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 HealthyAging.org:

  • 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.

Balancing Act: Keeping You On Your Feet

Do you find you are less confident than you used to be when walking in a crowded environment or on an uneven surface? Are you avoiding certain activities, or perhaps gripping the handrail a little tighter these days? If so, you’re not alone. Up to 85% of older adults are afraid of falling, and with good reason. One out of every five falls results in a serious injury and falling once doubles your likelihood of falling again.

Most people don’t even think about their balance until it starts to deteriorate, but there’s a lot going on behind the scenes to keep us on two feet. Our brain uses sensory input from our feet to adapt to the surface, and proprioceptors on our joints to know where we are in space. Our eyes and ears give us information about our environment, and our inner ear, or vestibular system, keeps our equilibrium. These systems work together to tell our motor system how to make corrections and keep us upright.

These corrections are typically fairly automatic and start with engaging our ankles, then bending at the hips, and eventually a quick step in order to recover. If these reactions aren’t strong enough or quick enough, we end up on the floor. Unfortunately, many medical conditions, as well as general deconditioning, can have a negative impact on your ability to both identify and correct a loss of balance. The good news, however, is there are things you can do to not only maintain your stability but gain it back! Some of these strategies include:

  • Strengthening your hips and thighs. These large muscles are responsible for keeping you upright and shifting your weight into your base of support
  • Stretching out your calves. Flexibility in your ankle actually plays a big role in whether your body can effectively right itself when you start to wobble.
  • Getting your eyes and ears checked regularly to maintain optimal function.
  • Wearing properly fitting footwear with good traction and reviewing your home for possible trip hazards.
  • If you’re struggling with dizziness, have your doctor review your medications with you for possible side effects.

The fear of falling may be a healthy fear at times. After all, it often keeps us from doing unsafe things. However, studies show that a fear of falling is associated with higher risk of falls, partly because individuals reduce their regular mobility and avoid activities that would normally challenge their system. This results in increasing weakness and perpetuates the cycle of instability.

Programs that target balance, like yoga and tai chi, are great, but the key to staying committed is to pick something you really enjoy. Activities like golf or gardening can be just as effective at challenging your system. Even going for a walk with a friend will require you to turn your head and hold a distracting conversation while picking your feet up and avoiding obstacles! If you’re unsure where to start, talk to a local physical or occupational therapist. They can do a specialized assessment to determine where your specific problems lie and recommend strategies to address them. Most importantly, keep moving! As they say, a body in motion stays in motion!

Rachel Hett, PT, DPT is a graduate of the University of Florida where she received her Bachelor of Health Science as well as her Doctor of Physical Therapy.  She is an experienced physical therapist as well as Team Leader in the senior living setting.  Her professional interests lie in Falls & Balance, Vestibular, Dementia, and Neuro programming.  Rachel is also a Certified Dementia Capable Care Specialist.

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.

Is Aquatic Therapy Right For Your Patient?

Physical therapy, historically, has been helping people since the early 1900s. However, the healing benefits of water for the human body date back to ancient Greek and Roman times. After battle, warriors and gladiators would soak in hot springs because they realized they were able to recover faster and get back to battle.

Fast forward, as physical therapists our number one job today is getting patients back to their previous level of function, or ‘back to war!’ We have learned what the ancients already knew, that water has many therapeutic properties including buoyancy, resistance, pressure, and warmer temperatures. These properties allow the patient to exercise with less impact to improve skills at all functional levels:

  • Strength: water is natural resistance, movement patterns allow gentle exercise with buoyancy to allow for improved tolerance to strength exercises.
  • Flexibility: warm water increases tissue temperatures to generate a comfortable environment for mobility exercises and improved range of motion.
  • Endurance: water is denser then air, therefore it is harder to do exercises in water than on land. This can be a stepping-stone to improve tolerance for activity on land.

Aquatic therapy has many benefits for the patient following injury as compared to a traditional land setting by removing gravity. Acute sprains, strains, and fractures with decreased weight baring are great candidates for the pool. Patients can benefit from aquatic therapy or land therapy individually.  They can also benefit from a combination of land and water therapy working together. The plan of care may look different for each patient. Some patients need one visit of land with one visit of aquatics each week, or half the session on land for manual therapy and half on water in the same day for exercises. Patients with poor tolerance to exercises due to chronic pain conditions may thrive in the water to build confidence to perform functional skills on land including; osteoporosis, arthritis, fibro myalgia, and balance disorders.

Aquatic therapy is a modality to aid the therapist in their quest for helping our patients get better faster, and back to their lives…or war!


Meagan Gearhart, PTA, is a Physical Therapist Assistant treating in the outpatient setting.  She has extensive experience in not only aquatics but also in orthopedics, post-surgical and non-surgical diagnoses, and a variety of conditions pertaining to musculoskeletal conditions and injuries.

Tennis Elbow? Golfer’s Elbow? I Don’t Play Sports!

My doctor diagnosed me with tennis elbow and/or golfer’s elbow, but I don’t play those sports. How is that possible? 

Tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis) are two common injuries associated with the elbow. They are both caused by playing sports or doing repetitive motions (gripping, pulling, grasping, and lifting) with the affected arm. Some common functional activities that could cause these injuries include tennis, golfing, painting, throwing a ball, and heavy lifting.

Over time, these repetitive motions will cause wear and tear of the tendons at the elbow and place strain on the muscles.

What are symptoms that someone may experience that would trigger the problem being tennis elbow? 

With both lateral and medial epicondylitis, the primary symptom is pain at either the lateral or medial elbow. Other common symptoms can include tenderness with palpation to either the forearm extensor or flexor muscle units, aching elbow in the evening, and elbow stiffness in the morning. Sensation deficits are not associated with either of these injuries and is an entirely different injury.

How are these injuries treated?  

A majority of these injuries are treated conservatively. Doctors can prescribe an anti-inflammatory medication along with a steroid injection to the painful area(s). Doctors can also refer a patient to see an occupational or physical therapist to have symptoms addressed.

An occupational therapist or a physical therapist will work with each patient to develop a personalized treatment plan that includes:

  • stretching
  • manual therapy techniques
  • education
  • home exercises
  • activity modification
  • strength training
  • custom orthosis

Are there risk factors for one person to get more than another?

Yes, there are certain activities that can exacerbate symptoms. Those activities include anything that leads to overuse of the forearm extensor and flexors (heavy repetition, poor posture, forceful grasp, etc.).

The incidence for lateral and medial epicondylitis is greatest between 35-55 years old (men and women are affected equally). If an individual is younger than 35 and experiencing symptoms, a screen should be completed for additional causes.

Can you prevent tennis elbow or golfer’s elbow?

There is no way to prevent lateral or medial epicondylitis, but there are ways to decrease your chances of having this injury. Those ways include having proper posture, avoiding repetitive motions, avoiding forceful grasping.

If you suspect Tennis Elbow, Golfer’s Elbow or any problem with your arm, find a Physical or Occupational Therapist in your area to start the program you need to get back to the activities you enjoy.


Joshua Eppinger, MOT, OTR/L received his Bachelor of Arts in Human Performance & Health and his Master of Occupational Therapy from West Virginia University.  Joshua’s professional interests are Orthopedics and Hand Therapy. He has experience and training in the evaluation and treatment of post-surgical and non-surgical diagnoses. Josh’s experience includes a variety of conditions pertaining to the hand and upper extremities including  fractures, dislocations, sprains, torn ligaments, Tennis Elbow, Golfer’s Elbow, as well as multiple other diagnoses of the hand, wrist, arm, and shoulder.

Physical Therapy & Wound Care

Wounds affect more than one million people every year. A wound or skin injury can occur due to an accident, injury, surgery, a burn, circulation problems, diabetes, or spending too much time in one position (not moving enough). Physical Therapists can help people not only prevent wounds, but they can also help heal wounds by providing advanced wound-care treatments and prescribing specific exercises and activities. Physical Therapists and Physical Therapist Assistants are movement experts who improve quality of life through hands-on care, patient education, and prescribed movement.

What is a wound?

According to the Oxford Dictionary, a wound is defined as an injury to living tissue caused by a cut, blow, or other impact, typically one in which the skin is cut or broken. It is advised that people should address any wound as soon as possible to lessen the potential for infection.

How can a Physical Therapist help?

A physical therapist will conduct a full evaluation which includes measuring the wound area and inspecting the surrounding skin. A patient’s range of motion, mobility, and strength also will be assessed, as these can contribute to the wound problem, and may assist in the healing process. Your physical therapist may also perform specific testing related to circulation and sensation. Your therapist will then design an individualized care plan based on your needs.

Common treatment approaches can include:

  • Measurement and documentation of the wound characteristics
  • Cleaning of the wound
  • Debridement (removal) of any dead tissue
  • Selection and application of wound dressing
  • Application of compression if necessary
  • Education of the patient, caregivers and/or family members regarding wound care and dressing changes

Who would benefit from physical therapy wound care?

Physical therapy wound care is for patients who have open wounds as a result of pressure, vascular insufficiency, trauma, surgery, and/or diabetes. The most common wounds that are treated by wound care physical therapist are:

  • Necrotic wounds
  • Stage III, IV or unstageable pressure ulcers
  • Diabetic wounds
  • Chronic wounds
  • Venous and/or arterial wounds
  • Extremity wounds with edema
  • Non-healing surgical wounds

How long will physical therapy wound care take?

All wounds heal at different rates and the duration of therapy will be based on the patient’s individual needs. Depending on the type of wound and amount of care needed, the patient may be seen as often as one-three times a week by a physical therapist. The duration of treatment can vary from one-several months. The wound care physical therapist will make adaptations as treatment progresses to maximize wound recovery.

April is Parkinson’s Awareness Month – #Take6forPD

According to the Parkinson’s Foundation, every six minutes someone is diagnosed with Parkinson’s Disease in the United States.

April is Parkinson’s Disease (PD) Awareness Month and along with the PD Community, we are encouraging everyone to take six minutes in an effort to raise awareness, advance the research, and become knowledgeable of the available treatments for this disease. With someone being diagnosed every six minutes, that totals 90,00 people per year in the United States alone.  Let’s be advocates.

Beyond awareness comes treatment. At Tx:Team, we have Physical, Occupational, and Speech Therapists who are trained and certified in treating patients with PD. One treatment program which has been proven beneficial is the LSVT BIG® and LOUD® Program.

How do the LSVT programs benefit Parkinson’s patients?

Parkinson’s can impact function in everything a person does at home, at work, and in their community recreational pursuits. The LSVT programs help patients to maintain movement and voice for normal function in everyday life beyond medication and repetitive, non-direct task training exercises utilizing principles of neuroplasticity backed by years of research. It takes all 16 visits (four times per week for four weeks) to achieve carry over so that by the end of one month, patients know how to move BIGGER and be LOUDER all the time.   

A unique feature of LSVT BIG® and LOUD® is that it recognizes there is an internal cuing proprioceptive issue in individuals with Parkinson’s such as softer voice and smaller movements, in people that are unable to recognize their deficits the majority of the time.   

What is the focus of LSVT BIG®?

  • Faster speed  
  • Greater arm swing   
  • Longer steps  
  • Overcoming difficulty getting through the doorway  
  • Longer distance  
  • Faster clothing donning  
  • Grasping materials during meal preparation  
  • Legible handwriting  
  • Amplitude of movement when showering  

What is the focus of LSVT LOUD®?

  • Louder voice that is not hoarse  
  • Improved facial expression   
  • Reduction of monotone speech  
  • Improved emotion  
  • Using more words  

Who would benefit from BIG® and LOUD®?  

Patients who have a decline in the amplitude of their movement, voice, posture, and balance in addition to reduced speech intelligibility are motivated to participate in all required sessions.  

Why are these programs so important to this patient population?  

LSVT BIG® and LOUD® assists this patient population in maintaining, enhancing, and slowing progression of Parkinson’s Disease, which in return facilitates their ability to maintain a level of independence with the following skill sets essential for daily living:   

  • Changes in cognitive function. People with PD can still learn, but it might take longer and require more repetition of practice. As a patient progresses, the therapist will work on dual tasking so you can keep moving bigger and being louder while doing something else at the same time. For example, getting dressed and talking, walking while carrying something, or tapping your leg while reading.
  • Changes in movement amplitude. Commonly, people with PD have difficulty with activities they didn’t before. As a patient progresses, utilizing larger movements helps patients return to these activities without cues and assistance. 
  • Changes in communication. People who have PD have soft speech and feel that they are talking WNL while others “need a hearing aid.” However, people may begin to feel embarrassed with social isolation. As a patient progresses with continuous use of a loud voice, they are able to participate in conversations without feeling excluded while maintaining their dignity.
  • Changes in emotional regulation, pacing, attention, cardiovascular health, sleep, and confidence can also be seen!  

If you have any more questions about the LSVT program for BIG® or LOUD®, find a certified therapist in your area or visit this website.


Nidhi, Alita, and Johanna are all experienced therapists in the Outpatient Clinic setting in Frederick, MD.  They work collaboratively together to support and treat patients with a variety of neurological diagnoses. Nidhi, Alita, and Johanna enjoy the relationships they foster with their patients, and they love to help them achieve their functional goals.

Nidhi Talpade, PT, DPT, BIG® Certified
Alita Borkar, MA, OTRL, BIG® Certified
Johanna Ebbs, MS, CCC-SLP, LOUD® Certified.

Prehab to Prevent Injuries

One of our innovative approaches to physical therapy at Tx:Team is Prehab. We focus on the prevention of injuries before an issue or pain arises. What does Prehab look like in terms of physical therapy? From ergonomic assessments in office environments to movement engagement for workers in the manufacturing setting, we can help.

The applications of Prehab are endless and they can end up saving companies and patients money in unneeded care. If you would like to learn more about preventing injuries from happening, fill out the form below:

    Please provide your email below to continue the conversation with Tx:Team.

    Virtual Physical Therapy

    The way that jobs are done has changed quite a bit in the past few years and physical therapy is no different. Since the pandemic began, a need for physical therapy in a virtual setting has grown exponentially and here at Tx:Team, we are ensuring we are delivering on this need. Individuals want to have services from the privacy of their own home or worksite, and virtual services enable better adherence to their plan of care.

    Tx:Team provides a fully virtual physical therapy service when the situation calls for it, and we do this on a safe and HIPAA-compliant platform that works on any web browser with no downloads needed. All you need to do is simply join the virtual waiting room at the time of your appointment and you will be connected to your physical therapist.

    While in-person visits are still preferred in certain situations, the outcomes data from FOTO supports the effectiveness of virtual physical therapy. FOTO is the top outcomes data platform in the U.S. with over 9.5 million encounters and more than 24,000 clinicians inputting results – and Tx:Team is ranked in the top 4% nationally on this platform..

    If you are looking for the most effective virtual physical therapy experience on the market today, contact us at Tx: Team.

    Direct Access for a Physical Therapy First Approach

    Did you know that if you are in pain or have sustained an injury you can see a physical therapist with no referral needed? Not only that, but it can save you both time and money in the long run.

    There is mounting evidence that visiting a physical therapist first can reduce costs and improve the overall outcome of injury rehabilitation. When you choose physical therapy first, it has been shown to lower costs by 72% and often provides similar if not better outcomes. A physical therapy first approach for uncomplicated low back pain leads to an average treatment duration of only 22 days, while seeing your primary care provider first leads to an average treatment duration of 66 days.

    Physical therapy helps patients reduce or eliminate pain by addressing the factors that are contributing to their pain. This also helps patients avoid surgery, and in the other cases pre-surgery PT helps patients recover more quickly with better outcomes. Plus, early physical therapy is associated with a reduced risk of opioid use.

    If you’re looking for someone to help you with a physical therapy first approach, contact Tx:Team today!