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Category Archives: Physical Therapy Facts & Information

General PT facts and information to assist with patient education and for general knowledge

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Keep Moving! A new study found nonoperative treatments were just as effective at reducing pain and disability as spinal fusion surgery for patients with lumbar degenerative disc disease.

PT found effective as spinal fusion for pain Nonoperative treatments, including physical therapy, were just as effective at reducing pain and disability as spinal fusion surgery for patients with lumbar degenerative disc disease. Nonoperative treatments, including physical therapy, were just as effective at reducing pain and disability as spinal fusion surgery for patients with lumbar degenerative disc disease, according to a recent study.

According to an American Physical Therapy Association survey, 61% of U.S. residents experience low back pain, of which degenerative disc disease is one cause. The same survey found just 40% of those with low back pain will try movement as a way to relieve the pain.

Researchers with the University of Virginia Health Sciences Center, Charlottesville, and the Thomas Jefferson University Hospital, Philadelphia, reviewed 200 consecutive patients with back pain and concordant lumbar discogram who were offered the option of spinal fusion then followed up with the patients to compare outcomes of those who chose fusion or nonoperative treatments, such as physical therapy. Their study was published online Sept. 17 in the journal World Neurosurgery.

The team used follow-up questionnaires including the pain score, Oswestry Disability Index, SF-12 and satisfaction scale. Researchers conducted follow-ups with 96 patients (48%). Patients who lacked follow-up data were slightly older and less likely to be smokers. Overall, pain score at initial visit, body-mass index and gender were not significantly different between patients with and without follow-up results.

Of the 96 patients with follow-up, 53 were in the operative group and 43 were in the nonoperative group. The researchers found no significant differences between the groups based on age, pain score, BMI, smoking or gender at baseline. The average amount of time that elapsed before follow-up was 63 months and 58 months for the operative and nonoperative groups, respectively.

According to the findings, patients in both groups reported much less pain at the final follow-up. The authors concluded the two groups �did not demonstrate a significant difference in outcomes measures of pain, health status, satisfaction or disability.�

Abstract: http://www.worldneurosurgery.org/article/S1878-8750%2813%2901111-X/abstract

 

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Physical Therapy Improves Balance & Prevents Falls

Research has shown that approximately 1/3 of all adults over the age of 65 suffer from at least one fall annually, the prevalence increases to 50 percent in adults over the age of 80. Falls are not only an inconvenience, but have also contributed in a major way to health care costs and disability in the older adults. Studies have shown that 20 percent of falls require some sort of medical attention. Furthermore, up to 10 percent of people who suffer from a fall sustain major injury such as major contusion/laceration, head trauma and disabling fractures. Fractures are a greater risk for patients with osteoporosis. You may also be surprised to find out that complications from falls are the leading cause of death from injury in adults over the age of 65.

There are multiple reasons why people fall and they include prior history of falls, visual deficits, gait abnormality, lower extremity weakness, arthritis, balance deficits and environmental hazards. As we age balance regresses, joints become more arthritic, flexibility decreases and reaction time slows down. However, balance impairments can be improved and the risk for falls can be reduced, with practice.

Medical studies show effectiveness of physical therapy interventions in treatment of balance dysfunction and therefore decreasing the risk for falls. Exercise programs may target strength, balance, flexibility or endurance. Programs that contain two or more of these components reduce rate of falls and number of people falling.

A skilled physical therapist is capable of accurately diagnosing balance dysfunction and risk for falls by a comprehensive evaluation including history taking, physical examination, as well as functional/balance tests. Physical therapy treatment should be patient specific and based on needs established during initial evaluation. Most often it will consist of a combination of balance activities, functional training, strengthening and stabilization exercises, as well as environmental awareness/modification training with the patient.

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Physical Therapist’s Guide to Groin Strain

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A groin strain is an injury to the groin area, the area of the body where the abdomen meets the leg and the inner thigh muscles attach to the pubic bone. Typically, groin strains occur in the muscles of the upper inner thigh near the pubic bone or in the front of the hip. Although more common in athletes than non-athletes, groin strains can occur during any type of forceful movement of the leg, such as jumping, kicking the leg up, or changing directions while running. Groin strains account for 10% of all hockey injuries and 5% of all soccer injuries.

Physical therapists treat groin strains by reducing pain and helping patients improve muscle strength and leg motion and to increase the speed of recovery.

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Tone-Up Your Triceps

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Looking for a workout move to tone up your triceps? Transform your arms with the one-arm kickback.

Biceps aren’t the only muscles we need to focus on when it comes to building strong arms. To tighten loose underarms, do the tricep-toning kickback. Here’s how: Hold a hand weight in your right hand. Lean over slightly and put your left foot forward. Place your left forearm on your left leg, or on a sturdy chair or table if you need additional support. Keeping a straight line from the top of your head to your tailbone, turn your right palm upward and push your entire arm back so that your right elbow points toward the ceiling. With your elbow in this upward position, kick the weight back and twist your palm toward the ceiling. Breathe normally. Maintain the up position and don’t drop the elbow. Try to do 50 repetitions on each side.

Excerpted from YOU: The Owner’s Manual, Updated and Expanded Edition: An Insider’s Guide to the Body That Will Make You Healthier and Younger by Michael F. Roizen and Dr. Mehmet C. Oz.

 

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Top 5 Things You Need to Know About a Superior Labral Tear

Understanding how a SLAP lesion occurs and what exactly is happening pathologically is extremely important to diagnose and treat these shoulder injuries appropriately.

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Classification of SLAP Lesions
There are several variations of injuries that can occur to the superior labrum where the biceps anchor attaches (see the above figure to view the biceps attaching into the labrum). Following a retrospective review of 700 shoulder arthroscopies, Snyder et al: Arthroscopy ’90 identified 4 types of superior labrum lesions involving the biceps anchor. Collectively they termed these SLAP lesions, in reference to their anatomic location: Superior Labrum extending from Anterior to Posterior. This was the original definition but as we continue to learn more about SLAP tears, they certainly do not always extend from anterior to posterior. But, the most important concept to know is that a SLAP lesion is an injury to the superior labrum near the attachment of the biceps anchor.

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Type I-IV SLAP lesions from left to right

•Type I SLAP lesions were described as being indicative of isolated fraying of the superior labrum with a firm attachment of the labrum to the glenoid. These lesions are typically degenerative in nature. At this time, it is currently believed that the majority of the active population may have a Type I SLAP lesion and this is often not even considered pathological by many surgeons.

•Type II SLAP lesions are characterized by a detachment of the superior labrum and the origin of the tendon of the long head of the biceps brachii from the glenoid resulting in instability of the biceps-labral anchor. These is the most common type of SLAP tear. When we receive a script from a surgeon to treat a “SLAP repair” he or she is more than likely talking about a Type II SLAP and surgery to re-attach the labrum and biceps anchor. Three distinct sub-categories of type II SLAP lesions have been further identified by Morgan et al: Arthroscopy ’90. They reported that in a series of 102 patients undergoing arthroscopic evaluation 37% presented with an anterosuperior lesion, 31% with a posterosuperior lesion, and 31% exhibited a combined anterior and superior lesion. (33) These findings are consistent with my clinical observations of patients. Different types of patients and mechanisms of injuries will result in slightly different Type II lesions. For example, the majority of overhead athletes present with posterosuperior lesions while individuals who have traumatic SLAP lesions typically present with anterosuperior lesions. These variations are important when selecting which special tests to perform based on the patient’s history and mechanism of injury. We’ll get to this in a future post on all the different clinical tests for SLAP tears.

•Type III SLAP lesions are characterized by a bucket-handle tear of the labrum with an intact biceps insertion. The labrum tears and flips into the joint similar to a meniscus. The important concept here is that the biceps anchor is attached, unlike a Type II.

•Type IV SLAP lesions have a bucket-handle tear of the labrum that extends into the biceps tendon. In this lesion, instability of the biceps-labrum anchor is also present, similar to that seen in the type II SLAP lesion. This is basically a combination of a Type II and III lesion.

What is complicated about this classification system is the fact that the Type I-IV scale is not progressively more severe. For example a Type III SLAP lesion is not bigger, or more severe, or indicative to more pathology than a Type II SLAP lesion.

To further complicate things, Maffet et al: AJSM ’95 noted that 38% of the SLAP lesions identified in their retrospective review of 712 arthroscopies were not classifiable using the I-IV terminology previously defined by Snyder et al (49). They suggested expanding the classification scale for SLAP lesions to a total of 7 categories, adding descriptions for types V-VII. (29)

•Type V SLAP lesions are characterized by the presence of a Bankart lesion of the anterior capsule that extends into the anterior superior labrum.
•Type VI SLAP lesion involve a disruption of the biceps tendon anchor with an anterior or posterior superior labral flap tear.
•Type VII SLAP lesions are described as the extension of a SLAP lesion anteriorly to involve the area inferior to the middle glenohumeral ligament.

These 3 types typically involve a concomitant pathology in conjunction with a SLAP lesion. Although they provided further classification, this terminology has not caught on and is not frequqntly used. For example, most people will refer to a Type V SLAP as a Type II SLAP with a concomitant Bankart lesion. Since then there have been even more classification types described in the literatue, up to at least 10 that I know of, but don’t worry, nobody really uses them.

Top 5 things you need to know about classifying SLAP lesions

1.Just worry about Type I-IV SLAP lesions and realize that any classification system above Type IV just means that there was a concomitant injury in addition to the SLAP tear.
2.You can break down and group Type I and Type III lesions together. Both involved degeneration of the labrum but the biceps anchor is attached. Thus, these are not unstable SLAP lesions are not surgically repaired. This makes surgery (just a simple debridement) and physical therapy easier.
3.You can also break down and group Type II and Type IV lesions togther. Both involve a detached biceps anchor and require surgery to stabilize the biceps anchor. Type IV SLAP tears are much more uncommon and will involve the repair and a debridement of the bucket handle tear.
4.Type II lesions are by far the most common that you will see in the clinic and are almost always what a surgeon is referring to when speaking of a “SLAP repair.”
5.We all may have a Type I lesion, it is basically just fraying and degeneration of the labrum.

source: MikeReinhold.com
Image via Wikipedia

 

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USA Today: Patients with back pain often get Wrong Treatment

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Patients with back pain often get the wrong treatment
Nanci Hellmich, USA TODAY 5:18 p.m. EDT July 29, 2013
“The majority of cases of patients with new back pain tend to get better with conservative treatment in three months.”

Story Highlights
• Back pain is one of the most common reasons for going to the doctor
• With treatment of back pain, often “less is more”
• Conservative treatments work for the majority of patients with back pain

Many patients are getting overly aggressive treatments for their back pain, says a large study out today. Physicians today are increasingly giving patients with back pain narcotic drugs, ordering expensive imaging tests or referring them to other physicians rather than offering them the recommended first line of treatment. That more conservative treatment calls for the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil), aspirin and naproxen (Aleve), or acetaminophen (Tylenol) and physical therapy, according to national guidelines from the American College of Physicians.

The guidelines caution against early imaging or other aggressive treatments, except in rare cases, says the study’s lead author John Mafi, a chief medical resident at Beth Israel Deaconess Medical Center, Boston. These guidelines are similar to those from other groups, and the bottom-line message is “less is more,” Mafi says. “The majority of cases of patients with new back pain tend to get better with conservative treatment in three months. If they don’t get better, physical therapy is an option. Narcotic medications, such as Percocet or Vicodin, have no proven efficacy in improving chronic back pain.”

Back pain is one of the most common reasons for going to the doctor; more than 10% of visits to primary-care physicians are for this problem and amounts to about $86 billion in health care spending annually, says senior author Bruce Landon, a professor of health care policy and medicine at Harvard Medical School. That’s a conservative estimate because it doesn’t account for lost productivity, he says. Using data from two national surveys, the researchers studied almost 24,000 visits to the doctor for back pain, both acute and chronic, from 1999 to 2010.

Findings published Monday in JAMA Internal Medicine, a Journal of the American Medical Association Network publication:
– The recommendation for using NSAIDs or acetaminophen per visit decreased from almost 37% in 1999 to about 24.5% in 2010.
– Narcotic drug use increased from about 19% in 1999 to about 29% in 2010.
– Physician referrals increased from about 7% in 1999 to 14% in 2010.
– Scans, such as computed tomography (CT) or magnetic resonance images (MRIs), rose from about 7% to about 11% during that same period.
– Physical therapy remained unchanged at about 20%; X-rays remained unchanged at about 17%.

“With health care costs soaring, improvements in the management of back pain represent an area of potential cost savings for the health care system while also improving the quality of care,” the study says. So why are doctors using these types of treatments? “Patients expect doctors to have some kind of magic cure, and so doctors want to offer them something,” Landon says. “Often it’s easier to offer them something rather than explaining why more aggressive treatments and testing won’t make them better in the long run.”
Donald Casey Jr., a clinical professor of medicine in the department of population health at New York University School of Medicine, who wrote the accompanying editorial, says there are a lot of different reasons for the findings, including the fact that there are 183 different guidelines just for treating low back pain. “A well-constructed clinical practice guideline doesn’t always give you the exact treatment for every single patient every time. But it should give physicians guidance about which treatments are most likely to work best for most patients.”

 

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What is a Physical Therapist?

Physical therapists (PTs) are health care professionals who treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives.

PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

Physical therapists provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a physical therapist practices.

The Physical Therapy Profession

Physical therapy is a dynamic profession with an established theoretical and scientific base and widespread clinical applications in the restoration, maintenance, and promotion of optimal physical function. For more than 750,000 people every day in the United States, physical therapists:

•Diagnose and manage movement dysfunction and enhance physical and functional abilities.
•Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
•Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.

The terms “physical therapy” and “physiotherapy,” and the terms “physical therapist” and “physiotherapist,” are synonymous.

As essential participants in the health care delivery system, physical therapists assume leadership roles in rehabilitation; in prevention, health maintenance, and programs that promote health, wellness, and fitness; and in professional and community organizations. Physical therapists also play important roles both in developing standards for physical therapist practice and in developing health care policy to ensure availability, accessibility, and optimal delivery of health care services. Physical therapy is covered by federal, state, and private insurance plans. Physical therapists’ services have a positive impact on health-related quality of life.

As clinicians, physical therapists engage in an examination process that includes:

•taking the patient/client history,
•conducting a systems review, and
•performing tests and measures to identify potential and existing problems.

To establish diagnoses, prognoses, and plans of care, physical therapists perform evaluations, synthesizing the examination data and determining whether the problems to be addressed are within the scope of physical therapist practice. Based on their judgments about diagnoses and prognoses and based on patient/client goals, physical therapists:

•provide interventions (the interactions and procedures used in managing and instructing patients/clients),
•conduct re-examinations,
•modify interventions as necessary to achieve anticipated goals and expected outcomes, and
•develop and implement discharge plans.

Physical therapy can be provided only by qualified physical therapists (PTs) or by physical therapist assistants (PTAs) working under the supervision of a physical therapist.

Source: Guide to Physical Therapist Practice, 2nd Edition (2003)

 

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