An essential component of lifestyle modification is EXERCISE.

ex·er·cise/ˈeksərˌsīz/
noun

1. activity requiring physical effort, carried out to sustain or improve health and fitness.

But, evidence has suggested that exercise may be an often neglected intervention in mental health care. How can that be when aerobic exercises, including jogging, swimming, cycling, walking, gardening, and dancing, have been proved to reduce anxiety and depression. These improvements in mood are proposed to be caused by exercise-induced increase in blood circulation to the brain and by an influence on the hypothalamic-pituitary-adrenal (HPA) axis and, thus, on the physiologic reactivity to stress. This physiologic influence is probably mediated by the communication of the HPA axis with several regions of the brain, including the limbic system, which controls motivation and mood; the amygdala, which generates fear in response to stress; and the hippocampus, which plays an important part in memory formation as well as in mood and motivation.

Exercise has also been found to alleviate symptoms such as low self-esteem and social withdrawal. So by staying active exercise can help you manage symptoms of depression, stress, and anxiety. Physical activity can also counteract the effects of some psychiatric medications that may cause weight gain. Consider walking, swimming, or gardening. Even light physical activity can make a difference like cleaning the house, doing laundry, or raking leaves now that fall has arrived.

What Will I Gain?

The other benefits from regular exercise that should be emphasized and reinforced by every mental health professional to their patients include:

1. Improved sleep
2. Increased interest in sex
3. Better endurance
4. Stress relief
5. Improvement in mood
6. Increased energy and stamina
7. Reduced tiredness that can increase mental alertness
8. Weight reduction
9. Reduced cholesterol and improved cardiovascular fitness

The 5% Rule

DON’T start out too hard in a new exercise program no matter what it is –listed above or otherwise. Walking for instance is GREAT exercise, but you don’t have to walk 20 miles in a week. Start out low and slow..follow the 5% rule, which might look like this:

Week 1: 3000 steps (1.5 miles)

Week 2: 3150 steps

Week 3: 3300 steps

Week 4: 3500 steps (1.75 miles)

Week 5: 3750 steps

Week 6: 4000 steps (2 miles)

The immediate effects of exercise are empowering and rewarding! Your body is the only house you have to live in so take care of it.

Without trying to adhere to the phrase coined the ‘new normal,’ unfortunately, it is just that and we have to adapt to it—for now anyway. Therefore, our stress levels are like a roller coaster ride right now; it can be physical, emotional, or financial…one at a time – or unfortunately all at once. Even for us!

Depending on who you ask, stress is defined differently. When you are charged with handling more than you anticipate, stress rules! To some, stress is simply a fact of life while others struggle to anticipate or identify stress, inhibiting their ability to react productively. Understanding what stresses you is key to being able to identify and manage your response.

Either way, people are still getting back and neck pain, overuse injuries and hurt while at work, or are deconditioned from being under active during isolation and/or quarantine. At Carousel, we are consistently having round table discussions about how we can keep you in the know on how – now more than ever – physical therapy should be an important part of your healthcare team. Matter-of-fact physical therapy came in at #3 in the 5 kinds of health appointments you should consider keeping despite the pandemic July 2020 Washington Post article that we shared on social media. Physical therapist and spokesman for the American Physical Therapy Association, Robert Gillanders was quoted in saying “when you treat injuries in the early stages, the outcomes are always better.”

Naturally, we will expand on injuries to include other treatments such as:

Deconditioning
Dizziness/Vertigo
Gait & Balance*
Pre- & Post-Surgical*
Stroke/Cardiac Rehabilitation
…and many other conditions and specialty conditions as outlined on our website.

(*) indicates home safety checks for fall risks and post-op home navigation staging can be requested with your treatment.

We Adapt to Keep Our Clinics Safe; We Are Trained to Handle It!

Many of you who would benefit from seeing our physical therapists are reluctant because of concerns over COVID-19 that our clinics are busy places with people coming and going. That’s understandable, but we have made changes to allow us to continue to serve you while keeping you and our staff safe.

Physical therapists are medical professionals who were trained to deal with infectious diseases and keep people safe long before COVID-19 existed. By making changes throughout our workflows and patient experiences, Carousel Physical Therapy continues to reduce the risk of spreading COVID among their staff and patient populations, while continuing to deliver needed services to the public. If you are in need of PT treatment but are hesitant to go into the clinic, give our clinics a call and talk about what policies and procedures we have in place. To reduce or eliminate going into the clinic, ask about using telehealth either exclusively or in combination with in-person treatment.

This is a time of uncertainty, but people are reacting with flexibility and creativity. Don’t let concerns over COVID keep you in pain or from the treatment you need. So Remember to….

Stay in the Know, NOT the don’t know!

By: Crystal Bondurant Salisbury, LPTA

I always hear people comment about having “flat” feet, use it synonymously with “bad” feet. Your flat feet aren’t any better or worse than your friend with those lovely, high arches. It all comes down to how to dress your feet, and it’s important to dress for success.

When it comes to flatter feet or feet that fall flat while walking, it helps to give a little support. Studies found that the further a person would run the more force came through the plantar or bottom surface of the medial or middle foot. Studies further showed that it was even more important the more a person would overpronate or “fall in” to provide support from a motion control shoe.

Does that mean that you need a motion control shoe if you’ve been told you have flat feet, or you think your feet are falling flat while walking or running? No, not necessarily, but there are a few things to keep in mind while shopping to address each one of the three parts of your foot; Forefoot, Midfoot, and Rearfoot

Foot Facts:

Forefoot: It is important to keep in mind your forefoot, or the ball of your foot including your toes needs enough room to spread out as you push off while walking. A foot can spread up to 5 mm when striking the ground, so your shoe must accommodate this spread comfortably from the arch up to the toes. Restricting your foot’s ability to comfortably spread can create circulation problems, impinge tendons and nerves, and bend joints in odd directions.

Midfoot: Generally, when talking about this part of the foot we want to keep in mind a goal of supporting the midfoot or the region of the foot where your arch is. With most issues stemming from this region the arch responds well to controlling the excessive motion of the arch dropping to the floor while walking. You want to pick a shoe that slows or reduces this drop, so pick a shoe that comfortably rests into your arch. The arch of a shoe should not be so high as to be painful or push you onto the outside of your foot (pronate).

An arch should allow you to rest comfortably in standing and respond well to you while walking. It could be uncomfortable to have support for the first 2-3 days but should get progressively more comfortable as you get moving in your new shoes.

Rearfoot: The heel of your shoe controls your rearfoot. A traditional shoe, running or walking, has a heel-toe drop of 12 mm, but a minimalist tennis shoe could have as low as 4 mm. The elevation is intended to relieve stress on the Achilles tendon and calf musculature and was intended to make it easier to progress through a normal walking pattern. Also, the cushion in the heel of the shoe also helps with shock absorption with walking and running.

Picking the Shoe:

When picking shoes, we have a lot to consider, from these three parts of your foot to the materials and the brands you’re thinking about purchasing. Motion-control shoes are a popular type of shoe used to address flat feet while running and walking. They are a little heavier than average shoes and improve a person’s ability to heel strike while walking, promoting a more normalized gait. Trail shoes can also be a good option for that may be a little more versatile, offering stability but also allowing more mobility in the ankle and foot laterally.

Keep Track of Mileage:

It is also good to keep in mind the life of a shoe ranges between three hundred and five hundred miles, and they tend to start breaking down around a year. So, just remember, your shoes should be comfortable and accommodating to your foot allowing a snug but not a too-tight fit and supporting your arch while you run, walk, or play.

There is a legit reason you feel so drained right now, and feeling a little ‘over it’.

The psychological reason for this has something to do with ‘surge capacity’.  What is ‘surge capacity’?

“It’s a collection of adaptive systems – mental and physical – that humans draw on for short-term survival in acutely stressful situations, such as natural disasters.”

The issue is that our surge capacity only allows us to adapt to major disasters if they are temporary.

However with the pandemic, the disaster stretches out indefinitely.

Many have had preplanned and pre-paid travel or events canceled, to find out it’s non-refundable because of this epidemic. This hits the wallet pretty hard!  The unknown of the future including the inability to plan. Social connections that provide support are missing – no hugs, limited physical closeness even laughter, and dancing.

Not- to- mention, your pain doesn’t stop or is suddenly onset because you have taken the opportunity to catch up on the ‘honey-do’s’, and overexerting yourself with exercises. Or, just deconditioning in general due to lack of energy caused by stress and anxiety.

Even the ones who are coming for physical therapy feel that the current state of the world is affecting their progress with PT.

Therefore, because this pandemic is going on, and on, and on…..your surge capacity is depleted and it needs to be renewed. Which now means the emergency phase has become chronic.

Even our own anxieties have increased dealing with work/life balance, so some have started using a guided meditation app in the recent past. And, as some of our patients expressed, they too had reached their limits, so we recommended meditation to them and have had really positive feedback.

So, here are some links providing evidenced-based research on the benefits of meditation, as well as some meditation apps that can promote resilience and help you cope better during these unprecedented times.

https://eric.ed.gov/?id=ED141339

https://www.mayoclinic.org/tests-procedures/meditation/in-depth/meditation/art-20045858

Calm.com

Headspace.com

“Arthritis” is a term used to describe inflammation of the joints.

Osteoarthritis (OA) is the most common form of arthritis and usually is caused by the deterioration of a joint. Typically, the weight-bearing joints are affected, with the knee and the hip being the most common.

Rheumatoid arthritis (RA) is a chronic inflammatory disease. It affects about 1% of the population. RA often results in pain and inflammation in joints on both sides of the body. In some people, it can become disabling due to its effect on the immune system.

What is Osteoarthritis?

Your bones are connected at joints such as the hip and knee. A rubbery substance called cartilage coats the bones at these joints and helps reduce friction when you move. A protective oily substance called synovial fluid is also contained within the joint, helping to ease movement. When these protective coverings break down, the bones begin to rub together during movement. This can cause pain, and the process itself can lead to more damage in the remaining cartilage and the bones themselves.

The cause of OA is unknown. Current research points to aging as the main cause. Factors that may increase your risk for OA include:

• Age. Growing older increases your risk for developing OA because degeneration and aging of the cartilage and synovial fluid increases over time.
• Genetics. Research indicates that some people’s bodies have difficulty forming cartilage. Individuals can pass this problem on to their children.
• Past injury. Individuals with prior injury to a specific joint, especially a weight-bearing joint (such as the hip or knee), are at increased risk for developing OA.
• Occupation. Jobs that require repetitive squatting, bending, and twisting (eg, construction, landscaping, childcare) are risk factors for OA. People who perform jobs that require prolonged kneeling (eg, miners, flooring specialists) also are at high risk.
• Sports. Athletes who repeatedly use a specific joint in extreme ways (eg, pitchers, football linemen, ballet dancers, runners) and those who engage in high-impact joint loading done in a repetitive manner (eg, running, jumping, landing on hard surfaces) may increase their risk for developing OA later in life.
• Obesity. Being overweight causes increased stress to the weight-bearing joints (such as knees), increasing the risk for development of OA.

How Does It Feel?

Typically, OA causes pain and stiffness in the affected joint. Common symptoms include:

• Stiffness in the joint, especially in the morning, which eases in less than 30 minutes
• Stiffness in the joint after sitting or lying down for long periods
• Pain during activity that is relieved by rest
• Cracking, creaking, crunching, or other types of joint noise
• Pain when you press on the joint
• Increased bone growth around the joint that you may be able to feel

Caution: Swelling and warmth around the joint is not usually seen with OA and may indicate a different condition or signs of inflammation. Please consult a doctor if you have swelling, redness, and warmth in or around a joint.

sources:

https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-osteoarthritis

https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-physical-therapists-guide-to-rheumatoid-arthritis

A special type of physical therapy is helping some patients with the novel coronavirus breathe more easily. The type of physical therapy, called manual therapy, is a bit different from the typical physical therapy and has helped some COVID-19 patients.

Dieterich, a hepatologist at Mount Sinai Hospital in New York City, was infected with the novel coronavirus in March and spent over three weeks in the ICU and hospital.

“Physical therapy for me before COVID was common for orthopedic injuries. This was different,” Dieterich said of manual therapy. “After I got home, my physical therapist was also certified in manual therapy so she addressed how my joints in the rib cage worked.”

The physician explained how they dealt with social distancing during treatments.

“The act of breathing is automatic but the depth of breath is dependent on the muscles functioning and the rib cage working efficiently,” Valerie Harris, who practices manual physical therapy at Thrive Integrated Physical Therapy in New York City, told Fox News.

The physical therapist said incorporating breathing exercises during and after these techniques allows for greater lung expansion and may help with a greater diffusion of oxygen throughout the body.

The novel coronavirus creates inflammation and attacks the lung tissue, according to health experts. Breathing becomes compromised and the patients typically become generally weak.

“The muscles were so tight and deconditioned from weeks in the hospital. It was difficult to take a deep breath in; the manual physical therapy really got in there and helped get the ribs to actually separate as I took a deep breath,” Dieterich said.

“When I first got out of the hospital in late April, I could not even sit up for 30 minutes. My oxygen saturation rate on the pulse oximeter would plummet to the 80s when I tried to stand and move around to cook in the kitchen, even with 6 liters of oxygen.”

— Dr. Douglas Dieterich 

Besides addressing the rib mobility, the physician said treatment also focused on the diaphragm, the muscle just under your rib cage.

“The diaphragm is the primary muscle of respiration and during inspiration, it contracts and pulls downward,” said Harris.

She explained how the muscles between the ribs, which are known as the intercostals muscles, work with the diaphragm to expand the chest to allow air to fill the lungs. When they are tight, the chest can’t expand as efficiently, according to the physical therapist.

“ICU-acquired weakness occurs in 33 percent of all patients on ventilators and up to 50 percent of patients who are in the ICU for greater than one week,” Amitay, the owner of Thrive PT, added.

Physical therapists say the muscles compensate for the weakness in many COVID-19 patients and many muscles no longer contract properly, which can contribute to inefficient breathing patterns.

“Patients who have been in respiratory distress may use their accessory muscles of respiration versus their diaphragm,” said Amitay. “This increases the work of breathing.”

Both physical therapists say when these muscles are tight, these manual techniques along with stretching and breathing exercises can really help patients recovering from COVID-19. Dieterich said the virtual sessions appear to be helping him in his recovery.

Although he has a long road to full recovery ahead, he noted that he can now “walk 2 miles on 2 liters [of oxygen], although I get tired and have to rest afterward.”

Falls are a major public health concern. According to the CDC, more than one-third of adults 65 and older fall each year in the United States, and 20% to 30% of people who fall suffer moderate to severe injuries. Falls can exact a toll long after the initial injury, outranking chronic kidney disease, asthma, and Alzheimer’s disease and other dementias in terms of effects on disability-adjusted life years, according to a 2017 Global Burden of Diseases, Injuries, and Risk Factors Study.

The physical therapy profession’s role in falls risk reduction and prevention is supported by a strong body of research. What we do works.

See how you score on this 8-question quiz on falls statistics and screening (scroll down for answers). Good luck!

1. According to the US Centers for Disease Control and Prevention (CDC), approximately how many Americans aged 65 and older experience a fall every year?
A. 1 in 3
B. 1 in 4
C. 1 in 5
D. 1 in 6

2. According to a clinical guideline statement from the APTA Academy of Geriatric Physical Therapy (AGPT), what question should physical therapists (PTs) routinely ask older adult patients?
A. “What medications are you currently taking?”
B. “Are you experiencing feelings of dizziness?”
C. “Have you been diagnosed with diabetes?”
D. “Have you had any falls in the last 12 months?”

3. Between 2007 and 2016, death rates due to falls in the US increased by what percentage?
A. 3%
B. 15%
C. 24%
D. 31%

4. Authors of a 2012 study in the Journal of Aging and Physical Activity studied a particular activity and found that adults who engaged in this activity had a reduced risk for falls. Which activity did researchers target?
A. Gardening
B. Driving a car
C. Shopping
D. Light household chores

5. A recent study in the American Journal of Preventive Medicine found that the falls risk factor affecting the largest number of adults 65 and over is:
A. Visual impairments
B. Medication interaction
C. Home hazards
D. Vitamin D deficiency

6. A recent CDC study ranked US states according to older adult death rates due to falls in 2016. At 142.7 per 100,000 individuals, which state reported the highest death rate?
A. Alabama
B. Florida
C. Arizona
D. Wisconsin

7. According to the CDC, among men and women aged 65 and older, which group has the highest rate of nonfatal falls, and which has the highest rate of fatal falls?
A. Men have the highest rates of both fatal and nonfatal falls.
B. Women have the highest rates of both fatal and nonfatal falls.
C. Women have higher rates of nonfatal falls; men have higher rates of fatal falls.
D. Men have higher rates of nonfatal falls; women have higher rates of fatal falls.

8. According to a survey of emergency department physicians in the US and Canada, the bathroom is the most risky location for a fall in the home among adults 65 and older, with 69% of home falls occurring in that space. Which area comes in second?
A. Kitchen
B. Bedroom
C. Stairs
D. Living room

ANSWERS:

1. B – About 24% of older Americans fall each year—the leading cause of fatal and nonfatal injuries among older Americans, according to the CDC.

2. D – There are of course many questions that may be appropriate for providers to ask (including some of the choices listed here), but the question that should never be skipped is whether the patient has experienced any falls in the past 12 months, according to the AGPT guidelines. Previous falls are 1 of the strongest falls risk factors, and should never be ignored.

3. D – Falls-related deaths rose by 31% between 2007 and 2016, according to the CDC. During the 10 years tracked in the study, falls-related deaths among US residents 65 and older rose from 18,334 to 29,668—in terms of rates of death from falls, that’s an increase from 47 per 100,000 to 61.6 per 100,000 in that age group. Deaths climbed by about 3% per year, according to the report.

4. A – In the study, researchers focused on gardening, and concluded that “gardeners reported significantly better balance and gait speed and had fewer chronic conditions and functional limitations than nongardners.” They believed the findings “suggest that gardening may be a potential activity to incorporate into future fall-prevention programs.”

5. C  – Home hazards were the leader in terms of falls risk factors, but that isn’t to say other factors don’t come into play as well, say authors of the study.

6. D –  According to the CDC, Wisconsin had the highest falls-related death rate among adults 65 and older, at 142.7 per 100,000. Authors aren’t sure of the reasons for the variance but suspect that the numbers might be related to demographic variables including differing proportions of older white adults in various states. Another possible explanation: the impact of who completes the death certificate.: According to the CDC researchers, a 2012 study showed that coroners reported 14% fewer deaths from falls than did medical examiners.

7. C – Women have higher rates for falls, but men have higher death rates related to falls, according to the CDC. Authors of the study speculate that the higher fatality rate “might have resulted from differences in the circumstances of a fall (e.g., from a ladder or while drinking), leading to more serious injuries.”

8. B – Caregiverstress.com reports that at 13%, bedrooms are the second-most-likely place for a fall, followed by kitchens and stairs.

Recent research is showing that surgery might not be needed as often as we think. A large review estimates that 10% to 20% of surgeries might be unnecessary and that in some specialties such as cardiology and orthopedics, that number might be higher. The reasons for so many unneeded surgeries being performed are varied, but the most common are that more conservative options aren’t tried first, or lack of knowledge by the operating physician.

Physicians undergo long and rigorous training programs to become surgeons, but if they don’t work hard to keep learning, their knowledge often stops growing when they leave residency. Recent research is showing that certain common surgeries aren’t any better than a placebo. Two such examples are:

kyphoplasty – a procedure for spinal compression fractures.

and

partial meniscectomy – a procedure used to treat tears of the meniscus in the knee.

If a surgeon hasn’t continued to learn, they won’t know that these surgeries often don’t offer any more benefit than a non-surgical treatment and will continue to perform them.

Every surgery, even “minor” ones carry risks. These include complications from anesthesia, blood clots after surgery, delayed healing of the incision, infection, and unintended damage to nerves or other organs near the surgical site. Some of these risks cause discomfort for a period after surgery and go away, but others can result in permanent disability or even death. For some patients and conditions, surgery is a great treatment option, but with all the associated risks, when surgery can be avoided, it should be.

For musculoskeletal problems like back and joint pain, sprains, and strains, seeing your PT before a surgeon can help keep you out of the operating room and get you back to life without surgery. Studies have shown that physical therapy is just as good if not better than surgery for a multitude of conditions and carries less risk. Some examples would include rotator cuff tears, meniscal tears, spinal stenosis, low back pain, and osteoarthritis.

Physical therapy can’t fix every problem, and for some patients surgery is the best choice. However, research is showing that surgery isn’t a cure-all, and is sometimes just a very expensive and risky placebo.

The takeaway? Starting with physical therapy is the right choice, and for many patients, PT is the only treatment necessary.

So you have been diagnosed with a painful condition and your doctor prescribes physical therapy (PT), what’s your next step? To come to PT of course!

Now you are coming to PT, but then you get to your appointment and start treatment revealing your fear of the reason you are in PT and all of the sudden freeze-up thinking about all of the “what if’s?”

Have you ever wondered, or been asked, if you were a coper or an averter? We don’t want our patients to make things worse for themselves by making bad coping choices such as isolation, too much or too little sleep, unhealthy eating, and we don’t want you to avert coming to therapy out of fear or unknowns.

The American Mindfulness Research Association describes mindfulness as “the state, process, and practice of remembering to observe moment-to-moment experience with openness and without automatic patterns of previously conditioned thoughts, emotions, or behaviors.”

At Carousel we want to investigate the missing piece of your PT treatment; your worry, why it worries you, and what is the worst thing that can happen (this is especially true for those of you that have had a fall and are afraid of falling again). Because once we help you confront the worst thing that could possibly happen—and help you realize the unlikeliness that it will happen again, or educate you on how to take care of yourself if it happens again—you can return to your daily activities worry-free.

By using mindfulness in PT (and we’re not talking about your body in tune with the universe or in harmony with the planets), it helps to let go of preconceived ideas and concepts about your body and listening to what it is telling you; as if for the first time. Some benefits of mindfulness are:

• It helps you slow down.
• It helps you to know yourself better.
• It helps you to focus or concentrate.
• It helps you to ruminate/stress less.
• It helps you change bad habits.
• It helps us be more resilient.
• It leads to a more enjoyable life.

We want to eliminate any of the stressors and stigmas of your condition, or about PT in general. We want you to be able to ask yourself are you coping or averting after applying the wisdom you relearned about your body; at Carousel of course!