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.

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.

Life is a Movement Journey, Here’s How PT Can Help

Now that spring has arrived, temperatures are starting to rise in many parts of the country. And
that means the transition from heating our homes to cooling our homes is right around the
corner. No matter what method you use to cool your home during the warm spring and summer
months (central air conditioning, window units, or fans and dehumidifiers), each spring you cross
your fingers that your approach still works. If not, you might be calling an expert for a tune-up,
or in extreme circumstances, you might need a complete overhaul.

Just like an AC system that has probably been dormant for many months of the year, a body
that hasn’t been physically engaged on a regular basis may have trouble getting started again.
And yet, this time of year, the warm temps draw many people to city and suburban streets,
tracks and trails, ready to take that first run of the season. A good percentage of these spring
runners haven’t kept up their strides throughout the winter. It should come as no surprise that a
4-mile run for a previously inactive person is going to stir up a few aches and pains.

Especially as we age, our ability to move undergoes changes. But whether we’re talking about a
college student or a retiree, returning to an activity without proper planning is a recipe for
disaster. That’s where physical therapy comes in. Physical therapists are trained to treat injuries
and ease pain, but they can also help their patients prevent injuries and safely prepare to
participate in new activities.

Think of physical therapists as “movement consultants” who can ensure that your body is
physically ready to tackle a new challenge—or resume a favorite leisure activity. Here’s another
example to illustrate what we’re talking about: Let’s say that you play in an adult soccer league
and you’re preparing to play in your first game of the season in a few weeks. You probably hung
up your cleats when the last season ended months ago, but expect to pick up just where you left
off. But it’s simply too much to ask for your 2019 debut on the field to be on the same level as
the last game of the previous season, when you likely had reached peak performance.

This is a good time for your PT to step in and help you shake off the rust. The rehab professional
can customize an exercise plan to help you slowly return to sport and avoid an injury that could
sideline you for the whole season. Or like cleaning the filters before firing up your air
conditioner for the first time this year, the rehab expert can help to ensure that your body is
prepared to return to its former activity level following a hiatus

Yearly Physical Therapy Visits are Just as Important as Annual Cholesterol Tests

You know the drill: During your annual visit, your primary care physician will order a cholesterol test. Combined with an assessment of health measures such as diet and exercise, the results of the cholesterol test will provide your physician with the information she needs to make a recommendation. If the results are positive, you might hear: “You’re doing great, keep doing what you’ve been doing!” If the results are unfavorable, then you’re more likely to be told: “I’d like you to walk for 20 additional minutes each day and eat cholesterol-lowering foods like oatmeal.”

Over time, high cholesterol can cause fatty deposits to form in your arteries, putting you in a high-risk category for heart disease and stroke. Similarly, the cumulative effects of poor posture or a muscular imbalance, for example, can take a toll on your body and inhibit your ability to move properly. That’s where a physical therapist comes in: Annual PT “checkups” can catch the musculoskeletal problems that put you at risk for injury or limit your ability to function down the
line.

One of the best tools in a PT’s prevention arsenal is the movement screen. By analyzing your fundamental movements with a movement screen developed for their own practice or one that requires certification such as the Functional Movement Screen (FMS™), PTs can get a clear picture of what the future will bring for you. Based on the information gathered, a physical therapist can help you safely reach your fitness goals and teach preventive strategies that can be
incorporated into your daily life.

Of course, it’s best to schedule your checkup before you’re experiencing a problem. That way, your physical therapist can establish a baseline based on your functional level at that time and use it to identify changes during subsequent annual visits. The effects of poor posture or a muscular imbalance may not be immediately apparent to you, but they will be to your PT.

An annual “checkup” gives your PT an inside look at your musculoskeletal system, which is comprised of your muscles, bones, cartilage, tendons, ligaments, joints and other connective tissues. It’s important that these essential internal structures are working together to support, stabilize and move your body.

Just as taking an annual trek to the primary care physician helps to monitor your cholesterol levels—and prevent heart disease—yearly physical therapy appointments allow your PT to identify and address any changes in the way you move before they become something more.

Call today to set up your appointment with one of the best physical therapists in town!