The Role of Physical Therapy in Women’s Health

When it comes to women’s health, many women don’t immediately consider physical therapy as a means of treating issues like incontinence, pelvic pain, bladder pain, pre-natal and post-partum issues and many other conditions that may be uncomfortable to talk about. Blair Green, PT, DPT, OCS, PHC, CSCS, hopes to change that mentality.

Women may come to see Blair for a variety of reasons. While many conditions stem from pregnancy, other women suffer due to stress or as a side-effect of aging. Cause and effect depend on the patient, as does treatment.

Blair uses a variety of methods to treat women – from manual therapy, to breathing exercises, body/posture awareness and general mindfulness, as well as pelvic floor education. By determining how the problem fits into the overall health and life of a patient, Blair is better able to treat her. For example, for a woman whose ailment stems from child care, treatment reflects that by addressing how she carries her child or the way in which she handles equipment. For a power lifter who suffers from stress-induced incontinence, Blair focuses on training that woman to strengthen her muscles to control her bladder.

The pelvic floor is a sensitive subject for many women. Typically, issues involving the pelvic floor affect intimacy, as well, and may stem from trauma – further contributing to the taboo nature of its discussion.

In treating a pelvic floor issue, a woman should anticipate a full physical exam – including an internal exam of the pelvic floor to fully understand the state of that muscle – how it contracts as well as its coordination and tone.

The pelvic floor makes up the bottom part of the core and works together with deep abdominal muscles, the diaphragm and lower back. Blair treats her patients for one hour in a private room and spends time explaining the function of the pelvic floor to her patient, including its effect on sexual function, urination, defecation and the overall support of internal organs.

Depending on the condition and cause, physical therapy treatment may last several weeks, months or as an on-going maintenance plan. For issues like stress-related incontinence, it may only take 6-8 weeks for a woman to gain the awareness of her muscles necessary to exercise on her own. For other pain related conditions, like bladder pain or pelvic pain, treatment may last up to a year or require regular “check-in” appointments.

For women entering child-bearing years, Blair envisions a future where physical therapy will be an integral component of pre-natal and post-partum care. Rather than post-partum care that depends on a single OB visit six weeks after giving birth, Blair wishes to incorporate physical therapy into the recovery process, including an examination of posture and abdominal muscles, as well as addressing pain during sex or exercise.

By removing the “taboo” surrounding women’s health – particularly with the pelvic floor – women will be better able to readjust to life after giving birth, as well as eliminate painful or embarrassing conditions unrelated to pregnancy.

For more information about women’s health and physical therapy, click here.

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Warm-Up and Cool-Down: the Bookends of Your Race

Warm-Up and Cool-Down: the Bookends of Your Race

Warm-Up: To improve performance and reduce the risk of injury, you should always warm up before running and especially before running at a higher intensity or racing.

  • Begin with 5-10 minutes of brisk walking or light jogging: your pace should be EASY (about 50% effort) and much slower than your race pace. The goal: to break a sweat.
  • Next you will need to focus on targeting specific muscles and ranges of motion (flexibility) required for running. You can actually target both with the right series of functional movements.

Lunge Matrix [Activates hip and thigh muscles, loosens hips]

-Perform 4 different lunges: forward, forward with a twist, side, and back; 3-5 reps each on each side (Don’t try these for the first time on race day, and keep them small at first to avoid overdoing it!)

Pedal Pushers [Dynamic calf stretching]

-In either a downward dog or traditional wall stretch position, pedal your heels back and forth: 5x with knees straight, 5x with knees bent, 5x with heels angled out, and 5x with heels angled in

Leg Swings with Abdominal Bracing [Hip opener with core activation]

-With a hand on a wall, fence or other support:

Swing the leg at the hip to the front and back while contracting your abdominal muscles (don’t hold your breath though). Use your abs to avoid letting your back arch when your leg goes behind you. 5-10x each leg

Swing the leg at the hip side to side while contracting your abdominal muscles (across the front of the body and then out to the side) 5-10x each leg

  • If you have traditional static stretches in your normal pre-run ritual, now is a great time for them.
  • If you’re getting ready for a high intensity race, drills such as skips, high knees, butt kicks, grape vines, bounds and strides are good to do in those last few minutes before the gun! Otherwise, try to keep moving, stay loose and rest assured you’ve taken smart steps towards a better, healthier race performance!

Cool-Down and Recovery: As much as you may want to collapse to the ground once you’ve scored your finisher’s medal and some H2O, your body needs you to stay on your feet for an active recovery!

  • Avoid sitting down or standing still for at least 10 minutes after you finish; if possible, keep moving by walking or light jogging (slow, easy pace). You may be uncomfortable at first, but your body often starts to feel better at this slower recovery pace. Take the opportunity for a victory lap!
  • After 10 minutes of active recovery, GENTLE static stretches may be performed at 3 x 30 seconds for major muscles groups such as the calves, quads, hamstrings, inner thighs, hip flexors, deep hip rotators and lower back. Stretch to the point of light resistance. This should not be painful! Coordinate deep breathing with your stretches for improved muscular relaxation.
  • Light self-massage with a foam roller, “stick,” tennis ball or other tool may also be helpful to relax tired, overworked muscles.
  • Be sure to replace the fluid, electrolytes and nutrients you lost. Make this a priority, especially if you’re feeling weak!
  • Pat yourself on the back and enjoy the sweet exhaustion that follows a race well run!

 

Join PT Move Better, Feel Better, Live Better for Walk with a PT

Only one in three adults receives the recommended amount of physical activity each week, according the President’s Council on Fitness, Sports and Nutrition. There are countless benefits to maintaining an active lifestyle – reducing risk of heart disease, diabetes, cancer, obesity. The list goes on, but many Georgians struggle to find the time or energy.

A daily walk is a simple way to incorporate regular exercise into your routine and move your way into a healthier lifestyle. A 30 minute walk is proven to elevate moods, increase energy and creativity and prevent chronic diseases. Something as simple as throwing on your tennis shoes during your lunch break or skipping the sitcom before dinner can drastically alter not only your shape, but also improve your mood and overall health.

To encourage this active lifestyle and educate Georgians about the benefits of physical therapy, PT Move Better, Feel Better, Live Better is hosting the first annual Walk with a PT on Oct. 22 in cities across Georgia, as part of National Physical Therapy Awareness Month.

Georgians are invited to join PT Move Better, Feel Better, Live Better and local physical therapists to walk their way to a healthier life, all while consulting PTs who can give them tips and tricks for proper form to maximize the benefits.

Walk With a PT will take place in Atlanta, Augusta and Gainesville. For more information, check Facebook.com/PTMoveBetter and @PTMoveBetterGA or email info@ptagonline.org.

How a Stroke Victim Regained Independence in Recovery

When Doug Deadwyler returned home for lunch on Dec. 1, 2006, he recalls feeling that “something was not quite right.” As he sat down to eat, his intuition kicked in and he placed the cordless phone next to him as a precaution. As he went to dial his parents’ number, however, Doug realized that something was very wrong.

Doug was in the early stages of an AV fistula – a type of stroke that affects the parietal and occipital lobes of his brain. His motor skills quickly become compromised, and while he could still think and speak clearly, he was only able to dial “0” for the operator to connect him with emergency responders. Doug stayed on the phone while paramedics broke down his door.

The last thing Doug remembers was the cold air as the paramedics wheeled him out of his house. He was transported to Emory, where he underwent two lifesaving surgeries and began a long recovery process. After 23 days in the Intensive Care Unit, Doug was deemed stable enough to move into in-patient rehab. His first memory is of Christmas Day when a physical therapist came in with reindeer antlers on to perform his evaluation.

As soon as movement was detected, Doug began the long road ahead of relearning how to use both sides of his body. Therapy began with small movements in his hospital bed. And when leg movement was detected several days later, daily PT began.

Doug’s goal was simple: to walk again.

Early therapies – including speech therapy and occupational therapy – concentrated not only on moving his left arm and improving his cognitive abilities, while Doug’s goal to walk again remained steadfast. A physical therapist visited Doug daily to assist with activities and exercises to strengthen his left leg, which he struggled to move at all. He suffered from “left-side neglect,” meaning his brain ignored all stimuli from the left side – creating an interesting challenge as he navigated his way in a wheelchair.

After Doug established his goals, therapy became a routine part of his life. He met with his PT and other members of his therapy team daily, focusing primarily on strengthening his left side to improve his function. He worked in the parallel bars to build his strength and endurance, eventually graduating from the wheelchair to a walker. Doug’s days of out-patient therapy were long and filled with appointments, but also gave him the opportunity to meet others in the same boat – providing him with additional support and appreciation for his family of caregivers.

His physical therapy appointments were one-on-one, consisting of a program designed specifically for not only his activity limitations, but also his strength and goals. Doug practiced using handrails to go up and down stairs. He practiced on ramps and used equipment to continue to strengthen his left side.

Upon “graduating” from out-patient therapy, Doug progressed to forearm crutches, providing him with more flexibility, as well as leading him one step closer to his long-term goal of walking on his own. Finally, Doug was able to move through narrow doorways and navigate a restaurant. He was free to use either bathroom in his home, rather than the one with a wide enough doorframe to accommodate his wheelchair or walker.

With the introduction of aquatic therapy to Doug’s plan, he began to learn to walk again without the use of a walker or forearm crutches. The flexibility that Doug found in the pool where, if he “fell,” it didn’t have any consequences, provided the push, strength and coordination he needed to begin to walk again independently.

While much of his progress in function peaked within the 6 – 12 months following his stroke, today, Doug continues to use physical therapy on an “as-needed” basis for back pain and building strength. He still attends Promotion classes – The Shepherd Center’s fitness center. He still visits his office twice a week, which provides a regular schedule and routine, as well as a piece of what his life was like before his stroke.

People who suffer an AV Fistula like Doug have a 50/50 chance of survival – and among those, only 25 percent have a meaningful recovery and return to a “new” normal life. Doug credits the quick action of his doctors and therapists, as well as his active lifestyle prior to the stroke, for his remarkable recovery. While his priorities and recreational activities have changed, Doug considers his life meaningful. It never crossed his mind that he wouldn’t “get better.”

Click here to learn more about how physical therapy is an integral component of stroke recovery.

Pain Free Movement with Physical Therapy

Pain management is one of the biggest discussions in the medical community today. The New York Times has dedicated numerous articles to discussing the chronic pain problem plaguing our nation, and campaigns like #ChoosePT serve to educate consumers about the dangers of misdiagnosis and over-prescription of opioid drugs.

This is why we spoke with esteemed physical therapist, Herb Silver, PT, DSc, MBA, to discuss his decades of experience managing – and eliminating his patients’ chronic pain.

According to Herb, many patients often arrive eager to focus on segmented, isolated pain. While, admittedly, his back, head and shoulders also hurt, the patient wants to focus on pain in his neck. Herb aims to eliminate this frame of mind by focusing on the systemic problem of chronic, wide-spread pain. Rather than focus on one area, Herb takes in the big picture with the goal of eliminating the root of his patients’ chronic pain.

A patient should expect his first PT appointment to begin with a standard exam, including an orthopedic, neurological and a manual therapy exam, as well as identifying pieces of patient history that may contribute to chronic pain. Perhaps he struggles with sleeping or anxiety or balancing work and play. Many times, these factors can intensify pain from an injury.

By incorporating a mindfulness of the entire central nervous system, Herb is able to lead his patients into recovery – one free of both pain and pills.

Mindfulness does not suggest that pain is just perception. It incorporates shifts in neurotransmitters as well as an injury or an area that physical therapy can address – which is why it is unique. PTs have the tools to treat localized pain while also being mindful of the central nervous system.

And these “mindfulness” techniques are quantifiable.

When treating an issue stemming from the central nervous system without being mindful of the root cause, the “bear” – as Herb describes it – will keep attacking. Patients begin losing sleep, suffering from anxiety. The brain remains in a state of attack. A PT may recommend something as simple as refocusing throughout the day – focusing on breathing, for example – or may even recommend more elaborate lifestyle changes.

When your brain perceives an attack, it reacts. But by incorporating techniques into daily life to eliminate the “bear,” a patient can eliminate the root of his pain.

Moving forward, Herb anticipates a continuous shift in the medical community to incorporating a holistic approach to pain management, one that includes physical therapy in its core. If you suffer from chronic pain, find a physical therapist near you.

Move More with Aquatic Therapy

When you think aquatic therapy, a picture of an older woman with a flower swim cap and floats is probably what comes to mind. However, aquatic therapy today is considered a safe and effective option for a wide variety of physical therapy patients. From high-functioning, independent patients returning from a sports injury, to 100-percent-dependent, wheelchair-bound patients recovering from a spinal cord injury, and even people living with multiple sclerosis, the “type” of person who may benefit from aquatic PT is endless.

Water’s unique environment enables patients to work on endurance, joint mobilization, stretching, balance, strengthening, gait training and the list goes on – oftentimes with more independence than what he or she may find on dry land. Therapy in the water challenges a patient’s core and stabilizing muscles in a way that may not be activated on the ground.

With the Rio Olympic Games kicking off, and the heat wave to end all bearing down on us, we spoke with Cathy Kramer, PT, an outpatient physical therapist at The Shepherd Center, and Lisa Ruger, the aquatics coordinator at The Shepherd Center, to discuss how patients find relief and recovery in the pool.

Lisa paints a picture of the pool facility at the Shepherd Center, complete with accommodations for nearly all patients and equipped to treat those with huge physical impairments, as well as with adaptive equipment to provide support for the various conditions and wide range of functionality treated.

The pool doesn’t discriminate. From day to day, Cathy may treat a patient who is 100-percent-dependent, hoping to find relief from chronic shoulder or neck pain from sitting in a wheel chair, followed by a teen with a goal of returning to his football team for his senior season.

Aquatic therapy also allows for flexibility in ways many patients or caregivers may not think of – like temperature control. The Shepherd Center’s pool varies in temperature, allowing physical therapists to treat conditions that are temperature sensitive and have different needs, as some patients have conditions that are sensitive to heat and some need the heat to reach their goals.

For patients who are considering PT in the pool, your first appointment likely won’t look too different from another’s – although your treatment plan will be tailored to your specific needs and goals. For example, Cathy explains that she holds the first appointment on land because that is the world we live in, and understanding patients’ limitations on land is key to developing a treatment plan as effective as possible for their everyday lives.

Once in the water, Cathy assesses a patient’s comfort-level as the pool may bring out anxiety in some patients. This may stem from the origin of the injury – a neck injury from diving into the pool, for example – or a drastic change in functionality in some who no longer know how to function in the water.

To prevent over assistance and impairment of natural movements, Cathy starts without equipment. She assesses the patient’s functionality and ability, and from there may add weights to increase ground reaction force or floats if necessary. Sessions and equipment are individualized to each person’s needs.

After determining the best treatment plan to reach a patient’s goals and help him or her gain functionality, Cathy’s focuses on helping the patient feel comfortable enough in the water to work their program on their own or with the assistance of a caregiver.

After reaching their PT goals, patients can continue their time in the pool with community classes. Lisa explains how continuing progress after your PT is “complete” is possible with open swims, community classes and other programs offered at The Shepherd Center. Who knows – you may see a former aquatic therapy patient in Tokyo for the 2020 Olympics.

Move Better, Feel Better, Live Better. How Physical Therapy, Mobility, Motion and Management can Improve Quality of Life

Staying fit and active is critical to achieving long-term health benefits. And while physical therapists are commonly sought after to treat athletic injuries and assist patients recovering from surgery, the techniques and exercise tools they provide can also help almost everyone improve their quality of life.

Simple daily activities such as cleaning up around the house or going for a run may put you at risk for injury. Abnormal body movements and awkward postures can cause stress on joints and strain important muscles, leading to long-term problems and discomfort.

Physical therapists provide the information and resources that can counteract incorrect patterns of movement and muscle imbalances that can cause pain and alter the way you move.

Regular physical therapy (PT) sessions have also been shown to reduce the risk of injury in everyday activities or sports.

According to a study in the American Journal of Sports Medicine of 1,435 NCAA Division 1 female soccer players, those who participated in physical therapy had a 41 percent lower rate of ACL injuries than those who only did regular warm-ups.

Whether you are a professional athlete or simply looking to maximize mobility – PT can help you reach your goals through individual evaluation, personalized plans, and exercises that help build strength, improve balance and restore flexibility – reducing the risk of injury and improving overall health.

Physical therapy can also assist with reduction and management of pain and discomfort that limits movement and serves as an effective tool against a variety of health issues, including: long-term disabilities, fall prevention, stroke recovery, diabetes and weight-loss.

The time for understanding that PT is no longer just a resource reserved for professional athletes or those recovering from injury is now. The health-preserving techniques delivered by physical therapists across Georgia provide the tools needed to improve the quality of life for everyone. Simply put, PT helps you move better, feel better and live better.

Minimizing Arthritis Symptoms by Maximizing Movement

Arthritis can be a debilitating and painful condition that may vary greatly in presentation, but nearly always inhibits safe and effective movement – the very thing that can alleviate or even prevent the condition.

The most common form of arthritis is known as osteoarthritis, which is caused by the deterioration of a joint and typically affects weight bearing joints, like the knee or hip, according to the American Physical Therapy Association (APTA). It may be characterized by stiffness after periods of inactivity or pain during activity and when you press on the joint.

With approximately 27 million Americans suffering from a form of arthritis, according to the CDC, there are many treatment resources available – and physical therapy (PT) is one of the most effective.

Physical therapy can provide patients who suffer from a form of arthritis with a number of exercises and resources to incorporate into their treatment plan that not only alleviate pain, but also improve mobility to lead a more active lifestyle. This is particularly important as it is sedentariness that can lead to weight gain, and then arthritis.

For a patient’s first PT appointment, the physical therapist will begin by taking a thorough history, examining your movement, range of motion and strength. From there, the physical therapist will determine the best exercises, movement strategies and, if needed, an appropriate assistive device to improve your mobility while managing your symptoms.

You may be given braces or splints to alleviate stress on particular joints, or advised on an aerobic exercise program that improves movement and can be continued at home. Your PT may even use manual therapy to improve the mobility of a particular joint and function of muscles. Often times, obesity is a contributing factor to developing arthritis, and your PT may recommend an exercise program to help you lose weight safely – and keep it off.

The key to progress is consistency. Working the program that your PT has designed for you is vital to improving your mobility and managing the pain caused by arthritis.

Do you have a physical therapist on your health care team? Integrate physical therapy into your arthritis treatment – click here find a PT near you.

How PT Moved Me: Diana Wynn

Diana Wynn - How PT Moved Me

Diana Wynn was a walker – it was both her mental escape and exercise. She walked four or five miles daily – until she tore the meniscus in her knee.

It was in the MRI that followed when Diana was informed that – not only was the tear confirmed – but Diana had severe arthritis and needed a total knee replacement. Up until that point, she thought her pain was normal – an expected side effect of getting older. She didn’t realize the pain was indicative of a more serious issue.

After completing surgery, Diana began the painful – and in her case, extremely frustrating – process of rehabilitation. For more than three months, her surgeon deemed her a “head scratcher.” Neither he, nor his team, could determine why Diana’s knee remained “stuck,” with nearly no range of motion. She could neither straighten nor fully bend her knee, and was forced to rely on a cane for support when walking.

Diana’s frustration mounted – as did her pain. Her body wasn’t healing, and a revision surgery loomed in the future.

That is until a friend recommended that she try a different approach and see her physical therapist. Diana thought she would give it a try.

Diana arrived at her PT appointment with a three week goal – three weeks until she had to be able to work again to maintain her benefits. And her team got her there.

By listening to Diana and working with her to solve her motion challenges, the PT team fulfilled their promise that they would not leave her in pain. They validated her challenges and took a collaborative approach to promote her healing with soft tissue and joint mobilization, trigger point dry needling and therapeutic exercise.

The knot that was in the back of Diana’s knee that she felt from day one gradually went away. Through hard work, involvement and a more concrete understanding of her healing, Diana amazed her doctor with her progress.

Today, Diana is readjusting to a life that doesn’t involve overthinking every day movement like getting in and out of a car, or going up and down a flight of stairs. As a photographer, she vividly remembers the first time she was able to pull over, get out of her car and capture the light just right – all without pain. Each click of the camera reminds her of just how far she has come.

Diana attributes the difference of night and day in her movement and quality of life to her physical therapy team. While people are often particular about which doctor they visit, a quality PT on your team is just as essential to healing.

If you need to add a physical therapist to your team, click here to find one near you.

PT From Head to Toe: Recovering from a Brain Injury with PT

More than 3.5 million children and adults sustain an acquired brain injury each year, according to the Brain Injury Association of America. A brain injury can result from numerous incidents, including falls, motor vehicle accidents, assaults and being struck by or against another object.

Brian injuries are typically not only traumatic for the patients, but also for family, friends and caregivers whose lives may also shift dramatically – and while the aftermath of a brain injury may be overwhelming, physical therapy can play an integral role in the recovery process toward a “new normal.”

In honor of Brain Injury Awareness Month, we spoke with Danielle C. Bonner, PT, DPT, NCS, in the Shepherd Center’s Acquired Brain Injury Unit, to discuss her experiences with patients recovering from brain injuries. And, according to Danielle, a “successful” recovery from a brain injury comes down to time, patience and hard work – which may be a tough road for patients and their families.

In her five years with the Shepherd Center, Danielle has treated patients with a variety of brain injuries – both traumatic and non-traumatic. The most common characteristic of these patients is that there isn’t much commonality. No two injuries present the same, regardless of the obvious similarities. And because of this, no two treatment plans look the same. Brain injuries are always unique, as are their treatment and recoveries.

When treating an individual with a brain injury, the process begins with an assessment by the full medical team to determine medical stability, identify physical and cognitive impairments and then set priorities. For a recently injured but medically stable patient, this may look different from a patient who has had an extended stay in the ICU. In these cases where the patient has minimal activity in his or her time in the ICU, it is imperative to make sure their heart and blood pressure are stable enough to handle a more active environment.

The physical therapy team then works together to determine a patient’s cognitive and communication abilities to identify the best types of assistance and cues necessary in his or her case – like whether or not a patient is able to follow verbal physical commands or requires more hand-on support. This is partially determined by a standardized assessment is called the Rancho Level of Cognitive Functioning Scale.

Strength, range of motion and balance are then taken into account to determine the best course of treatment – which can look dramatically different depending upon the patient. For some, this means an extended in-patient stay. Others are better suited for an out-patient or day program. And many patients may not even recognize the need for PT until much later in the recovery process when persistent pain or headaches appear. For more patients, cognitive improvements later in recovery may provide them with the insight to know that therapy is necessary to continue to increase independence.

Beyond the initial shock of the injury, the most difficult element of the recovery process, according to Danielle, is often the time it may take to achieve the best “new normal” possible. For many people, it may take years of returning to physical therapy to address a new element of recovery.

What are the most important things to keep in mind while you or a loved one is recovering from a brain injury?

Patience and hard work.

Click here to find a PT near you.