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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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Perk Up Energy, Reduce Stress and Alleviate Pain

Here’s how to perk up your energy, reduce stress and alleviate pain: Focus on taking deep, slow breaths.

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Paying attention to your breath — how fast, how deep — can help boost your energy, calm you down, lower your stress, and even help you feel less pain. Often called “belly breathing,” yoga’s three-part breath is one of the easiest ways to reap several different health benefits. This exercise will be most effective if you are lying on your back, either on the floor or on your bed.

Place your hands on your lower abdomen. Relax and take a couple of breaths. Just observe what happens in your body while breathing as you normally do. Now, think of taking a deep breath and expanding the area beneath your hands; it should feel as though you’re inflating a balloon deep in your belly. On the exhale, think of bringing your navel back toward your spine to empty your lungs. Feel your hands rise and fall as you inhale and exhale. Next, place one of your hands on your chest while keeping the other on your belly. Take another deep inhale and let some of that expansion reach your chest. You should feel both hands move — one on your belly, one on your chest. Exhale from your chest first, and then your belly. Repeat a couple of times and observe what happens with the movement of your body. Lastly, move the hand on your chest up above your heart. Inhale once again, this time expanding into the belly, the chest and then the upper chest. You should notice your breathing has slowed considerably, and you might even feel a bit light-headed. On the final exhale, empty your breath from the upper chest first, proceeding all the way down to your lower abdomen.

Because we don’t get air into the deepest part of our lungs, we have to breathe faster and more frequently in order to get enough. This shallow, fast breathing activates your fight-or-flight nervous system response, which can make you feel more anxious and stressed. Consciously slowing and deepening the breath turns off that stress response and leaves your mind and body feeling refreshed, calm and focused. — From Judi Bar, yoga program manager at the Cleveland Clinic, and Sally Sherwin, certified yoga instructor.

source:cleveland clinic

 

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Congratulations to Melissa Anderson, PT & team Seven Hills

Congratulations to Melissa Anderson and Team Seven Hills for receiving this compliment from one of your patients. Thank you for being such great examples of our company standards!

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“I had been having a stiff neck for a long time. After consulting with our neurologist, she suggested I go to physical therapy. She said there are various places in the area, but so often it comes down to personal preferences. Since we have used Angie’s List several times for finding other services (and have been extremely pleased), I read the reviews of Matt Smith’s office and felt this would be a good choice. They have various locations in the valley, but I chose one closest to my home – Near 7 Hills and St. Rose in Henderson. Melissa Anderson was my therapist and she was incredible from the beginning.

Melissa Anderson took a lot of time evaluating me and asking questions. (There are several physical therapists in that office – and from my observation, they all seem very competent)….I happened to be assigned to Melissa. It is busy office (can get noisy at times), but all the staff are working and monitoring you. After showing me the exercises that I need to do on my own, as well as in the office, they work through some of the equipment with you. The one thing that impressed me the most was what a clean environment they are working with and how they maintain that level of cleanliness. It is a very friendly office – all types of physical therapy issues are being addressed from (primarily) teenagers and “on up” in age. You get to know all of the staff (and they get to know you on a first name basis). Melissa (as the physical therapist) did the hands on work (massaging my neck)….and working it to stretch. I know I have made tremendous progress and would not hesitate to go to their facility for physical therapy in the future.
As I mentioned, this is a friendly office….there are a lot of patients going in and out. Sometimes, it can get a bit noisy, but it is a “fun” atmosphere. Going through physical therapy is not fun…..but they make it as pleasant as possible. Highly recommend this facility.”

 
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Posted by on October 1, 2013 in Clinic Reviews

 

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Congratulations to Ed Dolegowski, PT and Team Tenaya!

Congratulations to Ed Dolegowski and Team Tenaya for receiving this survey and compliment from one of your patients. Thank you for being such great examples of our company standards!

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“I love this office. Everyone in your office is very friendly and kind i love going there it feels like home away from home. Love it. Especially Mr. Dolegowski he is so funny and warm hearted .Keep up the great job. And your staff they are awesome.”

 
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Posted by on September 30, 2013 in Clinic Reviews

 

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Physical Therapy is Conservative Care

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As an adult, you have most likely experienced back pain at some point in your life. Given its frequency, one might assume the health care system adheres to the most current guidelines that call to treat the condition conservatively, with over the counter pain medication and physical therapy. But a recent study from the Journal of the American Medical Association (JAMA) suggests that back pain is often being over-treated with referrals to specialists, orders for expensive imaging, and prescriptions for pain medication. In our most recent episode of Move Forward Radio, we discuss the findings of this study and provide tips for avoiding back pain. http://bit.ly/1gy4V0p

 

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New Research says, “Some Brains May be Hard Wired for Chronic Pain”

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Structural differences in the brain may be one reason why one person recovers from pain while another develops chronic agony, a new study suggests. Researchers scanned brains of 46 people who had lower back pain for about three months, and then evaluated their pain four times over the following year. About 50% of the patients recovered during the year; the other half continued to have persistent pain throughout the study.

Looking back at the brain scans, researchers found structural differences in the brains of people who recovered compared with people who developed chronic pain. The differences were found in the brain’s white matter, which consists mostly of long connections between neurons and brain regions. Specifically, the differences lay in the connections between brains regions thought to be involved in pain perception, the researchers said.

“We may have found an anatomical marker for chronic pain in the brain,” study researcher Vania Apkarian, professor of physiology at Northwestern University Feinberg School of Medicine in Chicago, said in a statement. Such structural differences most likely exist independent from the incident that triggers back pain, and may mean that some people are more susceptible to developing chronic pain, the researchers said in the study, which will be published in the October issue of the journal, Pain.

Most people who suffer pain after an injury eventually return to a healthy state. However, some continue to suffer long after the injury has healed. It is not clear what mechanisms drive the transition from acute pain to chronic pain, which may persist for years. In the study, the researchers used a brain imaging technique called diffusion tensor imaging (DTI), which measures the integrity of the brain’s white matter. The results were further confirmed when the researchers compared the study participants with additional groups of people. They found that the white matter of patients with persistent pain looked similar to a third group of people who also suffered from chronic pain. In contrast, the white matter of patients whose pain did not persist looked similar to the white matter of healthy people.

To test the strength of the relationship between brain’s structure and chronic pain, the researchers looked at whether the brain differences shown in the initial brain scans could predict whether patients would recover or continue to experience pain. They found that the early brain scans predicted whose pain would resolve and whose pain would persist one year later.

“We were surprised how robust the results were and amazed at how well the brain scans predicted persistence of low back pain,” Apkarian said. “Prediction is the name of the game for treating chronic pain.”
The findings suggest that brain’s structural properties are involved in chronic pain, and more extensive studies are needed to understand the role of white matter integrity in chronic pain, the researchers said.

 
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Posted by on September 18, 2013 in Did You Know..., Journal Articles

 

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Mean People….Just Stay Positive

CC_Wellness TipTo deal with mean people, “Stay positive and courteous,” says mind-body coach Jane Ehrman. “Fighting back only fuels the problem.”

From rude coworkers to short-tempered bosses to impatient drivers, mean people do make an appearance now and then. As we all know from experience, being the recipient of someone else’s antagonistic behavior can really bring us down, even on an otherwise great day. Research shows that a negative interaction has a five times greater impact on us than a positive one. In other words, it takes five good things to offset just one bad thing. So how do you keep a mean person from ruining your day? Instead of attacking back, kill that meanie with kindness. And treat yourself with kindness too. Sometimes we don’t want to admit that someone has gotten under our skin. Instead of denying your hurt feelings, acknowledge them.

As for the other person, try to see past their actions. “Mean-spirited people are unhappy, to say the least. Inside they are hurting, living out of fear, insecurity and anger. They don’t feel good about themselves or their lives, so they lash out at others,” says Jane Pernotto Ehrman, MEd, mind-body coach and behavioral health specialist at the Cleveland Clinic Wellness Institute’s Center for Lifestyle Medicine. “Mostly, it isn’t about you, it’s about them. Recognizing that there are underlying issues can make it easier for you to respond with compassion and understanding. Take the high road and respond with kindness.” After all, while you can’t change another person’s behavior, you can change your reaction to him or her. Being kind to someone who has hurt you may inspire that person to see the good in themselves as well.

 

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Deep Tissue Massage too Expensive? Try a foam roller instead…

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Can’t afford a deep-tissue massage? Use a foam roller after your workouts to increase circulation and ease knots in all your muscles.

Ever wondered about those foam logs you see people rolling around on at the gym? They’re called foam rollers, and they’re an effective — and inexpensive — addition to your workout. Used as part of a warm-up, rolling improves circulation and gets the body ready for movement. It also helps with recovery after your workout. Like a deep-tissue massage, foam rollers help break up knots that tighten your muscles, helping you stay injury-free. Use them to loosen up tight areas in your quads, calves or outer thighs.

“The basic technique for using a foam roller is to slowly roll the targeted area over the foam roller. Once you hit a trigger spot, hold at that spot for a few seconds, slowly working yourself away from the spot,” says Melissa Hendricks, MEd, manager of the Cleveland Clinic Fitness Centers. “Use a foam roller with caution,” advises Hendricks. “When you hit the trigger spots, they can be very painful, and sometimes the foam rollers can cause mild bruising. Have a physical therapist show you how to properly use the roller when you’re trying it for the first time.”

 

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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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Consider Physical Therapy if you still have Pain

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YOU SHOULD CONSIDER PHYSICAL THERAPY…

You injured your back, your knee or your wrist. You’ve gone to the doctor who suggested rest, anti-inflammatories and perhaps a brace. However, even after time has passed, you’re still having pain. Have you considered physical therapy?

Physical therapy may sound like it’s just for recovery of major musculoskeletal surgeries like a knee replacement or after a stroke, but in reality physical therapy can help even in situations that seem less serious. Physical therapy can help anyone return to their optimal level of functioning who have suffered an injury, developed weaknesses or have muscle & joint imbalances.
Physical therapy can help with the reduction of pain using a variety of techniques. Many PT’s use evidence-based techniques and “hands on therapy” to release restricted muscles. They can locate and work on trigger points, which may be referring pain to other areas of your body.

Pain often continues after an injury due to weaknesses developed in the muscle groups that were affected, long after the muscle has actually healed. Often, other muscles are being overworked to compensate, creating more or different pain. Physical therapists can isolate and determine specifically where those weaknesses are and develop an exercise plan to help those areas regain their strength. Therapists can guide you through proper movement allowing your body to relearn what it feels like to once again move correctly. Physical therapy may also help you avoid surgery. As you strengthen and stretch particular muscle groups you may no longer need surgery. If you and your physician find you do need surgery, physical therapy will help get those muscles as strong and flexible as possible beforehand so you will have a faster, less painful recovery.

There are a variety of types of physical therapists with more expertise in a particular areas. Patients who have had a heart attack may see a cardiac rehab therapist, those with hip or knee replacements may see an orthopedic physical therapist. Certain physical therapists only work with children while others primarily work with seniors. There are also PTs in the area of woman’s health, helping women with pelvic pain issues or incontinence problems.

Resources are available to help a physical therapist to suit your needs. Ask friends who have had physical therapy if they would recommend their therapist to you. Some physicians have physical therapists they prefer to work with and will often refer to those particular clinics.
Call the physical therapy clinic and ask about a therapist’s experience working with patients with your type of issue. The office staff can also verify whether or not your insurance will cover the physical therapy and how much you will be responsible for with each visit.

Physical therapy is definitely worth a try for chronic problems that have not improved with other treatments. Ask the PT how many visits it should take before you would see some progress. The PT and your physician will develop a plan that works for you!

Sources:
10 Ways Physical Therapy Can Help. Lehigh Valley Health Network. Retrieved July 7, 2013.
http://www.lvhn.org/wellness_resources/wellness_articles/healthy_living/…

Physical Therapy. Teens Health from Nemours. Retrieved July 7, 2013.
http://kidshealth.org/teen/your_body/medical_care/pt.html

American Physical Therapy Association.
http://www.apta.org

“Find a PT”
http://www.apta.org/apta/findapt/index.aspx?navID=10737422525

 

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