Posts in general physical therapy
Research Documents Strong Children Are More Likely To Become Fit Adults
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In America we face a energy crisis where the CDC reports 1 in 3 adults and shockingly 1 in 5 kids are obese. The imbalance between caloric intake and caloric expenditure has literally tipped the scales and created an growing obesity problem. In Colorado we have seen our blue state (low levels of obesity) turn pink due to an increase in obesity especially among children. Aerobic and resistance training has been found to be both both safe and effective in children and teenagers leading to improvements in mental, emotional, and physical health. A recent review of the medical literature documents the impact of childhood and adolescent fitness on their transition to adulthood.

In the journal Sports Medicine Garcia-Hermoso and colleagues analyzed the available research to determine the association between muscular fitness in childhood and future health (2019). Authors included 30 studies on a total of 21,686 participants between 3 and 18 years old. As expected they reported a significant, moderate to large effect between baseline muscular fitness and future body mass index, fat mass, metabolic blood levels, and cardiovascular status as adults. In short, fit children and adolescents became fit adults. Embracing the American College of Sports Medicine’s Exercise is Medicine campaign, especially in children, may help our country regain the energy balance they need to live their best life.

Research Supports Physical Therapists As Primary Care Providers For Musculoskeletal Conditions
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Evidence continues to support the utilization of Physical Therapists as a first line treatment for patients with musculoskeletal conditions such as back, neck, shoulder, or knee pain. Patient self referral for Physical Therapy services or direct access has been safely utilized in our country since the late 1950s. Many large corporations and the U.S. Military utilize this model of care due to its’ clinical and cost effectiveness. Patient’s seen by a Physical Therapist first save on average $1000-1500 per episode of care. This model allows patients to access high quality care quickly after the onset of an injury avoiding lost time and money associated with delays in the traditional healthcare system.

Bornhoft and colleagues randomized patients from 3 medical clinics with musculoskeletal disorders to either a primary care physician or Physical Therapist (Ther Adv Musculoskeletal Dis. 2019). Patients were followed at 2, 12, 26, and 52 weeks after the initial consultation with a medical provider. Authors were interested in a patient’s symptoms, function, quality of life, and risk for developing chronic musculoskeletal symptoms. They found both groups of patients improved but consistently better outcomes in the group treated by Physical Therapists. The authors concluded Physical Therapists can be safely and effectively recommended as an alternative management pathway for patients with musculoskeletal conditions.

Resistance Training Improves Older Adults' Quality Of Life
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Inactive adults can expect up to a 5% loss of muscle mass each decade after age 30. This loss of muscle tissue, sarcopenia, occurs in part due to lack of exercise and is a major cause of disability and lost independence among aging adults. To combat this weakness experts recommend each American adult should participate in weekly Resistance Training sessions. According to our National Physical Activity Guidelines, the recommended amount of strength training involves exercising major muscle groups at least 2 times a week. Previous research has shown this frequency of strength training exercise can increase strength, muscle mass, and bone density among older adults.

A recent review of the available evidence was conducted by researchers investigating the relationship between strength training and quality of life in older adults (Hart et al. Health Promotion Perspective. 2019). Authors reviewed 16 research articles and found resistance training had a significant effect on both mental and physical health variables. They reported significant improvements in both health related quality of life and bodily pain among the trained participants compared to their sedentary peers. Specifically, resistance training was found to positively effect emotional and social functions within overall quality of life scores.

This article adds to the existing literature on the mental and emotional benefits of exercise. Contact the experts at MEND to learn which exercises are most appropriate for you.

Staying With One PT Provider Associated With Decreased Cost And Surgical Risk
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The statement, “Your treatment is only Physical Therapy if it is provided by Physical Therapists or Physical Therapist Assistants” rings true in today’s healthcare environment. Unfortunately, some high patient volume and Physician Owned Physical Therapy clinics in an effort to strengthen their bottom line utilize individuals such as technicians or aides to provide their treatments. These individuals lack the education, training, and most importantly licensure to safely and effectively provide care in a Physical Therapy clinic. The delegation of care from Physical Therapists to less educated and qualified personnel has also been shown to impact the outcomes for patients with low back pain.

In the journal Physical Therapy, researchers retrospectively analyzed the cost and clinical outcomes of patients with low back pain (Magel et al. 2018). Specifically, authors wanted to determine if the continuity of care (number of providers) was associated with low back pain outcomes and health care costs. Researchers found patients who experienced care from fewer Physical Therapy providers had a decreased likelihood of low back surgery. In addition, patients with greater continuity of care paid $800 less for their low back pain compared to those seeing greater numbers of providers. Although the study design cannot support a cause and effect relationship the evidence supports the use of fewer providers in patients with low back pain.

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Physical Therapy Exercises Are Cost and Clinically Effective Compared To Primary Care Alone For Knee Arthritis
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Physical Therapy interventions including manual therapy and exercise remain the primary intervention for patients with knee arthritis. These treatments have been shown to delay or prevent the need for costly, more invasive treatments including total knee replacement. Prescribed Physical Therapy exercises are designed to reduce pain, improve mobility, and increase a patient’s leg strength. Stronger muscles attenuate forces across the painful knee joint allowing a patient to achieve a higher level of physical function and participation their prior levels of activity. Additional treatment options available to patients include primary care or orthopedic management involving diagnostic imaging, medication, injections, and education. A recent study compared the cost and clinical effectiveness of usual care versus Physical Therapy management for patients with knee arthritis.

A randomized controlled trial in the journal Osteoarthritis and Cartilage was conducted to compare the effectiveness of different conservative interventions among patients with hip or knee arthritis (Abbott et al. 2019). Authors randomized 206 patients with either hip or knee arthritis to one of four groups: usual medical care, supervised Physical Therapy Exercises, manual Physical Therapy, or combined manual and exercise Physical Therapy. Physical Therapy participants were provided with 10, 50 minute sessions including follow up “booster” sessions at 4 and 13 months. Authors found the greatest cost and clinical effectiveness in the patients who received supervised Physical Therapy exercises in addition to usual care.

Research Does Not Support Use Of Instrumented Assisted Soft Tissue Treatments
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The human body is an amazing system of interconnected tissues and organ systems designed to handle and thrive against the forces of life, work, and sport. Our body tissues such as bone, muscle, and tendons are extremely resilient to repetitive forces, but can be modified through progressive, consistent loading. Examples include improvements in bone density, skeletal or heart muscle with exercise, as well as, changes in your smile through braces. All of these examples demonstrate the consistent forces and stimuli required to cause a body’s tissue to adapt. Conversely, smaller less consistent forces are unlikely to cause a tissue to adapt. Despite these physiological constants some health practitioners continue to recommend rolling an IT band or using metal instruments to break up adhesions, scar tissue, or improve tissue health. A new review of the available medical evidence highlights the limitations of these interventions.

A review article in the Archives of Physical Medicine and Rehabilitation analyzed the available evidence on the use of instrument assisted soft tissue mobilization among healthy and injured participants (Nazari et al. 2019). Authors reviewed 9 available trials on the effectiveness of these interventions on outcomes including pain, range of motion, strength or function. In head to head trials, instrumented assisted soft tissue mobilization was not more effective than a control group or other interventions. Authors of the review found only one trial which found small effects of improved muscle performance in active individuals compared to no treatment. The authors of the review concluded “the current evidence does not support the use of instrumented assisted soft tissue mobilization to improve pain, function, or range of motion in healthy individuals or those with varied pathologies”.