News from the Center for Physical Excellence

The Arizona Sundogs hockey team plays on the ice today because of fans who believed in them. After the Sundogs suffered an economic downturn, three fans bought the team to ensure its survival. The fans say the purchase reflects their belief in the Prescott community.

Watch the video report here. (Cronkite News reporter Blake Essig)

By Nancy Walsh, Staff Writer, MedPage Today
Published: December 22, 2011
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Starting aquatic therapy early led to better physical function in patients having total knee replacement, although early water-based exercise did not appear to be beneficial in patients undergoing hip arthroplasty, a German randomized study suggested.

Early institution of the pool-based therapy after knee replacement was associated with improved physical function, with effect sizes ranging from .22 after six months (absolute difference d=3.9, P=0.45) to .39 after two years (absolute difference d=6.9, P=0.12), according to Thoralf R. Liebs, MD, of the University of Schleswig-Holstein in Kiel, and colleagues.

But for hip replacement, improvements were greater if aquatic therapy was delayed until after wound healing, with effect sizes ranging from .01 at three months (absolute difference d=.30, P=0.80) to .19 six months later (absolute difference d=3.1, P=0.52), the researchers reported online in the Archives of Physical Medicine and Rehabilitation. While these differences were not statistically significant, the results of early therapy after knee replacement were considered "clinically important," because the effect sizes were similar to those seen in a meta-analysis for the use of nonsteroidal anti-inflammatory drugs in osteoarthritis, Liebs and colleagues explained.

Aquatic therapy is popular in Europe for patients undergoing joint replacement, and is thought to help patients regain balance and muscle strength.

Several studies have confirmed these benefits, but whether starting earlier than the conventional time of 14 days after surgery has been uncertain.

To explore this, Liebs and colleagues conducted a multicenter study that included 465 patients undergoing total knee or hip arthroplasty (280 hip, 185 knee).

Patients randomized to treatment beginning on day six wore waterproof dressings over the wound, and all participants spent 30 minutes, three times weekly, for a month doing pool-based exercises.

Two-thirds of the patients were women, and mean age was 68. The primary endpoint was patient-reported physical function as measured on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) after three, six, 12, and 24 months.

Secondary endpoints included stiffness and pain, also measured on the WOMAC, the short form-36 health survey, and patient satisfaction.

Weekend warriors are trying to hold aging at bay. Are you someone who has developed aches and pains related to your physical activity? Have you resorted to drugs or surgery to stop the ravages of aging?

Erika Feinberg, CEO of Active Forever said, "There are three major solutions to aches and pains: drugs, slowing down and taking it easy, or finding a non-drug-related product that can help you heal."

Based on her interaction with Boomers, she added: "It is safe to say that they do not care for drugs as the solution. Slowing down is also not an option."

Surgical relief is frequently an option, and after 38 years of full-court basketball, I am living proof with two new shoulders this year and a knee replacement several years ago. Surgery has not relieved all of my pain. Because of side effects, drugs are not a good option.

For the Boomer and those a bit older, there are a multiple of aches and pains.

According to Patience H. White, vice president for public health for the Arthritis Foundation, arthritis is the leading cause of disability in the United States, affecting 50 million Americans, or one in five adults. That number could jump to 67 million by 2030.

Osteoarthritis- a degenerative joint disease- is the most common form of arthritis.

In addition, osteoporosis, a precursor to osteoarthritis, affects 10 million Americans and another 34 million are at risk of getting this disease.

Research shows that 20 percent of seniors who break a hip die within one year. Experts are predicting that by 2025, osteoporosis will be responsible for roughly 3 million fractures and $25.3 billion in costs-per-year, according to the National Osteoporosis Foundation.

When you look at the products that are used for bone- and- joint related diseases, it is estimated by Global Industry Analysts that more than $9 billion will be spent on supplements like calcium fortification, glucosamine, methylsulfonylmethane , vitamins and soy to focus on disease prevention. "You should research and decide the efficacy of drugs to help you relieve pain," Feinberg said.

"The key to keeping aches and pains to a minimum, all comes down to eating correctly for your body, positive thoughts and moderate exercise, while enabling your body to heal faster than you are damaging it," she said.

The Arthritis Foundation supports motion as the best medicine for joint therapy. October 12th is Move Around the World Day. If you go to www.fightarthritispain.org you can determine your risk and keep track of your movement progress.

In searching non-drug ways to provide pain relief Feinberg suggested, "the products we have identified that have been the most and effective include products in the categories of infrared heat therapy, cold laser, compression and traction."

Tom Lescault, CEO of Renewal Technologies, invited me to use a new product that his company put on the market with FDA approval called Laser Touch One, a device that combines cold laser and electrical stimulation. I borrowed one to see if it would help with the recovery of my two shoulder replacements. I reviewed the testimonials and instructions on the website.

It has worked with a variety of conditions from shoulder pain to fibromyalgia. A research study was completed that compared three technologies, and the LTO was the most effective for pain, according to Okky Oei, M.D., a pain specialists and medical director for Renewal Technologies.

For me, I got pain relief and an increase in range of motion with only two weeks of application. Although Mayo has not tested LTO, my surgeon said that cold laser and electrical stimulation are proven techniques in rehabilitation therapy.

Written By: William Arnold

Resources:

Active Forever

Laser Touch One Information and Research

Movement Tips

Shoulder pain is a common diagnosis treated at our facility. Muscular and skeletal causes are normally to blame.

Examples of musculoskeletal causes include rotator cuff inflammation and tears, bursitis, rubbing of bone on a tendon, and lack of coordination of shoulder muscles. On occasion, nerves in the neck area may actually be the cause of shoulder pain. Past research suggests that treatments such as cortisone injections and surgery are not superior to physical therapy.

In addition, therapeutic exercises given by physical therapists have the added advantage of improving the health of muscles, tendons, and joints. Therapeutic exercises also address faulty muscle patterns that may be contributing to the cause of shoulder pain. Therapeutic exercises are exercises given at particular settings (repetitions, sets, ranges of motion, etc.) for specific goals. Three sets of ten are not appropriate for all goals and stages of rehabilitation.

The physical therapist may wish to address muscle coordination, improved tolerance of tendons to loading, range of motion, joint stability, endurance, or strength. Each patient's therapeutic exercise program is unique to his or her condition and stage of healing.

Physical therapy also includes manual therapy. Manual therapy is more than just "massage" of muscles. Joint gliding may be included to improve normal movement. Joint gliding can also decrease your amount of pain.

If you are experiencing shoulder pain, consult with your physician to see if physical therapy is appropriate for you. The sooner the pain is addressed, the quicker you will be on your way to becoming pain-free!

As of March 22, 2011, we are now offering Physical Therapy at 3221 N. Windsong Drive in Prescott Valley.

UPDATE! The Prescott Valley office is now open four days per week, Mondays - Thursdays.

Our phone number for scheduling is (928) 442-0005 and the office number in PV is (928) 583-6326.

You Do!!! That's right. Many people don't know it but you have a right to choose your provider. You have freedom to choose where you go for physical therapy with the exception of a small number of self insured companies and HMO Plans.

1. All patients have a common law right, based upon court decisions, to control the care provided to them, including who renders it. Thus, when patients voluntarily express preferences for certain providers, their choices must be honored regardless of the payor source or type of care.

2. Federal statutes of the Medicare and Medicaid Programs guarantee Medicare beneficiaries and Medicaid recipients the right to freedom of choice of providers (Medicaid recipients may waive this right if they participate in waiver programs). Consequently, when Medicare patients and non-waiver Medicaid patients voluntarily express preferences for providers, these choices must be honored.

Here are a couple web sites to check out regarding your rights. The first is FirstGov for Consumers at www.consumer.gov and the second is the United States Department of Health and Human Services at www.hhs.gov .

In Arizona, a direct access state, you can make an appointment with a physical therapist directly without a physician referral. Over the past several years, the American Physical Therapy Association (APTA), in cooperation with each state's Physical Therapy Association, has lobbied congress for Direct Access in each state. Direct Access, as stated by the APTA, "is the ability of a physical therapist to provide evaluation and treatment to patients without the need for a physician referral. At this time, more than 35 states have some form of direct access as part of their state practice act. Physical therapists in states that currently have restrictions to direct access are actively working with those state legislatures to make the changes needed to permit patients/clients to have access to care."

As the nation accepts Direct Access for Physical Therapy services, clients will now be able to go directly to a therapist for assessment and treatment. In most states, it is still required for patients to follow up with their primary care physician or specialist as a prescription for therapy services is still required to continue ongoing PT treatment. This immediate access to therapeutic care in cooperation and conjunction with the diagnostic assessment of the physicians and supporting medical community leads to a much higher rate of success in a timely manner for the individual seeking services.

Your physical therapist should coordinate care with your primary care doctor and/or specialist to assure open and direct communication with your physician. In all states and facilities, physical therapy services should be provided by a licensed physical therapist or physical therapist assistant under the direction and supervision of a physical therapist.

That said, how do you choose the best physical therapy? With over 20,000 physical therapy offices nationwide, choosing the best one can be overwhelming. The key is to research your choices so you find the office that fits your needs and provides quality care. Here is a list of factors to consider:

• Specialty "Niche" clinics. Many private practices have specialists in a variety of physical therapy realms such as sports medicine, orthopedics, aquatic therapy, pediatrics, neurology, balance, Alzheimers, Parkinsons, Feldenkrais, and Womens Health. Look for a setting that specializes in your area of need. Next, look into the education of the staff and their experience.
• Reputation of the clinic. Referrals from friends or references are excellent ways to choose the best clinic for you. Likely if your friends and family would recommend a certain location, you will also have a good experience.
• Location and availability. Easy access in and out of the location is important as is the physical location of the practice. Find a place that can accommodate any special needs you might have. Distance to the physical therapy office, however, should not be a primary concern.
• Customer/Patient outcomes. Ask the practice if they are engaged in a national outcome study. Outcome studies will tell you the percentage of patient satisfaction, level of patient improvement after therapy, and average number of treatments required for specific diagnosis. These numbers are compared to other practices around the country and can assist in maximizing quality and efficiency of care.
• Facilities available for continuum of care. See if the facility or practice you are interested in will offer pre and post operative programs as well as post rehabilitation fitness programs. Post rehabilitation programs will help keep you healthy and out of formal physical therapy.
• Atmosphere of the clinic. Trust your first impression (ie. Phone call, front office, etc.). Evaluate the quality of the phone conversation you have with the facility and the friendliness of staff to accommodate your needs.
• Interview and tour the clinic. Stop by the clinic/practice a tour of the physical property. It should be clean, safe, easily accessible for your personal needs and friendly.

Locations of clinical settings include private practices where the facility is owned and operated by licensed physical therapist(s), hospital departments (in and out-patient), rehabilitation facilities(in and out-patient) for more involved and neurological/brain injury cases, and in some cases, a physician owned clinic.

The most important part of a physical therapy office is the clients and community that are served. As a profession, it is a privilege to impact lives in our community in such a positive way. Always realize, you are the consumer and you have choices when it comes to your physical therapy provider.

Laura Markey, PT, DPT, FAAOMPT
Center for Physical Excellence

Even very small changes in muscle size can make a big difference in strength. This is especially true in people who already have lost a lot of muscle. Increased strength improves your ability to do things such as getting up from a chair or climbing stairs.

Your muscles are active even when you are sleeping. Their cells are still doing routine activities they need to do to stay alive. This work is called metabolism, and it uses up calories. That can help keep your weight in check, even when you are asleep!

To do most of the following strength exercises, you need to lift or push weights. You will need to keep gradually increasing the amount of weight you use. You can use hand/ankle weights sold in sporting goods stores. You can also use things such as empty milk jugs filled with sand or water, or socks filled with beans and tied shut at the ends.

Download the Exercises Here.

The most common reason people seek medical care is related to pain. Acute pain, defined as pain that came about quickly and has lasted less than 3 months, serves as a red flag to a person, indicating that something is wrong. Unfortunately chronic pain, defined as pain that has lasted greater than 3 months, does not necessarily serve the same useful function . Chronic pain can change every aspect of a person's life including emotion, relationships, wellbeing, job, and money. This article will talk about chronic joint or muscular pain and give guidance for improvement by encouraging the person be active in managing the problem.

A person's attitudes, beliefs, and coping have a huge impact on whether they are likely to improve quality of life by activity. Each person is individual in many ways, and their conditions are unique, so each problem requires a little trial and error as far as activity goes. Therefore, it is necessary that a person in chronic pain be patient, have a positive attitude, assume there is a natural and active way they can reduce their pain, and be productive in the way they deal with the pain.

There are general recommendations that may help a person with chronic pain. One is for people to be mobile in a dynamic fashion versus being in sustained postures over long periods of time. Avoiding immobility and repetitive tasks may be best. Finding new interests alternative to the ones that may increase pain would likely help. There are all kinds of physical activities that can be modified or different types of physical activity that would be tolerated much better and still be fulfilling to a person. For example, a person with knee pain who previously loved to run could try hiking, biking, or swimming. Modifications in things a person likes to do could make all the difference. How about just walking fast? People with chronic pain may restrict their leisure time because they cannot participate at the level they would like. It is important to prioritize and make time for alternative or modified activities.

Problems such as deconditioning, difficulty walking, history of falling, slow recovery from an illness, mental declines, poor nutrition, and incorrect use of medication can be made worse if a person has chronic pain. Pain is associated with depression, reduced tendency to socialize, and sleep loss. So, all efforts must be made to reduce the experience of pain to reduce its impact on the above issues.

An interesting aspect of pain in relation to strength and posture is that the painful joints often shut off or allow weakness in specific muscle groups of the body. If the back muscles that allow you to sit up straight become weak and over stretched over a period of time, then you are probably more likely to develop pain and arthritis. This weakness can be reversed, at least in part to improve posture and arm reaching overhead, by exercise and activity. Strengthening of your legs even with the presence of osteoarthritis in the hips or knees often reduces pain and improves walking and standing tolerance. Improved muscular strength by performing the proper exercises over a period of time would undoubtedly reduce joint stresses. Ways must be found to maintain strength of these joints without increasing pain significantly. Otherwise the muscle will continue to get smaller and weaker.

In some cases, chronic pain will remain to some extent despite varying levels of improvement in different people. Therefore, these people must learn to adjust. This means changing aspects about how they live, what they would like to do, and expectations about the future. As said before, ways must be found to alter the activity so it can be tolerated. For example, if the person has knee arthritis, loves to do gardening, but can't kneel due to pain. Maybe they could try knee pads, or lying on a side in order to do this. Or someone who loves to hike but can't due to increased knee pain and weakness. Maybe a trial with walking sticks would help or trying a different trail that isn't as long or challenging. A person may need to accept that there are things they just can't do anymore. A trial of avoiding these things temporarily or permanently in order to reduce pain, and improve quality of life wou ld be worthwhile. This would allow the opportunity to recognize the variety of activities there are and substitute.
One of the most wonderful concepts for pain and activity is using the strategies of pacing and goal setting. Setting reasonable goals that are important to the person in steps would be a good way to do it. Looking at pacing oneself for the long term benefit vs. short term is also best. If your long term goal is to be able to walk throughout the day doing your normal activities with a reasonable amount of pain, you should pace yourself to attain that goal and not expect to achieve it right away.

A person must try to avoid losing endurance or general conditioning of the body because they are in pain. They are likely to get along better and enjoy life more if endurance is addressed. There are many ways to improve general conditioning or endurance. Commonly, a person with chronic pain will have it mostly in one segment of the body, often a knee, hip, low back, neck, or shou lder. If this is the case, they could do endurance training on the other body segment in order to maintain general fitness. For example, if a person has severe R knee pain and arthritis, they could do an upper body circuit training ro utine at a gym, or exercise on an arm bike.
Other simple ways to reduce joint related chronic pain is to use an assistive device if needed, such as a cane or walker. These can help quite a bit with stability to avoid falls, reduce joint stresses and pain, and improve the amount of mobility. One common mistake among people who use a cane is holding it in their dominant hand or on the same side of the problem. If you have a cane you shou ld always use it on the opposite side of the painful area despite which arm you are dominant with. Another way that may be beneficial to reduce chronic pain is to ensure you get adequate amounts of sleep. This means staying away from your bed in general except to sleep.

Thank you for reading this article. You are always welcome to seek help from a physical therapist at the Center for Physical Excellence.

Reference: Strong, J., Unruh, A., Wright, A., & Baxter, G. (2002). Pain A Textbook/or Therapists. Churchill Livingstone.