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fitness with a side of dysfunction
By Louisiana Physical Therapy Centers Physical Therapy

Fitness, with a Side of Dysfunction?

This time of year, many people are focused on fitness so it’s worth taking a look at what fitness really means. The dictionary defines fit as “sound physically and mentally, healthy.” Using that definition, many “fitness” routines fall short of the goal. If you don’t enjoy running and dread every workout, you’re probably falling short of the “sound mentally” portion. Exercise should be enjoyable, reduce stress, and leave you feeling better, not worse.

NO PAIN NO GAIN?

Exercise should also leave you feeling better physically. If you can run a good time in a 5k, but have aches and pains for days after, you’re not “sound physically.” If you are increasing your PR in the squat rack, but your joint pain is increasing right along with it, you’re not “sound physically” either. Sure, some muscle soreness and fatigue after a hard workout is normal. But if you’re having pain that doesn’t go away, sore joints, or trouble moving after exercise, you’re probably developing movement dysfunction along with your fitness.

MOVEMENT DYSFUNCTION

Go back to the dictionary and you’ll find that dysfunction is “impaired or abnormal functioning.” So movement dysfunction is impaired or abnormal movement. When someone has a movement problem like a sore joint, limited range of motion, or strength loss, the brain finds a way to get the body to do what it wants. That usually means moving in a way that is less than optimal. For a while, it works. But eventually it leads to injury. As a concrete example, think of someone who has trouble bending one knee doing squats. When one knee bends further than the other, it will cause one side of the pelvis to drop lower than the other. Now that the pelvis isn’t level, the spine bends towards the high side to stay balanced. When that one side of the pelvis drops lower than the other one, it also usually rotates. Now the spine has to bend to the side and twist to keep you upright. This works for a while, but as weight gets added to the squat, and the repetitions add up so does the risk for a back injury.

PREVENTATIVE MEDICINE

Pain during workouts, or pain and soreness that don’t go away after can be warning signs of a movement dysfunction. If you’re experiencing any of these, your physical therapist is a movement expert who can help. PTs are trained to analyze movement, and figure out the root cause of problems. They can then design a program to treat the cause and correct the abnormal pattern. There is no need to wait until you’re injured to see your physical therapist. In fact, it’s preferable not to. Getting minor problems fixed early means fewer visits to the PT, less pain, and not having your workouts put on hold by injury.

By Louisiana Physical Therapy Centers Physical Therapy

Start Your Year With an Annual Movement Screen

Your car needs regular maintenance, so you probably have a mechanic. Your eyes and teeth are important, so you see your optometrist and dentist regularly. You get an annual physical from your family physician. You might even be getting ready to see your accountant to get your yearly income tax done. What about your physical therapist? Do you and your family have one? If not, you should. Your body is a lot like your car. It’s got multiple systems, all of which are complex, and all of which have to be working well for it to function. Physical therapists are experts in maintaining, diagnosing, and treating the movement system. Like the braking or ignition system in a car, most people only think of the movement system when it’s not working the way it should.

DON’T NEGLECT YOUR MOVEMENT SYSTEM

Similar to the systems in your car, problems with your movement system are much easier to deal with if they’re caught and treated early. This prevents small issues from becoming larger ones. For example, if you have a little bit of weakness, and balance that’s not quite up to par, improving those early could prevent a sprained ankle, or a fall and a broken wrist.
An annual movement screen from your physical therapist can find small issues that you may not have noticed with your strength, balance, flexibility, or coordination. Many of these minor issues can be fixed with a few exercises at home, or with just a few visits.

WHAT TO EXPECT

A screen of your movement system is quick and easy. Your annual visit may include:
● A history of your injuries, as well as a health history
● Assessment of your strength, balance, flexibility, etc.
● A review of your movement goals (do you want to run a marathon? Get on and off the floor easily playing with your grandkids?)
● A review and update of your exercise program

Your PT Can Help You Keep Your Resolution
By Louisiana Physical Therapy Centers Exercises, Health

Your Physical Therapist Can Help You Keep Your Resolution

As one year comes to a close and another begins, people begin to set goals and make resolutions. Losing weight, getting to the gym more often or getting into “better shape” are all common. These all require increasing your amount of physical activity. More activity is great for your health, energy levels, sleep, and mood. However, ramping up your activity level too quickly after a holiday season of eating, drinking and being merry can lead to pain, injury and disappointment if your body isn’t ready for it.

Your physical therapist is an expert in human movement, and can help you safely reach your fitness goals. People think of PTs as the person to see after an injury, but a visit before you change your activity level could prevent injury in the first place. An evaluation by your PT will include assessment of your strength, range of motion, and functional movement patterns – think jumping, running, squatting, carrying. Some PTs even like to use a standardized assessment, such as the Functional Movement Screen.

Most common injuries from new fitness routines are caused by underlying weakness, range of motion deficits, or compensatory movement patterns. Your PT will find these during your assessment. They can then prescribe exercises or movements to address the issues found and get you safely moving into the new year!

The other common way people get injured working towards their resolution is with overtraining, or doing too much too soon. Physical therapists are also experts in exercise prescription and program design. Your PT can help you create a routine specific to your needs and goals that will progress appropriately and keep you out of trouble.

So stop only thinking of your PT after you’re injured. In this case, it’s true that an ounce of prevention is worth a pound of cure. Seeing your physical therapist before you start on your resolution can keep you on track, injury free, and help you reach your goals for the new year!

By Louisiana Physical Therapy Centers Health, Physical Therapy

What’s a Movement Diagnosis?

Medical diagnoses don’t need much of an introduction. They’re what you get from your doctor when you’re sick. Examples would be influenza, diabetes, or hypertension. They describe the underlying problem that is causing your symptoms.

When people feel sick, they know they need to go to the doctor and find out what’s going on to get treated. We should treat movement the same way. If you’re having pain when you move, can’t do things you used to be able to – like get on and off the floor easily, or can’t do things you want to do – like go for a bike ride or pick up a grandchild then you need to get a movement diagnosis.

A movement diagnosis does the same thing as a medical diagnosis; it describes what’s causing your difficulty with movement. Some examples would be difficulty standing from a chair secondary to decreased force production, scapular down rotation syndrome, or lower crossed syndrome.

Diagnoses set the roadmap for treatment, so getting them right is crucial. Human movement is complex and is influenced by more than just your muscles and joints. According to the APTA, movement is impacted by the following systems:

– Endocrine
– Nervous
– Cardiovascular
– Pulmonary
– Integumentary
– Musculoskeletal

Because of the complexity and interplay between these components of the movement system, getting a movement diagnosis correct is often very difficult. Physical therapists are experts in human movement with doctoral level training and should be your first stop for movement issues. Not only can a physical therapist provide an accurate movement diagnosis, they will also design a treatment plan to correct the underlying issues and help get you moving well again.

References:

http://www.neuropt.org/docs/default-source/default-document-library/movement-system-diagnosis-in-neurologic-physical-therapy-where-are-we.pdf?sfvrsn=0

https://journals.lww.com/jnpt/FullText/2018/04000/White_Paper__Movement_System_Diagnoses_in.9.aspx

http://www.apta.org/MovementSystem/

http://www.apta.org/MovementSystem/Template/

Imaging Can Improve Physical Therapy Treatment
By Louisiana Physical Therapy Centers Physical Therapy

Imaging Can Improve Physical Therapy Treatment

Physical therapists are experts in the musculoskeletal system, and typically use patient history and a good physical exam to come to a diagnosis and treatment plan. However, PTs are increasingly using diagnostic imaging as they become the practitioner of choice for musculoskeletal injuries. Many PTs have access to diagnostic ultrasound right in the clinic, and in some practice settings like the military, and certain ACOs, therapists have the ability to order imaging like x-rays, CT scans and MRIs.

The research indicates that PTs are effective in using their ability to order imaging when it exists. A study of 108 imaging orders by PTs providing musculoskeletal primary care in a direct-access sports physical therapy clinic found that advanced diagnostic imaging was ordered appropriately in over 80% of cases.

So, PTs are good at appropriately ordering imaging, but how does it improve treatment? A case study published in the July 2015 issues of the Journal of Manual & Manipulative Therapy gives a good illustration:
The patient was a very active dentist who had chronic mid and upper back pain. He had a known history of benign neural tissue tumors of his head and upper back region, but no specific diagnosis for his back pain had been provided. After examination, the PT decided to start treatment for the patient’s back pain, but also order x-rays and an MRI of the symptomatic part of the patient’s spine. The MRI showed a previously undiscovered meningioma, or benign tumor of the membrane that covers the spinal cord.

The benefit to this patient was that the PT could continue treatment without making referrals and waiting for someone else to order the images. Also, once the tumor was discovered, the PT could select exercises and manual techniques that would help the patient, but avoid putting stress on the area of the tumor. It also allowed the PT to educate the patient on fitness activities that would be safe and appropriate.

The case study has a quote that sums up the benefits of imaging combined with PT nicely: “Orthopaedic physical therapists have high levels of musculoskeletal expertise and extensive knowledge of typical patterns and behaviors of musculoskeletal conditions. These competencies and experiential knowledge enable them to appropriately recognize situations requiring additional diagnostic screening for non-musculoskeletal pathology. This case demonstrates how privileges to order musculoskeletal imaging studies assisted the physical therapist in providing optimal, patient-centered care. The physical therapist in this case was able to continue treatment without multiple referrals back to the medical provider to obtain imaging, and so provided more cost-efficient and convenient care.”

Reference article and case study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5046964/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534847/

Anti Gravity Treadmill
By Louisiana Physical Therapy Centers Tools and Equipment

AlterG Anti-Gravity Treadmill

The AlterG Anti-Gravity Treadmill gives you the opportunity to rehab from surgery, or train through injury, without pain. AlterG’s unique unweighting technology reduces the impact of walking or running, while your body goes through the normal healing process.
  • 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!
pts can use diagnostic imaging
By Louisiana Physical Therapy Centers Physical Therapy

Did You Know That PTs Can Use Diagnostic Imaging?

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
Do You Know Your Movement Vital Signs?
By Louisiana Physical Therapy Centers Exercises

Do You Know Your Movement Vital Signs?

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

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

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.

Grip Strength

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.

Are You A Passive Patient or an Active Consumer of Healthcare?
By Louisiana Physical Therapy Centers 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
By Louisiana Physical Therapy Centers Sporting ,

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