Interesting Facts about Physical Therapy and Health

1-Direct access to physical therapy for neck and back pain can save you money

- Individuals with neck or back pain who see a physical therapist first before going to see a physician have on average $1,543 lower cost through the course of their care compared to those with a physician referral. 1

2-Sham (placebo) surgery may be just as beneficial as actual surgery

- A review of 6 previous research studies on sham surgery compared to actual surgery for many orthopedic conditions has shown that indivifrduals who had sham surgery had similar outcomes compared to those that had the actual surgery. 2

3-Only 44% of total knee replacements in the United States meet criteria to be performed

-In a study done on a group of individuals who received knee replacements, 34% were deemed to be inappropriate for a total knee replacement, 22% were inconclusive, and only 44% met criteria to actually be performed. Considering that more than $20 billion are spent each year on hip and knee replacements in the US it is possible that a great deal of money is spent on surgeries that really shouldn’t be performed. 3, 4

4-One in five individuals who get a spinal fusion require a second spinal fusion within 4 years.

- In a study of 433 individuals that had a lumbar spinal fusion about 20% of those individuals had to have a reoperation to their spine within 4 years. The most common reason for reoperation was pathology to an area adjacent to the initial surgery site. 5 This is especially concerning when considering the outcomes of lumbar fusion. In fact 55.8% of individuals that have a lumbar fusion report that they are no better or worse. 6

5-Meniscus repair surgery does not improve functional outcome compared to physical therapy

-A physical therapy protocol that focuses on knee range of motion, knee strength, and aerobic conditioning that consists of about 9 visits of therapy was just as effective as arthroscopic surgery of the meniscus according to patient reports at 6 months and 12 months. 7

6-Heavy load deadlifts can reduce low back pain

-The once prevailing belief that lifting heavy things was bad for your back can be put to rest. In a study of individuals with persistent (chronic) low back pain it was found that 12 weeks of progressively heavier deadlifting significantly reduces low back pain. Progressive deadlifting with training for proper form was just as effective as other physical therapy training for reducing low back pain. 8

7-When picking a running shoe comfort should be the most important factor

-When it comes to reducing injuries in runners with running shoes or inserts, it appears that the variable that is most important is that the runner select a shoe or an insert that they feel is the most comfortable. The decision on what kind of shoe should be decided by the runner, and not be swayed by fancy jargon used by a salesperson. 9

8- It is a myth that CrossFit is more dangerous than other sports such as running

-In a study from 2018 out of 1032 runners, 198 (19%) of them reported an injury, while out of 144 CrossFit athletes 12 (8%) of them reported injuries. Though the key to avoid injuries in any sport is proper training and skilled coaching. 10

9- Lumbar disc herniations will most commonly resolve on their own with no surgical intervention.

-A recent meta-analysis showed that 66.66% of lumbar herniations will spontaneously resolve with conservative care and no surgery. 11 The most unique aspect of spontaneous disc resorption is that it appears that the most severe cases of disc herniations are also the most likely to spontaneously resolve. 12

10- 50% of all non-contact ACL injuries can be prevented with proper training

-As little as 3 sessions of 20 minutes that includes strength and motor control training over 9 weeks can significantly reduce the risk of having an ACL injury by 50%. 13

11- Back braces and education about lifting techniques are not actually helpful at reducing low back pain

-A review from 2018 done on all past research found that back braces and instruction on lifting technique, regardless of whether or not it was 30 minutes or 4 hours, do not actually reduce the likelihood of someone getting back pain at work. In fact what was actually beneficial was performing exercise interventions such as back and abdominal strengthening, stretching, and cardiovascular fitness training 14

12-Breaks during work help prevent and reduce low back pain

-The best part is that they also do not impede on work production. It is definitely clear that active breaks from work are superior to passive breaks. 15 In this same vein a sit to stand desk can be helpful at reducing low back pain experienced at work. 16

13- Running does not actually increase the likelihood of an individual developing arthritis

-Despite what was once thought that arthritis develops related to overuse of joint; it actually appears that running does not increase the prevalence of arthritis. 17 In fact what we actually see is that recreational running is better for your knee cartilage than a sedentary lifestyle. 18 We see increases in arthritis in the hands linked to obesity which is indicative of the role that inflammation from fat tissue has in the development of arthritis in our bodies. Thus, exercise and maintaining a healthy lifestyle are ideal for reducing the likelihood of developing arthritis. 19

14- In order to improve endurance capacity athletes should include heavy and explosive resistance training to their training program.

-Many endurance athletes are still cautious of adopting heavy resistance training out of fear that it will impair their performance. Heavy lifting with fewer repetitions and sets in major lifts, both powerlifting and olympic lifts are helpful for endurance athletes as it improves neural recruitment of the muscles and decreases the oxygen demand to generate the same amount of force, thus improving running economy. 20

1- Denninger, T. R., Cook, C. E., Chapman, C. G., McHenry, T., & Thigpen, C. A. (2018). The Influence of Patient Choice of First Provider on Costs and Outcomes: Analysis From a Physical Therapy Patient Registry. Journal of Orthopaedic & Sports Physical Therapy, 48(2), 63-71.

2- Louw, A., Diener, I., Fernández-de-las-Peñas, C., & Puentedura, E. J. (2017). Sham surgery in orthopedics: A systematic review of the literature. Pain Medicine, 18(4), 736-750.

3- Lam, V., Teutsch, S., & Fielding, J. (2018). Hip and Knee Replacements: A Neglected Potential Savings Opportunity. JAMA, 319(10), 977-978.

4- Riddle, D. L., Jiranek, W. A., & Hayes, C. W. (2014). Use of a validated algorithm to judge the appropriateness of total knee arthroplasty in the United States: a multicenter longitudinal cohort study. Arthritis & Rheumatology, 66(8), 2134-2143.

5- Irmola, T. M., Häkkinen, A., Järvenpää, S., Marttinen, I., Vihtonen, K., & Neva, M. (2018). Reoperation rates following instrumented lumbar spine fusion. Spine, 43(4), 295-301.

6- Franklin, G. M., Haug, J., Heyer, N. J., McKeefrey, S. P., & Picciano, J. F. (1994). Outcome of lumbar fusion in Washington State workers' compensation. Spine, 19(17), 1897-903.

7- Katz, J. N., Brophy, R. H., Chaisson, C. E., De Chaves, L., Cole, B. J., Dahm, D. L., ... & Levy, B. A. (2013). Surgery versus physical therapy for a meniscal tear and osteoarthritis. New England Journal of Medicine, 368(18), 1675-1684.

8- Aasa, B., Berglund, L., Michaelson, P., & Aasa, U. (2015). Individualized low-load motor control exercises and education versus a high-load lifting exercise and education to improve activity, pain intensity, and physical performance in patients with low back pain: a randomized controlled trial. Journal of Orthopaedic & Sports Physical Therapy, 45(2), 77-85.

9- Nigg, B. M., Baltich, J., Hoerzer, S., & Enders, H. (2015). Running shoes and running injuries: mythbusting and a proposal for two new paradigms:‘preferred movement path’and ‘comfort filter’. Br J Sports Med, bjsports-2015.

10- Bueno, A. M., Pilgaard, M., Hulme, A., Forsberg, P., Ramskov, D., Damsted, C., & Nielsen, R. O. (2018). Injury prevalence across sports: a descriptive analysis on a representative sample of the Danish population. Injury Epidemiology, 5(1), 6.

11- Ming Zhong, M. D., & Liu, J. T. (2017). Incidence of spontaneous resorption of lumbar disc herniation: a meta-analysis. Pain Physician, 20, E45-E52.

12- Chiu, C. C., Chuang, T. Y., Chang, K. H., Wu, C. H., Lin, P. W., & Hsu, W. Y. (2015). The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical Rehabilitation, 29(2), 184-195.

13- Arundale, A. J., Bizzini, M., Giordano, A., Hewett, T. E., Logerstedt, D. S., Mandelbaum, B., ... & Beattie, P. (2018). Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy and the American Academy of Sports Physical Therapy. Journal of Orthopaedic & Sports Physical Therapy, 48(9), A1-A42.

14- Sowah, D., Boyko, R., Antle, D., Miller, L., Zakhary, M., & Straube, S. (2018). Occupational interventions for the prevention of back pain: Overview of systematic reviews. Journal of Safety Research, 66, 39-59.

15- Waongenngarm, P., Areerak, K., & Janwantanakul, P. (2018). The effects of breaks on low back pain, discomfort, and work productivity in office workers: A systematic review of randomized and non-randomized controlled trials. Applied Ergonomics, 68, 230-239.

16- Ognibene, G. T., Torres, W., von Eyben, R., & Horst, K. C. (2016). Impact of a sit-stand workstation on chronic low back pain: results of a randomized trial. Journal of Occupational and Environmental Medicine, 58(3), 287-293.

17- Lo, G. H., Driban, J. B., Kriska, A. M., McAlindon, T. E., Souza, R. B., Petersen, N. J., ... & Kent Kwoh, C. (2017). Is There an Association Between a History of Running and Symptomatic Knee Osteoarthritis? A Cross‐Sectional Study From the Osteoarthritis Initiative. Arthritis Care & Research, 69(2), 183-191.

18- Alentorn-Geli, E., Samuelsson, K., Musahl, V., Green, C. L., Bhandari, M., & Karlsson, J. (2017). The association of recreational and competitive running with hip and knee osteoarthritis: a systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 47(6), 373-390.

19- How Fat Affects Arthritis. Retrieved from https://www.arthritis.org/living-with-arthritis/comorbidities/obesity-arthritis/fat-and-arthritis.php

20- Denadai, B. S., de Aguiar, R. A., de Lima, L. C. R., Greco, C. C., & Caputo, F. (2017). Explosive training and heavy weight training are effective for improving running economy in endurance athletes: a systematic review and meta-analysis. Sports Medicine, 47(3), 545-554.

Personal Fitness, More Than Exercise

Personal Fitness, More Than Exercise

-Dan Allen, DPT

Resolutions are made leading up to every January 1st, but unfortunately, 80% of New Year’s resolutions fail by February. If your goal involved becoming a healthier you, maybe you joined a gym, or started a calorie deficient diet, or even opted for a “Dry January.” Honestly, you should be commended for your effort. The decision to improve your health is a good one. The problem is that health is complex and requires a plan with a great deal of patience and persistence to achieve.

The Plan of Attack is Crucial

From personal experience I remember the moments when I would walk into the gym and feel overwhelmed by the numerous choices of what could be done for the workout. Usually, I would simply step onto the treadmill or elliptical and try to sweat for awhile before hopping off without second-guessing my choice to workout that way. Surely, this is not bad. On the contrary those minutes were helpful for my heart health and kept my caloric burn above zero. However, I now see those moments were wasted opportunities that could have been remedied with a clear goal in mind.

The key to success is setting the right kind of goals and developing a plan to achieve them. Your plan needs enough detail to drive successful completion with enough freedom to modify when changes need to be made. The right plan of action involves a team to hold you accountable to ensure that you don’t drop your resolution by February.

The Right Kind of Goals

When I take on a client in personal training I help that person come up with clearly defined goals, so that we can mutually work to develop a plan for success. The plan should be focused beyond the most common goal of losing “x” amount of pounds.

When considering human motivation we know that pain can be a uniquely powerful tool to help us perform a behavior in hopes of feeling less pain. Sales people and marketers use these tools to encourage buyers to choose their product, whether or not they truly need or want it.

Salespeople have the skill of displaying their product in a way that gives soothing relief to one of our pain points. We can use this technique in ourselves to help instigate lasting change. So, is the point of losing weight just a matter of having less mass on the scale or is it more psychologically complex? Thus, your goals need to go beyond a number. The goal needs to correspond to something that really matters to you. What hurts you so much right now that you can’t do, but you would do anything to be able to?

Personal training should also focus on more factors of your health beyond your weight or body mass index. Training should focus on other health variables. For example, at the end of 2017 I had a client come to me for training who had an A1C, a measure of blood sugar levels, of 12.0, which would put her in the range of being very dangerous blood sugar and potentially deadly. By setting goals, increasing physical activity, and being held accountable, she lowered her A1C to a much healthier 6.5. That type of change is not one that will show up on the scale, but it is the kind of change that will keep you alive and functioning.

How to Stay Consistent

A lifestyle change is not a single moment in time, it is every moment in time. Patience and persistence is truly the key. The goal of all fitness intervention by a professional should be to educate, guide, and prepare someone to manage their own health.

If you would like to schedule a consultation to talk about what we offer for personal fitness training, please reach out via email dan@AGADAPT.com or phone (952)303-4550.

Some Americans Pay More for Back Pain Relief, But Are They Really Getting Less?

Payless recently conducted a very telling social experiment. You probably heard about the shoe chain’s stunt in the news but just to recap quickly, “The Payless Experiment” tricked consumers into buying their typically budget-friendly shoes at sky-high markups. To carry out the clever ruse, the discount retailer invited style influencers to a (fake) launch party for a new high-end label in one of Los Angeles’ glitziest shopping areas. The attendees believed that they were buying fashionable, high-quality footwear and therefore didn’t object to the three-figure price tags.

Aside from being a brilliant marketing ploy for Payless, what lessons does “The Payless Experiment” have for our current healthcare system, and specifically for patients suffering from low back pain? The experiment is a commentary on perceived vs. real value but also how easily people can be swayed into believing that something is reliable as presented. Think about someone who has had weeks of pain and dysfunction stemming from low back pain: she wants to find a solution that will relieve her symptoms. If a physician presents surgery as the best option—and she’s assured that her pain will go away—then it’s going to sound appealing, right?

Today’s consumer has so many choices when shopping for just about anything from apparel to healthcare. But while it’s customary to shop for the best price for a goose down jacket (without sacrificing quality), shopping around for the best solution (and value) for our ailments is less typical. Doing our due diligence in healthcare may ultimately bring us back to the first proposed solution, but it also may introduce us to solutions that we didn’t know existed.

In the case of low back pain, one such under-heralded solution is physical therapy. Physical therapy, yoga and acupuncture are gaining in popularity as equally (or more) effective and less costly than surgical procedures, injections, MRIs and pain relievers—and for good reason.

Physical therapists are trained to restore and improve patients’ mobility, reduce soft tissue pain, improve function and build muscle strength. They not only develop custom strategies to treat persistent or recurrent low back pain, but educate patients on the prevention of future issues. Some preventive techniques include adopting and following a regular exercise program and learning to lift correctly by keeping the object close to the body.

As the holidays kick into high gear, you likely have a long list of gifts to buy. I’m willing to guess that you have a strategy in place for selecting appropriate gifts for each recipient.

As you match the right price point, size and color to each person on your list this holiday season, think about approaching your healthcare needs with the same level of scrutiny. After all, finding the right solution at the right price for our health needs contributes to improved long-term outcomes and better piece of mind.

Get Those Kids Strong!

When it comes to children and adolescents participating in resistance training there are a lot of falsehoods, myths, and opinions that are not supported by any evidence. Most individuals believe that without a doubt strength training is not for children. This is unfortunate because we now know that children and adolescents can significantly benefit from participating in resistance training programs.

Won’t It Stunt The Child’s Growth?

It was once thought that resistance training would potentially stunt growth. The myth was that children performing resistance training would injure the growth plates in their bones, and thus it would literally stunt a child’s growth. No research has ever shown that resistance training will injure a child’s growth plates or limit their growth potential. Unfortunately, these prevailing beliefs act as a thought virus, and have held children and adolescents back from participating in resistance training.

The fact of the matter is that alternatively to resistance training being bad for you, we can actually see that participating in resistance training may actually be helpful by improving bone growth. The implications are huge because a disease such as osteoporosis (bone wasting) is a childhood problem with adulthood implications. Meaning that we need to have children doing higher load physical activities in order to reduce the likelihood of having osteoporosis in adulthood.

Strength Training Reduces Injuries

Strength training in youth and children can actually help to reduce the likelihood of injuries in sports. A program of resistance training can help children and adolescents increase their power, coordination, improve their change in direction speed and improve their motor control. When children participate in sports and initiate a resistance training program in the preseason there is a reduction in the likelihood of them getting injured during the season. Some of the most complex injuries such as anterior cruciate ligament (ACL) tears can be prevented by strength training.

Resistance Training and Obesity

Around the world obesity is becoming an epidemic for children and youth. Aerobic exercise and resistance training have both shown to be effective at improving body composition, improving cardiovascular health and reducing body fat. Children should be getting 60 minutes of exercises 7 days a week, and within that amount of exercise adding resistance training exercises 3 days a week should be sufficient.

Proper Training Is Key

When a child is beginning a resistance training program they should be monitored closely. Resistance should be added slowly to ensure that proper lifting mechanics and form are maintained throughout the training program. It is recommended that a skilled professional help the child to design a resistance training program that is ideal for them. Depending on the capacity of the child or adolescent resistance training can begin with body weight and then progress to include free weights, machines and resistance bands all under the direction of a skilled professional.

Make It Fun!

For all children and youth it is recommended to make physical activity enjoyable. The benefits of resistance training are short-term unless the behavior is continued. Children should find exercises that are fun for them. For younger children this may involve making training into a game such as tug of war, or climbing around a playground. As children age they may enjoy doing push-ups, pull-ups, sit-ups, bear crawls, or wheelbarrow walking. Exercise that is fun and enjoyable can make a big difference in helping to make it sustainable.

In conclusion coaches, parents and guardians should not discourage children and youth from participating in resistance training programs. On the contrary we should facilitate children in performing more physical activity including resistance training to improve their health, reduce their likelihood of injury and to promote their psychological well being.

If your child needs help to initiate a program or has suffered an injury please call for a free consultation.

Lloyd, R. S., Faigenbaum, A. D., Stone, M. H., Oliver, J. L., Jeffreys, I., Moody, J. A., ... & Herrington, L. (2014). Position statement on youth resistance training: the 2014 International Consensus. Br J Sports Med, 48(7), 498-505.

Treating Your Pain with Evidence

When it comes to musculoskeletal (think back, neck, shoulder, hip, knee etc.) pain there are just about as many treatment options as there are colors in the rainbow. That can be a good thing as it allows people to seek out potentially helpful options. However, in a country where hundreds of billions of dollars are spent each year on managing these conditions it is important to have some current facts to support how we manage musculoskeletal pain. That is why we look to the research.

In 2017 a research article was published that summarized 146 other research studies on the best treatments for musculoskeletal pain. The article gave us insight into what areas we can focus on to help people feel better when they are hurt. This was a valuable paper because it got to the heart of a complex problem and was supported by solid evidence, not the most recent fad treatment option that are shared by friends on Facebook or that you find on Buzzfeed.

Exercise, The Key To Pain Treatment

The pyramid below is a basic representation of what actually works based on current research.

The research article found that for musculoskeletal pain, exercise was the best treatment option available. The amazing thing about exercise as a treatment is that when someone is compliant with the exercise it has lasting effects. The trouble with more passive modalities such as acupuncture, TENS, ultrasound or manual therapy (hands on) techniques, is that when we follow individuals long-term the benefits decrease unless they are combined with exercise based interventions. It is amazing! A relatively low-cost treatment has a powerful effect to change pain for the long-term.

The Importance of Psychological Interventions

I do think that it is important to mention how important psychological treatments such as cognitive behavioral therapy and instruction on coping behaviors can be. It is important to always remember that none of us are just a bag of muscles and bones. We all have thoughts, emotions, feeling and perceptions, and all of those things can influence the pain that we feel. Because of that, it is important to dedicate time to making sure that our thoughts, emotions, feelings and perceptions are not interfering with our health and healing.

Pharmaceuticals and Surgery

Lastly, there are many cases where musculoskeletal conditions should be managed with surgery or pharmaceuticals such as NSAIDs or cortisone injections. However, those should be looked at as first line treatment options only in more rare circumstances. While also being costly, treatment of pain using pharmaceuticals and surgery comes at a greater risk of side-effects or complications. In most cases I highly recommend that an individual try more conservative options before moving towards injections or surgery to decrease the possibility of adverse effects as a result of these treatments.  As a former patient of mine once said, “No one ever dies of back pain, but some people have died from the treatment of back pain.”

So, next time your back pain flares up, or you try to throw someone out in your rec league softball and hurt your shoulder, consider trying conservative care before seeking out more involved treatment options. A physical therapist can be a great starting point that can help you determine whether or not you would benefit from conservative management with exercise or if you need to move further up the pyramid.

Babatunde, O. O., Jordan, J. L., Van der Windt, D. A., Hill, J. C., Foster, N. E., & Protheroe, J. (2017). Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PloS one, 12(6), e0178621.