Is Imaging Helping or Hurting Your Low Back Pain?

Low back pain is an extremely common problem that over 75% of the population will experience at some point in their lives. If that does not make your day better, how does it make you feel to know that around 60% of people that don’t even have low back pain still have some sort of abnormality such as a bulging disc. Now I am not writing this blog to try and scare everyone into thinking they are doomed to a life of back pain and disability. This post is all about showing you that, contrary to popular belief, most of the time a “slipped” or better defined a bulging disc is not a death sentence for a lifetime of pain and also that having medical imaging done when it’s not necessary may actually cause more harm than help. Let’s first talk about how we need to stop blaming the discs in our low backs for all our pain. There certainly are times when the disc tears through its protective space and irritates nerves however, this is not as common as many people think. Many people are told they have a bulging disc and immediately start thinking of all the people around them that have had the same diagnosis and how it seems like they have low back pain forever. The good news is that according to the research a large amount of the population has a bulging disc without any low back pain meaning that you will be able to live your life without pain even if you have this bulging disc for the rest of your life. For individuals one of the biggest correlations with the development of chronic low back pain is about their thoughts towards their back pain. This is why it’s important for us all to understand that the abnormality you may see on a medical image is not always a life sentence of pain and disability. It’s crucial to know that much of the population have a similar abnormality with no symptoms which is great for helping people understand that they can get back to having no low back pain as long as they work for it. Helping people maintain a positive outlook on their back pain is one of the most important things that a physical therapist can do to help people relieve their back pain and help prevent it from becoming chronic. If you suffer from chronic back pain and have been told it’s a “slipped” or bulging disc be sure to talk to your physical therapist about how positive thinking about your back pain can help reduce your chances of having chronic pain and get you back to your daily living. Knowing that back pain has a lot to do with the thoughts a person has towards their back pain and that so many people have an abnormality with their discs in their back it’s important for us to use imaging wisely. Everyone has had the experience where they are going about their day with no problems and then you look at your finger, realize you have a papercut and then your entire day your finger stings and hurts because of that tiny papercut. In a similar way if you get imaging done and don’t have really bad back pain and then you see these slipped discs you are more likely to have fear of hurting your back more and be more aware of pain. This is why it’s so important that people need to delay getting any imaging done unless there is a concern for a more serious condition in the low back. Physical therapists play a crucial role in recognizing the signs that may indicate a need for imaging to be done. Physical therapists are able to diagnose most causes of low back pain without the need for imaging and treat it in a more conservative way. Another reason why people should consider their physical therapist first before going to the Emergency Department or urgent care for their back pain. If people go to their physical therapist first they are more likely to be treated in a more conservative way without having the panic of seeing some abnormalities that are more than likely to show up on their imaging. This not only decreases the risk of unnecessary fear from imaging, but also reduces costs to the health care system significantly. It’s time that we stop blaming all low back pain on bulging discs and start recognizing the value of physical therapists in evaluating, diagnosing, and treating low back pain. If you have any concerns about your low back pain call your physical therapist and find out more about the important role physical therapy can play in restoring your daily function.

You Hate Exercising...Now What?

How many times have you heard the general statement that people need to exercise or be more physically active and had the immediate thought of "but I hate running so much?" Many people are told that they need to get active and exercise and the first thought is about having to deal with the gym or running endlessly on a treadmill. I discussed earlier about the importance of exercise as medicine and how important it is to overall health but what if you don't love exercising? You are going to be told constantly by your physical therapist and other health care providers to exercise and get physically active. I think it's important to understand that exercise and being active is much more than just intense running and lifting weights at the gym. The current physical activity guidelines for a majority of the population is simply to do moderate intensity physical activity for 150 minutes a week or vigorous intensity exercise for at least 75 minutes a week. It is also encouraged that people should be physically active more days in the week than they are not. Moderate intensity physical activity can be simple things such as going for a walk or simple hike, an enjoyable bike ride, or even just getting out and playing with kids and grandkids. Vigorous intensity activity can include brisk walking or hard hiking, playing sports, or fast swimming. When it comes to being physically active people have so many options that they just need to find something they enjoy doing and incorporate it into their daily lives. Physical activity and exercise does not have to be a scary thing. It's crucial for us to find things we like doing which will make it more likely for people to actually follow the physical activity guidelines.There are certain populations that benefit from specific kinds of exercise based on their family history and current health status. For example, if you know you have a family history of osteoporosis and you want to do all you can to minimize your risk you should focus on exercises that require you to bear weight on your bones. Again, there are more options out there than just walking or running. What about taking a dance class which will not only impress the man or woman in your life, but also decrease your risk for osteoporosis while helping you meet the physical activity guidelines! What about people with chronic pain or Fibromyalgia where exercising is literally the last thing they want to do? Even though it may seem like exercise and activity makes things worse, physical activity is crucial and extremely beneficial for this population. For these individuals you can get up to the amount of physical activity that is recommended...it's just going to take time. Start by walking or doing yoga for 5 minutes and then slowly progress that each week until you are reaping the health benefits of activity. For everyone trying to figure out how to get started get in contact with a physical therapist who can get you started and give you ideas for the best physical activities that will work for you.

Is Sleep Affecting Your Rehabilitation?

We have all heard the famous saying of "I'll sleep when I'm dead." Many are very familiar with the feeling of needing to pull an all nighter to finish a deadline for school or work. When things get busy sleep seems to be one of the first things that gets neglected however, it's one of the most important things we can do for the overall health of our body.

 Some people choose not to sleep while others are unable to sleep because of stress, pain, or other health condition. So many people suffer from things like short term or chronic insomnia and sleep apnea that leave them feeling tired and fatigued throughout the day. Did you know that sleep deprivation is much more detrimental to health than just feeling tired? Not getting the sleep our bodies need consistently has been shown to increase an individual's risk for depression, cardiovascular disease, and potentially even Alzheimer's Disease. Obviously those are major concerns to overall health...but how could your sleep be affecting physical rehabilitation or your risk for needing physical rehab? One important aspect of sleep is that your body is able to grow and repair your body tissue while in the deep sleep stage so you can recover faster from any injury or damage to your body. While you are sleeping your body is able to send blood which delivers things your body tissue needs to heal and repair. This means that if you are not getting adequate sleep your body tissues are not getting what they need to repair which slows down the recovery process. General fatigue is also a problem for those that are not sleeping and going through some sort of physical rehabilitation. People are already busy plus they are working hard at their physical therapy appointments and they are being told that they need to do their home exercise program everyday to really get better. If someone is not sleeping they are lucky to have the energy to go see their physical therapist let alone do their exercises at home. Doing exercises at home along with being physically active is crucial to getting better following an injury and to preventing future problems. To have the energy to do those things an individual needs to get sleep so they are not constantly tired throughout the day. Sometimes sleep and pain can be a vicious cycle that is hard to overcome. Pain can keep people up or wake them up so they can't sleep and then decreased sleep has also been shown to increase pain perception so people who don't sleep hurt more than those that are rested. Even your body is not injured as bad, the increased pain perception will make it feel hurt so it will feel like a person is not getting better even if their body is. Another important health concern that decreased sleep contributes to is an increased weight gain. A substance that controls appetite is released while you are sleeping and so if you are not sleeping you are going to have an increased appetite resulting in eating more and that, combined with the lack of energy results in increased risk of gaining weight. Excess weight is correlated with a lot of major health conditions and also puts more stress on your body overall. So if you are having trouble sleeping, what can you do about it. There are good habits that can be established known as sleep hygiene that can help you sleep better. Some of these are things like trying to go to bed and get up at the same time each day, using the bed for sleep only, and avoiding caffeine later in the day. One of the best things people can do is avoid screen time before bed. Replacing screen time with better habits such as writing in a sleep journal, reading, or stretching will help relax your body to prepare it for sleeping.
Sleep is often an overlooked aspect of health by both health care providers and the general population. Sleep can interfere greatly with quality of life and limit how quickly an individual can rehabilitate following an injury. Sleep assessments are something that physical therapists need to start doing as part of their evaluations because the amount of sleep our patients are getting has a significant impact on their rehab prognosis.

Prescribing Exercise as Medicine

There is a medication that can be prescribed that can help prevent and treat many of the leading causes of death and disability in the United States such as heart disease, diabetes, obesity, and even cancer. Plus this medication has shown potential for reducing the risk of Alzheimer's disease and dementia along with helping individuals with depression and anxiety. This prescription is also extremely cheap and for most cases can even be free. This prescription exists yet it's severely underutilized in the health care system. So what is this magical medication? This amazing solution is exercise and physical activity. When we think of medicine we so often think of those orange bottles of pills prescribed by the doctor for individuals. Exercise however, could literally be considered medicine! Exercise has so many benefits fro an individual in terms of preventing disease and leading to a higher quality of life. Former Director at the National Institute on Aging Dr. Robert Butler has said, "If exercise could be packed in a pill, it would be the single most widely prescribed and beneficial medicine in the nation."

The evidence is clearly there that shows how beneficial exercise and physical activity is in preventing many of the chronic health problems in our country, so why is it not being prescribed more? For most people they are simply told that they need to exercise to improve their health and sent on their way. Could you imagine if that is how it worked with medications? You would just be told to go to the pharmacy and pick out any medication without your doctor even figuring out which is best for you or giving you help to pick something out that will help. When people are simply told that they need to be more physically active that is essentially what is happening. Exercise is literally medicine and just like other prescriptions it needs to be tailored to the individual based on what will benefit them most. The Exercise is Medicine initiative was coordinated by the American College of Sports Medicine in collaboration with the American Medical Association to help health care providers and patients understand the physical activity guidelines, assess if people are meeting those guidelines, and providing resources to help individuals use exercise as medicine. To learn some more about Exercise is Medicine and find advice on becoming more physically active check out more on their website http://www.exerciseismedicine.org/support_page.php/about/. 

Exercise is packed with benefits for so many health conditions and the side effects are significantly lower than other medications. The research shows how much exercise does in disease prevention, but since it's impossible to pack all those benefits in a pill we need to help health care providers and the population learn that exercise is medicine and needs to be prescribed like one. As movement specialists physical therapists can play a valuable role once the health care system starts recognizing the magical medicine of exercise. It's time we start assessing physical activity as a vital sign just like heart rate and blood pressure and then treat with the same urgency that we would treat anything else. Ask yourself this question...if there was a single medication out there that had the ability to prevent many debilitating diseases, would you want to get your hands on it? The good news is that you already have access to it and all it takes is finding some exercise you enjoy and start doing it. 

Physical Therapy in Preventative Care

Remember needing to get your medical physical each year before playing sports or getting that exciting post card in the mail just to be disappointed that it was from the dentist saying it was time for your check up?

Rather than getting post cards in the mail most of us simply get e-mails or phone calls  reminding us that it's time for a visit to the physician or dentist. Even if you feel perfectly healthy and have no concerns these visits to health care professionals are highly advised, but why? Preventative care is a major goal of the health care field because it's way cheaper and easier to prevent a problem rather than fixing a problem. People also benefit from this focus on preventative care as well. Wouldn't you rather go to a yearly physical and find you are at risk for having a heart attack and have a discussion on ways to prevent it rather than just going to the hospital when you have a heart attack? What if the health care system worked that way? Imagine only being able to go see your dentist once a cavity is giving you problems and you can't eat without pain or only going to the physician only to find out you have an advanced stage of cancer that could have been stopped earlier with frequent check up visitis. This system would lead to a lot of unnecessary suffering and anxiety for the patients and even more money spent on health care. I feel safe saying that almost everyone out there agrees that preventative health care is important and are grateful that we have a health care system in place that encourages preventative care. A funny thing happens though when it comes to the physical therapist's role in the medical field because, for the most part, a physical therapist is really only seen when somebody has a problem that needs worked on. For most of health care we think preventative medicine is crucial but, physical therapists are under utilized when it comes to prevention. What can physical therapists even do in terms of prevention? While there are a lot of injuries and things that happen that no amount of prevention will avoid, there is still plenty of things that physical therapists can help prevent. Let's talk about one of the most common things that brings people in to see a physical therapist...low back pain. Did you know that around 80% of Americans will have some episode of low back pain in their lives? Did you also know that physical therapists can assist in preventing some of that low back pain? Physical therapists analyze posture, both standing and while moving, as well as potential areas of muscle weakness that could contribute to low back pain. Similar principles apply for people that have neck and shoulder pain. A lot of these individuals work behind a desk and on a computer all day. By having a physical therapist analyze posture and give ways to correct it there is a huge potential to decrease these issues before they become a problem. What about athletic injuries? With the early specialization in sports we are seeing a large increase in injuries at a younger age. People are going to be putting their kids in sports early and having them specialize even if they know the risks to it. By checking out motions of the athlete each year before a season starts a physical therapist has the ability to inform the person of their risks and what areas to address to try and prevent future injury. Those are just a few examples of how physical therapists can play a role in preventative medicine. We are so focused on preventing so many different diseases and problems in our bodies why not start trying to prevent musculoskeletal problems too. We find the idea of only seeing a dentist and physician when we have a problem ridiculous and yet that is exactly how we treat physical therapists. Do annual check ups to see your physical therapist sound impossible? Imagine if we could prevent just a small percent of conditions like low back pain. It would save billions of dollars each year and give people much higher quality of life. Do you think it's worth it to have an annual physical done by a physical therapist? Would you find it an important physical to go to each year?

How Much Is Your Quality of Life Worth?

How would you feel if you were told that your health was only worth a certain amount of money? Let's say you had a traumatic brain injury and needed rehabilitation but somebody told you that you were only worth about $2,000 before improving your quality of life just costs too much. This concept sounds ridiculous! Sadly, this is exactly what has been going on for the last 20 years for individuals with Medicare thanks to the Medicare Therapy Cap on the rehabilitation services of Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services. In 1997 Congress placed an annual cap on rehabilitation services for those on Medicare. This means that an individual on Medicare is only able to get rehabilitation services each year until they reach this arbitrary monetary amount that was set by congress. The worst part about this for those wanting to see a Physical Therapist is that this arbitrary cap has been set at $1,980, as of 2017, for physical therapy AND speech-language therapy combined. This cap set at $1,980 is just a random number and does not take into account the amount of clinical care needed by individual patients. This means that many people that are covered by Medicare following a stroke, spinal cord injury, Parkinson Disease, or any chronic  condition that lowers an individual's quality of life are not able to get the rehabilitation they need for a higher quality of life because they reach their cap each year before they can reach those functional goals. Some of these people need both physical therapy and speech therapy so with the combined cap they reach their limit rapidly severely limiting the care these patients receive. These individuals can try to extend their therapy cap to get more, but it has to be "medically necessary" which most of the time improving quality of life through outpatient therapy is not going to qualify them for that.  If you are thinking that this all sounds really bad for the patient and for rehabilitation services...then you are right! This is why the American Physical Therapy Association, APTA, believes that it's necessary for a full repeal of the Medicare Therapy Cap to occur. They have been taking action to work with congress to try and get this full repeal to occur. Now I am not just here to vent, I am posting this to inform everyone and give you some ways that you can get involved. The first is to get involved in the Flash Action Strategy occuring this year on September 12-13 which is an annual student led campaign that collaborates with the APTA. This year the campaign is completely focused on the full repeal of the Medicare Therapy Cap. To learn more about this and how to get involved check out this link:

Flash Action Strategy
http://www.apta.org/FAS/

You should also follow the APTA Student Assembly on Twitter @APTASA and like them on Facebook at APTA Student Assembly to keep up with what they are doing during this Flash Action Strategy.

You can also share the Flash Action Strategy graphics, which can be found on the link provided above, on your social media accounts using the hashtag #StopTheCap

To learn more about the Medicare Therapy Cap and find more actions you can take visit the following link:

APTA Medical Therapy Cap Information
http://www.apta.org/FederalIssues/TherapyCap/

Just because something has been done for 20 years does not mean it is the right way and now is the time to get rid of these arbitrary caps that are limiting the outpatient rehabilitation individuals need. If you had to put a price tag on your quality of life...would $1,980 a year be enough?

Who Is Your Physical Therapist?

Since I have attended three different colleges while being a student my little family has had the opportunity to move to different cities quite a few times. From these moves I have learned that among all the things I hate about moving, one of my least favorite things is trying to find a new dentist or, for my wife, a new cosmotologist. When you have your dentist or your physician for a good amount of time there is a certain comfort and trust that you build with them that takes time to replace. For my wife, it's hard to replace her hair stylist because the person who she has been going to knows exactly what my wife wants and how to do it. When it comes to health care most people are able to tell you instantly who their physician, dentist, or optometrist is however, if you ask them who their physical therapist is most people will have no idea. Why does this happen? One reason is that if you want to go see a dentist or physician you can just go without a referral from another health care professional. This is not always the case for people that want to see a physical therapist. Based on the state or insurance company you have some people have to get a referral from a physician before they go see a physical therapist. Along with that is most insurance companies cover things like dental visits, vision, and physician appointments, but physical therapy visits are very limited for most insurance plans. Those two factors combined make people less likely to see a physical therapist as frequently for their movement impairments as they would go see an optometrist for their vision. Less frequent visits means people will not feel that attachment or need to have a person be their physical therapist because they only saw them for a one time problem.

 Another important thing to consider is the wording people use when they need to see a physical therapist. Most people are told that they should try physical therapy or go to physical therapy. You never hear people say things like "you should go try some dentistry for your aching tooth" or "you need to get some optometry done for your bad vision." Both of those sound silly but for some reason it sounds fine to say that a person should recieve physical therapy for their hurt ankle. It seems small, but there is a big difference between that and saying "I am going to see a physical therapist for my hurt ankle." It's not just the physical therapy that treats you, the physical therapist matters as well. Once we realize that we start to build more of a relationship with the physical therapist. When that occurs and people can say that person is my physical therapist people will utilize them for more. Rather than just going to the ER for a sprained ankle people are more likely to directly make an appointment with their physical therapist. This is beneficial for patients as well because your physical therapist will already know your health history, your previous treatments, and your personal preferences which means less time explaining that each time you have to go in for treatment and a better overall experiene for the individual. When a person has their physical therapist they will have another medical professional on their side that they can turn to. Physical Therapists can then be utilized more to their potential of treatment and prevention of problems because people will use them more as their own therapist. People have their dentist, physician, and even hair stylist...isn't it about time everybody has their Physical Therapist?