NON-OPIOID TREATMENT AFTER SURGERIES

The results of a recent consumer survey found that 79% of patients who have undergone surgery would choose a non-opioid option for treatment of pain over opioids. These findings make clear the high level of interest patients have in nonopioid treatment after surgery, despite the nation’s growing opioid epidemic.

The survey (Opioid Addiction and Dependence after Surgery Is Significantly Higher Than Previously Known- June 13, 2016) provides valuable insight into the issue, and suggests more patient education is needed.

The study polled 500 adults in the United States who had orthopedic surgery or soft tissue surgery in June 2016, and was conducted in support of the Plan Against Pain campaign, an effort designed to educate patients about their choices in managing pain following a surgical procedure. 

According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States. In response to the growing epidemic, the CDC released opioid prescribing guidelines in March 2016, urging prescribers to reduce the use of opioids in favor of safe alternatives like physical therapy.

Physical therapists partner with patients, their families, and other health care professionals to manage pain through movement and exercise.

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

LOW BONE MASS

Osteopenia, now called low bone mass, is a term used to describe lower-than-normal bone density or thickness. Approximately 44 million adults in the United States have osteopenia.The condition is different than osteoporosis, which is a disease where normal bone structure becomes thinned out and porous.

Low bone mass can occur at any age, but noticeable and significant bone loss is most likely to occur in women during the 5 to 7 years following menopause. This group is also more likely to experience a bone fracture than someone with normal bone mass.

What is Osteopenia (Low Bone Mass)?

Low bone mass is a condition that develops when a person:

• May naturally have less-dense bones due to factors such as body size, genetics, or gender.
• Has gradually lost bone mass over time due to lack of exercise and poor diet.
• Has begun to experience perimenopause, symptoms that signal the onset of menopause or who is in menopause.
• Has rapidly lost bone mass due to an illness or use of medication.

How Does it Feel?

There are no specific symptoms oflow bone mass. You may have the condition and not know it. It is important to recognize your risk factors to prevent bone fracture. You should discuss any concerns with your health care provider and physical therapist.

How Is It Diagnosed?

Low bone mass is diagnosed through a quick and painless specialized scan ordered by aphysician. If you are seeing a physical therapist for rehabilitation, the therapist may confer with your physician when detecting a possible need for bone testing.

The results of the scan are reported using T- and Z-scores.

The T-score compares your score to that of healthy 30-year-old women. A T-score between -1 and -2.49 means that you have low bone mass. Those who have a T-score of -2.5 and lower have osteoporosis.

If you have a T score of -1 or less, you have a greater risk of experiencing a fracture. A person with a T-score of -2 has lower bone density than a person with -1.

The Z-score compares your bone mineral density to the average of peoplewho are of the same age, sex,weight,and race as you. A Z-score of -2 or lower might mean that something other than normal bone loss due to age is occurring. Your doctor will likely explore other health issues that might be causing the bone loss.

Other methods of screening bone density include x-ray, ultrasound, and CT scan.If you have risk factors that includecertain diseases, short- or long-term use of steroids, or a recent bone fracture, a DXA scan may be prescribed.

How Can a Physical Therapist Help?

A physical therapist can help you prevent and treat low bone massat any age by prescribing the specific amount and type of exercise that best builds and maintains strong bones.

When you see your physical therapist, the therapist will review your health history, including your medical, family, medication, exercise, dietary, and hormonal history. Your physical therapistwill also conduct a complete physical therapy examination and identify your risk factors for low bone density.

It is important to exercise throughout life, and especially when you have been diagnosed with low bone mass in order to build and maintain healthy bones. Exercise can help to build bone or slow the loss of bone.

Your physical therapist is likely to prescribe 2types of exercise that are best to build strong bones:

Weight-bearing Exercises

• Dancing
• Walking at a quick pace (122-160 steps per minute or 2.6 steps per second)
• Jumping, stomping, heel drops
• Running at least a 10-minute mile
• Racket sports

Resistance Exercises

• Weightlifting
• Use of resistance bands
• Gravity-resistance exercises (pushups, yoga, stair climbing, etc.)

Your physical therapist will design an individual exercise program for you based on your particular needs. Your physical therapist will test you to see how much resistance is needed and is safe for your specific bone density as well asother physical issues that you may have. Treatment starts at the level you can tolerate. Once you learn how to perform your program, your physical therapist may add more strenuous activity with physical effort to encourage your bones to grow stronger.

Your exercise prescription will include guidelines for weightbearing and resistance training for the hips, spine, shoulders, and wrists. The therapist will prescribe guidelines for the intensity, frequency, and progression of your exercises.

Exercise is only 1component of healthy bones. Your physical therapist will encourage you to pursue a healthy and varied diet, including foods rich in calcium, to reach the amount recommended according to your age and health status. Your physical therapist may recommend that you meet with a dietitian to learn about the many foods that contribute to bone health. Sometimes, medication or hormone replacement therapy may be recommended. Your physician will help guide you to find the best combination of exercise, diet, and medication to treat your condition.

Can this Injury or Condition be Prevented?

Risk factors that you can avoid in order to lower your chances of developing low bone mass include:

• Cigarette smoking
• Excessive alcohol intake (greater than 1 drink per day for women, 2 per day for men)
• Poor diet
• Low calcium and Vitamin D levels        
• Sedentary or low level activity—less than 5,000 steps per day

ARE YOUR HIPS SNAPPING MORE THAN YOUR FINGERS?

What is Snapping Hip Syndrome?

Snapping hip occurs when a muscle, tendon, or ligament rolls over a bony prominence in the hip. Snapping hip can occur in different areas of the hip:

• Front. Snapping at the front of the hip can involve the hip flexor muscle rolling over the front of the hip bone, or the hip ligaments rolling over the thigh bone or tissues of the hip joint.
• Side. This condition involves the ITB (iliotibial band) rolling over the outer thigh bone or the big muscle on the back of the hip (gluteus maximus) sliding over the outer thigh bone.
• Back. This condition involves one of the hamstring muscles rolling over the bottom of the hip bone.

Snapping hip can occur when the hip muscles are excessively used and become fatigued, tight, and/or swollen.

Athletic activities like track and field, soccer, horseback riding, cycling, gymnastics, and dance can trigger the condition. It can also occur during everyday activities that require repeated forceful movement of the legs.

How Does it Feel?

Snapping hip causes a snapping sensation and sound that can be felt in the front, the side, or the back of the hip. Often, the snapping can be pain-free. If it causes pain, the pain usually ceases when the leg movement causing the snapping is stopped. In athletes and dancers, the snapping can be accompanied by weakness and may diminish performance.

The snapping is most commonly felt when kicking the leg forward or to the side, when bringing the leg behind the body, when rising from a chair, or when rotating the body or the leg.

Often, walking and running in a straight line are snap-free and pain-free, although in some people these activities are limited by the pain of the structure that is snapping.

Signs and Symptoms

With snapping hip, you may have:

• Snapping or popping in the front, side, or back of hip when lifting, lowering, or swinging the leg
• Weakness in the leg when trying to lift it forward or sideways
• Tightness in the front or back of the hip
• Swelling in the front or side of the hip
• Difficulty performing daily activities such as rising from a chair and walking

How Is It Diagnosed?

If you see your physical therapist first, the therapist will conduct a thorough evaluation that includes taking your health history. Your therapist will ask you:

• How you injured your hip and if you heard a pop when you suffered the injury
• If you feel snapping, popping, or pain
• Where you feel the snapping or pain
• If you experienced a direct hit to the leg
• If you saw swelling in the first 2 to 3 hours following the injury
• If you experience pain when lifting your leg forward or backward, walking, changing directions while walking or running, or when lifting the knee
• If you participate in any repetitive, forceful, or plyometric (quick explosive jumping) sport activities.

Your physical therapist also will perform special tests to help determine whether you have a snapping hip, such as:

• Asking you to lift your leg quickly
• Asking you to push against the physical therapist’s hand when he or she tries to push your leg outward, backward, and forward (muscle strength test)
• Gently feeling the muscle to determine the specific location of the injury (palpation)

Your therapist may use additional tests to assess possible damage to other parts of your body, such as your hip joint or lower back.

To provide a definitive diagnosis, your therapist may collaborate with a physician or other health care provider. The physician may order further tests—such as an x-ray or magnetic resonance imaging (MRI)—to confirm the diagnosis and also to rule out other potential damage. However, these tests are not commonly needed for snapping hip syndrome.

How Can a Physical Therapist Help?

Your physical therapist will design a specific treatment program to speed your recovery, including exercises and treatments you should perform 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 advise you to:

• Rest the injured hip by avoiding walking or any activity that causes pain. In rare cases, crutches may be recommended to reduce further strain on the muscles when walking.
• Apply ice packs to the affected area for 15 to 20 minutes every 2 hours.
• Consult with another health care provider for further services such as medication or diagnostic tests.

Reduce Pain

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

Improve Motion

Your physical therapist will choose specific activities and treatments to help restore normal movement in the leg and hip. These might start with movements of the leg and hip joint that the therapist gently performs, and progress to active exercises and stretches. Treatment for snapping hip often involves 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 injury at each stage of recovery, and your physical therapist will choose and teach you the appropriate exercises that will restore your strength, power, and agility. These may be performed using free weights, stretchy bands, weight-lifting equipment, and cardio exercise machines such as treadmills and stationary bicycles. For snapping hip syndrome, muscles of the hip and core are often targeted by the strength exercises.

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, as well as design your plan of care to help you reach those goals in the safest, fastest, and most effective way possible. Your physical therapist will use hands-on therapy and teach you exercises and work retraining activities. Athletes will be taught sport-specific techniques and drills to help achieve sport-specific goals.

Prevent Future Re-injury

Your physical therapist can recommend a home exercise program to strengthen and stretch the muscles around your hip, upper leg, and core (abdomen) to help prevent future injury. These may include strength and flexibility exercises for the hip, thigh, and core muscles.

If Surgery Is Necessary

Surgery is rarely necessary in the case of snapping hip syndrome. If it 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?

Snapping hip syndrome can be prevented by:

• Warming up before starting a sport or heavy physical activity. Your warm-up should include stretches taught to you by your physical therapist, including those for the muscles on the front, side, and back of the hip.
• Gradually increasing the intensity of an activity or sport. Avoid pushing too hard, too fast, too soon.
• Following a consistent strength and flexibility exercise program to maintain good physical conditioning, even in a sport’s off-season.
• Wearing shoes that are in good condition and fit well.

SUMMER BREAK = WEIGHT GAIN IN KIDS?

Summer is associated with children at play, but a recent study suggests it’s also a time when kids are gaining weight at an increased rate compared with during the school year.

The Harvard University systematic review, published in the Centers for Disease Control and Prevention journal Preventing Chronic Disease(Accelerated Weight Gain Among Children During Summer Versus School Year and Related Racial/Ethnic Disparities: A Systematic Review” – June 12, 2014), analyzed 7 studies and found that all but 1 demonstrated evidence of a faster rate of weight gain among some children during the summer months compared with the school year.

The accelerated weight gain was most pronounced among children who were already overweight.

Potential solutions suggested by the authors included “greater access to summer camps and parks and recreation programs” and “increased use of summer food programs, which provide meals outside of the school year.

OBESITY ACCOUNTS FOR WHAT PERCENTAGE OF US ADULT DEATHS

At a time when more Americans are overweight than ever before, a study published in the American Journal of Public Health suggests that obesity is more deadly than previously estimated.

The study, which examined data from 1986 to 2006, when Americans were comparatively lean, determined that as many as 18% of deaths of individuals aged 40- to 85 are linked to obesity.

As NBC News reported ("Heavy burden: obesity may be even deadlier than thought" - August 15, 2013), many factors increase a person's likelihood of weight problems, from income to level of education. And people who are obese are more likely to have other unhealthy habits, such as smoking and poor diets.

"People who are overweight or obese are far more likely than thinner people to have heart disease, cancer, or diabetes, and to have strokes or heart attacks," NBC reported. "Usually, but not always, fatter people are less fit than thinner people, and exercise can clearly protect you from death and disease."

As experts in human motion, physical therapists at CHAMPION can design fitness programs to help you exercise safely. Give us a call for questions, or to set up an evaluation!

PREGNANCY ALTERS RUNNING FORM

A recent study published in The Journal of Orthopaedic & Sports Physical Therapy suggests that pregnancy causes biomechanical changes to a runner's stride that can linger after childbirth.

As reported in the New York Times (How Pregnancy Changes a Runner's Body - June 10, 2013), these changes have the potential to cause injury, although some runners participating in the study reported no pain as a result of the changes.

In an August 8, 2013 episode of Move Forward Radio, physical therapists involved in the study discussed their findings and provided tips for women hoping to run during or after pregnancy.

See a pelvic floor specialist of physical therapy here at CHAMPION to learn how to strengthen the pelvic muscles affected by pregnancy, or an orthopedic physical therapist here at CHAMPION for a running analysis. 

IS IT REALLY NECESSARY FOR SURGERY FOLLOWING A MENISCUS TEAR?

Could 1 of the most popular surgical procedures in the United States be unnecessary many of the approximately 700,000 times it is performed each year?

A study published in the New England Journal of Medicine suggests that might be the case for arthroscopic surgery to repair a torn meniscus—particularly if the tear is a result of wear and aging, as opposed to a traumatic event.

As the New York Times reported ("Common Knee Surgery Does Very Little for Some, Study Suggests" - December 25, 2013), a Finnish study of 146 patients between the ages of 35 and 65 found that those who had arthroscopic surgery had no better level of satisfaction 1 year later than had others in the study who had undergone a mock surgical procedure.

"Those who do research have been gradually showing that this popular operation is not of very much value," Dr David Felson told the Times.

What exactly does that mean? Well, it means that there's essentially a chance that the outcomes of a surgical repair are not significantly greater than that of physical therapy, meaning you can achieve close to the same outcome at a much cheaper cost. Does this concept apply to everyone? No, it absolutely does not. This study is one of a few that are starting to go public that only apply to those in generally good health, not other knee conditions, and no outstanding circumstances - meaning they are low risk patients who wish to get back to moderately stressful (on the body) activities, at the most. High level athletes, young athletes, and professional athletes are not considered in this category, as well as elderly, individuals with other degenerative conditions of the knee, and those with multiple injuries of the knee (like a meniscus tear and ACL tear, or something along those lines.) 

Talk to your physical therapist today, or come see an orthopedic physical therapist at CHAMPION  about whether surgery is a good option for you!  

CORRELATION BETWEEN ACL RECONSTRUCTION REHABILITATION & HAMSTRING STRAINS

ACL reconstruction rehabilitation is a very long, drawn out process.  Because of the way the body heals from those particular ACL procedures, the recovery is broken into a series of parts. 

The first, is either non-weight-bearing, partial weight-bearing, or full weight-bearing, with some form of immobilizer or ACL extension brace. The second; gradually strengthening while recovering the range of motion inhibited by the brace and swelling. The third; progress to higher level activity, beginning with jogging, biking, and swimming. 

The final 4-6 weeks of a 6-month protocol for young, active individuals includes a series progressions that include jumping, hopping, sprinting, deceleration training, and lateral movements. During this time frame, these individuals face an unusually high risk for a hamstring strain on that same, affected leg. But why?

Hope Hillyard, our Head Physical Therapist, goes more into detail: 

"The hamstrings are synergist to the ACL. While the ACL is recovering from reconstruction, [and likely will not be at 100%], more stress can be placed on the hamstrings muscle group and therefore, subjecting the hamstrings to a higher risk of strain, or being overworked." 

So, let's break this down. The ACL and hamstrings work together to solidify the knee joint in terms of preventing the femur from moving forward. In other words, anterior, or forward movements are what the ACL specializes in. The hamstrings muscle group also acts as as a stabilizer at the front of the knee joint - and when the ACL is not healthy enough to primarily prevent injury, the hamstring must compensate. 

The reason this is more likely during that last stage of rehabilitation is because the body is finally ready to increase the stress on the ACL as opposed to strengthening the muscles around it, and therefore, putting it to the test. Activities such as sprinting, lateral movements, and deceleration training accentuate the ACL, and when the body is not used to that load, it will recruit the help of the hamstrings. The exertion of so much extra force is more than enough to strain a hamstring muscle.

"It also depends on the procedure the patient underwent," Hillyard mentions, "For example, if a patient and their orthopedic surgeon opt for a hamstring autograft, the hamstrings muscle group will likely be at higher risk for strains, as those muscles are healing, too." 

This doesn't mean it's not safe to push your body, at that point. It's a gradual process, and your physical therapist knows based on experience combined with objective measurements what the body can and cannot handle. This also doesn't mean that strains are expected during recovery - there is just an increased risk. You can help prevent hamstring strains by listening to your physical therapist when they tell you to hold off on a certain activity, and by taking it slowly when you're cleared to move to another level. Remember: the body has been unable to do higher level activity for months up to that point, and it's best to ease in. 

If you have questions, please visit https://www.kcchampionperformance.com/ for our contact information.