News

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

Little League coach talks with pitcher and catcher

Spring training is here and the beginning of Little League baseball season is right around the corner. If you’re a proud parent and baseball fan like me, there will be plenty of trips to the ballpark for practices and games. And sometimes there will be injuries. One major concern for Little League pitchers is their arm health because most youth upper extremity injuries occur while pitching. In fact, the elbow is the most frequently reported area of overuse injury in child and adolescent baseball players. Here is the medical evidence to consider.

In a recent article for the American Academy of Orthopaedic Surgeons, Dr. Tetsuya Matsuura, reported that 25% of young players (age 8-12) experience elbow pain, with the highest rate of pain reported in pitchers. Specifically, Matsuura looked for osteochondral lesions, tears or fractures in the cartilage of bone covering the elbow joint.

Dr. Charles Metzger, an orthopaedic surgeon specializing in upper extremities, found that a simple stretch known as the posterior capsular stretch can help improve and prevent injury. “A posterior capsular stretch is done after play and since it is different from the general stretches players already know, it must be taught,” says Dr. Metzger. “Once learned, however, it is very simple, and takes only five minutes to complete. Nearly 97 percent of young players who perform the stretch properly and consistently report shoulder improvement.” Stretching exercises maintain good shoulder flexibility and reduce the risk of rotator cuff and other shoulder and elbow injuries to young pitchers. Without a stretching program, athletes tend to develop muscle imbalances through the season. The posterior capsular stretch is also known as the sleeper stretch. Click here for a video showing how to perform this stretch safely.

The good news is that Little League Baseball has taken steps to help limit the potential injury for today’s young pitcher by embracing the pitch count research and boldly altering their rules. Last year, I watched the Little League World Series in South Williamsport, PA and to my surprise, they had an outfield display for the pitch count of the pitcher.

In the February 6th issue of Sports Health, A Multidisciplinary Approach, Joseph J. Fazalare, et al published an article titled “Knowledge of and Compliance With Pitch Count Recommendations: A Survey of Youth Baseball Coaches.” The goal of the article was to see if coaches of youth baseball, in their region, were aware of the recommended guidelines and if they, in fact, followed these guidelines.

Their conclusions were that there was a deficiency in regard to knowing the guidelines set by the USA Baseball Medical and Safety Advisory Committee Pitching Guidelines. This led the authors to conclude that this may in fact put these young pitchers at increased risk for upper extremity pain and injuries.

Dr. George A. Paletta Jr., a surgeon at the Orthopedic Center of St. Louis and the team physician for the St. Louis Cardinals, firmly believes that sticking to the guidelines for playing baseball can significantly reduce injuries. “A young athlete should never throw through pain or continue to pitch when he or she is obviously fatigued,” said Paletta. He advises that parents should familiarize themselves with the recommended single game, weekly and season total pitch counts, suggested recovery times, and recommended ages for learning various pitches. Parents should insist that coaches and teams follow the Little League Baseball guidelines for the health and safety of young players.

For more information about reducing arm injuries for young pitchers, email Phillies Fan Joe Ruhl, PT.

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

Cam McCormack, PT, MSPT provides SFMA education.

New Comprehensive Movement Assessment Tool

On Saturday morning, February 25, Cam McCormack, PT, MSPT provided a specialized in-service training to over 40 E & A Therapists on the Selective Functional Movement Assessment (SFMA). The SFMA offers a new approach to the treatment of pain and dysfunction. This efficient diagnostic tool enables our physical therapists to isolate regional interdependence associated with the injury. It is a comprehensive movement assessment tool used to categorize movement patterns and direct manual treatment and therapeutic exercise choices. Developed by physical therapists, this assessment helps get to the root cause of pain and disability. McCormack is certified in this technique and provided our therapists with extensive training.

The SFMA is the big brother of the Functional Movement Screen (FMS). The SFMA differs from the FMS in that it is much more specific in determining the cause for movement dysfunctions. By identifying the specific area of dysfunction, a more individualized patient specific treatment plan can be started to address the precise problem. This leads to much more customized and treatment plans tailored to the individual patient.

Over 40 E & A Therapist Learn New Movement Assessment Technique

Due to participants’ overwhelming positive response, E & A Therapy anticipates a full course to facilitate SFMA certification for more of our physical therapists.To find a physical therapist utilizing the Selective Functional Movement Assessment, please contact Joe Ruhl, PT.

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