Are You a New Year’s Resolution Newbie, Master or Flunkee?

scrabble resolutions

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Turning the page on the new year is a chance to wipe the slate clean—and to be better versions of ourselves. And when it comes to what we want to improve, goals that fall in the health and wellness arena top all other New Year’s resolutions. In fact, three of the top four resolutions in a 2018 YouGov poll were health-related: eat healthier (1), get more exercise (2) and focus on selfcare, e.g., get more sleep (4).

People who choose a goal from the health and wellness category as a New Year’s resolution can be categorized in one of three ways: The resolution newbie, the resolution master or the resolution flunkee.  Let’s see which category you most identify with—and learn how to focus on the right strategy can help you be successful and get healthier in the New Year.

Resolution Newbie: Maybe this is your first time making a commitment to your health and wellness. Good for you! Did a recent health scare or loss of a loved one make you see the light? Or perhaps you want to be more active to enjoy activities with your grandchildren or to carry your own bag on the golf course. Whatever your goals are, taking that first step is a big one, so you will want to be prepared for the challenge. Particularly when exercising for the first time or returning to an active lifestyle after a long hiatus, it’s important to have the proper information and tools to be successful. Tap into the health care resources available to you — clinicians like nutritionists and physical therapists can ensure that your body is prepared to take on new challenges and work with you to a design a program that will help you achieve your goals.

Resolution Master: Perhaps you fall into a different camp — You vowed to get healthy in 2018 and you achieved it! For 2019, your resolution is to continue the work you have already begun. After all, living a healthy lifestyle is a lifelong commitment; it’s not something you do for a while and then revert back to your former habits. As you prepare to embrace the New Year, are there any small tweaks you can make to advance your goals? Maybe you are considering training for and running a half marathon, but don’t know where to begin. A physical therapist evaluation is a great place to start—PTs are trained to assess your movement patterns and identify any limitations or weaknesses. Based on that information, your physical therapist can design a personalized exercise program to help you safely and effectively prepare for the grueling race course.

Resolution Flunkee: Let’s say your plan for 2019 is to get in better shape and improve your overall health (we support you!), but this isn’t your first rodeo. Your 2018 resolution was pretty similar, but it’s one year later, and you’re in the same place you were at the beginning of 2018. Identify what stood in your way—Tim? Affordable options? Access to healthy choices and activities? If any of these barriers sound familiar, then along with your resolution, you need to set an action plan. Without planning ahead, you will find yourself staring down the year 2020 with the same goal in mind. However, don’t focus only on the negative—what went right last year? Maybe you made sleep a priority, which in turn helped you to make better food choices at breakfast but by afternoon, you found yourself choosing to energize with a soda and candy bar when all you probably needed was an apple and a 15-minute walk. Take some time to think about the previous year—good and bad.  Take with you what you need and leave the rest behind.  After all, you can’t plan where you’re going without understanding where you’ve been.

Which is your resolution type?

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Some Pay More to Treat Back Pain, but Get Less

grayscale photo of man

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Payless shoe stores recently conducted a very telling social experiment. You may have heard about the shoe chain’s stunt in the news, but to recap, “The Payless Experiment” tricked consumers into buying their typically budget-friendly shoes at sky-high markups. To carry out the clever ruse, the discount retailer invited style influencers to a (fake) launch party for a new high-end label in one of Los Angeles’ glitziest shopping areas. The attendees believed that they were buying fashionable, high-quality footwear and therefore didn’t object to the three-figure price tags.

Aside from being a brilliant marketing ploy for Payless, what lessons does “The Payless
Experiment” have for our current healthcare system, and specifically for patients suffering from low back pain? The experiment is a commentary on perceived vs. real value and how easily people can be swayed into believing that something is as reliable as presented. Think about someone who has had weeks of pain and dysfunction stemming from low back pain: She wants to find a solution that will relieve her symptoms. If a physician presents surgery as the best option—and she’s assured that her pain will go away—then it’s going to sound appealing, right?

Today’s consumer has so many choices when shopping for just about anything from apparel to healthcare. But while it’s customary to shop for the best price for a goose down jacket (without sacrificing quality), shopping around for the best solution (and value) for our ailments is less typical. Due diligence in healthcare may ultimately bring you back to the first proposed solution, but it also may introduce you to solutions that you didn’t know existed.

In the case of low back pain, one such under-heralded solution is physical therapy. Physical therapy, yoga and acupuncture are gaining in popularity as equally (or more) effective and less costly than surgical procedures, injections, MRIs and pain relievers—and for good reason.

Physical therapists are trained to restore and improve patients’ mobility, reduce soft tissue pain, improve function and build muscle strength. They not only develop custom strategies to treat persistent or recurrent low back pain, but educate patients on the prevention of future issues. Some preventive techniques include adopting and following a regular exercise program and learning to lift correctly by keeping the object close to the body.

As you prepared for the holidays, you likely had a long list of gifts to buy. I’m willing to guess that you had a strategy in place for selecting appropriate gifts for each recipient. Just as you matched the right price point, size and color to each person on your list for the holidays, consider approaching your healthcare needs with the same level of scrutiny. After all, finding the right solution at the right price for our health needs contributes to improved long-term outcomes and better piece of mind!

Are Your Arches Falling?

footBy Erin Buenger, DPT

Is there such a thing?  Yes!

“Falling” or “fallen” arches is another term for Adult Acquired Flatfoot Deformity (AAFD).  This three dimensional foot and ankle pathology can affect anyone during the normal aging process and can affect those with pes cavus (a high arched or supinated foot), neutral (normal) arches or those with pes planus (flat feet — yes, they can get flatter!)

Typically, you can see this change around age 30 or older.   Our arches will all flatten or fall a little over time, just as our skin develops wrinkles and becomes less elastic. Variables that may contribute to AAFD or fallen arches include rheumatoid arthritis, neuropathy or decreased sensation, diabetes, weight gain including pregnancy, non-supportive footwear, excess impact activities and injuries to the soft tissues or bones of the foot and/or ankle.

What exactly is a normal arch?  As a quick test, stand up without shoes or socks.  The inside region of the middle part of the foot should not touch the floor; the foot should maintain an arch upwards.  You can also have someone take a picture of your foot in this position from behind and count how many toes you can see in the photo.  With a flat foot, the foot is more likely to be pointed outward with visibility of more than the fourth and fifth toes.

Other issues that can occur with the development of flat foot include bunions, other toe deformities such as hammertoes, heel spurs, plantar fasciitis, posterior tibialis dysfunction and Achilles or calf dysfunction.  Posterior tibialis tendon pathology is a commonly blamed source, estimated to be responsible for approximately 80% of cases of AAFD.  This tendon runs through the arch and is responsible for holding it up (like a sling) when weight-bearing.  Common symptoms include pain on the inside of the ankle and worsening symptoms with increased standing or weight-bearing activities.

Even if you are asymptomatic, addressing this postural issue as soon as possible will benefit you.  During an examination, your doctor or physical therapist will assess your posture, gait pattern, arch structure, strength, flexibility and shoes.  If indicated, your physician will order imaging to rule out other injury or fracture.  More conservative management includes rest, bracing, icing, physical therapy, massage therapy, orthotic prescription, shoe wear modification, anti-inflammatories and potentially weight loss.  A study published in the Journal of Foot and Ankle Surgery in 2011 (Nielsen MD, et al) showed that over a 27 month period, conservative treatment was 87.5% successful for treatment of AAFD.

Surgical options include reconstruction to tighten or lift the flat arch and is classically minimally invasive.  The procedure requires tendon re-routing, ligament repairs, and bone cutting or fusion.  You can expect significant short-term activity restrictions and rehabilitation for a few months post-op.  Your surgeon may also require weight loss prior to surgery.   The prior study by Nielsen MD, et al, found that overall 78.12% of the patients with AAFD were obese.

If you are concerned that your arches are falling, call to schedule a consultation or evaluation with one of our physical therapists.  Your insurance may now allow you to see a physical therapist without a physician’s referral.  Conservative management, including manual interventions, strengthening, shoe wear education and modalities can be very successful in managing flat feet.

Fun fact:  Babies are born without a normal arch structure and it doesn’t progress to full development until around ages 7-10! 

Resources

https://www.health.harvard.edu/a_to_z/fallen-arch-a-to-z

https://www.rushortho.com/body-part/foot-ankle/flat-foot

https://www.ncbi.nlm.nih.gov/pubmed/21458301

Crevoisier X, Assal M, Stanekova K. Hallux valgus, ankle osteoarthrosis and adult acquired flatfoot deformity: a review of three common foot and ankle pathologies and their treatments. EFORT Open Rev 2016;1:58-64. DOI: 10.1302/2058-5241.1.000015.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367591/

Image:  http://www.healthysteporthotics.co.uk/medical-advice/fallen-arches/fallen-arches-hyper-mobile-flat-feet/

 

 

 

 

 

Get Back in Balance This Holiday Season

cautionBy Katrina Sholeen, PT, DPT

As the first snow of the year has fallen and everyone is gearing up for family gatherings and winter travel, physical health and exercise can easily be shifted to the back burner. However, Chicago’s often unpredictable weather conditions, colder temperatures, snow and ice can pose a risk for falling that you will not want to put a damper on the holiday festivities for you or your loved ones!  Fall-related injuries are particularly common among older adults, and according to the Centers for Disease Control (CDC), one in four older adults will have a fall each year, with one in five of these resulting in a serious injury1.

Not Just an Older Adult Problem

Falls are a leading cause of non-fatal injuries among all age groups, according to CDC statistics. While older adults are more likely to fall at home, younger, more active adults and teens are more likely to fall outdoors2, something to keep in mind when you bundle up for your daily run on a chilly morning or bustle around State Street with an armful of shopping bags. Speaking of shopping, it’s a great time to replace those old, worn out shoes and start your winter workouts on the right foot!

Preventing Falls and Fall-Related Injury

While it’s not possible to prevent every accident or injury, staying fit, flexible and improving your balance can help limit injury risk on those slippery sidewalks this winter. Activities like Tai Chi and yoga are great options for improving your balance, and engaging in any leisure-time physical activity has been shown to reduce falls and fall related injury in middle aged adults3. So whatever activity you enjoy, get your body moving!

Medication management is another important piece of fall prevention, as many older adults have multiple prescriptions, and dizziness, drowsiness or other side effects can increase your risk. With the waning sunlight hours, vitamin D deficiency is another possible culprit for injuries from falls. Talk to your doctor if you have questions about any of your medication side effects or if you are considering taking new supplements.

Other ways to prevent falls include staying on top of your vision screening, reducing clutter and tripping hazards, ensuring your home is well-lit, and installing safety equipment such as handrails or grab bars if you know you have difficulty with your balance. For other ideas, check out this handy brochure from the CDC.

Osteoporosis

Have you had your bone density checked recently? Osteoporosis affects almost 25% of women and 5% of men over the age of 654, increasing susceptibility to fracture with a fall. In January, PhysioPartners will be launching Shatterproof, a program to build your bones, which will incorporate evidence-based exercises for making your muscles and bones stronger and improving balance, reducing your risk for osteoporosis-related fractures.

Preventing falls is not an issue for only the old and infirm. Take a proactive approach to reducing your risk for injury, enjoy the winter wonderland and have your happiest holidays yet!

Resources:

  1. Centers for Disease Prevention and Control. Important Facts About Falls. Accessed Nov 19, 2019. Updated Feb 10, 2017. https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
  2. Timsina LR, Willetts JL, Brennan MJ, et al. Circumstances of fall-related injuries by age and gender among community-dwelling adults in the United States. PLoS One. 2017;12(5):e0176561. Published 2017 May 4. doi:10.1371/journal.pone.0176561
  3. Caban-Martinez AJ, Courtney TK, Chang WR, Lombardi DA, Huang YH, Brennan MJ, Perry MJ, Katz JN, Christiani DC, Verma SK. Leisure-time physical activity, falls, and fall injuries in middle-aged adults. Am J Prev Med. 2015;49(6):888–901. doi: 10.1016/j.amepre.2015.05.022.
  4. Centers for Disease Prevention and Control. Osteoporosis. Accessed Nov 19, 2019. Updated Aug 17, 2016. https://www.cdc.gov/nchs/fastats/osteoporosis.htm

 

 

New Parent, New Body

By Jennifer Nelson, PT, DPT, DScPT

Having a child poses a lot of new physical demands on the body. Besides the obvious physical changes on the woman’s body during pregnancy, she and her partner will find that they need to use their body in new ways to care for their new child. Postnatally, the core muscles, including the abdominals and pelvic floor muscles, are especially affected and can make lifting and holding your baby difficult. Below are some common tasks that are often challenging for new parents and some strategies to help support your body.

Lifting

  • The most important thing to remember is to keep the baby close to you. If you are lifting the baby from the changing table or the floor, make sure that you get him or her to you as close as you can to your body before you lift.
  • Plan ahead and make sure the baby/child is directly in front of you and not off to the side so that you can avoid twisting or awkward postures.
  • Position the baby as close as you can to the center of your body.
  • If possible, use your legs to lift rather then your back or arms. Bend your knees and use the leg and gluteal muscles to lift the baby, keeping your arms and back stable while holding the baby close to your body.
  • You can also kneel with one knee on the ground and the other foot in front of you if you are note able to bend your knees down far enough.

Nursing/feeding

  • While looking at your baby while he or she is feeding is completely natural, this forward head posture can lead to problems. Look for a chair with a high back rest so you may relax and lean back into the chair for support. Make sure to use pillows and arm rests to raise the baby up to breast level. If you are bottle feeding, find pillows to support both the arm holding the baby and the bottle. Keep your shoulders and head relaxed and back against the chair to prevent rounding forward. Reclining slightly will make it easier to see your baby without rounding forward, but make sure you do not slouch in the chair.

Transfers

  • New parents often find themselves lying in a bed or on the ground with their little one. When getting out of bed, do not try to sit straight up, especially if you are holding the baby, because it will create a lot of strain on your back and abdominals. Instead, turn to your side, slide your legs off the bed and then use your arms to help you sit upright.
  • When getting out of a chair or moving from sit to stand with your baby, make sure to keep the baby close to your body. Scoot your bottom to the edge of the chair. Lean forward and use your legs to push you upright instead of your back.

Baby Car Seat

  • Baby car seat carriers are heavy and can cause wrist and shoulder problems for many people. They are not meant to be used to carry a baby for long distances. Take the baby in and out of the car seat carrier and instead place him or her in a baby carrier or hold them.  When you do have to carry the carrier, make sure to keep your wrist and elbows neutral. Do not try to lift with your wrists or carry the carrier on your for arm like a bag. Ideally, carry the carrier with both hands in front of you because carrying it at your side leads to increases strain on the shoulder, wrist and low back.  If you must, make sure you are not leaning to either side.
  • When getting the baby in and out of the car, climb into the car by kneeling on the seat and/or floor. Turn your whole body towards the baby and seat instead of twisting and bending forward at the waist and leaning in.

Holding baby

  • Most people want to hold their child in their non-dominate arm to leave their dominate arm free. If the child is old enough, they will rest the baby on the hip. However, this can create a lot of strain on the quadratus lumborum muscle and low back. Instead, use a baby sling or baby carrier, which will give you two free hands, or hold the baby with two arms in front of you. If you need to hold the baby with one arm, make sure you are switching sides often.

Exercises

  • No matter how much you plan and try to use good body mechanics with a child, your body will still be doing new things and you will likely get sore. To help your body prepare and maintain good function try some of these exercises.  Exercises are for educational purposes only – performing them should never be painful and they are not a substitute for medical care or advice:
    • Pectoralis stretch on foam roller or door way (hold 30 seconds x 2)

    • Forearm wrist stretches (hold 30 seconds x 2)

    • Squats (10×2)
      image[7]
    • Standing back extensions (10x)
      image[10]

If you continue to have problems, you should consult with a physical therapist. We wish you success and congratulations on the new addition to your family!

 

80% of Americans Experience Back Pain, But 100% of PTs Know How to Prevent It

Got back pain? Yo377104BB-5056-A04E-37A935F4A2208A1Eu’re not alone. Eighty percent of Americans suffer from low back and neck pain at some point in their lives. Let that sink in. With such great odds that you—or someone close to you—will one day become a statistic, wouldn’t it make sense to arm yourself with preventive strategies and knowledge? Physical therapy is a good place to start.

By performing a thorough evaluation, a physical therapist can identify the muscular, postural and skeletal limitations that could one day lead to an episode of back pain. As part of the assessment, he or she will observe as you perform a series of exercises and then gather an account of your daily activity level and environmental factors like operating machinery or working at a desk 40 hours a week.

The physical therapist will then use all of this knowledge to design a personalized exercise program and teach you a few strategies to prevent back pain:

• Use good body positioning at work, home and during recreational activities.
• Keep the load close to your body during lifting.
• Ask for help before lifting heavy objects.
• Maintain a regular physical fitness regimen—staying active can help to prevent injuries.

Lifestyle can play a big role in back pain. In fact, inactivity and incorrect body mechanics while participating in certain activities are two of the biggest contributors to back pain. In addition to the strategies listed above, it’s also helpful to pay attention to little things throughout your day that could add up to bigger problems down the line. Let’s go back to that desk job for a minute: How often do you get up to walk, stretch and move throughout the day? A good rule of thumb is to stand up or move every 30 minutes. You may get bonus points with your boss, too, as your productivity soars due to the increased activity.

While low back pain rarely becomes serious or life-threatening, it can be quite painful and interfere with our daily lives. Working with a physical therapist can help patients identify the factors that might contribute to back pain and help to develop a prevention plan. But the healthcare professionals are also a great place to turn when you’re seeking treatment for back pain or hoping to prevent a recurrence.

With such good odds that you could one day become a low back pain statistic, why not do everything in your power today to change your trajectory? Seems like another good reason to find an activity (or better yet, two or three activities) that you enjoy, make it a regular part of your day and stick to it!

 

Avoid Insurance Surprises During Open Enrollment

person-filling-out-insurance-claim-formBy Angela Wilson Pennisi, PT, MS

Fall has arrived and with it, open enrollment for most insurance plans.  Patient out of pocket health care costs increased by 11% last year, and from our experience in 2018, this trend shows no signs of slowing.  Avoid unpleasant financial surprises by reading the fine print on the plans you are considering and asking targeted questions before you make your decisions for 2019.

Definitions:  

Deductible:  The amount you have to pay before your insurance company pays any benefits.  May be waived for services that have a copayment, such as annual check ups.  Many policies have separate deductibles for in and out of network providers and may also share a larger deductible across a family policy.

Coinsurance:  The percentage of each bill that you must pay.  For in-network providers, you are responsible only for the percentage of the negotiated amount that in-network providers have agreed to accept.  For out-of-network providers, the coinsurance will typically be a higher percentage and is a percentage of what the provider bills.

Copayment:  A set fee per service that the patient is responsible for and must be paid at the time of service.

Out of Pocket Maximum:  After your health care costs reach this level, the plan will pay 100% of health care costs for the remainder of the policy year.

Narrow Networks

A plan might sound great — no deductible, $10 copayment, reasonable premium.  What could be better?  Make sure you read the policy details and understand exactly what types of requirements these plans have to access your benefits.  Many plans will limit you to providers on a short list or limit you to accessing care only at specific hospital systems.  Before you sign up, make sure you not only look up all your providers, but also ask your regular providers whether they intend to participate in 2019.  If your preferred providers don’t participate, any savings might evaporate with increased out of pocket costs.

If your provider doesn’t participate, consider that they may have opted out because these plans deliver these savings by paying providers very low rates, which then require the provider to see many more patients to make the same amount of money.  Ask yourself whether you need more personalized attention that may not be able to be found through an extremely low cost plan or whether the savings will allow you to pay more to see an out of network provider in certain situations.

Calculate Your True Costs

Health care costs can have a huge impact on your household budget, so take the same time you commit for retirement planning or deciding whether you can afford a certain house payment before making a decision.  Look back over the past year or two — how often did you go to the doctor, how many medications do you take, and what were your out of pocket costs?  If you are healthy and go only for annual checkups, a higher deductible plan might be a great fit.  However, make sure you budget some money for that deductible in case of unforeseen expenses.  A health savings account is a great place to set aside pre-tax dollars and for that money to grow tax-free year to year if you don’t use the funds.  Consider the cost of the premium, the deductible, coinsurance and copayments, whether annual checkups are covered without application of the deductible, and whether you might use out-of-network providers under certain circumstances when calculating your true health care costs.  Finally, consider the time-cost of a plan that might come with a lot of administrative burden, such as ones that require preauthorization for many procedures or plans with insurance companies that have a reputation for putting up barriers to paying the bills.  If you have to spend hours on the phone resolving claim issues, you  must consider the cost of that time, as well.

Medicare Advantage Plans

There has been prolific growth in Medicare Advantage plans in recent years as patients are lured by lower premiums and out of pocket costs.  However, be aware that a name brand Medicare Advantage plan is not the same as having a name brand commercial policy.  Plans are frequently more restrictive and create more administrative burden for both the patient and provider.  Regular Medicare Part B coverage generally offers reasonable payment and hassle-free claims processing for most procedures.  While any federal program comes with its own set of regulations and requirements for your providers, providers are familiar with them and used to complying.  Medicare Advantage plans all have different rules and guidelines that may be difficult for you and your providers to stay on top of.  For more information, read on to learn about preauthorization and utilization review.

Preauthorization Requirements and Utilization Review

When you select a health care plan and review the coverage information, many patients consider whether they are covered for a certain number of visits in a year’s time.  However, in an effort to control health care costs, many insurers have contracted with outside companies to manage the preauthorization process or to retrospectively review charges for medical necessity (and request a refund!).  Unfortunately, the plan you chose that allows up to 80 physical therapy visits, may end up only approving 6 or 8 visits as medically necessary, whether you and your provider agree or not.

Additional problems arise when providers and patients are given different information from the insurer than they are given from the outside preauthorization contractor.  For example, the insurer may advise you that preauthorization is required, but when the provider submits for preauthorization from the outside contractor, he or she is advised that it is not required.  How the claim ultimately ends up processing is anyone’s guess, but many he said/she said phone calls may be required to get around the insurance company’s efforts to pass the buck!  As you review materials for open enrollment, talk directly with your human resources staff, as well as call the insurance company you are considering directly for more information about what types of procedures will require pre-authorization.

If you select a plan that requires additional authorization beyond your physician’s or physical therapist’s recommendation, be prepared to take names and reference numbers for every interaction to ensure your documentation is in place in case you ever need to demonstrate that you attempted to obtain preauthorization but were advised it was not required in this case.

Final Thoughts

As you navigate open enrollment, remember that the insurance company is trying to sell you a policy and that you may need to read between the lines to really understand the potential limitations and how they might affect you.  I’ve often advised patients that insurance companies have perfected behaving like the “children of divorced parents,” telling one parent (the patient) exactly what they want to hear and blaming everything on the other parent (the provider or the utilization management contractor for example).  When your insurance company tells you that your provider doesn’t know how to file a claim properly or that you don’t owe your provider for a service that was provided in good faith for your benefit, take it with a grain of salt and be empowered to advocate for yourself to access the benefits for which you have paid.

Angela Wilson Pennisi is president of PhysioPartners, with locations in Lakeview and the Loop in Chicago.