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weight loss

Weight Loss: What Are Your Options?

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The prevalence of obesity has increased steadily in Western cultures over the past century, particularly during the last several decades. In fact, most health professionals agree that we are in the midst of an obesity epidemic in the United States.

Being overweight is closely linked to many very serious health conditions. It is a significant risk factor for coronary artery disease (CAD), stroke, high blood pressure, high cholesterol, high triglycerides, low levels of HDL (high-density lipoprotein—the “good” cholesterol), and type 2 diabetes. Fortunately, even modest reductions in weight can help reduce the risk or improve these conditions. Plus, practicing the behavioral changes of a healthier diet and regular exercise may actually reduce these risk factors whether weight loss occurs or not.

Energy Balance: The Simple Principle of Weight Loss
Scientists often explain weight loss quite simply in terms of the energy balance equation: energy in versus energy out. To lose weight, you must consume fewer calories than you burn or, in reverse, you must burn more calories than you consume.

This is, of course, easier said than done. But no matter what weight loss methods you may employ—diet, exercise, medications, supplements, surgery, therapy, group support—the principle of energy balance is unavoidable. In fact, experts from both traditional and nontraditional disciplines agree that to achieve and maintain weight loss you must make changes in your diet and activity level to favorably affect the balance of the energy equation.

Using Strategies to Get Started
Getting started is often the most difficult part of losing weight. Any changes you make in your eating and exercising behaviors must become habitual, which takes time. In addition, carrying extra weight, no matter how much, can affect how you feel about yourself psychologically, sometimes making it more difficult to take the necessary steps to begin to change.

The following 5 strategies are crucial to successful weight loss and can help to overcome some of these barriers:

• Set and commit to realistic goals and monitor your progress toward achieving these goals
• Slowly modify your eating and exercise behaviors, as well as habits influencing both
• Examine and restructure unrealistic, negative thoughts, or expectations
Reduce stress
• Develop a network of social support and information

weight_loss

Looking at Weight Loss Aids
There is a great deal of interest in whether prescription medications or supplements can facilitate weight loss. Some medications suppress appetite by interfering with brain chemicals that affect mood and appetite. Others reduce fat absorption from the gut. Here are examples of medications that may be recommended for weight loss:

• Diethylpropion
• Lorcaserin
• Orlistat
• Phendimetrazine
• Phentermine—can be taken alone or in combination with another medication

Some studies have supported the use of these medications when combined with lifestyle changes. For example, as part of a review of weight loss drugs, researchers analyzed 15 trials involving almost 10,000 people who were either taking orlistat or placebo. Compared to the placebo group, those taking orlistat had a higher chance of achieving a 5% or 10% weight loss. These types of medications, though, are usually prescribed only for people who are severely obese when other methods of weight loss have not worked. Accordingly, these medications are not without side effects or potential adverse events and should only be used with careful monitoring by your doctor.

The same goes for dietary supplements. Supplements do not undergo the same rigorous approval process as drugs. That being said, certain supplements may provide weight loss benefits since they may contain similar mechanisms of action as drugs. Along the same line, some of the same risks and side effects may be present, as well, which is why you should talk to your doctor before taking any over-the-counter weight loss products.

Also, be sure you know what is in diet medications and supplements. Some medications and supplements that were used in the past have been pulled from the market as it was found that the dangers of taking them were higher than the benefits. Whenever you are considering taking a diet supplement, know exactly what is in the product and share this information with your doctor.

The question is: when should you consider taking these weight loss aids? While it depends on your overall health and medical history, the best approach may be a conservative one. For example, adopt lifestyle changes for 6-12 months before trying a drug or supplement. Your doctor can give you guidance as to which weight loss options you should try first.

by Jackie Hart, MD

RESOURCES:
National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov

National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

CANADIAN RESOURCES:
Dietitians of Canada
http://www.dietitians.ca

Health Canada
http://www.hc-sc.gc.ca

REFERENCES:
Choosing a safe and successful weight-loss program. National Institute of Diabetes and Digestive and Kidney Disorders. Available at: http://www.niddk.nih.gov/health-information/health-topics/weight-control/choosing-safe-successful-weight-loss-program/Pages/choosing-safe-successful-weight-loss-program.aspx. Updated December 2012. Accessed January 14, 2016.

Diets for weight loss. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 21, 2015. Accessed January 14, 2016.

Obesity in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 21, 2015. Accessed January 14, 2016.

Rucker D, Padwal R, Li SK, Curioni C, Lau DC. Long term pharmacotherapy for obesity and overweight: updated meta-analysis. BMJ. 2007;335(7631):1194-1199.

Weight loss medications for obesity in adults. Available at: http://www.ebscohost.com/dynamed. Updated October 7, 2015. Accessed January 14, 2016.

7/6/2009 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Seo DC, Sa J. A meta-analysis of psycho-behavioral obesity interventions among US multiethnic and minority adults. Prev Med. 2008;47(6):573-582.

10/15/2010 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: US Food and Drug Administration. Meridia (sibutramine): market withdrawal due to risk of serious cardiovascular events. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm228830.htm. Updated Sepember 9, 2013. Accessed January 14, 2016.

Last reviewed July 2016 by Michael Woods, MD Last Updated: 1/14/2016

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

feet cause pain

Can Your Feet Cause Pain in Your Knee, Hip or Back?

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Can your feet cause pain in other areas of the body?  Yes it can.  The foot is an arch and arches decrease compressive forces by distributing them across the span of the arch. Engineers use arches in building and bridges to hold up greater weight across longer spans.  The human foot has 3 arches that all work together to distribute the forces our bodies put on it.  This allows us to walk, run and jump.

We start running into problems when the arch is either too flat or too high – causing the forces put through the foot to be abnormally distributed, resulting in strain.

  • Flat feet limit the range of motion of our ankle, causing our hips to rotate inward and move towards the center of our body.
  • High arches do the opposite to our hip joints.
  • These changes cause strain to our ankle, knee and hip joints, and our back.

knee pain

People can be unaware that their feet cause pain throughout the body because they were born with flat feet or high arches and they do not know what “normal” feels like.   As physical therapists we have treated many children who didn’t realize that their feet are not supposed to be sore.  But instead of seeing them for prescribed foot pain, they come for pain in their joints or back.

Orthotics were developed to correct or adapt to changes in the foot.  Orthotics should be fitted by a healthcare professional trained in assessing the foot and gait.  Standing on a pressure plate in the store is not good enough.  Why?  If your foot hurts are you going to stand on it normally?  Probably not.  This results in an abnormal reading.

An orthotic by itself is not the best treatment.   A physical therapist will assess your function, strength, flexibility and range of motion.  Patients will present with other problems as the result of abnormal arches.  Treatment with orthotics combined with strengthening and stretching exercises, balance training, functional training and manual therapy is necessary to restore full function.

This article was written by Scott Van Bramer, PT, Partner/Clinic Director of Phoenix Physical Therapy.  Phoenix Physical Therapy is an outpatient physical therapy clinic in Canal Winchester, OH. For more information about Phoenix Physical Therapy in Canal Winchester, please call the clinic directly at 614-834-2995 or visit them online at www.phoenixptohio.com

PT News

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This Month in PT News. Featuring articles from PTandMe partnering clinics!

2. Early Intervention is the Key to Success
Written by Ben Eggleston, PTA at the Center for Physical Rehabilitation – Grand Rapids, MI

The relationship between longevity of symptoms and healing time is of reciprocal proportion? Read more

3. Overtraining Doesn’t Help, It Hurts 
Written by the Therapy Team at Momentum Physical Therapy – San Antonio, TX

Working to achieve a sports or fitness goal can drive many people to overtrain in an effort to get stronger, better, faster. Read more

high blood pressure

Recommendations to Help Prevent High Blood Pressure

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Hypertension is abnormally high blood pressure. High blood pressure puts extra strain on the heart, lungs, brain, and kidneys. It carries with it an increased risk of death and disability from coronary artery disease (CAD), stroke, heart failure, and kidney disease.

High blood pressure is very common but can’t be seen or felt. Many people with high blood pressure don’t know they have it. The best way to know if you have high blood pressure is to keep track of your numbers. You can get your blood pressure checked at your doctor’s office, at home, or at your local pharmacy. It’s important to get your blood pressure checked regularly.

Defining High Blood Pressure
High blood pressure is defined by 2 numbers (systolic and diastolic). The systolic or top number measures the pressure in your blood vessels when your heart beats. The diastolic or bottom number measures the pressure in your blood vessels when your heart rests between beats.

The normal blood pressure varies with age, usually increasing as we get older. In general, systolic blood pressure (SBP) less than 120 mm Hg and diastolic blood pressure (DBP) less than 80 mm Hg are considered normal and prehypertension is a SBP120-139 mm Hg or DPB 80-89 mm Hg. Abnormal levels include:
• Stage 1 hypertension—SBP 140-159 mm Hg or DPB 90-99 mm Hg
• Stage 2 hypertension—SBP more than 160 mm Hg or DBP more than 100 mm Hg

In people with diabetes or kidney disease, the targets numbers are lower. Check with your doctor to see what your target range should be.

Common Risk Factors
There is no single cause for high blood pressure, but there are several factors that can increase your risk.

Some risk factors for high blood pressure include:
• Age: middle-aged or elderly—onset generally happens at 20-50 years, but likelihood increases with age
• Race: African American
• Gender: Male

Medical factors, such as:
• Diabetes
Obesity
Metabolic syndrome—A condition marked by elevated blood pressure, cholesterol, blood glucose, and body weight. Excess weight centered around the midsection is of particular concern.
• A family history of high blood pressure
Sleep apnea
• Prehypertension

Lifestyle factors, such as:
Smoking
• Being physically inactive
• Taking birth control pills
• Having diet high in red meat, salt, and saturated and trans fats
• High alcohol intake

Risk factors don’t mean you will get high blood pressure, but that you have an increased chance of developing it. Fortunately, there are also factors that can help you prevent high blood pressure or lower your blood pressure if you already have elevated blood pressure.

blood_pressure

Lifestyle Guidelines to Prevent or Reduce High Blood Pressure
The National Heart, Lung, and Blood Institute’s recommendations to help prevent or lower high blood pressure include:
• Losing weight if you are overweight
• Increasing levels of physical activity—Aim for 30 minutes per day on most days of the week.
• Eating a diet rich in fruits, vegetables, and low-fat dairy products
• Eating a diet that is low in saturated and total fat
• Limiting consumption of sodium (salt) to less than 2,300 milligrams per day
• Drinking alcohol only in moderation—This means 1 drink or less per day for women and 2 drinks per day or less for men.

Another approach endorsed by National Heart, Lung, and Blood Institute is use of the DASH diet. This is a special low-salt diet which has been shown effective in both preventing and treating high blood pressure.

High blood pressure is a major player in heart disease and stroke. Protect yourself and know your numbers. The next time you take a trip to the pharmacy, check your blood pressure. If you do it on a regular basis and follow the lifestyle guidelines, you may be able to avoid future problems.

by Michael Jubinville, MPH

RESOURCES:
National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov

American Heart Association
http://www.heart.org

CANADIAN RESOURCES:
Health Canada
http://www.hc-sc.gc.ca

Heart & Stroke Association
http://www.heartandstroke.ca

REFERENCES:
Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206-1252.

How can high blood pressure be prevented? National Heart Lung and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/prevention. Updated September 10, 2015. Accessed August 2, 2016.

Hypertension. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 12, 2016. Accessed August 2, 2016.

Hypertension treatment in patients with diabetes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 11, 2016. Accessed August 2, 2016.

Preventing high blood pressure: Healthy living habits. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/bloodpressure/what_you_can_do.htm. Updated July 7, 2014. Accessed August 2, 2016.

Understanding your risk for high blood pressure. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandYourRiskforHighBloodPressure/Understand-Your-Risk-for-High-Blood-Pressure_UCM_002052_Article.jsp#.V6CgG02FPIU. Updated June 29, 2016. Accessed August 2, 2016.

Whelton PK, He J, Appel LJ, et al. Clinical and public health advisory from the National High Blood Pressure Education Program. JAMA. 2002;288(15):1882-1888.

Last reviewed July 2016 by Michael Woods, MD Last Updated: 8/2/2016

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

shoulder surgery

Self Care: Safe Dressing Following Shoulder Surgery / Injury

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When recovering from shoulder surgery, it can be difficult to dress and undress without assistance. With the help of one of our trusted Certified Hand Therapists (CHT) they have compiled a list of tips to get dressed safely and independently while recovering.  It is highly recommended that you follow the instructions prescribed by your surgeon or attending physician.

DRESSING

Upper Body
• Bend forward at your hips and let your affected arm dangle loosely forward
• Always dress the affected arm through the sleeve of your shirt first
• Proceed to dress the unaffected arm

Lower Body
• One handed techniques to don socks: touch all fingers to your thumb, then slide the sock over your hand. Spread your fingers apart to open the sock and slide it onto the foot

Bra
• Clip the bra from the front and as low as possible to your waist. Guide the bra enclosure towards your back. Slide the strap over the affected arm and then slide

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GROOMING

• Bend forward at the hips and dangle arm in order to clean and apply deodorant

These post shoulder surgery dressing tips were provided by The Hale Hand Center, with locations in Melbourne and Rockledge, FL. The Hale Hand Center offers both physical therapy and certified hand therapy services, as well as provides custom splinting. More information about The Hale Hand Center can be found on their website here.

heart healthy physical activity

Heart Healthy Physical Activity

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The heart is often used as a symbol of vitality for good reasons. The heart pushes blood and oxygen to every cell in the body to be used as fuel and carries waste away. Without this process, the body cannot function. The heart plays a role in many aspects of your health and wellness.

Efficiency Matters
The heart beats an average of 60-80 beats per minute, which can add up to millions of beats in just one month. When something works this hard, it is important that it also works efficiently. Well-conditioned athletes can have resting heart rates below 50 beats/minute. Even though their heart beats slower, it can do the same amount of work or more than a heart that beats 60-80 beats/minute. An athlete’s heart pumps stronger during each beat, needing fewer beats to get the job done. Over a lifetime, a difference of 10-30 beats/minute can add up to quite a few beats.

An Ounce of Prevention…
The heart can be affected by physical and mental stressors. You can feel your heart speed up when you sprint across a busy road or when you have a burst of emotion like anger or surprise.

Physical activity can decrease the effect of stress on the heart and body. A fit body and mind will help improve heart health. Regular physical activity can:

Improve physical abilities by:
• Improving the heart’s ability to pump blood
• Increasing energy levels
• Increasing muscle strength and endurance
• Improving agility

Change physical appearance by:
• Toning your muscles which gives you a tighter appearance
• Burning calories which helps with weight loss or maintenance

Improve overall wellness by:
• Helping with stress management
• Improving self-image
• Helping to decrease anxiety and depression
• Improving relaxation
Improving the ability to sleep
• Creating a social activity opportunity
• Promoting healthier cholesterol levels

If you have heart problems, physical activity can still play an important role. A strong and healthy body can help you manage your condition. Physical activity can help reduce the stress on a sick or weak heart and decrease secondary risks like obesity and diabetes. If you do have heart health issues, talk to your doctor before starting an exercise program.

Even if you are healthy, but have not exercised in a long time, you may need to talk to your doctor to make sure that you are in good physical condition to exercise.

heart veggies

Where to Start
For most people, you can begin right away. Find an activity program that you enjoy. Do not pick an activity that does not fit into your schedule, does not fit in with your personal preferences, or has too many obstacles, because you may lose interest quickly. A program that starts with too much intensity is also likely to lose your interest.

Work towards reaching these basic goals:
• 30-60 minutes of physical activity on most days of the week (total of at least 150 minutes/week)
• Include some strength activities at least 2 times/week

Make It Stick
Long-term regular physical activity will count more than a brief and spectacular burst of activity. Most people do not plan to become sedentary. It creeps up on you. Work to increase your physical activity the same way. Gradually add steps. Find activities you enjoy that can replace more sedentary activities.

Here are more tips that have been shown to be useful:
• Find an exercise partner. You are less likely to skip the activity if someone is waiting for you.
• Write it down or use a fitness tracker. Keep a log of your activities and how much you accomplished either by distance or time. It will help keep you honest.
• A long-term goal is fine, but also make short-term goals, because they provide quicker feedback.
• This is important, make it a priority. Plan it out. Find a time in your daily routine when you can regularly fit the activity in.
• Consider doing your activity in 10-minute spurts throughout the day. Spurts can be as effective as being active for 30 minutes straight.
• Be flexible. Life happens and you may find that you need to make adjustments to your routine. A rigid schedule and goal may not be worth the stress. Keep an open mind to new activities and schedules.

Make It Count
Any physical activity is better than none. But at least a few days per week you should aim for more than a leisurely stroll. A moderate intensity level is best to help you make health changes. Moderate intensity activity is enough to get your heart rate up and make you feel a little out of breath but not feel worn out when you are done.

Do not forget to enjoy your activity for the daily benefits it can bring and know that your heart appreciates it as well!

by Pamela Jones, MA

RESOURCES:
American College of Sports Medicine
http://www.acsm.org

American Heart Association
http://www.heart.org

CANADIAN RESOURCES:
Health Canada
http://www.hc-sc.gc.ca

Public Health Agency of Canada
http://www.phac-aspc.gc.ca

REFERENCES:
American Heart Association guidelines for physical activity. American Heart Association website. Available: http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/StartWalking/American-Heart-Association-Guidelines-for-Physical-Activity_UCM_307976_Article.jsp. Updated September 10, 2014. Accessed October 22, 2014.

Guide to physical activity. National Heart and Lung and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/phy_act.htm. Accessed July 21, 2016.

Haskel W, et al. Physical activity and public health, updated recommendations for adults from the American College of Sports Medicine and the American Heart Association. Circ. 2007;116(9):1081.

How much physical activity do you need? Centers for Disease Control and Prevention website. http://www.cdc.gov/physicalactivity/everyone/guidelines/index.html. Updated June 4, 2016. Accessed July 21, 2016.

Promoting physical activity with a public health approach. American College of Sports Medicine website. Available at: http://www.acsm.org/about-acsm/media-room/acsm-in-the-news/2011/08/01/promoting-physical-activity-with-a-public-health-approach. Accessed July 21, 2016.

2008 physical activity guidelines for Americans. United States Department of Health and Human Services website. Available at: http://www.health.gov/paguidelines/guidelines/default.aspx. Accessed July 21, 2016.

Last reviewed July 2016 by Michael Woods, MD Last Updated:10/22/2014

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

reduce back pain

No Turning Back: Reduce Back Pain with These Spine-Stabilizing Exercises

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We take so many things about our bodies for granted. They feel good, we go about our daily activities and we never think about the complex mechanisms at place. That is until something goes wrong. Take your back: it serves as stabilizer, flexor, movement and relaxor too. But unfortunately, back pain troubles many of us — about 8 in 10 people in their lifetime will experience back pain. But you don’t have to rely on pills to relieve symptoms or even countless trips to a doctor. Exercises offer a proactive approach to reduce back pain, and this graphic can help with ideas.

reduce-back-pain-with-these-spine-stabilizing-exercises-web-1

ice hockey injuries

Common Ice Hockey Injuries

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Ice hockey is one of the most popular sports played in North America. Physical therapy can provide specific treatment to a number of specific ice hockey injuries. Here are a few injuries that can happen during a hockey game or practice:

Common Ice Hockey Injuries

BACK INJURIES
Hockey players are at risk for low-back injuries due to the flexed (forward) posture of skating and the frequent hyperextension (backward) stress. Low-back pain and/or a pulled muscle are the most common injuries. Stretching of the hip flexors along with strengthening of the back and abdominal muscles will help avoid these injuries.

HIP INJURIES
The hip joint and groin muscle are susceptible to injury due to the mechanisms of the skating stride. Some of the most common soft tissue injuries in hockey players include a groin strain and a hip flexor strain. Off-season strengthening and dedicated stretching before and after practice are important to prevent these injuries. In addition, a direct blow to the outside of the hip can cause a hip pointer or trochanteric bursitis. Hockey pants with reinforced padding over these areas may help protect them.

KNEE INJURIES
The medial collateral ligament is the most susceptible to a sprain because of the leg position – pushing off the inside edge of the skate blade – and contact to the outside of the knee. Anterior cruciate ligament (ACL) disruption and meniscus tears (torn cartilage) can also occur but are less common in hockey that in other sports such as football, soccer and basketball.

hockey_goalie

SHOULDER INJURIES
The most common shoulder injuries in hockey are a shoulder separation and a broken collarbone. These injuries occur from direct contact of the shoulder with another player, the boards or the ice. Treatment can include a sling, rest and in serious cases surgery.

ELBOW INJURIES
The point of the elbow is a frequent area of contact, which can result in the development of bursitis. Thick and scarred bursal tissue (which feels like bone chips, but isn’t) can be a source of recurrent inflammation. The best prevention method is wearing elbow pads that will fit well and have an opening for the elbow, soft padding and a plastic outer shell.

WRIST INJURIES
A fall on the outstretched arm or contact with the boards that forces the wrist up or down, may cause a fracture. Players should try bracing themselves against the boards using their forearms instead of their hands.

PT News

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This Month in PT News. Featuring articles from PTandMe partnering clinics!

1. Simple Steps to Starting a Weight-Training Program
Written by the Therapy Team at The Jackson Clinics – Middleburg, VA

One of the challenges of weight training is determining how much effort to put in for the most benefits. Read more

2. Sit Up Straight! Avoid Sitting with Bad Posture
Written by Megan Russo, PTA at The Center for Physical Rehabilitation – CPR – Grand Rapids, MI

Do you ever find yourself sitting in a slumped position while at work or driving in the car? Read more

3. Minimizing the Risk of Ski Injury
Written by the Therapy Team at The Jackson Clinics – Middleburg, VA

If winter weather has you prepared to hit the slopes, be sure to take the necessary precautions to keep yourself injury-free this season. Read more

Frisco Physical Therapy

PT & Me Clinic Stands Above the Rest

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At PT & Me we love it when our partnering physical therapy clinics shine. We are so excited that we couldn’t help ourselves, we just had to highlight one of our award winning clinics!

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FRISCO PHYSICAL THERAPY – Physical Therapy Clinic – Frisco, TX
Frisco Physical Therapy was voted the BEST PHYSICAL THERAPY CLINIC in Frisco, Texas by over 32,000 readers of the Frisco Enterprise Newspaper. Clinic Director Colby Pigg, MPT graduated with honors in 1999 and has more than 18 years of experience in physical therapy. Perhaps one of the reasons Frisco Physical Therapy stands out among the crowd is the variety of services it offers to its patients. In addition to general orthopedics the licensed physical therapists in Frisco offer:

• Balance and Fall Prevention Programs
• Cancer Related Fatigue Program
• TPI Certified Golf Fitness Intructor
• Primal 7 and TRX Suspension Training
• Game-Ready Vasopneumatic Cold Compression

We are super excited for Colby and the rehab team at Frisco Physical Therapy for the honor they received by their community. We are certainly looking forward to all of the great things to come. More information about Frisco PT can be found at: www.friscopt.com