How to position yourself in the chair is more important than the chair itself. You should sit in a neutral pelvic position. To find neutral you will need to move through the end range of your pelvis. Do this by slumping (posterior pelvic tilt); then, stick your belly forward, arching your back (anterior pelvic tilt). Lastly, move your pelvis back half way. This is a neutral pelvic position. While seated, try to maintain this posture. It is easier to maintain this position by placing your feet in a staggered position rather than both feet side by side in front of you. Staggered is when one foot is in front and one foot is back.
Additionally, specific guidelines for your workstation can help maximize your comfort and safety.

Your chair should have the following:

The position of the keyboard is critical:

The position of your computer monitor is important:

How can Spectrum Physical Therapy help?
The physical therapists at Spectrum Therapy are experts at modifying workstations to increase efficiency and prevent or relieve pain. Additionally, if you are experiencing pain that isn’t relieved by modifications to your work station, you should see a physical therapist who can help develop a treatment plan to relieve your pain and improve your mobility.

Vol. 19 •Issue 21 • Page 12 
And the Winner Is…

New York practice owner receives ADVANCE’s 4th annual honor

By Rob Senior

ADVANCE congratulates Gary Welch, PT, DPT, CFMT, COMT, CFCE, the winner of our 4th annual PT Practitioner of the Year contest.

Dr. Welch became the first award winner to be nominated twice—patients Valerie DiGiovanni and Margaret Gallagher both acknowledged his fine service to the physical therapy profession in separate letters toADVANCE.

“Dr. Welch is a driven professional who successfully performs the duties of his position with a high degree of motivation and positive attitude,” wrote DiGiovanni. “He works more than 70 hours a week to make sure his patients are taken care of. He recently began office hours on Saturdays. His demeanor is very professional and positive. Patients love and look forward to coming to his practice.”

“I know Gary Welch invested a lot of time, energy, encouragement and support into my recovery,” added Gallagher. “It was an
Dr. Welch, the owner of  in Patchogue, NY, has been a licensed physical therapist since 2000 when he graduated from the State University of New York (SUNY) at Stonybrook. He later utilized Stonybrook’s transitional doctorate program to become a DPT last year.extremely frightening experience for me. Experiencing the quality of care and knowledge Gary Welch has as a physical therapist I knew I was getting the best there was out there.”

“I am so honored to receive this award,” said Dr. Welch. “It is humbling to know that my patients feel that their lives have been positively impacted to the point that they take time out of their busy schedules and nominate me for the award.”

After starting his career as a practitioner at St. Charles Hospital, an outpatient rehab facility in Patchogue, Dr. Welch made the decision to start his own practice in the winter of 2007.

As his specialty certifications attest, Dr. Welch is quite a continuing education enthusiast, and that passion helped lead him into developing his own practice. “I got involved in as much continuing education as I could,” he recalled, “and once I became a certified functional manual therapist, and took all the courses to become a certified orthopedic manual therapist, I felt that I had enough of my own skills to start my own practice.”

That was his motivation, but Dr. Welch’s inspiration came from a unique time and place. “I was out on my bike one day,” he recalled, “riding along Hospital Road, about a mile from my house. For some reason, instead of heading toward my house, I turned to ride down by the hospital.”

What Dr. Welch saw next changed his life and career. In the distance, across the street from the hospital was a brand-new medical building, still under construction.

“I stopped in my tracks,” he recalled. “I couldn’t believe this beautiful building was going to be right across the street in my neighborhood. But sure enough, there was a phone number to call for leasing information.”

Initially, Dr. Welch figured the cost would be prohibitive, but after months of planning, he found himself in the brand-new building in February 2007, the proud owner and founder of Spectrum Physical Therapy. A little less than two years later, his practice boasts close to a thousand patients treated, with more on their way through the doors every day.

Dr. Welch attributes the number of patients he has treated in such a short time to word-of-mouth, and his devotion to continuing education, which makes him more qualified and impressive to doctors in the area. “The doctors see the improvements being made, and they’re pleased with this progress,” he said. “My doctorate degree, my certifications as a manual therapist—these things help me to promote my practice and to promote physical therapy as a whole in our area.”

His own hard work plays a significant role, as Dr. Welch routinely puts in 70-hour weeks to develop and enhance his practice. “At the start, I was the only therapist here,” he reasoned. “Working those long hours was the only way to stay open from seven in the morning until 8:30 PM.”

Once the patient load became impossible to handle on his own, Dr. Welch’s wife—also a PT—came in to help out part-time. “She saw some of the extra patients I couldn’t treat, but I still was working 70 hours or so per week for the first eight months of the practice.”

The couple is currently co-owners and full-time employees of Spectrum Physical Therapy. “I’m glad to say I’m now down to 50 hours of work per week,” laughed Dr. Welch.

Margaret Gallagher’s nomination thanked Dr. Welch for showing her ways to exercise safely and condition herself in between appointments. “It’s imperative to get any patient to a point of independence with a home exercise program, while teaching them exercises that reduce pain and impairment while improving their function,” said Dr. Welch.

One of Dr. Welch’s biggest points with his employees is teamwork. “Patients have very busy schedules,” he reasoned, “so if I’m not here during one of my patients’ appointment, it’s important that I have someone on staff who can fill in for that appointment.”

This is possible because of the excellent notes Dr. Welch and all the therapists at Spectrum take on each visit. “Each therapist can look and see what programs the patient is working on and what protocols we’re following with each patient,” he said.

Even with all the work he’s completed recently with building his own practice, Dr. Welch isn’t stopping just yet. “I am currently in the process of starting a physical therapy office at Brookhaven National Labs, which will provide PT services for the employee’s of the lab and allow me to continue providing pre-employment screens for new hires,” he reported. “The pre-employment screens help to determine if a prospective employee is capable of performing the essential tasks that are required for that job and lower the potential for future injuries.”

He also enjoys teaching his course on Manual and Manipulative Therapy of the Spine and Pelvis for the transitional DPT students at Stony Brook. This course promotes instruction on mobilization and manipulation of the joints throughout the spine, which has recently been encouraged by the APTA and AAOMPT, which he is a member.

As far as his personal life, Dr. Welch gave all the credit for his success to others who are in his life. “I do feel strongly that this could never have happened without my guidance and faith that I have in God,” he said. “I give all of what has happened in my life to God and thank Him for his guidance, love and grace. I also want to give thanks to the people who have helped to mold and teach me the skills I have to help my patients. I’ll start with my wife, who is patient with me and an outstanding manual therapist herself, as well as my professors at Stony Brook, my clinical instructors who guided me and the teachers who taught me the advanced manual therapy skills that led to my two manual therapist certifications.”

In the precious little spare time he does have, Dr. Welch enjoys tinkering with his Shelby Mustang GT 500, and is an avid photographer.

But nothing trumps his love and passion for his profession. “It’s such a pleasure to come into work and help others who are going through struggles in their lives,” he said. “Just to be able to make a difference and help someone get through their activities of daily living with less pain and improved function. I find the field of physical therapy so rewarding and wouldn’t want to do anything else.”

Rob Senior is senior associate editor at ADVANCE and can be reached at rsenior@advanceweb.com

Second Place: Marie Lynch; New York, NY

This year’s second-place finisher in the PT Practitioner of the Year Contest is Marie Lynch, MS, PT, who works at the New York Roosevelt Children’s Center.

Nominated by colleague Lauren Garavuso, MSPT, Ms. Lynch has more than 20 years of experience working at the Roosevelt Center, and is beloved by co-workers and patients alike. Upon receiving word of her honor, Ms. Lynch wrote the following to ADVANCE:

“I am stunned by all the nice things that were said in the application. I am a very modest person who just tries to think of others. I am so appreciative that my colleagues took the time and effort to write and submit this application. It is actually a testament to them that they would do so.

“Even before I read this note, I had already decided that when I e-mailed you, I would emphasize the wonderful program I work for and the tremendously warm, generous and gifted people I work with. The children in our program always come first; everyone on staff is dedicated to them.

“We truly do work as a team. So any recognition I receive I feel is a recognition of my colleagues as well. They inspire me with the countless little ways on a daily basis they give of themselves to the children. I have learned so much from the teachers and other therapists I work with.

“I know this award and ADVANCE is about therapy, but I would like to also put a special word in for special educators who work with children with special needs. In my experience, they have such a positive and large impact on the children who come in to their rooms for a whole school day. They are the people who are responsible for the development of the children in so many areas: ADLs, feeding, social, communication, cognitive and physical.

“In summary, I could not have become the therapist described in the application without being surrounded by such dedicated people in the warm environment created within our preschool. I must add one more line to acknowledge the director of our preschool, Yuki Okuma, who is responsible for running our preschool and creating such a nurturing environment. She has been the director for as long as I have worked at Roosevelt.”

—Rob Senior

Third Place—Desirea Caucci; Conshohocken, PA

Congratulations to our third-place winner for 2008, Desirea Caucci, DPT.

Caucci is president and co-owner of Conshohocken Physical Therapy. She was nominated by her husband and co-owner, Robert.

“Desirea has a tremendous ability to make people feel comfortable and upbeat—from the staff, to patients, to referring physicians,” wrote Bob Caucci. “She spends a full hour on each patient evaluation, which gives her a chance to listen and truly understand the person and the ailment.”

Dr. Caucci graduated from Arcadia University in Glenside, PA before going on to work for a large facility. But she always had a dream to go into business for herself.

“I had very strong family support,” she said of her decision to open the practice. “It was something I’d always dreamt of, and it was perfect timing.”

That time was about three years ago. With her husband’s business abilities and Desirea’s clinical expertise, the Cauccis opened Conshohocken Physical Therapy. With the intention of making their business a part of the community, they found their location only a mile from their home.

Since that time, Dr. Caucci has built a highly successful—and growing—practice. With a total of three PTs, she says their current 1,000 square foot facility is somewhat “maxed out” but doesn’t rule out further growth in the future.

“As a therapist and the practice owner, Desirea has been forced to juggle every aspect of the business,” Bob wrote. “She has met every challenge head on and worked through them with ease and confidence. In just over two years she has opened the practice in the back corner of a training center, quickly grown into a private office in the center of town and hired another full-time therapist to handle the rapidly growing referral base. Ultimately, she has created an extremely healthy business, both therapeutically and financially.”

“In medicine, everything is rushed,” said Dr. Caucci. “Patients need someone to listen to and truly assess their needs. That’s the role PT can play. That’s why, at our facility, we see only one patient per hour. It’s a unique approach, but our patients are truly appreciative.”

—Rob Senior

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The foundation of every successful weight loss program remains a healthy, calorie-controlled diet combined with exercise. For successful, long-term weight loss, you must make permanent changes in your lifestyle and health habits. It may seem obvious to set realistic weight loss goals, but do you really know what’s realistic? Over the long term, it’s best to aim for losing 1 to 2 pounds a week, To lose 1 to 2 pounds a week, you need to burn 500 to 1,000 calories more than you consume each day, through a lower calorie diet and regular exercise.

Enjoy Healthier Foods

In particular, get your weight loss started by eating a healthy breakfast every day; eating at least four servings of vegetables and three servings of fruits daily; and using healthy fats, such as olive oil and vegetable oils. In addition, cut back on sugar (one soda a day = 50lbs of sugar you consume per year), choose low-fat dairy products and keep meat consumption to around a 3-ounce portion, about the size of a deck of cards. Cut back or just eliminate sodas, decrease carbohydrates (breads, pasta, potato, French fries, etc…), fatty and greasy foods.

Smaller Portion Sizes

Americans typically consume more calories because of a larger portions size. The old adage of more is better, or going to an all you can eat buffet. We’ve all done that, and a lot of times, we feel very full afterwards. In fact, we usually feel bloated or sick after eating too much. There are easy ways and more complex ways to figuring out correct portion size. To keep it simplistic, reduce your normal portion size by about 1/3. This should help considerably.

Here is a list of portion sizes based on the USDA recommendations:

According to the USDA, one serving equals:
one slice of whole-grain bread
1/2 cup of cooked rice or pasta
1/2 cup of mashed potatoes
three to four small crackers
one small pancake or waffle
two medium-sized cookies
1/2 cup cooked vegetables
1 cup (four leaves) lettuce
one small baked potato
3/4 cup vegetable juice
one medium apple
1/2 grapefruit or mango
1/2 cup berries
1 cup yogurt or milk
1 1/2 ounces of cheddar cheese
one chicken breast
one medium pork chop
1/4 pound hamburger patty

Get Active and Stay Active

While you can lose weight without exercise, exercise plus calorie restriction can help give you the weight-loss edge. Exercise can help burn off the excess calories you can’t cut through diet alone. Exercise also offers numerous health benefits, including boosting your mood, strengthening your cardiovascular system and reducing your blood pressure. Exercise can also help in maintaining weight loss. Studies show that people who maintain their weight loss over the long term get regular physical activity.

The key to weight loss is burning more calories than you consume. Because 3,500 calories equals about 1 pound (0.5 kilogram) of fat, you need to burn 3,500 calories more than you take in to lose 1 pound. So if you cut 500 calories from your typical diet each day, you’d lose about 1 pound a week (500 calories x 7 days = 3,500 calories).

How many calories you burn depends on the frequency, duration and intensity of your activities or workouts. One of the best ways to lose body fat is through a steady aerobic exercise, such as riding a bike or stationary bike, brisk walking, stepping on a standing or seated elliptical all for at least 30 minutes 4-5 days a week. Any extra movement helps burn calories, though. Lifestyle activities may be easier to fit into your day rather than going to a gym. Think about ways you can increase your physical activity throughout the day if you can’t fit in formal exercise on a given day. For example, make several trips up and down stairs instead of using the elevator, or park at the far end of the lot when you go to work or go shopping. Formal exercise is one of the best ways to burn calories. The equipment that you find at Spectrum Therapy or in the gym is made very well to allow for great cardiovascular exercises. Gym activities will allow you to reach your target heart rate much easier than activities of daily living. Make sure you ask your MD to see if you should follow any precautions during exercise.

Change your Habits

It’s not enough to eat healthy foods and exercise for only a few weeks or even months if you want long-term, successful weight loss. These habits must become a way of life. Lifestyle changes start with taking an honest look at your eating patterns and daily routine. After assessing your personal challenges to weight loss, try working out a strategy to gradually change habits and attitudes that have sabotaged your past efforts. You likely will have an occasional setback. But instead of giving up entirely after a setback, simply start fresh the next day. Remember that you’re planning to change your life. It won’t happen all at once. Stick to your healthy lifestyle and the results will be worth it.

If you have any questions, feel free to ask one of our professional staff members. We can assist you through your weight loss efforts or just staying active and leading a healthier lifestyle.
Thank you,

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Join host Jeff Worrell for an uplifting and fun discussion with a clinician that did not mention the woes of insurance reimbursement.

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So, is there anything you can do to help prevent this type of injury? Definitely! One of the core ideas in stabilizing your knee is through dynamic stabilization. This is strengthening all of the muscles that surround the joint to make it more stable. Some of the muscles that cross over the knee cross the hip joint as well; so, exercising the hip as well as the knee is recommended. Squatting with your knee over your toes, not forward of the toes or to the side of your feet! Leg press exercises are great for strengthening the quads and gluteal muscles. Straight leg raises, resisted walking, hip machine exercises are perfect for strengthening the muscles that affect the hip and knee.
Also, learn how to move with better awareness of your alignment. Always jump and land with a slight bend to the knees and with our knees directly over your toes. This alignment will put a lot less stress on ligaments in your knee. Do not let your knees collapse inward; this is a sign of bad technique and possibly weakness in the outer hip muscles (hip abductors). Warm up and stretch before practice or games! Perform a variety of drills until the movements feel second nature. Plyometric exercises are a perfect examples of drills to perform, and don’t forget “perfect alignment”.

If you participate in a sport where the possibility of being hit in the knees occurs, try a knee brace for extra stability; this may help in reducing the chance of injury in the future.
If you do injure your ACL, you may need surgery.
There are two main options for ACL graft selection: autograft and allograft. Autografts are the patients’ own tissues, and the most common options include the middle third of the patella tendon and the hamstring tendons. Allografts are cadaveric tissue sourced from a tissue bank; the most common allograft tissue used for ACL reconstruction is the achilles tendon. Each method has its own advantages and disadvantages; patellar tendon autografts are the most common and often considered the gold standard for young highly competitive athletes. However, the site of the harvest is often painful for weeks after surgery and some patients can develop tendinitis or generalized knee pain that can be difficult to recover from. Such complications are generally avoided when using hamstring autografts, although some clinicians feel hamstring reconstructions become loose over time. It should be noted that many clinicians used both with an extremely high success rate and their use is often surgeon preference or bias. ACL surgery reconstruction using allograft tissue does carry a slightly higher infection risk but patients often recover the fastest of all the graft choices.

The ACL surgery is performed arthroscopically, with tunnels drilled into the femur and tibia at the origin of the ACL. The graft is then placed into position and held in place by a variety of fixation devices available. These include screws, buttons and post fixation devices. The graft typically attaches to the bone within six to eight weeks. The original collagen tissue in the graft acts as a scaffold and new collagen tissue is laid down in the graft with time.

After ACL surgery, the knee joint loses flexibility, and the muscles around the knee and in the thigh tend to atrophy. All treatment options require extensive physical therapy to regain muscle strength around the knee and restore range of motion (ROM). For some patients, the lengthy rehabilitation period may be more difficult to deal with than the actual ACL surgery. External bracing is recommended for athletes in contact and collision sports for a period of time after reconstruction. It is important however to realize that many of the specific rehabilitation protocols are physician dependent. Generally speaking, most surgeons will prescribe a brace and crutches for post ACL surgery recovery for approximately one month. After that, a rehabilitation period of four to six months is required to regain pre-surgery strength and use.

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Risk Factors associated with falls:

Maintaining Physical Activity:

The most critical action seniors can take to help prevent falls is to maintain an active lifestyle. The less active you are the weaker your muscles become and the tighter they become. Also, your joints will become quite stiff, which doesn’t help matters. Physical therapists recommend activities, including walking, gardening, line dancing, pilates, yoga, and gym activities to help improve strength, flexibility, balance, and movement. Please check with your physician before attempting an exercise program, especially if you have pre-existing conditions that are affected by exercise.

Test Your Balance:
Balance may be improved with exercises that strengthen the ankle, knee, and hip muscles and with exercises that improve the function of the vestibular system. A simple assessment of your current balance can be done at home. Do Not Attempt to do this test alone, make sure that you have someone next to you to decrease the potential for risk of falling. If you believe that your balance is poor, seek assistance from your physician or a physical therapist.

1.Start with feet shoulder width apart and try to stand for 60 seconds.

2.Stand with one foot forward by about 12 inches for 60 seconds. Test both sides.

3.Stand with one foot in front of the other, like you are on a tight rope, for 60 seconds. Test both sides.

4.Single leg stance – Stand on one foot and hold as long as you can, up to 60 seconds. Test both sides.

How Physical Therapists Can Help:
Once a physical therapist has reviewed a complete history and thoroughly examined you, he or she will design an individualized program of exercises and activities with an emphasis on strength, flexibility, coordination, balance, and a proper gait pattern. A personalized plan may include a walking regimen that includes balance components such as changes in surfaces/terrains, distance, and elevations, foot positions, and walking in different directions with or without resistance. Equipment used to improve balance can include high tech balance systems i.e. Biodex balance system, which can test and challenge your balance dynamically and statically. Dynamic is when the platform you stand on can move underneath you and static is when the platform does not move. We also use the Wii Fit to challenge your balance, (a static platform); there are many programs from these two systems to aid in your recovery and reduce the likelihood for falls. Your physical therapist will also teach you specific strengthening and balance exercises that can be performed at the clinic and at home. If necessary, your physical therapist will refer you to other medical professionals, such as an ophthalmologist, or neurologist to improve your chances of a successful outcome.

If you have any questions on what you have read in this article, don’t hesitate to contact myself or one of our therapists.

As reported in the New England Journal of Medicine’s teaching topics – vol. 361, No 7, August 13, 2009, approximately 184,000 women are diagnosed with breast cancer each year in the United States, and 90% of these women will live at least 5 years. Lymphedema ranks high among the serous concerns of survivors, as it is chronic, progressive, and incurable. Lymphedema causes limb swelling and discomfort, considerably impairing arm function. The incidence of Lymphedema after breast cancer surgery varies across studies from 6% to 70%, depending on the criteria used for diagnosis and the follow up interval.

The concern about weight lifting has largely been based on epidemiologic studies of women who had undergone axillary-node dissection or radiation therapy, in which significant associations between infection or injury to the affected arm and Lymphedema were reported. In translating these data to simple patient – friendly steps for the prevention of Lymphedema, a strategy of avoidance, rather than rehabilitation, was adopted. Although such advice is intended to prevent harm, adherence to these precautions may limit physical recovery after breast cancer surgery, alter activities, and adversely affect employment. Conversely, a program of controlled exercise through weight lifting may increase the physical work capacity of the affected arm, thereby protecting it from injury sustained during common daily activities. Weight lifting offers additional benefits, particularly relevant to breast cancer survivors, including control of body fat, improved functional outcomes, and bone health.

In the Schmitz et al. study, women assigned to twice-weekly, whole-body resistance training did not have a significant increase in limb swelling, and had greater improvements in self reported severity of Lymphedema symptoms and in upper and lower body strength as compared with patients assigned to usual care. As compared with the control group, the weight lifting group also had a lower incidence of Lymphedema exacerbations as assessed by a certified Lymphedema specialist (14% vs. 29%). There were no serious adverse events related to the rehab interventions.

If you would like to talk with a therapist at Spectrum, feel free to give us a call and we can talk to you about both cardio and resistance training available at our office.

Dr. Gary Welch PT, CFCE, CFMT, COMT

Certified Functional Capacity Evaluator, Certified Functional Manual Therapist, Certified Orthopedic Manual Therapist.

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Physical Therapy, an Alternative to the High Risks of Methadone.

An investigative report published February 2003, in the New York Times, highlights the alarming increase in methadone prescriptions for the treatment of chronic spinal pain. The result has been a shocking increase in methadone related deaths. Sept. 30, 2009, Methadone deaths have risen sevenfold in less than a decade, according to a government report that largely blames the increase on the growing use of methadone for pain relief. In addition, drug deaths now outnumber traffic fatalities in the United States. Drugs exceeded motor vehicle accidents as a cause of death in 2009, killing at least 37,485 people nationwide, according to preliminary data from the U.S. Centers for Disease Control and Prevention. The Drug enforcement Administration noted that from 1998 to 2006, the number of methadone prescriptions increased by 700 percent. Many legitimate patients, following the direction of their doctor, have run into trouble with methadone, including death.

More recently and in our own neighborhood, we have seen the senseless deaths of innocent people while others attempt to steal these pain medications right out of the pharmacies. I’ve seen how this affects people in our neighborhood; it has negatively affected many people for the rest of their lives, both the users and their families, and the innocent by standers. Attempts need to be made to decrease the dependence on these highly addictive medications.
As a physical therapist, I know how we can play a role in providing patients and physicians with an alternative to dangerous pain medications like oxycodone and methadone. Methadone was once limited to use in addiction treatment centers to replace heroin, but today it is frequently given out by physicians to manage spine pain, joint pain, and other related chronic pain.

Patients should be aware that these medications are not the best option to reduce the symptoms of spinal pain. Research has shown that early movement and treatments like soft tissue mobilization, myofascial release, spinal manipulation, and exercise offer strong benefits to spine pain and disability. We too often initiate prescription drug therapy before choosing safe and effective alternatives. Many people in the medical community suggest that patients seek out physical therapists as a first-line treatment for these conditions.

A February 2008 report published in the Journal of the American Medical Association reports that from 1997 to 2005, pharmaceutical expenditures for the management of low back pain increased by 171% while the rate of good outcomes fell. “All the imaging we do, all the drug treatments, all the injections, all the operations have some benefit for some patients,” said Richard A. Deyo, a physician at Oregon Health & Science University in Portland and a coauthor of the report. “But I think in each of those situations we’ve begun using those tests or treatments more widely than science would really support.”

For more on the benefits physical therapists can provide in the management of spinal pain, contact us at Spectrum Physical Therapy or visit the American Academy of Orthopaedic Manual Physical Therapists website at www.aaompt.org. AAOMPT represents physical therapists by promoting excellence in orthopaedic manual physical therapy practice, education and research. You can also visit the American Physical Therapy Association (APTA) website http://www.moveforwardpt.com for information on symptoms and conditions, why physical therapy, patient resources, and how to find a local physical therapist.
If you have any questions, feel free to contact myself, or one of our therapists.
Thank you,

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In sports, the ankle is the most commonly injured body part and each year, approximately 8 million people sprain an ankle. Millions of those will then go on to sprain that same ankle, or their other ankle in the future. The recurrence rate for ankle sprains is between 30% to 80%. A growing body of research suggests that many of those second and often third or fourth sprains could be avoided with an easy course of treatment. Improving coordination between the four muscle groups around the ankle will improve balance and decrease the likelihood of uncontrollably inverting the ankle, which cause the tearing of the lateral ankle ligaments.

In one randomized controlled study, 31 adults with a history of multiple ankle sprains completed four weeks of supervised balance training with a physical therapist. So did a control group with healthy ankles. The injured started out much shakier than the controls during exercises. But, by the end of the month those with wobbly ankles had improved dramatically on all measures of balance. They also reported subjectively, that their ankles felt much’s less likely to give way at any moment. The control group had improved their balance as well, but only slightly. Similarly, a major review published in 2008 found that six weeks of rehab, which included balance training, begun soon after a first ankle sprain, substantially reduced the risk of recurrence. In the control group, the training also lessened the chances of suffering a first sprain at all.

Why should balance training prevent ankle sprains? Until more recently, clinicians thought that ankle sprains were primarily a matter of overstretched, torn, and traumatized ligaments. Brace or tape, rest, and ice the joint and a person should heal rather well. However, that approach ignored the role of the central nervous system, which is intimately tied in to every joint in the body. There are proprioreceptors in ligaments and when you damage a ligament, you damage these receptors. Your brain is no longer receiving reliable signals from the ankle on where your foot is in space or relation to the ground. Your proprioception, the sense of your body’s position in space is impaired. You’re more susceptible to loosing your balance, falling over and re-injuring yourself.

At Spectrum, a course of rehab for an ankle sprain will include a treatment protocol that includes an initial evaluation to identify the ligament(s) involved, the severity of the injury, range of motion, strength, edema, etc… Treatment options include, moist heat or ultrasound, soft tissue mobilization and cross friction massage to the torn ligament(s), retrograde massage for moderate to significant swelling, high volt electrical stimulation to promote collagen synthesis, therapeutic exercises to increase strength and coordination, and many balance activities which will promote strength, coordination, and a far less likelihood of re-injuring your ankle. Ice follows the treatment to help decrease pain and swelling.

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HHN PROVIDER SPOTLIGHT

“I wanted to join HHN to provide the best in physical therapy care for those who have made a huge sacrifice, our troops,” said Welch. “I know that many of these soldiers are coming back after receiving combat injuries, and are left with significant musculoskeletal & neurological impairments. This can lead to functional deficits and disabilities. With the proper care, these men and women have a much better chance to recover from their injuries and lead a normal life.”

We at HHN recognize that our wounded Heroes are suffering from a growing list of injuries, and chronic pain. Adding Dr. Welch to our family of providers will give HHN a fresh opportunity to tackle these various needs head-on.

Dr. Welch is the ‘08-’09 Physical Therapist of the Year for the Advance for Physical Therapists & Physical
Therapy Assistance Magazine. He is also a military man, having served in the Marine Corps, the Army and the Coast Guard. Now, he’s looking to give back to his brothers and sisters in arms.

“It’s an honor to be able to help those who have sacrificed so much,” said Welch. “I spent 10 years in the service myself, and feel that I can still serve by helping others. If you love this country, and you are a health care provider, dedicate some of your time for the troops who could use your help. You can make a difference in someone’s life.”

Website:healingheroes.org
Original Story: Provider Spotlight.pdf

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