Direct Access Saves You Money!

Posted May 14, 2014 by Sean
Categories: Rehab

You hurt your shoulder starting the lawn mower.  You can still move it, but every motion hurts.  It will take a few days to get in to see your doctor, and you don’t want to wait that long.  Also, you don’t want to spend $20-$40 on a co-pay if all they are going to do is recommend physical therapy.  What should you do?

You might not know this, but most states have at least some form of direct access for physical therapy.  What this means is that you can come straight to your physical therapist to deal with your aches and pains, no doctor’s referral is needed.  The sooner you start therapy, the sooner you can get back to the things you enjoy.  This saves you time and money!

So next time you find yourself in pain, call your physical therapist first.  We are experts in muscle and tendon injuries, and can equip you with the tools necessary to not only improve your quality of life, but keep it that way as well.

If you have any questions regarding your insurance and direct access, don’t hesitate to give us a call!

For more reading on how cost effective direct access is and research on this topic check out this article from the American Physical Therapy Association.

Why Choose Physical Therapy?

Posted May 14, 2014 by Sean
Categories: Physical Therapy Theory

Physical Therapy is about restoring motion, eliminating pain, and helping you get back to doing the things you enjoy.  Whether your goal is to return to competitive sports, your favorite hobby, playing with your kids and grandkids, or simply walking without the fear of falling, we can help you get there.  The official vision statement of the profession of physical therapy is:

Transforming society by optimizing movement to improve the human experience.”

Here are just a few of the diseases and conditions we treat in physical therapy: Muscle, tendon, ligament, and joint injuries, balance problems, work and sports injuries, headaches, pre and post-surgical rehab, workstation analysis, diabetes, MS, Parkinson’s disease, and much more.  Some clinics also offer specialty services, such as custom orthotics, pre-work screens for businesses, advanced vestibular rehab (for vertigo and dizziness), aquatic, pediatric, and lymphedema therapy.

Whether you are living with diabetes or recovering from a stroke, a fall, or a sports injury, your physical therapist is a trusted health care professional who will work closely with you to evaluate your condition and develop an effective, personalized plan of care.  We can help you achieve long-term results for many conditions that limit your ability to move.

For more on the types of things we treat in physical therapy, check out this great website – MoveForwardPT.

What Is Arthritis?

Posted May 14, 2014 by Sean
Categories: Physical Therapy Theory

Do you wake up experiencing pain and joint stiffness nearly every morning?  Is your daily routine limited because of pain?  You may think it’s just a part of life and there’s nothing you can do about it.  If you feel that way, there is hope, and it doesn’t come in a pill or with a surgery.  Read on to learn more.

What is it?  When most people talk about arthritis, they are talking about osteoarthritis, which is a degenerative condition involving your joints.  This blog post will focus on osteoarthritis as this is far more common than rheumatoid arthritis.  The word arthritis is Greek and literally means “joint inflammation.”  The Arthritis Foundation states that there are up to 100 medical conditions that fall under the umbrella term of arthritis.  Arthritis involves not only irritation of the joint, but the loss of cartilage. This tends to occur more frequently in weight-bearing joints like your hips and knees, but can also be found in your spine, hands, and really any joint in your body.  The major signs and symptoms of arthritis include pain, swelling, and joint stiffness or decreased motion.

What causes it?  No one is exactly sure why it happens, but there are many risk factors for developing arthritis.  You can develop this condition following an injury, from wear and tear on your joints through things your job or hobbies, and genetics can even play a role.  Another significant risk factor is obesity, as the more you weigh, the more pressure you put on your back, hips, and knees.

What can you do about it?  Don’t lose heart, there is something you can do!  While you can’t reverse the changes caused by arthritis, you can do many things to help slow it from progressing.  There are even things you can do to help prevent arthritis from starting in the first place!  Believe it or not, exercise is one of the best things you can do.  It may seem crazy that doing exercises can help those painful joints, but there is a mountain of research to support it.  That is where physical and occupation therapy comes in.  We can design an individualized exercise program that will help – not harm – your effected joints.  You don’t have to live with pain.

Always remember: your therapist is also your coach.  Please don’t be afraid to ask us questions and get our advice. We’ve worked with all sorts of people and have the experience needed to get you back to doing what you love.

For more in-depth reading, check out!

Getting A New Knee? Here’s What To Expect!

Posted May 13, 2014 by Sean
Categories: Anatomy, Post Surgical, Rehab

So, you’ve finally had enough of the pain and are ready to get surgery.  It seems like everyone you know has gone ahead and gotten it done once, if not twice.  But what exactly can you expect when you get a total knee replacement (Total Knee Arthroplasty or TKA)?  It might seem common, but it is far from just a simple procedure.  If you really want to know what this surgery entails and what therapy will be like, read on.

Pain.  Yes, there will be pain.  You might as well come to grips with it.  Your surgeon may have recommended you go through a short class on the surgery so you know what is being done.  They are giving you a totally new joint, and in the process are going to remove the old joint (check the video below for the visual).  This is going to hurt, but it’s for the better in the long run and it is very, very normal.  Sleeping will also be difficult at first because it is hard to get comfortable and stay comfortable, and is one of the biggest concerns of clients following a TKA.

Physical therapy will consist of building your strength back up, but most importantly it will help you get the range of motion (ROM) to get back to doing the things you enjoy.  While the cliche “no pain, no gain” doesn’t apply to physical therapy in general, rehabbing from a TKA can be painful.  This is due to several reasons, but there is something you can do to make it better.

1.  Do your exercises!  There is a reason your therapist gives you a home exercise program (HEP), and it isn’t to ruin your day.  We want you to get the absolute best outcome possible, but that is almost impossible from only three hours of therapy per week in the clinic.  If you don’t put in the time to stretch and exercise, it makes therapy much more difficult.

2.  Ice, Ice, Baby!  Wear your compression hose, elevate your leg, and ice that knee down frequently.  Excessive swelling leads to more pain, so make sure to do these things to help keep yourself from misery.  Less swelling also means your HEP will be less painful, and the same goes for your PT sessions.

3.  Stay ahead of the pain.  There is a reason your surgeon prescribed heavy duty pain medication.  Use them.  You won’t get addicted, but you’ll probably be much less grumpy (for your spouse’s sake) and sleep better.  If your pain pills are giving you some side effects (like nausea or constipation), call your doctor immediately and get some medications that will work for you.  There are other options out there; you don’t just have to suffer through it.

4.  You may have a new knee, but you’re stuck with the old muscles and tendons.  Depending on the condition of your knee prior to surgery, this may have an effect on your rehab.  One common example:  folks unable to bend or straighten their knee prior to surgery may have to spend extra time on that in rehab as the muscles around the joint are tighter than they should be.

If you’re the curious type, you might find the video below incredibly helpful.  It is narrated by a surgeon and shows clips of the procedure.

Above all, don’t fear. Rehabilitation takes time, patience, and hard work but, it will get better.  Your therapist is also your coach. Please don’t be afraid to ask us questions and get our advice. We’ve worked with all sorts of people and have the experience needed to get you back to doing what you love.

Adhesive Capsulitis: the Frozen Shoulder

Posted November 12, 2011 by Sean
Categories: Anatomy, Physical Therapy Techniques, Rehab

Adhesive Capsulitis (AC) is a real pain, and if you have it or have had it, you know what I mean.  First, lets start with a technical definition from the first article linked below.  “Adhesive capsulitis is a syndrome defined in its purest sense as idiopathic painful restriction of shoulder movement that results in global restriction of the glenohumeral joint.”  So, in layman’s terms, what you have is a painful shoulder that is very difficult to move in all directions with no known cause of injury.  Many times AC is also called “frozen shoulder”, but I’ll stick with the more technical and anatomically correct name.

There are generally two classifications of AC.  Primary is the version above, with no known cause of injury, the secondary version is recognized to be caused by some prior injury that has brought on the AC (rotator cuff tear, tendonitis, bursitis).  There are other factors that seem to influence the onset of AC.  This article suggests that as many as 40% of diabetics may experience AC at some point in their life and that up to 16 % may develop it in both shoulders.

AC generally resolves in 1-2 years and goes through three phases.  First is the “painful” phase that lasts anywhere from 2-8 months and is characterized by (you guessed it) pain and a general decrease in range of motion (ROM).  The second phase is the “adhesive” phase, and though less painful, is characterized by even more decrease in ROM, lasting 4-6 months.  The last stage is the “recovery” stage and is pretty self-explanatory.  This is when ROM gradually is restored and the pain continues to decrease.  Most people will regain all or most of their ROM, though some (approx 10% or so) may have permanent restrictions in their motion though not enough to be classified as a disability.

For effective treatment, it is imperitive that AC is diagnosed early.  Physical therapy can play a great role in maintaining ROM and keeping pain levels down.  Ultrasound is sometimes used as research shows it can help increase soft tissue extensibility.  Iontophoresis can help to deliver anti-inflammatory medication to irritated tissues.  TENS units can help to keep pain levels down so that medication isn’t overused and making sleep possible.  Passive range of motion by your PT will help to keep as much motion as possible, though it is important to note that it can be quite painful, especially in the early stages.

More serious treatment options are manipulation under anesthesia, where the surgeon forces your arm through the full motion, and arthroscopic surgery to release the tightened capsule.  Both are usually only reserved for cases where conservative treatment has failed.

There is hope for those suffering with AC.  It is worth restating that this can be an incredibly painful condition, but there is hope.  PT won’t be comfortable, but shouldn’t be a torture session either.  Be open with your therapist and understand that there is no quick fix for AC.

Here’s the article I quote and refer to the most.  Thorough and technical –

Here’s an article that’s a little more concise, but still kind of technical –

The Wikipedia article –

Trigger Points – And How To Deal With Them

Posted October 23, 2011 by Sean
Categories: Anatomy, Physical Therapy Techniques, Physical Therapy Theory, Rehab

Wanted to spend a little time on a subject that I feel is undervalued by many in the rehab industry, trigger points.  Check the bottom of this post for links, as the anatomy of the subject is worth many pages alone.  There is some debate in the medical community on how significant a role trigger points play as a cause of musculoskeletal pain, but most PT’s and physicians recognize that trigger points are something to be considered, especially in cases of chronic pain.

First, a working definition of trigger points, from the AAFP article cited below: “Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. The spots are painful on compression and can produce referred pain, referred tenderness, motor dysfunction, and autonomic phenomena.”  So, in laymen’s terms, you have a “knot” in your muscle that is very tender to the touch and may refer pain to other areas when you press on it.  The signs and symptoms associated with trigger points can vary quiet a bit from pain at rest, to pain with movement, decreased mobility from muscle pain, referred pain (headaches from trigger points in your neck) and many more.

The most common ways to acquire trigger points are from acute trauma (a fall, for example) or repetitive trauma (performing the same movement numerous times).  It is believed that chronically poor posture will also lead to trigger points from chronic overuse and/or shortening of certain muscles.  It is a condition that chronically effects those working desk jobs (from poor posture), to those on a factory line (repetitive motion injuries), and the athlete (repetitive motion).

There are three main treatment methods: injection, spray/stretch technique, and manual therapy.  The AAFP article details the injection method, and I will say that I have seen many patients benefit from it, but if you go this route you really should have it done by a physician who specializes in it.  Most specialized pain clinics will have a doctor who specializes in trigger point injections.  The spray/stretch technique is only something I’ve heard of in theory, never seen or met someone who practices it.  That is mostly because the spray is expensive and the technique isn’t something learned in PT or medical school.  The manual method is what physical therapists practice, and is usually the method of choice for chronic trigger points or for those who have a fear of needles.

Your physical therapist will assess not only where the trigger point is and how to deal with it, but will also focus on what are the potential causes and what to do to make sure they don’t come back again.  There are a couple different methods of treatment, one with sustained, direct pressure for approximately 90 seconds or more, and with a roll through the trigger point method.  I generally use whichever one is more tolerable for the patient.

There are some awesome tools out there both for self-use and to save your hands if you are a therapist.  A quick Google search will come up with all sorts of items, but my favorite for self use are the foam roll and the Thera Cane.  There are countless tools that you can use as a therapist, but I personally try to use my hands whenever possible and only use tools on the big muscles.

Lastly, some anecdotal notes.  I usually see trigger points in the following muscles, upper traps, rhomboids, gluts, hamstrings, and soleus.  The most common place is in the suboccipital area (where your neck attaches to your head at the back) and is a frequent cause of chronic tension headaches.  My favorite story is of a college basketball player with 2 months of sciatica symptoms that weren’t improved at all with chiropractic care.  A quick exam revealed trigger points in his piriformis and biceps femoris (lateral hamstring) were referring all his sciatica symptoms.  After one treatment he was 50-60% better and was 100% after just three treatments.  That won’t hold true for everyone, but a good story to show that the cause of pain can be both easily overlooked and easily treated too.

A book I own and highly recommend for therapists and those afflicted by trigger points (and it’s very reasonably priced!) –

The Wiki article on trigger points (not the best article out there) –

American Academy of Family Physicians article on trigger points (very technical) –

Physical Therapy versus Chiropractic Care

Posted October 13, 2011 by Sean
Categories: Physical Therapy Theory, Rehab

Hatfields and the McCoys, Capulets and Montagues, Ali v Frazier.  Just as these names instantly are known for their legendary rivalries, so are physical therapists and chiropractors.  This won’t be a complete rundown of the differences, that would be potentially hundreds of pages long, but will focus on the main differences, their at times heated rivalry, and what the future holds for their relationship.  I’ll try to be as objective as I can, though it should be pretty obvious that I’m on the side of PT.

There are generalities that can be made about both PT’s and Chiro’s, but it is very important to note that there are great practitioners on both sides, just as there are bad ones.  Twenty or so years ago, the line in the sand was very clear, with PT clearly within the traditional bounds of medical practice and Chiropractors in the alternative field.  PT’s would use statements like “voodoo medicine” when talking about Chiro’s, and they would call PT’s “puppets of the medical community”.  In general terms, if you find a PT or Chiro over the age of 50, you have a good chance that they look at each other with suspicious eyes.

I suppose if you boil it down, the main difference is that the heart of chiropractic care is centered on spinal manipulation.  True, they do other things, but even they will admit that this is their bread and butter.  Physical therapy’s heart is focused on muscular imbalances and asymmetry.  Like many things in life, there are different ways to look at the same situation.  If someone is experiencing back pain due to limited mobility of the spine, Chiro’s will generally say they need to be adjusted to restore that motion, PT’s will generally say that certain muscles need to be increased and certain muscles inhibited to restore that normal motion.

There are still battles brewing in many states over who can do what and see who.  Chiro’s claim that only they can do spinal adjustments and have taken to court and state legislatures to protect this area of practice.  But, many people don’t know that Osteopathic Physicians and PT’s can also do the same types of adjustments in most states, and are taught how to do them in their respective medical schools.  PT’s are also bringing lawsuits and attempting to change laws that only allow PT’s to perform certain interventions (like ultrasound and other modalities).  We’ll just have to see where the dust settles on all this.

I’ll keep this short, but don’t want to overlook the “bad” of both.  There are some Chiro’s out there that will claim that regular adjustments will cure everything from the common cold to appendicitis.  They will insist that you don’t need traditional medicine and that most or all of your ailments can be treated by them and to be skeptical of anyone else in the medical community.  On the PT side, there are some therapists who only do the old fashioned hot pack, ultrasound, and massage, making them a glorified masseuse.  Or they may practice a type of therapy or specific treatment that isn’t backed by research at all.  It is important to note that these folks don’t represent all practitioners in their respective fields.

Good PT’s and good Chiro’s realize that every person is unique and that just because someone presents with similar symptoms doesn’t mean that they will always respond well to the same treatment.  Make sure you go to someone who will spend quality time with you and develop a treatment plan that will work for you.  If they don’t have time to address your concerns, find someone who does.  Do your homework, many PT’s are trained specifically in different areas like orthopedics, manual therapy, women’s health, and pediatrics.  Search out someone who specializes in your field, trust me, they are out there.  There is no such thing as one-size-fits-all in the medical field.

Lastly, it seems that the younger generation of PT’s and Chiro’s are much more willing to recognize that we all play a part in the health field.  I personally had one Chiro tell me in private that he feels that he can help at least 60% of the clients he sees get back to normal, but that there are about 40% that still need further help of some sort.  In the PT field, while I’d like to say that we can help everyone, the reality is that some folks won’t be able to get back to “normal” with just PT alone.  In an ideal world, we all can work together so that our clients can achieve that perfect balance.  And in the town I work, there are a couple Chiro’s that we closely work with and have a great professional relationship.  My hope is that this becomes the norm someday.

Below are some links you can check out for more info, but most are biased one way or another.  There is research being done by both fields, but PT tends to put a lot more money into research in general.

A rundown of the myths and pros/cons of PT and Chiropractic Care –

About PT and myths –

About Chiro myths –