Category Archives: Ask Your Healthcare Provider

Do You Have a Physical Therapist?

Do You Have A Physical Therapist?

Written by: Matt Schildknecht PT, DPT

Raise your hand if you have your own, personal physical therapist, who knows you and your musculoskeletal history. If both your arms are still at your sides, don’t worry, you’re not alone. Most of us have our own pediatrician, family physician, dentist, orthodontist, dermatologist, etc. These clinical professionals know us by name and know our pertinent medial history. And yet, none of these professionals are skilled at assessing the one thing we all do every day…..MOVE! These professionals are essential to healthy physical growth and development, but they are not movement specialists like a physical therapist. So, why should YOU have YOUR own physical therapist?

 

Let’s first define who a physical therapist is and what he/she does? The American Physical Therapy Association (APTA) defines a physical therapist as a “highly educated, licensed healthcare professional who can help patients reduce pain and improve or restore mobility, in many cases without expensive surgery and often reducing the need for long-term prescription medications and their side effects.” More simply put, a physical therapist is a movement specialist. A physical therapist is a doctorate level clinician who specializes in examining, understanding, and correcting movement. Physical therapists consider the entire body, from head to toe, when assessing movement. They consider things like strength, muscular balance, flexibility, joint mobility, and coordination, and how each of these factors effect movement. Then, they develop a plan to ensure maximum efficiency and quality of any movement pattern, from the most basic getting up and down from a chair, to the more complex motions of throwing, swinging a golf club, and even gymnastics.

 

But why is movement so important? I mean, it seems pretty basic, right? We do it from the day we are born, and we typically do it without much thought. But, it’s not that simple. Our health and quality of life rely on movement. Most of the chronic pain we experience is due to repetitive faulty movement patterns. Many of the acute injuries we suffer are caused by a sudden break down and error in a movement. And, our musculoskeletal system (our muscles and bones), which makes movement possible, is considered the most reliable indicator of overall health. So, if you’re interested in avoiding chronic pain or acute injuries, and you value your overall health, then we can agree that healthy, functional movement is VERY important and should never be taken for granted.

 

So, what steps can you take to choose and build a relationship with a physical therapist (PT)? First, do some research and find a local PT who specializes in an area of your interest (e.g. running). Many PTs have specialty areas of clinical practice, including sports, chronic pain, vestibular dysfunction, and even specific regions of the body (e.g. low back or shoulder). Once you find a PT, talk to your parents about contacting the office where YOUR PT practices and setting up an initial evaluation. In many cases, YOUR PT will do a free screen and discuss with you (and your parents) any areas that may increase your risk of injury or impair your quality of movement. Ask YOUR PT for a home exercise program, which is a list of exercises you can do at home to address any movement related impairments found during your screen. Find out what social media YOUR PT uses and follow them, or check their website for regular updates. These can be great resources for daily and weekly tips and recommendations for a healthier, active, and injury free lifestyle. Ask your coach or teachers to invite YOUR PT to perform an injury prevention screen for your entire team or classroom (PTs love doing this!). Consult YOUR PT before you start a new sport, or change to a new exercise routine. They can make sure you have the necessary movement tools to avoid injury and perform your best. Make YOUR PT your first contact if you develop any new pain or suffer an injury (ask YOUR PT about Direct Access, which allows you to participate in physical therapy without a physician prescription for up to 30 days). And finally, schedule an annual movement screen with YOUR PT. As your body changes, your movement changes, so you’ll definitely want to follow up regularly with YOUR PT to get the most out of every move you make.

 

If you have any questions, please contact me, Dr. Matt Schildknecht, or Kinetic’s Adolescent Sports Medicine Program Director, Dr. Michelle Feairheller. Our contact information is right on this website. We’re more than happy to tell you the many ways a PT can make you an All Star in the game of life. And the next time someone says, “raise your hand if you have your own PT”, I hope you enthusiastically throw your hand in the air!

Prescribing Ice after an Injury- Is it time to COOL it?

Prescribing Ice after an Injury

Is it time to COOL it?

Written by: Greg Macionsky ATC

Most people who have played organized sports or competed in something that requires some sort of movement at one time or another suffered an injury.  Getting hurt is as much a part of the game as scoring a goal, making a basket, or catching a touchdown.  Frontline healthcare providers, such as athletic trainers and physical therapists, have relied on ice as a means of controlling pain and swelling after injury.  This goes back decades and is the most utilized modality to treat acute injuries; however, recent evidence suggests that not only have the positive effects of icing been overstated, but it may delay the healing process.

This isn’t to say that ice does not have any positive effects.  Ice is a proven pain control modality, but this relief typically only lasts for 20-30 minutes post icing.  Unfortunately, this short-term pain control can negatively impact the healing process.  It does so by reducing inflammation.  Wait what?  Isn’t inflammation a bad thing?  Hasn’t that been the message of every healthcare provider ever?  This has been the prevailing thought not only within the medical community but among the public as well.  However, recently this theory has come under fire from a number healthcare providers and researchers.  The general idea behind that critique is that inflammation is not a bad thing.  In fact, inflammation is vital to the healing process.  The fluid that enters the injured site is responsible for carrying cells that begin the healing process.  These cells are responsible for releasing hormones into the injured tissue.  There is no disputing that ice slows the inflammatory process, so it is not a stretch to conclude that by keeping those important cells from reaching the injured tissue the healing process would be delayed.

If ice is not the answer, what should healthcare providers be prescribing?  Exercise!  The best thing one can do after suffering an acute injury is promote healing via appropriate rehabilitative exercise.  This includes focusing on restoring range of motion, strength, proprioception, and balance.  Early introduction of range of motion exercises is vital to decreasing stiffness to the injured area and restoring normal motion.  Ice would do the exact opposite.  When ice is applied the injured area becomes stiffer which can delay the process of regaining normal motion.  Exercises that build strength are important for increasing stabilization of the injured area, and for preventing re-injury once the individual returns to sport participation.  After suffering an injury proprioception, or the body’s ability to sense where it is in space, is compromised.  The physical manifestation of decreased proprioception is the joint feeling unstable or a sensation of “giving out.”  Combating injury is most effective when these areas are addressed.

While ice can help limit pain after an injury overutilization of this modality can have a slowing effect on the healing process.  Most athletes want to get back onto the field as quick as possible.  To achieve this, a rehabilitation program that focuses on range of motion, strength, balance and proprioception should be implemented as early as possible.

 

Truth or Myth? Sports Related Concussions

Truth or Myth?  If You Sustain a Sports Related Concussion You Should Sit in a Dark and Quiet Room Until All Symptoms Subside…..MYTH!

Dr. Daniel Luczka PT, DPT, CSCS

More and more evidence is strongly supporting that an early return to physical activity, within 1 week, may reduce persistent symptoms of a concussion.   The Journal of the American Medical Association published a study that involved over 2,400 children and adolescents between the ages of 5 and 18 years old who sustained a concussion.  The findings showed that out of those who participated in early physical activity, only 28% still had persistent post-concussion symptoms compared to those who did not participate in early physical activity, over 40% of them continued to have persistent post-concussion symptoms at 28 days post injury.

The benefits of aerobic exercise on the brain have been documented for years.  Protocols such as the Balke or Buffalo Concussion Treadmill Test have been proven to be safe and effective in finding the proper dosage and intensity of physical activity post-concussion to help speed up the recovery of the athlete.

Do not fall into the out dated protocol of being told to “sit in a dark room and do nothing.” Make sure you are seeing a medical professional who is up to date on the most current research for Post-Concussion Syndrome.  Call your Physical Therapist as soon as you suspect a concussion to help ensure the best medical care is being provided!

Risk Factors and Prevention Strategies for Noncontact Anterior Cruciate Ligament (ACL) Injuries

One out of every 1,750 individuals between the ages of 15- 45 will suffer an ACL injury. While the total number of ACL injuries seen is greater for males, females are up to eight times more likely to sustain an ACL injury when compared to their male counterparts. So, what are some risk factors and what can be done to prevent an injury?
Currently there are several different avenues being researched to find direct links to ACL injuries. The primary risk factors that have been identified are as follows:
  1. Influence of shoe to surface interaction- There has been some problems with keeping consistent variables within this portion of research; however, there does seem to be one primary indicator. The greater the friction between the shoe surface and the ground, the greater the risk. While that information is easy to digest, it’s counterproductive to what an athlete wants/needs for optimal performance.
  2. Anatomical Risk Factors- The male and female lower extremities are built quite differently. The most commonly attributed differences to ACL injuries include increased femoral anteversion, increased Q angle, excessive tibial torsion, and excessive foot pronation. While one or all of these could be contributing factors, there has not been sufficient research to determine the functional movement effects of these differences. Joint laxity and muscular development are also commonly noted possibilities. All of the above are possible considerations; however, none of these factors have been directly correlated to in an increased risk of injury.
  3. Hormonal Risk Factors- There have been several recent research articles that have determined that female sex hormones can influence the composition and mechanical properties of the ACL. A couple of articles have analyzed the specifics of an individual’s menstrual cycle and its effects on injury risk, but there is not enough evidence to be conclusive due to conflicting results. More research is needed prior to making any conclusions specifically about ACL injury risk factors or prevention methods.
  4. Biomechanical Risk Factors- Neuromuscular and proprioceptive control are highly accepted as major factors in an individual’s risk of injury. These control both the conscious and unconscious motor units that are acting during movement and are needed for joint stability. The two primary locations of focus involve the knee as well as the hip-trunk in regards to being risk factors.
  5. Other Notable Risk Factors- From watching video and individual reports, these other risk factors include; deceleration, cutting, and poor movement quality.

Studies have shown that simply wearing a knee brace isn’t the solution, neuromuscular prevention programs are the best solution we have currently available. Ample research is consistently coming out pointing toward neuromuscular prevention programs as significantly decreasing the injury risk for individuals. A two year study of a Division I women’s basketball program saw a decrease of 89%. The techniques used in these programs are not complicated. They most often include learning proper mechanics for landing , cutting, and deceleration through drills and exercises. Kinetic offers multiple programs that offer help with injury prevention, don’t hesitate to ask about how we can help keep you, your child, or your team with a neuromuscular prevention program!

DIRECT ACCESS CAN GET YOU BACK IN THE GAME FASTER!

So, it’s a little over a week before District Playoffs begin, and the intensity at practice is the highest it’s been all season. Coach decides to conclude practice with a scrimmage, and it’s getting physical. It’s only practice, but you and your teammates are playing like it’s a playoff game. You advance the ball up the field and cut hard toward the goal. As you plant your right foot, you step on your teammate’s foot, and your right ankle collapses. You feel and hear a “pop”, followed by brief tingling in your foot, then intense pain on the outside of your ankle. You crumple to the ground, writhing in pain. Your teammates rush over to you, followed by the Athletic Trainer. You don’t want anyone to know how much pain you’re in, so you try to stand up, but you’re unable to put any weight through your right leg. Your teammates help you to the sideline, where the Athletic Trainer examines your ankle. After a thorough exam, she cannot be sure, but she believes your ankle is not broken, but that you have a “significant” ankle sprain. After a long night with your ankle wrapped, iced, and elevated, an AM X-ray thankfully confirms that you did not break your ankle. You lower leg is now very swollen and bruised, and you still cannot put any weight on it. How will you possibly be ready for District Playoffs in 10 days!

“I called our family doctor, and he gave me the name of a very good orthopedic specialist”, says your mom, as you hobble into the kitchen. “I made an appointment with Dr. Smith next Monday at four.” “NEXT MONDAY!” you exclaim. “But that’s not for six days, and Districts start that Friday! If I have to wait that long to see a doctor, I’ll never be ready to play!” “This doctor is the best, and it’s the soonest he can see you. We also need time because he wants you to get an MRI of your ankle.” “An MRI”, you question. “Why do I need an MRI? It’s just a sprain.” “The doctor wants an MRI before he sees you, so that’s what we’re going to do.” “Why can’t I just go see Dr. Michelle at Kinetic Physical Therapy? She’s treated me before and knows me really well.” “You have to get a prescription from the doctor before you can go to PT”, your mother reminds you. “Mom, Pennsylvania has Direct Access. I don’t need a prescription.” “Direct Access? What’s that?” asks your mom. “Direct Access means I can go see my physical therapist for up to 30 days without a prescription. And our insurance will pay for it. This way, I can get started on rehabbing my ankle right away. And I know Dr. Michelle will do everything she can to get me ready for Districts.” “Are you sure about that?” asks your mom. “Positive. You can even call Kinetic and ask.” “OK, I’ll call Kinetic right now.”

I don’t have to tell you how this story ends, but I will. You see Dr. Michelle, she evaluates your ankle, gets you started rehabbing immediately, and with her skill, your determination, and a little luck, you’re in the starting lineup for the first District Playoff game.

Yes, this story is fictional, but Direct Access is REAL. Just like you told your mom, the state of Pennsylvania has Direct Access, which allows you to see your physical therapist for up to 30 days without a physician prescription. YOUR physical therapist is a Doctorate level professional, a movement specialist, and a first contact provider. YOUR physical therapist will perform a thorough, FULL BODY examination, identify your movement impairments, and recognize any red flags that may necessitate referral to another health care provider (e.g. your pediatrician). YOUR physical therapist will then work with you to create goals that are important to you, and use those goals to develop a unique, personalized treatment plan. YOUR physical therapist has the knowledge and the skill to help you get back on the playing field and stay there. Did you know that with some common orthopedic conditions, going to a physical therapist first saves you and your insurance company thousands of dollars?

So, the next time an injury puts you on the sideline, don’t stay there long. Contact YOUR physical therapist at Kinetic. We specialize in “moving athletes back to the field”!

ASMP Blog

Welcome to our new weekly blog series!

Kinetic Physical Therapy’s Adolescent Sports Medicine Program was founded to address the rehabilitation unique to the adolescent athlete.  Understanding that athletes require a different approach, the Adolescent Sports Medicine Program applies the best evidence when designing sport-specific rehabilitation and injury prevention programs.  These programs aim to educate athletes on his or her injury, the importance of a dynamic warm-up prior to participation, implement exercises to combat injuries, and discuss other strategies to keep the athlete healthy and on the field.  In addition to this, Kinetic Physical Therapy has a host of other services available to the athlete including: sports nutrition, Functional Movement Screens, and ImPACT concussion testing.

The goal of these posts is to keep the athlete, parent, and coach informed on important topics in sports.  We will address sports performance, nutrition, the mental aspect of sport, when to seek out a physical therapist for a consultation or evaluation, provide injury prevention strategies that the athlete can implement immediately, and dive in to specific injuries and our approach to managing them.  All of this information drives us towards our ultimate goal, to keep athletes pain-free and on the field.