|Posted on December 2, 2015 at 8:25 AM|
|Posted on August 28, 2015 at 1:15 PM|
Rethinking Movement: Why You Should See a Physical Therapist Every Year
Why is it that superbly fit athletes can find themselves in as much back, knee, or neck pain as their flabby fans, who sit at desks all day long then watch sports from overstuffed sofas?
“When you do an activity over and over again, your body adapts to that activity,” warns Dr. Shirley Sahrmann, professor emerita of physical therapy at Washington University School of Medicine. “If you play tennis, your arm gets bigger on that side; if you do karate you get adaptations in your hip and leg. Even if you just sit, you lean, you slump, your neck goes forward.” Either your body fails to build up musculature to support itself, or it overbuilds certain muscles and throws off the symmetry your skeleton craves.
That’s why Sahrmann wants to see an annual physical therapy exam become as routine as a dental checkup. “We go to the dentist twice a year and spend thousands to straighten our teeth, and all we do with them is eat and talk. Meanwhile the rest of our body’s just hanging out there.”
People think of p.t. as something generic their doctor orders after an injury, she says. But by analyzing the way you walk, bend, sit, and carry yourself, physical therapists can prevent injuries and head off future surgeries and chronic pain.
“Kids don’t sit correctly, they slump, so they wind up sitting on the middle of their back,” she says. “We have these little bones on our bottom where we are supposed to sit and keep our spine erect. When you slump, the muscles get stretched out, and they’re not going to function optimally.”
A temporary phase? Maybe. But “bones adapt to the alignment that you keep them in,” Sahrmann points out, “and your spine becomes shaped like that.”
Watching teenagers walk makes her crazy: “They are not using what we consider a normal gait. They walk without bending at the hip and knee and pushing off. They shuffle. And they sway back—their shoulders are behind their hips—so their gluteal muscles don’t work as much as they should. All of these little cultural changes in sitting posture, what’s considered cool—even the clothing.” For a while there, she says, “the new waistline was the gluteal fold! And how do you walk when your legs are strapped together with a belt? Their knees get caught in the crotch of their pants—it’s hysterical. But it’s also not good.”
In years past, there was little appreciation of how lifestyle affected your health. “My family thought they just got diabetes or hypertension; it had nothing to do with the cans of Crisco my grandmother cooked with.” The way we move and align ourselves is just as important as what we eat, she says. “There is complexity to movement, and you can do it right or wrong.”
I bring up ergonomics—surely that’s helped? “It’s not just whether the setup is right,” she points out. “It’s what you bring to that setup and what you do when you’re not there.” We’re designed to keep changing position, not sit frozen in the perfect chair. Even working out requires real knowledge, if you want to lift weights or do aerobic training without compromising the performance of all your other joints.
Sahrmann’s one of the nation’s pioneers in pushing the concept of a movement system, emphasizing the subtle, necessary interconnections of muscles and bones and nerves but also heart, lungs, and the endocrine system. Her career has spanned more than half a century, and its twists and turns led her to see the body whole. She began work at the end of the polio era and spent nine years taking care of patients who’d suffered head injuries or strokes. In order to understand the disordered motor control of patients with central nervous system lesions, she left clinical practice to earn a Ph.D. in neurobiology. Then serendipity sent her a different kind of patient: athletes who had musculoskeletal pain.
“I started teaching them to move differently, and they got better for reasons I didn’t understand,” she says. “I’ve spent a good many years with my colleagues at Wash.U. working to analyze these relationships between movement and musculoskeletal pain.”
She’s written two books and talked herself hoarse, urging people to see the body’s movement as systemic. Now that approach is finally catching hold, not just here but nationally and internationally. But she’ll know she’s really succeeded when p.t. evaluations are annual, and there are formal diagnoses based on movement patterns that consistently cause pain: flexion syndrome, when the back bows out; extension syndrome when it bows in and hunches you over; tibiofemoral rotation that can lead to knee problems.
“We all move differently,” she says. “I’ve seen patients whose feet are so callused I don’t know how they put their shoes on, and I’ve seen marathon runners with no calluses at all.
“You need to have an exam by a body expert at least once a year,” she finishes crisply. “Even if insurance doesn’t cover it, the cost is no more than you’d pay a personal trainer. I think we could substantially reduce the number of injuries and slow the process of osteoarthritis as people age.” She’s not saying arthritis can be eliminated altogether—but it can be delayed and its effects minimized. “There’s evidence that if a joint is lax, or you have injury, or your muscles are weak, you can get these arthritic changes.” Move right, and you lower the chance of injury—whether you’re an Olympian or a couch potato.
|Posted on August 8, 2015 at 9:50 AM|
Your back hurts (join the club) and you go to see your primary care physician. Most of the time, your doctor will tell you to rest, maybe take some ibuprofen or ice the affected area.
But when researchers looked at 841 people who needed additional care, they found that the ones sent first for MRIs were more likely to have surgery or injections, see a specialist or visit an emergency room than those who were first sent to physical therapists. And they (or their insurance companies) paid an average of $4,793 more.
The reasons, said the study's lead author, are more likely found in the heads of patients and doctors than in anyone's back. MRIs tend to turn up all kinds of benign changes in spines and backs that occur as we move through life. But those prompt patients to look for fixes and to pressure doctors to refer them for those.
"The patient may feel and exert some pressure to wanting to work it up more," said Julie Fritz, a professor of physical therapy at the University of Utah. "It just changes the mind set of everyone involved. It tends to accelerate the course of intervention."
Take degenerative disc disease, for example. Most people older than 40 or 50 have it to some degree, Fritz said, but often not to the extent that it causes pain or other symptoms. But when an MRI turns up that ominous-sounding bit of news, patients often ask for therapy and primary care doctors can succumb, she said.
"It motivates patients to want to do more to look for fixes for that problem, when it probably should be [considered] more like wrinkles and gray hair," she said.
Another possibility is that some physicians have financial interests in imaging services, the study notes.
Low back pain is incredibly common and debilitating. According to one study, it causes more time disabled around the world than HIV, road injuries, tuberculosis, lung cancer, chronic obstructive pulmonary disease and pre-term birth complications. In the United States, Fritz's team noted in its paper, the direct cost of treating low back pain was $86 billion in 2005.
An MRI exam can cost $1,000 or $1,500 and while many are covered by insurance, patients often have to put up co-payments and meet deductibles. Several studies have shown no evidence of benefits to low back patients unless there are specific symptoms, according to Fritz's paper, which was published March 16 in the journal Health Services Research. [Fritz is a professor of physical therapy herself, but the paper is a peer-reviewed study, not her opinion.]
Fritz and her colleagues set out to compare what happens to patients sent first for MRIs versus those sent directly to physical therapists. "Patients have expectations around receiving something perceived as beneficial," they wrote. "Breaking an expectation by denying imaging may be unacceptable to patients or providers. Consumer research suggests offering an alternative to replace the broken expectation is important to patients."
In addition to seeking less invasive follow-up care, the people who went directly to physical therapists spent an average of $1,871, while those whose first move was an MRI spent an average of $6,664 in the year following their initial complaint to their doctors. With only a few hundred people in each sample, Fritz acknowledged, the cost figure was somewhat skewed by a small number of very expensive surgeries among those who had MRIs first. But overall, the cost difference is very clear.
Physical therapy focuses on educating patients about what might be causing their back pain, assuring them that most problems subside in time, and engaging them in their therapy, even if the therapist is providing hands-on aid, Fritz said. Perhaps people who choose that option are more motivated to be part of clearing up their problem, or they may just profit from the approach; the research doesn't make that clear.
Either way, "we think this is an area where our profession has something to offer, especially when it's timed correctly," Fritz said. "There's a place for advanced imaging. It's just not early in the course of care for most patients."
Take home message: CALL BDPT and get PT FIRST!
|Posted on May 2, 2015 at 9:35 PM|
OKLAHOMA CITY – Taking a “cash only” free market approach, the Surgery Center of Oklahoma City is causing a stir locally, and attracting nationwide attention.
What the company calls “price transparency” with guaranteed rates for procedures is even triggering a home-grown version of medical tourism.
A company in the Dallas metroplex has designated Surgery Center a partner for employee health care. Savings from procedures performed at the center, even with lodging and travel covered, yield lower costs for the employer.
Admirers laud physician-founder Dr. Keith Smith, who founded the center in 1997, for “lighting a candle, rather than cursing the darkness.”
At a state Capitol event, Dr. Smith explained the center’s up-front pricing of medical procedures in diverse areas of practice, including orthopedics, ear/nose/throat, general surgery, urology, ophthalmology, foot and ankle, and reconstructive plastics.
Bottom line, the institution’s operational structure and market-oriented billing methods provide an intriguing alternative to the third-party payer systems that now dominate American health care, including the highly centralized structure envisioned under the Affordable Care Act, or “ObamaCare.”
The center has avoided entanglement in Medicare and Medicaid, and only carefully engages with private health insurance plans.
This week, Brandon Dutcher and Tina Dzurisin of Oklahoma Council of Public Affairs hosted a seminar to tout Smith’s work, which has begun over the past few months to garner favorable attention in local news reports. Lobbyists for major health care institutions in the region were present, as well as association executives interested in the Center’s approach, either to support or oppose it.
That’s not all: Reasontv has taken notice, producing a mini-documentary on the price transparency, overall efficiency and affordability in the Surgery Center’s approach.
Three years ago, Dr. Smith, who describes himself as a libertarian, began to post prices for 112 common surgical procedures at the facility, which was established with his partner, Dr. Steve Lantier, in 1997.
The original founding of their health-care business was predicated on the confidence they could provide top-tier procedures at a fraction of the cost traditional hospitals charge. Their already-successful venture took off after the online price posting was implemented.
He recalls, “The first people who showed up at our door were Canadians. Then we heard from the heads of Human Resource departments at local and regional companies.”
The center works directly with several businesses that are self-insured, and which pay employee bills directly. Today, Smith reported, the vast majority of patients at the center are individuals drawn initially by lower prices, and retained by high-quality care.
The center lists a guaranteed price for procedures, including facility fee, surgeon’s fee and anesthesiologist’s fee. Prices listed include those for initial consultation and uncomplicated follow-up.
Not included in the listings are diagnostic studies prior to surgery, consultations, therapy and rehabilitation, hardware or implants. As Smith noted, hardware and implants are priced at cost with no mark-ups. Overnight stays at the facility are not included, nor are lodging and travel expenses.
As a practical matter, the center’s approach leads to patient bills that can be laid out, with all costs listed, on a single page. The actual cost of the center’s procedures is sometimes one-tenth, and often around one-sixth, of the price at a traditional hospital.
The Reasontv video, shown at the Capitol briefing, highlighted some of the most dramatic price differentials, including for a “complex bilateral sinus procedure.” At the Surgery Center, the all-inclusive price is $5,885. At nearby Integris Hospital the price in 2010 was $33,505 – but that did not include either the surgeon’s or the anesthesiologist’s fees.
In response to a question from CapitolBeatOK, Dr. Smith said there are presently no legal impediments to the Surgery Center’s approach embedded in the Affordable Care Act, widely deemed “Obamacare.” He said he hopes that remains the case, but pointed out that regulatory mandates are a moving target under the law.
The Surgery Center of Oklahoma City does not deal with Medicaid or Medicare systems, although some patients access those systems separate from the center’s work.
While making it clear he is no fan of big insurers, Dr. Smith said the potential key impediments to emergence of more systems like his are “The federal government, the federal government, and the federal government.” He said what he dubbed “the Unaffordable Care Act” is “driving out what’s left of markets in American health care.”
In dialogue with CapitolBeatOK, Dr. Smith said the center’s approach is helping to restore an old-fashioned medical ethic for provision of charity care. Many referrals to the hospital come from churches and other groups helping the poor. Patients are encouraged in those cases to pay what they can, while physicians and anesthesiologists can (and often do) waive their fees for individuals in need.
Surgery Center does work with insurance companies, but that triggers a separate pricing structure. Dr. Smith explained, “We take on a lot of risks when we file with insurance companies, so we have to charge for that risk.”
Oklahoma Commissioner of Labor Mark Costello, who attended the Capitol briefing, will be presenting an Entrepreneurial Excellence Award to Surgery Center next month.
Dutcher, vice president at OCPA, reflects, “The remarkable things Dr. Smith and his colleagues are doing deserve to be spotlighted. They are demonstrating that competition and price transparency can drive down costs in health care just as in every other sector of the economy.”
|Posted on March 20, 2015 at 8:35 AM|
Interesting Article on overall cost of having images before utilizing PT
|Posted on November 12, 2014 at 7:45 PM|
Understanding Disc Bulges
Disc bulge, commonly referred to as herniated nucleus pulposas (HNP) is a condition that relates to the spine. HNP can be caused by immediate trauma or injury (sports injury, auto accidents, etc.), as well as long term trauma (improper posture). Discs are located between each of the vertebral bodies of the spine. The discs are the shock absorbers of the body. They also help to give the spine more movement and flexibility as we twist and bend.
The discs are shaped like a hockey puck and are made up of cartilage, which is tough and leather-like. Each disc is made similar to an onion, in that they are layered in rings (the annulus). At the very center of each disc is a watery, gelatin-like center. This center is called the nucleus. In general, the discs have a high content of water and this is what gives them their flexibility. As we age, the discs lose some of their water content and become less flexible. This makes the layers of the "onion skin" more brittle and weaker.
As we participate in activities that place us in a bent or "flexed" position (sitting, driving, reading, watching TV, etc.), the low back can lose its natural curve and pressure from the nucleus can be exerted on the back side of the discs. Over time, one layer at a time of the "onion skin" (annulus) splits or cracks and the gelatinous center moves closer to the outside. Eventually this nucleus begins to distort the shape of the disc causing the disc to bulge. This can happen to the direct backside but most often is slightly to one side or the other (in rare cases the bulge can be on the front side).
The pain is caused because the back side of the disc has many nerves. Another factor is that the spinal cord is directly behind the disc and as the bulge increases, it begins to irritate the nerves that are attached to the spinal cord. In the low back, these nerves travel down the leg. This can cause feelings of pain as far down as the foot and toes, as well as numbness or tingling in the leg and foot.
One way to help with this problem is by beginning extension exercises. By arching the low back, pressure can be taken off the back side of the disc. If this is done with frequency, the layers of the annulus can begin to heal and can form scar tissue. As the disc heals, the bulges reduce in size and take the pressure off the nerves, decreasing or eliminating the symptoms.
Another item that can keep the low back in its proper curve is a lumbar roll. The lumbar roll is placed behind the low back while you sit, and helps keep the back in its proper curve.
Your doctor of physical therapy will show you the exercises best suited to your situation and if you have further questions make an appointment today!
|Posted on October 28, 2014 at 9:25 PM|
To understand Piriformis Syndrome it is necessary to have an understanding of some of the basic anatomy associated with this condition:
The piriformis muscle is located in the buttocks areas, deep underneath the gluteus maximus. The piriformis is one of the muscles that help to rotate the thigh bone outward, such as the movement of crossing the ankle over the knee. The muscle runs from the tail bone (the sacrum) and attaches at the hip bone (the greater trochanter of the femur). The sciatic nerve is a major nerve that begins in the low back area and travels down the back of the thigh and continues down branching off in the lower leg and foot. The sciatic nerve usually runs directly through the piriformis muscle although it may lie above or under the piriformis.
The cause of Piriformis Syndrome is not entirely clear and may become present from several different things. It is often associated with SI (sacroiliac) problems. Trauma, such as falling on the buttocks may incite the symptoms. Extended sitting can be a factor, as in the case of professional drivers who sit extensively in one position. Other problems, such as hip bursitis, back strains or gluteal tendonitis in the close vicinity of the piriformis may bring on the condition.
Symptoms include pain and tenderness in the buttocks area. The problem may be on one or both sides. Sitting is often uncomfortable. Walking, running, and ascending or descending stairs is often painful. In some cases radiating pain may shoot down the back of the thigh and into the lower leg because of irritation to the sciatic nerveas well as aggravated trigger points in the glute and piriformis itself.
There are many treatment options for Piriformis Syndrome. Moist heat can help relieve and control pain. Ultrasound may be beneficial since it is a method of deep heating and the piriformis is located very deep under other muscles. Certain therapeutic exercises may greatly help to recondition the muscle. There are several stretches for the muscle that can help relieve the tightness. Avoidance or at least decreasing the irritating factors such as stairs, extended sitting, etc., is crucial. Manual techniques such as myofascial release, deep tissue massage or dry needling may also help.
With proper treatment and follow through this condition can be resolved. In some cases it will resolve quickly and in others it may be a lengthy rehabilitation. For more information consult Bluegrass Doctors of Physical Therapy, to stop the pain in your butt!