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Tips for Staying Safe with Outdoor Spring Clean Up

March 21, 2023

The weather is starting to turn and spring has officially hit on the calendar. We have hit the second half of March and April and Easter are right around the corner. Spring sports have started and our high school teams are now playing baseball, soccer, golf, and running track. Our youth teams are beginning to get to practice outdoors and the adults are starting to look at their yards, landscaping beds, and gardens and starting to clean up and plan for this summer. How can we stay safe when working on our yards?

The first thing to remember is to plan. We need to plan what we are going to do and how we are going to do it. There can be a lot of lifting in the spring. Lifting fertilizer bags, bags of potting soil, rocks, tree limbs, etc. It is always important to lift with our legs and avoid excessive bending at the waist. Keep your feet shoulder width apart, squat down keeping your back straight and your hips only slightly flexed. Pick up the load with your arms and hold it close to your body. Push up with your legs and do not change your back position. If you have to move the load do not twist your back, but instead move your feet so that the load always stays between your feet and never moves outside one foot or the other.

Yard work can also include pushing a mower, digging some holes, raking some thatch, or preparing the vegetable garden. When working with these tools we wont’ to avoid fully extending our arms and pulling or digging with the tool too far away from our torso. As we are digging down we want to bend our knees and not our waists to drive and pick up the load. As we are emptying our shovel or rake we want to avoid twisting our torso and putting unneeded strain on our backs. 

It is always important to remember to stretch before and after any manual labor. We want to make sure our bodies are prepared for the upcoming work and given time to rest after the work is completed. We also want to make sure our leg and core muscles are strong and being utilized correctly to maximize our power and minimize our stress and risk of injury. Physical therapy can help with all of these things and should be used to prevent injury and to over come an issues or injuries that occur. Witte Physical Therapy has the staff and the training you need to prevent or recover from these injuries. Call us to today for a free consultation!

References

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

The History of Women and Physical Therapy

March 14, 2023

Did you know that March is Women’s History month? Did you know that women played a major role in starting and shaping physical therapy? It is important to look back on all the contributions that women have made in history, and as a physical therapy company it is especially important to understand how they shaped the profession of physical therapy.

In the United States Mary McMillian lead and trained a group of “reconstruction aides” to help the soldiers wounded in World War I get back to daily life. The first research article for physical therapy was published in March 1921 and in 1924 the American Women’s Physical Therapeutic Association was established. This organization now functions as the American Physical Therapy Association and is a resource to both physical therapists and patients.

As physical therapy began to grow the polio pandemic became a global issue. The women of physical therapy were used to help restore passive range of motion. In 1940 Sister Elizabeth Kenny brought her treatment practices to the United States to help patients who had been diagnosed with polio.

Throughout the next major wars several woman physical therapists enlisted to be stationed at bases where they could treat injured and wounded soldiers. After the war the profession was expanded to include more civilian uses and to cover injuries that include neuromuscular and cardiovascular issues.

Without these pioneer women the profession of physical therapy may look very different today!

Research

https://en.wikipedia.org/wiki/Physical_therapy

https://www.amhsjournal.org/article.asp?issn=2321-4848%3Byear%3D2014%3Bvolume%3D2%3Bissue%3D2%3Bspage%3D257%3Bepage%3D260%3Baulast%3DShaik%3Btype%3D3

https://journals.lww.com/jopte/abstract/2003/10000/the_history_of_physical_therapy_practice_in_the.3.aspx

Flexibility, Mobility, and Stability

March 7, 2023

How do flexibility, mobility, and stability work together? Is one more important than another?

Flexibility is the total range of motion of joint and the muscles that cross it. Flexibility is important as it is required to complete the most basic to the most complex tasks.

Mobility is the ability for a joint to have its full range of motion without restriction. Mobility is related more to complex and coordinated tasks and joints that work across multiple planes.

Stability is the ability to control a joint and its motion. It is vital in coordination of a joint with its movement and to support surrounding joints.

We can look at several joints in our body to see which joints are considered more mobile and which are considered more stable. Our mobile joints include our shoulders, hips, and thoracic spine. These joints give us the ability to move in many different directions and with different amplitudes of movement. Our stable joints include our cervical and lumbar spine and our knees. These joints are used more to control our motion. You will notice that most of our joints are adjacent to another joint of a different type. Meaning that our mobile joints are adjacent to our stable joints. This is important in dynamic movements, but also can cause issues when there are injuries. Often if you sprain your ankle you will notice some issues in your knee, this is because you have injured a mobile joint and now your stability joint has to work harder to allow for your normal mobility.

Whether you are in physical therapy or working out on your own it is important to work all of these aspects. Flexibility should be worked to improve your ability to maximize your mobility and stability. Mobile joints need to be worked to maintain ROM and stable joints need to be worked to strengthen their stability. As these things improve then you need to work to give your mobile joints some strength and your stable joints some mobility. This is where physical therapy can help find your baseline and build a plan to improve these areas and maximize your overall joint health and wellness.

References:

Physical Therapy and POTS

February 28, 2023

Postural Orthostatic Tachycardia Syndrome (POTS) is a condition that causes a number of symptoms when you transition from lying down to standing up. These symptoms can include an increased heart rate, dizziness, and fatigue. While there is no cure with adjustments in diet, medications, and exercise you can manage and improve your lifestyle.

POTS affects women more than men and can start as early as your teenage years or as late as your 50s. Higher risk patients tend to be those with serious viral infections, pregnancies, trauma or surgical patients, and patients with certain autoimmune diseases.

While there is no cure for POTS it is often treated with exercise, physical activity monitoring, diet and nutritional changes. This makes physical therapy an ideal discipline to help patients with POTS. A cardiac rehab program may be beneficial to recondition the cardiovascular system and management of POTS symptoms. Exercises could include biking, swimming, rowing, core and leg strengthening activities. Diet and nutritional changes can also help. Eating several smaller meals a day can help with blood flow throughout your body instead of 2-3 larger meals a day. General dietary changes include increasing sodium and water intake, eating higher fiber and complex carbohydrate foods. However, consulting a dietician is key in making changes that are best for you.

For help with your exercise and physical activity monitoring program contact Witte PT!

References:

https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots

https://www.paddykalish.com/blog/pots-postural-orthostatic-tachycardia-syndrome

The Importance of Adequate Sleep

February 21, 2023

We have been told by our doctors for years that eight hours of sleep per night is necessary. They continue to preach this, even today. While we are all aware of the eight-hour threshold, many of us may not be reaching that each night. And some of us may not understand why the eight hours is so necessary. With this blog, we will dive into the importance of adequate sleep, what constitutes a good sleep, and steps we can take to make sure we are getting enough sleep for proper function.

Why is sleep important?

                There are many benefits for our minds and bodies that sleep can provide. Sleeping has the ability to reduce stress. If we aren’t getting enough sleep, we tend to have higher cortisol levels due to the irritability we may feel throughout our day. The higher the cortisol levels, the higher the stress or anxiety in our system. Sleep is also known to help maintain an ideal weight. The less sleep we get, the more food we are likely to consume. This increases body weight or BMI and could potentially be detrimental to our health. It is known that our appetite increases when we haven’t received enough sleep and rest, causing us to eat more and gain extra pounds. Finally, sleep has the ability to alter our decision-making.  When we are deprived of sleep, our brain is not functioning at its optimal level, leaving us to make choices that may not be the best for us.

What constitutes a good sleep?

                As mentioned earlier, the best sleep for an adult is going to be between 7 and 9 hours long.  Any more, or less, and you may be looking at some of the issues described above. You’ll know you’ve had enough sleep when you can wake up feeling refreshed and re-energized, ready to take on the day! While some sleep all night, it may not be a restful sleep. Some may suffer from disorders that prevent restful sleep, such as sleep apnea, and continually feel fatigued throughout their day. Tests can be administered to determine whether or not a person suffers from one of these disorders. It is said that a person may enter in and out of “cycles of sleep” throughout the night with about 25% of your sleep being considered “deep”. As the body spends most of the night sleeping, it has the ability to heal and repair muscle tissue and balance hormones. 

How do we get enough sleep?

                The easiest adjustment to ensure plenty of sleep is changing your bedtime. Don’t be afraid to jump into bed earlier to make sure you hit at least the 7 hours of recommended sleep. Setting an alarm 10-15 minutes before bedtime may be a good reminder to wind down for the night. Creating a good sleeping space will also help you obtain the hours of sleep needed for one night. Put up some dark curtains, make the room a comfortable temperature, and utilize a fan or sound machine for a gentle, steady noise you can sleep to. If you have a favorite blanket or pillow, make sure those are nearby for optimal comfort. Finally, avoid electronics. The blue light from the screens is known to keep your brain firing and your body wide awake. Place all electronics out of reach and consider reading before your head hits the pillow. This will help your body move towards a relaxed state and prepare for a good nights’ sleep!

Resources:

https://health.gov/myhealthfinder/healthy-living/mental-health-and-relationships/get-enough-sleep

https://www.bannerhealth.com/healthcareblog/teach-me/how-sleep-can-affect-stress#:~:text=Sleep%20decreases%20cortisol%20levels,in%20anticipation%20of%20a%20fight.

https://www.healthline.com/nutrition/sleep-and-weight-loss#:~:text=Getting%20enough%20sleep%20may%20help%20prevent%20increases%20in%20calorie%20intake,intake%20(%2016%20%2C%2017%20).

https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea

CMC Joint Arthoplasty Rehab

February 7, 2023

Did you know that one of the most common joints to get arthritis in your body is at the base of your thumb? Many of us as we age see a “squaring” of the base of our thumb joint. This is often due to arthritis and if painful and restrictive could mean that joint needs replaced. Replacing it often decreases your pain and improves your function with things like grip, pinch, and grasp. While the surgery helps to improve these things, it often requires some rehab afterwards to improve your function and maximize your potential.

After surgery you are typically in a splint for 4-6 weeks consistently. After that time your surgeon will speak with you about weaning off of your splint and starting for physical therapy. Physical therapy typically starts with ensuring proper motion of your neck, shoulder, elbow, and wrist. These joints are often not used as you are recovering and could have become weak and stiff. Therapy also will discuss your sleep pattern, diet, and activity modification at home. Therapy will also spend the first few visits working on improving your range of motion passively and within the restrictions of your replacement.

About 6 weeks after surgery you can begin to work on range of motion actively. Your therapist will help you with the progression and restrictions of this new phase. As your motion improves you will be instructed to begin working on very light functional activities, such as writing. As these things improve over the next month you will be able to move into a strengthening phase.

About 10 weeks after surgery, you can begin to strengthen your thumb and hand. Working on gripping, pinching, and grasping on introduced. By this point you are nearly out of your splint with most activities and trying to start to return to normal activities without compensation. Most patients are back to using their hand with normal daily activities at about 12 weeks and will regain fully restored functional use of their thumb by about 6 months.

If you are have had a CMC replacement or are considering it please reach out to Witte Physical Therapy with any questions you may have!

https://www.verywellhealth.com/carpometacarpal-joint-arthroplasty-5208414#:~:text=CMC%20joint%20arthroplasty%20is%20a,treatments%20fail%20to%20relieve%20symptoms

https://www.paragonorthopedic.com/client_files/File/ThumbCMCPostOp-jan2019.pdf

https://www.ofc-clinic.com/sites/ofc-clinic.com/files/mcnamara_protocols/McNamara-CMC-arthroplasty-Protocol-McNamara.pdf

Total Hip Replacement Rehab

January 31, 2023

Have you been suffering from hip pain? Has it been ongoing for years? Is it limiting your ability to enjoy life? Total hip arthroplasties have been a cure for hip pain since the late 1800’s; however, the FDA approved the first total hip operation in the USA in 1969. Since then, the number of total hip surgeries performed in the USA has grown to nearly 400,000 per year, making it a very common operation today. But what does a total hip arthroplasty entail? How do you know if you need one? Will therapy be recommended afterwards?

                The hip joint is a ball-and-socket joint. It is formed by the acetabulum of the pelvis (the socket) and the head of the femur (the ball), which is the largest bone in the body! The hip takes the brunt of body weight as we walk and complete activities throughout our day. Because of the high demand on this joint, it can have a tendency to wear-down. Arthritis is one of the main reasons for needing a hip replacement. Arthritis can cause excess pain and inflammation in the joint and even limit your motion. This loss of function combined with pain will send patients to the doctor seeking replacement surgery. Fractures can be another reason for a replacement. While fractures typically have the ability to heal without surgical intervention, it becomes more difficult for the healing process to occur in our older age. Weakness within the bones and decreased healing may prompt the doctor to opt for surgery.

A total hip arthroplasty involves replacing the two sections of the pelvis and femur bone that come together to form the hip joint. Both get removed and replaced with metal or ceramic parts to allow for improved function. There are a couple different ways to access the hip joint. Surgeons will choose to use either the anterior approach or the posterolateral approach. With the anterior approach, they make an incision on the front side of the hip and push the muscles aside to reach the bones that need replacing. With this approach, there are some precautions to be aware of following the surgery. You want to avoid flexion and internal rotation (turning your foot inward) at the same time as well as crossing your legs and sitting in low chairs for the first 6 weeks. A posterolateral approach involves an incision on the backside of the hip joint. The doctor will cut through muscle tissue rather than push the muscle aside. The precautions for this approach are similar to that of an anterior approach. Too much flexion, crossing legs, and sitting in low seats or tubs will put you at risk of dislocation.

As with any replacement surgery, your doctor will likely send you to physical therapy afterwards. Each approach has its own protocol in which the physical therapists will use as a guideline to get you back to normal function. Within phase 1 of the protocol, the therapist will work to regain your range of motion and begin muscle activation of the entire leg. Early muscle activation includes isometric training which is engaging muscles without joint movement. The doctor will give you a walker to help with ambulation immediately after surgery. There are no weight bearing restrictions, so as soon as you feel you are able to put all of your weight through your leg, you can! This helps in progressing towards phase 2. Phase 2 of the protocol will include strength training within the entire leg with continued work on range of motion at the hip. Your physical therapist will typically work with you to get you out of the walker and onto a crutch or cane (if needed) at this time. Phase 3 will include resistance training for progressed strengthening of the muscles in the leg. This is also the point where balance training and stretching will be introduced.

Once you have completed each phase of the protocol successfully with your physical therapist, you will be able to make a steady return to your daily activities. You may not be up to jumping right into all the activities you did before surgery, but with a gradual return, you will feel better than ever! If you feel you are in need of exercises or surgery for your hip, consult with your primary doctor, local orthopedic specialist, or local physical therapist. They will be able to help set up a plan that best suits your needs. For a consult with a Physical Therapist, call us at Witte Physical Therapy. We have staff here ready and eager to help you take the first step to recovery!

Tips for Walking on Ice or Snow

January 24, 2023

This time of year we are worrying every week about ice and snow. It seems like lately we are getting more ice than snow and this can create some slippery issues. Let’s talk about some tips to avoid those slips and falls on the ice and snow that can land you in the ER!

Plan Ahead: It is important to plan extra time for your travel. Whether you are driving or walking, slowing down and taking some time can help you avoid the big fall. This extra time also will allow you to take a minute to survey your surroundings and set your course before you take off

Shoe Traction: Make sure you buy and wear the appropriate shoes with the right amount of traction. Avoid heels and wear shoes with rubber or neoprene bottoms for better traction.

Use Caution When Entering or Exiting Your Car or a Building: Use your hands to grab onto handrails, car doors, or the vehicle itself. Keep your hands out of your pockets and available to help. Take your time to make sure you look before you step down or up and keep your center of gravity over the leg you are standing on.

Walk on Sidewalks: Make sure to stay on paths where the snow is clear. Avoid walking over grass, uneven terrain, or large piles of snow or ice. Don’t use your phone when walking.

Walk Safely: It is important to take smaller steps and to stay slightly forward and your toes and soles of your feet. Avoid walking on your heels or leaning back.

Of course we can do all of these great things and still have a slip or fall. If you do fall try not to reach out your hand or arm to catch yourself. Try to make sequential contact with your thigh, hip, or shoulder. Tuck your chin and try to avoid hitting your head on ground.

References: https://www.ehs.iastate.edu/weather/winter/walking#:~:text=Walk%20safely%20on%20snow%20or%20ice.&text=Bend%20slightly%20forward%20and%20walk,your%20thigh%2C%20hip%20and%20shoulder.

Why Start a Wellness Program?

January 17, 2023

There are over 35,000 physical therapy clinics in the United States alone! That is an amazing number of patients coming through looking for help with their pain. In many cases, physical therapists can assist in relieving your pain and symptoms for good. In other cases, it may take further intervention such as injection or surgery. While you may not immediately feel the effects of therapy treatment, it can be very beneficial when the plan of care is followed all the way through. Therapists have the ability to teach you how to stretch, strengthen, stabilize, and even improve your cardiovascular endurance. Continuing with all of these tools, even after you’ve been discharged from therapy, will allow you to keep down a healthy, pain-free path.

                We occasionally see returning patients that have a sudden onset of symptoms similar to, if not identical to, the original symptoms they went to therapy for. There have been many occasions in which the returning patient admits to not complying with the home program the therapist discharged them with. Life tends to get in the way and schedules get busy, lessening the time we have to focus on the exercises that keep us feeling healthy and strong. With a decreased focus on our health, pain tends to slowly creep back into our lives. Wellness programs can be made for just this reason.

                A wellness program is similar to a home program you may receive from your physical therapist. But instead of a handful of exercises tailored to your specific pain, it can encompass all areas of health, as mentioned above. We can create a progressive program that gradually increases in intensity as you stick with it and get stronger. It can be created to fit into your personal schedule, so you won’t feel time is keeping you from staying healthy. With an all-compassing, tailored, easy-to-follow program, we will be able to help you maintain a pain-free, healthy lifestyle and decrease your odds of receiving a more invasive procedure or returning to square one with physical therapy treatment.

                After discharge, it can be common for a patient to forget how to successfully complete all of their home exercises. They may feel lost on what to do once an exercise begins to feel easy. Wellness programs can take the guess work out of your routine. Exercises, number of repetitions, level of resistance, and frequency per week can all be set out in the wellness program for you. With the therapists’ knowledge, they will be able to talk you through how to progress with each of these.

                Physical therapy clinics may have different policies on providing wellness programs. Some may require a visit every couple months to keep up-to-date with your changes in health and progress your program. Others may only need to see you once a year, similar to an annual check up with your doctor. In either case, it is less hands-on than a therapy regimen in which the patient comes into the clinic 2 to 3 times per week. However, it is more engaging than a discharge in which the patient is left on their own with solely the home program.

                If a full wellness program doesn’t suit you, but you feel you may need some guidance from your therapist, you can schedule a clinic session each year. You can discuss all you’ve done since your last visit, how you feel your improving, and areas you feel you are regressing or still need work in. Rather than a full program, the therapist can teach you the few exercises you would benefit from most.

                No matter what stage you feel you are at in the rehab process, your therapist can always be by your side to keep you headed in the right direction. To get set up with physical therapy, a home program, or a wellness program, contact your primary doctor or local physical therapist. Find out what your options are and what path is best for you.

References:

Tips for Shoveling Snow

January 10, 2023

With the winter months upon us, we are now experiencing cold outdoor temperatures, windy nights, and snow! As beautiful as the snow is when it falls, it comes with many challenges, especially for those of us who may be struggling with health. Whether you have to scoop it with a shovel or push a blower through the piles, it requires some physical effort that can be challenging if you are having trouble with chronic back pain. Pain will prevent us from completing many activities or job duties, but for some of us, we feel we have no choice. If we don’t get the job done, who will? So what do we need to watch for when taking care of these more demanding tasks such as scooping snow?

                Posture! Posture! Posture! This is the number one rule when completing any physically demanding task. We, as physical therapists, will discuss this all day long with our patients. Knowing how to maintain proper alignment through the spine, bracing your core, and utilizing the power in your legs will help prevent pain.

 I always start at the neck. Keeping your chin tucked, or pushed back gently, will place your head in a neutral position and take strain off your posterior neck muscles. These posterior neck muscles start at the top of the spine and connect towards the middle of the back or near the shoulders. With these muscles strained, it is likely you will feel discomfort not only in the neck, but also in the regions the muscles attach. You can see the difference between the two diagrams below.

                Next are the shoulders. Your shoulders should always be back! We tell our patients to think about positioning your shoulder blades back towards the spine and down towards the buttocks. This will allow for the chest wall to open up and the postural muscles near the spine to engage. Similar to the posterior neck, by keeping your shoulder blades back and down you are able to keep strain off of the muscles by the spine, allowing for improved function. By using your postural muscles when holding a shovel out in front of you, you may avoid over-utilizing the wrong muscles, such as your neck. Many patients will begin to feel tightness in their upper traps when they don’t have their shoulder blades properly stabilized. The next diagram portrays the difference between a “slumped” back and a “straight” one.

                Now that you know how to obtain the correct posture, the next step is to brace your core. The core consists not only of your “six pack” muscles, but also the deep, inner muscles that sit under the six pack. These muslces are important as they assist in maintaining your posture and providing stability when you go to lift that heavy shovel or push the snow blower. During therapy treatments, we tell our patients to make the “s” sound. As you slowly release your breath and the sound, you will notice some tightening within the lower abdominal muscles by your hip bones. The first step is to practice with the sound. Once you have that down, you can work on engaging those muscles without the sound. The third step would be to complete this “brace” with leg movements. Try to hold it while you complete marches or kickouts. This will prepare you to maintain the bracing while you lift and toss the shovel. This is arguably one of the most important steps as it will protect the spine and allow for proper alignment, decreasing your risk of injury.  

                The last thing to keep in mind when scooping snow is to use your legs! We have two, and they are both made of large bones and muscles, allowing them to take on a great deal of load. In the midst of your manual labor, it is sometimes hard to stop and think about your body positioning. However, if you can get set in good posture before lifting the shovel, you will save yourself from pain or injury. Good posture involves all 3 steps listed above. Tuck your chin, pull your shoulders back and down, and brace your core. At this point, the legs take over the heaviest portion of the movement. Get into a squat position to scoop, and return to standing when transitioning to toss the snow. This allows for the spine to remain straight, the core to stabilize, and the largest leg muscles to work as they should.

                So next time you have a job to do, stop and think about the task at hand. Picture your body positioning as it should be and imagine how completing the task with this body positioning will look. Take the time to get set so you can prevent injury and pain that has the potential to stick around for years. If you still aren’t sure on how to improve your posture or lift properly, discuss physical therapy with your primary doctor. Getting a script for therapy will allow a trained professional to get you on the track to better health not only today, but for years to come.

References:

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

https://reliva.in/cause-back-pain-poor-posture/

https://cprnj.com/stop-back-pain-with-proper-snow-shoveling-technique/