Friday, May 4, 2018

Plantar Fasciitis: More Than Just a Footnote

by James Bansberg, DPT
Feet: so far away and often overlooked…until you wake up one morning and realize it’s impossible to place any weight through your foot. Feet are our foundation - our body’s connection with the earth - yet we place them in tight, uncomfortably angled, or worn down shoes, and refuse to maintain them the way we do other body parts.  Considering that plantar fasciitis is the leading cause of heel pain, and affects more than 2 million people in the US, it may be time to give this hard-working appendage a little more love.  

The plantar fascia is made up of thick fibrous bands of connective tissue that act like a cable between the heel and toes. These bands work hard, acting as shock absorbers, foot stabilizers, and arch supporters. Since we can be so unforgiving to our feet, there are multiple impairments that can lead to aggravation of the tissue. So what kind of risk factors should you be looking for in order to get to the root of the cause?
  • Poor ankle and toe mobility
  • Ramping up activity too quickly (marathon training!)
  • Obesity
  • Age (typically 40+)
  • High or low arches
  • Stiff/cramping calf muscles
  • Prolonged daily standing on hard surface
  • Improper footwear (worn, poor fitting, high heels, low support)

The presence of any of these risk factors can lead to plantar fasciitis, and many of us have more than one. Fortunately, there are just as many options to reduce risk: stretching and strengthening muscles that may be cramping or that don’t get much opportunity to be fully stretched often helps, as does rest. Proper shoe fitting (as well as replacing stressful footwear with more supportive options) can dramatically reduce risk, and if obesity is a factor, weight loss may help as well. Depending on the severity of pain, your doctor may recommend other options, such as night splinting.

If you have foot pain, however,evidence suggests that physical therapy will help you recover faster and cost you less than if you do not receive treatment. Experienced therapists at Lakeshore Physical Therapy will administer a comprehensive evaluation to determine impairments and utilize current evidence and proper treatment to help lower pain and improve function.  


Resources:
“Utilization of Physical Therapy Intervention Among Patients With Plantar Fasciitis in the United States” (J Orthop Sports Phys Ther 2017;47(2):49–55. doi:10.2519/jospt.2017.6999).

Friday, April 13, 2018

The State of Rehab 2018

by Sally Fansler, PT
It is hard to believe that I have been in the physical therapy industry for more than three decades. Over the course of my career as a physical therapist, I have seen our profession flourish in many different settings. We are able to fundamentally help patients by learning the science of the human body and connecting our skills to restore dysfunction and freedom of movement. There are few experiences more rewarding than to see the pain disappear and the musculoskeletal system change based on the skills we share with our patients.
 
One of the best ways to grow as professionals is to learn what obstacles we face: based on a physical therapy industry survey with more than 5000 participants, recent trends revealed several stumbling blocks that have cropped up in the field of P.T. One of these is that the trend toward consolidation of clinics to larger companies continued in 2017, which can impart a financial struggle for the one-on-one care business model to compete in a market that is more and more saturated. The study also revealed that for many clinics, the average daily volume of patients increased with more use of assistants and techs. This obviously translates to less time physical therapists can actually put their hands on each patient. Not surprising with the current health care climate, the study noted an intensifying squeeze in insurance reimbursements. The insurance companies have ever-changing rules and regulations, which puts stress on each clinic and each provider. And lastly, the survey noted that each physical therapist spends 20% more time on documentation over the past 10 years due to compliance demands and insurance requirements.
 
It is not surprising that these factors could change the overall vibe of an outpatient physical therapy clinic. But this same survey also revealed that the number one reason people pursue a career in the field of physical therapy is to help people. That fact translates into genuinely good people with a solid dedication to patient care in our field. I am confident that no amount of frustration over declining reimbursements, increased regulations, or time-consuming documentation can stifle the passion engrained in physical therapists and the physical therapy profession as a whole.

Study cited: "The State of Rehab" WebPT

Friday, March 16, 2018

Staying (David) Wise on the Slopes


By Jill Jonda, PT
The 2018 Olympic games have come and gone! As we sat in front of our television screens, watching elite athletes perform with skill, speed, and drive to win, a lot of us tend to want to get out there and try to channel our own Olympic skills. As we saw athletes like Mikaela Shiffrin, Lindsey Vonn, and David Wise swiftly ski down a slope or half pipe without missing a beat, we may have thought, “I can do that!” Those athletes make complex arduous maneuvers look effortless. Unfortunately, when people who may not be as skilled try things that Olympic athletes make look so easy and natural, we tend to see more injuries. Before you hit the slopes, it’s important to be aware of common injuries and how to prevent them.

Because of the structure of the ski boot, the angle it puts on the knee, and of course the variability in the terrain of the snow, one of the more common body regions injured while skiing is, in fact, the knee.  Some of the most common knee-related injuries associated with downhill skiing include medial collateral ligament (MCL) sprain, anterior cruciate ligament  (ACL) sprain or tear, and meniscus tear. An injury to all three of these areas is often referred to as the “unhappy triad.”

That may sound pretty intense, but it’s no reason to cancel your trip and try to get your deposit back on your skis and helmet. If you want to have a good time and avoid the risk of injury, follow these steps listed below:

First, you want to understand your skill level.  All too often injuries occur because we end up doing too much too soon and get ourselves into quite a pickle.  If it’s your first time out in a while, take it easy and stay on the easier hills. Better yet, schedule a training session with one of the professionals and get a tune-up on your skills.

Second, it’s always important to warm-up before any type of physical activity, and is especially important for a demanding activity, such as downhill skiing.  A dynamic warm up will help to increase blood flow, prepare the nervous system for increased activity, and improve overall range of motion which all helps to reduce the risk of injury.

Third, it’s important to strengthen key muscles that help prevent aberrant movement of the knee. The hip abductor muscles (specifically, the gluteus medius muscle) help to stabilize the pelvis when weight is shifted onto one leg, which, in turn, prevents inward and torsional stresses on the knee.  If the femur bone becomes internally rotated and adducted (or “knock knee”), this causes a valgus force at the joint, which is the setting of most of these knee injuries. In the same way, the abdominal musculature is also essential in maintaining control and stability while skiing.  A strong core can help to block too much trunk displacement over one leg if you happen to “catch an edge” or lose your footing over a patch of ice and can prevent a fall.  Strong quadriceps and hamstring muscles also assist in demonstrating proper knee joint mechanics, especially as you squat closer to the ground to pick up speed as you ski down the slope.

Here are some options for strengthening exercises you can try before your next ski adventure:

Remember to always be safe and know your limits if you want to stay injury-free on the slopes.  If injury does occur, however, go see your physical therapist!

Wednesday, March 7, 2018

Fighting Inflammation with Food

by Liz Cascio,
Nutrition Specialist 
In honor of National Nutrition Month, we've invited LSF nutrition specialist and personal trainer Liz Cascio to be our guest blogger.

Inflammation is the body’s automatic security system: it activates when it recognizes anything that is foreign, such as an invading microbe, plant pollen, or chemical. It can also be triggered by tissue trauma, like an ankle sprain or a scrape - the body sends white blood cells and other immune chemicals to help keep the injured area clean and promote healing. In healthy individuals, inflammation is a good thing!

However, sometimes inflammation occurs even when the body is not under threat - the body responds as if normal, healthy tissues are infected or somehow abnormal. As a result, the body's normally protective immune system can cause damage to its own tissues. Fortunately, studies have shown that the solution to chronic inflammation might just be in the produce section of your grocery store. Below you’ll find some of the most powerful inflammation-fighting compounds and the foods you can start incorporating today to reduce your risk of inflammation and other chronic diseases!

Antioxidants 
Powerful phytochemicals (or plant chemicals) – such as Vitamin C and E, lycopene, lutein, beta-carotene, and polyphenols – protect the cells from exposure to free radicals and can also inhibit resulting inflammatory reactions in the body. A good rule of thumb is to fill 2/3 of every plate with an assortment of brightly colored fruits and veggies, like leafy greens, bell peppers, citrus fruits, berries, sweet potatoes, and tomatoes. Eating this way ensures you will get all the antioxidants you need to fight inflammation while also leaving less room for the processed, nutrient-poor foods that promote it.

Omega-3 and Essential Fatty Acids
Experts recommend no more than a 4:1 ratio of Omega-6 (which increases inflammation) to Omega-3 (which decreases inflammation). To keep the right Omega-6 to Omega-3 balance, reduce or eliminate the use of vegetable oils, margarine, saturated and trans fat and choose whole plant sources of fat (avocados, nuts, seeds, and olives). Reduce or eliminate refined grains, choose grass-fed meats and wild caught fish whenever possible and load up on leafy greens and berries. For an extra boost of omega-3, skip the fish oil supplements and instead add 1-2 tablespoons of ground flax seed, chia seed, or English walnuts to get a day’s worth of Omega-3 and the added benefit of fiber and protein.

Nitric Oxide
Nitric oxide is a powerful vasodialator (or blood vessel opener), increasing blood flow throughout the body and protecting the blood vessels from oxidative stress and inflammation. Beets and leafy greens like kale, Swiss chard, arugula, and spinach, are rich in dietary nitrates and nitrite, compounds that stimulate the production of nitric oxide in the body. Other nitric oxide-promoting foods include whole grains (brown rice, quinoa, and oats) legumes (lentils, beans, and peas), citrus, watermelon, and garlic.

Alkaline Balance
Studies have shown that foods high in acid – such as proteins – may promote inflammation and force the body to work harder to maintain its optimal pH of 7.4. Avoid low carb, high animal protein diets: limit animal protein consumption to 4-ounce servings 2-3 times daily. Opt for plant-based protein sources like legumes instead of meat regularly. Choose intact whole grains and starchy vegetables (potatoes, sweet potatoes and hard winter squashes) instead of processed carbs. Fruits and vegetables (especially those that grow in the soil, like root vegetables and leafy greens) are high in minerals, making them generally high-alkaline foods.

Keep it whole, keep it healthy 
The bottom line is that the guidelines for an anti-inflammatory diet are the same as those we’ve all heard over and over again: fill your plate with brightly colored fruits and veggies and unprocessed carbs, and pass on the processed and junk foods, unhealthy fats, and too much meat. In the words of nutrition and food journalist Michael Pollan, “Eat food, not too much, mostly plants.”

For more information or personalized nutrition support, email Liz at lizc@lakeshoresf.com.

Friday, February 9, 2018

Tape on Me: Kinesiology Tape and Physical Therapy

by Jill McCormick, PT
If you’ve watched sporting events recently, you may have noticed professional athletes sporting cool-looking tape on their shoulders or knees. It’s not some obscure form of body modification – it’s kinesiology tape. Believe it or not, kinesiology tape has become so mainstream lately that you may have even seen someone standing next to you in line at the grocery store with this unique-looking application.

Unlike the old-school athletic tape, kinesiology tape has both stretch and memory. This allows for unlimited movement of the joint or limb while keeping it in place. It is designed to stay on for days at a time, even in the shower or pool. While you may remember first seeing it on the US Women’s Volleyball player Kerri Walsh, t’s not just for athletes or sports injuries. This tape is used in physical therapy to treat all kinds of pain and injuries, including shoulder tendonitis, hamstring strains, low back pain and running injuries.



Upon application, it lifts the skin, allowing for increased circulation and reducing inflammation. The recoil effect helps support muscles, ligaments, fascia and even bones. Furthermore, the sensory effect of the tape on the skin can reduce pain signals to the brain, bring the brain’s attention to muscles that are atrophied or underutilized, and calm a muscle that is overactive or in spasm. Seemingly like magic, patients often see an improvement in range of motion and decreased pain immediately!

In summary, kinesiology tape can be used on sports and non-sports injuries alike and it often helps reduce pain and increase range of motion on the spot. While it isn’t magic, it certainly can seem like it and it can be a very valuable and effective adjunct to your physical therapy program. If you are unsure about whether kinesiology taping is a good option for treating the injury you have, Lakeshore Physical Therapy has therapists with expertise in the taping technique and can provide recommendations to help you to heal properly.

Monday, January 15, 2018

Swimmer's Shoulder: What You Should Know

by Stephanie Korso, PT
Swimming is a phenomenal way to improve cardiovascular fitness, burn lots of calories, strengthen muscles and prevent disease. As a non-contact sport, there is little risk for acute and catastrophic injuries, but there is still risk for injury. Prevention, early recognition and early treatment are key to managing swimming injuries and remaining active.

The most common swimming injury is swimmer's shoulder, which refers to any shoulder pain related to swimming. Up to 90% of swimming injuries involve the shoulder, and as many as 73% of swimmers may report shoulder pain during their career. The repetitive nature of swimming contributes to overuse and predisposes swimmers to shoulder injury.

Although swimmer's shoulder can involve any shoulder dysfunction, such as tendinosis or impingement syndrome, shoulder instability is the most common. This is because the same factors that improve swimming performance also contribute to shoulder instability:

Increased Shoulder Range of Motion
Increased shoulder range of motion helps reduce drag and allows for greater stroke length, both of which contribute to increased swimming speed. However, increased range of motion also contributes to increased ligament laxity and increased strain on rotator cuff muscles, which contributes to decreased stability.

Increased Shoulder Adduction and Internal Rotation Strength
Up to 90% of forward propulsion in swimming comes from the upper body. The pectoralis major and latissimus dorsi muscles, responsible for shoulder adduction and internal rotation, are the primary muscles that create the propulsive force needed in swimming. Increased strength in these muscles contributes to increased swimming speed, but it also leads to muscle imbalance and further instability.

Prolonged, Fatiguing Shoulder-Intensive Training
An experienced swimmer knows that swimming involves both shoulder strength and endurance. Training involves long work-outs that fatigue muscles. As rotator cuff and scapular muscles fatigue, shoulder instability increases.

The primary goals in management of swimmer's shoulder are to reduce inflammation, increase stability and return the athlete to full activity as soon as possible. Initially, the athlete will need to modify activity so that no pain is experienced. During this time, the athlete will implement exercises to decrease muscle imbalances, improve rotator cuff and scapular strength, and improve muscle endurance. The athlete may then gradually increase activity as pain decreases. Physical therapy is often helpful not only to guide progressions of strength exercises, but to also improve spine mobility and help release overworked pectoralis major and latissimus dorsi muscles.

As the saying goes, prevention is better than the cure. Therefore, incorporating exercises to strengthen the rotator cuff and scapular muscles into training regimens prior to onset of pain is optimal.

References:
Weldon EJ III, Richardson AB. Upper extremity overuse injuries in swimming. Clinical Sports Med. 2001; 20(3), 423-438.

Weiss Kelly A. Non-contact sports: Running, swimming, and dance - identifying common injuries. Pediatric Annals. 2010; 39(5), 279-285.

Khodaee M, Edelman GT, Spittler J, et al. Medical care for swimmers. Sports Med. 2016; 2(27).

Friday, December 22, 2017

Sailing the Seas of Insurance Coverage: Deductibles, Copays and Coinsurance, Ho!

by Lauren Sweeney, Office Manager
When last we left our intrepid pirate Sue, she had figured out what it meant for a service to be covered by insurance, and she understood what it meant if a provider was in or out of her network. Being a pirate, however, Sue is concerned about the bottom line. What is all this going to cost?

Like most companies, all of Pirate Health Network's plans have a deductible, an amount that a patient is expected to pay for their healthcare in a calendar year (in addition to the monthly premium). While this amount can vary enormously by plan, higher-deductible plans seem to be an increasing trend. According to a recent CNBC study, the average deductible for a Bronze-level plan on the Exchange is around $5000, and 44% of employers planned to offer high-deductible plans as the only option for employees over the next three years.

Let's say Sue's plan has a $2000 deductible - does that mean she needs to pay $2000 before she gets more than just her in-network discount?

Maybe, but maybe not. Remembers those rules we talked about previously when we discussed covered services? There are three that insurance companies tend to make:

  1. Deductible and coinsurance - Sue will have to pay the allowed amount per PHN's contract until she has paid $2000. After that point, her insurance will split the allowed amount with her. She'll have to pay at most half, but usually less (10-20% is pretty standard).
  2. Deductible and copay - Again, Sue will have to pay the allowed amount per PHN's contract until she has paid $2000. After that point, however, her insurance will tell her that she only owes, say, $30 each time she comes in.
  3. Copay - PHN would say that Sue just owes $30 each visit and doesn't have to meet her deductible first. This is probably the rule that people most often think go when they think of health insurance.
Here's the catch, though - each covered service is usually treated differently. Sue may have a copay for visits to a general practitioner, but have a higher copay to visit a specialist, and may need to meet her deductible before a coinsurance applies for physical therapy services. It's no wonder there can be so much confusion about benefits!

Luckily, Sue's been paying attention. She knows that physical therapy is a covered service, most of the providers in her area are in her network, and she's called Pirate Health Network to find out how physical therapy is covered. Her physical therapy provider has also called to verify her benefits - just like we do at Lakeshore PT - so both she and her provider are on the same page as to what she can expect to pay and what PHN will pay. Because she doesn't have to stress over understanding her coverage, Sue can focus her energy on strengthening her shoulder (and dreaming of the day she can finally get those gills).