The Life-Giving Current: Benefits of Aquatic Therapy for Physical Therapy Patients

Physical therapy offers a lifeline for individuals recovering from injuries, managing chronic conditions, and seeking improved physical function. Among its innovative tools, aquatic therapy stands out, harnessing the unique properties of water to create a gentle yet effective rehabilitation environment. This article delves into the diverse benefits of aquatic therapy, exploring how it empowers physical therapy patients to reclaim their physical potential and experience holistic well-being.

 

Diving into Relief: Pain Reduction and Inflammation Management:

One of the most sought-after benefits of aquatic therapy is its ability to combat pain and inflammation. Imagine submerged in warm water, feeling its buoyancy alleviate the weight-bearing stress on your joints and muscles. This, coupled with the hydrostatic pressure’s gentle massage-like effect, effectively decreases pain perception. Studies conducted by the National Center for Complementary and Integrative Health (NCCIH) support this, demonstrating significant pain reduction in patients with arthritis, chronic low back pain, and fibromyalgia who participated in aquatic therapy programs.

 

Unlocking Flexibility: Enhanced Range of Motion and Movement:

Imagine moving freely, performing stretches and exercises that once felt restrictive or painful. Water, with its variable resistance and supportive nature, becomes a partner in improving your range of motion and flexibility. Exercises in the pool gently challenge your muscles, promoting their elongation and increasing joint mobility. Research published in the Archives of Physical Medicine and Rehabilitation found that aquatic therapy significantly improved shoulder range of motion in patients with post-surgical stiffness, highlighting its efficacy in restoring movement freedom.

 

Building Strength and Endurance: A Current of Empowerment:

Don’t be fooled by the gentle nature of water. It can effectively challenge your muscles, building strength and endurance. The water’s resistance adapts to your movements, providing just the right amount of load, allowing your muscles to strengthen and build endurance in a low-impact environment. For example, walking in water is more demanding than walking on land, effectively strengthening your leg muscles. A study published in the Journal of Strength and Conditioning Research found that aquatic therapy significantly improved muscle function in patients after knee replacement surgery, highlighting its potential for strengthening muscles in various populations.

 

Finding Your Balance: Improving Stability and Coordination:

Think of water as a dynamic training ground for your balance and coordination. The ever-shifting nature of the aquatic environment challenges your body’s proprioception and core stability, leading to significant improvements in these crucial aspects. Specific exercises like walking on balance boards in the pool or performing tai chi movements offer targeted challenges, leading to improved fall prevention and overall stability. A study published in the Journal of Geriatric Physical Therapy found that aquatic therapy significantly improved balance and gait in older adults, highlighting its potential for reducing fall risk.

 

A Heartfelt Benefit: Cardiovascular Conditioning in Water:

Aquatic therapy isn’t just for muscles and joints; it can also benefit your cardiovascular health. From gentle water walking to more vigorous aqua aerobics, the possibilities for getting your heart rate up in a controlled environment are diverse. This translates to improved cardiovascular function, reduced risk factors for heart disease, and enhanced overall fitness. A study published in the Archives of Physical Medicine and Rehabilitation found that aquatic therapy significantly improved cardiovascular endurance in patients with chronic obstructive pulmonary disease, demonstrating its potential for improving heart health in various populations.

 

Beyond the Physical: Unlocking Psychological Benefits:

The benefits of aquatic therapy extend beyond the physical. The warm, supportive environment of the pool can be inherently calming and stress-reducing. The rhythmic movements of water exercises and the focus on mindful breathing contribute to improved mood, reduced anxiety, and enhanced well-being. Research published in the journal Complementary Therapies in Medicine found that aquatic therapy significantly reduced anxiety and depression scores in patients with chronic pain, highlighting its potential for improving mental health.

 

Considerations for Embracing the Current:

While aquatic therapy offers a wealth of benefits, it’s essential to consider patient suitability and potential contraindications. Discuss it with your physical therapist to determine if it aligns with your specific needs and health conditions. Additionally, remember the importance of qualified therapists designing and supervising your program to ensure safety and maximize effectiveness.

 

Accessibility and Safety: Navigating the Waters:

Concerns about safety and accessibility might arise when considering aquatic therapy. However, most facilities prioritize safety with trained staff and appropriate equipment. Additionally, various pool depths and assistive devices cater to individuals with varying abilities. Don’t hesitate to discuss your concerns with your healthcare team to explore accessibility options.

 

Aquatic therapy represents a powerful current within the physical therapy landscape. Its unique ability to combine gentle support with effective challenge empowers individuals to manage pain, improve flexibility and strength, enhance balance and coordination, and even boost

Rejuvenating Currents: Exploring the Use of Electrical Stimulation in Physical Therapy

Physical therapy plays a crucial role in helping individuals recover from injuries, manage chronic conditions, and improve their overall physical function. Among the diverse tools in its arsenal, electrical stimulation (e-stim) stands out as a unique and effective technique. By harnessing the power of electricity, e-stim offers a non-invasive approach to address various issues, from pain management to muscle strengthening. This article delves into the exciting world of e-stim in physical therapy, exploring its applications, benefits, and considerations for its use.

Understanding the Spark: Types of Electrical Stimulation:

Before diving deeper, let’s understand the types of electrical currents used in therapy. Two main categories reign supreme:

  • Transcutaneous Electrical Nerve Stimulation (TENS): This utilizes low-voltage, high-frequency pulses to target nerves, primarily for pain relief. Imagine a gentle tingling sensation that interrupts pain signals traveling to the brain, offering relief for chronic pain, muscle spasms, and even postoperative discomfort.
  • Neuromuscular Electrical Stimulation (NMES): This employs higher-voltage, lower-frequency pulses to directly stimulate muscles, causing them to contract. Think of it as a gentle nudge, prompting your muscles to activate, promoting strengthening, improving muscle function, and preventing atrophy after injury or surgery.

The Spectrum of Benefits: How E-Stim Transforms Therapy:

Now, let’s explore the diverse benefits e-stim brings to the table:

  • Pain Management: TENS therapy shines in this realm, offering non-addictive and drug-free pain relief for various conditions. Studies have shown its effectiveness in managing chronic pain due to arthritis, back pain, and even postoperative discomfort.
  • Muscle Strengthening and Function: NMES comes to the rescue for weakened muscles, helping them regain strength and function. This proves invaluable after injuries, surgeries, or neurological conditions that impact muscle control.
  • Improved Range of Motion: By gently stretching and activating muscles, e-stim can enhance your range of motion, making everyday activities easier and reducing stiffness.
  • Reduced Muscle Spasms: Spasticity, characterized by involuntary muscle contractions, can be tackled with TENS, offering much-needed relief and improved movement control.
  • Enhanced Blood Flow: The gentle stimulation can increase blood circulation in the targeted area, promoting healing and reducing inflammation.
  • Faster Recovery: Combining e-stim with traditional physical therapy exercises can accelerate the healing process after injuries or surgeries.

Considerations for the Current: Who Benefits and When:

While e-stim offers a plethora of benefits, it’s not a magic bullet and has its limitations. Here’s what to consider:

  • Patient Suitability: Discuss with your physical therapist to determine if e-stim is right for you based on your specific condition and health history. Some conditions, like implanted metallic devices or certain skin conditions, might preclude its use.
  • Treatment Goals: Clearly define your goals, whether it’s pain relief, muscle strengthening, or improved range of motion. This helps your therapist tailor the e-stim program accordingly.
  • Qualified Professionals: Ensure your treatment is supervised by a licensed physical therapist trained in using e-stim effectively and safely.

Safety and Comfort: Navigating the Electric Journey:

Safety and comfort are paramount when undergoing e-stim therapy. Here’s what to expect:

  • Mild Sensations: You might experience tingling, tapping, or muscle contractions during treatment, but it shouldn’t be painful. Communicate any discomfort to your therapist immediately.
  • Individualized Settings: The intensity and duration of the stimulation will be customized based on your needs and tolerance.
  • Gradual Introduction: Start with lower settings and gradually increase as your body adapts.

 

Electrical stimulation, with its unique ability to target pain, stimulate muscles, and enhance healing, has carved a prominent niche in the world of physical therapy. Whether you seek pain relief, muscle strengthening, or improved movement, e-stim, when used under the guidance of a qualified therapist, can be a valuable tool on your path to physical well-being. So, embrace the current, explore its potential, and unlock a renewed sense of physical function and pain-free movement.

Triumphant Comeback: The Role of Physical Therapy in Sports Injury Rehabilitation

For athletes, injuries are an unwelcome reality, often threatening their performance and dreams. Fortunately, the dedicated field of sports physical therapy stands as a beacon of hope, offering a pathway to recovery and triumphant returns. This article delves into the crucial role of physical therapy in sports injury rehabilitation, exploring its benefits, key components, and how it empowers athletes to reclaim their athletic potential.

 

The Battle Scars of Victory: Understanding Sports Injuries:

From sprains and strains to fractures and muscle tears, sports injuries come in various forms, impacting athletes of all levels and disciplines. These injuries can be acute, occurring suddenly during competition or training, or chronic, developing over time due to repetitive stress. Regardless of the type or severity, prompt and effective rehabilitation is crucial to minimize long-term consequences and ensure a successful return to sport.

 

Beyond Rest and Ice: Why Physical Therapy Reigns Supreme:

While rest and basic first aid play a role in initial recovery, relying solely on them often delays healing and increases the risk of re-injury. This is where physical therapy intervenes, offering a comprehensive and personalized approach to rehabilitation. Here’s why it’s superior:

  • Expert Assessment and Diagnosis: Sports physical therapists possess in-depth knowledge of athletes’ bodies and the demands of various sports. They conduct thorough assessments to pinpoint the exact nature and extent of the injury, ensuring a targeted and effective treatment plan.
  • Pain Management and Inflammation Reduction: Manual therapy techniques, like massage and joint mobilization, combined with modalities like ultrasound and electrical stimulation, effectively manage pain and reduce inflammation, promoting faster healing and improved comfort.
  • Restoring Range of Motion and Flexibility: Sports injuries often lead to stiffness and reduced movement. Physical therapists design personalized exercise programs to progressively restore flexibility, range of motion, and joint mobility, crucial for optimal performance.
  • Building Strength and Power: Weakened muscles due to injury or disuse hinder athletic performance. Strength and power training programs designed by physical therapists help athletes regain and even surpass their pre-injury strength, enhancing their power and explosiveness on the field.
  • Balance, Coordination, and Proprioception: Sports rely heavily on balance, coordination, and proprioception (body awareness). Physical therapy incorporates specific exercises and drills to improve these crucial aspects, minimizing the risk of future injuries and enhancing athletic performance.
  • Mental Conditioning and Return-to-Sport Strategies: The emotional toll of injuries can be significant. Physical therapists provide support and guidance, addressing psychological aspects of recovery and developing safe and effective strategies for a successful return to sport.
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Tailoring the Approach: Considerations for Individualized Rehabilitation:

No two athletes are the same, and neither are their injuries. Physical therapy programs are carefully tailored to consider several factors:

  • Type and severity of the injury: Different injuries require specific approaches. A torn ACL demands a different rehabilitation plan than a sprained ankle.
  • Sport and athletic demands: Each sport poses unique demands on the body. The rehabilitation program considers the specific movements and skills required for the athlete’s sport.
  • Individual needs and goals: Age, fitness level, pain tolerance, and personal goals all play a role in customizing the rehabilitation plan for optimal results.
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Beyond the Clinic Walls: Empowering Athletes through Education and Self-Management:

Effective rehabilitation transcends the walls of the physical therapy clinic. Empowering athletes with knowledge and self-management skills is crucial for long-term success. Physical therapists educate athletes about their injuries, the healing process, and the importance of adhering to the program. They also equip them with exercises and stretches they can perform independently, fostering self-efficacy and promoting adherence to the rehabilitation plan.

 

Sports injuries are inevitable, but their impact doesn’t have to be permanent. Physical therapy, with its personalized approach, evidence-based practices, and athlete-centric focus, empowers individuals to navigate the rehabilitation journey effectively. By restoring physical function, building strength and resilience, and providing mental support, physical therapists play a vital role in helping athletes not only recover from injuries but also return to their sport stronger and more prepared than ever before. So, if you’re an athlete facing an injury, remember, physical therapy is your ally on the path to a triumphant comeback.

Aqua Therapy: Preventative Maintenance to Help Ensure Your Long Term Health and Happiness

Aquatic therapy also known as hydrotherapy is becoming popular as an alternative to traditional land-based therapies. It is suitable for all the fitness levels, for children as well as for adults. Physical and sports therapists are using it as a preventative maintenance tool.

Aqua therapy is a physical therapy performed in water by qualified experts and aquatic trainers. Different types of treatment exercises are involved in the therapy that provides recovery, relaxation, fitness, rehabilitation, and many therapeutic benefits. It is popular for musculoskeletal and neurological problems.

Aqua therapy is performed in warm water. The pool is the safest environment to perform specific exercises. The temperature of the water varies according to the condition of a specific patient.

  1. The temperature for athletes should be in the range from 26 °C to 28 °C
  2. The temperature range for neurological and arthritis patients is 29 °C to 31 °C

When you exercise in water, it provides less physiological resistance as compared to the land.

Natural properties of water beneficial for therapy

To understand how aqua therapy works it is important to understand the natural properties of water.

Water possesses certain natural properties that create an ideal environment to perform therapeutic exercises which are difficult to perform on land. The injured and disabled persons can perform in water with much ease and comfort as compared to land.

The ideal properties of water that help perform exercises when the water is being used as a therapeutic agent are

  • Buoyancy force
  • Hydrostatic pressure
  • Natural viscosity

Buoyancy force

The buoyancy force is also known as the upthrust force. It is an upward force exerted by water when the object is partially or fully immersed in water. It opposes the weight of an object. It resists the motion of objects from the surface and assists the motion of an object towards the surface.

So, when you enter underwater you feel an apparent loss of weight. This buoyant force decompresses every joint. You feel so light and can easily perform vigorous exercises with little impact on joints.

  • This force reduces the pressure on joints and can be beneficial for edema and joint pains.
  • It also helps in reducing the friction between the articular cartilage of joints.

Hydrostatic pressure

Hydrostatic pressure is exerted equally on all parts of the surfaces of an immersed object by the thrust of molecules of a liquid. This pressure increases with the density and depth of liquid.

When the body is immersed in water it produces two effects.

  1. The body fluids would move from the extremities to the central cavity. The blood circulation would first increase in muscles, then in the abdominal cavity, and finally in the heart and chest cavity
  2. The chest wall would be compressed and work of breathing would increase

If you are a heart or lung patient, you should avoid in-depth exercises.

Viscosity of water

The viscosity of water provides resistance that is greater than that experienced on land while movement. This Natural property can be used for muscle strengthening and rehabilitation.

Effect of warm water during therapy

Water can retain heat for a longer period. It can transfer heat easily. These properties of warm water are beneficial for therapy as they produce some physiological effects.

  • Warm water dilates superficial blood vessels, activates sweat glands, and removes toxins from the body.
  • It relaxes the body
  • It helps decrease joint pain
  • Warm water diminishes the sensitivity of sensory nerve endings

Different types of popular aqua therapies

Aqua therapy is performed at health spas, physical therapy clinics and sometimes it can be performed at home as well. Different types of appliances used for therapy are Full body immersion tanks, whirlpool baths, body-specific tubs, cold and hot water compresses.

Popular aqua therapies are:

1. Aquatic exercises

Many different programmed exercises are being performed in a pool of hot water or cold water with the help of a qualified therapist. Underwater exercises provide lesser pressure on joints and help in pain management. Aquatic exercises can be performed before starting a physical land exercise program as they are easy to perform.

2. Balneotherapy

Balneotherapy is being offered in spas, wellness centers, and hot spring resorts. It involves the bath in mineral-rich hot water and is famous to treat numerous health problems such as blood pressure, arthritis, and respiratory disorders.

3. Sitz baths

A plastic large tub filled with warm water is used to treat different conditions such as hemorrhoids, fistulas, and other anorectal conditions.

4. Therapeutic baths

Therapeutic baths involve the use of soaking in hot tubs that contain therapeutic agents like Epsom salt, dead sea salt, herbs, and aromatherapy oils. Mud baths are an example of therapeutic baths. These baths are for treating skin conditions, emotional stress, and joint problems.

5. Watsu

Watsu is also known as water shiatsu. It is hydrotherapy that involves stretching, massages and acupressure while you float in a pool of warm water. It promotes physical relaxation, mental relaxation and has a calming effect on the whole body and organs by generating the energy flow.

6. Whirlpool hydrotherapy

If you need an improvement in circulation, mobility, and comfort after the surgery or an illness. Whirlpool therapy is the answer for you. It uses warm water or sometimes cold water in a tub. You immerse your body or whole body in the bathtub.

Benefits of Aqua therapy 

Aqua therapy provides a lot of benefits. Persons of all ages can benefit from it.

  1. It restores range of motion and flexibility during the early rehabilitation phase.
  2. Once your normal body functions restore followed by the early rehabilitation benefits, it further provides resistance training
  3. Helps in regaining balance and coordination
  4. Edema reduction
  5. pain management
  6. Improved range of motions
  7. Provides relaxation
  8. Improve circulation
  9. Helps in skin diseases
  10.  Helps for strains, sprains, and fatigue
  11.  Arthritis
  12.  Helps in re-educating paralyze muscles

Precautions

You should avoid aqua therapy if you have

  1. Fever
  2. Open wounds
  3. Pregnant
  4. Seizure issue
  5. Hepatitis
  6. Breathing issues

Aquatherapy allows you to benefit from therapy and to get involved in a recreational activity or enjoying nature at once. People of all age groups can benefit from this therapy.

Sources:

Communicating with Kids

 

Children can be scary.

I’m not talking about the teleporting dolls of horror movies – just regular pediatric patients.Some people have the natural ability to relate to children, and others might feel like they’ve been knocked out of their usual rhythm of patient communication. How do you explain pathologies to a 10-year-old? How do you make a personal connection, take an efficient subjective history, and get patient buy-in?

As a PT student during a pandemic, trying to practice pediatrics on baby dolls and my adult classmates, I’m curious. After all, somewhere in the world there is a scientist who has dedicated a significant portion of his life to studying kleptoparasitism in kangaroo rats (Kline et al. 2018). Surely someone in the research community has figured out how to talk to kids?

In their book, The Art and Science of Motivation: A Therapist’s Guide to Working with Children, Ziviani et al. emphasize the importance of empowering children by including their input and values in the therapy plan. Older children and adolescents especially benefit from selecting their own personal goals for therapy.

Here are some general recommendations from the authors for talking with children:

Verbal messages: Use words that the child will understand, depending on their age. Talk about how the child feels about the session and their goals. Use language that is “realistic, empathetic, encouraging and responsive”.
Nonverbal messages: Avoid using a “sing-song” voice, speaking loudly or overbearingly, and interjecting while listening. Instead, make eye contact with the child, and use a calm, positive tone of voice. Use facial expressions and body language to show that you are interested and enthusiastic about the session. Take time to listen to your patient and pause to wait for their responses.

Autonomy: Giving children choices and listening to their perspectives
“There are a few things you’ve mentioned you’d like to do; what do you want to do the most?”
“What do you think might happen if…?”
“How are you going to do it?”

Relatedness: Empathetic listening, feedback
“I understand…”
“It seems like this is hard for you….”
“Let’s see if we can figure this out together”
“Who can help you work on this?”

Competence: Affirm a child’s abilities
“Oops, it didn’t work out. Let’s think about other ways/strategies”
“What skills will help you to do it?”
“What will make you feel you can do it?”

I’ve summarized some general recommendations from Ziviani et al. by age:

Age 4: Try to match the child’s sentence length (avg. 4 words). Listen for descriptive words that the child uses and incorporate them into how you describe the therapy. Respect the child’s desire for independence. Understand that these children will become frustrated easily if they cannot accomplish a goal.

Age 5: Offer choices, and help the child find words for their emotions.

Age 6: Adult expectations influence the child’s self perception. Ask the child for explanations or directions, and ask about their feelings.

Age 7: The child describes personal experiences and understands 5-step directions. Use complex tasks and mirror the child’s developing gestures.

Age 8: The child is beginning to compare themselves to other children and seek social acceptance. Involve child in goal planning discussion and peer engagement.

Age 9-10: Use humor to make therapy more interesting.

Age 11-12: The child is developing responsibility and self-reflection. Encourage them to think about their behavior, thoughts and emotions, and to take more responsibility.  Here are some specific phrases that Ziviani et al. suggest using. They are tailored to three psychological needs of a child: Autonomy, Relatedness and Competence (ARC).

We all want to feel like we are making choices in our care. We want to feel heard, and we need genuine encouragement. Kids need the same. There’s no need to fear.

 

References:
Kline MP, Alvarez JA, Parizeau N. Kleptoparasitism of Harvester Ants by the Giant Kangaroo Rat (Dipodomys ingens) in the Carrizo Plain, California. Western North American Naturalist. 2018;78(2):208-211. doi:10.3398/064.078.0212.
Cuskelly M, Poulsen AA, Ziviani J. The Art and Science of Motivation: A Therapist’s Guide to Working with Children. Jessica Kingsley Publishers; 2013. pp. 159-182. Accessed October 8, 2020. https://search-ebscohost- com.libproxy.unm.edu/login.aspx direct=true&db=nlebk&AN=509756&site=ehost live&scope=site.

Telehealth during Covid- from a patient’s perspective.

 

Over the past four months or so I have had the opportunity to see healthcare during the COVID-19 era from the perspective of a patient. This has allowed me to personally feel how the changes we have made to keep providing patient care during a global pandemic have impacted our patients. This opportunity has allowed me the chance to see the good and the bad of telehealth and social distanced health care. To begin I want to start by saying all the health care providers I have worked with have been wonderful and are all phenomenal providers, and second this is only my perspective and is not meant as a fully encompassed view of the current state of health care.

I wanted to start by stating how weird it is to go into potentially life changing appointments while sitting at home and staring at a computer waiting for the doctor in the virtual waiting room. The setup just feels a bit odd, one minute you are sitting there drinking your morning coffee in your PJ pants and then all of a sudden you are in a deep virtual conversation with a provider about information that changes the trajectory of your day to day life. Before you know it the zoom, or google chat room closes and you are left sitting there trying to process the news in your living room. The good news is many doctors have understood this concept and are willing to sit in the virtual chat and discuss details for as long as you need, however the difficulty with this is that there is always an abrupt ending to the call and the patient is still left sitting there with their mind racing and the urge to google what they were just told. One thing I have found that has helped is that when a doctor gives life changing information many of them have allowed me the opportunity to schedule an in person visit after the virtual call to follow-up and do the physical examination. 

Another area that has been interesting to see is that there seems to be no set appointment length with patients during this time. My experience has been that my virtual appointments last anywhere between 6-45 minutes. This has been an adjustment as a patient because many times you go into physical appointments and can expect to be seen for around 20-30 minutes. My best virtual appointments have been with the doctors that take the time that would normally have been filled with physical examination and discussed research and things to try at home and scheduling in person visits as necessary. My less effective virtual appointments were doctors just telling me physical lab results that have already been uploaded to my patient portal and ending the call with no clear conclusion. As many professionals try to navigate this new era of health care one area that can not be lost is bedside manners.

One area that I have enjoyed about being a patient in this time is that it has expanded the network of clinicians I can see. I was able to see my PCP back in Minnesota, while still going to school in New Mexico and then within the same week see a specialist down in New Mexico. This type of care has allowed for a wider variety and a larger network of providers to work together. It makes it feel almost like you have your own personal pick of providers as long as they are covered by your personal insurance. This makes getting second opinions easier and more efficient than before. 

Telehealth has provided many challenges for providers to work through on their end, but one area that can not be forgotten is the patient’s experience. The struggle of having to log into a virtual chat to hear news that could alter an individual’s whole life and having that chat end leaving them sitting in their living room is unprecedented for many individuals. Having had the opportunity to live this reality has made me recognize the struggle our patients are going through. The lack of face to face interaction has taken a piece of the compassion out of a professional field that strives to provide our patients what they need during major life changes. This isn’t to bash on telehealth. I have actually thoroughly enjoyed being able to utilize telehealth as a patient, it is just to remind ourselves that our bedside manners are even more important when social distance creates barriers to the compassion that many of our patients need. Through our own continuing education and experiences I think telehealth can become an important piece of health care going forward. 

 

What Kind of Excerise is Right For You?

by Hannah Mullaney, SPT


Me: “What kind of exercise should I do?”

Also me: “Mmmm, it’s too complicated.”

“But I know it’s important for me.”

“Probably costs lots of money. I don’t know.”

“Just do anything, some push ups, planks, squats, jumping jacks!”

“Oh look, I’m out of time.”

These internal conversations abound when it comes to exercise. It is easy to become frustrated and overwhelmed. And the question often begins with, “what kind of exercise do I do?”

The simple answer is this: whatever you will actually do!

Strengthening the heart, building up the bones, balancing the chemicals messengers of the body and brain – a few of the direct benefits of exercise – these powerful outcomes blossom for doing things that challenge and move the body. Every person has distinct and individual interests, and effective, sustainable exercise training comes from doing something that matches someone’s interests with movement.

Guidelines start simple – move more! Take the stairs, park far away, stand on one leg while talking of the phone. But many people want to take that next step. Once people have experienced the relief of finishing a workout, the satisfaction of pushing their limits, or the sense of calm from endorphin release, they are ready for more. Officially, adults are recommended to do moderate to vigorous physical activity for 30-60 minutes, 5 days a week (HHS.gov).

At this point, the options may feel endless – gym membership, Zumba classes, rock climbing, running, biking, swimming, weight lifting, team sports league, golf….the list goes on an on. The volume of opportunities can be overwhelming. Some of these options are more expensive than others, and people need to think about their priorities and budget. Sometimes there are forms of exercise that may be easily overlooked, like roller blading, coaching a child’s soccer team, fishing (especially fishing someplace that can only be reached by hiking), a quick 10 minute circuit of squats, pushups, and planks, and dancing.

All of these things are valid forms of exercise. The trick is to pick something that is fun and interesting and puts a smile on the exerciser’s face.

“I HATE running!” Common sentiment. Solution…don’t run! Yes, it’s important to push oneself past the comfort zone, but, if it really is such a drag, maybe find something that is more interesting. Would running or biking to the movies to meet with friends make a difference? (Then, don’t eat the entire bag of popcorn.) Maybe if running doesn’t jive well, what about dancing? What about 3 v 3 basketball games on lunch break? All of these activities will still increase the heart rate and help make the body happy and healthy.

People talk about SMART goals, and someone who is motivated to move their body more can use these techniques to make their own game-plan. Here is the breakdown of moving more SMART-ly, using the example of someone who wants to swim 800 meters on an upcoming triathlon relay. For this individual, their spouse is doing running while another friend is doing the biking.

 

Specific – set a narrow goal. “I will go to West Side Pool.

Measurable – set a goal with something concrete to measure. “I will go to West Side Pool for 45 minutes.”

Achievable – set at goal that can actually be reached. “I will go to West Side Pool for 45 minutes on Wednesday and Friday afternoons, when I have a shorter work day. Also, I own goggles and know a little bit about swimming, so this is a realistic goal.”

Relevant – set a goal that matters to you personally. In this example, the individual is doing swimming, so swimming is the relevant activity.

Time-based – set a goal that has a clear start and end time. “The triathlon is in 6 weeks.”

 

Therefore, the whole goal is would look like this. “In order to prepared for my part of the triathlon relay, I will go to West Side Pool for 45 minutes on Wednesday and Friday afternoons for the next 6 weeks in order to swim 800 meters without stopping.”

Finally, accountability takes goal-making to goal-attaining. If someone is asking us how we are doing, bugging us about going to the gym, waiting for us at the trailhead at 7am, or trying to workout 5 days a week with us, we are that much more likely to follow through with our good intentions. In the example above, perhaps the spouse can run while the swimmer does laps.

Therefore, if you are thinking about exercising more, my encouragement is to dive right in! Find something enjoyable that you actually want to do. Set a SMART goal. And, very importantly, ask someone to hold you accountable. No need to wait – let’s get moving today!

Falls, Exercise and Evidence in Physical Therapy

Does exercise really help reduce falls? As physical therapists, we educate our clients in the importance of exercise daily.  Of course, we know that exercise truly does reduce fall risk.  Some clients are eager to exercise, experiencing an increase in energy and improved confidence with their mobility and walking. However, others need some convincing to jump on the exercise bandwagon.  As a physical therapist, I love to educate my clients in strategies to keep them as independent and active as possible.  Utilizing medical research studies provides great evidence to support exercise for independence.  Here we will review the correlation between older adults, falls, healthcare and exercise.

According to the Centers for Disease Control and Prevention (CDC), 1 in 3 adults over age 65 years falls each year, in the United States.  Almost half of individuals over age 80 fall each year.  Falls are the leading cause of injury-related death in this age group.  Falls not only impact the independence and quality of life of individuals as they age, but they also are very costly to the healthcare system.  According to the CDC, the direct medical costs of falls among older adults in 2013, was $34 billion.  Because of an aging population, this figure is likely to continue increasing.  The direct costs are calculated by insurance reimbursements for treating fall-related injuries.  This does not include the long term costs for future disability, dependence on others, lost work time and lower quality of life.  It is estimated that the average hospitalization cost for a fall injury is over $35,000.  As therapists, we know that conservative treatment through physical therapy can reduce healthcare costs drastically.  It is much less expensive for insurance companies to pay for 12 visits of physical therapy, than to pay for a hip replacement and all the aftercare necessary.

physical therapy for falls

Those staggering statistics can be a bit discouraging for older adults.  By educating clients in the modifiable risk factors, they can take an active role in reducing their own fall risk.  Research shows that risk factors highly associated with fall risk include: history of falls, balance problems, leg muscle weakness, vision problems, taking more than 4 medications, and difficulty walking.  Many of these factors can be significantly reduced through exercise.  Exercises should focus on leg strengthening, balance training and flexibility.  There are many published medical research studies to support this claim.

In a study systematic review of literature performed by Gillespie et al.(1), 111 clinical trials were reviewed to analyze the efficacy of exercise in reducing fall risk.  The authors concluded that exercise interventions reduce both the risk and rate of falling in older adults.  In another review of literature, Powers et al.(2) examined what type of exercise has the greatest impact on reducing falls.  They found that a program of muscle strengthening and balance training that was individualized to a person’s need (one prescribed by a trained health professional, such as a physical therapist) was highly beneficial.  In addition, they found that Tai Chi group exercise was shown to reduce risk of falls, as was participation in a home hazard assessment and modification session.  Group exercise classes were beneficial, but not as beneficial as individualized exercise programs.  As therapists, we should consider incorporating Tai Chi as part of home exercise programs.  Also, we should educate our patients in home safety strategies to reduce environmental hazards.

In another systematic review of the published literature, 54 trials were analyzed by Sherrington et al.(3), and found that exercise was the single best intervention to prevent falls.  This study noted that the exercise program must challenge the balance and improve muscle strength through resistance training.  The exercise program should be progressive and individualized to the client’s needs and limitations.

The main learning points of these research reviews are that the exercise programs must be tailored to individual limitations.  If the client has limited strength in their hip flexors and trunk, then they will not be able to properly elicit a hip strategy to maintain balance.  Therefore, the exercise program should focus on strengthening those areas of weakness.  In addition, the client’s balance improves, you will need to progress the difficulty of the exercise for continued improvement.  These strategies all seem like common sense to an experienced clinician.  However, sometimes patient’s need to see the proof that therapy can improve their safety and independence as they age.

As therapists, we must be our own advocates.  The physical therapist is a vital component of the healthcare team.  We are the most capable healthcare experts to reduce the risk of falls in aging adults, through a thorough evaluation and treatment plan.  We should empower our clients with a comprehensive and easy to follow home exercise program, in order to further improve their confidence and independence after completion of physical therapy.  So, next time you have a client that is not a believer, show him the evidence that exercise truly does reduce fall risk.

Utilization of outcome measurement tools, functional mobility tasks and simple examination components such as single leg balance, and tandem stance are excellent means of demonstrating improvement in physical performance and reduced fall risk.  Through utilization of bestPT software, we can easily document objective measures and compare pre and post intervention outcomes.  These improvements can be easily faxed, printed and shared with our clients and their other healthcare providers.  You will be able to turn skeptics into therapy believers.

Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.

  1. Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2009 Apr 15;(2): CD007146.
  2. Powers C, Farrokhi S, Moreno J. Can exercise reduce the incidence of falls in the elderly, and, if so, what form of exercise is most effective? Physical Therapy. 2002 Nov vol 82; no 11; 1124-1130.
  3. Sherrington C, Tiedemann A, Fairhall N, Close JC, Lord SR. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull. 2011 Jun;22(3-4): 78-83.

Caring for the Complex Pelvic Patient Part II: Treatment techniques

In the second installment of this three part series: Caring for the complex patient, we will review the patient’s presentation and discuss the treatment techniques employed and how documentation using bestPT supported the treatment.

The patient was a 34 year old female referred to physical therapy (PT) by her obstetrician-gynecologist (OB-GYN) for evaluation of pelvic organ prolapse (POP). The patient presented to physical therapy para 2 grava 2 (P2G2) indicating 2 pregnancies and 2 live births. On the day of evaluation she was 5.5 weeks post vaginal birth after cesarean (VBAC) of her second child. Her primary concern was a feeling of heaviness and a sense that her organs were falling out, especially during standing and lifting tasks. Her physician had not yet performed a complete six week post-delivery examination, though this appointment was scheduled for three days after physical therapy evaluation.

The patient reported neither pain nor unintentional loss of urine (incontinence), though she felt weak throughout the abdominals and pelvic floor. Pertinent past medical history consisted of cesarean section 11/19/12 (almost two years prior to PT evaluation date) with subsequent hematoma at the surgical site which resolved with use of an abdominal binder. She is otherwise a very healthy woman with no comorbidities. The patient lived at home with her husband and two children, works as a physician assistant specializing in hospital based gastroenterology which requires prolonged standing during procedures and patient rounds. She is an avid runner and aerobics instructor. Her primary goal was to be able to safely lift each of her children without the sense of heaviness in the pelvis. Secondary goals were to return to running and teaching aerobics classes which are her primary sources of recreation and stress reduction.

Physical therapy examination revealed abdominal strength to be 3+/5 on the Kendall scale. The Pelvic Floor Impact Questionaire (PFIQ-7) was utilized as standardized outcome tool. This patient received a score total of 0 on the bladder and rectum subsets, and a score of 19 on the pelvis subset for a total score of 19 on the scale. Internal examination and musculoskeletal physical therapy differential diagnosis included pelvic floor dysfunction resulting in prolapse, and increased abdominal pressure due to visceral adhesions from previous c-section.

The first priority of intervention was patient education to avoid bearing down and valsalva maneuvers. Discussion on the day of evaluation included contracting the pelvic floor prior to lifting her toddler or infant, safe lifting spinal mechanics, and breathing technique to avoid abdominal bulging or bearing down. Avoidance of constipation was discussed, though this was not an issue for this patient, nor was weight management. The patient was issued a copy of the American Physical Therapy Association’s postpartum health awareness information brochure to provide further education regarding postpartum back and pelvic pain, pelvic floor muscle care, post partum fatigue, posture, and cesarean scar management.

Following the internal pelvic exam, the patient was given a pelvic floor strengthening program. Given that the role of connective tissue in providing support to the pelvic floor has gained significant emphasis in the literature, it is understood that if the patient does not benefit from a pelvic floor strengthening program than other means of intervention may be warranted. The rationale for intensive strengthening of the pelvic floor muscle to treat POP is that strength training will build up the structural support of the pelvis by elevating the levator plate to a higher resting point, and maintain this position through hypertrophy and improved stiffness of the pelvic floor muscles.

As no single or absolute protocol has been reported to be the absolute gold standard in the literature, pelvic floor muscle (PFM) training was dosed based upon compilation of evidence in the literature, and patient response. Initially the patient was given a program of 80-100 kegels per day, with 4 sets of 10 being 5 second hold, and 4 sets of 10 being 15 second hold to address speed and endurance of the muscles. These numbers were calculated based upon her muscle test scoring durng initial evaluation. Due to her busy schedule and PFM strength of 4/5, she was advised that these could be performed in various positions, including supine hooklying, sitting, and standing. She was educated to gently draw in the abdominals during PFM contraction as transverse abdominis co-contraction has been demonstrated to enhance activation of the pelvic floor.

Progression of PFM exercise and lumbo-pelvic stability exercises were increased each visit as the patient became stronger. Progressions included diaphragmic breathing pattern with pelvic floor muscle contractions, sidelying clams while performing a PFM and transverse abdominis contraction, and quadruped PFM with transverse abdominis contraction. This exercise was progressed by adding an opposite upper and lower extremity lift (commonly referred to by physical therapists as a bird dog). Pelvic brace with cough was added to address co-ordination and timing of PFM contraction prior to increased intra-abdominal force.

Planks in the forward and side position were introduced at the fourth visit with instructions to contract the pelvic floor muscles and transverse abdominis. At this point, the patient was able to sustain this contraction and sense lift of the pelvic floor for approximately 20 seconds. Sit to stand with kegel and small range squats were added as well. At this point in treatment the patient reported that she was already feeling much better, noting a 50% improvement in overall symptoms during activities of daily living.

Manual therapy consisted of myofascial release (MFR) and scar mobilization, and was performed on the first several appointments to address restriction and adhesion from her cesarean scar. The scar was mobilized in all planes by applying gentle pressure to the scar itself and moving it in the caudal-cephalad, medial-lateral, and rotational planes. Myofascial release of the surrounding tissue was performed similarly. Tissue restriction was assessed to be restricted in all planes both above and below the scar.

Treatment consisted of applying gentle pressure downward with the patient positioned comfortably in supine-hooklying with a bolster under the knees. The theory behind MFR is that the pressure will stimulate increased blood flow and subsequent heat production, enhance lymphatic draining, and provide proprioceptive input into the tissue addressed. Treatment technique of this nature can be direct, wherein the tissue is mobilized in the direction of restriction, or indirect wherein the tissue is mobilized away from the direction of restriction, similar to sliding a stuck dresser drawer backwards in attempts to gain a smooth slide outwards.

Both direct and indirect techniques were utilized on this patient due to the fact that she tolerated both quite well. Once pressure was established and direction of restriction determined, which was both superior and inferior to the Pfannenstiel’s incision, and on the left of the incision, gentle pressure was held until a giving way sensation was felt. The patient was educated in self scar massage technique and advised to perform daily. Additionally, strain-counter-strain (SCS) technique was utilized to release tight and shortened iliopsoas muscles bilaterally.

Muscle energy technique (MET) was utilized in order to re-establish symmetry to the sacroiliac joints of the pelvis. The pubic shotgun technique was utilized prior to torsion MET to draw the left anterior innominate posteriorly and thus level with the right. The patient responded extremely well to treatment. The final installation of this three part series will discuss her outcomes and provide insight to other possible treatment techniques for this patient population.

-Amanda Olson, DPT