Category Archives: Blog

seniors start exercising

Seniors: It’s Never Too Late to Start Exercising

seniors start exercising

For years, seniors have attributed their aches, pains, and illnesses to the normal aging process. Age is often used as a reason to avoid exercise. But a regular exercise program can improve the quality of your life and help you avoid illness, including heart disease, stroke, and diabetes. As always, you should consult with your health care provider before starting any exercise program.

Most people know that with age, come certain physiological changes. Studies show that we lose the following as we age:
• Lean muscle tissue—Most of us will lose muscle mass as we get older. We usually hit our peak muscle mass early—around age 20—and begin losing muscle mass thereafter.
• Aerobic capacity—The aerobic capacity is the ability of the heart and the body to deliver and use oxygen efficiently. Changes in the heart and decrease in muscle tissue decrease aerobic capacity.
• Balance—As we age, our ability to balance decreases, making falls and injuries more likely. The loss of muscle is a major contributor to losses on balance.
• Flexibility—Our joints and tendons lose some of their range of motion with age, making it difficult to bend and move around comfortably.
• Bone density—Most of us reach our peak bone density around age 20. After that, bones can become gradually thinner and weaker, which can lead to osteoporosis.

Fortunately, regular exercise can help delay some of these changes and give you the energy you need to do everyday activities like walking, shopping, and playing with your grandchildren. Exercise may even help decrease depression and stress, improve mood and self-esteem, and postpone age-related cognitive decline.

By adding endurance, strength, flexibility, and balance training into your routine, you will be healthier, happier, and more energetic.

senior push ups

Decades ago, doctors rarely recommended aerobic exercise for older people. But we now know that most people can safely do moderate exercises. Studies have shown that doing aerobic exercise just a few days a week can bring significant improvements in endurance.

Aim to get 30 minutes of moderate exercise—such as brisk walking, bicycling, or swimming—at least 5 days a week. You do not have to do 30 minutes at once—you can break these sessions up into two 15-minute sessions or three 10-minute sessions. Moderate exercise will cause your heart rate to rise and your breathing to be slightly elevated, but you should still be able to carry on a conversation.

It is not just aging that makes people lose muscle. One of the main reasons older people lose muscle mass is that they stop exercising and doing everyday activities that build muscle.

Building stronger muscles can help protect your joints, strengthen your bones, improve your balance, reduce the likelihood of falls, and make it easier for you to move around in general. Even small changes in your muscle size and strength—ones that you cannot even see—will make things like walking quickly across the street and getting up out of a chair easier to do.

Aim to do strength exercises (eg, weight lifting) every other day, or at least twice a week. For each exercise, do three sets of 8-12 repetitions.

Increasing your overall activity level and doing stretching exercises can markedly improve your flexibility.

To improve the flexibility—or range of motion—of your joints, incorporate bending and stretching exercises into your routine. A good time to do your flexibility exercises is after your strength training routine. This is because you muscles will already be warmed up. Examples of exercises that you may enjoy include Tai chi, yoga, Pilates, and exercises that you do in the water.

By regularly stretching, you will be able to move around easier. You may also feel less stressed, and your posture will improve.

Just becoming more physically active will improve your balance and decrease your risk of falling. If you add some basic balancing exercises to your exercise routine, you will begin feeling more stable on your feet. Balance exercises can be done just about anywhere and usually require no more equipment than a chair.

Keep in mind that if you are having severe problems with balance, a fall prevention physical therapy program can be a great way to regain your balance, increase strength or improve flexibility.

To avoid injury, start slowly. Add one or two sessions a week at first and progress from there as you begin to feel stronger. A physical therapist, or other health professional, can help develop a program that will be both safe and effective. Check with your local fitness or community center, which may offer exercise classes designed especially for older adults. Check with your primary health care provider if you are planning to participate in vigorous activities.

Remember, it is never too late to start exercising. The sooner you start, the sooner you will start feeling healthier, more energetic, and less stressed.

American Heart Association

The President’s Council on Physical Fitness, Sports, and Nutrition

Health Canada

Public Health Agency of Canada


Effects of aging. American Academy of Orthopaedic Surgeons website. Available at: Updated September 2009. Accessed April 4, 2016.

Exercise and physical activity: your everyday guide from the National Institute on Aging. National Institute on Aging website. Available at: Updated February 16, 2016. Accessed April 4, 2016.

Physical activity: glossary of terms. Centers for Disease Control and Prevention website. Available at: Updated June 10, 2015. Accessed on April 4, 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.


FOOSH – Silly Name, Serious Injury


One of the most common mechanism of injury from falls is called a FOOSH (Fall on an Out Stretched Hand) injury. Don’t let the funny name fool you. A FOOSH injury is one of the most debilitating ways to injure your upper extremity and cause a significant loss of function. A Foosh occurs when a person is on their way down during a fall and tries to brace for impact using their hands. This is a natural response to falling and is difficult to try and prevent. The resulting impact of the hand and wrist on the ground can cause varying types of injuries from strains and sprains to fractures of the hand, wrist, elbow or shoulder.

What to look for if you experience a FOOSH Injury

1. Fractures: Typically, the fractures of the forearm from a FOOSH are the easiest to spot. They become swollen and bruised very rapidly and are associated with a lot of pain. Often times they produce a visible bulging of the skin of the forearm which can even protrude outside of the body. Fractures of the wrist and forearm will need to be evaluated and often times re-set and casted. Following casting the person must regain strength and range of motion through a guided exercise program before normal function can return. These injuries may take as long as 12 weeks to heal, but as many as 20 weeks for return to normalcy. This process can be expedited significantly by a referral to a well-trained physical therapist.

2. Sprains: Sprains from a FOOSH are much more difficult to spot. A sprain is a common injury to a ligament that normally holds one bone to another as a part of a joint. It most likely causes moderate to severe swelling, bruising, and pain. The pain may occur both by moving the joint yourself or having someone else move the joint while you are relaxed. During a sprain, a non-contractile piece of tissue becomes torn partially or completely. The result is a joint that is too lax to allow proper joint stability. This can cause problems for years following the initial injury. Think of the brake system on your bicycle. If the brake cable becomes elongated the brake does not function correctly until it is repaired. An evaluation by a physical therapist is necessary to diagnose and treat a sprain correctly and to prevent further injury to the injury site as well as allow for speedy recovery.

3. Strains: Strains are also difficult to spot following a FOOSH. A strain differs from a sprain in that it occurs as a tearing of the tendon instead of a ligament. This can present like a sprain with swelling and bruising, but will have a few different characteristics. Tendons attach to bone on one side and a muscle on the other. Tendons therefore hurt with both passive motion, but also with active motion. Strains of the wrist and hand can cause a significant loss in function with things like writing, typing, or even just holding an object in your hand. Without intervention, this can lead to progressively worsening problems like tendonitis and carpal tunnel syndrome which may need surgical intervention if not attended to quickly.

No matter your age or fitness level please use caution to avoid these types of debilitating injuries. If you do fall, it is important to consult your health care provider. During rehabilitation we can help you reduce pain, increase strength and regain function. Please feel free to call us for more information or to schedule an appointment.

remain active with a knee injury

How to Remain Active with a Knee Injury

remain active with a knee injury

In the U.S., ACL and other knee injuries are one of the most common orthopedic and sports-related injuries. For athletes, physically-active folks, and health-conscious individuals, suffering a knee injury can be particularly difficult as they find themselves suddenly immobilized, with minds craving for exercise. Fortunately, as with any injury, there is always something that can be done. As your knees heal, you need only to modify and adapt your training regimen and lifestyle so that you don’t lose the hard-earned strength, stamina, and sport-specific fitness that you’ve so far acquired.

Consider the following 3 tips on how to remain active with a knee injury and keep yourself in the proverbial game.

Tips to Remain Active

1. Find the Right Exercise Regimen

Knee or ACL injuries are particularly problematic as most endurance exercises, and many strength training activities, require activity and flexion in the knees. Thankfully, an injured knee should not keep you bedridden and away from any physical activity. There are still many other activities that you can do to stay active and physically fit, and even recuperate faster.

You do have to be smart about choosing the exercises and always (always!) consult your doctor, physical therapist, or other medical professional. Depending on the severity and extent of your injury, they may recommend a variety of exercises and activities and keep you from exacerbating your condition.

Knee-Friendly Cardio

It’s difficult to think of cardio exercises that do not require flexion and extension of your knees. You may have to wait until you’ve fully recovered to run, jog, or hike again. Nevertheless, you still have many other options for cardio that do not require one knee (or two). Ask your doctor about kayaking, one-legged cycling, rowing, or using an arm ergometer (the handcycle machine).

You could even try swimming, which is a favorite of many with joint or muscle issues! Of course, you’ll need some support or a buoy to keep you from kicking with your legs. Check your local swimming pool if hydrotherapy classes are available. As soon as you are able and approved by your physical therapist, return to doing regular walks, but keep them light and short.

Keep Flexibility and Strengthen Other Muscle Groups

Along with cardio, remember to keep your flexibility and strength up as well. Although you should expect some muscle loss in and around your problem knee, you can still train your other muscle groups.

Again, consult your doctor or a physical therapist before attempting any strength training methods. Depending on your condition, your PT may recommend assisted bench presses for your chest and arm muscles, Lat pulldowns or seated cable rows for your back, presses for your shoulders, as well as appropriate core exercises for your abs and obliques. You may also inquire of their recommended repetition and load for each exercise.

With strength training also comes the importance of flexibility exercises. These activities will keep you nimble, lower risk of injury, and make for more efficient muscles.

Always Warm Up thoroughly

Whatever physical activity you end up doing, never forget to warm up. The proper warm-up techniques deter injury and prepare you both physically and mentally.

2. Wear the right gear

You’ll also need to pay closer attention to your exercise gear whenever you’re physically active. Although you won’t be training your knee directly, a good supportive shoe that absorbs impacts will be invaluable to your recovery.

Another crucial accessory for staying active with an injured knee is a good compression knee brace. Look for the best compression knee brace you can get and find the one that suits your particular injury best. Compression knee brace gives added support to the knees, reduces swelling, relieves pain, increases blood circulation, and aids in the healing process.

You could also give resistance bands a try, particularly when your weight training or stretching. These will help reduce any pressure on your knees.

3. Focus on other healthy habits

An active mind will motivate you to stay physically active as well. Of course, you won’t get as much exercise as before, at least not until you fully recover. Thus, in the meantime, you can set your mind to other healthy activities. For example, now would be a great time to improve your diet and sleep routine. Find a good diet that will help you maintain and keep the weight off (or lose, depending on your doctor’s orders.

Getting better quality sleep is paramount regardless if you’re injured or not. In fact, it’s as important as exercise and diet for a healthy and active lifestyle.

Final Thoughts

No one wants to lose all the progress and fitness gains they’ve made when they’re injured. And with the right mindset and determination, you won’t have to. Find the right exercise, equip yourself with the right gear, and focus on other healthy habits. Give some time to healing and rehabilitation. You’ll be jumping again before you know it. Never let an injury discourage or demotivate you from reaching your health or fitness goals.

About The Author
Aaron Burns is the Owner and freelance writer for Apex Health & Care. A site dedicated to informing and educating people about the right products to support their injuries. Aaron discovered his passion for health and fitness at the young age of 9, after spraining his ankle during a weekly soccer match. He was forced to wear custom orthotics (thanks, flat feet!) and ankle braces to avoid re-injuring his ankle. This childhood experience spurred his passion for writing content surrounding the themes of health, fitness and nutrition. He hopes to aid people of all ages in their endeavor of remaining happy, healthy and mobile as they grow older.

common workout injuries

Common Workout Injuries and How to Avoid Them

Nothing can put a halt in your fitness journey like a workout injury. As we start the new year, many will embark on a journey to achieve their own personal fitness goals. However, injuries such as sprains, fractures, lower back pain, and other injuries can stop you from reaching your goals. Making sure you are educated on the different types of injuries and how to prevent them can help you avoid the headache of a potential injury. If you do injure yourself, resting, icing the injury, compressing it and elevating it can help you recover from minor injuries and get right back into your fitness routine. If you are experiencing a lingering pain, please consult your physical therapist. Pain can be a warning sign from your body that an injury is likely to occur. Fitness19 has created an infographic highlighting the most common workout injuries and how you can avoid them. Check it out below for more information.

Common Workout Injuries and how to avoid them.

PT News PTandMe

PT News December 2018

PT News PTandMe

This time in PT News we recap what our clinics have been posting throughout December, 2018. Featuring published articles from PTandMe partnering clinics!

Shedding Holiday Pounds

1. Shed Those Extra Holiday Pounds
Written by The Jackson Clinics with physical therapy locations throughout Northern Virginia and Maryland.

The holidays are here once again, with all their edible temptations, and you would like to get into better shape after they have passed. This time you are determined to find an approach that will prevent frustration, keep you motivated and help you achieve your fitness goal.  Read more


Snow Shoveling

2. Prevent Low Back Pain While Shoveling Snow
Written by the Therapy Team at Rehab Associates of Central VA with 11 physical therapy locations throughout Central Virginia.

As I was shoveling the snow off my driveway this week, I quickly realized that I needed to adjust my technique or I was going to pay for it later. Injury can result from repetitive movements with a general lack of awareness and variability in movement and may be prevented with some easy steps.  Read more

Fire fighter workers compensation

3. One Fire Captain’s Story: From a Workers’ Comp Injury to a Full Recovery
Written by the Therapy Team at ARC Physical Therapy+ with locations across Kansas, Missouri and Iowa

Bryan Bogue, the Fire Captain with the City of Independence, Missouri Fire Department was on a medical call and needed to lift a heavy bag over a concrete wall. It seemed like a fairly straightforward task until he raised his arms and felt a tendon snap in his elbow. The pain was immediate and severe. Read more

fall prevention physical therapy

Fall Prevention Programs Can Keep You On Your Feet!

Fall Prevention Physical Therapy Programs Can Keep You On Your Feet!

One in every three adults 65 and older fall each year in the United States – WWW.CDC.GOV

The numbers are staggering. Apparently not only does the eyesight go, but balance along with it. The two could be seen as going hand in hand since the worse your vision gets, the more likely you are to bump into or trip on something unnoticed. Fear not worried reader. Physical therapy may not improve vision, but it does improve the ability to manage and reduce the likelihood of a fall and even more importantly, a resulting hip fracture.

Fall prevention physical therapy conditioning programs offered by physical therapists are designed to increase independence with functional activities, functional mobility, and safety awareness while decreasing fall risk. Research has shown that a successful fall prevention program must be multi-dimensional. A program must address all underlying factors in addition to strength and balance. Physical therapists use valid and reliable assessments to determine all the factors affecting each individual’s fall risk. Therapy focuses on reducing the factors and decreasing fall risk. This is consistent with the protocols recommended by: The American Geriatrics Society and the American Academy of Orthopedic Surgeons’ Panel on Fall Prevention Guidelines.


  • Increase independence with Activities of Daily Living (ADLs)
  • Increase independence with functional mobility
  • Decrease fall risk
  • Prevent future fall
  • Increase safety
  • Patient education

Still on the fence?
Don’t take our word for it. We have included an adapted Tinetti Balance Assessment Tool to help assess the likelihood of a fall. The Tinetti tool is the oldest clinical balance assessment tool and the widest used among older people (Yelnik, Bonan 2008). The advantages of Tinetti’s balance assessment tool are its inclusion of both balance and gait and its good inter-rater reliability and excellent sensitivity. (You can read more at the US National Library of Medicine).

Once you have taken your test – ask your physical therapist to go over the results and what options are available to decrease the risk of falls. Find your PT HERE!


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

PT can Help

Elf Injuries and How PT Can Help: Part 1 of 3

Elf Injuries_2016-11_FBsize

It’s that time of year, when we check in on Santa’s helpers to see if they can use some physical therapy. With their heavy lifting and high demand job they’re always experiencing injuries. Our new elf friend Ziggy, is the perfect patient for physical therapy. Let’s see how PT can help Ziggy!

Here’s part of his story…

Ziggy was working late one night in the North Pole. When all of a sudden… he lifted a large toy scooter and fell over on to his back. OUCH!

elf on PT & Me website

Luckily, Santa and his elves have an amazingly good north pole internet provider, and Ziggy was able to go online to the PTandMe website and find great physical therapy clinics in his area.

elf on pt table

Now Ziggy is at one of PT & Me’s physical therapy clinics with one of our trusted therapists to help relieve him of all his back pain. He will be back to making more toys real soon, just in time for the holiday!

See Ziggy’s complete physical therapy experience here!

elf injuries physical therapy PTandMe   Elf on the Shelf Physical Therapy

elf injuries

Special thanks to Action Physical Therapy, in Houston, TX, for accommodating the demanding work schedule of Santa’s elves. Click Here for more information about Action Physical Therapy.

PT News PTandMe

PT News November 2018

PT News PTandMe

This time in PT News we recap what our clinics have been posting throughout November, 2018. Featuring published articles from PTandMe partnering clinics!

Seeing a physical therapist first with Direct Access

1. Seeing A Physical Therapist First, Through Direct Access, Improves Outcomes and Saves Money
Written by Mishock Physical Therapy & Associates with six physical therapy locations throughout Montgomery, Berks and Chester, PA Counties.

With direct access, getting the help you need has never been easier. Direct access is a law that allows you to seek care from your physical therapist without a physician referral. This means that as a patient, you can call us directly if you have an injury, pain, stiffness, or weakness that you want evaluated.  Read more


things you should know about vertigo

2. Things You Should Know About Vertigo
Written by the Therapy Team at Momentum Physical Therapy with 12  physical therapy locations throughout Greater San Antonio.

While anti-nausea medication and rest can help, there are ways to treat vertigo without medication. Vertigo can be helped with physical therapy. BPPV (Benign Paroxysmal Positional Vertigo), commonly described as having “loose crystals in the inner ear,” is the most common type of treated with physical therapy.  Read more

Questions to ask before surgery

3. Questions To Ask Before Choosing Surgery
Written by the Therapy Team at The Center for Physical Rehabilitation with 6, but soon to be 7, physical therapy locations throughout the Greater Grand Rapids Area.

Having surgery can be an intimidating process. Know what your surgical goals are. Are you looking to return to normal daily life functions or do you have plans to return to or start into high-level fitness/athletics? Read more

lack of exercise worse than smoking

Lack of Exercise Worse than Smoking, Diabetes, and Heart Disease

lack of exercise worse than smoking

As physical therapists, it is our job to promote movement and overall well-being.  Exercising regularly is linked to better physical and mental health and can help to prevent or delay heart disease, strokes, certain types of cancer, and diabetes. What is perhaps less known is that not being active can be harmful to your health. This lifestyle, called sedentary, has been linked to a number of preventable diseases. Researchers wanted to assess the impact of a sedentary lifestyle on all-cause mortality. The study, published in JAMA, suggests that a sedentary lifestyle has a larger impact on our health than previously thought.

About the study
The study by Jama included 122,007 participants at an academic medical center. The mean age of the participants was 53 years and they were 59% male. Among these, 13,637 died during the study.

The study followed participants for median of 8.4 years. Their physical fitness was measured using exercise treadmill testing and they were arranged by age and gender into the following performance groups:

  • Low—less active than 25% of participants
  • Below average—less active than 49% of participants
  • Above average—more active than at least 50% of participants
  • High—more active than at least 75% of participants
  • Elite—more active than almost 98% of participants

The study found that death from any cause was lowest among elite category. Death rates were highest among those in low category. It also found that the increase in risk of death linked to sedentary behavior was equal to or greater than the risk of death from smoking, diabetes, and heart disease.

How Does This Affect You?

Cohort studies are observational studies. These studies simply observe events as they unfold, but do not interfere or introduce factors that can affect the outcome. While they can’t show direct cause and effect, they can show a possible link between two factors. A large number of studies have found that sedentary behavior affects health, however this is the first that showed it may be as significant as smoking, diabetes, or heart disease.

If you are sedentary, start moving. Make changes in small increments to help you adjust. Starting a workout routine can be a challenge, but with the help of a physical therapist, you can learn how to get started and safely build up to a regular routine. Work toward at least 150 minutes a week of moderate intensity aerobic activity. Here are some tips to help you get started:

  • Start with short episodes of activity. Try doing 3-4 bouts of walking for 10 minutes at a time, spread throughout the day.
  • Try out different activities to see which work best for you.
  • Look for opportunities to move during the day. Take stairs instead of the elevator, park a little further away, or walk instead of taking your car. Little bits can add up and help you reach longer goals.

If you are already active, keep it up! Make sure to schedule activity into your daily routine.

Need help getting started? We have some great ideas for you here!

exercise tips starting a workout program


2008 physical activity guidelines for Americans Summary. Office of Disease Prevention and Health Promotion website. Available at: Accessed October 25, 2018.

Mandsager K, Harb S, et al. Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Netw Open. 2018;1(6):e183605. Available at: Accessed October 25, 2018.

physical therapy after a car accident

Who Pays for Physical Therapy After a Car Accident?

physical therapy after a car accident: Who pays for physical therapy after a car accident?

Being involved in a car accident can be a life-changing event. The shock alone from the accident can lead to emotional trauma, particularly if you are injured. Ideally, you will let your insurance company handle all aspects of recuperating any compensation due to you. This will include monies for damage to your vehicle as well as for your injuries. In addition to medical expenses, you will need to collect compensation for lost wages and pain and suffering. If you have to go through physical therapy, you will want to be compensated for those expenses, as well. Ideally, you will not have to pay anything out of pocket for medical expenses.

Who Is Responsible for Your Physical Therapy Expenses in a Car Accident?

If you are injured in a car accident, there’s a good chance you may have to go through physical therapy to enhance your recovery. Your insurance will be able to help you pinpoint the party that is responsible for paying for the therapy. If the accident is deemed as your fault, your insurance company will pay for the therapy up to a certain amount. The exact policy you have will determine what this limit is.

If the other person is at fault, then their insurance will cover your physical therapy expenses. Oftentimes, there is a medical expense limit in place, such as $30,000. If your expenses exceed this limit, this doesn’t mean the at-fault party’s insurance is not going to cover more. In addition to medical expense coverage, the person’s insurance will likely offer you some type of settlement.

If the other party does not have car insurance and you are not at fault, your insurance still may provide medical coverage to a certain amount. Beyond that amount, you would have to sue the at-fault party to cover your physical therapy expenses.

How Do I Recover Physical Therapy Expenses From an Accident?

The best way to recover physical therapy expenses is through the at-fault party’s insurance. Your insurance company or the other person’s insurance company may try to offer you a low-ball settlement amount. Have an attorney speak with the insurance companies for you and make sure you receive as much money as possible to pay for your physical therapy expenses, lost wages, pain, and suffering, and more.

How to Prove Your Expense?

No matter who is at fault for the accident, you will have to prove your physical therapy expenses in order to receive coverage for them. Many times, the physical therapist that you receive therapy from will bill the insurance company directly. If not, you will need to provide receipts that outline the services rendered as well as doctor notes detailing how the therapy relates to the injury sustained in the car accident.

Paying for Long-Term Injuries That Require Physical Therapy

Many people who are injured in a car accident will have to go through numerous sessions of physical therapy. Sometimes, these sessions can last for many years, especially if the person has suffered from a severe injury. Hopefully, the at-fault party’s insurance will have a liability coverage limit in place that exceeds what you have to pay for physical therapy. If not, you will have to use the settlement funds to pay for your expenses. You can speak with your physical therapist to determine how long it is predicted that it will take you to recover. From there, a settlement amount can be agreed upon with the at-fault party’s insurance that will likely cover your predicted expenses.

Who Do I Bring a Claim Against for Compensation If I Need Physical Therapy?

The entity to which you will bring a claim against compensation if you need physical therapy will depend on the details of the accident. If you were at fault, you will need to speak with your own insurance company. However, because insurance language can be difficult to understand, and because you likely don’t understand all of your rights, it is extremely important to have a qualified attorney speak with your insurance company for you. A physician can even speak with the insurance company to let them know how extensive your injuries are.

If another person is at fault, your claim will need to be brought against that person’s insurance or that person. Hopefully, you will have a lawyer handling all communications for you, allowing you to focus on your recovery and not have to worry about speaking with insurance companies. This lawyer can speak with your physical therapist to ensure everyone is on the same page regarding your injuries and compensation.

Collecting Compensation for Physical Therapy Costs After an Accident

There is an extensive process that must be followed in order to collect compensation for physical therapy after a car accident. All of the involved steps have to be completed thoroughly and effectively the first time around or the process has to be started over. Receiving all monies owed to you will be of the utmost help in covering your physical therapy expenses. It also will help pay for the daily living expenses that you incur while recovering, which can add up quickly and will become a financial burden since you won’t be able to work.