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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.

Physical Therapy and Fall Prevention

Physical Therapy and Fall Prevention

Every year one in four people over 65 falls. That means that millions of older adults fall every year, and 1 in 5 of those falls results in serious injury like broken bones or a head injury. Less than half of the people who fall will tell their doctor, maybe out of embarrassment or maybe because they assume that falling is a part of the aging process. But falling is not inevitable, and with some help from your doctor and your physical therapist, your chances of falling can be significantly reduced.

Research has shown that many risk factors contribute to falls. Some risk factors can be changed, like lower body weakness, difficulties with walking and balance, vision problems, use of certain medications, foot pain or poor footwear, and home hazards like throw rugs, extension cords, and uneven steps or floors.

A physical therapist can screen you for fall risk. They can also have a positive impact on many factors to reduce your fall risk through interventions like strengthening exercises, balance training, or teaching you to use a device like a cane or walker to keep you more steady when you’re walking. A physical therapist can also teach you how to make easy changes around the house that can reduce your risk of falling. Some easy examples would include:

Using night lights to help your vision at night
Removing throw rugs, extension cords, or clutter that you could trip over
Installing grab bars near the toilet or bathtub

A PT can help you work other professionals like your eye doctor if your vision is increasing your fall risk or with your doctor or pharmacist to review your medications to see if they could be making you feel dizzy, weak, or sleepy.

Falling is common in people over the age of 65, but that doesn’t make it a normal part of the aging process. If you have fallen, your chance of falling again is doubled, but by working with your physical therapist and the rest of your healthcare team, you can reduce your fall risk and maintain your independence.

Walking

A Physical Therapists Recommendation to Walk?

Most people know that physical therapists often recommend exercise as part of their treatment. What most people don’t realize is how simple that exercise can be. Instead of complicated workouts, heavy weight lifting, or running for miles, physical therapists often surprise people when they recommend walking.

While it seems like an easy exercise, walking still has powerful health benefits. Walking 30 minutes a day, 3 times a week has been shown to improve cardiovascular endurance, and reduce blood pressure and weight. Lots of people are using activity trackers and apps to track steps during their daily activities, and this too has been shown to have benefits. These include reducing disability and pain associated with conditions like knee osteoarthritis. While many people aim for 10,000 steps per day, research shows that as little as 6,000 steps a day can reduce pain and disability while boosting cardiovascular health.

If you’re thinking about starting a regular walking program or just increasing the amount of walking you do throughout the day, it’s important that you do it the right way. The general recommendation for building any physical activity is to take whatever amount of the activity you do in a week and increase it by 5% or less per week. A good general starting place would be 3,000 steps per day, and an example program following the 5% rule might look like this:

Week 1: 3000 steps (1.5 miles)

Week 8: 4500 steps (2.25 miles)

Week 2: 3150 steps

Week 9: 4800 steps

Week 3: 3300 steps

Week 10: 5000 steps (2.5 miles)

Week 4: 3500 steps (1.75 miles)

Week 11: 5250 steps

Week 5: 3750 steps

Week 12: 5500 steps (2.75 miles)

Week 6: 4000 steps (2 miles)

Week 13: 5800 steps

Week 7: 4200 steps

Week 14: 6000 steps (3 miles)

If you’re not sure if you’re ready to walk the recommended 6,000 steps a day, you can always visit a physical therapist for a review of your medical history and baseline testing to find out what a safe level for you to start at would be. A PT can also help you design a program to safely meet your goals.

One last thing to consider is footwear. Although walking is less stressful than running, it’s still important to take care of your feet. Shoes designed for running work well to cushion and support your feet when walking too. If you need help picking the right pair, a PT can help and so can the staff at a good specialty running store.

How Much Physical Activity Do Older Adults Need

How Much Physical Activity Do Older Adults Need?

Most people know that physical activity is important. In fact, not getting enough has been linked to illnesses like heart disease, stroke, diabetes, Alzheimer’s, high blood pressure and lung disease. So the important question is not if you need to be doing some form of physical activity to protect against diseases like these, but how much is enough?

The US Department of Health and Human Services answered that question for us in 2008 with their recommendations for physical activity. To improve or maintain health, adults over 65 need to do 2 types of physical activity: aerobic exercise and strengthening.

Aerobic Exercise

To meet the recommendations for aerobic exercise you should try to be active daily, and perform your aerobic activity for at least 10 minutes at a time. Each week you should aim for

150 minutes of moderate intensity activity
OR
75 minutes of vigorous intensity activity.

The general rule is that 1 minute of vigorous activity is equal to 2 minutes of moderate intensity activity, so a combination of moderate and vigorous activity can also be used to satisfy the recommended 150 minutes each week.

Some examples of moderate intensity aerobic activity would be:

Walking
Water aerobics
Riding a bike on a level surface
Doubles tennis

Vigorous intensity activities include:

Running or jogging
Riding a bike fast, or on hills
Singles tennis
Hiking uphill

Strengthening

Muscle strength is important for all daily movement, and in older adults it can help to maintain strong bones, as well as reduce the risk of falling. The recommendation for strengthening is to work each major muscle group twice a week.

Examples of strengthening activities include:

Carrying heavy loads
Lifting weights
Exercises using your own body weight like push ups, sit ups, or squats

For each exercise you should try to perform:

At least one set
8 to 12 repetitions in each set

Your resistance should be heavy enough that the last repetition is hard to complete.

These guidelines are general recommendations and do not take into account previous injuries, medical conditions, or limitations that individuals may have. Your physical therapist is an expert in exercise and physical activity who can help design a program to maintain or improve your health while considering your past medical history, limitations, and goals. Your PT can teach you safe exercise technique, and help you safely progress your program as you get fitter to continue making improvements in your overall health.