Physical therapists are highly trained health care professionals. They are experts in human movement who are trained to evaluate and treat all kinds of musculoskeletal issues with exercise and other techniques. Everyone moves and everyone can benefit from exercise, so physical therapists can help people through their entire lives!
Physical Therapy for Children
Physical therapists start treating some people very shortly after birth. Common reasons a baby might need PT include torticollis and cerebral palsy. Torticollis is a postural issue caused by a tight neck muscle. Babies with torticollis hold their heads tipped to one side. Cerebral palsy is a neurological disorder that causes difficulty with movement and coordination.
As children get older, some have trouble hitting their motor milestones – think of these as the “firsts” – sitting up, rolling over, crawling, standing, and walking. Physical therapists can help here too, using their expertise to help develop motor skills and coordination to get these children back on track.
Physical Therapy for Adolescents
In adolescents, sports injuries become more common. Whether it’s an ankle sprain, or an ACL surgery, a PT can help. The rapid growth in adolescents can cause issues too. Things like growth plate fractures, growing pains, Osgood-Schlatter’s disease, and Sever’s disease are all common in adolescence and are related to the changes the body is going through.
Physical Therapy for Adults
As adults, a lot of us will have back pain – studies say up to 80% of us. Physical therapy is one of the first treatments recommended for back pain. Physical therapists also see adults for injuries – maybe from weekend warrior type sports injuries, overuse, or from an accident at work. Some adults also start to show symptoms of diseases like multiple sclerosis, or myositis which also benefit from physical therapy.
Physical Therapy for Older Adults
Later in life, people tend to have more health issues that impact their ability to move. Things like arthritis, joint replacements, strokes, and heart attacks are all things a PT can help with. Physical therapists also help people age better – keeping them moving with exercise programs that help reduce falls, or helping them make adaptations and modifications to keep them in their homes safely.
Movement is a constant in life. As movement experts, PTs can help people of any age. Some specialize in treating pediatric patients, and some specialize in treating geriatric patients, but all PTs have the expertise to help people move better.
References
https://www.cdc.gov/ncbddd/cp/facts.html
PT for pediatric ataxia – https://pubmed.ncbi.nlm.nih.gov/31392562/
Adult in workplace – https://pubmed.ncbi.nlm.nih.gov/32270086/
Adult myopathy (an example of something treated for adults, not geriatrics necessarily) – https://pubmed.ncbi.nlm.nih.gov/31115788/
The Role of a Physical Therapist in Healthy Aging – https://www.ncoa.org/article/the-role-of-a-physical-therapist-in-healthy-aging
How Physical Therapists Can View Normal Versus Abnormal Aging – https://www.foxrehab.org/pt-impact-older-adults-optimal-function/
Don’t Keep Injury Secrets!
Physical therapists are experts in dealing with injuries, but your PT can’t help if they don’t know about your injury!
You might be wondering who would keep an injury secret. The answer is – lots of people!
The first thing that comes to your mind might be an athlete, like a football player, or maybe a baseball pitcher. But athletes aren’t the only ones that keep injury secrets. Performers like dancers keep injury secrets, and so do workers in all types of jobs.
Why would anyone want to keep their injury secret instead of getting it treated and letting it heal? Read on…
Stigma
Although there have been big improvements in the culture around sports, performing arts, and worker’s comp, some people still have the old “no pain, no gain” attitude. To some people, reporting an injury is an act of weakness, or a way of letting the team down.
There can also be external pressure from coaches, parents, teammates, supervisors, or fans to keep playing or working.
Fear of Loss
With the focus on head injuries in recent years, athletes that get hit in the head know if they report concussion symptoms, they’re coming out of the game. Workers who get hurt on the job fear loss of pay, or loss of their job. Performers who get hurt might fear that their replacement will outshine them on the stage and take their place.
Competitive Advantage
While the first two reasons can apply to athletes, performers, workers and most any other group that might be hiding an injury, this one is limited to athletes. If an opposing team knows a player is injured, and what the injury is, they might be able to take advantage of it. For example, if a football team has a running quarterback that has an ankle injury, it will change how the opposing defense plays.
These reasons all make some sense, but they’re also all shortsighted. Finishing a game, dancing tomorrow night, or working one more shift are never worth your long term health. Hiding a minor injury can turn it into a major one. It’s never weak to report an injury and you’re not letting your teammates, or coworkers down. If you’re not up to your best, you owe it to the people counting on you to let them know. Letting a healthy player, performer, or worker take your place is the right thing to do. If you’re injured, don’t hide it! Let the right people know, then go to the right person for help – your physical therapist!
What Physical Therapy Can Do For Arthritis
Arthritis is a chronic condition that causes inflammation of the joints. It can cause pain, stiffness, and swelling. The hips, knees, hands, and spine are the most commonly affected joints. Arthritis is not a single disease but an umbrella term that includes a variety of different types. Some of the more common examples are osteoarthritis, rheumatoid arthritis, gout, psoriatic arthritis and ankylosing spondylitis.
While physical therapy might not be the first treatment you think of for arthritis, it probably should be. A lot of people with arthritis choose to use medication to manage their pain, stop activities that hurt, and wait for things to get bad enough to have a joint replacement. But this isn’t a great plan – all medications have side effects, even over the counter ones. Reducing activity leads to muscle atrophy and even stiffer joints. Even though joint replacement surgery usually has good outcomes, it does come with its own set of risks and a painful recovery.
Physical therapy has been extensively researched as a treatment for arthritis, and demonstrates good outcomes. Physical therapists typically start with exercise as the base for arthritis treatment. Exercise helps to regain lost joint motion, decrease feelings of stiffness, and strengthen muscles surrounding the affected joint. These benefits are all somewhat obvious. What surprises many people is that exercise has been shown to be as effective as medication for pain relief in many types of arthritis, without the side effects.
Physical therapy has more to offer people with arthritis than just exercise though. Education helps people understand their condition, what to expect, and how to manage it. As experts in human movement, physical therapists are especially good at helping people modify the way they perform certain tasks or activities to reduce strain on joints affected by arthritis. They can also suggest ways to modify the environment at work or home to reduce pain and improve function. They may also suggest things like braces, orthotics, or other devices that can help maintain mobility and reduce pain. On top of all of that, PT has been proven to be a cost effective treatment, too.
With so many techniques that are proven effective in helping people with arthritis, physical therapy is a recommended first line treatment for many types of arthritis. Now that you have a better understanding of what PT can do, hopefully you’ll think of PT first when you think of arthritis too.
References:
1. Research (peer-reviewed)
a. PT for juvenile RA – https://pubmed.ncbi.nlm.nih.gov/1946625/
b. PT for hip and knee OA – https://pubmed.ncbi.nlm.nih.gov/33034560/
c. Systematic Review for Juvenile RA – https://pubmed.ncbi.nlm.nih.gov/28729171/
2. Articles and Content
a. Effectiveness and Cost-Effectiveness of Physical Therapy for Knee Osteoarthritis- https://www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/718
b. Can physical therapy reduce arthritis pain? – https://www.medicalnewstoday.com/articles/physical-therapy-for-arthritis
Fibromyalgia – What to Do When the Fibro Ignites
As we head into the dog days of summer, the weather is heating up. For the nearly 5 million people in the United States with Fibromyalgia, they might experience a different kind of heat – the burning pain that typically comes along with this diagnosis.
What is Fibromyalgia?
Fibromyalgia is a chronic condition that can cause a wide range of symptoms throughout the body. It’s usually diagnosed between the ages of 30 and 50, and 80% to 90% of the people affected are women.
The most common symptoms are:
● chronic pain all over the body
● fatigue
● memory problems
● sleep disturbances
● depression or anxiety.
How Does Physical Therapy Help?
Because of the wide range of symptoms, fibromyalgia can be a debilitating condition. It is not uncommon for people to begin avoiding activities altogether because of pain and fatigue. This begins a cycle of deconditioning that not only impacts the person’s overall health, but also makes the symptoms of fibromyalgia worse. The cause of fibromyalgia is currently unknown and there is no cure, so physical therapy treatments are designed to reduce and manage the symptoms. This requires a multi-pronged approach. Common treatments include:
Education
The first step in treating fibromyalgia is often helping people understand what’s going on, and what they can do about it. Research has shown that people who are knowledgeable about their condition have better outcomes, more confidence, and cope better.
Decrease Pain and Improve Range of Motion
Physical therapists are movement experts with a lot of tools and techniques to help with the pain and stiffness caused by fibromyalgia. A PT might use gentle manual therapy or massage, prescribe specific stretches, or a simple yoga routine. They might also use modalities like electrical stimulation, biofeedback or in states where it is allowed, dry needling.
Exercise
Once patients understand the condition and are able to move a little better with less pain, exercise often enters the treatment picture. Research has shown that low to moderate intensity aerobic exercise like walking, biking, or swimming is important in managing fibromyalgia symptoms. It can help with pain, fatigue, sleep disturbances, depression, and more. Physical therapists and patients work together to find the right type of exercise and the right intensity to best manage fibromyalgia. They often have to start slow, and make adjustments along the way.
Each physical therapy session is tailored to the needs of the patient and will vary depending on the severity of their symptoms. Despite there still being no cure for fibromyalgia, physical therapists can help with pain management, strength, mobility, fatigue and function to help patients find relief from their symptoms.
References:
1. Research (peer-reviewed)
a. Exercises for Fibro – https://pubmed.ncbi.nlm.nih.gov/32455853/
b. Manual therapy for fibro – https://pubmed.ncbi.nlm.nih.gov/32604939/
c. Aquatic PT for fibro – https://pubmed.ncbi.nlm.nih.gov/23818412/
d. Effectiveness of exercise with fatigue, etc for fibro – https://pubmed.ncbi.nlm.nih.gov/32721388/
e. Aerobic exercise for fibro – https://pubmed.ncbi.nlm.nih.gov/28636204/
2. Articles and Content
a. https://www.choosept.com/guide/physical-therapy-guide-fibromyalgia
b. https://www.everydayhealth.com/fibromyalgia/aquatic-therapies/
c. Physical Therapists are poised to treat and manage Pain (AOPT) https://www.orthopt.org/uploads/content_files/files/Pain_Manual_Draft_FINAL_6.25.2021%281%29.pdf
Your PT Can’t Do Your Exercises For You
If you’ve been to physical therapy, you likely got a home exercise program. Research says that if you do your home exercise program, you’ll have a significantly better chance of meeting your goals and feeling better. Not doing your program increases the risk of recurrent injury or flare-ups with less positive outcomes long term. Even though they’re important, adherence to home exercise programs is terrible. It’s estimated that only 40 to 50% of patients do their exercises the way they’re supposed to. What can you do to make sure you do your exercises and get the best outcomes? Here are a few ideas.
Plan ahead
Think about what’s going to get in your way – your schedule, that you’ll forget, or that you don’t have the space or equipment that you need. Once you figure out the problems, come up with solutions. Put your exercises in your schedule, talk to your PT about equipment, or adjusting your program to fit the time you have. If you solve problems before they start, they’re no longer problems.
Address pain and beliefs
You’ll need to work with your PT on these. If your exercises cause pain, you’re not going to do them. When your PT prescribes your exercises, try them out. If there’s pain, ask your PT about modifications to make them more comfortable. The other thing might need addressed are your beliefs. If you believe that the exercises won’t help, or that they’re a waste of time, you won’t do them. Again, work with your PT to understand why they’re prescribing those exercises, and what they’re meant to do. Once you know why you’re doing those exercises, you’re more likely to do them.
Get support
People who have social support are more likely to do their exercises. This is why CrossFit and group exercise classes work. Find a family member or friend to help you stay consistent with your exercises. Your PT can help here too. Have someone ask if you’re doing your exercises, and how they’re going. This will keep you accountable and more likely to do them.
Use Technology
If you like technology and gadgets, they can help you be consistent with your exercises. There are plenty of apps that can track your exercise. Seeing that streak of days you’ve exercised will motivate you not to break it. Smartwatches and activity trackers can fill the same role.
Doing your home exercise program will help you get the most out of PT. With a little planning and a little help, you can make sure you’re one of the 50% of the people who do their home exercises consistently to get the best outcomes.
References:
https://pubmed.ncbi.nlm.nih.gov/32669487/
https://www.physio-pedia.com/Adherence_to_Home_Exercise_Programs
PT – Not Just For Adults
When you think of physical therapy you might think of an injured athlete, someone recovering from surgery, or someone with a chronic medical problem. We’re here to let you know that you should think of kids, too. Physical therapists are trained to work with patients of any age. Some even specialize in pediatrics. Here are a few things PTs can help kids with:
Coordination Disorders and Gross Motor Delays
Some children are delayed in hitting their gross motor milestones – things like sitting up on their own, rolling, standing, walking, jumping and running. Other children show difficulty with coordination – activities like hand motions to “wheels on the bus”, feeding themselves with utensils, moving awkwardly or slowly, or even tripping or bumping into things a lot. Physical therapists can help encourage development of gross motor skills and coordination to help these kids get back on track.
Cerebral Palsy
This is the most common motor disability in childhood. The symptoms can vary from moving a little awkwardly to being unable to walk and needing assistance for almost all activities. There are also different types – the most common causes stiffness in the muscles, but other types affect control of movements, balance or coordination. No matter the type or severity of cerebral palsy, a physical therapist can help with things like stretching, exercise, bracing, and equipment like a wheelchair if needed.
Torticollis
Torticollis is a postural issue that usually becomes noticeable shortly after birth. Babies with torticollis typically hold their heads tipped one direction and rotated towards the opposite side. This is caused by a tight neck muscle. Research has shown that early referral to a physical therapist is a very effective treatment. The PT usually shows the baby’s caregivers ways to gently stretch the neck, and activities to encourage the baby to move his or her head into a more neutral position.
Pelvic Floor Issues
People don’t commonly think of pelvic floor issues in children, but you might be surprised at how common they are. The most common symptom is chronic constipation, but pelvic floor problems can also show up as urinary incontinence, bed wetting, or needing to go to the bathroom frequently. A physical therapist can help with education for the child and their family, exercise, and sometimes even the use of biofeedback to help the child learn to better control their pelvic floor muscles.
Pain and Injuries
Although kids have a list of problems specific to them, don’t forget about regular old pain and injuries. Your physical therapist can treat an ankle sprain, painful joint, or athletic injury in a child just like they can an adult.
Sometimes kids and even babies need some help with movement. From now on, when you think of your physical therapist, don’t leave kids out of the picture!
References
https://www.cdc.gov/ncbddd/cp/facts.html
https://pubmed.ncbi.nlm.nih.gov/29087112/
https://pubmed.ncbi.nlm.nih.gov/30277962/
https://pubmed.ncbi.nlm.nih.gov/31096249/
https://pediatricapta.org/consumers/
https://www.youtube.com/watch?v=fq62vwyrcXs
Elevate Your Heart Rate With Physical Therapy
Heart disease is a leading cause of death and disability. This shouldn’t be a surprise – it’s been at the top of the list for years. You know that taking care of your heart is important. That means doing things like eating right, avoiding smoking, and exercising regularly. While all of those things can be difficult, today we’re going to focus on exercise.
How Physical Therapy Can Help With Your Heart Health
Cardiovascular exercise is anything that makes you breathe harder and your heart pump faster. That could be walking, running, dancing, biking, swimming or hiking. It strengthens your heart and blood vessels. It can help control weight, lower blood pressure, reduce stress, and prevent heart disease.
If you’re regularly going for a run or swimming laps, you don’t need help from your PT. But 3 out of 4 adults aren’t exercising regularly. If you’d like to get started, your PT may be just the person to help you. It’s not uncommon to get injured, then never get back to your old routine. Your PT can help you deal with the old injury and design a plan to get you safely back to regular activity.
It’s also not uncommon to try to be more active on your own, only to stir up pain somewhere like your back, hip, knee or shoulder. Your PT can help with that too. They’ll figure out why you’re having pain, help you correct it, and get you a plan to reach your goals.
Physical therapists can also help you safely increase your activity levels after major medical issues like a heart attack, stroke, or even cancer. Recent research has shown improvements in cardiovascular fitness, fatigue levels and even pain in cancer patients who participate in a personalized physical fitness plan from a PT.
Whatever your barriers to physical activity are, your PT can likely help you overcome them. As movement experts, physical therapists are trained to deal with a variety of conditions. They’ll help you work around whatever issues you have so you can safely elevate your heart rate and keep cardiovascular disease away.
Stay Connected With Your PT Through Telehealth
The ongoing COVID-19 pandemic is responsible for a lot of bad stuff. But, if you look really hard and maybe squint just right, there are a few less-than-terrible things to be found. The pandemic forced society to quickly adapt. It pushed forward the adoption of new technologies like Zoom and new ways of doing things, like working from home. There were changes in rules, regulations, and payment related to telehealth. A lot of patients and providers experienced their first virtual health appointment in the past 2 years, and many of them see the benefits. The pandemic forced the telehealth genie from the bottle. Now that patients and providers have seen the benefits, it’s not going back.
Why telehealth is here to stay
Telehealth isn’t going to replace in-person rehab, but it’s likely going to complement it heavily. Research has shown that telehealth is as effective as in-person rehab for a lot of conditions. It’s also shown high satisfaction rates from patients – up to 94% in some studies. For a lot of people, telehealth makes sense. Think about people trapped at home because of a snowstorm or those who are at high risk of falling on the ice. Before the wide adoption of telehealth, these patients didn’t get to see their PT during the winter. Now, they can stay connected virtually and continue healing through the bad weather. Telehealth can also work well for busy people. Patients can check in or have a visit with their PT on their lunch break, or while their kids are at practice.
Where telehealth could go
Even though there have been big advances in telehealth, we’re still in the early phases. It’s hard to predict how telehealth will be used in the future and how it will evolve, but expect it to look a lot different in 5 years. The software being used for telehealth will continue to get better. Expect a more engaging user experience with educational content and maybe some gamification – levels to achieve, points or badges to collect, or some other metric. Hardware will also continue to advance. Maybe the fitness tracker you already have will integrate into your telehealth app, letting your PT track your activity, heart rate, and other metrics. Remote stethoscopes, scales and other medical equipment already exist and will continue to become more common as prices decline.
While telehealth has certainly seen a big advance because of the pandemic, most people still see it as an adjunct to in-person visits. Right now, telehealth tends to be used because it’s more convenient than a visit in real life, not because it’s better. With advances in software platforms and hardware options, telehealth could evolve into something just as good as in person rehab that makes high quality rehab available to everyone.
Expect to Get Better. You Probably Will.
Research has shown that positive expectations increase the chances of a good outcome. It’s the old self-fulfilling prophecy; your attitude determines your approach to situations. If you believe you’ll be successful, you’ll likely put in more effort. You’ll be more willing to try new things, take some risks and keep trying after failures or setbacks. A negative attitude will likely mean that you’ll take your first failure or setback as confirmation that what you’re trying won’t work or isn’t possible and you’ll give up. Why waste time and effort on something that’s doomed to failure anyway?
Your Expectations Influence Your Results
There’s some research to prove that positive thinking and expectations make a difference in rehab settings too. A review of 23 articles looking at outcomes for shoulder pain found a few interesting things. First, patients who expected to recover and believed that they had some control of the outcome, ended up doing better than those who didn’t. Second, optimistic patients were found to have less pain and disability after completing rehab. Third, patients who believed they’d have pain and disability after surgery tended to have – you guessed it – pain and disability after their surgery. Research says that you tend to get what you expect.
So Do Your Therapist’s
Your attitude is important, but what about your therapist’s? There isn’t much research specific to PT, but there is a study done in elementary schools that might give us some clues. Two psychologists – Rosenthal and Jacobs did a study showing that teacher expectations had an influence on student performance. They told teachers that randomly selected students in their classes were tested and found to be “late bloomers”. These students were expected to show large improvements in academic performance during the school year. When the students were tested 8 months later, the students the teachers believed would improve the most, did.
Why? When teachers think students have a lot of potential to improve, they hold them to higher standards. They teach more complex materials, don’t settle for simplistic answers and are more willing to spend time instructing and working with those students. It’s pretty easy to see how this could cross over into a PT clinic. If your PT thinks you can get better, they’ll probably put more effort into designing your program, spend more time with you and push you harder than someone they don’t believe has a lot of room for improvement.
To have the best chance for a good outcome, you and your therapist both need to expect one. You probably will.
References
● De Baets L, Matheve T, Meeus M, Struyf F, Timmermans A. The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review. Clin Rehabil. 2019 Jun;33(6):980-991. doi: 10.1177/0269215519831056. Epub 2019 Feb 22. PMID: 30791696.
● Rosenthal, R, and L. Jacobsen. Pygmalion in the classroom: teacher expectation and pupils’ intellectual development. New York: Holt, Rinehart and Winston, 1968.
Long COVID Sounds Awful! What Can Be Done?
Last month we introduced you to Long COVID and all of the challenges it brings. This month we’re going to talk about what physical therapists can do to help people living with Long COVID. Early in the pandemic, therapists started seeing people with what would later be known as Long COVID. They noticed that some of the symptoms people were describing overlapped with conditions they had treated before. Specifically, Myalgic Encephalomyelitis and Chronic Fatigue Syndrome also caused severe fatigue and delayed symptoms after activity. Because of this overlap, the current treatment for Long COVID is heavily based on what we know works to manage these diseases. Here are a few of those strategies.
Pacing
The first strategy that can help manage Long COVID symptoms is pacing. This is simply doing less activity than you have energy for. By keeping bouts of activity short with lots of breaks, pacing can help avoid severe fatigue immediately after activity. It can also avoid the delayed “crash” of PESE. A useful metaphor is to think of your energy level as a battery. When you do activities, you drain your battery. When you rest, you charge it back up a little bit. Physical therapists can help patients learn how much energy is in their “battery” and work to teach them strategies to conserve it. When used effectively, pacing can help patients with Long COVID accomplish more with less fatigue and less bouts of PESE.
Heart Rate Monitoring
Another strategy that comes from ME and CFS management is heart rate monitoring. With the huge number of wearable devices that monitor heart rate, this is becoming an easier strategy to use than ever. Heart rate monitoring uses your heart rate as a gauge of how hard your body is working. It’s based on your resting heart rate, which should be taken after you’ve been lying down, relaxed for at least 20 minutes. First thing in the morning before you get out of bed is a great time to measure your resting heart rate. Once you have your baseline, the goal is to keep your heart rate within 15 beats of your RHR while you’re doing activities. This keeps your heart rate below the threshold at which your muscles start to produce lactic acid. Build up of lactic acid is what gives you “the burn” when you’re working out really hard. It also causes your muscles to fatigue more quickly – by keeping activity light enough to avoid lactic acid, we can also reduce fatigue.
Exercise
What about exercise? Sure, lots of people think about exercise when they think about PTs. But exercise can make some diseases worse. For people living with Long COVID, CFS, or ME, “toughing it out” or “pushing through it” won’t make them stronger. It will cost them days of their lives – leaving them barely enough energy to get out of bed or complete basic tasks. For long-term, sustainable recovery, the first goal of rehabilitation of these folks is to stabilize and manage their symptoms. Using pacing, heart rate monitoring and other strategies like breathing exercises can stop the fatigue cycle and start to get the body responding to activity more normally. Only then can we very gradually and cautiously introduce exercise into the mix, monitoring symptoms during and after activity to make sure we don’t overdo it.
As we learn more about the pathology behind Long COVID’s symptoms, rehabilitation will surely change and improve. But people who are living with Long COVID can’t afford to wait until science figures everything out about their disease. Fortunately physical therapists have training and strategies that can help improve their lives right now.
