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.

Back pain is a huge problem in developed nations worldwide. It has or will affect most of us. The current estimate is that 80% of people will experience back pain at least once. It is the single biggest cause for disability, the third most common reason for doctor visits, and one of the most common reasons for missing work.

It’s also expensive. Back and neck pain makes up the biggest healthcare expense in the US, totaling $134 billion spent in 2016. The next two most expensive conditions were diabetes —$111 billion in spending — and ischemic heart disease at $89 billion.

Diabetes and heart disease being so expensive to treat doesn’t surprise most folks – they can both lead to other major problems, require long term medication, could require surgery, and both can be fatal. Back pain won’t kill you, usually doesn’t require long term medication, and usually doesn’t require surgery either.

Why is it so expensive?

The first reason is that it’s so common. The second reason is that our current system isn’t very good at treating it. Current recommendations include starting with activity modification, and active treatments like physical therapy. Research backs this up, showing better outcomes and lower costs with early PT. Unfortunately, only 2% of people with back pain start with PT, and only 7% get to PT within 90 days. At the same time, a study looking at about 2.5 million people with back pain in the Journal of American Medicine (JAMA) showed that 32.3% of these patients received imaging within 30 days of diagnosis and 35.3% received imaging without a trial of physical therapy. Both of these things go against current practice guidelines for treatment of back pain.

Try before you buy!

A new pilot program being rolled out by TRICARE, the insurance system used throughout the US military is waiving the payment owed by the patient for up to three PT sessions in an attempt to improve the use of what the Defense Health Agency calls “high value” treatment for low back pain. The theory is that once a person sees some benefit from PT treatment, they’re likely to go back for more. This is the “try it before you buy it” approach – think of the 7-day free trial Netflix offers, free samples poured in wineries and craft breweries, or the folks you see standing around in supermarkets with food on toothpicks. TRICARE’s data seems to indicate that it works just as well for healthcare as it does for other businesses. In a press release they state that once people attend one session of physical therapy, they’re likely to go back for more, no matter what their co-pay is. But TRICARE found that higher co-pays could be a barrier to people trying that first visit. For the group of patients with the highest co-pays in the system, only 38% of the people prescribed PT attended the first visit. That’s about half the rate of attendance found in
the lowest co-pay group.

What’s next?

The fact that such a major insurer is looking into the value of PT is great news for everyone. If TRICARE can show that lowering the cost of PT for patients can improve outcomes and save insurance companies money, other major insurers will likely follow. This could improve the lives of millions of people every year while reducing the huge cost of treating low back pain for the country.

That seems like a win for everyone involved.

By: Vicki VerMeer, MSPT and Owner

In 2021 the American Physical Therapy Association (APTA) is celebrating 100 years as a member association, raising awareness about our great profession.

As Franklin D. Roosevelt once said, “A smooth sea never made a skilled sailor.” That statement is a reminder to us all that life will have its ups and downs, but it is precisely these rough seas that make us compassionate, resilient, and dynamic people and professionals. Roosevelt should know as it was Alice Lou Plastridge, an experienced physical therapist in the field of polio who had been successfully treating him when he began visiting Warm Springs, Georgia, to swim in the thermal spring waters.

Strange that 100 years ago we were battling the influenza pandemic; and here we are combating the COVID-19 pandemic that keeps packing punches with new strains being recognized. The global focus is on the vaccine that we all hope will slowly get us back to normal.

Despite the pandemic, we are still here and doing our jobs day in and day out, doing our very best to CARE for you both in person and virtually in some cases. As our current APTA president Sharon Dunn stated, “Responding to hardship with purpose and progress is what we do, it’s who we are.” It’s the only control we have at the helm, for now, to help all of us continue to adapt and overcome the twists and turns we will continue to navigate in the foreseeable future.

The APTA’s vision statement for the physical therapy profession continues to be transforming society by optimizing movement to improve the human experience. So here we are 100 years later amidst a pandemic to help you; to be an extension of the care you need when surgeries are postponed, you become deconditioned from quarantine, or develop complications such as Acute Respiratory Distress Syndrome from COVID-19.

In closing, my hope is that each of YOU are taking good care of yourself physically and emotionally! Because as we all know if we don’t take care of ourselves, we are no good for those who need us the most!

By: Jenifer Walker, PT, DPT, CHT

Since the title of our next blog is in the form of the question. The answer is, if you are currently experiencing any pain, swelling, or functional limitations with one or both of your hands, then the answer is an emphatic YES!

Most people these days know that when their back is bothering them, or they have elected to have surgery on one of the joints in their body, that they can follow up with their favorite PT at Carousel.  But did you know that some physical therapists choose to specialize in the treatment of the hand and upper extremity?  I have been working towards becoming a CHT (Certified Hand Therapist) for the last few years of my practice, and in December I completed my studies and passed a rigorous certification exam!

CHTs are highly skilled in evaluating edema, pain, range of motion, strength & endurance, sensibility, activities of daily living, work activities, avocational activities, and sports activities.  We commonly manage conditions such as:

• • • • • • • Amputations
            • Arthritis
            • Burns
            • Disease processes
            • Fractures & dislocation,
            • Sprains & strains
            • Infections
            • Joint contractures
            • Nerve compressions
            • Nerve injuries
            • Rotator cuff injuries
            • Impingement syndrome
            • Tendinitis
            • And tendon injuries

One of the major skillsets developed by CHTs is the fabrication of customized orthotic devices for the upper extremity.

These are commonly required for carpal tunnel syndrome, cubital tunnel syndrome, tendinitis, basilar joint arthritis of the thumb, finger dislocations, finger fractures, tendon injuries, lateral epicondylitis, and joint sprain/strains. Orthotic devices are often required following surgery for the fingers/hand/wrist as well.

So, if you are unsure whether you should see a CHT, you can have a FREE consultation with me, and with your doctor as well! See you soon!

Colder weather means some changes to how we exercise. Of course, it’s harder to motivate
yourself to get outside for a run or bike ride when the temperature drops and the shorter days
compress our schedules, but there are changes in your body that affect your ability to exercise
too. For many people with arthritis or other joint problems, cold weather brings more complaints of pain. To stay warm, our bodies narrow blood vessels to reduce blood flow to the skin, and more superficial muscles. That means that there is an increased risk of muscle strains in the cold. There is also an increased strain on the heart because of the narrowed blood vessels. This isn’t to say that you shouldn’t be active outdoors in the cold, it just means you may have to make a few changes to your routine. Here are a few to consider:

Warm Up Right

A good warm-up is always important, but because of the tendency for joints to be stiffer, and
blood flow to muscles to be reduced in the cold, it’s even more important that you do it right this time of year. To start, do something to get your heart rate up a bit, maybe a brisk walk or light jog. Follow that up with a dynamic warm-up rather than static stretches. This could include walking or jogging while pulling your knees up high to your chest. Maybe some high kicks in front of you with straight knees to get your hamstrings loosened. A walking lunge with an upper body twist can get your whole body moving. Cater your warm-up to what you have planned in your workout. If you’re not sure how it should look, ask your physical therapist!

Dress For Success

Dressing in layers allows you to adjust your insulation to your activity level. After you warm-up, you might want to take off a layer to avoid getting too hot during your main activity. You’ll have it there later to put back on when your activity level drops and you start getting too cold.
Don’t forget about the sun either – just because it’s cold doesn’t mean the UV rays are gone.
Sunscreen and sunglasses aren’t just for the summer. A lip balm with SPF can protect you not
only from the sun but from the wind too.

Stay Hydrated

Drink water before, during, and after your workout. The temperature may be down, but you’ll still sweat and you’ll still lose water vapor in your breath. The drier air in winter lets your sweat evaporate more quickly, so it’s easy to underestimate how much fluid you’ve lost.

Cool Down

When you’re done, don’t rush to get inside and crawl under a blanket. Cool down properly. Keep moving with a walk or another form of active recovery to let your heart rate come down. After exercise is the right place for static stretching. You can also head inside for some foam rolling or self massage.

The days being shorter and the temperatures being lower don’t mean you’re stuck inside for all of your exercises. If you follow these tips, you can safely keep moving outside. If you’d like a customized warm-up or cool down or have questions about your exercise routine, your physical therapist is a great person to ask!