Most (70%) of the people with chronic pain who participated in a recent study have seen their condition worsen in terms of severity, frequency of episodes and interference in their daily activities during the pandemic, according to researchers.

The study, performed by the eHealth Lab, a research group affiliated with the Faculty of Health Sciences and the Universitat Oberta de Catalunya’s eHealth Center, was published in the Journal of Clinical Medicine.

A total of 502 patients took part in the study; 88% were women aged between 30 and 59, with long-duration chronic pain (mean duration, 7 years). Most participants (87.6%) had pain in more than one point; the most frequent locations were the abdomen, lower back and neck.

The participants answered online surveys, designed in accordance with the IMMPACT (Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials) methodology, and the CPGQ (Chronic Pain Grade Questionnaire) was used to compare changes in the pain perceived by the patients since lockdown began, a media release from Universitat Oberta de Catalunya explains.

How the Pandemic May Worsen Pain

The results suggest that job insecurity, worries about the future, the number of people living in the same dwelling, having someone close who has died of COVID-19, or fear of becoming infected with the virus may be related with a worsening of the pain.

The study also suggests that the pandemic has favored the emergence of new pain triggers. While stress and weather changes were the most frequently mentioned triggers before the pandemic, during lockdown a large number of participants have mentioned worrying about the future, sleep problems, insecurity, negative thoughts, sadness, loneliness, insufficient physical activity and fear of contagion as triggers.

Pain Management Changes

The pandemic has also changed how a significant proportion of patients manage their pain. More than half (54.5%) have changed how they cope with it, the researchers comment in the release.

“The study has shown that since the state of emergency began, more than half of the patients have used rest to manage their pain, and a similar percentage have increased the consumption of medication. Both could have counterproductive effects.”

— Rubén Nieto, professor and researcher at the UOC’s eHealth Lab

However, with the pandemic, people have also started turning to a new positive way to combat pain. Indeed, 48.2% have included stretching exercises as a new tool for dispelling pain, they add.

ICTs, a Way to Cope

“When there is a chronic pain problem, it is important that people be able to learn to live with it, focusing on achieving their life goals, with or without pain. It is difficult to eliminate the pain altogether, but it is possible to learn to cope with it and live with it. Biopsychosocial interventions may be useful, in which holistic approaches to pain management are used.”

— Rubén Nieto, a specialist in understanding, assessing and treating pain problems from a multidimensional viewpoint

Unfortunately, most people do not have access to these interventions, as few centers offer this type of treatment, and health professionals receive little specific training in pain management, according to Nieto, in the release.

However, information and communication technologies (ICTs) are emerging as a useful tool for taking this type of treatment to chronic pain patients, Nieto adds.

“ICTs provide an opportunity for combating pain and improving well-being, since they can facilitate access to evidence-based interventions at an affordable cost. And they can increase personal autonomy and empowerment.

“We need to learn from the experience gained from the pandemic in the use of ICTs in health. The possibilities are limitless, from the classic teleconsultation to solutions based on artificial intelligence. But first we must plan and test their use.”

Source(s):

Universitat Oberta de Catalunya, EurekAlert

Rehab Management/Posted by Debbie Overman | Mar 3, 2021  https://rehabpub.com/pain-management/chronic/covid-19-had-this-impact-on-chronic-pain/

People usually see a physical therapist for pain or loss of function. Think of the person who has back pain, the injured athlete, or the person who’s had a stroke. They all want to improve how they move and complete tasks. Now, there is good reason to wonder if physical therapists will start seeing more people who are not in pain or having difficulty moving. Why would these people come to a PT? To improve their overall health and wellness.

There is strong evidence suggesting that movement is a valuable predictor of future health and resilience against disease. Physical therapists are movement specialists, so taking advantage of their expertise makes sense if your goal is to become healthier and live longer. Here are some examples of the power of movement when it comes to predicting future health:

Gait Velocity

Gait velocity is how fast you walk. Studies have shown that if your typical walking speed is over 1 m/s or 3.3 ft/s, you’re likely able to complete typical daily activities independently. You’re also less likely to be hospitalized and less likely to have adverse events like falls.

If you’d like to test yourself, measure out a straight, flat course to walk between 10′ and 30′ long. You’ll also need 5′ or so at the beginning and the end for acceleration and deceleration. Walk the course at your typical speed and divide the length of the course by how long it took you to walk it (distance/time). That’s your gait velocity.

Get On and Off the Floor

A series of studies suggest that if you can go from standing to sitting on the floor and back to standing without using your hands, you’re a lot less likely to die than someone who can’t. It’s called the sitting-rising test. Here’s how it works:

You start standing, and without support, you sit down on the floor, then stand back up. You start with a score of 10. Every time you put a hand, knee, forearm, or the side of your leg on the floor you lose 1 point. Putting a hand on your knee or thigh to help also costs a point. In a sample of over 2,000 people, they found that scoring less than 8 points made you twice as likely to die in the next 6 years when compared to people who scored higher. Score 3 or less and you’re 5 times more likely to die in the same period. Overall, each point in the test is worth a 21% decrease in mortality from all causes.

Notice that both gait velocity and the sitting-rising test aren’t specific to any one thing. The risk of hospitalization in the gait velocity studies was hospitalization for any reason. Death in the sitting-rising studies was death from anything.

So while we know that exercise and healthy lifestyle reduce your risk of specific diseases like heart disease or diabetes, it appears that being able to move may provide much more wide-ranging protection than we previously thought.

One year ago our lives changed. Time stood still as our world abruptly changed from our normal day-to-day routines to the Pandemic.

Throughout this pandemic, we have witnessed the resilience of our patient, medical, and scientific communities as they have come together in extraordinary ways. As we emerge from it, we are now in the wake of the aftermath of those who have had COVID -19; acute or asymptomatic.

In recent weeks there has been a flood of news reports and studies from collected data being released. We are hearing and reading testimonials from individuals having NON-hospitalized, or asymptomatic Long-haul COVID-19.

Long-haul COVID-19 is defined as symptoms persisting for more than 6-weeks, with the consensus that most patients fully recover from COVID-19 in 4 to 6 weeks. Specifically, the presence of persistent symptoms after the apparent resolution from COVID by individuals labeled as “long haulers.”

These symptoms can include:

• • • Cognitive dysfunction – brain fog
    • Headache
    • Numbness or tingling
    • Loss of taste
    • Loss of smell
    • Muscle pain
    • Dizziness
    • Pain
    • Blurred vision
    • Tinnitus (ringing in the ears)

In addition, many reported NON-NEUROLOGIC symptoms, including:

• • • Fatigue
    • Depression or anxiety
    • Shortness of breath
    • Chest pain
    • Insomnia
    • Variation of heart rate and blood pressure
    • Gastrointestinal complaints
    • Low back/joint pain

Since the body of evidence regarding long-haulers, particularly among the 99% on asymptomatic/non-hospitalized cases is just coming into existence, symptom validation should be honored especially symptoms at day 61+:

• • • Muscle, general, and mental fatigue
    • Muscle and joint pain
    • Muscle atrophy
    • Breathing problems

Physical Therapy treatment will be beneficial in translating effective self-management through education and lifestyle and behavioral changes for those living with Long COVID, or post-COVID or post-prolonged deconditioning as we navigate these boom-bust cycles for those likely living with an episodic and unpredictable disability.

 

The basic coping skills in life are whether we are Hungry. Angry. Lonely. Tired (H.A.L.T.), and whether we gain or lose an hour with the time change there always seems to be some adjustments. However, for some, losing that hour can be brutal, therefore making us very TIRED and impact our decision-making…. until we adjust!

And make no mistake, the transition to daylight saving time isn’t just annoying, it can also have measurable effects on our health from increasing the risk of heart attacks, injuries, car accidents, and mood disorders.

Rather than chugging down coffee, cola, or your energy drink of choice, there are some non-caffeinated steps you can take to help make springing forward less stressful. Here are a few tips for adjusting to the time change as quickly as possible:

1. Tonight, go to bed when you feel sleepy—don’t worry about what the clock says—but tomorrow wake up at the right “new” time and get sunlight (or bright artificial light) as soon as you wake up. Bright light in the morning is the best way to get your internal clock set to your new schedule.

2. Tomorrow night, consider going to bed at the new time, but only if you feel sleepy.

3. Keep waking up at the same time each morning and getting bright light as soon as you can. Most people can make a one-hour shift in a couple of days.

Sleep Management

Managing your sleep is key to your overall health. Not getting enough sleep can be a problem and can contribute to the development of chronic pain.  It also may worsen anxiety or depression symptoms. So, what should you do if you are not getting enough sleep?

During the Day

1. Do more physical activity.

Staying active helps in getting restful sleep. Once cleared by a health care provider, try to get 150 minutes of moderate exercise each week. A physical therapist can help you find the right exercises for your needs and abilities.

2. Increase your exposure to light.

The lack of Vitamin D is linked to a higher risk of sleep disorders. Consider increasing your exposure to light during the day.

3. Avoid long napping.

As an adult, if you take naps, keep them to 20 minutes or less.

4. Don’t smoke.

If you are a smoker, stop smoking two to three hours before going to sleep.

5. Limit alcohol.

If you drink alcohol, do so sparingly.

6. Avoid caffeine after midday.

Caffeine is a stimulant that can make you more alert and limit restfulness. It is also a diuretic that can increase your need to urinate at night.

Before bed

7. Get enough sleep.

Set a bedtime that will allow seven or more hours of sleep.

8. Keep a sleep schedule.

Wake up and go to bed at the same time every day.

9. Set the temperature.

According to the National Sleep Foundation, somewhere around 65 degrees makes for the best sleep. Assure that the temperature is right for you, and you have the necessary blankets and pillows for your comfort.

10. Create a relaxing bedtime routine.

This may include dimming the lights, avoiding the use of technology, and reducing noises. Using meditation or soft relaxing sounds can help prepare you for sleep.

Keep in mind some medications may change how well you sleep. Talk to your doctor or pharmacist about timing your medications to promote a balance of sleep and wakefulness.

If sleep remains difficult, keep a sleep diary to learn more about your sleep patterns and discuss it with your physical therapist. A PT also can help you if you experience pain or discomfort that limits your movements or disturbs your sleep. Learning the right exercises and positions may be helpful for you.

And, If you have difficulty getting comfortable at night, our physical therapists can help you with positioning and pillowing to fall and stay asleep!

_____________________________________________________________________

Sources:
my.happify.com/hd/a-sleep-experts-tips-for-dealing-with-the-time-change/?fbclid=IwAR0ARr9XplOVFVTFZV9igqjxIDJ2h1tDna9aPK_nN-BRl3he-bwGg5WxdgY

www.thensf.org/sleep-awareness-week/

www.choosept.com/resources/detail/10-habits-better-sleep?fbclid=IwAR2K_btrfOYsCZW5yPovRCT2FCBajTowcadMI2ip9a1o73U57mYA5m4_IZE

 

By: Kara Everett, PT, DPT, CSCS, CKTP
LSVT BIG Certified
Operations Director, Hartfield Location

 

Due to the aging population, as therapists, we are seeing an uptick in elective shoulder surgeries. The incidence of shoulder arthroplasty per 100,000 members increased from 6.1 (95% confidence interval [95% CI] 5.5-6.7) in 2005 to 13.4 (95% CI 12.5-14.2) in 2013.

Two of the most common shoulder surgeries we see at Carousel are rotator cuff repairs and shoulder arthroplasty (shoulder replacement surgery).  Rotator cuff repairs can vary greatly based on the extent of damage to the shoulder and thus can affect recovery times. With shoulder replacements (regular and reverse shoulder replacements) all or part of the shoulder is replaced.

 

    

In both types of shoulder procedures, surgery is only performed when other conservative treatments have failed to provide pain relief or if you have significant difficulty in performing day-to-day activities as a result of shoulder pain. These surgeries can help reduce pain and improve the use of your shoulder but the recovery time from these surgeries are significant and requires some work to get the full benefit of surgery.

If you or someone you know needs shoulder surgery, knowing what to expect can help you have a better outcome. Here are four things to know about shoulder surgery:

1. Managing pain after surgery.

You can expect some pain after shoulder surgery. As you heal your pain will reduce drastically and most have trace to no pain following recovery.

Work with our physical therapists to understand positions and exercises that reduce pain and help you heal. Work with your surgeon and pharmacist to understand the dosing of pain medications after surgery. It is important to have a plan to wean off opioid medications in a timely manner.

Research shows that taking prescribed opioids before surgery leads to worse pain management after surgery. Consider weaning off these medicines prior to surgery with the supervision of your health care team. This can help with your pain management after surgery.

2. An initial need for help and assistance.

You can expect to be in a sling for weeks. You will not be able to use your arm for anything except prescribed exercises. Our therapists will teach you specific exercises to promote healing.

Consider having ready-to-eat meals that are easy to prepare. You may want to set things up at home that you need regularly at an easy-to-reach level. Button-up shirts are the easiest to wear while you cannot lift your arm.

Let your friends or family know that you are having major surgery, so they can support you while you recover.

3. Difficulty sleeping.

Initially, sleep may be difficult after surgery but will improve with good habits. Good sleep habits, also known as sleep hygiene include:

• Avoiding large meals and caffeine before bedtime.
• Limiting or avoiding alcohol.
• Avoiding nicotine.
• Removing electronic devices from the bedroom.
• Having a regular set bedtime.

Finding a well-supported position will also be important. Our therapists will educate you on sleeping positions that are safe for your shoulder and minimize pain and maximize comfort.

4. Improved mobility and function.

Physical therapy is a critical part of recovery after shoulder surgery.

However, before your surgery, our physical therapists can help you improve your shoulder mobility and strength for better outcomes after surgery. Prehab is the use of exercises to improve strength, range of motion, flexibility, and/or balance. Research has shown that an 8-week program of a strength and balance training program prior to your shoulder surgery can reduce pain and improve overall mobility and outcomes following a joint replacement. The same principle can be applied prior to any surgery including knee, hip, back, and neck surgery.

After surgery, a hospital physical therapist will educate you about what precautions to take when you go home and what movements to avoid during the initial healing phase. They also will teach you how to manage your affected arm, how to put on and remove your sling, get dressed, and get in and out of bed.

After discharge, continuing physical therapy is essential to ensure your safe recovery. Our physical therapists will work with you to progress your exercises at the right times in the healing process based on your doctor’s post-surgical protocol. We will help you get back your range of motion, improve your strength and function, and eventually help you get back to your everyday activities, job, or sport.

Our care revolves around you so be sure to let us know your goals so we can focus on returning you to the important things in life.

Evidenced-based research shows that as few as 1 to 2 sessions of pre-operative physical therapy can reduce post-operative care by 29% for patients undergoing a total hip or knee replacement; this could be a  $1,000 + per individual!

The Facts

Between 2012 and 2050 the number of Total Knee Replacements (TKAs) performed annually in the United States alone is expected to increase by 855%, equating to 2,854 procedures per 100,000 US Citizens over 40 years of age; prevalence was higher for women of 50 years of age.

Globally, hip and knee osteoarthritis (the most common form of arthritis when the protective cartilage that cushions the ends of your bones wears down over time) was ranked as the 11th highest contributor to disability among almost 300 health conditions.

Pandemic Era Hospital Stays Are Shorter

First of all, no one wants to stay in the Hosptial longer than necessary. Second, you most likely won’t be able to during the Pandemic anyways. Finally, depending on the type of surgery – some are outpatient which is why rehabbing is crucial to helping you prepare for the best post-operative health-related quality of life (HRQOL).

Components of Care

Pre-operative physical therapy can be as little as 1 to 2 visits. However, for more acute cases we suggest a minimum of 6 to 10 visits. This way we can complete a full motor function and strength training program while you are awaiting surgery which will increase optimal post-surgical outcomes of associated inactivity and decline for maximum recovery. Your sessions will include:

Thorough Physical Evaluation

Extensive Patient Education

  Pain Management

Customized Pre- & Post-Surgery Plan for Elective/Non-Urgent Procedures

Results

Post-operative outcomes could be achieved in a shorter period of time by maintaining a higher level of training and fitness before your surgery to be able to fully resume outpatient rehabilitation; possibly eliminating admission into respite or residential care, or home health therapy if there are no post-operative complications.

 

 

 

As one year comes to a close and another begins, people begin to set goals and make
resolutions. Losing weight, getting to the gym more often, or getting into “better shape” are all common. These all require increasing your amount of physical activity. More activity is great for your health, energy levels, sleep, and mood. However, ramping up your activity level too quickly after a holiday season of eating, drinking, and being merry can lead to pain, injury and disappointment if your body isn’t ready for it.

Your physical therapist is an expert in human movement and can help you safely reach your
fitness goals. People think of PTs as the person to see after an injury, but a visit before you
change your activity level could prevent injury in the first place. An evaluation by your PT will
include an assessment of your strength, range of motion, and functional movement patterns – think jumping, running, squatting, carrying. Some PTs even like to use a standardized assessment, such as the Functional Movement Screen.

Most common injuries from new fitness routines are caused by underlying weakness, range of motion deficits, or compensatory movement patterns. Your PT will find these during your
assessment. They can then prescribe exercises or movements to address the issues found and
get you safely moving into the new year!

The other common way people get injured working towards their resolution is with overtraining or doing too much too soon. Physical therapists are also experts in exercise prescription and program design. Your PT can help you create a routine specific to your needs and goals that will progress appropriately and keep you out of trouble.

So stop only thinking of your PT after you’re injured. In this case, it’s true that an ounce of
prevention is worth a pound of cure. Seeing your physical therapist before you start on your
resolution can keep you on track, injury-free, and help you reach your goals for the new year!

From the time we learned to walk we fell a lot, but our parents picked us up and we kept going. So, why on earth was it a natural instinct to break our falls with our hands, and, how come we never learned at that time how to fall without FOOSH’ing? Good question, right?

What is a FOOSH, and how can we not do it?

Well, FOOSH is the nickname for an injury caused by Falling Onto an Out Stretched Hand. These injuries ¹ are among the most common injuries affecting the hands and wrists that occur when trying to break a fall.

The severity of FOOSH injuries can vary greatly depending on various factors. These include:

• the force of your impact with the ground
• the type of ground you’ve fallen on
• the way in which you’ve fallen
• whether you have any existing health conditions or injuries affecting your hands and wrists.

FOOSH might be a silly Nickname, but it can have serious consequences.

FOOSH injuries often happen to people who participate in sports where falls are common, such as downhill mountain biking, skiing, and football.

But, really anyone can get a FOOSH injury if they fall on a hard surface and try to brace themselves with their hands or arms. Incorrect footwear can create tripping hazards and also lead to falls. So can scatter rugs and electrical cords in the home. A lack of balance or coordination, poor vision, or medications that cause drowsiness, may also cause falls with FOOSH injuries.

The Art of Falling Safely.

Believe it or not, there are ways to fall and not FOOSH. And we’re all going to fall down: The world is full of banana peels. So while avoiding a fall is job one, knowing how to take a fall when it’s inevitable is a crucial skill.

An article by Michael Zimmerman, AARP The Magazine, gives a 4-step explanation with pictures on the Art of Falling Safely with suggestions to help improve your footing and practice mindfulness. An added bonus in the article has a link on how to how to prevent falls in your home.²

The take-a-way is bittersweet. Remember – we’re all going to fall so let’s try to learn the art of it. However, there is still a 50/50 chance are we’re gonna FOOSH, and if you do we are here to help you!

____________________

sources:

¹Treating and Recovering from ‘Fallen Onto an Outstretched Hand’ Injuries: https://www.healthline.com/health/foosh

The Art of Falling Safely: www.aarp.org/health/conditions-treatments/info-2017/how-to-fall-safely.html

 

 

By: Kevin Flood, PT, DPT

 

Since we still have a ways to go before we get to warmer weather and school-aged kids are in between their hybrid school schedules, it’s possible you are running out of indoor physical activities for them after their virtual days and there might be weekends you can’t make it to Compass.

So here are some creative and old-school activities to do as a family, or independently if Mom and Dad are working from home or,  well, let’s be real….need a break!

And, of course, there isn’t any activity on here that the younger brothers and sisters can’t join in on too——did you say snowball fight?

Snowball Fight: Use ‘socks’ for snowballs!

 

Balloon Tennis: Keep the balloon off the floor, with your hand or with homemade rackets using a paper plate and tongue depressor/craft sticks; decorate them for added bragging rights!

 

Hallway Bowling: Fill up plastic beverage bottles with colored water and use any ball you have to knock them over!

 

52 Card Pickup: A different variation of the game some of us grew up with! Choose 4 exercises to correspond with each card suit. (examples: squats, high knees, push-ups, sit-ups, jumping jacks, mountain climbers). Draw a card,  and then you complete the number of reps for that exercise. (face cards count at 11 or 15, your choice).

 

Dance/Freeze! Have a dance party, and when the music stops you have to freeze in place!!

 

Tape Maze:  Use streamers (painter’s tape works too) to create a maze in a hallway;  like lasers in a spy movie! Then have the kids try to make it through the maze without tearing them down.