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 and 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 pectorals major and latissimus doors 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.

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).

Friday, December 8, 2017

'Tis the Season to be Stressful

by Joni Modaff, Office Coordinator
The month of December brings cold temperatures, crowded shopping malls and much anticipation for the holidays. We tend to put ourselves on the back burner in order to find the right gift or fruitcake to buy, and we frantically try to make sure we make it to every event, even our third cousin's best friend's party.

With all this hustle and bustle, our bodies can react to stress in ways that can be overwhelming and unhealthy. Since our expectations for ourselves run high during this time, it's important to prioritize what we really need to accomplish.

The following stress prevention tips can bring some relief during the most wonderful time of the year:

Exercise: Work out at least 20 minutes a day. Not only can it help burn off some of the delicious treats the season brings, it can boost mood and energy level.

Hydrate: Drink an average of 8 glasses of water a day. Minimize alcohol intake, especially during holiday parties - while it may be tempting to indulge in holiday cheer during parties, your body will thank you for your moderation later.

Nap: Listen to your body when it tell you to rest. Sleep helps your body to rejuvenate both physically and emotionally.

Volunteer: Give your time and energy to a charity, or help out someone you know who needs an extra hand.

Reach Out: Write a letter to a family member or friend that you haven't talked to or seen in a while. Connecting with people we care about can give us peace.

Think Positively: Remaining optimistic can help keep your blood pressure in check.

Laugh: Lots of laughter can reduce stress hormones, so laugh long and loud!

Less is more, a colleague once told me. Enjoy the now and what the season is about: being with family and friends. Overbooking ourselves with holiday parties can cause us to lose that focus - according to psychologist George Pratt, PhD, it's important to "take care of yourself by saying no at least once - and maybe more."

Holiday stress may be inevitable, but incorporating the tips above will be a nice holiday gift to yourself!

Cleveland Clinic, Managing Holiday Stress 5/23/17
25 Ways to Fight Holiday Stress, Laurie Pawlik-Kienlen 11/1/16

Friday, November 10, 2017

Sailing the Seas of Insurance Coverage

by Lauren Sweeney, Office Manager
Since the introduction of the Affordable Care Act, medical insurance has been a hot topic of discussion. Overnight, seemingly, people had to go from having passive knowledge about how insurance works to becoming their own insurance brokers. As our healthcare landscape continues to shift, it's easy to feel out to sea.

So let me introduce you to Sue the Pirate:
Sue is insured through the Pirate Health Network (PHN), and she's got some questions about her plan.
  • What services are covered through her insurance?
  • Which practitioners are in or out of her network, and what does that mean?
  • What can she expect to pay when she seeks out various medical services?
In insurance terms, a service being covered just means that the insurance company has rules in place regarding payment for that service - for example, it may go toward deductible, or the patient may have a copay. Most insurers have rules in place about how they pay for physical therapy, since it's a common evidence-based treatment. If Sue wants to have experimental surgery to have gills installed in her neck so that she can breathe underwater, chances are that her insurance company doesn't have rules about that and she'll be on the hook for the ENTIRE cost.

Okay, so Sue's going to wait on getting those gills, but she is having shoulder pain that she wants to get checked out. She knows that physical therapy is a covered service under her policy, and she knows some providers are in-network with PHN and some are not. Does that make a difference?

Yes and no. If a provider is in-network with a carrier, that means that the carrier has a contract with the provider that helps to manage patient costs. When Sue goes to her doctor to check out her shoulder, her doctor may say that the billed amount of the visit was $100, but if her doctor is in-network with PHN, they may have a rule that states that doctors can only charge $75 for an office visit (this is called the allowed amount). Essentially, Sue is guaranteed a discount for going to an in-network provider.

Just because a provider is out-of-network, however, doesn't mean that a patient shouldn't go there. While it's probable that Sue will pay a little more out of pocket (and some plans have no out-of-network benefits at all, so it's important to know if yours does), out-of-network benefits aren't ALWAYS that different from in-network benefits. Some plans even have a shared in- and out-of-network deductible, which means that the patient only has to meet one deductible for insurance to begin paying expenses.

Oh, that's right - we haven't even gotten to deductibles, coinsurance and copays yet, or what all that might mean for Sue. Don't worry - we'll get to that in our next installment.

Friday, October 6, 2017

Foam Rolling: Is it Worth the Hurt?

by James Bansberg, PT

The popularity of foam rolling and other self-massage techniques has skyrocketed in recent years. In this age of As-Seen-On-TV products and endless Facebook ads, however, there are so many fad items that claim to be good for our bodies that it can be hard to determine which of them is worth the time. Additionally, if you've ever used a foam roller, let's face it - they hurt! Since free time is a commodity for many of us, is rolling up and down on a solid piece of foam or PVC of any real benefit?

Fortunately, research investigating the effectiveness of and different uses for foam rolling are also at an all-time high. Given the number of studies on the subject, researchers have reviewed the literature, seeking to determine the following: if foam rolling improved joint range of motion without affecting performance; if, after exercise, foam rolling enhanced recovery and decreased delayed onset muscle soreness (DOMS); and if foam rolling before activity affected muscle performance during a workout.

After reviewing and synthesizing 14 peer-reviewed articles, here's what they concluded:

  • Both foam rolling and self-roller massage can increase flexibility and range of motion of the hip, knee and ankle in the short term.
  • Foam rolling and self-roller massage can diminish DOMS in lower extremity muscles as well as reduce perceived pain after an intense bout of exercise.
  • Short bouts of foam rolling or roller massage to the lower extremity prior to activity does not enhance or negatively affect muscle performance but may change the perception of fatigue.
So even though the thought of foam rolling may make you wince, a short bout of foam rolling can actually allow you to train harder or perform better. Moreover, it is effective when performed both before and after a workout and can benefit anyone from in-season athletes to the personal training client.

Cheatham S et al. 2015. The Effects of Self-Myofscial Release using a Foam Roll or Roller Massager on Joint Range of Motion, Muscle Recovery, and Performance: A Systemic Review Int J Sports Physical Ther 10(6):827-38

Friday, September 8, 2017

Good vs. Exceptional

by Sally Fansler, PT
Whether it is their first or their fiftieth time seeking physical therapy, patients want to put their health in the hands of a physical therapist that can help them achieve their goals. A good physical therapist has a solid education of the musculoskeletal system as well as training in biomechanics, neuroscience, physiology and kinesiology. Well-credentialed with a license in the state in which they practice is also a given requirement. But if you are seeking an exceptional physical therapist, there are some additional traits to look for in your provider.

Identifying a specific dysfunction takes natural problem-solving skills, and an exceptional therapist uses keen observations, deductive reasoning, and asking the right questions to get to the root of the issue. Any therapist can give a general exercise program to strengthen an area, but drilling down to the key problem to fix the issue takes a higher amount of skill and tenacity. For example, if a patient attends physical therapy with runner's knee, a program that exercises every muscle around the knee may hit the dysfunction, but it also may not resolve it. Using clear differential diagnosis skills and testing, the exceptional therapist will be able to address the exact cause of the pain, be much more specific, and ultimately much more successful. This allows the runner to return to training more quickly and efficiently.

Having the patience and proficiency to zero in on the source of a patient's pain is just one piece of the puzzle - the therapist has to be able to form a connection with the patient as well. The ability to establish rapport and a strong patient relationship early on is essential for the patient's success. A sense of understanding, empathy and sincerity helps patients feel as though they and their therapist are equal participants in their recovery. With a humble disposition, the exceptional physical therapist puts the concerns of the patient first and honestly wants to make a difference.

At Lakeshore Physical Therapy, our therapists average 12 years of experience (I did my share to elevate that average)! They are naturally gifted, but also take care to cultivate their talents to provide care that goes above and beyond rehabilitation. We realize that decisions about a patient's health should never be just another case or a job and we do our best to convey that every day.

Friday, August 4, 2017

Planes of Motion

by Meredith Franczyk, PT
We don't often think about it consciously, but as three-dimensional beings we naturally also move in more than one dimension. In fact, there are three distinct places of motion - sagittal, frontal and transverse - and all are required for our bodies to move with functional smoothness.

The most common plane of movement, the sagittal plane, divides the body into right and left halves. In this plane, we use the strength of our muscles to move forward or backward (flexion and extension). Key muscles such as the quadriceps, gluteals and biceps are typically worked in the sagittal plane: for example, a lunge forward or backward, which can be made more challenging by adding another sagittal exercise such as a bicep curl.

If we take an imaginary line and divide the body into front and back halves, this is the frontal or coronal plane. Movements in this plane are always sideways motions, called abduction (away from the center of the body) and adduction (toward the center of the body). Some of the muscles that work in the frontal plane include the middle deltoid, adductors (inner thigh) and gluteus medius. These muscle groups work as stabilizers to control the forward and backward movements in the sagittal plane. Sidestepping with a band around the ankles is an example of a frontal plane exercise.

The transverse plane, the plane most overlooked in exercise routines, divides the body into top and bottom halves. Movements in this plane are rotational in nature and critical in sports for pivoting, batting and golf swings. Common transverse plane muscle groups include the gluteal and adductor muscle groups and the rotator cuff. An example of an exercise in this plane would include a chop with a medicine ball.

(Left) Sagittal plane exercise. (Center) Frontal plane exercise. (Right) Transverse plane exercise.
A well-balanced fitness program should incorporate exercises along each plane of motion. By incorporating multi-planar movements in our warm-ups, strength training and stretching, we can reduce overuse injuries and muscular imbalances.