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Blog

From the desk of Dr. Dan Witte, PT, DPT, OCS

Witte Physical Therapy, Louisville & PlattsmouthBlog
By Dr. Dan Witte Exercises

How much energy do I need to shovel the snow?

                                                             

December 12, 2019 – Have you ever noticed that while you are shoveling snow that you get tired? Have you ever thought about why? Is it the cold, the extra layers, the heavy load? How much energy does it really take to move snow?

Energy is measured in MET levels. A MET level is the amount of energy or calories you expend each minute while resting quietly. The more demanding the activity the higher the MET level.

How many METs do we experience with each activity level?

  • 1-3 METs: dressing, casual walking, desk work
  • 3-4 METs: showering, doing laundry, golfing with a cart
  • 4-5 METs: having sex, push mowing, climbing a set of stairs, walking during golf
  • 5-7 METs: SHOVELING SNOW, walking at 5 mph, occasionally lifting 50 pounds
  • 7 METs or more: running, playing basketball, occasionally lifting 100 pounds

If daily, you are only expending 3-4 METs and then on a heavier day doing 5 METs it can be a shock to system when you now must expend 6-7 METs to shovel that snow. Usually these increased expenditures are also done under a time crunch making it even tougher.       

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As we prepare for the upcoming winter season, we must remember that it is important to have the snowblower and shovels ready, make sure to have hats and gloves that fit, and to condition our cardiovascular system for the rigors of moving snow. Start now by doing 30 minutes of brisk walking, stair climbing, or light weight training at the proper MET level 5 days per week. (Before starting any fitness program you should consult your physician or qualified healthcare professional.) If you need a place to increase your MET level tolerance or a support system to do it with, Witte 24/7 Wellness has both!

Your Witte Physical Therapy Team #homegrown #backtolife

By Dr. Dan Witte Therapy

Proper Lifting Mechanics

 
December 3, 2019 – As we start to enter the winter season and the dreaded “s” word is around the corner we must start to think about reaching for our shovels and preparing to dig ourselves out.

The incidence of low back pain tends to climb during the winter months. Overall, we are less active and then when the snow comes, we are put in a position to have to bend, lift, and push snow that is always heavier than it looks. It is important during these times that we slow down and think about how we are bending, lifting, and pushing that snow.

“Lift with your legs and not your back” is a message we have all heard in our lives. It is very important when it comes to proper lifting mechanics. As we are working to dig out under that pile of snow, we must get low enough for the shovel to be effective. We need to think about the following aspects of using proper lifting mechanics:

 

Squatting: Proper squat form is essential to be able to lift with our legs. Practice this by putting a chair behind you while you are standing. Begin to sit in the chair like you normally would but once you buttock contacts the chair stand back up before you sit down. This is how a proper squat should feel.

Carrying a Load: Whenever we are carrying a heavy load with our arms it is important to carry that load as close to our body as we can. As we extend our arms it causes more strain on lower back to stabilize the load which can lead to back pain.

Avoid Twisting: We need to be able to move that heavy snow filled shovel around our bodies to get it off our driveways and sidewalks. It is important not to twist your back to do this. You must pivot your body like it is a log on your feet. Think about making sure the heavy shovel is always over your feet and never outside of them. As you turn your body the shovel and feet will turn together, by taking small steps to pivot, to avoid twisting your back.

 

Following these simple steps will decrease your chance of having low back pain due to the harsh Nebraska winters. Of course, you can do everything right and sometimes your luck just runs out. We are always here for free consultations to help you start the journey to getting over you back pain.

The Witte Physical Team #homegrown #backtolife

By Dr. Dan Witte Therapy

Post Surgical Rehab: Function and Stability

November 26, 2019: In our post last week, we talked about the initial steps following a surgery including pain management, improving range of motion, and addressing strength. But that is only half of the picture. What good is range of motion if you can’t lift that jar of pickles from the top pantry shelf? What good is having the strength to do a squat if you can’t get up from your favorite soft easy chair? This is where function and stability must be addressed.

Function takes range of motion and strength a step further. If we set a goal for you to achieve 4+/5 strength in your shoulder, what does that mean to you? Probably not very much. But if your goal is to be able to put your groceries away without help, this functional goal means much more. Once we have the range of motion and strength as good as they can be for you, then we want to begin to work on what that means for you. If you like to play with your grandkids, then function may mean the ability to move about the playground. If you like to be able to get in and out of the tractor then that function may mean being able to walk on uneven farm ground and climb a ladder. This answer is different for everyone, but each answer is the most important one for you.

Stability and function go hand in hand. We must have stability in each of our joints if we are going to take on the task of being functional. Stability is much more than just staying upright while we walk or run. If you are going to reach out and turn on the water valve at your house, you must have good stability through your shoulder to do so. If you are going to climb a tall set of stairs to get a great view of the countryside you must have excellent hip stability to achieve this goal. Stability is achieved from the joints closest to our trunk first. Without good strength we can’t have good stability. Without great stability we can’t have great function. There is a systematic approach that must work together for you to achieve your goals. This is our primary focus at Witte Physical Therapy, you and your goals!

Your Witte Physical Therapy team #homegrown #backtolife

By Dr. Dan Witte Exercises

Post Surgical Rehab: Range of Motion and Strength

November 19, 2019 – Well you survived the surgery, but now what? What can I expect next? What does physical therapy work on? The answers to these questions can be as specific as we need them to be, but in generic terms we must get you moving again.

Outside of pain control, most physical therapy programs initially will focus on improving your range of motion and strength after surgery. This is done because we must build a foundation to work from. There is no point in working on balance, athletic situations, work scenarios, or how to get you going in the yard without having a good base.

First, range of motion. Often our initial goals focus on getting you back to moving fully and normally. This include things like being able to lift our arm above our head or bending your knee back so we can sit normally. These are very basic things, but without them you can’t wash your hair or get on and off the toilet. Range of motion is first addressed passively, where you focus on relaxing and remaining comfortable while our team works you through your available range of motion within a comfortable pain range. Next, we work on active assistive range of motion, where you use other body parts or machines to help the area regain its range of motion as pain free as possible. Finally, we work into active range of motion where we are focusing on improving your normal range of motion and function as much as possible.

As your range of motion is improving, we move our focus onto my strengthening activities. It is important to strengthen in a manner that allows for continued improvement in range of motion. It makes no sense to only be strong through 90 degrees of range of motion when that joint normally has 120 degrees of range of motion. Strengthening starts isometrically where we are working on pain free muscle contractions without any joint movement. As this strength improves, we can begin to work on concentric and eccentric strength. Concentric strength is used to move a load through a range. Think of a bicep curl. Eccentric strength is used to control a load through a range. Think of lowering your self down from a high step. These are both very important but treated very differently.

At Witte Physical Therapy we will help you work to efficiently improve your range of motion and strength while being aware of your pain levels are affected. We will work to develop a plan made only for you so that you can achieve your goals as quickly as possible. This is a big goal for us, and we continue to try to work for you every day.

Your Witte Physical Therapy Team 

#homegrown #backtolife

By Dr. Dan Witte Therapy

Prehab

November 12, 2019 – A lot of people refer to physical therapy as rehab. When the word rehab is spoken, we can also think of an athlete returning from an injury or a long-term care facility specializing in helping patients recover from more serious injuries. But what about “prehab”?

Prehab is becoming more and more prevalent in the research. As physical therapists we are seeing more and more people for prehab. So, what is it? Prehab refers to a physical therapy program that helps to prepare you for an upcoming life changing event, usually surgery. It is becoming more and more important to help speed recovery especially in the initial states of rehab after surgery.

Prehab is used to increase your range of motion before a shoulder surgery, improve your quad and hip strength before a knee procedure, decrease your back pain caused by injury or abnormal movements, and for many other deficits.

It is important that if you are planning a surgery with your physician to ask about prehab. Coming in to see a physical therapist can help better prepare you for that procedure. We can work on activity modifications that you may need due to having to use crutches, a walker, or a sling. We can give you some exercises to help with improving range of motion and strength. We can work with you on some pain relief strategies for both before and after surgery. Often a few visits of physical therapy before surgery can make the whole surgical process much more comfortable.

Your Witte Physical Therapy Team

#homegrown #backtolife

By Dr. Dan Witte Insurance

Health Insurance & PT Benefits

November 5, 2019 – As we near the end of the year we get more and more questions about our patient’s insurance, their benefits, and how they work. In this blog we will take a few minutes to dive deeper into insurance vocabulary and how it relates to physical therapy.

Below are some basic insurance terms and their definitions:

Deductibles: This is the amount that the patient must pay out of their pocket before their insurance benefits kick in. If your insurance has visit limits for physical therapy these start on day one, regardless of your deductible.

Co-Insurance: This is how insurance kicks in once your deductible is met. The most common scenario is based on insurance covering 80% of the cost and you paying 20% out of pocket. However, these numbers can range from 50% to 90% based on your plan.

Co-Pay: Not all insurance plans have a copay, but those that do usually follow a different set of rules. If you have a copay it is usually applied to each visit of physical therapy. Sometimes your copay is applied to your deductible limit and sometimes it is not. This usually takes the place of your co-insurance, meaning that you will either have one or the other.

Out of Pocket: This the dollar amount set by your insurance plan that caps the amount you will spend for the year. Meaning if your out of pocket is $5000 once you have paid that money to the providers you use; your insurance will now cover all your services at 100%.

Visits: Each insurance company and plan have different limits for visit. Lower visit limits are at 30 visits of physical therapy per year or less. These plans are more restrictive on how much therapy you can use and how you can use it. More traditional plans allow for 45 visits or more of physical therapy per year. A smaller number of plans have no visit limit and are only based on medical necessity.

The truth is that every insurance company has several different plans and each of those plans has different aspects to it. At Witte Physical Therapy we will take down your information and verify your plan and then review it with you so that you know what your out of pocket costs may be. Just like you contract with your insurance company for your coverage, we too contract with them to be in their network. Thus, we are subject to their contract prices and fees. So, when choosing a physical therapist and physical therapy company to work with you want to make sure you are getting the most bang for buck and are receiving care that you want to receive. This is a big goal for us, and we continue to try to work for you every day.

Your healthcare team at Witte Physical Therapy

#homegrown #backtolife