Brooklyn Physical Therapy News- Evolve NY

About EvolveNY-

Brooklyn's Premier Holistic 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 Brooklyn Physical Therapy Clinic Locations!

Jay C 3/21/23 Jay C 3/21/23

Workers’ Comp Physical Therapy 101

Workers’ Comp Physical Therapy 101- So, You’ve Been Injured at Work…Dealing with injury and illness is never fun and physical therapists are the healthcare providers sought out most to help recover from an injury or the effects of a serious illness. Physical therapists often encounter work-related injury and illness. While the approach to treating these conditions may be the same as or similar to any other injury or illness, it falls under a specific category known as workers’ compensation.

Workers’ Comp Physical Therapy 101

So, You’ve Been Injured at Work…

Dealing with injury and illness is never fun and physical therapists are the healthcare providers sought out most to help recover from an injury or the effects of a serious illness. Physical therapists often encounter work-related injury and illness. While the approach to treating these conditions may be the same as or similar to any other injury or illness, it falls under a specific category known as workers’ compensation.

Did you know that if your injury or illness occurred as a direct result of your employment you are entitled to workers’ compensation benefits that can cover the cost of physical therapy treatment? That’s right, if you are experiencing pain, weakness, loss of endurance, poor balance, muscle stiffness or difficulty performing work-related and daily tasks due to work-related injury or illness, physical therapy is a great way to help you to address these symptoms. Let’s take a deeper look at work-related injuries and illnesses, workers’ compensation benefits and how physical therapy can help you.

WORKERS’ COMPENSATION 101

In the state of New York, the Workers’ Compensation Board defines workers’ compensation as “insurance that provides cash benefits and/or medical care for workers who are injured or become ill as a direct result of their job.” Because of the role of physical therapy in treating injuries and illnesses affecting multiple body systems, physical therapy may be recommended to treat work-related injuries which are covered under workers’ compensation benefits.

With few exceptions, the amount that the claimant receives is not increased or decreased based on whether the employee or employer are “at fault”. If the employer or workers’ comp insurance agree that the injury or illness is a direct result of the person’s job then benefits will be paid out to cover the cost of necessary medical care. If there is a disagreement as to the cause of the claim, a judge specializing in workers’ compensation law will make a judgment.

WORK-RELATED INJURY AND ILLNESS BY THE NUMBERS

Since the 1980s, work-related illness and injury rates have been trending downward in the private sector thanks to safer practices, greater oversight and education, but the impact of each illness and injury can still be great. According to the Bureau of Labor Statistics, in 2020 private employers reported 2.7 million work-related injuries and illnesses which means that the lives of many workers are still being negatively affected by injury.

The National Safety Council maintains records on workplace injuries including how often they occur, what the incidence of injury is amongst different industries and what is causing the injuries and illnesses. Slips, trips and falls, transportation incidents, being struck by an object, caught in equipment and overexertion are some of the categories tracked by the council.

According to the National Safety Council, for the first time, in 2020 the “body systems” category was the body part most affected by injury and illness. This was in large part due to the COVID-19 pandemic because viral illness falls under the body systems category. On average, workers missed 13 days of work after an incident affecting “body systems” which pulled the overall median number of days missed from work due to work-related injury or illness from 8 days (in 2019) to 12 days in (2020). An injury to the shoulder resulted in a median number of 28 days of missed work, while a foot injury resulted in 13 days of missed work and a back injury, 9 days.

Since you may not have had to sit through multiple statistics courses in college like we did to earn our physical therapy degrees, let us discuss what the term “median” means when it comes to missed days of work. If we know the lowest and highest number of days missed by any worker due to an injury or illness, the median number is the value in the middle of the distribution. This means there is an equal chance of missing more and less days of work than the median value. So while missing 9 days of work for a back injury may not seem like a ton to some, by definition we know that there are many people who are missing more, in some cases many more days than that due to their injuries.

So why is this important? Work-related injuries, if not properly addressed, can impact a worker’s ability to perform their job duties temporarily and sometimes permanently. This can have large personal, social and financial impacts over time. Physical therapy, however, can help to treat the injury to ensure full recovery before returning to work, address underlying risk factors that may predispose a worker to re-injury and educate them on proper performance of work-related duties to reduce the risk of future injury.

WHAT TYPES OF WORK-RELATED INJURIES DO PHYSICAL THERAPISTS TREAT?

Physical therapists can help address many different types of work-related injuries. Below you will find some of the most common types of work-related injuries that workers’ comp physical therapy treats:

Musculoskeletal injuries: if you are experiencing injury, pain, or dysfunction in the muscles or bones, musculoskeletal physical therapy can help you heal and restore healthy movement. Examples of musculoskeletal injuries include:

Back pain and neck pain
Other joint pain or injury (knee, ankle, foot, hip, shoulder, elbow, wrist, hand)
Post-surgery recovery
Fracture recovery
Rotator cuff injury
Muscle strain
Ligament sprains
Muscle contusions
Muscle stiffness and tightness

Neurologic injuries: neurologic injuries or disorders resulting directly from the workplace such as concussions, traumatic brain injuries, strokes, spinal cord injuries or peripheral nerve injuries may require physical therapy to help recover from the injury and restore function.

Cardiac and pulmonary rehab: if injury to the heart and lungs occurred as a result of a workplace injury or as a complication of a workplace injury then you might work with a physical therapist trained in cardiac or pulmonary rehabilitation to improve the function of the heart and lungs.

WE TAKE AN INDIVIDUALIZED APPROACH TO YOUR CARE

At Evolve Physical Therapy we will always take an individualized approach to your care. Our team of physical therapists may prescribe manual therapy techniques, postural re-education, strength and flexibility training, gait and balance training and industry specific education to help improve your symptoms and get you back to work. Rather than trying to tolerate your symptoms and hope for the best, schedule a workers’ comp evaluation at our clinic today and allow us to support you in your long term recovery.

Click here for more information about our physical therapy services for workers compensation claims

About EvolveNY-

Brooklyn's Premier Holistic 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!

Multiple Brooklyn Physical Therapy Locations!

Jay C 2/20/23 Jay C 2/20/23

PT After Meniscal Repair Surgery

Meniscus Tear 101- So you have a torn meniscus. While meniscus tears are one of the most common injuries of the knee, it provides little comfort to those wondering what to do next? If you have been diagnosed with a meniscus tear or think you might have one, this article will help you learn bit more about this condition and how it is typically treated.

So You Have a Torn Meniscus…What’s Next?

So you have a torn meniscus. While meniscus tears are one of the most common injuries of the knee, it provides little comfort to those wondering what to do next? If you have been diagnosed with a meniscus tear or think you might have one, this article will help you learn bit more about this condition and how it is typically treated.

WHERE ARE THE MENISCI?

The meniscus (menisci for plural) is a C-shaped cartilage disc that cushions and helps stabilize the knee. There are two of these discs in each knee between the end of the thigh bone (femur) and lower leg bone (tibia). The one on the inside of the knee is called the medial meniscus while the one on the outer side is called the lateral meniscus.

WHAT ARE THE SYMPTOMS OF A MENISCUS TEAR?

Symptoms of a meniscus tear can vary somewhat depending on the acuity, location, and severity of the tear. Here are some common symptoms of a meniscus tear:

An audible or felt popping
Pain in the knee joint on the inside (medial), outside (lateral), or back of the knee
Swelling
Catching or locking of the knee joint
Pain with walking
Inability to fully bend or straighten the knee
Pain when twisting the knee
Feelings of the knee giving out

HOW DO MENISCUS TEARS TYPICALLY OCCUR?

Tears in the menisci are categorized as either acute or degenerative. Acute meniscus tears occur suddenly, as an injury, usually when the leg is twisted while the foot is planted and the knee is bent. Due to the mechanism of injury, other structures in the knee such as the anterior cruciate ligament (ACL) or medial collateral ligament (MCL) may be injured at the same time. Degenerative tears occur as a result of general wear and tear in the knee joint.

In general the menisci have less blood supply than other structures in the body. Blood is what carries the nutrients and growth factors and carries away damaged cells to help heal an injury. Because the blood supply is reduced, when torn, the meniscus is less likely to be able to heal on its own.

ARE THERE DIFFERENT TYPES OF MENISCUS TEARS?

Meniscus tears are categorized by type and location of tear. The type and location of the tear often guides the treatment approach that is most appropriate.

Radial tear: The tear occurs along the inside of the meniscus where blood supply is limited. This is the most common type of tear

Flap: In this type of tear a flap of cartilage peels partly away. It can cause symptoms of catching and locking as it can flip in and out of position.

Horizontal: The tear occurs parallel to the flat surface of the tibia and divides the meniscus into an upper and lower part, though it may not project all the way through the meniscus from one end to the other.

Vertical:. The tear occurs along the C-curve of the meniscus but is perpendicular to the flat surface of the tibia. If they get large enough the inner edge of the meniscus can tear away and develop into a bucket handle tear.

Bucket Handle: Appearing like the handle of a bucket, the inner edge of the meniscus separates from the rest of the cartilage. Because of their placement the bucket handle tear can sometimes cause the knee to lock which requires an urgent surgical evaluation.

Intrasubstance/Incomplete tear: These tears are usually asymptomatic and look normal during surgery but might be picked up on imaging. They signal early degenerative changes in the meniscus tissue but don’t require surgery

HOW ARE MENISCUS TEARS TREATED?

The recommended treatment approach for a meniscus tear depends on many factors. A small tear that is not restricting any range of motion is a good candidate for conservative management such as physical therapy. Conservative management is also considered the first line approach for degenerative tears as research has shown that in many cases trying to repair the frayed tissue has not added benefit over the effects of conservative treatment.

If the tear is large and is causing locking of the knee or is inhibiting full extension or flexion of the knee, surgical intervention may be the best option to restore normal motion to the knee. A tear that occurs in the inner edge, furthest away from the meniscus’ blood supply, is less likely to heal on its own and may be a good candidate for surgical intervention. Finally, someone who has tried conservative care without success or who has a tear that continues to worsen and is otherwise a good candidate for surgical intervention, may ultimately choose to have surgery.

THERE ARE THREE MAIN SURGICAL OPTIONS FOR MENISCUS TEARS

Currently there are three main methods of surgical management of meniscus tears (Doral et al., 2018). Which surgical approach is used often depends on the severity of tear, the location of the tear, and the type of tear.

Arthroscopic Partial Meniscectomy: During this procedure the damaged part of the meniscus is trimmed away and removed. As an arthroscopic procedure, it is minimally invasive. This is the most common surgical approach to treating meniscus tears as it is quick, has a low rate of morbidity, and good short term results. It is commonly used to treat degenerative tears and radial tears but may not have as good of long term outcomes as a meniscus repair and thus is often not recommended as a first line treatment of choice.

Meniscus Repair: This approach is intended to preserve the entire meniscus by repairing the tear. This technique can be performed through an arthroscopic approach or an open approach. Not every tear or every patient is a good candidate for this type of surgery but it is preferable when possible to retain as much of the meniscus as possible.

Meniscus Reconstruction: This is a more complex procedure used to replace a partially or totally resected meniscus in symptomatic patients who have been unresponsive to conservative management. The main goal is to fill the defect and safely place a functional meniscus that is similar anatomically and structurally to the native meniscus.

WHAT IS PHYSICAL THERAPY’S ROLE?

If conservative management is selected to treat your meniscus tear then treatments will be focused on managing symptoms of pain and swelling, restoring normal strength and motion in and around the knee joint, and facilitating return to your prior level of activity.

After assessing your symptoms and evaluating your range of motion, strength, ability to walk and bear weight in the knee, and observing for swelling or inflammation, your PT will prescribe a personalized treatment program to address these symptoms. Early on in your recovery your PT may advise you on how to modify weight bearing by using a device such as crutches or a cane. They may utilize modalities such as ice, electrical stimulation, or even hands-on treatments like massage or soft tissue mobilization to manage pain and swelling.

As your healing continues you may perform gentle stretching and begin strengthening exercises to prevent muscle atrophy and restore joint range of motion. As you begin to tolerate more weight through your knee your exercises will continue to advance to help achieve normal strength, power and agility so that you can resume as many of your previous activities as possible. Throughout your rehab program your PT will also assess you for any underlying biomechanical or musculoskeletal impairments that may have contributed to the tear in the first place so they can also be addressed during rehabilitation to decrease the likelihood of reinjury.

If you have undergone surgery to treat your meniscus tear then physical therapy is typically recommended post-operatively. In this case the surgeon often provides you with a post-operative rehab protocol that will guide you and your physical therapist through a progression of exercises. As you heal, you will begin to bear more weight through your leg and be allowed to do more intensive exercises. As with nonsurgical management of meniscus tears, the goal will be to restore normal movement, strength and coordination of the knee to allow you to return to as many of your previous activities as possible.

If you are trying to heal from a meniscus tear, our therapists at Evolve PT would love to share our expertise and experience to help with your recovery. An individualized plan is always best to help meet your goals and we are looking forward to working with you.

Find out more about physical therapy for torn meniscus

About EvolveNY-

Multiple Brooklyn Physical Therapy Locations!

https://EvolveNY.com

Jay C 2/17/23 Jay C 2/17/23

Which Type of PT Do You Need?

Do You Know Which Type of Physical Therapist You Need? If you have been considering physical therapy, you may be wondering if there is a specific kind of physical therapist you should be calling. Although all physical therapists go through a general curriculum that introduces them to many different areas of PT practice, many go on to specialize in one or two areas. Through clinical affiliations during their graduate program, continuing education programs, specialty board certifications and fellowships, physical therapists hone their skills in various areas of practice.

Do You Know Which Type of Physical Therapist You Need?

If you have been considering physical therapy, you may be wondering if there is a specific kind of physical therapist you should be calling. Although all physical therapists go through a general curriculum that introduces them to many different areas of PT practice, many go on to specialize in one or two areas. Through clinical affiliations during their graduate program, continuing education programs, specialty board certifications and fellowships, physical therapists hone their skills in various areas of practice. While all physical therapists are considered movement experts who improve quality of life through prescribed exercise, hands-on care, and patient education, knowing what kind of PT you need is important to ensure you get the best care.

Let’s take a look at some of the different specialty areas of physical therapy. We will discuss the kinds of conditions treated by therapists that practice in each area and what kind of education and advanced training these PTs might undergo.

Orthopedic Physical Therapy

Orthopedic physical therapists specialize in the evaluation and treatment of conditions and injuries that impact the musculoskeletal system. This includes injuries or conditions affecting the bones, joints, tendons, muscles, and ligaments. Most orthopedic physical therapists can treat any area of the musculoskeletal system but some therapists choose to specialize further in one or a few areas of the body or in certain conditions. For example, a therapist may dedicate their practice to treating spines, to treating hypermobility disorders, to treating wrists and hands, or chronic pain, etc.

Common conditions treated by orthopedic physical therapists include arthritis, sprains, strains, bone fractures, tendonitis, and post-surgical conditions. If you are having pain with activity in your muscles or joints, an orthopedic physical therapist can often help you pinpoint contributing factors and create a plan to address them.

Some orthopedic therapists will go on to get a board certification in orthopedic physical therapy or complete a fellowship in spine care or manual therapy which indicates a higher level of training and expertise in this area.

Sports Physical Therapy

Sports physical therapists have many of the same skills as an orthopedic physical therapist but have chosen to further specialize in working with an athlete population. They are more knowledgeable about common sports injuries as well as the physical demands that different sports place on the body. They also have an in-depth understanding of the physiological, psychological and performance aspects of athletics.

A sports physical therapist may seek out a board certification to become a certified Sports Clinical Specialist or certified Orthopedic Clinical Specialist. They may also seek out post-graduate Fellowship programs in Division 1 athletics, the upper extremity athlete, performing arts, manual therapy, or sports rehab.

Neurologic Physical Therapy

Neurologic physical therapy addresses injury, disease, or disorder of the neurologic, neuromuscular, and vestibular systems. Injuries or disorders affecting the brain, spinal cord, or peripheral nerves such as stroke, brain injury, spinal cord injury, multiple sclerosis, Parkinson’s Disease, cerebral palsy, peripheral neuropathy, and dizziness are conditions best addressed by a neurologic physical therapist. Individuals experiencing losses of balance or impairments in their functional mobility are often treated by neurologic physical therapists also.

PTs that practice neurologic physical therapy have typically undergone extensive training through residencies, board certification, or continuing education to develop an in-depth understanding of the anatomy and physiology of these systems and how to evaluate and treat these complex conditions based on the best available research.

Vestibular Physical Therapy

Vestibular physical therapy often overlaps with orthopedic and neurologic physical therapy. Vestibular physical therapy focuses on the evaluation and treatment of conditions affecting the vestibular system. The vestibular system is a sensory system in our body responsible for providing the brain with information about motion, spatial orientation, and head position. It also communicates with the parts of our brain and spinal cord that control motor functions to catch and maintain our balance, stabilize our head and bodies during movement, and maintain our posture. The main components of the vestibular system are located in the inner ear and connect with tracts throughout our nervous system.

You may want to consider seeing a vestibular physical therapist if you are experience dizziness with changes in position or with movement, are experiencing Post Concussion Syndrome, falls or losses of balance, or have been diagnosed with a condition such as BPPV, Meneire’s Disease, Vestibular Neuritis or Labyrinthitis.

Cardiovascular and Pulmonary Physical Therapy

With specialized education and training in the cardiopulmonary system and in depth understanding of the principles of exercise, cardiovascular and pulmonary physical therapists are a vital part of a care team for someone looking to strengthen their heart and their lungs so they can get back to their everyday activities. All physical therapists are taught these basic principles during their education, however, some will take continuing education to deepen their knowledge or go on to specialize further with a board certification in cardiovascular and pulmonary physical therapy.

These physical therapists are often found in cardiac and pulmonary rehabilitation programs to help those with cardiac and pulmonary conditions recover from heart attacks, lung or heart transplants, heart disease, COPD, cystic fibrosis, and more.

Oncology Physical Therapy

In the world of cancer treatment, surgery, chemotherapy, radiation, stem cell transplants, and hormone therapies are targeted to destroy cancer cells, but in the process of restoring health these treatments can cause mild to severe physical impairments. The development of specialty oncologic physical therapy has meant, however, that these physical impairments can be managed and addressed during and after cancer treatment.

Some of the oncologic conditions addressed by oncology physical therapy are as follows:

Pain
Radiation fibrosis
Muscle weakness, atrophy, or loss of stamina
Lymphedema
Chemotherapy-induced peripheral neuropathy
Cancer-related fatigue
Balance impairments

Many physical therapists that work in this area will undergo board certification in oncologic physical therapy to gain an expertise in the care of cancer survivors.

Hand Therapy

Physical therapists or occupational therapists can become Certified Hand Therapists (CHT). This certification requires at least three years and 4,000 hours of experience treating conditions of the hand and upper extremity. If you are looking for a therapist to address an acquired injury, a congenital or acquired deformity or disease of the hand or upper extremity, or recently underwent surgery in the hand or upper extremity, a CHT is an excellent choice to facilitate your recovery.

MORE KNOWLEDGE EQUALS BETTER CHOICES

Understanding what types of physical therapy exist can help make you a better self-advocate and consumer of healthcare. With a better understanding of the specialty areas of physical therapy, you can begin to look for a therapist in your area that provides this care. At Evolve Physical Therapy in Brooklyn, we offer many of these services and would love to help connect you with one of our skilled providers so that you can take the first step in recovery and rehabilitation of your specific needs.

About EvolveNY-

Multiple Locations!

Call to Schedule an Appointment!

Jay C 2/14/23 Jay C 2/14/23

Balance Wellness With a Personalized PT Plan!

Bolster Your Balance With A Personalized Physical Therapy Program

Physical Therapy for Balance: Why A Personalized Plan Is Best- Falls are a significant cause of morbidity and mortality among older adults. Changes in your balance can have many causes each which may require a different treatment approach. Commonly, when we begin to lose our balance, we decrease our activity level to avoid things that may cause a fall.

Bolster Your Balance With A Personalized Physical Therapy Program

Physical Therapy for Balance: Why A Personalized Plan Is Best

Falls are a significant cause of morbidity and mortality among older adults. Changes in your balance can have many causes each which may require a different treatment approach. Commonly, when we begin to lose our balance, we decrease our activity level to avoid things that may cause a fall. This can lead to deconditioning both of the balance systems and of the musculoskeletal systems which can ultimately worsen the problem. The wait and see approach is never the best option when it comes to improving balance and preventing falls. Luckily, physical therapists are professionals that specialize in this area, and after a thorough assessment, can provide you with a personalized balance rehabilitation program. If you are wondering how physical therapy can help your balance, keep reading to learn more.

WHAT’S BEHIND BALANCE?

Your brain uses information from three sensory systems to maintain your balance. These three systems are the vestibular system, the somatosensory system, and the visual system. Impaired functioning in any one of these three systems can affect your balance, especially if your body is not able to compensate by relying more heavily on the others. Let’s take a closer look at each of these systems:

Visual System: Your eyes provide feedback about where you are and how your body is positioned relative to other things in the environment. If you’ve ever tried staring at an unmoving object while attempting to stand on one foot, you’ve taken advantage of this system. Blindness or loss of vision, double vision, cataracts or glaucoma are some conditions that decrease the accuracy or usefulness of visual information for balance

Vestibular System: The vestibular system provides the brain with information about motion, spatial orientation, and head position. It also communicates with the parts of our brain and spinal cord that control motor functions to catch and maintain our balance, stabilize our head and bodies during movement, and maintain our posture. The main components of the vestibular system are located in the inner ear and connect with tracts throughout our nervous system.

Conditions that affect the vestibular system can result in dizziness, vertigo, or feelings of disequilibrium and imbalance. Examples of conditions that can impair this sensory system include brain injuries and concussions, multiple sclerosis, Meneire’s Disease, labyrinthitis or vestibular neuritis, acoustic neuroma, BPPV and more. The function of the vestibular system can also decline with age.

Somatosensory system: sensory receptors throughout our body respond to stretch, pressure, and movement in general to provide the brain with information about how our body is positioned in space. These sensors are located in our skin, muscles, and joints. Of greatest importance to balance are the sensory receptors in our feet and legs, trunk, and neck.

Loss or reduction in somatosensory input can be caused by injuries to the peripheral or central nervous system and include conditions such as spinal cord or brain injury, stroke, peripheral neuropathy or diabetic neuropathy, Multiple Sclerosis, and Guillain Barre Syndrome and more.

Finally, having appropriate muscle strength and motor control, flexibility, and mobility are important to be able to maintain your balance.

HOW WILL A PHYSICAL THERAPIST ASSESS MY BALANCE?

Your physical therapist will start by interviewing you about your medical history. Your medical history can provide many clues as to which balance system may be affected and contributing to your imbalance.

Additionally, describing to your therapist the conditions under which you typically lose your balance will often give them a clue as to what is causing these episodes. For example, telling your therapist that you lose your balance when you close your eyes in the shower, or when you walk over rocks or uneven terrain, helps them choose which tests and assessments they want to perform.

Balance testing is another important way that physical therapists assess your balance. These tests can assess each of the three balance systems and how your balance performs under various conditions. Here are some examples of tasks you may be asked to perform while your therapist stands close by to help prevent a fall:

Stand with eyes open and closed in various positions
Stand on firm surfaces, foam surfaces, or inclines
Stand with your feet apart, together, in front of one another
Stand on one foot
Stand with your feet in various positions while turning or nodding your head
Turning a circle
Reaching down to pick an item up off the floor
Standing from a chair
Walk while performing some or all of these actions:
Turning your head
Closing your eyes
Walking backwards
Stopping and turning
Stepping over an obstacle
Changing speed
Walking heel-toe

Additionally, walking speed, leg strength, posture, and flexibility can all impact the effectiveness of our balance strategies and will likely be assessed. Assessing the sensation in your feet and legs is also often performed to determine if the somatosensory system is affected. Finally, if you present with dizziness, vertigo, or disequilibrium then further vestibular testing may be indicated.

AN INDIVIDUALIZED BALANCE PLAN IS BEST

Participating in a group balance class or following along with a video-based balance routine can be a great way to maintain your balance abilities if you are not having falls or major balance concerns. In the case of those experiencing declines in their balance or recent falls, consulting with a physical therapist is a great way to get a personalized balance plan that is specific to your exact needs. If you need exercises to strengthen your legs, improve your flexibility, or strengthen the brain’s use of a specific balance system then you want a program that includes each of these things and that can be modified, regressed, and progressed, as needed. Once you have improved in as many of these areas as possible then your PT can educate you on what exercises you should continue to help maintain these gains after discharge.

Along with exercises to improve your balance, a physical therapist can educate you on other important areas such as:

Modifications to your home environment to reduce the risk for falls
Training on how to select, adjust, and use assistive devices like walkers or canes
How to set up a safe place to perform your balance exercises to prevent a fall

If you have found this page and read all the way to the bottom, there is a good chance you have been looking for ways to improve your balance. Well look no further, the therapists at Evolve are ready to learn about you and how they can create a personalized balance plan to help you to feel steadier, stronger, and excited about getting out and doing the things you enjoy without worrying about falls.

Click here for more information about physical therapy for balance rehab

About EvolveNY-

Brooklyn's Premier Holistic 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!

Multiple Locations!

https://EvolveNY.com

Jay C 2/8/23 Jay C 2/8/23

Daily Stretches to Keep You Limber

Fire Up Your Flexibility With These 8 Daily Stretches- Whether you find yourself sitting at a desk all day, running long distances, doing heavy manual labor, or simply maintaining one position or repeating a movement, you probably notice tight muscles by the end of the day. If you are looking for a stretching routine you can perform daily to help limber up those tight muscles and fire up your flexibility then read on!

Fire Up Your Flexibility With These 8 Daily Stretches

Whether you find yourself sitting at a desk all day, running long distances, doing heavy manual labor, or simply maintaining one position or repeating a movement, you probably notice tight muscles by the end of the day. If you are looking for a stretching routine you can perform daily to help limber up those tight muscles and fire up your flexibility then read on!

WHY IS MUSCLE STRETCHING IMPORTANT?

Maintaining flexibility has many benefits even beyond tackling the tension that daily life can cause in your muscles. A muscle that is spasming can cause pain and discomfort but a muscle that is shortened can cause injury or irritation as the body tries to move through a restricted range of motion. Performing a daily stretching routine can benefit you in the following ways:

Reduces muscle soreness
Improves posture
Can help prevent injury
Improve muscle and joint range of motion
Improve feelings of tightness

EIGHT GREAT STRETCHES YOU CAN PERFORM DAILY!

Standing Stretches -

Quadriceps stretch: Stand next to a counter or chair so you can hold on for balance. Reach behind you and grab your foot or ankle and pull it toward your bottom until you feel a stretch across the front of the thigh. If you don’t feel a stretch make sure your knee is pointed straight down to the ground and that you don’t let your back arch.

Calf stretch: Stand near a wall and step forward into a lunge position, hands on the wall. With your back foot pointed straight ahead and knee straight, lunge forward on the front leg until you feel a stretch down the back of your lower leg/calf. Hold.

Doorway pectoral stretch: Stand in front of a doorway. With elbows bent, raise your arms to at least 90 degrees and place them on each side of the door. Step one foot forward and lunge gently onto the front foot until you feel a stretch across both sides of your chest and hold. To target some of the other fibers in the pectoral muscles, slide your elbows further up and repeat the stretch in this position.

Seated Stretches -

Posterior shoulder stretch: Seated in a chair, use one hand to grab the back of the upper arm of the opposite arm and gently pull the arm across your body until you feel a stretch in the posterior shoulder and hold.

Tricep stretch: Seated in a chair, reach one arm straight overhead until it is in line (or close) to your head and then bend your elbow behind you as though you are trying to scratch your back. Use your opposite arm to gently push the arm further until you feel a stretch down the back of the upper arm in the tricep and hold.

Upper trap stretch: This stretch focuses on the muscles at the top of the shoulders. Seated in a chair, this is a three step stretch that requires you to combine these movements together to target the upper trapezius muscle.

First you will drop your chin toward your chest, then you will side bend the neck so the ear moves toward the shoulder and finally you will turn your head slightly to look towards the side you are stretching. You should feel this along the side of the neck and along the top of the shoulder. For added stretch you can use your opposite hand to gently pull the head a bit further forward and to the side or you can use the hand on the side being stretched to grasp underneath the chair you are sitting on.

Floor Stretches -

Child’s Pose: This is a great stretch to target the hips, glutes and back. To perform this stretch start on your hands and knees then shift your weight back toward your heels while you stretch your arms forward and head toward the ground. You may find it more comfortable to spread your knees wider if you are experiencing any pain or pinching in the hips. Hold this position.

Hamstring Stretch: Seated on the ground, extend one leg in front of you. Without letting your lower back round, bend forward and reach your hands toward the foot of the extended leg until you feel a stretch down the back of the thigh and hold

HOW LONG SHOULD I HOLD THESE STRETCHES?

For static stretching (holding the stretch for a prolonged period), aim for a total of 60 seconds of stretch for each muscle. You can hold the stretch for the entire 60 seconds or break it up into sets of 15, 20, or 30 seconds with breaks in between. If you are feeling increased tightness especially in one area you can repeat the stretch 2-3 times a day.

SHOULD STRETCHING BE PAINFUL?

No! We do not want to stretch into pain. Stretching does not need to be painful to be effective, in fact, overstretching a muscle can cause small muscle tears, soreness and injury. When you are holding a stretch it should feel no more than a 2-4/10 discomfort. For reference, 0/10 means you feel nothing at all while 10/10 means it is unbearable and time to call the ambulance.

IS STRETCHING SAFE FOR EVERYONE?

When done appropriately, stretching is generally considered safe though research suggests this type of long-hold, static stretching should not be done right before exercise as it can decrease performance and may increase risk for injury. Dynamic stretching, which is not covered in this article, is more appropriate as a pre-training warm up.

Another exception to this rule would be if you have or recently recovered from an injury. In this case stretching may be contraindicated or may need to be dosed very carefully to prevent reaggravation of the injury. If you feel that you have a specific injury then it's a good idea to schedule an appointment with one of our therapists at Evolve to evaluate the condition and educate you about which stretches will help you heal.

Additionally, if you are already hypermobile, you may experience muscle tension and tightness but in this case stretching is often not the answer. The body often creates tension or tightness in a muscle in an attempt to provide adequate stabilization around joints in persons with hypermobility, which means stretching may compound the problem. Working with a physical therapist in this case can help you develop the strength and stability you need to allow muscles to relax.

LIMBER UP FOR LIFE

If you don’t feel that you have extra time in your day to dedicate to stretching, try performing stretches while doing other daily activities. For example, performing a standing stretch while waiting for your food to cook on the stove. Sit on the ground while you watch TV and spend ten minutes stretching. You can even stretch while you are talking on the phone. Taking some time each day to perform stretching not only gives you a chance to decompress but helps build a habit that will improve your health.

Also, feel free to check out our Youtube channel for how to videos on different types of stretches!

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Want to Maintain Your Youth? Keep Active

Fight Aging with Physical Activity- The Secret to Fighting Aging is What? Let’s face it, if you were offered a sip from the fountain of youth, who could resist indulging? Reversing, slowing, and maybe even stopping aging is the subject of much research these days. As we age, it’s hard not to think about our body of yesteryear as we stretch out the little aches and pains that creep in over time or cross the finish line of a race feeling a lot slower than we did twenty years ago…

Fight Aging with Physical Activity

The Secret to Fighting Aging is What?

Let’s face it, if you were offered a sip from the fountain of youth, who could resist indulging? Reversing, slowing, and maybe even stopping aging is the subject of much research these days. As we age, it’s hard not to think about our body of yesteryear as we stretch out the little aches and pains that creep in over time or cross the finish line of a race feeling a lot slower than we did twenty years ago. While the effectiveness of so-called anti-aging pills and concoctions may be more hearsay than hard science, one habit that has garnered a lot of attention in recent years for its ability to increase longevity and slow the aging process is exercise. That’s right, exercise. If you’ve been looking for another reason to stop hitting the snooze button or turn off the TV and hit the gym, this is it.

WHAT IS AGING?

As you may have noticed, aging is rarely a linear process and there is actually quite a great deal of diversity in the older population, suggesting that aging is not only caused by accumulated molecular and cellular damage but can be enhanced or slowed by lifestyle habits and social experiences. Biologically, aging results in a gradual decrease in mental and physical capacity and an increased susceptibility to disease and untimely death.

WHAT THE SCIENCE TELLS US ABOUT EXERCISE AND AGING

People who are physically active for about 150 minutes a week have a 33% lower risk of all-cause mortality than those who are physically active. If you have been wondering if it’s worth the hassle, here’s your proof.

Arterial health, specifically arterial compliance and stiffness is often regarded as a barometer of physiologic and biologic aging. Given that cardiovascular disease is still the leading cause of death in the United States and most developed countries, maintaining the health of your arteries is an important strategy to increase longevity and combat the effects of aging. It has been shown through research that physical activity is the first-line treatment in addressing vascular dysfunction. In fact, consistent moderate to vigorous aerobic training from mid to late life is an effective strategy for the prevention of age-related arterial stiffening.

Exercise has also been shown in mouse studies to facilitate an enzyme release that enhances insulin sensitivity and promotes metabolic health, therefore lowering the likelihood of developing Type II Diabetes. Similarly, adults who exercise are at lower risk for developing many types of cancer. If these weren’t enough reasons to prioritize physical activity, adults who are physically active also have a lower risk for falls, lower risk for injuries from falls, and are able to maintain bone density and muscle mass that keeps them enjoying their life longer.

EXERCISE AND PHYSICAL ACTIVITY AREN’T EQUAL

When we talk about exercise and physical activity as combatants of aging, it is important that we define these terms. Despite how similar they sound, these terms are not interchangeable. Physical activity is defined as a bodily movement produced by skeletal muscles that requires energy. Sitting up, walking across the room, standing at the sink to do the dishes, or taking the stairs instead of the elevator are examples of physical activity. Exercise, however, is a subcategory of physical activity in which the movements are planned, structured, repetitive, and purposefully focused on the improvement or maintenance of one or more components of physical fitness. Lifting weights to build strength or going on a long slow run to build aerobic endurance are examples of exercise.

Does this matter? It might, because the body needs sufficient stimulus to undergo physiologic changes in response to exercise. Intensity, duration, frequency and type of activity matters greatly if you are trying to achieve a specific change in fitness and, according to much of the research, if you want to use physical activity to slow the aging process. So while you may be on your feet doing household- or work-related tasks throughout the day, if your body is accustomed to this level of physical activity, the body is likely not perceiving this as a stimulus to which it needs to adapt. That being said, if you have been quite sedentary for health or other personal reasons, increasing your level of physical activity may feel like a moderate to vigorous intensity task and doing this before initiating structured exercise likely still has great health benefits.

HOW MUCH EXERCISE SHOULD I DO?

Between the years 2008 and 2018 a National Health Institute survey found that on average, the number of adults participating in no physical activity or exercise during their leisure time declined whereas those meeting the recommended amount of aerobic and strength training each week increased. That being said, as of 2018 only 54.8% of U.S. adults surveyed were performing the recommended ≥150 mins of moderate intensity or ≥75 mins of vigorous intensity aerobic exercise weekly. Even more concerning is that only 27.6% of adults were meeting the recommendation of participating in strength training of major muscle groups twice or more, weekly.

HOW CAN I START BECOMING MORE ACTIVE?

As with anything, it takes time to build a habit. If you have been living a sedentary lifestyle and would like to first increase your overall physical activity here are some strategies to get you started:

Park a little further away each time you go to a store or an appointment which allows you to walk (or roll) a longer distance

Choose to stand and perform tasks at the countertop instead of performing them in sitting

Set a timer to remind you to get up each hour and walk to another room and back

Set a goal to increase the time you are performing physical tasks (even if it’s seated) before taking a break and slowly increase the duration over time.

Try and propel yourself in the wheelchair using your feet on the ground or hands on the wheels instead of having someone else push you

If you think you are ready to start an exercise program for the first time or to step up your current exercise routine it is always important to talk with your doctor and ensure it is safe for you. The Centers for Disease Control and Prevention (CDC) recommended that adults perform resistance training to major muscle groups at least twice weekly. They also advise getting ≥150 mins of moderate intensity or ≥75 mins of vigorous intensity aerobic exercise weekly. Moderate intensity means you are working hard enough to break a sweat and you can still talk but not sing. If you are doing vigorous physical activity then you will only be able to say a few words without pausing to take a breath.

Here are some tips to help you get started and stick with exercise:

Choose a mode of exercise that you enjoy! Dance, running, hiking, tennis, and hand-cycling, can all be modes of exercise.

Schedule exercise into your calendar and find an accountability buddy that can join you

Start slowly: start by lifting lighter weights and progressing to heavier ones. Start with bouts of 10-20 minutes of aerobic activity and work up to longer bouts as you gain fitness

“Moderate” and “vigorous” are terms of relative intensity. Many factors will affect how intensely you feel you are working on a given day including how well you slept, how stressed you feel, if you are doing an exercise you are very familiar with, or one that is new and challenging. Be flexible and listen to your body

If you are healthy and without injury, work with a certified personal trainer to help you learn how to strength train properly

Finally, if you are injured or have a medical condition that affects your ability to perform exercise, talk with a physical therapist about how to begin treating any injuries and how to safely modify and progress a strength and aerobic fitness routine. We can all benefit from physical exercise and activity and with few exceptions, with a little creativity and professional knowledge we can find a way for you to exercise too.

Please click here for more information about physical therapy services in Brooklyn

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Always Getting Headaches? PT Can Help!

Can Physical Therapy Help With Headaches? While some lucky people suffer only the occasional headache, for those who are dealing with frequent or chronic headaches, known as headache disorder, attempts to find lasting relief can leave them frustrated. Headaches are a global problem and nearly one third of men and one third of women in developed countries experience tension type headaches while 1 in 20 people in the U.S. will experience daily or near-daily headaches.

Can Physical Therapy Help With Headaches?

While some lucky people suffer only the occasional headache, for those who are dealing with frequent or chronic headaches, known as headache disorder, attempts to find lasting relief can leave them frustrated. Headaches are a global problem and nearly one third of men and one third of women in developed countries experience tension type headaches while 1 in 20 people in the U.S. will experience daily or near-daily headaches. Headache disorder has a high global disease burden and has a significant negative impact on quality of life, causes personal suffering, and poses a serious financial impact.

If you are experiencing headaches with some regularity and have been looking for a way to treat them, read on to learn more about the different types of headaches and how physical therapy may help in reducing your symptoms.

DIFFERENT TYPES OF HEADACHES

While pain and discomfort are the primary symptom that persists across all headache types, headaches can be classified into primary and secondary headaches based on symptom presentation and the underlying cause. Here are several common headache types

Primary Headaches

Migraine headaches (with or without aura)
Tension-type headache
Exercise headache
Trigeminal autonomic cephalgia
- (cluster headache and paroxysmal hemicrania)

Secondary Headaches (can be attributed to another condition, not a comprehensive list)

Medication overuse headache
Cervicogenic headache
Hypertension headache
Sinus/allergy headache
Exertional headache
Hormonal headache
Stroke and intracranial hemorrhage
Trigeminal neuralgia
Dehydration

While headaches are common and often not a sign of something serious, if you experience new or more frequent headaches it is important to see your doctor. If you experience a headache with any of the following characteristics it’s important to seek medical care right away:

The headache is severe, violent, or unbearable, the “worst headache of my life”

It is accompanied by changes in vision, slurred speech, problems moving your arms or legs, loss of balance, confusion, dizziness, or memory loss

You are also experiencing a stiff neck and fever, nausea or vomiting

Your headache occurs after a head injury

Your headache gets worse over 24 hours

You suddenly started getting headaches when you never had them before

HOW ARE HEADACHES TREATED?

As you can see, “headache” is really an umbrella term for what is actually a long list of headache subtypes. Headaches that develop as a result of muscle spasm or tension in the neck, jaw, or shoulders or related to posture or other movement patterns can often be helped by physical therapy. Some headaches, however, require medication and medical management which is the purview of your doctor or headache specialist. The goal of headache management is to decrease the intensity and frequency of your headaches and your physical therapist can work with your doctor to help address musculoskeletal components of your headache.

Identifying the type and triggers for your headache disorder is an important first step in treating this condition. If serious causes of headache have been ruled out, it can sometimes be tricky to identify what may be triggering your symptoms. Your physical therapist will interview you about the pattern of your headaches and may suggest that you keep a journal or log of your symptoms and some of the following information to help you identify potential patterns or relationships between your habits and your headaches:

What food did you eat earlier in the day or yesterday?
Where are you at in your menstrual cycle?
What have you been doing today activity-wise (i.e. sitting at a desk, lifting weights, sleeping, etc.)
How are you sleeping?
How is your stress level?
Do you have any other symptoms like neck or jaw pain, sinus congestion, muscle tension or stiffness?

HOW CAN PHYSICAL THERAPY TREAT HEADACHES

Physical therapy can be a great tool for treating the underlying causes of cervicogenic headaches or headaches caused by muscle spasms, muscle tension or tightness, postural impairments and movement errors. Aside from interviewing you about your symptoms your physical therapist will perform a physical exam to identify structures that may be contributing to your symptoms. The exam may include some or all of these components:

Manual muscle tests to evaluate muscle strength
Muscle length and flexibility assessments
Palpation of the muscles and tissues around the neck, shoulders, jaw, and upper back
Assessments of the mobility of the joints in your neck, upper back, shoulders, and jaw
Testing of the sensation in your arms
Measuring of the range of motion in your neck, back, and shoulders
Assessing your posture in sitting and standing
Asking you to demonstrate how you perform certain daily tasks so they can evaluate your movement patterns and posture

Once your PT has a better understanding of what may be causing your headache symptoms, here are some ways they will work to improve them:

Improve muscle strength: Strong muscles with good endurance are needed to stabilize the neck and back, allow for movement in the head and upper body, and maintain good posture. Your physical therapist can teach you exercises to strengthen these muscles.

Improve joint and tissue mobility: Your physical therapist may utilize gentle manual therapy techniques to improve the flexibility and mobility in the muscles, tissues, and joints of the neck, jaw, upper back, and shoulders.

Improve your posture: poor posture can cause muscle shortness and tightness and exacerbate pain and discomfort. Exercises and mindfulness techniques to improve and be aware of your posture will likely be included in your treatment.

Discuss modifications to your workstation or daily exercise or job duties: Having an ergonomic workstation and making modifications to the way you perform some of your job duties and even workout routines can help reduce the likelihood of triggering a headache. You can help your PT to do this by telling them about how you perform some of these tasks and what your workflow or workouts look like.

DON’T WAIT TO GET STARTED ON PHYSICAL THERAPY FOR HEADACHES

While it is true most headaches are not serious, the serious pain and disruption to your daily life they can cause is not something to be ignored. If you have been experiencing bothersome headaches, call and schedule an appointment with the team at Evolve PT and let them explain how they can help you find some long lasting relief with PT.

Click here for more information about physical therapy services in Brooklyn

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Schedule an Appointment!

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Back Pain Got You Down?

Got Back Pain? Back pain, whether it lasts a day, a month, or a year, has most of us looking for a way out of it. While back pain is a common concern, the good news is that most back pain is self-limited and will resolve with conservative care. If you are experiencing back pain now, though, you are probably wondering what is causing it and how you should approach treating it.

Oh! My Achin’ Back

Got Back Pain?

Back pain, whether it lasts a day, a month, or a year, has most of us looking for a way out of it. While back pain is a common concern, the good news is that most back pain is self-limited and will resolve with conservative care. If you are experiencing back pain now, though, you are probably wondering what is causing it and how you should approach treating it.

WHAT DO WE MEAN BY “BACK” PAIN?

When we talk about “back pain” we are using a general term to refer to an area that is quite complex and involves many different structures. The spine itself consists of bony vertebrae stacked atop one another that encapsulate the spinal cord and provide tunnels through which the nerves of the spinal cord exit and travel to the skin, muscles, bones, and organs. The back consists of many layers of muscles that stabilize the spine and move the arms, legs, neck and spine. It also consists of fascial tissue that surrounds muscles and organs and connects many areas of the body. Pain or discomfort can arise from many or several of these anatomical layers.

When it comes to addressing back pain it is important to understand that while in some cases, a specific anatomical structure may be primarily to blame such as a herniation in an intervertebral disc or a strain of a specific muscle, oftentimes, the underlying cause is nonspecific and due to faulty movement patterns or exceeding of the mechanical stress threshold and your physical therapist will be evaluating how you move as much as he or she is examining the structures of the back.

WHAT CAUSES BACK PAIN

Back pain is often multifactorial and any or several of these processes may be contributing to your symptoms:

Inflammation: inflammation occurs as a result of an acute injury or reinjury to the structures in the back such as muscles or ligaments. It is both a necessary part of the healing process and a common underlying cause of pain as the localized swelling and chemical changes can irritate the sensory nerves in the area. It can also result from other inflammatory conditions like an inflammatory arthritis.

Central sensitization: central sensitization refers to the increased responsiveness of pain-sensing (nociceptive) neurons to normal or subthreshold input, meaning these nerves interpret normally non-painful stimuli as pain. This is thought to contribute at least in some part to the pain felt by chronic low back pain sufferers.

Radiculopathy: Radiculopathy is caused by narrowing of the space through which the nerves of the spine exit. The underlying cause may be a herniated intervertebral disc, a tumor, localized inflammation, or bone spurs causing narrowing of the intervertebral space. Pain, weakness, or sensation changes that refer down into the buttocks or legs is often radicular in nature

Fascial and soft tissue restrictions: The appropriate sliding and gliding of fascial layers and soft tissue is important for normal, pain-free, and unrestricted movement.

Mechanical Back Pain: Mechanical back pain is the most common type of back pain and occurs when a load is placed on a structure of the back (ie intervertebral disc, joint, bone, muscle) that it cannot withstand and causes inflammation and irritation. This can be acute such as an injury that occurs when you suddenly lift something heavy or cumulative in response to something you’ve done over and over again.

WHEN SHOULD I SEEK URGENT CARE?

Though back pain may feel very serious, it can often be managed in an outpatient setting. In certain circumstances, however, back pain may signify a more serious medical condition that needs urgent evaluation and treatment. Here are some red flags to look out for:

Back pain accompanied by losses of sensation in the trunk or lower body, changes in bowel or bladder function or weakness in the legs needs immediate assessment

Low back pain that radiates to the abdomen and is characterized by a deep, stabbing pain in the abdomen between the breastbone and the belly button could indicate an abdominal aortic aneurysm. Suspicion for this condition is intensified if there is a pulsatile mass that can be palpated or felt in the abdomen. Shortness of breath, rapid heart beat, clammy skin, loss of consciousness, or anxiety may indicate shock.

Low back pain accompanied by numbness in the groin, genitals, buttocks, or inner thigh and/or trouble controlling bowel or bladder function including difficulty starting or stopping the flow of urine or feces or sexual dysfunction can indicate cauda equina syndrome. This serious condition occurs when there is compression of the nerves at the lowest part of the spine.

Unrelenting back pain that is not responsive to medication or rest that is accompanied by night sweats, fever, night pain, unexplained weight loss and progressive weakness could be a spinal tumor or infectio

Back pain after a trauma could indicate either soft tissue injury or fracture

Any one of these presentations necessitates urgent assessment by a medical professional so that appropriate medical intervention and treatment can be prescribed right away.

WHAT ABOUT PHYSICAL THERAPY?

Physical therapy is a great option for treating new or recurrent back pain. Physical therapy aims to give you immediate relief of your symptoms whenever possible, but most importantly, aims to address the underlying causes to reduce the likelihood they will return in the future. Here are some ways PTs will address your symptoms when you come in for a physical therapy treatment:

Improve flexibility: Your back PT program may include stretching, myofascial release techniques, joint mobilization and mobility exercises to improve flexibility in the back itself but also in other areas of the body such as the ankles, hips, and shoulders.

Build up your strength: You will learn exercises to help strengthen the muscles around the back and abdomen to properly stabilize the spine and also in the arms and legs to minimize excess strain transfer to the back. Having good strength throughout the body allows stress to be distributed across multiple joints and helps to prevent injury and irritation in the future.

Optimize your movement: Learning proper biomechanics and enhancing the neuromuscular control of joints and muscles is an essential component of healing and preventing back injuries. Physical therapists are movement experts and through analyzing your movements, can guide you in improving how you move and train your muscles to perform those movements in the safest and most effective way possible.

While back symptoms can be disruptive to your daily life, conservative treatments such as physical therapy are often highly effective. Physical therapists can identify the myriad of factors contributing to your specific back symptoms and provide you with a rehabilitation program to improve them now and help prevent them in the future. A physical therapist at Evolve can help you get on the road to healing your back.

Click here for more information about physical therapy for back pain in Brooklyn

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Am I Covered? Physical Therapy and Health Insurance

How Well Do You Know Your Physical Therapy Benefits? If I asked you to describe the physical therapy benefits included in your insurance plan without referencing your policy could you do it? For most of us the answer is probably a hard no. Unless you live with a chronic condition or are frequently injured this is probably not at the forefront of your mind when you are selecting an insurance plan. Deductibles, out of pocket max, in-network coverage, and monthly premiums are often the factors we weigh most heavily when selecting a plan.

Will my Insurance Cover Physical Therapy?

How Well Do You Know Your Physical Therapy Benefits?

Am I Covered Physical Therapy and Health Insurance (Without Text).jpg

If I asked you to describe the physical therapy benefits included in your insurance plan without referencing your policy could you do it? For most of us the answer is probably a hard no. Unless you live with a chronic condition or are frequently injured this is probably not at the forefront of your mind when you are selecting an insurance plan. Deductibles, out of pocket max, in-network coverage, and monthly premiums are often the factors we weigh most heavily when selecting a plan. It often isn’t until we are standing at the front desk of the physical therapy clinic before our first visit that we find out what our coverage actually looks like. For some of you it may be a pleasant surprise, for others it could be a bit of a disappointment. If you are hoping to start physical therapy and aren’t sure how your insurance plan will cover the treatment, this article will provide you with a six step plan to evaluate your insurance coverage for PT services.

STEP 1: DOES MY THERAPIST ACCEPT MY INSURANCE PLAN?

Just like physicians, dentists, or chiropractors, physical therapists and physical therapy clinics can select the insurance plans with which they want to be in contract. If you are hoping to use your insurance coverage for physical therapy you should contact your insurance provider to verify whether your therapist is in-network or out-of-network with your insurance plan and ask how this will affect the amount you will be responsible for paying for each visit.

STEP 2: DO I NEED A REFERRAL?

In the past a referral from a surgeon, physician, or other qualifying provider was required to initiate a physical therapy evaluation without exception. This rule has changed, however, in some cases in states that allow direct access. Direct access gives physical therapy providers the ability to evaluate a patient without a physician’s referral. Direct access is not allowed in all states and its scope varies quite a bit by state as well. In some states PT’s can evaluate you but not start treatment without a referral. In other states they can treat you for thirty days but not beyond that, and still in other states there is unrestricted direct access in which the PT can carry out an entire plan of care without getting a referral.

If you live in a state without direct access then you can be certain you need a referral to start care and to ensure insurance coverage. In states with direct access, however, even if the law allows a physical therapist to treat you without a referral your insurance may not pay for the services if they require that you have a referral. That’s right, some insurances require a referral as a necessity of utilizing your physical therapy benefits so be sure to read through your policy or call your insurance plan if you aren’t sure.

STEP 3: HOW MANY VISITS AM I ALLOWED?

While most insurance plans will cover physical therapy care that is appropriate and safe for your medical condition, meets the standard of good healthcare practices, and is medically and functionally necessary, they are not required to offer you unlimited coverage. Being aware of how many visits you are allowed under your current coverage will help ensure you use them wisely.

Insurance plans typically follow one of these rules when it comes to determining how many visits you are allowed each year:

The plan places a hard limit on the amount of visits covered each insurance-year (i.e. 15, 30, 60 visits). Whether you are seen for one, two, or three separate episodes of care during the year you will be slowly chipping away at this allowed total during each visit.

The plan specifies coverage for physical therapy is “based on medical necessity” Technically this type of plan does not place a hard limit on yearly physical therapy but this does not give carte blanche for physical therapists to continue treating patients without good reason. If your insurance plan requires intermittent authorization for continued visits or if they audit your chart at any point they will be looking for evidence that there is a medical or functional necessity for continued care, that you are responding to care, and/or that there is good evidence that your condition would decline without physical therapy intervention. Without this justification your plan will likely not pay for these services.

The plan specifies a certain dollar amount that they will pay for services

Medicare is the most well-known plan that uses this construct. Up until 2018 Medicare placed a hard “cap” on how much physical therapy, speech therapy, and occupational therapy could be reimbursed by Medicare. After you met that cap further services were no longer eligible for reimbursement. Since then the rules have been relaxed to allow beneficiaries to continue to receive care beyond the first cap as long as it is medically necessary. Effective January 1, 2022 the current Medicare cap for physical therapy and speech therapy combined is $2,150. Physical therapists are allowed to exceed this threshold if it is medically necessary with the addition of a “kx modifier” on their charges and after $3,000 a targeted medical review may be initiated.

STEP 4: DO I NEED PRE-AUTHORIZATION?

The need for pre-authorization is very plan-specific. Some insurance plans require that the therapist or clinic submit for pre-authorization prior to completing the initial evaluation. Other plans will allow the therapist to complete the initial evaluation but must submit a pre-authorization outlining their intended plan of care and wait for insurance approval before continuing care. Typically in these cases the insurance plan will supply the therapist with an authorization specifying what treatment codes and how many visits will be covered up until a certain date. Request for coverage of further visits usually requires that the therapist provide proof of response to therapy services and medical necessity for ongoing care.

STEP 5: HOW MUCH WILL THESE VISITS COST ME?

Many insurance plans limit out-of-pocket costs for physical therapy to a copayment. Other plans may require you to pay for part of all of your visits until you have met your deductible or your out-of-pocket max for the year.

STEP 6: ARE THERE CERTAIN TREATMENTS OR CONDITIONS NOT COVERED BY MY INSURANCE?

Treatments that are not considered medically necessary or targeted towards improving function may not be reimbursed by the insurance plan. In states where physical therapists perform dry needling, for example, you may be required to pay a cash rate for this service if it is not covered by insurance. Other treatments like electrical stimulation or ice/heat also may not be covered.

Similarly, wellness, sports performance, and fitness services are typically not covered by physical therapy benefits.

The key to documenting medical necessity for physical therapy is describing how PT services eliminate or improve impairments (pain, range of motion restrictions, weakness, etc.), activity limitations (difficulty going down stairs, pain with running, etc.) and participation restrictions (unable to return to work, can’t care for your children). If your medical condition impacts any of these areas then there is likely medical necessity for at least some physical therapy.

UNDERSTANDING YOUR COVERAGE IS IMPORTANT

After reading this article you should have a better understanding of how insurance plans reimburse for physical therapy. With this information you can make more informed decisions about how to use your current physical therapy benefits so there won’t be any surprises. Reviewing your policy and calling your insurance plan is the best way to get this information but the administrative staff at the physical therapy clinic can usually help answer some of these questions after verifying your benefits. Physical therapy is an excellent way to address any injuries or conditions impacting your ability to participate in your life fully. Now that you understand how your insurance coverage works it is time to call Evolve PT and schedule your physical therapy evaluation today.

Click here for more information about our physical therapy services in Brooklyn

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Schedule an Appointment Now!

https://EvolveNY.com

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Physical therapy for Neurological Disorders

Whether you are newly diagnosed with a neurologic condition or have been living with one for some time, you may be curious as to how physical therapy for neurologic disorders may help you…

Fighting Back Against Neurologic Disorders

Whether you are newly diagnosed with a neurologic condition or have been living with one for some time, you may be curious as to how physical therapy for neurologic disorders may help you. Though in most cases physical therapy is not able to stop or cure the condition affecting the nervous system, it has been shown to be highly effective in managing the effects that many of these conditions have on the body which leads to improved overall function and quality of life, despite having this condition.

LET’S TAKE A LOOK AT THE NEUROLOGIC SYSTEM

The neurologic system is a continuous network of nerves beginning in the brain and traveling through the spinal canal and out to all of the tissues of the body. The nerves that reside within the brain and the spinal cord make up the central nervous system. The nerves that extend from the brain and spinal cord and travel to all the other areas of the body are known as the peripheral nervous system.

In general, nerves are carrying either outgoing motor information to tell a muscle in the body to contract or incoming sensory information about how the body is moving, what it is feeling and how it is interacting with the outside world. Some of these nerves are under conscious control while others are under automatic and unconscious control. An example of nerves under conscious control would be the nerves that supply motor to the hand. In a healthy hand you can open and close the hand and move the fingers around as you desire. On the other hand, the nerves that control the beating of the heart are under involuntary control though you may be able to speed up and slow down your heart a bit through certain actions like taking slow deep breaths.

HOW DO INJURIES OR DISORDERS OF THE NERVOUS SYSTEM AFFECT THE BODY?

The body and all of its functions are mapped out within the central nervous system. We know generally which areas of the brain and spinal cord correlate with which body areas and bodily functions. This is important both because it can help diagnose neurologic conditions but also because it allows medical professionals to predict what kind of difficulties or symptoms a person may experience based on which part of the nervous system is affected or injured. Similarly, the peripheral nerves each innervate different areas of the body and play different roles in its function so the presence of specific symptoms can give a clue as to which nerve may be affected.

Because the nervous system is responsible for everything the body does and experiences, symptoms of a neurologic disorder can be wide ranging but certain neurologic disorders tend to present in specific ways depending on what part of the nervous system they are impacting. Here are some of the body systems that may be affected by a neurologic disorder and how it may present:

Visual System: changes or worsening of vision, double vision, loss of peripheral vision

Auditory and Vestibular System: changes in hearing, tinnitus, dizziness, vertigo or loss of balance

Musculoskeletal System: Alterations in muscle strength and flexibility and overtime changes in bone density

Neuromuscular System: Changes in coordination and motor control, alterations in muscle tone, losses of balance

Language: the ability to speak and understand simple and complex language

Sensory System: loss or alterations in light touch, sharp/dull, temperature and pain sensations

Because these conditions can affect so many body systems, symptoms common to neurologic disorders include muscle weakness, impaired sensation, pain, fatigue, poor balance, difficulty walking and difficulty performing mobility tasks and activities of daily living.

WHAT NEUROLOGIC CONDITIONS CAN PHYSICAL THERAPY ADDRESS?

Some of the neurologic conditions that would benefit from physical therapy treatment are:

Stroke
Dizziness
Brain injury or concussion
Parkinson’s Disease
Alzheimer’s and Dementia
Spinal cord injury
Cerebral Palsy
Peripheral neuropathy
Huntington’s Disease
Guillain Barre
General impairments in balance
Multiple Sclerosis
Amyotrophic Lateral Sclerosis
Peripheral nerve injury
Ataxia
Dysautonomia

This is not an exhaustive list, however, and there are other neurologic disorders that physical therapists also treat!

PHYSICAL THERAPY FOR NEUROLOGIC DISORDERS

A physical therapist experienced in working with neurologic injuries and disorders has extensive knowledge of the nervous system. They have also studied the different neurologic conditions and injuries and know what the research tells them is the most effective way to address these conditions. While a physical therapy program should be individualized to meet your specific needs, there exist some common goals of physical therapy for neurologic disorders.

By addressing muscle weakness, pain, range of motion limitations, balance issues, coordination and motor control impairments, physical therapy aims to:

Maximize your mobility (walking or wheeled) including such things as reducing the amount of physical support you need, increasing the distance you can travel without a break and improving your confidence.

Help improve independence with daily tasks in the home, at work and in the community

Reduce your risk for falls

Help you develop an appropriate regular exercise and fitness program to reduce your risk for secondary chronic diseases that may develop in response to decreased exercise and increased sedentary behaviors including high blood pressure, high cholesterol, diabetes and heart disease

Empower you to live your life to the fullest despite having a neurologic disorder

Ensure the equipment, orthotics, bracing and assistive devices you have meet your needs and help you meet your functional goals

AN OPPORTUNITY TO BE PROACTIVE IN YOUR CARE

If you have noticed that your function is being negatively impacted by a neurologic disorder, ask your doctor for a referral to physical therapy or if you live in a state where you can access physical therapy directly, you can schedule an appointment today! At Evolve PT we have therapists who specialize in working with these conditions and are looking forward to working with you on your goals.

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Neuromuscular Physical Therapy

Why Choose PT for Neuromuscular Diseases? Be Proactive With PT for Neuromuscular Diseases! Those diagnosed with Neuromuscular diseases may be experiencing a significant impact on their daily function or noticing that some tasks that used to be easy are becoming more difficult. While a diagnosis of a neuromuscular disease can be scary, physical therapy is an important tool to help you combat many of the consequences of these conditions.

Why Choose PT for Neuromuscular Diseases?

Be Proactive With PT for Neuromuscular Diseases!

Those diagnosed with Neuromuscular diseases may be experiencing a significant impact on their daily function or noticing that some tasks that used to be easy are becoming more difficult. While a diagnosis of a neuromuscular disease can be scary, physical therapy is an important tool to help you combat many of the consequences of these conditions. Let’s dive a little further into neuromuscular diseases and how physical therapy can help preserve function and address some of the common symptoms.

WHAT IS A NEUROMUSCULAR DISEASE?

Neuromuscular diseases are those which impair the function of the muscles due to their effects on the muscles themselves or the nerves that innervate the muscles. While relatively uncommon, these disorders are typically inherited, caused by a spontaneous gene mutation or at times by an immune system disorder. Some of them may show up early in life while others may remain unexpressed until later in life.

Some of the more well-known neuromuscular diseases include Muscular Dystrophy, Amyotrophic Lateral Sclerosis (ALS), Charcot-Marie-Tooth disease (CMT), Spinal Muscular Atrophy, Polymyositis and Myasthenia Gravis but there are many more. These diseases fall within several distinct categories based on how they affect the muscles and the motor nerves. These categories are:

Muscular dystrophies: a group of diseases that cause weakness and degeneration of the skeletal muscle due to their effect on the muscle cells

Motor Neuron Diseases: a group of diseases that cause progressive deterioration of the motor neurons–nerves that supply the muscles and signal them to contract

Ion Channel Diseases: these diseases are caused by defects in proteins called ion channels. Muscular weakness, periodic paralysis or absent muscle tone are hallmarks of these conditions

Mitochondrial Diseases: mitochondria produce energy within the muscle cells. This subcategory of diseases is caused by an impairment in mitochondrial function

Myopathies: a large umbrella category of diseases characterized by impaired functioning of the muscle cells

Neuromuscular Junction Diseases: where the motor nerve and the body of the muscle meet is called the neuromuscular junction. Several very important processes occur at this junction that facilitate the contraction and relaxation of muscles

Peripheral Nerve Diseases: while the central nerves are those that travel within the brain and spinal cord, the peripheral nerves travel in the periphery of the body to the skin, muscles and organs. Impairments in these nerves can cause both loss of muscle function and sensation.

WHAT ARE THE SYMPTOMS OF A NEUROMUSCULAR DISEASE?

Because neuromuscular diseases impair the muscles either directly or through the nerves that innervate them, a pattern of symptoms is often seen with these conditions though the area of the body most affected, the pattern or progression and severity can vary widely. Here is a list of some of the more common symptoms of a neuromuscular disease:

Muscle weakness, wasting/atrophy (most common)
Muscle twitching, cramps, aches and pain
Numbness, tingling and painful sensations
Difficulty with movement
Reduced balance
Difficulty walking
Trouble swallowing
Drooping eyelids
Difficulty breathing

Because muscle weakness is the primary symptom of a neuromuscular disease, performing everyday tasks may become more difficult. If the muscles that coordinate swallowing or breathing become affected, a tube to provide nutrition and machines to support breathing may be necessary.

WHAT CAN PT DO TO HELP WITH THESE SYMPTOMS?

There are many ways that a physical therapist can help a person diagnosed with a neuromuscular disease. Here are some of the elements of physical therapy treatment you may encounter:

Exercise: While it may seem counterintuitive, exercise to improve strength, endurance and aerobic capacity is safe and beneficial in most cases of neuromuscular diseases (Anziska, Y & Inan, S, 2014). That being said, it is a good idea to consult with a knowledgeable exercise professional like a physical therapist when starting an exercise program if you have been diagnosed with a neuromuscular disease. They will be able to individualize the program in a way that maximizes both safety and effectiveness given the severity of your condition.

Manual Therapy: Manual therapy includes hands-on techniques to improve joint and tissue extensibility, reduce pain, improve flexibility and range of motion.

Balance training: Impairments in the nerves that transmit motor and sensory information can lead to difficulty balancing and may lead to falls. Balance training can help your body compensate for these changes and reduce your risk for falls.

Gait and mobility training: Independent mobility is an important goal of physical therapy. Aside from working to improve strength, balance and endurance to improve walking (or rolling), prescribing and fitting assistive devices or assisting in getting a wheelchair can be an important aspect of physical therapy for neuromuscular diseases.

Pain Management: Pain may be a direct symptom of the disease itself or a result of altered movement patterns, joint position and stress that results from having weaker muscles. Your physical therapist can assess the underlying causes of your pain and work with you to find strategies for pain relief whenever possible.

Equipment prescription: When muscle weakness begins to impair the performance of daily tasks or activities we need and love to do, a physical therapist can help you with finding equipment to compensate for the loss of strength and mobility. This may include devices for mobility like canes, walkers and wheelchairs. They may also prescribe equipment to help you perform daily tasks in the kitchen, the bathroom, and the workplace. You may even find there is great equipment to help you continue to drive or participate in your favorite sport.

Bracing and orthotics: As muscles weaken, bracing and orthotics can help to support the joints externally. Bracing of the feet and ankles may help with standing and prevent tripping, for example. Bracing of the wrist and hand may provide the stability you need to grip and grasp onto something. Also, bracing and orthotics can help with pain relief when prescribed appropriately.

Education: Patient education is an important part of physical therapy for neuromuscular diseases. Not only can your PT help educate you on how your condition may affect your daily functioning and on strategies for compensation, but education on things like pacing and energy conservation are also a part of the treatment plan.

Living with a neuromuscular disease can feel scary but healthcare professionals like physical therapists are here to help you be proactive and take back some control over your health and function. Don’t wait to call us here at Evolve PT so that we can begin to work with you on a plan that will help meet your goals.

Click here to find out mor einformation about physical therapy for neuromuscular diseases

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Going In for Surgery? How Physical Therapy Can Help Pre and Post Op

Don’t Skip Physical Therapy Before or After Surgery- Did you know that physical therapy is not only a great tool to help you recover from surgery but also one that can help prepare you for surgery? It’s true. Physical therapy prior to surgery, sometimes called prehab, has many benefits that can help improve your surgical outcome. So if surgery has been recommended as the best treatment for your condition, read on to learn how physical therapy can set you up for success on both sides of the operating table…

Should I Start PT BEFORE Surgery?

Pre-and Post Surgery PT is the Key to Success…

Don’t Skip Physical Therapy Before or After Surgery

Did you know that physical therapy is not only a great tool to help you recover from surgery but also one that can help prepare you for surgery? It’s true. Physical therapy prior to surgery, sometimes called prehab, has many benefits that can help improve your surgical outcome. So if surgery has been recommended as the best treatment for your condition, read on to learn how physical therapy can set you up for success on both sides of the operating table.

WHY SHOULD I CONSIDER PREHAB?

Prehab was a term coined to describe the use of health interventions to avoid injury, decrease pain, or prepare for surgery. Many times after we’ve sustained an injury or if we’ve been dealing with symptoms for a long time we naturally decrease our level of movement and exercise to avoid provoking uncomfortable or painful symptoms. While this choice will most likely accomplish the goal of reducing your symptoms, it doesn’t necessarily put you in the best position for an easy recovery from surgery. If the surgery isn’t an emergency there are many ways that a physical therapist can help prepare you and your body for the upcoming procedure.

Know what to expect: The idea of surgery can frankly be quite scary. Having an idea of what to expect after the procedure can ease some of your anxiety and make sure you have what you need to support your recovery. Getting to know your physical therapist before surgery will help build trust with them when it comes time for post-operative care. They can also advise you on any equipment or modifications to your home that might be necessary, help you understand what kind of help or support you will need from others, and prepare you for how your body may feel after surgery.

Manage pain and inflammation: Pain and inflammation are natural results of injuries. They alert us that we need to protect the injured area and that the body is taking steps to start the healing process. In some cases, however, your surgeon may require that your injury is “quiet”, meaning it can tolerate some stress and activity without causing significant swelling, before they want to operate. If this is the case, or if surgery is delayed for any reason, learning strategies to manage pain and inflammation in the meantime will help you stay comfortable and as active as possible.

Learn how to use assistive devices: If you will be leaving the hospital with a shiny new walker, cane, or set of crutches, learning how to use them beforehand can be very helpful. Immediately post surgery, when you are still feeling the effects of anesthesia and pain and stiffness are setting in, is not the best time to learn how to use an unfamiliar device that is meant to protect your recently operated-on body part.

Build or maintain strength and flexibility: While the brain knows that surgery is intended to “heal” the injury, the body views the surgical procedure as another injury to the tissues. Think about it, surgery requires incisions and instrumentation that often disrupt many layers of tissue. While the surgeon may have sewn a torn ligament or fused a couple of vertebrae which will ultimately improve your symptoms and get you moving again, the body will need to heal from the effects of the surgery before that can happen. Maximizing strength and flexibility prior to the surgery can help decrease muscle atrophy and stiffness following the procedure which can ultimately quicken your recovery.

WHAT CAN I EXPECT AFTER MY SURGERY?

Post-surgical physical therapy has many goals:

Control pain and inflammation
Protect the surgical site while it heals
Promote the healing process
Educate you on how your healing is progressing and what you can do at home and in therapy to support this process
Restore strength, flexibility, and neuromuscular control
Help you to return to your prior level of activities

Most likely your surgeon will provide you or your physical therapist with a post-surgical protocol that outlines parameters for exercise and activity at different stages of your recovery. It often provides goals for each stage of rehabilitation and gives allowances for how much weight you can bear through your arms or legs, how much stretching or range of motion is allowed, how much weight you can lift, and what kinds of activities are permitted.

The type of surgery you had will dictate how long you can expect to be under the care of a physical therapist and how quickly you can progress back to your prior level of activity. Even when the surgeon feels that the surgical site can withstand normal activity, your body may not be ready to jump back into heavy weight lifting, long runs, or aggressive training. Ramping up activity too quickly without adequately preparing the body is a recipe for re-injury. Your physical therapist will continually assess you and help you prepare your body to safely accept the stresses of your favorite activities so you can keep this surgery a distant memory.

DON’T WAIT TO GET STARTED

If you know that a surgery date is on the calendar, call Evolve PT to schedule appointments today. The physical therapists at Evolve can help you prepare your body and mind for surgery and will be standing by to help you recover after it’s finished.

Click here to find out more information about prehab physical therapy and post-op physical therapy

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Jay C 1/6/23 Jay C 1/6/23

MSK Physical Therapy Services

Musculoskeletal PT: Get to the Root of the Problem? The Many Faces of Musculoskeletal Physical Therapy.- Physical therapy for the musculoskeletal system is the subspecialty of physical therapy with which most people are familiar. The term physical therapist often conjures up images of clients doing back strengthening exercises, athletes working on their shoulders and older adults rehabbing a total knee replacement.

Musculoskeletal PT: Get to the Root of the Problem?

The Many Faces of Musculoskeletal Physical Therapy

Physical therapy for the musculoskeletal system is the subspecialty of physical therapy with which most people are familiar. The term physical therapist often conjures up images of clients doing back strengthening exercises, athletes working on their shoulders and older adults rehabbing a total knee replacement. These are all examples of physical therapy for the musculoskeletal system and many PT professionals will dedicate their careers to mastering the assessment and treatment of the bones, joints, tendons, fascia, ligaments and soft tissue, the structures that make up the musculoskeletal system. Let’s take a further look into how physical therapists work with the musculoskeletal system.

WHAT KINDS OF MUSCULOSKELETAL CONDITIONS DO PHYSICAL THERAPISTS TREAT?

A wide range of conditions and injuries affect the musculoskeletal system. In general, we can think about musculoskeletal physical therapy as addressing four primary categories of musculoskeletal concerns.

Acute injuries: Acute injuries are those that have recently occurred, typically within the last few weeks (subacute injuries are included here). Symptoms of an acute injury to the musculoskeletal system include:

Pain
Swelling and inflammation
Muscle or joint stiffness
Muscle weakness
Redness and warmth
Local deformity
Difficulty moving or bearing weight through the area

Chronic injuries and issues: Chronic injuries are those that are more than a few weeks old, have (optimally) entered a more chronic phase of healing wherein things like pain and inflammation have significantly decreased. An example of this type of chronic injury is a person seeking PT four weeks after an acute ankle sprain. This can also include chronic irritation or pain that is ongoing or intermittent and may or may not be easily attributed to a particular incident. For example, someone who experiences knee pain whenever they run.

Pre- and post-surgical rehab: Surgeries are performed to address a wide range of medical conditions and injuries. Any surgery, no matter how small, disrupts tissues in the body and can lead to impairments in tissue mobility, scarring, pain, stiffness, muscle weakness and alterations in movement. Musculoskeletal physical therapy aims to address all of these concerns to help restore optimal functioning of the affected area. The goal of pre-surgical rehab is to prepare the body for surgery and to help optimize the post-surgical recovery and outcome.

Injury Prevention: Sometimes the goal of musculoskeletal physical therapy is to identify risk factors for injury and intervene to address them before the injury occurs. This is often done in the context of athletes who are preparing for an upcoming season or a new training block. In this case therapists combine their knowledge of the musculoskeletal system and their familiarity with the demands of a particular sport or activity to identify areas of movement and performance that may predispose the individual to injury in the future. After a thorough assessment, treatment and exercises are prescribed as necessary to optimize performance and lower the risk of injury. Another area of musculoskeletal physical therapy centered on injury prevention is PT for pre-partum women.

As you can see, musculoskeletal physical therapy can address a wide range of conditions affecting the body. Here is a list, though far from comprehensive, of conditions that musculoskeletal physical therapists treat

TMJ disorders
Back pain and neck pain
Other joint pain (knee, ankle, foot, hip, shoulder, elbow, wrist, hand)
Arthritis
Post-surgery (examples: ACL repair, bunion repair, hip or knee replacement, carpal tunnel surgery, spinal fusion, and many, many more)
Fracture recovery
Rotator cuff injury
Muscle strain
Ligament sprains
Muscle contusions
Joint replacement recovery (knee, shoulder, hips, etc.)
Headaches
Muscle stiffness and tightness
Pain with activity
Pre- and post-partum

WHAT DOES MUSCULOSKELETAL PHYSICAL THERAPY LOOK LIKE?

As with all physical therapy, musculoskeletal physical therapy should be individualized to meet your specific needs. After interviewing you about your symptoms and performing a physical exam, your physical therapist can discuss with you the plan of care. Typically you will work with your physical therapist between 1 and 3 times a week for a number of weeks, tapering off as you make improvements and near your discharge date. The main goals of this type of physical therapy is to help you return to the functional activities you need and love to do with as few symptoms as possible and to give you strategies to maintain the improvements you made during therapy to prevent recurrence of the problem in the future.

Some of the primary goals of musculoskeletal physical therapy are as follows:

Improve flexibility: Your PT program may include stretching, myofascial release techniques, joint mobilization and mobility exercises to improve flexibility and range of motion.

Build up your strength: You will learn exercises to help strengthen the muscles around the injured area and other connected areas of the body. Having good strength throughout the body allows stress to be distributed across multiple joints and helps to prevent injury and irritation in the future.

Optimize your movement: Learning proper biomechanics and enhancing the neuromuscular control of joints and muscles is an essential component of healing and preventing injuries. Physical therapists are movement experts and through analyzing your movements, can guide you in improving how you move and train your muscles to perform those movements in the safest and most effective way possible.

REST IS NOT ALWAYS BEST

Many of us are in the habit of resting and cutting back our activities whenever we feel pain or experience injury but active recovery is often the best strategy. The important thing, however, is to do it in a way that enhances the resiliency of the injured or irritated tissues and doesn’t injure it further. This is where the knowledge and expertise of a licensed physical therapist comes in handy. Even if the injured area must be immobilized and rested for a period of time, finding appropriate ways to exercise adjacent areas and promote movement will help with healing and recovery.

So if you are struggling with a new injury, planning on having surgery, looking to prevent a future injury or are tired of dealing with some chronic irritation, don’t play the wait-and-see game. Call Evolve PT today and let our skilled team of providers guide you to long lasting recovery and improvements.

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Wait… Do I have TMJ or TMD?

Wait… Do I have TMJ or TMD? You may hear people say that they have TMJ when referring to popping, clicking, tightness, or pain in their jaw joint. The term TMJ, however, actually stands for temporomandibular joint, the hinged joint located in front of each ear where the jaw bone attaches to the skull…

What is TMJ?

Here’s What We Have to Say About the TMJ

You may hear people say that they have TMJ when referring to popping, clicking, tightness, or pain in their jaw joint. The term TMJ, however, actually stands for temporomandibular joint, the hinged joint located in front of each ear where the jaw bone attaches to the skull.

What people usually mean to say is that they have TMD (temporomandibular dysfunction) or TMJD (temporomandibular joint dysfunction), the name of the condition affecting the inside or the outside of the TMJ that causes these symptoms.

Despite its relatively small size, the TMJ has some really important jobs to do and those suffering from TMD know that these joints can cause a whole lot of suffering when they aren’t working optimally.

WHAT AND WHERE IS THE TMJ?

The temporomandibular joint is located in front of the ear on each side of the face. It is the connection between the mandible or jaw bone and the temporal bone of the skull. The joint is a bit unique in that it acts a little like a hinge joint and a little like a ball-and-socket joint. This allows for movements of the jaw in many directions. The jaw can open and close, protrude (slide forward) or retrude (pull back), and move side to side. The two joint surfaces are separated by an articular disc and surrounded by fibrocartilage. Several ligaments stretch between the skull and the jaw bone to stabilize the TMJ. Muscles of the face allow movement of the jaw in its many directions.

Without the TMJ you would find a long list of things you could no longer do. The multiplanar movements of the jaw, facilitated by the TMJ, are necessary for chewing, sucking, talking, swallowing, breathing, facial expressions, and opening and closing the mouth to eat and drink. When loss of optimal function occurs in this joint we call it TMD or TMJD and now that you know how important the TMJ is, you can see why addressing this condition is so important.

LET’S TALK ABOUT TMD

Problems both within the joint itself and outside of the joint may fall under the umbrella of TMD. Aside from the functional problems with eating, talking, facial expressions, etc., dysfunction at the TMJ can also cause facial pain, jaw pain or soreness, jaw fatigue, earache or ringing in the ears. Additionally headache, popping of the joint, locking of the jaw, teeth sensitivity without dental issues, limited mouth motions, and changes in the way the teeth fit together can occur. Often these symptoms are more pronounced upon waking up and in the late afternoon. It is important to know that jaw sounds like popping or clicking that are not accompanied by pain or limited jaw movement are not considered a serious problem. The truth is, joints are noisy, even healthy ones can make noise when there are no problems to worry about.

The cause of TMD may originate from problems with the joint such as arthritis or it can originate in the muscles or ligaments that surround it. Often the cause of TMD is thought to be multifactorial. Biological, environmental, emotional, social, and cognitive triggers for TMD exist. The incidence is higher in persons diagnosed with other conditions such as autoimmune conditions, sleep apnea, mental illness, or fibromyalgia. TMD can be the result of arthritis in the TMJ or from displacement of the articular disc. Jaw or facial fractures and surgery of the face or jaw may lead to TMD in some persons. Also problems with teeth alignment (malocclusion) and frequent jaw clenching (bruxism) can trigger TMD. Even poor posture habits can lead to TMD if repeated frequently. We don’t know the exact statistics on TMD but some estimates suggest over 10 million Americans may be living with this condition.

WHAT CAN I DO IF MY JAW IS BOTHERING ME?

If you’ve noticed that you are experiencing any of the symptoms of TMD you may be wondering what you can do about it. If the problem is new and not severe or accompanied by warmth, redness, or swelling of the joint, chest pain or pressure, or fever, you can probably start with some at-home treatments to see if this helps. Here are some things you can try:

Set a timer when you are working to check in every 15-30 min and see if you are clenching your jaw. Practice separating your teeth and relaxing your muscles

Apply a cold or warm (not hot) compress to the area for 10-15 min. The cold can help reduce inflammation while the warmth will increase blood flow and help relax muscles. Be sure to set yourself a timer to remind you to take it off and don’t fall asleep with either of these on

Practice meditation or breathing techniques to help relax you and relieve stress. Jaw clenching and teeth grinding often increase when we are stressed

Work on your posture. Poor postural habits can exacerbate TMD. Try changing positions throughout the day if you tend to sit in one place to work, for example, for hours at a time

Get a good night’s sleep and use a pillow that is supportive and allows your neck and jaw to relax

WHEN TO CALL THE DOCTOR…OR DENTIST

If you’ve tried these home remedies for a couple of weeks and aren’t seeing improvements in your symptoms it is a good time to reach out to a professional. Because several other health conditions can cause symptoms that mimic TMD it is important to have a qualified healthcare professional examine you if you aren’t improving quickly or if you have any symptoms that suggest a more acute problem. A visit to your physician or dentist is a good first step. Sinus infections, certain types of headaches, dental issues like a tooth abscess, and a nerve condition called trigeminal neuralgia can also present as jaw symptoms but need to be treated differently than TMD.

The most concerning cause of jaw pain or discomfort is cardiac ischemia or lack of blood flow to the heart. This can occur during a heart attack but also can occur as a warning side of an impending cardiac event. Nausea, vomiting, chest pain or pressure, pain in the left hand, arm or shoulder, or even teeth pain that accompanies the jaw symptoms could indicate a cardiac origin and needs immediate medical attention.

WHAT ABOUT PHYSICAL THERAPY?

Physical therapy is an excellent form of conservative treatment for TMD. Because of the multifactorial nature of these conditions, a physical therapist that takes a holistic approach to your care can help you make changes or improvements in several of the areas that could be contributing to your symptoms and teach you how to prevent recurrence.

Here is a sneak peek at some of the treatments your physical therapist may use to address jaw joint dysfunction:

Postural re-education: PT will assess for any postural abnormalities and teach you how to be aware of them and begin to correct them.

Manual Therapy to improve jaw mobility: Restoring the normal motions and mobility of the TMJ and jaw can be done through gentle hands on techniques either outside of the mouth or sometimes from inside the mouth.

Strengthening Exercises: Exercises to strengthen the muscles around the jaw and neck can be very helpful in reducing symptoms of TMD, improving jaw range of motion, and reducing the likelihood of recurrence.

Dry needling, ultrasound, electrical stimulation: Your therapist may choose to apply these modalities to manage your pain and inflammation

Whenever possible a conservative approach is a good first step to addressing symptoms of TMD. If conservative treatments like physical therapy have not been successful, it may be time to talk with your doctor or dentist about treatment options like oral splints or night guards, botox injections, medication management and as a last resort, surgical intervention. If you have been dealing with pain or discomfort in the TMJ this article should help you understand more about your condition and give you an idea of first steps you can take on the road to improving your symptoms.

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Jay C 12/19/22 Jay C 12/19/22

Do You Have Issues in Your Soft Tissues?

What is Soft Tissue Mobilization? Soft tissue therapy or soft tissue mobilization techniques have long been a part of physical therapy practice. While massage is a broad term that encapsulates the practice of kneading or rubbing of muscles and joints with the purpose of relieving tension and can be performed by many different types of practitioners, soft tissue mobilization (STM) is a more specialized technique…

What is Soft Tissue Therapy?

What is Soft Tissue Mobilization?

Soft tissue therapy or soft tissue mobilization techniques have long been a part of physical therapy practice. While massage is a broad term that encapsulates the practice of kneading or rubbing of muscles and joints with the purpose of relieving tension and can be performed by many different types of practitioners, soft tissue mobilization (STM) is a more specialized technique that requires a deep understanding of the anatomy and physiology of deep tissue layers. STM requires the assessment of these tissues and an understanding of how manipulating them impacts function. In this article we will take a look at the layers of soft tissue in the body, examine the stages of healing that these tissues undergo after injury, and explore how soft tissue mobilization techniques can help treat pain, impaired posture, inflammation, and range of motion and mobility restrictions.

What is STM?

Soft tissue mobilization is a low load manual technique that employs long duration forces applied in various directions to improve mobility between underlying and adjacent layers of connective tissue. (Deshmukh, et al., 2014). STM is a general term and over the years different styles and approaches to STM have been discovered. Some examples of STM in physical therapy include:

Myofascial Release
Instrument Assisted Soft Tissue Mobilization (IASTM)
Active Release Technique
Cross Friction or Transverse Friction Massage
Graston Technique
Strain Counterstrain
Myofascial Decompression (Cupping)
Trigger Point Therapy
Manual Lymphatic Drainage
Foam rolling

Some of these techniques are performed using only the therapist’s hands while others require special tools to help facilitate the treatment.

LAYERS OF TISSUE

Between the visible top layer of skin and the underlying bones lie several layers of tissue that are important in soft tissue therapy. Most superficially we have the epidermis or the outer layer of skin. Beneath that lies the dermis which houses nerves, hair follicles, sweat glands, blood vessels, connective tissue and other structures. Underneath the dermis is the superficial fascial layer then the layer of subcutaneous fat, more blood vessels, and nerves, followed by the deep fascia and then the muscle.

When layers of soft tissue are not sliding and gliding like they should be it can result in pain, reduced joint mobility, scar tissue formation, and flexibility issues. Tissue dysfunction, pain, inflammation, and injury can happen at any of these levels and soft tissue therapy may play a role in treating the symptoms.

WHO CAN BENEFIT FROM SOFT TISSUE MOBILIZATION?

STM is indicated to help treat a variety of conditions. These conditions include tendinopathies, muscle strains and tears, subluxations or dislocations, overuse injuries, contusions, edema, inflammation, post-surgery, and scarring. It may also be used to address a range of motion restriction, pain, impaired posture, muscle guarding, and poor tissue mobility.

WHY DOES SOFT TISSUE MOBILIZATION WORK?

While research shows us that STM is effective in promoting tissue healing, reducing pain, and improving range of motion in many cases, the exact physiological mechanisms underlying these changes are still being examined (Hawkins, Williams and Galloway, Kaytlin, 2020). When you sustain a tissue injury it follows a predictable pattern of healing consisting of inflammation, proliferation, then remodeling. During the inflammation phase, blood flow to the injured tissue increases so that damaged tissue can be broken down and carried away, allowing for transition into the second phase. During the second phase, the proliferation phase, cells called fibroblasts increase in number around the injured area in order to synthesize collagen fibers that form the scaffolding that will eventually become fully-healed tissue in the remodeling phase.

It is thought that the compression of tissues during soft tissue mobilization can facilitate tissue healing by stimulating fibroblast activity during this proliferation phase and by helping to realign and reorganize the new collagen. It is also used to break up scar tissue and increase blood flow to the area to promote the formation of new and better-organized collagen fibers. Additionally, STM is thought to have an effect, at least temporarily, on pain receptors and mechanoreceptors which may account for reductions in sensitivity to pain and improvements in range of motion that occur after STM.

IS SOFT TISSUE MOBILIZATION SAFE?

When performed by a licensed physical therapist, soft tissue mobilization is generally considered safe but there are contraindications to using these techniques including, but not limited to, over areas of unhealed wounds, over a fracture, in an area of cancer, certain types of kidney and heart failure, and others. Talk with your physical therapist about your medical history so they can decide if these techniques are safe for you.

If you have been going to physical therapy or have been thinking about scheduling an appointment, talk with your therapist about whether soft tissue mobilization may be right for you. While soft tissue mobilization is only one part of a complete rehab program, it can be a great tool to help reduce and manage your symptoms now and in the future.

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Jay C 12/16/22 Jay C 12/16/22

What’s New in Nonsurgical Scoliosis Treatment?

What’s New in Nonsurgical Scoliosis Treatment? If you or a loved one have been diagnosed with scoliosis you may be wondering what new treatments are out there to address it. Scoliosis refers to an abnormal curvature of the spine and depending on its severity can range from a minor cosmetic annoyance to a severe deformity that causes pain and can affect breathing and movement. In this article we will examine some of the advances in nonsurgical scoliosis treatment so you can feel informed about the decisions you are making about your care…

Has Conservative Management of Scoliosis Changed?

If you or a loved one have been diagnosed with scoliosis you may be wondering what new treatments are out there to address it. Scoliosis refers to an abnormal curvature of the spine and depending on its severity can range from a minor cosmetic annoyance to a severe deformity that causes pain and can affect breathing and movement. In this article we will examine some of the advances in nonsurgical scoliosis treatment so you can feel informed about the decisions you are making about your care.

WHY IS SCOLIOSIS A PROBLEM?

When you observe a model of a healthy spine from the front or the back you will notice the vertebrae are stacked on top of one another in a straight line. When you move to the side, however, you will notice that it curves gently from back to front changing direction as the neck or cervical spine transitions into the thoracic spine, or mid back, and again as the mid back transitions into the lumbar spine, or low back. With scoliosis, the most noticeable change is often the presence of one or more curves from left to right forming a “C” or an “S” when you look at the spine from behind. It might not be as obvious, but scoliosis often involves some degree of abnormal spinal rotation and increase in the front to back curvature also making it a three dimensional problem.

It can be present at birth but is most often diagnosed in early adolescence. Scoliosis can be congenital, meaning it is present before birth (usually caused by abnormal formation of spinal bones)--or idiopathic, in which case it develops after birth. The cause of a scoliosis can typically be identified as one or more of three causes. A functional scoliosis develops in response to a skeletal or movement abnormality elsewhere in the body. For example, a discrepancy in length between the legs could cause a functional scoliosis to develop because the hips are not even. A scoliosis can also be neuromuscular in origin meaning it is associated with a condition that affects the nerves or the muscles. Finally degeneration of the vertebral bodies and weakening of their supporting ligaments can cause scoliosis to develop in adults.

Stopping progression of the curve is a primary goal of scoliosis treatment. Without treatment scoliosis curvature can progress leading to changes in appearance, difficulty walking or moving, pain, and can even restrict heart and lung function if the scoliosis compresses the ribcage. When treated during skeletal immaturity there is the greatest likelihood of stopping the progression and sometimes even improving the scoliosis as the skeletal system is more adaptable at this time. To better understand the current recommendations for the treatment of Scoliosis we reviewed the second edition of The Harms Study Group Treatment Guide published in 2021. The Harms Group is a worldwide cohort of surgeons, with over twenty years of productivity, who perform comprehensive, multi-center, prospective research studies focused on pediatric spinal deformity.

CONSERVATIVE TREATMENT:

Scoliosis treatment that is nonsurgical in nature is considered to be conservative. The most recent guidelines published by the International Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) list the goals of nonoperative intervention for Adolescent Idiopathic Scoliosis as stopping curve progression at puberty, preventing or treating respiratory dysfunction, preventing spinal pain, and improving aesthetics via postural correction. In adults, the primary goal is to treat pain and improve function. The use of spinal bracing and physiotherapeutic scoliosis-specific exercises will be discussed here.

Bracing: Despite advances in medicine, bracing of curves greater than 25 degrees is still the first line treatment in skeletally immature patients because of the likelihood of continued progression of the scoliotic curve even after reaching skeletal maturity (usually achieved by 25 years of age). Smaller curves should be carefully monitored on a regular basis, typically every six months. Curves greater than 45 deg will often be treated surgically.

Customized bracing made from a mold of the person’s torso, evidence shows, can not only prevent progression, but in some cases improvements, in larger scoliotic curves. Generally bracing is worn between 12 and 23 hours a day until skeletal maturity is reached. Additionally, nighttime bracing of smaller curves may prevent progression in up to 25% of people. While adjusting to brace-wearing can be difficult for young persons, getting to choose the color and pattern of the brace and picking out clothing that is fun and comfortable to use while wearing it, can help.

Physiotherapeutic scoliosis-specific exercises (PSSE): Physical therapy has long been considered an important form of conservative treatment for scoliosis. In recent years the physical therapy community has been studying the effectiveness of PSSE versus conventional physical therapy. The Harms Study Group further defines PSSE:

PSSE consists of very specific exercises developed based on a detailed assessment of the patient’s curve pattern characteristics in all three planes. Patients are trained to“autocorrect” or “self-correct” their alignment in all three planes: coronal, sagittal, and axial. This corrected alignment is then incorporated into stabilizing exercises as well as balance, coordination, and proprioceptive training to automatize the more centered alignment. Patients are taught to incorporate the corrected alignment into activities of daily living. Although PSSE and general or conventional physical exercise both work on core and posture strengthening, conventional therapy does not take into consideration the individual’s specific scoliotic curve pattern, and conventional therapists have not undergone specific education and certification in scoliosis assessment and management.

While research will continue to be done to assess who will benefit most from this type of physical therapy, you can learn more about these types of exercises by working with a therapist trained in the Schroth Method of PSSE. This treatment method focuses on achieving elongation of the spine and derotation of the vertebrae to improve breathing function and posture by individualizing treatment to each person’s unique curvature. It can also help relax stiff muscles, promote better pelvic alignment, and address pain.

EARLY TREATMENT IS OPTIMAL

If you or your child have been identified as having scoliosis, early management is optimal to prevent progression of the curve when possible and address symptoms of pain, breathing difficulties, and losses of function. If you are interested in learning more about the Schroth approach to scoliosis and how physical therapy can help, call and schedule a physical therapy evaluation at Evolve.

Click here to find out more information about physical therapy for Scoliosis.

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https://EvolveNY.com

Jay C 12/12/22 Jay C 12/12/22

Physical Therapy for Chronic Pain

Can Physical Therapy Treat Chronic Pain? Seeking Relief from Chronic Pain? If you have been experiencing chronic pain and are looking for solutions, you are not alone. Chronic pain may affect as much as 40% of the population worldwide (Cohen et al., 2021) and those living with chronic pain experience effects ranging from negative social-emotional and physical impacts to heavy financial and psychological burdens.

Can Physical Therapy Treat Chronic Pain?

Seeking Relief from Chronic Pain?

If you have been experiencing chronic pain and are looking for solutions, you are not alone. Chronic pain may affect as much as 40% of the population worldwide (Cohen et al., 2021) and those living with chronic pain experience effects ranging from negative social-emotional and physical impacts to heavy financial and psychological burdens. In this article we will discuss how chronic pain differs from acute pain, how it impacts an individual’s life and how physical therapy may be beneficial to alleviate some symptoms of chronic pain.

HOW DOES CHRONIC PAIN DIFFER FROM ACUTE PAIN?

Pain is the body’s method for recognizing a stimulus is injurious or potentially injurious to our tissues. Without pain, you would not know to lift your hand quickly off of a hot stove top or recognize that you should seek care and protection for a broken bone. Without the ability to perceive pain, serious injury or illness would occur possibly without seeking treatment.

Acute pain occurs in response to an injury or irritation to the body’s tissues. It can range from mild to severe. As the tissue heals we expect this pain to lessen, a sign that the tissue is becoming more healthy and recovered. One hallmark of acute pain is that it is generally short-lived, typically not lasting more than 3 months. Physical therapy typically treats the area of injury and the pain level will improve.

Chronic pain, on the other hand, is pain that lasts more than about 3 months. It can be localized but may also be more widespread. Sometimes chronic pain can develop from an acute condition in the case of an injury or surgery that does not heal well. In other instances, the pain may result from an underlying medical condition.

One hallmark of chronic pain syndrome is that unlike acute pain, chronic pain often occurs independently of actual tissue injury or irritation. This does not mean it is not real but indicates that the brain is incorrectly interpreting non-harmful or non-injurious body signals as evidence that there is a threat to the body. This misinterpretation can keep someone in pain well past normal tissue healing times as the brain remains on “high alert.” Many people with chronic pain fear movement and exercise because they assume that their experience of pain is truthfully alerting them that their tissues are being injured where in many cases (though not all), the pain centers of the brain have become oversensitized to normal everyday sensations.

WHAT ARE THE CONSEQUENCES OF CHRONIC PAIN?

While pain or discomfort may be the hallmark of chronic pain syndrome, many chronic pain sufferers find they develop more systemic symptoms over time. High levels of fatigue and deconditioning are common with chronic pain disorders and may be tied in with disturbances in sleep. Muscle aches, stiffness, burning or aching pain are also common. Mood problems such as depression, anxiety and irritability are often seen with chronic pain as well and all of these symptoms can contribute to difficulties completing daily tasks.

Chronic pain is one of the leading causes of disability and can have ramifications far beyond living with a high level of daily discomfort. It can have negative impacts on personal relationships and self esteem, and the ability to work and afford adequate housing (Cohen et al., 2021). Addressing chronic pain can lead to improvements in all of these areas leading to a global improvement in quality of life.

WHAT ARE SOME CONDITIONS THAT CAN CAUSE CHRONIC PAIN?

Chronic pain may originate from an injury or as a result of another medical condition but it is important to recognize that chronic pain is considered a disease in and of itself and not merely a symptom of another condition. Physical therapy can help address symptoms of chronic pain originating from many sources. Some conditions that may be associated with chronic pain are listed here:

-Acute injuries: In some instances chronic pain can originate from an acute injury. In this case the pain persists despite healing of the original injury.

-Cancer: localized tissue or more widespread nerve damage from cancer treatments can cause chronic pain symptoms.

-Low back pain: chronic low back pain can be caused by many triggers, both traumatic and nontraumatic.

-Headaches: chronic headaches can interfere significantly with one’s ability to work, go to school and take care of necessary daily tasks.

-Complex Regional Pain Syndrome: a form of chronic pain that typically affects the arm or leg, CRPS can develop after an injury or surgery and lead to severe and ongoing pain.

-Arthritis: Loss of the smooth and cushioned joint cartilage can lead to chronic pain, stiffness, inflammation and difficulty moving the joint.

-Fibromyalgia: Pain in multiple tender points as well as fatigue, trouble sleeping, and memory difficulties are classic signs of fibromyalgia.

-Neuropathies: damage to nerves which can cause burning, aching or weakness.

-Diabetes: diabetes can cause long term damage to nerves that can result in chronic pain.

-Limb amputation: after amputation chronic pain can develop as “phantom pain” experienced as though the amputated limb were still present and hurting.

HOW CAN PHYSICAL THERAPY TREAT CHRONIC PAIN?

A personalized and multimodal approach to chronic pain is most effective. Physical therapy may be only one aspect of an integrative treatment approach to your pain but conservative approaches like physical therapy can help improve symptoms of pain, deconditioning, muscle stiffness and more. Reprogramming the nervous system to move out of a “high alert” state so that you can move without pain is an important goal of physical therapy. While a physical therapy program is always individualized, the program may include:

Manual therapy: Manual therapy is a hands-on manipulative type of physical therapy that your physical therapist can use to reduce areas of pain and discomfort. This may include passive mobilization or manipulation of joints or mobilization of soft tissues, for example.

Postural re-education and body mechanics training: learning to move well can be an important step to managing chronic pain. By learning to adjust your posture and move in an efficient and safe way you can perform more activities with less pain.

Graded exercise: It may be scary at first to think of exercise as an appropriate treatment when you are experiencing chronic pain but regular participation in an exercise program has been shown to be more effective in improving function than the reduction of pain itself and can improve sleep and reverse deconditioning (Cohen et al., 2021). Rather than just prescribing general exercise, physical therapists will prescribe a personalized exercise program to target any specific impairments in the musculoskeletal or neuromuscular systems that may be contributing to your symptoms of pain. Relearning non painful movement is an important part of a physical therapy exercise program for chronic pain.

Education: Understanding the mechanics and physiology of chronic pain is an important first step in treating it. Education may also include ways to modify your activities to support your goals for physical therapy and how to use assistive devices or adaptive equipment.

IT’S NEVER TOO LATE TO GET STARTED

Whether you have been experiencing chronic pain for some time or you are sensing that your painful symptoms may soon become chronic, our team at Evolve PT is here to help. We will take the time necessary to get to know you and your story and work with you to develop a plan to address your chronic pain and help you to get back to the activities you enjoy.

Click here to find out more information about physical therapy for chronic pain in Brooklyn

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Multiple Brooklyn Locations!

Call to Schedule an Appointment!

https://EvolveNY.com

Jay C 12/6/22 Jay C 12/6/22

What are You Doing with Your Year-End PT Benefits?

Don’t Lose Those Year-End PT Benefits- Many people don’t consider what type of insurance coverage they have for physical therapy until something happens that necessitates treatment. Different types of insurance plans place various limits and allowances on the amount of physical therapy they will cover over a year’s time…

Don’t Lose Those Year-End PT Benefits

Many people don’t consider what type of insurance coverage they have for physical therapy until something happens that necessitates treatment. Different types of insurance plans place various limits and allowances on the amount of physical therapy they will cover over a year’s time. Typically when you schedule your first physical therapy visit the clinic will verify your benefits and tell you this information before the appointment but it is always a good idea to talk with your insurance company ahead of time.

Commercial, federal, and state-funded insurance plans can vary widely on their coverage but here are some different scenarios that you may encounter:

A doctor’s referral is required for the initial visit (this can vary based on insurance and also whether the state has direct access that allows physical therapists to treat a patient without a physician referral)

A patient can make an appointment for an initial evaluation without a referral from a physician

A patient can be seen for the initial evaluation but the clinic must request authorization for a prescribed number of follow up visits before they can be scheduled

A patient can be seen for the initial evaluation and then schedule follow ups without additional authorization from insurance

The number of allowed visits per year is decided by the insurance plan (example 15, 30, 40 visits) and more cannot be requested, even if they are needed, until the insurance plan renews

The number of visits is “based on medical necessity” and it is up to the physical therapist to provide documentation that supports the need for ongoing therapy. Some plans will require intermittent authorizations be performed to ensure it is medically necessary before agreeing to more visits.

WHAT HAPPENS AT THE END OF THE YEAR?

Most insurance plans renew on January 1 but certain plans may renew at other times of the year. Be sure to look at your policy so you know when your benefits and deductible will start over. As you approach the end of your insurance year, it’s time to think about what to do with remaining physical therapy benefits. Unused health insurance benefits do not roll into the next year so if you don’t use them, you lose them.

WHY SHOULD I CONSIDER PT AT THE END OF THE YEAR?

Physical therapy is an excellent way to address injuries, aches, and pains, weakness, balance problems, pelvic floor dysfunction, and more. You do not need to wait until your symptoms are severe to seek help. In fact when possible, it’s better to begin addressing these symptoms early on.

If you have a limited number of physical therapy visits available to you each year you can maximize the number of visits you have by using some before your insurance year ends. For example, if you have a chronic condition or severe injury and anticipate needing a long course of rehab but have a hard limit of 30 visits per year, starting your course of care before the year ends allows you to get more than 30 visits for one course of care. For example you may have ten appointments in December and then use ten visits in January which equals twenty visits but you still have twenty more visits to use throughout the rest of the year. If you started that care in January you would have only ten visits left to use for the rest of the year.

If you have met your deductible then your out of pocket expense may be lower depending on whether you have a co-insurance to pay or have met your out-of-pocket expenses for the year. This can save you a lot of money that you may not have wanted to spend early in the year. Once the insurance renews for the next year you are once again responsible for the entire deductible. Physical therapy visits can occur one to three times a week so taking advantage of the time when your deductible has already been met can save you money.

If you have a medical or health flexible spending account (FSA) and are approaching the end of the year you may want to act now. An FSA is a medical spending account that works like a savings account and is provided by certain employers. Pre-tax money is deposited throughout the year up to a maximal amount ($2850 in 2022) and can be used to pay medical expenses like copays, vision expenses, over-the-counter medications, etc.. Since the money is “pre-tax” you will be saving the money that would typically be taken out as taxes.

In the past, only 20% of the annual contribution limit could be carried over into the next year. All other unused funds would be lost. Recently, as part of COVID-19 relief, the Consolidated Appropriations Act, 2021, signed into law at the end of 2020, and IRS Notice 2021-15, issued February 2021 all remaining unused funds from accounts in 2020 could be carried over into the plan year ending in 2021, and account balances from year 2021 could be carried over into the plan year ending in 2022. This means that in the past two years no funds were lost. It is important to note that many of the rule changes for FSAs in 2020-2022 are not mandatory for employers to adopt. Also, it is unclear if this same rule will be renewed going into 2023, so stay tuned as the year progresses. If this benefit is not renewed into 2023 and you are nearing the end of the year and still have unused funds in your FSA, this is a good time to schedule appointments with a physical therapist as the money can help cover any copays or coinsurance you owe.

If you have a health savings account (HSA) this is another tool you can use to cover the cost of therapy near the end of the year. Like an FSA a health savings account consists of pre-tax dollars deposited into the account throughout the year and used for medical expenses. Annual inflation-adjusted limit on HSA contributions will be $3,650 for self-only and $7,300 for family coverage in 2022. Unlike an FSA which can be sponsored by any employer, an HSA is associated with a high deductible health plan. Also, money deposited into an HSA rolls over from year to year and has the potential to earn interest. If you have money in your HSA at the end of the year you can use it to cover therapy expenses.

In the end, we don’t always get to choose the time of year that we need physical therapy as we often don’t have control over when and how injuries or illnesses occur. If you do find yourself near the end of the year, having some aches and pains, don’t leave those benefits on the table. Call and schedule a physical therapy assessment and get started on your care right away. You may find you enjoy physical therapy so much that you are happy to save some visits in the next year, just in case.

Give Evolve Physical Therapy in Brooklyn a call today to see how you can use your end of year benefits! Call: 1-718-258-3300

About EvolveNY-

Multiple Brooklyn Physical Therapy Clinic Locations!

https://EvolveNY.com

Jay C 11/25/22 Jay C 11/25/22

Feeling Dizzy? You May Need Vestibular Therapy

Vestibular Physical Therapy Services- Symptoms of dysfunction in the vestibular system can include vertigo, or room spinning dizziness, disequilibrium or feelings of being off balance, motion sensitivity, loss of balance or falls, bouncing or blurred vision, nausea, feelings of floating or lightheadedness…

Vestibular Physical Therapy Services

Off Balance? Dizzy? Vestibular PT Can Help

Feeling off balance or dizzy after getting off of a ride at the local fair may be normal but if you are experiencing these symptoms in everyday life it may signal a problem with your inner ear, or vestibular system, and you may benefit from vestibular physical therapy.

Symptoms of dysfunction in the vestibular system can include vertigo, or room spinning dizziness, disequilibrium or feelings of being off balance, motion sensitivity, loss of balance or falls, bouncing or blurred vision, nausea, feelings of floating or lightheadedness.

If you have been experiencing these symptoms, read on to determine if a referral to a vestibular-specialist physical therapist may help.

WHAT EXACTLY IS THE VESTIBULAR SYSTEM?

Deep inside the inner ear lie what are called the vestibular organs. These organs are part of the vestibular system that gathers sensory information about the position and movement of the head and plays an important role in balance and stability. Inside each inner ear lie 5 small organs–3 semicircular canals that provide information about angular acceleration (head rotation) and 2 otolith organs that are sensitive to linear (straight line) acceleration.

When the head and body move, viscous fluid inside the organs in each ear is displaced which triggers sensory receptors and sends information via the vestibular nerve into the brain to update the nervous system about how the body is moving so it can fire the proper muscles to keep you balanced and stable. Typically, the signals in each ear balance one another. Certain medical conditions can cause a sudden imbalance in vestibular input between the ears or a reduction in function in both ears. When this system is not functioning optimally symptoms like vertigo, dizziness, and unsteadiness result.

WHAT IS CAUSING MY SYMPTOMS?

Symptoms such as dizziness, motion sensitivity, or disequilibrium, for example, can often be treated with vestibular physical therapy, but it is important to first identify the underlying cause of your symptoms. While in some cases the underlying cause may be relatively benign, in other cases it can signal a more serious condition or even a medical emergency. Strokes or TIAs, Multiple Sclerosis, cardiac conditions, brain tumors, or infections are examples of serious conditions that can cause these symptoms.

If you are experiencing symptoms of a vestibular problem along with any of these other symptoms it is essential to seek urgent medical care:

Weakness, especially on one side of the body or face
Loss of coordination
Changes in vision
Severe headache
Changes in sensation
Abnormal eye movements
Confusion
Changes in speech
Vomiting
Chest pain or pressure
Unrelenting vertigo or dizziness

At the onset of new symptoms your doctor may recommend imaging studies such as MRIs or CT scans to rule out some of these more serious causes of dizziness and imbalance. In some cases you may be referred to an ENT or audiologist for specialized testing of the vestibular system. Some medications can also be damaging to the vestibular nerve or vestibular organs so it is important to discuss your medications with your doctors as well.

As long as more serious conditions like a stroke or tumor have been ruled out, or have been addressed medically, physical therapists can also perform clinical testing during their evaluations to help determine the cause of your symptoms and guide treatment. Below you will find a list of some of the conditions that can benefit from treatment by a vestibular physical therapist:

Vestibular hypofunction: This is a term that refers to a reduction in the function of the inner ear in one or both ears. It can have many causes including ototoxic medications, brain tumors such as acoustic neuromas, a brain injury affecting one side of the brain, autoimmune diseases that affect the inner ear over time, weakening of the structures of the inner ear due to aging, and as a result of conditions such as Meneire’s Disease or Labyrinthitis.

BPPV: Benign Paroxysmal Positional Vertigo is characterized by brief episodes of room-spinning vertigo that are triggered by changes in position. BPPV occurs when small crystal-like otoconia which normally exist inside the otolith organ called the utricle are displaced into the semicircular canal. When the head changes position, these otoconia drift through the canals causing an increase in signaling from the affected ear and results in the sensation of vertigo.

Concussion: While a concussion injury does not show up on an MRI or CT scan, it can damage or affect the inner ear and vestibular system to cause lasting symptoms of dizziness, motion sensitivity, or imbalance.

Vestibular migraine: In persons with migraine headaches, spells of vertigo, nausea and imbalance may occur even without the accompanying headache pain. These spells can last seconds, minutes, hours, or days. Many people do not know about this type of “atypical” migraine.

Cervicogenic Dizziness: In persons with a history or whiplash, neck pain, or degeneration of the cervical spine, sometimes the symptoms of dizziness, nausea, headache, imbalance or feelings of unsteadiness may arise from problems in the neck. Neck pain, stiffness, or limited range of motion may accompany these other symptoms.

Persistent Postural Perceptual Dizziness (3PD): Symptoms of vague dizziness or lightheadedness that increases with movement or in busy or crowded places and improves with sitting or lying down and which persists for more than three months may be 3PD. It may be triggered initially by a sudden inner-ear event during which the body becomes more reliant on visual input.

HOW CAN VESTIBULAR PHYSICAL THERAPY HELP?

Vestibular physical therapy techniques will be prescribed based on the underlying cause(s) of your symptoms. This is why it is important to undergo screening or testing for these conditions at either a doctor’s office or at the physical therapy clinic. Depending on causes, here are some physical therapy treatments you may experience during vestibular therapy:

Canalith Repositioning Maneuvers: If your vertigo is caused by BPPV (see above), your therapist will take you through a series of head and body positions called canalith repositioning maneuvers to move the crystals out of the semicircular canals which should improve the vertigo symptoms.

Habituation exercises: In many cases the vestibular system has become oversensitized to movement and symptoms of dizziness, imbalance, or unsteadiness can occur with daily tasks. Habituation exercises involve performing symptom-inducing movements in a controlled fashion to help habituate and desensitize the vestibular system to these triggers

Gaze stabilization: The inner ear is intimately connected to the eyes and poor gaze stabilization can contribute to many of the symptoms outlined above. Gaze stabilization exercises can be performed in the clinic and at home to improve or compensate for the loss of stability.

Neck physical therapy: If there is a cervicogenic component to your symptoms your physical therapist may perform manual hands on techniques like joint mobilization or soft tissue mobilizations to improve neck pain and stiffness. You may perform strengthening and stretching exercises for the neck and work on the joint position sense of the neck called proprioception.

Cardiovascular training: If your symptoms are triggered by an increase in heart rate then a graded cardiovascular training program on a treadmill or bike will be prescribed to train the body to work at increasing intensities without symptoms.

Balance exercises: balance training may be needed if you are experiencing unsteadiness, falls, or losses of balance.

VESTIBULAR PHYSICAL THERAPY CAN HELP

As you can see, though there are many causes of symptoms like dizziness and disequilibrium, there are also many ways that vestibular physical therapy can help. If you have been experiencing these symptoms recently or for some time, call and schedule an evaluation at Evolve PT so we can get to the bottom of your symptoms and create a program to help you recover.

About EvolveNY-

Multiple Locations!