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.

Resources:
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.

Friday, July 14, 2017

Building Core Strength: The Plank

by Stephanie Korso, PT
The plank is a common exercise with which most people are likely familiar: even if they have never tried to do a plank themselves, they have likely seen someone doing a plank at the gym or read about it in their favorite fitness magazines. But what is all the fuss about? Is it really such a great exercise?

Simply put, the answer is yes! The plank is a great way to improve core strength and stability. Research suggests that proper core strength and stability can help alleviate low back pain, prevent injury, improve balance, and enhance performance. When performed correctly, however, planks can do more than just work the midsection: they can work muscles from head to toe, improving limb strength and toning the entire body.

If the idea of performing one exercise sounds like it might not prove enough of a challenge, there are also many variations of the plank, making it easy to keep things interesting and modify or progress the exercise. A prone plank (face down), for instance, increases activation of anterior abdominal muscles, whereas a supine plank (face up) increases activation of back muscles and a side plank increases activation of the obliques. Adding arm or leg movements increases the difficulty of the exercise by further challenging core stability and increasing shoulder and hip muscle activation.

Moreover, the plank is generally a safe exercise because it is isometric, meaning that muscles maintain a constant length as they contract and body parts do not move. This is easier on one's joints than other types of exercises in which the body changes position, such as sit-ups. The plank requires minimal time and can be performed without any equipment, making it easy to sneak in anytime, anywhere.

Consider mixing up your routine by trying out some of the variations below! As with any type of exercise, remember to breathe throughout and stop if you have pain. It is recommended that you consult your physician or physical therapist before beginning a new exercise routine.

  • Forearm plank
  • Straight arm plank
  • Side plank
  • Side plank with twist
  • Supine plank
  • Plank with alternating shoulder taps
  • Plank with alternating hip extension
  • Plank with legs elevated on stability ball
  • Plank with forearms supported on stability ball
References:
Escamila RF, Lewis C, Pecson A, Imamura R, Andrews JR. Muscle activation among supine, prone, and side position exercises with and without a Swiss ball. Sports Health. 2016; 8(4): 372-379

Calatayud J, Casana J, Martin F, et al. Trunk muscle activation during different variations of supine plank. Musculotskelet Sci Pract. 2017; 28: 54-58.

20 ways to do a plank. Health Magazine. http://www.health.com/health/gallery/0,,20813896,00.html. Accessed May 17, 2017.

Friday, June 9, 2017

More Than Trivial: Working Memory and Pain Management

by Lauren Sweeney, Office Manager
Knowledge of American history, popular music or sports may not be the first thing someone might be thinking about when they begin physical therapy, but our patients have come to expect that, when they walk through the door, they will be greeted by a Question of the Day. This rotating slate of various trivia and logic puzzles delights and challenges our patients so much that often a patient will end a phone call or email by asking, "What's the question today?"

While it may seem just a simple distraction, engaging the brain in recalling information or cracking a puzzle can serve a more useful purpose: pain management. Working memory, the part of short-term memory that takes on immediate cognitive tasks and processes language, also manages attention, meaning it is to a degree responsible for what we perceive and experience. When that working memory is engaged in a task, then, it can do so to the exclusion of other stimuli, such as pain. In a study conducted at the University Medical Center Hamburg-Eppendorf, participants were given a painful stimulation which was then followed by a cognitive task. The more complex the task, researchers found, the less pain the participants reported. And it wasn't all in their heads - MRI data showed a decreased neuronal response as well, meaning that fewer pain signals were making it to the spinal cord.

All that said, there's no evidence that working memory engagement is helpful in alleviating chronic pain, and it's certainly no substitute for seeing your doctor or setting up an appointment with a physical therapist. It may, however, lower pain just enough to start off a physical therapy session on the right foot. On that note, I'll leave you with my favorite riddle: A man lies dead, surrounded by 53 bicycles. What happened? (Feel free to answer in the comments below!)

Reference:
Sprenger, Christian et al. Current Biology, Volume 22, Issue 11, 1019-1022.

Friday, May 5, 2017

Diastasis Rectus Abdominis: Dealing with the Post-Partum Bulge

by Katie Hopkins, PT
While many women notice differences in their bodies after giving birth, some experience an extra bit of abdominal bulge that has nothing to do with baby weight. Diastasis rectus abdominis (DRA) is a separation of the two muscle bellies of the rectus abdominis muscle. Commonly referred to as the "six-pack" area, it is the main and largest abdominal muscle on the front side of the body. DRA most often occurs in women during pregnancy: the expanding uterus stretches the abdominals, which can cause a separation in the line alba (the connective tissue between the two sides of the muscle). While it can also occur in men and non-pregnant women due to inappropriate loading and pressure within the abdominal and pelvic regions, it is rare.

DRA is characterized by a visible and palpable separation of the rectus abdominis. This gap, assessed by contracting the muscle in a specific fashion, is measured in finger widths. While the separation of the rectus abdomens itself is not always painful, it can lead to other painful dysfunctions. Patients can experience a feeling of weakness in the abdominal muscles, pelvic floor dysfunction (urinary and bowel problems), low back pain, pelvic pain, hip pain, poor posture and sexual pain as a result of DRA, and the risk for separation increases with each delivery or being pregnant with multiples.


To treat DRA, a physical therapist can help develop an appropriate exercise program to strengthen the abdominals and decrease the separation. This program usually consists of a combination of transverse abdominal training, pelvic stabilization and postural training. Physical therapists can also tell you what exercises - such as crunches, sit-ups and twisting with weight - should be avoided, as they may exacerbate the separation. New mothers, or those who have older children that still like to be picked up and held, may also benefit from reviewing proper lifting mechanics: it is important to stabilize the abdominal and pelvic region, as well as lift properly, to avoid additional stress on the diastasis. Taping has also been shown to be effective for DRA.

DRA can be treated before and after pregnancy. Although it is rare for diastasis to close during pregnancy, treatment can help to minimize the gap and potential symptoms that occur after delivery. If you have recently given birth, talk to your doctor about when it may be appropriate for you to start treatment after delivery. Even if it has been a while since you've given birth, it's never to late to get treatment - separation can be decreased and improvements can be made no matter how old your kids are.

Resources:
Benjamin, DR, van de Water, AT, Peiris, CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014 Mar; 100(1):1-8. doi: 10.1016/j.physio.2013.08.005. Epub 2013 Oct 5. Review.

Physical Therapist's Guide to Diastasis Rectus Abdominis (May 2017) Retrieved from http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=f8a7ad12-eadf-4f42-9537-e00a399c6a03