Ask an Expert: How Can Therapy Help If I Have a Rotator Cuff Tear?

Question: What does the rotator cuff do, and how can therapy help if I have a rotator cuff tear?

Answer: The rotator cuff is a group of four muscles that work together to perform rotational movements of the upper arm, but also to maintain stability of the joint by preventing excessive sliding around of the “ball” (head of the humerus) in the “socket” (glenoid fossa) of the shoulder and scapula, and by keeping the ball centered in the socket.

There can be normal changes in the structure of the rotator cuff musculature, just as there are in the bones of a joint as we age.  Therefore, the rotator cuff is more susceptible to tears after age 50.

A partially torn rotator cuff can improve with Occupational or Physical Therapy intervention by providing treatment to reduce pain associated with a tear. Education in activity and postural modification, as well as instruction in therapeutic exercise and activity are also provided.  The purpose of this is to increase the stability of the shoulder joint, to keep the ball centered in the socket, maximize the space through which the rotator cuff muscles travel in the top shoulder joint to decrease pressure on the rotator cuff, and increase the ease of overhead reach and rotation. This can enable one to return to pain-free function of the involved arm, to perform activities such as fixing one’s hair, throwing a ball, playing golf, or casting that fishing line!

Erin Winters, OTR at Putnam County Hospital

Ask an Expert: How Long Will it Take to Recover From a Stroke and When Should I Start Therapy?

Question: How long will it take to recover from a stroke and when should I start therapy?

Answer: Every stroke is different, just as every person is different. Generally, you will see the most improvement or recovery within six months to a year. After a year, recovery and improvements are still possible, however, the rate of recovery tends to slow down.

To minimize disability and improve your recovery, therapies should begin as soon as possible. It is common for patients to think they need to rest after a stroke, but research shows greater improvements if you start therapy 24-48 hours post stroke.

There are various factors that may affect your rate of recovery including:

  • Severity of stroke regarding physical and cognitive aspects
  • Emotional factors that affect mood and motivation
  • Social environment and support of family/friends

It is normal to experience a wide range of difficulties or “bumps” along the way that could impede or slow progress including other medical complications. Once you have a stroke, you are at a higher risk to have a another stroke. It is important to continue to monitor blood pressure, blood sugar and heart rate, take all prescribed medications, follow up with doctors, and continue with therapies.

Erica Howard, PT, DPT

Ask an Expert: Can OT Help My Mom Feed Herself?

Question: My mom has dementia and seems to have forgotten how to use her silverware to feed herself. Can OT help?

Answer: Yes! Sometimes, as dementia progresses, people can have more difficulty feeding themselves. OTs can figure out what’s getting in the way of self-feeding and provide the best amount of support that helps the client maintain their skills for as long as possible.

Your OT can recommend changes in things like the type of dishes used, the kind of food offered and how it is presented, distraction level, and adjusting routines and schedules. OTs train caregivers in offering the right kind of cueing and support. OTs also take into consideration other factors outside of dementia that may be impairing self-feeding.

 

Stephanie Grunklee, MOT, graduated from Maryville University of St. Louis with a Master of Occupational Therapy degree. Stephanie is a champion of the Wound Care Program. She is passionate about geriatric rehabilitation and understands the importance of an interdisciplinary team-based approach to help patients reach their goals.

OT Solutions: Adaptive Equipment

Adaptive Equipment (AE) are pieces of equipment to compensate for a physical limitation, promote safety, and promote independence. They are used to facilitate completion of daily activities such as dressing, feeding, bathing, grooming, and functional mobility. One may also hear the term “assistive device;” these terms are often used interchangeably.

Pieces of adaptive equipment include, but are not limited to:

  • Dressing: long-handled shoehorn, sock aid, button hook and reacher
  • Bathing: long-handled sponge
  • Feeding: plate guards, cup adaptors, and built-up handles on utensils
  • Home management: ergonomic knives and adapted cutting board with side rails and prongs to stabilize foods
  • Additional pieces include: universal cuffs, doorknob extensions, and bed transfer devices.

Some patients may require the use of AE due to precautions put in place after an injury or surgery. For example, a sock aid, reacher, and long handled shoe horn are provided to individuals after a hip replacement to allow for increased independence with lower body dressing.

Pieces of AE are used in energy conservation and safety. For individuals with decreased balance, trunk stability, dizziness, or poor vision, a reacher is beneficial to eliminate the need to reach outside of their base of support to retrieve an item.  Additionally, too much bending and reaching can cause fatigue and shortness of breath. Utilizing pieces of AE can eliminate the need to bend/reach, and therefore allow for energy conservation during dressing tasks.

Adaptive equipment may also be used in conjunction with mobility devices, such as adding platform crutches and/or enlarged grips on walkers to comply with a non-weightbearing status or prevent further stress on joints.

Occupational therapists will carefully assess performance and collaborate which pieces may likely benefit an individual’s participation in their daily tasks. It may take lots of practice, patience, and trial and error as an individual learns to use a piece of adaptive equipment.

Occupational therapists will educate patients on how to use equipment with strategies and techniques based off of an individual’s needs and learning style. An occupational therapist will also collaborate with a patient’s interprofessional team, families, and/or guardians to allow for best follow through for use of the equipment.

Maggie Webber, OTD, OTR/L is an Occupational Therapist in the Senior Living setting but has experience with clients of all ages, from pediatric to geriatric. Her area of expertise are in General Occupational Therapy, Cardiac Critical Care Unit, Neurology & Neurotrauma ICU, Trauma & Trauma ICU Colorectal Surgery, Infectious Diseases, Dementia, and Parkinson’s Disease. Maggie believes in building positive, lasting relationships with her patients to help them reach their goals.

Choose PT First for Low Back Pain

Around four out of five people have low back pain at some point in their lives. Low back pain is one of the most common reasons people visit their healthcare providers.  

What Can Cause Low Back Pain?

  • As people age, bodies change. Being less active can accelerate changes including reduced flexibility and strength, which can result ini pain and stiffness.
  • People who are carrying excess weight are more likely to suffer from low back pain with the added weight increasing pressure on the joints of the body.
  • Repetitive lifting and bending as part of your daily work can increase the risk of injury.
  • Acute injury from overexertion including lifting a heavy object or performing several hours of activity that your body isn’t prepared for.

Evidence has shown that most patients with low back pain can recover faster when the patient chooses physical therapy first. PT is a less costly alternative to medication, surgery, and other invasive medical procedures. This is why states have passed legislation allowing patients to go directly to a physical therapist without a physician’s referral.  

Don’t Be a Statistic

  • $50 billion is spent on back pain annually
  • There are 31 million people with back pain
  • 50% of working Americans admit to back pain
  • Only 7% of low back pain patients go to see a physical therapist

For the senior population, Physical Therapist Thad Poitevint goes by the mantra, “Check yourself and correct yourself before you end up with pain.” He adds, “Go heavy on the emphasis on good body mechanics and positioning with the senior population. I tell them to check their posture and make corrections in real time. Small changes that are made consistently over time can help prevent low back pain and other spine issues.”  

How to Prevent Low Back Pain

You can’t prevent all lower back pain, but you do have control over some aspects in your life that can help.

  • Maintain a healthy weight.
  • Get regular exercise to maintain flexibility and strength.
  • Reduce risk of injury when lifting by testing the weight, keeping the object as close as possible, engaging your core, and using your legs.  
  • Avoid bending and twisting at the same time.  

Physical therapy can help determine the cause of your back pain and design a treatment plan that is specific to you and your goals. If back pain is changing how you move, impacting daily function, or limiting the activities you enjoy, contact a physical therapist to schedule an appointment.

Ask an Expert: Do I Need to Stop Running?

I have been diagnosed with Osteoarthritis (OA). Do I need to stop running or participating in sports?

This is a question that we are asked regularly during physical therapy sessions! A recent 2020 meta-analysis by Zampogna et al on of the effects of activity in people with OA concluded that, “compared to controls, aquatic exercise, land-based exercise, tai chi, and yoga showed a small to high effect for improving pain, physical function, quality of life, and stiffness. Active exercise and sport are effective to improve pain and physical function in elderly people with osteoarthritis.”

Furthermore, a 2018 study by Lo et al. in The Journal of Clinical Rheumatology concluded that, “among individuals over 50 years old with knee OA, self-selected running is associated with improved knee pain and not with worsening knee pain or radiographically defined structural progression.”

That being said, I recommend avoiding contact sports which have a higher risk of orthopedic injury, such as tackle football and rugby. I also recommend a well-rounded exercise program which incorporates mobility, balance and strengthening exercises into your regular routine.

When progressing activity, it’s a good idea to gradually increase intensity or duration of activities by no more than 10% per week. For example, if you normally run for 20 minutes on the treadmill at 7 mph and you want to progress this activity, you can either increase the time to 22 minutes or increase the speed to 7.1 mph.

If you are limited in your daily life and recreational activities due to pain, stiffness or weakness then consider making an appointment with a physical therapist to help you get moving again!

Meet Mitch Parsons

Tx:Team turns 40 in 2023!

Founded in 1983, Tx:Team will celebrate a big anniversary in May, 40 years in business. Because it is such a major milestone, we felt we should celebrate this achievement throughout the year.

Thank you to all Tx:Team associates throughout the decades for his or her part in our success.

Meet Mitch Parsons, Manager of Employer Based Clinics, and hear his story of his time with Tx:Team!

Static Vs. Dynamic Stretching

When I was initially tasked to write about stretching, I got excited because as a former athlete and now physical therapist for more than 16 years, I thought I understood the evidence and rationale to easily address this topic. However, like the evidence-informed therapist that I am, I decided to first perform a literature search in order to check my preconceptions. This would prove to be pivotal in how I decided to tackle the subject matter.

What is Static Stretching?

Static stretching is when you take a body part to a point where a “stretch,” or pulling sensation, is felt and hold that position for a length of time, generally less than 60 seconds in duration (position based). ​An Example of a static stretch for the arm would be a cross body stretch – holding the arm directly across the chest.

What is Dynamic Stretching?

Dynamic Stretching can be classified as a large/gross movement pattern that involves multiple joints and muscles groups moving in and out of various ranges of motion (movement based). An example of a dynamic stretch on the arm would be performing arm circles – moving the arms forward and/or backwards in various degrees of motion.

What are the Benefits of Stretching?

For years it was thought that static stretching prior to activity would help decrease injury, prepare the body for activity, improve range of motion (ROM), and even enhance performance. However, does stretching do any of these things?

  1. Reduce Injury: Most of the recent data suggests that static stretching alone is inefficient at reducing the likelihood of sustaining an injury with a sporting activity. In fact, depending on the sport, in an article recently reviewed pertaining to golf, adding static stretching seemed to increase in the likelihood of injury. However, if static stretching is incorporated into a comprehensive warm-up program, it may actually help reduce musculotendinous injury in sports that require sprinting/making sharp cuts, i.e., soccer, football, basketball, etc.
  2. Prepare Body for Activity: The idea of a “warm-up” is to increase blood flow to the muscles that we intend to use for the given activity we are about to perform as well as increase the body’s core body temperature prior to competition. Static stretching alone does not satisfy these goals, which is why many professionals would recommend dynamic stretching.
  3. Improve ROM: It has been shown that static stretching does increase ROM of the hip and knee with hamstring stretching, but there are very few research studies that have shown the same amount of change in other body areas. To observe these changes in ROM, the static stretch needs to be done consistently for no more than 45 seconds at a time for no fewer than three reps for a minimum of eight weeks.
  4. Enhance Performance: Initially, I was confident that there was indeed research that supports the notion that static stretching had been shown to reduce strength, power, and muscle performance. While that is not entirely false, the evidence is not as consistent as I had once thought. a 2013 Systematic Review of 104 studies concluded that there was a decrease in strength, power, and explosive performance (to varying degrees). However, when looking at how they did the analysis the individual study designs and the tests they used to measure strength, power, and explosive performance varied greatly, which makes it much more difficult to make blanket statements with regards to performance deficits that may exist after static stretching.

What is the Goal or Purpose of Stretching?

If your goal is to gain range of motion in a specific muscle group or joint, keep the stretch to less than 45 seconds. Dynamic stretching is preferred as it is more efficient and better prepared the body for an activity or sport.

If you want to warm up before an activity, work, or to help reduce injury, consider a Comprehensive Warm-Up (CWU). A CWU should include light aerobic activity (walking, jogging, cycling, jumping rope/jacks, etc. in which you can still speak comfortably), dynamic stretching, and a sport/activity/job specific tasks. For a sport or activity that requires sprinting/quick changes in direction, adding static stretching of less than 45 seconds in a given position may help reduce musculotendinous injury.

 

Josh Anderson, PT, DPT has over 15 years of diverse experience in both the on-site and outpatient settings treating patients by providing Injury Prevention Services and Early Intervention Screens, as well as utilizing a variety of Physical Therapy techniques to get patients back to work as quickly as possible. His professional interests include Balance and Vestibular Orthopedics, Sports Physical Therapy, and Manual Therapy. Josh is certified in Sports PT through Evidence in Motion, Selective Functional Movement Assessment (SFMA), and Rocktape Level 1. He is also a Certified Clinical Instructor via the APTA.

 

Bibliography:

1. K Small, et al. A Systematic Review into the Efficacy of Static Stretching as Part of a Warm-up for the Prevention of Exercise Related Injury. Research in Sports Medicine, 16:213-23, 2008
2. A Ehlert and PB Wilson. A Systematic Review of Golf Warm-ups: Behaviors, Injury and Performance. Journal of Strength and Conditioning Research, 33(12): 3444-3462, 2019
3. DG Behm, A Chaouachi. A Review of the Acute Effects of Static and Dynamic Stretching on Performance. European Journal of Applied Physiology, 111: 2633-2651, 2011
4. DM Medeiros, et al. Influence of Static Stretching on Hamstring Flexibility in Health Young Adults: Systematic Review and Meta-analysis. Physiotherapy Theory and Practice, 32(6): 438-445, 2016
5. DG Behm, et al. Mechanisms Underlying Performance Impairments Following Prolonged Static Stretching Without a Comprehensive Warm Up. European Journal of Applied Physiology, 121: 67-84, 2021
6. L Simic, et al. Does Stretching Improve Performance: A Systematic and Critical Review of the Literature.Scandinavian Journal of Medicine and Science in Sports, 23(2): 131-148, April 2013
7. Yamagichi, et al. Effects of Static Stretching for 30 seconds and Dynamic Stretching on Leg Extension Power. Journal of Strength and Conditioning Research, 19(3): 677-683, Aug 2005
8. DG Behm, et al. Effect of Acute Static Stretching on Force, Balance, Reaction Time and Movement Time. Med Sci Sports Exercise, 36(8): 1397-1402, 2004
9. AD Kay, AJ Blazevich. The Effect of Acute Static Stretch on Maximal Muscle Performance: A Systematic Review. Medicine & Science in Sport and Exercise, 44(1):154-164, 2012
10. I Shrier. Does Stretching Improve Performance: A Systematic and Critical Review of the Literature.Clinical Journal of Sports Medicine, 14(1): 267-273, 2004
11. DG Behm, A Chaouachi. A Review of the Acute Effects of Static and Dynamic Stretching on Performance. European Journal of Applied Physiology, 111: 2633-2651, 2011
12. H Chaabene, et al. Acute Effects of Static Stretching on Muscle Strength and Power: An Attempt to Clarify Previous Caveats. Frontiers in Physiology, 10 (1468): 1-10, 2019

Can the Value of Physical Therapy Be Measured?

October is Physical Therapy month, and the American Physical Therapy Association (APTA) has deemed the theme for 2024, “The Value of Physical Therapy.”

Value: noun – (val-ue) relative worth, utility or importance; consider (someone or something) to be important or beneficial.

Can the value of physical therapy really be measured?

We have tools to measure our patients’ outcomes, but can we measure the actual value of services?  Physical therapy provides a variety of benefits, including reduced pain, improved function, increased range of motion, proper alignment and more.

Physical therapists are experts at movement who are trained to optimize function, improve motion, and ultimately, live better!  They will assess your condition and help you regain maximum functional mobility and independence. Physical therapists will also  use a variety of treatment modalities and techniques to help you move better and feel better.  Treatment is highly individualized, cutting edge, and research-based to return patients to their optimum functional level and live life to its fullest.

Again, we ask, can the value of physical therapy be measured?

The answer to that question would depend on each individual patient.

  • How valuable is it to be able to walk across the room pain free?
  • What does is it worth to be able to play with your grandchildren in the backyard? Or go on a walk with them?
  • Does your pain or inability to function at your best hold you back from taking that dream vacation?
  • Does your desk set-up at work cause you to go home at the end of the day with headaches?
  • Are there any extra-curricular activities that you are passing up because your back, neck, or another body part is holding you back?
  • How much do you value a pain free life to participate in any activities you enjoy?

Physical therapists treat people across the entire lifespan. Many therapists have certifications or specializations to treat a certain population, like children, the elderly, or athletes. Regardless of age or population, if you have a condition that is keeping you from the activities in your life, a physical therapy evaluation may be warranted to offer treatment and a strategy to improve function.

The benefits of physical therapy include:

  • Prevention of the onset and/or slow progression of conditions resulting from injury, disease, and other causes
  • Pain management with reduced need for opioids
  • Avoidance of surgery
  • Improvement in mobility and movement
  • Recovery from injury or trauma
  • Recovery from stroke or paralysis
  • Fall prevention
  • Improvement in balance
  • Management of age-related medical problems

From the APTA:

“A recent study also examined the overall value of choosing physical therapy over other options. Researchers calculated the economic impact of choosing physical therapy for the following eight conditions, representing a broad spectrum of physical therapist treatment: Cancer Rehabilitation, Carpal Tunnel Syndrome, Falls Prevention, Stress Urinary Incontinence, Osteoarthritis of the Knee, Low Back Pain, Tennis Elbow, and Claudication (leg pain when walking due to restricted blood flow).  They found that physical therapy is effective and saves on all the hidden costs of your time, pain, missed life events, and the dollars paid for services.

Find a physical pherapist

If you have an injury or illness that results in pain, physical impairment, limited movement, or a loss of function, a physical therapist can help.  Some patients are referred to physical therapy from his or her physician, and others seek therapy directly. Find out how valuable physical therapy can be to you.

Meet Ann Hightower

Tx:Team turns 40 in 2023!

Founded in 1983, Tx:Team will celebrate a big anniversary in May, 40 years in business. Because it is such a major milestone, we felt we should celebrate this achievement throughout the year.

Thank you to all Tx:Team associates throughout the decades for his or her part in our success.

Meet Ann Hightower, Vice President of Internal Operations, and hear her story of her time with Tx:Team!