Covid-19 Update

During these unique and trying times, we realize your physical therapy treatments may have been pushed lower on your priority list.  Most orthopedic surgeries have been postponed, and aches and strains may not be limiting your activities in the same way they were a month ago.  However, for those of you that would like to see a physical therapist, we are here.  As an essential link in the health care continuum, we are currently open and seeing new patients.  We are taking every precaution to ensure your safety and the safety of our staff.  We are also offering telehealth services for those who would be more comfortable receiving our services remotely.  Telehealth sessions are covered at 100% by most insurers with no additional cost to you.  If you have any questions, please give us a call.

Your Physical Therapist Can Help You Keep Your Resolution

As one year comes to a close and another begins, people begin to set goals and make resolutions. Losing weight, getting to the gym more often or getting into "better shape" are all common. These all require increasing your amount of physical activity. More activity is great for your health, energy levels, sleep, and mood. However, ramping up your activity level too quickly after a holiday season of eating, drinking and being merry can lead to pain, injury and disappointment if your body isn't ready for it.

Your physical therapist is an expert in human movement, and can help you safely reach your fitness goals. People think of PTs as the person to see after an injury, but a visit before you change your activity level could prevent injury in the first place. An evaluation by your PT will include assessment of your strength, range of motion, and functional movement patterns - think jumping, running, squatting, carrying.

Most common injuries from new fitness routines are caused by underlying weakness, range of motion deficits, or compensatory movement patterns. Your PT will find these during your assessment. They can then prescribe exercises or movements to address the issues found and get you safely moving into the new year!

The other common way people get injured working towards their resolution is with overtraining, or doing too much too soon. Physical therapists are also experts in exercise prescription and program design. Your PT can help you create a routine specific to your needs and goals that will progress appropriately and keep you out of trouble.

So stop only thinking of your PT after you're injured. In this case, it's true that an ounce of prevention is worth a pound of cure. Seeing your physical therapist before you start on your resolution can keep you on track, injury free, and help you reach your goals for the new year!

PT Can Prevent Unnecessary Surgery

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

Recent research is showing that certain common surgeries aren't any better than a placebo. Two such examples are kyphoplasty - a procedure for spinal compression fractures, and partial meniscectomy - a procedure used to treat tears of the meniscus in the knee.

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

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

Physical therapy can't fix every problem, and for some patients surgery is the best choice. However, research is showing that surgery isn't a cure-all, and is sometimes just a very expensive and risky placebo. In most cases, starting with physical therapy is the right choice, and for many patients, PT is the only treatment necessary.

Physical Therapy and Back Pain

Chances are, you or someone you know has had back pain. Each year 15% of the population has their first episode of back pain, and over the course of our lives, 80% of us will have back pain. Even though back pain is common, the medical community does a poor job managing it. Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too common. Let’s look at some of the common treatments for low back pain and see how they stack up against physical therapy:

Medication

Low back pain is the #1 reason for opioid prescription in the US, however in 2106, the CDC recommended against the use of opioids for back pain in favor of “non-drug treatments like physical therapy.”

Imaging

Having an X-ray or MRI for back pain is common, however it’s rarely needed or helpful. Research has NEVER demonstrated a link between imaging and symptoms. As we age, degenerative changes on imaging is common.

● 90% of people age 50 to 55 have disc degeneration when imaged, whether they have symptoms or not

● In 2015 a study that looked at 1,211 MRI scans of people with no pain found that 87.6% had a disc bulge

● Just getting an image increases the chances that you’ll have surgery by 34%

Surgery

The US has sky high rates for back surgeries - 40% higher than any other country and 5x higher than the UK. You’d think that with all the back surgeries we do, we’d be pretty good at it but the outcomes are terrible! A worker’s comp study looked at 725 people who had spinal fusions VS 725 people who didn’t. The surgical group had:

● A 1 in 4 chance of a repeat surgery

● A 1 in 3 chance of a major complication

● A 1 in 3 chance of never returning to work again

Physical Therapy

● Current clinical practice guidelines support manual therapy and exercise

● Research proves that early PT lead to better outcomes with lower costs, and decreases the risk of surgery, unnecessary imaging, and use of opioids

● A study of 122,723 people with low back pain who started PT within 14 days found that it decreased the cost to treat back pain by 60%

● Unfortunately only 2% of people with back pain start with PT, and only 7% get to PT within 90 days.

Despite the data showing that PT is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. Almost every state has direct access, meaning that you can go directly to a physical therapist without a doctor’s referral. If you see your doctor for back pain, and PT isn’t one of the first treatment options, ask for it!

Life is a Movement Journey, Here’s How PT Can Help

Now that spring has arrived, temperatures are starting to rise in many parts of the country. And that means the transition from heating our homes to cooling our homes is right around the corner. No matter what method you use to cool your home during the warm spring and summer months (central air conditioning, window units, or fans and dehumidifiers), each spring you cross your fingers that your approach still works. If not, you might be calling an expert for a tune-up, or in extreme circumstances, you might need a complete overhaul.

Just like an AC system that has probably been dormant for many months of the year, a body that hasn’t been physically engaged on a regular basis may have trouble getting started again. And yet, this time of year, the warm temps draw many people to city and suburban streets, tracks and trails, ready to take that first run of the season. A good percentage of these spring runners haven’t kept up their strides throughout the winter. It should come as no surprise that a 4-mile run for a previously inactive person is going to stir up a few aches and pains.

Especially as we age, our ability to move undergoes changes. But whether we’re talking about a college student or a retiree, returning to an activity without proper planning is a recipe for disaster. That’s where physical therapy comes in. Physical therapists are trained to treat injuries and ease pain, but they can also help their patients prevent injuries and safely prepare to participate in new activities.

Think of physical therapists as “movement consultants” who can ensure that your body is physically ready to tackle a new challenge—or resume a favorite leisure activity. Here’s another example to illustrate what we’re talking about: Let’s say that you play in an adult soccer league and you’re preparing to play in your first game of the season in a few weeks. You probably hung up your cleats when the last season ended months ago, but expect to pick up just where you left off. But it’s simply too much to ask for your 2019 debut on the field to be on the same level as the last game of the previous season, when you likely had reached peak performance.

This is a good time for your PT to step in and help you shake off the rust. The rehab professional can customize an exercise plan to help you slowly return to sport and avoid an injury that could sideline you for the whole season. Or like cleaning the filters before firing up your air conditioner for the first time this year, the rehab expert can help to ensure that your body is prepared to return to its former activity level following a hiatus

Get Ready For Golf!

 

Golf season is upon us, and with it brings a renewed desire to improve upon last season’s accomplishments.  For some of us that may mean lowering a handicap or besting our all time score.  For others this may mean simply playing more.   For older adults this usually means staying healthy enough to play more days per week or more holes per round.  Many older adults take up golf for exercise or as an important social outlet.  In fact, 70% of golfers are over the age of 60.  As we age, it becomes harder to maintain good physical health in order to have success with golf.  The following is a brief break-down of some of the physical factors which may affect our game as we age.

It starts at the turf

 The interaction of your foot with the ground may be the most important and often overlooked aspect of the game.  We tend to focus so much on the motion at the hips, shoulders, and wrists we neglect the critical interaction that is occurring between our ankle and heel joints, and the ground.  During both back swing and follow through, having proper motion and control at these joints will set the foundation for everything that will happen above it, including proper loading of the hip muscles, from which we get most of our power.  Trying to golf without decent ankle/heel strength and flexibility is akin to golfing without spikes on.  Your body simply won’t interact with the turf like you want it to.

The Hips

The hips require a lot of internal rotation during the golf swing.  Internal rotation is the motion of your leg moving towards your body.  During backswing, the back side leg internally rotates, which activates and stretches the gluteal muscles, preparing them to accelerate the club.  Lack of internal rotation will result in poor gluteal activation, and decreased power.  The reverse is true with the front side hip during follow through.  As it internally rotates, the glutes are activated to decelerate all of the force from the swing.  Any loss of motion here may result in excessive strain up the chain (lower back), or further down the chain (knee).  This is why so many golfers, even at the elite level, have lower back and knee problems.   If you have had a hip replacement, which often results in some loss of hip internal rotation, you may have experienced difficulty getting your old swing back.  The good news is this can be fixed.

The upper back

The thoracic spine, which runs from the base of your neck to the bottom of your rib cage, is responsible for a tremendous amount of rotation during the backswing.  As we age, the thoracic spine tends to get stiff.  Age-related changes can cause a forward trunk posture, which makes proper rotation during both back swing and follow-through far more difficult, and sometimes painful.  Again, this may result in excessive strain elsewhere, such as the shoulders, elbows, and wrists.   Golfers elbow, when it occurs in the lead elbow (left elbow in right handed golfer), can often be traced back to poor rotation at the thoracic spine.  The player is attempting to decelerate the backswing motion using the elbow/wrist muscles, instead of the larger and stronger back muscles.

 

Balance

One of the most critical factors, and the one I probably spend the most time addressing with my older golfers, is balance.  Not only is good balance required for a proper golf swing, it is also an important safety factor.  The swing itself can cause one to lose their balance, as can walking on a variety of unstable surfaces including grass and sand.  Balance exercises, especially those designed specifically to golf, will help to keep you safe and enjoying the game.

Golf is a great sport because it can be played by people of all ages and ability levels, however it requires a certain amount of strength, flexibility, balance, and endurance.  It is possible, usually with a few simple exercises, to maintain optimal levels of balance and flexibility in order to continue to play at the level you desire.  When you prepare your body to keep up with the physical demands of the game you will be safer, you will be able to play more, and you will be better.

Brian O’Neil is a physical therapist and certified Nike Golf Performance Specialist at Magill and Gardner Physical Therapy, in Scituate.  For more information on the Golf Performance System, please contact him at BrianOneilPT@gmail.com, or 781-545-8114.

 

Holiday Special!

Give the Gift of Health this Holiday Season!

Magill and Gardner is currently offering our yearly membership for just $349, a savings of $50!  That's less than $30/month to exercise in a comfortable environment under the supervision of licensed physical therapists.  Treat yourself or a loved on to a healthier, happier lifestyle.  And don't forget, many private insurers reimburse fitness memberships up to $150/year!

Depression and Exercise

Ready, Set, Run! Combat Depression with Regular Exercise

Imagine going to the doctor with symptoms of depression and she hands you a new prescription: Do two sets of squats, 15 bicep curls, 10 laps around the track and call me in the morning. Though this is not (yet) an accurate picture, experts are starting to recognize that regular exercise is not only good for your mood but may help combat depression, too.

Until physicians and other healthcare providers universally prescribe exercise as an alternative treatment for depression, it’s best to turn to a group of professionals who are already in the know: physical therapists. PTs are trained to recognize the signs and symptoms of mental health illnesses like depression and understand how the disorder can interfere with a person’s ability to enjoy life.

An individualized care plan starts with a thorough assessment and detailed patient history so the PT can capture the limitations of the illness and understand the goals the patient would like to achieve. Each custom treatment plan includes some combination of flexibility, strength, coordination and balance exercises designed to achieve optimal physical function and to help shed the layers of depression.

For patients suffering from depression, it can be stressful and overwhelming to think about incorporating exercise into their lives either for the first time or after a long hiatus. Because the illness’ symptoms often include fatigue and loss of interest in activities, it can be difficult for patients to take that first step, both literally and figuratively. But physical therapists excel in motivating patients to perform exercises both safely and effectively. In fact, another bonus of seeing a physical therapist to get started on a new exercise program, is that he’s trained to identify other injuries or illnesses that require a special approach.

You don’t have to have depression to reap the benefits of exercise. In fact, the mood-boosting pastime can help anyone who might be temporarily sad or otherwise not themselves. Major life stressors—divorce, loss of a job, and death—are difficult for anyone and regular exercise is a great way to help people through a tough time.

With regular exercise, you’re guaranteed to see improvements in the following areas:

      • Strength and flexibility

      • Sleep

      • Memory

      • Self-confidence

      • Energy

      • Mood

Even minimal changes in any of these areas could change your outlook on the day and your ability to participate in activities you once enjoyed. So, what are you waiting for?

Arthritis and Muscle Function

Arthritis and Muscle Function

By Brian O’Neil PT, OCS, CSCS

Most of us have come to know osteoarthritis as a potentially devastating disease of the joints, causing pain, deformity, and disability in one or more joints of the body.  We have either first-hand knowledge or have watched loved ones suffer from their affliction.  What is less commonly known, and certainly less understood, is the relationship between the disease and our muscles.   Earlier research focused on how arthritis in a joint would affect the surrounding muscles; however more recent evidence is emerging on the role our muscles play in the development and progression of the disease.

Osteoarthritis (OA) is the most common form of arthritis, affecting some 27 million people in the US alone.  Fifty percent of people over the age of 65 will have some evidence of OA in at least 1 joint on X-Ray.  Risk factors for OA include age, being overweight, previous injury to a joint, genetics, and muscle weakness.  Early signs of arthritis include pain, swelling, and reduced joint motion.  One of the most common signs of osteoarthritis is stiffness in the morning or after a period of inactivity, which in the early stages usually resolves after a 10-15 minute warm-up period.

Many studies have focused on the relationship between muscle weakness and OA.  Significant weakness in both knee and hip muscles has been found in patients with knee arthritis.  Pain results in lack of use, which in turn leads to muscle atrophy.  It was always believed that the weakness was a result of the arthritis.  More recent evidence indicates that muscle weakness in many cases precedes the onset of OA at a specific joint.  Muscle weakness may lead to, or at least expedite the progression of the disease.  Therefore keeping your muscles strong will assist in delaying the progression.

It has also been well documented that swelling in a joint will inhibit, or shut down the muscles around the joint.  This is a normal protective reflex in which the body is attempting to protect an injured joint.  However, this prevents the muscle from being fully activated during voluntary contraction.  This can lead to muscle atrophy, loss of strength, and difficulty with functional activities.  In the knee, for example, inhibition of the quadriceps muscles will cause difficulty with squatting, stair climbing, and difficulty rising from a chair.  Researchers have also recently found that strength deficits are not strictly isolated to the leg with the arthritis.  The opposite limb will also exhibit muscle weakness, even when no OA yet exists in that limb.

Exercise, including targeted resistance training, global strengthening, and aerobic conditioning, has been shown to reduce pain and improve function in people with both knee and hip OA. Specific exercise can be used to reduce muscle inhibition.  Exercise programs must include the entire lower extremity, and should also include strengthening activities for the uninvolved limb to promote function and prevent or delay onset of OA.  Exercise programs must be considered long-term management of symptoms, with consistency the largest predictor of a positive long-term outcome.  With recent evidence suggesting that muscle weakness precedes the onset of OA, exercise must be considered an important factor not only in the treatment of OA, but also in prevention.

Ten Important Facts About Pain

        

  1.  Pain is an output of the brain.  For more than 350 years it was believed that pain was a sensory input that came from injured tissues in the body.  We now know that pain is an output, or response of the brain.  Nerve endings in the tissues relay signals of threat, or danger to the brain.  It is up to the brain to determine whether pain is needed or not to protect the body.  The brain has a map of the entire body in its cerebral cortex.  If the brain determines pain is a necessary response, it uses this map to project pain to the appropriate area of the body.  The brain can also modulate the threat response by releasing inhibiting chemicals down descending pathways.  These chemicals are many times more powerful than the strongest opiates.

  2. Injury/tissue damage can exist without pain.  Often we find cuts, bruises, and scratches that we don’t remember getting.  This is an example of an injury that our brain determined a pain response was not needed.

  3. Pain may exist without tissue damage.  Nerve endings in the brain, spinal cord, or out in the tissues may become sensitized.  This means the threshold at which they fire gets much lower, and normally non painful stimuli may result in pain.  Fibromyalgia and other pain syndromes are examples of this.

  4. The degree of injury does not always equal the degree of pain.  Paper cuts may be very painful, yet larger wounds may not be as painful.

  5. Diagnostic imaging may not determine the cause of pain.  This has been show many times through extensive research.  Healthy individuals who are not experiencing any pain will show many changes on radiographic imaging, including spinal stenosis, herniated discs, degeneration, rotator cuff tears, and arthritis.

  6. Ongoing pain does not indicate ongoing tissue damage.  Tissues in the body, including bone, muscle, tendon, ligament, and nerves will all heal in 3-6 months.  Any pain that continues beyond this time frame is unlikely to be from ongoing tissue injury and more likely from sensitized nerves.  Even if it feels your pain may be coming from a very specific spot, it is likely due to your brain continuing to feel protective of this particular body area.

  7. Psychological, emotional, and social factors will all influence pain.  An injury sustained in a remote area may feel substantially different than a similar injury sustained minutes from a hospital.  A shoulder injury may be more painful to a carpenter than to an office worker because it effects his livelihood.  By the same token, many patients experience more pain while at work or in other stressful situations.

  8. Pain will be shaped by expectations.  A child who falls often looks to his mother before crying.  He is forming his own expectations of what should be painful.  If you have often heard that arthritic joints ache when the weather changes, yours may also begin to do this.

  9. Your brain may adapt to pain by developing a neurosignature.  This means that your brain uses its memory areas to try to protect you from previous painful experiences.  Each time you pass a corner where you had a car accident you may feel pain.  A painful experience in April of one year may hurt every April in subsequent years.

  10. Understanding pain physiology can reduce pain.  Research has shown that the more a person understands the nervous system and how pain works, the less pain they have.  In one study conducted by the military, soldiers that had a 10 minute pain educating session had less reported lower back pain and improved outcomes than those that had physical therapy.


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