Author: Dr. Dan Witte

Its Summer, Let’s Hit The Pool!!!

July 12, 2022

                Now that summer is upon us, the heat can seem unrivaled most days. This will drive all of us to the nearest watering hole for some relaxation and cool-down. While the pool is a great way to cool off and have some fun with family and friends, it can also be a chance for us to get in some exercise! There are many benefits to aquatic therapy and various reasons why doctors may prescribe it.

Aquatic therapy refers to exercise performed in a pool for the purpose of rehabilitation for troubled muscles or joints. Due to the buoyant nature of water, pressure no longer rests on the joints when they are submerged, opposite of what we find to be true on land. This provides relief, allowing for a greater tolerance to strengthening and stability exercises. Exercise within a therapeutic pool is also known to decrease edema, or swelling, which will allow for improved joint mobility. Water provides a good resistance against the joints and muscles, improving strength without having to use weights or bands. This could save you money you may feel pressure to spend on equipment. If you have access to a therapeutic pool, the water sits at a higher-than-normal temperature, soothing sore muscles and decreasing pain. Water exercise is also known to decrease spasticity in muscles, helping to improve function and motor control with daily activities. There is a wide range of patient populations that may benefit from aquatic therapy. These include but are not limited to those diagnosed with arthritis, fibromyalgia, spinal cord injuries, vestibular deficiencies, and total joint replacements.

Here at Witte Physical Therapy Louisville, we have a state-of-the-art aquatic therapy pool in our clinic. The temperature rests at 93 degrees and has an underwater treadmill to assist in functional movement and gait training in a gravity-assisted environment. We have skilled therapists on-site and ready to guide you through a personalized plan of care set forth by the evaluating therapist. We provide the tools and exercise regimen needed to help you succeed. We will also help you set goals, create a plan to reach those goals, and help you progress back to your prior level of function. If you are looking for a different treatment option or are interested to learn more about our therapeutic pool, give us a call today at 1-402-234-3333.

Common Hand Injuries

July 5, 2022

It is (was) fireworks season. Unfortunately the hand surgeons and therapists never look forward to this time of year because inevitably accidents will happen that will cause injuries to hands, bodies and face due to fireworks. While these injuries are not overly common, it does give us a great platform to discuss the most common hand injuries.

OVERUSE INJURIES

These injuries in the hand tend to be directed more towards nerves and tendons. Carpal tunnel syndrome, cubital tunnel syndrome, medial or lateral epicondylitis, and De’Quervein’s syndrome. These can all be treated with activity modification, physical therapy interventions, and medications. Physical therapy will help you adjust your activities, regain your ROM and strength, and decrease you pain so that you can return to your normal life without issues. 

DEFORMITIES

These injuries tend to occur due to tendon or ligament dysfunction or rupture. Swan Neck, Boutonniere, Mallet, Trigger, and Depuytren’s are all issues that can cause a finger deformity. These issues often need splinting or surgery to be corrected. Physical therapy tends to be indicated after surgery to help regain normal function and strength. Physical therapy can also help with bracing, activity modification, and pain/swelling management.

MISC INJURIES

These can be caused by nerve dysfunction (such as peripheral neuropathy, hypo/hypertonicity) or traumatic injuries (fractures, burns, sprains, amputations). The physical therapy treatment for these items can vary depending on what is going on and its severity. However an individualized treatment plan can be developed to meet your wants and needs and contain a variety of interventions to help you reach your goals.

No matter the hand  injury, physical therapy can and  should be an integral part of your rehab. An evaluation by a physical therapist can get your started on the right path to decrease your pain and improve your function to get you back to work, back on the course, or just back to taking care of yourself. The quicker you start this path the quicker you will be back to being you!

Why Doing Your Exercises At Home Is VERY IMPORTANT

June 28, 2022

If you’ve been to physical therapy, you likely got a home exercise program. Research says that if you do your home exercise program, you’ll have a significantly better chance of meeting your goals and feeling better. Not doing your program increases the risk of recurrent injury or flare-ups with less positive outcomes long term. Even though they’re important, adherence to home exercise programs is terrible. It’s estimated that only 40 to 50% of patients do their exercises the way they’re supposed to. What can you do to make sure you do your exercises and get the best outcomes? Here are a few ideas.

Plan ahead

Think about what’s going to get in your way – your schedule, that you’ll forget, or that you don’t have the space or equipment that you need. Once you figure out the problems, come up with solutions. Put your exercises in your schedule, talk to your PT about equipment, or adjusting your program to fit the time you have. If you solve problems before they start, they’re no longer problems.

Address pain and beliefs

You’ll need to work with your PT on these. If your exercises cause pain, you’re not going to do them. When your PT prescribes your exercises, try them out. If there’s pain, ask your PT about modifications to make them more comfortable. The other thing might need addressed are your beliefs. If you believe that the exercises won’t help, or that they’re a waste of time, you won’t do them. Again, work with your PT to understand why they’re prescribing those exercises, and what they’re meant to do. Once you know why you’re doing those exercises, you’re more likely to do them.

Get support

People who have social support are more likely to do their exercises. This is why CrossFit and group exercise classes work. Find a family member or friend to help you stay consistent with your exercises. Your PT can help here too. Have someone ask if you’re doing your exercises, and how they’re going. This will keep you accountable and more likely to do them.

Use Technology

If you like technology and gadgets, they can help you be consistent with your exercises. There are plenty of apps that can track your exercise. Seeing that streak of days you’ve exercised will motivate you not to break it. Smartwatches and activity trackers can fill the same role.

Doing your home exercise program will help you get the most out of PT. With a little planning and a little help, you can make sure you’re one of the 50% of the people who do their home exercises consistently to get the best outcomes.

References:

https://pubmed.ncbi.nlm.nih.gov/32669487/

https://www.physio-pedia.com/Adherence_to_Home_Exercise_Programs

Tommy John Surgery

June 21, 2022

It is Baseball Season and we have all been hearing about “Tommy John” issues. Throwing athletes such as baseball players and more specifically pitchers often injure or tear a ligament in their elbow called their ulnar collateral ligament. This ligament is located on the inside of your elbow, and it helps to secure your elbow joint. The repair of this ligament gets its name from a baseball player who was a baseball pitcher and was the first person to successfully return to sport following repair in 1974.

Causes of injury could be due to improper throwing mechanics, a fall into your arm, weight bearing activities such as gymnastics, repetitive throwing without adequate rest breaks or throwing at high speeds. Common symptoms of a UCL tear or injury are feeling a pop in your elbow, pain on the inside of your elbow, increased difficulty with throwing motion and decreased range of motion of your elbow. Diagnosis often requires a physician visit and in some cases imaging.

Depending on the severity of injury non-operative options include physical therapy, rest and activity modification. Full thickness tears may require surgical repair. Following surgical repair, you are often placed in a brace to limit how much you can move your elbow and depending on your doctors’ recommendations you may begin physical therapy right away or wait a few weeks to allow healing and recovery. Most often patients attend physical therapy to improve their elbow motion and strength before they are cleared to return to their sport or job.

You can help to prevent injury by performing proper warm up and cool downs, avoiding throwing until your body has fully rested and recovered from your previous throwing activity, focusing on your mechanics and improving any muscle imbalances.

References:

https://sportsmedicine.mayoclinic.org/condition/ligament-injuries/

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/tommy-john-surgery-ulnar-collateral-ligament-reconstruction

What A Pain In The……Elbow!

June 14, 2022

Golfing can be a fun leisure activity unless it causes you pain. If you experience pain you may be experiencing a condition referred to as medial epicondylitis or golfer’s elbow. This often presents as pain from the inside or medial portion of your elbow to your wrist and is caused by excessive or repetitive force to bend your wrist toward your palm. This force and motion cause tiny tears and inflammation in the tendons of your forearm. Other activities that can cause similar diagnosis include carrying a heavy suitcase, chopping wood, operating a chain saw or using hand tools in a repetitive manner. Common symptoms include pain along the inside of your elbow or forearm that can worsen with certain directions, stiffness, weakness of your elbow, wrist or fingers and in some cases numbness and tingling.  

If golf isn’t quite for you tennis is another activity you may enjoy. Similar to golfer’s elbow too much tennis can cause lateral epicondylitis or tennis elbow as it is commonly referred to. Instead of pain along the inside or medial portion of your forearm you experience pain on the outside or lateral portion of your elbow and forearm. Frequent bending or straightening of your arm while keeping your wrist straight can cause rubbing of your muscle on bony aspects of your elbow causing tears and inflammation in the muscle. Common causes of tennis elbow include weak shoulder and wrist muscles, improper backhand stroke, painting with a brush or roller, operating a chain saw, frequent use of hand tools or professions that require prolonged repetitive movements like a butcher, painter or plumber for example. Symptoms often associated with tennis elbow include achiness, burning or pain along the outside of your forearm that with time or repetitive motions gets worse. Another symptom can include weak grip.

Both conditions are often diagnosed by your doctor through a physical examination however sometimes an X-ray or MRI may be required. Treatment can include physical therapy, rest, ice, gentle strengthening and stretching exercises or anti-inflammatory medications. Other alternatives can also include bracing, steroid injections and rarely surgery. Ways to prevent injury include strengthening your forearm muscles, proper warm up and cool down, fixing your form, using the correct equipment, knowing when rest is required to allow for recovery and using proper mechanics when lifting objects or weights. It is important to keep your hands, wrists and elbows strong and flexible to prevent potential injury.

Resources:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/medial-epicondylitis-golfers-and-baseball-elbow#:~:text=Medial%20epicondylitis%20is%20also%20known,the%20wrist%20toward%20the%20palm.

https://www.hopkinsmedicine.org/health/conditions-and-diseases/lateral-epicondylitis-tennis-elbow#:~:text=Lateral%20epicondylitis%2C%20or%20tennis%20elbow,become%20sore%20from%20excessive%20strain.

https://www.mayoclinic.org/diseases-conditions/golfers-elbow/symptoms-causes/syc-20372868

https://orthoinfo.aaos.org/en/diseases–conditions/tennis-elbow-lateral-epicondylitis/

How to Properly Hydrate

June 7, 2022

Drinking fluids such as water play a vital role in your overall health. Not drinking enough fluids can lead to dehydration, increased joint stiffness, muscle cramps, mood changes, kidney stones and memory loss to just name a few. Benefits of improved hydration include improved memory, digestive harmony, improved energy, weight management, heart health and improved mood. We get most of our daily hydration from the fluids we drink so it is important to opt for drinks with less sugar, better alternatives include plain water, sparkling or flavored water, plain tea or plain coffee to improve overall health and function of your body. Other beverages that can aid in hydration however should be consumed within recommended dietary caloric intake include low or fat free milk, 100% fruit juice or vegetable juice and in some instances sports beverages. These alternatives to water can include nutritional benefits including vitamin D, calcium or potassium.

It is even more important as the summer months approach to increase your fluid intake to account for increased body temperature and sweating. Increased hydration is also important in instances when you may be running a fever or have been ill. Some tips to improve your water intake could include a new water bottle, serving water during your meals, adding fruit such as lemons or vegetables such as cucumbers to add flavor or freezing a bottle of water you can drink all day long. A good rule of thumb for maintaining proper hydration recommended by most physicians is six to eight, eight-ounce glasses a day. It is important to discuss your health history, needs and medications with your physician to discover an intake goal that will best meet your needs.

Resources: https://www.ncoa.org/article/10-reasons-why-hydration-is-important

https://www.cdc.gov/healthyweight/healthy_eating/water-and-healthier-drinks.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fhealthywater%2Fdrinking%2Fnutrition%2Findex.html

https://www.nutrition.va.gov/docs/UpdatedPatientEd/PreventingDehydrationinOlderAdults2018.pdf

Keeping Time…

May 31, 2022

As I was doing some research for this post I noticed something noteworthy about this date. On this day in 1859 the Great Clock housing Big Ben starts keeping time. Now, some of you may think that this is an odd thing to find in a blog on a physical therapy website. However, as I was reflecting on my day I was reminded of how many conversations I had with patients today involving time. How long do I need to do this exercise for? How long do I need to follow my home exercise program? How long will I be in therapy? These are all great questions and ones that come up nearly every day.

First, how long do I need to do this exercise for? It is important to work with your therapist to understand why you are doing an exercise and how that affects how you are doing it. Sometimes we do exercises for time (holding a stretch for 30 seconds), or for reps (3 sets of 10), or for endurance, balance, stability, etc.

Second it is important to understand that therapy works best when it is done daily. If you want to be done with therapy as soon as possible it is imperative that you participate at home. This could be with a home exercise program or modifying your activities at home or following an icing regimen. If you follow your therapist’s instructions you are more likely to decrease your time in therapy.

Finally, how long will I be in therapy. This was somewhat addressed above, but you should have a good idea after your first visit how long your therapy plan of care could be. You should work with your therapist to address and assess this plan of care regularly. You more you understand what therapy is and the more you buy into the plan the shorter your time with therapy will be!

Want a Bargain? Try Physical Therapy!

May 24, 2022

It’s no secret that prices have been going up. Gas is expensive. Food is expensive. The housing market is crazy. If you’re looking for ways to pinch some pennies or stretch your dollars, physical therapy might be just what you’re looking for.

Physical Therapy Saves Cost

A study that looked at the claims data of 472,000 Medicare beneficiaries with back pain found that when PT was the first treatment, costs were 19% lower than when people got injections first and 75% lower than for people who were sent straight to surgery. The study also found that in the year following diagnosis, people who got PT first had costs 18% lower than those who got injections, and 54% lower than those in the surgery group.

Another example happened in 2006 when Virginia Mason Health Center in Seattle teamed up with Aetna and Starbucks. They sent workers with back pain to see both a physical therapist and physician for their first treatment. Use of MRI dropped by 1/3, people got better faster, missed less work and were more satisfied with their care. The cost savings was so great that Virgina Mason was losing money on treating back pain, so Aetna ended up paying them more for PT treatments because they were saving so much money.

Physical Therapy First Means Fewer Visits…

A paper published in Physical Therapy looked at outcomes when patients went to a PT first vs. seeing a physician first for back pain. It found that patients who went to their physician first needed 33 PT visits on average, while those who went to their PT first only needed 20. Seeing a PT first saves money, but it also saves time.

It Also Means Better Outcomes

A study of 150,000 insurance claims published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit.

High quality research consistently shows that taking advantage of direct access and getting to your physical therapist quickly leads to better outcomes in fewer visits with lower costs. We think that’s a deal worth taking advantage of.

References

1. https://ww1.prweb.com/prfiles/2010/11/03/4743604/0_ANovelPlanHelpsHospitalWeanItselfOffOfPriceyTests.pdf
2. https://pubmed.ncbi.nlm.nih.gov/33245117/
3. https://www.apta.org/news/2017/07/26/study-says-cost-savings-of-physical-therapy-for-lbp-are-significant#:~:text=Researchers%20say%20that%20not%20only,over%20treatments%20that%20begin%20with
4. https://academic.oup.com/ptj/article/77/1/10/2633027?login=true
5. https://newsroom.uw.edu/news/early-physical-therapy-benefits-low-back-pain-patients

How to Avoid “Bleacher Butt”!!

May 18, 2022

We all love to cheer on our loved ones or favorite sports teams however we also all know how sitting for those long games can cause pain in your low back and bottom. “Bleacher Butt” is a term caused by increased pressure through wooden or metal bleachers for prolonged periods of time on your sit bones (ischial tuberosities). Often these types of bleachers do not have back support either. Typical bleacher posture results in a slouched forward manner causing increased pull on your low back muscles as your hips often drop below your knees.

 Some tips that may be helpful at your next sporting event while cheering on a love one cane include:

1. Posture: Try to engage your core muscles to allow you to maintain straight back positioning to avoid increased unnatural curves of your spine. Gentle rocking from side to side of your bottom can help alleviate pain and pressure through this region.
2. Location: Depending on your sporting venue some bleachers back up to wall which can help provide some support to your back. Sitting at the top or bottom of the bleachers also allows you more access to stand up or walk around when needed.
3. Stand up and stretching: Avoiding prolonged seated “bleacher” posture can reduce strain through your low back and glute region. A good rule to follow would be to stand or walk following each quarter, half or inning. Performing gentle stretches can reduce tension in these muscles that are working harder to support you.
4. Bring your own chair: Bleacher pads or bleacher seats that attach to the bleachers are great alternatives to reducing the compression on your glutes while sitting for longer periods of time. Depending on your venue you could also bring your favorite lawn chair to sit in to reduce aches and pains. A good supportive lawn chair has a firmer seat and back rather than using a sling chair.

Pic taken from: https://swimcoachingblog.com/2017/05/22/save-yourself-from-bleacher-butt/

GRADUATION!!!

May 10, 2022

It is an important milestone in everyone’s life. Graduation! Whether you are graduating from kindergarden, 5th or 6th grade, high school, college, or physical therapy, it is important to celebrate the end of one chapter and the beginning of another. 

We often give patients the opportunity to celebrate their last day in therapy in a variety of ways. Some like to share snacks, some like to have some new music played during their final workout, and some like to have their picture taken with our graduation sign.

However, I want to focus this post on the high school graduations that are currently taking place.

We have been blessed at Witte PT to treat several high school students, especially this year high school seniors. While going to therapy is not everyone’s first choice we are glad that so many trust us with their care. This year’s group of seniors have put in a lot of time, sweat, and tears to get through their injuries and get back to living their life. Many of these students athletes want to return to their respective sports and many have exceled in doing so. However, it is this group of students and caliber of their character I want to comment on. Whether they have been from Plattsmouth, Weeping Water, Conestoga, Elmwood Murdock, Logan View, Scribner Snyder, West Point, Papillion, Gretna, or Louisville the character of these kids has been outstanding. All of these districts are losing great young men and women who help to set a culture of positivity and success. Success in the classroom, success on the field or court, and success in how they treat their fellow students and teachers. That is what I will miss the most. They were hard working and a great group of student athletes for our younger students to look up to. I have no doubt they will be successful in their future endeavors!

Thank you from Witte PT for all your hard work and what you have done for the classes below you!