Excel Physical Therapy and Fitness | News

Stretch for a healthier back.

For most of us, Spring means gardening, spring cleaning, cleaning out the garage, and of course, a push to exercise so we can fit into our swim suit in the summer. All of these activities require bending and lifting which means there is a potential for back pain. Stretching and exercises designed to strengthen lower back and abdominal muscles can prevent the onset of back pain. Try working these simple exercises into your daily routine. Regular low-impact exercises for just 30 minutes a day can increase muscle strength and flexibility for patients with lower back pain. Our physical therapists at any one of our 17 locations can provide a list of low-impact age appropriate exercises. We have provided a series of back exercise videos on our website demonstrating the exercises that are routinely performed under the direction of a physical therapist. Just click here to view the videos.

•    Always stretch before exercise or other strenuous physical activity.

•    Don’t slouch when standing or sitting. When standing, keep your weight balanced on your feet. Your back supports weight most easily when curvature is reduced.

•    At home or work, make sure your work surface is at a comfortable height for you.

•    Sit in a chair with good lumbar support and proper position and height for the task. Keep your shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support. If you must sit for a long period of time, rest your feet on a low stool or a stack of books.

•    Wear comfortable, low-heeled shoes.

•    Sleep on your side to reduce any curve in your spine. Always sleep on a firm surface.

•    Ask for help when transferring an ill or injured family member from a reclining to a sitting position or when moving the patient from a chair to a bed.

•    Don’t try to lift objects too heavy for you. Lift with your knees, pull in your stomach muscles, and keep your head down and in line with your straight back. Keep the object close to your body. Do not twist when lifting.

•    Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that taxes lower back muscles. A diet with sufficient daily intake of calcium, phosphorus, and vitamin D helps to promote new bone growth.

•    If you smoke, quit. Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate.

Courtesy of the National Institute of Neurological Disorders and Stroke of the National Institutes of Health. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm#191333102

Each month, we will highlight the continuing education courses completed by our E & A Therapists.

• Marsha Berger Grant was a Lab Instructor for: “Differential Diagnosis and Manual Therapy for Lumbo-pelvic and Lower Extremity Movement Impairments”. Marsha is the Director of our Chalfont Clinic.
• Christy VanderWyden and Caitlin Higgins completed Mulligan Lower Quadrant: Spinal and Peripheral Manual Therapy Mobilization with Movement Techniques. Christy and Caitlin are Physical Therapists in our Glen Mills Clinic.
• Emily Baith attended McKenzie Part C Advanced Lumbar Spine and Lower Extremities. Emily is a Physical Therapist at our Villanova Clinic.
• Brandi Feinberg finished Active Release Technique for Upper Extremity. Brandi is a Physical Therapist at our Society Hill Clinic.
• Antonio Greco finished McKenzie Part A Lumbar Spine. Attended The Philadelphia Hand Meeting: Focus on Best Practices. Antonio is a Physical Therapist at our Society Hill Clinic.
• Rob Epting Maitland completed Stabilization Training and Functional Rehabilitation. Rob is the Clinical Director at our Royersford Clinic.
• Claire Wiedmann attended Current Manual Therapy & Neuromuscular Stabilization Concepts of Lumbar Spine and Sacroiliac Joints. Attended the Women’s Health Summit: Conquering Pain. Claire is a Physical Therapist at our Royersford Clinic.
• Chrissy Biele completed Differential Diagnosis Module 1: Introduction to Screening. The differential diagnosis course includes introduction to screening for referral in physical therapy, pain types and viscerogenic pain patterns as well as physical assessment as a screening tool. Chrissy is a Physical Therapist at Rothman Institute in King of Prussia.
• Jason Bink attended Maitland III-Intermediate Spine. Jason is a Physical Therapist at our Cherry Hill Clinic.
• Meryl Goldstein completed the General Peripheral Joint Mobilization Course. Meryl is the Clinical Director at our Cherry Hill Clinic.
• Elizabeth Wantz attended “When the Feet Hit the Ground: Everything Changes.” Foot and Ankle Pathologies, Gait Assessment, and the Effects of the Kinetic Chain Beginning When the Foot Hits the Ground. Elizabeth is a Physical Therapist at our Lafayette Hill and Blue Bell Clinics.

Exercise provides significant reduction in low back pain.

Standing in the grocery checkout line, you’ll see any number of fitness magazines proclaiming exercise to be the cure for just about everything, except low back pain. The common misconception is to avoid back exercises if you have a sore back.

Clinical research suggests that exercise plays a major role in the management of chronic lower back pain. Studies show that exercise provides significant reduction in pain and disability for patients with low back pain. Physical therapist directed exercises, such as the McKenzie method and spine stabilization exercises, decrease recurrent pain. Exercise could just be the most effective way to reduce recovery time from low back pain while simultaneously strengthening back and abdominal muscles. We have posted a 6 video series of back exercises that are routinely performed during physical therapy with the assistance and guidance of a physical therapist. Please click here to view the videos on our website.

For patients with skeletal irregularities, maintaining muscle strength as well as building muscle is particularly important. Physical therapists can provide a list of gentle exercises that help keep patients muscles moving and accelerate recovery. A routine of back-healthy activities may include stretching, swimming, yoga, walking, and movement therapy to improve coordination and develop proper posture and muscle balance. Any mild discomfort felt at the start of these exercises should disappear as muscles become stronger.

- Contributed by: Joseph Ruhl, PT, Partner, E & A Physical Therapy

Back related issues are the most common patient complaint.

Low back pain is a common, disabling condition with high personal and economic costs. Low back pain will affect almost everyone at some point in their life interfering with work, daily activities or recreation. Consequently, it is the most common cause of work related disability. In fact, it is the number one reason why people visit E and A Therapy. Upwards of half the patients seen for therapy are seen for back related issues. The breadth of issues seen range from herniated disc with leg pain past the knee to central low back pain when sitting.

Time is a major variable with low back pain because in addition to the range of diagnoses, there is wide variability in chronicity of low back pain. Some people get into therapy within 10 days of onset and some may not get into therapy for 3 months. These variables greatly contribute to the patient’s outcome.

To assist physical therapists in the successful management of patients with low back pain, the Orthopaedic Section of the American Physical Therapy Association has recently published Clinical Guidelines in the treatment of low back pain. The Orthopaedic Section has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization’s International Classification of Functioning, Disability, and Health. This publication is no exception. The purpose of these guidelines is to describe the peer-reviewed literature and make recommendations related to the available evidence.

Given the prevalence of recurrent and chronic low back pain and the high costs, the evidence supports placing a high priority on interventions that prevent recurrences and prevent the transition to chronic low back pain. The guidelines report strong evidence supporting manual therapies in patients with acute low back pain and back related buttock or thigh pain. Accordingly, manual therapies reduce pain and disability in patients with mobility deficits and acute low back and back-related buttock or thigh pain. Manual therapy is effective to improve spine and hip mobility and reduce pain and disability in patients with sub-acute and chronic low back and back-related lower extremity pain.

There is substantial evidence supporting the utilization of trunk coordination, strengthening and endurance exercises to reduce low back pain and disability in patients with sub-acute and chronic low back pain and in patients following lumbar microdiscectomy. The guidelines show considerable evidence supporting the use of repeated motions that will help centralize leg pain in patients with acute, sub-acute or chronic low back pain. For reducing pain and disability in older patients with chronic radiating low back pain, flexion exercises in combination with other interventions such as manual therapy, strengthening exercises have proven to be very effective. For physicians and patients, we have posted video demonstrations of back exercises routinely performed in physical therapy under the guidance of a physical therapist. Please click here to take a look.

At E&A Therapy, we practice a patient centered approach that is manual therapy driven. These guidelines support our approach and confirm the accuracy and appropriateness of our treatment protocols. Take a look at our new feature, the Con-Ed Corner. The majority of the courses our therapists choose to take are directed at improving their manual therapy skills. And that is right on target for superior patient care.

To review the full text, please click here.

- Contributed by: Joseph Ruhl, PT, Partner, E & A Physical Therapy

Pitch counts reduce injury.

A little prevention goes a long way in avoiding throwing injuries. According to Dr. Charles Metzger, an orthopedic surgeon specializing in shoulder, elbow, wrist and hand surgery, there are some steps you can take to both improve your pitch and prevent injury. Here are Dr. Charles Metzger’s Top 10 Tips for Better Pitching from his website www.safethrow.com. These tips will help to reduce the risk of arm, elbow and shoulder injury for young pitchers.

1. Focus on legs, core and aerobic exercises on off days.
2. Work on pick-offs, field ground balls and field bunts at practice.
3. Before the game: jog, then whole body stretch, and warm up by throwing no earlier than
   20 minutes before game time.
4. In the game, stepping off can be just as effective as throwing to first for holding a runner.
5. Remember timing is key, so vary the time between the upcoming set and throwing.
6. Hand break, like breaking a stick over your knee, with thumbs down “thumbs to the thigh”.
7. Put your fingers on top of the ball in take-back.
8. Never let the catcher see the ball behind the pitcher’s head i.e. “show the ball to
   the shortstop”.
9. Be sure to finish with your hand near the ground “pick the grass”.
10. Pitchers are batters, so always practice batting. There’s no better way to get a win than hit an RBI double or HR.

For more tips to improve your pitch, go to www.safethrow.com.

- By Charles Metzger, MD and www.safethrow.com.

Physicians tasked with discussing financial implications of referrals with patients.

Physical therapy co-payments of $30, $40, $50 per visit or more are becoming more common. High co-payments provide a financial barrier for patients to get the treatment they need. An insurance plan with a high co-payment is really no benefit at all. In many cases, the patient’s co-pay responsibility is nearly the entire amount of the allowable fee.

The Pennsylvania Physical Therapy Association is working to address this issue at the state level. Recently, a bill was introduced in the Pennsylvania Senate that would cap co-payments at the lesser of $30 per visit or the insurer’s primary care co-payment amount. Similar laws have recently passed in Kentucky, North Dakota and New Jersey.

We have learned that because of high co-payments, physicians are often in the uncomfortable situation of having to discuss the financial implications of a physical therapy referral with patients. Hopefully, this legislation will pass and allow the focus to remain on the best course of treatment for the patient rather than money.

- Contributed by: Jeffrey Ostrowski, PT, Partner, E & A Physical Therapy