Author: Dr. Dan Witte

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!

Treatment for Plantar Fasciitis

May 3, 2022

We are starting to see signs of the weather turning. It seems slow but eventually summer will be here, and we will be in shorts and flip flops enjoying the warmer weather. Often our shoe choices turn “negative” as the weather improves. When we say “negative” we really mean less supportive. These less supportive shoe options can lead to increased heel and foot pain that most people refer to as plantar fasciitis.

What is plantar fasciitis?

Plantar fasciitis is the inflammation of the plantar fascia that is found on the bottom of your foot. This inflammation can cause pain with you first steps in the morning or after periods of sitting. This pain can cause abnormalities in how you walk, and those abnormalities can create other pains.

How can I prevent plantar fasciitis?

Wearing appropriate and supportive shoes is a great start. However, we understand that sometimes you want to wear shoes that go with an outfit or are specific to certain activity. Thus, what else can you do? Maintaining calf flexibility is one of the better things you can do to make sure you are “keeping plantar fasciitis at bay”.

First, the runner’s stretch for your gastroc and soleus muscles should be done at least daily. Links for those stretches can be found below. Ideally holding these stretches for 20 seconds and doing them several times per day.

Second, we want to work on our eccentric control of our calf muscles which will also provide a controlled stretch of these calf muscles. A link for this activity can be found below.

Finally, if you find that you are having heel pain the first step to relieve that pain is to wear more supportive shoes and to elevate your heel. This can be done by wearing shows with a thickened heel or by inserting a gel heel lift into your shoe.

If you have any questions about these steps or if you have tried these steps and they are not working for you, please give us a call at Witte Physical Therapy. It is important to remember that not all heel pain is the same, so treating it the same person to person will not help everyone. Witte PT can work with you to set up an individual treatment plan that will work best for you to optimize your results.

Links:

https://www.knee-pain-explained.com/calf-stretches.html (#1 and #2 for calf stretches)

https://www.verywellhealth.com/the-alfredson-protocol-for-achilles-tendonitis-2696560 (see Alfredson protocol)

National Kids and Pets Day and…..

April 26, 2022

On April 12, 2022 we posted our blog on how physical therapy can help with common pediatric issues. We highlighted our pediatric programs and how, Natosha Siemek, PT, DPT, can use her experience and expertise to help your child reach their full potential. Here we are two weeks later and now it is National Kids and Pets Day!

National Kids and Pets Day was created to highlight the bond between kids and their pets. Their pets can be an emotional support animal for the kids. Pets (depending on the type) can provide some companionship and love that is not tied or dependent on anything else. Their pet can provide an outlet for exercise and to burn energy. Pets can even serve as a companion for doing their physical therapy!

(the first person to email dan@wittephysicaltherapy.com and point out the error with this picture will win some Witte PT swag)

Whether we are treating them for coordination or developmental disorders, cerebral palsy, torticollis, pain, injuries, or sports injuries/dysfunction, pets can make that work more enjoyable. 

If you have a pet and/or a child please use today to help them bond and spend some time with them. If you notice your child is not moving well, having pain, or not developing as you would expect please let us know and we can help get them on the right path!

Also, is it a coincidence that tomorrow, April 27, 2022, is National Gummi Bear Day!