|Posted on May 20, 2019 at 4:25 PM|
One of the components of the cranial concept for practitioners who practice cranial manipulative therapy is that the bones of the head move along the sutures. The movement can be described as an expansion and compression that take place much how the rib cage moves during respiration. This idea has been highly controversial since it was first presented to the world over 60 years ago. To this day, there’s plenty of criticism that this concept is based on ‘pseudoscience.’ Many state that there is ‘no research’ supporting this idea. This statement is incorrect. There may not be sufficient evidence at this time supporting this idea. However, there is much more research showing that there the bones of the head can move, than there is research showing that the bones of the head do not move.
I'd like to to discuss 5 reasons I have found that support the bones of the head do move.
Reason 1: Embryological
Why are there sutures in the head? If you look at a skull, there are sutures throughout the head making each bone identifiable. This may seem insignificant as evidence but during development, there are many bones that form in separate parts and do actually fuse to form one bone. For example, each pelvic bone develops as three separate parts (ischium, ilium, and pubis) that fuse into one bone with no sutures between them. There are many examples of this during development. This even takes place in the head. The occiput forms by the fusion of 4 separate components. This fusion is complete and does not have any sutures between them. There are sutures between the occiput and the bones it articulates with. Clearly the human body would be capable of completely fusing the bones of the head if it intended it to do so. This fusion, however, does not take place or one would be unable to distinguish each separate bone of the skull once fusion had taken place. In addition, skulls can be disarticulated using the expansive properties of rice to separate the bones at the sutures. So if the body is capable of completely fusing the bones of the head, then why does it not do this?
Reason 2: Adaptation
Although there are not large amounts of movement in the head, there is some. Proper motion allows the head to be pliable to better absorb the shock of a trauma or changes in intracranial pressure. Part of the purpose of the skull is to encase and protect the brain. If one receives a blunt trauma to the head, the pliability allowed by movement of the bones of the head allows the bones to absorb much of the impact. This would allow the brain to be less affected by the trauma. If the skull fused, then the skull would be very hard like the outer casing of a helmet. A blunt trauma would break the skull easier like an egg shell and the force would be transferred to the brain more strongly. By not fusing, the head can then change and adapt better to changes in intracranial pressure. If a scenario occurs where the pressure in the head changes (such as flying or having a cold), then it would be helpful for the bones to be pliable and expand. That way, when the pressure in the head changes, the effect on the brain is minimized. Therefore, in terms of being able to handle traumas and changes in pressure, it would make sense of the head to be able to expand.
Reason 3: Braces
We have evidence that the bones of the head can move all around us. If the bones of the head fuse and could not move, there would be no reason for braces. Braces are based on the idea that the head is pliable and can be reshaped to align teeth.
Reason 4: Motion Testing
Part of the reason that there is so much controversy about whether or not the bones of the head move or not is because most practitioners put their hands on a persons head and palpate the subtle movement taking place under their hands. Others who come along who cannot palpate this motion, then argue that this cannot be felt. Although I can feel this subtle motion, I feel restrictions in the cranial bones by getting a hold of the accessible bones of the head and move them through their range of motion. I compare how one side moves compared to the other. Usually one side moves better than the other. Under normal circumstances each bone has a small range of motion. There is significantly more motion than taking a plastic skull and trying to move it. By understanding where there are restrictions in the sutures, then I can work on freeing them up until both sides feel more symmetrical in their movement. I prove this idea to myself every day that I am at work.
Reason 5: Layout of Sutures
Finally the last piece of evidence I have found is in the sutures themselves. This goes back to anatomy. If one studies the way the motion described in the skull and the anatomy of the sutures, then one could see this idea as being plausible. There are different types of sutures and they articulate differently depending on the area. For example, the frontal bone overlaps the parietal bone medially, but as one moves out further along the coronal suture, there is a transition spot followed by the parietal bone overlapping the frontal bone. The sagittal suture for example, acts more like a hinge and the suture is put together in a way that allows for this type of a function. These are just a few examples although this takes place with the way all the bones articulate with each other. Simply put, the bones of the head act like a 3D puzzle that allows the head to go through its motion. In addition, dural membranes in the head come out externally through the sutures. Evidence for this is that epidural bleeds in the head do not cross suture lines because the dura travels externally at the sutures. The dural membranes inside the head act as a barrier preventing the bones of the head from fusing completely.
We also know now that there are structures inside the skull that we are affecting with cranial manipulative techniques. The tentorium, cranial arterials, CSF, also transmit pain information to our brain. This can be attenuated with cranial technique.
I will post a video of the skull bones moving in real time!
|Posted on November 9, 2018 at 3:50 AM|
Don’t let TMJ (temporomandibular joint) dysfunction hijack your life. When it comes to managing chronic pain, small steps can make a big difference.
Sometimes Less is More
If you’ve had temporomandibular disorder (TMD) for any length of time, you are probably willing to try almost anything that promises a better quality of life. Keep in mind that an episode of worsening TMJ pain is often caused by inflammation around the joint itself. Sometimes, a few simple changes are all it takes to reduce the inflammation and stop the pain for a while.
Have you Tried and Failed?
We’ve all seen TMD handouts telling patients to eat soft foods, to use ice packs, and to avoid extreme jaw movements. These are well-intentioned ideas, but do they make sense in your daily life? Do you keep an ice pack in the office? Are you willing to subsist on a nursing home diet? Can anyone really avoid yawning?
TMJ Pain Relief for the Real World
Five Easy Ways to Relieve TMJ Pain Right Now:
1. Give up the gum habit.
Some people with TMJ dysfunction believe their symptoms might actually improve if they chew gum; after all, if jaw muscles get tight and sore, they should be exercised, right? Wrong. Unless you have taken a vow of silence and never eat solid food, your jaw muscles are getting enough of a work out already. If you absolutely must chew gum, be sure to chew for no more than three minutes before tossing it.
2. Try a quick and easy DIY massage.
Gently massaging the masseter—the powerful muscle that opens and closes your jaw--can relieve jaw tension and muscle pain. You may find it simpler to employ a set of therapy balls to do this massage. (Click here for a video tutorial.) This gentle technique is easy to learn and reduces muscle tension. It can improve chronic pain from conditions like TMD.
3. Fight pain with acupressure/Trigger point pressure.
Acupressure is a great way to help relieve TMD pain. Acupressure uses the same body points as acupuncture to activate the healing process. While acupuncture activates these points more strongly, you can try acupressure on your own. There are a host of online resources for finding acupuncture points. You may be surprised to discover that some of your most effective points for TMJ relief are nowhere near your jaw.
4. Relax your jaw.
Are you clenching right now? Whenever you notice tightness or pain, try to lower your jaw very slightly until your teeth stop touching. This is easily done with your mouth closed, so no one will notice. If your tongue is pressing upward on the roof of your mouth, this is the time to let it drop back down. The goal is to keep your teeth from touching, and to keep your jaw relaxed, for most of the day. With practice, you may be able to drastically reduce TMJ pain caused by clenching.
5. Check your posture.
Is your head on straight? If you’re not sure, have someone take a picture of you from the side while you sit or stand as upright as possible. If your ear is not in line with your shoulder, you may suffer from forward head posture. Along with the spinal misalignment mentioned here, forward head posture can contribute to TMJ pain. To help correct your posture, try this simple exercise: lie down on the floor—or stand tight against a wall--and tuck your chin to your chest as if you are trying to make a double chin. Repeat. This exercise strengthens the muscles in your neck and can help relieve TMD pain.
|Posted on February 13, 2018 at 1:50 PM|
What is Central Sensitization?
Central sensitization syndrome (CSS) is a condition of the nervous system that is associated with the development and maintenance of chronic pain. When central sensitization occurs, the nervous system goes through a process called wind-up and gets regulated in a persistent state of high reactivity. This persistent, or regulated, state of reactivity lowers the threshold for what causes pain and subsequently comes to maintain pain even after the initial injury might have healed.
Central sensitization has two main characteristics. Although these are not essential to diagnose CSS, both involve a heightened sensitivity to pain and the sensation of touch. They are called allodynia and hyperalgesia. Allodynia occurs when a person experiences pain with things that are normally not painful. For example, chronic pain patients often experience pain even with things as simple as touch or massage. In such cases, nerves (called interneurons which are not normally turned on but are on high alert in patients with CSS) in the area that was touched sends signals through the nervous system to the brain. Because the nervous system is in a persistent state of heightened reactivity, the brain doesn't produce a mild sensation of touch as it should. Rather, the brain produces a sensation of pain and discomfort. Hyperalgesia occurs when a stimulus that is typically painful is perceived as more painful than it should. An example might be when a simple bump, which ordinarily might be mildly painful, sends the chronic pain patient through the roof with pain. Again, when the nervous system is in a persistent state of high reactivity, it produces pain that is amplified.
This exercise can be done standing up or sitting down, and pretty much anywhere at any time. If you can sit down in the meditation (lotus) position, that's great, if not, no worries.
Either way, all you have to do is be still and focus on your breath for just one minute.
1 Start by breathing in and out slowly. One breath cycle should last for approximately 6 seconds.
2 Breathe in through your nose and out through your mouth, letting your breath flow effortlessly in and out of your body.
3 Let go of your thoughts. Let go of things you have to do later today or pending projects that need your attention. Simply let thoughts rise and fall of their own accord and be at one with your breath.
4 Purposefully watch your breath, focusing your sense of awareness on its pathway as it enters your body and fills you with life.
5 Then watch with your awareness as it works work its way up and out of your mouth and its energy dissipates into the world.
Throughout the month of February give your mindful breathing a try. Schedule yourself time or on the fly. It may be difficult at first to let go of wandering thoughts and focus on one thing your breath. Try not to get frustrated just relax and try again later or the next day. The more you practice the easier it will become.
|Posted on May 16, 2017 at 7:40 AM|
What does a headache behind the ear mean? Signs, causes, and treatments
There are several causes of headaches behind the ear. With proper medical treatment, these headaches can be relieved.
A headache behind the ear refers to any pain that originates from that specific area of the head. Though headaches themselves are very common, headaches that occur exclusively behind the ear are fairly unusual.
This type of headache pain can have several causes. The cause of the headache behind the ear will determine symptoms and treatment.
This article explores the signs and symptoms of headaches behind the ear and details what causes them. It also discusses how they can be treated to relieve pain and the associated symptoms.
There are several possible causes of a headache behind the ear. These include the following:
Occipital neuralgia[woman with a headache behind her ears]
Occipital neuralgia can cause pain behind the ears.
One of the most common causes of a headache behind the ear is a condition called occipital neuralgia.
Occipital neuralgia occurs when the occipital nerves, or the nerves that run from the top of the spinal cord up through the scalp, are injured or inflamed.
People often mistake sharp pain behind the ear to be the result of a migraine or similar types of headaches, as symptoms can be similar.
People who suffer with occipital neuralgia describe the chronic pain as piercing and throbbing. They also describe it as similar to the feeling of receiving an electric shock in the following places:
back of the head
behind the ears
Occipital neuralgia happens as a result of pressure or irritation to the occipital nerves. It typically only appears on one side of the head.
In some cases, the pressure or irritation maybe because of inflammation, overly tight muscles, or an injury. Often, doctors cannot find a cause for occipital neuralgia.
Mastoiditis is an infection of the mastoid bone, which is the bone directly behind the ear.
This infection is much more common in children than adults and generally responds to treatment with no complications.
Mastoiditis causes a headache behind the ear as well as fever, discharge from the ear, tiredness, and hearing loss in the affected ear.
The temporomandibular joints (TMJ) are the ball and socket joints of the jaw. These joints can become inflamed and painful.
[pointing out the symptoms of tmj on a model skull]
TMJ can cause aching behind the ear and it usually accompanied by jaw pain.
While most people with TMJ inflammation feel the pain in the jaw and behind the ear, others may just experience a headache behind the ear.
TMJ can be caused by:
Symptoms of headaches behind the ear can vary based on the causes.
Occipital neuralgia may cause intense pain to the back of the head and/or upper neck. Often, it can start in the neck and work its way up to the back of the head. The episodic pain is like an electric shock to the back of the head and/or neck.
Signs of an infection, such as fever or tiredness, often accompany mastoiditis.
People experiencing TMJ may sense jaw tightness and pain in addition to a headache behind the ear.
Additional symptoms that people who suffer from headaches behind the ear may experience include:
pain on one or both sides of the head
sensitivity to light
aching, burning, and throbbing pain
pain behind the eyes
pain with neck movement
The main causes of headache behind the ear often overlap. It is crucial to get a proper diagnosis so the condition can be treated appropriately.
For diagnosis, a doctor will ask a person questions about medical history. Information about any recent head, neck, or spine injuries should be included.
After asking questions, a doctor will probably do a physical examination. For this, the doctor will press firmly around the back of the head and base of the skull in an attempt to reproduce the pain through touch. This examination checks for occipital neuralgia, as this condition is sensitive to the touch in most cases.
Some additional steps in diagnosis may include a shot to numb the nerve. If a person experiences relief then occipital neuralgia is likely to be the cause of the pain.
In more atypical cases, a doctor may order an MRI or blood test to further confirm or rule out other causes of the pain.
If occipital neuralgia is ruled out as a possible cause of pain in the initial visit, the doctor will probably check for signs of mastoiditis, including fever and discharge from the ear.
For further diagnosis, a doctor may examine the jaw or recommend a visit to a dentist to check for TMJ.
Treating the pain is the primary method of dealing with a headache behind the ear, unless a root cause can be determined.
There are some at home treatment options for people to try before or in addition to a doctor's care.
[woman in yellow sweater sleeping on the couch]
A common way to manage headaches at home is to rest or nap in a quiet room.
Some at home treatments include:
rest in a quiet room
over-the-counter anti-inflammatory drugs, such as ibuprofen
massage of neck muscles
apply heat to back of neck
stop teeth grinding
As with any treatment options, a doctor should be consulted before adding medications.
Treatment of headaches behind the ear
When under a doctor's care, someone will have a treatment plan for headaches behind the ear that will include managing the pain and treating underlying causes of the pain.
Depending on the exact cause of headaches behind the ear, a doctor may prescribe medications, including:
prescription muscle relaxants
nerve blocks and steroid shots
antiseizure drugs, such as carbamazepine and gabapentin
antibiotics if mastoiditis is suspected
a night-guard for TMJ
Nerve blocks and steroid shots are often temporary and necessitate repeat visits to the doctor to be reinjected. Furthermore, it may be necessary to administer several shots before the pain is manageable.
In rare cases, an operation may be required. Typically, operations are used if pain does not get better with other treatments or keeps recurring.
Operations may include:
Microvascular decompression: This procedure involves the doctor finding and repositioning the blood vessels that are compressing the nerves.
Occipital nerve stimulation: A neurostimulator delivers several electrical pulses to the occipital nerves. In this case, the electric pulses may help block pain messages to the brain.
No matter the treatments decided upon, it is important to relay to a doctor whether or not they are effective.
In some cases, continued pain may indicate that it is the result of another condition, which needs to be treated differently.
Generally, headaches behind the ear are not the result of a life-threatening condition.
In many cases, people experience pain relief when resting and taking medication as prescribed or directed.
In most cases, people with a headache behind the ear should see full or nearly full symptom relief with proper diagnosis and treatment.
|Posted on November 14, 2016 at 4:35 PM|
Please Check out the Link Above For more information and how Bluegrass Doctors of Physical Therapy was selected.
Thanks to everyone who has supported us over the last few years. We hope to continue elevating your healthcare experience each and every day!
|Posted on July 7, 2016 at 9:35 AM|
Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex: A Brain Source Localization Study
Above is a title of a new article looking at what happens we apply joint manipulation in the spine, on the brain. Amazing. Again, this is yet another article that shows interventions that are applied to the spine and extremitieis affect our BRAIN. This in time could induce neuroplastic changes. Good stuff!
|Posted on June 29, 2016 at 11:10 AM|
Employee Satisfaction Linked to Wellness Programs
The prevalence of wellness programs in today’s work environment was examined in the 2012 Aflac WorkForces Report, an online survey of more than 1,800 benefits decision-makers and more than 6,100 U.S. workers. The study included findings about the impact of wellness programs on employee satisfaction, well-being and productivity. Compared to workers who are not offered wellness programs, employees who are offered wellness programs and participate in them are more likely to have a higher level of job satisfaction, feel happier with their employer, and be more satisfied with their overall benefits.
The bottom line is that companies can help increase employee satisfaction by focusing on the well-being of their workforce. For example, 28 percent of workers said they would feel more satisfied and more loyal to their employer if their company offered more options to improve their health and lifestyle. Workers also recognize the fact that they need to take an active role in workplace wellness. Thirty-five percent of employees were willing to change their lifestyle habits if it meant they could lower their health insurance premiums.
Financial Benefits of Implementing Wellness Programs
While companies certainly care about the well-being of their employees, benefits decision-makers admit that a primary reason their company maintains a wellness program is to help curb health care costs, and 59 percent of companies agree that wellness programs can help reduce these costs.
Despite the benefits of wellness program, nearly a quarter (22 percent) of companies do not offer them for their workforce due to the difficulty in quantifying the return-on-investment (ROI). However, a comprehensive analysis of 42 published studies of worksite health promotion programs showed that companies that implemented an effective wellness program realized significant cost reductions and financial gains, including:
· An average of 28 percent reduction in sick days
· An average of 26 percent reduction in health costs
· An average of 30 percent reduction in workers’ compensation and disability management claims
· An average $5.93 to $1 savings-to-cost ratio.
The 2012 Aflac WorkForces Report found similar results. Nearly all (92 percent) of the companies with a wellness program in place agreed that these programs are effective, and 47 percent reported the programs are very or extremely effective. In addition, 44 percent of employers agree they are able to offer lower health insurance premiums as a result of their wellness program, and six in 10 (61 percent) agree they have a healthier workforce as a result of having a wellness program in place.
Recognizing the Role Financial Stress Plays in Overall Health
Creating a healthy workforce requires more than physical health. Financial security is another factor that influences overall wellness. Many American workers today are facing financial predicaments and high debt as a result of the current economy and a lack of education about financial principles. These situations can lead workers to enormous amounts of stress which in turn can lessen overall wellness.
For instance, only eight percent of workers strongly agree that their family will be financially prepared in the event of an unexpected emergency, while 51 percent are trying to reduce debt. Nearly six in 10 workers (58 percent) don’t have a financial plan in place to handle the unexpected, and the same amount either don’t consider health insurance a part of their financial plan or consider it a minor part. Clearly, many Americans are in a difficult financial position and that often means turning to their employer for help.
Workers facing debt and unstable financial situations reported their stress has caused occurrences of ulcers, digestive problems, migraines, anxiety and depression. Results even showed heart attacks occurred at rates between two and three times the national average for these overstressed workers.
As a result, employers are also feeling the effects of their employees’ anxiety, beyond higher health care costs. One in five (20 percent) workers have experienced a health issue that has affected their ability to get their work done, which can result in higher productivity losses for companies. Additionally, nearly half of companies (43 percent) surveyed estimated their average productivity loss stemming from employees’ concern over personal issues is between 11 and 30 percent, and productivity losses related to personal and family health problems cost U.S. employers $1,685 per employee, per year, or $225.8 billion annually.
These statistics show the negative impact companies face if their workers are not adequately protected by their current benefits coverage. Voluntary benefits options are beneficial because they allow businesses to add coverage options at no direct cost to their company and, at the same time, help protect workers.
By making voluntary plans available to workers, companies can help alleviate financial concern and help employees feel more protected in case of an unexpected health event. Workers have more positive feelings about their benefits options when they are offered or enrolled in voluntary plans. For instance, 70 percent of employees whose benefit packages include voluntary options feel that a comprehensive benefits package safeguards their health and wellness
|Posted on May 15, 2016 at 7:20 PM|
Upper trapezius and its referral sources
The trapezius commonly contains trigger points, and referred pain from these trigger points bring patients to the office more often than for any other problem. As you can see from the picture, the trapezius is a large kite-shaped muscle, covering much of the back and posterior neck.
There are three main parts to the muscle: the Upper, middle, and lower trapezius, and each part has its own actions and common symptoms.
headaches on the temples / "tension" headaches
facial, temple, or jaw pain
pain behind the eye
dizziness or vertigo (in conjunction with the sternocleidomastoid muscle)
severe neck pain
a stiff neck
intolerance to weight on your shoulders
headaches at the base of your skull
TrP5 refers superficial burning pain close to the spine
TrP6 refers aching pain to the top of the shoulder near the joint
mid-back, neck, and/or upper shoulder region pain
possibly referral on the back of the shoulder blade, down the inside of the arm, and into the ring and little fingers (TrP7), very similar to a serratus posterior superior referral pattern
headaches at the base of the skull 5
TrP3 can refer a deep ache and diffuse tenderness over the top of the shoulder 6
Causes and Perpetuation of Trigger Points
one leg shorter than the other
a hemipelvis that is smaller on one side (the part of the pelvis you sit on)
short upper arms (which causes you to lean to one side to use the armrests)
tensing your shoulders
cradling a phone between your ear and shoulder
a chair without armrests, or the armrests are too high
typing with a keyboard too high
sewing on your lap with your arms unsupported
sleeping on your front or back with your head rotated to the side for a long period
playing a violin
sports activities with sudden one-sided movements
sitting without a firm back support (sitting slumped)
any profession or activity that requires you to bend over for extended periods (i.e.. dentists/hygienists, architects/draftsmen, and secretaries/computer users)
bra straps that are too tight (either the shoulder straps or the torso strap)
a purse or daypack that is too heavy
a mis-fitting, heavy coat
carrying a day pack or purse over one shoulder -- even if you think you are not hiking up one shoulder, you are, no matter how light the item
whiplash (a car accident, falling on your head, or any sudden jerk of the head) 10
walking with a cane that is too long
turning your head to one side for long periods to have a conversation
tight pectoralis major muscles
Often times, we can address these trigger points in 1-2 sessions and by eliminating these, patients see a drastic redution in neck, and headache pain as well as an immediate increase in AROM. Contact us today to set up an evaluation!!! 502-771-1774
|Posted on March 25, 2016 at 7:40 PM|
Direct Physical Therapy Access Could Reduce Healthcare Costs
A policy brief from the Health Care Cost Institute reports that Individuals with lower back pain who received physical therapy had reduced healthcare costs.
When it comes to healthcare costs, the federal government, medical providers, and payers are attempting to reduce rising spending and adopt value-based care reimbursement. A number of different strategies have been implemented including bundled payment models and accountable care organizations. In the realm of physical therapy, patients with lower back pain could benefit from reduced healthcare costs.
A policy brief from the Health Care Cost Institute reports that Individuals with lower back pain who received physical therapy had reduced healthcare costs when compared to patients who visited with another provider first. Patients who visited a physical therapist at the beginning of their treatment were less likely to end up in an emergency room. A lower likelihood of emergency department visits also produces hospitalization costs.
Since low back pain is a very common occurrence in the healthcare setting and a likely contribution to disability, these findings are key to reducing medical spending across the industry. In fact, $90.6 billion in direct healthcare costs are spent on treating back pain throughout the United States.
The study authors focused on analyzing beneficiary claims data from six states including Oregon, Washington, Wyoming, Alaska, Idaho, and Montana. The researchers looked at claims data showing three different groups of people including those who never saw a physical therapist, those who saw a physical therapist later in their treatment, and those who immediately received physical therapy.
The study found that patients who saw a physical therapist first were also less likely to be prescribed a painkiller when compared to others who saw a different type of clinician. The policy brief emphasizes that visiting with a physical therapist first will reduce the use of costly healthcare services and thereby cut spending across the board.
Researchers from the University of Washington and the George Washington University also found that taking away state restrictions on physical therapy could improve health outcomes among those on opioid prescriptions as well as enhance imaging. Individual states should consider addressing restrictions on direct physical therapy access, according to the policy brief.
State restrictions on physical therapy access could affect overall healthcare costs by impacting the use of differing medical services. Essentially, in order to reduce healthcare costs, state policymakers should allow patients direct access to physical therapy without physician referral, according to the study.
“The findings from this study suggest that seeing a physical therapist as the first point of care compared to seeing a physical therapist at a later point in time (or not seeing a PT) reduces utilization of potentially costly services,” the study from the Health Care Cost Institute stated.
“Of particular interest was the significant decrease in opioid prescription, ED visits, and imaging for those patients receiving PT first. The potential reduction in opioid prescriptions is notable given the increasing awareness on the overprescription of opioids and the high risk of substance abuse. These findings suggest that having access to PT could have an impact on healthcare costs including out-of-pocket costs across all settings.”
While reducing healthcare costs is an imperative within the medical industry, quality care and patient needs come first. However, a study from the American Physical Therapy Association shows that patient needs may not come first in a referral-for-profit environment.
The study illustrates that patients who obtained physical therapy services from a clinic owned by their original physician received twice as many PT visits as compared to patients who were referred to physical therapy not affiliated with the referring surgeon. The therapy was also less customized and less intensive, the researchers found.
“When there is referral-for-profit, and from this data as related to group therapy and an extended number of visits, it stands to reason there is increased risk that the patient’s individual needs are of secondary importance to revenue. This has long been the concern here at the American Physical Therapy Association (APTA) and it is why we have fought so hard, alongside our partners in the AIM Coalition, against physician-owned physical therapy services (POPTS),” American Physical Therapy Association President Sharon Dunn, PT, PhD, OCS, stated in a press release.
“This study provides further evidence that when the bottom line takes precedence in healthcare, the patient loses. A patient’s welfare and recovery should always be the primary focus of treatment.”
The researchers looked at more than 3,000 patients who underwent total knee replacement surgery. Out of all of these, nearly 19 percent were found to be completed through a physician self-referral process while 72.3 percent of cases did not have a doctor who had “ownership interest in physical therapy services.”
The findings show that treatment in a physician-owned physical therapy setting lasted a week longer than services not affiliated with the referring physician. About twice as many visits were seen in physical therapy offices in which the referring doctor had a financial stake.
The issue seems to be that, in physician self-referral cases, patients were more likely to receive group therapy instead of individual, one-on-one care, which tends to extend the amount of visits needed to complete treatment.
This type of physician self-referral practice may improve revenue for an individual physical therapy clinic, but it only increases overall healthcare spending and negatively impacts patient care, the researchers wrote. In order to meet the Triple Aim of Healthcare, providers will need to look beyond their own revenue cycle and consider patient needs first.
|Posted on March 25, 2016 at 7:30 PM|
Physical Therapy vs Opioids: When to Choose Physical Therapy for Pain Management
According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though "there has not been an overall change in the amount of pain that Americans report."
In response to a growing opioid epidemic, the CDC released opioid prescription guidelines in March 2016. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed.
But for other pain management, the CDC recommends nonopioid approaches including physical therapy.
Patients should choose physical therapy when ...
... Patients are concerned about the risks of opioid use.
"Given the substantial evidence gaps on opioids, uncertain benefits of long-term use, and potential for serious harms, patient education and discussion before starting opioid therapy are critical so that patient preferences and values can be understood and used to inform clinical decisions," the CDC states. Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids. As the CDC guidelines note, even in cases when evidence on the long-term benefits of nonopioid therapies is limited, "risks are much lower" with nonopioid treatment plans.
... Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia.
The CDC cited "high-quality evidence" supporting exercise as part of a physical therapy treatment plan for those familiar conditions.
... Opioids are prescribed for pain.
Even in situations when opioids are prescribed, the CDC recommends that patients should receive "the lowest effective dosage," and opioids "should be combined" with nonopioid therapies, such as physical therapy.
... Pain lasts 90 days.
At this point, the pain is considered "chronic," and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that nonopioid therapies are "preferred" for chronic pain and that "clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient."
Before you agree to a prescription for opioids, consult with a physical therapist to discuss options for nonopioid treatment.