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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

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/

pts can use diagnostic imaging

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
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 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.