Debunking 7 Myths About Physical Therapy

Moveforwardpt.com has written a great article debunking PT myths. You can read the full article here. Below we have edited the list of myths from the article and made them specific to our clinic. Any additions I have made will be in italics.

1. Myth: I need a referral to see a physical therapist.

Fact: A recent survey by the American Physical Therapy Association (APTA) revealed 70% of people think a referral or prescription is required for evaluation by a physical therapist. However, all 50 states and the District of Columbia (DC) allow patients to be evaluated by a physical therapist without a physician's prior referral. In addition, 49 states and DC allow for some form of treatment or intervention without a physician referral or prescription (Michigan being the exception). On January 1, 2015, patients in Michigan will be able to do so, as well. Some states have restrictions about the treatment a physical therapist can provide without a physician referral. Check out APTA's direct access summary chart (.pdf) to see the restrictions in your state.

Integrate 360 PT welcomes patients with and without doctor referrals. If you come to the clinic without a referral, but have spoken to an appropriate medical provider about this issue in the past year, we will communicate our findings and treatment with that provider as well as any other physician you wish to keep up to date with your treatments. If you have not mentioned this to a provider, or if it's been over a year, we will ask that you call your physician and have a referral faxed to our clinic.

2. Myth: Physical therapy is painful.

Fact: Physical therapists seek to minimize your pain and discomfort—including chronic or long-term pain. They work within your pain threshold to help you heal, and restore movement and function. The survey found that although 71% of people who have never visited a physical therapist think physical therapy is painful, that number significantly decreases among patients who have seen a physical therapist in the past year.

Even if you've been to other physical therapy clinics and experienced "necessary", but uncomfortable treatments, we may be able to provide you with pain-free alternatives at Integrate 360. For example, many traditional therapists will treat a frozen shoulder with aggressive, and often painful stretches both at home and in the clinic. Postural Restoration works differently. We make sure that the foundation or core (ribcage, pelvis, spine) is in proper position before stretching or strengthening. More often than not, when you correct the foundational position or alignment, proper mobility is restored and aggressive stretching is not needed.

3. Myth: Physical therapy is only for injuries and accidents.

Fact: Physical therapists do a lot more than just stretch or strengthen weak muscles after an injury or surgery. They are skilled at evaluating and diagnosing potential problems before they lead to more serious injuries or disabling conditions—from carpal tunnel syndrome and frozen shoulder, to chronic headaches and lower back pain, to name a few.

At Integrate 360 PT, we also treat vertigo/vestibular problems, jaw joint dysfunction as well as women's health issues or pelvic pain. Unsure if we can help? Call us at 314-733-5000 or email us at nancy@integrate360pt.com and let us discuss it with you.

4. Myth: Any health care professional can perform physical therapy.

Fact: Although 42% of consumers know that physical therapy can only be performed by a licensed physical therapist, 37% still believe other health care professionals can also administer physical therapy. Many physical therapists also pursue board certification in specific areas such as neurology, orthopedics, sports, or women’s health, for example.

Physical therapy utilizes many different interventions to achieve results such as exercises in the clinic and at home, modalities (ultrasound and electrical stimulation), and/or manual techniques (stretching, muscle energy techniques, joint mobilizations). Although physicians or chiropractors may use some of these techniques in their offices, only physical therapists are movement experts and know how to make an exercise program as effective as possible, and personalize it to make it work for you.

 Integrate 360 PT is the only certified Postural Restoration Institute (PRI) clinic in the St. Louis area (check out PRIs main website here). This physical therapy approach is holistic and preventative in nature. It focuses on restoring the body's musculoskeletal balance in the most complete way and teaching our patients to "fix themselves." We want to give you the tools to get yourself better and keep yourself feeling better for the rest of your lives. Our activities also transition from exercises to activities that you can naturally integrate into your daily life. That way, you don't spend the rest of your life doing your exercises! Your exercises seamlessly become incorporated into your life giving you the relief you want without another thing on your checklist.

5. Myth: Physical therapy isn't covered by insurance.

Fact: Most insurance policies cover some form of physical therapy. Beyond insurance coverage, physical therapy has proven to reduce costs by helping people avoid unnecessary imaging scans, surgery, or prescription drugs. Physical therapy can also lower costs by helping patients avoid falls or by addressing conditions before they become chronic.

Please contact us at 314-733-5000 or nancy@integrate360pt.com. We can tell you more specifically what to expect in terms of cost and insurance coverage.

6. Myth: Surgery is my only option.

Fact: In many cases, physical therapy has been shown to be as effective as surgery in treating a wide range of conditions—from rotator cuff tears and degenerative disk disease, to meniscal tears and some forms of knee osteoarthritis. Those who have recently seen a physical therapist know this to be true, with 79% believing physical therapy can provide an alternative to surgery.

As stated above, even if you've been to other clinics before and not gotten your desired results, let Integrate 360's unique approach to rehabilitation help you reach your maximal potential without surgery. Remember, you can always have surgery later on if needed, but you can't "undo" an unnecessary or failed surgery. In our opinion, it's always best to exhaust conservative options before taking more extreme measures.

7. Myth: I can do physical therapy myself.

Fact: Your participation is key to a successful treatment plan, but every patient still needs the expert care and guidance of a licensed physical therapist. Your therapist will leverage his or her specialized education, clinical expertise, and the latest available evidence to evaluate your needs and make a diagnosis before creating an individualized plan of care.

Even if you're only interested in a few sessions to get you started on the right track, let the experts at Integrate 360 PT get you on the right path to achieving your goals!

Avoiding Osteoporosis: How to Keep Your Bones Healthy

Osteoporosis is a condition that affects both men and women. According to the National Osteoporosis Foundation, "About 54 million Americans have osteoporosis and low bone mass, placing them at increased risk for osteoporosis. Studies suggest that approximately one in two women and up to one in four men age 50 and older will break a bone due to osteoporosis."

Most adults maximize their bone density by age 30. From that point forward, new bone is made but not fast enough to avoid overall bone loss over time. Therefore, it is extremely important to start improving your bone density as early as possible to avoid, or possibly, reverse a diagnosis of osteoporosis.

The Mayo Clinic has published another wonderful article describing bone health including what affects it and tips to keep your bones as healthy as possible. You can read the entire article here.

Did you know that the amount of calcium in your diet, amount of physical activity, tobacco/alcohol use, your hormone levels, and certain medications all have a dramatic effect on your bone density? It's important to speak with your doctor, physical therapist, or other health care professional about these areas of your life. Your healthcare team can come up with the best plan to keep your bones as healthy as possible.

The article recommends getting enough calcium and vitamin D in your diet to give your body the tools it needs to build more bone as efficiently as possible.

• Women ages 19-50 and men ages 51-70 have a recommended dietary allowance (RDA) of 1,000 mg of calcium a day. This increases to 1,200 mg a day for women after age 50 and men after age 70.
  • Good sources of calcium include dairy products, almonds, broccoli, kale, canned salmon with bones, sardines and soy products, such as tofu.
• As for vitamin D, adults from 19-70 have an RDA of 600 international units (IUs) a day. This increases to 800 IUs after age 71.
  • Good sources of vitamin D include oily fish, such as tuna and sardines, egg yolks, and fortified milk.

Exercise is essential to maintain and build bone mass. Typically, weight bearing activities such as walking are effective for individuals with osteoporosis or osteopenia. If you do not have any problems with your bone density yet, higher impact activities such as running or aerobic classes will be more effective. Your physical therapist at Integrate 360 will be able to give you suggestions individualized for you and your preferences. We will also provide additional physical therapy-based exercises and/or stretches to avoid any postures that can put excessive stress on your joints or bones/spinal segments.

It is also essential to know how to avoid fractures if you do have osteoporosis/osteopenia. Check out our blog post on how to properly fall here.

For more information on osteoporosis, check out the National Osteoporosis Foundation's website here.

Sleep and Chronic Pain – A Vicious Cycle

More and more research is being published discussing the importance of adequate sleep. However, individuals suffering from chronic pain often experienced fragmented or disturbed sleep; they may have extreme difficulty falling asleep and/or wake throughout the night due to discomfort. When sleep cycles are interrupted or there is not enough total time asleep, the body is not able to completely repair and heal itself. Thus starts a vicious cycle: less sleep = more pain = less sleep. This article from everydaywellness.com discusses the sleep deprivation and chronic pain cycle in more detail.

The take home message is that we’ve got to sleep better to feel better, and feel better to sleep better. This article from the Mayo Clinic offers some great tips to help promote better sleep hygiene. In order to break the pain/sleep cycle, the pain must be addressed while the sleep cycle is being restored. This may include becoming more physically active in general, working with your doctor on appropriate medications to speed the healing process, and/or working with the therapists at Integrate 360 Physical Therapy to address the cause of the and not just mask the symptoms.

Another important thing to remember, this will take time. Restoring your sleep and improving your pain is important for many aspects of your health. Don’t get frustrated if you’re not sleeping 8 hours consecutively after a single week. Do the best you can, as often as you can, and be patient. Some individuals find it helpful to keep a sleep and/or pain journal. Just write a few sentences or bullet points about your sleep and how much pain you were in the following day. After a month of sleep retraining and physical therapy, look back at your journal and see how much you’ve improved!

The Right Way To Fall

Falling is, unfortunately, something that happens to everyone. It is a main contributor to injury, hospitalization, and even admission into nursing home. Although it is important for everyone to know how to fall properly to avoid these situations, it is particularly important for older adults as our "righting" or balance reactions naturally slow as we age. Individuals with diabetes or any kind of nerve problem in their legs or feet should also heed this advice. Impaired sensation means that your legs and feet cannot tell you when they are standing or stepping on, which can lead to you losing your balance and falling. Those with osteopenia or osteoporosis are also at a much higher risk of sustaining a significant injury with even just a stumble, therefore, avoid a fall or falling properly is paramount. Additionally, those with chronic dizziness are also at a higher risk of falling and should take note of these tips (read our previous blogpost on dizziness and how PT can help here).

The New York Times has posted an excellent article explaining the right and wrong ways to fall (read full article here). Here are the highlights:

Avoid:

• Falling on your outstretched hands or knees. This can lead to broken bones.
• Falling directly forward or backward. This can lead to head injury causing a concussion or hemorrhaging (bleeding) either on the skin level or within the brain tissue.
• Staying rigid on impact. This doesn't allow your body to absorb or distribute the forces from falling and increases your chance of injury.

Try to:

• Fall onto the "fleshy" parts of your body such as your hip and/or shoulder. Falling on these areas may lead to some bruising and soreness, but can help you avoid breaking bones.
• Protect your head. Use your arms to cover your head to avoid direct trauma to your skull.
• Stay loose on impact. It's one of the hardest parts, but not bracing for impact will allow your body to absorb the blow better and avoid injury.

The physical therapists can do so much more in terms of falling as well. To avoid falling in the first place, we will assess your gait (walking pattern), muscular strength and endurance, current balance reactions, and screen you for any vestibular or visual impairments that may need to be addressed to fully improve your balance.

When we find areas that are of concern, we work specifically on those areas until you and/or we feel that we have restored your balance and safety as much as possible. We will even talk to you about how to improve the set up in your home to avoid fall hazards such as throw rugs or unsafe steps/stairs.

We will also work with you on the best way to get up from a fall. It's extremely important to minimize injury when you fall, but you're still in a lot of trouble if you can't get off of the ground and don't have a phone near you.

Call us at 314-733-5000 or email Lesley@integrate360pt.com or Nancy@integrate360pt.com and let us help you stay safe in your own home!

Make Your Workstation Work Better for Your Body

Many of us have jobs that require us to sit, and usually use a computer, for a prolonged period of time. Staying in one position over a length of time will cause stress on certain areas of the body and eventually cause pain. At Integrate 360 Physical Therapy, we are great at evaluating your specific dysfunction and working with you to return to your regular, pain-free activities. But how can you avoid developing significant pain in the first place?

1. Sit with your feet flat on the floor or a footrest. With your feet supported, you knees should be at hip height or higher. This will allow you rolls your pelvis back slightly and feel your sit bones well. These are the bones anatomically designed to bear weight in a seated position, you shouldn't have pressure on your pubic bone. If you have a lumbar support in your chair, chances are you need to lessen or eliminate it so you can feel your sit bones properly. Most furniture is made for people who are 5’8”, so don’t be afraid to get a footrest or lower your seat height if needed!

2. Throughout the day, allow your upper body to round. Don’t simply slouch your shoulders, think about your lower ribs or breast bone dropping or depressing. Hold this position and breathe. As you inhale, try to breathe into your upper back while keeping your ribs down. If you feel a stretch in your upper back (between your shoulder blades) when you breathe in, you’re doing great! This helps to mobilize our spine and break up any muscular holding patterns we may have developed.

3. Occasionally, breathe in through your nose and sigh out of your mouth. Hold your full exhale for 3-4 seconds. As we become engrossed in or stressed out because of a project, our bodies will begin to breathe with the muscles of our neck and shoulders causing tension. Holding an exhale will allow our diaphragms to reposition and take over as the primary muscle for breathing.

4. Every 20 minutes or so, look 20 feet ahead for 20 seconds. This will prevent eye fatigue and break up any holding patterns you are keeping in your neck and shoulders. This is a great tip to cut down on headaches and shoulder/neck tension.

5. Shift your left knee directly back, behind your right. If you’ve done this correctly, you’ll feel a little more weight through your left sit bone than your right. Because of our right-handed dominate world (and many other factors), our pelvis’ tend to twist to the right. This activity will gently overcorrect the problem temporarily and allow our pelvis to relax into a more neutral position.

6. When you stand up to take a break or go to the copier, stand up by shifting your left knee back like in #4 above. Then lean forward and push up with your legs with your weight on your heels (you should have more weight on your left heel). If you feel like you’re legs are a lot weaker this way, or standing up is more difficult, you’re doing it right!

7. Begin walking by stepping forward with your right leg and swinging your left arm. Then just continue walking as usual – alternating legs and swinging forward the arm opposite of your lead foot.

8. While you’re waiting for your copies to finish printing, shift onto and stand on your left leg. You can keep your right foot on the ground, but move your weight to the center of your left heel. Hold this position and breathe 4-5 times. Like the seated shift above, this helps remind our bodies not to over-utilize our right side and keep us more balanced, or neutral.  

9. Arrange your desk so that you occasionally have to reach with your left hand across your body and over to the right. Try keeping your phone on the right hand side of your desk, but reach over and pick it up with your left hand each time it rings.

10. When you are bent over to right, bend your upper body to the left side slightly. Your left shoulder will be slightly lower than your right. This helps to mobilize the ribcage, break up muscular holding patterns, and ensure that the diaphragm is able to work efficiently.

11. Cross your right leg over your left. Start paying attention to your natural tendency when crossing your legs. People typically cross their left leg over their right. This can lead to asymmetries if not altered.

This article inspired this one from the PRI official website.

Video: Voices in America PRI Education

While you may have a basic understanding of PRI, these two videos serve to further explain the need for integration, care and maintenance of our body's alignment. Short on time? The 60 second video is for you. When you can, come back to enjoy the six minute version which dives deeper into the complex systems of the body and our ongoing need to balance out the asymmetry within.

Decoding Dizziness

There are many reasons why we may experience dizziness. Some treatments are very easy and can be done at home, while others may require a visit to a doctor. It's important to know that dizziness is never a normal sensation. Something is wrong with your body and it's important you and your health care team determine the source of the symptoms as quickly as possible. Some common reasons for dizziness include:

1) Overheating and dehydration

2) Low blood pressure

3) Medication

4) Benign Paroxysmal Positional Vertigo (BPPV)

5) Other peripheral vestibular dysfunctions

6) Neck and/or jaw joint disorders

7) Hypersensitivity to motion

8) Infection or other malignancy.

Physical therapists can be the most helpful during this process for a number of reasons. First, we spend the most time with you. Doctors typically have approximately 15 minutes to spend with their patients whereas the physical therapists at Integrate 360 spend up to 90 minutes. This allows us to gather a much more thorough profile of the symptoms- from presentation to history of your symptoms and other relevant medical information. Additionally, physicians may not have the time for proper testing to determine your specific treatment. For example, they may determine you have BPPV, but not test which canal is effected. This can result in vertigo-inducing exercise prescription without any actual treatment.

In order to determine what is causing your dizziness, a detailed history will be taken. Information such as when the episodes occur, what they feel like, and how long they last will clue us in to the probable source of the problem. After a possible source is determined, testing can be done to verify that the source of the dysfunction has been correctly identified, and we can begin your treatment. 

If it looks like you need the help of another provider we can either provide you with a trusted referral to another provider or speak with your physician about our concerns and/or recommendations.

Most patients experiencing dizziness can be correctly diagnosed and treated within a handful of appointments. After our evaluation, we will be happy to explain the source of your dizziness, our treatment approach, and answer any questions you may have, taken as much time as needed.

Lesley at Integrate 360 Physical Therapy has had additional training in vestibular rehabilitation and can help you and your doctor determine the source of your dizziness as well as how to treat it. If you've been experiencing episodic or ongoing dizziness, call us today at 314-733-5000 and let us help you on your road to recovery.

Why Aren't My Abdominal Exercises Working?

There are a few reasons why your many hours at the gym don't feel as though they're paying off when you look in the mirror.

1) Too much tissue. No matter how much muscle mass you have, you'll never see defined abs like in the picture above if they're covered by a large amount of adipose tissue or fat. Try to be patient. Stick to your healthy eating and exercise regimen and you'll notice results over time.  Remember, it is unhealthy to lose more than 2 pounds a week. Additionally, if your eating healthier and exercising at the same time, you may not see the number on the scale change at all. This doesn't mean that your hard work isn't effective, it simply means that you're replacing your fat weight with muscle weight. You're well on your way to a more defined body. Handy tip: you may find it motivating to take pictures of yourself each month. This way, when you compare the photos the changes your body has undergone will be much more noticeable.

2) You may be doing the wrong exercises. Many popular gym exercises like the roman chair, leg lifts, and sit ups aren't actually working your lower abs, they're working your hip flexors! Any exercise in which you are bringing your legs and chest closer together is one in which the hip flexors will likely dominate the exercise.  

3) Perform more effective exercises. Activities like the forward and side plank, and bird dog typically utilize more of the abdominal muscles than the activities mentioned above. They use either a neutral spine with a neutral or extended hip, or flex the spine. The job of the lower abs and rectus abdominis ("six pack muscle") are to flex the spine forward, not bend the hip, so these exercises are able to target them better.

4) Use correct form. In our clinic, a majority of our patients present with an anterior pelvic tilt and arched lower back (see picture below). This posture is not normal and can lead to a lot of different pain problems, but it's terrible for performing abdominal and core work. One reason why is that the positioning of the skeleton elongates and inactivates the abdominals while it shortens and strengthens the hip flexors. You're literally in a faulty foundation for your gym routine. In order to perform any activity, not just abdominal ones, more effectively and with a truly "set core", you need to assume a neutral spine and pelvic position. If your exercises, including bringing your chest and legs closer together, be sure to engage your lower abs by flexing in your lower back before moving your legs or head. If your back is either on the floor or against a wall or piece of equipment during the movement, be sure your low back never pulls away from, or extends, from that support. If it does, you have lost the use of your abs. Stop the movement just short of that point in future repetitions.

Have no idea how to assume a neutral spine? Or have you tried the above recommendations and you still don't feel your abs activate? It's time for an assessment with us at Integrate 360. Let us help you understand how to assume this position and what it feels like to do your exercises correctly. Then you'll be all set to keep going with your exercises and feel confident that, with patience and consistency, you'll see your desired results!

Breathing- What's The Big Deal?

Whether it was from our choir director, yoga instructor, or a news article, we've all the heard the term "diaphragmatic breathing".  But what does that really mean?

When we are breathing correctly, or breathing diaphragmatically, the diaphragm does all of the work. The diaphragm is our primary muscle of inspiration, attaches to the inner sides of our ribs as well as the front of the bones in our lower back, and separates the chest cavity from the abdomen. When we breathe, the diaphragm moves down pulling air into our lungs and inflating them. We should see our ribcage move out toward the side and our upper chest inflate. When we breathe out, the diaphragm will passively dome back up into the chest cavity, pushing air out of our lungs and our ribcage will narrow and fall. Check out the video below for a visual.

Seems simple enough, right? Well our bodies are really good at finding out different ways to breathe which can cause problems down the road.

One way our bodies compensate is to breathe with our neck muscles. These muscles are called secondary respiratory muscles because they are meant to only help us breathe when we are running or panicking and need to draw a lot of air in per breath. They should not be used all the time. These muscles typically become overused when there is any kind of obstruction to our breathing- such as respiratory disorders, sinus congestion (especially chronic), severely deviated septum (bone between our nostrils), or even anxiety issues. When the relatively passive diaphragmatic actions cannot provide us with enough air, our bodies will instinctively begin to utilize our neck muscles to help draw additional air in. While this is fine in the short term, say during a head cold or sinus infection, prolonged overuse of these muscle and dysfunctional respiratory patterns can/will cause neck and shoulder tension as well as headaches.

Another way our bodies compensate to breathe is with our lower back muscles. This typically happens with people that have limited ribcage mobility because they are either holding their ribcage rigid during activities, they have a sway back posture (arched lower back and generally "leaned back" position of the upper body) or because of a disease process. For these individuals, it is either easier for them to use their low back muscles to compensate than their neck because either their low back muscles are in a better position to compensate or because their neck muscles are not strong enough to draw enough air in on inhalation. This happens by the person gently leaning back or extending as they breathe in. This opens up their ribcage, allowing their lungs to inflate, by letting the lower ribs move up and away from the abdomen. This, again, can be successfully used in the short term but over time will lead to lower back pain.

A person may also use a combination of these strategies to breathe. If these poor breathing patterns continue without rehabilitation, one can not only develop pain as we mentioned earlier, but it can also morph into shoulder, rib, hip, sacroiliac (SI) joint, knee pain, and many other ailments.

Traditional physical therapy does not address respiratory patterns when they are assessing, diagnosing, and treating your pain problem. What does that typically mean for the patient? As long as they do their exercises 2-3 times a day for the rest of their lives, they'll likely feel better. Are you looking for a better way? Let Integrate 360 give you a more complete rehab program to retrain your body how to breathe correctly so that you are able to overcome the weaknesses associated with your pain and allow you to live a pain-free life!

Why work harder for incomplete results? Call us at 314-733-5000 to schedule an appointment today.

Can Sport Specialization Be Bad For Our Kids?

Sports are great for kids, right? It promotes exercise, team work, discipline, and self confidence. Children are specializing in their sport at much younger ages than in years past for many reasons - the child gravitates to a certain sport, the parent is a fan of or participated in that sport when they were young, associated costs, and/or potential scholarship money in the future. But can this early specialization actually be hurting our kids?

According to Greg Schaible in "Early Sport Specialization Is Killing The Health of Our Kids" (find article here: https://drjohnrusin.com/early-sport-specialization-is-killing-the-health-of-our-kids/), the answer is yes. Kids who specialize in a sport experience more injuries which can possibly hinder their overall athletic development. They may develop a nagging injury that keeps them from achieving their maximum potential, or they may be injured during a moment of great potential growth and skill acquisition.

Playing multiple sports has many benefits, one of which is allowing that child's body to move, strengthen, and absorb stresses in different ways. What if, for whatever reason, you or your child don't want to get involved with other sports? It's important to be sure that their body doesn't overdevelop certain muscles, motions, and/or movement patterns while lagging behind in others.

At Integrate 360, assessing and treating movement and strength deficits is our speciality. Even if you aren't experiencing pain (yet), let us show you some activities to keep your body moving correctly in all planes and ranges of motions. This will help to prevent injury and help you or your child to become the finest athlete they can be! Call us at 314-733-5000.