Carousel Raises Awareness on the Many Benefits of Physical Therapy in October

Every October we celebrate National Physical Therapy Month to raise awareness with consumers about the many benefits of physical therapy. It’s also a great opportunity to appreciate the outstanding impact Physical Therapists and Physical Therapists Assistants have on society and healthcare.

People everywhere experience the transformative effects physical therapy can have on their daily lives, but some common misconceptions often discourage people from visiting a physical therapist.

This year marks the 30th-anniversary of NPTM emphasizing physical therapists’ value as movement experts as well as the benefits of regular physical activity, and the unique value PTs and PTAs bring to help people get moving.

The core of the physical therapy profession is about care and service. So, this is a great time to get to know about the important work we do. Because all-in-all our care revolves around you!

 

 

Falls Prevention is a Team Effort

It seems like common sense—everybody falls, no matter what age. However, for many older adults, an unexpected fall can result in a serious and costly injury. The good news is that most falls can be prevented. And one of the ways you can prevent a fall is by knowing who you can call on for help.

That’s why falls prevention should be a team effort, where each member of the team offers expertise in their area of responsibility or field of work. Some members include health care professionals, like your primary care physician, an occupational therapist, physical therapist, pharmacists, and more.  While health care professionals provide much of the expertise and experience to ensure you live independently and falls free, there are other resources in your community that contribute to falls prevention.

Let’s get to know your falls prevention team

From medication and vision impairment to poor lighting and chronic conditions, the factors to watch for are numerous. That’s why having a team to help spot and address fall risks is so helpful. Below are all of the resources that play a significant role in promoting safety and preventing falls for you.

Your falls prevention team should include:

Each of them brings a unique mix of expertise and familiarity that can provide important protections against falling. Check out this video to learn more.

Your family and friends

You know them, you trust them, and they are happy to help. Family and friends provide some extra hands or another set of eyes to check and rid your home of falls hazards. The next time they come over to visit or help around the house, ask them to take a little extra time helping you find common fall hazards. This checklist shows you what to look for. Family and friends can also join you during doctor visits and help ask questions and gather information about prevention falls.

Your occupational therapist (OT)

Whether you’re already working with an OT or not, they are a vital part of any falls prevention team. They can ensure your assistive devices fit your needs and assess your home to identify hazards to be eliminated and modifications that can prevent falls. During Falls Prevention Awareness Day a few years ago, we toured a real home with Scott Trudeau, PhD, OTR/L from the American Occupational Therapy Association. The video is a wonderful example of how teamwork can prevent falls.

Your primary care physician (PCP)

Primary care physicians are often best positioned to work with patients on falls prevention and get the process started because they see patients regularly. Your PCP knows your medical history and manages chronic illness like diabetes and arthritis that may put you at risk. PCPs can recommend evidence-based programs designed to reduce fall risk, spot hidden injuries resulting from a fall, and evaluate side-effects and other problems with medications that may increase your risk of falling.

Be proactive about addressing falls when you visit your doctor. Even if your appointment was made for something else, sharing information is always important. Tell your doctor if you’ve fallen recently, feel unsteady on your feet or are worried about falling. A good PCP wants to build trust and be accurate so you stay healthy.

Your pharmacist

Most older adults take some kind of medication or supplement each day. The effects of medications on our risk of falling isn’t usually something we think about when we’re trying to get over a cold or manage disease like high blood pressure or arthritis. That’s why pharmacists are an important part of any falls prevention team. When you pick up your medications, use the opportunity to get counseled about any side effects you’re experiencing, and any changes in the medications you’re taking. Check out this video which explore the role of medications in falls and the many ways that pharmacists can help.

Your physical therapist (PT)

Physical therapists are important members of the falls prevention team. They can work with you to improve balance, strength, and mobility to prevent falls and can help address the reasons you may be feeling unsteady. Physical therapists can also help you identify what you can do each day to manage your falls risk and connect you to resources in the community to maintain and improve your strength and balance.

Your fire department 

Your local fire department can play a key role in falls prevention and do more than help you in case you do fall. Fire departments can help prevent falls by offering home safety checks to spot falls hazards*, such as rugs without non-slip backing or too many electrical devices plugged into one outlet. They also can assist in testing and replacing smoke alarms. Firefighters can also connect you to resources in the community to prevent falls. View this infographic to learn more tips on how the fire department can help reduce your risk of falls.

Your senior center

Senior centers are local community-based meeting places where you can gather to enjoy recreational, social, cultural, health and wellness and educational programs to remain physically active, learn new things, and stay engaged with the community. They connect you to a broad array of community services like transportation, nutrition, and benefits access. Senior centers also are a trusted community hub for health and fitness programs to encourage exercise and movement.

Your hardware store

You can find household goods and many other home products and appliances to maintain and improve your home at any local hardware store. Your hardware store is the ideal one-stop shop if you want to make modifications to your home to reduce your risk of falls. They have all the supplies and materials needed to make your home a safe and comfortable place to age in place and remain independent, such as grab bars, a hand-held shower head, nightlights and lightbulbs for brighter light, and nonslip pads for your rugs. They can also help you find what you need to make these recommended home modifications. Installing a walk-in bathtub can also make bathing easier and safer.

Your faith-based organization(s)

You can depend on your faith-based organization to support and encourage you along your falls prevention journey. Faith leaders are trusted sources of important information and can connect you to community resources to address your needs, especially when it comes to your health. You can also count on your faith community for social support, whether it is joining you in a new activity, preparing for a medical visit, or going along with you to a falls screening or other falls prevention event.

Your library

Libraries are a valuable place to learn about falls prevention. They are filled with books and other media for you to use so you can be more informed and educated about your health. Library staff can also help you find specific information on falls risk factors and often know about important community events and other resources. Libraries are also a common place for falls prevention programming, such as A Matter of BalanceTai Chi, and Bingocize! 

Your local sporting goods store

Your local sporting goods store is a valuable resource for the most appropriate shoes, clothes, and equipment to help you stay active and falls free. These stores can help you pick out the best shoes for walking, hiking, and other exercise activities. Sporting goods stores can also help you pick out the right equipment for health and fitness programs, such as yoga mats, ankle weights, dumbbells, walking sticks, and more. They also carry water bottles and specialized clothing to help you stay cool during the summer and warm during the winter.

Ready to build your falls prevention team?

As you start to pull together those who will help you protect your health and independence, you can always turn to organizations like ours for information. Falls Prevention Awareness Week only happens once a year, but we are constantly creating new resources for older adults, caregivers, and professionals to use whenever you need. Check out NCOA’s Falls Free CheckUp, a quick 12-question screen to help you better understand your risk for falling.

Falls Prevention Awareness Week is made possible in part by grant number 90FPSG0051 from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.  

source:  ncoa.org

*Carousel PT offers home safety checks, such as evaluating proper nighttime lighting and clear paths of travel to restrooms when falls are the highest risk, and much more.

What Medications Increase the Risk of Falling Among Older Adults?

Key Takeaways

  • Potentially hazardous medications and medication combinations are known to be significant contributors to falls in older adults.
  • Over-the-counter medications can cause harmful interactions that can increase falls risk and cause other health problems for older adults.
  • A HomeMeds evidence-based medication review can help to mitigate the negative effects of medications as contributors to falls in older adults.
Although not an inevitable part of the aging process, falls are a significant concern for older adults and can be scary, dangerous, and even life-threatening. And certain medications, as well as combinations of both over-the-counter and prescribed drugs, can increase the risk of falling.

What can older adults and the people who care about them do? Getting regular exercise, having vision checked, making one’s living environment safer, and managing medications are all steps that can help to prevent a fall. Be sure to tell your doctor about all medications, even herbal remedies, you are taking.

And when it comes to managing medications, a thorough medication review is very important for older adults who are at risk for falls.

How can a HomeMeds medication review help prevent falls?

HomeMedsSM is an evidence-based program developed at Partners in Care Foundation in San Fernando, California, that is a great tool for identifying potential medication-related hazards. HomeMeds can be used as part of a case management program to help screen for medications that are particularly risky for older adults. It uses algorithms in conjunction with a pharmacist review to look at five important problem areas affecting individuals:

1. Unnecessary therapeutic duplication

This means someone is taking two medications that essentially do the same thing.

“This can happen when a patient is discharged from the hospital and they are given a prescription for a brand name drug and they are already taking the generic version, which was prescribed by their primary care physician,” said HomeMeds consulting pharmacist Preston Hall. “It could also be that they are taking an anti-inflammatory prescription like meloxicam and an over-the-counter like Aleve. Taking both anti-inflammatory drugs could cause a gastrointestinal bleed.”

Another example: taking multiple antidepressants, antianxiety, or blood pressure medications.

“The prescribed medications may be the appropriate treatments, but HomeMeds lets us dive deeper by alerting the pharmacist to analyze if the risk versus benefit is appropriate for that individual,” Hall said.

2. Medications that can cause falls and confusion

These can include psychotropic medications like anti-depressants or anti-anxiety drugs that can affect balance, as well as antipsychotic medications used for behavioral issues, which can increase the risk of dizziness and confusion and increase a risk for falls, Hall said.

Health experts flag these types of medications as increasing falls risk:1

  • Psychoactive medications, including anticonvulsants, antidepressants, antipsychotics, benzodiazepines, opioids, and sedatives/hypnotics
  • Prescription and over-the-counter antihistamines
  • Muscle relaxants
  • Medications affecting blood pressure
  • Anticholinergics, including medications to treat urinary incontinence, overactive bladder, or COPD

3. Medications that can cause cardiovascular problems such as high/low blood pressure or low pulse

“This protocol is based on an alert which is triggered when the recorded blood pressure and/or pulse reading is below or above normal ranges,” Hall said. “When the alert is triggered it will have the pharmacist examine if any of the medications currently taking could be the contributing factor. Typically the medications that contribute to this are medications that treat hypertension.”

4. Inappropriate use of non-steroidal anti-inflammatory drugs (NSAIDS) in people with high risk of peptic ulcer/gastrointestinal bleeding

Use of such drugs could be considered “inappropriate” in people older than 80 because of age-related increased risk of ulcers and bleeding when taking an NSAID, including aspirin. This medication review alert also happens if someone is taking a NSAID and also another medication, such as an anticoagulant, that, when combined with a NSAID, would increase the risk of bleeding.

5. Reviews for effectiveness of opioid prescriptions and alternate options

Opioids, if either not prescribed appropriately or not taken appropriately, can substantially increase the risk of side effects, which include sedation, confusion, and loss of balance. All of these side effects can increase a person’s risk of falling.

“This is why it is best to recommend alternative treatments and therapies of non-opioid options,” Hall said. “The alternatives can either be taken or not taken with opioids to help reduce or fully stop the use of the opioid.”

The HomeMeds intervention has four simple steps:

  1. An inventory of all your prescriptions, over-the-counter medications, and any supplements is entered into a web-based tool
  2. The program assesses the inventory for duplications, psychotropics, NSAIDS (such as Ibuprofen and Tylenol), and other potential medication risks
  3. A pharmacist reviews the HomeMeds analysis and identifies any risks
  4. The prescribing physician is notified by the pharmacist of risks and the need to act on behalf of their patient

When potentially serious issues are identified with the medications a patient is taking, the physician will generally call the client or their caregiver to discuss the concerns or ask the client to come into the office to discuss options. A report is also provided to the patient and/or their caregiver so that they can bring up any concerns with their physician at their next visit.

How has medication review helped prevent older adults from falling?

HomeMeds is currently being used by 70 organizations in 23 states. Improved health outcomes and quality of life have been reported by many clients who have received a HomeMeds review. For example, an 84-year-old in Pennsylvania who reported having three falls within three months told the staff member doing the review that they were taking an over the counter (OTC) medication that increases the risk of a fall in elderly people.

“I just have been taking the OTC, and I never told my doctor,” the client said.

After the client, family member, and physician reviewed the HomeMeds’ report, the OTC medication was discontinued. The client was also referred to an evidence-based falls prevention program to learn other tangible techniques to aid in their functional abilities and preserve their independence at home.

Another example: an 88-year-old client with multiple medical and geriatric conditions had recently been released from the hospital. The community-based organization’s medication safety staff met with the client to review 25 medications they were taking. The HomeMeds assessment found an OTC sleep aid that was reported to interact adversely with the client’s prescribed medications. The client promptly followed up with their doctor to discuss the pros and cons of continued use of the medication, which was ultimately discontinued. The client was also thrilled to rid their home of expired and unused medications and learn how to safely dispose of those medications.

Following a medication review, physicians have modified prescriptions or helped patients evaluate whether they should continue taking medications that may have adverse interactions with other prescribed medications.

Family members/caregivers have been relieved to know that their loved ones are taking medications that are safe and are providing benefit, rather than causing harm.

HomeMeds helps to facilitate medication reconciliation after a hospitalization, monitor adherence to medications for chronic illnesses. It pairs well with medication management interventions such as dispensers and reminder systems. It fits well with care transition coaching and promotes creative solutions such as using pharmacy students to assist in the review of the patient’s Part D Plan medication therapy management to mitigate costs.

How can I find out more about HomeMeds?

If you are interested in learning more about HomeMeds, visit the Partners’ HomeMeds web page.

 

References:

1. Medications Linked to Falls. Fact Sheet. Centers for Disease Control and Prevention. 2017. Found on the internet at https://www.cdc.gov/steadi/pdf/steadi-factsheet-medslinkedtofalls-508.pdf

Source:

https://www.ncoa.org

Recognizing Signs of a Concussion

concussion is a mild traumatic brain injury caused by a direct blow to the head, face, or neck. In the United States, an estimated 300,000 sports-related concussions occur annually.

In high school gender-comparable sports, girls have a higher concussion rate than boys. Female athletes have also been shown to have a greater recovery time in postconcussion symptoms as compared to males.

Signs of a Concussion

Concussion symptoms usually appear within minutes of the injury, but some symptoms may take several hours to occur. Any athlete who has lost consciousness during a sports-related impact should be examined for a concussion or a spine injury.

A headache is the most common complaint of an athlete with a concussion. If you suspect your child has suffered a concussion, they may exhibit the following symptoms, which could worsen with stress or activity:

  • Loss of consciousness
  • Headache
  • Feeling in a “fog”
  • Difficulty remembering
  • Behavioral changes (irritability, rapid changes in mood, exaggerated emotions, aggressiveness, depression, decreased tolerance to stress, etc)
  • Nausea/vomiting
  • Difficulty with balance
  • Pupils that are enlarged or not equal in size
  • Double or blurred vision
  • Slurred speech
  • Difficulty falling asleep
  • Excessive drowsiness

What to Do If you Suspect a Concussion

  • Do not allow the athlete to return to any sporting event.
  • The athlete should be allowed to rest until there is a resolution of symptoms. This allows the brain to recover. Rest involves allowing time to sleep or take frequent naps. It is important to minimize distractions, such as television, the Internet, reading, or phone use.
  • It is not necessary to wake the athlete up every hour. This disturbs sleep patterns, which can interfere with the healing process of the brain.
  • The athlete should avoid pain relievers, like aspirin or other anti-inflammatory medicines. These may increase the risk of bleeding in the brain.
  • The athlete should not be left alone after the injury. Symptoms should be monitored closely. If they worsen, the athlete may need to be evaluated in the emergency room to determine if a more serious brain injury exists.

Our physical therapists can assess symptoms to determine if a concussion is present, and treat your injury by guiding you through a safe and personalized recovery program.

 

source:

choosept.com

 

“Specialized” High School Athletes More Likely to Report Hip and Knee Injuries

The study was small, but the results lined up with what many health care professionals have been saying for years: youth athletes who specialize in a single sport may be at a higher risk for injury.In a study published in The American Journal of Sports Medicine (Prevalence of Sport Specialization in High School Athletics: A 1-Year Observational Study, June 2016), “highly specialized athletes were more likely to report a history of overuse knee or hip injuries.””There are so many great aspects to sports participation, and we don’t want this information to scare athletes or parents,” said study author David Bell of the University of Wisconsin-Madison, in a press release from the university. “We just want them to be wise consumers and to participate as safely as possible.”Physical therapists typically encourage athletes of all ages to diversify their exercise to avoid injury, but it can be particularly important for young athletes.

According to physical therapist Sue Falsone, PT, ATC, MS, the former head physical therapist for the Los Angeles Dodgers, in an interview with Move Forward Radio (Avoiding Baseball Injuries-May 8, 2014), “Sometimes we ask the immature body to do things that they just physically can’t handle. And even if you’re getting through it at that time, it’s usually something that might break down later on.”

source:

www.choosept.com

What Physical Therapy Can Do For Arthritis

Arthritis is a chronic condition that causes inflammation of the joints. It can cause pain, stiffness, and swelling. The hips, knees, hands, and spine are the most commonly affected joints. Arthritis is not a single disease but an umbrella term that includes a variety of different types. Some of the more common examples are osteoarthritis, rheumatoid arthritis, gout, psoriatic arthritis, and ankylosing spondylitis.

While physical therapy might not be the first treatment you think of for arthritis, it probably should be. A lot of people with arthritis choose to use medication to manage their pain, stop activities that hurt, and wait for things to get bad enough to have a joint replacement. But this isn’t a great plan – all medications have side effects, even over-the-counter ones. Reducing activity leads to muscle atrophy and even stiffer joints. Even though joint replacement surgery usually has good outcomes, it does come with its own set of risks and a painful recovery.

Physical therapy has been extensively researched as a treatment for arthritis and demonstrates good outcomes. Physical therapists typically start with exercise as the base for arthritis treatment. Exercise helps to regain lost joint motion, decrease feelings of stiffness, and strengthen muscles surrounding the affected joint. These benefits are all somewhat obvious. What surprises many people is that exercise has been shown to be as effective as medication for pain relief in many types of arthritis, without the side effects.

Physical therapy has more to offer people with arthritis than just exercise though. Education helps people understand their condition, what to expect, and how to manage it. As experts in human movement, physical therapists are especially good at helping people modify the way they perform certain tasks or activities to reduce strain on joints affected by arthritis. They can also suggest ways to modify the environment at work or home to reduce pain and improve function. They may also suggest things like braces, orthotics, or other devices that can help maintain mobility and reduce pain. On top of all of that, PT has been proven to be a cost-effective treatment, too.

With so many techniques that are proven effective in helping people with arthritis, physical therapy is a recommended first-line treatment for many types of arthritis. Now that you have a better understanding of what PT can do, hopefully, you’ll think of PT first when you think of arthritis too.

References:

  1. Research (peer-reviewed)
    1. PT for juvenile RA – https://pubmed.ncbi.nlm.nih.gov/1946625/
    2. PT for hip and knee OA – https://pubmed.ncbi.nlm.nih.gov/33034560/
    3. Systematic Review for Juvenile RA – https://pubmed.ncbi.nlm.nih.gov/28729171/
  2. Articles and Content
    1. Effectiveness and Cost-Effectiveness of Physical Therapy for Knee Osteoarthritis  https://www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/718
    2. Can physical therapy reduce arthritis pain? – https://www.medicalnewstoday.com/articles/physical-therapy-for-arthritis

Female Athlete Triad: What You Should Know

Female athlete triad is a condition that involves an imbalance among three factors:

  • Energy available for physical activity.
  • Quality and strength of bones.
  • Menstrual cycle (periods).

The risk of developing the triad has increased with the high demand that athletics place on the female body. In addition, societal pressures for performance and image can contribute. For example, a runner may feel that restricting calories will help her run faster and earn her greater success.

The triad has negative effects on multiple body systems in the early stages. It also can lead to long-term effects on health and well-being as a woman ages.

The three measurable factors of female athlete triad are:

Energy availability. This is the amount of energy you get from your diet, minus the energy used during activity.

Bone mineral density, or BMD. When bones do not get needed nutrients or too much exercise stresses them, their structure can change and they may lose density (mass). This can lead to osteopenia (lower than normal BMD). Osteopenia can lead to osteoporosis (loss of bone strength that increases fracture risk).

Menstrual dysfunction. Menstrual cycles range from periods that are normal to irregular to absent in females from about ages 11 to 51 (menopause). Triad involves an irregular or absent cycle.

Symptoms related to the triad may develop over months or years and may include:

  • Low energy during school, work, or exercise.
  • Irregular or absent menstrual cycles.
  • Stress-related bone injuries (stress reactions or fractures).
  • Difficulty concentrating.
  • An unexplained drop in performance.
  • Changes in eating habits.
  • Altered sleeping patterns.
  • An unusually high focus on performance or image.
  • Experiencing high levels of stress.

Physical therapists can identify the signs and symptoms of the female athlete triad. They will initiate a team approach to care, as needed. Physical therapists also understand the effects that the triad may have on prescribed exercise. Once symptoms resolve, your physical therapist will design a safe return-to-activity program to help you perform at your best.

source: choosept.com

Brisk Walking Can Reduce Hip Fracture Risk in Men by 62%

Hip fractures in older adults can result in loss of mobility. This type of fracture also can lead to significant medical expenses. But a 2014 study published in the American Journal of Public Health offers hope. It suggests that four hours of walking each week can greatly reduce hip fracture risk later in life.

The study looked at nearly 36,000 men over a 24-year period. It showed that men who walked briskly for four or more hours a week had a 62% lower risk of hip fracture than men who walked less than four hours a week.

Researchers also found that even men who walked four or more hours a week at a slower pace saw benefits. Those who walked at a slower pace for four or more hours a week had a 43% lower risk of fracture compared with those who walked less.

The Health Professionals Follow-up study reported time spent walking, sitting, and in 10 other discretionary activities every 2 years in 35, 996 men aged 50 years and older from 1986 to 2010. The study calculated hazard ratios (HRs) for risk of hip fracture by amount of activity and sitting in Cox proportional hazards models, adjusted for age, body mass index, smoking, medication use, disease diagnoses, and diet.

Over 24 years, participants reported 490 low-trauma hip fractures. Energy expenditure from all activities was weakly associated with lower risk of fracture. More walking time, with little alternat exercise, lowered risk by 43%, and risk decreased linearly with more frequent walking. Brisk (vs leisurely) pace lowered risk by 47%. Sitting lowered risk primarily among those who also walked for exercise. We observed no benefit of strenuous activity.

Walking is a relatively safe and easy activity for hip fracture prevention.

How Physical Therapy Can Help:

If you have limitations due to pain or decreased inactivity, our physical therapists can help by discussing what barriers are keeping you from starting a walking routine. Then we can help you by creating a safe and enjoyable routine that you can build upon, including an appropriate recommendation for footwear and orthotic inserts.

sources:

choosept.com

pubmed.ncbi.nlm.nih.gov

aphapublications.org

 

 

The Benefits of a Lunch Hour Walk

To combat afternoon slumps in enthusiasm and focus, take a walk during the lunch hour.

A new study finds that even gentle lunchtime strolls can perceptibly — and immediately — buoy people’s moods and ability to handle stress at work.

It is not news, of course, that walking is healthy and that people who walk or otherwise exercise regularly tend to be more calm, alert and happy than people who are inactive.

But many past studies of the effects of walking and other exercises on mood have focused on somewhat long-term, gradual outcomes, looking at how weeks or months of exercise change people emotionally.

Fewer studies have examined more-abrupt, day-to-day and even hour-by-hour changes in people’s moods, depending on whether they exercise, and even fewer have focused on these effects while people are at work, even though most of us spend a majority of our waking hours in an office.

So, for the new study, which was published in the Scandinavian Journal of Medicine and Science in Sports this month, researchers at the University of Birmingham and other universities began by recruiting sedentary office workers at the university.

Potential volunteers were told that they would need to be available to walk for 30 minutes during their usual lunch hour three times a week.

Most of the resulting 56 volunteers were middle-aged women. It can be difficult to attract men to join walking programs, said Cecilie Thogersen-Ntoumani, the study’s lead author and now a professor of exercise science at Curtin University in Perth, Australia. Walking may not strike some men as strenuous enough to bother with, she said. But she and her colleagues did attract four sedentary middle-aged men to the experiment.

The volunteers completed a series of baseline health and fitness and mood tests at the outset of the experiment, revealing that they all were out of shape but otherwise generally healthy physically and emotionally.

Dr. Thogersen-Ntoumani and her colleagues then randomly divided the volunteers into two groups, one of which was to begin a simple, 10-week walking program right away, while the other group would wait and start their walking program 10 weeks later, serving, in the meantime, as a control group.

To allow them to assess people’s moods, the scientists helped their volunteers to set up a specialized app on their phones that included a list of questions about their emotions. The questions were designed to measure the volunteers’ feelings, at that moment, about stress, tension, enthusiasm, workload, motivation, physical fatigue and other issues related to how they were feeling about life and work at that immediate time.

A common problem with studies of the effect of exercise on mood, Dr. Thogersen-Ntoumani said, is that they rely on recall. People are asked to remember hours or days after the fact how exercise made them feel. Given how fleeting and mysterious our emotions can be, recalled responses are notoriously unreliable, Dr. Thogersen-Ntoumani said.

Instead, she and her colleagues wanted in-the-moment assessments from people of how they felt before and after exercise. The phone app questions provided that experience, she said, in a relatively convenient form.

Then the first group began walking. Each volunteer was allowed to walk during one of several lunchtime sessions, all of them organized by a group leader and self-paced. Slower walkers could go together, with faster ones striding ahead. There was no formal prescribed distance or intensity for the walks. The only parameter was that they last for 30 minutes, which the volunteers had said would still allow them time to eat lunch.

The groups met and walked three times a week.

Each workday morning and afternoon during the first 10 weeks, the volunteers in both groups answered questions on their phones about their moods at that particular moment.

After 10 weeks, the second group began their walking program. The first group was allowed to continue walking or not as they chose. (Many did keep up their lunchtime walks.)

Then the scientists compared all of the responses, both between groups and within each individual person. In other words, they checked to see whether the group that had walked answered questions differently in the afternoon than the group that had not, and also whether individual volunteers answered questions differently on the afternoons when they had walked compared with when they had not.

The responses, as it turned out, were substantially different when people had walked. On the afternoons after a lunchtime stroll, walkers said they felt considerably more enthusiastic, less tense, and generally more relaxed and able to cope than on afternoons when they hadn’t walked and even compared with their own moods from the morning before a walk.

Although the authors did not directly measure workplace productivity in their study, “there is now quite strong research evidence that feeling more positive and enthusiastic at work is very important to productivity,” Dr. Thogersen-Ntoumani said. “So we would expect that people who walked at lunchtime would be more productive.”

As a pleasant, additional outcome, all of the volunteers showed gains in their aerobic fitness and other measures of health at the completion of their 10 weeks of walking.

But, tellingly, many said that they anticipated being unable to continue walking after the experiment ended and a few (not counted in the final tally of volunteers) had to drop out midway through the program. The primary impediment to their walking, Dr. Thogersen-Ntoumani said, had been “that they were expected by management to work through lunch,” suggesting that management might wish to acquaint themselves with the latest science.
____________________________________________________

source: archive.nytimes.com

Physical Therapy Guide to Hip Impingement (Femoroacetabular Impingement)

Read Time: 6 minutes

What Is Hip Impingement?

Hip impingement, or femoroacetabular impingement, involves a change in the shape of the surface of the hip joint. It can lead to stiffness, pain, and damage of the tissue and/or bone. It most often occurs in young, active people. Conditions that cause hip impingement can be present at birth or develop over time. It affects men and women. Physical therapists help people with hip impingement regain movement, flexibility, and strength, and return to their regular activities and sport.

The two types of hip impingement, “pincer” and “cam,” may occur alone or together. Hip impingement usually affects people who are younger than 50. It may precede hip osteoarthritis.

Illustration of hip impingement

Pincer-Type Impingement

Pincer-type impingements affect men and women. This type may result when:

  • The hip socket, which is typically angled forward, angles toward the back.
  • Protruding bone develops on the pelvis. This makes the hip socket deeper so that it covers more of the ball or head of the femur bone.

Regardless of the cause, pincer-type impingements pinch the labrum, a rim of connective tissue around the edge of the hip socket. This pinching happens especially when flexing the hip (moving the leg up). Over time this extra pressure leads to wear and tear that can cause inflammation. Sometimes it causes a labrum tear. If this condition persists, the cartilage that lines the hip joint may become worn, form holes, and develop bone spurs.

Cam-Type Impingement

Cam-type impingements affect men more often than women and may result when:

  • The shape of the bone around the head of the femur (the ball at the top of the thigh bone) is misshaped. This deformity can be due to:
    • Variation of the “normal” shape of the head of the femur. This may be present at birth or can develop over time.
    • Bone that is overgrown at the top and front of the femur head. The nickname “pistol grip” deformity often describes this bony overgrowth on X-rays.
  • The overgrown or misshapen bone contacts the cartilage that lines the hip socket, possibly causing it to peel away from the bone in the socket. The labrum can become worn, frayed, or torn as well.

Signs and Symptoms

Hip impingement may cause you to experience:

  • Pain that begins gradually and may worsen with time. People with hip impingement often describe their pain by making a “C” with the thumb and hand and placing it on the fold at the front and side of the hip. This is called the “C” sign.
  • Groin pain or discomfort in the outside of the hip, thigh, low back, or buttocks.
  • Sharp, stabbing pain when squatting, sitting and standing, or performing athletic moves like running, “cutting,” jumping, twisting, pivoting, or moving side to side.
  • Loss of motion or a stiff feeling when rotating your leg inward and/or lifting your leg.
  • Pain that increases after sitting for long periods or leaning forward.

How Is It Diagnosed?

Your physical therapist will interview you to learn when and how your symptoms first began. They also will ask how your symptoms affect your daily life. They will discuss your goals for physical therapy and work with you on how best to achieve them.

Your physical therapist will perform an exam, which may include:

  • Watching you walk and noting any abnormalities.
  • Observing movements that are difficult, but not painful, for you to do (such as squatting).
  • Evaluating the range of motion (movement) of both hips, lower extremities (everything from your hips to your toes), and trunk.
  • Assessing the strength of both hips, lower extremities, and trunk.
  • Checking your balance and coordination for each lower extremity.
  • Testing the flexibility of each hip and other joints of the lower extremity.
  • Performing special tests to help determine whether the hip is the source of your symptoms. For instance, your physical therapist may gently roll your leg in and out (the “log roll” test), or bend your hip up and inward while turning the lower leg out to the side (the FADDIR test) to help determine the source of your condition.

For a firm diagnosis, your doctor may order tests to help identify any changes in the joint or labrum. These tests may include X-rays or an MRI. A diagnosis of hip impingement may take some time, especially if you also have low back, buttock, or pelvic pain.

Can a Physical Therapist Help?

Your physical therapist will conduct a thorough examination, including taking a detailed history, and may prescribe stretches and strengthening exercises to balance the muscles around your hip. They may use manual (hands-on) therapy to help restore your hip’s range of motion. Your physical therapist also may discuss making changes to your activities and lifestyle to help improve function and decrease your pain.

Without Surgery

Physical therapy may be beneficial for people with low-level hip pain and/or disability. Conservative care aims to:

  • Ease pain and discomfort.
  • Address individual limitations.
  • Improve overall function.

Your physical therapist may use some or all of the following approaches to help you achieve these goals. They may help you avoid the need for surgery or delay your condition getting worse. Your treatment may include:

Modifying your daily, job-related, and sports activities. Your physical therapist will recommend and discuss specific positions and activities for you to avoid or modify. These will be designed to protect your hip. They may recommend limiting how often you bend at the hip to avoid further hip damage. To minimize tension on the hip, your physical therapist will teach you safe, controlled movements.

Improving lower-extremity muscle flexibility and joint movement. Stretching tight muscles. Stretching the hip directly can reduce abnormal forces that cause pain with motion. Stretching other body regions (trunk, leg, ankle, or foot), also may decrease stress at the hip.

Joint mobilization. Your physical therapist may gently move your hip to help ease pain. This may improve your ability to stretch or extend your hip joint.

Improving the strength of your lower extremities and trunk. Strengthening the hips and trunk can reduce abnormal forces on the already injured joint. Your physical therapist will help you develop movement strategies to compensate for the injured hip joint.

Improving lower-extremity balance and coordination. Your physical therapist will prescribe exercises to help improve balance and coordinating movements. These can minimize forces and stress on the hip joint.

Home exercise program. Your physical therapist will design a specific home exercise program based on your needs and goals for you to do on your own. These will help you to stay strong and healthy safely, once your physical therapy visits have ended.

Functional training. Once your pain, strength, and motion improve, you will be able to slowly return to more demanding activities. Based on your unique needs and goals, your physical therapist will create a series of activities for you to do. They will help you learn how to use and move your body correctly and safely during your daily, work, and sports activities.

Following Surgery

Surgery for hip impingement is performed using arthroscopy. Arthroscopy is minimally invasive and only requires small incisions in the skin. The surgeon will insert pencil-sized instruments into the joint to repair the damage. The surgeon may perform one or more techniques during surgery as needed.

After surgery, physical therapy will depend on the type of procedure performed. On your first visit with a physical therapist, they will go over your history thoroughly and perform a physical exam (within the limits set by your surgeon). During later visits, your physical therapist may provide the following treatments:

Education. Your physical therapist will educate you about your condition.

  • Postsurgical wound care: You will learn how to watch for signs of infection and learn how to keep your wound clean.
  • Restrictions: Your physical therapist will go over any restrictions your surgeon has given you.
  • Brace: Your physical therapist will teach you how to put on and remove any brace prescribed by your surgeon, and explain the reasons for using the brace.

Gait training. Your physical therapist will teach you how to walk with an assistive device (such as crutches or a walker) if needed. They will teach you how to avoid putting too much weight on your hip as it heals.

Range-of-motion exercises. Initially, hip range-of-motion exercises will be gently performed for you by your physical therapist. As you heal, your physical therapist may teach you active range-of-motion exercises for you to do on your own.

Flexibility exercises. Your physical therapist may teach you stretching exercises for the entire lower extremity and your trunk.

Strengthening exercises. At the appropriate time, your physical therapist will teach you how to do the following types of strengthening exercises:

  • Isometric strengthening: tensing and relaxing your muscles.
  • Isotonic strengthening: tensing and moving your muscles (such as bending your knee).
  • Eccentric strengthening: tensing your muscles to move your hip joint safely.

Balance and coordination exercises. Your physical therapist will teach you how exercises to improve your balance and coordination.

Job- or activity-specific training. As you regain strength and movement, your physical therapist may add more specific exercises. Doing these will help prepare you to return to your work and sports activities.

Most people return to normal daily activities around three months after surgery. Returning to high-level activities and sports may take four to six months after surgery. Your physical therapist will recommend a gradual return to your regular activities based on your condition. Research shows that about 74% of athletes return to their prior playing ability after rehabilitation from this type of hip surgery. Each person is different. How long it takes to return to your desired activities will depend on the surgery performed and your sport.

Can This Injury or Condition Be Prevented?

Currently, there are no recommendations to prevent hip impingement. Despite a significant increase in research to learn more about this condition, there is a great deal that is unknown. For example, many active young people whose X-rays show abnormal hips do not have pain, despite active lives and playing sports.

However, evidence shows that physical therapy treatment, along with anti-inflammatory medicines, can:

  • Decrease pain.
  • Slow joint damage.
  • Improve function.

Physical therapy is very important for people who:

  • Have mild hip impingement.
  • Wish to avoid surgery.
  • Are not candidates for surgery.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat patients who have hip impingement. You may want to consider:

  • A physical therapist who is experienced in treating people with musculoskeletal problems. Some physical therapists have a practice with a sports or orthopedic focus.
  • A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in sports or orthopedic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
Our physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact us directly for an evaluation.
___________________________________________________________
source: choose pt