Near the top of the list of reasons to give the “boob tube” the boot was a desire to reduce our exposure to advertising. I’ve often agreed with what the early 20th century comedian and social commentator, Will Rogers, said about advertising. “Advertising is the art of convincing people to spend money they don’t have for something they don’t need.”

Of course as the owner of a small, home-based business, I understand how important advertising can be as a way to inform and educate the public regarding what is available.

Over the past few months I’ve seen several advertisements that have drawn my interest. The common thread was, at the start of each, they could have been advertising the services of a physical therapist. But alas, they were not.

One advertisement offers those with arthritis the opportunity to move better with less pain. It was a pharmaceutical company. It seemed that all the benefits physical therapy would confer to a person with arthritis could be had by taking a pill. How can I compete with that? Easily. All I had to do was look at the remainder of the ad- the part that lists all of the things that can go disastrously wrong as a result of taking the medication: serious skin reactions; stomach and intestine problems; heart attacks; stroke; and even death.

Physical therapy empowers people to move better with less pain and without all the negative side effects! In fact, physical therapy has many positive side effects: improved overall wellness; improved mood; and even improved relationships with loved ones.

Another advertisement asks if you have fallen in the past year. If so, you can have Medicare pay for a motorized scooter. The message is that if you have fallen and are thereby at risk for falling again you should walk less and sit more!

How many people who obtain a scooter become dependent on it for mobility and weaker as a result? How many people weigh the option of a course of physical therapy to improve their safety and mobility?

Physical therapy can often prevent those who are at risk for falling from suffering a catastrophic injury, all while improving strength, mobility, and their ability to perform enjoyable activities.

Last but not least, there is the “I’ve fallen and I can’t get up” cadre of commercials. These advertise home alert monitoring that allows people to call for help when needed. I have no qualms with these services. I have no doubt that they have brought needed aid when otherwise a person may have struggled alone for hours if not days due to injury. I have no doubt that they have saved many lives.

However, these commercials do not address the fact that so many falls are easily preventable. Take a look at our past blog, Autumn Thoughts on Fall Prevention, for ideas of things you can do to keep from falling. Better yet, if you are concerned that you or a loved one may be at risk for falling, call and schedule a free Falls Risk Assessment.

I urge you to consider physical therapy as the first choice in your quest to move better and feel better. In many cases, physical therapy can improve your mobility and motion, reduce pain without medication, and even help you avoid surgery! Remember, it’s your body and your choice.

Most states allow for direct access to a physical therapist, meaning that a physician’s referral is not needed. You may find a Physical Therapist through the APTA’s “Find a PT” link. Medicare and some insurance companies do require a physician to certify a physical therapy plan of care; however, the majority of commercial insurance companies do reimburse for physical therapy services without a referral.

Heat is an analgesic, meaning that it will block the perception of pain. A few years ago, products providing low level heating that can be worn for several hours during the day became popular. These products can be used while being active. They have been shown in clinical studies to provide some good benefit.

Ice is an anesthetic and an anti-inflammatory. While heat blocks the perception of pain, ice blocks all sensations.

Due to its anti-inflammatory properties, the use of ice is recommended for the first few days following injury. (There is concern that heat can cause an increase in inflammation. Therefore, its use during the first few days after injury is not recommended.) A simple rule of thumb is this…if it is bruised or swollen, do not use heat. Use ice instead.

I recommend the use of an “ice massage”. Simply fill a disposable insulated cup with water and freeze it. (Some thin cups will tear as the water expands when it turns to ice…in that event, put ice cubes in the cup and top it off with water.) Tear the top of the cup off, exposing the ice. Apply it directly to the involved area. Move the ice over the area. Do not keep it stationary.

The first thing you will notice is…it is cold. Yes, ice is cold. Very cold. It is…ice cold. My advice to you is to bear it for the first few minutes, because after a while it will not feel cold. Instead, it will burn. (I know that doesn’t sound like much of a tradeoff.) My advice is again to bear it, because after a few more minutes the area will get numb. This is the effect you are looking to create. It typically takes eight to ten minutes to achieve this. Your skin should show a bright pink hue. It should be extremely cold to the touch. (Don’t give yourself frostbite!)

Regularly icing an inflamed body part will reduce the inflammation and thereby reduce the pain, beyond just the temporary numbing effect that ice offers. This can be effective for both acute inflammation, as in an ankle that has ballooned up due to a sprain, or chronic inflammation as can occur with tennis elbow.

To most of us the holiday season is all about faith, tradition, fun, and family, but if we’re not careful, the holidays can also be a pain in the neck—literally! Typical holiday activities, such as shopping “till you drop,” lifting heavy boxes and presents, and countless hours of cooking and baking, can cause muscles to work harder than usual, many times resulting in neck, shoulder, and back pain. 

This holiday season Paul recommends taking precautions—from distributing the weight of shopping bags equally on both sides of your body to lifting boxes carefully—in order to keep aches and injuries at bay.

“The added demands of the holidays stress the body, which may increase the risk of injuries related to the extra activities,” says Paul. “Using proper body mechanics can help prevent muscle and joint discomfort this holiday season.”

Lifting

• Test an object’s weight before attempting to lift heavy packages or luggage. Try pushing it with your foot. If it seems too heavy then take smaller loads, which are less likely to strain your back and are easier on arm and shoulder muscles.
• Keep the load close to your body when lifting.
• Ask for help or use an assistive device to lift heavy objects.
• Seek help from a physical therapist if your back pain lasts more than a few days or gets worse.

Shopping Without Dropping

• Distribute the weight of shopping bags equally on both sides of your body.
  
• Consider carrying a small backpack rather than a heavy purse.
• Wear comfortable shoes; carrying packages while wearing high heels on hard surfaces can contribute to foot and ankle injuries.
• Don’t carry overstuffed shopping bags for extended periods.
• Consider using a shopping cart or getting help to carry packages to your car.
• Make frequent trips to the car to drop off purchases.
• Avoid prime shopping times to decrease wait times that can increase or exceed standing/walking time tolerances.
• Plan your shopping trip ahead of time. Having a set list of gifts you intend to buy will help you plan for extra help, if needed, to carry purchases.

Baking

• Choose a work surface that is approximately at the level of your forearms when your elbows are bent at a right angle (90 degrees) or at elbow height. Shoulders and upper back will be in better position and this will decrease the risk of upper back, neck, and shoulder strain.
• Work on a padded surface.  If you have tile, vinyl, or wood flooring, for cushioning consider purchasing an inexpensive area rug  that has grippers on the back to keep the rug from moving and you from slipping or tripping. Standing long periods on a hard surface can lead to muscle fatigue and back ache.
• Use good lifting mechanics when retrieving small kitchen appliances from lower shelves or drawers. Kneel down if necessary and keep the object close to your body.
• Be careful when bending to take items in and out of a conventional floor-model stove.
• Frequently perform gentle movement exercises to keep the muscles in your neck and shoulders loose.

Did you know that falls are a leading cause of injury among older adults?

The physical changes and health conditions which occur as one age can put one at a higher risk for taking a tumble.  While falls are a common problem among the seniors, falling is NOT a normal part of the aging process.  

Answering yes to either of these questions is a risk factor for falling:

Have you fallen in the past year?
Have you stopped doing your normal activities because of a fear of falling?

A simple Fall Risk Assessment can determine if you are at risk for falling.  If this assessment shows a risk for falls, your physical therapist can recommend a Fall Prevention Program of balance, flexibility and/or strengthening exercises and awareness training to improve your safety and lessen your risk for falls.

During the Fall Risk Assessment:

• You will be asked about your health history.  Some health issues, such as disorders of the eye or ear, joint pain, and muscle weakness may increase your risk for falling.
• You will be asked about your history of falls. Be prepared to give as many details as possible, including where, when, how and how many times you’ve fallen.  Are there times when you’ve almost fallen but someone caught you or you were able to grab hold of something to steady yourself?
• You will be encouraged to review your medications with your physician or pharmacist.  Certain medications may have side-effects that could put you at a higher risk for falls.
• You will be taken through a standardized balance assessment.  The Berg Balance Scale is a series of 14 tests. The tests start out easy, and they become progressively more difficult. Each test is graded on a 5 point (0-4) scale. The test scores are totaled, giving an assessment of your risk for falls.

Even though a Fall Risk Assessment is a fairly simple procedure, often taking as little as 15 minutes to perform, it offers very accurate results.  You may have excellent balance while performing some parts of the test, yet struggle with other parts.  Or you may have few issues with balance, yet have difficulty with environmental hazards or footwear.  Information gained from the assessment allows your physical therapist to know exactly how to help you.

A Fall Prevention Program can be developed to focus on your areas of need.

A Fall Prevention Program may include:

• A carefully monitored custom exercise program that tailors activities to your specific needs, such as exercises that improve balance, flexibility, muscle strength and/or the way you walk.
• A plan for increasing your environmental awareness by encouraging habits such as scanning your area, thinking about where you are going and how you will get there, locating obstacles and assistance, and planning your route.
• A footwear assessment.  High heels, floppy sandals or slippers, or shoes with slick soles can increase your risk for falling.  Walking around in your stocking feet can also pose a risk.  Proper footwear is imperative in the prevention of falls.
• Removing hazards from your home and/or work area.  Start by removing clutter and keeping walkways clear.  Make sure loose cords are kept away from traffic areas.  Secure loose rugs with double sided tape or, better yet, remove rugs entirely.  Have loose floorboards and handrails repaired.  Store commonly used items within easy reach.  Immediately clean spills, and use non-skid floor cleaners.
• Always insure you have proper lighting and keep your home brightly lit.  Place night lights in your bedroom, bathroom and hallways.  Have a lamp within easy reach of your bed.  Be sure to turn on lights before going up or down stairs.  In case of power outages, store flashlights in multiple, easy to find places.
• Your physical therapist may suggest assistive devices, such as a cane or walker to keep you steady.  Hand rails for both sides of stairways are often useful.  The addition of nonslip treads for bare wood steps can help reduce the risk of falling.  Other items such as raised toilets, grab bars and/or sturdy plastic seating for shower or tub, and a hand held shower nozzle for bathing while sitting down can help to increase your safety.

Movement helps us to stay healthy.  It becomes even more important as we age, allowing us to maintain independence with our daily activities.  Your physical therapist can help you brainstorm other fall-prevention strategies and ways to keep you moving safely.

Many of Cedar Hill Physical Therapy’s patients have found improved confidence as a result of our Fall Prevention Programs.

Life moves.  Move with it!

Sue Stovall, PT, DPT spoke about Passion, Professionalism, and Prostitution.  Yes, you read that correctly.

I looked for myself in all three areas.

Sue’s main passion is for her beautiful family, who I had the pleasure of meeting. (Well, I met most of her family. She didn’t bring Barry Ollama or any of her other farm animals. Angie and I are looking forward to meeting them some time soon.)

Sue is also passionate about her profession.  Just ask her patients and they will tell you that their quality of life is of the utmost importance to Sue.

When Angie and I married, in our vows I spoke of the passion that is in our relationship. We love spending time together.  Whether it’s kayaking in the Caribbean or taking long walks with our dog Sadie, we truly enjoy each other’s company.  This was a key factor in our decision to open our own business.

Working one-on-one with patients is also a passion of mine and the reason I entered the field of physical therapy.  The importance of focusing on each patient as an individual was key in the development of Cedar Hill’s care philosophy.

Sue spoke of professionalism.  Not only does it involve developing the necessary skills and attitudes to help your patients, it is also about giving back to the profession, sharing your knowledge and experience.

I couldn’t help but smile inside. I saw where sharing my knowledge and skills with those who came to my presentation fit into one of her definitions. After listening to her speak, I am also inspired to do more pro bono work.

But what about the other thing, that “oldest profession” thing?!  Well, I’m getting to that.

I first met Sue at a time when I was working for a physician owned physical therapy service. I found myself frustrated being employed by people outside of my profession.  I was asked to work in ways with which I disagreed. The practices that I objected to, increased patient volume, dividing my time between multiple patients, and delegating treatment to aides, would have brought my employers greater profit. They would also decrease the time that I could spend with my patients. This type of working environment is what Sue described as prostitution.

Not the common definition of the word.  I believe that Sue was speaking more so of the state of being prostituted; debasement; the lowering of quality or character.

Due to the rise in physicians who employ physical therapists or refer patients to PT clinics in which they have a financial interest, physician self-referral has come under increasing scrutiny.  The American Physical Therapy Association (APTA) refers to this practice as “referral for profit.”

The APTA has long opposed this practice.  As Michael Weinper, MPH, PT, president of a national network of independent rehabilitation providers, states, physician self-referral poses “an inherent conflict of interest which impedes both the autonomous practice of the physical therapist and the fiduciary relationship between the therapist and patient.”

What does physician self-referral mean for the public?  Multiple independent studies have shown that referral for profit often leads to:

• Unnecessary procedures and/or services.
• Compromised quality of care with staff not trained and licensed as physical therapists or physical therapy assistants.
• Higher costs for consumers.

For more information, please see Referral for Profit Drives up Health Care Costs.

What can the average person do to combat this problem?

• Question the necessity of tests and procedures.  Ask your physician, surgeon, and or therapist to explain the necessity.  If it is not a matter of life or death, you may even want to ask for a second opinion (and not from someone in the same practice).
• Know that in NC a physician referral is not needed to seek help from a physical therapist.  If you have aches and pains or difficulty with movement, you have direct access to physical therapy.
• Know that you have a choice in the physical therapist you see.  Your physician should give you several choices in whom you may see, and be able to explain why that particular therapist would be a good match for you.
• Research the physical therapists and clinics in your area.  Not all PTs are created equal and neither are all PT clinics.  PTs may have advanced training in a particular specialty area.  Some clinics are larger and more gym like, while others are smaller and more relaxed.
• Urge your legislators to support health care reform that will strengthen Stark II referral-for-profit regulations.

Our profession is a strong one, rooted in the practices of Hippocrates and Galenus.  We have long answered the call to help people feel better, move better and live life to its fullest.

Sue is one of many physical therapists working hard to preserve the integrity of our profession.  Shortly after I first met Sue, I spoke with her about my plans to start my own private practice. She was tremendously supportive of my endeavor. My wife and I visited her in Southern Pines. She shared with us her insights, and I found her time invaluable.

I gave Sue a big hug after her talk at the conference last week. I thanked her for all she has done, and continues to do, both as a colleague, a mentor, and friend.  She told me that people in my situation, therapists moving away from referral-for-profit clinics into a patient centered service, were exactly who she was trying to help.

Now I’m really looking forward to meeting Barry.

Ultrasound assessment of the back muscles.

Over the past decade, I have developed an interest in motor control training and ultrasound imaging for low back pain. I first came across several papers that described its uses in 1997.  I soon saw the potential benefit for the patients with whom I work. The basic science is impressive. The benefits for patients are even more so.

In order to learn more about the subject, I’ve spent a lot of time studying and a lot of money traveling to and attending courses.  I’ve had the privilege to learn from leading practitioners in the field, including world renowned researcher Dr. Paul Hodges.

Over the past several months, I’ve spent even more time attempting to condense my knowledge on the subject into an 8 hour presentation for the North Carolina Physical Therapy Association (NCPTA) Fall Conference.

In the past, I have spoken in public, and, in the past, I have experienced anxiety related to this. I feared having a similar response. My biggest fear was going through all my material too quickly and being left with hours of class time and nothing to present!

It's the multifidus conga line!

My fears were relieved after my first hour of speaking when, due to participants’ enthusiastic questions, our discussion encroached into our break time.  I finished the conference feeling good about the material presented, and even had a few more hours of material “in reserve”!  Participants left with hands-on laboratory experience and a nice introduction to a “cutting-edge” technique (without the cutting) in the treatment of low back pain.

The group that I presented to was small. Initially, I was disappointed to see that only a handful of people signed up for my class. Dee Daley, the president of the NCPTA, was reassuring.  She talked about how my topic was at the forefront of physical therapy for low back pain and that those who attended my class were “early adopters” of a new technique.

I decided to look at it as a better learning opportunity for those in attendance. I would

Ultrasound assessment of the abdominal muscles.

be able to give them more attention. It has been my experience to attend a PTseminar and be one of a large group of people vying for the instructor’s time and feedback, wondering if I was performing the techniques shown correctly. That would not be the case in my class! I was happy to hear my students expressing the same sentiment.

I was somewhat surprised, and somewhat proud at the same time, when I talked to a UNC Chapel Hill PT student in attendance. The material I was presenting had only been part of class discussions on state of the art techniques in the treatment of low back pain.  His classmates had not had the opportunity to have hands-on experience using imagers.  I asked him to pass on my card to his instructor, in hopes of another speaking opportunity.

I’m extremely proud to be one of only two clinics in North Carolina offering this state-of-the-art therapy.  My colleagues at Alamance Regional Medical Center in Burlington also offer this service.

When I came to the end of my presentation, Dee again reassured me. She encouraged me to present at local NCPTA chapter meetings and to present again at the NCPTA State Conference in a couple of years. More people will have heard about it and be interested in learning.

I left the conference revitalized.  It was an honor to give back to my profession and to see the enthusiasm in my students to learn new ways to help people feel better.

I have never once in my life had such a positive public speaking opportunity, and I look forward to doing it again!

In conjunction with the American Physical Therapy Association, Cedar Hill Physical Therapy has also created a brochure filled with exercises to prevent pain while traveling. The exercises are simple, seated exercises to keep the blood flowing, the joints mobile, and the muscles relaxed. They are also helpful for prevention of deep vein thromboses (blood clots) that can develop due to poor circulation in the legs and feet. For more information download our  In Flight Fitness Guide (287).

Neither the brochure nor the article is intended as a substitute for professional health care. If you have an existing back problem or are at risk for developing deep vein thrombosis, appropriate guidance should be given to you by your physical therapist before any extensive travel. Working as a team, you and your therapist can design a plan to promote movement, prevent pain and make your travel much more comfortable and enjoyable.

Through the McKenzie approach, you gain an experiential education and learn to self-treat your back and/or neck pain.

Remember, not all therapists are created equal. It is important to seek out a well-trained McKenzie practitioner.

For more information on the McKenzie Method and how it works, check out this link to Paul’s article, The McKenzie Method Works (326) which can also be found in the June/July edition of The Guilford County Women’s Journal.

Everyone that I have the opportunity to work with is unique. I constantly find myself trying new techniques in order to bring about the desired results. In this blog I’m going to talk about those techniques which I use to improve follow through with the exercise prescription which is tailored to help the individual to reach his or her goals.

Most people that I see experience pain with movement. One of the surest ways I have found to get a person to perform their exercises is if they can see an immediate improvement as a result of doing them. For example, I recently had the opportunity to help a lady who was experiencing back pain when she climbed stairs. After evaluating her, I took her to the stairs leading into my clinic. I had her to climb them and asked her to make a mental note of how it felt. It was indeed painful for her.

Based on her description of her problem and the results of my physical examination I tested her on exercise that I thought would help to decrease the pain that she was experiencing. After taking her through this exercise we noticed that some of the stiffness she initially presented with had improved. I then asked her to climb the stairs again. I smiled when I saw the curious expression on her face. She was able to climb the stairs with much less pain than she had immediately before performing that exercise.

We had initially planned for her to attend several visits of physical therapy. When she came in for her second follow-up visit she told me that she was ready to graduate, and indeed she was. As it turns out, any time she had a hint of back trouble she did her exercises and her back troubles subsided. I believe that the manner in which I taught her this exercise was instrumental in her understanding that the exercise would decrease her pain and since it was her goal to experience less pain she was committed to its regular performance. Now, it is entirely possible that the first exercise I showed her would not have yielded such a positive result. If that were the case, we would have tried other exercises and treatments until we found what would help her or until we exhausted these efforts.

About half of the people that we see have such a rapid response. Indeed, it is the other half who present with a greater challenge. While the results may not be as rapid, the principle of linking the exercises to a person’s goal remains a key element. When the results are not as rapid, I know that the patient must have confidence in the prescribed treatment in order to take an active role. In order to gain that trust I educate them in regards to how the exercises will be of benefit.

For example, let’s look at a person who experiences pain with picking things up from the floor. Oftentimes for this to be accomplished with a minimum of discomfort it is necessary to lift with the knees. However, in the case of someone who does not have the requisite strength in their legs to perform this task they will not be able to immediately derive a benefit. In that case I would prescribe an exercise program to improve the strength in their legs such that they could be used to lift things from the floor with proper body mechanics.

In many ways, this represents to me the most enjoyable part of my work.