Positive Attitude: And the Recovey Process
by: Jeff Batsche
In physical therapy, we use a variety of tools for improving patient outcomes. Sometimes what works well for one patient may not be as appropriate or effective for another. However, there is a commonality between successful interventions and functional improvements and that is a Positive Attitude.
Positive Mental Attitude or PMA is the state of optimism or hope in a situation which attracts a positive change. One study of 167 people reports, 94% of the people agree that PMA can aid in recovering from illness and 77% agree PMA can even prevent illness.
It is no wonder that many researchers have shown interest in how our mindset affects so many systems in our bodies, called psychoneuroimmunology. We know the body is composed of millions of chemical reactions happening all the time and that our attitudes affect our chemical make up the reaction processes.
The research strongly supports a correlation between positive attitude leading to positive outcomes and negative attitude leading to poorer outcomes. Many times in the clinic negativity and stress can cause a patients' body to react by changes in vitals, increased stress hormones, decreased sleep, increased tension in tissues, poor posture, and heightened sensitivity to pain.
A study on how expectations impact post-operative improvements states, PMA can affect patient outcomes through, “triggering of a physiologic response, acting to help motivate patients to achieve better outcomes, conditioning the patient psychologically to observe certain types of symptoms and ignore others, changing the understanding of the disease, or acting in concert with anxiety to heighten or reduce symptoms.”
So the next time you visit your physical therapist, remember to approach the treatment with a Positive Mental Attitude and know the recovery process is a process; it takes time. Stay positive!
What is Dry Needling?
by: Dr. Ken Wheeler
Over the last 10-15 years there has been a gradual increase in popularity of a technique called dry needling. It is shared among many different healthcare professions and varies some in technique between providers. The term sounds less than appealing, but has been shown very effective for a variety of neuro-musculo-skeletal conditions, and many people often wonder what it is, why it’s used, and if it works.
The name originates from overseas where occasionally injections are referred to as wet needling, and anytime a monofilament needle is used without medication to affect various tissues it’s referred to as dry needling.
Dry Needling varies slight from traditional Chinese acupuncture due to the underlying theories, diagnosis, and treatments chosen. In traditional Chinese acupuncture the same needles are used, but the goal is to move and balance energy, or Chi, along varying meridians in the body. Although in western practice with dry needling we do utilize many of these same points, our goal is to affect the target tissues specifically in a variety of different ways.
These changes and affects on the tissues can be broken down into mechanical, chemical, and neural changes, both locally where you are having pain or dysfunction, and systemically in the entire body. On a chemical level dry needling helps release a variety of cells and messengers in the blood that combat the pain response. Many of these are chemically the same as pain medication that you take in the pill form, like endogenous (opioids and serotonin). Other cells are brought into the area to help clean up debris and tissue (macrophages), others to trigger a healthy immune response (T cells), and lastly other cells assist by helping lay down new tissues appropriately (Fibroblasts).
Research shows dry needling can affects tissues on a mechanical level as well, stimulating production of new capillary formation, which we call neovascularization, and can with enough use create a lasting change in nitric oxide levels which also represents increased blood flow.
Possibly the most interesting of changes, though, happens on the neurological level. The areas in the brain associated with judging pain responses appropriately as well as interpreting sensation and feedback for resting muscle tone and activation patterns seems to be stimulated at increased levels with needling of certain local and distal points.
All together these tissue changes make dry needling is a fascinating tool, and when used appropriately with a variety of other treatment techniques it can be a huge boost to your recovery and treatment of pain symptoms.
Opioids: A Chronic Pain
by: Dr. Ken Wheeler
Chronic pain, defined as pain every day for at least the last 3 months, affects over 11% of our nation’s population and is the number one cause of first use and continued use of opioid pain medications like hydrocodone and oxycodone among others. It’s no secret that our healthcare system and thought processes about chronic pain need some attention considering the recent call to action on the topic by both our current and previous presidents. It’s interesting, too, that we spend by far more than any other country on healthcare and pharmaceuticals, but our outcomes for improving pain and function are not as high.
One type of treatment for countless pain issues is physical therapy. More than just strengthening and stretching, physical therapy has proven itself over and over again as a way to combat and educate about chronic pain.
Countless studies have shown the positive benefits of being treated by a physical therapist in dealing chronic pain and curbing use or preventing the original need for opioid meds. A very interesting and recent study that made tabloids last month was one by Frogner and colleagues that analyzed over 150,000 health insurance claims from 2009 to 2013.
They found that patients who saw a physical therapist before trying other treatments had an 89 percent lower probability of eventually needing an opioid prescription, a 28 percent lower probability of having any advanced imaging services, and a 15 percent lower probability of making one or more ER visits.
So what does this mean to you? There are a lot of great insights from a study of this magnitude, but the number that stands out the most is 89 percent . Out of 150,000 patients, nearly 90 percent who saw a physical therapist first didn’t have to get pain medicine as strong as opioids…ever. That’s a wild statistic for our nation’s patients, insurers, and those that determine healthcare policy and law.
At RiedPT, we want you to know that if you are struggling with chronic pain, talk with your doctor about referral to physical therapy sooner rather than later. If you or someone you know has an upcoming surgery or had a traumatic injury, remind them of the potential of physical therapy to restore motion, strength, and pain free movements…without the side effects that your risk with stronger pain medications.
Sitting: "The New Smoking?"
by: Dr. Ken Wheeler
The importance of activity and motion in daily life can’t be overstated. At RiedPT we understand the impact that these small changes can make in the recovery of wide range of conditions. Consider a low back pain patient that is struggling with disc pain. Conventional medical advice would tell them to rest, stay off their feet, and minimize movement. Many studies are showing, though, that the pressure applied to the disc and through the lumbar joints themselves is actually increased in sitting positions. In a study by Wilke in 1999, researchers found that intradiscal pressure significantly increased during supported sitting vs standing, and increased again with sitting unsupported (hunched forward).
There are a wide variety of treatments that are appropriate for disc patients to decrease symptoms and improve function, but another part of the recovery over time is dependent upon what you do with most of your hours, movements, exercise, and positions during the day. At first glance it may sound like standing is ALWAYS better than sitting based on the previous study, but this isn’t always the case either. In another study by Callaghan in 2001, researchers compared tissue forces, muscular activation, and load of the low back during different positions. They found that although standing appears to be a good rest from sitting given the reduction in passive tissue forces, the constant loading in one position would probably not provide as much relief for muscular activation levels as one with dynamic movement.
So all that to say…the best position for you is one that is dynamic and always changing. Some sitting, some standing, some stretching, some walking, etc. Your spine (and all parts of your body) benefit from movement in terms of pain reduction, fluid dynamics, blood flow, tissue oxygenation, and calming effects on muscle and nerve tissues. So when your therapist goes over ergonomics and varieties of positions that may help you during your day, remember that they all have a purpose, and when in doubt, get moving.
Tai Chi for Fibromyalgia
by Dr. Meredith Lymer
For years, aerobic exercise was believed to be the most beneficial non-drug treatment approach for fibromyalgia. Now, a recent study has discovered tai chi may be an even more effective physical activity in reducing and managing pain associated with conditions like fibromyalgia.
Tai chi concentrates on relieving the physical and psychological effects of stress on the body. Researchers believe tai chi mind-body exercise improves psychological well being and helps patients with fibromyalgia become more confident in managing their symptoms. Tai chi has also been found to be effective for Parkinson's Disease, COPD, heart failure, and osteoarthritis. It can commonly be recommended for older adults and fall prevention candidates as well.
A recent study published in the British Medical Journal observed a large number of participants over a one year period who participated in tai chi or aerobic exercise for 12 weeks or 24 weeks. They found that participating in tai chi for 60 min a day twice a week for 24 weeks, significantly reduced depression/anxiety and improved sleep and overall health compared to the aerobic exercise group. Even those that participated in tai chi for 60 min twice a week for 12 weeks showed significant improvements over the aerobic group, lasting to the one year mark. All participants in both the tai chi and aerobic groups reported reduced use of medications.
Overall, aerobic exercise and tai chi are both beneficial conservative management approaches for chronic pain conditions like fibromyalgia. Even so, tai chi is generally a slower paced, more mindful form of full body exercise than aerobic exercise. This mindfulness can have lasting effects on the body. If you, or someone you know, has a condition like fibromyalgia, it might be beneficial to check out tai chi to improve overall well-being.
Cancer and Physical Therapy
by Dr. Meredith Lymer
Most of us know that October is Breast Cancer Awareness Month; however, most of us don’t know that approximately 30-50% of all cancer patients experience pain.
More than 200,000 women are diagnosed with breast cancer each year in the US. There are several options for treatment of breast cancer, most involving systemic or global effects on the body, even after the cancer is removed or destroyed. This means that tissues surrounding the breast and other body parts (i.e. shoulder, neck) may be affected by the treatment process causing pain or limited function.
Physical therapy can be beneficial for those with breast cancer before and after chemo, radiation, lumpectomy, or even full mastectomy to restore healthy tissue and improve quality of life. Several studies show using a variety of physical therapy techniques (stretching, exercises, manual treatments, etc) are effective to treat postoperative pain and impaired range of motion after treatment for breast cancer. Physical therapy can also improve posture, increase blood flow to healthy tissues, reduce lymphedema, and review/modify activities of daily living to make them easier or more successful for each patient.
One complication after breast cancer treatment is the formation of lymphedema, which is chronic swelling caused by a buildup of fluid that occurs when the lymphatic system is faulty or damaged. The lymphatic system is a network of vessels that take fluid from the tissues to the blood to be filtered. When the lymphatic system is compromised, this fluid cannot be moved and builds up in the affected area, usually the arm for breast cancer patients. Two of five breast cancer patients will develop lymphedema within five years from mastectomy or lumpectomy.
Luckily, there are specific treatment approaches physical therapists and physical therapy assistants can use to effectively treat lymphedema. Here at Ried Physical Therapy, we have a PTA certified to treat lymphedema. Jeff Batsche individualizes his treatments specifically for those dealing with this condition. If you or someone you know are dealing with chronic swelling, give us a call to set up an appointment to start getting the treatment you deserve.
How Physical Therapists Can Be Primary Care Providers
by Dr. Meredith Lymer
Recent research has shown the United States will be facing a doctor shortage of 120,000 by 2030. This is a problem and how can we fix it?
We can look to the US miltary for some advice. The US miltary has been employing physical therapists as primary care providors for years. They have experience shortages of physicians several times in its history, leading to the development of new models of health care. This new model has been validated through reviews of miltary medicine by The Joint Commission and the National Committee for Quality Assurance.
Primary care providers need to be able to evaluate and manage a variety of conditions and injuries which makes it hard for one speciality to be effecient. Each speciality and type of health care provider offers unique knowledge and expertise, when combined with others, can allow for proper triage of care. In the US military, physical therapists work with physicians, nurse practitioners, physician assistants, and behavioral health care providers to allocate the appropriate care.
Physical therapists have attempted to become civilian primary care providers by progressing the degree from a Masters to a Doctorate. Physical therapy schools have included more education, especially on conditions we can't treat to know when to refer out to another medical professional. Physical therapy schools have also extended the length of clinical rotations to ensure competence when entering the work force.
The biggest limitation in physical therapists becoming primary care providers in civilian life is insurance companies. Medicare does not recognize PTs as primary care practitioners and Medicare tends to set the precident for other insurance companies.
One positive note is that Direct Access has started to spread and pass legislation throughout the country. Direct Access allows people to bipass the doctor's office and go straight to physical therapy. This can eliminate long waits, prescription meds, tests, and other procedures that may not be necessary. Most states have some form of this direct access to care for physical therapy.
The state of Texas is one of the last states to allow for Direct Access. The two bills presented to the Texas state congress were never heard by the Senate or the House due to unwillingness to take a political side on health care. We encourage you to reach out to your representative or senator when the bills go up for a vote in the future.
Blood Flow Restriction Training
by: Dr. Meredith Lymer
Blood flow restriction training, or BFR, is one of the most recent treatment techniques circulating the US. BFR techniques were developed in Japan and have been used by health care professionals and fitness professionals world wide since 1997.
BFR is the technique of adding a band of pressure around the upper portion of arms or legs, in order to reduce venous blood flow leaving the working muscles and reduce the arterial blood flow coming in during low load exercises. The amount of pressure is calculated by acheiving 80% arterial occlusion for legs and 50% arterial occlusion for arms. Even with this amount of occlusion, many research studies have not found any increased risk of blood clots using BFR.
Blood flow restriction training can be helpful to a variety of populations in the healthcare field. Athletes, post-operative patients, elderly patients, patients with elevated pain levels, and even patients in the ICU can all benefit from this approach. When used in the early stages of rehab, it combats muscle wasting by increasing muscle protein synthesis and reducing risk of muscle atrophy. One study found low load BFR training at 20% of maximum effort produced a 41% increase in quad strength compared to high load training at 80% of maximum effort produced a 36% increase in quad strength, demonstrating BFR as an effective intervention for strengthening with significantly decreased amounts of stress on the tendons and joints.
Overall, BFR has been shown to significantly improve muscle hypertrophy and strength similar to that of high intensity training while only performing low load exercises. BFR is a safe technique that has been researched for many years. In summary, using BFR can create a more effective treatment that can be more tolerable than heavy-load rehabilitation.
Strength Training and Aging
by: Dr. Meredith Lymer
Strength training has often been viewed as a younger person's activity, but in reality it can be beneficial for people of all ages. New studies are showing that strength training can potentially add years to your life.
As we age, we lose about 1% of muscle mass and about 3% of muscle strength each year. Decreased muscle mass and strength are associated with increased risk of dementia, the need for caregivers, and, ultimately, mortality. The good news is, there is a non-medication way to reduce this muscle loss and actually start increasing overall health.
This non-medication technique is through strength training. Strength training can actually stimulate muscle growth due to it's anabolic nature. By performing at least 2 days a week of moderate (5-6) to hard (7-8) intensity exercises, on a scale from 0 to 10 , including the major muscle groups, you can reduce age-associated decline in muscle mass and strength.
In the early 1990s, strength training was introduced into nursing homes to treat the loss of these age-associated symptoms. After 8 weeks, these adults saw 174% increased strength, on average. A couple adults were able to stop using a cane to walk, and one was able to stand up from a chair without help.
Additionally, a recent Brittish study showed adults who participated in strength training 2 days a week reduced their risk of mortality from any cause by 20% and a reduction in cancer mortality by 43%. A separate Women's Health Study showed strength training up to 145 minutes per week reduced risk of mortality by 19-27%. And yet another study showed strength training after a hip fracture reduced the risk of mortality by 81% and reduced the risk of going to a nursing home by 84%.
Strength training has also been linked with increasing bone strength in postmenopausal women, managing blood sugar levels in Type II Diabetics, counteracting the side effects of certain medications for men with prostate cancer, reducing inflammation in adults with kidney failure, and increasing cognitive function in aging adults.
Ultimately, there are many studies that have assessed the effects of strength training and aging with the similar outcomes. Two days a week may be all you need to add years to your life and quality to your health.