The Value of Physical Therapy in Osteoarthritis of the Knee

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Osteoarthritis of the knee is the most common type of osteoarthritis, or OA, in the United States. According to the American Physical Therapy Association (APTA), nearly 12.4 million Americans ages 65 or older suffer from symptoms of knee OA, including morning stiffness, pain during or after activity, discomfort after sitting, knee popping or grinding, swelling, and joint tenderness.

Physical therapy is a proven, effective treatment for knee OA. The goal of treatment is to reduce pain, get you moving again, and help you enjoy life’s little pleasures — whether that’s a walk in the park or dancing at a family gathering.

The APTA’s 2023 report highlighted the cost-effectiveness of treating knee osteoarthritis with physical therapy. They used quality-adjusted life years (QALYs) to measure both how long someone lives and their quality of life, making it easier to compare treatments like reducing pain or improving mobility. On average, physical therapy for knee osteoarthritis provides a net benefit of nearly $14,000 per episode of care, including all the hidden costs of your time, pain, missed life events, and the dollars paid for services. Compared to steroid injections, patients who received physical therapy had a 0.07 higher QALY, with only a slight increase in medical costs.

Physical therapy offers patients valuable benefits, including knowledge to help reduce the risk of opioid addiction and cost savings by avoiding invasive steroid injections and surgeries. Additionally, it provides long-term advantages such as improved mobility, balance, strength, and flexibility. These enhancements contribute to better overall health and a lower risk of developing conditions that may require additional healthcare services in the future.

Your physical therapist can refer you to an orthopedic surgeon to discuss your options for dealing with knee OA. If you choose surgery after consulting with healthcare professionals, physical therapy plays a crucial role in both preparation and recovery, as noted by the APTA. Pre-surgery physical therapy (“prehab”) helps improve strength and flexibility, setting you up for a smoother recovery. After surgery, your physical therapist will create a personalized program based on your condition and goals to help restore function and mobility.

If you’re dealing with knee OA, give physical therapy a try. It’s an investment in getting back to the things you love without pain.

You Take that First Step and OUCH

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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.

April is Parkinson’s Awareness Month – #Take6forPD

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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.

Female Athletes and ACL Prevalence

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As a former female division 1 gymnast, I personally experienced and witnessed many types of injuries. I had a few teammates who had recurring injuries that impacted their ability to continue the sport they loved. Seeing the sub-par rehabilitation process in a college setting without physical therapy interventions available, re-injury was extremely common. Many of these recurring injuries involved the knee and internal knee structures such as the ACL, PCL, MCL, and LCL. 

ACL injuries are becoming more and more common in the young athlete, but did you know that female athletes are up to 10 times more likely to experience an ACL injury compared to men? This may be due to the anatomy and biomechanics of the female knee joint. Often due to wider hips and a smaller groove at the bottom of the femur where the ACL inserts, the ACL in the female knee may experience greater stress and further restriction during twisting, jumping, changing direction, and landing movements compared to men. Other contributors to increased risk of injury include weakness of the posterior chain musculature (glutes and hamstrings) and ligament laxity during hormone cycles. Recent studies have found that woman may be more susceptible to ACL injury just prior to ovulation compared to the follicular phase due to increased ligament laxity.

The most common form of treatment following ACL injury is a reconstructive surgery using a graft from either the patient’s own patellar tendon, hamstring, or an ACL from a cadaver. Although an athlete may go through ACL reconstruction, it does not guarantee normal functions of the knee or prevention of subsequent knee injury. In recent studies, it has shown that about half of athletes who underwent ACL reconstruction return to high level sports, and only about 20% of these younger athletes will return to higher level sports in the first year following injury. Given these findings, it is extremely important that ACL rehabilitation encompasses deficits related to surgical interventions as well as initial cause of injury occurring prior to surgery.

Current generalized ACL rehabilitations programs may not have all-inclusive motor training, and neuromuscular re-education needed to safely allow return to sport within one year’s time. It has been statistically proven that proper recruitment and strength of the posterior chain as well as muscles that stabilize the knee will decrease risk of  re-injury in the young athlete with a prior ACL tear. Physical therapists have the training and knowledge to specifically pinpoint weakness and instability within the hip and knee complex, analyze gait and movements patterns, and build sport specific training programs to assist in injury prevention of the young athlete. 

In early rehabilitation, it is crucial to protect the graft site, and begin regenerating the quad musculature. Research shows that following knee injury or surgical interventions there is a reflex response to inhibit muscle activation called Arthrogenic Muscle inhibition (AMI). Physical therapy can assist in targeting the muscles that have been affected during this reflex inhibition process. Some examples include quad setting, resisted terminal knee extension, straight leg raises with a knee extension brace until the patient can complete a straight leg raise without knee flexion. Other exercises to assist overall hip and knee stability include closed chain activity such as partial squats, step ups, single leg balance activities, and bridges. It is critical for the physical therapist to ensure the patient is completing exercises without compensatory strategies and progressing toward proper movement patterns. 

Due to the high prevalence of re-injury, as well as muscular inhibition following knee injury, it is highly recommended that athletes, specifically women receive intensive rehabilitative care following ACL repair. Without specific neuromuscular re-education, proper movement pattern restoration, and addressing pre-injury mechanical deficits, young athletes are at risk for re-injury or significant time lapses as they attempt to return to sport. Physical therapy can provide young athletes with the education and tools they need for success as they return to the sports they love. 

Amanda Lievendag, DPT, CMTPT is a Physical Therapist in the outpatient setting at Frederick Health Physical Therapy & Sports Rehab. Amanda’s professional interests are Sports Orthopedics, Sports Rehab, Trigger Point Dry Needling, and Spine Rehabilitation. She is a high energy physical therapist who has specialized experience with post-op, sports injuries, return-to-sport training, overuse injuries, and general wellness with athletes and patients of all ages.

 

The Importance of Rehab When Recovering from Covid-19

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Patients recovering from Covid-19 experience a variety of negative side effects, both cognitive and physical, and without rehabilitation, those side effects can continue for much longer if not permanently.

In a study published by The Lancet, 76% of Covid-19 patients reported that they were still experiencing at least one symptom associated with the Covid-19 six months after they were discharged from the hospital, including 63% who reported experiencing fatigue or muscle weakness at the time of the evaluations. According to the researchers, fatigue and muscle weakness were the most-reported symptoms among the participants at the six-month follow-up evaluations.

Fatigue and muscle weakness are two main physical symptoms that patients experience during and after being diagnosed with Covid-19. After only three days in the ICU, a patient may lose up to 9% of muscle mass, while some reports indicate brain scans resemble that of a traumatic brain injury. That’s where the role of rehabilitation comes in.

“It’s important not to wait (to start rehab) – the longer you experience muscle atrophy, it becomes a vicious cycle,” said Rich Stieglitz, Director of the Department of Rehabilitation at Tx:Team in Frederick, MD. “If you’ve become deconditioned and weak, you could start to experience back pain and joint pain; you’re at risk to hurt yourself if you’re not strong enough. When you don’t feel good, you don’t move. When you don’t move, you don’t feel good. It’s important to get your body systems going, being able to move and move correctly.”

Rehab in the Hospital After a Covid-19 Diagnosis

After being diagnosed with Covid-19 during the acute phase, it’s important to start exercises in small doses. “The more exercises they can tolerate in short stints, the better their lung capacity can be,” said Stieglitz. “We work with patients all the way from being on ventilators to getting out of bed to walking. When you’re hospitalized due to Covid-19, your strength and endurance is compromised, you need assistance. And because of the addition of Covid fog, you lose the ability to think and connect all the dots. If a patient doesn’t have any strength and they’re gasping for air, it’s hard to tell them to turn over in bed – we have to show them. Simply sitting up and not falling over is a challenge. We’re trying to protect patients.”

Outpatient Rehab for Recovery 

After leaving the hospital, it’s important to address everything from fatigue to depression in Covid patients. While we have the ability to do rehab in-person, patients can also choose to do their rehab through telehealth in the comfort of their own home during the quarantine phase for early intervention. Through telerehab, we can work on strength, endurance, cognitive, and respiratory functions with patients through physical, occupational, and speech therapy.

Covid-19 Rehabilitation

When it comes to rehabilitating a patient during or after Covid-19, there are a variety of exercises available. “Depending on the patient’s ability, we’re going to focus on generalized strength training and endurance,” said Stieglitz. “It might be a challenge to walk to the mailbox for a patient, maybe you can’t carry in your groceries. We’ll assess a patient from a functional standpoint and then work to simulate tasks that you used to be able to do but can’t do now.”

Covid rehab starts with breaking down the activity or exercise to its sub-components to strengthen the pieces a patient is struggling with and increase their function. For example, if a patient is getting winded walking a flight of stairs, a therapist can work with them to walk on a treadmill or walk against water currents in a pool.

“There are lots of techniques to try to make it fun and encouraging,” said Stieglitz. “We want to set them up for success and engage the patients so they can see their progress. It’s all designed at returning to what they were doing before they got sick so they can return to their job or recreational activities. Let’s get motion back into your life while we monitor your blood oxygen levels, blood pressure, and vital signs to make sure you’re okay and won’t crash. Covid knocks you down and we want to make sure patients are safe.”

Is It Safe to Go to Rehab?

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Many people are wondering…is it safe to go to a therapy clinic? During the pandemic, many people have adjusted their lives; working from home, less social activities, and simply staying sedentary on the couch.

All of these lifestyle changes can result in an increase of mild and chronic pains as well as a decrease in functional abilities. This is where physical therapy, occupational therapy, and speech-language pathology can step in and help.

Delaying procedures, reducing spending on preventive care and chronic care could and oftentimes causes negative long-term impacts on a person’s health. A survey by the Alliance of Community Health Plans (ACHP) found…

  • 72% said that the pandemic has in some way impacted their health care.
  • 41% have delayed care during the pandemic.
  • 53% of seniors have delayed care.
  • 60% with chronic conditions have delayed care.
  • 38% will continue to delay care in the near future.

Physical, occupational, and speech therapists are considered essential workers and have played an important role throughout the pandemic. Therapists’ treatment plans are individualized and specifically address function to improve a patient’s quality of life while also treating pain and preventing future problems.

There are many conditions that physical, occupational, and speech therapists can treat to help patients avoid hospital visits. Therapists have been identified as professionals who can effectively deliver interventions to not only help patients with chronic pains which have been mounting up over the past months but they can also help those suffering from anxiety and depression, which has become more prevalent during COVID-19.

Fortunately, we don’t have to change our clinic practices during this time because we have always operated in a one-on-one capacity with our patients.  Tx:Team is also ultra-focused on the safety of our patients and our clinics by social distancing from other patients and following all recommended CDC guidelines. Our clinics are working extremely hard to ensure cleanliness for each patient through proper sanitation; all equipment and areas are sanitized after each patient’s treatment. Our therapists are also well-trained on the use of PPE and hand hygiene.

Our treatment philosophies remain the same – you will continue to get the same great service individualized for you in a one on one atmosphere that we have been delivering since 1983. Don’t ignore or delay possible care for a condition that physical, occupational, or speech therapy can help.  Come back to rehab confident that your safety and care is our top priority.

The Lymphedema Superheroes among us

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Today, Tx:Team celebrates Lymphedema Day and the work of therapists to serve those living with Lymphedema. Physical Therapists and Occupational Therapists perform really incredible work so that their patients regain the strength and confidence to live a life they thought was out of reach. One of our own therapists, Amy Rutherford, pursued a specialty in Lymphedema therapy early in her career, and today, we highlight the care and compassion that she provides to the residents of Frankfort, Indiana.

Amy works at IU Health Frankfort Hospital, located about an hour northwest of the state’s capitol, Indianapolis, in its more rural Clinton County. In her area, she mostly sees Lymphedema patients coming in with swelling of the lower extremities from COPD and diabetes. For Amy, she appreciates how simple lifestyle changes can greatly affect her patients and reduce the burden of Lymphedema on their lives.

What’s Lymphedema?

Lymphedema is a diagnosis of body swelling that is caused from damage to the lymphatic system. Whereas healthy bodies can manage their fluids and dispose of waste properly, bodies with damaged lymph nodes can build up the fluid that would normally be filtered out. On the outside, we see that buildup of fluid looking like an arm or leg that’s been blown up like a balloon.

In early stages, Lymphedema is easily treatable and reversible. However, the signs of this stage are so subtle that they can be very difficult to detect. A patient might feel tight in clothing or they’ll need to loosen the notch of their wristwatch. By the time the body is noticeably swelling, Lymphedema has typically progressed into a lifelong chronic condition that can significantly interfere with someone’s quality of life.

How does Lymphedema affect a person’s life?

A swollen arm or leg can make it difficult for a person to get dressed in the morning because their body is heavier, and they might not fit in the clothes they usually wear. It can be more difficult to do some of life’s basic routines, like bathing, for example. Little things that we don’t think about in our everyday lives- like washing our feet- can suddenly become near impossible because it’s too straining to reach passed the swelling to the feet.

It’s not just a physical condition. You can imagine that not being able to fit in your normal clothes and going out in public with a large swollen arm could affect your self-confidence. And if you can no longer wash your feet, you probably feel less clean than you’d like to be. For these reasons, Lymphedema can take a toll on a person’s mental health. Feelings of embarrassment and depression can creep in and linger throughout the day.

Just about all superheroes don’t wear capes.

Day in and day out, Amy is committed to making her patients feel healthy and great about themselves. She provides not only her expertise, but also compassion for her patients’ lives. When a patient arrived unable to properly clean himself, she knelt down to wash his feet. Really wash his feet of likely weeks of grime. “Cleaning a patient,” she says, “is work that really creates a bond. It’s work that reminds you of the biblical act of washing feet to show your care for another.” Encouraging patients to use proper soap and lotions, like Dove and Eucerin, and getting them to be a little more active in their day has undoubtedly improved the lives of many. We remember how simple, yet genuine care can impactfully change lives.

So today, we thank Amy Rutherford for almost twenty years of work in her field. Lymphedema is a debilitating and frustrating condition that can bring a lot of pain into patients’ lives. Therapists like Amy, who have committed themselves to treating Lymphedema, offer support that restores independence and dignity to those they serve.

Amy is just one of our Certified Lymphedema Therapists. We are thankful for all our CLTs and the work they do.

 

Specialized Wound Care in Rural Indiana

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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

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.

Baby-Led Weaning A Developmental Perspective

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Baby-led weaning.  Every parent has experienced the scenario. Seated comfortably at dinner with their six-month old baby in his high chair, a mother and father look over to see the face of an infant who wants nothing to do with his puréed carrots. He wants only one thing: their grilled chicken and steamed green beans. So, what’s a parent to do? The infant is at an age when pediatricians say that parents can start to offer smooth, blended (puréed) foods as a way to introduce different flavors. Yet some parents feel that, if their infant shows interest in solid foods, he or she must be ready for those foods.

baby-led weaning

Does your baby show interest in a new food?

Baby-led weaning (BLW) is an infant-driven feeding approach in which the parent offers the infant any food in which he or she shows interest. This could include, but is certainly not limited to, raw apples, french fries, potato chips, fish sticks, pieces of grilled chicken, and carrot sticks. Many parents report success with BLW, though studies have demonstrated an increased risk of choking using this approach. But why?

 

Each parent has to decide what works best for their child. (Parenting seems to be an endless series of decisions, does it not?) As with all decisions in parenting – bottle vs. breast, pacifier vs. no pacifier, co-sleeping vs. separate crib, Baby- Led Weaning vs. progressive textures – it’s important to have the facts. Once we have the facts, we as parents can make educated decisions about what’s best for our family and our little ones.

When deciding if BLW is right for your infant, there are many points about normal development that are important to consider. A large number of developmental factors play a role in an infant’s feeding progression. These include: vision (the infant’s ability to see the food), sensory input (the infant’s ability to distinguish different colors, tastes, smells, and textures of various foods), trunk control (the infant’s ability to sit up and support himself, promoting a safe, upright position for eating solid foods), and fine motor skills (the infant’s ability to hold a piece of food in his hand and bring it to his mouth).

While  all of these are important, some of the most critical developmental milestones to be aware of when considering BLW are those associated with the progression of oral motor functions. In order to safely chew and swallow foods, a person’s oral motor skills must be refined about to be able to 1) keep the food in his mouth, 2) move the food forward and backward, as well as side to side using his tongue, 3) chew the foods in a rotary pattern (this is a circular chewing pattern, like a cow chewing cud, not just munching or smashing the foods against the roof of the mouth), and 4) be able to purposely move the food backward in the mouth using the tongue.

Below are the milestones related to oral motor development that are important for readiness for solid foods (not just liquids or purées):

  • 0-4 months: During this time, infants continue to develop reflexes that protect their airway and prevent choking. They are able to coordinate two to three sucks from a nipple or bottle prior to swallowing, and respond with consistency to stimulation provided around the mouth (for example, a pacifier or toys).
  • 4-6 months: Infants continue to develop the ability to move liquid and watery purees backward in the mouth with their tongues, though these textures continue to move backward primarily through pressure within the mouth when the lips are closed. The tongue begins to move items back and forth (but not yet from side to side, which is important for being able to effectively chew.) Around six months, a primitive “munching” pattern may begin to emerge. This marks the first step toward a rotary chewing pattern.
  • 6-9 months: This is when developmentally mature movement of a bite of food from side to side in the mouth occurs. Infants are able to transition slightly more textured foods forward and backward, side to side in the mouth, and demonstrate emerging ability to chew these foods. Infants continue to move food to the back of the throat to swallow primarily via pressure within the mouth, rather than coordinated tongue movement. The primitive munch continues to be refined.
  • 10-12 months: Infants develop the ability to lick food off their lips effectively. Biting becomes more isolated, which is important in development of rotary chewing. Rotary chewing begins to emerge toward the end of this timeframe, but continues to be refined from 12-24 months. By this age, infants demonstrate the ability to move foods from side to side in their mouths without difficulty.
  • 14-16 months: Infants are able to chew and move firmer and more textured bites of the food throughout the mouth. By this age, they are able to reliably keep a bite of food in the mouth (hooray for no more bibs!)

All of these abilities (containment of a bite in the mouth, moving a bite forward and backward, moving a bite side to side, rotary chewing, active rather than passive movement of a bite backward to swallow) should be present for chewing and swallowing of solid foods to be considered safe.

You know your baby best. You are also in the best position to make the safest choice based on his or her abilities and whether BLW is right for your infant. If you have any questions, consult with your trusted medical provider.

Lauren Most, CCC-SLP, is a speech-language pathologist for Tx:Team partnered with Frederick Regional Health System. She received her Bachelor’s degree in speech-language pathology from Loyola University in Maryland, and her Master’s degree from the University of Maryland, College Park. Her work includes providing services to infants and toddlers in the neonatal intensive care unit and the community who have difficulty with feeding and/or swallowing.

Avoiding Sports Specialization to Preserve our Young Athletes’ Health

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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.

sports specialization

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

young athlete

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.