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
Best Way To Get Rid Of Back And Neck Pain… Physical Therapy!
Dennis Kaster, PT
Unfortunately, one of the best-kept secrets around, is that Physical Therapy is one of the most effective and cheapest ways to get rid of back and neck pain. Most back and neck pain is due to muscle weakness, tightness, poor posture, or work stations that are set up poorly and put extra stress on your body. A Physical Therapist will assess which of these issues is causing the pain and help you to get rid of it by doing things such as specific stretches, strengthening, improving posture, performing treatment to decrease pain or swelling, using better lifting mechanics, or helping you to set up your work or home workstations to put less stress on your body.
The typical process in the past has been that when someone injures their back, they go to a medical doctor. The doctor would decide what to do next, which many times included rest, medications, or expensive imaging. Several years ago a large medical organization, Virginia Mason, broke down the process of medical care for back injuries, looking for the quickest, most effective, and cheapest way to treat low back pain. In the end, they found that people who saw a Physical Therapist first for low back pain recovered much quicker, returned to work sooner and the overall cost of care was much less. This is because Physical Therapists specialize much more in the anatomy and mechanics of how the back works and how to stop and prevent pain. Physical therapists also do not prescribe opioid pain medications. Many times medical doctors prescribe opioid prescriptions, advise patients to rest until the pain goes away, or order expensive medical imaging, which many times is not necessary. Many other research studies have found the same results.
As a result of the findings of multiple research studies, many insurance companies no longer require a physician referral to cover physical therapy, as they realize that people with mechanical low back pain respond much quicker and better if they see a Physical Therapist first. Most people are not aware of this. Several studies have shown that as little as 7% of people with low back pain see a Physical Therapist. This is crazy…..when Physical Therapy is one of the most effective ways to treat low back pain. Also, Physical Therapists have the expertise to recognize more serious medical issues that would require a referral to a medical doctor. So if you see a Physical Therapist first and your pain is due to a medical issue, you can rest assured that the Physical Therapist will recognize it and direct you to the appropriate care. PLEASE HELP US TO GET THE WORD OUT!! IF YOU HAVE BACK OR NECK PAIN, SEE A PHYSICAL THERAPIST FIRST. IF YOU OR SOMEONE YOU KNOW HAS BACK OR ANY MUSCLE OR JOINT ISSUE, LET THEM KNOW THAT PHYSICAL THERAPY MAY BE THE BEST FORM OF TREATMENT FOR IT. If you have questions, please give us a call and we can answer them for you or check with your insurance to make sure our treatment is covered.
References
Furhmans V. Withdrawal Treatment: a novel plan helps hospital wean itself off of pricey tests. The Wall Street Journal. January 12, 2007
Pendergast J, Kliethermes S, et al, A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy. Health Research and Educational Trust DOI:10:1111/j.1475-6773.01324.x, Oct. 2011
Mitchell JM, de Lissovoy G. A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy. Phys Ther. 1997;77: 10-18
Moore JH, McMillian DJ, et al. Risk determination for patients with direct access to physical therapy in military health care facilities. J Orthop Sports Phys Ther. 2005;35:674-678
Leemrijse CJ, Swinkles I, Veenoff C. Direct access to physical therapy in the Netherlands: Results from the first year in community based physical Therapy. Phys Ther 88;8:936-946
Kenney. Transforming Healthcare, Virginial Mason Medical Center’s Pursuit of the Perfect Experience. CRC Press, 2011
Pediatric Physical Therapy
By Dr. Beth Leffel, PT, DPT
If you’ve recently had a new bundle of joy you can certainly testify to the massive changes that happen in the first years of life. But have you ever wondered if your child is where they are supposed to be with their motor skills? Or perhaps you are just curious about what you can expect them to be doing next? Most of us know the basics: roll -> sit -> crawl -> walk, but there is so much more! Here's a list of milestones you should be seeing from birth - 4 years.
0-3 Months
• Turns head to each side when on back
• Holds head up 45 degrees when on tummy
• Head bobs upright in supported sitting
• Random body movements
3-6 Months
• Lifts chest from surface when on tummy
• Pushes up on straights elbows on tummy
• Rolls belly to back
• Sits with slight support or independently for brief moments
• Pivots around on belly
• Actively moves head when supported in sitting
• Head control in all positions
6-9 Months
• Sits independently
• Rolls back to belly
• Stands, holding (may bounce on legs)
• Pulls to stand at furniture
• Belly crawls
• Gets into hands and knees position
9-12 Months
• Transitions from sitting to belly
• Creeps on hands and knees
• Stands momentarily
• Cruises along furniture
• Walks with hands held
12-18 Months
• Stands alone well
• Kneels
• Walks without support
• Creeps upstairs
• Balance improves
• Runs/hurried walk
• Walks backward
• Walks upstairs with hand hold
18-24 Months
• Kicks a ball forward
• Runs fairly well
• Moves on ride-on toys without pedals
• Walks downstairs with one hand hold
• Climbs into an adult chair
• Walks upstairs alone, both feet on the step
• Walks downstairs holding the rail, both feel on step
2-3 Years
• Jumps 8-14 inches
• Jumps from the bottom step
• Catches large ball, using the body to secure
• Walks downstairs alone, both feet on the step
• Walks upstairs with support, alternating feet
• Able to stop and avoid obstacles while running
• Pedals tricycle
• Imitates one-foot standing
• Jumps sideways, backward, and over a 2-8 inch hurdle
3-4 Years
• Catches 8” ball with hands only
• Gallops
• Walks on a line
• Stands on one foot
• Hops on one foot
• Jumps down from 12 inches
• Walks up and down stairs alternating feet, without rail
When children are not reaching their milestones pediatric physical therapists are the health care providers to correct the problem. Pediatric physical therapists (PTs) work with children and their families to assist each child in reaching their maximum potential. The goals of treatment include the promotion of active participation in home, school, and community environments. Physical therapists have expertise in movement, motor development, and body function (eg, strength and endurance), this makes PTs the health provider of choice to correct delayed motor development in children.
Pediatric physical therapy is a specialized division of PTs. They apply clinical reasoning during a unique examination, evaluation, and diagnosis process. Pediatric physical therapists also have a universal ability to make exercise fun for the children in order to keep them engaged. As primary health care providers, PTs also promote health and wellness as they implement a wide variety of supports in collaboration with families and other specialists.
If you have questions about Pediatric Therapy contact Dr. Beth Leffel at Marinette or Shawano locations.
Why do you make physical activity a priority in your life?
Dean J Sondrol, PT
Why do you make physical activity a priority in your life? This question was a recent topic of discussion one day between myself and some of my clients at Advanced Physical Therapy and Sports Medicine, and then later on between some friends and I. It was sparked by a recent article I read on the APTA Website- see article below.
Here are some of the responses that came up:
-to stay’ healthy (was the most common)
-to keep up or stay with my children (one of my main reasons)
-to enjoy the outdoors; hiking, kayaking, and biking
-to dance at my granddaughter’s wedding
-my wife tells me to, or my kids tell me I need to
-so I look good
-cause of my heart attack or new hip or knee
-So I can play high school sports (from some of the younger people)
-in case I get COVID (a more recent reason)
-so I can fit into that dress or pair of jeans
-my high school reunion is coming up
-so I can drink more beer, or eat more food
-it just feels good
Of course, this also led to a discussion on why we don’t make physical activity a priority in our life, (that is a topic for an article in itself). The benefits of physical activity are well documented, we all have heard reason on TV, at the Dr office, from social media and from family and friends. So I won’t lecture you in this article but I would encourage you to find the one or two reasons why you should make physical activity your priority. Write it down if you want, post it on your phone, or just think about it from time to time. I will also think of my reasons why I’m doing that activity and it makes that walk or work out all the more meaningful. So if you see me out running, biking, or walking and ask what I’m thinking about I would probably tell you my children or how many more miles I should run so I can eat that jelly doughnut.
You may have some of the same or have your own reason. Please feel to share your reason with me…. Remember to keep making physical activity your priority!
From: Top 10 Benefits of Physical Activity. From Choose PT August 2020
https://www.choosept.com/resources/detail/top-10-benefits-of-physical-activity
Most Americans do not move enough. The good news is that regular physical activity is one of the easiest ways to reduce your risk for chronic disease and to improve your quality of life.
Make physical activity a priority to:
1. Improve your memory and brain function (all age groups)
2. Protect against many chronic diseases.
3. Aid in weight management.
4. Lower blood pressure and improve heart health.
5. Improve your quality of sleep.
6. Reduce feelings of anxiety and depression.
7. Combat cancer-related fatigue.
8. Improve joint pain and stiffness.
9. Maintain muscle strength and balance.
10. Increase the life span.
Physical therapists are movement experts who improve quality of life through hands-on care, patient education, and prescribed movement. Physical therapists treat people of all ages and abilities and empower you to take an active part in your care. After an evaluation, your physical therapist will create a treatment plan for your specific needs and goals.
Choose more movement. Choose better health. Choose physical therapy.
Speed and Agility Training
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.
Image- https://mishockpt.com/speed-and-agility-training/
Agility Ladder drill example:
2 feet out, 1 foot in.
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.
Better going into surgery, better coming out.
Briana Wasielewski, PTA, CCCE, BS
Having the best rehab after surgery is one of the top priorities of all surgical candidates. Many spend a lot of time getting the best surgeon in place, getting their place to rest in order, and thinking about who can help them with daily life and getting to and from appointments once the surgery is done. While these are all things one should think about prior to surgery, many are not thinking about what they can do to ultimately increase their chances of having a better surgical outcome: exercise prior to surgery. Exercise comes in many forms and is something everyone can do prior to surgery. If done appropriately, exercise before surgery will likely make recovery better. Who better to help figure out your unique pre-op exercise plan than a physical therapist!
First, a physical therapist will discuss and evaluate your reason for surgery. Many times the reason a patient is thinking about having surgery is that they have pain or their movement is affected. Exercise is usually not something surgical candidates think they can or should do before considering surgery. Prehab exercise is specifically designed by physical therapists to improve the outcome of patients’ post-surgical rehab. The idea here is “the better going into the surgery, the better coming out”. Whether that means breathing exercises, simple strengthening, flexibility work, or practicing how to use crutches, seeing a physical therapist before surgery can help the healing process in the long run.
A physical therapist prehab visit also gives the opportunity for surgical candidates to ask questions specifically about the most dreaded part of having surgery: the recovery. Physical therapists are experts in rehabilitation and can tell you exactly what to expect in recovery, and how to prepare yourself with pain management tools.
If you are thinking about having surgery or know someone who is, make sure you prepare yourself and your body by seeing one of our physical/occupational therapists.
Head to our location page to find a clinic near you!
Does Selecting the Right Running Shoe Help Prevent Injury?
Josh Zilm PT, DPT
Does Selecting the Right Running Shoe Help Prevent Injury?
It’s spring and time to strap on those shoes and get outside.
There has been an entire industry built around providing runners with the best possible shoe. When answering the question, “Does selecting the right running shoe help prevent injury?” one often has to tread lightly as there are many opinions. As physical therapists, we like to turn to the scientific literature to answer a question. Can a running shoe offer a return on energy? Is it better to run barefoot? Are minimalist shoes better? What about orthotics? Those are topics for another time. This post will focus only on the running shoe’s ability to reduce injury and not attempt to answer any of those other questions that can often muddy the waters.
The industry
The running shoe industry dates back to the mid to late 1800s, but most credit the start of the modern-day training shoe to the founder of a little company called Nike when he started selling shoes out of the back of a van in the 1960s. Since that time running and shoes have grown into a multi-billion dollar industry. Did you know that the first New York City Marathon was held in 1970 and had 127 competitors? That is quite a contrast from 52,812 finishers in 2018. As the sport has grown so has the market for better shoes with an attempt to meet the needs and demands of the runner. Research, technology, science, expert opinion, and business has delivered a vast shoe market that boast a variety spanning barefoot the ultimate support and cushion. So with all the shoes available today, is there a shoe for your foot type that can reduce injury associated with rigors of the sport?
The Amazing Foot
The foot is designed to help our bodies absorb energy as we impact the ground in an action called pronation. The foot and ankle accomplish these amazing feet through a team effort. We have muscles from our trunk to our feet that actually fine-tune how the body absorbs shock and then in a split second prepares to propel us forward with each step. Running injuries are most often associated with the loading phase of running and more specifically the rate at which we load. Don’t be afraid I won’t get too technical, but it is important to understand that the primary focus on injury reduction regarding the shoe is slowing the rate of loading, that is how fast our bodies have to accept the load with each strike of the foot on the ground.
Foot Type
The hard part about designing the perfect shoe is that there are 7.66 billion people on the planet with a lot of different foot types (I know they are not all runners). Thankfully, the orthopedic and running world has been able to classify foot type to offer some order to our attempts to best categorize the variety of feet that walk or run into the clinic. Foot type does offer some predictive value to the injuries that we typically experience. Nature(genetics) and nurture(lifestyle) lend way to a spectrum of people have rigid high arched feet, flat feet flexible feet, and everything in between. The shoe industry has tried to match foot type with the appropriate shoe. For example, the rigid high arch foot type should consider a softer shoe, while the flat flexible foot could use a more supportive shoe.
The Shoe Spectrum
The soft shoe would be categorized as a “cushioned” shoe while the more supportive shoe is given the name “motion control”. It would be intuitive to think that a person with a poor ability to control the position of the foot would benefit from added support and the person with a rigid high arch foot may need a little more cushion because they hit the ground harder. (funny that studies show that joint reaction forces are actually higher in a cushioned shoe versus minimal support. The working theory is that runners hit the ground harder with a cushioned heel simply because it’s cushioned.) This could be a multiday conversation, but my attempt is to explain the basic shoe spectrum that starts with no support(barefoot/running sandal) to motion control(high degree of pronation control). There are many variations within this spectrum that attempt to meet the needs of the runner, but the question we are trying to answer is can we reduce injury by pairing the runner with the right running shoe? What does the research say?
Theisen et at 2014 Br J Sport Med completed a study looking at over 200 runners. They found:
1. Midsole Hardness and Injury rates: no different. The amount of cushion had no significant difference in injury rates.
2. Energy absorption and injury risk have no scientific correlation. A shoe that absorbs energy does not reduce injury rates.
3. Shoe wear does not appear to have an effect on biomechanics. You cannot correct your biomechanics by running with a shoe.
4. 1% increase in metabolic cost for every 3.5 ounces of shoes. Heavy shoes require more energy.
The recommendation: Promote light shoes. Refrain from claiming that shoes reduce injury through cushion or biomechanical changes.
Ryan et al. (2011) Br J Sport Med found;
Shoe assigned by foot posture index(match the shoe with the foot type). Static foot type should not be the determining factor for shoe selection. The highest rate of injury was in runners wearing a motion control shoe that were appropriately matched based on foot type.
The recommendation: Don't use the algorithm alone in an attempt to match foot type and shoe type to dictate the choice of running shoe.
Nielsen et al. (2014) Br J Sports Med.
Foot pronation was not associated with increased injury risk in novice runners wearing a neutral shoe. The “Over pronator” did not experience a greater rate of injury when left unsupported versus supported.
