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Getting Kids Moving: Pediatric Physical Therapy

Physical therapists don’t just help adults recover from injuries. Pediatric physical therapists are
specially trained to help children of all ages overcome challenges and reach their full potential.
Whether your child has a developmental delay, a sports injury, or a chronic condition, a PT can
create a fun and effective program to get them moving.

How PT for Kids Works
Unlike a typical doctor’s visit, pediatric PT sessions are all about play! Therapists use games,
activities, and exercises tailored to your child’s needs and interests. This might involve:

● Building Strength and Coordination: Using fun exercises and activities like animal walks,
obstacle courses, and games, PTs help children improve their balance, agility, and muscle
control. This can be essential for everything from playing on the playground to keeping up
with friends.

● Addressing Developmental Delays: Physical therapy can be a game-changer for children
who are experiencing delays in reaching milestones like rolling over, crawling, or walking.
Your PT will assess your child to identify the areas holding them back, and create a fun
program to help them develop the skills they need to progress.

● Recovering from Injuries: Did your little athlete take a tumble? PTs can help kids heal from
sports injuries and surgeries. A PT will help your child restore strength and flexibility so they
can safely get back to their favorite activities.

● Managing Chronic Conditions: Children with conditions like cerebral palsy or muscular
dystrophy can benefit from physical therapy to help manage their symptoms and improve
their overall function and well-being. A PT will assess your child to identify areas of strength
and areas that need improvement. They will then develop a program to help your child
maximize their strength, range of motion, coordination, and endurance. They’ll educate you
and your child on things you can work on at home. They can also help get your child any
needed equipment like wheelchairs, braces, or walkers.

Benefits Beyond Movement
Physical therapy isn’t just about physical health. While physical therapists play an important role
in promoting physical activity and health in kids, PTs can also help children with:

● Self-Confidence: As kids gain strength, coordination, and independence, their confidence
soars. This can have a positive impact on all areas of their lives.

● Pain Management: PTs can teach children techniques to manage pain and discomfort,
improving their overall quality of life.

● Socialization: Gross motor skills help children participate in play and games with peers,
which help children develop social skills and build friendships.
If you think your child might benefit from physical therapy, talk to your pediatrician or
give your PT a call. They can assess your child’s needs and create a personalized plan to
help them reach their goals!

PTs Fuel Healthy Movement With Nutrition

Physical therapy and nutrition are often seen as separate, but the truth is, they are deeply
intertwined. To get the most out of PT, especially after an injury or surgery, integrating both is
crucial. Here’s why:

Food Fuels The Body
During recovery from an injury or surgery, your body is working to heal itself. The activities and
exercises you’re doing in PT are designed to help it along. To take advantage of all the work
you and your body are putting in, proper nutrition is critical.
Protein provides the building blocks for tissue repair and muscle growth. Carbohydrates provide
energy and help support your immune system. Your body also needs healthy fats to regulate
inflammation and to build certain cells. Being short on any of these critical components will slow
your recovery down.
You also need enough micronutrients, like vitamins and minerals. For example, vitamin C is
needed to make collagen, which goes into bones, skin, and connective tissue. Vitamin D helps
your body absorb calcium, which is important for healing fractures, or surgeries involving bones.
Iron helps your blood cells carry oxygen throughout your body, which is needed for healing in
general. Again, being low on any of these micronutrients will affect your healing.

Your Weight Affects Your Health
Being overweight directly affects your health. It puts you at higher risk for cardiovascular
disease, stroke, osteoarthritis, back pain, diabetes, sleep apnea, and more. All of these are
conditions that you might see a PT directly for, or that will impact your healing. Eating a healthy
diet is the most effective way to reduce body weight. Combining a healthy diet with exercise is
even better for your health.
As an example, an 18-month study of 450 people with knee osteoarthritis showed that the group
that lost weight through a diet and exercised had less pain, better walking speed, and lower joint
forces in their knees than groups who either only lost weight, or only exercised.

How can a physical therapist help with nutrition?
While PTs are not authorized to provide individual diet plans or medical nutritional advice, they
can still help with your nutrition.

• PTs can screen for potential nutritional deficiencies or imbalances that may impact your
progress in PT or your overall health. This might involve screening for malnutrition,
sarcopenia (muscle loss), or assessing dietary habits affecting energy levels, healing, or
muscle building.
• Your PT can educate you on the importance of nutrition for various aspects of
rehabilitation and recovery. This includes explaining how specific nutrients like protein,
vitamins, and minerals contribute to tissue repair, muscle building, energy production,
and pain management.
• They can offer general guidance on healthy eating patterns, portion control, and
choosing nutrient-rich foods to support reaching your specific physical therapy goals.
• PTs recognize that overall health and well-being involve various factors, including proper
nutrition. They can encourage you to adopt healthy lifestyle habits that include a
balanced diet alongside regular exercise and proper sleep hygiene.

Finally, your PT can recognize when your nutrition needs exceed what they are able to provide.
In that case, they can refer you to and collaborate with a registered dietician or other qualified
healthcare professional for help in dealing with complex nutritional needs or recommending
specific dietary changes.

By combining the power of physical therapy and nutrition, you can achieve your
recovery goals faster and feel your best!

References:
1. Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and
Clinical Outcomes Among Overweight and Obese Adults With Knee
Osteoarthritis: The IDEA Randomized Clinical Trial Effects of Intensive Diet and
Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among
Overweight and Obese Adults With Knee Osteoarthritis: The IDEA Randomized
Clinical Trial | Obesity | JAMA | JAMA Network
2. Ottawa Panel Evidence-Based Clinical Practice Guidelines for the Management
of Osteoarthritis in Adults Who Are Obese or Overweight Ottawa Panel
Evidence-Based Clinical Practice Guidelines for the Management of
Osteoarthritis in Adults Who Are Obese or Overweight | Physical Therapy |
Oxford Academic (oup.com)
3. Strategies for optimizing nutrition and weight reduction in physical therapy
practice: The evidence Strategies for optimizing nutrition and weight reduction in
physical therapy practice: The evidence: Physiotherapy Theory and Practice: Vol
25, No 5-6 (tandfonline.com)
4. Body mass index and risk of knee osteoarthritis: systematic review and metaanalysis of prospective studies Body mass index and risk of knee osteoarthritis:
systematic review and meta-analysis of prospective studies – PMC (nih.gov)
5. Nutrition: A Portion of PT’s Menu of Services Nutrition: A Portion of PTs’ Menu of
Services | APTA
6. Considerations for PT’s Role in Nutrition Considerations Related to the PT’s Role
in Nutrition and Diet | APTA
7. Nutrition and PT a Powerful Combination – Nutrition and Physical Therapy: A
Powerful Combination | APTA

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

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 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.

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.

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.

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.