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Low Back Pain is one of the most common and disabling injuries. It is known to affect 60-70% of adults during their lifetime, and up to 5% of adults each year. It leads to over 149 million days of missed work in the United States each year and leads to health care costs of 100 to 200 billion dollars per year. The frequency and costs of LBP makes it one of the top 10 most burdensome diseases and injuries as defined by the World Health Organization.

Even though it is quite common, Low Back Pain continues to be poorly understood. There is not one specific known cause for LBP. We know that obesity, age, and occupational postures play a role in causing low back pain. However, no one specific cause can be identified. Beyond this, X Rays and MRIs of the low back are often misleading. They can show findings (such as “degeneration”) that can be unrelated to the pain that someone is experiencing. MRIs of healthy individuals with no back pain can show spine degeneration that is similar to people with low back pain. This makes it a challenge for some health care providers to identify and treat low back pain.

However, a physical therapist is uniquely skilled to provide treatment for low back pain. Physical therapists provide known methods of improving low back pain. These include exercise, hands on treatment, and a progressive return to daily activities. Research studies show that Physical Therapists are also skilled at guiding patients through an episode of low back pain, providing assurance that things will improve and progressing exercises in a way so as not to increase symptoms. These treatments, while seemingly simple, are shown to be the best treatment for low back pain according to medical research.

Physical therapists are also positioned to treat the spine effectively because they utilize treatment-based classification. Treatment based classification means that therapists group patients based on symptoms that are known to respond to specific treatments. An example of this is that patients with low back pain who have no pain spreading below the knee and pain duration of less than 16 days typically respond favorably to hands on manipulation of the spine. Similar treatment-based classifications are available for direction specific exercises, core stabilization, and traction of the spine. Treating patients based on clusters of symptoms allows therapists to bypass the difficult and unreliable method of diagnosing specific spine injuries. Additionally, they do not have to rely on MRIs or X Rays, which can be misleading and costly. Instead, they provide treatments that are matched to the person’s symptoms.

Research also shows that the time a patient waits to receive treatment is critical to recovery. Patients receiving PT within 2 weeks from the start of low back pain have better results and have a lower cost of care. In Wisconsin, you can see a physical therapist without a referral. This is called Direct Access, and it allows patients to access the care they need immediately without waiting for a physician’s approval. Direct Access can get patients to the correct provider in less time. Direct Access improves outcomes and decreases cost of care to the consumer.

When a patient is referred to PT, the average time for a patient with low back pain to receive care is 60-75 days. This is a major barrier to patients receiving the best results possible. By going to a PT directly, a patient can avoid the wait and get results faster. Early access to care also leads to less use of surgery, injections, imaging and opiate medication use. Direct Access is legal throughout the State of Wisconsin and is provided by more than 50% of Physical Therapists. Determining availability of these services is as easy as calling your preferred Physical Therapy location.

To summarize, people with low back pain achieve the best outcomes at a decreased cost when seeing a Physical Therapist within 14 days of onset. See your physical therapist today! Neal Scibelli, PT, DPT Board-certified Orthopedic Clinical Specialist Board-certified Sports Clinical Specialist Neal Scibelli is the Spine Coordinator of Rehab Services for Aurora Health Care’s Greater Milwaukee North and South Regions. He promotes best practice in Spine Care throughout this region, emphasizing a patient first approach, with best outcomes at the lowest cost a priority.

Choose PT First

How can Choosing PT as Your First option save you time and money?

You wake up one morning with a new ache or pain in your neck or your knee- what do you think about first?
What the heck happened? What did I do this time?
Next you start to think about how to manage your new problem.
Maybe you should rest it?
Maybe you could stretch it out?
Maybe you could just take an over the counter pain medication like Advil, Tylenol, or Aleve?
Or what about a heating pad or ice pack?
These are all reasonable strategies for that occasional short term ache or pain. But if it persists or reoccurs- what should you do next?

Exploring Your Options: Do nothing
Doing nothing is always an option you can choose. Perhaps the ache or pain will resolve on its own? Perhaps if you stop running or playing ball or rough housing with the grandkids you won’t have this problem?
But giving up being active and doing the things you love also has consequences!
Will you be reducing your cardiovascular fitness? Would it result in decreasing your strength and or flexibility?

Forgoing activities that you enjoy with friends or family effects may affect your happiness. Don’t settle for less than your best life! Seeking an answer to your problem from a physical therapist can result in getting the right care you need now to stay active and keep doing the things that are important to your health and happiness.

Rely on Medications
Taking medications that you can buy either over-the-counter or prescribed by your doctor is certainly another option. Manyl medications mask pain and don’t do much to address the underlying problem. If you rely on pills, what types of side effects might they have? Are they addictive? How might they interact with other medications or supplements you are already taking? Will you need to keep taking them indefinitely to keep your problems at bay? A Physical Therapist can identify and address the cause of your problem and not only provide prompt relief but teach you how to avoid or manage any recurrence while reducing or eliminating your reliance on pills.

Visit your doctor
Sometimes a visit to your doctor can help you identify what your problem is through a physical examination or imaging like x-rays, CAT-scans or MRIs. But did you know that research has demonstrated that other than an orthopedic surgeons (who should be consulted for fractures or severe/persistent injuries) a physical therapist is the most skilled evaluator of musculoskeletal problems?
A physical therapist will perform careful, hands-on diagnostics and work with you to begin to immediately address the problem - often avoiding X-rays and expensive diagnostics. Physical therapists can correct spinal or joint alignment problems, stretch muscles that are tight, and provide soft tissue work that reduces pain and spasms. The also provide you with just the right exercises and movement interventions you need to conquer your problem and help you avoid or manage it in the future.

Choose PT First!

The good news is that there is strong evidence that seeing a PT first can result in faster resolution of your problem, with less reliance on medications, fewer doctor visits, fewer images and overall less cost of care! With PT first you will get answers to what is going on, receive hands on care, and learn how to prevent or manage your condition in the future! To learn more about Choosing PT First see:

https://www.moveforwardpt.com/choose-physical-therapy-over-opioids-for-pain-management-choosept

Why is exercise good for us?

Exercise has many benefits for all age groups. It can increase strength, improve heart health, and help to keep a healthy weight or even lose weight. Exercise also lowers the risk of getting many diseases like cancer, stroke, heart disease and diabetes. Luckily, there are a lot of ways to exercise like walking, yoga, swimming, running, weight lifting, and participating in sports.

What happens to someone with Parkinson’s Disease?

Parkinson’s Disease (PD) is a brain disorder that gets worse over time. It affects parts of the brain called the basal ganglia which helps our bodies to move strongly, smoothly and quickly. There is no cure and medications become less effective over time.

What kinds of problems does a person with Parkinson’s Disease have?

• slower, smaller movements
• uncontrolled hand shaking (tremor)
• stooped posture
• poor balance
• stiffness
• quiet voice

Overtime, the disease typically gets worse and it affects walking, standing, balance, getting into bed, and getting out of a chair or car. People with PD need increasingly more help with daily activities and are at a high risk for falls.

So, how does exercise help?

It was recently discovered that exercise can help protect the brain by slowing down the disease process, protecting from other injuries, and keeping the healthy parts of the brain strong. Seeing a Physical Therapist is a great way to start exercising in a way that will be both safe and productive. A Physical Therapist’s job is to help to keep people strong, safe, and as independent as possible. Physical Therapists focus on treatments that can help to make people stronger, tolerate more activity and lower the number of falls they have. Exercise helps keep people flexible, increase walking speed and distance, and improve or maintain balance. It also helps make tasks like getting in and out of bed, the tub and the car easier.

The American College of Sports Medicine (ACSM) exercise guidelines can be used with people who have PD. The best way to see exercise benefits is by doing it often and at a high intensity, where it you are breathing heavily. If someone is worried about exercising, a Physical Therapist will make sure everyone is safe!

How much and what kind of exercise is needed?

ACSM says exercise for adults should include:

• Aerobic (endurance) activity: 150-300 minutes of moderate intensity per week OR 75 minutes of high intensity per week
• Strengthening activity: 2 times per week of moderate intensity

How intensely are you working?

• Moderate Intensity: light sweating after 10 minutes of activity, and breathing quicker but not out of breath.
• High Intensity: breathing is deep and fast, more sweating, and saying a few words before needing to pause to breathe.

Research has shown…

• Exercises given by physical therapists are safe for people with PD.
• Exercise is best when it is more intense, which means when heart rate is high (70-80% of a person’s highest heart rate).
• Exercise slows down the steady decline of the disease overtime.
• Studies show that exercise makes quality of life better.

Where do I start?

Physical Therapy can be helpful for people at any stage of their Parkinson’s Disease. While a person does not need a doctor’s prescription to see a physical therapist in Wisconsin, the therapists may want a doctor to confirm that there are no concerns about a person’s ability to exercise. People with PD have specific types of problems and there are physical therapists that have specialized training to help them understand and effectively treat these movement challenges. Physical therapists can test people’s current physical ability level and will know the right amount and types of activities people should do, as well as provide specific suggestions for helpful equipment or different ideas to address their challenges. A therapist can tell people about community exercise program, support groups, and give a personalized home exercise program to keep a person safe and moving! The important thing is to stay active.

Looking for more information?

As you now know, there are some therapists who have specialized experience in working with a person with Parkinson’s Disease. Here are some places to look for these people:

• https://www.lsvtglobal.com/LSVTFindClinicians
• https://www.pwr4life.org/professional-directory/

If you do not have a specialized therapist in your area, here are some other resources that provide exercise classes for people with Parkinson’s Disease:

• https://www.rocksteadyboxing.org/
• https://metroymca.org/wellness-programs/delay-the-disease/

If you or someone you know has Parkinson’s Disease, seeing a local physical therapist is a great way to safely exercise and remain active as long as possible!

What’s Going on Down There?

Part 3

Nope. Not Australia. In your pelvis!

This is the third blog post in the series, but to review, the bony pelvis houses a few essential functions of our bodies. The 3 Ps: Pee, poo and pleasure. Or in medical terms, bladder, bowel and sexual functioning. These can be embarrassing topics that many people do not want to talk about, but they are common issues. However, these problems are not normal, but are quite treatable! Did you know that there are physical therapists (PTs) that specialize in treating conditions related to these functions?

If you missed the first two Ps, take a look back to learn about pee and poo from the previous two blog posts.

Onto our last P: pleasure. Sexual functioning is an important part of quality of life. Sex should not be painful, in any circumstance. Not after menopause, not after having a baby, not after an abdominal, gynecological or urological surgery, and not after cancer treatment.

There are multiple reasons and scenarios that can be contributing to painful sex. The pelvic floor muscles, hormone imbalances, reduced lubrication and loss of integrity in the tissue can all contribute. While a pelvic floor PT may not be able to treat all aspects of the problem, they can be an important part of the medical team to address these issues.

In women, some common medical diagnoses that may have a symptom of painful sex are: vulvodynia, vaginismus, endometriosis, or dyspareunia (which means painful sex) among others. In men, a common medical diagnosis that means pelvic pain is prostatitis or any pain in the perineum, or testicles. Again, a pelvic floor PT can assess the pelvic floor muscles to see if the group is functioning as it should, assess any scars in the abdomen or pelvis that may be contributing, and help with nutritional and lifestyle strategies to reduce pain.

Bottom line, do not be afraid to discuss these topics and issues with your healthcare team. These are not things to just live with. Help is out there!

An easy way to search for a pelvic floor PT is through https://ptl.womenshealthapta.org/

What’s going on Down There?

Part 2 (Poo)

Nope. Not Australia. In your pelvis!

To review, the bony pelvis houses a few essential functions of our bodies. The 3 Ps: Pee, poo and pleasure. Or in medical terms, bladder, bowel and sexual functioning. These can be embarrassing topics that many people do not want to talk about, but they are common issues. However, these problems are not normal, but are quite treatable! Did you know that there are physical therapists (PTs) that specialize in treating conditions related to these functions?

The second P is poo , BMs, and the colorectal system.

Somewhere in the ballpark of 42 million Americans are continually backed up or constipated. Yikes! Symptoms of constipation are straining or pain with bowel movements, having fewer than 3 per week and/or feeling incomplete evacuation.

Simply explained, after our gastrointestinal system keeps what our bodies need from the food and fluid we ingest, it creates our stool, the waste product. This work is done in the large intestine, or colon. The end of this pathway is the rectum.

The rectum is a similar holding tank for stool, like the bladder is for urine. When stool enters the rectum, it should stretch it, and this sends a signal which our brains interpret as a need to go to the bathroom. Sometimes, this signalling doesn’t work quite right. Sometimes the signalling is functioning, and the pelvic floor muscles don’t know what to do to help push the poo out.

Again, this is where a pelvic floor PT can help! A pelvic floor PT can assess your pelvic floor muscles to see if they are performing their job of contracting and relaxing at the appropriate times. PT can also help with tips on positioning, as well as with nutritional advice in order to keep your GI system run smoothly.

Bowel movements should be fast and easy. If they aren’t, talk to your healthcare provider about your options and seek out a pelvic floor PT as part of your team!

An easy way to search for a pelvic floor PT is through https://ptl.womenshealthapta.org/

What’s going on Down There?

Part 1 (Pee)

Nope. Not Australia. In your pelvis!

The bony pelvis houses a few essential functions of our bodies. The 3 Ps: Pee, poo and pleasure. Or in medical terms, bladder, bowel and sexual functioning. These can be embarrassing topics that many people do not want to talk about, but they are common issues. However, these problems are not normal, but are quite treatable! Did you know that there are physical therapists (PTs) that specialize in treating conditions related to these functions?

Let’s talk about pee and bladders first.

Urine Incontinence is a medical diagnosis for not being able to control pee. More often this is called “leaking,” and it can happen in both men and women. People may experience this with everyday movements, exercise, or activities like coughing, laughing, sneezing. It can also happen when you are already on the way to the bathroom and you just don’t quite make it.

This can happen when the pelvic floor muscles are weak or too tight. The pelvic floor muscles can become weak for multiple reasons. Just to name a few: pregnancy and childbirth, abdominal or pelvic surgery (prostate or gynecological), or with general deconditioning, which is common with aging. Many people see television ads for protective products like Depends or Poise and think leaking is a normal part of aging. That is just not true! A pelvic floor PT can do a thorough assessment of your pelvic floor muscles, as well as surrounding anatomy, to determine the best way to reduce or stop your leaking.

So please, talk to about these issues to your healthcare provider, or search for a pelvic floor PT in your area. There are physical therapists ready to help you regain your strength and control over these issues!

An easy way to search for a pelvic floor PT is through https://ptl.womenshealthapta.org/

New Year- New Medicare Therapy Dollars!

What does the Medicare Therapy CAP mean to You?

Every year- Medicare beneficiaries are given new therapy dollars to be used for Physical, Occupational & Speech Therapy Services received in an outpatient setting. Physical Therapy is important for Medicare beneficiaries in their efforts to stay healthy and active, independent and pain free!

In 2018- Medicare eliminated the inflexible limit to the amount of therapy they will pay for in a calendar year- once termed the Therapy CAP. Instead they reinforced requirements of these services being “Medically Necessary” under the benefit.

In 2019- the Therapy CAP amount initially provide is $2040 for Physical and Speech Therapy combined and $2040 for Occupational Therapy. which is subject to a deductible of and then a 20% co-pay. This co-pay may be submitted to a Medicare recipient’s secondary plan or Medicaid if you are eligible.

Therapy Services that are “over the CAP” in any calendar year are still payable by Medicare if the therapy meets certain criteria of being “medically necessary”.

What types of Physical Therapy services does Medicare Part B (Outpatient) cover for me?

Rehabilitative Therapy: Your ability to function related to a …. “condition that has the potential to improve or is improving in response to [skilled] therapy, maximum improvement is yet to be attained; and there is an expectation that the anticipated improvement is attainable in a reasonable and generally predictable period of time. Improvement is demonstrated by specific measurements whenever possible.”

Maintenance Therapy: Your … “treatment by the therapist is necessary to maintain, prevent or slow further deterioration of your functional status and the services cannot be safely carried out by the by yourself or by a family member, another caregiver or unskilled personnel.”*

What does Skilled Therapy mean?

Therapy services must be considered “skilled” to be covered by Medicare.

Medicare describes skill as:

“The services shall be of such a level of complexity and sophistication or the condition of the patient shall be such that the services required can only be safely and effectively performed by a qualified clinician, or therapists supervising assistants.”*

* (see the National Government Services Outpatient Physical and Occupational Therapy Local Coverage Determination)

Talk to your Physical Therapist or Physician to determine if Physical Therapy is for you in 2019 to help you attain your goals of staying active, independent & pain free!

Treating persistent swelling

In the previous articles we discussed the issue of swelling that does not go away, some of the more common causes of swelling, and simple strategies that can be used to address the swelling.

So, what can you do if the swelling does not go away?

Often times your medical provider will refer you to a Physical or Occupational Therapist that specializes in treating persistent swelling called a lymphedema specialist or lymphedema therapist.

What will a lymphedema therapist do to help with the swelling?

There are various techniques used to treat swelling and these techniques include:

• Edema massage

• Compression pumps

• Compression wraps

• Compression garments

• Exercise/Activity

Edema massage

Lymphedema therapists use a special gentle massage that stimulates the lymphatic system to take fluid from the interstitial space. Most importantly the large molecules are moved out of the interstitial space along with the fluid clearing the space for normal fluid movement.

Compression pumps

Some therapists are making use of sequential compression pumps which is an inflatable sleeve that mimics the hands-on massage techniques of the therapist. These devices can allow for more frequent treatments and can be used in cases where access to therapy may be a challenge. A device can be set up and clients can be trained to apply the device in their own home.

Compression wraps

Following edema massage the therapist will typically apply some type of compression in the form of wraps or a sleeve. The purpose of the compression wrap is to support the area to discourage swelling from returning and also to continue to stimulate the lymphatic system and encourage further reduction in swelling.

Compression garments

Once the swelling is reduced it may or may not return depending on the individual circumstances. The therapist may measure and fit the person with a compression sock or sleeve. The use of a compression garment is to support and maintain the reduction in swelling that has been achieved. Sadly lymphedema therapists see many cases where clients were provided compression garments by well meaning, but uninformed medical providers as a method to reduce the swelling. This is a painful, potentially dangerous, and a largely unsuccessful method that makes clients skeptical of further intervention. Applying compression garments alone does get rid of the fluid, however it leaves all of the large molecules behind which act as a sponge to bring back the fluid once the compression garment is removed. With increased awareness and design methods, garment manufacturers have developed a wide variety of garments to suit all tastes and styles from athletic socks to fashion wear.

Exercise

Throughout the treatment process lymphedema therapists will incorporate exercises and encourage activities such as walking or swimming to help clear the fluid and assist in reducing swelling.

Closing remarks

If you have swelling that has not responded to simple treatments or is persistent I encourage you to talk to your medical provider or look into lymphedema therapists in your area to begin managing your swelling and improving your health. Please feel free to leave a comment or ask additional questions in the comment section below.

Steve Johnson DPT is a physical therapist from the La Crosse area with over twenty years of clinical practice experience and has been lymphedema certified therapist since 2004.

Causes of swelling in the legs

Venous Insufficiency

Venous insufficiency is a condition where the veins in the legs start to fail to efficiently return blood to the heart. This pooling causes pressure to push fluid out of the circulatory system into the lower legs. Similar to the river that overflows its banks and floods a neighborhood. This often results in a heavy feeling in the legs that can be relieved with elevation. In extreme cases red blood cells squeeze out of the veins causing red staining of the shins, and when the fluid pressure becomes so great the fluid actually begins to push out through the skin.

What are the risks of untreated Venous Insufficiency

Left untreated there is increased risk of infections (cellulitis), surface wounds (stasis dermatitis), and permanent damage to the tissues from the excessive stretch and pressure. It is important that patients with venous insufficiency work with their health care providers to develop long term management strategies to avoid chronic infections and permanent tissue changes. Unfortunately, many of the patients that I have met over the years have been given the misguided impression that they need to “just live with it”. Nothing could be further from the truth, and I will be discussing management strategies in Part II of this article.

Swelling in Congestive Heart Failure (CHF)

Swelling can also be a symptom of a serious health condition, congestive heart failure. With congestive heart failure, the fluid builds up in the extremities due to the inefficiency of the pump (heart) to move fluid through the circulatory system causing it to pool and leak out into the interstitial space (typically in the lower legs). Swelling that is the result of congestive heart failure is serious and requires careful monitoring and management by your healthcare team. Management strategies are often employed by therapists in conjunction with good medical management to improve function and quality of life.

Persistent swelling in breast cancer

The most common form of cancer associated with persistent swelling is breast cancer. Although the vast majority of cases of persistent swelling involve the lower extremities, the after effects of breast cancer treatment involve swelling of the upper extremity. Unfortunately, breast cancer often infiltrates the nearby lymphatic system, and the surgical interventions and radiation treatments can all result in damage to the lymphatic system. As a result, fluid movement in the affected upper extremity becomes compromised resulting in persistent swelling. Advances in surgical intervention techniques and targeted radiation have thankfully reduced the incidence of persistent swelling (lymphedema). In addition, Oncologists have worked with lymphedema therapists to ensure effective management strategies for breast cancer patients.

Primary Lymphedema

The last cause of swelling we will discuss as part of this article is Primary Lymphedema. This is when people experience swelling due to a genetic predisposition. Just like some of us are tall or short, the efficiency of our lymphatic system has a genetic component. This inefficient lymphatic system although rare may be present and observable from birth, or first noticed during a period of increased demand such as pregnancy or injury.

As you can see there are many causes of swelling but regardless of the cause, it is important to recognize that swelling is an abnormal condition and the longer it persists the greater the risk for permanent tissue damage and secondary complications such as wounds or infection. If you have persistent swelling it is important that you discuss management options with your medical provider knowing that you don’t have to “just live with it”. In the Part II of this article we will discuss treatment options and management techniques employed to address swelling issues.

Steve Johnson DPT is a Physical Therapist from the La Crosse area with over twenty years of clinical practice experience and has been Lymphedema Certified Therapist since 2004.

Why do I have swelling that will not go away?

This is a question I often get from clients that I see in my physical therapy practice. In my clinical practice I often see patients with persistent swelling, which we medical people refer to as edema or lymphedema. As a way to avoid confusion for the purposes of this article, I will refer to all of these conditions with the general term “swelling” as a physical therapist trained and certified in lymphedema/edema management there can be a wide ranging variety of causes for swelling, from dietary habits to genetics. To better understand what is happening, it helps to understand the mechanisms that create swelling. Before you stop reading out of fear that this will be a confusing article filled with scientific jargon please read on, I promise to do my best with the use of some simple analogies to explain the how and why of swelling. I often use these analogies with my clients to help them visualize what is going on. Persistent swelling is almost always the result of the accumulation of fluid in the interstitial space. The interstitial space is a fancy word for the space between the individual cells that make up our bodies. Think of the cells as houses on a street, and the streets, alleyways, and yards as the interstitial space surrounding those houses. Just like a house, the cells of our body require supplies like water, electricity, and food to be brought in from the interstitial space outside and garbage and waste need to be taken out. When conditions change this interstitial space can become flooded much like when a river overruns its banks.

What causes swelling?

Fluid retention: The most common cause of swelling is a temporary swelling referred to as fluid retention which is often the result of varying dietary habits or hormonal shifts. These episodes are typically short lived, and the swelling is alleviated as the diet is adjusted or hormone levels shift.

Injury: Another common cause that triggers inflammation and can result in swelling. Anyone who has ever sprained an ankle, “jammed” their finger, or had the misfortune of breaking a bone has experienced the body’s incredibly quick swelling response. Without getting too technical the swelling in the interstitial space is due to an accumulation of large inflammatory molecules and proteins from the injury acting like a sponge, pulling water from the circulatory system. As the body heals the swelling is reduced through the gradual removal of those large molecules and proteins from the interstitial space.

Other medical conditions:

• Venous Insufficiency

• Congestive Heart Failure

• Breast Cancer

• Primary Lymphedema

Further information on each medical condition will be covered in part II of this blog, coming next week!

Ways to manage Swelling

The standard recommendation in cases of minor sprains and strains is RICE (Rest, Ice, Compression, and Elevation). This is good advice as each of these actions help reduce swelling and pain.

How does RICE actually work?

Rest allows the body to heal the damage and remove those molecules. Consistent Icing not only decreases pain but also slows down the metabolism of the inflammatory process allowing the body time to catch up in removing those large molecules and proteins. Using the sponge analogy, Compression squeezes the interstitial space preventing fluid from being pulled into the sponge. Elevation allows gravity to assist with moving the fluid away from the affected area. We will discuss compression in more detail in Part III of this article, but one common mistake is the idea that with compression “more is better”. Effective compression in almost all cases is gentle like using tubigrip, a compression sleeve, or lightly applied wrap. In cases where the swelling remains, and the body cannot seem to catch up Lymphedema Therapists often get involved.

For further information on other medical conditions that cause swelling make sure to check out part II of this article!

Steve Johnson DPT is a Physical Therapist from the La Crosse area with over twenty years of clinical practice experience and has been Lymphedema Certified Therapist since 2004.

Whiplash: Symptoms & Treatments

The holiday season is one of the most dangerous times for traveling on the roads. Increased traffic, winter weather conditions and impatient drivers all increase risk for getting into a fender bender.

One of the most common auto accident injuries is whiplash. Often referred to as a neck sprain or strain, whiplash is caused by an abrupt backward and/or forward jerking motion of the head, typically the result of getting rear ended. Whiplash injuries can also occur from other injuries, for example falling off a bike or falling while on the ski slopes.

If your pain is severe, you have pain in your mid or lower back, you are experiencing symptoms such as new numbness and tingling, dizziness, weakness in your arms and legs, or balance problems, seek care from physician immediately.

Other, less serious symptoms of whiplash include neck pain and stiffness, shoulder pain, and headaches.

Most whiplash symptoms will subside in 2-4 weeks, and don’t require much intervention. But when symptoms persist or are more severe, physical therapy is an important part of whiplash treatment. Similar to other injuries, a faster recovery depends on early mobilization. To help restore function and movement, a physical therapist may include the following in your individualized treatment plan:

• Range of motion exercises, with variations based on specific limitations.

• Manual (hands on) therapy, which could potentially include soft tissue mobilization, dry needling, and joint mobilization and/or manipulation.

• Strengthening exercises for the neck and shoulder blade region

• Education on gradual return back to usual activities

Of course preventing whiplash is the best option of all. While on the roads this holiday season, take your time, give yourself and the cars around you plenty of space and avoid using your phone while driving.

Join the conversation: How do you stay safe on the roads during the holiday season?

What is temporalmandibular joint dysfunction (TMD)?

Temporomandibular joint dysfunction (TMD) is a term used by medical professionals to describe a pain that occurs in the temporomandibular joint (TMJ), known to most people as your jaw joint. This pain may lead to limiting the types of foods you eat or changing the way you eat due to the repetitive nature of eating. TMD affects thousands of people, but many health professionals, including dentists, have struggled with how to effectively manage this condition. The purpose of this blog is to give you hope that someday you can eat the food you love without having to suffer afterward.

How do I know if I have TMD?

The TMJ is located just in front of your ear hole. Sometimes individuals will experience a loud click or a pop when opening or closing their mouth, or in more severe cases, will experience a locked jaw. The click that most people experience is a result of the displacement of a disc that helps to cushion your joint when opening or close your mouth. Early signs of TMD can involve an audible click with or without pain immediately when opening the mouth. As the dysfunction progresses, the clicking actually occurs at a wider position of opening, and eventually goes away. Many people think that this progression is a good thing because the clicking has stopped. However if left untreated, it will lead to more problems down the road. It is also important to know that you don’t have to have clicking in the jaw to have TMD (for instance, some have pain without clicking), however it’s the clicking that tends to get your attention.

Shouldn’t I see a Dentist for this?

Yes, you should definitely consult your dentist if you are experiencing these symptoms. They do offer some interventions (such as mouth guards) that can help give you some relief. However, dentists often struggle with getting rid of the symptoms completely.

So Physical Therapist can treat TMD?

Absolutely! Physical therapy interventions can provide some immediate relief as well as long term strategies to manage the condition. One of the main contributors to TMD is poor posture, (stay tuned to MoveLivePlay blog to learn more about the mechanisms behind posture’s role in causing TMD and other conditions!). Some Physical Therapists have more experience than others with treating jaw pain, so it’s important to ask the clinic or hospital if they have a PT that is skilled in treating TMD. Physical Therapist utilize hands on techniques to help move that displaced disc back into place, in addition to stretching the joint and providing strengthening exercises for the muscles inside your mouth! Yup I said strengthen the muscles inside your mouth!Often times the muscles in your mouth can get weak,tight, or overstretched which changes the way your mouth functions. PT’s can correct these things, now that’s something to chew on!

So please please don’t give up hope on eating some of your favorite foods, there is still hope! Contact your Physical Therapist today for treatment of your TMD. Please ask questions below if there is something you would like to have further explained.

Exercising outdoors during the winter makes winter a bit more bearable. It not only allows you to explore nature in a different season, but improves your mood. Why fight winter when you can just embrace it!

That being said, during summer, going outside for a workout is easy peasy. Throw on a pair of shorts and a t-shirt and you’re good to go. Once winter sets in, it requires a little more effort. But with proper planning, you can stay active even when the days are shorter, temperatures drop and there’s snow on the ground.

Here are our tips for staying active during the winter season:

1. Wear the right shoes – Falls are much more likely on ice and snow. You can help avoid a nasty fall by picking a shoe with a heavier tread to avoid slipping on wet leaves, snow or ice. For additional traction, you may also consider adding cleats to your shoes (such as Yaktrax or other similar product). Also, keep in mind that it’s wise to slow down if you can’t see the pavement due to snow or ice covering. Doing so can help you stay balanced and avoid a nasty fall!
2. Layer up! - The best way to stay warm is to layer your clothing. Always aim for  a bit more than you think you will need, that way you can remove layers if you get too warm. A moisture wicking base layer just over your skin can be quite helpful in keeping you warmer, not to mention numerous options for pants, pullovers, sweaters and socks.  Here are some great online resources for ideas on what to wear under different conditions for various outdoor activities:

• running
• cycling
• hiking
• walking

3. Keep your extremities warm – Even while working up a sweat, your extremities – fingers, toes, ears, etc. – may get too cold. And with age, comes a greater risk of frostbite due to slower circulation. To keep everything warm, wear a pair of gloves or mittens, warm socks and a hat or head warmer that covers your ears. Many manufacturers of gloves and mittens provide temperature ratings for their products.
4. Make time for a warmup – Doing a pre-exercise warmup is especially important during the cold weather months. For Example, we suggest 5-10 minutes of brisk walking and dynamic stretches to make sure your muscles are warmed up before launching into a run.
5. Remember to hydrate – As temperatures drop, it’s easy to forget that you still need to stay hydrated when doing physical activity. But it’s still important to take in fluids before and after your workout to avoid fatigue and keep your muscles working properly. If your workout is longer than about 1 hour, it is important to take in fluids during exercise as well.
6. Exercise during daylight hours – If you normally exercise in the early morning or evening hours, you may consider switching things up so your workout falls during daylight hours. Doing so will allow you to exercise when there is ample light and when it’s a bit warmer outside.
7. Light it up! – If you decide to venture outside for a workout before the sun comes up or after it goes down, make sure you’re visible in the dark by wearing a glow in the dark coat, vest, or belt and /or a red flashing light. You might also consider investing in a small headlamp to make yourself more visible – and to light the path in front of you!
8. Try something new! - Winter provides an opportunity to try some new activities that we can’t do during the warmer months. Examples include snowshoeing, cross country skiing, ice skating, and downhill skiing. Try out a new sport, you never know, you might find your next outdoor obsession!
9. If all else fails, take your workout indoors – When the weather is really uncooperative, it may be safer to move your workout indoors. Although getting fresh air is wonderful, sometimes it’s safer and more productive to hit the gym
10. Have a nagging injury that prevents you from getting outside? - See your physical therapist! A physical therapist’s goal is to keep you moving and doing the things you enjoy, including getting outside this winter!

Tell us: How do you stay active during the winter months?

October is National Physical Therapy Month and we’re celebrating by recognizing the positive ways PT can help people move forward. Here are 31 unique PT applications you may not have known about. These are designed to help you stay active throughout your life!

1. Foot and Ankle Conditions, such as plantar fasciitis, turf toe, and bunions

A physical therapist (PT) can help determine the underlying causes of conditions such as plantar fasciitis, turf toe and bunions, and provide treatment including manual therapy, orthotics, taping, and more, to help provide relief.

2. Developmental challenges

A pediatric physical therapist is skilled at recognizing areas of a child’s development that may not be progressing appropriately. PTs can then design and implement a program to help improve areas such as strength, sensory processing (developing the five senses), balance and coordination.

3. Cancer recovery

A physical therapist is an important partner in helping patients recover from cancer and its treatment effects. Interventions often include a personalized progressive exercise program that has been shown to greatly improve cancer survival and recovery, as well as management of pain, edema (swelling) and deconditioning.

4. Lymphedema (swelling of the legs and arms)

Physical therapists go through specialized training to help reduce a buildup of fluid (edema) that can occur in any part of your body (typically on one side) as a result of a damaged lymphatic system. A PT is trained on how to manually push the swelling out of the affected areas of your body.

5. Urinary incontinence

Physical therapy can assist both women and men that may be suffering from urinary incontinence (inability to hold urine) and erectile dysfunction by retraining and strengthening the muscles within the pelvic floor.

6. Vertigo from a Variety of Sources, including positional

Physical therapists are skilled at treating acute dizziness that is worsened with head movement in a particular direction. A PT is trained in a technique that helps to reposition the tiny crystals in your ear that can be responsible for vertigo, as well as treating many other forms of dizziness and imbalance.

7. Effects of concussion

Physical therapists are trained in aiding in the recovery process for patients that continue to show symptoms from a concussion lasting more than two weeks. PTs can determine if remaining symptoms are due to faults in proper eye tracking (symptoms increase when watching things moving fast or very busy backgrounds), migraines, faults with the autonomic nervous system (symptoms worsen with increased physical activity), or remaining tension in muscles from the initial insult.

8. Aquatic therapy

Physical therapists provide aquatic therapy for a variety of conditions, including a successful transition back to full weight bearing on land and pain management. For example, it may be used to help treat older individuals with arthritis or fibromyalgia as well as young individuals after ACL reconstruction.

9. Carpal tunnel syndrome

Physical therapists are trained in techniques that help decrease tension on the median nerve (the nerve responsible for carpal tunnel syndrome) in addition to providing education on ways to optimize your work area and tasks to prevent excessive loading on the nerves in the hand. PTs can help distinguish numbness in the hand that can come from other sources, including pinched nerves in the neck or arm.

10. De Quervain’s

This painful condition in the wrist can be effectively treated by a physical therapist through physical modalities, exercises and splinting, not to mention providing education on ways to optimize your work area and tasks to prevent excessive loading on the wrist and thumb.

11. Bursitis

Bursitis is inflammation of a bursa – fluid-filled sacs that exist in and around multiple joints such as the shoulder, elbow, hip, knee and ankle. Physical therapists can help distinguish pain that comes from a bursa vs. other pain sources and provide the correct education, advice, exercise, manual treatment or modality to help relieve symptoms and treat the underlying cause that may be irritating the bursa.

12. Patellofemoral Pain (pain behind knee cap)

This common condition occurs in individuals of all ages. A PT helps determine and treat, when possible, the underlying factors that promote wear and tear to the joint, such as pes planus (flat feet), weak hip muscles, tight knee and hip muscles and poor loading mechanics.

13. Tendinitis

Tendinitis, often called tendinosis or tendinopathy, can occur in various areas of the body such as the knee, ankle, elbow and shoulder, often from overuse of the muscles/tendons. A physical therapist can help alleviate symptoms through various treatment approaches, but more importantly, analyze factors such as inflexibility, decreased strength and altered body mechanics to help decrease symptoms and prevent recurrence.

14. Headaches

Physical therapists use manual techniques to help realign and increase mobility throughout the spine. In addition, they can provide soft tissue mobilization and/or dry needling (a type of massage) to decrease tension in the muscles of the neck that can commonly reproduce headaches from the base of the skull, behind the eyes, and around the temples. Your PT will also help strengthen your neck muscles and improve your posture to prevent the occurrence of future headaches.

15. Fibromyalgia

Fibromyalgia is often a disabling condition causing pain in multiple areas of the body. A PT can help educate a patient as to why they are having pain and help guide individuals with the condition through a customized exercise program to help improve symptoms and decrease pain.

16. Wound care

Physical therapists are often involved in wound care, both in hospital and clinic settings. This includes wound prevention (such as pressure sores), wound debridement (cleaning), dressing (bandage) management, managing edema (swelling), and ensuring a patient is able to return to full physical functionality after a wound is healed.

17. Effects of peripheral vascular disease

When blood supply to the legs is affected, Physical Therapists can help with associated symptoms such as pain, edema, muscle weakness and evaluation for an assistive device to make mobility easier.

18. Children with congestion issues such as cystic fibrosis

Physical therapists help patients with congestive diseases by strengthening their diaphragm (the muscle responsible for the inhalation of air) and by performing manual therapy to help drain fluids from the lungs to allow patients to take a larger breath.

19. Pre- and Post-natal physical therapy

Pregnancy and childbirth can have both major and minor effects on your body including pelvic pain, incontinence and sexual dysfunction that a PT who specializes in women’s health can help alleviate.

20. Weight management

Weight loss presents many challenges including aches and pains that can prevent you from being active. PTs offer professional advice and treatment to help you move better as well as help you define activity goals for weight loss and management.

21. Jaw pain

Jaw pain is a common affliction caused by various sources including muscle tension, bad habits and poor posture. A physical therapist can use various methods including manual therapy, exercise and education to help alleviate this painful condition.

22. Pet physical therapy

Some PTs treat pets, such as dogs, after injuries and surgery. It takes a creative approach to help your four-legged loved one learn to walk again.

23. Alzheimer’s disease and dementia

Physical therapists are often involved at all stages of Alzheimer’s Disease and other forms of dementia and can help prevent falls, improve mobility and educate patients and their family on ways to maximize safety. They can also advise on physical activity to help decrease the effects of dementia.

24. Cerebral Palsy

Physical Therapists are integral members of a patient’s care team for mild to severe cases of Cerebral Palsy and can help improve mobility, gait, balance, muscle tone and provide advice on wheelchairs, as needed.

25. Whiplash

Physical therapists are often involved in helping to manage this painful condition. PTs work with patients to decrease muscle and joint pain, improve range of motion and recommend strengthening exercises so they feel better, faster.

26. Multiple Sclerosis

Physical therapists are frequently called upon to help improve strength, mobility, gait and pain associated with exacerbations or progressive multiple sclerosis. When needed, they help patients learn to cope and compensate for progressive neurological diseases.

27. ALS

Physical therapists often provide a professional evaluation plus recommendations for mobility assistance and strategies to individuals with ALS.

28. Osteoporosis

Physical therapists serve an integral role in managing osteoporosis by helping patients stay active and as strong as possible to help prevent fractures. Treatments include improving balance to help prevent falls, loading the body to prevent further loss of bone density, and improving posture.

29. Spinal cord injury

Aggressive physical therapy early on after a spinal cord injury can help minimize nerve damage and even help restore limited abilities (NIH). For individuals that are less acute, PTs work to maximize their function and improve their quality of life by showing them how to independently care for themselves and maintain strength and flexibility throughout their bodies.

30. Parkinson’s disease

This disease affects the motor systems of the brain making movement extremely difficult. The disease is often managed with medication or treated with surgery, however PTs play a key role in maximizing your ability to move with less effort.

31. Herniated disc

Herniated discs most often occur in the lumbar region of the spine and are the result of nucleus pulposus (gel-like substance) breaking through the anulus fibrosus (tire-like structure) of an intervertebral disc (spinal shock absorber). A PT can help you recover with a combination of passive treatments, such as deep tissue massage, and active treatments, such as a customized program to condition and strengthen your back.

 

To learn more or to find a physical therapist near you, check out our PT Finder.

Physical Therapist’s Guide to Patellofemoral Pain problems

What is patellofemoral pain syndrome?
Patellofemoral pain syndrome, commonly known as movie goers or runner's knee, describes pain in the front of the knee. This syndrome is more common in athletes, especially those who are jumping and running, or individuals who work at a desk job and sit for prolonged periods of time. This pain occurs due to malalignment and abnormal stress of the knee cap on the femur.

There are multiple causes for patellofemoral pain syndrome including:

• muscle imbalance: weakness and tightness in other muscles leads to abnormal tracking of the patella on the femur during movement. Abnormal alignment of the knee cap causes increased stress on the knee joint. Unnecessary stress on the knee joint can lead to pain.

• overuse: repetitive use of the quadriceps muscle can translate to increased stress of knee joint.

• trauma: a traumatic fall or dislocation of the knee cap has been linked to patellofemoral pain syndrome.

How does it feel?
Many patients describe this pain as sharp and deep within the knee joint. Patients often first notice this knee pain when going up or down the stairs, transitioning from sitting to standing, sitting for long periods of time, squatting, kneeling, and lunging. Since the patella is not optimally tracking on the femur, the individual can feel knee pain whenever they bend their knee or place more weight on their affected leg.

Knee pain can make a person avoid performing functional daily activities such as navigating the stairs negotiation, walking, and squatting to lift objects. The more an individual avoids an activity, the more de-conditioned and fearful the patient can become to perform that activity.

How can a Physical Therapist help?
Physical Therapists provide patient-centered care based on each person's personal presentation. Your physical Therapist will help you to strengthening your core, hips, and leg muscles, to ensure that there is a balance between all of the muscles surrounding the patella. Additionally, your PT will prescribe stretches to effectively lengthen any tight muscles and provide additional education regarding optimal shoes to ensure that enough shock absorption is occurring while an individual walk or runs.

What to expect when I see my Physical Therapist
If you see your physical therapist first, the physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist will also ask you detailed questions about your condition, such as:

• Which activities increase your pain?

• Which activities decrease your pain?

• Do you have difficulty with any daily activities or work duties?

• Have you used a knee brace?

• Have you received imaging of you knee?

• What are your goals?

Can this injury or condition be prevented?
To help prevent patellofemoral syndrome, your physical therapist will likely advise you to:

• keep moving: Avoiding a sedentary lifestyle ensures that you are not having pre-mature deconditioning of the muscles that insert into the patella.

• keep stretching: Making a habit out of stretching will prevent tight hip and thigh muscles from pulling the patella out of alignment.

What kind of Physical Therapist do I need?
All physical therapists are prepared through education and clinical experience to treat knee syndromes, specifically patellofemoral knee syndrome. However, you may want to consider:

• A Physical Therapist who is experienced in treating people with orthopedic conditions. Some physical therapist's clinical experience varies from orthopedic, nervous system to vestibular and balance conditions. Other physical therapists have a clinical
  experience solely focused on orthopedic conditions.

• A Physical Therapist that is a board-certified orthopedic specialist or has received a fellowship within orthopedic Physical Therapy. This therapist has advanced knowledge, experience, and skills that can improve the rehabilitation process for patellofemoral joint syndrome.

Schedule Today

To find more information about how to access a Physical Therapist in your area in order to help you over come your patellofemoral pain visit the home page of www.moveliveplay.org and click on the “find a PT” tab!

Whether it’s playing a game of football or soccer, enjoying the neighborhood playground or taking a road trip, people of all ages tend to be more active during the summer months. However, these very same activities can also increase your risk for suffering a concussion.

Concussions are considered a traumatic injury and occur when the brain is violently shaken, often due to a blow to the head or a rapid change in head position, such as what occurs in motor vehicle accidents when people sustain a whiplash related injury to the head/neck region. Although this type of injury does not usually require hospitalization, it’s important to recognize symptoms and seek treatment immediately to help avoid long-term consequences.

A person suffering from a concussion may experience a variety of symptoms, including:

• Dizziness
• Headache
• Sensitivity to light and noise
• Double or blurred vision
• Weakness or loss of balance
• Fatigue
• Confusion
• Difficulty concentrating
• Changes in personality or behavior

If you suspect you or a loved one has a concussion, the first thing you need to do is contact a sports medicine physician, neurologist, or primary care physician with concussion management experience. After initial diagnosis and treatment, he or she may refer you to a physical therapist.

No two concussions are alike, and a PT can create an individualized recovery plan. He or she will identify your threshold for physical activity and then prescribe a plan that is appropriate for your condition in order to allow a safe progression back to physical activity. As your symptoms resolve, your PT will help you gradually increase your activity level.

PTs can also help if you experience dizziness or loss of balance after a concussion. Vestibular physical therapy targets the inner ear and its connections with the brain and may help stop or reduce dizziness or balance problems through special treatments and specific exercises.

After a concussion you may experience muscle weakness or a loss in endurance. A PT can help you regain strength by creating a tailored exercise program and closely monitor your symptoms as you increase your activity level back to the intensity of your desired sport or recreational activity.

Although not everyone needs physical therapy after suffering a concussion, it can be beneficial to assess your tolerance to activity and limitations regarding strength and movement and develop a progressive program so you can successfully return to your sport.

To learn more about concussion treatment, visit a PT near you.

If you’ve recently been injured, you may wonder who you should see for treatment – a primary care physician, an orthopedic specialist, a physical therapist or maybe even a chiropractor. There are many options available to you, but seeing a physical therapist (PT) first may help you recover faster.

Many people believe they can’t see a PT without a referral from a physician. This simply isn’t true. In Wisconsin, you can see a PT first, and in most cases your insurer will pay.

Here are four reasons you should consider seeing a PT first:

1. Seeing a PT is the fastest way to treat the root cause of your issue, rather than masking it and waiting for the problem to go away.
2. In patients with low back pain, seeing a PT first reduces the likelihood of needing advanced imaging, injections, strong medications or other more invasive procedures, such as surgery.
3. Physical therapists treat patients using a variety of approaches, including exercise, manual therapy and providing patient education and advice. PTs provide other forms of interventions to treat the problem on a broader scale and to meet the needs of the patient. We also collaborate with other providers, which gives us additional insight and perspective.
4. Physical therapy is often less expensive than other types of treatment. PTs are less likely to recommend advanced testing, medications or other types of treatment that ramp up costs. We’re more focused on evaluating your condition, treating it and providing you with the tools to manage it long term and prevent it from recurring.
If you’re ready to see a PT, get recommendations from family and friends or check out a website like VisitYourPT.com and using the Find a Physical Therapist feature. This will allow you access to several PTs located near you.

James Cumming, PT, OCS (Board-Certified Orthopedic Clinical Specialist)

With so many options, it can be difficult to choose which physical therapist to work with. But finding the right one for you can greatly improve your treatment outcome. To help you narrow down your options, here are five key questions to ask:

1. What specialized training do you have?
PTs may have special board certifications. What this means is the PT has taken post-graduate courses and passed an exam to prove aptitude in the specialty area. For example, if you have symptoms of pelvic pain or incontinence, you may choose to work with a PT with a Women’s Health Specialty. Or if you have mechanical neck pain or back pain, you may choose to work with a PT who specializes in treating orthopedic conditions.

2. Do you commonly treat patients with conditions similar to mine?
Often, PTs specialize in treating specific conditions or populations. For example, some PTs specialize in treating older patients. Others may have special certifications in treating low back or neck pain. For the best treatment outcomes, find a PT that specializes in and has a lot of experience with treating your particular condition.

3. How can physical therapy help me?
When faced with several treatment options – physical therapy, medication and surgery, to name a few – you should find out if and why physical therapy is the best treatment option for your condition. A PT will be happy to walk you through the benefits and, if it turns out it isn’t right for you, provide a referral to the proper medical specialist.

4. What will happen during a typical appointment?
During your initial appointment, your therapist will ask you multiple questions related to your condition, perform a detailed and personalized examination, and suggest the best treatment options for your situation. It’s a good idea to understand what will happen during a typical follow-up appointment. Find out if you’ll see the same PT at each appointment as well as if you’ll work one-on-one with a PT or a physical therapy assistant.

5. What is my role in treatment and recovery?
It’s likely your treatment plan will include homework. So make sure you find out what’s expected of you, such as the time commitment, types of exercises you’ll need to do and if any special equipment is needed.
Above all, it’s important that you feel comfortable with your PT. Being able to ask questions is one way to keep the lines of communication open so you both have a clear understanding of your condition and treatment.

Join the conversation: What’s important to you when choosing a PT?

Even when temps soar well into the 80s, it’s still important to warmup before starting your workout to prep your muscles for the work ahead and prevent injury.
There are two main types of stretching:

• Dynamic Stretching– This type of stretching involves doing movements that are specific to your activity. For example, high knees and butt kicks before a run. This type of stretching recruits all of the muscles involved in your upcoming workout.
• Static Stretching– This type of stretching targets one or two muscles at a time and involves holding a stretch for a period of time, typically 30 seconds. The key to successful static stretching is doing it repeatedly. If you only stretch your muscles once, they go back to their regular size. But if you stretch them multiple times they stay in an elongated position.

You may have heard that it’s best to save static stretching for after a workout because your muscles are already warm and easier to stretch. But there’s really no downside to doing both types of stretches before your workout. I usually recommend people do what they feel is best for their performance.
In addition to stretching, I recommend strengthening your hips. A lot of hip, knee and back issues can stem from having weaker hips so I suggest doing bridges and clamshells before engaging in a lot of running, jumping and cutting movements.

Question: Can physical therapy help a person recover from a stroke?

Answer:
The short answer is YES! Every stroke is unique in the way it affects a person. However, there are some similarities depending on what part of the brain is affected. There may be physical changes, such as weakness or sensory loss; communication challenges, such as with speech and the ability to read or write; and there may be alterations in behavior or personality. All of these changes may affect how a person is able to perform their daily activities and interact with others. Fortunately, treatment including physical therapy can help improve a person’s recovery and quality of life.
Depending on how significant the stroke was, a person may anticipate recovery to normal or near-normal function, while others may struggle with long term disability. Most people will show at least some initial improvement, although how much better they will get is somewhat of a mystery. One thing that does help is beginning rehabilitation as soon as possible after a stroke.
Physical therapy is designed to address both sensory and motor impairments. Depending on the person’s condition and situation, physical therapists use a variety of techniques and strategies to help individuals recover strength and improve their motor control while encouraging them to challenge themselves to move better. During early rehabilitation sessions, we see patients in the hospital every day to focus on function, including bed mobility, transfers, balance, and walkingEventually patients are discharged, usually to home, and therapy is provided as home care or outpatient services, which may continue for several weeks to months, with visits a few times per week and tends to focus on community mobility and reintegration skills like endurance, higher level balance and transfers like getting off the floor, carrying objects, managing doors, stairs, sidewalks, grass, etc.
One exiting scientific discovery about the brain is that people can continue to see improvements for years after their stroke because the brain is plastic. This means that it is capable of changing in response to experience. . So while progress may be ongoing even after formal therapy is done, the gains slow down and become smaller, and it takes more effort to make changes. So nowadays we’re a lot more optimistic about long-range recovery, and recognize that opportunities for progress extend much further than we once thought.
It’s very encouraging for therapists and stroke survivors alike to know that its movement and exercise that drive brain change for the better – after all, that’s what physical therapy is all about!
For more information about stroke treatment and prevention, visit stroke.org.

Can Choosing Physical Therapy First Really Save You Money?
As healthcare consumers, we automatically assume that healthcare services are expensive regardless of who or where they are coming from.  There is an exception to this: Physical Therapy (PT).  

When we experience pain we often take a “wait and see” approach, rely on over-the-counter medications or seek a prescription for medication from a doctor.  We worry about spending both our time and our money.  In fact, if we were a bit quicker to seek care from a PT for our aches and pains we might be able to stay active and pain free longer, and also learn how to take better care of ourselves to maintain an active lifestyle.  

Does PT really save money?
PT has been shown to save thousands of dollars for healthcare consumers who access physical therapy first (PT-1^st) to start their healing process.
Research has shown that a PT-1^st approach by consumers:
· For shoulder injuries, PT saved 5 times the cost versus surgery.
· For knee injuries, PT saved almost 7 times the cost versus surgery.
· For neck injuries, PT saved over 10 times the cost to the consumer versus surgery.
· Getting in early (defined as within 14 days of injury/onset) to see your PT for low back pain was shown to save $3000 per case.

The better news is not only does getting PT-1^st reduce your likelihood of paying more; it reduces your chances of needing surgery, injections, opioid prescriptions and repeat doctor’s visits!  

Who Pays for PT?:
Physical therapy is a mandated benefit in healthcare so you will find that it is covered by Medicare, Medicaid, your insurance plan and worker’s compensation.  Most of your insurance plans will cover PT with a limited co-pay or co-insurance. 

Will My Insurance Pay for PT-1^st?
Most insurance plans will pay for PT-1^st!  Check with your local physical therapy provider or insurer to see what your healthcare plan requirements are.

With physical therapy, you can save time and money, get back to your life,, all while keeping your body and your bank statement happier and healthier!