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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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Stay Away from the Market when you’re Hungry…

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If you need to stop by the market on your way home from work, eat a healthful snack first to avoid splurging on high-calorie items.
Dropping by the grocery store on your way home from work? Here’s why that could make it harder for you to maintain a healthy diet: Research shows that even short-term food deprivation (like the hours between lunch and quitting time) is enough to make you buy nutritionally bankrupt food. A better time to shop: after you’ve already eaten. If you know you’re stopping by the market on your way home, be sure to have a healthful snack first. Keep a small fruit bowl on your desk, or stock some nuts, sunflower seeds and dried fruit in your drawer. Other good choices to keep in the office fridge: baby carrots, hummus, no-fat string cheese and no sugar added Greek yogurt.

 

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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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Don’t Forget to Neglect Strength Training!

cleveland clinicWalking every day? Good for you! But don’t neglect strength training, which helps preserve muscle and improve balance.
When it comes to preventing health problems, exercise is one of the best medicines we have. It eases anxiety, lowers stress, stabilizes mood, and improves body image and self-esteem. It also helps with hot flashes, back pain and depression. Still, only 20 percent of U.S. adults get even less than the optimal recommended aerobic and muscle-strengthening exercise by U.S. Centers for Disease Control and Prevention. Though we’re making progress with aerobic exercise — nearly 52 percent of Americans meet the weekly, but in our opinion still minimal, guidelines of 150 minutes of exercise — only 29 percent of us make strength training a priority. Wondering why you have to do strength training if you’re already walking 150 minutes each week? Strength training helps preserve and build muscle; you otherwise lose one-half of one percent each birthday. Having more muscle also helps you burn calories, which keeps weight under control. It also improves balance to keep you injury-free, and it maintains bones, which can reduce the risk of osteoporosis, says Melissa Hendricks, MEd, manager of the Cleveland Clinic fitness centers. “I think the biggest obstacle I see for Cleveland Clinic employees is that they simply don’t know what they should be doing,” says Hendricks. “And weight rooms can be very intimidating places!” The good news is that you don’t even have to set foot in one to get a good workout. To get started, try these moves, which are perfect for beginners and require nothing more than your body and a set of dumbbells.

Original Post from Cleveland Clinic

 

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Customer Review: Way to go Tenaya Clinic!

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Congratulations to the Tenaya Clinic Team!

Casey was excellent. Actually, I had seen her last year and was very happy with the treatment so I asked my doctor to recommend me to go back to her at Matt Smith. Also, I have seen Tyler for foot therapy and so far I am very pleased. Both are professional.

Casey is an asset to your company and the standard of care has been excellent both times.

 
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Posted by on July 10, 2013 in Clinic Reviews

 

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Get Your Vitamin D3 Levels Tested

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Get your vitamin D3 levels tested. Proper amounts will help your body absorb the calcium you need and reduce your risk of disease.
Vitamin D3 may be calcium’s best friend. Without it, calcium has a really tough time being absorbed into your bones. Besides being essential for bone health, research suggests that vitamin D3 also helps slow the progression of arthritis, hypertension, kidney disease, atherosclerosis (a cause of heart disease and stroke), wrinkles, memory loss, and even impotence. It may also decrease the incidence of several cancers. Do yourself a favor and pop your D3 with healthy fats such as fish, olive oil and avocados. Or spend 10 minutes in the sun. Michael Roizen, MD, the chief wellness officer at the Cleveland Clinic, recommends that you start with 1,000 IU of supplemental vitamin D3 if you’re younger than 60 and 1,200 IU if you’re over 60. Then get your levels checked to make sure they fall into the desired range.

Excert from the Cleveland Clinic Daily

 

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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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