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What’s a Movement Diagnosis?

Medical diagnoses don’t need much of an introduction. They’re what you get from your doctor
when you’re sick. Examples would be influenza, diabetes, or hypertension. They describe the
underlying problem that is causing your symptoms.

When people feel sick, they know they need to go to the doctor and find out what’s going on to
get treated. We should treat movement the same way. If you’re having pain when you move,
can’t do things you used to be able to – like get on and off the floor easily, or can’t do things you
want to do – like go for a bike ride or pick up a grandchild then you need to get a movement
diagnosis.

A movement diagnosis does the same thing as a medical diagnosis; it describes what’s causing
your difficulty with movement. Some examples would be difficulty standing from a chair
secondary to decreased force production, scapular down rotation syndrome, or lower crossed
syndrome.

Diagnoses set the roadmap for treatment, so getting them right is crucial. Human movement is
complex and is influenced by more than just your muscles and joints. According to the APTA,
movement is impacted by the following systems:
● Endocrine
● Nervous
● Cardiovascular
● Pulmonary
● Integumentary
● Musculoskeletal

Because of the complexity and interplay between these components of the movement system,
getting a movement diagnosis correct is often very difficult. Physical therapists are experts in
human movement with doctoral level training and should be your first stop for movement issues.
Not only can a physical therapist provide an accurate movement diagnosis, they will also design
a treatment plan to correct the underlying issues and help get you moving well again.

References:
https://www.neuropt.org/docs/default-source/default-document-library/movement-systemdiagnosis-in-neurologic-physical-therapy-where-are-we.pdf?sfvrsn=0
https://journals.lww.com/jnpt/FullText/2018/04000/White_Paper__Movement_System_Diagnose
s_in.9.aspx
https://www.apta.org/MovementSystem/
https://www.apta.org/MovementSystem/Template/

Imaging Can Improve Physical Therapy Treatment

Physical therapists are experts in the musculoskeletal system, and typically use patient
history and a good physical exam to come to a diagnosis and treatment plan. However,
PTs are increasingly using diagnostic imaging as they become the practitioner of choice
for musculoskeletal injuries. Many PTs have access to diagnostic ultrasound right in the
clinic, and in some practice settings like the military, and certain ACOs, therapists have
the ability to order imaging like x-rays, CT scans and MRIs.

The research indicates that PTs are effective in using their ability to order imaging when
it exists. A study of 108 imaging orders by PTs providing musculoskeletal primary care
in a direct-access sports physical therapy clinic found that advanced diagnostic imaging
was ordered appropriately in over 80% of cases.

So, PTs are good at appropriately ordering imaging, but how does it improve
treatment? A case study published in the July 2015 issues of the Journal of Manual &
Manipulative Therapy gives a good illustration:
The patient was a very active dentist who had chronic mid and upper back pain. He had
a known history of benign neural tissue tumors of his head and upper back region, but
no specific diagnosis for his back pain had been provided. After examination, the PT
decided to start treatment for the patient’s back pain, but also order x-rays and an MRI
of the symptomatic part of the patient’s spine. The MRI showed a previously
undiscovered meningioma, or benign tumor of the membrane that covers the spinal
cord.

The benefit to this patient was that the PT could continue treatment without making
referrals and waiting for someone else to order the images. Also, once the tumor was
discovered, the PT could select exercises and manual techniques that would help the
patient, but avoid putting stress on the area of the tumor. It also allowed the PT to
educate the patient on fitness activities that would be safe and appropriate.

The case study has a quote that sums up the benefits of imaging combined with PT
nicely: “Orthopaedic physical therapists have high levels of musculoskeletal expertise
and extensive knowledge of typical patterns and behaviors of musculoskeletal
conditions. These competencies and experiential knowledge enable them to
appropriately recognize situations requiring additional diagnostic screening for nonmusculoskeletal pathology.
This case demonstrates how privileges to order musculoskeletal imaging studies assisted the physical therapist in providing optimal,
patient-centered care. The physical therapist in this case was able to continue
treatment without multiple referrals back to the medical provider to obtain imaging,
and so provided more cost-efficient and convenient care.”

Reference article and case study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5046964/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534847/

Do You Know Your Movement Vital Signs?

Most people think of heart rate or blood pressure when they think of vital signs. It is common to
use numbers to quantify health and risk of disease. The American Heart Association
encourages people to “know their numbers” referring to blood pressure, blood cholesterol, blood
glucose, and weight. However, research is now showing the importance of moving properly for
health. Let’s take a look at some of the numbers you can use to quantify your movement health:

Walking Speed

Walking speed has been called the “sixth vital sign” in medical literature recently. It is easy to
measure, and takes into account strength, balance, coordination, confidence, cardiovascular
fitness, tolerance to activity, and a whole host of other factors. It has also been shown to be
predictive of future hospitalizations, functional decline, and overall mortality. Normal walking
speed is considered to be 1.2 to 1.4 meters per second.

Push Ups

Push ups are popular to build strength, but a recent study found that they can show us a lot
about your heart too. Researchers found that men who could do 40 or more consecutive push
ups were at a 96% lower risk for cardiovascular disease than were men who could do less than
10. The push up test was also more useful in predicting future cardiovascular disease than
aerobic capacity measured on a treadmill.

Grip Strength

Hand grip strength has been shown to be strongly correlated with health. The stronger your
hand grip is, the less likely you are to suffer from cardiovascular disease, respiratory disease,
COPD, and all types of cancer. In the study, muscle weakness was defined as grip strength <26
kg for men and <16 kg for women. Grip strength below these numbers was highly correlated
with an increase in disease.

Standing From the Floor

If you can’t easily get down on the floor and back up your health might be in trouble, according
to a study that looked at more than 2,000 people. The study asked people to go from standing
to sitting on the floor and back up with as little support as needed. They found that if you need to
use more than one hand to get up and down from the floor that you were 2 to 5 times more
likely to die in the next 7 years than someone who can do it with just one hand, or even better,
no hands at all.

Moving well is obviously important to overall health and longer life. These tests can give a
snapshot of how you’re doing. If you’re having trouble with any of them, considering seeing a
movement specialist – your physical therapist.

Are You A Passive Patient or an Active Consumer of Healthcare?

Think about the last time you made a big purchase, say $1,000 or more. Did you go out and buy
the first thing you saw? Take one recommendation from somebody? Or did you research it,
learn some things, compare it to other options, and select something that was right for you?
Most people tend to be educated and research large purchases like cars, televisions, or the
newest iphone. So why do we so often fail to do this with healthcare?

By becoming more educated healthcare consumers we can go from passive patients who take
the first recommendation that comes from a practitioner to an active consumer who weighs
options and makes choices. Here are some questions to talk through with your practitioner the
next time a healthcare decision comes up.

What are the benefits or expected results?

When a treatment or procedure is recommended, the patient often assumes that it will make
them “better.” But what the patient expects and what the healthcare provider expects are often
two different things. For example, a patient having back surgery expects to be pain free after
surgery. The surgeon probably doesn’t expect that to happen. Outcomes from back surgeries
are terrible. A large study of 1450 patients in the Ohio worker’s comp system showed that after
2 years 26% of patients who had surgery returned to work. Compare that to 67% of patients
who didn’t have surgery. There was also a 41% increase in the use of painkillers in the surgical group.

What are the risks and downsides?

Patients want to hear about the benefits of a treatment, but they often don’t ask or care about
the risks. To be an educated consumer, you need to. If one treatment has a 3% edge over
another, but has a high risk of making you itchy or causing frequent headaches, do you want it?
Going back to the back surgery study from before, the researchers found a 1 in 4 chance of a
repeat surgery and a 1 in 3 chance of a major complication. With surgery you risk infection,
blood clots, complications with anesthesia, and a whole host of other things. These risks need
compared with other treatments. In the case of back pain, physical therapy is a valid alternative
with a much lower risk profile. You might have some soreness with physical therapy, you might
sweat some and be challenged with exercise, but the risks of PT compared to surgery are minimal.

What are the alternatives?

Don’t feel bad asking about alternative treatments. If you were looking at a certain car you
wouldn’t go out and just buy it. You’d at least consider the competitors and probably even test
drive them. You should at least look at the other options in healthcare too. Maybe the first
recommendation that your practitioner makes is the right one for you, but if you don’t consider
the alternatives you’ll never really know.

Why this treatment over the other ones?

This is the question where the rubber meets the road. You’ve learned about all the options, now
you can see if your practitioner is balancing the risks and benefits to make the right choice for
you. Staying with the back pain example, research shows that more than 40% of people who
seek care for back pain will not receive a treatment of known effectiveness. Back pain is also
the #1 reason for opioid prescriptions, despite a 2016 recommendation from the CDC to avoid
prescribing opioids for back pain, and opt for non-drug treatments like physical therapy. By
asking for the rationale and carefully weighing options, you can avoid being one of the people
who gets an ineffective treatment.

What’s it cost?

This last question is becoming more important as patients bear an increasing share of the cost
of healthcare. Even if you don’t have a high deductible plan or hefty co-pays, by being
financially responsible today, you’ll probably see smaller price increases in your premiums down
the road. That back surgery that we’ve been talking about? It’ll likely cost between $60,000 and
$80,000. So if we put the whole picture together, a patient who takes the first recommendation
for surgery will have a $60,000 procedure that leads to a higher risk of disability, and a higher
risk of long term painkiller use, while risking infection, and blood clots. Don’t forget the 25%
chance that you’ll get to do it all again in a repeat surgery. Seems like a bad deal. An educated
consumer would learn that physical therapy is a viable alternative to surgery with comparable
outcomes, much less risk and lower cost. In fact, a large study of 122,723 subjects showed that
people with back pain who got physical therapy in the first 14 days lowered their healthcare
costs by 60%. It’s easy to see why bargain shoppers love PT!

PT Can Prevent Unnecessary Surgery

Recent research is showing that surgery might not be needed as often as we think. A large
review estimates that 10% to 20% of surgeries might be unnecessary and that in some
specialties such as cardiology and orthopedics, that number might be higher. The reasons for so
many unneeded surgeries being performed are varied, but the most common are that more
conservative options aren’t tried first, or lack of knowledge by the operating physician.

Physicians undergo long and rigorous training programs to become surgeons, but if they don’t
work hard to keep learning, their knowledge often stops growing when they leave residency.
Recent research is showing that certain common surgeries aren’t any better than a placebo.
Two such examples are kyphoplasty – a procedure for spinal compression fractures, and partial
meniscectomy – a procedure used to treat tears of the meniscus in the knee. If a surgeon hasn’t
continued to learn, they won’t know that these surgeries often don’t offer any more benefit than
a non-surgical treatment and will continue to perform them.

Every surgery, even “minor” ones carry risks. These include complications from anesthesia,
blood clots after surgery, delayed healing of the incision, infection, and unintended damage to
nerves or other organs near the surgical site. Some of these risks cause discomfort for a period
after surgery and go away, but others can result in permanent disability or even death. For some
patients and conditions, surgery is a great treatment option, but with all the associated risks,
when surgery can be avoided, it should be.

For musculoskeletal problems like back and joint pain, sprains, and strains, seeing your PT
before a surgeon can help keep you out of the operating room and get you back to life without
surgery. Studies have shown that physical therapy is just as good if not better than surgery for a
multitude of conditions and carries less risk. Some examples would include rotator cuff tears,
meniscal tears, spinal stenosis, low back pain, and osteoarthritis.

Physical therapy can’t fix every problem, and for some patients surgery is the best choice.
However, research is showing that surgery isn’t a cure-all, and is sometimes just a very
expensive and risky placebo. In most cases, starting with physical therapy is the right choice,
and for many patients, PT is the only treatment necessary.

Life is a Movement Journey, Here’s How PT Can Help

Now that spring has arrived, temperatures are starting to rise in many parts of the country. And
that means the transition from heating our homes to cooling our homes is right around the
corner. No matter what method you use to cool your home during the warm spring and summer
months (central air conditioning, window units, or fans and dehumidifiers), each spring you cross
your fingers that your approach still works. If not, you might be calling an expert for a tune-up,
or in extreme circumstances, you might need a complete overhaul.

Just like an AC system that has probably been dormant for many months of the year, a body
that hasn’t been physically engaged on a regular basis may have trouble getting started again.
And yet, this time of year, the warm temps draw many people to city and suburban streets,
tracks and trails, ready to take that first run of the season. A good percentage of these spring
runners haven’t kept up their strides throughout the winter. It should come as no surprise that a
4-mile run for a previously inactive person is going to stir up a few aches and pains.

Especially as we age, our ability to move undergoes changes. But whether we’re talking about a
college student or a retiree, returning to an activity without proper planning is a recipe for
disaster. That’s where physical therapy comes in. Physical therapists are trained to treat injuries
and ease pain, but they can also help their patients prevent injuries and safely prepare to
participate in new activities.

Think of physical therapists as “movement consultants” who can ensure that your body is
physically ready to tackle a new challenge—or resume a favorite leisure activity. Here’s another
example to illustrate what we’re talking about: Let’s say that you play in an adult soccer league
and you’re preparing to play in your first game of the season in a few weeks. You probably hung
up your cleats when the last season ended months ago, but expect to pick up just where you left
off. But it’s simply too much to ask for your 2019 debut on the field to be on the same level as
the last game of the previous season, when you likely had reached peak performance.

This is a good time for your PT to step in and help you shake off the rust. The rehab professional
can customize an exercise plan to help you slowly return to sport and avoid an injury that could
sideline you for the whole season. Or like cleaning the filters before firing up your air
conditioner for the first time this year, the rehab expert can help to ensure that your body is
prepared to return to its former activity level following a hiatus

#GetPT1st For Back Pain

Chances are, you or someone you know has had back pain. Each year 15% of the population
has their first episode of back pain, and over the course of our lives, 80% of us will have back
pain. Even though back pain is common, the medical community does a poor job managing it.
Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too
common.

Let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy:

Medication

Low back pain is the #1 reason for opioid prescription in the US, however in 2106, the CDC
recommended against the use of opioids for back pain in favor of “non-drug treatments like
physical therapy.”

Imaging

Having an X-ray or MRI for back pain is common, however it’s rarely needed or helpful.
Research has NEVER demonstrated a link between imaging and symptoms. As we age, degenerative changes on imaging is common.
● 90% of people age 50 to 55 have disc degeneration when imaged, whether they have symptoms or not
● In 2015 a study that looked at 1,211 MRI scans of people with no pain found that 87.6% had a disc bulge
● Just getting an image increases the chances that you’ll have surgery by 34%

Surgery

The US has sky high rates for back surgeries – 40% higher than any other country and 5x higher
than the UK. You’d think that with all the back surgeries we do, we’d be pretty good at it but the
outcomes are terrible!
A worker’s comp study looked at 725 people who had spinal fusions VS 725 people who didn’t.
The surgical group had:
● A 1 in 4 chance of a repeat surgery
● A 1 in 3 chance of a major complication
● A 1 in 3 chance of never returning to work again

Physical Therapy
● Current clinical practice guidelines support manual therapy and exercise
● Research proves that early PT lead to better outcomes with lower costs, and decreases
the risk of surgery, unnecessary imaging, and use of opioids
● A study of 122,723 people with low back pain who started PT within 14 days found that it
decreased the cost to treat back pain by 60%
● Unfortunately only 2% of people with back pain start with PT, and only 7% get to PT
within 90 days.

Despite the data showing that PT is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. Almost every state has direct access, meaning that you can go directly to a physical therapist without a doctor’s referral. If you see your doctor for back pain, and PT isn’t one of the first treatment options, ask for it!

80% of Americans Experience Back Pain, But 100% of PTs Know How to Prevent It

Got back pain? You’re not alone. Eighty percent of Americans suffer from low back and neck pain at some point in their lives. Let that sink in. With such great odds that you—or someone close to you—will one day become a statistic, wouldn’t it make sense to arm yourself with preventive strategies and knowledge? Physical therapy is a good place to start.
By performing a thorough evaluation, a physical therapist can identify the muscular, postural and skeletal limitations that could one day lead to an episode of back pain. As part of the assessment, she will observe as you perform a series of exercises and then gather an account of your daily activity level and environmental factors like operating machinery or working at a desk 40 hours a week.
The PT will then use all of this knowledge to design a personalized exercise program and teach you a few APT-approved strategies to prevent back pain:
Use good body positioning at work, home and during recreational activities.
Keep the load close to your body during lifting.
Ask for help before lifting heavy objects.
Maintain a regular physical fitness regimen— staying active can help to prevent injuries.

Lifestyle can play a big role in back pain. In fact, inactivity and incorrect body mechanics while participating in certain activities are two of the biggest contributors to back pain. In addition to the strategies listed above, it’s also helpful to pay attention to little things throughout your day. That could add up to bigger problems down the line. Let’s go back to that desk job for a minute: How often do you get up to walk, stretch and move throughout the day? A good rule of thumb is to stand up or move every 30 minutes. You may get bonus points with your boss, too, as your productivity soars due to the increased activity.
While low back pain rarely becomes serious or life-threatening, it can be quite painful and interfere with our daily lives. Working with a physical therapist can help patients identify the factors that might contribute to back pain and help to develop a prevention plan. But the healthcare professionals are also a great place to turn when you’re seeking treatment for back pain or hoping to prevent a recurrence.
With such good odds that you could one day become a low back pain statistic, why not do everything in your power today to change your trajectory? Seems like another good reason to find an activity (or better yet, two or three activities) that you enjoy, make it a regular part of your day and stick to it!

ARTHRITIS & FIBROMYALGIA & AQUATIC THERAPY

Relaxation is one of the most important aspects of controlling arthritis and fibromyalgia pain. Therapeutic warm water provides sensory stimulation, which encourages relaxation and stress relief. Combining this warm water with our deep penetrating massage system can greatly reduce the stress and pain on aching muscles and joints.
Walking on the underwater treadmill or exercising against the resistance jets can also help manage your pain. When standing chest deep in water, the body is 80% weightless, bearing only 20% of its body weight. This weightlessness significantly reduces the stress on joints and muscles.
BENEFITS OF AQUATIC THERAPY FOR THOSE WHO SUFFER FROM ARTHRITIS AND FIBROMYALGIA:
-Relaxation
-Increased joint range of motion
-Pain relief
-Enhanced mobility
-Improve flexibility
-Mobility and strength
-Removes weight from joints and bones
-Strengthens muscles and joints after surgery
-Decreased side effects

Call Freedom today to set up your appointment OR ask about our free 30 minute session.

Patients Reap the Benefits of Playing a More Active Role in Physical Therapy

Patients can no longer be passive players in the game of health. Studies show that informed patients are not only more engaged during physical therapy but also reap the benefits in overall health and well-being.

Those who understand why they’ve been referred to physical therapy, are actively engaged in the process, and develop useful self-management skills are more likely to achieve lasting results. With a few pointers, building one’s health literacy doesn’t have to be an overwhelming prospect.

To get the most out of your rehabilitation, it’s important to keep an open line of communication with your physical therapist. Your physical therapist is a wealth of knowledge and is there to help you regain mobility and relieve pain. The interaction should be positive, informative, and collaborative. Here are a few questions to ask your physical therapist so you may understand the rehab approach and how it impacts your injury or illness:
Why have I lost function/why do I hurt?
Your physical therapist has been trained to determine why a particular injury causes a loss of mobility or interferes with your ability to complete a task. It’s helpful for patients to gather information and understand the body’s mechanics as it relates to an individual injury.
Did my lifestyle contribute to this issue?
Your physical therapist will gather information about your lifestyle in order to identify habits that might be contributing to the problem. Perhaps the patient needs to wear shoes with support and limit time in flip flops. Or maybe the patient is experiencing low back pain due to poor posture at work.
How will physical therapy help me?
Physical therapists work with patients to devise an individualized and concrete care plan. You should feel comfortable asking your physical therapist why a specific goal has been chosen, how it will help you, and what you personally need to do to succeed.
What can I do to make sure I get better?
Showing up for appointments is only half the battle. Being ready to participate and understanding what you should be doing in between appointments is critical. You should be prepared to carry over goals at home and make modifications to habits at home and work to change contributing behavior.

It’s important that you feel comfortable asking your physical therapist questions and continue to understand how you can contribute to your care plan. Advocating for your own care and maximizing educational opportunities will give you the confidence and tools to succeed in physical therapy and beyond.