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“To realize the full benefits of the Affordable Care Act, physicians will need to embrace rather than resist change. The economic forces put in motion by the Act are likely to lead to vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups.”

The above quote is an excerpt from an article that appeared in a recent edition of the Annals of Internal Medicine, which is the professional journal of the American College of Physicians.  The article is titled “The Affordable Care Act and the Future of Clinical Medicine: porThe Opportunities and Challenges“. You can read the article here. There is a bullet point summary of the purported benefits of the Affordable Care Act. They sound good.

Wait a minute.  Go back a reread the quote above.  I am reminded of something I heard someone say recently.  “If you are not at the table, you are on the menu.“  If you are in private practice like me, you have to be a bit concerned about what “vertical organization”, “employment” and “aggregation” mean to you.  Will we be marginalized if we stay in private practice?  What does this foretell about the professional autonomy that many of us in private practice seek?

Alas, I don039#t have any answers to these questions.  And therein lays the trouble.  The uncertainty is troubling.  In the meantime, the best we can do is do what we are doing everyday…. treat our patients well and look for efficiencies and opportunities to improve our practices.  I wish you the best of success.

On a final note, take a read through the responses to the article for a general flavor from the readership about the content.  It appears that not everyone is signed on to embrace.

- Contributed by: Jeff Ostrowski, Owner/CEO

As the new school year approaches, make sure you and your children are armed with the following tips to help ensure proper backpack fit and safety:

• Wear both straps

Use of one strap causes one side of the body to bear the weight of the backpack. By wearing two shoulder straps, the weight of the backpack is better distributed.

• Wear the backpack over the strongest mid-back muscles

Pay close attention to the way the backpack is positioned on the back. It should rest evenly in the middle of the back. Shoulder straps should be adjusted to allow the child to put on and take off the backpack without difficulty and allow free movement of the arms. Straps should not be too loose, and the backpack should not extend below the low back.

• Lighten the load

Keep the load at 10-15% or less of the child039#s body weight. Carry only those items that are required for the day. Organize the contents of the backpack by placing the heaviest items closest to the back. Some students have two sets of books so as not to have to carry the heavy books to and from school.

Courtesy of APTA, American Physical Therapy Association

WRONG: (left) Load too heavy.
CORRECT: (right) Load no more than 10-15% of body weight

WRONG: (left) Strap on only one shoulder.
CORRECT: (right) Wide, padded straps on both shoulders

A physical therapist can help you choose a proper backpack and fit it specifically to your child. Children come in all shapes and sizes, and some have physical limitations that require special adaptations.

Additionally, a physical therapist can help improve posture problems, correct muscle imbalances, and treat pain that can result from improper backpack use.

Physical therapists can also design individualized fitness programs to help children get strong and stay strong—and carry their own loads!

Your IT (Iliotibial) band is a thickening of the fascia that runs along the outside of your thigh and end on the outside of your knee. Running and cycling can cause friction and pain along the outside of your knee. This stretch helps prevent this common overuse syndrome:

When training for a distance run, one of the top 5 overuse injuries that runners encounter is called Iliotibial Band (ITB) Syndrome. This syndrome presents itself most often as pain on the outside of your knee during or after a run. The ITB is a thickening of the fascia that runs along the outside of your thigh or femur bone. It connects the lateral hip muscles (gluteus maximus and tensor fascia latae) to the outside of the knee. As the ITB travels down the leg, it narrows, causing the potential for friction between the soft tissue and the bone in the knee. This friction occurs during repetitive knee bending associated with running, squatting, lunging and hills/stairs. The constant rubbing or irritation can cause inflammation leading to knee pain. Several factors in how you train can increase your risk for developing ITB syndrome including a rapid increase in mileage, consistent running in the same direction on a track or outside loop, and running hills and stairs as a workout.

Lateral hip weakness can also lead to ITB syndrome. If the gluteus medius is weak, it places more stress on the tensor fascia latae (both hip abductors) overworking the ITB. Prevention of ITB syndrome should include stretching as well as lateral hip strengthening.

You can use the following strengthening video and stretching video to help prevent ITB.

Initial treatment for this condition includes rest, ice, stretching and massage. The use of a foam roller along the entire length of the ITB can reduce tightness, promote healing, and minimize painful adhesions along the soft tissue. When the pain has subsided at rest and does not return with any daily activities, an incremental return to running progression may be instituted, increasing mileage and speed slowly while monitoring symptoms. A fun, safe way to return to running may be to join a running group such as Team Philly Race Training. This program offers runners (beginner to intermediate) an opportunity to train in a motivated environment with professionals that can assist in coaching, cross training and injury prevention/treatment.

If the pain returns, stop running immediately and return to rest, ice, gentle massage and stretching. If the pain persists for  more than one week it may be time to contact a physical therapist, who can help with pain relief and provide the necessary treatment such as Active Release Technique to restore full activity as quickly and safely as possible. If left untreated, this injury may become chronic which will be more difficult to treat and require more time away from running.

- Contributed by: Desirae Gaspero, PT, DPT

Training for an endurance event such as a triathlon or a marathon can be challenging and rewarding, but can often result in injury. There are multiple reasons injury can occur: progressing training too quickly, not allowing enough rest between workouts, muscle imbalance or poor footwear.  A common injury that runners and triathletes experience is shin splints, or tibial stress syndrome.

Tibial stress syndrome is somewhat of a catch-all term for injuries in the front of the lower leg.  Pain can occur along the inside or outside border of the shin bone (tibia) and usually increases with intensity or duration.  Pain often resolves with rest.  However, after a tough workout, aching can persist at rest.  The muscle along the bone is often tender to the touch and can swell.

One cause of this pain can be irritation (either acute or chronic) of the muscles around the shin bone.  If the problem is strictly muscular, it can often be resolved with stretching, appropriate strengthening, modalities such as heat or ice, and massage. Another possibility could be stress fractures along the shaft of the tibial bone.  They are tiny, hairline fractures that sometimes can039#t even been seen with an x-ray.  Similar treatment can be applied but only after long rest periods and wearing a boot or splint. Additionally, a cause can be tightness in the fascia, or outer covering of the muscle, called compartment syndrome.  Symptoms are similar but should be monitored to ensure that the condition is not worsening, in which numbness and weakness can occur.  This condition can be treated conservatively with stretching and massage but surgery could be indicated depending on severity. Check out the video below for a sample stretch that you can do:

As previously mentioned, shin splints can indicate various injuries and it is important to know what the issue is. If pain continues for more than 1-2 weeks then a physical therapist can evaluate and help determine the cause.  From there, the PT can guide you through an appropriate treatment plan, help adjust your footwear, or refer you for further testing in order to safely address the issue and get you back on your feet.  Once it is appropriate to get back into training, it may be beneficial to do so with a group such as Team Philly Race Training. Team Philly consists of trained professionals who help runners at all levels train for various distances, in a safe and controlled manner.  A group may help you reach your goals and avoid re-injury.

Contributed by: Emily Baith, PT, DPT, ART

Erica Gerlach, PT,MPT, Cert. MDT, ART, Clinic manager of Excel's Northeast Philadelphia location, became certified in Active Release Technique (ART) for the shoulder, arm, wrist and fingers this past February and is already reporting outstanding results!

She tells us that within as little as one visit, she has seen improvements in
shoulder flexibility that allows the individual to perform functional overhead activities. She has also seen reduction in elbow pain when the person is performing activities that involve using the wrist and hand.

Erica recently worked with a patient who had been dealing with shoulder pain and limited motion overhead for several years, with minimal relief from previous physical therapy treatment. Within four visits and use of Active Release Technique, the patient was able to reach overhead to touch the back of his head with improved mobility and little to no pain!  This was his major reason for attending therapy and his goal was achieved in a short time.

“It is because of this that I love incorporating this manual treatment in my patients program and of course they love the quick results as well”, says Erica. Here is a quick demonstration and explanation from Erica on the benefits of Active Release Technique:

Active Release Technique® (or ART®) is a patented manual therapy technique that corrects soft tissue restrictions that lead to pain and decreased mobility. Combined with traditional rehabilitation activities, this technique is producing extraordinary functional outcomes with patients.

Patients with repetitive use injuries, frozen shoulder, tendinopathy, carpal tunnel syndrome, plantar fasciitis, rotator cuff pathology, restricted joint motion and sprains/strains are examples of diagnoses that respond well to ART®. Usually a patient will see significant results within just a few visits. ART® is not only the treatment of choice for high performance athletes and workers’ compensation managers, but also for top sports medicine physicians in the tri-state area.

Excel Physical Therapy & Fitness has more certified ART® providers than any physical therapy practice on the East Coast. Each of our eight locations has at least one certified ART® therapist. Click here for a list of Certified ART providers near you.