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

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/

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.

#GetPT1st For Back Pain

Chances are, you or someone you know has had back pain. Each year 15% of the population
has their first episode of back pain, and over the course of our lives, 80% of us will have back
pain. Even though back pain is common, the medical community does a poor job managing it.
Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too
common.

Let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy:

Medication

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

Imaging

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

Surgery

The US has sky high rates for back surgeries – 40% higher than any other country and 5x higher
than the UK. You’d think that with all the back surgeries we do, we’d be pretty good at it but the
outcomes are terrible!
A worker’s comp study looked at 725 people who had spinal fusions VS 725 people who didn’t.
The surgical group had:
● A 1 in 4 chance of a repeat surgery
● A 1 in 3 chance of a major complication
● A 1 in 3 chance of never returning to work again

Physical Therapy
● Current clinical practice guidelines support manual therapy and exercise
● Research proves that early PT lead to better outcomes with lower costs, and decreases
the risk of surgery, unnecessary imaging, and use of opioids
● A study of 122,723 people with low back pain who started PT within 14 days found that it
decreased the cost to treat back pain by 60%
● Unfortunately only 2% of people with back pain start with PT, and only 7% get to PT
within 90 days.

Despite the data showing that PT is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. Almost every state has direct access, meaning that you can go directly to a physical therapist without a doctor’s referral. If you see your doctor for back pain, and PT isn’t one of the first treatment options, ask for it!

The Number One Thing You Can Do to Improve Your Physical Therapy Experience

Dealing with the pain and limited mobility associated with an injury or illness can be stressful for so many reasons. You might have questions like, “How long will I be sidelined?” and “What do I need to do to get better?” Or maybe you’re worried about how you’ll pick your children up from school, walk to the train for your commute or prepare meals for your family.
These are all perfectly normal concerns. Luckily, there are some ways that you can gain control over the situation and ensure that you return to the activities you care most about—especially if physical therapy is part of your plan.

What you can do before your very first appointment—and during physical therapy—to take control of that injury-related stress? First and foremost, it’s important to come prepared for physical therapy. And no, I’m not talking about dressing appropriately and arriving on time (or even better, 15 minutes ahead of your scheduled appointment). That stuff is important, of course, but there’s one thing you can do in the days leading up to your appointment that will set you up for success.

Any guesses? I’m talking about starting a list. What kind of list? Well, every time that you feel pain in the affected area or notice an activity that is harder than it was pre-injury, add it to the list! And the more specific you are, the better. Here’s an example to help drive this point home: Let’s say that you’re recovering from a moderate meniscus tear and you have an appointment with your physical therapist in three days. Take notes on how your knee feels first thing in the morning after you’ve been off your feet. How does your knee react when you stand up from a chair—does it feel unstable? Or do you find that you need to clutch the back of the couch on your way to the bathroom? Sharing each of these details helps your physical therapist understand your limitations beyond the injury printed on your intake form.

Now let’s take that list a step farther and add some details about the activities that you typically participate in on a regular basis. Let’s say that you normally play a weekly round of golf, spend your mornings weeding your garden or meet up with friends for a four-mile walk two evenings a week. These activities have become an important part of your life so let’s make sure that they’re factored into your list, perhaps in the “what you hope to get out of physical therapy” category. Painting a clear picture of how active you are—and what types of activities and sports you participate in—can help your physical therapist design an individualized treatment plan and to better help you on your road to recovery.

Have you been to physical therapy lately for an injury? Did you find anything else that helped maximize your time in rehab or that improved communication with your physical therapist?

What Brings You to Physical Therapy Today?

When you kick off a new project at work, chances are you spend a fair amount of time setting and reviewing goals. These goals help you—and those you’ll be working with—get a clear sense of what you’re looking to achieve and begin to map out a plan of attack. Along with specific goals, you also probably find it helpful to set some key milestones to ensure that you stay on task and to prevent your motivation from waning.

These same principles apply when going to physical therapy for an injury. Communicating what you hope to get out your therapy sessions can help your physical therapist to individualize the treatment plan and design an exercise program that aligns with your goals. The idea is to move from “I’m here because my knee hurts” to “I’d like my knee to feel better so I can get back to doing X, Y and Z.”

Let’s talk about a concrete example to illustrate goal setting in action: A father of three ruptures his Achilles tendon while playing a game of pickup basketball after work. When he lands in rehab, he explains to his PT that he’s due to walk his oldest daughter down the aisle at her wedding in a few months. This gives the PT a specific goal—and a timeline—to aim for. Of course, not every patient has a goal tied to such a momentous occasion. It can be as simple as carrying your groceries to your car unassisted or lifting your grandchild into a highchair. Either way, it’s important to have goals—and to communicate them clearly to your physical therapist.

Your PT wants you to get better but without the right guidance from you, he might default to following a checklist and design a program that unknowingly misses your goals. Only you know precisely what you want out of PT: If you have a wrist injury and getting back to your knitting hobby is important to you, then be specific! Another patient could come in with the same injury but have completely different goals, so guide your PT to help you achieve what’s most important.
Proper communication ensures success, and that means you can’t passively participate in your care and simply listen to what the PT recommends. Instead, communication needs to be a two-way street. So next time you’re at physical therapy, speak up: Make sure that your PT knows precisely why you’ve made the appointment, what you hope to get out of it and why it’s important to you. This information not only helps your PT make important decisions about your care but also to think of new ways to keep you motivated during therapy.

If you find yourself making an appointment to see a physical therapist for a new injury or a nagging pain, make sure that you prepare in advance. Being prepared to answer this one simple question can help to ensure that rehab is a success: What brings you to physical therapy today? After all, you wouldn’t walk into a kickoff meeting at work without first giving some thought to the goals that you planned to share with your team, would you?

80% of Americans Experience Back Pain, But 100% of PTs Know How to Prevent It

Got back pain? You’re not alone. Eighty percent of Americans suffer from low back and neck pain at some point in their lives. Let that sink in. With such great odds that you—or someone close to you—will one day become a statistic, wouldn’t it make sense to arm yourself with preventive strategies and knowledge? Physical therapy is a good place to start.
By performing a thorough evaluation, a physical therapist can identify the muscular, postural and skeletal limitations that could one day lead to an episode of back pain. As part of the assessment, she will observe as you perform a series of exercises and then gather an account of your daily activity level and environmental factors like operating machinery or working at a desk 40 hours a week.
The PT will then use all of this knowledge to design a personalized exercise program and teach you a few APT-approved strategies to prevent back pain:
Use good body positioning at work, home and during recreational activities.
Keep the load close to your body during lifting.
Ask for help before lifting heavy objects.
Maintain a regular physical fitness regimen— staying active can help to prevent injuries.

Lifestyle can play a big role in back pain. In fact, inactivity and incorrect body mechanics while participating in certain activities are two of the biggest contributors to back pain. In addition to the strategies listed above, it’s also helpful to pay attention to little things throughout your day. That could add up to bigger problems down the line. Let’s go back to that desk job for a minute: How often do you get up to walk, stretch and move throughout the day? A good rule of thumb is to stand up or move every 30 minutes. You may get bonus points with your boss, too, as your productivity soars due to the increased activity.
While low back pain rarely becomes serious or life-threatening, it can be quite painful and interfere with our daily lives. Working with a physical therapist can help patients identify the factors that might contribute to back pain and help to develop a prevention plan. But the healthcare professionals are also a great place to turn when you’re seeking treatment for back pain or hoping to prevent a recurrence.
With such good odds that you could one day become a low back pain statistic, why not do everything in your power today to change your trajectory? Seems like another good reason to find an activity (or better yet, two or three activities) that you enjoy, make it a regular part of your day and stick to it!