Big companies offering more on-site health care for employees

An increasing trend in health care is employer sponsored, on-site clinics for employees.  These healthcare professionals include physician, physical therapists, chiropractors and nurse practitioners.

Kinesio Taping

Kinesiotaping is a popular tool used by healthcare professional like physical therapists.  It is a cotton strip with an acrylic adhesive that is used for treating athletic injuries and a variety of physical disorders.  The tape is used in therapy to relax overused muscles and in rehabilitation to facilitate underused muscles.The elastic properties can also be utilized in a mechanical fashion to limit or encourage a specific motion at a joint.  There is very little evidence that Kinesiotaping does as it advertises.  More clinical trials are in the works, but overall the benefits of Kinesiotaping are ambiguous at best.

Chronic Pain

As a physical therapist, I work a lot with chronic pain.  Its one of the hardest patient types to work with, simply because the origin of the symptoms are deep rooted and often psychological in nature.  A new study out of Northwestern University suggests that ones emotions play a HUGE roll in the chronic pain cycle.  ""The research involved 40 volunteers who had all suffered an episode of back pain lasting one to four months.

Four brain scans were carried out on each participant over the course of one year.

The results, published in the journal Nature Neuroscience, made it possible to predict with 85% accuracy which individuals would go on to develop chronic pain.

The nucleus accumbens teaches the rest of the brain how to evaluate and react to the outside world.

Prof Apakarian said it may use the initial pain signal to teach other parts of the brain to develop chronic pain.

''Now we hope to develop new therapies for treatment based on this finding,'' he added.""

Spinal Manipulations

Usually, the term ''spinal manipulation" has people immediately thinking of chiropractors.  From there the camps are divided evenly.  Those who understand the benefits of spinal manipulations, and those who dread the thought of it.  What most people don't realize is that physical therapists (PTs) are also manipulators of the spine.  They perform the same, or similar, spinal adjustments that create the ''cracking'' sound and free up movement for patients.  The biggest difference between chiropractors and PTs is that PTs have a multitude of interventions in their tool box, where as chiropractors have only manipulation.  Additionally, PTs offer home exercise programs to help maintain the newly found movement from a manipulation.  Either way, the realm of spinal manipulation is not nearly as dangerous as some think.  No one has ever become paralyzed, had a stroke or died due to a manipulation of the neck. 

Synthetic lubricant injections for arthritis

As a physical therapist who treats osteoarthritis of the knee on a daily basis, I've for quite some time questioned the efficacy of synthetic lubricant injections in the knee. Normally the body's joints are lined with articular cartilage to prevent bone on bone movement. Also, a fluid called synovial fluid is produced to act as the lubricating "oil" within the joints. As we age, both out cartilage and synovial fluids are reduced. This is particularly common in the weight bearing joints such as knees and hips. Physician have for years used a synthetic lubricant to help decrease pain and improve movement in joints. A common brand name is Synvisc. A new study found in the Annals of Internal Medicine suggest there is no functional improvement of the knee, and statistically little decrease in pain when compared to a control group. Moreover, those subjects who did receive synthetic lubricant injections were found to have more likelihood of other orthopedic issues.

Ergonomic Evaluation of desk workstation

Ergonomics are an essential aspect of any desk jockeys' well being.  Sitting for 6+ hours a day at desk with bad posture and poor positioning can lead to low back pain, hip, knee pain and upper back and neck pain.  Having an ergonomic evaluation by a physical therapist is a great way to figure out whats wrong, and develop a plan to correct it.  These evaluations can be done in person, or by simply supplying a picture of yourself sitting at your work station.  

Parkinson's Disease

Parkinson's Disease is is one of the most common nervous system disorders of the elderly. Parkinson's disease most often develops after age 50. Sometimes Parkinson's disease occurs in younger adults. It affects both men and women.

In some cases, Parkinson's disease runs in families. When a young person is affected, it is usually because of a form of the disease that runs in families.

Nerve cells use a brain chemical called dopamine to help control muscle movement. Parkinson's disease occurs when the nerve cells in the brain that make dopamine are slowly destroyed. Without dopamine, the nerve cells in that part of the brain cannot properly send messages. This leads to the loss of muscle function. The damage gets worse with time. Exactly why these brain cells waste away is unknown.

Parkinson's is rare in children. It may occur because the nerves are not as sensitive to dopamine.

The term "parkinsonism" refers to any condition that involves the types of movement changes seen in Parkinson's disease. Parkinsonism may be caused by other disorders (called secondary parkinsonism) or certain medications.

Physical therapy is a good intervention in the process of Parkinson's disease.  Treatments are aimed at increasing spinal mobility, increasing muscle length, increasing gait parameters and improving balance.  These sessions are best done one-on-one as more progressed Parkinson's patients are in need of at least contact guarding.

Knee replacement revisions

Total knee replacements are normally a very successful procedure.  They offer a patients a new life in a sense, with increased ability to walk, exercise and a generally speaking better quality of life. In these procedures the distal end of the femur and proximal end of the tibia are removed and replaced with a prosthetic.  If possible the surgeon will salvage the patients patella, but its not uncommon for a prosthetic patella to be used.  Patients are typically up and walking the same or next day.  The journey continues with a lengthy course of physical therapy. 

However, some recipients are not so lucky in their recovery.  There is possibility of infection immediately and several years after the implant is placed.  The infection is indicated by an increase in pain, swelling and lack of mobility.  These patients are usually in store for a knee replacement revision, which is a much more involved process and includes a rather large rod inserted into the femur.

"Steamboats"

"Steamboats" are a great physical therapy exercise that aim to promote strength and stability in the involved lower extremity.  These exercises are usefull for a number of patient diagnoses (from s/p bunionectomy to knee pain).  The patient starts with a theraband wrapped around the uninvolved ankle.  Then standing only on the injured leg, the patient will perform small, controlled kicking motions with the uninvolved leg.  It is important to keep the stabilizing leg slightly bent throughout the exercise.  After the prescribed reps, the patient turns 90 degrees and then kicks TOWARDS THE SAME OBJECT.  This is an important step in making sure the resistance band is working properly.

Ball exercises

Physical therapists commonly prescribe ball exercises in their exercise prescription.  These ball exercises can stress the quads, hamstrings, glutes and can even promote knee stability.  These exercises offer increased challenges to balance, proprioceptive mechanisms and are essential in progressing any athletically inclined patient past static exercises.

Tension headaches

For headache sufferers, understanding the source of their problem is the initial step towards relief. A major cause of headaches is muscular tension in the upper back and neck(tension headache). This tension stems from a number of major sources: Lack of sleep, poor posture, internal and external stress, fatigue, and anxiety. Eliminating these triggers is a good foundation for eliminating your headaches. Physical therapy is another great way to eliminate or reduce symptoms. Your physical therapist may employ modalities like ultra sound, heat or ice, as well as hands on massage treatments. Trigger point needling also is a highly effective way to reduce muscular tension that can lead to tension headaches.

Squats

Squats are a very functional therapeutic exercise used by physical therapists.  The squat motion activiates primarily the glues and quads to not only push your body up from the down position, but to slowly lower your self in an eccentric fashion.  It is important to keep the knees and hip flexed throughout the exercise.  The motion should mimic sitting down onto a chair.

Office Ergonomics

Working in a white collar environment does not reduce your risk of bodily injury.  Sitting at a desk and working on a computer 8 hours a day can put stress through various parts of the spine and the muscles associated with posture.  A poor ergonomic set up at your desk can contribute to low back pain, neck pain and strained postural muscles.  Seeing a physical therapist for a full office ergonomic evaluation and assessment is the best way to avoid 6-8 hours per day of continuous stress on the body.  Postural exercises that focus on the shoulder blades and paraspinal muscles of the back are important in maintaining better posture while sitting for long periods of time.

Kinesio taping

Kinesiotape is a widely used taping procedure. It can be found in an athletic training bag, locker room and physical therapy clinic. The basic concept behind k-taping is striations in the tape are arranged either parallel or perpendicular to muscle fiber in order to promote or inhibit muscle activity respectively. K-tape also has an elasticity to it which allows for varying amounts a resistance to be placed through it. The combination of these two properties make k-taping a versatile tool. As a physical therapist, I use k-tape regularly. Most commonly I use it to help promote VMO activity. I've found one consistent problems with this tape: it simply does not stick. Even after rounding the edges as suggested, and using adhesive spray the tape lasts 12 hours at most.

The return of HouseCall medicine

The initial concept of HouseCall PT DC arose from watching patients waiting in frustration at busy physical therapy clinics. This was often compounded by parking and traffic issues. At HouseCall PT DC your time is valuable to us! We not only provide top notch, hands on treatments, but its at the convenience of your home or office. A recent New York Times article shows the increasing trend of wasted time and money hidden within the complex equation of money spent on healthcare : http://economix.blogs.nytimes.com/2009/02/09/a-hidden-cost-of-health-care-patient-time/

Tiger Woods

Despite his epic personal meltdown a couple years ago, Tiger Woods remains a major force in golf and throughout all of sports. This was reaffirmed by his final round 62 at the PGA National. While its easy to talk about Tiger's moral insufficiency, I'll keep this post limited to his golf swing and physical abilities. 
Tiger, like no one before him, changed the sport in which he excelled.  Within the course of 4-6 months golf, which was once seen as an ''overweight man's game'' or not really for ''athletes'', was thrust into the spotlight by Tiger's physical fitness, workout routines and commitments to exercise.  The golf swing itself was transformed from a linear movement to a torsional force, which is directed around the spine and unloaded on the ball.  This, in concert with an explosion in technology forever changed the game.  Today's top golfers are lean, fit and well conditioned athletes that put their counterparts from 30 years ago to shame. 

Tiger was one of the first pro golfer to use a full-time physical therapist.  He underwent extensive physical therapy after his left knee injury.  His personal therapist, Keith Kleven, has also been involved in the1984 Olympic Games and the United States Boxing team.. He was also Mike Tyson’s and Larry Holmes’ therapist/trainer for 8 years.

Femoral Acetabular Impingment

Femoral acetabular impingement (FAI) is a common orthopedic issue of the hip usually found in women.  FAI occurs when there is a pinching force between the acetabulum (hip socket) and the femoral head (ball).  This pinching occurs due to 3 anatomical issues:  1)  A CAM shaped femoral head or excessive bone growth at the superior (top) margin of the femoral head. 2) A Pincer shaped rim of the superior border of the acetebulum. 3) a combination of the 2.  These FAI's can lead to labral tears, osteoarthritis, decreased strength and range of motion at the hip and general ache/pain with flexed, abducted or rotated position at the hip.  FAI is diagnosed through exclusion and potential surgical candidates can expect an Xray and an MRI with contrast dye. 

If you suspect you have FAI, or any other hip problems, I suggest you see a physical therapist who may recommend you see an orthopedist  for an evaluation.  Dr. Andy Wolff is a great physician the Washington DC area who works with FAI and other hip diagnoses.

Downtown DC outpatient orthopedic clinic

Part of the DPT (Doctorate of Physical Therapy) curriculum involves clinical rotations much like medical school.  One of my clinical rotations was under the tutelage of two great physical therapists, Chris Cousins and Dan Baumstark.  The two offered years of insight into my educational experience.  It was unquestionably the best learning experience I had while in PT school. 
I mention them because they recently opened an outpatient orthopedic clinic in Downtown DC called PhysioDC.  They offer a lot of services at this clinic:  ergonomic evaluations, custom orthotic fitting, personal training, hand therapy and physical therapy. 

Mobile Wellness

Lets face it:  we are all very busy.  We run at full speed in 3 different directions and assume many different roles and responsibilities throughout the day.  This often leaves little or no time for ourselves to focus on our health and life goals. 

A lot of daily diversions involve our smart phones.  Emailing, texting, banking, and a wide assortment of other daily functions are found in apps and are just a touch of a finger away.  An innovative group at Delight Me have designed an app that helps bridge the gap between our busy lives and wellness.  "Delight Me is developing the first collaborative care platform designed to improve self-awareness, motivation, compliance, and health outcomes. Delight Me will delight you by making it fun and easy to manage lifestyle goals and get results with the support of your privately invited network of friends, family, coaches, and health professionals. Delight Me provides instant access to your own data and a team to motivate you..."  Their team of health care professionals include an endocrinologist, psychologist, physical therapist, personal trainer and life coach.  I've seen the alpha version for both their mobile and web based versions and its looks great!!  I look forward to working more with the Delight Me team, and with mobile clients to improve their health and wellness !!

Winter Warmth

I had been working on an elaborate post about cross-country skiing and its great cardiovascular benefits, but with the 65 degree weather in DC today my mind has drifted elsewhere:  golf. 
I have been an avid golfer for about 20 years now.  Its a little scary to say you've been doing anything for 20yrs when you're barely 35, but my love for the game has not dwindled a bit.  Golf is one of the most dynamic activities in terms of demands on the core and spine.  Ab, glut and quad strength are paramount in trying to stabilize the axis (spine) as the rotation of the shoulders and hips generate torque and club head speed.  This is why the best body type for golf is a tall wiry, lean frame. 

When looking at a clip of a golf swing from behind, one can see the proper, neutral posture needed at address.  This position should be held throughout the entire swing.  That requires tremendous core stability + spinal mobility. 

Most physical therapists work with golfers to help achieve the spinal postures and core strength needed for a golf swing that reduces risk of injury.  Golfers of any age will undoubtedly suffer from some ailment such as low back pain, shoulder pain and wrist injuries.  HouseCall PT DC offers private golf fitness lessons to help alleviate and prevent injuries.  Simple, straight forward golf swing tips are given to clients after a golf swing video analysis is made.  These tips are usually aimed at increasing balance within the swing and promoting lower scores.

Knee pain

A good percentage of my clientele suffers from knee pain.  They are runners, tennis players, hikers and even sedentary desk jockeys.  One major component of knee pain is poor patellar tracking.  In lay terms, this means the knee cap is not moving properly up and down inside the femoral groove as you bend and extend you knee.  This post will help explain the reason for poor patellar tracking and offer some simple home exercises to help resolve it.  As always, consulting a physical therapist for an evaluation and treatment would be highly advisable. 

The patella is a diamond shaped bone that sits in a groove at the end of the femur.  The patella should track up when extending the knee and down when flexing the knee.  The up and down movement in kept in balance by equal forces from all sides of the patella.  Due to increased tension in the lateral quad muscle and distal iliotibial band (IT band), in combination with weakness in the medial (vastus medialis) quad muscle, the patella often get pulled laterally over the rim of the groove.  Obviously this is not only painful, but can cause long term wearing away of the cartilage on the underside of the patella.
Increased IT band tension is commonly seen in runners or athletes.  Women are particularly afflicted because of the anatomical width of their hips.
Vastus medialis weakness is quite common with even small amounts of joint edema.  This makes poor patellar tracking quite common post knee surgery (arthroscopic).

A great intervention to help decrease IT band tension is to have a therapist manually massage the structure.  I've also found trigger point needling of the IT band to be quite successful in releasing the tension.  At home exercises include an IT band stretch and rolling of the IT band.  Another treatment for poor patellar tracking is McConnell patella taping.  This is a taping technique that helps the patella sit properly inside the femoral groove, and increases vastus medialis activation.

If you have knee pain, have tried these home exercises and are still dealing with pain, feel free to contact me at: housecallptdc@gmail.com

Mental Refreshment

If you live in a city like me, then you're probably used to dealing with swarms of people throughout your day.  Traffic. Lines. Parking issues. A million demands for your time.  The list goes on and on...
For me its a necessity to find a diversion from city life.  Luckily, my beautiful girlfriend and our dog Georgia, along with another couple found some refuge in the gentle slopes of the Shenandoah Mountains over the New Years weekend.  After getting accustomed to rushing through the day, it was a nice change of pace to slowly spend the day deciding between hot tub, book or a nap. 

Mental health is an important component of wellness.  Decreased stress levels through exercising, meditating and simply escaping the daily nonsense can go a long way in increasing happiness, physical health and overall outlook on life.  I suggest scheduling something monthly to change your scenery.  It can be a 2 hour trip to a secluded mountain spot or the perverbial "stay"cation.