Strong evidence suggests that movement is a valuable predictor of future health and resilience against disease. If your goal is to live a longer, healthier life, seeing a PT makes sense, given their expertise in human movement. Here are some examples of the predictive power of movement:
Gait VelocityGait velocity is how fast you walk. If your typical walking speed is over 1 m/s or 3.3 ft/s, you're likely able to complete typical daily activities independently. You're also less likely to be hospitalized or to have an adverse event like a fall.
To test yourself, measure out a straight, flat course to walk between 10' and 30' long. You'll also need 5' or so at the beginning and the end for acceleration and deceleration. Walk the course at your typical speed and divide the length of the course by how long you took to complete it (distance/time). That's your gait velocity.
Get On and Off the FloorAnother series of studies suggest that if you can go from standing to sitting on the floor, then back to standing without using your hands, you're a lot less likely to die than someone who can't. It's called the sitting-rising test. Here's how it works:
You start standing and without support you sit down on the floor, then stand back up. You start with a score of 10. Every time you put a hand, knee, forearm or the side of your leg on the floor you lose 1 point. Putting a hand on your knee or thigh to help also costs a point. In a sample of over 2,000 people, they found that scoring less than 8 points made you twice as likely to die in the next 6 years when compared to people who scored higher. Score 3 or less and you're 5 times more likely to die in the same period. Overall, each point in the test is worth a 21% decrease in mortality from all causes.
Notice that both gait velocity and the sitting-rising test aren't specific. The risk of hospitalization in the gait velocity studies was for any reason. Death in the sitting-rising studies was death from anything. So while we know that exercise and a healthy lifestyle reduce your risk of specific diseases like heart disease or diabetes, it appears that being able to move well provides more wide ranging protection than we thought.
TRICARE has decided to waive the cost-sharing requirement of up to three visits to a physical therapist for low back pain. They've said that the goal is to encourage more use of "high-value" treatments for low back pain. TRICARE tells us in their summary of this demonstration what they mean by high vs low-value care: "Increasing the value of health care refers to improving patients’ quality of care and outcomes, improving patients’ access to care, and reducing overall costs of care. In contrast, low-value care refers to interventions that: are not proven to benefit patients; may harm patients; result in unnecessary costs; or waste health care resources."
High-value care leads to better outcomes, is easy to access and is cheaper for both patients and insurers. Physical therapy fits into this category, but looking at other high-value treatments helps us start to see a theme. In 2017 the American College of Physicians released widely endorsed guidelines for treating low back pain. Initial treatment recommendations include exercise, stretching, tai chi, yoga, progressive relaxation, heat or ice, cognitive behavioral therapy, and motor control exercise. These are all active treatments, where the practitioner and the patient are working together to improve. This is "well care".
In contrast, low-value care tends to be "sick care" where the patient is a passive participant. TRICARE puts imaging before six weeks in the absence of red flag symptoms, surgery for nonspecific low back pain, opioids as the first or second-line treatment, and bedrest in the low-value category. Spinal injections also fall in this category for most people.
This isn't to say that imaging, surgery, or injections are always bad. For a small percentage of people with back pain, they're the right treatment. But, most people should start with treatments that have the best outcomes for the lowest cost. If those treatments tend to focus on putting the person in pain in power to actively participate in their care rather than making them dependent on someone to "heal" them, that's even better. Physical therapists know this and have been providing care that fits this model for years. TRICARE's demonstration that waives cost-sharing clearly shows that insurers are recognizing the value of this type of care and that they are actively moving in this direction.
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Back pain is a huge problem in developed nations worldwide. It has or will affect most of us. The current estimate is that 80% of people will experience back pain at least once. It is the single biggest cause for disability, the third most common reason for doctor visits, and one of the most common reasons for missing work.
It's also expensive. Back and neck pain makes up the biggest healthcare expense in the US, totaling $134 billion spent in 2016. The next two most expensive conditions were diabetes — $111 billion in spending — and ischemic heart disease at $89 billion.
Diabetes and heart disease being so expensive to treat doesn't surprise most folks - they can both lead to other major problems, require long term medication, could require surgery, and both can be fatal. Back pain won't kill you, usually doesn't require long term medication, and usually doesn't require surgery either. Why is it so expensive?
The first reason is that it's so common. The second reason is that our current system isn't very good at treating it. Current recommendations include starting with activity modification, and active treatments like physical therapy. Research backs this up, showing better outcomes and lower costs with early PT. Unfortunately, only 2% of people with back pain start with PT, and only 7% get to PT within 90 days. At the same time, a study looking at about 2.5 million people with back pain in JAMA showed that 32.3% of these patients received imaging within 30 days of diagnosis and 35.3% received imaging without a trial of physical therapy. Both of these things go against current practice guidelines for treatment of back pain.
A new pilot program being rolled out by TRICARE, the insurance system used throughout the US military is waiving the payment owed by the patient for up to three PT sessions in an attempt to improve the use of what the Defense Health Agency calls "high value" treatment for low back pain. The theory is that once a person sees some benefit from PT treatment, they're likely to go back for more. This is the "try it before you buy it" approach - think of the 7-day free trial Netflix offers, free samples poured in wineries and craft breweries, or the folks you see standing around in supermarkets with food on toothpicks. TRICARE's data seems to indicate that it works just as well for healthcare as it does for other businesses. In a press release they state that once people attend one session of physical therapy, they're likely to go back for more, no matter what their co-pay is. But TRICARE found that higher co-pays could be a barrier to people trying that first visit. For the group of patients with the highest co-pays in the system, only 38% of the people prescribed PT attended the first visit. That's about half the rate of attendance found in the lowest co-pay group.
The fact that such a major insurer is looking into the value of PT is great news for everyone. If TRICARE can show that lowering the cost of PT for patients can improve outcomes and save insurance companies money, other major insurers will likely follow. This could improve the lives of millions of people every year while reducing the huge cost of treating low back pain for the country. That seems like a win for everyone involved.
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March is National Lymphedema Awareness Month. You have probably heard of lymphedema and have a general idea of what it is. The overall perception regarding lymphedema is that it is associated with cancer, which is not always the case. We asked our own specialist Vicki Magnan, OTR, to discuss lymphedema on a broader spectrum and how it can be managed.
The lymphatic system does a great deal more than fight off the flu bug; it is a filtering system. In simple terms, it’s the plumbing for your body. Other than filtering out toxins, your lymphatic system creates white blood cells and lymphocytes to fight against foreign invaders, including cancer cells. Though cancer, cancer-related surgeries and treatments may be the culprit to some lymphedemas, other diagnoses have a large impact on the lymphatic system.
“Over the past few years, I’ve been treating more patients with varying diagnoses that one might not think is the normal for a lymphedema therapist,” Magnan says. “Though a person may not have visible swelling, it still can occur at a micro level and can be just as painful and destructive.”
Rheumatoid Arthritis, Fibromyalgia, and Lyme’s disease are just a few examples of diagnoses that get relief from specialized manual therapies. This is known as Manual Lyphatic Drainage (MLD), which includes a comprehensive home program for patients to carry over lymph stimulation.” This treatment not only helps reduce edematous areas (areas with lots of swelling or edema) and filter out toxins, but it also increases the happy hormones of seratonin, dopamine, and endorphin in the brain. This is especially important for those with chronic illness.
Patients that see Vicki Magnan, OTR, usually have chronic swelling issues that have turned into a disease process. At times, lymphedema will occur after having a surgery. Magnan’s goal is to educate those that undergo surgical procedures to decrease the risk of developing edema and lymphedema post-surgically.
“Edema is a symptom that can be resolved in time, but lymphedema is a disease process that causes permanent damage.” Says Magnan, “Those with chronic pain often find PT Plus for their unique treatment approaches, and lymphatic treatment in the combination are effective tools for providing relief.”
In addition, it is important that the treatment received by Vicki Magnan, OTR, is only successful when the person seeking treatment is under the care of a physician. Communication between the patient, their physician and Vicki is key. Even people without a chronic illness can benefit from MLD, Magnan explains, “Those that experience migraine headaches receive noticeable relief from a combination of specialized manual therapies and lymph stimulation/toxin clearing treatment. Contact the staff at PT Plus to learn more.
October is National Physical Therapy Month, and physical therapist Amy Snyder, MPT, DPT, of PT Plus Physical Therapy’s Milwaukee clinic, would like to take the opportunity to remind people about the important role improved and restored movement has on improving society.
“Movement is central to a person’s quality of life, no matter the age or personal hurdles,” Snyder said. “Young athletes, expecting and new moms, white- and blue-collar workers, outdoor enthusiasts, seniors intent on maintaining personal independence … it all centers on optimal movement. That’s what we provide as physical therapists.”
According to the American Physical Therapy Association (APTA), physical therapists are highly educated, licensed health care professionals who exist to help patients reduce pain and improve or restore mobility – in many cases without the need for expensive surgery and often reducing the need for long-term use of prescription drugs.
“Our bodies crave movement – we need movement,” Snyder said. “We as physical therapists ensure that everyone, no matter what stage of life they’re in, is able to reach their potential when it comes to living active, mobile and functional lives.”
This, of course, includes post-injury/surgical rehabilitation, but physical therapy is much more than that. In fact, physical therapists are specially trained and licensed to improve people’s lives through the treatment of a number of ailments you may not have previously suspected. These include:
Headaches: Following a thorough evaluation, a physical therapist (PT) can treat chronic tension-type headaches, the most common primary headache disorder, according to the World Health Organization. A PT can identify the cause of such headaches (e.g., muscle tension, joint dysfunction in the neck/jaw, poor posture or stress) and work to improve mobility, strength, posture, and daily work/office routines.
Pre-Natal/Post-Partum Care: Physical therapists can offer relief for expecting mothers experiencing pain and discomfort in the back, hips and legs through treatment and exercise. After delivery, physical therapy is effective in treating back and pelvic pain while helping new moms strengthen their bodies for the rigors of motherhood.
Balance, Dizziness & Vertigo: Physical therapists can assess a person’s balance and risk of fall, then provide treatment (e.g., strength training, flexibility or range of motion exercises, for instance) to help improve balance. Many physical therapists are also specially trained to treat positional vertigo, which can often be successfully treated in a single visit.
Athletic Enhancement: From weekend warriors to elite athletes, physical therapists work with our most active to help them move better, train better and realize their greatest potential as competitors. PTs can provide movement analyses, establish a better training regimen, and assist with equipment selection and adjustments (e.g., shoe orthotics, for instance, or bike fitting).
In addition, Snyder notes that clients don’t need a physician’s referral in order directly access physical therapy services – unless, of course, such referral is required in order to bill insurance. Contact the PT staff at PT Plus Physical Therapy to learn more.
Researchers from the Netherlands recently found that a combination of supervised strength and aerobic training during the early stages of breast cancer treatment reduces fatigue while helping patients increase muscle fitness. As Breast Cancer Awareness Month approaches in October, Amy Snyder, MPT, DPT, of PT Plus’s Milwaukee clinic points out this study is the latest in a line of research that touts the important role physical therapists can play in breast cancer treatment, general rehabilitation and the early diagnosis of potential complications following treatment.
“Physical therapy can play a critical role in improving the quality of life for breast cancer patients during and after treatment through hands-on interventions as well as therapeutic exercise,” Snyder said. “The goal is to reduce pain while helping patients improve flexibility, strength and range of motion following treatment.”
For women battling with or who have survived breast cancer, physical therapy exists to alleviate the impact of surgery related to breast cancer treatment. Working closely with surgeons and oncologists, Snyder says the ultimate goal of a PT is to help clients attain the highest level of function, getting them back on track toward the life they lived before diagnosis.
“Physical therapists are trained to help restore motion in patient following a mastectomy or axillary lymph node dissection, while at the same time guiding them toward return to their daily activities and lifestyles,” she said. Snyder points to a few of the ways PT can help those affected by breast cancer:
Combat Fatigue: The Netherlands study mentioned above, which appeared in a recent issue of BMC Medicine, found that a supervised strength and conditioning regimen during the first 18 weeks of treatment helped breast cancer patients offset the deconditioning effects of chemotherapy. It also built muscle strength while increasing a feeling of “general self-efficacy and mastery” among patients.
Early Diagnosis of Lymphedema: Physical therapists have taken on a greater role in the early detection of lymphedema, abnormal swelling of the arm and hand that may result when lymph nodes are removed or treated with radiation as a part of cancer treatment. Once detected, a PT can treat the early stages of the condition through massage, range-of-motion and strength exercise, and the use of compression sleeves.
Exercise for Prevention: Studies have shown that regular exercise and physical activity may actually lower the risk of the onset and reoccurrence of cancer (including breast cancer) when compared with living a sedentary lifestyle. Following cancer treatment, physical therapists like those on the PT Plus Physical Therapy team, can work with breast cancer survivors to establish an exercise program that maintains long-term strength, cardio fitness and overall functionality.
From homework and tests to extra-curricular activities, students already shoulder plenty of weight during back-to-school time. Their backpacks should be the least of their worries, says physical therapist Amy Snyder, MPT, DPT, of PT Plus’s Milwaukee clinic.
“Backpacks are so practical, but they’re also so easy to misuse,” Snyder said. “If they’re too heavy or just worn incorrectly, backpacks can cause strained muscles, sore joints, back pain and even injury in kids.” The American Occupational Therapy Association estimates that about 79 million students across the U.S. carry school backpacks. Among these, nearly 22,000 strains, sprains, dislocations and fractures – ailments caused by improper backpack use – were reported by medical providers in 2013, according to the U.S. Consumer Safety Commission.
“These injuries are preventable,” Snyder said. “Parents can play an active role in in preventing these injuries by first selecting the right packs for their kids, then ensuring these packs are worn correctly.”
In this spirit, Snyder offers the following tips for parents, guardians and teachers: