Physical Therapy Hows & Whys

Is Physical Therapy a good way to get started on an exercise program if you have been inactive for a long period of time or is a personal trainer a better option?

It is always best to consult with your doctor before beginning an exercise after prolonged inactivity. Your doctor will perform a complete physical and determine if you will be at risk or if you are safe to begin an exercise program. If the MD gives you the “Go Ahead”, physical therapy is your best option for proceeding.

The PT will evaluate your body before developing an exercise program. Tests may include an assessment of muscle strength in your arms, legs and core. He or she will assess your flexibility, your ligamentous stability, your range of motion in your joints, your endurance level, and your current fitness level. The PT will measure our blood pressure and your heart rate at rest and determine an appropriate activity level for your exercise program. He or she can tailor the program towards your specific fitness goals, for example, weight loss, improved endurance, strength gains, toning or others you may have in mind. If you wish, the PT can also measure your body fat level and develop a plan to reduce that level.

One benefit of beginning a fitness program with a PT is that you are being medically monitored. As you proceed with your fitness program, the PT will assess your heart rate and blood pressure before, during and after activity. Your exercises will be adjusted accordingly. If you have any previous injuries, alert the PT so that area can be protected in your program to prevent a flare up. Additionally, the PT can add exercise to your program to rehabilitate the injured area.

One last advantage of a fitness program which is performed under the direction of a Physical Therapist is the price. A medically guided program may be covered under your health insurance. This means that you may only need to pay for your copayment or coinsurance. If, however, you do not have insurance, many Physical Therapists provide personal training to their clients. The cost may be slightly higher than the fee a personal trainer may charge (about $10-$20 on average). But, the Physical Therapist is a medical professional who has either a Masters or a Doctor of Physical Therapy degree and is trained in the biomechanics of the body, muscle structure and function, injuries and rehab, anatomy and physiology, orthopedics, and strengthening and conditioning.
North Tahoe Physical Therapy works with many clients for reconditioning programs both through insurance and on a cash payment basis. We also offer personal training and Pilates exercise programs.

-Jane O’Brien, MSPT

Position For a Good Night’s Sleep

For A Good Night’s sleep… According to one Physical Therapists perspective

Have you ever awoken from a long night of sleep feeling sore, stiff, or in pain? Sleep is supposed to be the body’s way of recovering, resting and rejuvenating the body. Many people find that the 6-8 hours they spend sleeping is anything but restful.

As a physical therapist, I inquire of my client’s sleep position. I find that they are often sleeping in the wrong position. I rarely advocate sleeping on one’s stomach due to the extreme neck rotation combined with extension required in order to achieve this position. This small change in sleep position from the stomach to the side or back can relieve a tremendous amount of neck pain. If you must rest on your stomach to fall asleep, put a pillow under the chest to lift the trunk and allow for the neck to drop into flexion and rotation. One should also remove the pillow from under the head.

Pillows can be used to support the spine during sleep. Side sleepers can place a pillow between the knees to keep the hips from rolling forward and to keep the pelvis level. Back sleepers can place a pillow under the knees. This will allow the back to rest flat against the bed. A rolled towel can be placed inside of the pillow case to support the neck arch just as a contoured pillow would do. Lastly, one can buy pillows designed for side sleepers or for back sleepers in bedding stores. The firmness of these pillows differs to provide the proper amount of support for the cervical spine.

The mattress is an important component of a proper nights sleep. Imagine if you had to stand for 6 hours on a pair of shoes such as flip flops which do not support your arches. Later that day, you may have foot, leg or low back pain. If you had to sit on a chair for work all day that was leaning to one side and too tall for you, your body would ache after the work day. Now, think of sleeping on an old bed that is sinking in the middle or perhaps it is too soft. This bed cannot support the curves of your spine. Your muscles must work all night to give you that support. If you have not replaced your mattress in 4 or 5 years, it may be time to consider a change. Also, remember to flip the mattress as directed by the manufacturer to promote proper wear of the mattress. Firmness of a mattress is dependent upon taste to a degree. A mattress that is too firm may cause a backache while one that is too soft will not provide support. It is up to the sleeper to determine the density that will both create comfort and support.

-Jane O’Brien, MSPT

Do I need diagnostic tests and results before I start PT?

Do I need to have an X-ray or MRI and get the results before I start Physical Therapy?

Diagnostic tests are always helpful when assessing a client’s dysfunction, but they are not necessary prior to starting Physical Therapy. During the initial examination, the physical therapist (PT) will take the patient’s history to assess the nature of the problem. She will perform an examination of the client consisting of inspection of the body for posture and deformity, palpation of the tissues involved checking for tension, pain and inflammation. She will look at active and passive movements of the dysfunctional area. Additional clinical tests will be performed by the PT to help determine a diagnosis. The results of this comprehensive evaluation will indicate the nature of the client’s problem and lead to the development of a treatment plan.

Diagnostic tests can be used to validate the clinical exam results. They can provide clarity to any uncertainties regarding the dysfunction that the exam could not pick up. Many times, clients begin therapy without having had diagnostic tests and find that therapy alleviates their symptoms. If the problem is corrected, there is no need to have diagnostic tests after the fact. If the problems continue, X-rays or MRI may be ordered to determine how to redirect their treatment. The common thought is not to delay the healing measures by waiting to receive tests but to start therapy early, shorten the healing time and add diagnostic tests later if needed.

-Jane O’Brien, MSPT

Pelvic Floor Dysfunction and Physical Therapy

North Tahoe Physical Therapy June 11, 2008

The term pelvic floor refers to the sling of muscles, ligaments, and fascia which spans from the front of the pelvis at the pubic bone to the posterior pelvis at the tail bone. The purpose of the musculature is to support the pelvic organs (uterus, colon, and bladder), allow for control of the outlets (urethra and rectum) and provide tone for sensation for the sexual functions. It is important for this area to have proper muscle tone. Excess tone of the muscles can cause difficulty sitting, pain during intercourse, hip and low back pain or retention. Diminished tone may lead to incontinence, organ prolapse and possibly decreased sexual response.
Commonly, people associate pelvic floor dysfunction with incontinence. However, there are a myriad of diagnoses that fall under this category such as overactive bladder, pelvic pain, prolapsed uterus, painful periods (dysmenorrhea), interstitial cystitis, coccyx pain, painful intercourse, and many others. Symptoms may limit a man or woman’s ability to perform daily activities, cause a change in exercise habits and create embarrassment. Problems in this area are often not discussed with medical professionals and therefore, go untreated.

Many physical therapists have specialized training that can benefit men and women with issues of the pelvic floor. These therapists utilize every aspect of their physical therapy training to evaluate patients and to provide intervention to overcome these dysfunctions. Treatments may consist of a combination of many techniques. Exercises such as “Kegels,” which are geared for this area, greatly enhance muscle function when performed properly. Relaxation techniques may be utilized to assist with decreasing tone and pain. Manual techniques, such as Myofascial Release and soft tissue massage are often used to relieve tension. Biofeedback is used to increase awareness of proper muscle recruitment or to quiet overactive muscles. Electrical stimulation may be used to recruit and train pelvic floor musculature or to relieve pain. Joint mobilizations are often utilized to restore pelvic alignment and motion. In addition, patient education can assist with prevention of dysfunction.

Physical therapy for the pelvic floor dysfunction is relatively new and not widely known by many medical professionals in the USA. There are only a handful of Physical Therapists who are trained in Pelvic Floor therapy in Northern Nevada. But, Pelvic Floor Dysfunction is common. Just consider the number of commercials from the pharmaceutical industry promoting drugs aimed at treatment of these issues. Numerous surgeries are advocated as an answer for many pelvic floor issues. Many are unsuccessful. Physical Therapy can provide tremendous relief for Healthcare consumers who want to take control of their symptoms and overcome them without the use of longterm drugs or surgeries.

When choosing a physical therapist for treatment of a pelvic floor dysfunction, it is important to inquire of their training, experience and outcomes with this area to ascertain if they are qualified to treat this area. The Section on Women’s Health of the American Physical Therapy Association offers training and mentoring leading to a certificate program called the Certificate of Achievement in Pelvic Physical Therapy (CAPP). Approximately 150 PT’s have received the CAPP to date. To find a Physical Therapist who is trained to work with Pelvic Floor Dysfunction, one can contact the Section on Women’s Health of the American Physical Therapy Association. The web site is http://www.womenshealthapta.org/. The website provides articles and resources for consumers to learn more. One can also log onto www.northtahoept.com for further information and treatment options.
Jane O’Brien, MSPT is a physical therapist at North Tahoe Physical Therapy who provides services for the pelvic floor, orthopedics and pain. She is a candidate for the CAPP expecting to complete her certificate in summer 2008.

-Jane O’Brien, MSPT

Pelvic Floor Dysfunction

Commonly, people associate pelvic floor dysfunction (PFD) with incontinence. However, there are a myriad of diagnoses that fall under this category such as overactive bladder, pelvic pain, prolapsed uterus, interstitial cystitis, coccyx pain, painful intercourse, and many others. Symptoms may limit a woman’s ability to perform her daily activities, change or limit her exercise habits, and create embarrassment. Problems in this area are often not discussed with medical professionals, and therefore, go untreated.

Physical therapy can greatly benefit the pelvic floor. Exercises geared for this area greatly enhance muscle function. Relaxation techniques may be utilized to assist with decreasing tone and pain. Manual techniques, such as Myofascial Release and soft tissue massage are often used to relieve tension. Biofeedback is used to increase awareness of proper muscle recruitment or to quiet overactive muscles. Electrical simulation may be used to recruit and train pelvic floor musculature. In addition, patient education can assist with prevention of dysfunction.

When choosing a physical therapist for treatment of a pelvic floor dysfunction, it is important to ascertain if she is qualified to treat this area. Be sure she has taken coursework specifically for PFD. Ask her how many clients she has treated for your issue. Ask outcomes of treatments. Ask if she can help you gain relief of your symptoms and improve your lifestyle.

PFD is common, but not normal. You do not need to simply accept your symptoms as a process of growing old or due to childbirth. You can take control of your symptoms and often relieve them completely.

Jane O’Brien, MSPT works with clients ( male and female) who have Pelvic Floor Dysfunction at North Tahoe Physical Therapy.

The Certification of Achievement in Pelvic Physical Therapy

The Certification of Achievement in Pelvic Physical Therapy is offered by the Section on Women’s Health of the American Physical Therapy Association. The Section on Women’s Health offers three levels of Pelvic Physical Therapy courses. These courses provide evidence-based education for the learner to acquire skills and knowledge to provide Physical Therapy interventions for male and female clients of all ages with pelvic floor dysfunctions, including pelvic pain, urinary incontinence, endometriosis, and many other conditions. This certification prepares the learner for the Women’s Health specialization Exam.

The requirements are attendance at the SOWH Pelvic Physical Therapy classes level 1,2,3, pass the competency skills tests for each level, pass didactics tests for each level, and submit a case report. Experienced therapists who have completed previous training in pelvic physical therapy can apply for the transitional CAPP. I qualify for the tCAPP.

I have nearly completed the requirements for the Certificate of Achievement in Pelvic Physical Therapy. I just received my certificate of completion for the Level 3 class I took in March 2008 in Portland. I received a 94% on my post test. All that is left to do is to complete my Case Study and submit it. This could take some time as it involves both evaluating and following a client through their pelvic floor therapy, writing the requirements for the case study, and having it accepted. I expect to complete this process in the next 6 months. I’ll keep you posted!

-Jane