Physical Therapy 1st Option to Treat Low Back Pain

Chances are, you or someone you know has had back pain. Each year 15% of the population has their first episode of back pain, and over the course of our lives, 80% of us will have back pain. Even though back pain is common, the medical community does a poor job managing it. Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too common.  Let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy:

Medication: Low back pain is the #1 reason for opioid prescription in the US, however in 2106, the CDC recommended against the use of opioids for back pain in favor of “non-drug treatments like physical therapy.”

Imaging: Having an X-ray or MRI for back pain is common, however it’s rarely needed or helpful. Research has NEVER demonstrated a link between imaging and symptoms. As we age, degenerative changes on imaging is common. 90% of people age 50 to 55 have disc degeneration when imaged, whether they have symptoms or not. In 2015 a study that looked at 1,211 MRI scans of people with no pain found that 87.6% had a disc bulge.  Just getting an image increases the chances that you’ll have surgery by 34%

Surgery: The US has sky high rates for back surgeries – 40% higher than any other country and 5x higher than the UK. You’d think that with all the back surgeries we do, we’d be pretty good at it but the outcomes are not good! A worker’s comp study looked at a group of 1450 people with similar symptoms: half had spinal fusions and half didn’t. The surgical group had:

  • 1 in 4 chance of a repeat surgery
  • 1 in 3 chance of a major complication
  • 1 in 3 chance of never returning to work again

Physical Therapy: Current clinical practice guidelines support manual therapy and exercise. Research proves that early PT leads to better outcomes with lower costs, and decreases the risk of surgery, unnecessary imaging, and use of opioids. A study of 122,723 people with low back pain who started PT within 14 days found that it decreased the cost to treat back pain by 60%. Unfortunately, only 2% of people with back pain start with PT, and only 7% get to PT within 90 days.  Despite the data showing that PT is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. With direct access, patients can go directly to a physical therapist without a doctor’s referral. If you see your doctor for back pain, and PT isn’t one of the first treatment options, ask for it!

Keep up the Pace: Why Gait Speed Matters

Gait is the medical term for the way you walk and includes not only the mechanics of walking, but the speed as well.

Why is Gait Speed Important?

  • Gait speed is an indicator of your overall health and life expectancy. Improving your walking speed is associated with improved survival rates.
  • Senior walking ability begins to decline past 65. As we age our walking can become slower, less coordinated, less stable, less efficient, and have poor timing. With potential decline in vision and hearing as well as our posture becoming less upright and flexible, it makes it harder for us to respond to our environment when walking.
  • In order to be able to cross the street safely in time before the light changes, you need to be able to walk 1.14 meters/second. People who have a walking speed of less than 1 meter/second have reported ceasing involvement in any regular physical activity
  • You can assess your own gait speed and a program including strengthening, stretching, balance training, postural improvements, and task-specific exercises can ALL help to increase walking speed!

How to Assess your own Walking Speed using the 10 Meter Walk Test

What you will Need: 10 meters of clear space measured. Add a mark at the first 2 meters and then a mark at 8 meters (see below).  You will also need a stopwatch and a friend or family member to help time you (optional)

How to Perform the Test:

  • Perform 2 trials of walking: One at your comfortable walking speed and another at a fast walking speed
  • Begin walking: Start the timer when any part of the leading foot crosses the 2-m mark. Stop the timer when any part of the leading foot crosses the 8-m mark.
  • The time will be measured for the middle 6 meters.
  • You can use any assistive device that you typically use to walk (I.e. cane, walker).
  • Your gait speed will be the time divided by 6 m

Ways to Improve your Gait Speed:

There are 2 primary approaches to improving your gait speed.
1. Address the physical changes that occur in the body as we age. This works on the “machinery” we need to walk. This includes working on strengthening and stability of our legs and trunk as well as flexibility of our joints so our limbs can move efficiently.  A review of research studies showed that resistance training to strengthen lower extremity muscle was the most effective way to improve gait speed.

Exercise Examples
Strengthen muscles of legs -Repeated standing/sitting from a chair
-Heel raises (Standing with support, rising onto toes and then back down)
Improve flexibility in legs -Calf Stretch
-Hamstring Stretch
-Hip flexor Stretch
Aerobic exercise -Cycling, elliptical, treadmill, etc.

2. Train your brain to walk more efficiently. Practice makes perfect – by practicing we restore and improve the brain’s pattern to engage muscles to better meet the demands of walking.

Task Examples
Practice walking -Increase gait speed for short distances
-Walk forward, sideways, & backwards
-Practice walking while carrying objects
-Practice walking in a figure-8 pattern
-Practice walking while counting or to a beat to make walking more rhythmical
Add obstacles to walking -Place objects on floor and practice stepping over and walking around them
Varied surfaces -Practice walking on various surfaces (I.e. grass, carpet, gravel)

A combined and individualized approach always works best! If you have any questions or concerns about your gait or would like advice on what exercises you can do to help, feel free to contact a Physical Therapist at one of our offices to make an appointment. We would love to help you achieve your goals and get you right out of the gate again.

“If you don’t like the road you’re walking, start paving another one”   ~ Dolly Parton

Blog written by Natasha Clarke, PT, DPT

 

Who, Me? Three Factors that Increase Your Risk for Falls

When you were little did you like to think about monsters, thunderstorms, or sharks in the ocean? Unpleasant things are unpleasant to think about. But unlike the boogeyman, falls are a real occurrence and considering your risk for a fall now can save you from one big nightmare later on. Below we discuss three main factors that can substantially increase your risk for falls.  Assess your risk now and keep a potential fall from happening.

Multiple medications lead to massive instability. Sedatives and antidepressants can be culprits as well as seemingly innocent over the counter medications. Dizziness is a common side effect of many medications and can also occur due to drug interactions when taking multiple drugs. Check with your doctor or pharmacist to ensure all medications are necessary and will not interact negatively with each other.

Nerve pain and poor vision could inhibit your body’s natural ability to balance. Do you have poor sensation in your feet or nerve damage courtesy of neuropathy? Those important nerves send signals to your brain telling you how to balance and move reactively to your environment. Without these signals, you are at a higher risk for falls. Vision deficits also heavily contribute to fall risk, as your vision is the largest single sensory contributor to maintaining your balance. Eye care is crucial in preventing a fall.

Poor environment sets you up for disaster. That cute throw rug, poor lighting or a slippery tub could all lead to a fall. Take an honest look around your home environment to see what simple changes you can make to increase safety in your home. If you frequently get up in the middle of the night, a nightlight is essential.  In addition, ensure all electronic cords, books, and decor are out of walking areas prior to going to bed each evening.

If any of these risk factors apply to you, it means you are at an increased risk of falling. But don’t worry! Although some of these factors are beyond your control, there are several actions you can take to reduce your risk for a fall!

Balance and strength (which is necessary for good balance) can be improved, even if vision or sensation is impaired. CLICK HERE to view a video offering 5 easy exercises that you can do at home to help improve your balance (all you need is a chair!).  Please be have someone available to spot you the first time you try these exercises and start slow.

In addition, balance training is offered here at HARTZ Physical Therapy to keep you confident and stable. Our therapists are trained to push you beyond your limits while maintaining your safety at all times. In addition, our balance master is a unique machine that can aid in training you to react to a variety of situations. Free balance screenings with the balance master are available at our Lancaster office on New Holland Avenue. We would love to assist you with your balance goals, keeping you safe without worrying about the possibility of a fall.

Source: “Home and Recreational Safety.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Feb. 2017, www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.

Are you a New Year’s Resolution Newbee, Master or Flunkee?

Turning the page on the new year is a chance to wipe the slate clean—and to be better versions of ourselves. And when it comes to what we want to improve, goals that fall in the health and wellness arena top all other New Year’s resolutions. In fact, three of the top four resolutions in a YouGov poll were health-related:
(1) eat healthier
(2) get more exercise
(3) focus on selfcare, (ie: get more sleep)

There are three types of people who choose a goal from the health and wellness category as a New Year’s resolution: the resolution newbie, the resolution master and the resolution flunkee.  Let’s see which category you most identify with—and how focusing on the right strategy can help you get healthier in the new year.

Resolution Newbie. Maybe this is your first time making a commitment to your health and wellness. Good for you! Did a recent event like a health scare or loss of a loved one make you see the light? Or perhaps you want to be more active to enjoy activities with your grandchildren or to carry your own bag on the golf course. Whatever your goals are, taking that first step is a big one so you’ll want to be sure that you’re prepared for the challenge. Particularly when exercising for the first time or returning to an active lifestyle after a long hiatus, it’s important to have the proper information and tools to be successful. And that means tapping the healthcare resources available to you.  Clinicians like nutritionists and physical therapists can make sure that your body is prepared to take on new challenges and work with you to a design a program that
will help you achieve your goals.

Resolution Master. Perhaps you fall into a different camp: You vowed to get healthy in 2018 and you achieved it! For 2019, your resolution is to continue the work you’ve begun. After all, living a healthy lifestyle is a lifelong commitment; it’s not something you do for a while and then revert back to your former habits. As you prepare to embrace the new year, are there any small tweaks you can make to advance your goals? Maybe you’re thinking about training for and running a half marathon, but don’t know where to begin. A physical therapy evaluation is a great place to start—PTs are trained to assess your movement patterns and identify any limitations or weaknesses. Based on that information, the PT can design a personalized exercise program to help you safely and effectively prepare for the grueling half marathon course.  We have a great option for those who desire personalized care when working out: check out our Medically-Adapted Gym!

Resolution Flunkee. Let’s say your plan for next year is to get in better shape and improve your overall health (we support that resolution!), but this isn’t your first rodeo. Your resolution last year was pretty similar but it’s one year later, and you’re in the same place you were last New Year’s Eve. What stood in your way—was it time? Affordable options? Access to healthy choices and activities? If any of these barriers sound familiar, then along with your resolution, you need an action plan. Without planning ahead, you’ll find yourself staring down the new year with the same goal in mind. But let’s not focus only on the negative—what went right last year? Maybe you made sleep a priority, which in turn helped you to make better food choices at breakfast but
by afternoon, you found yourself choosing to energize with a soda and candy bar when all you  probably needed was an apple and a 15-minute walk. Take some time to think about the previous year—good and bad—and take with you what you need, and leave the rest behind. Afterall, you can’t plan where you’re going without understanding where you’ve been.

So, Which resolution type are you?

Arthritis: It is Not Always the Same Animal

Arthritis is a buzz word coined for joint pain, however rarely is a difference delineated between the two different types of arthritis: Osteoarthritis and Systemic Arthritis. These forms of arthritis stem from different causes and are treated with different approaches. According the Centers for Disease Control and Prevention (CDC), it is estimated that Osteoarthritis affects an estimated 27 million Americans and develops later in life, whereas rheumatoid arthritis affects an estimated 1.3 million Americans and generally develops in patients anytime between the ages of 30 and 60 years old.

OsteoarthritisAs we age, normal wear-and-tear of our weight-bearing joints can often cause pain.  Cartilage is the tissue between joints that provides cushioning between bones and allows for smooth gliding of bones. Repetitive activities place continuous pressure on those same joints which may erode the cartilage. Furthermore, previous injuries that did not heal properly, increase the risk of developing osteoarthritis.  Symptoms include:

  • Joint pain and stiffness usually affecting hands, fingers or knees
  • Joints on one side affected worse than on the other side
  • Morning stiffness lasting fewer than 30 minutes
  • Possible spine and hip pain as well

Systemic Arthritis: Systemic arthritic (also called rheumatoid or psoriatic arthritis, depending on the location of the pain) is triggered by an autoimmune disorder whereby harmful antibodies are produced that attack the healthy joint tissue in patients. The triggering factors for systemic arthritic conditions are thought to be genetic, environmental, hormonal, and even certain lifestyle factors like smoking and obesity. Symptoms include:

  • Joint pain, stiffness, swelling affecting multiple joints
  • Symmetrical symptoms affecting both sides of the body
  • Morning stiffness lasting longer than 30 minutes
  • Additional symptoms like fatigue, fever, and malaise

Common Treatments:

  1. Thorough physical exam: Treatment generally begins with a visit to the family doctor or the physical therapist. A proper physical evaluation combined with the patient’s medical history will help to distinguish the proper course of action.
  2. Imaging: The patient is often required to get medical imaging (ex: X-ray or MRI) performed to evaluate the joint surfaces.
  3. Bloodwork: If signs and symptoms appear to be more consistent with a Systemic Arthritis, the patient is generally referred to a rheumatologist to undergo blood work and evaluation to properly diagnose. Systemic Arthritis generally requires medicinal interventions.
  4. Physical Therapy is generally prescribed for patients with both Osteoarthritis or Systemic Arthritis. Physical therapy can help alleviate stress on joints by increasing flexibility and strengthening muscle surrounding the joint which will ultimately reduce pain.
  5. Targeted Exercise: Believe it or not, a few simple exercises may quickly and effectively reduce pain and improve mobility.

If you think you have Osteoarthritis or Systemic Arthritis, call your physician or physical therapist to get an evaluation; a few simple exercises may be the difference between living with constant pain or doing the things you want to do!

HARTZ Physical Therapy has 4 convenient locations in Lancaster County and most insurances do not require a physician’s referral to be treated.  Don’t live another day in pain! Call today!

Does your Growing Athlete have Knee Pain?

Patellar Femoral Pain Syndrome, otherwise known as PFPS, is common in adolescent athletes especially those who participate in sports year-round. This diagnosis presents itself with generic soreness in and around the front of the knee and/or kneecap. Since most athletes in their teens have growth spurts, their bones grow faster than their muscles. This causes an imbalance with the forces around the knee causing abnormal motion of the kneecap. Typically, this will cause pain with prolonged standing, negotiating stairs and athletic activity in general.

Physical therapy is one of the few avenues available to reduce the pain and accelerate a return to sports with full function. The typical plan of care is as follows:

  1. REDUCE SWELLING: Modalities, such as ice, heat or electric stim can help
  2. INCREASE FLEXIBILITY:  Chances are good that the ligaments surrounding the knee (IT Band, lateral retinaculum) haven’t kept up with the bone growth and are therefore very tight.  As a result, the patella moves laterally (to the outside) when running or walking, creating extra friction, and often pain.  Stretching the tight ligaments allows the knee cap to return to its normal tracking pattern and will reduce pain.
  3. STRENGTHEN WEAK MUSCLES:  As the therapist works to stretch tight ligaments, the patient must also strengthen key muscle groups, such as quadriceps, hamstrings, gluteus medius, gluteus maximus. These muscles help to stabilize the joint which provide increased endurance with sport-related activities and also help to keep the patella moving smoothly.
  4. ADD PLYOMETRICS:  As pain and swelling is alleviated, it is time to introduce a plyometric program, such as agility or sport-specific training.  This is the final step with therapy to help the athlete ease their transition back to his/her sport. This last step challenges the athlete with higher functional tasks in order to simulate game or field conditions. Quick steps, lateral jumps, and ladder drills are just a few of the techniques that a therapist may use to help move a young adult toward reentry to their sport or activity.

Don’t wait and deal with pain! Come in and see a physical therapist today.

What Can be Done about Bunions?

We have all seen them.  The painful looking big toe that is twisted and misshapen, sticking out from a flip flop.  Bunions (or hallux valgus) are the most common problem affecting a person’s forefoot (front of the foot), and can significantly impact the quality of life for those suffering from the problem.  Studies have shown that approximately 23-35% of people are affected by bunions and that those rates increase for individuals over the age of 60.

A hallux valgus deformity typically includes a medial shift (moving towards the inside of the foot) of the first metatarsal joint and a lateral shift (moving towards the outside of the foot) of the big toe.  There has been debate about whether footwear can cause the deformity, however the most common cause of the issue can be traced back to bad genes (yes, blame your parents) and results in biomechanical instability of the joint due to arthritic changes or laxity (looseness) of the ligaments around the joint.

Symptoms include:

-swollen, inflamed tissue around the joint
-mild to severe pain in the big toe
-difficulty tolerating footwear
-pain with pushing off the big toe or rising up on the toes

So, how can physical therapy help?  There are a number of ways that physical therapy can aid in reducing some of the symptoms associated with painful bunions.  First, your physical therapist will be able to provide information regarding footwear and modifications that can be made to footwear.  Certain types of shoes (such as high heels) can make the pain worse by increasing the pressure on the painful joint.   A large toe box, toe spacers, splints, and metatarsal pads are all options that can be used to help alleviate pain.

Secondly, stretching the muscles in the back of the leg can help to decrease the amount of stress that is placed on the foot.  Tightness in the back of the leg can lead to increased pressure on the ball of the foot and can make symptoms more severe.

Finally, moving the joint (mobilization) can help to reduce some of the stiffness found in the joint and can be an effective way to reduce pain.

Unfortunately, sometimes physical therapy is not enough to reduce pain levels and improve motion in the joint, and surgery cannot be avoided.  Following a bunionectomy surgery, physical therapy is an essential part of your recovery to help restore motion to the foot and big toe, and will help improve your gait mechanics so that you can return to the activities that you love.