Let's Talk About Swelling....Glycocalyx?

Let's Talk About Swelling....Glycocalyx?

By: Teresa Iattoni MSPT, CLT, CES

March is lymphedema month, you might ask how does that impact me? Most people will experience swelling during their life, whether it is a result of an injury like an ankle sprain or a result of a chronic condition like lymphedema.  Swelling in the medical world is commonly referred to as edema.  It may be caused from a specific event or have multiple causes.  If you have swelling, you should discuss that with your medical provider.  Swelling can develop due to the following: 1) as a side effect of your medication, 2) as a symptom of a cardiac/lung/kidney condition, 3) because of diabetes mellitus, 4) secondary to a protein deficiency, 5) in the presence of venous insufficiency/varicose veins, or 6) from an infection (Stout et al., 2012). Physical and occupational therapists commonly see swelling related to inflammation from an injury or surgery, which leads to increased pain, decreased muscle activation, abnormal movement, and impaired healing.  In many cases, physical and occupational therapists can help by providing education for appropriate exercises and special treatments for swelling.

What is Glycocalyx?  First, you should understand the basics of the circulatory system.  The heart pumps the blood out into the arteries.  The arteries are linked via small blood vessels (capillaries) to the veins.  The veins take the blood back up to the heart. If our circulation was that simple it would be easy, but our bodies are extremely complex.  The third part of the circulatory system is the lymphatic system.  The lymphatic system follows the path of the veins and eventually brings fluid back to the large vein (superior vena cava).  The lymphatic system’s job is to fight infection by filtering fluid at each lymph node, to maintain the balance of fluid throughout the body, and helps process dietary fat (Lee, Rockson, & Bergan, 2018).  The glycocalyx is a protein tunnel in the capillaries that allows fluid and protein from the blood to go into the tissue spaces in our body (Hansen et al., 2015).  The glycocalyx tunnel functions as a one-way road, so what goes out cannot normally come back in.  The lymphatic system has the job of clearing the extra fluid and waste materials from the tissue space (Levick & Michel, 2010).

How does that relate to my swelling?  Your swelling is best managed by addressing the cause of the swelling and encouraging fluid return thru the lymphatic system.  In cases where the lymphatic system is not working appropriately, lymphedema can occur.  Lymphedema is a high protein swelling.  It commonly appears in arms or legs but can develop in any body part.  Lymphedema left untreated can lead to chronic large body parts, pain, limited motion, repeated infections, and to permanent thickening of tissue (Lymphedema Framework, 2006).  Advanced Physical Therapy & Sports Medicine has specialty trained physical and occupational therapists, who can provide treatment for your swelling and lymphedema, through the application of manual lymphatic drainage, compression garments, exercises, skin care, kinesiotape and pumps.   

References

Hansen, K.C., D’Alessandro, A., Clement, C.C., & Santambrogio, L. (2015). Lymph formation, composition and circulation: a proteomics perspective. International Immunology, 27(5), 219-227.

 Lee, B-B, Rockson, S.G., & Bergan, J. (Eds.). (2018).  Lymphedema: a concise compendium of theory and practice (2nd ed.). Switzerland: Springer

Levick, J.R., & Michel, C.C. (2010). Microvascular fluid exchange and the revised Starling principle. British Journal of Anaesthesia, 108(2), 198-210.

Lymphedema Framework. (2006). Best practice for the management of lymphoedema.  International Consensus. London: MEP Ltd.

Stout, N, Partsch, H, Szolnoky, G, …et al. (2012). Chronic edema of the lower extremities: International consensus recommendations for compression therapy clinical research trials.  International Angiology, 31(4), 316-329.

Athletic Trainers - An Extension of Your Health Care Team.

You have probably seen us. Yes, the one wearing khakis, a polo, and a fanny pack, while running across the field with scissors to assist an injured player. Or, perhaps donning our teams colors, proudly; while weathering the storm to monitor the sky with our trusty lightning detectors. The Athletic Trainer.

Often times, Athletic Trainers are mistaken for personal trainers. However, Athletic Trainers are actually an extension of your health care team! Athletic Trainers are allied health professionals who have endured diverse education and extensive hands on training that must meet the requirements of the Board of Certification Inc., while working within the guidelines put forth by state licensing board. It is these educational requirements, certification and licensure, work setting, and standards of practice that set athletic trainers apart.

While athletic trainers work collaboratively with other health care professionals, namely physicians and physical therapists, they often work independently to educate athletes on injury prevention, provide immediate and emergent care, evaluate and clinically diagnose injuries, and assist with therapeutic intervention and rehabilitation.

Recognition of the skill set of athletic trainers is the most notable reason for the rapid growth within the profession. Traditionally, athletic trainers have worked with secondary school, collegiate, and professional athletics. As valued members of the health care team, athletic trainers are extending their care to those in occupational and industrial work settings, performing arts and dance, law enforcement, military personnel, physician offices and sports medicine clinics.

Possessing the knowledge and tools to help you recover quickly, and safely, athletic trainers are health care. So – When in doubt, seek an AT out!

Cassy Timmers, ATC, LAT

Licensed Athletic Trainer

Appleton North High School

Sharing Your Goals!

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

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

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

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

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

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

Content borrowed from PPS of APTA.

Come to PT First!

Come to PT first!!!!

It's human nature,   when we injure ourselves we immediately want to know what we damaged.  If  we roll our ankle (Is it broken?), twist our knee (Did I tear a ligament?),  strain our low back (Did my disc just explode?).   

Two summers ago I was playing beer league softball.   In the midst of reliving my glory days I fully extended for a fly ball landing awkwardly on my right side and twisting my knee.    Not only did I badly miss the ball, I could barely walk following this incident (although a teammate told me I looked really good doing it).    Over the next few days multiple scenarios ran through my head ranging from how I would work on crutches after they repair my ACL, to how likely it was that I would end up with a knee replacement at 50.    I scheduled an appointment with an Orthopedic doctor I work with frequently and contemplated scheduling an MRI on my own.   

                The next day,  after I took a deep breath,  stopped catastrophizing and thought about the situation rationally, I decided to perform some light exercise and see if I could improve my mobility and decrease my pain.     Now, mind you,  I’ve been a PT for 10 years at this point.    This is a conversation I have had with people daily for that length of time,  yet, my critter brain was in such a state of fight or flight I couldn’t see anything but the worst possible scenarios playing out.    Literally 2 days later following  a very rudimentary ROM and light closed chain strengthening regimen my knee felt like nothing had happened and I was back to embarrassing myself on the softball field.   

So, the moral of the story should be apparent , but if you are anything like the guy in this story who hurt his knee on the softball field, it doesn’t occur to you right away.   COME TO PT FIRST!       It will save you time, money and likely, pieces of yourself that you can’t get back.   

Now I know what you’re thinking and let me answer for you before you ask:  

•             No you don’t need a referral      

•             Yes,  we can order Xrays if we need to   

•             Yes, we are less expensive than getting an MRI,  Injections or surgery

•             Yes,  we are qualified and capable of recognizing when your condition would warrant you seeing your physician.

•             For Low Back and Neck issues we are qualified and capable of manipulating the spine

The fact is that there is mounting evidence that if you come to PT 1st it will:

1.            Lower utilization of high-cost, often unnecessary medical services such as advanced imaging (MRI) and ER visits

2.            Greatly reduce the amount of opiods prescribed to you. ( 1)

So the next time you strain a muscle,  tweak your back, or come up lame after laying out for an unreachable fly ball in a meaningless softball game,  come to PT first.    We will  get you back to embarrassing yourself as soon as possible.  

1.            Frogner BK1, Harwood K2, Andrilla CHA1, Schwartz M3, Pines JM4.    Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs.    Health Serv Res. 2018 Dec;53(6):4629-4646. doi: 10.1111/1475-6773.12984. Epu

By Bill Rein, PT, MSPT, OCA, COMT, FAAOMPT

Photosource: pixabay

New Year Newbie, Master, or Flunkee

Are You a New Year’s Resolution Newbie, Master or Flunkee?

Turning the page on the new year is a chance to wipe the slate clean—and to be better versions of ourselves. And when it comes to what we want to improve, goals that fall in the health and wellness arena top all other New Year’s resolutions. In fact, three of the top four resolutions in a 2018 YouGov poll were health-related: eat healthier (1), get more exercise (2) and focus on selfcare, e.g., get more sleep (4). There are three types of people who choose a goal from the health and wellness category as a New Year’s resolution: the resolution newbie, the resolution master and the resolution flunkee. Let’s see which category you most identify with—and how focusing on the right strategy can help you get healthier in the new year.

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

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

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

Ron Lawrence PT

Certified Strength and Conditioning Specialist

Certified Functional Movement Specialist and Level 2 Dry Needling Therapy

Photo Credit:

Photo by Simon Migaj from Pexels

Start of a New Year – Start of a New Deductible

Kelsey Hinkley, PT, DPT

With the start of the New Year, many people’s deductibles start over.  Suddenly, that bothersome knee pain (or insert your own body part/ailment) doesn’t seem to be worth the cost of the ever increasing medical bill. Does this sound familiar?

While we completely respect your dollar, we highly encourage you to seek professional help before that small injury causes more of an issue down the road. With more people having higher deductibles, they may avoid seeking medical care until they can’t tolerate the pain anymore. However, injuries are easier to resolve in the earlier acute or sub-acute stages rather than the chronic, later stages.

We all tend to think it will get better in a few days but then weeks come and go. We continue with our busy schedules and make excuses for why we don’t seek treatment. Time and time again I see people that didn’t realize physical therapy was an option for them. If they would have started their medical treatment sooner, it would ultimately have saved them time, money, and relieved their pain.  

There have been many studies on the effectiveness of early physical therapy intervention with musculoskeletal injuries. One article explored assigning people with low back pain into groups:  early therapy intervention and delayed therapy groups. The outcomes showed that among the 3 groups, the patients in the early intervention had more favorable outcomes including fewer physician visits, less restricted work days, days off from work, and a shorter healing time.  (Zigenfus, et al., 2000)

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When to Start Physical Therapy Treatment? 

For the majority of cases, “the sooner the better.”  If you aren’t sure, start with a COMPLIMENTARTY FREE 15 MINUTE SCREEN.  Call any office to schedule.   Prompt treatment benefits include but are not limited to:

§  Decrease need for opioids or surgeries

§  Relieving your pain quicker via joint mobility techniques, soft tissue massage, or modalities

§  Improving your scar tissue quality and mobility using techniques to guide the direction it forms

§  Getting you back to a sport or work sooner

§  Strengthen or stretch the injured area with individually prescribed home exercise programs

§  Correct any biomechanical faults that may be affecting your movement pattern

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What if I do Nothing?

Injuries that are left untreated can take longer to heal and have lingering pain. In addition, they are more likely to reoccur or have flare ups. This can leave you with:

·        Muscle weakness

·        Altered movement patterns or avoidance of a movement

·        Joint stiffness and loss of range of motion

·        Abnormal scar tissue formation

Remember that symptoms lasting longer than three month can become habitual and are much harder to resolve.  The sooner you get on top of your symptoms the better your outcome.

While it may cost you a little more now, it will save you money in the long run. Let the New Year equal a new you! Don’t let that deductible dictate your health and functional mobility!  

References:

Zigenfus G, Yin, J, Giang G, Fogarty W (2000)  Effectiveness of Early Physical Therapy in the Treatment of Acute Low Back Musculoskeletal Disorders. J. Occup. Environ. Med. 42(1) 35.

Photo Credits

NordWood Themes  Sharon McCutcheon

Finding the Balance

Photo Credit: Pixabay/Derdento

-You hear about it every winter in Wisconsin: someone you know – a family member, a friend, a neighbor - has fallen and become severely injured. It's unfortunate, but true.

Often times a broken bone is the result of these tragedies. We already know that physical therapy (PT) can help prevent falls; let’s say you weren’t convinced PT could help prevent your fall.

What if I told you that physical therapy (PT) could be the difference between your fall resulting in a broken bone or simply a superficial flesh wound?

Physical therapists are movement experts, and research has shown that exercise, the foundation of PT, increases bone mineral content & density across the lifespan – from childhood to older adults (Behringer, et al., 2014 & McMillian, et al., 2017).

More bone mineral density means stronger bones, and stronger bones could be the difference between a bruise and a fractured hip. According to McMillian and company, “a seemingly small 1–3% improvement in bone mineral density may be sufficient to avoid a fracture” (2017). 

Although many various types of exercise are beneficial for bone health, it is hypothesized that higher impact activities (running, jumping, lifting heavier weights, etc.) result in higher bone densities (Behringer, et al., 2014).

A famous Wolff once created a law stating “bones will remodel based on the stresses placed upon them”. In summary, sitting on the couch = weak bones; physical activity = strong bones.

Another large variable playing a role in bone health is nutrition. Making sure you have enough calcium and Vitamin D in your diet also ensures stronger bones; calcium makes our bones strong, and vitamin D assists in our bodies’ absorption of calcium (Behringer, et al., 2014). 

Combine physical activity with these nutrition tips and your long bones will be grinning from end to end. Keep in mind that, which we see less of during the winter months, helps us to obtain more of this crucial vitamin.

Last, but not least, it is very important that when you are planning to increase your physical activity level you consult a medical profession who can create and individualize program that fits all your needs.

As mentioned before, physical therapists are movement experts, and this is where we at Advanced Physical Therapy & Sports Medicine come in.

Happy Bone Building,

Dr. PJ

References:

Behringer M, Gruetzner S, McCourt M, Mester J (2014) Effects of weight-bearing activities on bone mineral content and density in children and adolescents: A meta-analysis. J Bone Miner Res 29: 467–478. 

McMillian L., Zengin A., Ebeling P., Scott D. (2017) Prescribing Physical Activity for the Prevention and Treatment of Osteoporosis in Older Adults. Healthcare 5(4): 85.

Photo Credit: Pixabay/Derdento

Revisiting the Opioid Topic

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. or http://www.apta.org/OpioidEpidemic.

All the Best

PJ

Reference:

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

Staying Active During Pregnancy

Staying Active during Pregnancy

With National Women’s Health & Fitness Day coming up on September 26, it is a great opportunity to highlight the importance of staying active and discuss basic guidelines for exercise during pregnancy.

Is exercise during pregnancy safe?

In general, if you are healthy and have a low-risk pregnancy, most exercise is safe to continue or begin. Modification, especially as your baby grows, may be necessary in later stages of pregnancy.  It is important to discuss your exercise routine with your midwife or obstetrician in your early prenatal visits.

Exercises to avoid during pregnancy include: contact sports (soccer, basketball, hockey), activities with a risk of fall, scuba diving, hot yoga  

What are the benefits of exercise during pregnancy?

Benefits may include:

Increased energy

Improved mood

Decreased constipation

Decreased risk of gestational diabetes, preeclampsia, caesarean delivery

Improved muscle strength and tone

Decreased back pain

Promotion of healthy weight gain during pregnancy

 What can the role of a physical therapist be in staying active during pregnancy and the postpartum period?

The anatomical and physiological changes that occur during pregnancy can increase the risk of musculoskeletal pain for pregnant women, especially low back pain or pelvic pain. As musculoskeletal experts, physical therapist have an important role in decreasing pain and improving function during pregnancy. Physical therapists can also assist patients in exercise prescription and modification during pregnancy and the postpartum periods. Physical therapists with specialized training in “women’s health” or “pelvic health” work with patients that may experience pelvic pain or urinary frequency or incontinence.

For postpartum patients, physical therapists also have a role in the assessment and treatment of disastasis recti (abdominal separation). Patients may have pain or dysfunction related to pregnancy and childbirth many years after it started, but physical therapy can still be beneficial.

If you feel that you would benefit from physical therapy during pregnancy or after giving birth, please contact Advanced Physical Therapy & Sports Medicine at (920) 991-2561.

References:

“Exercise during Pregnancy” https://www.acog.org/Patients/FAQs/Exercise-During-Pregnancy

“Exercise during Pregnancy” http://americanpregnancy.org/pregnancy-health/exercise-during-pregnancy/

“ACOG Committee Opinion” https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care

“Pregnancy and Low Back Pain: Physical Therapy Can Reduce Back and Pelvic Pain During and After Pregnancy”J Orthop Sports Phys Ther 2014;44(7):474. doi:10.2519/jospt.2014.0505

Let's Play Catch, Grandma!

“Grandma/Grandpa, can you play catch with me” says little Billy. “I wish I could, but I’m too stiff and sore” says Grandpa. “Okayyyy” says little Billy.

 Have you encountered a situation where you felt physically limited? If so, it’s never too late to work toward a new goal! But how you might ask? The answer is simple, find something you like to do (that involves movement) and do it! Yes, that simple. As we know, aging takes a toll, but did you know that activity/exercise even increases in importance as we age, especially if you want to keep up to those fast grandkids. You’re never too old to begin. Even if you have not been previously active, it is important to get started! Growing evidence supports the notion that physical activity can preserve independence and offset functional decline, especially after retirement.

Strength is estimated to decrease by 40%-50% between 25 and 80 years of age. A supervised or safe independent exercise program can assist you to lessen this decrease in strength over the years. Simons et al. explains that a walking program or resistance training program both improve function in individuals 66 years or older. Not only will activity & exercise help you to move around better, but it will also help improve your mood, boost your immune system, manage or lessen the impact of diabetes, heart disease, osteoporosis, depression, and many other conditions. Despite all of the great benefits, the amount of individuals who do participate in leisure physical activity is relatively low (15%).

As a healthcare provider, my goal is to allow you to reach your full potential. Whether this is by designing a specific program to achieve your goals, listening to concerns, giving recommendations, or anything else that contributes to your well-being I am here for YOU! As stated before, but I will say it again “You are never too old to set a new goal or dream a new dream.” Let’s work together to increase the amount of individuals living an active lifestyle. So there ya have it folks… it’s time to get moving and grooving.

Kaitlyn J

Sources

Simons R. Andel R. 2006. The effects of resistance training and walking on functional fitness in advanced old age. J Aging Health. 18 (91).

Newsinhealth.nih.gov/special-issues