Custom Physical Therapy looking for a Physical Therapist.


Custom Physical Therapy is seeking an outdoorsy, mountain biking, hiking, Lake Tahoe loving, skiing, camping, life loving outpatient orthopedic physical therapist to join us in Reno, Nevada.


We love what we do and are expanding because of the experiences our patients have and the absolutely amazing people who work at Custom Physical Therapy. Yes, I am biased but it’s totally true.


If you are a PT or know of someone who is a PT or a new grad and may be interested in working with us, contact me at (775) 813-2332 or ameintjes@usphclinic.com.

I’d love to chat with you.

André

(Aka owner/physical therapist/chief goofball)

A huge need for changes worldwide as to the excessive sugar consumption. Try consuming only natural sugars that are consumed with double the amount of fiber. This prevents the spike in blood glucose and thus the large insulin response that ultimately changes the sugar to fat.


https://www.wits.ac.za/news/latest-news/research-news/2016/2016-04/ssb-tax-home/sugar-facts/

“Is this a model or is it the real thing?”


I had the pleasure of meeting with one of our local orthopedic surgeons, Dr. Benjamin Bjerke, and the Zimmer-Biomet rep, Christina Escobar, to talk Mobi-C Disc Replacement technology and surgical technique developed by Zimmer-Biomet. Incredibly interesting.

Seeing the prosthesis, my first question was, “Is this a model or the real thing you are showing me?” It was much smaller than I anticipated!

Mobi-C_neck image_9-2016.pngMobi-C_hand-image_1_2016.png

Secondly, I found the specificity of the patient suitable for this intervention impressive – someone with neck pain and or radiculopathy (pain down the arm originating from nerve root compression in the neck) without much cervical spondylosis (degeneration of the discs and joints in the neck) and good vertebral alignment. The Mobi-C can replace discs at one or two levels of the cervical spine between the third and seventh cervical vertebrae.

So lets take a look in more detail.

Anatomy and Pathology of the Neck

  • The cervical spine has discs between each bone that provide cushioning for movements and body loads. The discs and bones in a healthy neck allow bending from side-to-side and front-to-back, and turning left-to-right. Disc problems can start from over-use, an accident, or just the wear and tear of daily life.  When a disc degenerates it becomes thinner and provides less padding to absorb movement.  Degenerated discs can also bulge (herniate) and pinch the spinal cord or nerves, which causes loss of feeling, weakness, pain, or tingling down the arms and hands. Below  you can see the normal cervical spine anatomy and adjacent is a graphic of what a spine with pathology may look like:

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Treatment Options

  • Before artificial discs were available, patients would traditionally receive an Anterior Cervical Discectomy and Fusion procedure to alleviate the pain from a herniated disc. In a fusion surgery, the disc is removed and either a bone spacer or a plastic implant is placed in the disc space to restore disc height and remove pressure on the pinched nerves or spinal cord.   A metal plate and screws is placed on the front of the vertebral column to hold the implant in place.  The result – a segment that no longer moves, or is “fused”.  The potential downside of a fusion procedure, in addition to the loss of motion, is that it can create additional stress on the spinal levels above and below it.  This can cause degeneration at those levels and potentially result in another future surgery.
  • An artificial disc like Mobi-C is an option instead of a fusion that will also be placed inside the disc space to restore height and remove pressure on the pinched nerves. However, the Mobi-C device is designed to allow the neck to maintain normal motion and thus limit adjacent levels from degenerating, possibly preventing future surgeries.

Image_40a_v02_2016.pngImage_61b_20pct_2016.png

 

Since Mobi-C cervical disc replacements are preferred over fusions because they preserve movement in the spine, lets take a look at this video to see what happens in the spine when a patient with the Mob- C implanted flexes and extends his/her neck versus a two level fusion:

Cervical disc replacement procedures are anticipated to experience rapid growth in the near future, due to multiple factors:

  • A growing library of clinical evidence demonstrating the long term safety and efficacy of cervical disc replacement.
  • Cervical disc replacement is being shown as a superior treatment to fusion for use at two cervical levels.
  • Better outcomes of cervical disc replacement over fusion such as reduced re-operation rates, reduced adjacent segment degeneration rates and surgeries, as well as a faster return to work.
  • Most patients return to work within six weeks of surgery. In the U.S. Mobi-C clinical trial, the return to work time was 20.9 days shorter for Mobi-C patients compared to fusion patients for two-level surgery and 7.5 days shorter for Mobi-C patients compared to fusion for one-level surgery.

What about physical therapy after the Mobi-C disc replacement?

  • Wear a neck collar to lessen neck movement for around a week after the surgery.
  • Avoid heavy lifting, repetitive bending, and prolonged or strenuous activity for up to 6 weeks after surgery.
  • When your surgeon releases you to start physical therapy the physical therapist will do a comprehensive evaluation to assess your cervical, scapular and shoulder range of motion as well as cervical, arm and trunk strength. Based on the data collected, you will be given specific exercises to address any deficits to ultimately improve your function. You may start of with cervical isometrics and progress to upper thoracic and arm strengthening exercises as well as neuromuscular reeducation of the deep neck muscles. The physical therapist will also utilize soft tissue mobilization techniques to limit scar formation and address any myofascial pain and muscle trigger points, present from inactivity. You will need to participate fully by being totally compliant with the home exercise program you are given by the physical therapist at your very first visit.

Successful outcomes are determined by multiple factors which include choosing the right surgical procedure done by a skilled surgeon, following post operative activity limitations and brace use as well as being totally compliant with physical therapy instructions and exercises. It is a 3 person team that makes your recovery work: you (and your home supporters), the surgeon (and their staff) and the physical therapist (and their clinical team members).

Thank you to Zimmer-Biomet for help with supplying me with information and photographs.

Just Move to Improve!


The problem?

80% of us work in sedentary jobs in a longer full time work week which averages 47 hours. In 1960 only 20% of jobs were sedentary in nature. The problem with this trend is that our muscles and joints love movement through their full range of motion so being motionless for all those hours each day leads to the sensation of “tightness.”

We all get tight after prolonged immobility and, repeated day after day (the desk job at work then sitting watching TV each evening) our “envelope of function” becomes limited. Over time, our joints develop smaller ranges in which they can move and hence we become susceptible to overuse injuries or pain as a consequence of prolonged end range tension (stress) on our muscles, ligaments and joints. Anyone had low back pain at the end of a work day that’s gone the next morning?

The solution?

Once daily, move your joints through their full range of motion. Actively stretch your muscles and ligaments by following the specifically designed 10 to 15 minute “movement program.” It is that simple. As I mention to my patients, “motion is lotion.” Could you do it two or three times a day? Sure thing – it may improve your productivity and cut your work week down to 40 hours instead of the 47 because you feel better during your day!

Flexion in Standing

Bending forward top to bottom, vertebrae by vertebrae is one great movement to do each day.

We must maintain our youthful joint, muscle and ligament pliability and movement as we age to limit the guaranteed onset of general stiffness which is part of getting older. This means the younger we are when we start such an exercise routine, the more likely we are to limit this aspect of aging. In doing so, we will have a better quality of life because of our healthier joints, muscles and ligaments.

The videos of the exercises are on the Custom Physical Therapy YouTube Channel. Follow this link to get started:  Rage of Motion Program    They should be done in order and only 10 repetitions of each one.

Battling El Nino with Your Core in 10 minutes.


El Nino is arriving with massive amounts of snow and rain, right? We all hope for drought relief but with the forecasted “big winter” comes the need for strength and control of your hidden muscles to weather (pun intended) the wet, cold, white, slippery Reno-Sparks-Lake Tahoe area.

A generally accepted definition of “the core” is the muscles from below the neck and above the upper thigh (shoulders to hips). The importance of these muscles is in injury prevention, maintaining erect, “regal” posture and providing a base for functional strength (the ability to push a heavy door open, get in and out of a car, stand up out of a chair or lift a box form the floor to a counter). Training all the core would take all day if you try to isolate each muscle individually. So, do 3 exercises and get nearly all of them done in less than 10 minutes!

“YTWL” – shoulder and back muscles.

Keeping your body straight over a therapy ball beneath your lower abdominal-pelvic area and feet against the wall, raise your arms in 4 different planes noted by “YTWL”. Arms overhead at a 45° angle between head and shoulders, in line with shoulders, elbows tucked into your sides flexed 90°, and finally rotation of shoulders up with upper arms at shoulder level. No therapy ball? Just do it off the corner of your bed.

The Y of the YTWL Series

The Y of the YTWL Series (see YouTube channel for video)

Front Plank – abdominals, butt and shoulder.

Lying prone, support your body in a straight line from shoulders to ankles resting on your elbows and toes. Pull your navel in and up (“make yourself skinny”) and pinch your glutes together while rounding out your shoulders. Hold this position for up to a minute (must have perfect technique the entire hold). Repeat three to five times.

Front plank

Front plank (see YouTube channel for video)

Clamshell Progression – Hip muscles.

Lay on your side, knees bent to 90° and hips at 45°, one leg atop the other. Rotate your hip out by lifting your top knee while keeping feet together, 10 times. Rotate foot up keeping thighs together 10 times. Lift top leg parallel to bottom and rotate 10 times around the axis of the femur. Straighten your hip, keeping knee at 90° and rotate 10 times around the femurs axis. Tough people, repeat 3 times on each side.

Clamshell # 4

Clamshell # 4 (see YouTube channel for video)

To see a video of each exercise on our YouTube channel, go to The El Nino Core Program .

El Nino dump your snow, your rain and whatever icy weather you care to bring us. Our core is now ready for shoveling snow, lifting and carrying sand bags (hope not!) and preventing falls when slipping on ice. Bring on those pressure changes that make my back ache – El Nino we got the work done before you came!. See you when you arrive, that’s if you don’t chicken out again!

The Custom Physical Therapy Challenge Rules


If you dare ….. get fitter, stronger and healthier with the monthly Custom Physical Therapy Challenge.

Every month we will have a daily series of exercises to do for anyone and all who would like to join us. Employees, friends and family may join in.

Here are the rules:

  1. You complete all repetitions of each exercise every day and check it off the schedule of exercises.
  2. If you miss a day you may double up the next day – not advisable particularly towards the end of the series.
  3. It is purely the honor system.
  4. If you complete all exercises for the entire month you let us know by faxing the checked schedule to Custom Physical Therapy (775-331-1180) or emailing it to us with your name on it and contact number: customptchallenge@gmail.com
  5. Prize: $50-$75 gift certificate from a local business (Previously: Great Full Gardens Restaurant, 1 hour massage).

Exercise technique can be seen on our Youtube Custom Physical Therapy Challenge Channel. Here is the URL:

Let us know how you like it and what you would like to challenge in future months. For example, an arm challenge, butt challenge, core challenge, chest challenge, aerobic challenge, rope jump challenge.

If you have any concerns about doing the exercises and need help modifying them feel free to call us at the Sparks location: 775-331-1199. You can also email us with questions: customptchallenge@gmail.com

Have fun, be safe and get strong!

The Custom Physical Therapy Challenge Department

www.custom-pt.com

http://www.customphysicaltherapy.wordpress.com/

Smoking, Health and Forest Fires.


Living in Reno, Nevada, we are frequently engulfed in smoke from forest fires around the area. Last year it was the big Yosemite fire, this year we were living under a blanket of smoke from the massive King Fire just east of Sacramento, California. Air quality was in the unhealthy range day in and day out. With clean air in the Truckee Meadows so dependent on the wind direction, we were praying for wind direction changes and the return of our Nevada blue skies.

Someone told me about a scene he saw at his work during the time we were blanketed in smoke. He left for lunch and walked past the smoking area outside the building. He saw two people smoking outside in the already smoky air and one waving her hand, cigarette in the other, “This smoke is killing me!” We humans are a funny bunch!

So I thought I would have some fun with that and take a photo. My disclaimer: I am not a smoker and never have been and boy did I learn something about smoking in the brief 10 minutes I had cigarettes going for the photograph!

  1. My tongue felt fury.
  2. My wife did not enjoy our first kiss.
  3. My clothes smelt of smoke immediately afterwards and this did not disappear until I washed them.
  4. I coughed immediately.
  5. I had to brush my teeth and take a shower right away.
  6. If I disliked it so much then it must be addicting as I struggle to believe those who have chosen to smoke don’t eventually bypass these sensations and thereby continue to smoke.
Smoking and our Reno Air Quality

Smoking and our Reno Air Quality

My Dad was a thoracic surgeon with a specialty in lung and esophageal cancer. As a consequence, I have always been very aware of the health issues related to smoking. I have never been addicted to anything (some who know me well may say I am addicted to exercise, talking to strangers and coffee!). I have seen numerous patients who smoke despite having significant reasons not to. For example, one person I recall had COPD, was on oxygen, had cardiovascular disease and had recently had a spine fusion (smoking delays healing) and was still smoking. Some of these smokers are in the healthcare profession too. Putting these factors together suggests to me that whether we like it or not, smoking must be incredibly addicting. Everyone who smokes knows it is bad for their health but they continue doing it. This begs the question: “What makes people change?”

People change because the pain of their present situation (smoking) is more than the pain of making the change (the withdrawals after stopping?). The pain of smoking depends on the individual and is different for each person. Some may see their wife pregnant and decide to stop smoking on account of the youngster about to be born. Some will have significant ongoing disease and still keep smoking (not painful enough yet). I have even spoken with someone who had simply given up as the disease process had gone too far.

I feel somewhat cheap talking about smoking cessation as I am not a cessation specialist nor am I a smoker who has kicked the habit. I have a real interest in why people change. This is the reason for my post. That being said, I recently met an incredible man. During his lifetime he stopped alcohol, methamphetamine, smoking and violence all cold turkey!

How is it he was so strong and quit all those things and many of us struggle?

Reasons to Choose Custom Physical Therapy


5 Simple Things to do Before a Knee Replacement.


Pre-operative conditioning!

Vital in determining the post-operative outcome of a total knee replacement.

Ask anyone who did the right things before surgery.

Sharine came in to see us for a single visit to learn what to do and then exercised daily until the day before her knee replacement.  “After watching my Mother and my husband go through knee replacements I took the advice from Andre’ and my surgeon to exercise and strengthen the muscles in my legs as well as other parts of my body. I am now about 3 1/2 weeks after surgery and I must say it has helped me. I am told that I have reached goals that others do not reach this soon. You MUST exercise before your surgery and I would recommend you start at least 6 weeks before.”  Her husband, Bob, had a knee replacement without pre-op instruction.  “Eight years ago I had a knee replacement. I was dismayed at how weak my “good” leg was!  I had the good fortune to be treated at Custom Therapy.  I learned that anyone having this surgery should or must exercise weeks before the event to ease the recovery period.  My wife just had her knee done.  We went to André 6 weeks prior for his counsel.  He examined her and recommended a course of pre-surgery exercise.  Having done without myself and seeing her result and progress I cannot recommend more strongly that others should absolutely follow this advice.”

  1. Ride a bike daily.

Bike riding creates controlled movement in a non-weight bearing position so will be less traumatic to the joint than walking or any other weight bearing exercise.

  1. Stretch hamstrings and calf muscles.

This helps get/keep your knee straight.  Painful knees are typically kept in a slightly flexed position for comfort which shortens these muscles. 

  1. Stretch your knee into full extension.

It can be done sitting in a chair with your heel on a coffee table or ottoman or lying face down on your bed with the edge of the bed just above your knee. 

  1. Pull your heel to your butt.

This will maximize your knee flexion.  The more range you have before your surgery, the more you will regain afterwards. 

  1. Strengthen your quads.

Your goal is to maximize your quad recruitment pre-operatively; this makes it easier to contract them after the trauma of the surgery.  A simple quad set, SAQ, or SLR (my favorite) is what is needed.

Your Call to Action:

  1. If you are planning on having a total or partial knee replacement consult a physical therapist as to what you need to do preoperatively to maximize your post-operative outcome.
  2. Forward this post to someone you know who may be having a total/partial knee replacement.
  3. Please post your comments regarding your experience with having or not having preoperative exercises and how they helped you.