Does your medical insurance have your best interest in mind?

Does your medical insurance have your best interest in mind?
Stethoscope and pen resting on a sheet of medical insurance records

Stethoscope and pen resting on a sheet of medical insurance records


In our physical therapy office, we see patients every day, who come in with serious pain and injuries, and they want the best in care for themselves. Our patients also pay a lot for their insurance and they want to be able to use what they’ve paid for. This makes complete sense and I would want to do the same thing. However, most are finding out that after paying so much every month for their insurance, they also have a high co-payment every time they see a doctor or a physical therapist. When coming to physical therapy, their co-pay is categorized as a specialist visit, which makes the visit more costly.  The normal co-pay these days average $30 to $40 per visit, but we are seeing absurd co-pays of up to $60 – $75/ visit, which is higher than our cash based fee for service.  Over the years, we’ve not only seen the insurance costs and co-pays go up, but the amount of documentation has significantly increased, inundating the clinicians to the point that it takes a lot of valuable time away from treating our patients.

When a patient comes in physical therapy, we perform an initial evaluation. We than send the clinical findings to the insurance company along with a recommendation for the number of visits needed to improve the patient’s signs and symptoms.  Two or three days later, I may receive an authorization allowing us to begin treatment on the patient, but with a glitch. The insurance company will generally only authorize a fraction of the visits requested, which were originally based on the findings during the evaluation. I’ve discussed these cases with a representative at the insurance company; wait, I’m not actually talking to the insurance company, it’s a third party company hired by the insurance company to manage the authorizations. These companies are hired because they guarantee the insurance company that they can keep costs down, by aggressively managing the authorization of physical therapy visits. This makes their decisions financially based, not a decision based on medical necessity for that patient. Now, back to my story. The representatives tell me that the number of visits authorized is based off of the diagnosis code, not what is observed in the initial evaluation! This is how insurance companies can get in the way with the care needed by the patient.

Here’s a case scenario. A 45 year old male is doing house work and while on a ladder falls from a height of ten feet. He lands on the right side of his back causing a vertebral fracture and significant soft tissue trauma. The patient is complaining of 9/10 pain with light activity and 7/10 pain at rest or while lying down. He also complains of numbness and tingling down his right leg. His diagnosis code if for low back pain with radiculopathy. The representative at the third party company ties this diagnosis into a generalization for how many visits it should take to make the patient better and authorizes us 8 visits. After the 8 visits, the patient is feeling better, and rates his pain at 6-7/10 with light activity and a mild decrease in numbness, but can’t work because he’s an electrician and can’t perform the tasks that his job requires. So, he needs to continue physical therapy services to decrease his back pain, reduce muscle tone, improve vertebral range of motion, decrease the peripheral neural compression, and increase his flexibility. So, on re-submission for authorization, the insurance company states that they will give him 4 more visits, but that is it. No more PT will be authorized. After the four visits, the patient states that his pain is improving and that he’s moving better. He rates his pain at 5-6/10 and that his movement is at 50% of where it should be. He states that he’s not quite able to return to work.  The insurance company has cut him off at this point, stating that he should be better by now.  The patient however, decides that he’s going to continue with physical therapy until his pain level is tolerable. After 8 more visits, the patient reports that his pain is 1/10 with the absence of numbness, and that he’s returned to his job and is working without difficulty.

There is nothing more frustrating than this for patients living with pain that want to get help, or for the clinician who knows that they can help, but are limited by insurance coverage.  We began offering continued care, for these situations, when the patient and referring physician agrees that continued treatment would be beneficial.  We made this change because we found that we began changing our treatment approach in response to these healthcare insurance guidelines, but were becoming frustrated because we knew, and the patient knew, that this wasn’t what was best for the patient.  We reached a point where we were filling out paperwork constantly, our patients would get denied, or their case is being reviewed for so long that the progress achieved would be lost.

I hope that our lawmakers will intervene, decreasing the cost of co-payments to no more than 20% of an agreed visit charge.  For example, if the treatment charge were $60, than the patient would pay a $12 co-payment.  I would also like to see that the number of visits authorized based on the clinical findings from our exam and assessment of the patient’s signs and symptoms, not a number based on a code!

In my opinion and other clinicians I’ve talked to, the high co-pay is a two-pronged strategy.  First, it allows an employer’s healthcare coverage for their employees not to go up as much if they accept an increase in the employee’s co-payments. It also will limit the use of healthcare by the patient, because it is financially too high of a cost to seek treatment. By making these changes, it would make health care more reasonable and would allow the patient to base their decision on medical care from a needs perspective, not a financial constraint.

 

Dr. Gary Welch PT, CFCE, CFMT, CKTP, COMT

Owner – Spectrum Physical Therapy

100 Hospital Road, Suite 112

Patchogue, NY 11772

(631) 456-5512

Cell (631) 871-5652

 

Dr. Welch received his doctorate degree in physical therapy at Stony Brook University and is a Certified Functional Manual Therapist and Certified Orthopedic Manual Therapist.  He is also certified in Job site analysis, functional capacity evaluations, and a kinesio taping practitioner.  2008 National Physical Therapists of the Year – Advance for Physical Therapist Magazine.

ACL Injury Prevention Tips and Exercises

ACL Injury Prevention Tips and Exercises

Not one athlete I’ve spoken with has ever stated that they would like to have an injury and become sidelined. One of the most common injuries I’ve seen in the past is a sprain to ACL (Anterior Cruciate Ligament). This is a ligament within the knee that prevents anterior translation of the tibia on the femur or lower leg on the thighbone. The ACL can become torn, also known as a sprain, from forces put on the lower leg pushing it forward. These forces can be from other players who fall onto the leg or hit the leg from behind or from the outer side of the leg. Force can come from your own movements, sudden stopping, landing on an extended leg, and quick shifting/accelerating from side to side.

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.

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

 

Dr. Gary Welch PT, CFCE, CFMT, COMT

Owner – Spectrum Physical Therapy

Obesity in Our Children, Who Wants To Do Something?

Obesity in Our Children, Who Wants To Do Something?

Remember when you were a kid, playing outside all day long, all weekend long!  At school, going outside for recess and playing for 30 to 45 minutes; then, coming home and playing for hours, every day.  Have you noticed a change in the amount of physical activity in our children lately?

Do you ever remember seeing a vending machine in your school when you were a kid?  I remember visiting the water fountain a lot, but not a soda or snack machine.  How about all the sweet snack foods and candy that we see at the store, in the office, and during parties.   This food seems to be abundant and always in reach, even when were trying to be good.

The two leading causes in childhood obesity are decreased physical activity and the over indulgence of food that has a lot of sugar or carbohydrates.  Lets talk some facts.  The obesity rate continues to climb, where adolescent children 6-19 years old, has nearly tripled since 1966, now at 15-17% of the adolescent population.  More than 10% of children between the ages of 2 and 5 are overweight, up from 7% in 1994.  It’s not just an epidemic in children, 65% of all American adults are overweight or obese too.

Overweight and obese children are at risk of serious health problems.  Type II diabetes, also known as adult onset diabetes, is no longer adult onset.  A dramatic rise of children suffering from type II diabetes is occurring, where 1 in 4 children are showing early signs of the disease, and 60% of children already have one risk factor for heart disease.  In fact, 80% of type II diabetes is related to obesity.  Other illnesses related to obesity include:  70% of the obese population have cardiovascular disease, 42% breast and colon cancer, 30% of gall bladder surgery, and 26% have high blood pressure.

If current trends continue, adolescents with type II diabetes may experience heart trouble beginning as young as 30 to 40 years of age.  In addition, being overweight or out of shape makes the heart work harder.  Overweight children are at increased risk of heart failure, and children with serious asthma are more likely to be overweight.

Who wants to do something about it?

So, what can we do about it?  I have a few suggestions for all of us.  Parent’s can provide better foods while their children are at home.  First, decrease portion sizes a little.  How about avoiding the cereals that are predominantly made with sugar, you know the cereals I’m talking about!  We can also decrease the consumption of snack foods such as cookies, cakes, ice cream, candy, and soda: all of this excess sugar in the body gets converted to fat.  In addition, the calories in these foods provide no nutritional value to you.  Parents can also encourage their children not to use the snack and soda machines at school, send them off with a good lunch and a few healthy snacks that they can eat while at school.  How many times do you go out to eat?  Eating out frequently is a contributor to obesity.  Decrease the frequency of fast food, and if you go, eat more of the healthy items on the menu.  Parents, don’t encourage play time on the computer, Game Boy, X-Box, or the TV.  Encourage your children to go outside and run around with their friends, the dog, and you can even get out there with them!

School administrators, continue educating the children about eating correctly using the basic food groups of fruits, vegetables, grains, dairy products, and meats.  Then, practice what you teach.  Get rid of the soda in the vending machines and replace it with bottled water and a few juices.  If you can’t do that, then eliminate the vending machines all together.  It won’t hurt the kids to use the water fountains!  Provide a well balanced lunch at school with moderate proportions.  You don’t have to bring in high priced produce that takes a lot of prep time to accomplish this either.  Recess should occur everyday when possible; get the kids out playing kick ball, soft ball, hop scotch, or running around the play ground for 30 minutes.  For older students, ensure physical education is included in the schedule at least 3 days, 5 would even be better.

Kids, don’t think that I was going to leave you out of this.  Try your best to go outside and have fun.  You can have so much fun outside.  You can walk with your friends, ride your bikes, play with your toys, play baseball, football, soccer, hockey, or Lacrosse.   Let your imagination go wild and explore the outside world.  I would suggest saving the computer games for the rainy days or at night.

A little discipline to change our eating and playing habits will go along way.  And you will be on your way to a healthier and a better quality of life.

 

Dr. Gary Welch, PT, CFCE, CFMT, CKTP, COMT

Owner – Spectrum Physical Therapy

Common Overuse Injuries Attributed to Cycling, and Ways to Minimize These Injuries

 

Listed are a few of the most common overuse injuries associated with cycling long distances.

  1. Cervical and upper back pain.
  2. Low back pain.
  3. Strains and sprains of the calf muscles.
  4. Achilles and Patella tendinitis.
  5. Strains of the quadriceps and hamstring muscles.

Each of these will be discussed with suggestions of bike fitting, staying fit throughout the year, warm ups and stretches.

Cervical and upper back pain can occur from the forward angle that your body is in while riding. This position puts your head forward of your shoulders rather than above the shoulders, thus causing your cervical paraspinals and upper traps to work very hard. So, what can we do about it?

Let’s start with bike fit options: A bike position that is aggressive, meaning lowered handle bars (short stem) and the seat is set back, can cause you to be positioned in a significant amount of forward flexion. This makes you more aerodynamic, but can hurt after long periods of time. A few options would be to lengthen the stem tube raising the bars and bring the seat forward a bit. This will bring you into more of an upright position.  If you’re not sure how to do this, ask a professional at a local bike shop.

Staying fit: With your head positioned in front of you, the cervical muscles  including the upper traps, are working very hard  to keep your head from falling downward. This is a lot of work for those muscles. So here are a few tips to help strengthen these muscles when you are not cycling and a few stretches, which will alleviate the stress and tightness caused by your long rides.

Cervical Isometrics: These are exercises with no movement and the best time to perform these exercises, to be optimal, would be during the off season.

  • Cervical flexion isometric- position yourself on your back and raise your head just off the floor and tuck your chin downward slightly, to keep your neck straight. Hold this anywhere between 30 seconds to 2 minutes. This is a difficult exercise, because the anterior neck muscles (neck flexors) are generally the weakest muscles in the body. You can perform this exercise once a day.
  • Cervical Extension isometric- position yourself on your stomach with your face at ground level or with your head off the end of your bed for improved comfort. Your arms will be down at your sides, palms down. Begin to raise your head up, just off the floor and tuck your chin in to keep your neck straight, preventing you from looking upward. At the same time, lift your arms off of the floor, squeezing your shoulder blades together. Hold this position from 60 seconds to 4 minutes. You can perform this exercise once a day.

The stretches can be performed prior to a ride, *in the middle of your ride, and definitely after your ride!    *But not while you are riding!!  Hold these stretches for 30 seconds. If you can’t hold the stretch for 30 seconds, you’re probably pulling too hard, giving yourself too much of a stretch, thus decreasing your stretch time. So, stretch easily keeping the time to at least 30 seconds.

  • Upper Trap Stretch- Reach over your head and gently pull your ear towards your shoulder, hold for 30 seconds. Repeat for the other side. This stretch can be repeated 1 to 3 times a day.
  • Cervical extensor stretch- with both hands behind your head, move your head downward to stretch the muscles in the back of your neck. Don’t pull your head down, just use the weight of your arms to assist in the stretch. Hold for 30 seconds. This stretch can be repeated 1 to 3 times a day.

In addition, long periods of shoulder stabilization while holding onto the handle bars can cause the muscles around your shoulder blades to become sore (Rhomboids, middle, and lower trapezius muscles). Try to loosen/relax your grip a bit, and relax your shoulder blades as well. You can try anti-vibration tape around your handle bars and change hand position occasionally throughout your ride. The hand holds are the top of the bars, front of the bars and the bottom of the bars.

During the off season, perform the doorway stretch described below and add cable column pull downs and rows to your exercise regiment to keep these muscles strong along with increased endurance.  You will need that during the riding season, and this will also address postural issues associated with cycling!

  • Doorway stretch – This is where you put both of your forearms onto the door frame, step through the doorway with one foot and lean forward slowly, stretching out the pectoral muscles. Hold for 30 seconds. This stretch can be repeated 1 to 2 times a day.
  • Shoulder stretch- To stretch out the right shoulder, move your arm across your chest. With your left hand, grab the right arm just above the elbow and slowly pull your arm over to the left side until you feel a good stretch. Hold this stretch for up to 30 seconds. This stretch can be repeated 1 to 2 times a day.

Low Back Pain can be attributed to high frequency and long durations of riding, in an aggressive position.  In addition, the back pain can be attributed to not moving into a different position at times and/or weak abdominal strength.

Bike fit: See bike fit above, in the cervical and upper back pain paragraph.

Staying fit: While in a flexed position for long periods of time there are a few things you can do to alleviate your low back pain. When you get off of your bike stand straight up and then slowly begin to extend the spine by bending backwards, hold for about 10 seconds and repeat 2-3 times.  Also, the position that we are in while cycling does not promote core strength. So in the off season and during the riding season, be sure to incorporate core strengthening exercises into your routine.

  • Pelvic tilts – While lying on your back and both knees bent, place your index and middle fingers on the front of your pelvis. Begin to push the small of your back down into the floor, while tightening your lower abdominal muscles. Your pelvis will rock upward during this movement. You can repeat these for up to 3 sets until fatigue.
  • Segmental Bridges – While lying on your back and both knees bent, initiate the pelvic tilt described above and then continue to move up one vertebra at a time until you have moved into a bridged position. As you begin to move back down, initiate your movement from the upper most vertebrae on the floor and lower yourself back down one vertebra at a time until you roll back out of the pelvic tilt. You can repeat these for up to 3 sets until you fatigue.
  • Crunches and/or sit ups – With your hands on your chest or behind your head, initiate an abdominal contraction, lifting up the head and shoulders off of the floor, and slowly lower your shoulders back to the ground. You can hold the crunch for ~ 5 seconds. Repeat until you fatigue performing 2-3 sets. Sit ups will work your abs very well too, and will engage your hip flexors strengthening them as well. Have someone hold onto your legs and feet for assistance.
  • Hamstring stretches – The hamstring stretch described here is for the rider who may have low back pain and bending forward is painful. Lying on your back, raise your leg up with your hands, keeping the knee straight. Hold this stretch for 30-60 seconds. You can also use a yoga belt or karate belt to assist you in raising your leg. The belt would go around your foot and pull the rope with both hands.

Injuries to the lower extremities, associated with cycling, are strains of the quadriceps, hamstring, and calf muscles, along with overuse (tendinitis) of the Achilles and patella tendons.

 Bike Adjustments: Overuse of the calf muscle and Achilles tendon can cause pain behind the lower part of your leg and behind the ankle, and can be attributed to a seat that is adjusted too high. This will cause you to reach for your pedal, forcing the calf muscle to contract on a constant basis. Lower your seat to a point so that your knee has a slight bend in it at the bottom of the pedal stroke, and this will allow the calf muscle and tendon to relax a lot more during your rides. Lowering your seat will also help alleviate saddle sores.

For patella tendon pain, located just below your kneecap, check that seat height! If the seat is too low, this causes the knee to flex more causing the quads to work harder and the gluts to work less. This increased angle will also increase pressure on the patella and femoral joint surfaces, which can cause joint pain in the knee. Another adjustment you can make for patella tendinitis while cycling is to lower the gear(s) down a bit, which will increase your cadence and decrease the stress in the knee area.

Knee angle adjustment there are several methods of adjusting saddle height and the method described is the LeMond method, which works very well. While sitting on the saddle and your foot on the pedal, your knee angle should be between 25-35 deg., with 25 deg. being optimal for most riders. Be sure that the pedal is at the bottom of the down stroke when you check this angle. The angle can be checked with an inclinometer or goniometer. There are also apps available, for your smart phones, that check these types of angles. Place the side of your phone in line with your thigh to check the angle. You will need someone to measure the angle for you, while you are on the bike.

Stretches for the lower extremities Hold these stretches for 30 to 60 seconds each.  If you can’t hold the stretch for 30 seconds, you are probably pulling too hard.

  • Quad stretch – Standing up straight, raise one leg up with your hand towards the buttocks. Keep your leg straight and don’t lean forward, stay straight. Hold the stretch for 30 seconds. If you’re balance isn’t that good, hold onto a stable surface to prevent falls.

 

 

 

  • Hip flexor (Psoas) stretch – Kneeling down, begin to lean forward putting the lower leg’s hip flexor muscles on stretch. If you want more of a stretch, reach for the back foot and bend the knee until you feel a good stretch and can tolerate it for 30 seconds.

 

 

  • Hamstring Stretch – Several ways are shown to stretch your hamstrings. Hold these stretches for 30 seconds. Bouncing a stretch may increase your chance of straining the muscle.

 

 

  • Piriformis / Pigeon stretch – The first stretch is a piriformis stretch. Place one foot over the other thigh. Reach behind your leg with both hands and begin to lightly pull towards your chest. You will feel a stretch in the buttocks area. Hold for 30 seconds. The second stretch shown is a pigeon stretch. This will stretch the gluteus muscles on one side and the hip flexors on the back leg.  As shown, place your left leg in front with your foot in front of you and position your right leg behind you, keeping it inline with your body, not out to the side. Hold this stretch for up to 30 seconds and repeat on the other side.

 

 

 

 

Tips:

Train during the off season to strengthen the essential muscles for cycling.

While cycling, be sure to keep these muscles flexible and give your body time to rest.

Eat good whole foods, protein, produce, and be sure to stay hydrated!

  • If any of the described symptoms persist, see your doctor for a prescription for physical therapy. At Spectrum we have advanced training as manual therapists, and correct the dysfunction causing your symptoms, and get you cycling in no time. You can contact us at 631-456-5512 or at spectrumpt.com

 

Dr. Gary Welch  PT, CFCE, CFMT, CKTP, COMT

Certified Functional Capacity Evaluator

Certified Functional Manual Therapist

Certified Kinesiotaping Practitioner

Certified Orthopedic Manual Therapist

LeMond Bike Fitter

 

Physical Therapy Manager at Brookhaven National Lab

Upton, NY

 

Physical Therapy, an Alternative to the High Risks of Methadone

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 methadoneMethadone 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,

Dr. Gary Welch PT, CFCE, CFMT, CKTP, COMT

Owner – Spectrum Physical Therapy

Strategies for Healthy Weight Loss

Set Realistic Goals

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 special dietary needs or concerns, please talk to your physician about your particular diet.

Dr. Gary Welch PT, CFCE, CFMT, CKTP, COMT

Owner – Spectrum Physical Therapy

The Negative Effects of Not Exercising and Inactivity

I think that we’ve all been there before; the decision on whether to exercise or not to exercise. The excuses that I’ve made or have heard in the past range from “I don’t have time in my day to do this” – “My Schedule is too busy” – “I’m tired” – “I’m over weight” or I’m out of shape and I won’t ‘fit in’ at the gym.”

An inactive lifestyle leads to a gradual decline in many important markers for cardiovascular health, such as heart disease, hypertension, increased cholesterol, lower HDLs, and decreased efficiency of the muscles absorbing oxygen. These alone should motivate most people to get up off of their chairs, or COUCHES, and get out and be more active!!

It’s a personal choice on whether you’re going to do something about it or not.  Let me share some more of the negative consequences of inactivity.

  • Increased weight, or obesity. Increased compression on vertebral joints, hips, knees and ankle joints. “Less Muscle and more fat.”
  • Decreased metabolism.
  • Increased Stress.
  • Feelings of depression and anxiety.
  • Type II diabetes, which can be reversed with good diet and exercise.
  • Increased risk of cancers, such as breast and colon cancer. Maintaining a healthy weight has been shown to reduce your risk of breast, prostate, lung, colon, and kidney cancer.
  • Frequently tired and run down.
  • Physically weaker.
  • Pain throughout the body with simple activities – weak muscles strain more easily.
  • Activities of daily living and work activities become harder to accomplish.
  • Bone weakening: Osteopenia, which leads to osteoporosis.
  • Vasoconstriction of blood vessels and capillaries.

It’s not age as much as it’s inactivity that makes you feel old, tired, stiff, and achy.  The less active you are the tighter everything becomes.  For instance, muscles, tendons, ligaments, and joint capsules all adaptively shorten over periods of inactivity.  You become stiffer, less flexible and movement becomes difficult.

Regular exercise will decrease age related changes in your body. Many of the detrimental effects of physical inactivity can be reversed and, in most cases, improved with moderate exercise. In fact, research has shown that the people who exhibited the greatest decline in physical status during inactivity benefited the most from exercise training.

The benefits of exercise and staying active:  You feel better, have more energy, have less stress, have an increased metabolism, reverse type II diabetes, improve cholesterol levels, reduce chances of heart disease, reduce blood pressure, reduce the risk of cancer, have stronger muscles and bones, the activities of daily living become easier for you, and you have improved blood flow.

*If you have any medical issues that require independent guidance, be sure to consult your physician before starting an exercise program.

Dr. Gary Welch PT, CFCE, CFMT, CKTP, COMT

Owner – Spectrum Physical Therapy

Wearable fitness Technology – What are the options, benefits, and potential for overuse?

There are two technologies on the market that fall under the wearable fitness/ health category. There is the health monitoring devices: Numera’s wearable mobile device, Zephyr Technology’s BioHarness, and Avery Dennison’s wearable patch. And there are the personal wearable fitness devices: Apple watch, Basis Peak, Garmin, and the Jawbone, just to name a few. This market is still young and the number of devices will increase significantly, along with the advancement in technology, in the near future. There are clear benefits to this technology. So, lets look into the benefits and lets also look into the potential these devices have for overuse injuries.

The health monitoring devices perform many functions for personal and health care reasons. The Numera device is a wearable mobile device that provides a two-way, hands-free communication, GPS location tracking, and a fall detection mechanism which can alert emergency response services when a fall occurs. This will help save a life, if a person has fallen in their home and can’t call emergency services on their own.

Zephyr Technologies BioHarness BT sensor is used by third party makers of products to add biometric monitoring capabilities to wearable fitness gear, like Under Armour’s electronic compression garment, which tracks the wearer’s breathing, heart rate, blood oxygen levels, ECG, and blood pressure, and the data can be sent to a computer or mobile device. Not only can this information can be sent to your smart phone, for personal review, it can get uploaded to the Zephyr portal, which forwards the information to your personal health records.

Another technology is the patch from Avery Dennison, which is a wearable sensor that evaluates weight management by collecting caloric burn, steps taken, activity levels and sleep patterns through multiple sensors that collect more than 5,000 data points per minute. This data can be uploaded to a computer or mobile device for use as a guideline to determine the need for weight loss and wellness efforts.  One other health monitoring device that is used to save the life of a person with a heart condition is the Zoll life vest, a wearable defibrillator that monitors a patient at risk for sudden cardiac arrest. If a life-threatening heart rhythm is detected, the device will deliver a shock to restore normal heart rhythm. The Life Vest can be used for a wide range of patient conditions, including a past heart attack, before or after stent placement or bypass surgery, or congestive heart failure. It can also be used by the patient’s physician to evaluate the long-term arrhythmic risk and treatment plans.

Personal Wearable Fitness Technology will allow a person to get into shape and lose weight by monitoring their activity levels. These devices help, because you’re able to watch how much exercise you get each day, weekly, and monthly. The feedback provided by these wearable devises can motivate you to walk more, take the stairs instead of the elevator, park the car further away, or even sit less, knowing that your activity is being recorded. Each day you will look for new ideas to beat yesterday’s goals and to increase your overall activity. The wearable fitness technology stemmed from the old pedometers, but are much more accurate and have many more features. These devices allow the user to monitor sleep, calories burned, heart rate, blood pressure, blood oxygen levels, steps taken during the day, distance walked, and even time spent standing. Lets look at a few of the devices on the market:

The Apple watch gives you a more complete picture of your all-day physical activity because it measures more than just the quantity of your movement, such as the number of steps you take. It measures the quality and frequency as well. The three rings of the Activity app show your progress at a glance and provide the motivation you need to sit less, move more, and get some exercise. There’s also a separate Workout app for dedicated cardio sessions. Over time, the Apple Watch can use what it learns about the way you move to suggest personalized daily fitness goals and encourage you to achieve them. The back of the watch is made from Zirconia that encases four sapphire lenses. Within these lenses, there are infrared LEDs and photo sensors that detect your heart rate. When you add the built in accelerometer, gyroscope and add GPS in the Iphone, you will have all the data to give you accurate step count, distance, heart rate, calories burned, daily activity, and sleep patterns. The watch will also store each day’s numbers so that you can compare your progress over time. The dedicated workout app will allow the user to select the type of workout. i.e. walk, run, cycle, etc… The watch will allow you to track your progress in real time or at the end of each work out. You can even select your goals for your workout and watch your progress towards your goal in real time. There are three levels of Apple watches that range in price from $349 to $5,000.

Basis Peak will automatically track walks, bicycle rides, walking and your sleep. It can measure heart rate, steps taken, body temperature, perspiration and motion to monitor your progress and adjust your goals automatically. It’s compatible with both IOS and Android devices. It’s water resistant and has a rechargeable lithium battery. $199

Garmin Forerunner 15 has a built in GPS allowing for accurate recording of your distances during exercise. To monitor heart rate, you need the optional chest strap, because it doesn’t have a built in optical monitor. It comes in five colors and looks very sporty. It’s more of a cyclist or runners watch because of the GPS and that it tracks pace, heart rate, lap times, distance, etc…

Jawbone UP24 is light weight and sleek in design. When monitoring your sleep, it knows the difference between a light sleep and deep sleep. It has a vibrating reminder if you’ve been idle too long. It requires a mobile device and works with both IOS or Android. The jawbone doesn’t have a display on it, so you will have to look at the data on your smart phone, but it will track your steps, count calories burned, and heart rate. This device is not full of features, but the price makes it more affordable at $149.

Advantages to wearable fitness devices are numerous.  With all of the new technology found in sensors that can send data to your mobile device or computer, we now have the capability of monitoring respiration, perspiration, heart rate, blood pressure and oxygen levels, activity level and calories burned in a given period of time, which can motivate the user to become more active, burning more calories, losing weight, reversing type II diabetes, decreasing cholesterol and triglycerides, and lowering your blood pressure, which all equates to feeling better about yourself and living a healthier life.

So, could there be concerns with wearable fitness products? Let’s look at some possibilities. The first thing I think of when you have all of this information, at your finger tips, is that it motivates you to do better or to do more, and the competitive side of you will probably want to beat your previous days record. This can be a problem if you’re constantly trying to increase your activity.  To prevent an injury, you need to know what your body is capable of while you’re exercising, and if you don’t, start out easy and see how you feel during and after your workout. Common musculoskeletal overuse injuries involve the muscles and tendons. The tendon is the tissue that attaches the muscle to the bone. Overuse injuries are generally micro trauma to the tissue, occurring over long periods of time, also known as a strain or tendinitis. Common areas for tendinitis are at the shoulders, elbows, side of your hip, at the knee just above or below the kneecap, and the achilles tendon.

If a person starts a new exercise or activity routine with their new smart watch, they run the risk of one of these overuse injuries, because the focus will be to beat their previous days record and do more the next day. With this scenario, he or she may also find them self exceeding recommended ranges of heart rate, respiration, and even blood pressure. If you don’t feel good, i.e. faint, short of breath, light headed, chest pain, etc… you need to stop. More can be better when you stay within a safe heart rate range, but can be devastating when you exceed your targeted or maximum range.

If you don’t set a target range specific to your age in the device than you need to know what it is yourself. For heart rate, you can calculate your max heart rate by 220 – your age. For the average person, your target range while working out, could be between 50% to 80% of that number.  Here’s an example: We have a 39 year old female who wants to work out between 60-80% of her max heart rate. First calculate 220 – 39 = 181. This is your “safe” max heart rate.  Now, let’s multiply that by 60% and 80%. .60 x 181 = 109 and .80 x 181 = 145. So, the 39 year olds target heart rate, during exercise, is between 109-145 beats per minute.  If you are training at a higher rate than this for competitive reasons, that’s normal; but, be safe and get to understand how you feel when you push your body too much. Note: If you have a cardiac condition, high blood pressure, or any other health risk, be sure to talk to your doctor about whether exercise is safe for you.

Have fun with your new wearable fitness device, and stay active. Movement is life!

Dr. Gary Welch PT, CFCE, CFMT, CKTP, COMT

Owner – Spectrum Physical Therapy

What You Need To Know About Balance and Falls

Falls among the elderly are prevalent, dangerous, and can diminish their ability to lead an active and independent life. About one in three seniors above age 65, and nearly one in two seniors over age 80, will fall at least once this year, many times with disastrous consequences. I have seen falls result in bruising, fractures to the wrist and arm, hip fracture, and even concussion. The intent of this article is to inform our community on the risks of falls, ideas to stay active, a simple way to test your balance, and treatment options when you find your balance is poor.  I would rather educate and treat preventatively, than see someone fall and hurt them self.

 

Risk Factors associated with falls:

  • Increasing age
  • Decreased activity levels
  • Difficulty with balance or walking
  • Leg or trunk weakness
  • Poor vision, sensation, proprioception
  • Pre-existing medical conditions, such as Parkinson’s, stroke, or diabetes
  • Taking more than 4 medications at one time
  • Use of an assistive device for walking i.e. cane or walker
  • Past history of falls
  • Tight joints and or decreased flexibility in the lower legs

 

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.
    1. Fail – Do not attempt the rest of this test. Very poor balance
    2. Pass – Go to the next step.
  2. Stand with one foot forward by about 12 inches for 60 seconds. Test both sides.
    1. Fail – Do not attempt the rest of this test. Very poor balance
    2. Pass – Go to the next step.
  3. Stand with one foot in front of the other, like you are on a tight rope, for 60 seconds. Test both sides.
    1. Fail – Do not attempt the rest of this test. Fair to Poor balance depending on length of time.
    2. Pass – Great balance
  4. Single leg stance – Stand on one foot and hold as long as you can, up to 60 seconds. Test both sides.
    1. Pass – Good to excellent balance. Keep up the good work!

 

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.

 

 

Dr. Gary Welch PT, CFCE, CFMT, COMT

Owner – Spectrum Physical Therapy

Osteoarthritis

Osteoarthritis
A young woman massaging her painful knee

A woman massaging her painful knee

Osteoarthritis (OA) affects millions of people in the united states and can cause pain in every joint in the body. However, the major joints affected the most are the hips, knees, and shoulders.  When the joint looses cartilage, the underlying osteochonral bone can become exposed. Thus, reducing the slippery surface provided by the cartilage, and now you have a bone on bone situation, which increases the friction at the joint. The most predisposing factor for OA is age. The condition primarily affects the middle-aged to elderly population, most often over 60 years (J Orthop Sports Phys Ther 2009:39 (4) A1-A25).

When the joint becomes painful and/or swollen, the person tends to reduce demand on that joint by compensating their movement.  This causes several issues: decreased mobility of the joint, decreased synovial (lubricant) production, decreased strength and stability around the joint, and decreased flexibility of surrounding musculature, all from disuse of the joint. The compensatory movements will also cause pain in other extremities and joints.

Current treatment approaches include:

Over the counter pain medications can be taken for OA pain as well as prescription strength NSAID’S (non-steroidal anti-inflammatory drugs).

Physical Therapy to regain lost movement, flexibility, strength, endurance, and return to normal functions.

Artificial synovial fluid (Synvisc) injections can be administered to provide the patient with lost lubricant in the joint, thus reducing friction from bone on bone contact.

Surgical interventions include arthroscopy for mild to moderate OA, unilateral compartment Osteotomy (removal of sub-chondral bone), unilateral joint arhroplasty (joint replacement of one compartment), and total knee replacement (arthroplasty).

 

Dr. Gary Welch PT, CFCE, CFMT, CKTP, COMT

Spectrum Physical Therapy
100 Hospital Road, Suite 112
Patchogue, NY 11772