Are You Fall-Savvy? Take This Quick Quiz

Falls are a major public health concern. According to the CDC, more than one-third of adults 65 and older fall each year in the United States, and 20% to 30% of people who fall suffer moderate to severe injuries. Falls can exact a toll long after the initial injury, outranking chronic kidney disease, asthma, and Alzheimer’s disease and other dementias in terms of effects on disability-adjusted life years, according to a 2017 Global Burden of Diseases, Injuries, and Risk Factors Study.

The physical therapy profession’s role in falls risk reduction and prevention is supported by a strong body of research. What we do works.

See how you score on this 8-question quiz on falls statistics and screening (scroll down for answers). Good luck!

1. According to the US Centers for Disease Control and Prevention (CDC), approximately how many Americans aged 65 and older experience a fall every year?
A. 1 in 3
B. 1 in 4
C. 1 in 5
D. 1 in 6

2. According to a clinical guideline statement from the APTA Academy of Geriatric Physical Therapy (AGPT), what question should physical therapists (PTs) routinely ask older adult patients?
A. “What medications are you currently taking?”
B. “Are you experiencing feelings of dizziness?”
C. “Have you been diagnosed with diabetes?”
D. “Have you had any falls in the last 12 months?”

3. Between 2007 and 2016, death rates due to falls in the US increased by what percentage?
A. 3%
B. 15%
C. 24%
D. 31%

4. Authors of a 2012 study in the Journal of Aging and Physical Activity studied a particular activity and found that adults who engaged in this activity had a reduced risk for falls. Which activity did researchers target?
A. Gardening
B. Driving a car
C. Shopping
D. Light household chores

5. A recent study in the American Journal of Preventive Medicine found that the falls risk factor affecting the largest number of adults 65 and over is:
A. Visual impairments
B. Medication interaction
C. Home hazards
D. Vitamin D deficiency

6. A recent CDC study ranked US states according to older adult death rates due to falls in 2016. At 142.7 per 100,000 individuals, which state reported the highest death rate?
A. Alabama
B. Florida
C. Arizona
D. Wisconsin

7. According to the CDC, among men and women aged 65 and older, which group has the highest rate of nonfatal falls, and which has the highest rate of fatal falls?
A. Men have the highest rates of both fatal and nonfatal falls.
B. Women have the highest rates of both fatal and nonfatal falls.
C. Women have higher rates of nonfatal falls; men have higher rates of fatal falls.
D. Men have higher rates of nonfatal falls; women have higher rates of fatal falls.

8. According to a survey of emergency department physicians in the US and Canada, the bathroom is the most risky location for a fall in the home among adults 65 and older, with 69% of home falls occurring in that space. Which area comes in second?
A. Kitchen
B. Bedroom
C. Stairs
D. Living room

ANSWERS:

1. B – About 24% of older Americans fall each year—the leading cause of fatal and nonfatal injuries among older Americans, according to the CDC.

2. D – There are of course many questions that may be appropriate for providers to ask (including some of the choices listed here), but the question that should never be skipped is whether the patient has experienced any falls in the past 12 months, according to the AGPT guidelines. Previous falls are 1 of the strongest falls risk factors, and should never be ignored.

3. D – Falls-related deaths rose by 31% between 2007 and 2016, according to the CDC. During the 10 years tracked in the study, falls-related deaths among US residents 65 and older rose from 18,334 to 29,668—in terms of rates of death from falls, that’s an increase from 47 per 100,000 to 61.6 per 100,000 in that age group. Deaths climbed by about 3% per year, according to the report.

4. A – In the study, researchers focused on gardening, and concluded that “gardeners reported significantly better balance and gait speed and had fewer chronic conditions and functional limitations than nongardners.” They believed the findings “suggest that gardening may be a potential activity to incorporate into future fall-prevention programs.”

5. C  – Home hazards were the leader in terms of falls risk factors, but that isn’t to say other factors don’t come into play as well, say authors of the study.

6. D –  According to the CDC, Wisconsin had the highest falls-related death rate among adults 65 and older, at 142.7 per 100,000. Authors aren’t sure of the reasons for the variance but suspect that the numbers might be related to demographic variables including differing proportions of older white adults in various states. Another possible explanation: the impact of who completes the death certificate.: According to the CDC researchers, a 2012 study showed that coroners reported 14% fewer deaths from falls than did medical examiners.

7. C – Women have higher rates for falls, but men have higher death rates related to falls, according to the CDC. Authors of the study speculate that the higher fatality rate “might have resulted from differences in the circumstances of a fall (e.g., from a ladder or while drinking), leading to more serious injuries.”

8. B – Caregiverstress.com reports that at 13%, bedrooms are the second-most-likely place for a fall, followed by kitchens and stairs.

PT Can Prevent Unnecessary Surgery

Recent research is showing that surgery might not be needed as often as we think. A large review estimates that 10% to 20% of surgeries might be unnecessary and that in some specialties such as cardiology and orthopedics, that number might be higher. The reasons for so many unneeded surgeries being performed are varied, but the most common are that more conservative options aren’t tried first, or lack of knowledge by the operating physician.

Physicians undergo long and rigorous training programs to become surgeons, but if they don’t work hard to keep learning, their knowledge often stops growing when they leave residency. Recent research is showing that certain common surgeries aren’t any better than a placebo. Two such examples are:

kyphoplasty – a procedure for spinal compression fractures.

and

partial meniscectomy – a procedure used to treat tears of the meniscus in the knee.

If a surgeon hasn’t continued to learn, they won’t know that these surgeries often don’t offer any more benefit than a non-surgical treatment and will continue to perform them.

Every surgery, even “minor” ones carry risks. These include complications from anesthesia, blood clots after surgery, delayed healing of the incision, infection, and unintended damage to nerves or other organs near the surgical site. Some of these risks cause discomfort for a period after surgery and go away, but others can result in permanent disability or even death. For some patients and conditions, surgery is a great treatment option, but with all the associated risks, when surgery can be avoided, it should be.

For musculoskeletal problems like back and joint pain, sprains, and strains, seeing your PT before a surgeon can help keep you out of the operating room and get you back to life without surgery. Studies have shown that physical therapy is just as good if not better than surgery for a multitude of conditions and carries less risk. Some examples would include rotator cuff tears, meniscal tears, spinal stenosis, low back pain, and osteoarthritis.

Physical therapy can’t fix every problem, and for some patients surgery is the best choice. However, research is showing that surgery isn’t a cure-all, and is sometimes just a very expensive and risky placebo.

The takeaway? Starting with physical therapy is the right choice, and for many patients, PT is the only treatment necessary.

 

The Benefits of Mindfulness

So you have been diagnosed with a painful condition and your doctor prescribes physical therapy (PT), what’s your next step? To come to PT of course!

Now you are coming to PT, but then you get to your appointment and start treatment revealing your fear of the reason you are in PT and all of the sudden freeze-up thinking about all of the “what if’s?”

Have you ever wondered, or been asked, if you were a coper or an averter? We don’t want our patients to make things worse for themselves by making bad coping choices such as isolation, too much or too little sleep, unhealthy eating, and we don’t want you to avert coming to therapy out of fear or unknowns.

The American Mindfulness Research Association describes mindfulness as “the state, process, and practice of remembering to observe moment-to-moment experience with openness and without automatic patterns of previously conditioned thoughts, emotions, or behaviors.”

At Carousel we want to investigate the missing piece of your PT treatment; your worry, why it worries you, and what is the worst thing that can happen (this is especially true for those of you that have had a fall and are afraid of falling again). Because once we help you confront the worst thing that could possibly happen—and help you realize the unlikeliness that it will happen again, or educate you on how to take care of yourself if it happens again—you can return to your daily activities worry-free.

By using mindfulness in PT (and we’re not talking about your body in tune with the universe or in harmony with the planets), it helps to let go of preconceived ideas and concepts about your body and listening to what it is telling you; as if for the first time. Some benefits of mindfulness are:

  • It helps you slow down.
  • It helps you to know yourself better.
  • It helps you to focus or concentrate.
  • It helps you to ruminate/stress less.
  • It helps you change bad habits.
  • It helps us be more resilient.
  • It leads to a more enjoyable life.

We want to eliminate any of the stressors and stigmas of your condition, or about PT in general. We want you to be able to ask yourself are you coping or averting after applying the wisdom you relearned about your body; at Carousel of course!

Why You Need a Physical Therapist on Your Healthcare Team

With health in sharp focus as a result of the pandemic, now may be a good time to look at the team of experts you have in place and see if there are any improvements you could make. You probably have a family doctor, dentist, and optometrist. Maybe you have some specialist physicians, a trainer, or a massage therapist. If a physical therapist isn’t a part of your healthcare team, you’re missing out on taking care of a big part of your health. To understand why you need a physical therapist, you need to understand what they do.

PHYSICAL THERAPISTS HELP YOU DO THINGS

The American Physical Therapy Association defines PTs as “health care professionals who diagnose and treat individuals who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives.” So physical therapists help you do things that you have trouble with. That could be going for a hike, playing with your kids, or getting through a day of work without pain.

PHYSICAL THERAPISTS REDUCE PAIN

Chronic pain is a huge problem worldwide. A big part of that is low back pain. Statistically, around 80% of people will have low back pain in their lifetimes. Physical therapists are trained to treat pain without surgery or medications. If you have back pain, an arthritic knee, neck pain, or an old injury that won’t go away, a PT may be able to help.

PHYSICAL THERAPISTS KEEP YOU HEALTHY

The APTA goes on to say that “PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.” That means that a physical therapist can help you determine your risk for injury, choose the right fitness program, and improve the quality of your life by improving your health and ability to move.

PHYSICAL THERAPISTS CAN HELP YOU LIVE LONGER

It’s well known that the risk of many of the leading causes of death can be reduced by exercise. Some of these conditions would include heart disease, cancer, lung disease, diabetes, and stroke. By helping you move better with less pain, finding the right exercise program, and helping you to make healthy lifestyle choices, a PT could help you live longer.

Physical therapists have a unique set of skills and expertise that can do a lot to improve your health and quality of life. If you don’t have one, consider adding one to your healthcare team.

Youth Baseball, Softball and T-ball: What Parents Need to Know

Youth sports injuries have been on the rise for years, and baseball players are not immune to this trend. 1 in 5 players between the ages of 9 and 15 will have an injury each year. The good news is that only 5% of these injuries result in surgery, or being unable to continue to play baseball. More good news comes when you learn that the majority of injuries are preventable with proper training and awareness.

Many of the injuries seen in baseball are common to other youth sports and include things like:

  1. Sprains and strains
  2. Fracture
  3. Minor injuries like bruises, scrapes, abrasions, and muscle cramps

Keys to preventing these types of injuries are making sure that players have a proper base of strength and fitness to participate, adequate warm-up before practice and games, and making sure that players have enough recovery time built into their schedules throughout the season.

INJURIES UNIQUE TO BASEBALL/SOFTBALL

In addition to the common injuries above, baseball sees a large number of injuries due to overuse. These most commonly occur in the shoulder and arm, typically in a pitcher. Parents of athletes who pitch need to be aware of the risks of pitching and guidelines to minimize them. Studies have shown that pitchers who average more than 80 pitches in a game are 4x more likely to get injured. They have also found that pitching for more than 8 months out of the year, causes your injury risk to increase by 5x.

Tips to prevent pitching injuries

  1. Pick a team to pitch for -if you play on multiple teams, choose one to pitch for and play a different position on the other to reduce the chances of injury
  2. Don’t play a position that requires a lot of throwing on your non-pitching days, like catcher
  3. Take 2 to 4 months off each year from pitching to rest your arm
  4. Keep your arm healthy and strong. The thrower’s ten was developed specifically for throwing athletes and is a good place to start.
  5. Stop pitching if you feel pain or fatigue. Throwing through problems will change your mechanics and put you at risk for serious injury
  6. Follow the guidelines for rest days and total pitches below.

If you’re 14 or under:

Pitches Thrown Rest Days
1-20 No rest day required
21-35 1 rest day
36-50 2 rest days
51-65 3 rest days
66+ 4 rest days

15 and under can throw a bit more:

Pitches Thrown Rest Days
1-30 No rest day required
31-45 1 rest day
46-60 2 rest days
61-75 3 rest days
76+ 4 rest days

Finally, you should aim to keep under the maximum number of daily pitches set by Little League Baseball and Softball:

Age Max Pitches Per Day
7-8 50
9-10 75
11-12 85
13-16 95

Your Alignment: It’s Off the Chain….Kinetically

Imagine there is a spool of thread anchored at the top of your skull, and you can pull the thread down; you pull it down through your shoulders, kidneys, pelvis, thighs, shins, and stop at your ankles. See it? That is your body’s kinetic chain. Why is the kinetic chain so important, you ask? Kinetic suggests movement, and when you are in the standing position, your body is confined to the force of gravity and your kinetic chain helps you to stay vertical and balanced so you can keep moving.

Now imagine that thread snapping at one, or two, of those places (note: two parts do not need to be connected with each other to be affected), your body will now compensate for the area of injury, meaning the healthier ones will work harder for the painful ones, and over a long period of time, your movement pattern may become hard-wired and more painful.

For instance, your neck hurts; this could be because of a shoulder injury or your pelvis is rotated, or both. Hey, you could have a leg length discrepancy causing your whole kinetic chain to be affected.

It is also important to point out that the kinetic chain is congruent with the musculoskeletal system (the framework of the body) which relies heavily on the other for precision alignment also helping you move pain-free. So, when there is a disconnect between the two, this can produce additional stress and strain elevating pain, and discomfort.

So, don’t let your pain become unbearable without knowing the root cause. You could have a break in your chain and not even know it!

Do You Know Your Knees?

Do you know that the largest joints in the human body are in your knees? Taking on their fair share of impact, these joints can only take so much.

You may know your body, including your knees, and your activity limits; but how well? For instance, you’re motivated, you’re moving and grooving with your activity of choice when OUCH! now you have pain in your knees. But you sucked it up, pressed-on, and have more pain.

What do you do? Do you risk making your pain, and the condition causing it, worse? Moreover, do you know if your knee condition is structural or inflammatory?

How can you tell the difference between structural and inflammatory knee problems? According to Charles Bush-Joseph, MD (Rush University Medical Center), Structural damage is present when knees are visibly swollen or cannot get into a squatting position with knees at 90-degree angles. Inflammatory damage is over-use of your knees caused by improper lifting of heavy objects, poor flexibility, bad shoes, muscle weakness, or starting a high-impact fitness routine without warming-up.

The Key? Know your limits. Knee pain is not discriminatory, “It can happen to anyone at any age,” says Bush-Joseph.

What’s next? STOP! Always let pain be your guide. If you start having pain, temporarily discontinue the activity. If your pain lasts longer than 2-weeks after starting back up, it’s a good idea to consult your physician for a proper diagnosis and treatment.

Remember movement is the key to your freedom! Staying active helps control weight and build muscle, both of which can help protect your knees from further damage when done properly. Because healthy, strong pain-free knees can make all the difference in the world!

 

Exercises for Seniors to Stay Active During “Social Distancing”

The coronavirus outbreak has disrupted our lives and forced us to change our habits, including hindering most group fitness activities. Whether you like to do your own thing outside, take a class, or work one-on-one with a personal trainer, you might be feeling a little lost when it comes to staying active in your own home.

Exercising is important to our health in a variety of ways. It can improve strength, improve balance, give you more energy, prevent or delay disease, improve mood, and improve cognitive function. As long as your doctor says it’s safe for you to exercise, you should workout to improve the quality and increase the longevity of your life.

It may be daunting to start an exercise program at home, so we’ve broken down some exercises you can do with just one piece of equipment: a chair.

(Remember during this time that it’s important to keep your body moving and also to keep yourself safe, but never attempt an exercise routine without confirming with your doctor that it’s safe to do so. These chair exercises are a great way to strengthen your muscles and get your heart rate up in this time of “social distancing.”)

 

  1. Calf Raises

There are two ways to complete this exercise. First, you can sit upright in a chair with your feet flat on the floor hip-distance apart. Make sure you’re looking straight ahead and engage your core. Start with your right foot and lift your heel as high as you can and raise up on your toes as high as you can. Complete ten reps on each side for three sets.

Another way to complete calf raises is to stand behind the chair and hold onto it for balance. Stand with your feet shoulder-width apart. Complete the same movement of putting your weight on your toes and lifting your heels as high as you can, but this time, do it on both legs at the same time. Complete ten reps for three sets.

 

  1. Modified Push-Ups

Push-ups are an effective upper body exercise because they work so many muscles. By using a chair, you can decrease the difficulty of the exercise, decrease the impact on your joints avoid getting all the way down on the ground.

To perform this move, place the chair so that the seat is up against a wall to make sure that it’s not going to move while you complete the exercise. Stand behind the chair with your feet shoulder-width apart. You want to stand far enough away that you can extend your arms but close enough to feel comfortable and stable. Engage your core and keep your body as straight as possible. Slowly bend your elbows and lean your body forward to complete a push-up. Complete ten reps for three sets.

 

  1. Modified Planks

Planks are one of the best exercises to work your core. To complete it on the chair, start in the same position as the push-up. The seat of the chair should be against the wall, and you should stand behind the chair with your hands holding onto the top of the chair with your feet shoulder-width apart. Take a step back so your body is at a slight angle. Make sure your hips are aligned with your knees and shoulders. Hold the position for 10 to 60 seconds – however long you feel comfortable, and then return to standing. Complete three sets.

 

  1. Modified Squats

Squats are an effective lower body exercise that work your quads, glutes, and core. Stand behind the chair with your hands holding onto the top of your chair. Your feet should be about shoulder-width apart. Gently lower yourself down and imagine that you are sitting into a chair. The movement should be almost identical, but you can go however low you feel comfortable. Hold onto the chair for balance. Complete ten reps for three sets.

 

  1. Seated Leg Lifts

Seated leg lifts are a great exercise for your core and your legs. Sit at the edge of the chair with your back straight. Start with your legs shoulder-width apart extended in front of you with just your heels on the ground. Hold onto the chair for balance, and slowly lift your right leg up as high as you can without moving your torso. Hold it at the top for a second and then slowly lower your right leg back to the starting position. Then complete the move with your left leg. Complete ten reps on each side for three sets.

 

  1. Seated Shoulder Press

If you have a pair of light dumbbells, you can use those. You can also use objects you might find around your house, such as cans of soup or bottles of water – just make sure the two items you choose are identical in weight. You can also complete this exercise without weights. Start in seated position with your back straight, with elbows out to the side of your body. Your elbows should start below your shoulders with your wrist directly above your elbows. Your palms should be facing forward. Slowly extend your arms above your head as high as you can. At the top of the movement, they should be fully extended, but don’t lock your elbows. Slowly bring your elbows down keeping your elbows out. Complete ten reps for three sets.

 

 

Concussion 101

A Q&A session with Nicole Somers, PT, DPT

Did you know?

  • A concussion is a type of brain injury.
  • Imaging, such as MRI and CT scans, are not able to diagnose a concussion.
  • Most concussions (90%) are not associated with a loss of consciousness.

What is a concussion?

A concussion is a type of mild traumatic brain injury or mTBI. It occurs as a result of a direct blow to the head or a blow elsewhere to the body where the force is transmitted up through the head (think about whiplash and how the brain is bouncing around inside the skull). Loss of consciousness does not always occur. In fact, most people who have a concussion do not lose consciousness.

So, what really happens?

The impact on the brain causes the brain cells to stretch and become damaged. The damage to the brain cells causes them to release neurotransmitters, which are the chemicals of the brain that allows it to function normally. The imbalance of these chemicals causes the brain to have to work harder and requires more energy, resulting in an “energy crisis” within the brain.

What are the signs and symptoms?

Signs and symptoms of a concussion can occur immediately or hours to days following the injury and include¹:

  • Emotional: anger, sadness, nervous or anxious, irritability
  • Mental: confusion, feeling foggy, poor memory, poor concentration
  • Physical: headache/migraine, clumsiness, dizziness or loss of balance, nausea or vomiting, fuzzy or blurry vision, sensitivity to noise or light
  • Sleep: feeling tired, trouble falling asleep, trouble staying awake, too much or too little sleep

What is the recovery time?

A typical concussion will fully resolve in less than 3 weeks with minimal intervention, with significant improvement in the first 7-10 days. In about 20% of concussed people, a concussion takes greater than 4 weeks to resolve. A second concussion before fully recovering from the initial injury can have detrimental effects, including prolonged recovery, permanent brain damage, and even death.

How can physical therapy help?²

Physical therapists are part of the multidisciplinary team capable of helping people return to their normal activities and lifestyles after a concussion. Physical therapists will complete a comprehensive assessment and are highly qualified to address:

  • Orthopedic issues and pain from the injury
  • Balance, dizziness, and vestibular/vertigo problems
  • Visual and ocular motor problems

___________________________

¹ “Symptoms of Traumatic Brain Injury (TBI).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 11 Mar. 2019, www.cdc.gov/traumaticbraininjury/symptoms.html.

² Mucha, Anne, and Susan Whitney. 4 May 2020., MedBridge Education. https://www.medbridgeeducation.com/certificate_programs/11026-concussion-assessment-medical-management.

 

Constipation Trouble?

By: Kennan Wyne, PT, DPT

Everyone has had constipation at some point or another and it is uncomfortable, painful and embarrassing.  Chronic constipation and/or straining can lead to excessive stress on pelvic organs and nerves.  This may contribute to bladder dysfunction, pelvic floor dysfunction, and/or prolapse (bulging of structures occurring commonly due to weakened supportive structures).  Constipation is defined as infrequent (fewer than 3) bowel movements per week.  Normal stools should be about the size, shape, and consistency of a ripe banana.*

Listed below are tips to keep your colon happy.

Tip #1: Avoid regular use of laxatives and enemas.

Tip #2: Discuss fiber needs with physician/pharmacist/nutritionist. Typical recommendations for fiber intake are 25-35 grams per day. If adding fiber to diet remember to DRINK 6-8 cups of WATER to move stool through the colon. You may experience a bloating feeling and/or gas when adding fiber to your diet, but this should pass in a few weeks.  This may be eased by adding fiber SLOWLY to your diet.

    • Examples of high fiber foods are bran, shredded wheat, whole grain bread, and whole fresh fruits with skin (apples, raw veggies).

Tip #3: Proper positioning: Position yourself on the toilet to allow for maximal relaxation of your pelvic floor muscles by using a Squatty Potty or stool to obtain maximal knee and hip flexion (similar to a squat position) and leaning forward and supporting elbows on knees. NO STRAINING OR HOVERING as this increases intraabdominal pressure and pressure on the pelvic floor.

Tip #4: Regular exercise helps stimulate a sluggish bowel.

 

*Any persistent change in bowel habits, such as increase or decrease in frequency, size of the stool, blood in the stool, or an increased difficulty in evacuating, warrants a medical consultation.