Physical Therapy and Custom Fitness Programs

PT and Different Types of Fitness Programs

Sooner or later, you will graduate from your Physical Therapy program. This means that you have reached your goals - decreased or eliminated the pain, you are able to move again, you are able to go back to work. However, more often than not, many patients stop doing their exercises when they finish the program. This will more than likely mean you have recurring pain and have to return another round of Physical Therapy sessions before too long. 

What Should You Do After Physical Therapy?

Well, you should definitely continue to exercise! Most patients stop doing even simple exercise programs when they stop coming for Physical Therapy. Continuing your exercises will ensure that you keep all the flexibility, strength, balance and skills that you gained through your sessions. Stopping it will only put you at risk of re-injury. However, diving into fitness programs without any knowledge could potentially do you more harm than good. 

In post-rehabilitation fitness programs, the main goal is to avoid re-injury and maintain or improve your current strength and flexibility. These fitness programs are facilitated by personal trainers, or you might’ve guessed it, other physical therapists! Your trainers will make sure you perform exercises at an appropriate level. For example, basketball players that have been injured and rehabilitated cannot return to their previous fitness training immediately, their healed structures might not be able to take the pressure of being used at such a high level. An injured athlete will need to gradually ease back into their original fitness training program post-rehab. 

Ordinary individuals who do not participate in sports or activities, but who put strain on their bodies, can participate in regular fitness programs facilitated by personal trainers or fitness instructors. It is important to let their instructors know that they have just finished a bout of Physical Therapy. They will likely adjust their program for you to protect your still healing body. 

Finding the Right Program

It can be overwhelming to find the right program for you. There are loads of gyms, clinics and centers available for you, but finding the right trainer and program is important. 

Here are some steps to take before deciding on a program:

1. Figure out the pre-exercise and dynamic warm up and cool down routines that are perfect for you. If it’s not painful, and it’s warming your body up (or cooling it down) in a good way, then it’s perfect. 

2. If the exercise of program hurts, then you need to find another one. Remember that even though you’re done with PT, your body is still in the process of healing. Your body mechanics are completely different pre-injury to post-injury, so listen to your body. If it’s painful, then you should stop. 

3. Find a program that you enjoy. It can be lifting weights in the gym (supervised, of course), yoga, pilates, cross fit, swimming or even dancing! Choose a program that you will love, so that it will be easier to maintain and continue!

Why do I still need a Fitness Program?

Again, even though you have graduated from a PT program, your body is still healing and there is still a risk of re-injury. We want to prevent that. We also want to maintain whatever gains you obtained during your sessions with your PT! Other reasons to work out after PT are:

1. To further rebuild muscle - Did you know that staying in bed for two straight days can already have muscle wasting effects on your body? Or that sitting in front of the TV/desk all day can actually weaken your muscles? Your muscles need to be continually challenged for it to maintain its strength, but it’s more important to challenge them post-injury or post-rehab. 

2. To restore bone strength and density - muscles put pressure and load on our bones. When a person leads a sedentary lifestyle, there can be a certain level of muscle wasting and atrophy, and therefore a decreased bone density and strength. Load your muscles, and they will load your bones. This will protect you from fractures and musculoskeletal pain. 

3. To improve mental health - Sometimes, people get depressed, angry or lonely after an injury, surgery or even physical therapy. This is because they feel the difference in their bodies and may feel that they are not the same. Enrolling in a fitness program will help with a person’s emotional or mental well-being, while also addressing their physical needs. 

4. To improve overall health and wellness - Even if Physical Therapy had your body in an improved state, your cardiovascular system may still have a hard time keeping up. If you’re a runner, you might have a hard time returning to your normal running distance and routine. Even if you’re a stay at home mother, you might still have a hard time doing chores or chasing the kids. A consistent fitness program will help everyone ease back into their normal self. 

As much as we love seeing our patients, it’s better to see them doing well and injury-free! 

Would you like assistance creating a custom fitness program? Give us a call! 1-718-258-3300

About Evolve Physical Therapy-

Advanced, One on One, Hands On Physical Therapy in Brooklyn-

Parkinson's Boxing Training - Active Release Physical Therapy - Sports Physical Therapy NYC - Manual One on One Physical Therapy Brooklyn NYC - Hand Physical Therapy - Running + Gait Training - Soft Tissue Physical Therapy- Pediatric Physical Therapy - Schroth Method - Pre-Hab Physical Therapy - TMJ Specialists- Post-surgical Physical Therapy Care - Occupational Physical Therapy Clinics - Orthopedic Physical Therapy in Brooklyn, NY

Multiple Locations!

1-718-258-3300

https://EvolveNY.com

Physical Therapy and Pain Management

Physical Therapy and Pain Management

Pain is primarily a protective mechanism of the body, it is our body’s way of telling us that there is something wrong. It can feel sharp or dull, it can come and go or be constant. If you have never felt pain, then you might be at risk of hurting yourself or that you may never be aware if there’s something wrong with your body. You can experience pain in one area of the body, but can also feel it in various parts at the same time. Physical Therapy is a recommended alternative by doctors instead of solely relying on medications as it eliminates pain through movement, exercise and body awareness. 

What is Pain?

There are two types of pain, acute and chronic. Acute pain is pain that comes quickly, can be severe but goes away immediately when the initial underlying cause is eliminated. It is usually because of an initial injury, sickness or disease, or inflammation. This is easy to diagnose and should last in most cases, 3 to 6 months. After acute pain goes away, you can go on with life as usual. However, acute pain can also lead to chronic pain. 

Chronic pain is one that persists even when the initial injury is healed. This usually lasts longer than 6 months. Chronic pain can have debilitating effects and can influence every aspect of an individual’s life. It can affect a person physically, emotionally, and/or mentally. Sometimes, this type of pain becomes apparent even when there is no past injury or initial damage. Chronic pain is often times difficult to diagnose because of numerous contributing factors. For example, a patient is experiencing severe back pain. His back pain can be a result of the poor posture he assumes when at work, poor lifting techniques at the gym, or maybe he has un-diagnosed scoliosis. Chronic pain can also be a sign of a disease such as osteoarthritis, rheumatoid arthritis, or fibromyalgia. 

A  closer look on how pain works...

Pain management is largely a part of physiotherapy. It is often the first step of treatment. Before we discuss how physical therapy can help with pain management, let’s understand how pain works and why it can persist.

When you are injured or develop a painful diagnosis, the nerves in your body will send information to the brain about the affected area. The brain then analyzes this information and classifies if this pain means there is a threat to the body or not. If the pain signal means that there is a threat, the brain will send signals to protect your body. For example, when your finger touches a hot stove, your brain will immediately send signals to tell your arms to withdraw your hands. This protects you from getting hurt. 

When pain becomes constant, your brain and nervous system switch into “high alert” mode making your body and extremities highly sensitive. The nerves and cells in the rest of your body becomes highly sensitive too that even a soft touch or any other gentle kind of stimuli is perceived by the brain as pain that poses a threat to the body. This mechanism continues in a cycle even when the initial cause has healed. 

Common Causes 

Acute pain comes in quickly and has a specific source. This is usually because of an injury such as a bone fracture, muscle strain, or ligament sprain. You can also feel this type of pain after surgery, get sick, or when you get into an accident. 

Chronic pain is present even when there is no obvious damage to the body. Some common causes of chronic pain are arthritis, cancer, nerve damage, and fibromyalgia. Some factors like bone and joint malalignment, muscle and soft tissue tightness, and weakness such as those found in lower back pain patients, can contribute to chronic pain. 

How Can Physical Therapy Help?

The goal of physical therapy with pain management is primarily to find and fix the source of the problem, instead of just treating the symptom. Physical Therapists will use a number of treatment strategies to help you manage your pain. 

Treatment Modalities. Modalities make use of electrical, thermal, or mechanical energy that can influence physiological changes in the body. A Physical Therapist may use electrical stimulation to help numb the painful area. He can also choose to use either a hot or cold compress to help lessen your pain. Another machine he can use is the ultrasound which generates sound waves to create heat inside a muscle or joint. These modalities are used in conjunction with exercise and other procedures to alleviate pain. Modalities can relieve pain, improve blood circulation, reduce swelling and muscle spasms. 

Manual Therapy. Your Physical Therapist will do all the hard work in this part of your session. Manual Therapy is a specific, gentle, hands-on approach in which your Physical Therapist will try joint mobilization or manipulation to improve your alignment, increase range of motion, and consequently improve your symptoms of pain. 

Exercise. The treatment modalities and manual therapy techniques are usually used to prepare your body for exercise. Your Physical Therapist will teach you stretching and strengthening exercises to help your body move with ease and comfort. This can be quite challenging but these are graded-exercises and specifically tailored for your individual level and needs. Exercising even just for 30 minutes everyday can help you improve your posture and movement. Being strong and flexible will reduce the strain and stress on your body, therefore decreasing your pain as well. 

Your Physical Therapist will also teach you about pain in general. How it occurs, and what you can do to manage it at home. They will also teach you a home program which consists of exercises that you can safely perform independently. Lastly, your physical therapist will also teach you proper body mechanics. This will help you move about your surroundings in a safe and correct way, such as how to lift a bag of groceries to prevent lower back pain or how you should sit in front of your desk to prevent neck pain and shoulder pain. 

The Takeaway...

Always remember that pain is a normal and vital part of our life since it helps us protect our body. However, we must also learn how to manage pain. It is important that we be able to address pain while it is still “acute” and stop it from progressing to the “chronic” type which more or less prevents us from living our best lives. Pain medications are appropriate for some cases, but they just mask the pain and do not address the source of the problem.

For sure, your Physical Therapist will work with you in figuring out what strategies would be best for you to manage your pain. 

About Evolve Physical Therapy in Brooklyn, NY-

Brooklyn's Premier Physical Therapy Clinics-

There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Locations!

1-718-258-3300

https://EvolveNY.com

What Are Cervicogenic Headaches and How Can PT Help?

By Nicholas Mazzone, PT, DPT, CSCS

 

What are cervicogenic headaches?

A cervicogenic headache is caused by dysfunction in the neck, whether it be from stiff joints in the upper cervical spine or from tension in the muscles near the base of the skull. Pain from this type of headache is typically felt around the skull, temple regions, and eye sockets. The origin of this condition can be traumatic, as in a whiplash injury from a motor vehicle accident, or it could be due to prolonged abnormal load on the joints and muscles of the neck (getactivephysio.com.au).

What would be a non-traumatic cause of these types of headaches?

The most common non-traumatic cause of cervicogenic headaches is excessive, prolonged load on the joints and muscles of the neck. This is common in people who sit at a desk for most of their day at work. This occurs because the person winds up in a slumped posture in their spine, which eventually leads to what is known as “forward head posture”. This posture leads to increased tension in the muscles at the base of the skull as well as increased pressure on the first three segments of the cervical spine. Over time, this poor sitting posture can cause cervicogenic headaches. Adjusting one’s desk setup to ensure prevention of this situation can be as simple moving the keyboard closer to you. If the keyboard is placed too far away, you will have to slump forward to reach it, which will lead us to the forward head posture discussed above in order to ensure that you can see what is on your screen. Check out the picture below to get a better idea of what your desk setup should look like.

How can PT help?

Your physical therapist will create a program for you that includes manual therapy, therapeutic exercise, postural training, and stability training. Your program will also include education on how to adjust your desk setup or information on how to alter your current lifestyle in order to help your condition. Manual joint mobilization of the upper cervical spine, soft tissue mobilization of tense muscle tissue, and manual stretching of the region will help soothe the muscles and decrease pressure in the neck region. You will also be given specific exercises to target the muscles that are weak as well as the muscles that need to be lengthened. While heating modalities can feel good, they should not be the main intervention used in the treatment of cervicogenic headaches.

Check out this video that demonstrates 3 simple exercises that can help with your cervicogenic headaches:

Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

Resources:

Cervicogenic Headaches. (2016, March 09). Retrieved from http://www.getactivephysio.com.au/cervicogenic-headaches/

Desk posture photo retrieved from https://sinicropispine.com/tips-improve-posture/

Main photo retrieved from http://yoffielife.com/sweat-dictionary/cervicogenic-headaches/

Manual therapy photo retrieved from https://learnmuscles.com/blog/2017/11/10/treat-spinal-joint-dysfunction-manual-therapy/

Whiplash photo retrieved from https://www.bouldercentre.com/news/whiplash-diagnosis-and-treatment

A cervicogenic headache is caused by dysfunction in the neck, whether it be from stiff joints in the upper cervical spine or from tension in the muscles near the base of the skull. Pain from this type of headache is typically felt around the skull, temple regions, and eye sockets. The origin of this condition can be traumatic, as in a whiplash injury from a motor vehicle accident, or it could be due to prolonged abnormal load on the joints and muscles of the neck (getactivephysio.com.au).

How Can Physical Therapy Help My Sciatica?

By Nick Mazzone, PT, DPT, CSCS

What is Sciatica?

Sciatica is one of the most common symptoms associated with lower back pain. It refers to the sensation of burning pain that tends to radiate from the buttock down the leg. The distance the pain travels is typically correlated to the extent of the irritation effecting the nerves. The name “sciatica” comes from the sciatic nerve, which is one of the largest nerves in the body. The spinal nerves that become irritated are typically those that eventually come together to form the sciatic nerve (from spinal level L4 to S3). Sciatica is not a permanent condition and does not typically require surgical intervention.

What causes sciatica?

 These symptoms are typically caused by excess pressure on a nerve after it exits the lumbar spine (lower spine). This pressure can come from a herniated disc, arthritis in the lumbar region, and other conditions in which the space that the spinal nerve travels becomes compressed or shrinks.

How can physical therapy help improve this condition?

 This condition is relieved by decompressing the region in which these spinal nerves travel. This can be achieved through a specific mobility and strengthening program that includes postural education and awareness training. These specific exercises will depend on the location at which the nerve is being irritated. Generally speaking, in order to decrease pressure in the lumbar region of the spine, you must be mobile in not only the lumbar spine but the thoracic region (mid back) and hips. This will help take pressure off the low back by allowing a more even distribution of movement. Think about it this way: If you are lacking proper mobility in your thoracic spine, your lumbar spine will have to make up for this lack of mobility. This can lead to increased stress and strain in this area. The same idea works for the hips.

Postural training is important in helping to decrease pain and inflammation in the low back. The pelvis and lower spine are anatomically connected (the lower spine actually sits in the pelvis), and therefore movement between the two will be interrelated. The position of the pelvis will dictate the posture in our lumbar spine during all activities (including at rest!). Depending on where the nerve irritation is occurring, this positioning of the pelvis will either increase or decrease pressure on the nerve. If the irritation is occurring at the point where the nerve exits the spinal canal (at the nerve root), extension of the lumbar spine should help alleviate the pressure by “opening” the region where the spinal nerves exit, while flexion of the lumbar spine may increase pressure due to “closing” of the region. Refer to the picture above for a visual of this phenomenon. “Lordosis” is known as lumbar spine extension, while “flat” spine refers to a flexed spine. The picture below demonstrates these movements.

 Click here to find out more information about physical therapy for sciatica or call 1-718-258-3300

Check out this video that demonstrates a simple mobility exercise for the sciatic nerve to help alleviate your symptoms of sciatica:

Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

Resources:

 Main photo of sciatica pain in leg retrieved from https://www.magnilife.com/blog/5-effective-ways-for-dealing-with-sciatica-pain/

Photo of irritated nerve retrieved from http://arizonapaintreatmentcenters.com/from-dr-craig-peterson-mva-sciatica

Photo of lumbar flexion and extension retrieved from https://b-reddy.org/making-pull-ups-and-burpees-more-shoulder-and-lower-back-friendly/

Photo of pelvis position and lumbar spine retrieved from https://body-motion.co.uk/injuries/postural-pain/improve-your-sitting-posture/

What is Tennis Elbow and How Can Physical Therapy Help?

By Nick Mazzone, PT, DPT, CSCS

What does tennis elbow mean?

“Tennis elbow” is the nickname given to a condition known to the medical community as lateral epicondylitis (also seen ending in -osis or -algia). This name describes the region from which the pain originates on the outside of the elbow. The lateral epicondyle is the part of the upper arm bone that serves as the origin for all of the muscles that extend the wrist.

What causes tennis elbow?

Tennis elbow is considered an overuse injury. It typically occurs after repetitive stress to the involved region over time, however one traumatic incident such as a fall or work accident may also cause inflammation in this region. Tennis elbow got its name because it is a common overuse injury seen in those who play the sport. Tennis players tend to hold a tight grip on their racquets while producing powerful forces with their wrist extensor muscles. In certain cases, this may be a recipe for inflammation. Another common population that tends to get tennis elbow is the office worker. Being in a position of wrist extension while typing for prolonged periods may cause repetitive stress to the outside of the elbow.

Here is an example of what your posture should look like while in front of your computer:

How Will Physical Therapy help me?

Your physical therapist will design a specific treatment plan tailored to your needs based on your background and activity level. The program will consist of soft tissue mobilization to assist in the healing process, stretching/mobility training, functional strengthening of eccentrics (the muscle’s ability to control movement from wrist extension to wrist flexion) and grip strengthening, training of ergonomics and posture, and education on how to prevent the condition from reoccurring.

Your specific program will depend on how you acquired the condition in the first place. An office worker will be trained to alter their desk setup in order to decrease the stress on the wrist extensors. A tennis player may be prompted to consider changing the thickness of their racquet handle or the tightness of the strings. Both of these variables may help contribute to the repetitive stress that occurs during the sport since more force production is necessary to produce the desired effect when these conditions are not optimal.

This picture shows one way to stretch the wrist extensor muscles.

Click here to find out more information about physical therapy for tennis elbow

Check out this video for 3 simple exercises to help with your tennis elbow:

About-

Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn, NY. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

Resources 

Main photo retrieved from https://www.mayoclinic.org/diseases-conditions/tennis-elbow/symptoms-causes/syc-20351987

Photo of bones of arm retrieved from http://cruxcrush.com/2014/06/26/climber-problems-elbow-injury/

Picture of wrist and finger extension retrieved from http://www.militarydisabilitymadeeasy.com/images/handmuscles/

Picture of ideal desk posture retrieved from xhttps://www.microsoft.com/accessories/en-us/support/ergonomic-comfort

Photo of wrist extensor stretch retrieved from https://www.therapeuticassociates.com/athletic-performance/golf/stretching-for-golfers/

What is the Rotator Cuff and What Does It Do?

 By Nick Mazzone, PT, DPT, CSCS

What is the rotator cuff?

The rotator cuff is the name given to the group of 4 muscles that originate from different positions on the shoulder blade and connect to the humerus (upper arm). These muscles all work together to ensure stability of the shoulder joint during movement (dynamic stability). When isolated, each of these muscles acts on the humerus and moves the shoulder joint in different directions. These muscles are named supraspinatus, infraspinatus, teres minor, and subscapularis.

Why do we need this dynamic stability?

As we move the arm, these rotator cuff muscles will contract together to help keep the humerus centered nicely inside the cup of the shoulder joint (think ball and socket). If there is an asymmetry in strength among these muscles, the positioning of the shoulder inside the socket may be altered while you move your arm. Over time, this can cause irritation of other tendons, ligaments, and bone in the shoulder region. Some of the common diagnoses associated with rotator cuff muscle weakness are shoulder impingement syndrome and non-traumatic rotator cuff tears.

What happens if the rotator cuff is torn?

The most commonly torn rotator cuff muscle is the supraspinatus. People with supraspinatus tears typically have trouble elevating the arm and may exhibit a compensatory shrugging of the shoulder in order to assist in raising the arm.

If a partial tear is present, the muscle and tendon have the ability to heal without surgical intervention. In order for proper healing to occur, we must provide an ideal environment for the muscle and tendon to recover. This would include intervention aimed at decompressing the region where the muscle attaches to the humerus, which would be achieved through range of motion exercise and strengthening of all 4 rotator cuff muscles to help produce more efficient movement of the shoulder (to put it briefly).

If a complete tear is present, there are two options that one may follow. The non-surgical route would include strengthening other muscles around the shoulder joint that will help to compensate and act as a substitute for the torn rotator cuff muscle. Fortunately, the shoulder joint was designed to be able to withstand this type of injury and with the right rehab protocol, may return to normal functioning. In cases where this method does not help, surgical intervention is typically indicated. After surgery, patients will be sent to a physical therapist in order to help them return to their prior level of functioning.

What does physical therapy typically consist of for rotator cuff injuries?

The plan of care will consist of manual stretching and soft tissue mobilization of tense muscles, specific strength and stability exercise to improve the function of the shoulder, range of motion exercises to help normalize joint movement, and movement re-education to ensure pain-free use of the arm.

Click here to find out more information about physical therapy for rotator cuff injuries

Check out this brief video for 3 exercises that will strengthen the rotator cuff muscles:

Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn. To view some of his other content, visit drnickmazzonedpt.wordpress.com.

Resources

Photo depicting widespread shoulder pain (top photo) retrieved from https://www.myanthemhealth.com/blog/shoulder-paincould-it-be-my-rotator-cuff

Photo depicting different muscles of the rotator cuff retrieved from https://www.slideshare.net/prkhuman/shoulder-impingement-syndrome-24685952

Photo depicting a rotator cuff tear retrieved from https://www.vivehealth.com/blogs/resources/rotator-cuff-tear

Photo depicting the compensatory shoulder shrug during shoulder elevation retrieved from https://healtheappointments.com/chapter-16-the-musculoskeletal-system-essays/5/

How Can PT Help My Spinal Stenosis?

By Nick Mazzone, PT, DPT, CSCS

Spinal stenosis is one of the most commonly diagnosed conditions that affects the lumbar spine (lower back). It is common for people with stenosis to feel tightness and pain that radiates from the low back and buttocks down into both legs.

It is estimated that only about 5% of people with spinal disorders actually require surgery (Eidelson, 2018). So, what are the other 95% of people expected to do? This is where physical therapy comes into play. There are many methods your PT will use in order to help address the issue causing your pain and discomfort. This includes but is not limited to therapeutic exercise, soft tissue mobilization, manual stretching of the hips and spine, and postural re-education.

What is spinal stenosis of the lumbar region?

As you can see from the picture above, stenosis of the spine involves a narrowing of the canal in which the spinal cord sits. This leads to increased pressure on the spinal cord as well as the nerves that branch from it. This is the reason why people feel pain in the buttocks and legs; the region of pain stems from a specific section of the spinal cord that is under pressure. For this reason, two people with the same condition will present with different symptoms.

How can physical therapy help with this problem?

The treatment plan will be specifically tailored to each patient with stenosis. The main objective is to help decompress the spinal cord and its nerve branches by using techniques that create more space in the spinal canal. Bending backward, also known as extension of the lumbar spine, will decrease the space in the spinal canal due to the way the joints of the spine are oriented. This may increase pain and symptoms in a person with spinal stenosis. For this reason, the treatment plan will be focused on utilizing and improving spinal flexion, more commonly known as bending forward. This will help to widen the canal and decompress the inflamed structures, effectively providing relief of symptoms.

A comprehensive treatment plan will help you find positions of maximal comfort and give you more drug-free and surgery-free options for taking care of your lumbar spine and preventing pain in the future.

Please check out this brief video that provides 3 simple exercises to help decrease symptoms due to lumbar spinal stenosis, or click here to find out more information about physical therapy for spinal stenosis.

Resources

Eidelson, S. G., & An, H. S. (February 2018). Spinal Stenosis Center | Lumbar, Cervical, Symptoms, Exercise, Surgery. Retrieved March 18, 2018, from https://www.spineuniverse.com/conditions/spinal-stenosis

Picture of person with low back pain retrieved from http://www.omegapainclinic.com/spinal-stenosis-pain-treatment-utah

Pictures of stenosis in lumbar region retrieved from https://www.spineuniverse.com/conditions/spinal-stenosis

Nick Mazzone received his doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn.

How Can Physical Therapy Help My Arthritis?

By Nick Mazzone, PT, DPT, CSCS

What is Osteoarthritis?

Osteoarthritis is a major cause of chronic pain and disability in our society today. People with arthritis typically report deep, aching pain in the joints affected as well as stiffness and inability to get up and get right out of bed in the morning. The most common treatments for this painful condition include cortisone injections aimed at decreasing inflammation, over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs), and knee replacement surgery once the condition significantly worsens.

What is going on in my joints that causes this pain?

Osteoarthritis is a degenerative condition that leads to wearing away of the outer layers of cartilage and bone as you can see in the image above. This causes an inflammatory process to be induced by the body which leads to swelling, increased sensitivity to touch and pressure, and pain. On an X-ray, you will see decreased space between the bones and potentially bone spurs, which the body lays down in response to excess pressure in the area. This inflammatory condition typically leads to inactivity, which then leads to decreased range of motion along with muscle weakness.

What will physical therapy accomplish?

The hallmarks of arthritis include joint stiffness, swelling, muscular weakness, and pain. In physical therapy, your therapist will prescribe specific exercises that will help improve range of motion, and therefore, stiffness, as well as exercises for strengthening the surrounding muscle groups. These exercises will also act to help decrease the central nervous system’s hypersensitivity to pressure and touch, which will allow you to perform your daily tasks with much greater ease. Your therapist will also work on improving your patterns of movement in order to ensure that you are decreasing the pressure on your arthritic joints and using the most efficient pattern available to your body. There are also modalities and other methods used that will help to decrease the amount of swelling in the joint, which then leads to decreased pain.

Great. Stronger muscles, improved range of motion. How exactly is this helping my condition?

Good question. I would like to start by saying that there is currently no way to reverse the arthritic condition. That being said, I would like you to consider this example. Think about a stiff and swollen knee joint. When a person bends their knee, the stiffness in the muscles and fibers of the joint force the bones to glide along a smaller surface area. This will eventually lead to more breakdown of the cartilage and outer layers of bone, which means progression of the osteoarthritis. Now imagine we have a knee joint that has been sufficiently stretched and has less swelling. These bones glide in a smoother manner across a larger surface area (due to less range of motion restrictions). Now that the force can be spread evenly across the bony surfaces, there is a much less chance of increasing breakdown of the cartilage and bone.

Strengthening the muscles helps to ensure that while walking or performing other functional daily tasks, the joint is kept in a position that ensures proper alignment and efficiency of muscle function. This formula along with a prescribed home exercise program will prevent progression of the condition and assist in avoiding knee replacement surgery.

Check out this brief video which shows how to utilize a “hip-first pattern” to help offset pressure on the knee joint when bending down and squatting.

For more information or any questions, give us a call at 718-258-3300 or contact us today!

or click here to find out more about physical therapy for arthritis

Nick Mazzone received his doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn.

Physical Therapy and Your Insurance

Authorization

Though your insurance company may allow many physical therapy visits per year, they usually also reserve the right to do a pre-check to ensure that the treatment you’ll be receiving will be medically necessary or able to make a positive change.

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or pre-certification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost.

- Healthcare.gov

In and Out of Network

Some insurance companies have in-network providers, which means that they have pre-negotiated rates with those doctors or physical therapists, but insurance companies may also restrict the patient to the in-network providers. Some insurance providers that have in-network providers will also have out-of-network providers, although they may cover less of the expense of the treatment and have the patient pay the remainder of the bill.

Knowing your rights when it comes to your insurance

• First, you should know that your insurance company is there to help you, you are not subject to their demands

• You have a right to go out of network if your provider doesn’t have any in-network providers

• If you are denied for authorization, you have your right to have your voice heard and to request more visits. If you are entitled to more visits than you were authorized for, you can speak to your insurance along with you physical therapists and doctor to be granted more visits

• You are never locked into a healthcare provider, whether it is a doctor or a physical therapist. If you are unhappy with the care you are receiving, you are entitled to finding a care provider that you feel is good for you

• For some more detailed info concerning healthcare laws in New York, please visit: http://www.dfs.ny.gov/consumer/hrights.htm

If you have any questions, give us a call at 718-258-3300 or contact us today!

What Is Direct Access and How Can It Help You?

What is direct access?

Direct access is the legal term that states that patients can go straight to a physical therapist to receive treatment, and do not have to get referrals from physicians, which can cause delays and be costly. The term has different conditions in every state, but direct access is available in all 50 states in the US, which means that patients are put at the focus of the treatment plan, and are allowed to receive faster and cheaper services than when required to go through a physician.

Are physical therapists qualified to deliver services independent of referral?

Absolutely. Physical therapists are educated at the post-baccalaureate level and receive extensive education and clinical training in the examination, evaluation, diagnosis, prognosis, and intervention of patient/clients with functional limitations, impairments and disabilities. All accredited entry-level physical therapist education programs currently culminate in a Doctor of Physical Therapy (DPT) degree. Physical therapists are qualified to recognize when a patient presents with signs and symptoms inconsistent or outside the scope and expertise of the physical therapist and when the patient should be referred to a physician. APTA's Guide of Professional Conduct advocates that physical therapists should assist patients in receiving appropriate medical care when the physical therapist's examination and evaluation reveals signs and symptoms inconsistent with a condition that can be appropriately treated with physical therapy or needs a physician's care and expertise.

Direct Access Laws in New York

The direct access laws in New York have three conditions:

• Treatment can be rendered by a Licensed PT without a referral for 10 visits or 30 days, whichever comes first.  

• Licensed PT must have practiced PT on a full-time basis for no less than three years; be of at least twenty-one years of age.

• PT must provide written notification that services without a referral might not be covered by the patient’s health plan or insurer; notification must state that said services might be covered by health plan or insurer with a referral. Must keep a copy of the written notification in the patient’s file.

The Bottom Line

Allowing individuals to make decisions regarding their health care is inherently good. Eliminating the referral requirement is one step to making health care more accessible to more people across the United States.

Physical therapist education supports practice without referral. Physical therapist practice in the states that allow treatment without referral has proven that it is safe. Yet consumers in many states continue to face arbitrary barriers to physical therapist services.

Direct access is about individual choice in health care decisions through the elimination of unnecessary and burdensome regulation. Direct access also puts control in the patients’ hands, and allows them to be a part of their own plan of care.

What this means for you

This means that you can come to Evolve Physical Therapy without a referral and get treated by one of our amazing physical therapists right away! Should you need more than ten visits, we’d need to get in contact with your doctor, which we’ll try to make as smooth a process as possible.

If you have any questions, give us a call at 718-258-3300 or contact us today!