Precise unweighting allows you to walk or run between 20 and 100 percent of your body weight
Easily select your reduced body weight where movement becomes pain free
Give yourself the opportunity for a smooth progression back to full recovery
Lower the impact on your joints and muscles during exercise
Fun and easy to use, run or walk like you’re on the moon!
When most people think of diagnostic imaging, they think of X-rays, CT scans and MRIs, but the use of musculoskeletal ultrasound is becoming more popular for physical therapists. With most states having direct access laws, physical therapists are becoming primary care providers for musculoskeletal injuries. Despite a long history of therapists effectively using imaging in the military, and some managed care organizations like Kaiser Permanente in Northern California, in the United States PTs usually can’t order X-rays, CT, or MRI scans. They can, however use musculoskeletal ultrasound.
A musculoskeletal ultrasound is very similar to the more common sonogram used during pregnancy. Both use sound waves to create an image of what’s going on in the body in real time. Ultrasound can show a PT many structures in the body and can be used to help diagnose strains, sprains, inflammatory conditions like tendonitis or bursitis, nerve entrapments, and hernias.
Ultrasound is not popular with PTs just because they are limited in the ability to order other imaging. Research and clinical experience supports ultrasound as the preferred diagnostic test for many musculoskeletal injuries. Here are some benefits of ultrasound that support why:
- Ultrasound uses no radiation and has no known harmful effects on humans
- Real time imaging allows ultrasound to capture movement in the tissues, something x-ray, CT, and MRI can’t do
- Ultrasound is widely available, and less expensive than most other types of imaging
- Ultrasound may provide greater detail of soft tissues like muscles, tendons, or joints
- Ultrasound can be used on people who can’t have an MRI such as patients with pacemakers, and certain metallic implants
- Patients don’t have to remain still for an ultrasound, meaning it can be easily used on people who are claustrophobic or nervous about other imaging types
With such a list of advantages, it seems that ultrasound is a great type of imaging technology. This is true, but it’s not without a few drawbacks. These would include:
- Difficulty penetrating bones, and through large amounts of soft tissue, limiting the ability to see the deepest tissues in the body
- Ultrasound also has difficulty showing the internal structure of bones, making other techniques better for detecting suspected fractures
Most people think of heart rate or blood pressure when they think of vital signs. It is common to use numbers to quantify health and risk of disease. The American Heart Association encourages people to “know their numbers” referring to blood pressure, blood cholesterol, blood glucose, and weight. However, research is now showing the importance of moving properly for health. Let’s take a look at some of the numbers you can use to quantify your movement health:
Walking speed has been called the “sixth vital sign” in medical literature recently. It is easy to measure, and takes into account strength, balance, coordination, confidence, cardiovascular fitness, tolerance to activity, and a whole host of other factors. It has also been shown to be predictive of future hospitalizations, functional decline, and overall mortality. Normal walking speed is considered to be 1.2 to 1.4 meters per second.
Push ups are popular to build strength, but a recent study found that they can show us a lot about your heart too. Researchers found that men who could do 40 or more consecutive push ups were at a 96% lower risk for cardiovascular disease than were men who could do less than 10. The push up test was also more useful in predicting future cardiovascular disease than aerobic capacity measured on a treadmill.
Hand grip strength has been shown to be strongly correlated with health. The stronger your hand grip is, the less likely you are to suffer from cardiovascular disease, respiratory disease, COPD, and all types of cancer. In the study, muscle weakness was defined as grip strength <26 kg for men and <16 kg for women. Grip strength below these numbers was highly correlated with an increase in disease.
Standing From the Floor
If you can’t easily get down on the floor and back up your health might be in trouble, according to a study that looked at more than 2,000 people. The study asked people to go from standing to sitting on the floor and back up with as little support as needed. They found that if you need to use more than one hand to get up and down from the floor that you were 2 to 5 times more likely to die in the next 7 years than someone who can do it with just one hand, or even better, no hands at all.
Moving well is obviously important to overall health and longer life. These tests can give a snapshot of how you’re doing. If you’re having trouble with any of them, considering seeing a movement specialist – your physical therapist.
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.
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.
What 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.
What 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.
Why 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.
What’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 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:
- Sprains and strains
- 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
- 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
- Don’t play a position that requires a lot of throwing on your non-pitching days, like catcher
- Take 2 to 4 months off each year from pitching to rest your arm
- Keep your arm healthy and strong. The thrower’s ten was developed specifically for throwing athletes and is a good place to start.
- Stop pitching if you feel pain, or fatigue. Throwing through problems will change your mechanics and put you at risk for serious injury
- 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|
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 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.
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.
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.
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.
Do small shoulder circles for 30 seconds, first clockwise and then counter clockwise.
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.
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.
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
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:
- Flexibility exercises
- Aerobic activity
- 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.
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.
- Stress incontinence is when leakage happens during coughing, sneezing, or laughing.
- 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:
- Avoid contracting your abdominals or glutes
- Tighten the muscles as if you’re trying to stop the flow of urine
- 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!