HAMSTRING INJURIES RESPOND BETTER TO EXERCISE, ACCORDING TO APTA

Platelet-rich plasma injections might sound like cutting-edge treatment for hamstring injuries, but according to the APTA, a 2012 systematic review of 10 randomized clinical trials indicates that rehabilitation exercises actually have a superior effect on acute hamstring injuries (“Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries: an updated systematic review and meta-analysis” – July 21, 2015).

Specifically, lengthening exercises and progressive agility and trunk stabilization exercises have been identified in previous studies as appropriate “for daily practice” to treat acute hamstring injuries. However, the authors of the above study discourage the use of platelet-rich plasma injections, in which a patient’s own platelet-enriched blood is injected into an injured part of the body with the intent to promote healing, finding that the injection is ineffective.

Hamstring injuries are one of the most common lower body injuries, particularly affecting athletes participating in sports, such as football, soccer, or track. After tearing a hamstring muscle, a person is 2 to 6 times more likely to suffer a subsequent injury. Participants from the reviewed studies were all associated with sports.

Physical therapists can design individualized treatment programs for hamstring injuries that may include range of motion, muscle strength, manual therapy, and function training.

UT COMPENSATION

WHAT IS IT?

UT compensation, or Upper Trap compensation, is the overuse of the upper fibers of the trapezius muscle due to injury or weakness.

WHY DOES IT HAPPEN?

Supraspinatus Injury:

The most prominent injury leading to UT compensation is a rotator cuff tear - most often, the supraspinatus muscle. The supraspinatus is primarily responsible for abduction of the shoulder, and stabilization of the humeral head (top of the arm bone) in the glenoid fossa (socket). Abduction of the shoulder joint is the arm moving out to the side, and away from the body - as if you are doing a jumping jack. Once the arm reaches shoulder height, the deltoid muscle takes over and continues abduction by raising the outstretched arm the rest of the way to get entirely overhead. 

When an injury occurs in the supraspinatus, the deltoid immediately becomes responsible for abduction - however, it still is unable to raise the arm in abduction before it reaches shoulder height entirely on it's own - so the UT raises the entire shoulder, not just the arm, to help the arm reach higher without the supraspinatus muscle. 

Scapular Weakness:

The other common reason for UT compensation is scapular weakness and instability. The scapula is the bone that creates your shoulder blade, as well as the socket portion of the ball-and-socket shoulder joint. Multiple muscles attach to the scapula from all different aspects that work together help to control the strength and mobility of the shoulder. 

When there is weakness present in the elevators (function to lift up) and retractors (function to pull back, like you're puffing out your chest) of the scapula, the UT activates to help the scapula maintain it's range of motion, so as to allow the shoulder joint to maintain it's normal range of motion. 

WHAT HAPPENS NEXT?

It is not uncommon for UT compensation to go unnoticed for weeks, to months, to even years. Some individuals with plenty of strength elsewhere may get away with it for longer, some individuals with less functional strength may notice it immediately. Common symptoms are elevated shoulders, stiff/tight muscles in the neck/upper back, and residual pain in the shoulder.

IS IT CURABLE? 

The longer you wait to talk to your doctor, the longer it will take to reverse the symptoms and retrain your body to activate your muscles properly. With effort and hard work, prognosis is usually fair to excellent. Talk to your physical therapist about performing a screening or evaluation to identify if UT compensations are occurring due to a larger issue in your upper extremities. 

Ask us at CHAMPION today!

PHYSICAL THERAPY AND YOUR INSURANCE

A Patient's Guide to Getting the Best Coverage

The best way to take care of your health is to take an active role in your own health care. To do this, you need to know about your options and your rights as a patient. Patients across the country are becoming better educated and demanding more and better options from their health insurance companies. The right to physical therapist services is an important option, and it is your right as a patient.

Federally qualified HMOs are required to have physical therapy in their benefits packages.

In most states you may see a physical therapist without a doctor's referral, but be sure to check your health insurance plan to see if physical therapist services are covered without a physician's referral.

What You Can Do to Improve Your Physical Therapy Coverage

Talk with your employer/benefits manager. The employers who contract and pay for employee health care plans often have the most influence with insurers. Employers are interested in keeping their employees on the job and their premiums low, so providers who can help employees prevent injuries and avoid recurrence (as well as promote a healthy lifestyle) have particular appeal to them. Arrange a meeting with your human resources director or whoever is responsible for negotiating the terms of the company's insurance plan.

Ask your human resources director or insurance company the following questions to determine if your current benefits package gives you access to appropriate physical therapy services:

1. Is your physical therapy benefit "bundled" with those of other providers of care? Physical therapy services should be listed separately in the benefit language so that access to necessary services is not compromised.

2. Does the benefit language permit access to physical therapists for each condition during the year? Benefit language should permit treatment of more than one condition in a calendar year (eg, ankle fracture in January and low back injury in July).

3. Does the benefit language permit access to physical therapists for each episode of care? A person may require more than one episode of care for the same condition. For example, someone with arthritis may receive physical therapy intervention for knee weakness in an attempt to avoid surgery. While this is often successful, some patients may still require surgery for the knee condition (eg, total knee replacement), which may require post-operative physical therapy treatment. The benefit language should support each "episode of care."

4. Does the benefit language ensure coverage that facilitates restoration of function? Benefit language that restricts physical therapy care to a 60- or 90-day period imposes an arbitrary limit on recovery. In determining an appropriate physical therapy benefit that will allow an individual to return to his or her previous level of function, benefit language should reflect the normal amount of time that it takes to recover from an injury or from surgery.

5. Does the benefit language ensure coverage that promotes functional independence for those with chronic conditions? Someone who has a chronic condition may need to be seen periodically by a physical therapist. The physical therapist will determine if the individual's home program, equipment, or adaptive devices should be modified. (For instance, children requiring orthotic devices will need modifications to those devices as they grow.) Benefit language should ensure that someone with a chronic condition may receive the kind of care that promotes personal safety and the greatest degree of function possible.

Choosing a Health Plan

Millions of Americans are offered a choice of health plans through their employers, but the question is "What makes a good health care plan?" Here are some things to consider when choosing a health plan.

• Are you choosing a plan simply because it is the cheapest? This may not be the best way to go. Some inexpensive plans have a high deductible and no comprehensive coverage.
• Is the plan accredited by the National Committee on Quality Assurance? This is a good indicator of quality.
• Are your current doctors and specialists in the plan? If not, make sure you will be able to see a certain provider or specialist, such as a physical therapist, without too much added expense and difficulty.
• Is physical therapy coverage adequate? If you should have an injury or illness requiring rehabilitation, you will need a plan that offers an unlimited number of visits to a physical therapist or that allows for the number of visits to be extended if needed.
• Are there lifetime limits on benefits? If so, you could face a serious financial crisis if you or a covered member of your family suffers a major illness or injury.
• Does the plan have an out-of-pocket maximum? In this case, once you have paid a certain amount (usually several thousand dollars) the plan would cover the rest.
• How does the plan handle grievances and appeals? The procedure should be simple, timely, and accessible.
• Does the plan permit use of out-of-network doctors, specialists, or hospitals? Called "point-of-service" option, this would allow you to see a provider, such as a physical therapist, who is not in your plan. There may be an additional cost, but it may be worth it.
• What is the plan's disenrollment rate? A high rate of members leaving the plan annually may indicate customer dissatisfaction.

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.

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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.

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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.

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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.

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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.

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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!

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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.

LOW BACK PAIN: WHY YOU SHOULD GET PHYSICAL THERAPY FIRST

Over any 3-month period, about 25% of Americans will have low back pain. In most cases, it is mild and disappears on its own. But sometimes the pain lingers, returns, or worsens, leading to a decrease in function and quality of life.

In an era when back pain is often over-treated, due in part to unhelpful imaging scans (like x-rays) that may lead to unnecessary surgery, narcotics, and higher costs, physical therapy is a proven and cost-effective treatment option that you should consider as a first choice.

Studies show that early physical therapy for low back pain significantly lowers the total scope and cost of care.

Here's why you should consider getting physical therapy first:

Back Pain Often Leads to Missed Work and Overly Expensive Treatment

• According to the most recent news release (December 2014) Employee Cost Index from the Bureau of Labor Statistics, more than 200,000 incidents related to back injury were reported in 2013, causing an average of 7 days of missed work.
• Direct costs to treat back problems totaled $30.3 billion in 2007. Of that, $4.5 billion was spent on prescription medications. The average expenditure per person for treatment was $1,589, and $446 for prescription medications.

Physical Therapy Is An Effective, Cheaper First Choice

• Scientific research overwhelmingly points to the effectiveness of conservative treatments, such as physical therapy, for low back pain. Despite this, and published guidelines suggesting conservative treatment as the best first option, physicians still often order imaging scans (like x-rays), prescribe narcotics, and refer patients to other physicians, including surgeons.
• A September 2013 study found that there was no significant difference in outcomes between patients who chose spinal fusion surgery, as compared to those who chose the nonoperative treatment (physical therapy).
• An award winning 2015 study demonstrated substantial potential for lowered costs and reduced health care utilization for patients who received, and adhered to, early physical therapy for low back pain.

ARE YOU AT RISK FOR OSTEOARTHRITIS?

What is osteoarthritis?

Osteoarthritis, also known as Degenerative Joint Disease (DJD) but more commonly known as "arthritis", is the degeneration of cartilage in a joint leading to bone-on-bone degradation. 

What causes osteoarthritis?

Osteoarthritis results in the deterioration of the cartilage that acts as a protective cushion between bones.  It is more common in the general population in partially weight-bearing joints, such as the hips and knees. As bones grind against one another, it can result in hardening of the joint, inflammation of the fluid-filled, protective bursa sacs, and possibly bone spurs and other problems that lead to pain. 

What risk factors increase my chances of getting osteoarthritis? 

Unfortunately, not qualifying for any risk factors does not guarantee you'll never have osteoarthritic symptoms, but it can help to decrease chances. Some risk factors are out of our control, but some definitely aren't!

1.  Old Age increases your risk significantly, as not only do the proteins in the body that recreate and make up cartilage become more sparse in the joints, but the fluid that protects the cartilage is produced less as you age, as well. 

2. Obesity puts added stress on weight-bearing joints, and adipose (fatty) tissue produce proteins that can lead to harmful, degrading inflammation in the joint cavities. 

3. Joint Injuries that stemmed from an accident or sports injury can increase your risk of osteoarthritis.

4. Bone Deformities or Protein Deficiencies can increase the amount of stress on a certain area of the joint that will later lead to a breakdown of cartilage, and life-long protein or hormonal deficiencies diagnosed at a young age can eventually cause an early onset of osteoarthritis. 

5. Genetics has also proven to be a major factor in developing osteoarthritis, not only because of gene function, but lifestyles. Some are more prone to the breakdown of cartilaginous proteins and fibers. As far as genetically inherited lifestyles, that's probably more accurate when described as a nuture versus a nature problem. More often than not, children are going to have similar lifestyles to that of their parents. Parents who developed osteoarthritis due to being extremely active in their youth and adulthood likely passed those same habits onto their child, which could, in turn, potentially lead to the same osteoarthritic developments. 

Does meeting these risk factors necessarily mean you'll develop osteoarthritis? No. Like every medical condition, qualifying for a risk factor is not a guarantee. Simply worry about the ones you can control. 

OUR NEXT BLOG POST: What to do when you already have osteoarthritis.