I.P.’s Adjustments Amidst COVID19

As we’re setting ourselves up for a new decade at 2020, we wanted to share 20 tips to keep your ‘health vision’ 20/20!!

1. Set realistic SMART goals 
   • See our BLOG by clicking here https://www.fortcollinspt.com/january-2018-setting-smart-goals-in-the-new-year/
2. Get MOVING!
   • Most studies recommend a healthy adult gets in 150 minutes of moderate or 75 minutes of vigorous aerobic exercise per week! Spread this time out over the week and this is very easily attained!
3. Kickstart your January with Whole30! 
   • While we don’t promote crash or fad diets, the Whole30 program can be used to discover food sensitivities you may have and get back to eating WHOLE foods!
   • This program has you eliminate processed sugars, dairy, grain, legumes, alcohol, etc. for 30 days. You then slowly introduce these foods back in to see how they affect your energy levels, digestion, and inflammation!
   • Learn more here https://whole30.com/whole30-program-rules/
4. Consume Local Honey!
   • Honey has anti-inflammatory properties that can help your body recover.
   • Two teaspoons before bed will even out your blood sugar and help you sleep better!
5. Get STRONG!
   • Though aerobic cardio exercise is very important, strength training is equally if not more important for your overall health! Most studies say as a general guideline all “major muscle groups” should be trained 2x week (good thing IP exercises incorporate your entire body!)
6. Get a yearly skin check
   • With how much time we spend in the great outdoors of Colorado, it is important to get a full body skin cancer check at the dermatologist! 
7. Stay Hydrated! 
   • The Mayo Clinic suggest men should drink between 3-4 liters/day and women 2-3. If you are very physically active, this number should increase!
8. Read books to stimulate your mind! Some of our staff favorites are:
   • John
     • The Body Electric by Robert O. Becker
   • Jen: 
     • Bad Science by Ben Goldacre 
     • The Fourth Turning by Neil Howe and William Strauss
   • Dina: 
     • Love Letter to the Earth by Thich Nhat Hanh
   • Alex: 
     • Shantaram by Gregory David Roberts
9. Get outside every day!
   • For your body to produce/maintain healthy levels of Vitamin D, shoot for 15-30 minutes outside during the daytime. 
10. Limit screen time at least one hour before bed
    • The blue light emitted from electronics can delay the release of melatonin and disturb your circadian rhythm responsible for the sleep/wake cycle.
11. Set up an in person social interaction at least 1x/week
    • Having a thriving social network can reduce depression and anxiety!
12. Start a gratitude journal
    • As part of a quick morning or bedtime routine, jot down a few things you’re thankful for to put things into perspective!
13. Limit caffeine intake 
    • Though this will vary person to person, most adults can tolerate up to 400mg of caffeine in a day (roughly 4 cups of coffee). In 2020, see if you can keep this under 200mg!
14. Take a daily 30 min walk!
    • Get your heartrate up, improve your mental health, stimulate your digestive system, need we go on?
15. Listen to a podcast!
    • Learn something new while you commute to work, clean your house, or get ready for the day!
16. Get a yearly physical
    • Whether you have a pre-existing condition or typically are in great health, it is important to partake in preventative measures! 
17. Go on a social media cleanse!
    • Limit your social media usage to help you boost your productivity. If you decide to “mindlessly scroll,” set a timer for 5 minutes and then close the app before 5 minutes becomes an hour!
    • Most apps will have a way to monitor how much time you spend per day scrolling. Take a look and decide if you need a break!
18. SLEEP! 
    • Most adults should be getting 7-9 hours of sleep per night (children should be 10-12), but rarely get that much! Start prioritizing good sleep habits and your body will thank you!
19. Try a new physical activity
    • Your body craves movement, especially new ones! Grab a friend and go to a yoga class, climbing gym, skiing, hiking, kickboxing, etc. The possibilities are endless!
20. Schedule an appointment at IP!
    • Lingering injury? Chronic Pain? Difficulty achieving maximal performance? Schedule an evaluation and we will make sure 2020 is your best year yet!

October is National Physical Therapy Month and with that we want to dive into what makes this profession so special and why you should always #ChoosePT first! Read below to learn where the field of PT got its roots and some common FAQs that we get about physical therapy!

History of Physical Therapy

Modern Physical Therapy began to be recognized as a legitimate medical profession in the early 1900s, beginning with the polio outbreak in 1916. “Reconstruction aides” (later to be known as PTs) began to rehabilitate disabled children affected by this epidemic with therapeutic exercises. Following the start of World War II in 1918, reconstruction aides worked to restore function to wounded soldiers at the same time the first PT school was established at Walter Reed Army Hospital in Washington, D.C. In 1921, the mother of physical therapy, Mary McMillin established what is now known as the APTA in order to advocate for the field and encourage treatment protocol research. As awareness of PT began to spread, the field grew into what it is today with treatment taking place not only in hospital settings, but outpatient facilities, public schools, skilled nursing facilities, and rehabilitation centers towards the end of the 1950s.

Physical Therapy FAQs

How long do you have to go to school to become a PT?

 In the United States (requirements differ in each country), students are required to obtain a Doctor of Physical Therapy degree (DPT) following a 4-year bachelor degree. The APTA has changed this from the previously required Master of Physical Therapy degree in the past two decades. If you currently hold a Master’s, you may continue to practice, but are encouraged to continue your education to help broaden your knowledge of differential diagnosis, evidence based research, and systems analysis.

What types of patients do physical therapists treat?

When thinking of PT, most people expect post-op care, injured athletes, or the person making you get out of bed in the hospital with the gait-belt. In reality, physical therapists treat an enormous variety of patients! Did you know PTs could treat in all of these areas?

• Orthopedic
• Sports
• Acute Care
• Neuro Rehab
• Cardiovascular and Pulmonary
• Pediatrics
• Geriatrics
• Integumentary and Wound Care
• Women’s Health
• Hand Therapy
• Pelvic Floor
• Palliative Care
• Oncology

Do I need a prescription from my MD to get physical therapy?

No! As of 2016, Colorado is a direct access state for physical therapy. This means you may schedule an appointment without needing a referral (unless you have Medicare). At the initial evaluation, your DPT will perform a thorough differential diagnosis and multi-systems analysis and refer you out for further medical testing, consultation, and/or imaging if it is suspected that your symptoms are not amenable to pt services.

What is the difference between physical therapists and chiropractors?

While both practitioners may co-treat the same patient, the focus of that treatment often varies. Chiropractic care often focuses on disorders of the spine and joints and achieving alignment throughout the body to alleviate pain and symptoms. Physical therapists are often thought of as the “movement specialists.” PTs evaluate, diagnose, and treat a wide range of musculoskeletal, neurological, cardiopulmonary, developmental, and integumentary conditions using manual (hands-on) treatment, therapeutic exercises, neuromuscular re-education, and various modalities. Most people don’t expect this, but PTs can perform grade V (high velocity low amplitude) joint manipulations that you would receive at a chiropractor’s office!

The topic of posture is something almost every patient inquires about during their PT stint. “What is good posture?” “Do I have bad posture?” “How do I build strength in my postural muscles?” While there isn’t exactly a “perfect posture” that will work for everyone, we have plenty of anecdotal and evidence-based research to safely say certain postures can contribute to pain in sitting, standing, etc. Since August is all about Back to School, we know this means back to sitting for 8 hour days for students. For many adults, sitting at work for long periods of time is inevitable. This is why addressing posture and building postural stability and strength is so important! 

Before we dive in to what good posture IS, lets first discuss what good posture ISN’T:

• Pulling your shoulder blades back and down
  • This creates tension/strain on your brachial plexus (the nerve network that runs from your neck to your arms)
• Standing with your butt tucked under you with posterior pelvic tilt
  • Thinking of your spine being straight will contribute to unnatural loading patterns for your vertebral column and your discs
• Keeping your neck held “straight” with a chin tuck
  • This will lead to military neck and loss of cervical lordosis and your natural curvature

Message from all of this? KEEP YOUR CURVES! Your spine is S-shaped and maintaining this is what good posture is all about! If you have worked with us at IP, you may have heard some expressions like: keep your ears over your a$$, pull your butt up to your blades, or  _________ . We aren’t saying these expressions for a laugh, but to cue to you to keep your natural lordosis and kyphosis (spinal curves). In the picture below, you see the anatomical plumb line. If maintaining good posture, this line should cross your earlobe, outside of the shoulder, outside of your hip, outer knee, and outer ankle in standing!

Think of maintaining these curves the next time you have to stand or sit for a prolonged amount of time to begin building postural endurance and strength! If you struggle with sitting or standing for prolonged amounts of time without aches and pain, consider scheduling your PT evaluation at IP!

Happy 4th of July! Summer has finally arrived in Colorado! This means more time spent outdoors doing your favorite activities, covering up with some SPF (see the last blog…), and of course, traveling! One of the biggest questions we get from our patients during this time of year is, “What exercises can I do while I’m gone so I don’t lose progress in my rehab?” Vacation and traveling don’t have to get in the way of a steady recovery as long as you stay consistent!

There are dozens of body-weight exercises that we prescribe our patients at IP, with our favorite being the Fire Hydrants. This sequence of four exercises works on stability AND mobility for the spine, hips, shoulders, knees, and wrists, need we say more?! Check them out below and try to hold each position for up to a minute! For added resistance and a more challenging workout, throw a pair of furniture sliders and therabands in your bag and you’ll be able to enjoy your vacation with a healthy body! 

Another concern with summer traveling is the increased stiffness and pain that comes from long flights or car rides. Below we are going to show some simple, yet easy ways to stay mobile while getting to your destination!

Seated Thoracic Extension/Flexion

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Lumbar Flexion/Extension

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Seated Figure 4 Stretch (Stay active by pulling knee open and keeping foot flexed)

Seated Thoracic Rotation (push your thigh out into hand for resistance)

Hip Adduction with Hand Resistance

Did you know that PTs are educated on skin care and the integumentary system as part of their coursework and that many PTs specialize in skin and wound care? As the weather starts to warm up (waiting for normal weather in Fort Collins…) and everyone starts to spend more time outdoors, taking care of your largest organ, your skin, is so important! You should have a head to toe skin check yearly to screen for skin cancer by your provider, as well as perform self-checks on larger moles, freckles, etc. regularly. Early detection is key to prevent spreading of lesions and treatment with excision. You can see Dr. John getting his #FatherhoodFitness on with Malaki, enjoying sunny Colorado and practicing safe skin care! Tag us on social so we can see those dad bods moving!

Here is what you should look for when performing a self-check:

The ABCDE’s of Skin Cancer

Asymmetry: If you draw a line through the lesion, the halves will be uneven
Border: Edges of the lesion will be uneven, crusty, or notched
Color: Uneven coloring, especially appearance of white and/or blue
Diameter: Lesions larger than a pencil eraser in diameter
Evolving: The lesion will begin to change in size, shape, or color or begins to bleed and scab

Summer Skin Care Tips

• Apply broad-spectrum, water-resistant sunscreen of 30 SPF minimum to all exposed areas of skin when spending time outdoors (and reapply every 2 hours!)
• Wear lightweight protective clothing to prevent prolonged sun exposure, especially between 10am and 2pm
• Avoid tanning beds and sunbathing
• EXERCISE! While it won’t protect you from skin cancer, working up a regular sweat is the best way to keep your skin healthy. Exercise increases circulation, delivers nutrient-rich blood to the skin, helps to flush out damaging free-radicals, and boosts skin cell turnover!

With Mother’s Day approaching, we thought it would be helpful to dive into a topic affecting the moms in our lives and in the IP community: Diastasis Recti. A woman’s body goes through incredible changes during pregnancy, delivery, and eventually post-partum. Typically these changes lead to overstretching and weakness of the abdominal wall and pelvic floor which can result in:

• Low back pain
• Sacroiliac Joint Disorder
• Difficulty with lifting child and performing functional activities

The good news is, these problems can be addressed and treated with physical therapy!

What is Diastasis Recti?
Diastasis Recti is a term that describes separation in the abdominal wall between the two sides of your rectus abdominis muscles (*think your 6 pack*) that leads to a bulging/herniation of organs when sitting up or increasing pressure throughout your abdomen. The dysfunction itself is typically painless, but the generalized weakness and loss of integrity of the abdominal wall can lead to low back pain, etc. Although this condition is most prevalent in post-partum women, this can affect people of all ages, gender, and fitness levels.

How do I know if I have it?

Lie on your back with your knees bent
Lift your head and shoulders off of the floor and reach your arms towards your feet
You will then feel for a bulging both slightly above and below the belly button
If the herniation is >2cm wide, it is a positive test for D.R.

How can I fix it?
Post-partum training of a muscle called the Transverse Abdominis (TrA) is crucial to closing the diastasis recti and strengthening the abdominal wall safely. This muscle wraps around your sides and pulls your waist in with the fibers pointing towards your belly button. To activate, start by lying comfortably on your back with your knees bent and think of “pulling in your corset” around the sides. Another way to activate is to imagine a string drawing your belly button towards your spine.Without having to hold your breath, you should feel your waist draw in and there should be no abdominal bulging. Hold this contraction and count to 10 while slowly breathing in and out. This can begin as soon as 4 days post-delivery.

Once you can successfully hold this contraction, you can begin a series of movements know as “Sahrmann Exercises” to place a higher demand on the TrA. Click the link here to follow along with these exercises.

As the diastasis recti begins to close, your physical therapist will continue to progress you to more demanding core stabilization exercises! If you or someone you know would benefit from these exercises and post-partum PT care, give us a call!

Challenge Your Core and Your Pelvic Floor with these Exercises!

Since April is “All About Adolescents,” we thought we would dive into an important topic that affects injury recovery in our young female population. Have you or an adolescent female you know had a difficult time recovering from an overuse injury? This young woman may be suffering from a phenomenon know as “Female Athlete Triad.”   This condition is the culmination of 3 main factors including:

Energy Deficiency

• Disordered Eating
• Decreased Caloric Intake
• Insufficient protein intake
• Disruption of hormone levels
• Decreased micronutrient levels (iron/zinc) = anemia

Disruption in Menstrual Cycle

• Irregular menstrual periods
• Amenorrhea: Complete cessation of menstrual periods

Decreased Bone Mineral Density

• Osteopenia
• Osteoporosis

HOW DO THESE TIE TOGETHER?

Low energy availability for a prolonged period of time will ultimately lead to a decrease in a person’s basal metabolic rate (BMR). This BMR reduction will result in higher levels of blood cortisol (stress hormone) and decreased levels of estrogen. This decrease in estrogen will lead to irregularity or complete absence of the menstrual period. The lack of estrogen and increased cortisol will finally result in decreased bone mineral density and ultimately osteopenia (osteoporosis in severe cases).

When this energy deficit becomes a chronic issue and leads to the other precipitating factors, the young woman may experience symptoms including increased fatigue, difficulty recovering from training, delayed healing, cardiac arrhythmia, difficulty gaining muscle mass, stress fractures, as well as difficulty concentrating and cognitive issues.

As physical therapists, we are trained to recognize the signs and symptoms of the female athlete triad and treat accordingly. As part of our integrative treatment approach, we may counsel the young woman on proper nutrition, incorporating adequate rest into the training schedule, and injury prevention methods. If your daughter, sister, friend, etc., may be suffering from the female athlete triad, have them schedule an appointment at IP to begin their road to a successful recovery!

What body part is treated most in our clinic behind the low back and neck? If you guessed the shoulder you are correct! Recent studies show that shoulder injuries and disorders make up roughly 15-25 percent of all outpatient physical therapy visits. Of these patients, we are typically diagnosing and treating conditions that include:

• Impingement Syndrome (subacromial, subcoracoid, internal)
• Labral Tears (SLAP, bankart)
• Adhesive Capsulitis
• Degenerative Arthritis
• AC Joint Disorders
• Scapular Dyskinesia
• Bursitis
• Rotator Cuff Tendonopathy
• Rotator Cuff Tear (Partial and Full Thickness!)

When people hear or see the word TEAR, the first knee-jerk reaction is, am I going to need surgery? While surgery is an option for some severe cases, our goal at IP is to get our patients out of pain and back to their functional and recreational activities without going under the knife! With the right PT protocol, conservative treatment can be just as successful, if not more successful than surgery.

If you have been to IP for a rotator cuff tear, we most likely have provided you with an article that discusses the non-surgical approach to treatment. In this study, done by Kuhn et al. in 2013, they found that of the 452 subjects with full-thickness rotator cuff tears, 75% recovered successfully with physical therapy. With customized, appropriate therapeutic exercises, manual treatment, and compliance with our home exercise program, these outcomes are very realistic!

Another non-operative approach and adjunct to physical therapy treatment is PRP (Platelet-Rich Plasma) stem cell injections. Dr. Abrahamson of Integrative Sports Medicine can diagnose a rotator cuff tear using diagnostic ultrasound and perform either of these techniques on-site at 2020 if he deems the procedure is appropriate. This, along with the appropriate rehab protocol can significantly reduce recovery time! Read more on these procedures here:

If you’ve been told surgery is your only option for a shoulder injury (or any musculoskeletal injury), consider trying a conservative approach first! We will design a customized, evidence based plan of care to get you back to optimum performance faster!

https://www.ncbi.nlm.nih.gov/pubmed/23540577