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/

Knee Pain! Osteoarthritis!


To my fellow Boomers out there ….. How are your knees doing?  We are an active sector of the population and we want to remain that way for the health benefits (and the fun!) thereof.  Knee pain due to osteoarthritis, whether one or both knees, has a dramatic impact on a person’s ability to continue with their chosen active lifestyle and, if it gets painful enough, may impact activities of daily living such as getting into and out of a car or a chair, cooking a meal or simply walking.

 WHY KNEE OSTEOARTHRITIS?

Osteoarthritis affects 25 million North Americans and is symptomatic in 13% of people aged 55 years and older.  It has been shown to be the most frequent cause of functional disability including being dependent on alternative forms of mobility due to the tremendous pain with walking.  Ouch!  The prevalence of osteoarthritis is rapidly increasing due to two main factors.  Firstly, the aging of the American population (that includes us!) is increasing the share numbers of people older than 55 years.  Secondly, the rapidly increasing obesity in our population is increasing the rate of joint degeneration.  One study reported 83% of males who had knee osteoarthritis were obese compared to 42% of males without it.  Wow!  Now there is a statistic that says a lot and leaves nothing to the imagination as to what we need to do to address the issue.

WHAT IS IT?

Osteoarthritis is the joints response to structural damage caused by mechanical problems.  It is the body’s attempt to repair a joint under unusual stress and often leads to a stable, pain free joint.  If this process fails (is insufficient for the magnitude of mechanical stress placed on the joint) the knee becomes symptomatic and hence functionally debilitating.

MECHANICAL STRESS YOU SAY?

Pathological mechanical stress of the knee joint may be due to:

  1. Increased overall load through the weight bearing joint surfaces (e.g. obesity).
  2. Reduced load bearing surface area thereby increasing the pressure (same force through a smaller area) exerted through the joint (e.g. misaligned joint: bandy or bow-legged).
  3. Repetitive impulsive loading of the joint (e.g. trauma, doing moguls).

Obesity increases the overall load through the joint and overwhelms the joint tissues resulting in osteoarthritis.  Being bandy or bow-legged reduces the weight bearing surface area in the knee joints (shifts it from throughout the knee to one side or the other of the joint) and results in excessive wear and tear of the joint on the outer or inner surfaces respectively.  Sustaining a serious injury to the knee in which ligaments are torn and the joint surfaces are banged together in the injury may initiate the osteoarthritic “repair” process as well.  Thus, when stress on the joint tissues exceeds their physiological tolerance breakdown ensues and osteoarthritis begins.

HOW CAN WE ADDRESS THE CAUSATIVE FACTORS?

Weight loss in an effort to attain a normal body weight for your frame is paramount in reducing the forces through the knees.  Walking results in a force through the knee equal to 3 – 4 times your body weight each step.  If you lose 20 – 50 pounds in an effort to attain your normal weight, you reduce the forces through your knees by 80 – 200 pounds each step you take!  Talk about happier knees!  An 11.2 pound weight loss over a 10 year period has been shown to reduce the likelihood of developing knee osteoarthritis by 50%.

For misaligned knee joints (those of you who are bandy or bow-legged) there are unloading braces to modify (increase) the load bearing surface and hence reduce stress to the one side of the affected knee.

In all osteoarthritic knee joints muscle weakness, joint stiffness and poor balance are factors.  Muscles around the knee joint serve to cause movement in bending and straightening the knee, can reduce mechanical stresses to the joint by absorbing loads applied to the limb (e.g. cushioning during landing a jump or when skiing) and stabilize the knee joint during daily tasks of walking, running, lifting and carrying to name a few.  Patients with knee osteoarthritis are 20% to 40% weaker in their quadriceps than people without the condition.  As the disease worsens the knee muscle activation patterns become less efficient and less specific and joint proprioception (the brain’s ability to know what is happening at the joint and react accordingly) is suppressed.  A well constructed, evidence-based physical therapy program will improve strength, range of motion and proprioception and result in improvements in physical function, pain and quality of life.  Modifying the mechanical problems causing the osteoarthritis together with addressing the inflammatory and pain aspects of the disease process through pharmacological intervention from your physician can result in an 86% success rate in improving your function.  Who would not like that!?

All our physical therapists at Custom Physical Therapy have undergone specialized training for treating osteoarthritis.  The therapists work as part of a team comprised of you the patient, your physician and the physical therapist.  Using physical therapy interventions to modify the mechanical factors impacting the progression of osteoarthritis together with the physician addressing the pharmacological aspects and the patient being compliant with an exercise and stretching program (see our very first post on this blog) as well as brace use, if prescribed, the team of patient-physical therapist-doctor minimizes the effect of the disease process on your function.

YOUR CALL TO ACTION!

  1. If you are overweight start a simple lifestyle change that entails weight loss (Call Joe Dibble, dietician at Sierra      Strength and Speed, for a consult.  He is really knowledgeable and practical.)
  2. Call Custom Physical Therapy so we can evaluate your      arthritic knees and set you up with appropriate treatment.
  3. Forward this post to someone you know who has sore      knees or you think may be interested in the information.

You are encouraged to call Custom Physical Therapy to talk to one of our accredited physical therapists about your knee pain.  You may be a candidate for this customized evidence-based program specifically developed to improve your function which deteriorated due to knee osteoarthritis.

Break a Leg? Literally!


I really enjoyed Laura’s blogging of her total knee replacement.  I think this is a great idea and one which can help other people who are potential knee replacement candidates get a sense of what the process looks like from a patient’s perspective.

Great job, Laura.  We all hope you are doing well.

Break a Leg? Literally!.

Total Knee Replacement Season – What does the rehab look like?


Total joint replacements surgeries tend to increase towards the end of the year because insurance deductibles have been met and out-of-pocket expenses tend to be less.  An additional cost to the patient is the rehabilitation after the surgery, which also tends to impact insurance deductibles.

The most frequent type of joint replacement that needs the most rehabilitation is the total knee replacement, also known as total knee arthroplasty (TKA).  So what does the rehabilitation process involve?

The first thing to understand is that 50% of a successful outcome is the caliber of the surgery.  If you have done your due diligence by being an educated healthcare consumer (see my very first post on this blog) and asked the best surgeon to do your total knee arthroplasty, you should be pretty confident that the actual prosthesis is the right size and was put in correctly.  That is the easy part of the process; after all you slept through it!

Then you wake up and realize your knee hurts.  It is swollen, stiff, and the muscles in your thigh (both quadriceps in the front and hamstrings in the back) do not contract well despite you attempting to make them to work.  You have difficulty transferring from supine (lying on your back) to sitting and then to standing.  Now you have to walk with a walker, another foreign experience.   After 3-5 days, the doctor may send you home from the hospital.  Now you need to get into the car to be driven home.  This requires you to bend your new knee, another daunting thought.  Once home you need to do the right thing to keep your progress going and prevent complications such as deep vein thrombosis (DVT: a blood clot) in either one of your legs, arthrofibrosis (excessive scarring from the surgery) and infection.

HELP!

Physical therapists now become your best friends and should be for a number of weeks to months following the surgery.  You will be guided through a steady progression to return you to full function.

FIRST INPATIENT PHYSICAL THERAPY:

You will have inpatient physical therapy to get you ready for returning home i.e. avoid DVTs, know how to take care of your surgical wound and, you need to learn how to walk safely with a walker.  You will also need to ascend and descend stairs,  You should return home with enough active range of motion (AROM) to get into and out of the car and be instructed in transfers from supine to sitting to standing as well as how to get in and out of a chair.  Detailed instruction should be given regarding how to control the postoperative swelling.

Avoiding DVTs:  perform the embolic isometric contraction sequence of the calf, quadriceps and gluteus musculature (in that order).  Also, do ankle pumps.

Surgical wound care:  keep it dry, no showering – I have had one patient, 13 years ago, who decided to shower before the surgical wound was healed sufficiently.  The knee became infected and was never the same again.  Luckily it was not a TKA and the infection, therefore, did not enter the bone.  It is worthwhile doing it right and accepting you will be a little dirtier than usual!

Walking:  The majority of TKA patients start walking with a front wheel walker, day one or two after surgery.  The large base of support gives the individual more stability.  You must use an assistive device as your quadriceps (muscles comprising the front of the thigh) are not contracting efficiently.  This is because of the incision and the pain impacting the function of the extensor mechanism (quadriceps + patella + patella tendon).  As a result, you have difficulty straightening your knee and controlling it in full extension.  When you transfer weight to the leg, the knee will have a tendency to give way (knee buckles under the weight) and you may fall.

Negotiating stairs with your walker:  The inpatient physical therapist will teach you the correct technique for going up and down stairs with and without the walker.  All homes have at least one to three steps to ascend from the garage to the house or at the front door.  Just remember:  the nonsurgical leg does all the work so you lead with it up stairs and lower your surgical side down with it when going down stairs.

AROM:  Immediately you need to start working on getting your new knee straight (OUCH!) and getting it bending (OUCH!).  The inpatient physical therapist should show you simple but effective exercises such as passive knee extension, hamstring and calf stretching to get it straight.  They will also instruct you in heel slides to regain knee flexion.  If you leave the hospital with full knee extension (straight knee) and 90° of flexion, you will be ahead of the game.  With 90° of flexion you can get into and out of as well as sit in the car that will take you home.

Transfers:  Inpatient physical therapists are the gurus at instructing in transfers under a variety of circumstances, all in an effort to get you more functional and independent.  You should leave the hospital knowing exactly how to do a variety of transfers e.g. change positions in bed, sit to stand, in and out of a car, the commode,  avoiding low chairs like a couch.  You walker is your friend here to and you must focus on safety in all your mobility.

Control the swelling:  This is a vital component of regaining full range and quadriceps function and should be a major focus immediately following surgery. (read the second post on this blog which discussed this topic in detail).  Make sure you get iced in the hospital for 45 minutes at a time, all around your knee at least 4-6 times a day.  You, the patient, must be vocal about this to get it done.  You will be glad you followed this procedure.  Recognize you will have bandages around your knee so it will take a while for the cold to penetrate them.  Do not get the bandages wet (see paragraph above on infection!).  Once the bandages are removed (7 to 10 days after surgery) you will ice for 30 minutes.

Now you are home.  Feel better already, albeit a little beaten up I am sure.  Out patient physical therapy now takes over.  (if you are frail, you may get home health physical therapy but make sure they follow the following guidelines).

OUT PATIENT PHYSICAL THERAPY:

The other 50% of a good outcome is dependent on a good relationship between you and your physical therapists.  Here is where the hard work really starts and you must be dedicated.  Focus on the right things and you will get a great result.

Note: There is no need for the physical therapist to aggressively bend or straighten your knee.  This may inflame the joint and increase the likelihood of arthrofibrosis.  I typically set my patients specific goals to attain each week and it is their responsibility to achieve the range required.  I measure at the beginning of each physical therapy session to track progress.  If they struggle to improve at the agreed upon rate (typically 10° to 15° of active flexion per week), then I will step in and stretch their knee gently.

Rehabilitation is typically broken down into phases.  Transition from one phase to the next is dependent on specific criteria such as degree of pain and swelling.  Progression is not based purely on a timeline.

Phase 1:  Post op days 1-10

Goals:

  1. Understand the goals of the rehabilitation process.
  2. Good pain control (pain less than 5/10)
  3. Good control of swelling.
  4. Can contract your quadriceps.
  5. Can do a straight leg raise (SLR) with minimal lag (minimal loss of full knee extension when you raise your leg off the table while sitting).
  6. Full passive extension (straight knee).
  7. Active knee flexion 90°.
  8. Independent gait and transfers.

Phase 2: Weeks 2 – 12 post-op

Goals:

  1. AROM 0°-130° (we routinely are attaining 140° or more)
  2. Mild joint effusion (swelling within the joint).
  3. Can keep knee straight between physical therapy sessions.
  4. Full SLR.
  5. Normal gait pattern.
  6. Independent in a suitable gym and/or home program based on specific individual needs of the patient at discharge.

So, there is a lot of work to do in recovering from a total knee replacement.  It is not rocket science but it does require focused dedication.  Focus on the right things based on your discussion with the physical therapist and be dedicated with your home exercises as well as those in the physical therapy clinic.

Your call to action:

  1. If you are planning on a total knee replacement (or any other joint replacement) and have questions of any sort, call us at Custom Physical Therapy and a physical therapist will address your questions.  Call 775-331-1199.
  2. Forward this to a friend, family member or coworker who may be having a total knee replacement.
  3. Forward this post to your physician and have them post a comment.  It would be great to have their input too.
  4. If you have had a total knee arthroplasty, please post a comment.  People having knee replacements would benefit from hearing what worked and what challenges you faced during your recovery.
  5. Do something kind for a stranger today!

 Thanks for reading this.

 André

It is Your Right to Choose Your Physical Therapy Clinic.


At Custom Physical Therapy, we come across many people who are not aware that it is their right to choose where they do their physical therapy. We also see patients who do not know that they can (and should) request their doctor to refer them to physical therapy if they think they need it.

Most people are referred to us by their physician, physician’s assistant, nurse practitioner, case manager or chiropractor. These providers partner with us in your recovery. We work together, as your “recovery team”, to provide the needed interventions for your speedy recovery.
 What about you? How should you be involved in the decision-making process?

1. You must be an informed consumer of healthcare.

Thus this blog! We want you to use this blog as an information source, a place to discuss (POST) your questions with other members of the Custom Physical Therapy community and our clinicians. Learn! Learn! Learn! Being informed takes effort on your part. We are here to answer any questions either by phone, in person or after you post them on the blog. Your choice. Obviously, we cannot give you concrete medical advice through the blog but we can give you access to information that may be in our head! We can direct you to appropriate resources if need be. This is an invitation to you whether you are a patient of ours, a prior patient or someone who has not visited our three clinics at all.

2. Actively participate in your healthcare.

To do this you need to be informed sufficiently to ask questions. Yes, you need to ask questions. Lots of them! Ask questions until you understand what interventions are being proposed by your doctor, nurse practitioner, physician’s assistant, case manager, physical therapist or chiropractor. This new understanding you have allows you to accept or reject what interventions we propose. You can also request other interventions – as long as you, the patient, are informed, i.e. you have done your homework! Educate yourself then actively participate in your care.

3. Make sure you know who you want to treat you.

Which clinic you attend and which provider (physical therapist) you want to be treated by is your choice. As long as they are on your insurance provider list (in-network) you will be covered by in-network benefits and typically pay less out-of-pocket than if you see someone who is out-of-network. You can, however, go out-of-network if your provider of choice hasn’t signed a contract with your health insurance company. You may then have a higher out-of-pocket expense.
At Custom Physical Therapy we try to match your out-of-network out-of-pocket cost to your in-network cost. So, never think you cannot see us if we are out-of-network. We will check your benefits and let you know what your out-of-pocket cost will be before you schedule your first appointment.

When should you request physical therapy if your doctor or other healthcare provider does not recommend it to you?

For any musculoskeletal issue there is a high likelihood physical therapy will benefit you.  Afterall, we specialize in the rehabilitation of musculoskeletal problems.  These include, but are not limited to, low back pain, neck pain, headaches, shoulder problems (weakness, pain, stiffness), arm and leg problems, ankle sprains, and numerous other conditions.  If you are unsure, call us at one of our clinics and we will be honest with you and tell you if we are an appropriate route to get you back to full function.

Regarding low back pain, research has documented the longterm benefits of physical therapy when started within 2 weeks of the onset of low back pain. Treatment with medications only (anti-inflammatories, muscle relaxers and/or pain killers) and no physical therapy resulted in an 85% reoccurrence within 1 year of resolution of the episode of low back pain, which took 3 months on average to resolve. Medical management combined with physical therapy (specific exercises and manual therapy interventions) only had a 35% reoccurrence!  That’s a huge difference!  Worthwhile I would say! It is totally appropriate for you to request physical therapy at the initial visit to your doctor for your low back pain.

Another condition where you should specifically request physical therapy immediately is for an ankle sprain, even if it is a slight one. Chronic ankle sprains may occur if early rehabilitation is not pursued.  There is a greater likelihood of arthritis in the ankle joint each time you traumatize the joint by spraining it. Research on ankle sprains shows that one sprain leads to another and then another if the brain’s ability to control the ankle in unstable situations (known as proprioception) is not retrained.  This involves being instructed in specific exercises to enable the brain to “adjust” to the faulty information, due to the ankle sprain, arising from the muscles, ligaments and tendons which control the ankle joint.

IN SUMMARY:

  1. Be proactive with your healthcare and learn as much as you can.
  2. Ask questions to gain understanding.
  3. You choose who you see for physical therapy.
  4. You can and should request physical therapy when you think it is needed.

 YOUR CALL TO ACTION!

  1.  Post a question concerning your health on this blog. If we do not know the answer, we will find it for you from another expert in the field.
  2. Check out the videos on the blog and rate them. Why do you think they are good?
  3. What topics would you like to see covered in this blog?
  4. Ask a friend to do action 1 through 3 above.  This will get our information out to many others with your help.

See you for the next post!  Plan on once a week visits to this blog for new information!