Category Archives: General Information

aquatic therapy

Is Aquatic Therapy For You?

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Aquatic therapy offers an alternative environment for therapeutic exercise. If you have tried traditional physical therapy, or have restrictions on your physical therapy program, aquatic Therapy may be the perfect solution for your physical therapy needs.

Why Aquatic Therapy is Beneficial

Less pressure: The buoyancy of the water decreases the amount of pressure, or compressive forces, on your joints and spine. When you’re immersed in water up to your neck, the weight pressing down on your body is reduced by 90%. When the water is up to your waist, the pressure is reduced by 50%.

Reduced swelling: The pressure of the water helps to move fluid from the injured area back into the body. Decreased swelling is essential for regaining the strength and motion needed for recovery.

Ease of movement:
Water is an element that supports and assists movement. It offers a safe setting for regaining strength and joint range of motion.

Faster progress: Aerobic conditioning can often be performed in the water, even when it may be too soon or too difficult to do in the clinic. Staying stable in the water, challenges your core and balance. Plus, sports specific activity can begin earlier than on land.

old man swimming

Who Can Benefit From Aquatic Therapy

• Chronic pain patients requiring a more gentle form of therapy
• Patients at risk of falls due to balance and gait disorders
• Patients with severe arthritis or other weight-bearing restrictions
• Prenatal and postnatal patients
• Patients with general deconditioning
• Sports medicine and orthopedic patients requiring an accelerated component to their rehab protocol

This information was written by Life Fitness Physical Therapy, a privately-owned, outpatient physical therapy practice operating 14 clinics in the metro and surrounding Baltimore, Maryland area. Life Fitness Physical Therapy was founded in 2000 based on the core values of providing the highest level of customer service and clinical excellence in outpatient physical therapy. For more information click here.

physical therapy

Try Physical Therapy First

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Benefits of Physical Therapy Over Pain Killers and Surgery:

  • Conservative treatment with physical therapy has no side effects
  • Treat the cause of the problem and not just the symptoms
  • The best effect is getting you more involved in a healthy lifestyle
  • Affordable and covered under most insurance plans

As Physical Therapists We Provide:

  • Improved awareness
  • Increase strength and flexibility
  • Education and exercise designed to prevent future injuries
  • A program that increases your overall strength and flexibility
  • Modifications of movement for daily living

spine doctor

DID YOU KNOW THAT IF YOU HAVE…

BACK PAIN
If you are experiencing physical pain going to physical or occupational therapy for a musculoskeletal screening first may result in long term solutions without the use of expensive prescriptions or tests such as MRI’s, and reduces the risk of re-injury.
Source: http://www.ncbi.nlm.nih.gov/m/pubmed/22614792/

KNEE INJURY
Physical Therapy is equally effective In treating degenerative knee disease. One of the most common orthopedic procedures in the United States — knee arthroscopic surgery — is proving to be an unnecessary course of action for many patients who have a torn meniscus in their knee.
Source: New England Journal Of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMoa1305189?query=featured_home&

CONCUSSION
Physical Therapists are key to helping in the recovery from concussion by monitoring the physical, mental, and emotional symptoms of an athlete to determine when they are no longer symptomatic.
Source: http://www.momsteam.com/health-safety/post-concussion-treatment-physical-therapy-can-help

We understand that you are concerned with maintaining your health. So ask your medical provider if physical therapy is the right choice for you. By trying physical therapy first, it is likely that you can reduce or remove the need for surgery, as well as remove the risk of dependence on prescription pain killers.

Prediabetes

What Does It Really Mean to Have Prediabetes?

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Type 2 diabetes usually occurs as a result of genetics and lifestyle. It is marked by abnormally high levels of blood sugar, known as glucose. Glucose is the primary source of energy for our cells that the body makes from food we ingest. The onset of type 2 diabetes is triggered when the body is no longer able to properly use insulin, the hormone that helps cells take in glucose from the blood. When glucose stays in the blood stream instead of moving into the cells, nerves and blood vessels can be damaged. This increases the risk of cardiovascular disease, stroke, blindness, kidney disease, and circulation problems.

What Is Prediabetes?
Prediabetes is a condition that precedes the onset of type 2 diabetes. It is characterized by blood glucose levels that are elevated, though not high enough to be classified as diabetes. Doctors usually refer to prediabetes as impaired glucose tolerance or impaired fasting glucose. The American Diabetes Association (ADA) recommends screening for all adults 45 years old and older. Also, if you are younger than 45 and are overweight or obese and have risk factors for diabetes, you should be screened. Risk factors include:
• Family history of diabetes
• Having hypertension, high cholesterol, or high triglycerides
• Sedentary lifestyle
• History of gestational diabetes or giving birth to a baby weighing more than 9 pounds (4 kilograms)
• History of cardiovascular disease
• Having a condition associated with insulin resistance, such as polycystic ovary syndrome or metabolic syndrome

People of Hispanic American, Asian American, Pacific Islander, Native American, or African American descent are at higher risk.
Having prediabetes means that you are at high risk for developing diabetes and may already be experiencing adverse effects of elevated blood sugar levels.

How Do You Know If You Have Prediabetes?
During a routine office visit, your doctor can order tests, such as:
• Fasting plasma glucose test—For this test, you fast overnight and have your blood glucose measured in the morning before eating. Results in the range of 100-125 mg/dL (5.6-6.9 mmol/L) may indicate prediabetes.
• Oral glucose tolerance test (OGTT)—Again, you fast overnight and have your blood glucose measured after the fast. Then, you consume a sugary drink and have your blood glucose measured two hours later. Results in the range of 140-199 mg/dL (7.8-11 mmol/L) indicate prediabetes.
• Hemoglobin A1c (HbA1c)—This is an indicator of your average blood sugar levels over the previous three months. Results in the range of 5.7%-6.4% indicate prediabetes.

What Can You Do If You Have Prediabetes?
If you are diagnosed with prediabetes, it is important to take action to manage your condition. If you are overweight, your doctor may recommend that you lose weight. Reducing your body weight, even by 5%-10% can help improve your health. In general, changing your diet and being physically active and exercising at least 30 minutes a day will help you stay on track. Participating in a behavioral modification program may further help you achieve your weight loss goals.

Because many of the lifestyle-related risk factors associated with diabetes are also risk factors for other health issues, making lifestyle changes to reduce your risk of diabetes may have a positive effect on your overall health.

Some people can take medication to manage their blood glucose levels, though lifestyle modification should be the first approach to manage prediabetes. Medications that may be used include metformin, pioglitazone, and acarbose.

obese_man_gym

How Can You Prevent Prediabetes?
The same strategies that are used to lower your risk of type 2 diabetes can be applied to prediabetes, as well. The American Diabetes Association (ADA) recommends these strategies:
• Lose excess weight.
• Exercise for at least 150 minutes per week.
• Reduce your intake of calories and fat.
• Try to eat more fiber and whole grains.

If you do have prediabetes, you can take steps that may slow or avoid the progression to type 2 diabetes. It will take a lot of effort on your part, but the potential benefits—being healthy and living longer—are worth it.

by Julie J. Martin, MS

RESOURCES:
American Diabetes Association
http://www.diabetes.org

National Diabetes Education Program
http://www.ndep.nih.gov

CANADIAN RESOURCES:
Canadian Diabetes Association
http://www.diabetes.ca

The College of Family Physicians of Canada
http://www.cfpc.ca

REFERENCES:
Am I at risk for type 2 diabetes? Taking steps to lower the risk of getting diabetes. National Diabetes Information Clearinghouse website. Available at: http://diabetes.niddk.nih.gov/dm/pubs/riskfortype2/risk.pdf. Published June 2012. Accessed April 26, 2016.

American Diabetes Association and National Institute of Diabetes, Digestive and Kidney Diseases. The prevention or delay of type 2 diabetes. Diabetes Care 2002;25:1-8.

Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or Metformin. NEJM. 2002;346:393-403.

Diabetes mellitus type 2 prevention. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 22, 2016. Accessed April 26, 2016.

Diagnosing diabetes and learning about prediabetes. American Diabetes Association website. Available at: http://www.diabetes.org/are-you-at-risk/prediabetes. Updated December 9, 2014. Accessed April 26, 2016.

Kanaya AM, Narayan KM. Prevention of type 2 diabetes: Data from recent trials. Primary Care. 2003;30:511-526.

Narayan K, Imperatore G. Targeting people with prediabetes. British Medical Journal. 2002;325:403-404.

Nathan DM. Diabetes Care. 2007;30:753.

Prediabetes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 22, 2016. Accessed April 26, 2016.

Tuomilehto J, Lindstorm J. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2004;344:1343-1350.

10/21/2008 DynaMed’s Systematic Literature Surveillance: http://www.ebscohost.com/dynamed: Greaves CJ, Middlebrooke A, O’Loughlin L, et al. Motivational interviewing for modifying diabetes risk: a randomised controlled trial. Br J Gen Pract. 2008;58:535-540.

10/12/2009 DynaMed Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Crandall JP, Polsky S, Howard AA, et al. Alcohol consumption and diabetes risk in the Diabetes Prevention Program. Am J Clin Nutr. 2009;90:595-601.

2/15/2010 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: American Diabetes Association. Standards of medical care in diabetes—2010. Diabetes Care. 2010;33(suppl 1:S11-S61).

2/15/2010 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(suppl 1:S62-S69).

Last reviewed April 2016 by Michael Woods, MD Last Updated: 6/3/014

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.

What Should I Tell My Physical Therapist?

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If you have never been to a physical therapist before you may have some questions about your care and expectations. Here are some general questions and points about physical therapy you may want to talk about during your initial evaluation.

Talk about the pain you are experiencing.
Go into detail about what sort of activities you have trouble with and where the pain is coming from.  The more details you can provide the more it will help your therapist develop a treatment plan.

How did your injury happen and/or when did your pain begin?
Did you have an injury or accident, or did the pain develop gradually over an extended period of time? Whether it’s sports, work or surgical post-op related your PT can guide you to recovery following an injury. As part of physical therapy, they can teach you exercises, stretches, and techniques using specialized equipment to address your pain.

What are your recovery goals?
If you have specific goals in relation to your recovery, let your therapist know. Do you want to be able to run a marathon, or is the goal to cook dinner and be able to reach up into your cabinets? Maybe your goal is to have enough strength to play with the grand kids. Your Physical Therapist needs this information when designing a treatment plan that best suits your needs. Whether you’re a professional athlete who’s suffered an injury or an orthopedic patient who needs assistance following surgery, your recovery starts with physical therapy.

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Give your physical therapist you primary care provider’s information.
Good communication between your physical therapist and your primary care provider can help eliminate the need for unnecessary drugs/medications and provide great detail about your medical history. Your physical therapist can help clarify referral guidelines and the decision-making process as well.

Tell your physical therapist about any medications you are currently taking.
Different medications can cause adverse side effects due to physical activity and your physical therapist wants to make sure you are ready for physical therapy. Make sure you have a detailed list of your medications and be ready to discuss them at your evaluation.

Always tell your physical therapist your pain levels and how you feel your progress is going.
Physical Therapy is intended to make changes in your body.  As physical therapists make changes to your tissues and mechanics, the stresses on your body will change, and may change where you feel the pain or symptoms. Be open with your physical therapist. If you have any questions about your treatment or want to go over any pain you are experiencing let your physical therapist know and they can go over it with you. Chances are what you are experiencing is completely normal and part of the healing process.

For more information about physical therapy programs and treatment techniques visit our About Physical Therapy section by clicking here.

Need to find a physical therapist? Visit our Find A PT Page

removing kinesio tape

Removing Your Kinesio Tex Tape

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Removing Kinesio Tape can seem pretty daunting. The whole point is for it to stay on, so what do you do when it’s time to remove it? Fear not friends, we have the answers here.

DON’T TAKE IT OFF TOO FAST! It’s not a Band-Aid.

1. Put some baby oil or cooking oil on the tape and let it soak for a few minutes to break down the adhesive.
2. Remove the tape in the direction of hair growth by slowly rolling down the tape and applying pressure on the skin with your other hand.
3. Use oil to remove any extra residue.

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TIP: The tape can be worn for 3-5 days as long as there is no skin irritation.

To learn more about Orthopedic Kinesio taping visit our treatment technique section here

This information about removing Kinesio Tape was written by Desert Hand and Physical Therapy, a physical therapy group with locations throughout the greater Phoenix and Mesa AZ area. Desert Hand and Physical Therapy has specialized treatment centers providing therapeutic treatment and rehabilitation to restore optimal upper extremity function. For more information about the group click here.

More PTandMe articles about Kinesio Taping can be found here:

kinesio taping pain relief   kinesiotaping helpful for lymphedema patients

Modalities: What They Are and Why We Use Them

Every treatment is truly a modality with exercise (including Therapeutic Exercise, Therapeutic Activities and Neuromuscular Re-education) being the most popular and effective.

ULTRASOUND: Can be performed for thermal or non-thermal benefits. A crystal in the sound head vibrates at a specific frequency (usually 1 or 3 MHz) when an electrical current is passed through the crystal. The ultrasound waves that are produced are absorbed best by high collagen content tissues (tendon, ligament, and muscle). The frequency controls the depth of penetration with 3 MHz being more superficial and heating up more quickly than 1 MHz. An effective treatment area is no greater than twice the area of the ultrasound head (5cm^2 US head). Physical therapists use ultrasound frequently on tendinosus injuries, or plantar fasciitis as well as ligament injuries, and in conjunction with transverse friction massage and exercise.

ELECTRICAL STIMULATION: Most often performed in outpatient orthopedic PT clinics for muscle re-education or pain control. The waveform, frequency and wavelength are different depending on the reason for using this modality.

With neuromuscular estim (NMES) two electrodes are typically used. Physical therapists use NMES to the quadriceps (specifically VMO) to regain quadriceps control to restore active terminal knee extension. There is an on and off time with NMES, and the patient is usually performing a quadriceps exercise during the time the NMES is on.

When electrical stimulation is used for pain control the term TENS is commonly used, which stands for Transcutaneous Electrical Nerve Stimulation, but even NMES is technically TENS. With TENS various set-ups can be used, but the most common is IFC (Interferential Current) at 80-150 Hz with 40% scan. This requires 4 electrodes in a crossed-diagonal pattern with the treatment area in the middle. An interference pattern is created, and varies throughout the treatment giving the sensation that the current is moving around, and preventing the patient from becoming too accustomed to the sensation. There can be some carryover of pain-relieving TENS effects between sessions, but I generally consider this to have a temporary effect lasting for up to 2-3 hours after the session. Often heat or ice is applied during the treatment as well. If you want to prescribe a home TENS unit for a patient for pain management we are happy to assist by working with vendors to obtain a device for a patient, and to teach them how to use the device.

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TRACTION: Static (constant tension) traction is most commonly used, unless the patient’s condition is very reactive, and then intermittent traction may be used. A home traction unit may also be ordered for a patient, and we can train the patient in the set-up and usage of those devices. They are available for both cervical and lumbar traction, but lumbar traction is much less commonly used. A patient must be able to tolerate 20# of cervical traction, typically, for insurance to cover a home device.

PHONOPHORESIS AND IONTOPHORESIS: Both of these are drug delivery methods. Iontophoresis uses direct current electricity to drive a charged medication deeper into the tissues while phonophoresis is the usage of a medication in an ultrasound gel or cream. The research support is better for iontophoresis than phonophoresis, but neither are very good. Iontophoresis most often is done with dexamethasone with a negative polarity and the medication is placed under the negative electrode. With phonophoresis the US, at least theoretically, opens up channels to allow the medication to be absorbed more readily, but in doing US with a medication, the ultrasound transmission is not as good as with the normal ultrasound gel.

WHIRLPOOL: Cold or warm whirlpools are somewhat common still in athletic training rooms, but not utilized nearly as much in a PT clinic. They also used to be used very commonly for wound debridement, but the time and expense of the water and sterilizing the whirlpool after use, coupled with the existence of good medicinal/chemical methods for wound care have made whirlpool use for that purpose much less common.

Eating Healthfully on a Tight Budget

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When you are on a tight budget, shopping for food can be challenging. It is a common misconception that cutting back on food expenses means sacrificing good nutrition. However, you can be healthier and wealthier by getting wiser about planning meals and shopping. Here are some guidelines that can help:

Let the Plate Be Your Guide
Many people plan their meals around meat, and leave grains, vegetables, and fruit for side dishes. However, according to Choose My Plate, the bulk of your diet should be made up of vegetables and fruit. And at least half of your grains should be whole grains such as whole wheat breads, pasta, and brown rice. Meats and dairy products should be treated as side dishes and eaten less frequently. This is not only more economical but more healthful. Here are a few examples of meals made mostly with whole grains, fruits, and vegetables:
• Chili—beans, vegetables, and meat, served with a salad
• Stir-fry—vegetables with a small amount of meat served over rice or pasta and a salad
• Stews or soup—beans, vegetables, pasta, rice, meat or chicken, served with salad
• Taco—beans or meat with lots of lettuce, tomato, onions, and a corn tortilla

Make It From Scratch
Many of the prepackaged, boxed, canned, and frozen foods you buy from the store are high in fat, calories, sodium, sugar, and cost, compared with foods prepared at home. They may also be lower in vitamins and minerals. You pay for the fancy packaging and convenience of these items, but you get much less for your money. For example, you can make many more bags of popcorn from a bag of unpopped corn compared to buying a bag of already-popped popcorn. The pre-made popcorn is much more expensive and has more fat and sodium than what you can make at home. Of course, making food from scratch may take a little more time, but it can be well worth it in terms of cost and nutrition.

Have a Game Plan for Shopping
Have a game plan for shopping that includes what you are going to buy and where you are going to buy it. Here are some tips on developing a shopping plan:
• Plan meals and snacks several days in advance. Then write a shopping list—and stick to it!
• Compare prices among grocery stores. Shop at national chains and discount food outlets. Do not shop at convenience stores.
• Go to stores that sell generic foods, store brand foods, and foods in bulk.
• Use coupons with caution. They are often for foods that are more expensive. Do not buy junk food or something you normally would not buy, just because you have a coupon.
• Never shop on an empty stomach.
• Look for sales on items that are on your list.

When shopping, it’s also important to look for foods that are fresh. Check the dates on perishable items like meat, cheese, and yogurt. If you aren’t able to consume the item before the date, then you shouldn’t purchase it.

Check the Unit Prices of Items
The unit price calculates the cost of a product per unit. For example, a unit could be by the ounce, pound, or number of items in a package. Unit prices are usually marked on the shelf below the product. For example, let’s say you are looking for canned beets and there are three different brands to choose from. If you look at the unit price below each one, you can find the brand that is cheapest, especially if you buy the largest can. However, it only makes sense to buy the largest can if you are sure you will use it all.

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Read Food Labels
It is easier to make the most nutritious choice when you know how to read the nutrition facts label. These labels contain the nutritional information and are found on most packaged foods. Use the nutrition facts label to focus on the facts that are most important to you, such as the fat, sugar, or sodium content. Nutritional labels make it easier for you to compare similar products.

Buy in Bulk… When It Makes Sense
Save time and money by buying in bulk. You can buy in bulk through supermarkets, buying clubs, food cooperatives, farmer’s markets, and warehouses. When you buy in bulk, you can purchase a product in multiple or large units that can be stored, or from an open container in the store, such as a bin of rice where you can scoop out as much as you want. Before buying in bulk, keep the following tips in mind:
• Buy only products that your family will like and use often enough so that they will be used before spoiling or becoming outdated. Otherwise, you will waste food and money.
• Not all bulk items are bargains. Make sure the item is really a good buy and saves you money. Check the unit price; do not just look at the size of the package.
• When you buy in bulk, you buy more than you can use before your next shopping trip. Be sure you have enough money to do this.
• You should know what type of storage is needed for the product and have enough space to store it.
• Beware that buying in bulk can lead families to overeat or eat too quickly. If this happens, you could run out of food or money before the end of the month. Make sure you can store food so that it will not get eaten too quickly.
• Freeze prepared items in small containers rather than one large container so you only need to thaw the servings you need.
• Know proper storage times for different foods. For example:
• Ground meats: 3-4 months in the freezer
• Hot dogs: 1-2 months in the freezer
• Eggs: 3-5 weeks in the refrigerator
• Opened lunch meats: 3-5 days in the refrigerator
• Bacon: 7 days in the refrigerator
• Fresh chicken or turkey parts: 9 months in the freezer

Eat at Home
Eating out can be expensive and the food is often high in fat, salt, and sugar. A spaghetti dinner at a restaurant could cost $10 or more, but only a few dollars if you prepared it at home. At a restaurant, your extra costs go toward profits and tips. Consider having a potluck. When you entertain guests at home, ask them to bring a dish.

Be Prepared
If you are going to be out running errands or shopping with your family, bring some healthy snacks and drinks with you. That way, if hunger hits, you will not be tempted to stop at a fast food restaurant or buy snacks from a vending machine—something that can hurt your wallet and your waistline. Whether you make snacks at home or buy them from the grocery store, it is less expensive than buying them in the mall.

by Amy Scholten, MPH

RESOURCES:
American Dietetic Association
http://www.eatright.org

Choose My Plate—US Department of Agriculture
http://www.choosemyplate.gov

CANADIAN RESOURCES:
Canada’s Food Guide
http://www.hc-sc.gc.ca

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

REFERENCES:
Charts: food safety at a glance. FoodSafety.gov website. Available at: http://www.foodsafety.gov/keep/charts/index.html. Accessed January 27, 2016.

Eating better on a budget. Choose My Plate, US Department of Agriculture website. Available at: http://www.choosemyplate.gov/ten-tips-eating-better-on-a-budget. Updated September 1, 2015. Accessed January 27, 2016.

Lino M. Nutrition doesn’t have to be expensive. Choose My Plate, US Department of Agriculture website. Available at: http://www.choosemyplate.gov/sites/default/files/printablematerials/USDABlog-NutritionDoesntHaveToBeExpensive.pdf. Published August 25, 2011. Accessed January 27, 2016.

Last reviewed January 2016 by Michael Woods, MD Last Updated: 3/13/2014

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.

Managing BMI to Improve Pre & Post Surgical Outcomes

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MANAGING A PATIENT’S BMI can reduce pain and improve outcomes pre & post surgically.
Physical therapists can treat patients for their pain (potentially related to their obesity) and can provide can provide general population information to patients regarding healthy eating, healthy recipes, general daily activity.

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