Staying Active During Pregnancy

Staying Active during Pregnancy

With National Women’s Health & Fitness Day coming up on September 26, it is a great opportunity to highlight the importance of staying active and discuss basic guidelines for exercise during pregnancy.

Is exercise during pregnancy safe?

In general, if you are healthy and have a low-risk pregnancy, most exercise is safe to continue or begin. Modification, especially as your baby grows, may be necessary in later stages of pregnancy.  It is important to discuss your exercise routine with your midwife or obstetrician in your early prenatal visits.

Exercises to avoid during pregnancy include: contact sports (soccer, basketball, hockey), activities with a risk of fall, scuba diving, hot yoga  

What are the benefits of exercise during pregnancy?

Benefits may include:

Increased energy

Improved mood

Decreased constipation

Decreased risk of gestational diabetes, preeclampsia, caesarean delivery

Improved muscle strength and tone

Decreased back pain

Promotion of healthy weight gain during pregnancy

 What can the role of a physical therapist be in staying active during pregnancy and the postpartum period?

The anatomical and physiological changes that occur during pregnancy can increase the risk of musculoskeletal pain for pregnant women, especially low back pain or pelvic pain. As musculoskeletal experts, physical therapist have an important role in decreasing pain and improving function during pregnancy. Physical therapists can also assist patients in exercise prescription and modification during pregnancy and the postpartum periods. Physical therapists with specialized training in “women’s health” or “pelvic health” work with patients that may experience pelvic pain or urinary frequency or incontinence.

For postpartum patients, physical therapists also have a role in the assessment and treatment of disastasis recti (abdominal separation). Patients may have pain or dysfunction related to pregnancy and childbirth many years after it started, but physical therapy can still be beneficial.

If you feel that you would benefit from physical therapy during pregnancy or after giving birth, please contact Advanced Physical Therapy & Sports Medicine at (920) 991-2561.

References:

“Exercise during Pregnancy” https://www.acog.org/Patients/FAQs/Exercise-During-Pregnancy

“Exercise during Pregnancy” http://americanpregnancy.org/pregnancy-health/exercise-during-pregnancy/

“ACOG Committee Opinion” https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care

“Pregnancy and Low Back Pain: Physical Therapy Can Reduce Back and Pelvic Pain During and After Pregnancy”J Orthop Sports Phys Ther 2014;44(7):474. doi:10.2519/jospt.2014.0505

Let's Play Catch, Grandma!

“Grandma/Grandpa, can you play catch with me” says little Billy. “I wish I could, but I’m too stiff and sore” says Grandpa. “Okayyyy” says little Billy.

 Have you encountered a situation where you felt physically limited? If so, it’s never too late to work toward a new goal! But how you might ask? The answer is simple, find something you like to do (that involves movement) and do it! Yes, that simple. As we know, aging takes a toll, but did you know that activity/exercise even increases in importance as we age, especially if you want to keep up to those fast grandkids. You’re never too old to begin. Even if you have not been previously active, it is important to get started! Growing evidence supports the notion that physical activity can preserve independence and offset functional decline, especially after retirement.

Strength is estimated to decrease by 40%-50% between 25 and 80 years of age. A supervised or safe independent exercise program can assist you to lessen this decrease in strength over the years. Simons et al. explains that a walking program or resistance training program both improve function in individuals 66 years or older. Not only will activity & exercise help you to move around better, but it will also help improve your mood, boost your immune system, manage or lessen the impact of diabetes, heart disease, osteoporosis, depression, and many other conditions. Despite all of the great benefits, the amount of individuals who do participate in leisure physical activity is relatively low (15%).

As a healthcare provider, my goal is to allow you to reach your full potential. Whether this is by designing a specific program to achieve your goals, listening to concerns, giving recommendations, or anything else that contributes to your well-being I am here for YOU! As stated before, but I will say it again “You are never too old to set a new goal or dream a new dream.” Let’s work together to increase the amount of individuals living an active lifestyle. So there ya have it folks… it’s time to get moving and grooving.

Kaitlyn J

Sources

Simons R. Andel R. 2006. The effects of resistance training and walking on functional fitness in advanced old age. J Aging Health. 18 (91).

Newsinhealth.nih.gov/special-issues

The Name is Arthur, Arthuritis.

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

Polka away Wisconsinites,

Dr. PJ

Reference:

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

What's So Special about Specialization?

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

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

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

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

#ChoosePT #ChoosePT1st 

References:

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

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

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

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

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

Bike Because Queen Said So!

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

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

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

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

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

Safe riding,

PJ

References:

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

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

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

A Green thumb’s guide to injury prevention

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

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

TRIGGER THUMBS OR FINGERS

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

WRIST TENDINITIS

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

ELBOW EPICONDYLITIS

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

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

HAND INFECTIONS

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

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

Recovery Inn

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

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

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

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

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

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

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

Happy healing!

Allie :)

Allison M. Salm, OTR, CLT

Director of Therapy Services—Recovery Inn

Advanced Physical Therapy and Sports Medicine

What is OT?

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

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

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

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

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

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

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

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

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

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

April is Occupational Therapy Month! 

Allison M. Salm, OTR, CLT

A Day in the Life!

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

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

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

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

Ready to do start this all again tomorrow?  

Thanks for reading.

Ashley Rottier, MSAT, LAT

At Your Own Risk

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

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

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

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

Please explore more about athletic training at the following pages:

NATA.org

AtYourOwnRisk.org

Wisconsin Athletic Trainers' Association: Homepage

Reference:

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

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