During the COVID-19 pandemic, activity levels dropped for a lot of people. Between stay at home orders, gym closures and working from home, people became more sedentary. On top of that, there were shortages of equipment like dumbbells and bicycles, making staying active at home difficult even if you wanted to.
But this summer, things look different; vaccines are widely available, restrictions are loosening and people are looking to get active and enjoy the warm weather. That’s all good news, but if you had a long break from activity, your body might not be ready to jump right back in. Here are a few tips to help you get more active without getting hurt:
Start slow
● If you’re a runner, think about a walk to run program
● If you’re a weight lifter, start with lighter weights and less reps.
● Whatever your activity of choice is, start with short periods of activity and gradually work your way back up.
Warm up and cool down
Warming up gets your heart and lungs ramped up and prepares your muscles and tendons for the increase in activity about to come. Include some light cardio like jogging, calisthenics, or cycling, followed by active stretching like butt kicks, high knees, or yoga.
Cooling down transitions your body back to a lower state of stress – it brings your heart rate and breathing down, decreases blood flow to your muscles and back to places like your digestive system, and helps you relax. It’s also a great place for static stretches if you need some work on your flexibility.
Take a day off
Rest days let your body recover and keep you from getting burned out. Not enough exercise isn’t good for you, but too much of a good thing can cause problems too.
Watch for early signs of injury
Some soreness for a few days after activity is normal, especially if you’ve had a long break. But there are a few common issues to watch out for as you return to activity:
● Swelling or bruising
● Joint pain, especially in the knees or shoulders
● Foot pain, which could be a sign of plantar fasciitis
● Muscle strains – particularly common in the hamstrings
● Sprains – most common in the ankle
Any of these issues justifies a call to your physical therapist. Getting checked out early can prevent an injury that derails your attempt to return to activity. PTs see all of the issues just mentioned on a regular basis and can help safely guide you back into a more active lifestyle.
Physical Therapy Isn’t Just For Pain. It Can Keep You Healthy For Life.
You know that physical activity is good for you. The benefits are well researched and the list is impressive.
Here’s just a sampling:
● Releases endorphins to make you feel good and fight depression
● Helps control weight
● Prevents diseases like stroke, diabetes and some forms of cancer
● Improves sleep
● Helps you live longer
Recent studies even show that physical activity strengthens your immune system, with a protective effect against COVID, and that staying active through middle age protects your brain as you age.
Physical activity is a wonder drug. If it was a pill, you’d buy it and take it every day. But even though activity is free, less than 25% of Americans meet the CDC recommendations for activity. We clearly need help.
Physical Therapists Are The Experts in Human Movement
To be active, you need to be able to move. Physical Therapists do more than help you recover from surgeries or major injuries. They are the experts in human movement. Sure, you could see a strength coach to lift weights, hire a personal trainer, go to a yoga class to work on your flexibility and balance, and see a chiropractor for adjustments. But that seems like a lot of people when a PT can help you with all of these things and more. Nobody knows more about human movement or looks at your health the same way a PT does. Your PT can help you with every aspect of movement including strength, range of motion, flexibility, endurance, balance and coordination.
As medical professionals they can help you with injuries or other issues. Your PT can work with your doctor to help use activity to manage things like diabetes, cholesterol levels or blood pressure instead of prescriptions. Your PT is also trained to work with people of all ages, so you can develop a long-term relationship and they can continue to adjust and modify your routine as you age or your goals change.
Stay Healthy For Life
Staying active has a long list of benefits both now and in the future. But chances are you’re not moving enough to make the most of those benefits. Most people need help. Physical therapists are the most qualified professional in existence to help keep you healthy now and in the future. So don’t think of your PT as someone you see when you need help with pain or an injury. Think of them as your partner and coach working to help you stay healthy for life.
Want to Stay Healthy? Move More.
COVID has certainly made the importance of health very clear and we have all seen how quickly
things can change with an illness. While COVID is currently front and center in most people’s
thoughts, it isn’t the only thing out there that can change your life. Heart disease, diabetes,
strokes and cancer can all be devastating too.
Movement offers a defense
If you’re looking to be more resilient and defend against these things, physical activity can do it.
The dangers of being sedentary are well known and documented in the research. Excessive
sitting and sedentary time have even been called the new smoking. For many of us, sitting and
being inactive is part of our jobs. However, research has shown that getting in enough
movement can counteract the negative effects of being sedentary.
A large study done in the U.K. found no association between the amount of time people spent
sedentary and their chances of illness. But the authors didn’t conclude that being sedentary is
OK. Instead, they felt their findings were likely “attributable to a protective effect of the high
volumes of daily walking.” The study was conducted in London, where people tend to spend
much more time walking or standing than average. The people in the study had daily walking
times that were over double the average amount reported in the U.K.
Physical Therapists Are Unequaled Experts in Human Movement
While walking was the activity in this particular study, other research has shown that all kinds
of movement can help protect your health. If you’re looking to get those protective benefits for
yourself you could choose to walk, bike, lift weights, dance or garden. If you’re not moving as
much or as well as you’d like, see your physical therapist. PTs are the most qualified
professionals on the planet to help you move better and allow you to stay healthy and enjoy
life. From designing a program to get you started or moving more to helping you recover from
an injury, your PT is the right person to look to for help.
Will COVID-19 Change the Typical PT Patient?
People usually see a physical therapist for pain or loss of function. Think of the person who has
back pain, the injured athlete or the person who’s had a stroke. They all want to improve how
they move and complete tasks. Now, there is good reason to wonder if physical therapists will
start seeing more people who are not in pain or having difficulty moving. Why would these
people come to a PT? To improve their overall health and wellness.
There is strong evidence suggesting that movement is a valuable predictor of future health
and resilience against disease. Physical therapists are movement specialists, so taking
advantage of their expertise makes sense if your goal is to become healthier and live longer.
Here are some examples of the power of movement when it comes to predicting future health:
Gait Velocity
Gait velocity is how fast you walk. Studies have shown that if your typical walking speed is over
1 m/s or 3.3 ft/s, you’re likely able to complete typical daily activities independently. You’re also
less likely to be hospitalized and less likely to have adverse events like falls.
If you’d like to test yourself, measure out a straight, flat course to walk between 10′ and 30′ long.
You’ll also need 5′ or so at the beginning and the end for acceleration and deceleration. Walk
the course at your typical speed and divide the length of the course by how long it took you to
walk it (distance/time). That’s your gait velocity.
Get On and Off the Floor
A series of studies suggest that if you can go from standing to sitting on the floor and back to
standing without using your hands, you’re a lot less likely to die than someone who can’t. It’s
called the sitting-rising test. Here’s how it works:
You start standing, and without support you sit down on the floor, then stand back up. You start
with a score of 10. Every time you put a hand, knee, forearm or the side of your leg on the floor
you lose 1 point. Putting a hand on your knee or thigh to help also costs a point. In a sample of
over 2,000 people, they found that scoring less than 8 points made you twice as likely to die in
the next 6 years when compared to people who scored higher. Score 3 or less and you’re 5
times more likely to die in the same period. Overall, each point in the test is worth a 21%
decrease in mortality from all causes.
Notice that both gait velocity and the sitting-rising test aren’t specific to any one thing. The risk
of hospitalization in the gait velocity studies was hospitalization for any reason. Death in the
sitting-rising studies was death from anything. So while we know that exercise and healthy
lifestyle reduce your risk of specific diseases like heart disease or diabetes, it appears that
being able to move may provide much more wide ranging protection than we previously thought.
Insurers Are Moving From “Sick-care” to “Well-care”
TRICARE has decided to waive the cost-sharing requirement of up to three visits to a physical
therapist for low back pain. They’ve said that the goal is to encourage more use of “high-value”
treatments for low back pain. Understanding what they mean by “high-value” vs “low-value”
treatment can help us see the direction healthcare payers are moving and how physical therapy
is a part of that.
TRICARE tells us in their summary of this demonstration what they mean by high and low-value
care: “Increasing the value of health care refers to improving patients’ quality of care and
outcomes, improving patients’ access to care, and reducing overall costs of care. In contrast,
low-value care refers to interventions that: are not proven to benefit patients; may harm patients;
result in unnecessary costs; or waste health care resources.”
High-value care
High-value care leads to better outcomes, is easy to access and is cheaper for both patients
and insurers. We already know that physical therapy fits into this category, but if we look at
other things that fall into this category, a larger theme starts to emerge. In 2017 the American
College of Physicians released guidelines for treating low back pain that have been widely
endorsed. Initial treatment recommendations include exercise, stretching, tai chi, yoga,
progressive relaxation, heat or ice, cognitive behavioral therapy, and motor control exercise.
These are all active treatments, where the practitioner and the patient are working together to
improve. This is “well care” or “let me help you get better.”
Low-value care
In contrast, low-value care tends to be “sick care” where the patient is a passive participant and
the practitioner is saying “let me make you better.” TRICARE puts imaging before six weeks
without red flag symptoms, surgery for non-specific low back pain, opioids as the first or secondline treatment, and bedrest in the low-value category. We would also place spinal injections in
this category for most people. They’re expensive, only offer temporary relief, usually have a long
wait before they’re available and include the risk of serious infection and damage to surrounding
soft tissues like skin, cartilage, and ligaments.
This isn’t to say that imaging, surgery, or injections are always bad. For a small percentage of
people with low back pain, they’re the right thing. But, most people should start with treatments
that have the best outcomes for the lowest cost. If those treatments tend to focus on
empowering the person in pain to actively participate in their care rather than making them
dependent on someone to “heal” them, that’s even better. Physical therapists have known this
and have been providing care that fits this model for years. TRICARE’s demonstration that
waives cost-sharing clearly shows that insurers are recognizing the value of this type of care
and that they are actively moving in this direction.
TRICARE Thinks PT is so Valuable, They’re Covering the Whole Cost!
TRICARE, one of the nation’s largest insurers wants their members to get physical therapy for
back pain. They think that treating back pain with PT is so important that they’re willing to waive
the cost to their members. That’s a huge deal. When’s the last time you remember an insurance
company covering the entire cost of anything? Let’s dive into back pain treatments and see why
TRICARE likes PT so much.
You probably already know that back pain is a common problem. What you might not know is
that the medical system isn’t very good at treating it. “Non-drug treatments like physical therapy”
are the first treatment recommended for back pain. Unfortunately, many providers don’t follow
this and treatments are often recommended based on opinion rather than research. This means
insurance companies and patients often end up spending a lot of money for outcomes that are
less than stellar.
Here’s how it usually goes: You go see your doctor with back pain. They might give you
medication, recommend rest, some stretches, send you for x-rays or an MRI. Next will likely be
a referral to a specialist like an orthopedic surgeon. Chances are you won’t be having surgery
right away, so the specialist will either refer you to PT, or back to your PCP where you’ll end up
with a PT referral. The path will look different for each person, but the end result is usually the
same – multiple failed treatments, imaging you probably didn’t need and a delay of weeks or
months to get to a physical therapist.
Multiple large studies have looked at the effects of early physical therapy on low back pain with
impressive results. One of them was done in 2006 in Seattle by Virginia Mason Health Center.
They teamed up with Aetna and Starbucks to send workers with back pain to see both a
physical therapist and physician for their first treatment. Use of MRI dropped by 1/3, people got
better faster, missed less work and were more satisfied with their care. The cost savings was so
great, that Virgina Mason was losing money on treating back pain and Aetna ended up paying
them more for PT treatments because Aetna was saving so much money.
Intel ran a similar program with their employees, getting people with back pain to a PT within 48
hours. Previously it took about 19 days for people to get to a PT. With the earlier access,
patients completed their care in 21 days, compared with 52 days previously and costs dropped
between 10 and 30%. Intel also found more satisfaction with care and a faster return to work.
The data is out there that proves physical therapy is the cheapest and most effective treatment
for most people’s low back pain. It’s clear that people with back pain should start treatment with
their physical therapist, but most don’t. TRICARE’s pilot program that waives copays for up to
three PT visits aims to change that. If successful it will lead to lower costs for both TRICARE
and their members while delivering better outcomes in less time.
Finally, Some Good News About Back Pain
Back pain is a huge problem in developed nations worldwide. It has or will affect most of us. The
current estimate is that 80% of people will experience back pain at least once. It is the single
biggest cause for disability, the third most common reason for doctor visits, and one of the most
common reasons for missing work.
It’s also expensive. Back and neck pain makes up the biggest healthcare expense in the US,
totaling $134 billion spent in 2016. The next two most expensive conditions were diabetes —
$111 billion in spending — and ischemic heart disease at $89 billion.
Diabetes and heart disease being so expensive to treat doesn’t surprise most folks – they can
both lead to other major problems, require long term medication, could require surgery, and
both can be fatal. Back pain won’t kill you, usually doesn’t require long term medication, and
usually doesn’t require surgery either. Why is it so expensive?
The first reason is that it’s so common. The second reason is that our current system isn’t very
good at treating it. Current recommendations include starting with activity modification, and
active treatments like physical therapy. Research backs this up, showing better outcomes and
lower costs with early PT. Unfortunately, only 2% of people with back pain start with PT, and
only 7% get to PT within 90 days. At the same time, a study looking at about 2.5 million people
with back pain in JAMA showed that 32.3% of these patients received imaging within 30 days of
diagnosis and 35.3% received imaging without a trial of physical therapy. Both of these things
go against current practice guidelines for treatment of back pain.
A new pilot program being rolled out by TRICARE, the insurance system used throughout the
US military is waiving the payment owed by the patient for up to three PT sessions in an attempt
to improve the use of what the Defense Health Agency calls “high value” treatment for low back
pain. The theory is that once a person sees some benefit from PT treatment, they’re likely to go
back for more. This is the “try it before you buy it” approach – think of the 7-day free trial Netflix
offers, free samples poured in wineries and craft breweries, or the folks you see standing
around in supermarkets with food on toothpicks. TRICARE’s data seems to indicate that it works
just as well for healthcare as it does for other businesses. In a press release they state that
once people attend one session of physical therapy, they’re likely to go back for more, no matter
what their co-pay is. But TRICARE found that higher co-pays could be a barrier to people trying
that first visit. For the group of patients with the highest co-pays in the system, only 38% of the
people prescribed PT attended the first visit. That’s about half the rate of attendance found in
the lowest co-pay group.
The fact that such a major insurer is looking into the value of PT is great news for everyone. If
TRICARE can show that lowering the cost of PT for patients can improve outcomes and save
insurance companies money, other major insurers will likely follow. This could improve the lives
of millions of people every year while reducing the huge cost of treating low back pain for the
country. That seems like a win for everyone involved.
When the Weather Gets Cold, Don’t Forget to Warm Up
Colder weather means some changes to how we exercise. Of course it’s harder to motivate
yourself to get outside for a run or bike ride when the temperature drops, and the shorter days
compress our schedules, but there are changes in your body that affect your ability to exercise
too. For many people with arthritis or other joint problems, cold weather brings more complaints
of pain. To stay warm, our bodies narrow blood vessels to reduce bloodflow to the skin, and
more superficial muscles. That means that there is an increased risk of muscle strains in the
cold. There is also an increased strain on the heart because of the narrowed blood vessels. This
isn’t to say that you shouldn’t be active outdoors in the cold, it just means you may have to
make a few changes to your routine. Here are a few to consider:
Warm up right
A good warm up is always important, but because of the tendency for joints to be stiffer, and
bloodflow to muscles to be reduced in the cold, it’s even more important that you do it right this
time of year. To start, do something to get your heart rate up a bit, maybe a brisk walk or light
jog. Follow that up with a dynamic warm up rather than static stretches. This could include
walking or jogging while pulling your knees up high to your chest. Maybe some high kicks in
front of you with straight knees to get your hamstrings loosened. A walking lunge with an upper
body twist can get your whole body moving. Cater your warm up to what you have planned in
your workout. If you’re not sure how it should look, ask your physical therapist!
Dress right
Dressing in layers allows you to adjust your insulation to your activity level. After you warm up,
you might want to take off a layer to avoid getting too hot during your main activity. You’ll have it
there later to put back on when your activity level drops and you start getting too cold.
Don’t forget about the sun either – just because it’s cold doesn’t mean the UV rays are gone.
Sunscreen and sunglasses aren’t just for the summer. A lip balm with SPF can protect you not
only from the sun but from the wind too.
Stay hydrated
Drink water before, during, and after your workout. The temperature may be down, but you’ll still
sweat and you’ll still lose water vapor in your breath. The drier air in winter lets your sweat
evaporate more quickly, so it’s easy to underestimate how much fluid you’ve lost.
Cool down
When you’re done, don’t rush to get inside and crawl under a blanket. Cool down properly. Keep
moving with a walk or another form of active recovery to let your heart rate come down. After
exercise is the right place for static stretching. You can also head inside for some foam rolling or
self massage.
The days being shorter and the temperatures being lower don’t mean you’re stuck inside for all
of your exercise. If you follow these tips, you can safely keep moving outside. If you’d like a
customized warm up or cool down, or have questions about your exercise routine, your physical
therapist is a great person to ask!
In Person or Virtual PT? Maybe Both!
Virtual physical therapy has quickly moved from a niche offering to the mainstream. Having more options is great, but it can also complicate decision making. Having an understanding of the benefits of both can help make clear which one would best help you meet your goals.
In Person Physical Therapy
The main advantage of traditional “brick and mortar” PT is that the therapist is in the room with you. That means they can move around to see how you’re moving from different angles, physically adjust your position or movement as you exercise, and physically examine you – testing your strength, measuring your range of motion, etc. They can also use things like manual therapy, electrical stimulation or ultrasound when you’re in the clinic. In person PT may work best for:
● New patients – the ability to physically examine you makes it easier for your PT to accurately diagnose what’s going on
● Less active patients – if you’re not used to exercising and moving, having someone physically present to coach you along can be a big benefit
● People with complicated or chronic conditions – if your back has been hurting for the last 5 years and you’ve been ignoring it, providing a diagnosis and treating it totally virtually will be difficult for your PT
● Less motivated patients – virtual PT requires you to do most of your exercises by yourself. If you need someone watching over you to make sure you do them, in person PT might work better for you
Virtual PT
The main benefit of virtual PT is convenience. Because virtual PT relies on you doing most of your exercise and treatment on your own, appointments can be shorter. This also means that motivation is a prerequisite to choosing virtual PT. The fact that you don’t have to travel to the clinic makes it easier to squeeze a visit into a busy schedule. Virtual PT works well for:
● Athletes and others with good body awareness – being on your own for your home exercise program requires you to be in tune with your body and how it’s moving
● People with common athletic injuries – things like tendonitis, sprains, strains, plantar fasciitis, and overuse injuries are commonly treated by PTs. Because of that, there is a template for treatment that is easily adapted to individual needs.
● People who are comfortable with technology – you don’t have to be a technology whiz, but having some familiarity with skype, facetime, or zoom helps!
● Existing and returning patients – if your physical therapist knows you, it’s easier to treat you virtually.
Both options have benefits and limitations. One or the other might be right for you and your needs, but they’re not mutually exclusive. Combining the two can work well for many people. Doing an in person visit for your initial evaluation and perhaps a follow up visit or two will let your therapist provide an accurate diagnosis and get you started on your exercise program. Once you’re comfortable with your exercise program, you can transition to virtual visits.
5 Reasons You Need a PT to Coordinate Your Fitness Regimen
Physical therapists aren’t just for people that are injured or have had surgery. Physical therapists can also help healthy people improve their fitness. Here are 5 reasons why you should consider seeing yours.
You Want a Baseline
When you see a physical therapist to improve your fitness, you’ll get an assessment of your strength, range of motion, posture and movement patterns. This not only helps your physical therapist design a customized program just for you, it gives them a baseline to compare things to in the future should you start having pain or suffer an injury.
You Want Expert Guidance
Sure, other professionals could help with your fitness routine, but the fitness industry is not well regulated. Some certifications just require an online course and paying a fee. There are no licenses or other requirements to use many titles. Becoming a physical therapist requires at least a bachelor’s degree and most PTs practicing today have a doctorate. Every PT has passed a national board exam and maintains a state license. That guarantees you that every physical therapist is a verified expert in human movement.
You Want to Prevent Injury
Physical therapists don’t just work to heal injuries, they are also experts in preventing them. After a thorough assessment, a PT can help you design a program that will not only help you reach your fitness goals, but that can address any issues that increase your risk for injury.
You Want Unbiased Advice
Yoga instructors will want you to do yoga. Personal trainers will want you to come to their gym. Pilates instructors will want you to do Pilates. Strength coaches will want you to strength train. A physical therapist doesn’t have a bias or vested interest as to what type of fitness regimen you choose. They are only interested in helping you reach your goals.
You Have a History
If you have some kind of history that affects your ability to exercise, a PT is the best person to help you design a fitness regimen. It doesn’t matter if it’s an old injury from athletics or work, back pain that comes up from time to time, COPD, arthritis or heart disease, a PT can help you safely work around it and meet your fitness goals.
