Archives for posts with tag: Physical Therapy

Consumer Direct Access to Physical Therapists in California was signed into law by Governor Jerry Brown, on October 7, 2013. Being able to directly access a physical therapist will save people time and money.

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We were reading through “Diagnostic Testing and Treatment of Low Back Pain in United States Emergency Departments: A National Perspective” on MedScape and were struck by a couple items.

“Diagnostic testing was performed in nearly 1 of every 2 patients with low back pain and opioids were administered to nearly two-thirds of the sample.” http://www.medscape.com/viewarticle/732744_4

Most low back pain can be evaluated clinically and manually without imaging studies. A clinician familiar with back problems is usually able to determine the etiology (root cause) of the back pain, and then decide on an appropriate course of action. For example, in physical therapy graduate programs, neurological testing — sensation, reflexes, strength, etc. — is recommended (required really) when there are symptoms past the gluteal fold into the thigh or leg. If no loss of strength and function is present, then treatment and education may proceed.

Then the question of opioids comes in. While a physical therapist cannot prescribe medication, all treatment interventions are considered in the context of desired results. Pain control is a laudable goal, but healing, resolution, self management education, and return to function might be considered more desirable in the long, and even near, term.

“Savings may be realized if visits can be shifted to primary care settings, where typical charges and propensity for diagnostic testing may be less.”

We’d like to see people offered a solution to their problem, not simply more tests and treatment to mask the symptoms. What do you think?

There remains some confusion around Medicare’s coverage of maintenance physical therapy. The general idea is that if a skilled service is required to prevent decline in a person’s condition, then the service is now covered under Medicare.
The following is from the Center for Medicare Advocacy website:

SERVICES FOR BENEFICIARIES WITH CHRONIC CONDITIONS

A chronic condition requiring skilled care services can take many forms and is not limited to a particular set of disease, diagnosis, or disabling conditions.

COVERAGE REQUIREMENTS

The Medicare program recognizes the need for skilled care and related services for chronic, long-term conditions.  For care to be covered, the patient must require skilled services which may be designed to:

  • Maintain the status of a medical condition or the functioning of a body part; or
  • Slow or prevent the deterioration of a medical condition or body part.

WHERE ARE SERVICES PROVIDED?

Services can be provided in a variety of settings – at home, through Medicare certified home health agencies, in Medicare certified outpatient facilities, rehabilitation hospitals and centers, and in Medicare certified skilled nursing facilities.

WHO PROVIDES SKILLED SERVICES?

Skilled services are those services provided by (or under the supervision of) technical or professional personnel such as registered nurses, licensed practical nurses, physical therapists, occupational therapists, speech pathologists, and audiologists. Services must be a type that are not ordinarily performed by non-skilled personnel.

More information may be found at

http://www.medicareadvocacy.org/medicare-info/chronic-conditions/#Coverage%20Requirements

Lindsay Haas, DPT at our Castro Clinic is also an amateur knitter, passionate about sharing her expertise in human mobility and movement with other knitters. Interviewed here by Knit and Tonic blogger, Wendy Bernard:
http://www.knitandtonic.net/knitandtonic/2013/02/and-to-think-i-thought-knitting-yoga-was-a-joke-.html

LindsayKnitting“Just one more row.”  I’ve thought it myself countless times- only to realize another 20 minutes has gone by without making any move to stop.  Regardless of your level of skill, anyone who knits has probably dealt with the aches and pains associated with working on a project for too long.  How can you avoid it?  One of the best things you can do is work on developing good habits so you can stop issues before they start.  As a knitter and a physical therapist, I see many patients with overuse injuries.  Here are some basic tips on how to stay comfortable while working:

Good Posture – I know we’ve all heard it time and time again but that doesn’t make it any easier to sit properly.  First, it is important to have good light when you are knitting so you do not need to ‘squint’ down at your project.  A good chair is key- not too hard, not too soft, but just right.  When sitting, your knees should be slightly lower than your hips, and your feet should be flat on the floor.  You should try to have your bottom at the back of the chair and have your weight shifted slightly forward.  Sometimes a towel or roll behind your low back can help provide proper lumbar support.  Your shoulders should be down away from your ears and your shoulder blades slightly squeezed together on your back.  Your elbows should be in at your sides and your chin slightly tucked.

Take Breaks – No one said it would be easy to maintain good posture, especially when you are just getting used to it.  Set a timer for 30-45 minutes and when it goes off, put your knitting down and get up to move around.  You should plan to take a 5-10 minute break.  Walk around, which helps with circulation, or do a few of the exercises below.  Changing your activity will keep you from developing repetitive strain injuries, and gives your body time to recover.

Stretch – Now that you are taking breaks- use the time to move around.  Gently stretch your neck side to side, and slowly look over each shoulder.  Roll your shoulders forwards and backwards.  Try to touch your elbows behind your back.  Make circles with your wrists clockwise and counter clockwise.  Use one hand to gently stretch the other wrist down and up.  Repeat on the other side.   If it feels okay gently twist your torso to the right and the left.  Reach both arms up as if you were to touch the ceiling.  None of these movements should cause you any pain or discomfort, just gentle stretch.  If one bothers you, try to modify it or lessen the intensity, or just don’t do it.

Breathe – When your posture isn’t optimal you aren’t breathing as efficiently.  Many people become ‘chest breathers’ using the neck muscles and shoulders to elevate the ribs.  Ideally you should use the diaphragm (the muscle at the bottom of your ribs, right above the belly button) to fill your lungs.  To do so focus on pushing your belly button out as you breathe in.  No one should see your shoulders moving up and down.

Listen to your body – If you do find yourself getting symptoms, it is important to rest and give your body time to recover.  Otherwise you can be at risk to develop repetitive or chronic injury.  Icing the area may help calm any irritation and decrease soreness (but make sure to put something between the ice and your skin!)  If your symptoms to not resolve with a week of rest, or if they get worse, you should go see a health professional.  You should DEFINITELY go if you are experiencing any numbness or tingling, loss of strength, or radiating pain.

Making small modifications and developing good habits will help you avoid knitting related injuries and ensure healthy knitting.  And remember to stop knitting and rest if you begin to notice any symptoms.

Lindsay Haas is an amateur knitter and a professional physical therapist at san francisco sport and spine physical therapy.  She enjoys helping knitters and other crafters ensure they can continue their projects pain free, as well as comparing notes on projects and learning new techniques from her patients.