New Year, New Health Insurance Benefits!

With the New Year, most insurance plans start over. This means that there could be changes associated with your health benefits, so the New Year is the perfect time to review your insurance coverage. At Agility Physical Therapy, we want to make sure patients have a full understanding of the costs associated with their visits. Here are some tips to stay on top of the new changes with your insurance:

  • Have a current insurance card with you. This will expedite the process in verifying your benefits.
  • Familiarize yourself with your new benefits. The more you know, the easier the check in process will be at the beginning of the year.
  • Understand that the amount you pay at one office may be different than what you pay at another office. Each office could have different costs depending on the level of care and service provided.

To better understand what your health insurance plan covers, you must first understand the terminology. Here are some common terms to help when looking over your plan:

  • Premium: the amount you pay your insurance company for health coverage each month or year.
  • Health Insurance Deductible: the amount that the patient typically must pay out-of-pocket before the insurance company will begin to pay. For example, if your deductible is $1,000, your insurance will not pay for anything until you have paid $1,000 for services subject to the deductible. Depending on your plan, even if you have met your deductible, you may still owe a copay or coinsurance. In most cases, the lower the premium, the higher the deductible.
  • Out-of-Pocket Maximum: the maximum amount an individual/family will pay for the calendar year for services covered under their health insurance plan (includes deductibles, copays, and coinsurance) until the insurance company pays for all covered expenses.
  • Co-pay: a fixed amount you will pay for a covered health service, as defined by your health plan. Copays usually vary for different plans and types of services. Insurance requires that copay is paid at every visit. In most cases, copays go toward your deductible.
  • Co-insurance: the predetermined percentage of costs you pay to a medical provider once the deductible has been met. In other words, the coinsurance is your share of the total cost for a particular service. Coinsurance amounts very based on each insurance plan. For example, if your insurance plan’s allowed amount for an office visit is $100, you have already met your deductible and you are responsible for a 15% coinsurance, then you would pay $15 at the visit. The insurance company would then pay the rest of the allowed amount for that visit.
  • In-Network: this term refers to medical establishments that deliver patient services covered under the insurance plan. In-network providers are generally the cheapest option for policyholders. Insurance companies typically have negotiated lower rates with the in-network providers.
  • Out-of-Newtork: this term refers to medical establishments not covered under your insurance plan. Services from out-of-network providers are usually more expensive than those rendered by in-network providers.
  • HMO (Health Maintenance Organization) Plan: With an HMO plan, you are assigned a specific primary care provider, and you can then only receive treatment and care from physicians and specialists within the established provider network. Referrals are required for certain providers. Please check with your insurance carrier to see if a referral is required for our facility.
  • PPO (Preferred Provider Organization) Plan: With a PPO plan, you do not have to select a primary care doctor and referrals are not required for specialists.

Remember, your health insurance benefits should be something you use all the time—from yearly check up visits to movement screenings and wellness benefits. Make the most of your plans this year, and make it a happy and healthy 2019!

The majority of insurance plans, including Medicare and private insurers, pay for physical therapy services that are medically necessary. In the state of Colorado, you can go directly to a Physical Therapist under a law that grants “direct access.” This means that, with most insurances, you can visit your physical therapist first without a physician’s referral. With direct access, you can reduce costs with fewer visits to multiple providers, such as your primary care physician or an orthopedic surgeon, for conditions that are affecting your movement. For example, if you were to sprain your ankle or “throw out your back”, you can simply walk into your physical therapists office, who can then diagnose your injury, order imaging to rule out bone fractures or breaks, and begin your plan of care all in one visit.

At Agility Physical Therapy, we are currently accepting all major health insurance plans, with the exception of Aetna no co-pay plans, BCBS Federal and Kaiser non-PPO plans. For a complete list of insurances we accept, visit our insurance page. In addition to accepting most insurance plans, Agility Physical Therapy offers payment plans as well as discounted packages for self-pay rates. For more information or if you have a question regarding whether or not we accept your insurance, contact us at agilityphysio.com or 303-773-0771 and we will verify your benefits for you.

 

 

Exercise is a Miracle Drug.

“Exercise is a miracle drug. I’m such a believer that it’s the key to health, wellness and longevity that I prescribe it to every patient I see. It’s the most powerful, readily available drug in the world, and it’s free.” Sports Medicine Physician Jordan Metzl expresses his support for physical activity as an intervention to mitigate the effects of almost any adverse health condition.

Many conditions that we as Physical Therapists treat could, if done correctly, be prevented by regular physical activity, as well. If a drug were invented that could do for human health everything that exercise can, people would fight to get their hands on it. It would be the most valuable pharmaceutical ever developed.

There are an unlimited number of benefits behind increased daily movement and PA that have been established in people of all ages, including:

  • Decreases risk of premature death due to coronary heart disease
  • Decreases risk of developing Type II Diabetes
  • Decreases risk of developing hypertension or high blood pressure
  • Reduces blood pressure of those who already have hypertension
  • Decreases risk of developing breast and colon cancer
  • Helps maintain healthy weight
  • Builds and maintains health bones, muscles and joints
  • Decreases number of falls in older adults
  • Reduces mortality rates compared to sedentary populations
  • Reduces arthritis symptoms and delay progression of Osteoarthritis
  • Increases self-esteem, promotes mental health, prevents depressive illness, and possible protective effect from cognitive decline
  • Possible increase in brain cell growth which enhances learning and memory (animal studies)
  • Possible link to increased capacity for learning and academic achievement in students
  • Reduces frequency of tobacco, drug and alcohol use among physically active
  • Reduces direct medical costs among Americans by $76.6 billion (regular moderate exercise)
  • Reduces workplace short-term sick leave by 6-32% and increase productivity by 2-52%

While many are aware of the physical and aesthetic benefits of exercise, not everyone realizes the significant positive impact on mental health. Physical activity has a role in management of severe mental illnesses in its ability to lessen symptoms and also potentially extend the life in these populations.

The European Psychiatric Association (EPA) has issued recommendations for supervised physical activity as a potentially effective intervention for individuals with severe mental illnesses, such as schizophrenia, bipolar disorder and major depression. According to researchers, those with severe mental illnesses face an increased risk of early mortality by as much as 10 to 20 years, with physical disorders accounting for as much as 70% of those early deaths.

In its latest edition of nationwide guidelines for physical activity (PA), the Department of Health and Human Services state “adults should move more and sit less throughout the day.” 80% of all Americans are not meeting current PA recommendations, a failure that is contributing to the prevalence of a host of chronic health conditions. Regular PA reduces your risk for many chronic diseases, including prostate and breast cancers, dementia and brain strokes, and is considered to be as effective as taking medication for many conditions.

The new guidelines emphasize the concept that some amount of PA is better than none in preventing disease and extending life, no matter an individual’s age. The revisions to the PA guidelines are the first in 10 years, and they do not significantly alter the goals for adults. Instead, the new guidelines further reinforce the benefit of PA at any level by removing the statement that activity must occur for at least 10 minutes to be effective. The Department of Health and Human Services recommendations for physical activity vary by age and are as follows:

Children and adolescents (6 to 17 years): 60 minutes or more per day of moderate-to-vigorous PA; with at least 3 days of muscle- and bone-strengthening PA per week

Adults: 150 minutes per week of moderate-intensity PA, or 75 or more minutes per week of high-intensity PA is recommended for adults; at least 2 or more days per week should include muscle-strengthening activities.

Older adults: If possible, 150 minutes per week of moderate-intensity PA, tempered by an individual’s “level of [PA] relative to their fitness,” and a clear understanding of how various chronic conditions can affect the ability to reach PA goals. No matter what PA level is achieved, activities should include balance training, aerobic, and muscle-strengthening activities.

A brisk walk, gardening, housework and cycling count toward the recommended 150 minutes of moderate aerobic exercise a week. If you are struggling to fit a gym routine into your schedule, yet you would like to begin incorporating more movement into your day, you can start with some of the following simple changes:

  1. Organize a walking group with coworkers during lunch or meet friends in the park. Bonus: fresh air and being social without food and drink.
  2. Get off one stop earlier on the bus or subway
  3. Choose one meal a day and walk for 10 minutes after it. Walking after eating regulates blood sugar and helps weight loss.
  4. Walk your dog rather than letting them out in the backyard
  5. Choose a parking spot in the back of the lot, further from the front entrance of your work or store
  6. Walk around the track or field while your kids play sports
  7. Walk to breakfast, lunch or dinner.
  8. Take the stairs instead of the elevator
  9. Drink more water. This will ensure you take breaks often to use the restroom (great tactic for mental clarity) and also keep you hydrated!
  10. Return your missed calls while walking

I am sure you have heard the phrase, “physical activity as medicine” at least once before. After reading through some of the general benefits of increased physical activity and simple ways to fit more movement into your day, one must be convinced.

 

This information is for informational purposes and is not intended to be used in place of seeking individualized care from a healthcare professional.

 

 

References:

Sallis JF, McKenzie TL. Effects of health-related physical education on academic achievement: Project SPARK. Research Quarterly for Exercise and Sport 70(2):391-5.

Physical Activity May Decrease Mortality Risk in Frail Older Adults, Says Researchers. PT in Motion News. October 30, 2018.

European Psychiatrists Recommend Physical Activity in the Treatment of Severe Mental Illness. PT in Motions News. November 9, 2018.

What You May Not Know About Cigarette Smoking and Your Health

Cigarette smoking negatively affects every organ of the body and is widely recognized as one the major causes of preventable disease. According to the Centers for Disease Control (CDC), smoking causes more deaths each year than the following causes combined: HIV, illegal drug use, alcohol use, motor vehicle injuries, and firearm-related incidents.

Most people know that smoking is linked to heart and lung diseases, as well as several cancers. However, many people are not aware that smoking has a serious negative effect on other parts of the body, including bones, muscles and joints.

Cigarette smoking negatively impacts the rate and quality of healing from injuries, illnesses, and chronic conditions on multiple levels. Adverse effects of smoking on tissue oxygen levels have been demonstrated immediately after smoking just one cigarette, regardless of smoking history. On a microscopic level, chemicals found in cigarette smoke cause many changes to the way the body handles oxygen. Carbon monoxide is a poisonous by-product of cigarette smoke that has a 200 times greater affinity to bind with hemoglobin than oxygen. Hemoglobin is the molecule that carries oxygen throughout the body and, when exposed to cigarette smoke, it replaces oxygen with carbon monoxide to deliver to tissues. Cigarette smoking also increases the thickness of blood and narrows blood vessels, which both further contribute to impaired oxygen delivery.

When oxygen is not delivered to our tissues, cellular metabolism in the tissues is inhibited and healing is delayed or disrupted completely as a result. Furthermore, smoking increases chance of re-injury, as bones, tendons, and ligaments do not regain their full strength without adequate oxygen and nutrients.

Healing of injuries is a complex process. The air we breathe is filled with oxygen, which is needed for most functions in the body, including the repair process after an illness or injury. The healing trajectory can be interrupted at any stage by lack of oxygen to tissues.

Imagine a busy four-lane highway filled with big trucks hauling precious cargo necessary to survive in the same way that oxygen is required for human function. If this were the body, smoking would have the effect of shutting the highway down to two lanes, shrinking the trucks down to small cars with half the cargo, and pouring sticky tar on the road to delay the delivery. Much less cargo would arrive at its destination in a longer time. In the same way, areas of the body that need oxygen will go without, and will receive a toxic chemical instead of an essential nutrient.

In addition to poor healing and increased chance of re-injury, lack of oxygen to tissues has been found to increase infection risk and also results in reduced tolerance for exercise, frequent headaches, dry and inelastic skin with wrinkles and dull and grayish skin tone.

When you smoke, the number of white blood cells (the cells that defend your body from infections) remains high. Elevated white blood cell levels are a sign that the body is under constant stress as it is chronically fighting the inflammation and damage caused by smoking. With the immune system continuously trying to repair the damage done by smoking, the body’s ability to fight off any foreign pathogen, such as a virus or bacteria, is impaired. Chronic systemic inflammation also affects the way the body interprets pain signals. Many studies have found that smokers report more pain after surgery than non-smokers.

No matter your age or how long you have smoked, quitting can help. It is important to recognize that you are not alone in the struggle to stop smoking and there are many resources available to help you. By calling 1-800-QUIT-NOW or visiting www.smokefree.gov, you will be linked up with a professional “quit coach” free of charge to help you through this process.

Immediate benefits of quitting smoking within one day include decreased heart rate and blood pressure, and improved ability to breath. Within one month, quitting smoking will result in greater blood circulation, enhanced lung function and better sense of taste and smell. Within one year of quitting smoking, a person will have fewer colds and illnesses, decreased coughing, less shortness of breath and 50% decreased risk of heart disease.

It can be hard to quit because nicotine is addictive. Symptoms of nicotine withdrawal usually peak within 7-10 days and may include dizziness, depression, anxiety/irritability, trouble sleeping, difficulty concentrating, restlessness, headaches and increased appetite and weight gain.

To help get through this process and reduce withdrawal symptoms, you can take extra steps to manage the stress of quitting. Drink plenty of water, eat nutritious foods and get enough sleep. Avoid temptation to smoke by staying away from people and places that remind you of smoking. Keep substitutes ready when you are tempted to smoke, such as carrots, celery, pickles, apples, and sugar free gum. Utilize nicotine replacement therapy, such as gum, patches, inhalers and throat lozenges. Stay active by exercising, walking or cycling to help with restlessness and weight gain. People who exercise while quitting smoking have reported better success and fewer withdrawal symptoms. Finally, acknowledge that anger, frustration and worry are normal—you are worth the extra effort it takes to quit!

Article written by Dr. Jessica Khani, PT, DPT, CSCS

This information is for informational purposes and is not intended to be used in place of seeking individualized care from a healthcare professional.

18 Ways Physical Therapy Can Make a Difference

If you are reading this post, chances are that you have heard of physical therapy (PT). Perhaps you have attended PT as a patient or know a friend who has had PT in the past. But if asked, you might not be able to define physical therapy or describe all the ways it can benefit a person. That’s no surprise; physical therapy is such a large profession with so many practice settings that it can be tough to describe what PT truly is!

Physical Therapists are movement experts who combine their extensive education, clinical experience, and the latest medical research to assess and treat people of all ages and abilities, from highly athletic to extremely physically debilitated. PT is a dynamic profession with established theoretical and scientific bases for therapeutic interventions, with an end-goal being to maximize and optimize each person’s capacity for movement. With use of patient education, corrective exercises and manual therapy, PTs can help relieve pain and normalize imbalances to ensure patients are as independent as possible.

Physical Therapy is a high-benefit, low-risk solution to treat many conditions. PT is considered a conservative intervention, meaning that it is less taxing on the body than harsh medications and surgeries, which should be considered last resort options. PT can truly make a difference in the following ways:

1. Avoid surgery. Physical Therapy can often help avoid unnecessary and costly invasive surgery altogether. Research has shown that PT can be more effective than surgery in the long-term for injuries such as rotator cuff tears, spinal stenosis, and disc herniation. If it is necessary to perform surgery, physical therapy will expedite your recovery by increasing your strength pre-operatively and preparing your body for the rigors of an operation.

2. Assess your Injury risk. In the same way you visit your primary care physician for an annual check-up, you can visit a PT for a full movement screen and orthopedic examination every year. PTs are trained to recognize postural habits and biomechanical shortcomings of each individual’s unique body. Movement screens can bring your attention to areas of weaknesses that may predispose you to future injury.

While everyone has different muscle imbalances, range of motion and alignment, a PT can pinpoint your specific limitations. After recognizing your individual impairments, your physical therapist can then give you the tools to overcome these subtle postural habits or limitations to prevent future injury.

3. Reduce or eliminate pain. Chronic pain, pain that lasts several months, is a common problem and can be very frustrating, especially if the underlying cause is unknown.

People can suffer from chronic pain in a number of areas in the body, including headaches or neck pain caused by postural syndromes, hip and knee pain as a result of osteoarthritis, or low back pain due to work-related activities. Patients who are experiencing chronic pain often fear performing daily activities and experience tightness, stiffness or increased used of pain medications.

If you are experiencing pain, PTs can provide hands on treatment to mobilize your joints, release soft tissue and restore muscle function, thereby reducing aches and pain. Patient education is important in understanding that chronic pain is complex involving more than damaged muscles, tendons, ligaments and joint tissues. Emotions, depression, anxiety and nervous system hypersensitivity are important components of chronic pain that will be addressed by your PT. Finally, understanding how to properly lift, sit, bend, reach and perform specific daily activities will help facilitate healing and decrease repetitive trauma to your body. Physical therapy can give you the tools and guidance you need to live pain free and improve your quality of life.

4. Avoid Prescription Medications. The ongoing opioid crisis in the United States reflects the unintended consequences of a nationwide effort to help individuals control their pain. The health care system has, since the mid-1990s, employed an approach to pain management that focuses on the pharmacological masking of pain, rather than treating the actual cause of pain. This strategy has resulted in a dramatic increase in opioid prescriptions, causing widespread misuse and addiction. In recent years, it has also led to a growing realization that current strategies for managing pain have to change, as opioid-centered solutions for dealing with pain at best mask patients’ physical problems and delay or impede recovery and at worst may prove to be dangerous and even deadly.

Ensuring that patients are aware of and have access to various options for care is a significant step in addressing this complex issue. PT interventions are an essential component of the multidisciplinary undertaking that is required to improve patient outcomes and alter the trajectory of this public health crisis.

The CDC released opioid prescription guidelines in March 2016, which recognized that properly-dosed opioids are appropriate for pain management in cancer treatment, palliative care, certain acute care cases, and end-of-life care. For other conditions, the CDC recommends non-opioid approaches, such as physical therapy. The CDC’s recommendations reference high-quality evidence that treatments provided by PTs are especially effective at reducing pain and improving function in cases of low back pain, fibromyalgia and hip and knee osteoarthritis.

Similar to how PT can help avoid costly surgeries, it can replace the need to purchase and consume expensive drugs. PT will address the underlying cause of your injury or condition, rather than prescription drugs which mask pain, and is a safer alternative for long-term pain. During an initial evaluation, your physical therapist will focus on your symptoms and the movement patterns that may be contributing to pain.

5. Prevent falls. A fall can result in joint dislocations, fractures, reduced self-confidence, permanent disability or other health, psychosocial and economic consequences. There are many reasons that a person may be at risk for falls. Potential causes for imbalance include reduced joint position awareness, visual impairments or problems of vestibular origin.

During your initial evaluation, your physical therapist will perform a screen to evaluate your fall risk. After isolating the cause behind your imbalance, your PT will prescribe treatment to address deficits that are contributing to your fall risk.

PT intervention will improve your balance, increase your neuromuscular control and coordination, and decrease your fear of falls. Fall prevention is important to avoid further injury and ensure that you can carry out your day safely and independently.

6. Refer you to specialists. Although it may seem like physical therapists can do it all, we recognize that, at times, your health condition may be out of our scope of practice. PTs identify problems that may require consultation with or referral to other professionals when appropriate.

Sometimes a person might require simultaneous multidisciplinary care from a team of health care practitioners. In such cases, your PT will work hand in hand with your primary care physician or specialty provider to ensure your wellness goals are met.

7. Increase your functional independence. Functional independence is the ability to carry out activities of daily living safely and autonomously. Whether you are experiencing a physical disability or not, participation in daily living activities is essential to your health and well-being.

If you are having difficulty standing, walking, standing from a chair or other daily activities, physical therapy can help. The treatment approach chosen by your PT depends on your specific goals, the degree of functional limitation experienced and the type and severity of the skill impairments noted.

8. Recover from a stroke, neurological injury or chronic disease. PT is essential following a traumatic injury or diagnosis of chronic disease. Adults and children who experience a stroke, Multiple Sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS), Cerebral Palsy and many other conditions have shown to benefit significantly from physical therapy.

After an unexpected injury, it can be difficult for patients to return to daily activities such as writing, eating, or climbing stairs. If you have been diagnosed with a chronic disease, PT can help manage symptoms or delay progression of the disease by maintenance of strength and mobility, incorporation of nutritional education, and improvement of gait and balance. It is current knowledge that nutrition, the intestinal microbiota, the gut mucosal immune system, and autoimmune pathology are deeply intertwined. Nutritional intervention can be very effective in managing autoimmune diseases, such as diabetes and hypothyroidism, which share the underlying pathology of chronic systemic inflammation.

At Agility PT, Dr. Marci has obtained her functional medicine certification. Dr. Marci’s training has equipped her with the scientific knowledge and experience to recommend individualized diet and lifestyle modifications to decrease your symptoms, restore hormone balance, and support the gut and immune system. Studies have shown that nutritional intervention is effective in controlling the progression of MS, Systemic Lupus Erythematosus (SLE), and Diabetes by modulating the autoimmune response and systemic inflammation. For example, symptoms of disease, such as fatigue in MS, pain and diarrhea in inflammatory bowel disease, or the need for acute medication in type 2 diabetes are considerably affected by food intake.

9. Recover from sports injury. While we try to prevent injuries, sometimes accidents occur. The fact that athletes place higher demands on muscles and joints increases their risk for injury. However, an injury on the field does not mean that you have to sit on the sideline indefinitely.

PTs have experience rehabilitating athletes with rotator cuff injuries, ligament sprains, muscle strains, tendinitis, overhead sports injuries, and pains that occur with running and cycling.

After a thorough evaluation of your condition, your PT will develop a custom rehabilitation program of hands-on techniques for pain and inflammation control. Your PT will also help you build up strength in your muscles, restore normal joint and soft tissue mobility, and recover neuromuscular control, speed, power and agility. It is important for an athlete to practice and feel confident in sport-specific drills before returning to play, such as deceleration, jumping and cutting. Studies have shown that instability activities which challenge the athlete’s balance after an injury make a successful return to sport 5x more likely.

If surgery is required, the physical therapists at Agility PT are trained to help athletes recover from operation of the knee, shoulder, ankle, hip and spine. Your PT is trained to monitor for signs of infection or complications that can occur in the operated joint or joints above and below as a result of injury or post-surgery. We will work with you to optimize your performance and help you reach your fullest potential following a sports injury.

10. Reduce or eliminate vertigo. Vertigo is a sense of rotation or rocking, even when a person is perfectly still. Movement of the head or body can worsen symptoms, and may lead to lightheadedness, nausea or vomiting. If untreated, this imbalance will likely lead to a fall or accident and cause further complications.

There are various reasons that dizziness and vertigo may occur. Some causes of vertigo include nervous system abnormalities, cervical spine conditions, vascular impairment, Meniere’s disease, vestibular neuritis, benign paroxysmal positional vertigo (BPPV), or inner ear infections.

PTs will perform an evaluation to determine the cause behind your symptoms. For example, if you have BPPV, our vestibular therapy experts can perform a series of simple movements, such as the Epley maneuver, which can facilitate the return of the crystals in the inner ear to their normal position. With this specific condition, symptoms can typically be completely resolved within one or two visits.

Dr. Marci at Agility PT has completed continuing education to receive Advanced Vestibular and Vestibular Rehab Certifications. With her specialization in vestibular rehab, Dr. Marci has helped numerous patients eliminate their symptoms.

11. Prevent an injury. PTs understand how different sports can increase your risk for specific types of injuries. For example, stress fractures and patella tendinitis are common in runners, while ACL tears often occur in female soccer players. PTs can design an appropriate injury prevention program individually tailored to you to keep you healthy all year long.

At Agility PT, Dr. Jessica has earned her certification as a Strength and Conditioning Specialist (CSCS). Her experience has prepared her with in-depth knowledge pertaining to biochemistry of energy systems and nutrition, exercise modalities, training strategies for performance adaptations, and most importantly, injury prevention. Her experience has prepared her to apply scientific knowledge in the design of safe and effective strength and conditioning programs with the primary goal of improving athletic performance and preventing injuries.

12. Find the best workout for you. PTs gather information from prior surgeries, diet, lifestyle, body mechanics, and personal preferences to determine what physical activities will best fit you.

Proper programming and prehab before starting a new type of exercise or increasing the intensity of a current exercise routine will help you address muscle imbalances, guarantee that you are progressing adequately and prevent injury in the long run.

Whether your goal is to manage weight, increase strength after an injury, improve athletic performance, or combat the effects of chronic conditions such as type 2 diabetes, PTs can develop a safe, individualized exercise plan.

With guidance on the fundamental principles of strength training and training cycles and individualized exercise prescription, you can avoid new and recurring injuries. Additionally, a model of progression needs to be implemented and followed, or results will be slow or non-existent.

13. Nutritional education. PTs are educated in nutrition, fitness and exercise. It is well known in the literature that nutrition plays a key role in both prevention and treatment of injuries.

When muscles are exercised, the result is tears at the microfiber level. This is a normal process that results in local inflammation in the specific muscle to repair the fibers and increase resilience against future damage. This is the process by which muscles grow, or hypertrophy. In a similar manner, when a person is injured, an inflammatory response is initiated.

The success of this repair and build process depend on the person’s body composition and is influenced by nutrition. If a person does not meet adequate dietary intakes when the body requires extra energy for recovery with exercise, repetitive stress injuries may result, such as tendinitis or ligamentous tears. Furthermore, nutrient deficiencies during recovery will delay the repair process and prolong healing. Therefore, nutritional status and energy requirements should be assessed throughout recovery and nutrient intake adjusted accordingly for optimal prevention and recovery from injury.

Often patients come in the clinic with a musculoskeletal condition, but sometimes working on mobility, control and strength aren’t enough to relieve their pain. These patients will truly benefit from lifestyle changes in addition to physical treatment. Nutrition is often the missing link to comprehensive care in managing and relieving musculoskeletal pain.

At Agility PT, Dr. Marci has completed training to become a functional medicine practitioner. Often there are multiple factors contributing to an individual’s clinical presentation and finding the root cause is the heart of functional medicine. Nutritional intervention is an effective and useful tool to improve overall health outcomes, optimize performance and help patients achieve goals.

14. Order Imaging. Incorporating greater purposes for imaging by PTs systematically improves patient management and cost containment.

The role of PTs in ordering diagnostic imaging has been in existence for several decades. The most notable example is in the U.S. military, where since 1972, PTs have practiced as direct access providers with imaging privileges. Imaging instructional content is foundational in PT education programs, allowing for competencies in imaging use and decision making in physical therapy practice.

The 53 United States jurisdictions define the regulatory scope of PT practice differently. The ability to perform certain skilled tasks, including imaging, may be granted overtly through explicit regulatory authority or denied by that same authority. The Colorado State Physical Therapy Board states that PTs may order diagnostic imaging.

How does this affect you? The ability for PTs to order imaging will reduce the delay in treatment that occurs with referral to another provider for imaging. Additionally, the combined advantage of direct access for PTs and their authority to order imaging will decrease costs for yourself and the healthcare system in terms of less visits to multiple providers.

15. Diagnose your movement pathology. PTs are recognized as practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for and prevention of impairments, functional limitations, and disabilities related to movement, function and health.

In Colorado, you can go directly to a PT under a law that grants “direct access.” This means that you can simply walk into a clinic and a PT can diagnose your ailment. This is an advantage that is not legal in all states. Going straight to your PT, rather than visiting your primary care physician who will then likely refer you to a PT, can save you a trip and get you better faster!

When people experience an injury, one of the first things they do is look up their symptoms on the web. Another common tendency is to follow the same treatment that a friend had for their injury. While we want you to be self-sufficient, diagnosing and treating yourself can be dangerous, costly and will likely lead to delayed recovery.

Physical therapists can distinguish a particular disease or condition from others that present with similar symptoms. For example, a PT can differentiate between kidney or liver condition and symptoms that mimic low back pain.

16. Save you money. Depending on your insurance, physical therapy treatment can be free or include copay. Although a copay may seem to be a burden initially, seeking treatment early on before your condition worsens will save future expenses.

Research shows that the longer you wait to treat a condition, the further delayed the recovery and the greater likelihood of developing compensations in surrounding joints. Additionally, the total costs of other treatments, such as surgery and expensive medications, can exceed the cost of seeing a physical therapist.

The scope of PT practice with direct access has demonstrated enhanced quality of patient care and reduced costs. The advantage of direct access to a PT will save you time and money as you can skip the steps of obtaining a prescription for PT from your physician.

17. Orthotics. Each step we take involves a remarkably intricate network of bones, muscles, tendons and ligaments functioning together as pulleys and levers to meet the demands placed on them with walking, running, jumping, and more. The complexity of this system, combined with the weight feet carry, account for why feet can be prone to many orthopedic injuries.

Some of the injuries PTs treat include bone fractures, arthritis, plantar fasciitis, bunions, and tendinitis, among many other conditions.

If you have had a foot injury, you know that it can cause a big restraint in your daily life. If left untreated, foot problems typically lead to more injuries up the chain, including the knees, hips and back. You can take a proactive approach by having a full evaluation by a physical therapist BEFORE symptoms occur in your feet.

The PTs at Agility Physical Therapy can make orthotics customized to fit your feet and promote proper alignment of your body from the ground up. While orthotics are appropriate for some patients, others don’t need them at all. For hypomobile or rigid feet, orthotics can cushion and support those stiff segments of the foot. For hypermobile conditions, as in pronated feet, orthotics can stabilize the foot. Orthotics can also help the foot redistribute forces during weight bearing activities to alleviate pain and prevent injuries.

18. Achieve Developmental milestones. At certain ages, children should reach specific gross and fine motor skill milestones. These skills are required to control muscles of the body for walking, running, sitting, crawling and other activities. While some children may develop faster than others, there are some milestones that should be achieved by a specific age.

Early identification of delayed developmental milestones allows communities to provide more effective and affordable treatment during preschools years. Proactive intervention can also lessen the need for expensive special-education services later in childhood or worsening conditions in the future. Physical therapists can provide early intervention services for children with developmental delay to achieve their age-appropriate milestones.

8 Tips to Get a Better Night of Sleep

If you are not sure how to get a good night of rest, look no further. To optimize sleep and wake up feeling refreshed, start by tackling some of the following tips.

1. Exercise!
Experimental evidence has suggested that exercise may be associated with better sleep quality. One study that evaluated exercise in patients with insomnia showed that an acute bout of moderate-intensity aerobic exercise about 3 hours before bed reduce sleep onset latency, total wake time and pre-sleep anxiety, while increasing total sleep time and sleep efficiency.
2. Limit use of artificial light during evening hours.
Blue light influences secretion of melatonin, which is a neurotransmitter that makes us sleepy and regulates our circadian rhythm. Circadian rhythms regulate nearly all of the body’s processes, from metabolism and immunity to energy, sleep, mood and cognitive function. Unfortunately, computer screens, tablets, televisions and cell phones all emit blue light. Many electronic devices have a “night shift” setting that automatically switches your device to a warmer color at a designated time. Set a curfew on the amount of artificial light exposure to get a better night of quality sleep. Also try to avoid checking your phone in the middle of the night if you wake up. As soon as the blue light from a screen hits the retina in the eye, the effect of melatonin is immediately reversed and actually promotes a state of wakefulness over sleep.
3. Avoid caffeine and alcohol 5 hours before bed.
Caffeine is the most popular drug in the world. While it is very beneficial to improve performance in workouts and keep us alert during the day, caffeine does not replace sleep. After consuming caffeine, its effects can occur within 15 minutes and take up to 5 hours to die down. Considering this timeline, caffeine should not be consumed 5+ hours before bed in order to avoid a restless night.

Consuming alcohol close to bedtime can also increase your heart rate and keep you awake. While alcohol is commonly used to aid a person’s ability to fall asleep, it can interfere with quality of sleep. Alcohol blocks REM sleep, which is the most restorative type of sleep. Alcohol consumption also affects the normal production of neurotransmitters and increases tendencies to wake up in the middle of the night.
4. Calm your mind.
Your body and mind need time to wind down and shift into sleep mode before bed. Incorporate a routine, bedtime ritual away from activities that cause excitement, stress or stimulation, will make it easier to fall or remain asleep. Relaxing activities include meditation, a warm bath, reading, foam rolling, stretching or belly breathing. It is best to take work materials, computers and televisions out of the bedroom to strengthen the association between bed and sleep. Checking email or doing work right before bed can also trigger anxious thoughts and make it difficult to fall asleep.

Practicing breathing and meditation exercises before bed can increase parasympathetic response to relax the entire body and decrease your heart rate. Lie down comfortably with one hand on your stomach and your second hand on your chest. Inhale deeply through your nose for a count of 5 while pushing your belly through your hand on your stomach. Then exhale through your mouth for a count of 10 as if you are blowing out candles very slowly while gentle pressing on your stomach to facilitate air exiting. Repeat this 3 to 10 times.

Essential oils have been proven to promote and induce a calmer state of mind and encourage a more balanced central nervous system, which allows us to more effectively prepare for sleep. Essential oils are broken down organic plant molecules that can be very powerful and aromatic. Natural fragrances such as lavender, chamomile, sandalwood, ylang, valerian, bergamot, and cedarwood are often used in the bedroom to infuse the air with calming molecules, relax our systems and encourage deeper breathing.
5. Tailor your sleeping environment.
Evaluate your bedroom to ensure ideal temperature, sound and light. The bedroom should be in the colder temperatures for optimal sleep. Your bedroom should also be free from any noise or extra light that may disturb your sleep. Using blackout curtains, eye shades, ear plugs, white noise machines, fans or other devices may help reduce distractions in the bedroom.
6. Have sex!

Experiencing an orgasm during sex has a sedative effect due to the rush of endorphins and other hormones towards the same part of your brain that regulates arousal and sleep-wake cycle. Endorphins are hormones that can activate the pleasure center in your brain and drop cortisol levels, which relate to stress. Additionally, dopamine and oxytocin are both released during orgasm, which relaxes the mind and eases anxiety.
7. Create a consistent sleep schedule
Going to bed early may seem obvious but also difficult to enact. Many of us are guilty of bedtime procrastination, or delaying going to because we didn’t accomplish everything on our to-do list. Sticking to the same sleep and wake time, during the week and on the weekends, will subconsciously regulate your body’s internal sleep-wake clock and help you fall asleep better at night. Life will inevitably interfere, but try not to sleep in for more than an hour or two, tops, to stay on track.

If you are currently going to bed at 11 pm, don’t decide that tonight you will go to bed by 9 pm, because it likely won’t happen. Your internal clock resets at a rate of about one hour per day. Generally, when making behavioral changes, aim to take small steps towards the bigger end-goal. Set a reminder and aim to go to bed 15-30 minutes earlier tonight.
8. Find a comfortable sleeping position.
There is no single sleeping position that works for every person. With that being said, your sleeping position impacts your sleep quality and general feeling the following day in various ways and is therefore very relevant in this discussion.

Some people are most comfortable sleeping on their stomachs and have no issues, but it does put the neck, spine and shoulders in poor positions for blood flow, muscle imbalances and nerve tension. Regardless of your ideal sleeping position, try to strive towards keeping the body in neutral alignment to avoid kinks and imbalances. This is especially important when it comes to the neck position. Pillows that are too soft or bulky, as in the photos, will lack support for the neck or overstretch the soft tissue and likely lead to shoulder and neck aches. Aim to use a pillow that will keep your neck in line with the rest of your spine.

Sleeping on the back is typically the most recommended position, as it allows the body to rest in a neutral position. If this position is uncomfortable on your back, try putting a small pillow under both your knees. Sleeping on your back has also been shown to minimize the formation of face wrinkles. This position may be uncomfortable for people (or their partners) because it usually causes a person to snore more than other positions.

Side sleeping may prevent snoring completely. If you are most comfortable sleeping on your back, use a rounded pillow to support the natural curve of the neck and a flatter pillow beneath the head. Also, having a pillow under the knees will support the low back. In all sleeping positions, avoid using a pillow that is too high and takes the neck out of neutral alignment, as this leads to pain and stiffness the following day. If sleeping on your side, use a pillow between the knees and arms to keep the front body open and supported, promoting optimal body alignment. Side sleeping is recommended for those with sleep apnea. Sleeping on the left side is advised for those with heartburn and acid reflux.

Sleeping on the stomach is very hard on the cervical spine and the remainder of the system as the neck must be turned to breathe in this position and the rib cage doesn’t expand in the anterior direction as it should.

Finally, If you have an injury on one side of the body, it is not advised to sleep on that side.

It may seem difficult and overwhelming to follow all these recommendations right off the bat. Start by identifying the factors that are most disruptive to your own sleep and then focus on altering particular behaviors to overcome those factors. Happy sleeping!

If you haven’t already read our last post on the importance of sleep, you can find it here

Article written by Dr. Jessica Khani, PT, DPT, CSCS

The information provided is not medical advice and is not intended to be used in place of seeking advice from a professional.

Sources:
“Sleep Duration as Risk Factor for Diabetes Incidence in a Large US Sample.” Sleep Research Society. Sleep. Dec 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276127/.

“Association Between Sleep Disorders, Obesity, and Exercise: A Review.” Nature and Science of Sleep. Dovepress. March 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630986/

“How Much Sleep Do We Really Need?” National Sleep Foundation. 2018.

You should be getting at least 7 hours of sleep. Here’s why.

We all know sleep is important, but it is often under-appreciated. Sleep is a low hanging fruit to make progress in almost any goal, no matter what it may be. By tending to our sleep-related needs, we can maximize our productivity throughout the day, enhance immune system function, balance hormones, improve recovery, and overall cultivate a deeper connection with the world around us with the extra boost of energy.

The National Sleep Foundation recommends that adults ages 18-64 years old should sleep 7-9 hours a night. However, every person has a different load of stress and activity in their life. Therefore, an individual’s workload, amount of exercise, underlying sickness, or other stressors influence the amount of sleep required for adequate rest each night.

Regardless of the individual amount of sleep needed per night, if your body learns to function on low levels of energy over the course of a period of insufficient sleep, there will be less energy to facilitate recovery from daily stressors. While caffeine and other stimulants cannot substitute for sleep, but they do help to counteract some of the effects of sleep deprivation. Additionally, the body excels in managing acute damage or stress by utilizing our fight or flight system to allow us to meet challenges while performing at a high level. While it is beneficial that our bodies can adapt and function at low energy levels, chronic stress without recovery is temporary and will lead to burnout and decreased function of all bodily systems.

Not getting enough sleep, while still allowing us to function in a seemingly normal manner, impairs motor and cognitive functions. A person who is sleep deprived will typically experience reduced ability to concentrate, memory lapses, loss of energy, fatigue, lethargy, difficulty with complex thought, delayed response to stimuli, and emotional instability.

Furthermore, chronic lack of sleep has been associated with many adverse health conditions, including chronic fatigue, diabetes, high blood pressure, heart disease and even musculoskeletal injury. Studies in which subjects underwent short-term sleep deprivation to examine the immediate effects of a lack of sleep were found to have heightened blood pressure, lowered blood glucose levels and increased inflammation. It follows that long-term persistence of these symptoms could lead to more deep-rooted dysfunction. Sleep disturbances are also highly prevalent in chronic pain patients and have been shown to deteriorate the pain condition. It has been hypothesized that descending pain control may be compromised by disturbed sleep.

Sleep is the number one recovery mechanism from stress and it affects the way we look, feel and perform on a regular basis. We tend to think of sleep as a time when the mind and body shut down, but this isn’t the case. During sleep, the body is in an elevated anabolic state, meaning that repair mechanisms are used throughout the body when we are resting. Sleep is an active process during which important processing, restoration and strengthening occur.

One of the essential roles of sleep is to consolidate memories. Our brain takes in unlimited amounts of information throughout the day. While we sleep, experiences, memories and skills are processed and stored from short-term memory to long-term memory in more efficient and permanent brain regions. This results in higher proficiency and better recollection the next day.

In addition to improved memory of past information, sleep also helps us synthesize new ideas. While you are sleeping, pieces of knowledge can be pulled together from different experiences and parts of the brain to create novel concepts.

A recent study found that when subjects slept abundantly throughout the night, cellular waste byproducts that were accumulated in the interstitial space were removed. This clearance of toxins also allows the brain to function optimally the next day.

An internal biological clock, known as the circadian clock, regulates the timing for sleep in humans. The activity of this clock is coordinated by light input during the day, which promotes wakefulness, and melatonin secretion during the night, which makes us sleepy. Most hormone secretion is controlled by the circadian clock or in response to physical events.

Sleep is one the events that modify the timing of secretion of certain hormones. Hormone imbalances that occur as a result of sleep deficiency increase the prevalence of mood swings and anxiety and predispose the body to weight gain.

While we are resting, our body stimulates the parasympathetic nervous system. Lack of sleep stimulates our fight or flight system instead of the parasympathetic system, which has been associated with greater secretion of cortisol, a stress hormone. Elevations of evening cortisol levels in chronic sleep loss are likely to promote the development of insulin resistance, a risk factor for obesity and diabetes. Additionally, the regulation of leptin, a hormone released by the fat cells that signals satiety to the brain and thus suppresses appetite, is markedly dependent on sleep duration. Decreased leptin levels in individuals who lose sleep may lead to feelings of hunger, despite adequate food intake. One study that examined shorter sleep duration found decreased leptin levels to be significantly correlated with increased BMI.

Another hormone that is influenced by sleep is growth hormone. Growth hormone plays a key role in growth, body composition, cell repair and metabolism, with the highest secretion levels occuring at night. It has been hypothesized that nocturnal growth hormone increases are involved in various tissue repair mechanisms throughout the body.

Studies have shown that sleep deprivation also decreases levels of glycogen, which is the body’s principal store of energy used for mental and physical activity. Because the brain does not typically utilize fat for energy, glycogen is the only source of spare energy for brain cells. During the metabolically active wakeful period, glycogen is exhausted. Glycogen supply takes time and reduced activity to restore. Both muscle and liver glycogen levels have been shown to replenish with recovered sleep, providing our brain with the energy to function optimally.

If you are not sure how to get a good night of rest, look no further. To optimize sleep and wake up feeling refreshed, start by tackling some of the following tips in the blog post next week!

Article written by Dr. Jessica Khani, PT, DPT, CSCS

The information provided is not medical advice and is not intended to be used in place of seeking advice from a professional.

Sources:
“Sleep Duration as Risk Factor for Diabetes Incidence in a Large US Sample.” Sleep Research Society. Sleep. Dec 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276127/.

“Association Between Sleep Disorders, Obesity, and Exercise: A Review.” Nature and Science of Sleep. Dovepress. March 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630986/

“How Much Sleep Do We Really Need?” National Sleep Foundation. 2018

Core Strength Reduces Low Back Pain and Prevents Injuries in Sport

Core strength is the number one therapy to reduce low back pain and prevent injuries in sport. Low back pain is a prevalent disorder in modern society, with 80% of the population suffering from this condition at least once in their lifetime. This condition is increasingly seen in patients due to the economic development of society and changing work environment. The causes of low back pain are complex and multifactorial. One major cause of low back pain is typically weakness along with decreased motor control of the core muscles.

The core is an anatomical bridge between our hips and shoulders. The core muscles, which are the primary active stabilizers of the spine, can be divided into two groups according to their functions and attributes.

The first group is the deep core muscles, which act to locally stabilize the spine. These include the transversus abdominis, lumbar multifidus, diaphragm and pelvic floor muscles. The transversus abdominis attaches the ribs to the pelvis, while the lumbar multifidus is directly attached to each lumbar vertebral segment. The transversus abdominis and lumbar multifidus activate a co-contraction mechanism to provide spinal segmental stability and precise motor control.

The second group, known as global stabilizing muscles, are more superficial and include the rectus abdominis, internal and external obliques, erector spinae, quadratus lumborum, and hip muscles. These muscles enable additional spinal control by producing high torque to counteract external forces that impact the body. When both groups of core muscles function normally, they can maintain segmental spinal stability, protect the spine, and reduce stress to the lumbar vertebrae and intervertebral discs. Furthermore, increased core stability helps transfer the full force and power of movement from the lower extremities to the upper extremities and vice-versa.

In the large majority of sport-specific movements, such as kicking, throwing and swinging a bat, power is generated in the hips and then transferred through the core to the upper extremities. Likewise, the ability to maintain strong trunk positions during deceleration of momentum and reorientation of the body to run in a new direction on the field are critical for change-of-direction. A weak core will diminish the transfer of power and limit athletic performance.

A sound core exercise program will strengthen spinal muscles, enhance lumbar stability and result in a better foundation for force production in the extremities. Restoring function of weakened muscles in low back pain patients will augment the ability to support and control the spine and pelvis, thereby alleviating mechanical irritation and pain in the low back region.

Additionally, multifaceted injury prevention programs including core stabilization exercises are effective in reducing lower extremity injury rates. Evidence shows core instability training may reduce anterior cruciate ligament (ACL) injuries. Many muscles related to the knee joint originate in the lumbopelvic region and thus the core is an important contributor to knee and ankle stability.

A literature review examined the effects of core strengthening programs which included trunk balance, stabilization, segmental stabilization and motor control, as well as full body resistance training to strengthen the trunk and lower limb muscles. Pre- and post-evaluations were performed to determine the effectiveness of the exercise interventions among the control and experimental groups in the studies. The results showed reduced pain in the core strengthening group according to the Visual Analog Scale and McGill pain questionnaire. The experimental group also had significant improvements in muscle thickness on ultrasound following intervention.

There are a number of ways to build strength and challenge the core. Isolated exercises, such as the standard plank and side plank, can increase muscle activation and improve spinal stability. Dynamic or instability exercises are used to promote postural imbalance and require a greater stabilizing effort of the core muscles. Examples of instability exercises are bird dogs, side plank with rotation and bear crawl.

 

 

Article written by Dr. Jessica Khani, PT, DPT, CSCS

The information provided is not medical advice and is not intended to be used in place of seeking advice from a professional.

 

 

References:

Behm, DG, Drinkwater, EJ, Willardson, JM, and Cowley, PM. Canadian Society for Exercise Physiology position stand: The use of instability to train the core in athletic and nonathletic conditioning.

Chang, Wen-Dien. “Core Strength Training for Patients with Chronic Low Back Pain.” Journal of Physical Therapy Science. March 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4395677/.

Appl Physiol Nutr Metab 35:109-112, 2010. Behm, DG, Drinkwater, EJ, Willardson, JM, and Cowley, PM. The use of instability to train the core musculature. Appl Physiol Nutr Metab 35:91-108, 2010.

Myer, GD, Ford, KR, and Hewett, TE. New method to identify athletes at high risk of ACL injury using clinic-based measurements and freeware computer analysis. Br J Sports Med 45:238-244, 2011.

Bliven, Kellie. “Core Stability Training for Injury Prevention.” Sports Health. 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806175/.

Cho, Hwi-Young. “Effects of the Core Exercise Program on Pain and Active Range of Motion in Patients with Chronic Low Back Pain.” Journal of Physical Therapy Science. 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155227/.

The Most Important Part of a Workout

Warm up exercises are crucial to any sport or fitness program and should precede every exercise session. This component of the work out is the most important part and, if done correctly, will reduce risk of injury and improve overall movement quality. A proactive approach should be used in the warm up to improve strength, mobility and flexibility in areas where the athlete is weak. There are major factors influencing the extent of improvement elicited from a warm-up, such as structure and specificity of warm-up to the task.

Warm-ups are beneficial for many reasons. First, it serves to prepare the athlete mentally and physically for exercise or competition. Second, a thorough warm up will result in physiologic responses to improve subsequent performance. Temperature-related responses will increase muscle tissue temperature, enhance neural function, and disrupt transient connective tissue bonds. Non-temperature-related effects are related to a rise in heart rate and respiratory rate and lead to increased blood flow to muscle, elevation of baseline oxygen consumption, and post-activation potentiation. Post-activation potentiation is the phenomenon by which the contractile history of a muscle directly affects its subsequent ability to generate force in a rapid manner. In other words, post-activationpotentiation results in short-term improvement in performance (i.e. jumping) due to use of a conditioning exercise before hand (i.e. back squats).

Among these positive effects of a warm up are faster muscle contraction and relaxation of both agonist and antagonist muscles, improvements in the rate of force development and reaction time, increases in muscle strength and power, lowered viscous resistance in muscle and joints, enhanced metabolic reactions, and increased psychological preparedness for performance. Furthermore, increased muscle tissue temperature has been shown to increase resistance to tears.

There are several key elements to a proper warm up. The warm up should progress gradually and provide sufficient intensity to increase muscle and core temperatures without causing fatigue or reducing energy stores. Warm-ups should last 10-20 min and end no more than 15 minutes before the start of the next activity, as positive effects of warm-up start to dissipate after this time.

There are two main phases of a proper warm up. The first phase, the general warm-up, should consist of five minutes of slow aerobic activity, such as jogging, skipping, cycling, rowing, or jump rope. The goal of the general warm up phase is to increase key physiological parameters—heart rate and respiratory rate—to improve blood flow to muscles, increase deep muscle temperature and decrease viscosity of joint fluids. The second phase, the specific warm up, incorporates movements similar to those to be performed in the upcoming sport or exercise with a goal of activating key muscle groups. This phase is analogous to stretching with addition of movement patterns required for the workout and in the athlete’s overall development by actively moving through the range of motion. For example, a person warming up for squats with a barbell may perform body weight lunges and squats in the specific warm up phase. The athlete will perform specific movements in this phase that progress in intensity until they are performing at the intensity required for the subsequent competition or training session. This phase presents the opportunity to address particular movement issues the athlete demonstrates and also work on other aspects of performance such as speed and agility.

Beneficial warm up effects are best elicited with active movements rather than passive. Dynamic stretching in a warm up is time efficient and will target activation of key muscle groups, maintain the increased temperature of the general warm up phase and incorporate many joints. Examples of dynamic stretching are toy soldiers for the hamstrings and low back muscles, spiderman lunges for the hips, and inchworms for the pectoral muscles and triceps. Static stretching prior to exercise has shown negative effects on performance in force production, power development, running speed, reaction time, and strength endurance. However, studies have shown that static stretching performed after exercise compared to pre-exercise facilitates greater range of motion improvements. The elevated body temperature post-exercise increases the elastic properties of collagen within muscles and tendons, which allows for a greater stretch magnitude.

The range of motion required for the exercise should be considered in a warm up. Those in sports that require greater range of motion, such as golf, volleyball or gymnastics, may need to spend more time with dynamic stretching than those with a lower range of motion required for exercise.

The more power necessary for the sport or activity, the more important the warm-up becomes. A warm up routine for plyometrics, such as box jumps, broad jumps and sprinting, deserves its own discussion. In short, a warm up for plyometric exercises should consist of low-intensity, dynamic movements. For example, butt kicks and straight-leg jogging prepare the body for the impact of plyometrics and emphasize quick take off and landing to mimic plyometric activities.

Article written by Dr. Jessica Khani, PT, DPT, CSCS

 

The information provided is not medical advice and is not intended to be used in place of seeking advice from a professional.

 

References:

Fletcher, I.M., and B. Jones. The effect of different warm-up stretch protocols on 20 meter sprint performance in trained rugby union players. J Strength Cond Res 18(4):885-888. 2004.

Knudson, D.V., P. Magnusson, and M. McHugh. Current issues in flexibility fitness. Pres Council Phys Fitness Sports 3:1-6. 2000.

Funk, D.C., A.M. Swank, B.M. Mikla, T.A. Fagan, and B.K. Farr. Impact of prior exercise on hamstring flexibility: A comparison of proprioceptive neuromuscular facilitation and static stretching. J Strength Cond Res 17(3):489-492. 2003.

Haff, Greg. Triplett, Travis. Essentials of Strength and Conditioning. Fourth edition. Champaign, IL: Human Kinetics, 2016. Print.

Are you Drinking Enough Water?

Drinking water is crucial to staying healthy and maintaining the function of every system in your body, including your heart, brain, digestion and muscles. Water acts a lubricant, shock absorber, building material and solvent. Water is essential for body temperature regulation through sweat, nutrient transport, waste product removal, and maintaining fluid balance. In the summer when it is hot and people sweat more, they often don’t get enough fluids. Air travel also negatively effects hydration status due to low humidity levels in the airplane cabin.

Elderly populations are at a higher risk of dehydration as a result of physiological changes and age-related decline in fluid intake. Children are also at a higher risk of dehydration as they have increased heat gain from the environment. This is due to greater surface area-body mass ratio compared to adults, increased heat production during exercise, decreased ability to dissipate heat via sweat, and decreased sensation of thirst compared to adults. Pregnant and lactating women require additional fluid intakes to avoid dehydration, as well.

Clothing, equipment and larger body size can increase sweat rate and thus dehydration risk, along with environmental conditions such as hot, humid environments and altitude. Furthermore, athletes may be more prone to dehydration during the beginning of training season. However, repeated exercise in hot environments helps the body adapt to heat stress and will result in greater sweat volume, lower electrolyte concentration of sweat, and lower temperature for onset of sweat.

Thirst may not be a reliable indicator for fluid needs and those with great sweat losses may not voluntarily drink enough fluid to adequately rehydrate. Therefore, a systematic approach to fluid replacement is necessary. For every pound of weight lost with exercise, a pint of fluid is required for replenishment (Essentials of Strength and Conditioning). Fluid guidelines differ for children and adults. The recommended water Adequate Intake is 3.7 L (125.1 oz) for men and 2.7L (91.3 oz) for women per day (Food and Nutrition Board, Institute of Medicine, National Academies). During activity, children weighing ~88 pounds should drink 5 oz cold water or flavored salted drink every 20 min during the event whether they are thirsty or not (American Academy of Pediatrics). All sources of fluid (coffee, tea, juice, soda, food fluid, etc) contribute to meeting a person’s water needs.

During exercise, sweat output can’t keep up with increases in core body temperature unless fluids are consumed. Sweat losses that exceed fluid intake can quickly lead to a hypohydrated state with subsequent increase in body temperature, decrease in blood plasma volume, and increase in heart rate and perceived exertion. Mild dehydration can greatly affect performance, resulting in increased fatigue, decreased motivation, neuromuscular control, accuracy, power, strength, muscular endurance, and overall function.

All electrolytes, including sodium chloride, potassium, magnesium and calcium, are essential to muscle contraction and nerve conduction. Increased loss of electrolytes with significant sweat production could alter performance. When large quantities of hypotonic fluid are consumed, lots of urine is produced long before the person is hydrated. Likewise, athletes who exercise intensely or for many hours and hydrate with only water or a no- or low-sodium drink may dilute their blood sodium levels to dangerously low levels, called hyponatremia. Hyponatremia leads to intracellular swelling and the athlete may present with HA, nausea, vomiting, muscle cramps, swollen hands and feet, restlessness, and disorientation. Some athletes need to replace sodium losses with higher-sodium foods and add electrolytes to drinks. Fluid intake shouldn’t exceed sweat losses to avoid hyponatremia (for example, athletes should not weigh more after workout).

 

Article written by Dr. Jessica Khani, PT, DPT, CSCS

 

The information provided is not medical advice and is not intended to be used in place of seeking advice from a professional.

 

References:

Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (2002/2005) and Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005). National Academies.

American Academy of Pediatrics, Committee on Sports Medicine and Fitness. Sports Medicine: Health Care for Young Athletes. 2nd ed. Elk Grove Village, IL. American Academy of Pediatrics; 1991:98.

Haff, Greg. Triplett, Travis. Essentials of Strength and Conditioning. Fourth edition. Champaign, IL: Human Kinetics, 2016. Print.

Mobile Devices Aging the Spine, Causing Headaches

Your Smart Phone Could Be Rapidly Aging Your Spine

Chances are that you probably haven’t given much thought to how your neck and back are faring in the era of the smart phone, but studies show that you most certainly should. It’s practically a reflex these days to pull out our smart phones when we’re standing in line, sitting at the airport or riding the subway. And while it’s great that we rarely need to venture beyond our pockets for entertainment, our bodies are beginning to retaliate—and mourn the pre-texting days.

Feeling headache after Texting?

So, what exactly are these contemporary conveniences doing to our bodies? A surgeon-led study that published in Surgical Technology International assessed what impact surgeons’ head and neck posture during surgery—a posture similar to that of smart-phone texters—has on their cervical spines. With each degree that our heads flex forward (as we stare at a screen below eye level), the strain on our spines dramatically increases. When an adult head (that weighs 10 to 12 pounds in the neutral position) tilts forward at 30 degrees, the weight seen by the spine climbs to a staggering 40 pounds, according to the study. How pervasive of a problem is this? According to the study, the average person spends 14 to 28 hours each week with their heads tilted over a laptop, smart phone or similar device. Over the course of a year, that adds up to 700 to 1400 hours of strain and stress on our spines.

As a result, the number of people dealing with headaches, achy necks and shoulders and other associated pain has skyrocketed. Trained to address postural changes and functional declines, physical therapists are well-versed in treating this modern-day phenomenon, widely known as “text neck.” Over time, this type of poor posture can have a cumulative effect, leading to spine degeneration, pinched nerves and muscle strains. Scheduling an appointment with a physical therapist can help people learn how to interact with their devices without harming their spines. The PT will prescribe an at-home program that includes strategies and exercises that focus on preserving the spine and preventing longterm damage. Exercise is an important part of taking care of our spines as we age, but what we do when we’re not in motion matters, too. So next time you pick up your smart phone or curl up with your e-reader, do a quick check of your head and neck posture. Your body will thank you for years to come

Dr. Marci Catallo-Madruga is Trained to help you relieve headaches and improve posture.

Call to schedule (303)773-0771

Request an appointment at www.agilityphysio.com