Are Your Workouts Giving You What You Want?

Are Your Workouts Giving You What You Want?

How much thought have you put into the exercises you’re going to use for your next workout?
Did you choose them yourself, or did you find them on the internet or in a magazine? What’s
your workout designed for? Do those goals match yours? Are the exercises even safe for you?
Using the wrong program can lead to wasting time in the gym, frustration, plateaus in progress
and injury. Let’s take a closer look at what goes into program design and the cost of getting it
wrong.

Exercise Selection
There are many things to think about when choosing specific exercises. Machine vs. free
weights, isolation vs. compound lifts, number of reps and sets, etc. Each one of these factors
affects the results, so making the wrong choices could lead to wasting time working on the
wrong things, limit your results or lead to injury.

Technique
If you choose the right exercises, but don’t know how to do them properly you will again limit
your results, or worse, end up injured. Poor technique leads to inefficient movement and limits
the power your muscles can create. It also changes the load on your muscles, joints, and
ligaments which can lead to pain and injury.

Volume
Volume is a way of thinking about how much work you’re doing during a workout. Doing a few
reps with a heavy weight or a lot of reps with a light weight could end up being the same
volume. Same goes for running a shorter distance quickly uphill vs a longer run at a slower pace
on flat terrain. If your volume is too great you won’t recover well between workouts and create
the possibility of injury. Too little volume and you won’t see results.

Progression
If you’ve been doing the same exercises with the same weight and the same number of reps
and sets, you’re not progressing. Same goes if you jump on the treadmill for the same amount
of time with the same settings each time. To make progress, things have to change and the
program that works for your first 6 months won’t work for you 2 years down the road.

Designing an exercise program is a complex challenge with a lot of factors to consider. Most
people have a history of injuries and don’t have perfect movement in every joint which further
complicates things. If you’re not making progress or just want to make sure your workouts are
as effective as they can be, have your physical therapist take a look at your program. Your PT
can help design an individualized program to help you reach your goals while keeping you safe
and injury free.

Your Physical Therapist Can Help You Keep Your Resolution

Your Physical Therapist Can Help You Keep Your Resolution

As one year comes to a close and another begins, people begin to set goals and make
resolutions. Losing weight, getting to the gym more often or getting into “better shape” are all
common. These all require increasing your amount of physical activity. More activity is great for
your health, energy levels, sleep, and mood. However, ramping up your activity level too quickly
after a holiday season of eating, drinking and being merry can lead to pain, injury and
disappointment if your body isn’t ready for it.

Your physical therapist is an expert in human movement, and can help you safely reach your
fitness goals. People think of PTs as the person to see after an injury, but a visit before you
change your activity level could prevent injury in the first place. An evaluation by your PT will
include assessment of your strength, range of motion, and functional movement patterns – think
jumping, running, squatting, carrying. Some PTs even like to use a standardized assessment,
such as the Functional Movement Screen.

Most common injuries from new fitness routines are caused by underlying weakness, range of
motion deficits, or compensatory movement patterns. Your PT will find these during your
assessment. They can then prescribe exercises or movements to address the issues found and
get you safely moving into the new year!

The other common way people get injured working towards their resolution is with overtraining,
or doing too much too soon. Physical therapists are also experts in exercise prescription and
program design. Your PT can help you create a routine specific to your needs and goals that will
progress appropriately and keep you out of trouble.

So stop only thinking of your PT after you’re injured. In this case, it’s true that an ounce of
prevention is worth a pound of cure. Seeing your physical therapist before you start on your
resolution can keep you on track, injury free, and help you reach your goals for the new year!

Start Your Year With an Annual Movement Screen

Start Your Year With an Annual Movement Screen

Your car needs regular maintenance, so you probably have a mechanic. Your eyes and teeth
are important, so you see your optometrist and dentist regularly. You get an annual physical
from your family physician. You might even be getting ready to see your accountant to get your
yearly income tax done. What about your physical therapist? Do you and your family have one?
If not, you should. Your body is a lot like your car. It’s got multiple systems, all of which are
complex, and all of which have to be working well for it to function. Physical therapists are
experts in maintaining, diagnosing, and treating the movement system. Like the braking or
ignition system in a car, most people only think of the movement system when it’s not working
the way it should.

Don’t Neglect Your Movement System

Similar to the systems in your car, problems with your movement system are much easier to
deal with if they’re caught and treated early. This prevents small issues from becoming larger
ones. For example, if you have a little bit of weakness, and balance that’s not quite up to par,
improving those early could prevent a sprained ankle, or a fall and a broken wrist.
An annual movement screen from your physical therapist can find small issues that you may not
have noticed with your strength, balance, flexibility, or coordination. Many of these minor issues
can be fixed with a few exercises at home, or with just a few visits.
What to Expect
A screen of your movement system is quick and easy. Your annual visit may include:
● A history of your injuries, as well as a health history
● Assessment of your strength, balance, flexibility, etc.
● A review of your movement goals (do you want to run a marathon? Get on and off the
floor easily playing with your grandkids?)
● A review and update of your exercise program

Fitness With a Side of Dysfunction?

Fitness With a Side of Dysfunction?

This time of year, many people are focused on fitness so it’s worth taking a look at what fitness
really means. The dictionary defines fit as “sound physically and mentally, healthy.” Using that
definition, many “fitness” routines fall short of the goal. If you don’t enjoy running and dread
every workout, you’re probably falling short of the “sound mentally” portion. Exercise should be
enjoyable, reduce stress, and leave you feeling better, not worse.

No Pain no Gain?
Exercise should also leave you feeling better physically. If you can run a good time in a 5k, but
have aches and pains for days after, you’re not “sound physically.” If you are increasing your PR
in the squat rack, but your joint pain is increasing right along with it, you’re not “sound
physically” either. Sure, some muscle soreness and fatigue after a hard workout is normal. But if
you’re having pain that doesn’t go away, sore joints, or trouble moving after exercise, you’re
probably developing movement dysfunction along with your fitness.

Movement Dysfunction
Go back to the dictionary and you’ll find that dysfunction is “impaired or abnormal functioning.”
So movement dysfunction is impaired or abnormal movement. When someone has a movement
problem like a sore joint, limited range of motion, or strength loss the brain finds a way to get the
body to do what it wants. That usually means moving in a way that is less than optimal. For a
while, it works. But eventually it leads to injury. As a concrete example, think of someone who
has trouble bending one knee doing squats. When one knee bends further than the other, it will
cause one side of the pelvis to drop lower than the other. Now that the pelvis isn’t level, the
spine bends towards the high side to stay balanced. When that one side of the pelvis drops
lower than the other one, it also usually rotates. Now the spine has to bend to the side and twist
to keep you upright. This works for a while, but as weight gets added to the squat, and the
repetitions add up so does the risk for a back injury.

Preventative Medicine
Pain during workouts, or pain and soreness that don’t go away after can be warning signs of a
movement dysfunction. If you’re experiencing any of these, your physical therapist is a
movement expert who can help. PTs are trained to analyze movement, and figure out the root
cause of problems. They can then design a program to treat the cause and correct the abnormal
pattern. There is no need to wait until you’re injured to see your physical therapist. In fact, it’s
preferable not to. Getting minor problems fixed early means fewer visits to the PT, less pain,
and not having your workouts put on hold by injury.

What’s a Movement Diagnosis?

Medical diagnoses don’t need much of an introduction. They’re what you get from your doctor
when you’re sick. Examples would be influenza, diabetes, or hypertension. They describe the
underlying problem that is causing your symptoms.

When people feel sick, they know they need to go to the doctor and find out what’s going on to
get treated. We should treat movement the same way. If you’re having pain when you move,
can’t do things you used to be able to – like get on and off the floor easily, or can’t do things you
want to do – like go for a bike ride or pick up a grandchild then you need to get a movement
diagnosis.

A movement diagnosis does the same thing as a medical diagnosis; it describes what’s causing
your difficulty with movement. Some examples would be difficulty standing from a chair
secondary to decreased force production, scapular down rotation syndrome, or lower crossed
syndrome.

Diagnoses set the roadmap for treatment, so getting them right is crucial. Human movement is
complex and is influenced by more than just your muscles and joints. According to the APTA,
movement is impacted by the following systems:
● Endocrine
● Nervous
● Cardiovascular
● Pulmonary
● Integumentary
● Musculoskeletal

Because of the complexity and interplay between these components of the movement system,
getting a movement diagnosis correct is often very difficult. Physical therapists are experts in
human movement with doctoral level training and should be your first stop for movement issues.
Not only can a physical therapist provide an accurate movement diagnosis, they will also design
a treatment plan to correct the underlying issues and help get you moving well again.

References:
https://www.neuropt.org/docs/default-source/default-document-library/movement-systemdiagnosis-in-neurologic-physical-therapy-where-are-we.pdf?sfvrsn=0
https://journals.lww.com/jnpt/FullText/2018/04000/White_Paper__Movement_System_Diagnose
s_in.9.aspx
https://www.apta.org/MovementSystem/
https://www.apta.org/MovementSystem/Template/

Imaging Can Improve Physical Therapy Treatment

Physical therapists are experts in the musculoskeletal system, and typically use patient
history and a good physical exam to come to a diagnosis and treatment plan. However,
PTs are increasingly using diagnostic imaging as they become the practitioner of choice
for musculoskeletal injuries. Many PTs have access to diagnostic ultrasound right in the
clinic, and in some practice settings like the military, and certain ACOs, therapists have
the ability to order imaging like x-rays, CT scans and MRIs.

The research indicates that PTs are effective in using their ability to order imaging when
it exists. A study of 108 imaging orders by PTs providing musculoskeletal primary care
in a direct-access sports physical therapy clinic found that advanced diagnostic imaging
was ordered appropriately in over 80% of cases.

So, PTs are good at appropriately ordering imaging, but how does it improve
treatment? A case study published in the July 2015 issues of the Journal of Manual &
Manipulative Therapy gives a good illustration:
The patient was a very active dentist who had chronic mid and upper back pain. He had
a known history of benign neural tissue tumors of his head and upper back region, but
no specific diagnosis for his back pain had been provided. After examination, the PT
decided to start treatment for the patient’s back pain, but also order x-rays and an MRI
of the symptomatic part of the patient’s spine. The MRI showed a previously
undiscovered meningioma, or benign tumor of the membrane that covers the spinal
cord.

The benefit to this patient was that the PT could continue treatment without making
referrals and waiting for someone else to order the images. Also, once the tumor was
discovered, the PT could select exercises and manual techniques that would help the
patient, but avoid putting stress on the area of the tumor. It also allowed the PT to
educate the patient on fitness activities that would be safe and appropriate.

The case study has a quote that sums up the benefits of imaging combined with PT
nicely: “Orthopaedic physical therapists have high levels of musculoskeletal expertise
and extensive knowledge of typical patterns and behaviors of musculoskeletal
conditions. These competencies and experiential knowledge enable them to
appropriately recognize situations requiring additional diagnostic screening for nonmusculoskeletal pathology.
This case demonstrates how privileges to order musculoskeletal imaging studies assisted the physical therapist in providing optimal,
patient-centered care. The physical therapist in this case was able to continue
treatment without multiple referrals back to the medical provider to obtain imaging,
and so provided more cost-efficient and convenient care.”

Reference article and case study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5046964/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534847/

Did You Know That PTs Can Use Diagnostic Imaging?

When most people think of diagnostic imaging, they think of X-rays, CT scans and MRIs, but the
use of musculoskeletal ultrasound is becoming more popular for physical therapists. With most
states having direct access laws, physical therapists are becoming primary care providers for
musculoskeletal injuries. Despite a long history of therapists effectively using imaging in the
military, and some managed care organizations like Kaiser Permanente in Northern California,
in the United States PTs usually can’t order X-rays, CT, or MRI scans. They can, however use
musculoskeletal ultrasound.

A musculoskeletal ultrasound is very similar to the more common sonogram used during
pregnancy. Both use sound waves to create an image of what’s going on in the body in real
time. Ultrasound can show a PT many structures in the body and can be used to help diagnose
strains, sprains, inflammatory conditions like tendonitis or bursitis, nerve entrapments, and
hernias.

Ultrasound is not popular with PTs just because they are limited in the ability to order other
imaging. Research and clinical experience supports ultrasound as the preferred diagnostic test
for many musculoskeletal injuries. Here are some benefits of ultrasound that support why:

● Ultrasound uses no radiation and has no known harmful effects on humans
● Real time imaging allows ultrasound to capture movement in the tissues, something xray, CT, and MRI can’t do
● Ultrasound is widely available, and less expensive than most other types of imaging
● Ultrasound may provide greater detail of soft tissues like muscles, tendons, or joints
● Ultrasound can be used on people who can’t have an MRI such as patients with
pacemakers, and certain metallic implants
● Patients don’t have to remain still for an ultrasound, meaning it can be easily used on
people who are claustrophobic or nervous about other imaging types

With such a list of advantages, it seems that ultrasound is a great type of imaging technology.
This is true, but it’s not without a few drawbacks. These would include:
● Difficulty penetrating bones, and through large amounts of soft tissue, limiting the ability
to see the deepest tissues in the body
● Ultrasound also has difficulty showing the internal structure of bones, making other
techniques better for detecting suspected fractures

Do You Know Your Movement Vital Signs?

Most people think of heart rate or blood pressure when they think of vital signs. It is common to
use numbers to quantify health and risk of disease. The American Heart Association
encourages people to “know their numbers” referring to blood pressure, blood cholesterol, blood
glucose, and weight. However, research is now showing the importance of moving properly for
health. Let’s take a look at some of the numbers you can use to quantify your movement health:

Walking Speed

Walking speed has been called the “sixth vital sign” in medical literature recently. It is easy to
measure, and takes into account strength, balance, coordination, confidence, cardiovascular
fitness, tolerance to activity, and a whole host of other factors. It has also been shown to be
predictive of future hospitalizations, functional decline, and overall mortality. Normal walking
speed is considered to be 1.2 to 1.4 meters per second.

Push Ups

Push ups are popular to build strength, but a recent study found that they can show us a lot
about your heart too. Researchers found that men who could do 40 or more consecutive push
ups were at a 96% lower risk for cardiovascular disease than were men who could do less than
10. The push up test was also more useful in predicting future cardiovascular disease than
aerobic capacity measured on a treadmill.

Grip Strength

Hand grip strength has been shown to be strongly correlated with health. The stronger your
hand grip is, the less likely you are to suffer from cardiovascular disease, respiratory disease,
COPD, and all types of cancer. In the study, muscle weakness was defined as grip strength <26
kg for men and <16 kg for women. Grip strength below these numbers was highly correlated
with an increase in disease.

Standing From the Floor

If you can’t easily get down on the floor and back up your health might be in trouble, according
to a study that looked at more than 2,000 people. The study asked people to go from standing
to sitting on the floor and back up with as little support as needed. They found that if you need to
use more than one hand to get up and down from the floor that you were 2 to 5 times more
likely to die in the next 7 years than someone who can do it with just one hand, or even better,
no hands at all.

Moving well is obviously important to overall health and longer life. These tests can give a
snapshot of how you’re doing. If you’re having trouble with any of them, considering seeing a
movement specialist – your physical therapist.

Are You A Passive Patient or an Active Consumer of Healthcare?

Think about the last time you made a big purchase, say $1,000 or more. Did you go out and buy
the first thing you saw? Take one recommendation from somebody? Or did you research it,
learn some things, compare it to other options, and select something that was right for you?
Most people tend to be educated and research large purchases like cars, televisions, or the
newest iphone. So why do we so often fail to do this with healthcare?

By becoming more educated healthcare consumers we can go from passive patients who take
the first recommendation that comes from a practitioner to an active consumer who weighs
options and makes choices. Here are some questions to talk through with your practitioner the
next time a healthcare decision comes up.

What are the benefits or expected results?

When a treatment or procedure is recommended, the patient often assumes that it will make
them “better.” But what the patient expects and what the healthcare provider expects are often
two different things. For example, a patient having back surgery expects to be pain free after
surgery. The surgeon probably doesn’t expect that to happen. Outcomes from back surgeries
are terrible. A large study of 1450 patients in the Ohio worker’s comp system showed that after
2 years 26% of patients who had surgery returned to work. Compare that to 67% of patients
who didn’t have surgery. There was also a 41% increase in the use of painkillers in the surgical group.

What are the risks and downsides?

Patients want to hear about the benefits of a treatment, but they often don’t ask or care about
the risks. To be an educated consumer, you need to. If one treatment has a 3% edge over
another, but has a high risk of making you itchy or causing frequent headaches, do you want it?
Going back to the back surgery study from before, the researchers found a 1 in 4 chance of a
repeat surgery and a 1 in 3 chance of a major complication. With surgery you risk infection,
blood clots, complications with anesthesia, and a whole host of other things. These risks need
compared with other treatments. In the case of back pain, physical therapy is a valid alternative
with a much lower risk profile. You might have some soreness with physical therapy, you might
sweat some and be challenged with exercise, but the risks of PT compared to surgery are minimal.

What are the alternatives?

Don’t feel bad asking about alternative treatments. If you were looking at a certain car you
wouldn’t go out and just buy it. You’d at least consider the competitors and probably even test
drive them. You should at least look at the other options in healthcare too. Maybe the first
recommendation that your practitioner makes is the right one for you, but if you don’t consider
the alternatives you’ll never really know.

Why this treatment over the other ones?

This is the question where the rubber meets the road. You’ve learned about all the options, now
you can see if your practitioner is balancing the risks and benefits to make the right choice for
you. Staying with the back pain example, research shows that more than 40% of people who
seek care for back pain will not receive a treatment of known effectiveness. Back pain is also
the #1 reason for opioid prescriptions, despite a 2016 recommendation from the CDC to avoid
prescribing opioids for back pain, and opt for non-drug treatments like physical therapy. By
asking for the rationale and carefully weighing options, you can avoid being one of the people
who gets an ineffective treatment.

What’s it cost?

This last question is becoming more important as patients bear an increasing share of the cost
of healthcare. Even if you don’t have a high deductible plan or hefty co-pays, by being
financially responsible today, you’ll probably see smaller price increases in your premiums down
the road. That back surgery that we’ve been talking about? It’ll likely cost between $60,000 and
$80,000. So if we put the whole picture together, a patient who takes the first recommendation
for surgery will have a $60,000 procedure that leads to a higher risk of disability, and a higher
risk of long term painkiller use, while risking infection, and blood clots. Don’t forget the 25%
chance that you’ll get to do it all again in a repeat surgery. Seems like a bad deal. An educated
consumer would learn that physical therapy is a viable alternative to surgery with comparable
outcomes, much less risk and lower cost. In fact, a large study of 122,723 subjects showed that
people with back pain who got physical therapy in the first 14 days lowered their healthcare
costs by 60%. It’s easy to see why bargain shoppers love PT!

PT Can Prevent Unnecessary Surgery

Recent research is showing that surgery might not be needed as often as we think. A large
review estimates that 10% to 20% of surgeries might be unnecessary and that in some
specialties such as cardiology and orthopedics, that number might be higher. The reasons for so
many unneeded surgeries being performed are varied, but the most common are that more
conservative options aren’t tried first, or lack of knowledge by the operating physician.

Physicians undergo long and rigorous training programs to become surgeons, but if they don’t
work hard to keep learning, their knowledge often stops growing when they leave residency.
Recent research is showing that certain common surgeries aren’t any better than a placebo.
Two such examples are kyphoplasty – a procedure for spinal compression fractures, and partial
meniscectomy – a procedure used to treat tears of the meniscus in the knee. If a surgeon hasn’t
continued to learn, they won’t know that these surgeries often don’t offer any more benefit than
a non-surgical treatment and will continue to perform them.

Every surgery, even “minor” ones carry risks. These include complications from anesthesia,
blood clots after surgery, delayed healing of the incision, infection, and unintended damage to
nerves or other organs near the surgical site. Some of these risks cause discomfort for a period
after surgery and go away, but others can result in permanent disability or even death. For some
patients and conditions, surgery is a great treatment option, but with all the associated risks,
when surgery can be avoided, it should be.

For musculoskeletal problems like back and joint pain, sprains, and strains, seeing your PT
before a surgeon can help keep you out of the operating room and get you back to life without
surgery. Studies have shown that physical therapy is just as good if not better than surgery for a
multitude of conditions and carries less risk. Some examples would include rotator cuff tears,
meniscal tears, spinal stenosis, low back pain, and osteoarthritis.

Physical therapy can’t fix every problem, and for some patients surgery is the best choice.
However, research is showing that surgery isn’t a cure-all, and is sometimes just a very
expensive and risky placebo. In most cases, starting with physical therapy is the right choice,
and for many patients, PT is the only treatment necessary.