Are You A Passive Patient or an Active Consumer of Healthcare?

Are You A Passive Patient or an Active Consumer of Healthcare?

Think about the last time you made a big purchase, say $1,000 or more. Did you go out and buy the first thing you saw? Take one recommendation from somebody? Or did you research it, learn some things, compare it to other options, and select something that was right for you? Most people tend to be educated and research large purchases like cars, televisions, or the newest iPhone. So why do we so often fail to do this with healthcare? By becoming more educated healthcare consumers we can go from passive patients who take the first recommendation that comes from a practitioner to an active consumer who weighs options and makes choices. Here are some questions to talk through with your practitioner the next time a healthcare decision comes up.

Doctor and Patient

What are the benefits or expected results?

When a treatment or procedure is recommended, the patient often assumes that it will make them “better.” But what the patient expects and what the healthcare provider expects are often two different things. For example, a patient having back surgery expects to be pain free after surgery. The surgeon probably doesn’t expect that to happen. Outcomes from back surgeries are terrible. A large study of 1450 patients in the Ohio worker’s comp system showed that after 2 years 26% of patients who had surgery returned to work. Compare that to 67% of patients who didn’t have surgery. There was also a 41% increase in the use of painkillers in the surgical group.

Risks and DownsidesWhat are the risks and downsides?

Patients want to hear about the benefits of a treatment, but they often don’t ask or care about the risks. To be an educated consumer, you need to. If one treatment has a 3% edge over another, but has a high risk of making you itchy or causing frequent headaches, do you want it? Going back to the back surgery study from before, the researchers found a 1 in 4 chance of a repeat surgery and a 1 in 3 chance of a major complication. With surgery you risk infection, blood clots, complications with anesthesia, and a whole host of other things. These risks need compared with other treatments. In the case of back pain, physical therapy is a valid alternative with a much lower risk profile. You might have some soreness with physical therapy, you might sweat some and be challenged with exercise, but the risks of PT compared to surgery are minimal.

Consider AlternativesWhat are the alternatives?

Don’t feel bad asking about alternative treatments. If you were looking at a certain car you wouldn’t go out and just buy it. You’d at least consider the competitors and probably even test drive them. You should at least look at the other options in healthcare too. Maybe the first recommendation that your practitioner makes is the right one for you, but if you don’t consider the alternatives you’ll never really know.

Rubber Meets the RoadWhy this treatment over the other ones?

This is the question where the rubber meets the road. You’ve learned about all the options, now you can see if your practitioner is balancing the risks and benefits to make the right choice for you. Staying with the back pain example, research shows that more than 40% of people who seek care for back pain will not receive a treatment of known effectiveness. Back pain is also the #1 reason for opioid prescriptions, despite a 2016 recommendation from the CDC to avoid prescribing opioids for back pain, and opt for non-drug treatments like physical therapy. By asking for the rationale and carefully weighing options, you can avoid being one of the people who gets an ineffective treatment.

Health Insurance CostWhat’s it cost?

This last question is becoming more important as patients bear an increasing share of the cost of healthcare. Even if you don’t have a high deductible plan or hefty co-pays, by being financially responsible today, you’ll probably see smaller price increases in your premiums downthe road. That back surgery that we’ve been talking about? It’ll likely cost between $60,000 and $80,000. So if we put the whole picture together, a patient who takes the first recommendation for surgery will have a $60,000 procedure that leads to a higher risk of disability, and a higher risk of long term painkiller use, while risking infection, and blood clots. Don’t forget the 25% chance that you’ll get to do it all again in a repeat surgery. Seems like a bad deal. An educated consumer would learn that physical therapy is a viable alternative to surgery with comparable outcomes, much less risk and lower cost. In fact, a large study of 122,723 subjects showed that people with back pain who got physical therapy in the first 14 days lowered their healthcare costs by 60%. It’s easy to see why bargain shoppers love PT!

Youth Baseball Softball and T-ball - What Parents Need to Know

Youth Baseball, Softball and T-ball: What Parents Need to Know

Youth sports injuries have been on the rise for years, and baseball players are not immune to this trend. 1 in 5 players between the ages of 9 and 15 will have an injury each year. The good news is that only 5% of these injuries result in surgery, or being unable to continue to play baseball. More good news comes when you learn that the majority of injuries are preventable with proper training and awareness.

Many of the injuries seen in baseball are common to other youth sports and include things like:

  1. Sprains and strains
  2. Fracture
  3. Minor injuries like bruises, scrapes, abrasions, and muscle cramps

Keys to preventing these types of injuries are making sure that players have a proper base of strength and fitness to participate, adequate warm up before practice and games, and making sure that players have enough recovery time built into their schedules throughout the season.

Injuries Unique to Baseball/Softball

In addition to the common injuries above, baseball sees a large number of injuries due to overuse. These most commonly occur in the shoulder and arm, typically in a pitcher. Parents of athletes who pitch need to be aware of the risks of pitching and guidelines to minimize them. Studies have shown that pitchers who average more than 80 pitches in a game are 4x more likely to get injured. They have also found that pitching for more than 8 months out of the year, causes your injury risk to increase by 5x.

Tips to prevent pitching injuries

  1. Pick a team to pitch for -if you play on multiple teams, choose oneto pitch for and play a different position on the other to reduce the chances of injury
  2. Don’t play a position that requires a lot of throwing on your non-pitching days, like catcher
  3. Take 2 to 4 months off each year from pitching to rest your arm
  4. Keep your arm healthy and strong. The thrower’s ten was developed specifically for throwing athletes and is a good place to start.
  5. Stop pitching if you feel pain, or fatigue. Throwing through problems will change your mechanics and put you at risk for serious injury
  6. Follow the guidelines for rest days and total pitches below.

If you’re 14 or under:

Pitches Thrown Rest Days
1-20 No rest day required
21-35 1 rest day
36-50 2 rest days
51-65 3 rest days
66+ 4 rest days

15 and under can throw a bit more

Pitches Thrown Rest Days
1-30 No rest day required
31-45 1 rest day
46-60 2 rest days
61-75 3 rest days
76+ 4 rest days

Finally, you should aim to keep under the maximum number of daily pitches set by Little League Baseball and Softball:

Age Max Pitches Per Day
7-8 50
9-10 75
11-12 85
13-16 95
Prevent Unnecessary Surgery

PT Can Prevent Unnecessary Surgery

Recent research is showing that surgery might not be needed as often as we think. A large review estimates that 10% to 20% of surgeries might be unnecessary and that in some specialties such as cardiology and orthopedics, that number might be higher. The reasons for so many unneeded surgeries being performed are varied, but the most common are that more conservative options aren’t tried first, or lack of knowledge by the operating physician.

Physicians undergo long and rigorous training programs to become surgeons, but if they don’t work hard to keep learning, their knowledge often stops growing when they leave residency. Recent research is showing that certain common surgeries aren’t any better than a placebo. Two such examples are kyphoplasty – a procedure for spinal compression fractures, and partial meniscectomy – a procedure used to treat tears of the meniscus in the knee. If a surgeon hasn’t continued to learn, they won’t know that these surgeries often don’t offer any more benefit than a non-surgical treatment and will continue to perform them.

Every surgery, even “minor” ones carry risks. These include complications from anesthesia, blood clots after surgery, delayed healing of the incision, infection, and unintended damage to nerves or other organs near the surgical site. Some of these risks cause discomfort for a period after surgery and go away, but others can result in permanent disability or even death. For some patients and conditions, surgery is a great treatment option, but with all the associated risks, when surgery can be avoided, it should be.

For musculoskeletal problems like back and joint pain, sprains, and strains, seeing your PT before a surgeon can help keep you out of the operating room and get you back to life without surgery. Studies have shown that physical therapy is just as good if not better than surgery for a multitude of conditions and carries less risk. Some examples would include rotator cuff tears, meniscal tears, spinal stenosis, low back pain, and osteoarthritis.

Physical therapy can’t fix every problem, and for some patients surgery is the best choice. However, research is showing that surgery isn’t a cure-all, and is sometimes just a very expensive and risky placebo. In most cases, starting with physical therapy is the right choice, and for many patients, PT is the only treatment necessary.

Strength Training for Seniors

Strength Training for Seniors

Strength training is an important type of exercise, but becomes even more important as people age. Without resistance training, we begin to lose somewhere between 0.5% and 1% of our muscle mass each year.

With this loss of muscle mass comes higher levels of arthritis pain, more difficulty with things like getting out of a chair or going up steps, higher risk for falls and injuries, and eventually the possibility of loss of independence.

Research has shown that people of any age can benefit from strength training, so just because you’re getting older doesn’t mean that you can’t get any stronger. When many people hear “strength training” they automatically picture someone straining under a heavy barbell. However, strength training can be performed with resistance bands, machines, dumbbells, barbells, and many other types of equipment. The key to strength training is that the resistance gets stronger as you do.

The data we have also shows that increasing strength can reduce pain from arthritis, and make things like climbing steps, carrying groceries, taking a bath, and preparing a meal easier. Strength training can also help to reduce your risk of falls and maintain your independence.

If you’d like to begin strength training and start reaping the benefits, your physical therapist can help you design a plan that’s both effective and safe. They can teach you the correct movements and monitor your progress, helping you increase your resistance the right amount at the right time.

Physical Therapy to Improve Your Golf Game

Physical Therapy to Improve Your Golf Game

We’ve all heard that a proper warm up is important before exercise, and that skipping it can lead to injury. As physical therapists, one of the more common places we see people skipping warm ups or doing them improperly is at the golf course. For many golfers, the warm up is carrying the golf bag from the trunk of the car to the cart. For others hitting a bucket of balls at the driving range or taking some practice swings is a warm up.

The golf swing is a complex, full body motion that puts a lot of force through the bones, muscles, and ligaments. Jumping straight into swinging a club without properly preparing those bones, muscles and ligaments puts golfers at risk for injury. A good rule of thumb to help you remember what a proper golf warm up looks like is that you can’t swing to warm up, you have to warm up to swing.

A proper warm up happens right before you start golfing, so that means you’ll be doing it at the course. If swinging a club isn’t a good warm up, what does one look like? It’s a series of dynamic activities that raises your heart rate to 60% of your maximum. The easy way to figure this number out is to subtract your age from 220 to get your maximum, then multiply that by 60% to get your target heart rate for your warm up. So for a 55 year old, the maximum heart rate would be 165 (220-55) and 60% of that is 99 (165 x 0.6).

Each exercise below should be done for about 1 minute on both sides of your body to keep symmetry and be done a pace to get your heart rate up to the target you calculated.

Neck circles

Drop your chin down to your collar bone, then rotate your head in a circle, bringing your ear to your right shoulder, up to the sky, to your left shoulder, then down at the floor. Repeat for 30 seconds and then switch directions.

Neck Rotation

Turn your head to the left and hold for 2 seconds, then to the right and hold for 2 seconds. Continue for 60 seconds.

Torso Rotation with Club

Stand in a 5-iron posture with your feet shoulder-width apart, and a slight bend in your knees and waist. Hold the club in front of your shoulders with crossed arms, and keeping your hips steady, rotate your shoulders from side to side.  The end of the club should point forward at the biggest point of the stretch

Side Bends with Club

Stand with your feet shoulder width apart.  Hold the club on your shoulders behind your neck. Keeping your back straight, bend to your left and hold for two seconds, then to the right and hold for two seconds. Make sure you’re not bending forward or backward as you bend from side to side.

Shoulder Circles

Do small shoulder circles for 30 seconds, first clockwise and then counter clockwise.

Toy Soldiers

Walk forward, kicking one leg and then the other out in front of you while keeping your back and knees straight. As you kick, reach your arm on the same side, aiming to touch your toes to your fingers. Keep your toes flexed toward your body as you kick.

High Knees Walk

Walk around where you are, and with each step, grab your leg just below the knee with both hands and pull it as close to your chest as possible, feeling a stretch in the glute. Hold the stretch for a second and then release and take the next step.

Reverse Lunge Calf Stretch

Stand with feet shoulder-width apart and step back with one leg. Keep your back knee straight with your heel on the ground as you bend your front knee and drop into a slight lunge. Hold for a moment and then switch legs, alternating legs for 60 seconds.  Hold onto a wall or chair if you need to.

You might wonder where the static stretching is in this warm up. Research has shown that static stretching (holding a stretch for a long period of time) done before activity can actually hurt your performance. Static stretching is important as part of the cool down after activity, however. So before you head to the 19th hole, stretch and re-hydrate with some water.

Physical Therapy for Parkinson’s Disease

Physical Therapy for Parkinson’s Disease

What is Parkinson’s?

Parkinson’s affects about a million adults in the United States. It is a progressive nuerodegenerative disorder meaning that over time it does get worse, and that it’s caused by degeneration of neurons in the brain. The specific neurons affected produce a chemical called dopamine. Parkinson’s causes tremor, slow movement, loss of coordination, and muscle stiffness.

While Parkinson’s does not have a cure, symptoms can be managed, and progression can be slowed allowing people with Parkinson’s to live a high quality and active life.

What can be done?

Currently, the primary treatments for Parkinson’s are medication and exercise. There are surgical options for people who have exhausted the medications available, or who suffer profound motor deficits. Additional studies are ongoing looking at medical marijuana and other complementary or alternative treatments as well.

Medication

It is important for people with Parkinson’s to work closely with their neurologist because each patient will require a different combination of medications.

The first choice for many patients will be one of the levadopa drugs. This chemical is converted into dopamine in the brain to reduce symptoms like tremor, rigidity, and poor coordination.

There are other drugs that may be used in place of, or in combination with levadopa to manage symptoms. Most patients will need ongoing assessments and changes in their medication regimen as their symptoms progress and change

Exercise

Research has shown that exercise can help with both motor and non-motor symptoms in people with Parkinson’s. The most important thing for people with Parkinson’s is to get started with exercise early in the disease process and to be consistent with exercise. Your exercise program should focus on a few different components:

  1. Flexibility exercises
  2. Aerobic activity
  3. Muscle strengthening

Some types of exercise like Tai Chi, yoga, Pilates, biking, or dancing combine several of these elements.

Your physical therapist will complete an individualized evaluation to determine the areas where you have the most trouble, then work with you to design an exercise program to address these areas. They can help you find beneficial types of exercise that you enjoy, which will help you stay consistent with your program and reap the most benefits.

There are exercise programs specifically designed for treatment of Parkinson’s disease, including the LSVT BIG program. This is a program delivered by a specially trained physical therapist over 16 sessions that focuses on getting people to make bigger movements. The BIG program has been shown to improve balance, increase quality of life, and help people walk faster with bigger steps.

While there is no one answer to manage symptoms and slow progression of Parkinson’s disease, working with your physician and your physical therapist using a combination of medication and exercise has been shown to lead to the highest quality of life.

latpc incontinence

Physical Therapy for Incontinence – In Men and Women

What is Urinary Incontinence?

Urinary incontinence is the involuntary leakage of urine. 25 million Americans experience this condition, and ¼ of women between the ages of 18 and 59 have urinary incontinence. There are different types of incontinence, with the most common being stress and urge incontinence.

  1. Stress incontinence is when leakage happens during coughing, sneezing, or laughing.
  2. Urge incontinence is a result of the bladder being overactive or unstable. People with urge incontinence often often have triggers that cause the involuntary loss of urine, such as hearing running water.

What Can Be Done?

Physical therapy can be used to effectively treat urinary incontinence. A typical program consists of a combination of exercise and education. Exercise is used to improve the strength of the muscles of the pelvic floor, providing better support to the bladder and improving your ability to control the flow of urine. Education helps you learn how the bladder normally functions and changes you can make to improve your symptoms. Examples of these changes are making sure that you are adequately hydrated, avoiding “just in case” peeing, and dietary changes to avoid bladder irritants like spicy foods, citrus fruits, caffeine, and carbonated beverages.

A common example of a pelvic floor strengthening exercise is the Kegel. Although this exercise is well-known and commonly attempted, it is frequently done incorrectly. Many people substitute muscles that are not part of the pelvic floor during a Kegel like the abdominals, glutes, or hip adductors.

 

To perform a correct Kegel:

  1. Avoid contracting your abdominals or glutes
  2. Tighten the muscles as if you’re trying to stop the flow of urine
  3. Then imagine a string pulling those muscles up towards your belly button.

Physical therapy can help you take back control of your bladder and stop worrying about where the next restroom is. If you’re experiencing urinary incontinence, a pelvic PT can provide a comprehensive evaluation and develop a treatment plan specifically for you!

Choose Physical Therapy for Back Pain

Choose Physical Therapy for Back Pain

Chances are, you or someone you know has had back pain. Each year 15% of the population has their first episode of back pain, and over the course of our lives, 80% of us will have back pain. Even though back pain is common, the medical community does a poor job managing it. Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too common.

Let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy:

Medication

Low back pain is the #1 reason for opioid prescription in the US, however in 2106, the CDC recommended against the use of opioids for back pain in favor of “non-drug treatments like physical therapy.”

Imaging

Having an X-ray or MRI for back pain is common, however it’s rarely needed or helpful. Research has NEVER demonstrated a link between imaging and symptoms. As we age, degenerative changes on imaging is common.

  1. 90% of people age 50 to 55 have disc degeneration when imaged, whether they have symptoms or not
  2. In 2015 a study that looked at 1,211 MRI scans of people with no pain found that 87.6% had a disc bulge
  3. Just getting an image increases the chances that you’ll have surgery by 34%

Surgery

The US has sky high rates for back surgeries – 40% higher than any other country and 5x higher than the UK. You’d think that with all the back surgeries we do, we’d be pretty good at it but the outcomes are terrible! A worker’s comp study looked at 725 people who had spinal fusions VS 725 people who didn’t. The surgical group had:

  1. A 1 in 4 chance of a repeat surgery
  2. A 1 in 3 chance of a major complication
  3. A 1 in 3 chance of never returning to work again

Physical Therapy

  1. Current clinical practice guidelines support manual therapy and exercise
  2. Research proves that early PT lead to better outcomes with lower costs, and decreases the risk of surgery, unnecessary imaging, and use of opioids
  3. A study of 122,723 people with low back pain who started PT within 14 days found that it decreased the cost to treat back pain by 60%
  4. Unfortunately only 2% of people with back pain start with PT, and only 7% get to PT within 90 days.

Despite the data showing that PT is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. Almost every state has direct access, meaning that you can go directly to a physical therapist without a doctor’s referral. If you see your doctor for back pain, and PT isn’t one of the first treatment options, ask for it!

osteoporosis and physical therapy

Osteoporosis and Physical Therapy

What is Osteoporosis?

Osteoporosis is a condition that causes degeneration and weakening of the bones. It is most common in women, but can affect men as well. It is also more common as we age, with 55% of Americans 50 or older affected.

Bone is living tissue and like all living tissues, old cells are constantly being removed and replaced by new cells. In normal bone, the removal and replacement of cells happens in a balanced process. In osteoporosis, bone is weakened when the removal of cells outpaces the addition of new cells.

Osteoporosis is often called a “silent disease” because there are often no symptoms until a fracture occurs.

How can Physical Therapy Help?

Your physical therapist will complete a comprehensive evaluation and develop a treatment plan to address your specific needs. In most cases, your PT will include weight bearing activities, or resistance exercises using weights or bands because these types of exercises have been shown to strengthen bones.

Your PT might teach you proper posture to decrease the stress on your spine and help reduce the risk of fracture. Another way to reduce unnecessary bone stress is to learn proper posture and alignment during daily tasks like reaching for items or bending to pick up an object.

To help reduce the risk of fracture from a fall, your PT might incorporate balance activities, or specific strengthening activities.

If you already have a fracture, your PT can work with you to reduce pain. They can also assess you for things like braces or splints that may help you heal or improve your posture.

Get Back Into Balance

Get Back Into Balance

Your physical therapist can play a big role in helping you maintain or improve your balance as you age. Unfortunately, falls are becoming increasingly common in adults age 65 and over. Just because they’re common, doesn’t mean they’re inevitable though. Research shows that falls are caused by a variety of factors, and many of them can be improved. Let’s take a look at some of them and some tips to help you get back into balance.

Lower Body Weakness

As we age, without resistance training we lose muscle mass every year. Weakness in your lower body has been shown to increase your fall risk. A physical therapist can design an exercise program to help you strengthen your legs and lower body safely.

Inactivity

Another reason we lose muscle mass and our balance decreases is inactivity and deconditioning. People who have fallen in the past often have a fear of falling again, which leads them to do less. As their activity levels decrease, they get weaker and even more fearful of falling.

This downward spiral can be stopped with balance training from a physical therapist to build your confidence on your feet and allow you to become more active.

Group exercise classes are another great way to become more active, work on your balance and meet new friends at the same time. Ask your PT for recommendations for a class near you.

Vision Problems

Many people don’t realize that your body uses your vision for balance. If you want to prove this to yourself, try standing with your feet together with your eyes open, then compare that to doing it with your eyes closed. Visual problems can also make you miss things like bumps and changes in the surface you’re walking on, or objects that you could trip over.

If you’re having problems with your vision, see your eye doctor for an exam and recommendations on what can be done.

Medications

Certain medications can increase your risk of falling and impact your balance by making you sleepy, slowing your reactions, or causing weakness. Some examples of medications that can increase fall risk are certain types of antidepressants, blood pressure medications, and water pills.

Your physical therapist can help you work with your doctor or pharmacist to review your medications and consider changes to improve your balance and reduce your risk of falling.

When it comes to helping you improve your balance, and reduce your risk of falling, your physical therapist is an important part of the team. They can evaluate you to determine where your problem areas are, and design an individualized program for you. They can also refer you to other professionals who can help like your eye doctor and your pharmacist. If you’re starting to feel out of balance, your PT can help you stop falls before they start.