Will COVID-19 Change the Typical PT Patient?

People usually see a physical therapist for pain or loss of function. Think of the person who has back pain, the injured athlete, or the person who’s had a stroke. They all want to improve how they move and complete tasks. Now, there is good reason to wonder if physical therapists will start seeing more people who are not in pain or having difficulty moving. Why would these people come to a PT? To improve their overall health and wellness.

There is strong evidence suggesting that movement is a valuable predictor of future health and resilience against disease. Physical therapists are movement specialists, so taking advantage of their expertise makes sense if your goal is to become healthier and live longer. Here are some examples of the power of movement when it comes to predicting future health:

Gait Velocity

Gait velocity is how fast you walk. Studies have shown that if your typical walking speed is over 1 m/s or 3.3 ft/s, you’re likely able to complete typical daily activities independently. You’re also less likely to be hospitalized and less likely to have adverse events like falls.

If you’d like to test yourself, measure out a straight, flat course to walk between 10′ and 30′ long. You’ll also need 5′ or so at the beginning and the end for acceleration and deceleration. Walk the course at your typical speed and divide the length of the course by how long it took you to walk it (distance/time). That’s your gait velocity.

Get On and Off the Floor

A series of studies suggest that if you can go from standing to sitting on the floor and back to standing without using your hands, you’re a lot less likely to die than someone who can’t. It’s called the sitting-rising test. Here’s how it works:

You start standing, and without support, you sit down on the floor, then stand back up. You start with a score of 10. Every time you put a hand, knee, forearm, or the side of your leg on the floor you lose 1 point. Putting a hand on your knee or thigh to help also costs a point. In a sample of over 2,000 people, they found that scoring less than 8 points made you twice as likely to die in the next 6 years when compared to people who scored higher. Score 3 or less and you’re 5 times more likely to die in the same period. Overall, each point in the test is worth a 21% decrease in mortality from all causes.

Notice that both gait velocity and the sitting-rising test aren’t specific to any one thing. The risk of hospitalization in the gait velocity studies was hospitalization for any reason. Death in the sitting-rising studies was death from anything.

So while we know that exercise and healthy lifestyle reduce your risk of specific diseases like heart disease or diabetes, it appears that being able to move may provide much more wide-ranging protection than we previously thought.

Long-Haul COVID: Post-COVID or Prolonged Deconditioning

One year ago our lives changed. Time stood still as our world abruptly changed from our normal day-to-day routines to the Pandemic.

Throughout this pandemic, we have witnessed the resilience of our patient, medical, and scientific communities as they have come together in extraordinary ways. As we emerge from it, we are now in the wake of the aftermath of those who have had COVID -19; acute or asymptomatic.

In recent weeks there has been a flood of news reports and studies from collected data being released. We are hearing and reading testimonials from individuals having NON-hospitalized, or asymptomatic Long-haul COVID-19.

Long-haul COVID-19 is defined as symptoms persisting for more than 6-weeks, with the consensus that most patients fully recover from COVID-19 in 4 to 6 weeks. Specifically, the presence of persistent symptoms after the apparent resolution from COVID by individuals labeled as “long haulers.”

These symptoms can include:

In addition, many reported NON-NEUROLOGIC symptoms, including:

Since the body of evidence regarding long-haulers, particularly among the 99% on asymptomatic/non-hospitalized cases is just coming into existence, symptom validation should be honored especially symptoms at day 61+:

      • Muscle, general, and mental fatigue
      • Muscle and joint pain
      • Muscle atrophy
      • Breathing problems

Physical Therapy treatment will be beneficial in translating effective self-management through education and lifestyle and behavioral changes for those living with Long COVID, or post-COVID or post-prolonged deconditioning as we navigate these boom-bust cycles for those likely living with an episodic and unpredictable disability.

 

Tired? Tips for Dealing with the Time Change.

The basic coping skills in life are whether we are Hungry. Angry. Lonely. Tired (H.A.L.T.), and whether we gain or lose an hour with the time change there always seems to be some adjustments. However, for some, losing that hour can be brutal, therefore making us very TIRED and impact our decision-making…. until we adjust!

And make no mistake, the transition to daylight saving time isn’t just annoying, it can also have measurable effects on our health from increasing the risk of heart attacks, injuries, car accidents, and mood disorders.

Rather than chugging down coffee, cola, or your energy drink of choice, there are some non-caffeinated steps you can take to help make springing forward less stressfulHere are a few tips for adjusting to the time change as quickly as possible:

1. Tonight, go to bed when you feel sleepy—don’t worry about what the clock says—but tomorrow wake up at the right “new” time and get sunlight (or bright artificial light) as soon as you wake up. Bright light in the morning is the best way to get your internal clock set to your new schedule.

2. Tomorrow night, consider going to bed at the new time, but only if you feel sleepy.

3. Keep waking up at the same time each morning and getting bright light as soon as you can. Most people can make a one-hour shift in a couple of days.

Sleep Management

Managing your sleep is key to your overall health. Not getting enough sleep can be a problem and can contribute to the development of chronic pain.  It also may worsen anxiety or depression symptoms. So, what should you do if you are not getting enough sleep?

During the Day

1. Do more physical activity.

Staying active helps in getting restful sleep. Once cleared by a health care provider, try to get 150 minutes of moderate exercise each week. A physical therapist can help you find the right exercises for your needs and abilities.

2. Increase your exposure to light.

The lack of Vitamin D is linked to a higher risk of sleep disorders. Consider increasing your exposure to light during the day.

3. Avoid long napping.

As an adult, if you take naps, keep them to 20 minutes or less.

4. Don’t smoke.

If you are a smoker, stop smoking two to three hours before going to sleep.

5. Limit alcohol.

If you drink alcohol, do so sparingly.

6. Avoid caffeine after midday.

Caffeine is a stimulant that can make you more alert and limit restfulness. It is also a diuretic that can increase your need to urinate at night.

Before bed

7. Get enough sleep.

Set a bedtime that will allow seven or more hours of sleep.

8. Keep a sleep schedule.

Wake up and go to bed at the same time every day.

9. Set the temperature.

According to the National Sleep Foundation, somewhere around 65 degrees makes for the best sleep. Assure that the temperature is right for you, and you have the necessary blankets and pillows for your comfort.

10. Create a relaxing bedtime routine.

This may include dimming the lights, avoiding the use of technology, and reducing noises. Using meditation or soft relaxing sounds can help prepare you for sleep.

Keep in mind some medications may change how well you sleep. Talk to your doctor or pharmacist about timing your medications to promote a balance of sleep and wakefulness.

If sleep remains difficult, keep a sleep diary to learn more about your sleep patterns and discuss it with your physical therapist. A PT also can help you if you experience pain or discomfort that limits your movements or disturbs your sleep. Learning the right exercises and positions may be helpful for you.

And, If you have difficulty getting comfortable at night, our physical therapists can help you with positioning and pillowing to fall and stay asleep!

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Sources:
my.happify.com/hd/a-sleep-experts-tips-for-dealing-with-the-time-change/?fbclid=IwAR0ARr9XplOVFVTFZV9igqjxIDJ2h1tDna9aPK_nN-BRl3he-bwGg5WxdgY

www.thensf.org/sleep-awareness-week/

www.choosept.com/resources/detail/10-habits-better-sleep?fbclid=IwAR2K_btrfOYsCZW5yPovRCT2FCBajTowcadMI2ip9a1o73U57mYA5m4_IZE

 

Posture and Your Pelvis!

By: Katie Reynolds, PT, DPT
Pelvic PT/Women’s Health

 

Do you remember when you were little and having your mother or grandmother fussing at you about your posture? Head up! Shoulders back! Ugh, just wanted to roll my eyes but as I have gotten older, man were they right!

Posture is so important for so many things, and not just for appearances at the dinner table. With our ever-changing society with computers, cell phones, cars, computer/desk work, etc it is more important now than ever to have good posture. So you are probably thinking well that is great for my head and upper body but how does that affect my pelvis? Think of the pelvis as the bottom of the bowl (and your core), if it is tilted you are going to spill your contents!

In standing, your ear should be in line with your shoulder which should then line up with your hip bone and then down to your ankle bone. In this position, you are putting your pelvis in neutral therefore all your muscles are able to work properly. If you have round shoulders, this will cause your lower back to round and tilt your pelvis up only allowing you to activate part of your pelvic floor muscles and core. This is very important with dealing with any form of incontinence, even the very so slight of losing a few drops with sneezing.

 

By maximizing muscle contraction, you can strengthen properly and improve your core strength and stability. Form is everything when exercising! So remember, it doesn’t matter the number of reps or amount of weight that is used, if you maintain good posture you will see improvements in everyday life!

What To Expect After Your Shoulder Surgery.

By: Kara Everett, PT, DPT, CSCS, CKTP
LSVT BIG Certified
Operations Director, Hartfield Location

 

Due to the aging population, as therapists, we are seeing an uptick in elective shoulder surgeries. The incidence of shoulder arthroplasty per 100,000 members increased from 6.1 (95% confidence interval [95% CI] 5.5-6.7) in 2005 to 13.4 (95% CI 12.5-14.2) in 2013.

Two of the most common shoulder surgeries we see at Carousel are rotator cuff repairs and shoulder arthroplasty (shoulder replacement surgery).  Rotator cuff repairs can vary greatly based on the extent of damage to the shoulder and thus can affect recovery times. With shoulder replacements (regular and reverse shoulder replacements) all or part of the shoulder is replaced.

 

    

In both types of shoulder procedures, surgery is only performed when other conservative treatments have failed to provide pain relief or if you have significant difficulty in performing day-to-day activities as a result of shoulder pain. These surgeries can help reduce pain and improve the use of your shoulder but the recovery time from these surgeries are significant and requires some work to get the full benefit of surgery.

If you or someone you know needs shoulder surgery, knowing what to expect can help you have a better outcome. Here are four things to know about shoulder surgery:

1. Managing pain after surgery.

You can expect some pain after shoulder surgery. As you heal your pain will reduce drastically and most have trace to no pain following recovery.

Work with our physical therapists to understand positions and exercises that reduce pain and help you heal. Work with your surgeon and pharmacist to understand the dosing of pain medications after surgery. It is important to have a plan to wean off opioid medications in a timely manner.

Research shows that taking prescribed opioids before surgery leads to worse pain management after surgery. Consider weaning off these medicines prior to surgery with the supervision of your health care team. This can help with your pain management after surgery.

2. An initial need for help and assistance.

You can expect to be in a sling for weeks. You will not be able to use your arm for anything except prescribed exercises. Our therapists will teach you specific exercises to promote healing.

Consider having ready-to-eat meals that are easy to prepare. You may want to set things up at home that you need regularly at an easy-to-reach level. Button-up shirts are the easiest to wear while you cannot lift your arm.

Let your friends or family know that you are having major surgery, so they can support you while you recover.

3. Difficulty sleeping.

Initially, sleep may be difficult after surgery but will improve with good habits. Good sleep habits, also known as sleep hygiene include:

  • Avoiding large meals and caffeine before bedtime.
  • Limiting or avoiding alcohol.
  • Avoiding nicotine.
  • Removing electronic devices from the bedroom.
  • Having a regular set bedtime.

Finding a well-supported position will also be important. Our therapists will educate you on sleeping positions that are safe for your shoulder and minimize pain and maximize comfort.

4. Improved mobility and function.

Physical therapy is a critical part of recovery after shoulder surgery.

However, before your surgery, our physical therapists can help you improve your shoulder mobility and strength for better outcomes after surgery. Prehab is the use of exercises to improve strength, range of motion, flexibility, and/or balance. Research has shown that an 8-week program of a strength and balance training program prior to your shoulder surgery can reduce pain and improve overall mobility and outcomes following a joint replacement. The same principle can be applied prior to any surgery including knee, hip, back, and neck surgery.

After surgery, a hospital physical therapist will educate you about what precautions to take when you go home and what movements to avoid during the initial healing phase. They also will teach you how to manage your affected arm, how to put on and remove your sling, get dressed, and get in and out of bed.

After discharge, continuing physical therapy is essential to ensure your safe recovery. Our physical therapists will work with you to progress your exercises at the right times in the healing process based on your doctor’s post-surgical protocol. We will help you get back your range of motion, improve your strength and function, and eventually help you get back to your everyday activities, job, or sport.

Our care revolves around you so be sure to let us know your goals so we can focus on returning you to the important things in life.

Undergoing Surgery? Prehab Before You Rehab!

Evidenced-based research shows that as few as 1 to 2 sessions of pre-operative physical therapy can reduce post-operative care by 29% for patients undergoing a total hip or knee replacement; this could be a  $1,000 + per individual!

The Facts

Between 2012 and 2050 the number of Total Knee Replacements (TKAs) performed annually in the United States alone is expected to increase by 855%, equating to 2,854 procedures per 100,000 US Citizens over 40 years of age; prevalence was higher for women of 50 years of age.

Globally, hip and knee osteoarthritis (the most common form of arthritis when the protective cartilage that cushions the ends of your bones wears down over time) was ranked as the 11th highest contributor to disability among almost 300 health conditions.

Pandemic Era Hospital Stays Are Shorter

First of all, no one wants to stay in the Hosptial longer than necessary. Second, you most likely won’t be able to during the Pandemic anyways. Finally, depending on the type of surgery – some are outpatient which is why rehabbing is crucial to helping you prepare for the best post-operative health-related quality of life (HRQOL).

Components of Care

Pre-operative physical therapy can be as little as 1 to 2 visits. However, for more acute cases we suggest a minimum of 6 to 10 visits. This way we can complete a full motor function and strength training program while you are awaiting surgery which will increase optimal post-surgical outcomes of associated inactivity and decline for maximum recovery. Your sessions will include:

Thorough Physical Evaluation

Extensive Patient Education

  Pain Management

Customized Pre- & Post-Surgery Plan for Elective/Non-Urgent Procedures

Results

Post-operative outcomes could be achieved in a shorter period of time by maintaining a higher level of training and fitness before your surgery to be able to fully resume outpatient rehabilitation; possibly eliminating admission into respite or residential care, or home health therapy if there are no post-operative complications.

 

 

 

Losing Your Resolutions Battle? We Can Help!

As one year comes to a close and another begins, people begin to set goals and make
resolutions. Losing weight, getting to the gym more often, or getting into “better shape” are all common. These all require increasing your amount of physical activity. More activity is great for your health, energy levels, sleep, and mood. However, ramping up your activity level too quickly after a holiday season of eating, drinking, and being merry can lead to pain, injury and disappointment if your body isn’t ready for it.

Your physical therapist is an expert in human movement and can help you safely reach your
fitness goals. People think of PTs as the person to see after an injury, but a visit before you
change your activity level could prevent injury in the first place. An evaluation by your PT will
include an assessment of your strength, range of motion, and functional movement patterns – think jumping, running, squatting, carrying. Some PTs even like to use a standardized assessment, such as the Functional Movement Screen.

Most common injuries from new fitness routines are caused by underlying weakness, range of motion deficits, or compensatory movement patterns. Your PT will find these during your
assessment. They can then prescribe exercises or movements to address the issues found and
get you safely moving into the new year!

The other common way people get injured working towards their resolution is with overtraining or doing too much too soon. Physical therapists are also experts in exercise prescription and program design. Your PT can help you create a routine specific to your needs and goals that will progress appropriately and keep you out of trouble.

So stop only thinking of your PT after you’re injured. In this case, it’s true that an ounce of
prevention is worth a pound of cure. Seeing your physical therapist before you start on your
resolution can keep you on track, injury-free, and help you reach your goals for the new year!

If You Fall, Don’t FOOSH!

From the time we learned to walk we fell a lot, but our parents picked us up and we kept going. So, why on earth was it a natural instinct to break our falls with our hands, and, how come we never learned at that time how to fall without FOOSH’ing? Good question, right?

What is a FOOSH, and how can we not do it?

Well, FOOSH is the nickname for an injury caused by Falling Onto an Out Stretched Hand. These injuries 1 are among the most common injuries affecting the hands and wrists that occur when trying to break a fall.

The severity of FOOSH injuries can vary greatly depending on various factors. These include:

  • the force of your impact with the ground
  • the type of ground you’ve fallen on
  • the way in which you’ve fallen
  • whether you have any existing health conditions or injuries affecting your hands and wrists.

FOOSH might be a silly Nickname, but it can have serious consequences.

FOOSH injuries often happen to people who participate in sports where falls are common, such as downhill mountain biking, skiing, and football.

But, really anyone can get a FOOSH injury if they fall on a hard surface and try to brace themselves with their hands or arms. Incorrect footwear can create tripping hazards and also lead to falls. So can scatter rugs and electrical cords in the home. A lack of balance or coordination, poor vision, or medications that cause drowsiness, may also cause falls with FOOSH injuries.

The Art of Falling Safely.

Believe it or not, there are ways to fall and not FOOSH. And we’re all going to fall down: The world is full of banana peels. So while avoiding a fall is job one, knowing how to take a fall when it’s inevitable is a crucial skill.

An article by Michael Zimmerman, AARP The Magazine, gives a 4-step explanation with pictures on the Art of Falling Safely with suggestions to help improve your footing and practice mindfulness. An added bonus in the article has a link on how to how to prevent falls in your home.2

The take-a-way is bittersweet. Remember – we’re all going to fall so let’s try to learn the art of it. However, there is still a 50/50 chance are we’re gonna FOOSH, and if you do we are here to help you!

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sources:

1Treating and Recovering from ‘Fallen Onto an Outstretched Hand’ Injuries: https://www.healthline.com/health/foosh
The Art of Falling Safely: www.aarp.org/health/conditions-treatments/info-2017/how-to-fall-safely.html

 

 

Overcoming Cabin Fever: Fun Physical Activities for the Kids!

By: Kevin Flood, PT, DPT

 

Since we still have a ways to go before we get to warmer weather and school-aged kids are in between their hybrid school schedules, it’s possible you are running out of indoor physical activities for them after their virtual days and there might be weekends you can’t make it to Compass.

So here are some creative and old-school activities to do as a family, or independently if Mom and Dad are working from home or,  well, let’s be real….need a break!

And, of course, there isn’t any activity on here that the younger brothers and sisters can’t join in on too——did you say snowball fight?

Snowball Fight: Use ‘socks’ for snowballs!

 

Balloon Tennis: Keep the balloon off the floor, with your hand or with homemade rackets using a paper plate and tongue depressor/craft sticks; decorate them for added bragging rights!

 

Hallway Bowling: Fill up plastic beverage bottles with colored water and use any ball you have to knock them over!

 

52 Card Pickup: A different variation of the game some of us grew up with! Choose 4 exercises to correspond with each card suit. (examples: squats, high knees, push-ups, sit-ups, jumping jacks, mountain climbers). Draw a card,  and then you complete the number of reps for that exercise. (face cards count at 11 or 15, your choice).

 

Dance/Freeze! Have a dance party, and when the music stops you have to freeze in place!!

 

Tape Maze:  Use streamers (painter’s tape works too) to create a maze in a hallway;  like lasers in a spy movie! Then have the kids try to make it through the maze without tearing them down.

Finally, Some Good News About Back Pain!

Back pain is a huge problem in developed nations worldwide. It has or will affect most of us. The current estimate is that 80% of people will experience back pain at least once. It is the single biggest cause for disability, the third most common reason for doctor visits, and one of the most common reasons for missing work.

It’s also expensive. Back and neck pain makes up the biggest healthcare expense in the US, totaling $134 billion spent in 2016. The next two most expensive conditions were diabetes —$111 billion in spending — and ischemic heart disease at $89 billion.

Diabetes and heart disease being so expensive to treat doesn’t surprise most folks – they can both lead to other major problems, require long term medication, could require surgery, and both can be fatal. Back pain won’t kill you, usually doesn’t require long term medication, and usually doesn’t require surgery either.

Why is it so expensive?

The first reason is that it’s so common. The second reason is that our current system isn’t very good at treating it. Current recommendations include starting with activity modification, and active treatments like physical therapy. Research backs this up, showing better outcomes and lower costs with early PT. Unfortunately, only 2% of people with back pain start with PT, and only 7% get to PT within 90 days. At the same time, a study looking at about 2.5 million people with back pain in the Journal of American Medicine (JAMA) showed that 32.3% of these patients received imaging within 30 days of diagnosis and 35.3% received imaging without a trial of physical therapy. Both of these things go against current practice guidelines for treatment of back pain.

Try before you buy!

A new pilot program being rolled out by TRICARE, the insurance system used throughout the US military is waiving the payment owed by the patient for up to three PT sessions in an attempt to improve the use of what the Defense Health Agency calls “high value” treatment for low back pain. The theory is that once a person sees some benefit from PT treatment, they’re likely to go back for more. This is the “try it before you buy it” approach – think of the 7-day free trial Netflix offers, free samples poured in wineries and craft breweries, or the folks you see standing around in supermarkets with food on toothpicks. TRICARE’s data seems to indicate that it works just as well for healthcare as it does for other businesses. In a press release they state that once people attend one session of physical therapy, they’re likely to go back for more, no matter what their co-pay is. But TRICARE found that higher co-pays could be a barrier to people trying that first visit. For the group of patients with the highest co-pays in the system, only 38% of the people prescribed PT attended the first visit. That’s about half the rate of attendance found in
the lowest co-pay group.

What’s next?

The fact that such a major insurer is looking into the value of PT is great news for everyone. If TRICARE can show that lowering the cost of PT for patients can improve outcomes and save insurance companies money, other major insurers will likely follow. This could improve the lives of millions of people every year while reducing the huge cost of treating low back pain for the country.

That seems like a win for everyone involved.