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.
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
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/
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!
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
