PHYSICAL THERAPIST'S GUIDE TO BALANCE PROBLEMS

Balance problems make it difficult for people to maintain stable and upright positions when standing, walking, and even sitting. Older people are at a higher risk of having balance problems; 75% of Americans older than 70 years are diagnosed as having "abnormal" balance. Older women are more likely than older men to develop balance problems, although the difference between the genders is small. Balance problems increase by almost 30% in people aged 80 years or more. Mexican-Americans have the highest rate of balance problems among all Americans. Physical therapists develop individualized physical activity plans to help improve the strength, stability, and mobility of people with balance problems.

What are Balance Problems?

A balance problem exists when an individual has difficulty maintaining a stable and upright position. A range of factors can cause balance problems, including:

• Muscle weakness
• Joint stiffness
• Inner ear problems
• Certain medications (such as those prescribed for depression and high blood pressure)
• Lack of activity or a sedentary lifestyle
• Simple aging

Balance problems can also be caused by medical conditions, such as:

• Stroke
• Parkinson’s disease
• Multiple sclerosis
• Brain injury
• Arthritis
• Spinal cord injury
• Cognitive diseases
• Diabetes

Balance problems occur when 1 or more of 4 systems in the body are not working properly:

• Vision
• Inner ear
• Muscular system
• Awareness of one's own body position (called “proprioception”)

Poor vision can result from age, eye tracking problems, or eye diseases. Inner ear problems, also called vestibular problems, can develop from trauma, aging, poor nutrition, or disease. Body-position sense can become abnormal as a result of trauma or a disease, such as diabetes. Muscle strength and flexibility can decline due to lack of exercise, a sedentary lifestyle, or disease.

The brain coordinates impulses from the eye, inner ear, and body-position senses, and sends signals to the muscular system to move or make adjustments to maintain balance. If one or more of the senses is not sending correct signals to the brain, or if the muscular system cannot carry out the necessary movements, a person may not be able to maintain or correct their balance.

How Does it Feel?

A person with balance problems may experience tripping, swaying, stumbling, dizziness, vertigo, and falling. Although a person’s "static" balance may be fine when standing still or only performing a single task at a time, “dynamic” balance problems may become apparent when the person is moving about or trying to do more than 1 thing at a time (ie, walking, while turning the head to talk to another person), or when there is not much light (at night, or in a darkened room). If someone’s dynamic balance is abnormal, it can cause a fall and possible injury.

Balance problems can make a person fearful of performing simple daily activities. As a result, they may lose muscle strength and become frail because they avoid strenuous or challenging movements. A person who has balance problems may start to feel frustration about the condition, and become depressed.

How Is It Diagnosed?

If you see your physical therapist first, the physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist will also ask you detailed questions about your condition, such as:

• How often do you experience problems with your balance?
• What are you doing when you experience balance problems?
• Is your balance worse at nighttime or in dark rooms?
• Does the room spin, or do you feel off-balance?
• How many times have you fallen in the past year?
• Have you suffered injuries from falling?
• Have you changed or limited your daily activities because of your balance problems?
• What medications do you take?
• Have you had a vision or ear checkup recently?
• Do you have difficulty with any daily activities?
• How much, and what kind of daily exercise do you get?
• Do you have any other medical conditions or problems?
• Are you under the care of a physician?
• What are your goals?

Your physical therapist will perform tests, such as motion, strength, coordination, visual tracking, and balance tests, to help assess your overall physical ability. Your physical therapist may collaborate with your physician or other health care providers, who may order further tests to rule out any underlying conditions that may exist.

How Can a Physical Therapist Help?

Physical therapists offer numerous options for treating balance problems, based on each person’s needs. They are trained to evaluate multiple systems of the body, including the muscles, joints, inner ear, eye tracking ability, skin sensation, and position awareness in the joints (proprioception). Physical therapists are experts in prescribing active movement techniques and physical exercise to improve these systems, including strengthening, stretching, proprioception exercises, visual tracking, and inner ear retraining. 

Your physical therapist can help treat your balance problems by identifying their causes, and designing an individual treatment program to address your specific needs, including exercises you can do at home. Your physical therapist can help you:

Reduce Fall Risk. Your physical therapist will assess problem footwear and hazards in your home that increase your risk of balance problems or falling. Household hazards include loose rugs, poor lighting, unrestrained pets, or other possible obstacles.

Reduce Fear of Falling. By addressing specific problems that are found during the examination, your physical therapist will help you regain confidence in your balance and your ability to move freely, and perform daily activities. As you build confidence in your balance and physical ability, you will be better able to enjoy your normal daily activities.

Improve Mobility. Your physical therapist will help you regain the ability to move around with more ease, coordination, and confidence. Your physical therapist will develop an individualized treatment and exercise program to gradually build your strength and movement skills.

Improve Balance. Your physical therapist will teach you exercises for both static balance (sitting or standing still) and dynamic balance (keeping your balance while moving). Your physical therapist will progressively increase these exercises as your skills improve.

Improve Strength. Your physical therapist will teach you exercises to address muscle weakness, or to improve your overall muscle strength. Strengthening muscles in the trunk, hip, and stomach (ie, “core”) can be especially helpful in improving balance. Various forms of weight training can be performed with exercise bands, which help avoid joint stress.

Improve Movement. Your physical therapist will choose specific activities and treatments to help restore normal movement in any of your joints that are stiff. These might begin with "passive" motions that the physical therapist performs for you, and progress to active exercises that you do yourself.

Improve Flexibility and Posture. Your physical therapist will determine if any of your major muscles are tight, and teach you how to gently stretch them. The physical therapist will also assess your posture, and teach you exercises to improve your ability to maintain proper posture. Good posture can improve your balance.

Increase Activity Levels. Your physical therapist will discuss activity goals with you, and design an exercise program to address your individual needs and goals. Your physical therapist will help you reach those goals in the safest, fastest, and most effective way possible.

Once your treatment course is completed, your physical therapist may recommend that you transition to a community group to continue your balance exercises, and maintain a fall-proof home environment. Many such community groups exist, hosted by hospitals, senior centers, or volunteer groups.

Your physical therapist may recommend that you consult with other medical providers, including:

• An eye doctor, to check your current vision needs.
• An ear doctor, to check your outer and inner ear status.
• Your personal physician, to review your current medications to see if any of them may be affecting your balance.

Can this Injury or Condition be Prevented?

To help prevent balance problems, your physical therapist will likely advise you to:

• Keep moving. Avoid a sedentary lifestyle. Perform a challenging physical activity each day to keep your muscles strong and flexible, and your heart and lungs strong. Use your body as much as you can to walk, climb stairs, garden, wash dishes by hand, and other daily activities that keep you moving. If you work out or follow a fitness program, keep it up!
• Have yearly checkups for vision and hearing. Make sure your vision prescription is up-to-date.
• Carefully manage chronic diseases like diabetes, whose long-term side effects can include balance problems. These side effects can be greatly reduced by following the recommended diet and medication guidelines given to you by your physician.
• Monitor your medications. Make note of any medications that you think may be affecting your sense of balance, and talk to your physician about them.
• Report any falls to your physician and physical therapist immediately. They will evaluate and address the possible causes.

Your physical therapist will also prescribe a home exercise program specific to your needs to prevent future problems or injuries. This program can include strength and flexibility exercises, posture retraining, eye-tracking and vestibular exercises, and balance exercises.

Real Life Experiences

Margaret is a 70-year-old retiree. She and her husband have lived in the same house for 30 years. Margaret is as active around the house as ever, taking care of all the household cleaning and maintenance, growing vegetables in her garden, cooking, and tackling light landscaping.

One night recently, Margaret tried to close the bathroom window when it turned chilly outside. She didn't bother to switch on the bathroom light. In order to reach the window, she had to step into the tub with her right foot. She found that she had to push harder on the stubborn window, and lifted her left leg to place it in the tub. The next thing she recalled was explosive pain in her ribs. She realized that she was on her side, sprawled half in and half out of the tub. She did not recall falling. Her husband got her to the doctor.

Margaret's doctor x-rayed her ribs, shoulder, and toe, and found no broken bones. He instructed Margaret on how to care for her many bruises. He bandaged a torn toenail on her right foot, and told Margaret that she would not be able to wear a closed-toe shoe for awhile.

When her doctor asked Margaret if she had fallen before, she admitted that she had lost her balance while going upstairs recently. She admitted that she felt more off-balance in the dark. Margaret also mentioned that she and her husband attended ballroom dancing sessions each week, and joked that she never could learn to “spot a turn.” The physician, knowing that the dancer technique of “spotting a turn” requires inner ear and vision function, recommended that Margaret consult with her eye doctor, and her physical therapist.

Margaret met with her eye doctor and got her vision prescription updated; she noted that she felt somewhat more balanced with proper eyeglasses. She then met with her physical therapist.

Margaret's physical therapist took her medical history and performed a full battery of tests, assessing Margaret's muscle strength, balance, body-position sense (proprioception), eye-tracking ability, and inner ear (vestibular) function.

She noted Margaret's bruises from her fall. In addition, she found that Margaret lacked the ability to keep her eyes focused on an object while turning her head, and that her balance was severely affected when her eyes were closed. She asked what Margaret's personal goals were for therapy; Margaret said she wanted to avoid falling, return to her normal vigorous household activities, and attend her ballroom dance sessions 3 times per week.

Margaret's treatment began with simple eye-tracking exercises, and moved on to standing and walking balance exercises. Her physical therapist then added specific strengthening exercises to the routine. She also performed hands-on therapy, somewhat like massage, to increase the healing speed of the shoulder and rib muscles that were bruised and strained. She also applied electrical stimulation and cold packs to those areas to reduce swelling and pain.

Margaret continued her physical therapy sessions for 4 weeks, increasing her exercises as her strength returned. She learned about fall-proofing her home, including installing night lights in the bathrooms, and about wearing proper footwear.

At the end of her treatment program, Margaret was able to return to all her household tasks, and maintain a home-based exercise program designed by her physical therapist. She reported that she felt much more confident about maintaining her balance, even at night. She and her husband returned to ballroom dancing—and she was able to gently “spot a turn” for the first time in her life!

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat balance problems. However, you may want to consider:

• A physical therapist who is experienced in treating people with balance or vestibular problems. Some physical therapists have a practice with a balance or vestibular focus.
• A physical therapist who is a board-certified clinical specialist, or who completed special training in vestibular physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapist’s experience in helping people who have your type of problem.
• During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

PT'S GUIDE TO PELVIC FRACTURES

A pelvic fracture is a break in 1 or more bones in the pelvis. It is sometimes referred to as a "hip fracture" or "broken hip" because it occurs in the bones that make up the hip area. A pelvic fracture causes difficulty walking or standing. It can also cause abdominal pain, bleeding from pelvic cavities, and difficulty urinating. Pelvic fractures in the United States are relatively rare, making up 0.3% to 6% of all fractures. Pelvic fractures are most common in people 15-28 years of age. In people younger than 35, males suffer a higher incidence of pelvic fractures than females. In people older than 35, females suffer pelvic fractures more often than males.

What is a Pelvic Fracture (Hip Fracture)?

A pelvic fracture is a crack or break in one or more of the pelvic bones, which are located at the base of the spine. The pelvis is often referred to as part of the hip. (When you "put your hands on your hips," your hands are actually resting on your pelvic bones.)

A pelvic fracture can result from a low-impact or high-impact event.

Low-impact pelvic fractures most commonly occur in 2 age groups: adolescents and the elderly. Adolescents typically experience fractures of the tips of 1 of the pelvic bones, resulting from an athletic injury (football, hockey, skiing) or an activity such as jogging. Pelvic fractures also can occur after minor falls in people with osteoporosis or even occur spontaneously when bones are weak. The elderly frequently suffer fractures of the thicker part of the pelvic bones. These "pelvic ring fractures" result from falling onto the side of the hip. These falls can be caused by balance problems, vision problems, medication side effects, general frailty, or unintended obstacles such as pets underfoot, slippery floors, or rumpled rugs. Low-impact pelvic fractures often are mild fractures, and they may heal with several weeks of rest. Physical therapy is very helpful in restoring strength and balance in these cases.

High-impact pelvic fractures most commonly result from major incidents such as a motor vehicle accidents, a pedestrian being struck by a vehicle, or a fall from a high place. These pelvic fractures can be life-threatening, require emergency room care, surgery, and extensive physical therapy rehabilitation.

How Can a Physical Therapist Help?

Pelvic fracture recovery often involves surgery or long periods of bed rest. In the case of athletes, avoidance of sport activities is recommended until pain has resolved. During these periods of rest, which are usually weeks to months, a person often loses strength, flexibility, endurance, and balance abilities.

Physical therapists can help you recover from a pelvic fracture by improving your:

• Pain level
• Hip, spine, and leg motion
• Strength
• Flexibility
• Speed of healing
• Speed of return to activity and sport

When you are cleared by your physician to begin physical therapy, your physical therapist will design a specific treatment program to speed your recovery, including exercises and treatments you should do at home. This program will help you return to your normal life and activities and reach your recovery goals.

The First 24-48 Hours

Your physical therapist may help you learn to use crutches so you can move around your home without walking on the leg of the injured side. This will more commonly apply to low-impact pelvic fractures, as in athletes. More severe pelvic fractures will require a wheelchair, in which your physical therapist can instruct your safe usage.

Reduce Pain

Your physical therapist can use different types of treatments and technologies to control and reduce your pain, including ice, heat, ultrasound, electrical stimulation, taping, exercises, and special hands-on techniques called manual therapy that gently move your muscles and joints.

Your physical therapist will choose specific activities and treatments to help restore normal movement in the leg and hip. These might start with passive motions that he or she applies to your leg and hip joint, and progress to active exercises and stretches that you perform yourself. Treatment can involve hands-on manual therapy techniques called "trigger point release" and "soft tissue mobilization," as well as specific stretches to muscles that might be abnormally tight.

Improve Strength

Certain exercises will benefit your healing at each stage of recovery, and your physical therapist will choose and teach you an individualized exercise program that will restore your strength, power, and agility. These exercises may be performed using free weights, stretch bands, weight-lifting equipment, and cardio exercise machines such as treadmills and stationary bicycles. For pelvic fractures, muscles of the hip and core are often targeted by the strength exercises.

Improve Balance

The hip area contains many muscles that are vital for balance and steadiness when walking or performing any activity. Your physical therapist will teach you effective exercises to restore strength and endurance to these muscles so that you can regain your balance.

Speed Recovery Time

Your physical therapist is trained and experienced in choosing the treatments and exercises to help you heal, get back to your normal life, and reach your goals faster than you might be able to on your own.

Return to Activities

Your physical therapist will collaborate with you to decide on your recovery goals, including return to work and sport. Your treatment program will be designed to help you reach these goals in the safest, fastest, and most effective way possible. Your physical therapist will use hands-on therapy and teach you exercises and work re-training activities. Athletes will be taught sport-specific techniques and drills to help achieve sports-specific goals.

Prevent Future Problems

Your physical therapist can recommend a home exercise program to strengthen and stretch the muscles around your hip, upper leg, and core to help prevent future problems, such as fatigue and walking difficulty. This program may include strength and flexibility exercises for the hip, thigh, and core muscles. Your physical therapist will also review with you and your family ways to prevent falls in your home. These fall-prevention strategies may include clearing the floors of loose obstacles (throw rugs, mats), using sticky mats or chairs in the shower, preventing pets from walking near your feet, and using non-slippery house shoes, as well as installing grab bars or rails for the shower, toilet, and stairs.

If Surgery Is Necessary

If surgery is required, your physical therapist will help you minimize pain, restore motion and strength, and return to normal activities in the speediest manner possible after surgery.

Can this Injury or Condition be Prevented?

Pelvic fracture can be prevented by:

• Warming up before starting any sport or heavy physical activity. Your warm-up should include stretches taught to you by your physical therapist, including stretches for the muscles on the front, side, and back of the hip.
• Increasing the intensity of an activity or sport gradually, not suddenly. Avoid pushing yourself too hard, too fast, too soon.
• Following a reasonable and safe nutritional plan. Nutritional factors can contribute to osteoporosis, which can put you at higher risk of pelvic fracture.
• Maintaining good balance skills. Balance problems can increase the risk of falling and thus increase the risk of incurring a pelvic fracture. Physical therapy can help maintain and improve balance ability, which can help prevent falls.
• Driving safely to avoid motor vehicle accidents.
• Clearing your house of obstacles that you could trip over, and eliminating slippery walking surfaces.

THE FIELD IS GROWING.... IS IT RIGHT FOR YOU?

There are many reasons you should consider a career in physical therapy. Could it be right for you?

Make a Difference. "Being a physical therapist is very rewarding. You will work with patients one-on-one, see them progress through treatment, and know that you are really making a difference in their lives," said APTA spokesperson Meredith Harris, PT, DPT, EdD. Whether the patient's problem is a result of injury or disease, the physical therapist is a rehabilitation specialist who fosters the patient's return to maximal function. Physical therapists also will work with individuals to prevent loss of mobility by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

Be a Movement Expert. Physical therapists are highly educated experts in the movement and function of the human body. The goal of a physical therapist is to promote the patient's ability to move, reduce pain, restore function, and prevent disability. Physical therapy is an essential element of patient care. Therapeutic exercise and functional training are the cornerstones of physical therapist treatment. Depending on the particular needs of a patient, physical therapists may "mobilize" a joint or massage a muscle to promote proper movement and function. Physical therapists may use other techniques such as electrotherapy, ultrasound (high-frequency waves that produce heat), hot packs, and ice in addition to other treatments when appropriate.

Enjoy Job Security. For Americans looking for a rewarding career in a struggling job market and down economy, a career in physical therapy could be the perfect answer. The soaring demand for physical therapists can be attributed to the aging American population, particularly baby boomers who are more vulnerable to chronic and debilitating conditions that require physical therapist services. According to the Bureau of Labor Statistics, the demand for physical therapists is expected to spike upward by an astonishing 34% between 2014 and 2024—a much quicker rate than average. Currently, there are approximately 210,900licensed physical therapists in the United States, and that number is expected to jump to 282,700 by 2024.

Love Your Job. Helping people to attain or regain the ability to walk and carry out daily life can lead to a great feeling of personal satisfaction. Physical therapists report one of the highest job-satisfaction levels in the country! Forbes ranked physical therapists as having 1 of "The Ten Happiest Jobs," according to articles published in 2013 and 2011. CNNMoney.com gave physical therapists a grade of “A” in Personal Satisfaction in 2012, as well as in its “Benefit to Society” categories. A National Opinion Research Center survey, which was chronicled in an April 17, 2007, article of the Chicago Tribune. With more than three-quarters of physical therapists polled reporting to be "very satisfied" with their occupations, PTs were second only to clergy, and were the only health care professionals in the top 5.

Choose Your Location. Physical therapists work with patients of all ages all across the country. Choose from a wide range of locations and work settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, employer settings, and nursing homes.

Be an Entrepreneur. Do you want to be your own boss? More than twenty-one percent (21.6%) of physical therapists are owners of, or partners in, a physical therapy practice.

PHYSICAL THERAPY: A HISTORY, Q&A, AND DIRECT ACCESS

Physical Therapy has gone through a major, major expansion in the last 10 years. So much so, in fact, that as laws are trying to change quickly enough to keep up with our progress, our clientele is growing each and every year. Patients can now seek physical therapy treatment to some extent in all 50 states without a physician's referral. Although "to some extent" varies greatly throughout the states, progress is shifting forward to allow more individuals than ever the ability to seek physical therapy. 

I, myself, have encountered many "non-believers" in the concepts of physical therapy, so I decided to host a little questionnaire with a couple of patients to see what exactly it was that they were curious about.

"How long has physical therapy been around, and why is it I've never heard of it before?" 

Physical therapy was actually started as a "reconstruction aid" program during World War 1, back in the early 1900's - what's known today as the APTA was started shortly thereafter in 1921. In the 1960's, the APTA introduced the Physical Therapist Assistant (PTA) to aid with the serious lack of physical therapists required to handle the overwhelming number of patients that required treatment during the Korean War. So long-story-short, it's been around for quite some time, now.

"Why is it I've never heard of Physical Therapy before?" 

Why have you never heard it before? For the same reason you've never heard of an Otolaryngologist (more commonly known as an ear, nose, and throat specialist) until you actually needed one: visits to specialists require a physician's prescription. 

"What's the difference between a Chiropractor and a Physical Therapist?" 

Truth be told: we do something very similar, the difference is the method of approach. TYPICALLY (notice, I said typically), a chiropractor is going to provide fast, but short-term relief, whereas a physical therapist is going to provide slower, but long-term relief. 

For example, consider a patient who's primary concern is back pain due to a misaligned spine. One manipulation adjustment from a Chiropractor, that patient is suddenly pain-free and free to go about their day. However, pain can return as quickly as later that day, to months later. A physical therapist, on the other hand, while they may perform a manipulation to relieve the pain immediately, they're going to treat the muscles surrounding that area of the spine. The skeleton is nothing more than a lever system being controlled by the muscles, tendons, and ligaments that attach to it. If certain muscles are too tight, or certain muscles are too lax, that'll require stretching and strengthening to even the muscle tone surrounding those misaligned bones. Once the muscle tone is evened out, the bones will no longer be misaligned. So does it take longer? Yes. But does it last longer and give you the tools to prevent it from coming back? Yes. 

Keep in mind, your physician made their decision on which to send you to for a reason and it is of the utmost importance that you trust their judgement on which they've sent you to. Not all conditions can be treated by both specialties. Some conditions, in certain cases, can be ruled out by seeing one versus the other.

"How long do Physical Therapists have to be in school?"

Physical therapists are required by law to have graduated from an accredited (by CAPTE) Doctorate in Physical Therapy. It's 7 years including the undergraduate degree, and while residencies following the degrees are not required, they are highly recommended. 

"What is The Movement System?"

The Movement System is a term used to represent a collection of systems that must interact to the move the body or it's component parts. 

It is a method of approach adapted by the APTA within the last 5 years to allow physical therapists to encompass aspects of 7 different bodily systems that come together to form a comprehensive physical therapy diagnosis. It includes the musculoskeletal, nervous, pulmonary, cardiovascular, endocrine, and integumentary systems. 

Human movement is a complex behavior within a specific context. Physical Therapists provide a unique perspective on purposeful, precise, and efficient movement across the lifespan based upon the synthesis of their distinctive knowledge of the movement system and expertise in mobility and locomotion. 

NOTE: A physical therapy diagnosis is NOT the same as the medical diagnosis given to you by your physician. 

"What can we do if we want physical therapy?" 

In the state of Kansas, you can come in for physical therapy without a referral. The problem isn't always the state - it may be your insurance. Make sure to contact your insurance for details regarding your coverage and benefits. 

In the state of Missouri, you may be evaluated by a physical therapist without a prescription under 2 conditions:

1. Treatment for a condition that has already been diagnosed by a physician within the last 12 months, and the physical therapist must still send out for a prescription upon determination to continue from the evaluation with treatment, or

2. A consultation, education, or preventative program for asymptomatic individuals. 

Again, it is crucial that while the state may allow that you see a physical therapist without a prescription under certain conditions, it is imperative that you first, contact your insurance to verify that you are eligible for coverage without a prescription - no matter the reason. 

"What do we do if our insurance doesn't cover physical therapy?"

Just about every insurance plan available now includes physical therapy coverage. However, in certain situations, your plan may not have great coverage, or still may require a hefty out-of-pocket maximum or deductible to be met. We at CHAMPION Performance and Physical Therapy have what's called a self-pay option, where you pay entirely out of pocket for your appointment (the same way you'd pay for your lunch) if you're unable to utilize your insurance benefits, or simply do not want to. You'd pay each and every time before the start of your appointment, and we would not contact your insurance for reimbursement. 

HOW PHYSICAL THERAPISTS MANAGE PAIN

As America combats a devastating opioid epidemic, safer, non-opioid treatments have never been of greater need.

Physical therapy is among the safe, effective alternatives recommended by the Centers for Disease Control and Prevention in guidelines urging the avoidance of opioids for most pain treatment.

Whereas opioids only mask the sensation of pain, physical therapists treat pain through movement. How movement? 

The Movement System is the new, widely-accepted way to approach injury and pain by the American Physical Therapy Association. It encompasses all aspects involved with an injury, from the skin to the nervous system - and everything involved, in-between. Most musculoskeletal pain is due to a discrepancy between muscle tightness and weakness which pulls bones into the wrong place to the point where it becomes painful. So what do we do to help?

Here's how:

1. Exercise. A study following 20,000 people over 11 years found that those who exercised on a regular basis, experienced less pain. And among those who exercised more than 3 times per week, chronic widespread pain was 28% less common1. Physical therapists can prescribe exercise specific to your goals and needs.

2. Manual Therapy. Research supports a hands-on approach to treating pain. From carpal tunnel syndrome2 to low back pain3, this type of care can effectively reduce your pain and improve your movement. Physical therapists may use manipulation, joint and soft tissue mobilizations, and dry needling, as well as other strategies in your care.

3. Education. A large study conducted with military personnel4 demonstrated that those with back pain who received a 45 minute educational session about pain, were less likely to seek treatment than their peers who didn't receive education about pain. Physical therapists will talk with you to make sure they understand your pain history, and help set realistic expectations about your treatment.

4. Teamwork. Recent studies have shown that developing a positive relationship with your physical therapist and being an active participant in your own recovery can impact your success. This is likely because physical therapists are able to directly work with you and assess how your pain responds to treatment.

Read more about Pain and Chronic Pain Syndromes.

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management. Learn more at our #ChoosePT page.

References

1. Holth HS, Werpen HK, Zwart JA, Hagen K. Physical inactivity is associated with chronic musculoskeletal complaints 11 years later: results from the Nord-Trøndelag Health Study. BMC Musculoskelet Disord. 2008;9:159. Free Article.

2. Fernández-de-las Peñas C, Ortega-Santiago R, de la Llave-Rincón AI, et al. Manual physical therapy versus surgery for carpal tunnel syndrome: a randomized parallel-group trial. J Pain. 2015;16(11):1087–1094. Article Summary in PubMed.

3. Delitto A, George SZ, Dillen LV, et al. Low back pain. J Orthop Sports Phys Ther. 2012;42(4):A1–A57. Free Article.

4. George SZ, Childs JD, Teyhen DS, et al. Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military cluster randomized trial. BMC Med. 2011;9:128. Free Article.

Author: Joseph Brence, PT, DPT, FAAOMPT, COMT, DAC

WHAT IS STRENGTH TESTING?

WHAT IS IT?

Strength testing, in a PT sense, is not the same as maxing out in the weight room. Strength testing, professionally known as Manual Muscle Testing (MMT) is a graded technique that provides the ability for a therapist to produce an objective measurement of perceived muscle strength based on a patient's ability to resist an opposing force. 

In Layman's terms, this essentially means your physical therapist is going to place a body part of yours in a specific position, and they're more than likely going to push against that same body part and ask you to resist that external force as best you can. With that numerical value, they'll be able to test continuously throughout your treatment to determine whether or not therapy is/has been beneficial for your specific injury.

SIDE NOTE: They are not going to push hard.

They're simply trying to determine whether or not you can withstand the force and maintain your position with only slight deviation, or whether or not your muscles give out due to weakness, or maybe even pain. 

HOW DOES GRADING WORK?

They are going to grade you on an integer - only, numerical scale, with 5 being the best. You may hear some therapists use terminology such as 4+ or 4- and that is more of a subjective notation for your therapist to notate smaller gains or regressions in strength or ability. 

SIDE NOTE: They do not share these tested scores with anyone aside from your referring specialist, as it is common lingo utilized to extend information across fields of medicine. 

CAN I DO THIS AT HOME?

No.

Simply put, Manual Muscle Testing seems like a simple concept, but your physical therapists complete a 3-year doctorate program to ensure that they're testing injured areas in the correct way, while respecting protocols instilled by your orthopedic specialists, or your surgeon. It's vital that you do not attempt to test yourself, whether alone or with a partner.