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Cancer Fatigue Physical Therapy

Physical Therapy can Help Battle Cancer Related Fatigue

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Should you Consider a Physical Therapy Cancer Fatigue Program?

Cancer treatments are rigorous and can take a toll on the body. If you are feeling tired all the time you’re not alone. The number one complaint of cancer patients, affecting 78% to 96% of those undergoing treatment, is cancer related fatigue(CRF). The goal in Physical Therapy is to help you become as independent as possible. Anyone who experiences signs and symptoms of pain or loss of function would benefit from an individualized physical therapy program.

Physical therapy can help you recover from:

  • Chronic pain
  • Leg pain
  • Shortness of breath after light activity
  • Difficulty walking short distance
  • Difficulty performing daily tasks
  • Extreme weariness and tiredness
  • Difficulty paying attention or concentrating

What to Expect from A Physical Therapy Cancer Fatigue Program

Licensed Physical Therapists provide specialized therapeutic services that address the needs of CRF patients. Therapy sessions last approximately thirty minutes to one hour, depending on the patient’s tolerance. The average number of visits per week is 2-3. The physical therapy program is concurrent with cancer therapy and may last throughout the entire treatment phase. Most programs require a thorough physical therapy evaluation and a team approach with your physician is maintained.

Consider it a stepping stone approach towards your recovery.

  • Address pain—which in turn can alleviate fatigue
  • Use non-drug based treatments such as physical modalities:
    – Soft tissue & joint mobilization
    – TENS
    – Heat/Cold
  • Coach patient on how to exercise
  • Alleviate musculoskeletal dysfunction
  • Improve posture
  • Combat effects of bed rest
  • Help to maintain muscle strength and flexibility, and restore muscle balance
  • Help to decrease depression by increasing endorphins
  • Improve balance
  • Improve endurance
  • Core body strengthening

Lady bandana

The Motivation Behind a Cancer Recovery Program

From a physical therapy perspective, one of the main reasons for helping cancer patients comes from seeing individuals for pain problems who were S/P cancer and chemo/radiation. When asked about their the post-treatment care, they said that either; there was none provided, or that they got a few sessions with a lymphedema nurse. Their fatigue and pain symptoms were not addressed.

In looking at what was offered in the community (with the exception of lymphedema nurses) there appeared to be no one addressing the cancer patients—once medical treatment had been completed.

Previous advice for cancer patients was often to get more rest and avoid activities that are physically challenging. Recent studies have shown that exercise was found to be effective in preventing or reducing CRF. No adverse effects of exercising have been reported. Identified as “remarkably underutilized”, exercise is one of the few interventions suggested to diminish CRF and other psychosocial symptoms. If you are struggling to regain your strength and endurance talk to your physical therapist and see if they offer a cancer-related fatigue program that can help you get back to doing the things you enjoy.

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Information Provided by PTandMe Physical Therapy Partner, Advance Rehabilitation. Advance Rehabilitation has locations throughout GA and Northern FL. More information about Advance Rehabilitation can be found on their website at www.advancerehab.com.

For more information on cancer-related physical therapy programs click here:

    
benefits of a home exercise program

Why Should I Do My Home Exercise Program?

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benefits of a home exercise program

When a patient walks in for physical therapy, one of the things they are sent home with is a home exercise program. But why do they do that? Aren’t they supposed to take care of everything while you are in the clinic?  These are questions that may run through your head, but what exactly are the benefits of a home exercise program? If you’re on the fence about whether or not to take your HEP seriously, we’re here to tell you why you should.

  • Continuation of forwarding progression in rehabilitation: Physical and occupational therapists tailor each program to the abilities and strengths of each patient. A patient that completes their home exercise program is more likely to excel in the one-on-one sessions at the clinic and experience fewer setbacks in rehabilitation.
  • Increases level of mobility and endurance: Exercise in the home is designed to continue the progress of the clinic visit by increasing a patient’s flexibility and stamina. A good home exercise program allows a patient to increase function and improve muscle memory so that progress is gained rather than lost from one visit to another.
  • For some patients, therapy doesn’t end at discharge: A home exercise program can help a patient remain pain-free and functional without having to pay for repeat visits and costly medical bills. For patients experiencing chronic pain – a home exercise program is a ticket to staying out of the doctor’s office.

Despite the benefits of a home exercise program, patients have trouble following through on their home exercise program goals. We’re going to go over some of the more common excuses:

  • I don’t have time, because life at home is too busy: It can be hard, especially for those running a household with multiple schedules to accommodate. However, a physical therapist can offer suggestions on working these into your schedule. Some exercises can be done at work, at home, on the playground. If time is truly a concern then don’t be afraid to let the therapist know.
  • It hurts: Some pain is considered normal – it’s a normal part of the exercise. However, if you are doing an exercise and something feels wrong, let your physical therapist know immediately. Don’t wait until your next appointment and tell yourself you will take care of it then. It could be something as simple as not doing the exercise correctly and they can talk you through it over the phone. Communication is a large part of rehabilitation and your therapist wants to know if something is causing concern.
  • Not motivated: Not seeing the point of the exercises your therapist gave you – ask them why it is so beneficial. Going to see a physical therapist 2-3 times a week alone without doing home exercises will not be enough to maintain muscle strength and flexibility. Healthy habits begin with persistence. If you need motivation talk to your therapist, they are born motivators and want nothing more than to watch you succeed. Enlist the help of family or friends to keep asking about your progress.

Physical therapists may utilize print copies of exercises or they may choose to go utilize a digital version that you can access from a mobile device. No matter the delivery, the goal for each is the same. To help you heal more effectively. If you have questions about your home exercise program and what it contributes to your recovery talk to your physical therapist. Education and understanding are crucial to making sure your experience in recovery is successful. If you need help finding a physical therapist to answer your questions, we have you covered in our “Find a PT” section.

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fall prevention at home

Fall Prevention: Risks & Tips in your home

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fall prevention tips at home

While falls can happen anywhere, more than half of them happen in the home. One in every three adults 65 and older fall AT HOME each year in the U.S. One of the easiest ways to help prevent a fall is to make sure that certain tripping hazards are addressed and removed. We’ve compiled a short list below to help you get started.

COMMON WARNING SIGNS FOR FALLING ARE:

  • Feeling pain or stiffness when you walk
  • Needing to walk slower or to hold on to things for support
  • Feeling dizzy or unsteady when you get up from your bed or chair
  • Feeling weak in your legs
  • You take more than one medication
  • You have problems seeing
  • You have had at least one fall in the past year

RISKS TO CONSIDER WHEN FALL PROOFING YOUR HOME:

Lighting

  • Is the lighting adequate, especially at night?
  • Are stairwells well lit?
  • Is there a working flashlight in case of power failure?
  • Can lights easily be turned on even before entering
    a dark room?

Surfaces

  • Are there any wet surfaces that are frequently wet?
  • Are steps and stairs in good repair and the
    appropriate rise?
  • Do steps have handrails in good repair?

Trip Hazards

  • Are there throw rugs in the walking path?
  • Does the family pet often sleep in walking paths?
  • Is the carpet in good repair without tears or fraying?
  • Are there extension cords or raised door sills in the walking paths?
  • Is there a clear path from the bed to the bathroom?

If you feel that you are at risk for falls, talk to your physical therapy provider. Most physical therapy clinics offer fall risk assessments that can help determine any areas of risk. By participating in a fall prevention program, you can reduce the likelihood of a fall and increase the ability to live independently. Fall prevention programs mainly focus on core strength, flexibility, and patient education.

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FLYR_FallPrevention_HomeFalls

For more information about balance and fall prevention click the links below:


    
high school sports injuries

High School Sports Injuries

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Every year, millions of teenagers participate in high school sports. An injury to a high school athlete and the pressure to play can lead to decisions that may lead to additional injury with long-term effects. High school sports injuries can cause problems that require surgery as an adult, and may lead to arthritis later in life.

When a sports injury occurs, it is important to quickly seek proper treatment. To ensure the best possible recovery, athletes, coaches, and parents must follow safe guidelines for returning to the game.

Teenage athletes are injured at about the same rate as professional athletes, but because high school athletes are often still growing they are more susceptible to muscle, tendon, and growth plate injuries.

Types of High School Sports Injuries

Injuries among young athletes fall into two basic categories: overuse injuries and acute injuries. Both types include injuries to the soft tissues (muscles and ligaments) and bones.

Acute Injuries
Acute injuries are caused by a sudden trauma. Examples of trauma include collisions with obstacles on the field or between players. Common acute injuries among young athletes include contusions (bruises), sprains (a partial or complete tear of a ligament), strains (a partial or complete tear of a muscle or tendon), and fractures.

Overuse Injuries
Not all injuries are caused by a single, sudden twist, fall, or collision. Overuse injuries occur gradually over time, when an athletic activity is repeated so often, parts of the body do not have enough time to heal between playing.

Overuse injuries can affect muscles, ligaments, tendons, bones, and growth plates. For example, overhand pitching in baseball can be associated with injuries to the elbow. Swimming is often associated with injuries to the shoulder. Gymnastics and cheerleading are two common activities associated with injuries to the wrist and elbow.

Stress fractures are another common overuse injury in young athletes. Bone is in a constant state of turnover—a process called remodeling. New bone develops and replaces older bone. If an athlete’s activity is too great, the breakdown of older bone occurs rapidly, and the body cannot make new bone fast enough to replace it. As a result, the bone is weakened and stress fractures can occur—most often in the shinbone and bones of the feet.

Concussion
Concussions are mild traumatic brain injuries. They are caused by a blow to the head or body that results in the brain moving rapidly back and forth inside the skull.

Although some sports have higher instances of concussion—such as football, ice hockey, and soccer—concussions can happen in any sport or recreational activity.


Growth Plate Injuries

Growth plates are areas of developing cartilage tissue near the ends of long bones. When a child becomes full-grown, the growth plates harden into solid bone.

Because growth plates are the last portion of bones to harden (ossify), they are vulnerable to fracture. Growth plates regulate and help determine the length and shape of adult bone, therefore, injuries to the growth plate can result in disturbances to bone growth and bone deformity.

Growth plate injuries occur most often in contact sports like football or basketball and in high impact sports like gymnastics.

ThinkstockPhotos-90911121

Treatment

Treatment will depend upon the severity of the injury, and may include a combination of physical therapy, strengthening exercises, and bracing. More serious injuries may require surgery.

Return to Play

A player’s injury must be completely healed before he or she returns to sports activity.

In case of a joint problem, the player must have no pain, no swelling, full range of motion, and normal strength.
In case of concussion, the player must have no symptoms at rest or with exercise, and should be cleared by the appropriate medical provider.

Prevention
Many high school sports injuries can be prevented through proper conditioning, training, and equipment.

High school athletes require sport specific training to prevent injury. Many injuries can be prevented with regular conditioning that begins prior to the formal sports season. Injuries often occur when athletes suddenly increase the duration, intensity, or frequency of their activity. Young athletes who are out of shape at the start of the season should gradually increase activity levels and slowly build back up to a higher fitness level.

Using proper technique for the position being played is also key to preventing injury. Proper equipment—from the right shoes to safety gear—is essential. In addition, injuries can be prevented when athletes understand and follow the rules of the game, and display good sportsmanship.

Information provided by American Academy of Orthopaedic Surgeons

Hot Weather Exercise Tips

Hot Weather Exercise Tips

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Hot Weather Exercise Tips

As the temperatures continue to rise, we have decided to put together a few hot weather exercise tips to consider while staying active and for staying hydrated through the summer.

Set your alarm: Sunrise is generally the coolest time of day, so get up and get out early. It may be more humid, but it is generally still hot at sunset because the ground radiates accumulated heat.

Hydrate: It is recommended to drink at least eight ounces of liquids prior to heading outside to exercise and 6-8 ounces of fluids every 15 minutes, switching between water and an electrolyte drink. Remember to drink plenty of fluids post-exercise to speed recovery.

  • Remember to drink water and other fluids throughout the day. Carry a water bottle with you or grab a drink each time you pass a water fountain.
  • Drink 16oz of fluid 2-3 hours before exercise
  • Drink an additional 10oz of fluid 10-20 minutes before exercise
  • Consume 20-40oz of fluid for every hour of exercise
  • Always have water available. Take a bottle to work, the gym or wherever you are headed, and remember to use it.
  • Drink up any time you are in the sun. Just being outside can lead to dehydration
  • Children and the elderly are more susceptible to dehydration
  • Finally don’t rely on thirst as a signal to drink water. Thirst is actually a sign that the body is under stress and by the time you feel thirsty, dehydration has already begun to set in. Other symptoms of dehydration include dry mouth, irritability, headache, weakness, dizziness, cramps, nausea, and fatigue. Even mild dehydration can lead to diminished performance, the elevation of core body temperature, and increased cardiovascular strain.

Acclimatize: It is advisable to gradually build up your tolerance for exercising in warmer conditions

Wear Technical Fabrics: Technical fabrics wick sweat from your body to keep you cool. Also, wear a visor to keep the sun out of your eyes, not a hat, which traps the heat.

Slow Down: For every 5-degree rise in temperature above 60 degrees F, slow down your activity intensity by 5%

Protect: Use sunscreen to protect your skin and prevent sunburn.

Be realistic: Do not overestimate your level of physical fitness; set realistic exercise goals.

What happens if I feel pain after a workout?

Keep in mind that even when you follow these hot weather exercise tips, some discomfort and muscle soreness is to be expected. If your pain does not resolve within a few days, that is when it’s time to ask for help. Your body may be able to accommodate your pain for a short period, but if left alone, you may begin to experience weakness, a lack of flexibility, and even additional injury if your body moves to avoid the pain by overcompensating with other muscle groups. The sooner you ask for help the better. During your physical therapy first visit, we will evaluate your injury and from there we can:

  • Alleviate pain
  • Correct improper movement patterns
  • Correct muscle imbalances through flexibility and strength training
  • Modify training when possible
  • Educate you about faulty or improper posture or body mechanics with training

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office ergonomics

The Ergonomic Workstation

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Having an ergonomic workstation means that your desk and the things on it are arranged in such a way, that they prevent injury and are well within reach and use. An ergonomic workstation also promotes good posture. Posture is the position in which you hold your body upright against gravity while standing, sitting or lying down. An ergonomically designed workstation promotes good posture and helps to:

  • Keep bones and joints in the correct alignment so that muscles are being used properly.
  • Help decrease the abnormal wearing of joint surfaces that could result in arthritis.
  • Decrease the stress on the ligaments holding the joints of the spine together.
  • Prevent the spine from becoming fixed in abnormal positions.
  • Counter fatigue because muscles are being used more efficiently, allowing the body to use less energy.
  • Prevent strain or overuse problems.
  • Avert backache and muscular pain.

Proper ergonomics plays an instrumental role in how effectively you accomplish work and will help prevent suffering from work-related injuries due to strain and overuse. In the diagram below you will find both sitting and standing workstation recommendations to achieve a proper ergonomic workstation.

seated ergonomic workstation

SITTING: Body position guidelines

  • Lower back supported by a lumbar curve
  • Bottom & Thighs distributed pressure
  • ARMS minimal bend at the wrist
  • The area behind the knee not touching the seat
  • Feet flat on the floor or on a footrest
  • Wrists and hands do not rest on sharp or hard edges
  • The telephone should be used with your head upright (not bent) and your shoulders relaxed (not elevated)

 

Standing Ergonomics

STANDING: Working Guidelines

  • Precision Work – above elbow height
  • Light Work – just below elbow height
  • Heavy Work – 4-6 inches below elbow height

 

Setting Up Your Ergonomic Workstation

Video Provided by North Lake Physical Therapy

Physical and occupational therapists have experience working with patients to improve posture and ergonomics. Some clinics have therapists that go into the workplace and arrange a patient’s workplace, making it ergonomically efficient. For more information or to find a therapist near you

physical therapy near me

posture causes neck pain

Posture is a leading cause of Neck Pain.

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posture causes neck pain

Neck pain is a common problem among adults and with the help of smartphones and tablets, is becoming more frequent among young adults.  Studies have shown that the incidence of neck pain is increasing making it second only to low back pain in worker’s compensation costs.  Seventy percent of adults will experience neck pain in their lifetime and over fifty percent of adults have experienced neck pain in the last six months.  Symptoms of cervical dysfunction may include dizziness and headaches as well as neck pain. Neck pain may be a result of trauma, stress, poor posture, static or repetitive movements.

Physical therapy can be effective in treating many types of neck pain.  The combination of modalities, manual therapy, and exercise, as well as postural and ergonomic correction, is proven to provide the best long-term results. It’s also important to look at the whole body for postural issues as well as movement disorders that could cause increased stress on the neck. Chronic neck pain may be from altered patterns of muscle activation with upper extremity use, resulting in the increased use of the accessory muscles.  The increased use of these muscles along with the decreased use of the neck flexors can lead to decreased ability for neck stabilization which can result in neck pain, headaches or dizziness.

Physical therapists can design a specific program to restore alignment and muscular stabilization, resulting in decreased neck pain. Range of motion and posture can be improved with cervical and scapular strengthening exercises, which are an integral part of any physical therapy program for the neck. However, no physical therapy program for neck pain is complete without patient education. This includes a home exercise program along with the postural and ergonomic correction. This is specific to each patient and also encompasses all aspects of life including sleeping, work, and recreation.

See if your posture may be contributing to your neck pain.

Posture IQ Quiz

1. When you’re sitting at the computer are you:

A. Leaning into the computer with your head closest to the screen?

B. Sitting upright with your back to the office chair?

2. Is your keyboard:

A. Positioned in the middle of the desk (forcing you into a reach)?

B. Directly in front of you at the edge of your desk?

3. Is your computer screen:

A. At an angle or tilted

B. At eye level, directly in front of you

4. When driving, can you feel your head against the headrest?

A. No, I’m leaned forward looking out the windshield

B. Yes, and I use the lumbar support feature in my car


If you answered A to 2 or more questions, you’re most likely going to suffer from posture-related symptoms throughout your life.
If you answered B to most questions, you’ve got an excellent posture IQ and will save yourself years of potential back, neck, and shoulder pain.
(Quiz provided by Life Fitness Physical Therapy  – Ellicott City, MD)

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More information you may find helpful:

text neck   office ergonomics

sports medicine physical therapy

The Role of Physical Therapy in Sports Medicine

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Sports medicine through physical therapy comes in many forms. Many clinics keep licensed athletic trainers on staff that will go on-site to schools and other sporting events to act as an initial caregiver at the time of an injury. If an injury occurs, you may be referred to physical therapy. From there, your physical therapist will have an array of different programs tailored to your specific type of injury, the severity of the injury, and your fitness level. However, you don’t have to wait until you have an injury to get help from a physical therapist. Sometimes the best medicine is prevention.

WHEN YOUR BODY EXPERIENCES PAIN:

  • It’s telling you that something is wrong
  • Your body can accommodate the pain, but eventually, a breakdown will happen
  • While you accommodate to your pain, weakness and stiffness begins
  • Once you have a breakdown, pain will happen and more than likely you will stop training

Some ways physical therapists help athletes from experiencing an injury:

Sports Injury Prevention Programs: Physical Therapists offer classes and/or programs geared to specific injuries. Commonly offered programs are geared towards ACL Injury prevention, Golf Strengthening (TPI), Running Injuries, and more.

Gait Analysis for runners: A three-dimensional video assessment of a runner’s biomechanics using a state-of-the-art motion analysis system. See yourself run at variable speeds from five different camera angles. An athlete can learn how to prevent injuries and improve performance through increase cadence and strengthening/stretching.

Functional Movement Screenings (FMS): One way to determine physical weaknesses is to perform the Functional Movement Screen. FMS is an innovative system used to evaluate movement pattern quality for clients and athletes. The functional movement screen is used to identify and correct weaknesses in the movement and strength of athletes.

ONCE AN ATHLETE DOES EXPERIENCE AN INJURY, PHYSICAL THERAPY MAY INCLUDE:

  • Education on faulty or improper posture or body mechanics with training
  • Education and help with technique on exercises that help your muscles stretch farther
  • Flexibility training helps prevent cramps, stiffness, and injuries, and can give you a wider range of motion
  • Correction of muscle imbalances through flexibility and strength training
  • Endurance training
  • Kinesiotaping
  • Alleviation of pain
  • Correction improper movement patterns

If you are in need of sports medicine physical therapy, we have licensed professionals throughout the country.

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snow shoveling safety tips

Snow Shoveling Safety Tips

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snow shoveling safety tips

Snow Shoveling: A common cause of soft tissue injuries & low back pain

An average of 11,500 people are treated at emergency rooms for injuries and medical emergencies related to snow shoveling each year, according to a report released Jan. 17 by the Center for Injury Research and Policy at Nationwide Children’s Hospital.  Data from between 1990 and 2006 shows the majority of the injuries were soft-tissue injuries, with the lower back being affected 34 percent of the time. Acute musculoskeletal exertion was the cause of injury in 54 percent of the cases, followed by slips and falls (20 percent) and being struck by a snow shovel (15 percent).  Study authors recommended individuals talk to their doctor before shoveling snow, particularly those who do not exercise regularly, have a medical condition or are in a high-risk group. They also recommended alternative snow removal methods.

Clearing snow & Ice

Clearing snow and ice from driveways and sidewalks is hard work. To prevent injuries, follow these safety tips from the National Safety Council, the American Academy of Orthopaedic Surgeons, and other prevention organizations.

  • Dress warmly, paying special attention to feet, hands, nose,
    and ears.
  • Avoid shoveling snow if you are out of shape. If you have a history of heart trouble, do not shovel snow unless your doctor says it’s okay.
  • Do light warm-up exercises before shoveling and take
    frequent breaks.
  • If possible, push snow in front of you. If you have to lift it, pick up small amounts and lift with your legs, not your back. Do not toss snow over your shoulder or to the side.

Use ergonomic lifting technique

Whenever possible, push the snow to one side rather than lifting it. When lifting the snow shovel is necessary, make sure to use ergonomic lifting techniques.

  • Always face towards the object you intend to lift (ie have your shoulders and hips both squarely facing it)
  • Bend at the hips, not the low back, and push the chest out, pointing forward. Then, bend your knees and lift with your leg muscles, keeping your back straight
  • Keep your loads light and do not lift an object that is too heavy
    for you
  • If you must lift a shovel full, grip the shovel with one hand as close to the blade as comfortably possible and the other hand on the handle (handle and arm length will vary the technique)
  • Avoid twisting the back to move your object to its new location – always pivot your whole body to face the new direction
  • Keep the heaviest part of the object close to your body at your center of gravity – do not extend your arms to throw the snow
  • Walk to the new location to deposit the item rather than reaching or tossing

Video provided by the Center for Physical Rehabilitation with locations throughout Grand Rapids, MI. Check them out online here.

snow shoveling safety tips PTandMe

SENIORS NOTE:

Whenever possible, avoid shoveling snow first thing in the morning. If this is not an option, a proper indoor warm-up will prepare the body for additional activity. Jogging in place, or using a treadmill or stationary bike for 5-10 minutes are options for safely raising the heart rate while in a neutral temperature. As with any exercise, drinking lots of fluids will help maintain electrolyte balance and prevent fluid loss.

 

For more cold weather safety tips to keep you out of harm’s way this winter check the articles below!

Staying Warm in Winter PTandMe  Winter Safety PTandMe  

 

Need help from a physical therapist?

We work with expert teams around the country to make sure you have access to the best care possible.

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ladder safety

Ladder Safety

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ladder safety

As we start to put up our holiday decorations, it’s important to remember that safety comes first.
We’ve collected a few tips on proper ladder safety usage to help you stay safe this holiday season!

LadderSafety

  • If you feel tired or dizzy or are prone to losing your balance, stay off the ladder.
  • Wear clean slip-resistant shoes. Shoes with leather soles are not ideal for ladder use as they are not considered sufficiently slip-resistant.
  • When the ladder is set-up for use, it should be placed on firm level ground and without any type of slippery condition present at either the base or top support points.
  • Ladders should not be placed in front of closed doors that can open toward the ladder. The door should be blocked open, locked, or guarded.
  • Before using a ladder, inspect it to confirm it is in good working condition.
  • Ladders with loose or missing parts should not be used.
  • Rickety ladders that sway or lean to the side should not be used.
  • Make sure you’re using the right size ladder for the job.
  • The length of the ladder should be sufficient so that the climber does not have to stand on the top rung or step.
  • Only one person at a time should be on a ladder unless the ladder is specifically designed for more than one climber (such as a Trestle Ladder).
  • Never jump or slide down from a ladder or climb more than one rung/step at a time.

Ladders can be extremely hazardous when they aren’t used properly, so please take advantage of the safety precautions above. If you find yourself in pain, please come see us. We can help get rid of your pain and back to the holiday traditions and events that you look forward to. It’s our job to make sure you feel great and ready to celebrate!

Looking for a physical therapist to help you recover from a ladder injury?

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More information about ladder safety can be found in our Newsletter

Avoiding Ladder Hazards

Looking for more holiday survival tips? We have them here for you!

  Lifting Safety Tips PTandMe  elf injuries physical therapy PTandMe