What is a PT Express Visit?

Have you ever “Googled” an injury in an attempt to avoid a visit to the doctor or physical therapist?

Do you ever “just live with it” because it doesn’t seem bad enough to see someone?

Do you know you need to consult a professional, but physical therapy takes too much time and costs too much?

If any of these apply to you, you might be a candidate for a PT Express package!

Physical therapists are experts at human movement and create treatment plans that help you move better to feel better. The human body is complex piece of machinery, and we love making all those parts are work together in harmony and with efficiency.

But let’s be honest — sometimes you don’t have time or money for optimal efficiency and harmony and just want to make sure you don’t “break down” on the side of the road! We get it — no judgment — which is why we created PT Express visits and packages.

These innovative sessions are designed to give you fast relief of sprains, strains, tweaks and pains. Many studies have demonstrated that the earlier you see a physical therapist, the sooner they will resolve, the better the long-term outcome, and ensuring that you do not need more invasive and costly treatments down the road. They are a great alternative to walk-in clinics that may have limited treatment options to offer.

The session begins with a thorough evaluation so you and your therapist know exactly what you are dealing with. If your symptoms and examination findings point to something more serious, we will refer you to someone in our amazing network of sports medicine physicians, orthopedists, internists and podiatrists. If physical therapist care can help, we will develop a tailored and focused treatment plan just for you. The 20-minute in-person or virtual follow-up sessions are easy to squeeze into your busy schedule, allow us to review your progress, update your treatment plan and provide hands-on interventions.

Now we are not miracle workers — you will have homework! But if you are motivated to follow our self-care instructions and perform exercises on your own, many new onset conditions and minor injuries will respond very quickly. If at your evaluation you therapist recognizes that your injury, condition or prior history requires a more comprehensive plan of care, he or she will discuss it with you so you can make an informed decision about your health.

Packages including the evaluation and 4 follow up sessions start at $280 and is most likely covered by your insurance, so stop suffering in silence — or complaining loudly — and take action today!

What is a Cuneiform and How Will They Impact Joe Biden?

We know that President-Elect Joe Biden had a mishap while playing with his dog over the holiday weekend, leading to a twist of his ankle and hairline fractures of 2 bones in his foot. The lateral and intermediate cuneiforms that were fractured are pictured here:

There is much discussion of President-Elect Biden’s advanced age, and two possible age-related risk factors may have contributed to his likelihood of experiencing this injury.

Low Bone Mineral Density

For men, bone mineral density is at its highest between the ages of 20-29. (Sezer, 2015) While men do not experience the rapid drop off in bone mineral density that women do following menopause, bone density does decline as men age. Osteoporosis in men is an underdiagnosed condition and increases risk for fractures.

Limited Ankle Mobility

Several studies have demonstrated loss of ankle range of motion in older adults, which is also considered to be a significant risk factor for falls. (Menz, 2015) When the ankle cannot bend through its normal range (imagine pulling your toes up towards your nose) because of calf muscle tightness or joint stiffness, other motions must make up the difference during an unanticipated movement. This potential for increased stress to the internal foot bones and foot and ankle ligaments could contribute to sustaining a fracture under the right conditions.

Rehabilitation Implications

President-Elect Biden is anticipated to have full recovery with a few weeks of immobilization in a walking boot, but immobilization itself can also be problematic. Even just one week of ankle immobilization has a detrimental effect on calf strength and balance. (Caplan, 2013) Longer periods of immobilization may require consultation with a physical therapist to restore range of motion, strength, balance and gait pattern to ensure a full recovery and addressing any risk factors for future injuries.

References:

Sezer A, Altan L, Ozdemir O. Multiple Comparison of Age Groups in Bone Mineral Density Under Heteroscedasticity. Biomed Res Int. 2015; 2015:426847.

Menz HB. Biomechanics of the Aging Foot and Ankle: A Mini-Review. Gerontology. 2015;61:381-388.

Caplan N, Forbes A, Sarkhell R., et al. Effects of 1 Week of Unilateral Ankle Immobilization on Plantar-Flexor Strength, Balance, and Walking Speed: A Pilot Study in Asymptomatic Volunteers. Journal of Sport Rehabiliation. 2013;24:156-162.

Cincinnati Bengals’ No. 1 Draft Pick Joe Burrow Out for Season

By Joseph Ascher, PT, DPT, Board-certified Clinical Specialist in Orthopedic Physical Therapy and Mike Henderson, SPT

If you were able to stomach watching the video above, you will see the defender hit Joe Burrow on the outer front side of his knee, causing it to hyperextend and move inward. Our hinge-joint knees are not intended to move in that direction due to — you guessed it — the anterior cruciate ligament or ACL. The ACL restricts the lower leg bone (tibia) from sliding on the upper leg bone (femur), but when high forces like the ones observed here are applied. it can exceed the tolerance of the ligament, causing a rupture.

Unfortunately, in Joe’s case, the force was significant enough to not only rupture his ACL, but momentarily dislocate his knee, which we thankfully see reset in the abrupt shift in the knee later in the video. Joe said “see ya next year” in a Twitter post afterwards, which is probably accurate as it takes about nine months to recover from an ACL reconstruction surgery. Even then, he won’t be fully out of the woods as athletes who return to football after ACL injury have have a 4.32 higher chance of reinjury.

Joe and his Physical Therapist are about to spend a lot of time together, and we are certain that both will be working very hard this off season! Good luck, Joe!   

You can work with Dr. Joe Ascher and student physical therapist intern, Mike Henderson, at PhysioPartners.

Endurance Athlete Worries Severe Ankle Sprain Will End Competition

Endurance athlete Ashley L. had many concerns after her ankle injury, but her path back started at PhysioPartners with physical therapist Mandie Martuzzo.

“Being an endurance athlete, I was terrified [that] my severely sprained ankle was a catastrophic end to my beloved hobbies. From the start to completion of my physical therapist care with Mandie, she gave confidence [that] I’d be able to successfully regain strength in my ankle, as well as get back to running, biking and the other activities that I love.”

Ashley L

Physical therapist Mandie Martuzzo recalled Ashley’s first visits, noting that she was initially in an ankle brace and had difficulty walking normally. She was unable to stand for prolonged amounts of time, descend stairs, run or jump without pain. Ashley is very athletic and wanted to return to running races and competing in triathalons, which she enjoys.

She began therapy with decreased mobility and strength in her ankle and an abnormal gait pattern, and treatments were aimed at improving her gait, ankle mobility, ankle stability and strength, as well as balance. By the end of therapy, Ashley was back to all her normal activities without pain or difficulty and has returned to running for exercise. And hopefully she will soon compete again!

Though Ashley is still building back her mileage, she reports that she has never felt better or more confident in her ankle to tackle her next challenges, the first being wearing heels at her wedding last month!

What is Your Physical Activity Plan?

Photo by Burst on Pexels.com

By Angela Wilson Pennisi, PT, MS

Cooler temps are descending on most of the country and daylight is waning. For many of us, winter will contain many days that are inhospitable to outdoor physical activity, which has become critical during the pandemic. If you are working from home, you might only take 2,000 steps a day without a concerted effort to engage in physical activity.

The American Heart Association recommends at least 150 minutes of moderate-intensity aerobic activity per week or 75 minutes of vigorous activity, as well as two days per week of strength training. And don’t forget about your balance and flexibility!

Chances are that your physical activity status has taken a hit during the pandemic, but you may not even realize that you have lost strength, mobility and/or flexibility until you are challenged by an activity that used to be easy!

If you are wondering how your strength and flexibility are holding up, I encourage you to take the Fit Factor self-assessment, which will demonstrate how your physical health compares to others and identify the gaps in your physical activity plan!

Once you know your needs, begin to make a plan for improving your physical activity status or sustaining your current routine through inclement weather. For me, that meant purchasing more wind-resistant and waterproof gear, as well as purchasing some resistance bands for home.

We also invite you to join our virtual wellness classes, offered several days each week, or exercise with one of our instructors privately in our clinically cleaned and sanitized gyms. In a pinch, the 7-Minute Workout series from the New York Times can also help meet your needs!

If you have been less active than usual this year, consider the following reasons to see your physical therapist to coordinate your fitness regimen. Physical therapists aren’t just for people that are injured or have had surgery. Physical therapists can also help healthy people improve their fitness.

Here are 5 reasons why you should consider seeing yours:

1. You Want a Baseline
When you see a physical therapist to improve your fitness, you will receive an assessment of your strength, range of motion, posture and movement patterns. This not only helps your physical therapist design a customized program just for you, it gives them a baseline to compare things to in the future should you start having pain or suffer an injury.

2. You Want Expert Guidance
Sure, other professionals could help with your fitness routine, but qualifications across the fitness industry vary greatly. Some certifications just require an online course and paying a fee. Becoming a physical therapist requires at least a bachelor’s degree and most PTs practicing today have a doctorate. Every PT has passed a national board exam and maintains a state license. That guarantees you that every physical therapist is a verified expert in human movement.

3. You Want to Prevent Injury
Physical therapists don’t just work to heal injuries, they are also experts in preventing them.
After a thorough assessment, a PT can help you design a program that will not only help you
reach your fitness goals, but that can address any issues that increase your risk for injury.

4. You Want Unbiased Advice
Yoga instructors will suggest yoga. Pilates instructors will suggest Pilates. Strength coaches will want you to strength train. A physical therapist doesn’t have a bias as to what type of fitness regimen you choose. They are only interested in helping you reach your goals.

5. You Have a History
If you have some kind of history that affects your ability to exercise, a PT is the best person to help you design a fitness regimen. It doesn’t matter if it’s an old injury from athletics or work, back pain that comes up from time to time, COPD, arthritis or heart disease, a PT can help you safely work around it and meet your fitness goals.

Angela Wilson Pennisi is a physical therapist and founder of PhysioPartners.

Avoiding Injury as We Return to Activity

Photo by samer daboul on Pexels.com

By Mandie Martuzzo, PT
Board-Certified Clinical Specialist Orthopedic Physical Therapy

During the stay-at-home period, we have all been much less active than we are used to. Even if we have made an effort to exercise, we are still engaging in much less daily activity than normal. Going to work, walking around, running errands, all add physical activity to our days.

Tissue responds to stress placed on it. So, less stress on the tissue (e.g. inactivity) can lead to muscle atrophy or decreased strength in muscles and tendons and decreased bone density.  Decreased physical activity can also reduce the motor recruitment of muscle fibers, meaning it takes more effort to turn the muscle on than it did before.

Alternately, physical activity and exercise will increase circulation around muscle fibers, allowing more oxygen and greater muscle performance during endurance training. Resistance exercise increases muscle fibers (e.g. muscle mass and strength). Tendons also become stronger to prevent tendon damage, as the force produced by muscles is transferred to tendons that attach the muscle to bone.

Keeping in mind the importance of loading on muscle and tendons and the effects that it can have, it is important that we cautiously return to our normal activity and exercise so we can avoid strain and sprain injuries.

If done improperly, resistance training can lead to overuse injuries of the muscle, tendon, or bone. These injuries can occur if the load is too heavy or if the muscles are not given sufficient time between workouts to recover or if joints are not aligned properly during the exercises. It is also common for an injury to occur when there is a sudden increase in duration, intensity, or frequency of an activity. (American Academy of Orthopedic Surgeons. Available from: orthoinfo.aaos.org. Accessed 26 February 2019).

muscle strain occurs when muscle fibers cannot cope with the demands placed on them by exercise overload and leads to tearing of the fibers. It is a contraction-induced injury in which muscle fibers tear due to extensive mechanical stress. This mostly occurs as result of a powerful eccentric contraction or over stretching of the muscle. Therefore, muscle strains typically occur during non-contact sports with dynamic characteristics, such as sprinting and jumping. (Garrett WE. Muscle strain injuries. Am J Sports Med. 1996; 24:S2-88)

Some considerations or things to keep in mind as you increase your activity levels to prevent injury include:

* Heart rate variability and fitness level: Training too hard/too fast can lead to muscle injury. Monitor your heart rate and how quickly your heart rate lowers from 125 bpm after intense exercise. How fast your resting heart rate climbs and then lowers after activity is a good indication of your current cardiovascular performance. Then you can ensure that you are working out at an intensity level that is within a moderate range.

* Eccentric strengthening: This type of exercise trains your muscles to maintain strength and tension while they are lengthening. This helps prevent tears, which often occur when a muscle suddenly elongates and must absorb a high amount of force.

* Vitamin-D can impact muscle strength/performance, and deficiency can cause premature muscle fatigue leading to injury. If you think you may have low Vitamin-D levels, check with your doctor and get recommendations for a supplement if needed. (https://www.hindawi.com/journals/bmri/2015/953241/)

* Warm up before and stretch after: A short period of warm up activity prior to exercise will help to prevent an injury. Save the stretching for after exercise to help reduce chemical build-up in the muscles and reduce soreness.

* Consider a Wellness360 exam with a physical therapist. PhysioPartners offers the Wellness360 Annual Exam for an evaluation of strength, mobility, and function that can help find areas where you can improve to avoid injury.

Your physical therapist is here to keep you moving and return to your life with confidence!

Get Physical Therapy First During the COVID-19 Pandemic

annual_musculoskeletal_examBecause of the closures of physician’s offices, stoppages of elective surgeries, and social distancing guidelines resulting from COVID-19, many people with pain or joint issues have had appointments or surgeries delayed. If you’re one of them, and you haven’t seen your physical therapist yet, you should. Here are some reasons why:

Early Physical Therapy Leads to Better Outcomes

Studies have shown that people who receive physical therapist care sooner have better outcomes, lower costs, are less likely to have surgery, use opioids or have unnecessary testing. Because back pain is so common, there is a lot of outcome data from people with back pain. A study of 150,000 insurance claims published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit. Unfortunately, only 2% of people with back pain start with physical therapy, and only 7% see a physical therapist within 90 days.

Early Physical Therapy Saves Money

The rising cost of healthcare is well known and early physical therapy is something that has been shown to reduce costs without reducing the effectiveness of treatment. A study published in the Journal of Orthopaedic and Sports Physical Therapy showed that patients who obtained physical therapy via direct access had significantly lower medical costs—an average of $1,543 less per patient than those who chose referral from a physician. They also had significantly fewer visits and spent significantly fewer days in care.

Surgery May Not Be as Effective as You Think

Many patients look to surgery as the fix for their pain, but surgeries are not always as effective as patients believe. A large study looking at worker’s compensation patients with back pain found that people who have surgery have a 1 in 4 chance of having a repeat surgery, a 1 in 3 chance of a major complication, and a 1 in 3 chance of never returning to work again. Recent large studies of arthroscopic surgeries for meniscal tears have shown no difference in outcomes between people who have surgery and those who don’t. Other procedures with questionable effectiveness include kyphoplasty, vertebroplasty, and injections for nonspecific back pain.

So, if you were planning on seeing your primary care physician or a specialist for an orthopedic condition or pain and you have not seen a physical therapist yet, you should consider making physical therapy your first stop. You could end up getting better faster for less money and you might avoid riskier treatments like opioids or surgery.

Request an in-person or Telehealth appointment with one of our physical therapists today! 

How Much Physical Activity Do Older Adults Need?

Aging AthleteMost people know that physical activity is important. In fact, not getting enough has been linked to illnesses like heart disease, stroke, diabetes, Alzheimer’s, high blood pressure and lung disease. So, the important question is not if you need to be doing some form of physical activity to protect against diseases like these, but how much is enough?

The US Department of Health and Human Services answered that question for us in 2008 with their recommendations for physical activity. To improve or maintain health, adults over 65 need to do two types of physical activity: Aerobic Exercise and Strengthening.

Aerobic Exercise

To meet the recommendations for aerobic exercise you should be active daily and perform your aerobic activity for at least 10 minutes at a time. Each week you should aim for

  • 150 minutes of moderate intensity activity

OR

  • 75 minutes of vigorous intensity activity.

The general rule is that 1 minute of vigorous activity is equal to 2 minutes of moderate intensity activity, so a combination of moderate and vigorous activity can also be used to satisfy the recommended 150 minutes each week.

Some examples of moderate intensity aerobic activity that can be done during the current COVID-19 crises:

  • Walking
  • Riding a bike on a level surface
  • Gardening

Vigorous intensity activities include:

  • Running or jogging
  • Riding a bike fast, or on hills
  • Singles tennis
  • Hiking uphill

Strengthening

Muscle strength is important for all daily movement, and in older adults it can help to maintain strong bones, as well as reduce the risk of falling. The recommendation for strengthening is to work each major muscle group twice a week.

Examples of strengthening activities include:

  • Carrying heavy loads
  • Lifting weights
  • Exercises using your own body weight like push-ups, sit ups, or squats

For each exercise you should try to perform:

  • At least one set
  • 8 to 12 repetitions in each set

Your resistance should be heavy enough that the last repetition is hard to complete.

These guidelines are general recommendations and do not consider previous injuries, medical conditions, or limitations that individuals may have. Your physical therapist is an expert in exercise and physical activity who can help design a program to maintain or improve your health while considering your past medical history, limitations, and goals. Your physical therapist can teach you safe exercise technique, and help you safely progress your program as you get fitter to continue making improvements in your overall health.

Physical Activities for Parents & Kids!

selective focus photography of three disney princesses figurines on brown surface

COVID-19 has eliminated the question of what stay-at-home moms/dads do forever! Now the bigger problem emerges:  How do they fit in the daily physical activities their children desperately need? Public resources such as playgrounds and parks are no longer safe, so the need to get creative for home activities is in high demand.

Running, jumping, and active movement is important for a child’s health because it reduces weight, increases muscle strength, improves bone density, and stimulates attention in school. The improvement in concentration is even more valuable as parents take on the role of the teacher as they now homeschool their children.

In order to remove another obstacle for parents to solve, here is a list of resources that will promote healthy, engaging, and entertaining physical activities that can be done in the home.

 

  • Fairytale Physical Therapy Dance Along

 

This company teaches online dances (that are secretly composed of therapeutic exercises) to some of the most popular songs amongst children. Want to learn a dance to “Let It Go” or “Kiss the Girl”? They have it! You can even play that part of the movie for your child to practice the dance as a reward for participating.

Resource: https://www.youtube.com/watch?v=TlqdErkox8g&list=PL7taw2nYgJPNqMUkgceZh9SYlx6CoPit8

 

  • Explore Nutrition and Physical Activity

 

LearntobeHealthy.org is an online health science learning site designed to help parents communicate important health concepts to their children in grades PreK-12. The site contains comprehensive lesson plans, interactive games and activities, Webquests, assessments, an individualized Health Log and more. The goal of the site is to inspire children and their families to make healthy choices that may last a lifetime.

Resource: www.learntobehealthy.org/kid

 

  • Little Sports

 

Little Sports is a youtube channel that provides entertaining workouts led by cartoons! These are 15 to 20 minute follow-along workouts that are great for challenging your child’s attention span and getting the blood flowing throughout their bodies. This is a great activity to utilize in place of running around the playground.

Resource: https://www.youtube.com/channel/UCTIwFB4ciFi5ZCIu-VlwaOg

 

  • Get Moving with Disney Family

 

Is your child a Disney fan? Get Moving with Disney Family is a great activity where your child gets to do healthy movements inspired by some cherished Disney movies such as Mulan, The Jungle Book, The Incredibles, and more! This is a wonderful activity to get the whole family moving together.

As parents keep their children safe at home, including healthy physical activities is extremely valuable. If you are unsure if the physical activities are safe for you child, check with a physical therapist to clear your child for participation. Every child needs daily physical activity to continue to grow and mature healthfully!

Physical Therapy During Quarantine: How to Manage Your Physical Health

The pandemic has changed the way many of us go about daily personal, social and work routines. The Center for Disease Control recommends social distancing, and depending on where you live you may have lost access to in-person visits with your physical therapist. While our daily lives have changed, good physical health should remain a priority and your physical therapist can help you stay on track with the following guidelines.

  1. To not regress, stay in touch with your physical therapist and continue with the home exercise programs that you and your physical therapist have discussed. This way, you can pick up again where you left off when access to your physical therapist returns.
  2. Many physical therapy offices are using telehealth services. This allows you to have access to your physical therapist from the comfort of your own home and with decreased risk of exposure to the coronavirus. Video conferencing or even checking in with your physical therapist via telephone on a weekly basis will make sure you stay on track and your home exercise program is adjusted based on your status.
  3. Many people have been asked to work from home. You may have to adjust to a new workstation which is not set up the same as your desk at the office. Poor ergonomics can lead to decreased productivity, decreased motivation to work and increased neck pain, low back pain or shoulder pain. Making sure your computer and desk chair are set up at the right height are initial adjustments your physical therapist can help you with. Neck and upper back exercises such as chin tucks and rows can help you offset pain created by poor posture.  Our occupational therapist is available for virtual ergonomics assessments of your home work station.
  4. Due to social distancing and many health clubs temporarily closing their doors, you may feel lost with your daily exercise routine. By contacting your physical therapist, he or she can provide recommendations to keep up with your health goals or just to stay active.
  • Walking: Walking 30 minutes a day, 3 times a week has been shown to improve cardiovascular endurance, reduce blood pressure and weight.
  • Physical activities you enjoy: Exercise causes the brain to release chemicals that can lead to a feeling of accomplishment and relaxation. Research shows exercise can be very effective in the treatment of depression and elevating your mood. In addition, exercise can boost your immune system.
  • Eight minutes of strength training per day can lead to many health benefits and can all be done without any equipment. Always check with your physical therapist if these exercises are right for you. A routine could consist of planks, pushups, the bridge, lunges, heel raises and squatting.

Staying active during these uncertain times is important. Exercising will help improve your mood and stress from the pandemic. Your physical therapist can help you enhance an exercise routine with creative exercises to keep you engaged and excited.