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

The Name is Arthur, Arthuritis.

Arthritis has become a very common word in society today, but what is it? Arthritis can be broken down to its word roots to find the definition. “Arthr” is a medical prefix meaning joint, while “itis” is a medical suffix relating to inflammation. For today’s blog, we are going to take things a step further to investigate osteoarthritis (you guessed it, “osteo” means bone). Joints are a meeting place for two bones in the body, with cartilage cushioning in between; the knee is a prime example.  Osteoarthritis (OA) occurs when the cushion between these two bones – the femur and tibia - breaks down, resulting in the infamous situation referred to as “bone on bone”. What many individuals do not realize is that this “bone on bone” situation does not always have to end in a knee replacement. A recent research article showed that participating in physical therapy is beneficial for individuals with knee OA, when compared with other medical treatment not involving physical therapy (Abbott et al., 2013). Even more great, this research study followed-up with patients one year after their physical therapy, and they were still reporting relief!  Obviously the quality of physical therapy is an important factor in this magical logarithm, and that’s where we come in at Advanced Physical Therapy & Sports Medicine. Our great teams of physical therapists at APTSM are excited and willing to take on your “bone-on-bone” nightmare and get you back to dancing the night away.

Polka away Wisconsinites,

Dr. PJ

Reference:

Abbott JH, Chapple C, Pinto D, et al. (2013). Exercise therapy, manual therapy, or both, for management of osteoarthritis of the hip or knee: a randomized clinical trial. Osteoarthritis and cartilage, 21.

What's So Special about Specialization?

Some parents can live vicariously through their own children, often encouraging specialization in ONE sport at very young ages. As a pop culture reference, check out the Netflix Documentary "The Short Game" to see parents coaching their kids in this incredibly competitive tournament and tour, all hoping for them to become the next Tiger Woods. Specialization, defined as the "Hyper-focus of involvement within one-specific SPORT on a year round basis, is a complex process that should not occur until more information regarding advantages and disadvantages are known". We often find parents playing such an important role in promoting specialization, more so than other pressures affecting young athletes.  According to Wilk et al., (2015) in a study researching rehabilitation of the throwing athlete, The shoulder has also been reported as the most common injury region in high school baseball players, and tremendous forces are placed on the glenohumeral joint as anterior shear forces approach 50% of the body weight during the throwing motion".  This throwing motion, if improper or done excessively, can exacerbate such conditions and increase the likelihood of early long-term shoulder pathologies, particularly in baseball players. 

Although there are some advantages to specialization, such as playing at a highly competitive level, motor skill acquisition, as well as enhancement of scholarship opportunities, we can all agree though that some of these advantages are more the exception than the rule. Dr Charles Popkin, pediatric Orthopedic Surgeon at Columbia University reported, "Sadly, what parents want and what parents hope to gain from their children's participation in youth sports is often at as significant extreme to what the kids actually want.... Children who specialize in one sport early in life were found to be the first to quit their sport and ended up having higher inactivity rates as an adult."  As it relates to baseball, Yang et al (2014) stated that "high pitching volume and limited recovery will lead to arm fatigue, placing younger pitchers at a greater risk for elbow and shoulder problems and, subsequently, an increased risk for arm injuries"  Other more serious concerns of intensive training include growth retardation and puberty delay in females, specifically gymnasts (Hecimovich et al., 2004).

Although there are clear benefits to children for being physically active and participating in sports (much more than at home playing video games), there is an appropriate line to be drawn in the sand, or on the court, or on the field. And we must all be cognizant that the age for specialization of sport, if absolutely necessary, doesn't arrive until much later than we may previously have thought.  According to the American Academy of Pediatrics Committee on Sports Medicine and Fitness, specialization is not recommended before the age of 12 or 13 years old.  There are are also methods to avoid the burnout in sport, so that motor skill acquisition can be maintained at a high level, while preserving the long term orthopedic health of the young athlete. Dr. Popkin goes on, "Expose your children to as many activities as possible and support what they like.  But if they're performing more hours of a sport a week than their age in years, they're probably overdoing it. "  Another avenue is to become the coach or volunteer, and then help develop the schedule as to not overdo it for these young athletes.

And for those with an interest in Wisconsin sports and their heroes, we can learn from the phenomenal athletes that have demonstrated an active interest within their communities, such as JJ Watt. We can even read about how JJ Watt doesn't want us to play just one sport. And look where he ended up?

#ChoosePT #ChoosePT1st 

References:

1. Hecimovich, Mark (2004).  Sport Specialization in Youth: A Literature Review.  JACA, 41 (4). 

2. Wilk, Kevin.  Hooks, Todd. (2015) Rehabilitation of the Throwing Athlete.  Where we are in 2014.  Clinical Sports Med 34 (247-261.

3. Rosenbaum, Daryl. Callender, Shelley. (2010) The Early Specialization of Youth in Sports.  Athletic Training & Sports Health Care, 2 (6). 

3. Epstein, David.  Sports Should Be Childs Play.  New York Times. 

4. Brody, Jane.  How to Avoid Burnout in Youth Sports. New York Times.  Popkin, Charles.  Columbia University Medical Center. 

Bike Because Queen Said So!

“I want to ride my bicycle, I want to ride my bike “ - Queen

With World Bicycle Day being June 3rd, it only seems right.

The weather is getting warm, the smell of burgers and brats fill the air, and you’re ready to bust out your bicycle.  New or old, tandem or unicycle, red or green, Trek or Schwinn, you’re ready to hit road for another summer – determined to finally complete that triathlon you’ve put off for the last 3 years. Hold on cowboy - before you mount your horse let’s get a few things straight regarding proper bike fitting. Bike fit varies a lot based on your primary goal: recreational riding vs leisure riding. See below for a great graphic illustrating this from article recently published by the Wisconsin State Journal (2018). In general, seat height should be set with the goal of achieving a 25-30 degree knee bend; specifically avoid your knee going past your toes. This reduces risk of knee pain and makes for optimally efficient riding (Bini et al., 2011). On the contrary, setting your seat too low will result in greater overall fatigue and higher risk for anterior thigh/knee pain. While research has shown upright trunk positions are most comfortable for riders, it obviously results in less advantageous aerodynamics (Priego Quesada et al., 2017); again, your goals should drive your bike fit – no pun intended. If you have further questions, please stop in your local APSTM for a FREE 15-minute screen and pick our providers’ brains in order to optimize your summer biking experience.

Also, please be sure to look into our Tour de Ripon bike even going all summer in the Ripon area; sign up, bike to a restaurant, and get incentivized with free food & drinks!  The event runs from June 1, 2018 – August 31st, 2018 – sign up anytime! More info available on our website and Facebook page.

With World Bicycle Day being June 3rd, it only seems right.

Safe riding,

PJ

References:

Bini, R.,Hume, P., Croft, J. (2011). Effects of bicycle saddle height on knee injury risk and cycling performance. Sports Medicine: 41(6), 463-476.

Kittner, G. (2018). Time to Tune Up. Wisconsin State Journal.

Priego Quesada, J., Perez-Soriano P., Lucas-Cuevas A., Salvador Palmar R., Cibrian Ortiz de Anda, R. (2017). Effect of bike-fit in the perception of comfort, fatigue and pain. Journal of Sports Sciences: 35(14).

The Green, but "Injured" Thumb

Most of us don’t think of overuse injuries when starting a new hobby.  Especially those hobbies that involve what we perceive as less strenuous activities.  But, did you know that planting and tending to your garden can predispose you to some of the same injuries of as athletes such as golfers and rowers?  We always advise you to start a new activity at a gradual pace, increasing duration and intensity slowly. The same is true for gardeners anxious to get digging into the fresh spring soil. Don’t attempt to clear all the winter debris in a single day, or plant the flats of annuals brought home from the nursery all at one time.  This is why they have the yard pickup team arrive at your curb over a 6-week timeframe instead of 1x/season.  Instead, undertake these new hobbies at moderate intervals and take a few minutes to stretch prior.

Typically, the pain of sprains, tendinitis and even arthritis is mild at first and often ignored. However, these ailments can develop into serious conditions if left untreated. Here are a few common gardening-related problems that would require medical attention:

TRIGGER THUMBS OR FINGERS

The repetitive motion of opening and closing shears or other hand tools can lead to a painful triggering or locking of the fingers or thumb. The condition is caused when the “eyelet” that holds the flexor tendons in place along the finger or thumb interferes with the smooth gliding of the tendons through it. Patients may feel a pain in the palm or the finger and, in severe cases, the finger is stuck downward and requires “unlocking” with the help of the other hand.  In addition, using vibrating tools and blowers excessively can cause significant vibration concerns. This adds pressure on the median nerve, which could potentially lead to pre-carpal tunnel like symptoms.

WRIST TENDINITIS

Persistent pain in the wrist could develop from repeated motion of the wrist. In De Quervain’s tendinitis, the tendons that attach at the base of the thumb become irritated or constricted, causing painful swelling along the wrist. Heavy raking can cause pain in the forearm about three inches above the wrist, a condition called Intersection Syndrome. It results from the overuse of the wrist extensor tendons, which rub against one another as the wrist repeatedly bends backward. The friction caused by the rubbing tendons leads to irritation, inflammation and painful swelling.

ELBOW EPICONDYLITIS

Tennis and golfer’s elbow (medial and lateral epicondylitis) are painful conditions involving the tendons that attach to the humerus bone at the elbow. With tennis elbow, repeated bending of the wrist while gripping something like a rake weakens tendons attached to the outer, or lateral, side of the elbow. Similarly, weakened tendons attached to the inner, or medial, side of the elbow and can lead one to suffer from Golfer’s Elbow.

In most cases the overuse-related conditions described above can be resolved with activity modification, ice and over-the-counter anti-inflammatory medication. If the pain persists more than five days or so, however, it would be wise to consult with a physician who can assess whether bracing, physical therapy or other treatments are needed.

HAND INFECTIONS

One other gardening-related risk to mention is Sporotrichosis. Also known as Rose Thorn Disease, Sporotrichosis is caused by fungus found in soil, rose thorns, hay, moss and twigs and usually enters the body through a thorn prick. The fungus is more closely related to mold found in stale bread or yeast used to brew beer than to bacteria. Once the mold spores enter the skin, the disease can take days or months to develop. The first symptom is usually a painless bump or lesion that is pink or purple in color. In most cases, the mold spreads to the lymph nodes. Over time, new nodules can develop from your fingers all the way up the arm, becoming open sores or ulcers that are susceptible to infection. The disease is rarely life threatening, but it is important to seek medical attention. Left untreated, the ulcerative lesions can develop into a chronic condition that can persist for several years. All the more reason to wear garden gloves.

(Some content borrowed from WAG, May 2, 2o17)

Recovery Inn

The Recovery Inn Experience:  Where top-notch therapy services meet 5-star customer service and accommodations

            That nagging pain in your left knee just won't go away!  Conservative measures including physical therapy and injections have failed, and your orthopedic surgeon is recommending a total knee replacement.  Now what?  Weather you have your surgery at the Orthopedic and Sports Institute of the Fox Valley or at the hospital, Recovery Inn is a fantastic place to recover and meet all of your acute therapy needs. 

Recovery Inn is a unique skilled nursing facility that provides transitional care for patients after scheduled total joint replacement, or for patients who need rehabilitation after an unexpected injury or illness.  Therapy services at Recovery Inn are provided by Advanced Physical Therapy and Sports Medicine. 

 Therapy at Recovery Inn is provided by a team of highly skilled Occupational and Physical Therapists who specialize in orthopedic care after total joint replacement.  You can expect to meet with therapy staff as soon as a few hours after your surgery for a warm welcome, evaluation, and maybe even a short walk! 

 Occupational therapy staff will provide you with and teach you to use adaptive equipment that will help you to complete activities of daily living, including self-care tasks like dressing, toileting, and showering.  They will educate you about pain and edema management.  Before you go home, they will help you with a shower, discussing your actual home environment and making recommendations for simple home modifications.

 Physical Therapy staff will teach you how to use a walker, cane, or crutches to get you safely back on your feet again.  They will review lower body exercises to help you regain strength and endurance.  PT staff will work with you to master stairs and improve balance to reduce your risk for falls. 

  The therapy team at Recovery Inn looks forward to helping you on your journey towards better mobility...with less pain!  We know that total joint replacement surgery or recovery after an injury can be scary.  But our therapists are here to answer all of your questions and put your mind at ease. 

Happy healing!

Allie :)

Allison M. Salm, OTR, CLT

Director of Therapy Services—Recovery Inn

Advanced Physical Therapy and Sports Medicine

Have you hugged your OT today?

Have you hugged YOUR OT today?

             April is Occupational Therapy Month!  Um, excuse me, but what the heck is OT anyway?  Is that kinda like physical therapy?  Do occupational therapists help you find a job, or what?  Not exactly... 

            Occupational therapy is the only profession that helps people across the lifespan to do the things they want and need to do through the therapeutic use of daily activities (occupations). Occupational therapy practitioners enable people of all ages to live life to its fullest by helping them promote health, and prevent—or live better with—injury, illness, or disability.

            Common occupational therapy interventions include helping children with disabilities to participate fully in school and social situations, helping people recovering from injury to regain skills, and providing supports for older adults experiencing physical and cognitive changes. Occupational therapy services typically include:

•       an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals,

•       customized intervention to improve the person’s ability to perform daily activities and reach the goals, and

•       an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan.

                      Occupational therapy practitioners have a holistic perspective, in which the focus is on adapting the environment and/or task to fit the person, and the person is an integral part of the therapy team. It is an evidence-based practice deeply rooted in science.

            There are a handful of highly skilled occupational therapists who are an integral part of the Advanced Physical Therapy and Sports Medicine clinical team .  The OT's at APTSM work in a variety of settings: 

•         Outpatient clinics.  Several OT staff members specialize in hands and upper extremity, treating patients with pain and dysfunction associated with injury or the wear and tear of daily living and aging. 

•         Industrial sites across Northeast Wisconsin.  OT provides on-site work-hardening, job-site analysis, education for body mechanics, and pre-injury screenings.

•         Recovery Inn in partnership with the Orthopedic & Sports Institute of the Fox Valley. Occupational therapists provide therapy for acute care, post-surgical patients, helping them return to maximum independence before returning home.

April is Occupational Therapy Month!  Have you hugged YOUR OT today? 

Allison M. Salm, OTR, CLT

References:

www.aota.org   

A Day in the Life!

Last week we introduced you to what exactly is Athletic Training, and where do you find these mysterious healthcare figures.  We want to dive a little further into this today, and see one of their most sacred rituals: game day. 

It's game day, you're standing in the tunnel, the crowd is cheering....whoa, whoa, whoa, wait, we should back up 6 days to when the preparation for game day really began. It's Sunday, treatments are occurring. Treatments range from contusions, ankle sprains, overuse injuries, and ongoing rehab from previous injuries.

It's Monday, typical practice preparation, rehab during the day and emails out to the visiting team. Throughout the remainder of the week, it's decisions regarding if an athlete can play on Saturday, nutritional advice so the athlete can fuel for the big game, more rehab, and too many other things to list. 

Now, it's game day. Arrive earlier than anyone else, make last minute decisions and time to prep. 10 gallons ICE, water bottles, AED, crutches, splints, emergency airway equipment, treatment tables, and all of the tape that fits in the sideline kit. Pregame treatments begin followed by pregame taping and a last minute glance to make sure everything is ready. Warm ups begin, last minute stretching while organizing the sideline. EMS arrive on scene along with the team physician; introductions are made and review of the emergency action plan is discussed. Finally, the national anthem. The game begins. 

Ready to do start this all again tomorrow?  

Thanks for reading.

Ashley Rottier, MSAT, LAT

At Your Own Risk

Given that March is National Athletic Training Month, I would like to open up to the world of Athletic Training to you! What is an Athletic Trainer?  Athletic Trainers (AT’s) are health care professionals who work under the direction of physicians as prescribed by state licensure statutes. What services can an AT provide? The services provided by AT’s comprise prevention, emergency care, clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions.

The statutory title of “athletic trainer” is actually a misnomer, but is derived from the profession’s historical roots. Athletic trainers provide medical services to all types of people – not just athletes participating in sports – and do not “train” people as personal or fitness trainers do. However, the profession continues to embrace its proud culture and history by retaining the title. In other countries, the profession bears the label of athletic therapist or physiotherapist.

Here in the U.S., the National Athletic Trainers’ Association (NATA) represents more than 44,000 members domestically and internationally, there are about 50,000 ATs practicing nationally. The athletic training profession began early in the 20th century, and NATA was established in 1950. At Your Own Risk is a public awareness campaign sponsored by the National Athletic Trainers’ Association designed to educate, provide resources and equip the public to act and advocate for safety in work, life and sport. In an effort to provide comprehensive information, the association has launched a website, AtYourOwnRisk.org that provides recommendations on keeping student athletes and communities active and employees safe on the job.

Did you know that Advanced Physical Therapy and Sports Medicine provides Athletic Trainers for the Appleton Area School District, St. Mary Catholic High School, Lawrence University and numerous industrial sites in the area? Well, they do! Advanced Physical Therapy and Sports Medicine can provide the care for you, your student-athlete, or your event!

Please explore more about athletic training at the following pages:

NATA.org

AtYourOwnRisk.org

Wisconsin Athletic Trainers' Association: Homepage

Reference:

Profile of Athletic Trainers. NATA.org.https://www.nata.org/sites/default/files/profile-of-athletic-

trainers.pdf.Published July 2016.Accessed March 1,2018.

Falling For You!

Falling for You #PunnyValentinejokes

You hear about it every winter in Wisconsin: someone you know – a family member, a friend, a neighbor - has fallen and gotten severely injured. Often times a broken bone is the result of these tragedies. Based on an earlier blog post, 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 epiphysis to epiphysis.

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.

Sedentary Behavior! by Ross VonGlahn, PT, DPT

For further information, I recommend you reference the perspective article below by Wheeler et al, 2017 from the journal, Alzheimer’s & Dementia: Translational Research & Clinical Interventions, titled Sedentary behavior as a risk factor for cognitive decline? A focus on the influence of glycemic control in brain health.

Intro

Many of us know that exercise is good for you. However, the effects of exercise go beyond just looking good and feeling good. New research is being conducted, looking at the effects of exercise and disease prevention. However, is exercise enough? New literature suggests no. The benefits of exercising for the recommended 150 minutes per week may be cancelled out by sedentary behavior (sitting/laying) the rest of your waking day. Think about it. How much sitting do you do in a day? One hour? Five hours? Eight hours? Take some time to actually tally this up between driving to and from work, sitting at work, sitting for meals, and sitting in front of a screen. The number may surprise you. A survey by the U.S. National Health and Nutrition Examination Survey shows that on average people are sedentary greater than 9 hours per day, perform light activity 5 hours per day and perform 11.3 minutes of moderate to vigorous activity per day. Of the 150 minutes per week of recommended moderate to vigorous activity, nearly one-third of people do not meet this recommendation. The number of people not meeting this recommendation increases as age increases as well.

What is it about?

This article reviews the physiologic processes involved in regulation of glucose (sugar) in the brain as well as the effects of abnormal glucose levels in the brain. Glucose is the primary fuel for the brain and is essential for the proper functioning and health of the brain. When blood sugar is too high, the brain will regulate this by decreasing blood flow to the brain as to decrease the overall amount of glucose to the brain. When it is too low, the brain struggles to have enough energy source to work efficiently and may cause damage known as apoptosis (cell death). Also, when your brain accustomed to high glucose levels (hyperglycemia), it can experience relative hypoglycemia when it returns back to normal blood glucose values, leading to damage.

Why does this matter?

Think about eating a big meal, full of carbs and sugar. You will have a large spike in your blood sugar, which signals the brain to decrease blood flow to the brain, as well as release insulin from the pancreas. The insulin helps drive glucose into your cells, effectively lowering your blood glucose (ie, blood sugar). However, this tends to overshoot and leads to a “hypoglycemic event” as referenced in the above article. This hypoglycemic event can lead to apoptosis (cell death) in the brain. This is a process involved in Alzheimer’s and Dementia. They cite that those with type 2 diabetes are 50% more likely to develop dementia compared to those with normal blood sugar control and regulation.

Tying it all together

Reviewed in the above article, sedentary behavior increases the risk for diabetes and poor glucose control. By decreasing sedentary behavior, an individual may better regulate the hyperglycemic events that subsequently lead to a hypoglycemic event and causing damage to the brain. Limiting this undulating pattern of high blood sugar to low blood sugar may limit the damage to the brain and maintain brain health. It recommends that outside of the recommended 150 minutes/week of exercise, intermittent walking or light activity throughout the day may help control blood sugar and maintain brain health. Point of the story is, get up and move and move often.

Change Society, Make them Healthy!

As the current changes take place in the healthcare system, the Science of Medicine and the Art of Healing, rings true and our profession must take a stand by participating in the role of “wellness professionals”. We must strive to corner the market in this arena and present our level of expertise as we position ourselves for the future of healthcare. We have all the tools necessary and we need to put them into practice by being the conductors of healthy lifestyles in society.

At the World Economic Forum this year, the focus was on a new and rather upbeat topic:  the need for countries to invest in health to achieve long-term economic growth. “The time is right to elevate the conversation on health,” said Robert Greenhill, the managing director and chief business office of the forum.  “This year, there is a sense that the global economy is out of intensive care and embarking on rehabilitation. As we ask how, metaphorically, to improve the economy’s health, literally improving the population’s health is a good place to start.”

What an inspiring statement and a good choice of words to show our world is embarking on rehabilitation; this is an excellent segway for Physical Therapy to take the ball and roll with it!  It appears as a challenge for physical therapists to capitalize on this opportunity. We have heard a great deal about incorporating wellness into our profession and our vision for the last few years but I am uncertain we know how to put this into practice. We have the knowledge regarding exercise and fitness, but are we incorporating lifetime wellness into our discharge plans and daily practice of physical therapy? Everyone comprehends the benefit of transitional programs upon discharge from skilled physical therapy; personal training, performance enhancement, group fitness and small group training. Whether or not we choose to personally engage in these entities, we possess the knowledge to assist our patients and direct them to utilize or locate these programs as necessary. I view our role as therapists to ascertain whether or not our patients need the additional expertise, guidance or support to follow through with our directions and home program upon discharge.

In addition to the referrals as, appropriate, to the programs listed above, are we preparing our patients on a very basic level for lifetime wellness and exercise? Beyond the diagnoses for which they sought our care, are we educating them in healthy behaviors and fabricating plans for this in our discharge goals? We are in the perfect position to serve as role models to discuss weight loss principles for our OA patient. If our patient leads a sedentary lifestyle, there is a huge opportunity to share the research on inactivity and encourage them to step away from the chair. We can present the evidence between sitting time and premature mortality rates. I think we all realize individuals may be averse to exercise, however educating them on the benefit of how simply standing an extra 1-2 hours per day can burn enough calories to lose between 5-10# over a year’s time.

Prevention is a key in overall health, so do we appropriately discuss osteoporosis indicators for the patient population we treat that falls into this strata? Do we report the NIH recommendations for exercise as a way to keep our patients exercising upon discharge? Lastly, do we as a profession take responsibility for societal or global health? I have taken it upon myself to frequently write letters to MD’s to encourage referral of their patients for exercise, walking programs or strength training when they diagnosis them with chronic diseases, such as CAD, Diabetes, OA, Parkinsons, MS and Osteoporosis. Many times a MD will tell their patient to become more active but that individual may not comprehend how to take the next step. Our profession can assist with this task. We can also market the consumer for direct access to our services by informing the public of our skill set.

As a doctoring profession, we have all the tools and education to lead our consumers to a healthier lifestyle, however we need to ask ourselves how and when we are willing to use them. Each of us can play a major role in educating our patients to behavioral changes to promote wellness. Preventing disease as opposed to merely treating it must become an even greater priority. In this manner, we can all support our APTA Brand-Move Forward; Physical Therapy Brings Motion to Life!

Jean Darling PT, LAT is an Impact editorial board member and Vice President of Advanced Physical Therapy & Sports Medicine. She can be reached at jean@advancedptsm.com

A Glimpse Into the Next 20 Years

A GLIMPSE INTO THE NEXT 20 YEARS -- WILL THESE ADVANCES BE GAME CHANGERS?

The future of health care is at our doorstep.   Throughout the next 20 years, advances in medicine and technology will allow the industry to recalibrate its focus toward health and wellness strategies. PHYSICAL THERAPISTS have front row seats regarding these game-changing trends -- prevention, health coaching, personalized medicine, personal technology and a team approach will all share time on the playing field.

Prevention, first, will hopefully serve as a roadblock in the soaring costs of health care. Many insurance companies are now offering reimbursement, or have established a 100% payment for wellness programs. And, who is the best qualified to direct movement in our society regarding wellness? PHYSICAL THERAPISTS!  Many individuals seeking health care though a medical clinic are presenting with multiple issues from knee pain, to high blood pressure, to obesity.  We're here to help!

Health coaching presented through health care organizations, medical institutions, PHYSICAL THERAPY Clinics, and health clubs will assist by offering continued support to help people remain healthy. Alignments with corporations, which take an interest in their employees and keeping them physically well, shall increase with innovative approaches regarding their physical educational needs. It may even allow all types of working Americans to make the choice to live a longer, healthier life!

Personalized medicine should SOAR with new advances in health care and research-based decisions by the medical world.   Medicine will become more personalized with genetic advancements; these advances could lead to an increase in more individualized goal setting for patients. Currently, health care professionals are operating in a disease-management society -- hospitals are rewarded for keeping patients in house and staying full to capacity. Drug companies are compensated for successfully selling more drugs.  The shift to more personalized medicine will assist in keeping more people out of hospitals and, once again, who is highly qualified to take the “offensive approach” in this game-- PHYSICAL THERAPISTS!

Personal technology will help by offering the remote care needed to keep people out of hospitals. We are already noticing the trend toward “exercise prescription” on mobile devices, and the idea of providing general education and nutritional advice on these devices as well. The new, personal technology will expand to apps for modality uses that allow independent follow through at home.  Don’t get me wrong!  I am not advising that we remove the human factor from our approach to health care; I’m suggesting that we call a “time out” to be certain the technology is able to offer increased access but is driven and directed by educated, knowledgeable providers following appropriate, qualified assessments.

Especially in health care, this team approach is a winner in any setting.  With new advancements in appropriate technology enhancements, the treatment of the patient as an individual will be continuously improved. PHYSICAL THERAPY has positioned itself to be the catalyst to help propel our nation into a healthier game! Our profession has and will have unparalleled opportunities to take control of the health and wellness of our nation and, together, everyone will be winners within a healthier society!

-Smartphones may NOT BE SO SMART--

You’ve heard it said before, everything in moderation....  This couldn’t be more fitting when applied to our usage of cellular and mobile devices.  We are told to correct our posture when sitting, driving, and even when sitting on the couch. But have you ever thought about why your thumb, wrist, & neck hurt more, especially after holding your personal cellular device for an extended period of time? You guessed it!  Poor posture. 

According to Dr. Daniel Polatsch, a renowned orthopedic hand surgeon, trigger finger or trigger thumb can develop from those spending long hours at the computer. Carpal tunnel rates have increased, especially in younger populations.  Certainly, we know our ancestors were not afflicted with these types of conditions when related to device usage.  We can also bet that our ancestors predicted these problems as they may have been slower to adapt such technology.

With that said;
Here are some of our best wellness solutions to this 21st century problem (and If we properly mitigate these risks now, we may just be able to prevent this from becoming a  22nd century problem). 

1.       Bring the device to you  versus holding it out away from your body, and take breaks when typing for long periods of time.
2.       Send long articles to your computer/email to read in a more ergonomic position.
3.       Dictate to text-especially if you are writing a short story to your BFF.  Or turn the phone sideways.
4.       Resist slouching. Alternate hands. And use other fingers.
5.       Limit phone usage at night prior to bed – it can keep us awake for longer than we want.

And finally, come see us if these stresses start to cause you any or all of the following; difficulty/pain/weakness of the hands/wrist/shoulders or neck, or limitations with certain activities, etcetera.  Our Occupational Therapy Department will be able to help you identify these stresses that decrease your overall wellness/posture and help you to use these in moderation.  Call us today- or anytime- without moderation!

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.