning to other common alternatives, or lighting cigarettes in the kitchen like Ellen Griswold, it may be time to call your local Advanced Physical Therapy Medical providers! 

Countless studies have already shown that exercise can reduce stress in all patient populations and as movement experts, exercise is at the core of what we do. A recent study has shown that spinal manipulation, a common intervention utilized by physical therapists, reduces levels of cortisol in your saliva (Sampath et al., 2017). Why is this important? Cortisol is your body’s stress hormone, and higher levels often reflect that your body is running on overdrive. Therefore, spinal manipulation = less stress = less newel posts being cut with a chainsaw. Despite these new findings, if you haven’t been receiving any spinal manipulation in your physical therapy plan of care, have no fear.   

“I don’t know what else to say, but it’s Christmas, and we’re all in misery”

Dr. PJ

References:

Sampath, K., Botnmark, E., Mani, R. Cotter, J., Katare, R., Munasinghe, P., & Turnilty, S. (2017). Neuroendocrine Response Following a Thoracic Spinal Manipulation in Health Men. Journal of Orthopaedic and Sports Physical Therapy, 47(9).

BRRRRR, IT’S COLD IN HERE!

With winter fast approaching, many peoples’ minds begin to race: some with excitement over the upcoming holiday seasons and winter adventures, while others dread the next few months of Wisconsin below freezing temperatures. Despite all this winter wonderland talk, whether you are a winter-lover or a winter-loather, one thing everyone should also be thinking about is falling. No, not in love sappy-pants, physically falling. The infamous ice monster leads to multiple falls each winter! The good news is that there are many things we can do to reduce our risk of this trauma: cue physical therapy.

Falls in general (it’s not all the ice monster’s fault) wreak havoc, both on an individual level and on our healthcare system. Direct medical costs from falls total near $30 billion each year (Phelan et al., 2015); with an aging population you can only assume this number will grow in the future. This makes sense when you consider at least 30% of individuals over the age of 60 fall each year (Gerards et al., 2017). For the individual, falls often result in personal injury, loss of independence, reduced participation in social activity, and overall quality of life. As mentioned, however, there is good news. It has been documented that up to a 20% risk reduction in falls can be achieved after participating in common physical therapy interventions including: balance training, resistance training, and aerobic exercise. Twenty percent risk reduction makes a big deal when this many people are falling each year.

To reduce you risk of being attacked by the ice monster, and have a darn good time in the process, stop over to your local APTSM and let us help prevent you from turning into another fall statistic.

Safe Hunting and Happy Thanksgiving,

Dr. PJ

PS: For more information on preventing falls: https://www.cdc.gov/steadi/pdf/check_for_safety_brochure-a.pdf

References:

Gerards, M. H. G., McCrum, C., Mansfield, A., and Meijer, K. (2017) Perturbation-based balance training for falls reduction among older adults: Current evidence and implications for clinical practice. Geriatrics & Gerontology International.

Phelan, E. A., Mahoney, J. E., Voit, J. C., & Stevens, J. A. (2015). Assessment and Management of Fall Risk in Primary Care Settings. The Medical Clinics of North America, 99(2), 281–293.

Wrinkles

Wrinkles

As individuals grow older, it is common for their bodies to began to show signs of “wear & tear”. One of the most common signs of aging is wrinkles. Just as our bodies show signs of aging on the surface, they also show signs of aging under the surface (IE: arthritis, muscle atrophy, decreased bone density, etc.). One of my favorite professors in graduate school described this process in a way that really resonated with me: “wrinkles on the inside, wrinkles on the outside”.

Why is this relevant? Medical imaging (IE: x-rays, MRI’s, CTs, etc.) often picks up on these “wrinkles on the inside”, which can be very beneficial. However, sometimes these imaging devices act in just the opposite way, identifying “problem areas” that are really just normal signs of aging.

For example, a recent study showed spinal disc degeneration was present - on CT & MRI findings- in 37% of asymptomatic 20-year-olds; this number increased to 96% of asymptomatic 80-year-olds (Brinjikji et al., 2015). This study is a great example of the effects of our bodies’ natural aging process; however, these same individuals may be labeled as having problems with their back, even if they have no pain at all. Furthermore, not only is medical imaging not always consistent with symptoms, but it can also result in higher cost of care and overall utilization of health care services if completed early on in an individual’s plan of care (Fritz et al., 2015).

Physical therapists are trained to identify which “wrinkles” are normal process of aging, and which “wrinkles” need to be addressed further. Therefore, before you run to get that MRI (especially the cash-pay imaging entities), head to your local Advanced Physical Therapy and Sports Medicine provider so we can check out your wrinkles.

PJ

References:

1. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., … Jarvik, J. G. (2015). Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology, 36(4), 811–816.

2. Fritz, J. M., Brennan, G. P., Hunter, S. J. (2015). Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges. Health Services Research, 50(6), 1927–1940.

Pumpkin Spice Physical Therapy

All this fall weather and pumpkin spice latte talk has me thinking about Starbucks.

In the first blog post earlier this month, I discussed direct access – an import pillar in the physical therapy profession. To expand, today’s blog post will include a great example of how beneficial direct access can truly be.

In the early 2000’s, a physician named Dr. Robert Mecklenburg, chief of medicine @ Virginia Mason Medical Center, sat down to determine how his hospital could lower its healthcare costs; a major insurance company (Aetna) was threatening to remove them from their network due to high cost for care.

Since Starbucks was represented by Aetna @ this time, Dr. Mecklenburg reached out to the benefits manager @ Starbucks to determine how he could make their health care more financially efficient. Starbucks determined the most common healthcare costs for their companies were low back pain and headaches, and therefore Dr. Mecklenburg analyzed the entire process of how back pain patients passed through the healthcare system. He determined the following:

“90 percent of what we did was no help at all,” says Mecklenburg. “Does an appointment with an orthopedic surgeon, a neurologist, a neurosurgeon help for uncomplicated back pain? The evidence says no. Does an MRI help? No. As far as we could tell, the only thing the evidence showed [that] was worth anything was physical therapy.”

Naturally, Virginia Mason Medical Center changed their health care process so individuals with low back pain were seen first by a PT (a great example of direct access). This resulted in same-day treatments, reduced healthcare costs, and patient satisfaction through the roof!

In summary, go see your local ATPSM physical therapist, grab a pumpkin spice latte, and pray the Packers get it together!

PJ

PS: Below is a great visual of how direct access works can save resources!

PT ASAP

Given October is National Physical Therapy Month, I wanted to take the time to discuss an important PT topic – a “pillar” in our profession that many people are not familiar with: direct access; hence our push for more education on the topic.

Many of my patients have grown accustom to hearing the phrases “don’t put your pain off” or “make your pain a priority”. The rationale behind these statements, and/or other similar ones, stems from one simple fact: it makes our job easier!

Why might you ask? It makes our job easier because your body heals faster when we correct problems before they progress. Just think - if you took the time to pull that one dandelion out of your garden each week, you likely wouldn’t end up with a garden full of weeds, since the spread of their seeds results in rapid multiplication. Similarly, if you paid the interest off your student loans, the interest wouldn’t compound and you wouldn’t have insurmountable debt (I promise I am not speaking from experience). There are countless examples in everyday life that mimic our bodies and reiterate the same concept: the sooner we address issues in life, the better off we are.

An article recently published by the Clinical Journal of Sports Medicine confirms this belief. The article looked at 200 athletes who had sustained a stress fracture in their low back. Patients who initiated physical therapy within the first 10 weeks returned to full activity an average of 25 days quicker than their counterparts who waited until after the 10-week mark (Selhorst et al., 2016). That’s an entire month people!!

Luckily, in Wisconsin, our mission of addressing pain ASAP is very feasible with direct access, which allows patients to be treated by a physical therapist without a physician’s referral.  "This allows us to streamline patients’ treatment, which results in a quicker recovery; not to mention a reduced expense. So, call your local ATPSM today, and let us help correct that small ache or pain before it becomes a field full of dandelions!"

#ChoosePT

PJ

Selhorst et al. (June, 2016).  Timing of physical therapy referral in adolescent athletes with acute spondylolysis: A Retrospective Chart Review.

Clinical Journal of Sports Medicine.

PT vs. Opioids. The Why. #ChoosePT

Recapping blog episode number one this month: opioids are a growing and significant problem and physical therapy is the proper solution.

Today’s agenda: Why? Prove it!

As most people can probably guess, a recent study reported that individuals’ (people currently seeking treatment for opioid addiction) primary goal for initially taking opioids was pain relief (Weiss et al., 2014). However, the majority of these same individuals then reported their main rationale for continuing opioid treatment was avoidance of withdrawal symptoms (Weiss et al., 2014); pain was no longer the culprit. To me, this situation has addiction written all over it.

As physical therapists, reducing pain/discomfort is the root of virtually all our interventions. If we can reduce patient pain ASAP (Science, 2017), therefore reducing the need for patient opioid dependency early, we can be the barrier that prevents the continuation of this addiction cycle. As the research article stated, people’s main reason they continue to take prescription pain medication is to prevent withdrawal symptoms; PT = less pain = less opioids = less withdrawal(s) = less people continuing opioids = less addiction. I wasn’t a math major, but that equation makes sense to me!

References:

1. Weiss, R. D., Potter, J. S., Griffin, M. L., McHugh, R. K., Haller, D., Jacobs, P., … Rosen, K. D. (2014). Reasons for opioid use among patients with dependence on prescription opioids: The role of chronic pain. Journal of Substance Abuse Treatment, 47(2), 140–145.

Opioids versus Physical Therapy

Prescription medication abuse, specifically relating to “opioids” (the medical word for pain medication), has been well documented. It seems this issue is gaining increased mainstream attention in the media, however, one problem remains: what is the solution?

Although many solutions have been proposed, one has consistently remained atop the lists of many of these solution-seekers: physical therapy. In fact, the U.S. Surgeon General recently penned a letter, which was sent to physicians across the country, addressing this fast-growing issue. In addition to educating people about negative side effects of opioid abuse, related resources specifically listed physical therapy as primary alternative to treatment of chronic pain (APTA, 2016).

At Advanced Physical Therapy & Sports Medicine, we acknowledge the growing opioid epidemic and utilize many treatment interventions specifically aimed at reducing your pain. If reducing pain is your goal, APTSM is your solution!

For more constructive information on the overuse of opioids, please visit http://turnthetiderx.org.

Reference:

APTA. (November, 2016).  Surgeon General Letter Urges Action on Opioids Recommends Treatment Guideline That Includes Physical Therapy.PT in Motion, 8(10), 46.

Diaphragmatic Breathing

To Breathe, Or Not To Breathe…That Is The Question!

“Just take a few deep breaths and everything will be ok”. Sound familiar? In many instances throughout our lives we are told this, or even reiterate this common practice subconsciously to ourselves during stressful times. So what is the method to this madness?

Believe it or not, there is actually a “correct” way to breathe that can provide optimal benefit both during times of high stress and absence of stress (if there is such a thing). Diaphragmatic breathing is a breathing technique that involves emphasizing using your diaphragm, a large breathing muscle below your lungs. Via many complex methods in our body that are initiated when participating in this form of breathing, this technique results in better breathing efficiency, lowering cortisol (stress hormone) levels in our body, improving our mood and attention, and many more positive health benefits. See below for a step-by-step tutorial in this technique.

For more questions about diaphragmatic breathing, regarding the technique or the benefits it can have for you, please reach out to your physical therapist or occupational therapist at your local Advanced Physical Therapy and Sports Medicine!

Breath in through your nose so your stomach elevates while your chest remains still

Figure 2. Exhale through your mouth, allowing your stomach muscles relax; again your chest should remain still

References:

1)      Cleveland Clinic. (2016). Diaphragmatic Breathing. Retrieved from https://my.clevelandclinic.org/health/articles/diaphragmatic-breathing

2)      Ma, X., Yue, Z.-Q., Gong, Z.-Q., Zhang, H., Duan, N.-Y., Shi, Y.-T., … Li, Y.-F. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in Psychology, 8, 874.