If you’ve been to physical therapy, you likely got a home exercise program. Research says that if you do your home exercise program, you’ll have a significantly better chance of meeting your goals and feeling better. Not doing your program increases the risk of recurrent injury or flare-ups with less positive outcomes long term. Even though they’re important, adherence to home exercise programs is terrible. It’s estimated that only 40 to 50% of patients do their exercises the way they’re supposed to. What can you do to make sure you do your exercises and get the best outcomes? Here are a few ideas.
Plan ahead
Think about what’s going to get in your way – your schedule, that you’ll forget, or that you don’t have the space or equipment that you need. Once you figure out the problems, come up with solutions. Put your exercises in your schedule, talk to your PT about equipment, or adjusting your program to fit the time you have. If you solve problems before they start, they’re no longer problems.
Address pain and beliefs
You’ll need to work with your PT on these. If your exercises cause pain, you’re not going to do them. When your PT prescribes your exercises, try them out. If there’s pain, ask your PT about modifications to make them more comfortable. The other thing might need addressed are your beliefs. If you believe that the exercises won’t help, or that they’re a waste of time, you won’t do them. Again, work with your PT to understand why they’re prescribing those exercises, and what they’re meant to do. Once you know why you’re doing those exercises, you’re more likely to do them.
Get support
People who have social support are more likely to do their exercises. This is why CrossFit and group exercise classes work. Find a family member or friend to help you stay consistent with your exercises. Your PT can help here too. Have someone ask if you’re doing your exercises, and how they’re going. This will keep you accountable and more likely to do them.
Use Technology
If you like technology and gadgets, they can help you be consistent with your exercises. There are plenty of apps that can track your exercise. Seeing that streak of days you’ve exercised will motivate you not to break it. Smartwatches and activity trackers can fill the same role.
Doing your home exercise program will help you get the most out of PT. With a little planning and a little help, you can make sure you’re one of the 50% of the people who do their home exercises consistently to get the best outcomes.
References:
https://pubmed.ncbi.nlm.nih.gov/32669487/
https://www.physio-pedia.com/Adherence_to_Home_Exercise_Programs
PT – Not Just For Adults
When you think of physical therapy you might think of an injured athlete, someone recovering from surgery, or someone with a chronic medical problem. We’re here to let you know that you should think of kids, too. Physical therapists are trained to work with patients of any age. Some even specialize in pediatrics. Here are a few things PTs can help kids with:
Coordination Disorders and Gross Motor Delays
Some children are delayed in hitting their gross motor milestones – things like sitting up on their own, rolling, standing, walking, jumping and running. Other children show difficulty with coordination – activities like hand motions to “wheels on the bus”, feeding themselves with utensils, moving awkwardly or slowly, or even tripping or bumping into things a lot. Physical therapists can help encourage development of gross motor skills and coordination to help these kids get back on track.
Cerebral Palsy
This is the most common motor disability in childhood. The symptoms can vary from moving a little awkwardly to being unable to walk and needing assistance for almost all activities. There are also different types – the most common causes stiffness in the muscles, but other types affect control of movements, balance or coordination. No matter the type or severity of cerebral palsy, a physical therapist can help with things like stretching, exercise, bracing, and equipment like a wheelchair if needed.
Torticollis
Torticollis is a postural issue that usually becomes noticeable shortly after birth. Babies with torticollis typically hold their heads tipped one direction and rotated towards the opposite side. This is caused by a tight neck muscle. Research has shown that early referral to a physical therapist is a very effective treatment. The PT usually shows the baby’s caregivers ways to gently stretch the neck, and activities to encourage the baby to move his or her head into a more neutral position.
Pelvic Floor Issues
People don’t commonly think of pelvic floor issues in children, but you might be surprised at how common they are. The most common symptom is chronic constipation, but pelvic floor problems can also show up as urinary incontinence, bed wetting, or needing to go to the bathroom frequently. A physical therapist can help with education for the child and their family, exercise, and sometimes even the use of biofeedback to help the child learn to better control their pelvic floor muscles.
Pain and Injuries
Although kids have a list of problems specific to them, don’t forget about regular old pain and injuries. Your physical therapist can treat an ankle sprain, painful joint, or athletic injury in a child just like they can an adult.
Sometimes kids and even babies need some help with movement. From now on, when you think of your physical therapist, don’t leave kids out of the picture!
References
https://www.cdc.gov/ncbddd/cp/facts.html
https://pubmed.ncbi.nlm.nih.gov/29087112/
https://pubmed.ncbi.nlm.nih.gov/30277962/
https://pubmed.ncbi.nlm.nih.gov/31096249/
https://pediatricapta.org/consumers/
https://www.youtube.com/watch?v=fq62vwyrcXs
Elevate Your Heart Rate With Physical Therapy
Heart disease is a leading cause of death and disability. This shouldn’t be a surprise – it’s been at the top of the list for years. You know that taking care of your heart is important. That means doing things like eating right, avoiding smoking, and exercising regularly. While all of those things can be difficult, today we’re going to focus on exercise.
How Physical Therapy Can Help With Your Heart Health
Cardiovascular exercise is anything that makes you breathe harder and your heart pump faster. That could be walking, running, dancing, biking, swimming or hiking. It strengthens your heart and blood vessels. It can help control weight, lower blood pressure, reduce stress, and prevent heart disease.
If you’re regularly going for a run or swimming laps, you don’t need help from your PT. But 3 out of 4 adults aren’t exercising regularly. If you’d like to get started, your PT may be just the person to help you. It’s not uncommon to get injured, then never get back to your old routine. Your PT can help you deal with the old injury and design a plan to get you safely back to regular activity.
It’s also not uncommon to try to be more active on your own, only to stir up pain somewhere like your back, hip, knee or shoulder. Your PT can help with that too. They’ll figure out why you’re having pain, help you correct it, and get you a plan to reach your goals.
Physical therapists can also help you safely increase your activity levels after major medical issues like a heart attack, stroke, or even cancer. Recent research has shown improvements in cardiovascular fitness, fatigue levels and even pain in cancer patients who participate in a personalized physical fitness plan from a PT.
Whatever your barriers to physical activity are, your PT can likely help you overcome them. As movement experts, physical therapists are trained to deal with a variety of conditions. They’ll help you work around whatever issues you have so you can safely elevate your heart rate and keep cardiovascular disease away.
Stay Connected With Your PT Through Telehealth
The ongoing COVID-19 pandemic is responsible for a lot of bad stuff. But, if you look really hard and maybe squint just right, there are a few less-than-terrible things to be found. The pandemic forced society to quickly adapt. It pushed forward the adoption of new technologies like Zoom and new ways of doing things, like working from home. There were changes in rules, regulations, and payment related to telehealth. A lot of patients and providers experienced their first virtual health appointment in the past 2 years, and many of them see the benefits. The pandemic forced the telehealth genie from the bottle. Now that patients and providers have seen the benefits, it’s not going back.
Why telehealth is here to stay
Telehealth isn’t going to replace in-person rehab, but it’s likely going to complement it heavily. Research has shown that telehealth is as effective as in-person rehab for a lot of conditions. It’s also shown high satisfaction rates from patients – up to 94% in some studies. For a lot of people, telehealth makes sense. Think about people trapped at home because of a snowstorm or those who are at high risk of falling on the ice. Before the wide adoption of telehealth, these patients didn’t get to see their PT during the winter. Now, they can stay connected virtually and continue healing through the bad weather. Telehealth can also work well for busy people. Patients can check in or have a visit with their PT on their lunch break, or while their kids are at practice.
Where telehealth could go
Even though there have been big advances in telehealth, we’re still in the early phases. It’s hard to predict how telehealth will be used in the future and how it will evolve, but expect it to look a lot different in 5 years. The software being used for telehealth will continue to get better. Expect a more engaging user experience with educational content and maybe some gamification – levels to achieve, points or badges to collect, or some other metric. Hardware will also continue to advance. Maybe the fitness tracker you already have will integrate into your telehealth app, letting your PT track your activity, heart rate, and other metrics. Remote stethoscopes, scales and other medical equipment already exist and will continue to become more common as prices decline.
While telehealth has certainly seen a big advance because of the pandemic, most people still see it as an adjunct to in-person visits. Right now, telehealth tends to be used because it’s more convenient than a visit in real life, not because it’s better. With advances in software platforms and hardware options, telehealth could evolve into something just as good as in person rehab that makes high quality rehab available to everyone.
Expect to Get Better. You Probably Will.
Research has shown that positive expectations increase the chances of a good outcome. It’s the old self-fulfilling prophecy; your attitude determines your approach to situations. If you believe you’ll be successful, you’ll likely put in more effort. You’ll be more willing to try new things, take some risks and keep trying after failures or setbacks. A negative attitude will likely mean that you’ll take your first failure or setback as confirmation that what you’re trying won’t work or isn’t possible and you’ll give up. Why waste time and effort on something that’s doomed to failure anyway?
Your Expectations Influence Your Results
There’s some research to prove that positive thinking and expectations make a difference in rehab settings too. A review of 23 articles looking at outcomes for shoulder pain found a few interesting things. First, patients who expected to recover and believed that they had some control of the outcome, ended up doing better than those who didn’t. Second, optimistic patients were found to have less pain and disability after completing rehab. Third, patients who believed they’d have pain and disability after surgery tended to have – you guessed it – pain and disability after their surgery. Research says that you tend to get what you expect.
So Do Your Therapist’s
Your attitude is important, but what about your therapist’s? There isn’t much research specific to PT, but there is a study done in elementary schools that might give us some clues. Two psychologists – Rosenthal and Jacobs did a study showing that teacher expectations had an influence on student performance. They told teachers that randomly selected students in their classes were tested and found to be “late bloomers”. These students were expected to show large improvements in academic performance during the school year. When the students were tested 8 months later, the students the teachers believed would improve the most, did.
Why? When teachers think students have a lot of potential to improve, they hold them to higher standards. They teach more complex materials, don’t settle for simplistic answers and are more willing to spend time instructing and working with those students. It’s pretty easy to see how this could cross over into a PT clinic. If your PT thinks you can get better, they’ll probably put more effort into designing your program, spend more time with you and push you harder than someone they don’t believe has a lot of room for improvement.
To have the best chance for a good outcome, you and your therapist both need to expect one. You probably will.
References
● De Baets L, Matheve T, Meeus M, Struyf F, Timmermans A. The influence of cognitions, emotions and behavioral factors on treatment outcomes in musculoskeletal shoulder pain: a systematic review. Clin Rehabil. 2019 Jun;33(6):980-991. doi: 10.1177/0269215519831056. Epub 2019 Feb 22. PMID: 30791696.
● Rosenthal, R, and L. Jacobsen. Pygmalion in the classroom: teacher expectation and pupils’ intellectual development. New York: Holt, Rinehart and Winston, 1968.
Long COVID Sounds Awful! What Can Be Done?
Last month we introduced you to Long COVID and all of the challenges it brings. This month we’re going to talk about what physical therapists can do to help people living with Long COVID. Early in the pandemic, therapists started seeing people with what would later be known as Long COVID. They noticed that some of the symptoms people were describing overlapped with conditions they had treated before. Specifically, Myalgic Encephalomyelitis and Chronic Fatigue Syndrome also caused severe fatigue and delayed symptoms after activity. Because of this overlap, the current treatment for Long COVID is heavily based on what we know works to manage these diseases. Here are a few of those strategies.
Pacing
The first strategy that can help manage Long COVID symptoms is pacing. This is simply doing less activity than you have energy for. By keeping bouts of activity short with lots of breaks, pacing can help avoid severe fatigue immediately after activity. It can also avoid the delayed “crash” of PESE. A useful metaphor is to think of your energy level as a battery. When you do activities, you drain your battery. When you rest, you charge it back up a little bit. Physical therapists can help patients learn how much energy is in their “battery” and work to teach them strategies to conserve it. When used effectively, pacing can help patients with Long COVID accomplish more with less fatigue and less bouts of PESE.
Heart Rate Monitoring
Another strategy that comes from ME and CFS management is heart rate monitoring. With the huge number of wearable devices that monitor heart rate, this is becoming an easier strategy to use than ever. Heart rate monitoring uses your heart rate as a gauge of how hard your body is working. It’s based on your resting heart rate, which should be taken after you’ve been lying down, relaxed for at least 20 minutes. First thing in the morning before you get out of bed is a great time to measure your resting heart rate. Once you have your baseline, the goal is to keep your heart rate within 15 beats of your RHR while you’re doing activities. This keeps your heart rate below the threshold at which your muscles start to produce lactic acid. Build up of lactic acid is what gives you “the burn” when you’re working out really hard. It also causes your muscles to fatigue more quickly – by keeping activity light enough to avoid lactic acid, we can also reduce fatigue.
Exercise
What about exercise? Sure, lots of people think about exercise when they think about PTs. But exercise can make some diseases worse. For people living with Long COVID, CFS, or ME, “toughing it out” or “pushing through it” won’t make them stronger. It will cost them days of their lives – leaving them barely enough energy to get out of bed or complete basic tasks. For long-term, sustainable recovery, the first goal of rehabilitation of these folks is to stabilize and manage their symptoms. Using pacing, heart rate monitoring and other strategies like breathing exercises can stop the fatigue cycle and start to get the body responding to activity more normally. Only then can we very gradually and cautiously introduce exercise into the mix, monitoring symptoms during and after activity to make sure we don’t overdo it.
As we learn more about the pathology behind Long COVID’s symptoms, rehabilitation will surely change and improve. But people who are living with Long COVID can’t afford to wait until science figures everything out about their disease. Fortunately physical therapists have training and strategies that can help improve their lives right now.
What If Your COVID Symptoms Don’t Go Away?
You may have heard about people who got a COVID-19 infection and have symptoms for weeks or months after. This is now referred to as Long COVID. In this post we’re going to dive into what Long COVID is, what the symptoms are and who it affects. Next month we’ll talk about strategies that are helping people with Long COVID and where physical therapy fits in. Let’s get started.
What is Long COVID?
Long COVID is generally defined as ongoing signs or symptoms lasting 12 weeks or more after a COVID-19 infection.
What is it like?
Like all things COVID-19, we don’t fully understand Long COVID and new information is being discovered all the time. Long COVID tends to involve more than one system and currently has a list of over 200 possible symptoms.
The most common are:
1. Fatigue
2. Post-exertional symptom exacerbation (PESE)
3. Problems with memory or concentration, often referred to as “brain fog”
Other common symptoms are shortness or breath, chest pain or tightness, insomnia, muscle or joint pain, depression/anxiety, and stomach problems like stomach aches, loss of appetite or diarrhea.
What’s the fatigue like? Does rest help?
Long COVID fatigue is an extreme exhaustion that isn’t relieved by rest or sleep. It’s not fatigue after some physically demanding task. People experience exhaustion for no obvious reason. The fatigue is so severe that it impacts the ability to complete daily tasks.
What about this PESE thing?
Post-exertional symptom exacerbation is a disabling and often delayed exhaustion disproportionate to the effort made. Patients are referring to this as a “crash”. PESE is very common in people suffering from Long COVID. 75% of people who have Long COVID have PESE after 6 months. The activity that brings on the crash is something that the person could easily tolerate before their COVID-19 infection. Things like taking a shower, walking, attending a social activity, or even being in a high sensory environment with flashing lights and loud noises may all now trigger a crash.
Who does Long COVID affect?
This is difficult to answer. We still don’t understand what causes some people to have symptoms long after their initial infection. What we do know is that about 25% of people who get COVID have symptoms that last at least a month. Around 10% of the people who get the virus will experience Long COVID. Long COVID isn’t related to how severe your initial symptoms were, or if you were hospitalized. It also doesn’t appear to be related to your previous health as it affects children and people who were previously fit and healthy.
Now that you know what Long COVID is, in our next installment we’ll talk about what’s being done for it and how physical therapy helps.
What is Post-Intensive Care Syndrome and What Does PT Have To Do With It?
When you think about a person going into intensive care, you probably picture someone who’s very ill and likely fighting for their life. They may be on a ventilator or other equipment that’s keeping them alive. When you’re in that situation, surviving would be a win. But what happens after these people survive? Do they recover and go back to life as it was? What’s the road to recovery look like?
Fortunately, medical advances have led to higher survival rates for people who end up in intensive care units – it’s now between 71% and 90%, which is great. But, survival is not the end goal, and getting out of the ICU is not the end of the battle. Many patients show significant losses of physical, mental and cognitive abilities after discharge. It makes sense – if you don’t use it, you lose it! This cluster of problems is called Post-Intensive Care Syndrome or PICS.
PICS is now recognized as a public health burden. Interventions against PICS need to start in the ICU. Then they need to continue after discharge.
Physical declines often include significant losses of strength, endurance, and mobility. These can lead to serious difficulty completing basic daily tasks like getting to the bathroom, preparing a meal, or walking to the mailbox. This may keep some people from returning home. For others, it means they need a caregiver to safely return to their previous setting. 50% of ICU survivors have limitations in daily activities 1 year later, so this is a serious and long-lasting problem.
Mental health is also a very real concern for ICU survivors. They show significant rates of depression – the mean is 28%. 24% of survivors have anxiety and 21% report PTSD. Again, these conditions have a real impact on the quality of life after leaving the ICU.
Last, declines in cognitive abilities are very common in ICU survivors. 77% have cognitive impairments at 3 months post-discharge and 71% have impairments 1 year out. Cognitive issues after discharge can include poor memory, slower thinking, problems making decisions, or difficulty concentrating.
Physical therapists play a significant role in the fight against PICS. PT typically begins while the patient is in ICU, focusing on getting the patient up and walking early. Patients begin a progressive exercise program as soon as it’s safe for them. We expect a rise in PICS due to the number of people who COVID-19 has put into critical care and/or on a ventilator.
While we can’t prevent every problem that critical illness causes, recognizing the losses that remain after discharge from the ICU is an important step. Physical therapists play an important role in combating the effects of PICS and helping people return to higher-quality lives.
Physical Therapy is a Tree With Many Branches
Starting a career in physical therapy is like climbing a tree. Everyone starts with the same trunk, but pretty quickly, you have to make some decisions about which way you’re going to go. What kind of people do you want to work with? Where do you want to practice? And how far up the tree do you want to climb? You’ll get to grow professionally – learning more, getting better clinically, and maybe even improving your sales and business skills, but that’s not all. Physical therapy gives you a chance to grow personally too.
Pick your people
You can pick the type of people you want to work with – sports physical therapists work with athletes, helping them recover from injuries and improve performance through exercise and hands-on techniques. Geriatric physical therapists work with elderly patients on mobility problems, pain or managing chronic conditions. Pediatric physical therapists work with infants and children providing developmental assessments and helping them improve their gross motor skills.
Pick your place
You can also pick where you work – there are physical therapy jobs in nursing homes, hospitals, outpatient clinics and schools. Physical therapists provide care wherever people need it. So far, we’ve only mentioned the more common places you’ll find PTs – if you want to specialize further, you may find yourself working only in the ICU with critical care patients, in a factory doing industrial rehabilitation and ergonomics, in a women’s health clinic, or even working in a preventative, public health role.
Grow professionally
Most physical therapy careers start in a general role, working with all types of different patients. If you work in a large health system, you may even rotate between settings. But as you find the type of people you like to work with and the setting you prefer, you have the option to improve your skills and focus on a specialty area of practice. Again, you have lots of options on how to do this. You could:
● Take an internship position or join a fellowship program
● Attend workshops or conferences
● Read journals and textbooks
● Collaborate with your colleagues and mentors
● Take courses in other areas of medicine
● Study abroad or take courses online
Grow personally
Your clinical skills aren’t the only thing a career in physical therapy can grow though – you’ll grow personally as well. You have to learn to have compassion and empathy when you work with ill or injured people. You have to work as a part of a team. You need sales skills – most people aren’t going to want to make changes in their routines, or do the exercises you prescribe at home. You’ll learn to work with people who have different opinions and different viewpoints from all kinds of cultures and backgrounds.
You may also have a chance to improve your business skills. You could advance out of the clinical setting and into a management role. Some PTs start their own practices, or a company in a field related to physical therapy like wellness, performance, injury prevention or population health for large corporations.
Wherever you start in physical therapy, you’ll have a lot of options on where you end up. Chances are you’ll explore more than one branch of the physical therapy tree. That’s OK, having the chance to grow and change is part of what makes PT so exciting!
Working in physical therapy has benefits that extend beyond the clinic
Stories about hiring difficulties are all over the news right and physical therapy clinics haven’t been left out. An aging population with more chronic diseases has been pushing up the need for physical therapy for years. The pandemic has accelerated the problem. Clinics aren’t only looking for PTs and PTAs either. Finding the right people to fill roles in billing, administrative and tech roles is difficult too. Many clinics also employ people like nutritionists, athletic trainers and fitness professionals. If you’re looking for a new place to work or a change in career, a PT clinic might be a great setting for you. Here’s a few reasons why:
Build relationships
Physical therapy is unique in the world of healthcare because of the time that patients spend in the clinic. People often come in 2 to 3 times a week for anywhere from a few weeks to several months depending on what they’re coming in for.
When people spend that much time together, it’s easy for great relationships to form. Often these relationships end up lasting a lifetime and have benefits that extend outside the clinic. Having a large and diverse network is never a bad thing and a PT clinic is a great place to build one.
Make a difference
Physical therapists work with people who have injuries or disabilities that affect their mobility, as well as those who have chronic illnesses like heart disease or diabetes. They help people heal faster and get them back to normal life, with a focus on function. That means PTs want to help people get back to meaningful things like going to work, recreational activities, hobbies, or playing with grandkids. Being able to return to things like that means a lot more to patients than lowering their blood pressure or improving their lab values. And it feels good to be a part of making that happen.
If you’ve never considered working in a PT clinic, it might be right for you. It’s rewarding and a great way to build relationships, become valuable in the community, and make a difference in people’s lives.
