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.



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!


Falls Prevention Week

Each September, we recognize Falls Prevention Week to raise awareness of the impact of falls. The good news is that most falls are preventable.  Tx:Team’s Teaming Up Against Falls Program incorporates the components of the Otago Exercise Program including balance, strength, flexibility, vestibular, and proprioception evaluation and treatment to tackle balance issues and help prevent falls.

According to

  • Falls are the leading cause of injuries in older adults. One out of five falls result in a significant injury such as broken bones or a head injury.
  • Each year, three million older adults go to the emergency room because of falls. Over 800,000 need to go into the hospital.
  • Older women are twice as likely to fall and break a bone as older men. Men have a higher risk of dying after a fall. 


What can I do to decrease my risk of falling?

  • 75% of falls occur in the home. You can decrease your chance of falling by keeping your home safe for you to move around.
  • Make sure you have good lighting in every room. Include night lights in your bedroom, hallways, and bathrooms.
  • Rugs should be firmly fastened to the ground, especially at the corners. Electrical cords should be kept off the walking areas.
  • Add handrails to your bathrooms for support for your bath, shower, and toilet use.
  • Always use the rails on stairs on both sides and ensure that each stair is well lit or has a visual cue.
  • Wear shoes with firm, nonskid, non-friction soles. Avoid wearing loose slippers that could cause you to trip.
  • Keep kitchen items within easy reach to avoid using step stools.
  • Place the bed at a proper height to allow for feet to be flat on floor while sitting at bedside.

Taking good care of your body will also keep you strong, mobile, and more independent.

  • See your eye doctor once a year.
  • Care for your feet and see a doctor if you have pain or corns.
  • Use assistive devices if they are recommended to you.
  • Sit on the bed for a few minutes before getting up to go to the bathroom at night. This will prevent dizziness in the dark.

If you notice that you may have some trouble with your balance or mobility in general, talk to a physical therapist and find out how they can help you to stay on your feet and prevent falls.

You Take that First Step and OUCH

You get out of bed and go to take that first step. OUCH! 

A sharp pain hits your foot. You limp a few steps but before you are out the door, the pain is gone. After sitting at work for a couple hours, you get up for another cup of coffee and the pain returns. 

It’s possible you are dealing with plantar fasciitis.

But what exactly is plantar fasciitis and what can we do about it? 

The suffix -itis indicates inflammation. Plantar fasciitis is inflammation of the plantar fascia. This leads to the next question, what is the plantar fascia? Plantar is the bottom side of the foot and fascia is a thin casing of connective tissue. Putting those two together, the plantar fascia is a band of connective tissue that runs from your heel to your toes, and it helps support the arch of your foot, stability of the foot, and is involved with normalized foot mechanics. Unfortunately, through a series of microtears from overstress and over stretch, the fascia can get inflamed and plantar fasciitis occurs.

Why exactly does plantar fasciitis occur is a great question. There are a few common risk factors to look at first. Generally, it will occur in people 40-70 years old. Activities such as running and dancing can increase the risk of developing plantar fasciitis. Occupations that keep you on your feet also increase the risk for developing it. People who are overweight or obese place more stress on their feet and this can cause plantar fasciitis. Lastly, if you have abnormal foot posture or walking pattern, e.g. flat feet, high arches, this can increase risk as well.

Now what to do about it? 

  • It is important to keep your calves loose. When the calf muscles become tight, they will pull up on the achilles, which pulls up on the heel, which stresses the plantar fascia.
  • Improving the strength of the arches of the feet can also reduce stress placed on the plantar fascia.
  • Stretching your big toe backward (toward the top of your foot) can provide an excellent stretch on the plantar fascia and rolling your foot on a lacrosse ball is another great option.
  • Orthotics can also help to normalize your foot if you have high arches or flat feet, thus reducing the stress on the plantar fascia.

Although plantar fasciitis can be a painful way to start the day, it is certainly treatable through a variety of stretches, exercises, and lifestyle modifications. If you feel you are suffering from plantar fasciitis, make an appointment with your local Physical Therapist and get back on your feet and  walking pain free.

Alex Strahle, PT, DPT, CSCS graduated from the University of Evansville with a Bachelor of Science in Exercise Science and a Doctor of Physical Therapy.  He is currently a Physical Therapist in the Employer-Based Clinic setting for Tx:Team.  Alex enjoys seeing patients return to an active lifestyle after treatment for their pain and dysfunction.

August is Spinal Muscular Atrophy Awareness Month

August is Spinal Muscular Atrophy Awareness Month!

Spinal Muscular Atrophy (SMA) is a hereditary neurodegenerative disorder that negatively affects the motor control of 1/10000 people across the lifespan depending on type with which diagnosed. A decline in muscle strength is common affecting an individual’s ability to contribute and participate in society, increasing their economic burden, and in extreme cases, results in death. Hospitalization costs an average of 100k annually for these individuals. Therapy can help reduce hospitalizations, burden on caregivers, and provide education on how to manage this progressive chronic condition to improve these outcomes.

How Physical Therapy Can Help

Physical therapists screen for neuromuscular delays while monitoring gross motor developmental milestones as part of their SMA assessment. They reduce fall risk by slowing the decline of range of motion, endurance, and strength to maintain and possibly increase mobility (walking, standing, sitting etc.) through therapeutic exercise and neuromuscular electrical stimulation. Seating/mobility device and orthotics recommendations may be made. Preventing the worsening of scoliosis may be included in treatment.

How Speech Therapy Can Help

Speech therapists screen for oral/laryngeal/pharyngeal motor delays as part of their typical assessment. Communication devices and vital stim to aid in breathing and swallowing function may be recommended to aid the individual with SMA in returning to social and mealtime participation.

How Occupational Therapy Can Help

Occupational therapy can assist people with SMA in becoming more independent in their daily activities, including with basic self-care, work, or hobby pursuits through the use of therapeutic activities. A screening for fine motor and self-care developmental milestones is part of the typical assessment for SMA. Home and lifestyle modifications, adaptive equipment and assistive technology recommendations, energy conservation strategies, and basic mental health care may be provided.

Therapy has been associated with reduced anxiety/depression and increased hopefulness for the future. Early intervention and collaboration with physicians is the key to comprehensive care. Help facilitate access to therapy services for individuals you may know with SMA today!

Alita Borkar MA, OTR/L, CPAM is an Occupational Therapist in the outpatient setting.  Alita believes everyone deserves access to therapy services that improve the ability to live a happy, meaningful, and productive life.  She believes in ethical, evidence based, high quality services and is passionate about developing evidence based programs, advocacy, and mentoring students for effective family services.



Ch’ng, G.S., Koh, K., Ahmad-Annuar, A. et al. A mixed method study on the impact of living with spinal muscular atrophy in Malaysia from patients’ and caregivers’ perspectives. Orphanet J Rare Dis 17, 200 (2022).
“Cure SMA, Novartis Publish Economic Burden of SMA Analysis in Journal of Market Access & Health Policy – Cure SMA.” Cure SMA, 20 Dec. 2020. Accessed 26 July 2023.
“List of Treatments for Spinal Muscular Atrophy.” MySMAteam, 2023.
“Spinal Muscular Atrophy (SMA) | CDC.”, 20 Dec. 2021.

Ask an Expert: I Was Diagnosed with Moderate Hip Arthritis, Can PT Help?

I recently got diagnosed with moderate hip arthritis, but the Doctor does not recommend a hip replacement yet. Can Physical Therapy help?  

Physical therapy is a form of treatment that helps to alleviate pain and improve movement in those who have mild to moderate hip arthritis. It is a non-invasive and drug-free approach that can be very effective in managing the symptoms of this and other arthritic conditions.  Physical therapists are trained to work with people who have arthritis and can develop a personalized plan of care to help alleviate your pain and improve your mobility. They may use a combination of techniques, such as exercises, stretches, and hands-on therapy, to help you regain strength and flexibility in your hip joint.

Exercises are an important part of physical therapy for hip arthritis. Your therapist may prescribe exercises that are specifically designed to help improve the strength and flexibility of the muscles around your hip joint. These exercises may include range of motion exercises, leg strengthening exercises and balance exercises.  Stretching is also an important component of physical therapy for hip arthritis. Stretching can help to increase the flexibility and range of motion in the hip joint, which can help to reduce pain and improve your ability to move around.  Hands-on therapy, such as massage and manual therapy, can also be used to help alleviate pain and improve mobility in people with hip arthritis.

Physical therapy can also help you learn how to move and do everyday activities in a way that puts less stress on your hip joint. This can help you to reduce your risk of injury and further damage to your hip joint.   It is important to note that physical therapy can be an effective treatment option for hip arthritis, but it is not a cure. However, it can help to alleviate symptoms, improve mobility, and reduce the risk of further injury. It is always best to consult with a physical therapist to discuss if physical therapy is right for you.

Jeremy Dunker, PT, DPT, OCS