Physical Therapy Archives - Page 4 of 5

Choose Physical Therapy as Your Option

In celebration of Christina Kuzma’s successful fight against breast cancer at the age of 33, Tx:Team brings you Part Three of our weekly series to share her experience making decisions about her treatment.

The month of February was incredibly stressful for Christina. Uncertainty reigned as doctors ordered different scans to assess the lump that she found in her breast. She’ll tell you that the anxiety she experienced then was worse than any part of her treatment thereafter. When she was officially diagnosed with HER2-positive breast cancer, she was able to regain control of her path. She began studying, using research articles, blog posts about others’ experiences with breast cancer, and her coworkers’ expertise in health care to make sense of all the information available. Looking back, the information-gathering period of Christina’s first months with breast cancer was vital to the success that she’s currently experiencing as a survivor.

At this point, we’d like to pause Christina’s story to talk about the research behind Christina’s decision to forego opioids in her treatment plan. Opioids are medications that can help manage pain, such as that caused by cancer and its treatment, by blocking pain signals from injured nerves to the brain. They vary in strength and form. In the first blog post of this series, Christina revealed that the side effects of opioids were the primary reason for her decision to opt out of using them as part of her treatment plan. The temporary and limited pain relief that they could provide was not worth relying on them. This was about deciding to be cautious with the risks and committing to a plan that was reliable and effective.

HOW RISK-TAKING DEVELOPS INTO CRISIS

Christina believes strongly that “addiction doesn’t discriminate.” The composition of opioid analgesics is similar to that of morphine and heroin and they act on the same parts of our brain, so they intrinsically present an abuse and addiction risk. There has been awareness of this risk for decades, but opioids continued to be prescribed because it was believed that the drugs’ benefits outweighed the risks. Numbers now show that the rates of addiction and accidental death from opioid overdoses have turned that risk into a crisis.

The severity of the opioid crisis is underwritten by the drastic increase of written and dispensed prescriptions, the greater social acceptability of using medications, and aggressive marketing by pharmaceutical companies. Between 1991-2014, the number of opioid prescriptions has tripled. In 2016 alone, 214 million opioids were prescribed- that’s a prescription for every 2 out of 3 Americans. Of course, opioid prescriptions are often only one part of the pain management plan proposed by a provider. For breast cancer-related pain, opioids are not considered the first line of treatment. And yet, the number of opioid prescriptions among breast cancer patients has surged similarly, becoming a normalized method for pain relief.

While opioid medications will reduce pain for a short period of time, they are predictably dangerous as extended methods of pain relief. A 2016 survey by the Washington Post-Kaiser Foundation released its findings: 34% of survey respondents who had taken opioids for at least 2 months said they had become addicted or chemically dependent, while 54% of opioid users’ household members surveyed said they thought the opioid user would struggle to discontinue use. Furthermore, opioid overdoses currently account for 2/3 of drug overdoses, which are now the leading cause of accidental deaths in the United States. In 2016 alone, roughly 115 Americans died every day from opioid overdoses. These staggering statistics should cause providers to be extremely cautious when prescribing pain medication and focused on the long-term health of the patient.

TALK TO YOUR DOCTOR ABOUT A RELIABLE PLAN

Anxiety surrounding the pain management process can factor in to a patient’s decision-making. Pain, especially cancer-related pain, is very real. Fearing this pain, an opioid medication’s appeal for quick relief cannot be underestimated. Furthermore, especially in older breast cancer patients, there is a high correlation between the number of patients extending the use of opioid pain relievers and those who also use medication for anxiety or depression. This information indicates that opioids, when mishandled, will likely perpetuate the physical and mental pain for which they are prescribed. To avoid dependence on a medication that is unreliable, talk to your doctor about other options for pain relief. Be your own advocate and speak honestly about the concerns you have and the research you have done. Most importantly, consider the long-term health of your body and the quality of life that you desire.

A NATIONAL SOLUTION

The American Physical Therapy Association (APTA) developed a national campaign, #ChoosePT, to bring awareness to physical therapy as an effective and safe treatment for pain. This is about avoiding the risk of creating a bigger life problem while trying to care for your body. On the front page of the #ChoosePT site, APTA writes, “When it comes to your health, you have a choice. Choose more movement and better health.” While treating the pain of a current problem, physical therapy will strengthen the body and reduce the risk of developing other chronic conditions in the future.

The Centers for Disease Control and Prevention (CDC) has also recognized the epidemic of our current environment of opioid use. As the national health protection agency, the CDC released a set of guidelines in March 2016 for prescribing opioids in the United States. Within the guidelines, the CDC writes, “Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.” There are multiple health treatment cases cited where opioids could have been significantly reduced or avoided altogether. Additionally, “there is high-quality evidence that exercise therapy (a prominent modality in physical therapy) improves function immediately after treatment and that the improvements are sustained for at least 2-6 months.”

When Christina Kuzma was diagnosed with breast cancer in February 2018, she was determined to save her life and preserve her health. She spent a lot of time that month researching the pros and cons of each known method for treatment. The best thing that you can do if you find yourself in a similar situation is to find a treatment plan that you are confident in and commit to that plan. To inform yourself on the topics we have covered, please include these sites and research articles in your own study:

America’s Addiction to Opioids: Heroin and Prescription Drug Abuse

CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

Move Forward. ChoosePT

Preparing to Fight

in Physical Therapy

In celebration of Christina Kuzma’s successful fight against breast cancer at the age of 33, Tx:Team brings you Part Two of our weekly series to share her experience making decisions about her treatment.

These days, Christina Kuzma is at work like usual, hosting meetings, educating whomever she can about Tx:Team services, and plugging in a radiation treatment where they fit. She’s doing extremely well but it has been a long road to get to this point. From her month of “scanxiety” in February after receiving her diagnosis to feeling like she’d been hit by a truck throughout her 4 months of chemotherapy, Christina faced incredible pains in her mind and in her body. But before she could tackle her cancer, she knew that she had to get her head right. Her motto was simple, which kept her focused: “I won’t back down.” And with that, she prepared herself to fight by placing her trust in the treatment plan and her physical therapy regime.

LIVING LIFE NORMALLY, BUT WITH A LITTLE EXTRA UMPH

If you’re already humming Tom Petty, you’re right there with Christina. Petty’s song, “I Won’t Back Down” strengthened her during the toughest weeks of chemotherapy. He’s a big deal in the Kuzma family. Just this past month, Christina’s daughter, at 3 years old, proudly declared that she was going as Tom Petty for Halloween.

Well, I know what’s right
I got just one life
In a world that keeps on pushin’ me around
But I’ll stand my ground
And I won’t back down

The Grateful Dead’s “Touch of Grey” was a second anthem. Some days, carrying on with normal activities during chemo was really hard. However, the sun was still shining and her heart was still beating, so Christina echoed Garcia: “I will get by, and I will survive this day!”

To keep things normal, Christina launched her favorite saying: “controlling the controllables.” Amongst the loss of control that is cancer, she took hold of what she could.

Most importantly, she continued working during chemo. She arranged Thursday infusions so that she could take Fridays off and rest over the weekends. Even so, Mondays were agonizing, and Tuesdays weren’t easy either- like “the worst hangover of your life.” To combat the soreness and fatigue, Christina picked up yoga. Yoga helped her stretch her aching joints. She also opted for cold cap therapy, a non-invasive scalp cooling technique. Keeping her hair was exactly the mind trick she needed. When she didn’t look sick, she didn’t feel as sick. She could look in the mirror and feel like herself. And that extra boost of energy during treatment made a world of difference.

CHRISTINA’S SURGERY

On August 10, 2018, Christina had a bilateral mastectomy and began reconstruction. Her breast surgeon removed all of her breast tissue and 4 lymph nodes to test for any cancer remaining after chemotherapy. Next, the plastic surgeon inserted expanders, which are temporary implants that stretch the skin and optimize radiation treatment. Christina verifies, “Expanders are about as comfortable as they sound. They feel like two bowls just sitting in your chest.” Finally, a drainage tube was inserted on each side of the breast to collect the fluid that gathers after surgery. Altogether, the surgery lasted 6 hours and left her body exhausted and in pain.

In typical Kuzma fashion, Christina focused on the best part of her surgery. She and her family had a small win to celebrate big time- the biopsied tissue came back with zero traces of cancer. Christina’s body had a complete response to the chemotherapy. She paused to reflect on the past months, and at 33 years old, watching as her life flashed before her eyes, she felt aged and wiser. The small stuff is everything, and you’ve got to appreciate the simple things that saturate life in emotion and meaning.

SHE CHOSE PT

Christina’s recovery began full-force on Day 1 in the hospital. The overwhelming pain that follows a surgery like the one Christina had can lead a patient to consider stronger medications for relief. Christina had concluded that stronger pain relievers would not serve her as well as physical therapy could in the long run. The day after surgery, Christina cut off her opioid pain medication, had her first meeting with a physical therapist, and began managing her pain with Tylenol. The therapist introduced exercises for her to practice 3 times a day and she progressed daily.

After all her body had been through in surgery, Christina started basic exercises to soothe her lymphatic system: stretching the neck, deep breathing, and massage. She also made a point to move her arms immediately. Even simple things like eating, brushing her teeth, and combing her hair were taxing. While on a bed, she held her arm above her heart for 45+ minutes. A specially created pillow helped to keep her arm in place, which significantly decreased swelling. And of course, the trusted Tx:Team stress ball came in handy. Katie Guerdan, Manager of HR at Tx:Team, dropped it off in a get-well basket with the challenge to use it. Christina built up to 25 squeezes. By Day 3 post-operation, she was able to begin chest exercises.

In 2 weeks’ time, Christina regained about half of her full range of motion and she could finally wash her hair by herself! A small, but huge win for Christina, for which she was so grateful. That weekend, with drains still in place, she was eager to get busy living. She went out with her family on their boat, content to watch the world around her, and appreciate getting back to living the normal life of Christina Kuzma.

Physical Therapy: A Better Solution for Pain

in Physical Therapy

In celebration of Christina Kuzma’s successful fight against breast cancer at the age of 33, Tx:Team begins a weekly series to share her experience making decisions about her treatment. Christina is the Manager of Business Development at Tx:Team, and more than that, she is the catalyst for making things happen – an entrepreneur, easily connecting with others and quick to inspire them to be their best. It’s no surprise then that when she was diagnosed with breast cancer, Christina explored all treatment strategies and committed to one that she believes in. She hopes that more people will consider her approach, especially if they find themselves in similar circumstances to hers in the beginning of 2018. Being honest about her “crappy 2018” is a strong suit, so we’ll come to understand how the months since Christina’s diagnosis on February 5, 2018, have pained her body, given life to the small stuff, and ultimately transformed her into a different person.

The Weekend Warrior and Olympian Champs All Rely on Physical Therapy

in General, Physical Therapy, Sports Injury

The Winter Olympics are starting! For an Olympic athlete, training is a year-round activity. But many of us non-Olympians go to the gym, work hard, and participate in recreational activities we love.

Olympians put a lot of stress and strain on their bodies. And so do we as weekend warriors. Odds are when you incur an injury, much like the Olympians, you will start a rehabilitation program. What are the differences? Not many! Your physical therapist is most times using the same treatment strategies that are used on Olympic athletes

Evaluation

Your therapist will evaluate your current status and work with you to develop a treatment plan based on your goals. They will ask you questions about your current lifestyle, routines, and history to customize an individualized plan unique to you. At each visit, your progress and treatment plan are reviewed and your therapist may ask you additional questions and adjust your goals to help you reach maximum success.

Remember, no matter your level, all athletes set goals.

Treatment Plans

Your physical therapist will take in account your current limitations and devise a plan to slowly and methodically reach your short and long-term goals. They will be careful to push you just enough so that you see progress without overusing those areas that you are seeking treatment. Just as Olympic trainers push their athletes to reach success.

Participation

When Olympians stop participating in the recovery plans, their chances of success diminish. Your active participation in your rehabilitation recovery is crucial. Communicating with your Physical Therapist about your daily routine, exercise habits, work schedule, and other obligations can help ensure you accomplish as much as possible during your Physical Therapy session. And they will always ask you about your Home Exercise Program so be sure you are keeping up with your plan. Your Physical Therapist expects you to reach self-management – actively maintain the strength, range of motion, and flexibility you have achieved.

Whether you’re a professional athlete, weekend warrior, or recovering from a recent fall, a sprain, or surgery, you can benefit from the same rehab strategies that help Olympians climb on top of that podium and achieve gold!

Specialized Wound Care in Rural Indiana

in Indiana, News, Physical Therapy, Rehabilitation

In 1908, twenty-six Putnam County female citizens started what would be the founding of a hospital to serve their family and friends. The hospital would offer solutions to their ever-changing healthcare needs, and would bring technologies only previously offered in larger cities to their rural community.

The team at Putnam County Hospital (PCH) provides comprehensive inpatient and outpatient physical, occupational, and speech therapies to the residents in Putnam County. Today, over 100 years later, one program in particular is a continuation of its founding females’ goal of bringing the latest in technologies to the hospital: Wound Care.

Wound care at PCH is a comprehensive team approach using the latest technology including treatment, nutrition, labs, radiology, surgical, and AOI services. With the newest technology and the vast experience of treating wounds, Putnam County Hospital Rehabilitation can treat the residents of the community locally without the need to travel to Indianapolis.

The PCH Team provides Wound Care Services that include but not limited to compression, specialty wound care treatments, swelling relief, education, debridement and modalities. The functional piece of the program is the continued monitoring and guidance with the specialty dressings used.

Wound Care services are so important to speed the healing of the wound and educate the patient from the wound returning in the future. The impact is better healing at a faster rate and return to prior function so they can return to a better life.

Terry Schaefer, PTA, WCC, CLT, CEAS, CCI, COF is no stranger to the current and innovative treatment with complex open wounds. Having spent 30 years treating wounds, he has learned the importance of using the most advanced equipment as Qoustic Ultrasound Machine. Terry is very passionate about the treatment of wounds and its possibilities for healing. He strives to help his patients to achieve their goals of healing and his varied background provides the perfect foundation for helping to achieve those treatment goals.

“Our goal is to speed healing in the best manner with the less impact on patient’s life.”

If one were to walk into the PCH gym, you would see a caring environment with lots of education about wound and wound healing and our team answering all patient questions. Treatment plans for wounds vary depending on the level of care needed. A typical plan would include treatment 2- 3 times per week for about 8 weeks.

Many patients do not understand the complexity of a wound, the way it affects their lifestyle, or the treatments that are available for them. As a clinician, the Wound Care Program has made Terry realize the varied degree of patient understanding and involvement with their wound care prior to treatment.

Our partner, Putnam County Hospital, knows for a fact that patients are getting the best wound care with the best equipment and technologies in Putnam county. It’s not uncommon for hospital employees to give referrals to patients. “Go see Terry!”

Putnam County Hospital is a critical access hospital committed to providing affordable, high-quality healthcare close to home. For more information about Putnam County Hospital and the expanded services and specialties now being provided, please visit www.pchosp.org.

Avoiding Sports Specialization to Preserve our Young Athletes’ Health

in Physical Therapy, Rehabilitation, Sports Injury, Wellness

Nicholas, Harbaugh, PTA

Sports Specialization has led to a trend over the past couple of years involving our young athletes: the increase in cases of injuries ranging from simple overuse to breaks and/or sprains. This increase in rate and number of injuries seen in young athletes, according to multiple studies, can be linked to the increase of sport specialization in children. Sport specialization is defined as “year-round intensive training in a single sport at the exclusion of other sports.”

Sport specialization has been associated with high volume training that can result is psychological and physiological stress in an athlete. This stress has been linked to an increased rate of burnout in athletes, as well as recurring and overuse injuries in multiple studies. Overuse injuries otherwise known as cumulative trauma disorders, are described as tissue damage that is a result from repetitive demand over the course of time. The term refers to a vast array of diagnoses: occupational, recreational, and habitual activities. Along with these studies the American Academy of Pediatrics (AAP) have released statements on their position against sport specialization to prevent these problems from arising.

Children were not always encouraged to specialize in a sport. A factor that may have contributed to this cultural change may be in part due to the increased pressure that coaches and parents place on their children to perform at a higher level to attain a collegiate scholarship or professional contract. In 1993, Ericsson and colleagues proposed a statement that in order for a musician to achieve mastery/expertise in that area you must practice for 10,000 hours. Parents and coaches have adopted this rule and applied it to sports to justify year-round intensive training. Many have adopted and applied this rule to athletes without realizing this was made primarily for musicians. These are high, sometimes costly, expectations for an athlete who performs repetitive, rigorous, sometimes high velocity movements and techniques year round without adequate rest time.

Some people ask “But doesn’t focusing on a sport make our youth excel at that particular sport?” Studies have shown that is not necessarily the case. Some studies have even shown that most multisport athletes (participating in 2-3 sports) show more promise to excel in a sport than a specialized athlete due to an increased overall athleticism and better gross motor function. Many professional and collegiate athletes were multisport athletes.

Examine the Ohio State varsity recruitment habits of coach Urban Myers as they depict a preference for the

There have been statements from multiple coaches, along with Urban Meyer’s graph, pertaining to their preference of multisport athletes for example

multisport athlete. According to Pete Carroll former USC and current Seattle Seahawks coach: “The first questions I’ll ask kids are; “What other sports does he play? Does he play ball? All of those things are important to me. I hate that kids don’t play 3 sports in high school…. I really don’t favor kids having to specialize in one sport.” Dan Starsia University of Virginia men’s lacrosse coach and Tim Corbin of Vanderbilt Baseball both concur with Carroll.

If this is the thought process of elite coaches, why, as parents, is ours so different? If the athletes goal is to play in college or to try and make it to a professional level, they need to have an all-around athleticism as most elite athletes do.

Examples of multisport athletes are:

Michael Jordan- Basketball and Baseball
Abby Wambach- Soccer and Basketball
Terry Bradshaw- Football and Baseball
Amy Rodriguez- Soccer, Swim, Softball, and Track
Tom Brady- Football and Baseball
Lauren Holiday- Soccer, Track, and Basketball
Babe Zaharias- Track and Field, Golf, Basketball, Tennis, Swimming and Volleyball
Wilt Chamberlain- basketball, volleyball and track

With many elite athletes being multisport, we need to get away from the thought process that sport specialization will make our children elite. In fact, sport specialization may be the reason a child does not get to that elite level. With burnout and overuse, reoccurring, and surgery required injuries, specializing in one specific sport may actually do more harm.

Year round training through a child’s growth spurt period places an increased work load on lengthening muscles and developing joints. During a growth spurt, performing consistent intensive training throughout the year will increase the stress that is placed on muscle attachments and the coinciding joints. This increased work load causes an increased risk of joint and ligamentous damage and injury. The more repetitive the motion…the more risk for overuse injuries.

Common overuse injuries associated with sport specialization are as follows with patellofemoral (knee) pain being the most prominent:

Osgood-schlatter disease
Sever’s disease
Medial epicondyle apophysitis
Distal radial physeal stress syndrome
Proximal humeral physiolysis
Stress fracture (e.g. spondylolysis)

A common overuse injury seen in pitchers, for example, is ulnar collateral ligament damage which can lead to having Tommy John surgery. This is the reason why we have pitch counts to limit the amount of stress placed on the elbow joint and the associated ligaments.

To allow proper rest time for the young athlete in organized sports, the AAP recommends

that children play multiple sports (2-3)
play no more than 8 months a year
play no more hours per week than the child’s age (13 year old =13 hours) with a maximum of 16 hours per week total.

You may ask: “What do I if my child is specializing in a sport or gets injured in that sport?” The first thing to do if a child is injured is to get them examined by an orthopedist or physician. Depending on the findings, the next step would be starting a physical therapy plan to address the injury and to examine the mechanics of the athlete and their sport. The physical therapist will help evaluate each athlete’s situation on an individual basis and help to prevent any further injury or re-injury.

If an athlete does not suffer from an injury requiring immediate attention, it is recommended that he or she see a physical therapist to examine their movement patterns and form as well to prevent an injury from occurring and needing any further treatment. Before an athlete gets to that point though, the change must start at home with parents and coaches encouraging children to participate in multiple sports as well as decreasing the amount of pressure to play. After all, the main purpose of participating in sports is for overall physical activity and health and most importantly, fun, and enjoyment!

Talk to your children about their goals and encourage them to participate in more than one sport. Once you know their goals, you will know what they want to achieve! Encouraging diversity in sports can help to decrease the occurrence of overuse injuries.

Nicholas Harbaugh is a Physical Therapist Assistant at FMH Rehabilitation Aspen Ridge Outpatient Clinic. Nick is experienced in treating orthopedic and sports-related injuries with traditional land therapy techniques as well as aquatic therapy.

Exercise During Pregnancy

in General, Physical Therapy, Rehabilitation, Wellness, Women's Health

Amelia Iams, DPT

aquatic exercise during pregnancy

Exercise is important to include in everyone’s daily life, but it becomes even more important when you are pregnant. Pregnancy causes many changes in a woman’s body. Hormone changes in the body cause softening of the ligaments, joint laxity, and instability in the ankles. Hormones and anxiety can be the reason for increased mood swings. Changes in the center of gravity due to a growing belly can cause increased occurrence of back pain. Increased retention of fluid in the body causes swelling in both the hands and feet and can amplify complaints of constipation.

Exercise during pregnancy provides similar benefits to your body as it does during other times in your life, but it also can prevent and minimize changes in the body and pain or discomfort that occurs when you are pregnant. Some of the proven benefits that exercise during pregnancy includes are:

Avoidance of excessive weight gain
Maintenance or improvement in endurance, muscle strength, and flexibility
Reduction of the likelihood of gestational diabetes
Decrease or reduction in symptoms of low back pain or pelvic girdle pain
Reduction in occurrence of preeclampsia
Decrease in the risk of cesarean delivery
Reduction in psychological stress

The American College of Obstetricians and Gynecologists (ACOG) states “for healthy pregnant and postpartum women, the guidelines recommend at least 150 minutes per week of moderate-intensity aerobic activity (ie, equivalent to brisk walking). This activity should be spread throughout the week and adjusted as medically indicated.” That is equal to about 30 minutes 5 times a week of moderate exercise. Research also indicates that including both strengthening and aerobic exercise to your routine is important to help support the changes that occur in your body with pregnancy.

Despite all the benefits to exercising while pregnant, most women do not begin an exercise program and those who were exercising prior to pregnancy actually decrease their activity during pregnancy. Through several studies and surveys, women have stated various reasons for decreasing their activity during pregnancy. The two most common reasons are: not enough time and pain with movement associated with the pregnancy.

Choosing an exercise program that is safe, can be maintained during the entire 40 weeks of pregnancy, and can fit into a busy work and family schedule is a difficult task. It is recommended that pregnant women avoid high contact sports and activities that have an increased risk for falls or impact, such as soccer, basketball, hockey, snow skiing, water skiing, and off road cycling. Exercises that require jumping and quick changes in directions, such as Zumba, Cross fit, and trail running, are not recommended due to joint instability brought on by hormones. Also high impact aerobics can be difficult to and uncomfortable to perform later in pregnancy.

An underutilized exercise avenue is aquatic exercise programs. Several research studies have advocated the use of pool exercises for women who are pregnant. The natural properties of water help alleviate many of the adverse changes associated with pregnancy. The buoyancy of the water will help to eliminate the stresses on the joints and to support the abdomen. Women have reported feeling more comfortable moving in the water and able to assume better postures as a result of the additional support. Hydrostatic pressure is an additional benefit when exercising in the water. The pressure that the water exerts on the body helps to decrease the swelling in the limbs brought on by pregnancy.

Aquatic exercise is non-weight bearing and low impact, so stress on the joints is minimized. Water provides natural resistance to movement which helps to strengthen muscles and thereby incorporating both strengthening and aerobic exercise into one session. This can help you meet both suggestions for a healthy body during pregnancy without increasing the time you spend at the gym. Many women stop exercising as their pregnancy progresses because of decreased balance, increased swelling in their feet, or pain and discomfort in their back. The water helps to support the body, and it is not likely that you will be injured falling in the water. Several studies have proven that exercising in the water during pregnancy helps to decrease low back pain and reduce time off from work due to pain and discomfort. There are many benefits to exercising in the pool that cannot be achieved with land based exercise, therefore making it an excellent option for women during pregnancy.

There are many fitness centers as well as physical therapy centers that offer aerobic exercise classes in a pool and individualized pool exercise sessions. Choosing the right one for you should be based on several factors, such as cost, location, available time, and expertise of the instructor. In some cases aquatic therapy can be covered through your health insurance when provided by a physical therapist. A physical therapist can help design an exercise program that is individualized to you. Other options to consider when choosing a pool are temperature of the water, depth of the water, and air temperature of the pool area. Exercising in the water decreases your ability to sweat but there is increased loss of heat through skin contact with both the water in the pool and the air temperature difference in the pool room. It is recommended that pools utilized for aerobic exercise for pregnant individuals be at about 80-86 degrees Fahrenheit. Most pools at a gym are cooler to allow for longer time and more intense exercise while therapeutic pools at rehabilitation clinics will be warmer and offer increased comfort for those suffering from back pain.

Safety and monitoring your exercise regimen in the pool is important. The properties of water will naturally decrease the heart rate by increasing the volume the heart pumps out. If you use your heart rate to gauge your exercise, it is suggested that you decrease your heart rate guidelines by 15 beats per minute. When exercising in a pool is better to gauge your exercise intensity by using a scale called Borg Rating of Perceived Exertion. A physical therapist can provide you with the scale and educate you on how to use it. Dehydration with exercise can occur in the pool as easily as it can on land. Having access to water during exercise can be important to avoiding any complications with exercise.

All exercise programs are most effective when you can choose an activity they enjoy and a program that is individualized to your needs and goals. We highly recommend water aerobics or any aquatic exercise for women during pregnancy. Aquatic exercise is an exercise program that women would be able to follow throughout the entire 40 weeks of pregnancy.

Amelia Iams, DPT is a Physical Therapist at FMH Rehabilitation Aspen Ridge in the treatment and management of sports related and orthopedic injuries.

Aquatic Therapy Can Help Get You Back to…

in General, Physical Therapy, Rehabilitation, Sports Injury

There is no worse feeling than the aching pain that won’t go away, prevents you from accomplishing everyday tasks, and keeps you from doing the activities you love. If you have recently been injured or identified with having a debilitating diagnosis, aquatic therapy may be your answer to a pain-free lifestyle and get back to the activities you enjoy.

Diagnoses for Patients who benefit from Aquatic Rehabilitation

Spinal Issues: Thoracic, Cervical, and Lumbar Spine Issues, Posture Issues, Spine Compression Fractures, Herniated Discs, and Spinal Stenosis

Imagine you are floating vertically in the pool using a floatation device. Since you are not touching the bottom, the water decreases the effect of gravity on the spine and creates traction. This process removes the pain you are feeling so you can now focus on learning the therapist’s exercises and doing them appropriately. Core stabilization will be the focal point of your exercises as it permits increased trunk/back movement with less pain due to the warmth, buoyancy, and pressure of the water.

Lymphedema Issues

If you have lymphedema issues, you may be experiencing swelling in your extremities. When you find yourself in the SwimEx Pool, you will notice a decrease in the swelling due to the hydrostatic pressure, making it easier and less painful to do strength exercises. This decrease in swelling will also make walking much easier.

Foot and Ankle Issues: Achilles Tendon Repairs or Tears and Toe, Foot, or Ankle Fractures

Typically, your doctor will give you weight bearing restrictions and you will most likely need a device to assist you while you walk and/or a boot. However, due to the anti-gravity properties of the water, you would not have to adhere to the restrictions. Other positive effects would be a decrease in swelling and less painful side effects. The pool helps you recover much faster because it allows you to work on balance in the early stages of recovery. Normally, patients have a hard time working on this if they are not in the pool due to the stress and pain of their foot or ankle.

Knee or Hip Replacements: ACL Repairs, Arthroscopic Repairs of Hip/Knee, and Patellar Tendon Repairs

The water provides a good environment to work on range of motion, stretching, and strengthen of these tender areas. An important distinction between aquatic and land therapy is the level of soreness associated with each, with aquatic causing much less soreness. Also, aquatic therapy allows you to perform most exercises sooner than on land with much less pain, getting you back to normal in much less time.

Fibromyalgia and Chronic Pain patients

Normally physical therapy is the last straw for this type of diagnosis. However, physical therapy in the pool should be one of the first choices since it will help you build stamina, endurance, and strength and manage your pain.

There are many more diagnoses that can be treated utilizing aquatic therapy. If you are not able to tolerate the pain associated with land therapy, aquatic therapy is an excellent alternative due to the anti-gravity environment. You will feel less pain and pressure in the pool and be able to make progress sooner than typical land therapy.

Get the therapy you need so that you can get back to your day-to-day routine and the actives you love. The goal of any rehabilitation team is to get you back to doing the activities you enjoy. Swinging a tennis racket. Walking through the woods. Peddling a bike around town. Pushing a cart down the grocery aisle. Even folding laundry! No matter the activity, enjoy life!

The ultimate goal of any therapy program is to get you back to _______ . What is your blank?

Contributors: Morgan Thompson, Amelia Iams, DPT, Cynthia Brendle, PTA

Does your Bladder Dictate your Life? Let’s talk.

in Physical Therapy, Rehabilitation, Wellness

May 8^th through the 13^th is Women’s Health Week and the goal is to empower women to make their health a top priority and educate on the steps women can take to improve their health. During the week, you can get the answers to top questions that are asked about Women’s Health.

~Lynne Schill, Physical Therapist, Guest Author

Lynne Schill is a Women’s Health Physical Therapist at FMH Rehabilitation Women’s Center Crestwood. She has experience in treating women’s health diagnoses and has found this work to be extremely rewarding because of how significantly it can improve quality of life. Her compassionate nature coupled with an incredibly warm bedside manner inspires confidence, determination and empowers the individual to become proactive in their own recovery.

Does your bladder dictate your life? Do you have to plan your day around where the next bathroom is? restroom sign Are you afraid to leave your home for fear of not making it to the next bathroom or leaking? Do you feel something bulging in your vagina or have you been diagnosed with pelvic prolapse? Do you suffer from pelvic pain which affects your lifestyle and intimacy? Do you skip the jumping jacks or walk instead of run during your exercise routine?

May 8th through the 13th is National Women’s Health Week with the goal to empower women to make their health a top priority and to educate women on the steps to take to improve their health. Women’s issues are important and most women suffer needlessly because they are not aware of the rehabilitation programming designed especially for women.

So, did you answer yes to any of the questions above? If so, you may be a candidate for women’s health physical therapy! Physical therapy (PT) is a great alternative for women who don’t want to take medication and want to avoid surgery for incontinence, pelvic pain, and pelvic prolapse. Don’t let your bladder dictate your life or continue to suffer from pelvic pain, which can affect your lifestyle and intimacy.

Women often suffer in silence, not mentioning these problems to their healthcare provider and think they just have to “live with it”. However, there is hope—and help available, with physical therapists who have been specially trained to treat these conditions.

According to the National Association for Continence (NAFC), 26% of women between the ages of 18-59 have involuntary leakage, 20% of women over 40 also have overactive bladder, and 66% of women and men ages 30-70 have never discussed their bladder health with a healthcare provider.

It’s time to start the conversation!

My incontinence…

There are three types of incontinence: urge, stress, and mixed (which is combination of the first two).

Urge incontinence is when there are strong urges to urinate even though the bladder may not be full and there is an increased frequency of urination. Physical therapy treatment approaches include filling out a detailed three-day bladder log. Information gathered in this log includes the number of voids per day and night, how much is voided, what the patient was doing at the time, determining if the patient is drinking enough water, and identifying any dietary triggers. Often, eliminating bladder irritants from the diet including caffeine, alcohol, citrus, carbonated beverages, and artificial sweeteners can help decrease or stop the problem. Smoking can also be a factor, as can constipation.

Running to the bathroom and frequent emptying ‘just in case’ can actually make the problem worse. Teaching patients urge control techniques including standing or sitting quietly, doing a few quick Kegel contractions, and deep breathing can help decrease the urge. Another mistake women make is restricting their fluid intake. This can not only lead to dehydration, but it can also cause the urine to be more concentrated, which can be irritating to the bladder lining and lead to further urgency.

Urge incontinence and overactive bladder sufferers can benefit from physical therapy relaxation techniques including deep breathing and nervous system quieting in order to help calm the bladder.

Stress incontinence happens with coughing, sneezing, laughing, exercising, or lifting. The increased pressure in the lower abdominal and pelvic region can cause leakage because of weakened pelvic floor muscles. Pelvic floor muscles provide support to the pelvis and pelvic organs. One exercise many women know that can help strengthen the pelvic floor is Kegels. However, it might be surprising to know that more than 50% of women perform Kegels incorrectly! A physical therapist can educate you further on pelvic floor anatomy to help identify which muscles you need to be contracting, how to isolate the contraction in order to do a correct Kegel, and then advise you on a home exercise program. Strengthening the pelvic floor and lower abdominal muscles is especially important for this type of incontinence. Also, modifying activities and exercise by avoiding a lot of heavy lifting, jumping and running can decrease symptoms.

My pelvic prolapse diagnosis…

Pelvic Prolapse is when a pelvic organ—such as your bladder, rectum or cervix—drops from its normal position. If you suffer from pelvic prolapse, you may benefit from postural education, strengthening of the pelvic floor muscles, activity modification, and positioning techniques to help reduce prolapse symptoms. Eliminating constipation is also important; a physical therapist can teach strategies to achieve regularity in order to avoid bearing down hard, which can potentially increase prolapse.

My pelvic pain…

Pelvic pain can be another life-changing problem for women—causing problems with simple daily activities and affecting intimacy. Pelvic pain and pelvic discomfort can be associated with menopause, post hysterectomy and other surgeries, trauma/injury, pregnancy/child birth, and pelvic malalignment. A physical therapist performs a thorough assessment and develops a program to meet individual needs. Treatment may include hands on soft tissue techniques, biofeedback, and/or relaxation techniques.

Biofeedback is a valuable tool that is used to assess the muscle activity of the pelvic floor muscles and helps patients recognize when their pelvic floor is relaxed versus in a contracted state. While being coached by a physical therapist, the patient can become more aware of the pelvic floor muscles and how to use them via visual feedback.

Ask yourself, “Would I like to improve my pelvic health and quality of life without surgery or medication?” It’s time to do something about it and Women’s Health Week is the perfect time to start!

A Physical Therapist trained in treating pelvic floor dysfunction is available for your specific needs and diagnosis. Your bladder doesn’t have to dictate your daily routine; you don’t have to live with pelvic pain in silence. You deserve your life back!

Tx:Team Women’s Health Physical Therapy programs can be found at FMH Rehabilitation in Frederick, MD, St. Vincent Frankfort Hospital in Frankfort, IN, and St. Vincent Jennings Hospital in North Vernon, IN. Ladies, it’s time to take the steps to improve your health and Women’s Health Week is the perfect time to start!

My First Women’s Health Visit is Today

in General, Physical Therapy, Wellness

What would I expect on my first visit?

In the first visit, a lot of history taking is done! The more history on the issues that the patient has, the more information can be gathered to work on the best plan of care.

You will be taken to a private treatment room where all you will receive one on one treatment. An extensive personal medical history will be taken as well as a thorough physical assessment of both external structures and internal structures. From there, your plan of care will be discussed and patient centered goals will established.

How long would my physical therapy treatment last?

The initial evaluation will be approximately an hour. Follow up visits will vary depending on your need and pain level. As the pain begins to subside, frequency of visits will be gradually decreased.

What will happen during therapy?

This depends on the diagnosis. During the first couple of follow up visits, you will receive a lot of patient education surrounding your anatomy so you may visualize and understand what area of the body and which muscles specifically we will be targeting. Your treatment plan might also consist of biofeedback, manuals therapy, and a home exercise program.

You will always be in a private room due to the sensitivity of the situation. Even if no internal work needs to be done, a private setting will allow you the freedom to discuss everything openly with your therapist.