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Health

Concussion & Post-Concussion Syndrome

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What is a concussion? A concussion, also known as mild traumatic brain injury (mTBI), is a common injury that may cause impairments in brain function.¹ Now often described as a public health crisis due to its increasing occurrence, concussion most often occurs as a result of a blow to the head that causes a rapid, jarring brain movement within the skull.

Forces from injuries to the head (such as those suffered in sports or in falls) can “slosh” the brain back and forth, which causes the brain to be pulled and stretched in a way that leads to widespread injury and results in various debilitating symptoms.2, 3

What Are Initial Signs and Symptoms of Concussion?
Signs and symptoms of concussion will be noticeable at the onset of the injury. Many athletes experience difficulty recalling events prior to or after a hit or fall. They appear to be dazed or stunned, they might even forget instructions or where they are. If you notice someone has lost consciousness, shows mood or behavior changes, or is moving slowly they should stop their activity or play and seek help. More serious symptoms, include vomiting, blurry vision, dizziness, being bothered by light or sound, or just not feeling “right”. Again, we advise coaches, parents, and athletes to monitor players to seek professional help immediately.

What is Post-Concussion Syndrome?
Most concussion symptoms will improve within 7-10 days if the patient is able to adequately rest (physical and mental rest is very important within this time frame). However, for a number of reasons, some people may experience symptoms for much longer. If symptoms persist for longer than 10 days, post-concussion syndrome (PCS) may have developed.

Symptoms of Post-Concussion Syndrome include:

  1. Cognitive deficits (memory, attention, and concentration difficulty)
  2. Fatigue, sleep disturbance/insomnia
  3. Headache, dizziness
  4. Irritability, personality changes

Physical Therapy and Post-Concussion Syndrome
While the symptoms of post-concussion syndrome may be debilitating, physical therapy has been shown to be an effective treatment that allows a patient to return to daily life and sport.3 For athletes, research has shown that those who participate in active rehabilitation like PT are four times more likely to return to sport in eight weeks than those who did not. Physical therapy for PCS will include several individualized exercises and techniques aimed at reducing a patient’s specific symptoms and limitations. Exercises may be targeted to address dizziness, cognitive deficits, aerobic limitations, and associated neck pain, among others.4

Excel Physical Therapy has many physical therapists with certifications and experience treating those with concussions. If you suspect that you or someone else may be suffering from acute or long-standing concussion symptoms, you should consult with your physician and/or a sports medicine specialist, and ask about a referral to physical therapy. A call to your local Excel Physical Therapy office can help point you in the necessary direction.

 

By Andrew Bacon, PT, DPT, Washington Square Clinic

Fitness, Health

Keeping Up With PT on Vacation

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Summer is a time for vacations! A break from our busy schedules and endless tasks to kick back and relax. Taking a vacation during physical therapy treatment, especially this time of year, is not uncommon. Missing several sessions during your plan of care can run the risk of losing some of your hard-earned progress. We encourage all of our patients to talk to their physical therapist and plan ways to stay active throughout their trip. Here are a few general things you can do to maintain your progress.

  • Talk to your PT about a Home Exercise Program (HEP). Schedule your exercises at the same time each day and you will be more likely to complete them.
  • Make the most of your wait times, like waiting for your flight or getting ready to go out to eat. Take a few minutes throughout the day to incorporate your prescribed stretches and exercises.
  • Ask your physical therapist for advice on how to prevent re-injury while you are away from the clinic.

Our team of experts is always here to help. Your physical therapist will develop a plan specific to you and your goals. By sticking to your home exercise plan, and avoiding situations that could increase your pain or injury, you can still have an amazing vacation full of fun.

Even if you haven’t started treatment yet, we can give you ways to keep from reinjuring your body further and proactively schedule treatment for your return. Contact your local Excel Physical Therapy clinic today!

Fitness, Health, News

Decrease Neck Pain and Improve Your Quality of Life

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Your Neck and You

Have you been experiencing neck pain, headaches, dizziness, or stiffness? Are you using a computer or mobile device more frequently than normal? You aren’t alone. According to a literature review performed by Dr. Bart Green, approximately 67-80% of people will have neck pain at some point in their lives 1.  We’ve also seen that adolescents, who frequently spend more and more time in front of a screen are not immune to this either. Paula Hakala and associates found through research that 2-3 hours of screen time a day is enough to be a threshold for neck and shoulder pain 2.

During this time in which many people have transitioned to remote work environments somewhat abruptly, we’re seeing more issues. People may be spending significant amounts of time in a relatively fixed position, staring forward at computer screens or other monitors. Worse still is that very frequently, we find that people have poor posture and ergonomics with their positioning, resulting in increased pain or stiffness relative to if they had appropriate posture.

However, there is good news! We’ve found through research that physical therapy, including the hands-on manual therapy that our physical therapists use, has resulted in improving pain and outcomes in people with neck pain3. We’ve also found that something called scapular stabilization can help individuals struggling with chronic neck pain4. Your scapula and the muscles supporting it, commonly referred to as your shoulder blade, are important parts of your neck’s strength and stability.

Here at Excel Physical Therapy, therapists are trained in a variety of hands-on treatments to help alleviate your pain and get you feeling better. Soft tissue mobilization is a technique we use to help improve any restrictions or adhesions present in your soft tissue structures, like muscles or ligaments. Joint mobilization is another technique that your therapist may use to address any issues present in your neck. In joint mobilization, physical therapists use manual techniques to help alleviate any stiffness and improve discomfort in your cervical spine, or neck bones. Among the many others your physical therapist would be trained in, these two techniques can help address your pain or disability.

While at Excel, your therapist will be with you every step of the way, whether it’s your first visit or your last. Unlike some other physical therapy practices, we don’t employ any aides or assistants; every appointment will be with your therapist. No matter what’s going on, we’ll be there with you to help you excel in your recovery.

by: Eric Medaglia-Kurtz, PT, DPT, Assistant Clinic Director in Newtown Square

 

 

References:

1: Green B. N. (2008). A literature review of neck pain associated with computer use: public health implications. The Journal of the Canadian Chiropractic Association, 52(3), 161–167.

  1. Paula T. Hakala, et [al], Frequent computer-related activities increase the risk of neck–shoulder and low back pain in adolescents, European Journal of Public Health, Volume 16, Issue 5, October 2006, Pages 536–541,
  2. Hoving JL et. Al Manual therapy, physical therapy, or continued care by a general practitioner for patients with neck pain. A randomized, controlled trial. Ann Intern Med. 2002 May 21;136(10):713-22. doi: 10.7326/0003-4819-136-10-200205210-00006. PMID: 12020139.
  3. Seo YG, Park WH, Lee CS, et al. Is Scapular Stabilization Exercise Effective for Managing Nonspecific Chronic Neck Pain?: A Systematic Review. Asian Spine J. 2020;14(1):122-129. doi:10.31616/asj.2019.0055
Health, News

Don’t Delay Treatment For Your Back Pain

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Back pain is the leading cause of disability worldwide¹. Annual healthcare system costs in the US alone are in the billions for the treatment of back pain². Recent research shows an increasing prevalence of back pain in men and the elderly population, resulting in time away from work, hobbies, family occasions, and more¹.

While acute back pain (first 4-6 weeks after injury/onset) can be resolved in the majority of cases, individuals often delay seeking treatment, which can lead to both chronic pain and injury recurrence where symptoms often feel worse.3,4

The Benefits of Starting Physical Therapy EARLY for Acute Back Pain

Early access to Physical Therapy (PT) in the acute phase after injury/onset has been shown to reduce pain, minimize the risk of injury recurrence and decrease overall healthcare costs, including the utilization of diagnostic imaging, injections, medication, or surgery.3,5 In addition, the current American College of Physicians clinical practice guidelines suggest nonpharmacologic treatments (such as PT) are highly recommended and considered best practice in the treatment of acute back pain². These guidelines also emphasize the importance of remaining active during an acute episode of back pain, as physical activity has superior outcomes compared to rest.

Back pain can sometimes be related to other issues such as sciatica or new symptoms in the leg(s) including numbness, tingling, and burning. In a recent study, those referred to Physical Therapy by their Primary Care Provider in the acute stage of sciatica experienced less pain and disability than those who did not receive Physical Therapy6. In addition, those who received Physical Therapy continued to report better outcomes after one year.

Physical Therapists are experts in differentiating the cause of your
symptoms and developing the appropriate treatment plan for you, whether it is a muscle, joint, or nerve-related. Physical Therapists are highly trained in recognizing these “red flag” signs and symptoms in the rare event of a more serious condition and will refer you out to a specialist.

How Excel Physical Therapy Can Help

At Excel Physical Therapy, we offer a variety of services to address your back pain including Manual Therapy, the McKenzie Method, Graston Technique, exercise, stability training, and more. We will provide you with useful, applicable education to maximize your workplace ergonomics, athletic performance, or lifting mechanics so you can pick up your grandkids or crush a gym workout without pain. With our flexible hours including evenings and weekends, we can accommodate your busy work or family schedule. Many insurances offer Direct Access (DA) benefits where you do not need a Physician referral to see a Physical Therapist. If you don’t have DA benefits, don’t worry! Our team can help you obtain a referral and recommend a Physician if needed. We will schedule your Initial Evaluation within 24-48 hours after calling one of our clinics, ensuring you are taken care of as soon as possible.

 

By Sarah Pichini, PT, DPT
Excel PT – West Chester

Health, News

What is Men’s Pelvic Health?

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What is Men’s Pelvic Health?

To discuss men’s health, you first have to acknowledge that men too have pelvic floor muscles! Often, this area of the body is commonly associated with women, pregnancy, and birth. However, there are a variety of common issues that affect the male pelvic floor.

Broadly, men’s health is the optimal functioning and health of a man throughout his lifespan. One part of this functioning is related to the pelvic region. In men, the pelvic floor has three main functions: bladder function, bowel function, and sexual function (1).

What Does the Pelvic Region do?

The role of the pelvic floor is to tighten or relax in response to any of these activities. These muscles also help coordinate with the lower back, abdominal and hip muscles during daily activity and sport. There is both voluntary and involuntary control of the pelvic floor muscles, depending on the type of activity.

Common Conditions

Conditions that affect the male pelvic floor can occur in three categories:

  1. Pelvic pain – Pain can occur throughout the pelvis, lower back, testicles, penis, abdomen, and hip regions.
  2. Sexual dysfunction – Erectile dysfunction and pain during or after sexual activity can both contribute to the sexual dysfunction domain.
  3. Pelvic floor muscle dysfunction – Pelvic floor muscle dysfunction can contribute to bowel or bladder difficulties, incontinence, and pain during voiding.

Seek a Men’s Pelvic Health Specialist

Physical therapy can be helpful for all three domains that center around men’s pelvic health. If you would like more information about men’s pelvic health, please contact our Krewstown Clinic at 215-676-6760. Free screenings are also available to more thoroughly discuss how these issues may be related to your condition.

  1. The role of pelvic floor muscles in male sexual dysfunction and pelvic pain. Cohen et. al. Sexual Medicine Reviews
Fitness, Health

The Benefits of Exercise During Pregnancy

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We all know that exercise has many health benefits, but many women are unsure of how to approach exercise when they become pregnant. According to The American College of Obstetricians and Gynecologists (ACOG), “Women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength-conditioning exercises before, during, and after pregnancy.” In the absence of any medical or obstetric complication or contraindication, physical activity during pregnancy is safe and encouraged. Benefits of exercise during pregnancy include lower incidences of gestational diabetes mellitus and gestational hypertension (preeclampsia) as well as reduction of depressive disorders in the post-partum period.  There are also benefits for the fetus that include lower incidence of preterm birth, lower incidence of cesarean birth, and lower incidence of lower birth weight babies.

The U.S Department of Health and Human Services Physical Activity Guidelines for Americans recommends at least 150 minutes of moderate-intensity aerobic activity per week during pregnancy and the postpartum period. Examples of exercises that have been extensively studied to be safe and beneficial during pregnancy are walking, stationary cycling, aerobic exercises, dancing, resistance exercises, stretching exercises, and water aerobics. A pelvic health physical therapist can assist in establishing safe exercise parameters throughout the stages of pregnancy and post-partum.

Many pregnant women can develop orthopedic conditions during pregnancy secondary to weight gain, reduced balance, and ligamentous laxity.  More than 60% of pregnant women experience low back pain during their pregnancy.  An evaluation with a pelvic health physical therapist can assist in the treatment of mid and low back pain as well as pelvic pains associated with pregnancy.

At Excel, we are able to spend 1-hour sessions one-on-one with our patients which allows us to focus on each patient’s individual needs and ensure safe completion of the exercise.  Pelvic health physical therapists have specialized training in pregnancy and post-partum related conditions, so we can also provide education on laboring positions, pelvic recovery following vaginal or cesarean birth, and appropriate peripartum and post-partum exercises.  It is also encouraged that a woman returns to physical therapy 6 weeks post-delivery to reduce diastasis recti (separation of abdominal muscles) as well as to work on the pelvic floor, core, and back muscle strength and posture. If you are pregnant or post-partum and would like to learn more about appropriate exercise, contact your OBGYN and ask for a referral for a pelvic health physical therapist.

“While pregnant with twins, I saw Michelle for pelvic and hip pain.  Having 2 toddlers at home while pregnant with twins definitely had its challenges, and Michelle was able to modify my sessions based on my needs which were ever-changing. The insights she provided benefitted me in becoming more mindful with my movements and allowed me to remain active with my daughters during my last trimester.  This was my third delivery and probably the best one because I was able to apply the techniques I learned!  6 weeks post-partum, I returned to PT and have continued to improve my strength and reduce my pain so that I now feel healthy and strong again!” –Jessica Chan

Michelle Fritz, PT, DPT, Blue Bell Clinic

References:

American College of Obstetricians and Gynecologists (2015). ACOG committee opinion no. 650: Physical activity and exercise during pregnancy and the postpartum period. Obstetrics & Gynecology, 126(6), e135-42. Doi: 10.1097/AOG.0000000000001214

U.S Department of Health and Human Services (2018). Physical activity guidelines for americans 2nd ed. https://health.gov/paguidelines

Health, News

Movement is Medicine

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How The LSVT-BIG Program Helps Treat Parkinson’s Disease

Parkinson’s disease is a “progressive disease of the nervous systems marked by tremor, muscle rigidity and slow, imprecise movement. It is associated with degeneration of the basal ganglia of the brain and a deficiency of the neurotransmitter dopamine.” It commonly affects 4-6 million people worldwide.  It is most prevalent in Caucasian and Hispanic men over the age of 60, with a prevalence of twice as many men affected compared to women. It is diagnosed by motor symptoms including bradykinesia (slow movement), rigidity, tremor, as well as a positive response to dopamine replacement therapy.

Lee Silverman Voice Treatment- BIG (LSVT-BIG) is one part of a dual-treatment program for people diagnosed with Parkinson’s disease. At Excel Physical Therapy, LSVT-BIG is taught by a certified physical therapist. LSVT-BIG is defined as an “intensive amplitude-based exercise program for the limb motor system and re-education of the sensorimotor system.” In other words, as the name implies, the exercises are comprised of big, exaggerated movements.

A common presentation of people diagnosed with Parkinson’s is bradykinesia or small amplitude movements. This can include decreased arm swing or short step length (shuffling) while walking.  The LSVT-BIG program begins by addressing the person’s maximum amplitude of movement, meaning “the largest range of motion with the highest effort and the best biomechanics” that the patient is capable of. Then, specific exercises are given to increase their amplitude of movement with the goal of improving their overall gait pattern and balance to reduce their risk for falls. In other words, the exercises are focused on big, exaggerated movements.

The accelerated program is built to slow the disease progression by protecting dopamine neurons, restore connections in the brain, and specifically train the patient’s individual deficits. The LSVT-BIG program is a specific exercise program consisting of 16 one-hour sessions for four consecutive days per week for four weeks. Throughout the four weeks, patients are completing daily homework and carry over learned exercises for 30 days straight. This is followed by the coaching of five everyday tasks that the patient is having difficulty completing, such as sit-to-stand transfers or pulling keys out of pocket, all under close supervision of the licensed physical therapist.

Our team of certified experts is here to help slow the progression of the disease and enhance the quality of life. For more information about the LSVT-BIG program at Excel Physical Therapy, please see our location list to find a certified LSVT-BIG clinician near you.

More information can also be found at https://www.lsvtglobal.com/

By: Katie Kelly, PT, DPT, Excel Physical Therapy – Blue Bell

 

Health, News

Medical mystery: What was causing woman’s chronic hip pain?

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To ensure that the patient would be able to remain pain-free, I reached out to Brian Warenius, clinic director of Excel Physical Therapy in Blue Bell, for help. In non-traumatic injuries, most symptoms initially come on because the patient had developed a bad habit or some type of weakness in the area. Until these issues are addressed, the patient will often get temporary relief but have a flare-up a few months later.

Warenius said there are two simple and safe exercises that a patient can perform to strengthen and stabilize the back and hip.”

Read the full Inquirer story, here.

Fitness, Health, News

Is Your Lower Back Ready For Winter?

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Your holiday shopping is done, but is your lower back ready for this winter?

Your hat and scarf were thrown aside after about 10 minutes of shoveling, once you started sweating. You got down the sidewalk with ease, breathing heavy but feeling good. It wasn’t until you tackled the ridge of packed snow, plowed around the cars into a dense mound, that you realized you were in for it. By the second to last ambitious shovel lift, you feel that familiar twinge in your lower back and by the next morning, you can hardly get out of bed!

Have you been in this situation before?  If you have, you are not alone. Winters can be treacherous. Snow shoveling sends approximately 11,500 people to the hospital each year[1]. On top of that, slips on ice forced around 42,480 Americans to miss work in a 2014 study by the bureau of labor statistics[2]. Lower back pain is one of the leading causes of doctor’s office visits and results in work lost, pain medication and billions of dollars in US health care costs annually[3].  A curved snow shovel and some rock salt will only take you so far.

The good news is there are options. Whether you have a new injury, chronic pain, or are just having trouble moving around the way you used to, Excel Physical Therapy is here to help.

At Excel, your first visit will be a one on one, hour-long assessment with a doctor of physical therapy. Your physical therapist is specially trained to evaluate your core, alignment, strength, and flexibility. Any deficits in these areas can lead to injury-inducing lifting techniques. If these imbalances in your biomechanics are not addressed, they can lead to wear and tear in the future. On top of that, repetitive lifting required for common activities like snow shoveling, moving boxes, and even carrying small children can fatigue your muscles and place your joints in positions that are vulnerable to injury.

Luckily, our treatment model is designed for precisely these kinds of issues. You’ll receive an individualized plan of care that’s centered on your functional goals as well as the measurements we take in your initial examination. Our certified specialists tailor treatment to a host of orthopedic issues including disc herniations, arthritis, pinched nerves, scoliosis, sciatica, and low back sprains. We utilize hands-on care with each patient to get to the cause of your problem and find the solution together.

If you have any concerns regarding your pain or mobility leading up to this winter season, don’t wait for it to worsen!  A growing number of studies suggest that early physical therapy can help improve outcomes and help decrease health care costs[4]. Call today to schedule your first visit and take your first step to overcome any problems holding you back this winter.

Samuel Kelly, PT, DPT

Assistant Clinic Director

Certified Vestibular Therapist

Excel Physical Therapy – Levittown

[1] Watson DS, Shields BJ, Smith GA. Snow shovel-related injuries and medical emergencies treated in US EDs, 1990 to 2006. Am J Emerg Med. 2011 Jan;29(1):11-7. doi: 10.1016/j.ajem.2009.07.003. Epub 2010 Mar 25. PMID: 20825768.

[2] 42,480 work injuries involved ice, sleet, or snow in 2014 : The Economics Daily: U.S. Bureau of Labor Statistics (bls.gov)

[3] Chou R, Deyo R, Friedly J, et al. Noninvasive Treatments for Low Back Pain [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Feb. (Comparative Effectiveness Reviews, No. 169.) Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK350262/

[4] Ojha HA, Wyrsta NJ, Davenport TE, Egan WE, Gellhorn AC. Timing of Physical Therapy Initiation for Nonsurgical Management of Musculoskeletal Disorders and Effects on Patient Outcomes: A Systematic Review. Journal of Orthopaedic & Sports Physical Therapy. 2016;46(2):56-70. doi:10.2519/jospt.2016.6138

Excel Physical Therapy is excited to offer an electronic version of our  January Newsletter

Fitness, Health

Balance & Dizziness: How You Can Prevent Falls

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Falling is one of the most important day-to-day risks for individuals 65 and older. With as many as 30% of falls resulting in a moderate to severe injury, it’s not uncommon to see a single fall as the beginning of a vicious cycle. 

 

Falls are not inevitable and, in the vast majority of cases, are easily preventable. Here are some tips to help prevent falls and keep yourself safe at home. 

 

Warm-Up Before You Get Up

Sometimes, you can get lightheaded or dizzy when first standing up after sitting for a while, blood pools in your feet. When you get up too quickly, your body doesn’t have enough time to get the blood up to your brain before you stand up. You can help this by marching or kicking your legs before you stand up to help your blood circulate and prevent dizziness upon movement. 

 

Keep Your Home Free of Tripping Hazards

-Keep a clear walkway throughout your home. Make sure there are not any objects or furniture that you have to step over. Make things easier on yourself!

-Rugs should lay flat. A rug pad will help if your rug tends to bunch up. 

-Keep an eye on your pets. Know where they are so that they don’t try to trip you. Consider using a baby gate if they like to stay underfoot on the stairs. 

 

Control Your Environment

-The majority of falls occur in the bathroom. Consider setting up a shower bar and some floor grip pads, even if you don’t feel unsteady right now. Make the change before you need it!

–Many people are hesitant to start using an assistive walking device. There will be bad days when you may feel off balance or dizzy. Even if you don’t use a mobility aid every day, it is good to have a cane around. Suppose you are concerned about getting tired or weak farther into a walk and needing rest. In that case, rollator walkers can double as a convenient seat. 

 

Keep Moving!

Regular exercise will ensure that your body maintains the strength and conditioning necessary to keep yourself upright. Walk confidently and at a brisk pace. Balance deteriorates more quickly than strength or flexibility. If you don’t use it, you lose it!

 

Reach Out!

Treat falls seriously. If you or a loved one experiences a fall, please don’t shrug it off. A fall can mean that there’s an underlying issue at play that you may not even be aware of yet. If you’re feeling unstable or dizzy when walking around, don’t hesitate to seek help from a Physical Therapist. We can help improve your overall balance and conquer the specific challenges you face in your daily life. 

Read the full article in our digital flipbook,  Excel PT: Balance & Dizziness

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