Exercise....friend or foe. When watcing the exercise videos on TV, do you feel overwhelmed? "Will I look like that in 6 weeks or less?" In real life, the answer is probably "not really." But don't let that stop you. Exercise is a good thing....when done on your own terms.
The "magic" of exercise comes from making you feel good in body, mind and spirit. To be effective, you need to enjoy the exercise you do. Swim laps, walk with a friend, join a Zumba class, lift weights, play tennis or golf, take a hike, or go snow shoeing. Better still, do any three....variety is the spice of life, especially when it comes to the benefits of exercise.
As a physical therapist, I carefully design an exercise plan appropriate to a patient's needs at the time. Documenting their progress ensures I know what works best for them. When they are ready for discharge, I encourage them to continue regular exercise which complements their recovery. Remaining active prevents injury recurrence and leads to a feeling of well-being. Consistent workouts can be addictive...and fun.
To ensure you are getting the most out of your exercise time, ask yourself a few questions:
- Are you achieving your goals? Weight loss, body toning, improved endurance?
- Can you "see" a difference in your body?
- Is your breathing comfortable? Short of breath or holding your breath?
- How are your muscles and joints doing? Pain, stiffness, or tenderness continue to occur with exercise?
- Does your workout leave you feeling good?
If you find nothing is changing, its time to make a change. Workout at a different time of day, vary your current exercise routine...or try a new form of workout. Be aware of your body to ensure your workouts are balanced - focus on your upper body one day and the lower part another day, focus on strength one time and cardio another. If you consistently experience joint or muscle soreness, its also time to alter your technique, change the frequency or intensity or try a new way to workout. The goal is improvement, not destruction.
Consider the level of exercise intensity to determine if your breathing is too labored.
- Easy - you should be able to maintain an easy conversation while exercising (walking with a friend)
- Moderate - you are only able to speak a few words, not complete sentences, without breathing
- Hard - it is difficult to talk while working out
Through all the sweat and fatigue, when your workout is over you should feel it was worth it.
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What have you done for your shoulders today? An odd question? Perhaps not when you consider what your shoulders do for you each and every day. Looking at this ball and socket joint as an engineering marvel, it is the mechanism which allows us to reach to the ceiling, get that itch in your midback, and make "angel wings" in the snow. Our movement depends on keeping our shoulders mobile. Arthritis, tendonitis....even bursitis may hinder movement from time to time. Joint restriction can be temporary.
Shoulder mobility is directly related to postural control. Stiff shoulders tend to sag, pulling your head and neck forward. The "domino effect" follows with the rounding of your upper back and flattening of your lower spine. Rounded, sagging shoulders leads to labored breathing and consequent tiredness. Postural control and shoulder mobility go hand in hand.
A few simple shoulder mobility exercises can make the difference.
Pendular arm swing
Stand with your arm at your side. Slowly swing arm back and forth. 20 - 30x, two to three times a day
Diagonal pole swing
Place ends of pole in palm of each hand. Begin with arms straight down in front of you. Slowly swing pole up and out to the side, keeping elbows straight. Swing back across lower body, moving up and out to the opposite side. Repeat 20 times to each side.
Behind back pole slide
Place pole behind low back. Hold pole with each hand, palms up. Slowly slide pole up toward mid back. Hold. Slowly lower pole to start position. Repeat 10 - 12 times.
Angel wings
Stand with arms at your sides, palms facing toward side. Slowly inhale as you raise both arms out to the sides, upward above your head. Bring back of hands together. Slowly lower arms back to sides while you exhale. Relax. Repeat 10-12 times.
Shoulder blade pinch
Stand or sit with arms at your sides. Bend your elbows, keeping them next to your body. Turn palms to face each other, leaving the thumb in the "hitchhike" position. Slowly pull your elbows backward, allowing your shoulder blades to pinch together, keep thumbs in the "hitchhike" postion. Do not lift shoulders during exercise. Hold for 3 seconds. Relax, moving arms back to starting position. Repeat 10-12 times.
More physical therapy exercises available thru the
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You love your workout days, but this morning your left knee is telling you "not today." Rubbing your kneecap......something is different. It feels warm.....and even a little puffy. Give it a day or two....maybe a week or two. Now its been three weeks and still no improvement. In fact, now it hurts worse than when you stopped working out. What to do next? Call your doctor? Talk to a personal trainer? See a physical therapist?
Unresolved knee pain, it's definitely time to see a doctor or a PT. Most states have "direct access" laws for physical therapy which allow you to go directly to a licensed PT without seeing a physician first. Growing in popularity, self-referral saves time and money. It allows you to be evaluated and treated more quickly.....and minimizes the cost to your insurance and to you in the form of additional co-pays. If your condition is not appropriate for therapy, it is the responsibility of the therapist to immediately refer you to a physician.
During your initial visit, your evaluation will be carefully documented. In most cases, an electronic medical record (EMR) will be created. "Look" and "listen" are essential components to determine the cause of your knee pain and the best course of action. Your PT will watch you walk, move your hip and knee, compare it to your right knee, and perform selective tests. Treatment will depend on the findings in your evaluaton. If, however, it is determined PT treatment is not appropriate, you will be referred to a doctor. To further expedite your care, the PT will send your digital EMR to the physican and insurance company, if required. Keeping all your records together - ensuring quality care.
"Direct Access" refers to your legal ability to be seen by a physical therapist (PT) without a physican's referral. Forty-five states and the District of Columbia allow physical therapists to evaluate and treat patients without a physican referral. Currently, the only states not offering "direct access" are Alabama, Indiana, Michigan, Missouri, and Oklahoma. Michigan and Oklahoma do allow you to self-refer for an evaluation, but require a physican referral for treatment. The "direct access" law has built-in safeguards to protect patients. Some states, as Ohio, require the therapist to inform the patient's physician of their evaluation within five days. In all "direct access" states, if no significant progress is noted in your condition after 30 days, your PT must consult directly with or refer you to a doctor.
The benefits of "direct access" are numerous
- Eliminate delay in access to pain treatment
- Decrease patient frustration in gaining access to treatment
- Allows for earlier return to "normal life" and return to work
- Earlier treatment intervention = reduced healing time
- Reduced risk of long term loss of function
- Improve communication between PT and physician
Most insurance companies recognize "direct access" to PT. It saves money by eliminating unnecessary physican visits. They recognize costs are reduced when patients have options....and treatments are not delayed. Contact your insurance provider to check on your options for "direct access." Your knees will thank you.
For more information on Direct Access read this
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Shoulder discomfort occurs in many forms....sharp, burning, aching, pinching.....all spell p-a-i-n. It is estimated that more than one-quarter of all visits to a physical therapist is due to shoulder pain. How does this happen?
Our shoulder joint is an engineering marvel. Not only is it a ball and socket joint, it also contains some of the most vital blood vessels and nerves in our body. When working right, we can move mountains or at least reach the top. The ball-shaped top of our arm bone (humerus) fits into a socket formed by an extension of our shoulder blade. As our arm reaches, pushes and pulls, the shoulder blade provides the stabilizing force to give us power.....to lift, climb, and carry heavy objects.
Rotator cuff injuries get the most attention. True....they occur fairly frequently and have a long healing period - with and without surgery. Sometimes overlooked, a torn labrum is also a common injury. Both conditions are very painful and limit activity.
Labrum - an interesting word - describes a group of soft tissues which hold the ball or head of the humerus inside the socket, preventing dislocations when moving your arm in different directions. The labrum protects the shoulder joint. When a tear occurs in a portion of this group of soft tissues, it is not likely to heal with time. Instead, it usually worsens by getting larger or fraying - both cause increased pain. Tears can occur with sudden trauma or with highly repetitive, intense shoulder movements as in manual labor or high speed pitching. We often hear of a famous baseball pitcher or tennis player whose career is in jeopardy due to a torn shoulder labrum.....but this can affect other professionals whose jobs require strenous, repetitive overhead work as electricians, plumbers, and drywall hangers.
A common symptom is a feeling "your arm is falling out of its socket." A torn labrum will cause the ball or head of the humerus to slip out of place. If you find yourself supporting your arm or putting your hand in your pocket to protect your arm, make an appointment to see an orthopedist. Heaviness, arm fatigue, muscle weakness are also symptoms of a torn labrum. These symptoms occur as the head of the arm bone slips out of place, the surrounding muscles including those of the rotator cuff have to do more physical work - overtaxing them - leading to fatigue and more pain. Shoulder and arm movements also change to compensate to avoid pain and make up for the loss of muscle power. Other symptoms as popping, catching, or a "locked" sensation may indicate a labral tear. These occur when the ball drops out of position, causing tendons to rub or soft tissues to "snag."
Physical therapy comes into play both to help determine the exact problem via specific movement tests and postions....and for treatment. In today's digital world of EHR's, therapists can quickly document their test results and send these electronic medical records to an orthopedist ensuring the patient receive treatment in a timely manner.
Surgery is usually the best course of action for all labral tears - the sooner the better. Long-term inflammation and fraying limit the effectiveness of surgical intervention. These tears can occur at any age - and treatment results are positive for all age groups. For those who are not good candidates for surgery... or choose a more conservative approach...exensive modified strengthening programs help to restore function.
Take good care of your shoulders, you never know when the Yankees or Red Sox may call.
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Ahhh! What a great day to be a physical therapist. Grab that second cup of coffee as you wander over to your desk only to be greeted by a giant stack of manila folders. This stack of folders contains everything you need to know about your day ahead. Each folder is labeled with a name - a very important name - your next patient. All is well............well, maybe not everything? Two charts are missing - and that's when the fun begins!
Mrs. Bo Peep and Mr. Wey Offcourse are nowhere to be found. Your next step is the clerk in Medical Records. The news is not good. Your missing charts are being held hostage on someone else's desk who saw them two days ago. The charts were not returned per the "official law of the land." Medical records had made the request - twice, but with no success. Medical records will try again, you have two hours until Mrs. Peep's appointment.
Time goes by, Mrs. Peep's all-important medical record is still AWOL. Time to jump into action. Race up three flights of stairs, dash down the hall to a busy waiting room. Work your way to the reception desk and explain your dilemma. The medical chart must still be here. Alas, Mrs. Peep's medical record is still sitting on her physican's desk - waiting for me. All's well with the world again - Mrs. Peep's medical record has been in good hands, just not mine. Now to find Mr. Wey Offcourse's elusive chart - then my day will be perfect.
Every physical therapist, occupational therapist, and health care provider can relate to this tale of events. For years patient charts have been stored in manila folders filled with pen and paper documents. There was only one chart for every patient. The problem was sharing that one chart with every provider involved in their care and treatment. EHR's and EMR's are solving that problem for patient and provider alike. Electronic health records allow each provider to have access to a patient's medical history ensuring a view of the "total" person, not just their side of the story.
As a physical therapist, I can honestly say using EMR's has changed my life for the better - and for Mrs. Bo Peep as well.
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Tennis Elbow is not reserved for the faint of heart. It's painful symptoms are shared equally by amateurs and pros. In fact, this condition is also commonly found in novice carpenters, plumbers, electricians and weekend gardeners. It's primary cause is a combination overuse and poor body mechanics. The primary symptoms are pain, inflammation, swelling........and more pain.
Tennis elbow is a form of tendonitis found in the forearm near the elbow. It's basic cause comes from repetitive gripping or holding a handle or device in an incorrect way for excessive periods of time. In both situations, the work demand on these specific forearm muscles is greater than they can handle - resulting in muscle tension, loss of flexibility.......and greater stress to that tendon attaching the muscle to the bone near the elbow. For carpenters, plumbers, and electricians, a tool may be too heavy or the handle too small. Physical therapy offers effective treatment options. Using manual stretch techniques, ultrasound, graduated strengthening and the application of a padded elbow wrap, tennis elbow tendonitis is very treatable. The best solution is to recognize the symptoms before treatment is necessary.
There is light at the end of tunnel - prevention. At the first signs of soreness (before pain develops), touch the outside edge of your elbow and follow the tendon, moving toward your wrist, for about 3 inches. If these two areas are sore to the touch, consider loosening your grip when holding a tool.......or a tennis racquet. Another solution is slightly increasing the size of the grip by wrapping tape or foam wrap over the surface area. Or simply trying a racquet with a larger grip or tool with a bigger handle. Frequently relaxing your grip inbetween hits on the ball or when using a tool, will allow your forearm muscles to recover.
Warm-ups before work or tennis also make a big difference. It can be as easy as standing with your arms at your sides and gently shaking hands, wrists, and fingers - improving blood flow and stretching muscles groups at the same time. A simple 2 minute warm-up:
- Hold arms out in front, straight elbow, wrist and fingers, palms face down
- Allow fingers to relax and dangle
- Make a fist with each hand, bend wrists downward, thumbs tucked in. Count 1 - 5 (elbow remains straight)
- Straighten wrist, relax fingers and thumb, dangle fingers, count 1 - 5
- Repeat 10 times. Lower arms to sides. Gently shake wrist and fingers for few seconds.
Other stretches involve holding your arm out straight in front of you with the palm facing up. Bend your wrist to allow your fingers to point towards the floor, while using your opposite hand to apply gentle pressure to your palm. Hold position for 15 - 30 seconds, relax. Repeat 5 times. Turn arm over so than palm is facing down. Again bend wrist to allow fingers to point downward, apply gentle pressure to back of hand to further stretch forearm and wrist.
Let's not forget the thumb's role in all of this. Tennis elbow is caused by a problem with your grip. Our thumb is vital is our grip. A simple exercise for our thumbs is:
- Hold arm in front of you with your elbow and wrist in a straight or neutral position, palm down
- Make a fist - keeping your wrist straight
- Straighten fingers and thumb, extending your wrist upward while moving thumb away from palm. Turn your palm face up
- Use opposite hand to gently pull thumb farther from palm. Hold for 7 seconds. Return hand to starting position for 5 repetitions, 3 - 5 times a day
Once the pain and inflammation subside, a session with a tennis pro is highly recommended. The pro can identify problems with your racquet grip and body mechanics, reducing the chance of a recurrence of tennis elbow. Once is enough.
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"If you build it, they will come." Technical advances in joint replacement devices are advancing at a rapid pace....just in time for the Baby Boomers and their not so youthful joints. A successful new procedure provides an option for knee replacement surgery - the partial knee replacement or unicompartmental arthroplasty. It is an excellent option for people with osteoarthritis in just one part of the knee. During surgery, only the damaged joint section is replaced. The remaining healthy cartilage and bone in the knee is left alone.
Basically, there are two types of partial knee replacements - fixed and mobile. In the fixed device, a metal plate is placed on the end of the thigh leg (femur) and plastic on the end of the shin bone (tibia). The mobile version consists of metal on the ends of both the femur and tibia with a plastic pad inbetween. Mobile partial knee replacements allow more strenous activity after surgery. They have a 91% success rate for patients under 60 years old and 96% success for patients over 60 years old.
Fixed implant 
Mobile implant
As with all surgery, there are pros and cons. The pros of a partial knee replacement are quicker recovery time, less pain after surgery, less blood loss.....and a more "natural" feeling than a total knee replacement. The main drawback is that a future total knee replacement may be necessary if the current healthy bone and cartilage develop severe arthritis.
The procedure is not for everyone. If you have chronic inflammation, significant knee stiffness, or ligament damage, this may not be the right surgery for you. Success is not related to age - excellent results have been noted in both young and older people. Selection is based on your medical history, a physical exam, an MRI and other tests.
After surgery patients can expect to have physical therapy 2 - 3 times a week to regain full movement and strength. Another component is to help you develop a normal walking pattern again. Often, pre-surgery, people develop compensatory habits to avoid normal weight bearing on the painful knee. As you recover, your brain remembers these habits. Even though your pain is gone, people often return to these altered habits. Therapy is designed to ensure you return to your very own personal walking style.
Dr. John Lynch, an orthopedic surgeon at Melrose-Wakefield Hospital in Massachusetts, recently began performing customized partial knee replacement surgery - another postive innovation in joint replacement surgery. After this procedure, patients begin walking the night following surgery, putting some weight on their affected leg. They usually go home the following day with a walker or cane. Patients follow a physical therapy regime for a few weeks to regain mobility and strength. Most patients resume their regular activity level within 6 weeks after surgery. Dr. Lynch uses customized implants. After screening for partial knee replacement surgery, Dr. Lynch sends a patient to have a CT scan of their knee. That image is then used to create a 3-D model of their knee. An implant is then designed and manufactured specifically for that patient. Dr. Lynch's program is reporting a 99 percent satisfaction rate. More information can be found at www.hallmarkhealth.org
Exercise combined with joint replacement surgery provides new options for active lifestyles. Keep moving.
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Much to the surprise of many experts on aging, a recent scientific study in Canada found older adults learn concepts and skills much better by trial and error than by the more passive methods as previously thought. Most doctors and experts on aging have long believed that asking older people to "figure things out" would slow down or interfere with the actual learning process and memory. The previous approach was to provide the answer or solution and repeat it over and over again. The experts' concern was based on the theory that making mistakes would confuse the aging brain - and hence, interfere with learning new things. This study demonstrates the opposite - making mistakes allows the older adult to relate better to the concept or task. It is a more effective way for the aging brain to learn and remember.
In a study at the Rotman Research Institute in Toronto, two groups were studied - an older group with an average age of 70 and a group of younger adults in their 20's. Both groups were asked to perform tasks by both a trial and error method and a passive method in which they were given the answer to memorize. It was found that when the older group was able to make a connection between their errors and the correct solution, they remembered it more accurately than when they were given the correct answer to memorize without associating any experience to the answer. Experience is a more effective learning tool than repetition and memorization alone.
Not only did the older group learn the concepts more effectively by trial and error, but they learned them two and a half times more accurately than the 20+ year old group. The study's lead investigator suspects this is due to the older group's more intent focus on the assigned tasks.
After working as a physical therapist in a geriatric setting for three years, the result of this study comes as no surprise. In college my training taught me that therapy for older adults needed to be done more slowly, simply and with more repetition than with younger patients. It did not take long for reality to set in. This concept did not fit the people appearing for therapy in my rehab department. From hip fractures to stroke patients, many of these older adults met the challenges of recovery by attempting a variety of ways to perform a set task. Allowing them to make corrections to their mistakes, trial and error methods helped them succeed - dressing themselves with one hand, climbing stairs, walking with a brace. I invited them to be actively involved in problem solving. Success came after trial and error. Success came when they learned what worked for them.
It is a relief that science has now proven what senior citizens have known for a long time - we learn from our mistakes.
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In our baby boomer age of body bionics, joint replacements are becoming commonplace. As a physical therapist, I have seen amazing changes in the evolution of these implants. Total or partial joint replacements bring positive changes to those dealing with limited mobility, loss of function, and constant arthritic pain and swelling. In the past few years data compiled from on-going studies has reminded us to not take this life-changing innovation for granted. Some people with metal-on-metal hip replacement devices have become the subject of close monitoring, with a few resulting in removal of the implant.
The first documented attempt for hip replacement surgery was performed in Germany in 1891, using ivory to replace the head of the femur bone. In 1940 Dr. Austin Moore developed the first metal femoral head implant which was to become the standard for the next 20 years. Until 1962 no hip socket replacements were available. British surgeon, Dr. John Charnley, developed the modern total hip implant - a plastic socket (acetabulum) combined with a metal (chromium and colbalt) femoral head to become the basis for the majority of hip implants throughout the world. These implants allowed previously impaired patients to now resume normal walking, stair climbing, and even cycling......and significantly reduced pain. An excellent success rate was noted through the 1990's, 95% of all total hip replacements (plastic socket and metal femoral head) remained effective ten years after surgery.
As with all innovations, we are never satisfied. Physicians and patients wanted the implants to be stronger and more durable - the primary goal for the patient was to resume life-style activity as it had been before their hip impairment. To meet this goal, new metal-on-metal hip implants evolved and have been used extensively in the past decade. Even though designed for a specific group (tall, middle-aged men), these metal-on-metal implants were marketed to be used for all age groups and gender - for everyone. In fact, 65% of these implants went to women and elderly adults. In 1996 only a tiny fraction of the 250,000 hip implants done world-wide were metal-on-metal. By 2008, 1 out of 3 new hip implants were metal-on-metal.
Recently, two metal-on-metal hip implant devices manufactured by DuPuy (a division of Johnson and Johnson) have been recalled. The reason for the recall is based on laboratory findings of tiny microscopic metal shavings found in the blood stream. These metal shavings are the result of the shearing frictional forces of metal-on-metal surfaces. The metallic particles enter the blood supply and may cause reactions as high fever, pain, imflammation, and the potential destruction of bone and surrounding tissue. The implants from DuPuy were the ASR XL Acetabular System and the ASR Hip Resurfacing System. It was found that five years after implant, 13% of the patients with the Acetabular System have needed revision surgery. 12% of those with the Resurfacing System have also required surgery. A very high failure rate. Problems arose when the FDA allowed these implants to be tested only on machines to assess amount of wear and tear without the consideration of the actual mechanical forces involved in human activity and the negative physiological impact of these particles released into the body. A recall was issued by Johnson and Johnson. A Help Line for the recall is 888-627-2677. http://www.depuy.com/asr-hip-replacement-recall
The good news is the majority of those with hip replacements (old and new) do very well - resuming an active lifestyle. In physical therapy I have seen over 200 hip implant patients. The positive impact of this procedure cannot be overstated. Watching someone climb stairs without pain, resume their independent lifestyle, and walk out of the clinic with a smile......makes my day.
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You are about to embark on a new adventure - your first visit to physical therapy. Relax, you are among friends. No matter what you may have seen in the movies and on TV, therapists are regular people, not giantic hulks who love to push you beyond the "pain limit."
On your first visit, wear comfortable clothes and shoes. Wear shorts if your knee, ankle or hip are the reason for the visit. Bring along a sleeveless top if it's your shoulder or arm. Physical therapists like to be thorough, bring shoes you wear everyday as well as shoes to exercise in. Watching you walk will give a therapist vital information about how to help you.
Physical therapists are famous for asking questions, lots of questions.....about your injury, activities you can and can't do since your injury, your work, pain level, and other symptoms. Years of academic and clinical training are involved to prepare a physical therapist to evaluate and determine your appropriate plan of care. Gathering information about your injury and lifestyle helps determine the best method of treatment. Be honest about your answers. Don't be shy, if your pain level is an 8, let them know. If your discomfort is interferring with your sleep, tell them.
In today's digital world, many clinics are now using electronic medical records to not only collect your medical information, but also to track your progress. Electronic entry is not only secure and efficient, it also ensures your records are readable (no more bad handwriting issues). Security and safety are vital elements in your care. Physical therapy documentation becomes one more piece of your medical record.
It's your time.......don't hesitate to ask your own questions as well. It's important for you to know what to expect from the initial treatment and what the treatment goals are? It's a team effort.
As your therapy progresses, tell your therapist if your pain intensity changes, if swelling or other symptoms occur following a visit. The key to success in any form of therapy is consistency - by the physical therapist and the patient. Consistent follow-up visits and your follow-thru at home make all the difference in the world. Don't expect miracles, but positive results come much sooner than most people expect when working together.
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