5 Shoe Mistakes Many Older Adults Make

Your feet have been taking you where you want to go nearly every day of your life. But eventually, those decades of wear and tear are bound to take their toll. In fact, among people over the age of 65, foot pain ranks among the top 20 reasons for seeing a doctor, according to a study in the Journal of Foot and Ankle Research.  

What’s more, many people have habits that can make foot discomfort worse. Here are five common mistakes people make when it comes to their feet—and what to do instead.  

Mistake #1: You Wear Slippers Around the House 

“Seniors often think they’re doing themselves a favor by wearing slippers, but slippers are basically the same as walking barefoot,” says podiatric surgeon Marlene Reid, D.P.M. She’s co-owner of Family Podiatry Center in Naperville, Illinois, and past president of both the Illinois Podiatric Medical Association and the American Association for Women Podiatrists.  

“Podiatrists across the country have been seeing a ton more heel pain during the coronavirus pandemic because people have been home and walking around the house in slippers or no shoes at all,” she says.  

Soft, fuzzy slippers may feel cozy, but they lack arch support, and if they’re mule style (with nothing securing them to your heel), they can come off easily, contributing to falls.  

In a study published in Footwear Science, 765 men and women ages 70 and older were followed for about two years and asked to keep track of any falls that took place in their homes. Fifty-two percent of falls occurred when people were barefoot, wearing slippers, or wearing socks without shoes.  

What does that mean for you? Wear athletic shoes at home. They have much more stability to help prevent heel pain, and the rubber soles can help prevent falls. Choose a pair with a wider toe box to give your toes space to spread out.  

If you keep your home shoe-free to avoid tracking in dirt, purchase a pair of shoes that will be worn only inside.  

Mistake #2: You Buy the Wrong Shoe for Your Foot Type 

There are three different foot types: normal, high arch, and flat-footed. Each has its own shoe requirements to achieve healthy, happy feet. (Not sure what type of foot you have? Ask a podiatrist for an assessment. You can find DIY tests online, but they aren’t always accurate, Dr. Reid says.)  

Once you know your type, here’s how to shop accordingly:  

If your foot type is normal, also called neutral arch: Look for shoes with a firm midsole and a straight to semi-curved last, which refers to the shape of the sole. To determine a shoe’s last, simply turn it over and look at the outsole. A straight-lasted shoe is symmetrical relative to a line drawn from the middle of the toe box to the middle of the heel.   

If your foot has a high arch: You need extra cushioning, because “most people with high arches have a problem with shock absorption,” Dr. Reid says. A softer midsole and flexible footbed will help too, according to the American Podiatric Medical Association.

If you have flat feet: Your feet probably roll in (or pronate) when walking. Look for shoes designed to help with stability and motion control, which typically have a straight last.  

Mistake #3: You Don’t Test Out Your Shoes Before Deciding to Keep Them 

Your shoes may feel good when you walk a few paces in the store, but whether they’ll still feel comfortable after a full day of wear is another story.

Dr. Reid says it would be a good idea to ask the store if you can bring them home and wear them inside for a full day to make sure they don’t cause pain or blisters. (Because you’ll be wearing them indoors, the sole won’t get dirty, so there shouldn’t be an issue if you need to return them.) 

Some shoe stores will even let you return them after wearing them outdoors. Nike, for instance, offers 60 days to take your purchases for a trial run, and Zappos.com offers 30 days on certain shoes.  

Be sure to try them on in the evening too. Feet swell as the day goes on, Dr. Reid says, so you want to make sure they feel comfortable when your feet are at their largest. 

Mistake #4: You Wear Flip-Flops 

Flip-flops are a total flop for feet of all ages, thanks to their lack of shock absorption and arch support. “They keep me in business,” says Suzanne Levine, D.P.M., a board-certified podiatric surgeon at Millennium Podiatry in New York City and co-author of My Feet Are Killing Me.  

Dr. Levine says these beach bag staples will aggravate your feet if you have arthritis, a bunion, or a neuroma, which is a painful bundle of nerve tissue usually located in the ball of the foot between the third and fourth toes. Flip-flops can also lead to plantar fasciitis, a condition that causes pain on the bottom of the heel.  

Even worse, flip-flops can increase your chances of an injury, whether it’s from an object accidentally dropping on your foot (no shoe protection), a stress fracture (from stubbing your toe or breaking your pinkie toe as it slips off the flip-flop), or by causing you to trip and fall.  

It’s fine to wear them for short periods of time at the pool or in the locker room, where they can help you avoid funguses and wart viruses, but don’t wear flip-flops all day long. Better yet, pick up a pair of slides, which offer the same easy-on, easy-off access, are waterproof, and, thanks to their increased thickness, offer a bit more shock absorption and put less pressure on the balls of the feet.  

Mistake #5: You Buy Rocker-Bottom Shoes Just Because You Think You’re Supposed to 

With their super-stiff, rounded bottoms, rocker-bottom shoes are heavily marketed toward older adults, with claims of easing pain. And they can do just that for individuals with foot arthritis. Because they don’t bend, they limit motion in the middle of the foot, an arthritis-pain hot spot. If you’re one of the nearly 20 percent of adults age 50 and older who have foot osteoarthritis, these shoes can help.  

But rocker-bottom shoes aren’t helpful for people with heel pain (plantar fasciitis), and they can even exacerbate it. “I had a 62-year-old patient who came in with heel pain caused by plantar fasciitis, which means the ligament that runs along the bottom of the foot from the toes to the heel, called the plantar fascia, was inflamed,” Dr. Reid says. 

“Her physical therapist recommended a brand of shoes that allowed no motion whatsoever. But unless you have arthritis, you need a shoe with some flexibility that allows the plantar fascia to stretch. So the more she wore these shoes, the tighter the fascia got and the worse her heel pain became,” explains Dr. Reid.   

If you think rocker-bottom shoes may help you, talk with a podiatrist before purchasing a pair. Once you have them, ease into wearing them, starting with an hour on the first day, two hours the next, and so on.  

“These shoes will change your gait by limiting motion, which affects the muscles and tendons, as well as the joints, and it can take some getting used to,” Dr. Reid says.  

Carousel PT is a Vasyli Accredited medical facility. Claim back YOUR “Footprint” with Carousel!


By Leslie Goldman | October 9, 2021

blog source: https://www.silversneakers.com

The Whole-Body Wellness Challenge is rooted in the understanding that health isn’t just about fitness. This month, we’re sharing fun and easy ways to bring everything you love about SilverSneakers classes and your time at the gym to other areas of your life. You’ll find workouts, tips, and activities to help you build strength, eat healthier, sleep sounder, and be more present in your life, so you can feel good—body, mind, and spirit.

A Promise Is A Promise, And You Made A Promise To Get More Exercise In The New Year!

So your kids got you to promise to exercise more in 2022 during the festivities of the holiday season. You couldn’t resist. After all, you agreed because you love them, but now you either disappoint them and take it easy, or you convince yourself to give it a try. Come on, you can do it whether you turn 60, 70, or even 80 years of age this new year, says Rebecca Weber, CEO of the Association of Mature American Citizens [AMAC].

“No one’s telling you to go to Olympic extremes. All you have to do is the basics, such as going for a 15 to 30-minute walk every day. Once you get used to it, you’re bound to up the ante and start doing things like carrying a pair of dumbbells on your outings. Pretty soon, you’ll find yourself doing sit-ups and push-ups. But be sure not to go to extremes, particularly if you have health issues. In fact, it is best to have a chat with your health care provider before you begin your exercise routine,” Weber advises.

The National Institute on Aging [NIA] recommends that you take it slow at first. You don’t want to overdo it. Over-exercising – particularly at the outset – can make you want to quit, or worse, cause injury.

The right way to get started, according to the NIA, is to:

  • Begin your exercise program slowly with low-intensity exercises.
  • Warm-up before exercising and cool down afterward.
  • Pay attention to your surroundings when exercising outdoors.
  • Drink water before, during, and after your workout session, even if you don’t feel thirsty.
  • Play catch, kickball, basketball, or soccer.
  • Wear appropriate fitness clothes and shoes for your activity.
  • If you have specific health conditions, discuss your exercise and physical activity plan with your health care provider.

The pandemic has been hard on all of us, but it has been a particularly difficult experience for senior citizens creating an additional disincentive to take it easy if you can. However, says AMAC’s Weber, it can also be another good reason for working out. At the very least, it can take your mind off of the disease for a while on a daily basis, which can raise your spirits.

“When you consider what is required for someone to engage in exercise—time, motivation, goal, and willingness to put up with some discomfort—it becomes a little clearer as to why a person dealing with stress and anxiety would be less likely to engage … Despite having time on their hands, this person is struggling with psychological discomfort due to negative thoughts which saps away motivation and energy to engage in activities, let alone exercise,” says Dr. P. Priyanka.

In fact, a poll conducted by researchers from Canada’s McMaster University and Western University in April showed that participants who had worked out regimens prior to the COVID outbreak were exercising less as a result of the pandemic.

“But don’t use the coronavirus excuse to get out of doing your exercises,” says Weber. “Think of the benefits you’ll derive – the stamina and energy you’ll gain, not to mention the fact that it improves your mood and helps you fight off depression and not to mention the fact that you made a promise to your kids and your loved ones.”


source: https://amac.us/a-promise-is-a-promise-and-you-made-a-promise-to-get-more-exercise-in-the-new-year/WASHINGTON, DC, Jan 7

Expect to Get Better. You Probably Will.

Research has shown that positive expectations increase the chances of a good outcome. It’s the old self-fulfilling prophecy; your attitude determines your approach to situations. If you believe you’ll be successful, you’ll likely put in more effort. You’ll be more willing to try new things, take some risks and keep trying after failures or setbacks. A negative attitude will likely mean that you’ll take your first failure or setback as confirmation that what you’re trying won’t work or isn’t possible and you’ll give up. Why waste time and effort on something that’s doomed to failure anyway?


There’s some research to prove that positive thinking and expectations make a difference in rehab settings too. A review of 23 articles looking at outcomes for shoulder pain found a few interesting things. First, patients who expected to recover and believed that they had some control of the outcome, ended up doing better than those who didn’t. Second, optimistic patients were found to have less pain and disability after completing rehab. Third, patients who believed they’d have pain and disability after surgery tended to have – you guessed it – pain and disability after their surgery. Research says that you tend to get what you expect.


Your attitude is important, but what about your therapists? There isn’t much research specific to PT, but there is a study done in elementary schools that might give us some clues. Two psychologists – Rosenthal and Jacobs did a study showing that teacher expectations had an influence on student performance. They told teachers that randomly selected students in their classes were tested and found to be “late bloomers”. These students were expected to show large improvements in academic performance during the school year. When the students were tested 8 months later, the students the teachers believed would improve the most, did.

Why? When teachers think students have a lot of potential to improve, they hold them to higher standards. They teach more complex materials, don’t settle for simplistic answers, and are more willing to spend time instructing and working with those students. It’s pretty easy to see how this could cross over into a PT clinic. If your PT thinks you can get better, they’ll probably put more effort into designing your program, spend more time with you and push you harder than someone they don’t believe has a lot of room for improvement.

To have the best chance for a good outcome, you and your therapist both need to expect one. You probably will.


De Baets L, Matheve T, Meeus M, Struyf F, Timmermans A.
The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review. Clin Rehabil. 2019 Jun;33(6):980-991. doi: 10.1177/0269215519831056. Epub 2019 Feb 22. PMID: 30791696.
Rosenthal, R, and L. Jacobsen. Pygmalion in the classroom: teacher expectation and pupils’ intellectual development. New York: Holt, Rinehart and Winston, 1968.



Let’s Move: 5 Studies Supporting Physical Activity’s Long-Term Health Benefits

As APTA continues its public information campaign on the importance of physical activity, here are five recent studies that underscore the message that more movement means better health — now and in the future.

Exercise Could Aid in Decreasing Anxiety Disorder Symptoms
This study from Sweden chronicles the effects of a 12-week exercise program among patients diagnosed with an anxiety disorder. A total of 286 patients were assigned to one of three groups: a control group that didn’t receive exercise interventions, a cardiorespiratory exercise group, and a resistance training group. After the 12-week program, researchers found the exercise groups were associated with 3.6 times higher odds for improved self-reported anxiety scores, and 4.8 times higher odds for improved depression scores, compared with the control group. Those odds increased with increased levels of moderate to high-intensity exercise. (Journal of Affective Disorders)

Better Cardiorespiratory Fitness in Mid-Life Pays Off Years Later
A study of 2,962 individuals who participated in a long-term health study conducted between 1979 and 2001 looked at reported levels of cardiorespiratory health in midlife (between ages 20 and 78) and later emergence of subclinical atherosclerosis, vascular stiffness, hypertension, diabetes, chronic kidney disease, and mortality. Researchers found that higher rates of cardiorespiratory fitness in midlife was associated with lower risk of all conditions. Authors of the study write that the findings “suggest that midlife [cardiorespiratory health] may serve as a prognostic marker” for chronic conditions in later life. (JAMA Network Open)

Exercise Doesn’t Increase Risks of Later Knee Osteoarthritis
Does running or other recreational physical activity contribute to later knee OA? Authors of a recent study say no. In a study of 5,065 participants followed over the course of five to 12 years, researchers found that, based on metabolic equivalents of tasks, various sports as well as running, biking, and walking had a “non-significant” effect on the later emergence of knee OA. (Arthritis & Rheumatology)

Physical Activity Correlates With Lower Risk of All-Cause Mortality for Individuals With Parkinson Disease
A nationwide study of 10,699 individuals with PD found that “all physical activity intensities” were associated with reduced all-cause mortality, and that the reductions increased as PA increased. Individuals with PD showed even lower rates of mortality if they were physically active both before and after the PD diagnosis. (JAMA Neurology)

Research Makes Inroads Into How PA Helps Reduce Dementia Risk
Scientists have understood that PA reduces dementia risk, but exactly how that risk is reduced has remained something of a mystery. Now researchers examining human brains of deceased individuals whose levels of PA had been tracked for years prior to their deaths think they may have a clue. Their analysis found that physical activity appears to reduce the proportion of morphologically activated microglia, also known as PAM. Activated microglia have been associated with damage to the brain through the release of chemicals that increase inflammation, which is in turn related to dementia. Researchers found that lower levels of PAM were correlated with individuals who reported higher levels of PA in their lifetimes. (Journal of Neuroscience)

If pain or a condition is holding you back, contact a physical therapist. A physical therapist can help get you moving to reduce your risk of chronic disease, enhance your fitness, and prevent injuries. It’s never too late to get moving!

source: American Physical Therapy Association

Bone Health: What You Should Know

Healthy bones can help you stay strong and active throughout your life. If good bone health is achieved during childhood and maintained, it can help to avoid bone loss and fracture later in life. For healthy bones, it is important to maintain a physically active lifestyle and eat a balanced diet with plenty of calcium, vitamin D, and perhaps other supplements as needed. Physical therapists can design a unique program for you to help keep your bones healthy.

Osteoporosis is a common bone disease that affects both men and women (mostly women), usually as they age. It is associated with low bone mass and thinning of the bone structure, making bones fragile and more likely to break.

Some people are more at risk for osteoporosis than others. Not all risk factors can be changed, but healthy habits and a proper exercise routine designed by your physical therapist can keep bones healthy and reduce risk. Risk factors* include:

  • Age: More common in older individuals
  • Sex: More common in women
  • Family History: Heredity
  • Race and Ethnicity: Affects all races. In the US, increased risk for Caucasian, Asian, or Latino
  • Weight: Low body weight (small and thin)
  • Diet, especially one low in calcium and vitamin D
  • History of broken bones
  • Menopause
  • Inactive lifestyle
  • Smoking
  • Alcohol abuse
  • Certain medications, diseases, and other medical conditions

Physical therapists can help prevent osteoporosis and treat its effects by designing individualized exercise programs to benefit bone health, improve posture, and enhance core stability and balance. Most of these exercises are simple and can be done at home with no special equipment.

Bone Health Begins With Good Posture

Physical therapists recommend good posture and safe movements to protect bones from fracture during daily activities. Using proper posture and safe body mechanics during all activities protects the spine against injury. Here are some tips:

  • Keep your back, stomach, and leg muscles strong and flexible.
  • Do not slouch.
  • Use good body positioning at work, home, or during leisure activities.
  • Ask for help when lifting heavy objects.
  • Maintain a regular physical fitness regimen. Staying active can help to prevent injuries.

Fight Fracture with Fitness

Inactivity is a major risk factor for osteoporosis. The right exercises and good habits can keep bones strong and prevent or reverse the effects of osteoporosis. Weight-bearing exercise, such as walking, is an important way to build and maintain healthy bones. Muscle-strengthening exercises have been found to stimulate bone growth and can help prevent and treat osteoporosis. These types of exercises are best if started early in life and done regularly. However, it is important to remember that you can begin exercising at any age and still reap great benefits.

If you have osteoporosis, are at high risk for a fall or fracture, or have a medical condition, affecting your ability to exercise, do not begin an exercise program without first consulting your physician and a physical therapist.

Avoid exercises and daily activities which round the spine, such as sit-ups, crunches, bending down to tie your shoes, exercise machines that involve forward bending of the trunk, and movements and sports that round and twist the spine.

Physical therapists are movement experts who improve quality of life through hands-on care, patient education, and prescribed movement.



Long COVID Sounds Awful! What Can Be Done?

Recently we introduced you to Long COVID and all of the challenges it brings. This month we’re going to talk about what physical therapists can do to help people living with Long COVID. Early in the pandemic, therapists started seeing people with what would later be known as Long COVID. They noticed that some of the symptoms people were describing overlapped with conditions they had treated before. Specifically, Myalgic Encephalomyelitis better known as Chronic Fatigue Syndrome (CFS) also caused severe fatigue and delayed symptoms after activity. Because of this overlap, the current treatment for Long COVID is heavily based on what we know works to manage these diseases. Here are a few of those strategies.


The first strategy that can help manage Long COVID symptoms is pacing. This is simply doing less activity than you have energy for. By keeping bouts of activity short with lots of breaks, pacing can help avoid severe fatigue immediately after activity. It can also avoid the delayed “crash” of  PESE. A useful metaphor is to think of your energy level as a battery. When you do activities, you drain your battery. When you rest, you charge it back up a little bit. Physical therapists can help patients learn how much energy is in their “battery” and work to teach them strategies to conserve it. When used effectively, pacing can help patients with Long COVID accomplish more with less fatigue and less bouts of PESE.


Post-exertional symptom exacerbation is a disabling and often delayed exhaustion disproportionate to the effort made. Patients are referring to this as a “crash”. PESE is very common in people suffering from Long COVID. 75% of people who have Long COVID have PESE after 6 months. The activity that brings on the crash is something that the person could easily tolerate before their COVID-19 infection. Things like taking a shower, walking, attending a social activity, or even being in a high sensory environment with flashing lights and loud noises may all now trigger a crash.


Another strategy that comes from ME and CFS management is heart rate monitoring. With the huge number of wearable devices that monitor heart rate, this is becoming an easier strategy to use than ever. Heart rate monitoring uses your heart rate as a gauge of how hard your body is working. It’s based on your resting heart rate, which should be taken after you’ve been lying down, relaxed for at least 20 minutes. First thing in the morning before you get out of bed is a great time to measure your resting heart rate. Once you have your baseline, the goal is to keep your heart rate within 15 beats of your RHR while you’re doing activities. This keeps your heart rate below the threshold at which your muscles start to produce lactic acid. Build up of lactic acid is what gives you “the burn” when you’re working out really hard. It also causes your muscles to fatigue more quickly – by keeping activity light enough to avoid lactic acid, we can also reduce fatigue.


What about exercise? Sure, lots of people think about exercise when they think about PTs. But exercise can make some diseases worse. For people living with Long COVID, CFS, or ME, “toughing it out” or “pushing through it” won’t make them stronger. It will cost them days of their lives – leaving them barely enough energy to get out of bed or complete basic tasks. For long-term, sustainable recovery, the first goal of rehabilitation of these folks is to stabilize and manage their symptoms. Using pacing, heart-rate monitoring, and other strategies like breathing exercises can stop the fatigue cycle and start to get the body responding to activity more normally. Only then can we very gradually and cautiously introduce exercise into the mix, monitoring symptoms during and after activity to make sure we don’t overdo it.

As we learn more about the pathology behind Long COVID’s symptoms, rehabilitation will surely change and improve. But people who are living with Long COVID can’t afford to wait until science figures everything out about their disease. Fortunately, physical therapists have training and strategies that can help improve their lives right now.

Light Exercise, Not Bed Rest, Can Speed Concussion Recovery

Contrary to long-held wisdom, teen athletes recover from concussions sooner if they do light aerobic exercise rather than resting in a dark room, new research suggests.

Instead of so-called “cocoon therapy,” new research-supported therapy has young concussion patients getting out of bed and doing protected exercise earlier.

“What the research found was that adolescents were having a hard time recovering from sports-related concussions if we completely shut them down,” said study author Dr. Travis Miller, from Penn State Health Sports Medicine.

Treatment for teens with a suspected or diagnosed concussion typically begins with 24 to 48 hours of relative rest, followed by cautious exercise.

“Patients usually start with light cardio, such as walking, the elliptical or stationary bike. I wouldn’t put someone on their normal bicycle, where they could fall and injure their head,” Miller said. “As symptoms subside and days roll on, you can increase the intensity and duration of exercise.”

Young athletes may want to rush their return to full activity, but that’s not a good idea because they may develop chronic symptoms — such as headaches, foggy thinking and difficulty concentrating — and may be more susceptible to further concussions.

“We recognize they want to return [to full participation] as fast as possible. We, as sports medicine professionals want that, too. We grew up loving to play. We’ve been trained to get you back in the safest way possible,” Miller said.

“It is important to make sure symptoms are successfully resolved, and we are meeting all the guidelines for recovery before stepping back onto the court, field or rink,” he said, emphasizing that this will reduce chances of a repeat concussion.

Choose Carousel for your concussion protocol treatment including Variable Speed Reaction training using our state-of-the-art Korebalance System.



Six Ways the U.S. Military Has Shaped the Physical Therapy Profession

15 Ways the US Military Has Shaped the Physical Therapy Profession

The physical therapy profession and U.S. armed forces have a long and collaborative relationship, one that includes a formal partnership with the U.S. Department of Veterans Affairs.

Following are a few accomplishments of our women and men in uniform.

The military introduced the country to physical therapy.

 Credit: U.S. Army Photograph.

On April 16 1947, President Harry S. Truman, posing here with Major (later Col.)
Emma Vogel, far right, and other senior officers, signed Public Law 80-36,
establishing the Women’s Medical Specialist Corps (WMSC) in the U.S.

The first physical therapists were reconstruction aides (“re-aides”), civilian employees of the Medical Department of the U.S. Army during World War I who rehabilitated injured soldiers and taught them how to adapt to everyday life after injuries and amputations.

After WWI’s end, as the military cut back on the number of aides, the first physical therapists took their knowledge to the civilian population, working for the U.S. Public Health Service, industrial accident clinics, orthopedic surgeons’ offices, hospitals, and schools for children with physical limitations.

The U.S. Army was key to the process of standardizing procedures.

According to Col. Emma Vogel, one of the first re-aides, prior to WWI very few physicians performed physical therapy procedures, which were looked upon with suspicion by many of their colleagues. It was not a defined discipline with clear standards or guidelines, and there was no research being conducted. Vogel, who later became the first chief of the Women’s Medical Specialist Corps in 1947, wrote that as a result of the success of the re-aides, “civilian practice in this field was given a tremendous impetus” and the Army played a key role in “stabilizing and standardizing physical therapy procedures.”

After WWII, thousands of soldiers were treated for amputations, spinal cord injuries, and other injuries. As a result, some hospitals began to specialize in treating specific populations, allowing for study of effectiveness of patient care, including wound healing, prosthesis fitting, gait analysis, progressive resistance exercise, and constant current stimulation. Severe injuries that would have resulted in immobility during WWI now had a much better prognosis.

Some of the first African American PTs were trained at Fort Huachuca.

The success of Emma Vogel’s 1941 War Emergency Training Course of WWII led to the launch of several more across the country, among them the Special Women’s Medical Service Corps Program for African-Americans at Fort Huachuca, Arizona, which was set up in 1943 to serve the all-black unit. Some of the first graduates included Edythe F. Bingham, Ruth R. Jones, Bernice P. Lockhart, Lillyanne Plummer, Anna L. Rogers, and Valjeanne Taylor.

Military therapists served with honor, even behind enemy lines.

Like their WWI predecessors, WWII therapists served stateside as well as overseas. Metta Baxter, stationed in Italy, was a prisoner of war and received the Legion of Merit. Helen Filbert and Bella Abramowitz Fisher received Bronze Stars for their work in the Dutch East Indies and Okinawa, respectively. Brunetta Kuehlthau and Mary McMillan were captured and held at an internment camp in Manila, Philippines — where Kuehlthau continued to treat patients. These heroes and their colleagues did not gain full commissioned status until 1944.

During the Korean Conflict, several military PTs were recognized for exceptional service, including Major Ethel M. Theilmann, with the Legion of Merit; and Captain Mary Torp and Major Elizabeth C. Jones, with Bronze Stars. During the Vietnam War, 47 Army PTs — including at least three men — treated soldiers, civilians, and POWs in three of the four combat zones.

The military was the first to train physical therapist assistants.

Late in WWII, the Army recognized the need for formally trained enlisted staff to assist PTs in the clinic. Previously, enlisted men were informally trained to help in the clinics but were needed in combat roles. In 1945, the Army approved the first formal program of instruction for the new classification of “physical therapy technicians.”

The military leads the way in direct access and team-based care.

Since the 1970s, the military has allowed soldiers with neuromusculoskeletal disorders to see a PT without referral from a physician, expediting recovery for more minor conditions and freeing up physicians to treat patients with traumatic injuries—which is especially important during combat. Rather than relying on old models of care, the military health system evaluates what needs to be in place for successful outcomes and what resources are needed to achieve them. Military PTs treat patients within a multidisciplinary team of providers, offering a model for the private sector in the shift toward value-based care.

To all our military PTs and PTAs and their families, past and present, thank you for your service.

This post features content originally published Nov. 11, 2019. We’ve included a few updates in this revision, and believe it’s a relevant tribute to our armed forces.

Date: Friday, November 6, 2020

For Some Patients, COVID Just Won’t End.

We know there is a lot of variation in how COVID affects people. Some feel like they have a
bit of a cold, some feel like they have the flu, and some end up in the hospital. No matter the
symptoms, we tend to think that people get sick, get better and recover, then move on.
Most of the time, that’s what happens, but for about 10% of people who get COVID, the
experience is different.

So Why Won’t It End?

Long COVID is defined as ongoing symptoms for more than 12 weeks after the initial
infection. Exactly what those symptoms are varied. There’s currently a list of over 200
possible symptoms – but most people have the 3 most common. Those are: extreme fatigue,
post-exertional symptom exacerbation, and problems with memory or concentration –
commonly referred to as “brain fog.”

Extreme Fatigue:

The extreme fatigue associated with Long COVID affects the ability to complete daily tasks. It
causes severe tiredness that you can’t get rid of with rest or sleep. It’s also not related to
doing some physically demanding task.


Post-exertional symptom exacerbation, or PESE is a disabling and often delayed exhaustion
disproportionate to the effort made. Patients are referring to this as a “crash”. The activity that
brings on the crash is something that was easily tolerated before the COVID-19 infection.
Some examples would be taking a shower, walking, attending a social activity, or even being
in a high sensory environment with flashing lights and loud noises.

Brain Fog:

“Brain fog” isn’t a medical condition. Instead, it’s a term used by patients to describe thinking
that is sluggish or fuzzy. In severe cases, people describe it as feeling like their brain shuts
down. They could be in the middle of a sentence and not be able to think of anything more to
say. They could be at work doing a task they’ve done a thousand times and be unable to
think of the next step. Just like the extreme fatigue and PESE we’ve already described, the
brain fog associated with Long COVID is disabling and affects every aspect of daily life.

We’re still learning exactly what causes Long COVID and how best to manage it. What we do
know is that Long COVID has an ongoing effect on patients. It touches every part of their
lives. We also know that we need to learn more about this condition, but we are treating people
who have it based on the training and facts we have to date!

Concussion Q&A and How We Can Help!

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 and implement:

  • Orthopedic issues and pain from the injury
  • Balance, dizziness, and vestibular/vertigo problems
  • Visual and ocular motor problems
  • Concussion Protocol using Korebalance System

What is the Korebalance System?

A state-of-the-art system uses the latest in virtual and interactive technology, offering high-tech balance assessments and rehabilitation.

How it Works:

It’s the world’s first balance training system incorporating Variable Speed Reaction training together with cognitive interaction; it delivers a higher quality of physical therapy by allowing us to customize programming and gradually adjusting difficulty levels and tasks over the course of treatment.  Korebalance® uses visual, vestibular (inner ear) and proprioception (knowing where the body is in space) to find or create new pathways in the brain, improving balance.

eye  ear  foot

What it Does:

  • Improves balance, stability, coordination & posture;
  • Improves agility, reaction time and motor control;
  • Improves confidence for seniors decreasing fall risks;
  • Trains the body to respond to an unstable environment (real-life activities);
  • Rehabilitates concussions, traumatic brain injuries (TBI’s), and associated dizziness;
  • Keeps athletes on the field.


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.