Have You Scheduled Your 2023 PT Exam?

Haven’t thought about having an annual PT exam? We’re biased, but we think you should. You see your optometrist and dentist regularly because your eyes and teeth are important. You get an annual physical from your family physician. You might even be getting ready to see your accountant to get your yearly taxes done.

But what about the rest of your body? Have you lost range of motion, or strength? How’s your balance and coordination? These all affect how you move. You might not notice small changes until you have problems like trouble lifting a heavy load, joint pain, or a sprained ankle from a stumble. An annual PT exam can catch problems early, then correct them before they lead to something bigger.

What to Expect

An annual PT exam 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

How Important Is Moving Well?

There is strong evidence suggesting that movement is a valuable predictor of future health and resilience against disease. Moving well can keep you healthier and help you live longer. Here are some examples of the power of movement when it comes to predicting future health:

Gait Velocity

Gait velocity is how fast you walk. Studies have shown that if your typical walking speed is over 1 m/s or 3.3 ft/s, you’re likely able to complete typical daily activities independently. You’re also less likely to be hospitalized and less likely to have adverse events like falls.

Get On and Off the Floor

A series of studies suggest that if you can go from standing to sitting on the floor and back to standing without using your hands, you’re a lot less likely to die than someone who can’t. It’s called the sitting-rising test. You can find the instructions and examples with a quick internet search.

Notice that both gait velocity and the sitting-rising test aren’t specific to any one thing. The risk of hospitalization in the gait velocity studies was hospitalization for any reason. Death in the sitting-rising studies was death from anything. So science says that moving well is incredibly important to your overall health. It’s also important for your quality of life. We think moving well is just as important as your teeth, eyes, and taxes. If you agree, get that annual PT exam scheduled!


References
Why provide an annual physical therapy visit – https://www.apta.org/patient-care/interventions/annual-checkup

Physical Therapists’ Role in Prevention, Wellness, Fitness, Health Promotion, and Management of Disease and Disability – https://www.apta.org/apta-and-you/leadership-and-governance/policies/pt-role-advocacy

Ability to sit and rise from the floor is closely correlated with all-cause mortality risk — ScienceDaily

Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older – PubMed (nih.gov)

What is Post-Intensive Care Syndrome and What Does PT Have To Do With It?

When you think about a person going into intensive care, you probably picture someone who’s very ill and likely fighting for their life. They may be on a ventilator or other equipment that’s keeping them alive. When you’re in that situation, surviving would be a win. But what happens after these people survive? Do they recover and go back to life as it was? What’s the road to recovery look like?

Fortunately, medical advances have led to higher survival rates for people who end up in intensive care units – it’s now between 71% and 90%, which is great. But, survival is not the end goal, and getting out of the ICU is not the end of the battle. Many patients show significant losses of physical, mental and cognitive abilities after discharge. It makes sense – if you don’t use it, you lose it! This cluster of problems is called Post-Intensive Care Syndrome or PICS.

PICS is now recognized as a public health burden. Interventions against PICS need to start in the ICU. Then they need to continue after discharge.

Physical declines often include significant losses of strength, endurance, and mobility. These can lead to serious difficulty completing basic daily tasks like getting to the bathroom, preparing a meal, or walking to the mailbox. This may keep some people from returning home. For others, it means they need a caregiver to safely return to their previous setting. 50% of ICU survivors have limitations in daily activities 1 year later, so this is a serious and long-lasting problem.

Mental health is also a very real concern for ICU survivors. They show significant rates of depression – the mean is 28%. 24% of survivors have anxiety and 21% report PTSD. Again, these conditions have a real impact on the quality of life after leaving the ICU.

Last, declines in cognitive abilities are very common in ICU survivors. 77% have cognitive impairments at 3 months post-discharge and 71% have impairments 1 year out. Cognitive issues after discharge can include poor memory, slower thinking, problems making decisions, or difficulty concentrating.

Physical therapists play a significant role in the fight against PICS. PT typically begins while the patient is in ICU, focusing on getting the patient up and walking early. Patients begin a progressive exercise program as soon as it’s safe for them. We expect a rise in PICS due to the number of people who COVID-19 has put into critical care and/or on a ventilator.

While we can’t prevent every problem that critical illness causes, recognizing the losses that remain after discharge from the ICU is an important step. Physical therapists play an important role in combating the effects of PICS and helping people return to higher-quality lives.

Returning to Activity After a Pandemic

During the COVID-19 pandemic, activity levels dropped for a lot of people. Between stay at home orders, gym closures and working from home, people became more sedentary. On top of that, there were shortages of equipment like dumbbells and bicycles, making staying active at home difficult even if you wanted to.

But this summer, things look different; vaccines are widely available, restrictions are loosening and people are looking to get active and enjoy the warm weather. That’s all good news, but if you had a long break from activity, your body might not be ready to jump right back in. Here are a few tips to help you get more active without getting hurt:

Start slow
● If you’re a runner, think about a walk to run program
● If you’re a weight lifter, start with lighter weights and less reps.
● Whatever your activity of choice is, start with short periods of activity and gradually work your way back up.
Warm up and cool down
Warming up gets your heart and lungs ramped up and prepares your muscles and tendons for the increase in activity about to come. Include some light cardio like jogging, calisthenics, or cycling, followed by active stretching like butt kicks, high knees, or yoga.

Cooling down transitions your body back to a lower state of stress – it brings your heart rate and breathing down, decreases blood flow to your muscles and back to places like your digestive system, and helps you relax. It’s also a great place for static stretches if you need some work on your flexibility.

Take a day off
Rest days let your body recover and keep you from getting burned out. Not enough exercise isn’t good for you, but too much of a good thing can cause problems too.

Watch for early signs of injury
Some soreness for a few days after activity is normal, especially if you’ve had a long break. But there are a few common issues to watch out for as you return to activity:
● Swelling or bruising
● Joint pain, especially in the knees or shoulders
● Foot pain, which could be a sign of plantar fasciitis
● Muscle strains – particularly common in the hamstrings
● Sprains – most common in the ankle

Any of these issues justifies a call to your physical therapist. Getting checked out early can prevent an injury that derails your attempt to return to activity. PTs see all of the issues just mentioned on a regular basis and can help safely guide you back into a more active lifestyle.

Insurers Are Moving From “Sick-care” to “Well-care”

TRICARE has decided to waive the cost-sharing requirement of up to three visits to a physical
therapist for low back pain. They’ve said that the goal is to encourage more use of “high-value”
treatments for low back pain. Understanding what they mean by “high-value” vs “low-value”
treatment can help us see the direction healthcare payers are moving and how physical therapy
is a part of that.


TRICARE tells us in their summary of this demonstration what they mean by high and low-value
care: “Increasing the value of health care refers to improving patients’ quality of care and
outcomes, improving patients’ access to care, and reducing overall costs of care. In contrast,
low-value care refers to interventions that: are not proven to benefit patients; may harm patients;
result in unnecessary costs; or waste health care resources.”

High-value care

High-value care leads to better outcomes, is easy to access and is cheaper for both patients
and insurers. We already know that physical therapy fits into this category, but if we look at
other things that fall into this category, a larger theme starts to emerge. In 2017 the American
College of Physicians released guidelines for treating low back pain that have been widely
endorsed. Initial treatment recommendations include exercise, stretching, tai chi, yoga,
progressive relaxation, heat or ice, cognitive behavioral therapy, and motor control exercise.
These are all active treatments, where the practitioner and the patient are working together to
improve. This is “well care” or “let me help you get better.”

Low-value care

In contrast, low-value care tends to be “sick care” where the patient is a passive participant and
the practitioner is saying “let me make you better.” TRICARE puts imaging before six weeks
without red flag symptoms, surgery for non-specific low back pain, opioids as the first or secondline treatment, and bedrest in the low-value category. We would also place spinal injections in
this category for most people. They’re expensive, only offer temporary relief, usually have a long
wait before they’re available and include the risk of serious infection and damage to surrounding
soft tissues like skin, cartilage, and ligaments.


This isn’t to say that imaging, surgery, or injections are always bad. For a small percentage of
people with low back pain, they’re the right thing. But, most people should start with treatments
that have the best outcomes for the lowest cost. If those treatments tend to focus on
empowering the person in pain to actively participate in their care rather than making them
dependent on someone to “heal” them, that’s even better. Physical therapists have known this
and have been providing care that fits this model for years. TRICARE’s demonstration that
waives cost-sharing clearly shows that insurers are recognizing the value of this type of care
and that they are actively moving in this direction.

Finally, Some Good News About Back Pain

Back pain is a huge problem in developed nations worldwide. It has or will affect most of us. The
current estimate is that 80% of people will experience back pain at least once. It is the single
biggest cause for disability, the third most common reason for doctor visits, and one of the most
common reasons for missing work.


It’s also expensive. Back and neck pain makes up the biggest healthcare expense in the US,
totaling $134 billion spent in 2016. The next two most expensive conditions were diabetes —
$111 billion in spending — and ischemic heart disease at $89 billion.


Diabetes and heart disease being so expensive to treat doesn’t surprise most folks – they can
both lead to other major problems, require long term medication, could require surgery, and
both can be fatal. Back pain won’t kill you, usually doesn’t require long term medication, and
usually doesn’t require surgery either. Why is it so expensive?


The first reason is that it’s so common. The second reason is that our current system isn’t very
good at treating it. Current recommendations include starting with activity modification, and
active treatments like physical therapy. Research backs this up, showing better outcomes and
lower costs with early PT. Unfortunately, only 2% of people with back pain start with PT, and
only 7% get to PT within 90 days. At the same time, a study looking at about 2.5 million people
with back pain in JAMA showed that 32.3% of these patients received imaging within 30 days of
diagnosis and 35.3% received imaging without a trial of physical therapy. Both of these things
go against current practice guidelines for treatment of back pain.


A new pilot program being rolled out by TRICARE, the insurance system used throughout the
US military is waiving the payment owed by the patient for up to three PT sessions in an attempt
to improve the use of what the Defense Health Agency calls “high value” treatment for low back
pain. The theory is that once a person sees some benefit from PT treatment, they’re likely to go
back for more. This is the “try it before you buy it” approach – think of the 7-day free trial Netflix
offers, free samples poured in wineries and craft breweries, or the folks you see standing
around in supermarkets with food on toothpicks. TRICARE’s data seems to indicate that it works
just as well for healthcare as it does for other businesses. In a press release they state that
once people attend one session of physical therapy, they’re likely to go back for more, no matter
what their co-pay is. But TRICARE found that higher co-pays could be a barrier to people trying
that first visit. For the group of patients with the highest co-pays in the system, only 38% of the
people prescribed PT attended the first visit. That’s about half the rate of attendance found in
the lowest co-pay group.


The fact that such a major insurer is looking into the value of PT is great news for everyone. If
TRICARE can show that lowering the cost of PT for patients can improve outcomes and save
insurance companies money, other major insurers will likely follow. This could improve the lives
of millions of people every year while reducing the huge cost of treating low back pain for the
country. That seems like a win for everyone involved.

When the Weather Gets Cold, Don’t Forget to Warm Up

Colder weather means some changes to how we exercise. Of course it’s harder to motivate
yourself to get outside for a run or bike ride when the temperature drops, and the shorter days
compress our schedules, but there are changes in your body that affect your ability to exercise
too. For many people with arthritis or other joint problems, cold weather brings more complaints
of pain. To stay warm, our bodies narrow blood vessels to reduce bloodflow to the skin, and
more superficial muscles. That means that there is an increased risk of muscle strains in the
cold. There is also an increased strain on the heart because of the narrowed blood vessels. This
isn’t to say that you shouldn’t be active outdoors in the cold, it just means you may have to
make a few changes to your routine. Here are a few to consider:

Warm up right

A good warm up is always important, but because of the tendency for joints to be stiffer, and
bloodflow to muscles to be reduced in the cold, it’s even more important that you do it right this
time of year. To start, do something to get your heart rate up a bit, maybe a brisk walk or light
jog. Follow that up with a dynamic warm up rather than static stretches. This could include
walking or jogging while pulling your knees up high to your chest. Maybe some high kicks in
front of you with straight knees to get your hamstrings loosened. A walking lunge with an upper
body twist can get your whole body moving. Cater your warm up to what you have planned in
your workout. If you’re not sure how it should look, ask your physical therapist!

Dress right

Dressing in layers allows you to adjust your insulation to your activity level. After you warm up,
you might want to take off a layer to avoid getting too hot during your main activity. You’ll have it
there later to put back on when your activity level drops and you start getting too cold.
Don’t forget about the sun either – just because it’s cold doesn’t mean the UV rays are gone.
Sunscreen and sunglasses aren’t just for the summer. A lip balm with SPF can protect you not
only from the sun but from the wind too.

Stay hydrated

Drink water before, during, and after your workout. The temperature may be down, but you’ll still
sweat and you’ll still lose water vapor in your breath. The drier air in winter lets your sweat
evaporate more quickly, so it’s easy to underestimate how much fluid you’ve lost.

Cool down

When you’re done, don’t rush to get inside and crawl under a blanket. Cool down properly. Keep
moving with a walk or another form of active recovery to let your heart rate come down. After
exercise is the right place for static stretching. You can also head inside for some foam rolling or
self massage.


The days being shorter and the temperatures being lower don’t mean you’re stuck inside for all
of your exercise. If you follow these tips, you can safely keep moving outside. If you’d like a
customized warm up or cool down, or have questions about your exercise routine, your physical
therapist is a great person to ask!

In Person or Virtual PT? Maybe Both!


Virtual physical therapy has quickly moved from a niche offering to the mainstream. Having more options is great, but it can also complicate decision making. Having an understanding of the benefits of both can help make clear which one would best help you meet your goals.


In Person Physical Therapy


The main advantage of traditional “brick and mortar” PT is that the therapist is in the room with you. That means they can move around to see how you’re moving from different angles, physically adjust your position or movement as you exercise, and physically examine you – testing your strength, measuring your range of motion, etc. They can also use things like manual therapy, electrical stimulation or ultrasound when you’re in the clinic. In person PT may work best for:

● New patients – the ability to physically examine you makes it easier for your PT to accurately diagnose what’s going on
● Less active patients – if you’re not used to exercising and moving, having someone physically present to coach you along can be a big benefit
● People with complicated or chronic conditions – if your back has been hurting for the last 5 years and you’ve been ignoring it, providing a diagnosis and treating it totally virtually will be difficult for your PT
● Less motivated patients – virtual PT requires you to do most of your exercises by yourself. If you need someone watching over you to make sure you do them, in person PT might work better for you


Virtual PT


The main benefit of virtual PT is convenience. Because virtual PT relies on you doing most of your exercise and treatment on your own, appointments can be shorter. This also means that motivation is a prerequisite to choosing virtual PT. The fact that you don’t have to travel to the clinic makes it easier to squeeze a visit into a busy schedule. Virtual PT works well for:

● Athletes and others with good body awareness – being on your own for your home exercise program requires you to be in tune with your body and how it’s moving
● People with common athletic injuries – things like tendonitis, sprains, strains, plantar fasciitis, and overuse injuries are commonly treated by PTs. Because of that, there is a template for treatment that is easily adapted to individual needs.
● People who are comfortable with technology – you don’t have to be a technology whiz, but having some familiarity with skype, facetime, or zoom helps!
● Existing and returning patients – if your physical therapist knows you, it’s easier to treat you virtually.

Both options have benefits and limitations. One or the other might be right for you and your needs, but they’re not mutually exclusive. Combining the two can work well for many people. Doing an in person visit for your initial evaluation and perhaps a follow up visit or two will let your therapist provide an accurate diagnosis and get you started on your exercise program. Once you’re comfortable with your exercise program, you can transition to virtual visits.

5 Reasons You Need a PT to Coordinate Your Fitness Regimen

Physical therapists aren’t just for people that are injured or have had surgery. Physical therapists can also help healthy people improve their fitness. Here are 5 reasons why you should consider seeing yours.


You Want a Baseline

When you see a physical therapist to improve your fitness, you’ll get an assessment of your strength, range of motion, posture and movement patterns. This not only helps your physical therapist design a customized program just for you, it gives them a baseline to compare things to in the future should you start having pain or suffer an injury.


You Want Expert Guidance

Sure, other professionals could help with your fitness routine, but the fitness industry is not well regulated. Some certifications just require an online course and paying a fee. There are no licenses or other requirements to use many titles. Becoming a physical therapist requires at least a bachelor’s degree and most PTs practicing today have a doctorate. Every PT has passed a national board exam and maintains a state license. That guarantees you that every physical therapist is a verified expert in human movement.


You Want to Prevent Injury

Physical therapists don’t just work to heal injuries, they are also experts in preventing them. After a thorough assessment, a PT can help you design a program that will not only help you reach your fitness goals, but that can address any issues that increase your risk for injury.


You Want Unbiased Advice

Yoga instructors will want you to do yoga. Personal trainers will want you to come to their gym. Pilates instructors will want you to do Pilates. Strength coaches will want you to strength train. A physical therapist doesn’t have a bias or vested interest as to what type of fitness regimen you choose. They are only interested in helping you reach your goals.


You Have a History

If you have some kind of history that affects your ability to exercise, a PT is the best person to help you design a fitness regimen. It doesn’t matter if it’s an old injury from athletics or work, back pain that comes up from time to time, COPD, arthritis or heart disease, a PT can help you safely work around it and meet your fitness goals.

5 Reasons You Need a PT to Coordinate Your Fitness Regimen

Physical therapists aren’t just for people that are injured or have had surgery. Physical
therapists can also help healthy people improve their fitness. Here are 5 reasons why you
should consider seeing yours.


You Want a Baseline

When you see a physical therapist to improve your fitness, you’ll get an assessment of your
strength, range of motion, posture and movement patterns. This not only helps your physical
therapist design a customized program just for you, it gives them a baseline to compare things
to in the future should you start having pain or suffer an injury.

You Want Expert Guidance

Sure, other professionals could help with your fitness routine, but the fitness industry is not well
regulated. Some certifications just require an online course and paying a fee. There are no
licenses or other requirements to use many titles. Becoming a physical therapist requires at
least a bachelor’s degree and most PTs practicing today have a doctorate. Every PT has
passed a national board exam and maintains a state license. That guarantees you that every
physical therapist is a verified expert in human movement.

You Want to Prevent Injury

Physical therapists don’t just work to heal injuries, they are also experts in preventing them.
After a thorough assessment, a PT can help you design a program that will not only help you
reach your fitness goals, but that can address any issues that increase your risk for injury.

You Want Unbiased Advice

Yoga instructors will want you to do yoga. Personal trainers will want you to come to their gym.
Pilates instructors will want you to do Pilates. Strength coaches will want you to strength train. A
physical therapist doesn’t have a bias or vested interest as to what type of fitness regimen you choose.
They are only interested in helping you reach your goals.

You Have a History

If you have some kind of history that affects your ability to exercise, a PT is the best person to
help you design a fitness regimen. It doesn’t matter if it’s an old injury from athletics or work,
back pain that comes up from time to time, COPD, arthritis or heart disease, a PT can help you
safely work around it and meet your fitness goals.

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.