Falling For You!

Falling for You #PunnyValentinejokes

You hear about it every winter in Wisconsin: someone you know – a family member, a friend, a neighbor - has fallen and gotten severely injured. Often times a broken bone is the result of these tragedies. Based on an earlier blog post, we already know that physical therapy (PT) can help prevent falls; let’s say you weren’t convinced PT could help prevent your fall. What if I told you that physical therapy (PT) could be the difference between your fall resulting in a broken bone or simply a superficial flesh wound? Physical therapists are movement experts, and research has shown that exercise, the foundation of PT, increases bone mineral content & density across the lifespan – from childhood to older adults (Behringer, et al., 2014 & McMillian, et al., 2017). More bone mineral density means stronger bones, and stronger bones could be the difference between a bruise and a fractured hip. According to McMillian and company, “a seemingly small 1–3% improvement in bone mineral density may be sufficient to avoid a fracture” (2017). Although many various types of exercise are beneficial for bone health, it is hypothesized that higher impact activities (running, jumping, lifting heavier weights, etc.) result in higher bone densities (Behringer, et al., 2014). A famous Wolff once created a law stating “bones will remodel based on the stresses placed upon them”. In summary, sitting on the couch = weak bones; physical activity = strong bones.

Another large variable playing a role in bone health is nutrition. Making sure you have enough calcium and Vitamin D in your diet also ensures stronger bones; calcium makes our bones strong, and vitamin D assists in our bodies’ absorption of calcium (Behringer, et al., 2014). Combine physical activity with these nutrition tips and your long bones will be grinning from epiphysis to epiphysis.

Last, but not least, it is very important that when you are planning to increase your physical activity level you consult a medical profession who can create and individualize program that fits all your needs. As mentioned before, physical therapists are movement experts, and this is where we at Advanced Physical Therapy & Sports Medicine come in.

Happy Bone Building,

Dr. PJ

References:

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

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

Sedentary Behavior! by Ross VonGlahn, PT, DPT

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

Intro

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

What is it about?

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

Why does this matter?

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

Tying it all together

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

Change Society, Make them Healthy!

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

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

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

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

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

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

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

A Glimpse Into the Next 20 Years

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

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

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

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

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

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

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

-Smartphones may NOT BE SO SMART--

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

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

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

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

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

Squishing Holiday Humbugs via Exercise

Bah Humbug!

With the holiday season in full swing, many people are experiencing excitement, joy, and happiness as talk of Christmas cookies, family gatherings, and Clark Griswold fill the air. “SQUIRREL!!!!!” 

However, on the flip side of all these warm fuzzy feelings can often be the chilly reality that everything isn’t so great. You’ve had to spend your vacation savings fund to buy Christmas presents, you agreed to show up to 9 different Christmas gatherings, and you spent all day putting lights on your house that don’t work. Or the wind blows down the reindeer and sleigh you just put up in your front yard.  True story, happened to me. 

So what do you do when the holiday stress sets in? Instead of stress eating, turning to other common alternatives, or lighting cigarettes in the kitchen like Ellen Griswold, it may be time to call your local Advanced Physical Therapy Medical providers! 

Countless studies have already shown that exercise can reduce stress in all patient populations and as movement experts, exercise is at the core of what we do. A recent study has shown that spinal manipulation, a common intervention utilized by physical therapists, reduces levels of cortisol in your saliva (Sampath et al., 2017). Why is this important? Cortisol is your body’s stress hormone, and higher levels often reflect that your body is running on overdrive. Therefore, spinal manipulation = less stress = less newel posts being cut with a chainsaw. Despite these new findings, if you haven’t been receiving any spinal manipulation in your physical therapy plan of care, have no fear.   

“I don’t know what else to say, but it’s Christmas, and we’re all in misery”

Dr. PJ

References:

Sampath, K., Botnmark, E., Mani, R. Cotter, J., Katare, R., Munasinghe, P., & Turnilty, S. (2017). Neuroendocrine Response Following a Thoracic Spinal Manipulation in Health Men. Journal of Orthopaedic and Sports Physical Therapy, 47(9).

BRRRRR, IT’S COLD IN HERE!

With winter fast approaching, many peoples’ minds begin to race: some with excitement over the upcoming holiday seasons and winter adventures, while others dread the next few months of Wisconsin below freezing temperatures. Despite all this winter wonderland talk, whether you are a winter-lover or a winter-loather, one thing everyone should also be thinking about is falling. No, not in love sappy-pants, physically falling. The infamous ice monster leads to multiple falls each winter! The good news is that there are many things we can do to reduce our risk of this trauma: cue physical therapy.

Falls in general (it’s not all the ice monster’s fault) wreak havoc, both on an individual level and on our healthcare system. Direct medical costs from falls total near $30 billion each year (Phelan et al., 2015); with an aging population you can only assume this number will grow in the future. This makes sense when you consider at least 30% of individuals over the age of 60 fall each year (Gerards et al., 2017). For the individual, falls often result in personal injury, loss of independence, reduced participation in social activity, and overall quality of life. As mentioned, however, there is good news. It has been documented that up to a 20% risk reduction in falls can be achieved after participating in common physical therapy interventions including: balance training, resistance training, and aerobic exercise. Twenty percent risk reduction makes a big deal when this many people are falling each year.

To reduce you risk of being attacked by the ice monster, and have a darn good time in the process, stop over to your local APTSM and let us help prevent you from turning into another fall statistic.

Safe Hunting and Happy Thanksgiving,

Dr. PJ

PS: For more information on preventing falls: https://www.cdc.gov/steadi/pdf/check_for_safety_brochure-a.pdf

References:

Gerards, M. H. G., McCrum, C., Mansfield, A., and Meijer, K. (2017) Perturbation-based balance training for falls reduction among older adults: Current evidence and implications for clinical practice. Geriatrics & Gerontology International.

Phelan, E. A., Mahoney, J. E., Voit, J. C., & Stevens, J. A. (2015). Assessment and Management of Fall Risk in Primary Care Settings. The Medical Clinics of North America, 99(2), 281–293.

Wrinkles

Wrinkles

As individuals grow older, it is common for their bodies to began to show signs of “wear & tear”. One of the most common signs of aging is wrinkles. Just as our bodies show signs of aging on the surface, they also show signs of aging under the surface (IE: arthritis, muscle atrophy, decreased bone density, etc.). One of my favorite professors in graduate school described this process in a way that really resonated with me: “wrinkles on the inside, wrinkles on the outside”.

Why is this relevant? Medical imaging (IE: x-rays, MRI’s, CTs, etc.) often picks up on these “wrinkles on the inside”, which can be very beneficial. However, sometimes these imaging devices act in just the opposite way, identifying “problem areas” that are really just normal signs of aging.

For example, a recent study showed spinal disc degeneration was present - on CT & MRI findings- in 37% of asymptomatic 20-year-olds; this number increased to 96% of asymptomatic 80-year-olds (Brinjikji et al., 2015). This study is a great example of the effects of our bodies’ natural aging process; however, these same individuals may be labeled as having problems with their back, even if they have no pain at all. Furthermore, not only is medical imaging not always consistent with symptoms, but it can also result in higher cost of care and overall utilization of health care services if completed early on in an individual’s plan of care (Fritz et al., 2015).

Physical therapists are trained to identify which “wrinkles” are normal process of aging, and which “wrinkles” need to be addressed further. Therefore, before you run to get that MRI (especially the cash-pay imaging entities), head to your local Advanced Physical Therapy and Sports Medicine provider so we can check out your wrinkles.

PJ

References:

1. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., … Jarvik, J. G. (2015). Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology, 36(4), 811–816.

2. Fritz, J. M., Brennan, G. P., Hunter, S. J. (2015). Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges. Health Services Research, 50(6), 1927–1940.

Pumpkin Spice Physical Therapy

All this fall weather and pumpkin spice latte talk has me thinking about Starbucks.

In the first blog post earlier this month, I discussed direct access – an import pillar in the physical therapy profession. To expand, today’s blog post will include a great example of how beneficial direct access can truly be.

In the early 2000’s, a physician named Dr. Robert Mecklenburg, chief of medicine @ Virginia Mason Medical Center, sat down to determine how his hospital could lower its healthcare costs; a major insurance company (Aetna) was threatening to remove them from their network due to high cost for care.

Since Starbucks was represented by Aetna @ this time, Dr. Mecklenburg reached out to the benefits manager @ Starbucks to determine how he could make their health care more financially efficient. Starbucks determined the most common healthcare costs for their companies were low back pain and headaches, and therefore Dr. Mecklenburg analyzed the entire process of how back pain patients passed through the healthcare system. He determined the following:

“90 percent of what we did was no help at all,” says Mecklenburg. “Does an appointment with an orthopedic surgeon, a neurologist, a neurosurgeon help for uncomplicated back pain? The evidence says no. Does an MRI help? No. As far as we could tell, the only thing the evidence showed [that] was worth anything was physical therapy.”

Naturally, Virginia Mason Medical Center changed their health care process so individuals with low back pain were seen first by a PT (a great example of direct access). This resulted in same-day treatments, reduced healthcare costs, and patient satisfaction through the roof!

In summary, go see your local ATPSM physical therapist, grab a pumpkin spice latte, and pray the Packers get it together!

PJ

PS: Below is a great visual of how direct access works can save resources!

How direct access saves you time and money.

PT ASAP

Given October is National Physical Therapy Month, I wanted to take the time to discuss an important PT topic – a “pillar” in our profession that many people are not familiar with: direct access; hence our push for more education on the topic.

Many of my patients have grown accustom to hearing the phrases “don’t put your pain off” or “make your pain a priority”. The rationale behind these statements, and/or other similar ones, stems from one simple fact: it makes our job easier!

Why might you ask? It makes our job easier because your body heals faster when we correct problems before they progress. Just think - if you took the time to pull that one dandelion out of your garden each week, you likely wouldn’t end up with a garden full of weeds, since the spread of their seeds results in rapid multiplication. Similarly, if you paid the interest off your student loans, the interest wouldn’t compound and you wouldn’t have insurmountable debt (I promise I am not speaking from experience). There are countless examples in everyday life that mimic our bodies and reiterate the same concept: the sooner we address issues in life, the better off we are.

An article recently published by the Clinical Journal of Sports Medicine confirms this belief. The article looked at 200 athletes who had sustained a stress fracture in their low back. Patients who initiated physical therapy within the first 10 weeks returned to full activity an average of 25 days quicker than their counterparts who waited until after the 10-week mark (Selhorst et al., 2016). That’s an entire month people!!

Luckily, in Wisconsin, our mission of addressing pain ASAP is very feasible with direct access, which allows patients to be treated by a physical therapist without a physician’s referral.  "This allows us to streamline patients’ treatment, which results in a quicker recovery; not to mention a reduced expense. So, call your local ATPSM today, and let us help correct that small ache or pain before it becomes a field full of dandelions!"

#ChoosePT

PJ

Selhorst et al. (June, 2016).  Timing of physical therapy referral in adolescent athletes with acute spondylolysis: A Retrospective Chart Review.

Clinical Journal of Sports Medicine.

PT vs. Opioids. The Why. #ChoosePT

Recapping blog episode number one this month: opioids are a growing and significant problem and physical therapy is the proper solution.

Today’s agenda: Why? Prove it!

As most people can probably guess, a recent study reported that individuals’ (people currently seeking treatment for opioid addiction) primary goal for initially taking opioids was pain relief (Weiss et al., 2014). However, the majority of these same individuals then reported their main rationale for continuing opioid treatment was avoidance of withdrawal symptoms (Weiss et al., 2014); pain was no longer the culprit. To me, this situation has addiction written all over it.

As physical therapists, reducing pain/discomfort is the root of virtually all our interventions. If we can reduce patient pain ASAP (Science, 2017), therefore reducing the need for patient opioid dependency early, we can be the barrier that prevents the continuation of this addiction cycle. As the research article stated, people’s main reason they continue to take prescription pain medication is to prevent withdrawal symptoms; PT = less pain = less opioids = less withdrawal(s) = less people continuing opioids = less addiction. I wasn’t a math major, but that equation makes sense to me!

References:

1. Weiss, R. D., Potter, J. S., Griffin, M. L., McHugh, R. K., Haller, D., Jacobs, P., … Rosen, K. D. (2014). Reasons for opioid use among patients with dependence on prescription opioids: The role of chronic pain. Journal of Substance Abuse Treatment, 47(2), 140–145.