Can you believe the holiday season is already upon us?! 2020 and the COVID-19 pandemic has presented its own set of challenges for health and wellness and we want to discuss some of this with you as we close out the year.

Currently, Colorado is in the “red” category of the dial system. This means that while we can stay open as a medical clinic, gyms are operating at a very limited capacity of around 10%.  On top of this, the weather is getting colder, making outdoor recreational activities much more difficult. So does that mean it’s time to throw in the towel on your physical activity for the year? NO!

In addition to mask wearing, washing your hands, and social distancing, there has been multiple sources of evidence that states regular physical activity can not only help prevent contracting infectious disease, but also prevents death from infectious disease.

Da Silveira et al performed a meta-analysis of the current literature (55 publications) supporting this theory. In his review he states, “This study shows that higher levels of habitual physical activity are associated with a 31% lower prospective risk of infectious disease and 38% lower risk of infectious disease related mortality.”

This is incredible! So let me get this straight:

Regular physical activity and exercise:

• Lowers and/or prevents the risk of developing chronic diseases such as type-2 diabetes, metabolic disorder, atherosclerosis, high blood pressure, etc. 
• Modulates stress hormones and neurotransmitters related to experiencing depression and anxiety and can improve mood
• Improves digestion and bowel function
• Regulates sleep cycle 
• Stimulates memory and cortical functioning
• AND can help you battle COVID-19!!

Are you convinced? Today, make it your mission to MOVE! If you are struggling to find an at home exercise routine that can address your needs specifically, schedule an in-person or virtual appointment with us, your movement specialists, ASAP! 

Last but not least, from all of us at Integrative Physiotherapy, we wish you and your loved ones a safe and happy holiday season and thank you for your continued support of our practice. 

Reference

da Silveira MP, da Silva Fagundes KK, Bizuti MR, Starck É, Rossi RC, de Resende E Silva DT. Physical exercise as a tool to help the immune system against COVID-19: an integrative review of the current literature [published online ahead of print, 2020 Jul 29]. Clin Exp Med. 2020;1-14. 

September is Spinal Cord Injury Awareness Month and at I.P. we have a unique perspective on this topic. In 2004 Dr. John suffered a spinal cord injury while playing football that resulted in severe loss of function in his entire right arm. While many people may know bits and pieces of what happened, we thought sharing his story would help shine some light on what motivated John to start Integrative Physiotherapy and help others MOVE! 

Tell us how your injury happened. 

I was playing cornerback, in a semi-pro league, on the left side when I went to strip the ball. My arm was fully extended and the safety crowned me in the elbow as the back kept running with my hand. I sustained a grade 3 brachial plexus strain with medial ulnar avulsion and a complete rupture of my tricep, UCL ligaments and 6 forearm muscles. I was writhing in pain and shaking immediately afterwards. I don’t have a sweet tooth but I have never had such a craving for sugar in my life. At the hospital they tried to yank my arm straight to get an X-ray, I kicked the tech as a response because of the pain. They sent me home with pain meds and told me that I was going to wish I broke my arm because the soft tissue damage was going to be way worse. Correct statement knowing the recovery from breaking my wrist 3 times… but that’s a different story.  I experienced chills, hot flashes, bowel and bladder symptoms, insomnia, nausea and vomiting for days and months, even the first few years after the event. 

Did you undergo surgery?

No and I should have. My tendon and ligaments needed to be fully reattached for me to have full function of my arm. I had the opportunity to have surgery at the time. I still was on my mom’s insurance for a few more months and the surgeon had told me he had only ever seen one case worse than mine and that I absolutely had to have surgery. But because I had met some mentors who had shown me how often surgery could be avoided, I challenged myself to see how much I could get done without surgery. In retrospect, it was appropriate that surgery should have been performed, but I also wouldn’t know what I know now about rehabilitation if I would have gone through the surgery. As far as function goes, the surgery was definitely necessary. That is an aspect I contemplate any time patients ask me about surgeries while there are so many variables that go into deciding to have surgery or not. I always say once the knife goes in, it can’t come out; but it may be the right course of action depending on the person and situation. That’s why it’s important to know the current science behind the efficacy of surgeries – for long term benefit and considering the dynamics surrounding each individual. A patient’s co-morbidities and lifestyle are huge indicators of whether it would be possible for someone to avoid surgery. Respecting every profession and their part of the comprehensive care process is paramount. 

What was the hardest part of your recovery process?

The mental aspect of how long it took to recover and the emotional changes that go into an altered self-identity post-injury… let alone the patience. The hardest part as an athlete with an injury that is that severe, is that you lose your ‘runner’s’ high’. You’re used to running and jumping and moving and competing. I’d been in an almost obsessive physical routine for the better part of a decade, and overnight I only had use of 3 limbs. I was injured; I wasn’t releasing my happy hormones from exercise. That emotional state really makes you question your motivations, who you are as a person, and how you decide what your new identity is going to be after experiencing something that traumatic. 

How long did it take you to regain function of your right arm for daily activities, and then also for sport/fitness?

Took about a year for functional activities and about 2.5 years for sport. At first my arm and fingers were curled in a rigid position. I could only use the very tips of my fingers for the better part of 6 months. Couldn’t eat with that arm, couldn’t brush my teeth, couldn’t do basic self-care ADLs… The first time I tried to wipe my own a** and using my left arm was very humbling to realize my body had never turned the other way. 

It was a painstakingly slow process of breaking down the whole system; the mechanical, chemical and electrical engineering. You have to take all the segments through the whole system – like trying to rewire a computer. Since the arm gets its strength from the legs, you have to take the arm all the way down the ankle. You keep going through this process..over and over again. Sometimes there are huge gains, and other times it’s the smallest little things that are battle victories. I keep working on each aspect of the journey…constantly looking for new and innovative ways to restore function. That rolls into being able to treat simple to complex cases with a lot of variability to pull from and push past plateaus. 

How do you apply your personal experience towards patient care?

My injury has fostered my ability to keep being innovative and creative while empathetic and sympathetic in clinic; approaching the patient as a whole person, addressing each point of that pyramid (chemical/emotional/physical). Addressing the emotional distress that comes with injuries/ailments is so important to consider in the recovery process. There’s a lot of evidence that shows if you believe you aren’t going to get better, you’re not going to get better. Addressing people as a whole by checking each point of their pyramid has enabled me to better see what they are needing at that time. Re-integrating a person back into their life, if you will. You see stories of amputees or veterans that have gone through so much and are still able to play basketball or handstand with or without the use of prosthetics or assistance. A neurologic injury makes you focus on body entities rather than muscles, requiring a restoration of a certain harmony between the systems to become your best current self. 

What symptoms do you still have to this day?

I’m still unable to fully straighten my right arm in a couple angles. I have difficulty with certain manual therapy techniques in clinic when I need to fully straighten my arm. I get occasional numbness and tingling and still have muscle atrophy from the lower motor neuron damage. There’s always something to work on, something that reminds you of what you once were, where you are, and where you are going. 

Some of these dysfunctional gait patterns include:

• Scissoring Gait: Criss-crossing your legs while running, minimal width between where your left and right foot land on the ground
• Heel or Toe Contact: Unless sprinting, most runners should be landing on their midfoot to decrease excess load through ankles, knees, and hips
• Shortened Stride: Expending energy to propel upwards instead of primarily forward, often due to glute weakness
• Midfoot Position: Excess pronation or supination upon landing
• Forward Trunk Lean: Often due to lumbar spine weakness contributing to lack of upright position

***Want to watch individual videos of these common dysfunctions? Check out our latest instagram post @IntegrativePT that displays these slow-mo running gait analyses!***

We unfortunately have also seen more running-related injuries enter the clinic. Oftentimes (there is no black and white in PT!), overuse lower extremity injuries may occur as a result of glute weakness and lack of ankle mobility. A systematic review in American Family Physician shows the most common running injuries as:

• Knee
  • • Patellar Tendinopathy: 12%
    • Iliotibial Band Syndrome: 10%
    • Patellofemoral Syndrome: 6%

• Ankle and Foot
  • • Ankle Sprain: 10%
    • Achilles Tendinopathy: 6-9%
    • Plantar Fasciitis: 5-18%
• Hamstring 
  • • Hamstring Tendinopathy: 12%
    • Hamstring Muscle Tear: 7%
• Bone 
  • • Medial Tibial Stress Syndrome: 10%
    • Tibial Stress Fracture: 4%

Have no fear, most of these are overuse injuries that can be managed with our conservative treatment and our unique IP approach utilizing kinetic chain movement patterns and tailored manual therapy treatments! Whether you are experiencing a running-related injury or would like to work on improving performance, give us a call and we can have you putting your best foot forward in no time!
 

“I don’t go to the gym, how do I stay active at home?”

“I’m traveling this month, what exercises will work on the road?”

“I don’t have space for a lot of equipment at home, what should I use?”

Each week, we get dozens of patients asking questions like these. Whether you are staying home to social distance, traveling for work, exercising on a budget, or prefer the minimalist home gym, we have two words for you: FURNITURE SLIDERS! Over the past few years, Dr. John has created a 25 exercise-sequence that addresses the entire body and can be personalized and modified to address your injuries, goals, and fitness levels. You I.P. team uses these slider exercises to treat diagnoses such as:

• Disc herniations (neck and low back)
• Sciatica
• Shoulder impingement
• Labral tears (hip and shoulder)
• Muscle strains
• Tendinopathies
• Spinal Instabilities
• Patellofemoral Pain Syndrome/Patellar Tracking Dysfunction
• Post-Op for shoulder, wrist, knee, hip, ankle, and spine   

Our slider sequence helps to strengthen, restore posture, improve balance, and enhance motor control. These exercises will get you on the pathway to our “Three P’s” by helping reduce your Pain, Improve your Performance, and Prevent future injuries! 

I.P.’s Adjustments Amidst COVID19

We know everyone is inundated and overwhelmed with information right now, so we want to keep our updates succinct, and help contribute to keeping calm amongst the chaos.

Here’s the short of what you need to know about your sessions at Integrative Physiotherapy as we navigate this time of uncertainty: 

• Unless otherwise enforced/announced, we are remaining cautiously open for in-person sessions at both Fort Collins and Wellington locations. See details below.
• We have ramped up our sanitation procedures & frequency in the clinic. We also ask that if you come in for a session to please wash your hands upon entering the facility and remain 6-feet distance from other patients. More details below.
• If you have a session and are feeling sick at all or are in contact with someone who has been sick, please stay home. We are rolling out options for tele-sessions and consults effective 3/18/2020. See details below.
• Be proactive, wash your hands, continue to move your mind and mind your movement. Let us know how we can help!

• There will not be more than 10 people in the clinic at once, until recommendations indicate otherwise. You are encouraged to text us to let us know you have arrived for a session and wait in your car until your therapist is ready to begin your session.
• Stay 6 feet from others when in clinic
• Wash hands before and after sessions
• Wipe down any equipment used during sessions
• WELLINGTON: You will need to be let in, even if you are a gym member. As gyms are closed to the public, your key fob will not work for entry for the next 30 days. Please text when you have arrived.
• If you feel sick, know someone who is sick, stay home!

• We will be offering the option of live video sessions and phone consults to prevent regression while practicing social distancing. You know we’re creative so we can keep you on track in quarantine!
• Call or email to designate an existing appointment as a video session, or to schedule a virtual session.
• Currently, Medicare is the only insurance that is across the board not allowing physical therapy tele-sessions. You can write your congressmen here in a pre-formatted letter (you only have to enter in your name and contact info!) to request they lift the restriction.
• For other insurance or pricing options, call or email.
• We are able to offer virtual sessions via 
  • GoToMeeting
  • Google Duo
  • Google Meet
  • Facetime
• We have been assured if our providers get to a place where they are conducting these sessions from a home environment, that our virtual documentation software is HIPAA compliant.