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!
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!
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.
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.
Get PT First During the COVID-19 Pandemic
Because of the closures of physician’s offices, stoppages of elective surgeries, and social distancing guidelines resulting from COVID-19, many people with pain or joint issues have had appointments or surgeries delayed. If you’re one of them and you haven’t seen your PT yet, you should. Here are some reasons why:
Early PT leads to better outcomes
Studies have shown that people who receive PT sooner have better outcomes, lower costs, are less likely to have surgery, use opioids or have unnecessary testing. Because back pain is so common, there is a lot of outcome data from people with back pain. A study of 150,000 insurance claims published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit. Unfortunately, only 2% of people with back pain start with PT, and only 7% get to PT within 90 days.
Early PT saves money
The rising cost of healthcare is well known and early PT is something that has been shown to reduce costs without reducing the effectiveness of treatment. A study published in the Journal of Orthopaedic and Sports Physical Therapy showed that patients who obtained physical therapy via direct access had significantly lower medical costs—an average of $1,543 less per patient than those who chose referral from a physician. They also had significantly fewer visits and spent significantly fewer days in care.
Surgery may not be as effective as you think
Many patients look to surgery as the fix for their pain, but surgeries aren’t always as effective as patients believe. A large study looking at worker’s comp patients with back pain found that people who have surgery have a 1 in 4 chance of having a repeat surgery, a 1 in 3 chance of a major complication, and a 1 in 3 chance of never returning to work again. Recent large studies of arthroscopic surgeries for meniscal tears have shown no difference in outcomes between people who have surgery and those who don’t. Other procedures with questionable effectiveness include kyphoplasty, vertebroplasty, and injections for nonspecific back pain.
So, if you were planning on seeing your PCP or a specialist for an orthopedic condition or pain and you haven’t seen a PT yet, you should consider making PT your first stop. You could end up getting better faster for less money and you might avoid riskier treatments like opioids or surgery.
Are Your Workouts Giving You What You Want?
Are Your Workouts Giving You What You Want?
How much thought have you put into the exercises you’re going to use for your next workout?
Did you choose them yourself, or did you find them on the internet or in a magazine? What’s
your workout designed for? Do those goals match yours? Are the exercises even safe for you?
Using the wrong program can lead to wasting time in the gym, frustration, plateaus in progress
and injury. Let’s take a closer look at what goes into program design and the cost of getting it
wrong.
Exercise Selection
There are many things to think about when choosing specific exercises. Machine vs. free
weights, isolation vs. compound lifts, number of reps and sets, etc. Each one of these factors
affects the results, so making the wrong choices could lead to wasting time working on the
wrong things, limit your results or lead to injury.
Technique
If you choose the right exercises, but don’t know how to do them properly you will again limit
your results, or worse, end up injured. Poor technique leads to inefficient movement and limits
the power your muscles can create. It also changes the load on your muscles, joints, and
ligaments which can lead to pain and injury.
Volume
Volume is a way of thinking about how much work you’re doing during a workout. Doing a few
reps with a heavy weight or a lot of reps with a light weight could end up being the same
volume. Same goes for running a shorter distance quickly uphill vs a longer run at a slower pace
on flat terrain. If your volume is too great you won’t recover well between workouts and create
the possibility of injury. Too little volume and you won’t see results.
Progression
If you’ve been doing the same exercises with the same weight and the same number of reps
and sets, you’re not progressing. Same goes if you jump on the treadmill for the same amount
of time with the same settings each time. To make progress, things have to change and the
program that works for your first 6 months won’t work for you 2 years down the road.
Designing an exercise program is a complex challenge with a lot of factors to consider. Most
people have a history of injuries and don’t have perfect movement in every joint which further
complicates things. If you’re not making progress or just want to make sure your workouts are
as effective as they can be, have your physical therapist take a look at your program. Your PT
can help design an individualized program to help you reach your goals while keeping you safe
and injury free.
Your Physical Therapist Can Help You Keep Your Resolution
Your Physical Therapist Can Help You Keep Your Resolution
As one year comes to a close and another begins, people begin to set goals and make
resolutions. Losing weight, getting to the gym more often or getting into “better shape” are all
common. These all require increasing your amount of physical activity. More activity is great for
your health, energy levels, sleep, and mood. However, ramping up your activity level too quickly
after a holiday season of eating, drinking and being merry can lead to pain, injury and
disappointment if your body isn’t ready for it.
Your physical therapist is an expert in human movement, and can help you safely reach your
fitness goals. People think of PTs as the person to see after an injury, but a visit before you
change your activity level could prevent injury in the first place. An evaluation by your PT will
include assessment of your strength, range of motion, and functional movement patterns – think
jumping, running, squatting, carrying. Some PTs even like to use a standardized assessment,
such as the Functional Movement Screen.
Most common injuries from new fitness routines are caused by underlying weakness, range of
motion deficits, or compensatory movement patterns. Your PT will find these during your
assessment. They can then prescribe exercises or movements to address the issues found and
get you safely moving into the new year!
The other common way people get injured working towards their resolution is with overtraining,
or doing too much too soon. Physical therapists are also experts in exercise prescription and
program design. Your PT can help you create a routine specific to your needs and goals that will
progress appropriately and keep you out of trouble.
So stop only thinking of your PT after you’re injured. In this case, it’s true that an ounce of
prevention is worth a pound of cure. Seeing your physical therapist before you start on your
resolution can keep you on track, injury free, and help you reach your goals for the new year!
Start Your Year With an Annual Movement Screen
Start Your Year With an Annual Movement Screen
Your car needs regular maintenance, so you probably have a mechanic. Your eyes and teeth
are important, so you see your optometrist and dentist regularly. You get an annual physical
from your family physician. You might even be getting ready to see your accountant to get your
yearly income tax done. What about your physical therapist? Do you and your family have one?
If not, you should. Your body is a lot like your car. It’s got multiple systems, all of which are
complex, and all of which have to be working well for it to function. Physical therapists are
experts in maintaining, diagnosing, and treating the movement system. Like the braking or
ignition system in a car, most people only think of the movement system when it’s not working
the way it should.
Don’t Neglect Your Movement System
Similar to the systems in your car, problems with your movement system are much easier to
deal with if they’re caught and treated early. This prevents small issues from becoming larger
ones. For example, if you have a little bit of weakness, and balance that’s not quite up to par,
improving those early could prevent a sprained ankle, or a fall and a broken wrist.
An annual movement screen from your physical therapist can find small issues that you may not
have noticed with your strength, balance, flexibility, or coordination. Many of these minor issues
can be fixed with a few exercises at home, or with just a few visits.
What to Expect
A screen of your movement system is quick and easy. Your annual visit may include:
● A history of your injuries, as well as a health history
● Assessment of your strength, balance, flexibility, etc.
● A review of your movement goals (do you want to run a marathon? Get on and off the
floor easily playing with your grandkids?)
● A review and update of your exercise program
