Human Performance and Rehabilitation Centers, Inc.

Physical Therapy at the gym: HPRC Physical Therapy opens satellite inside MÜV Fitness

Imagine the convenience of an experienced physical therapist on site in the gym where you work out. Suddenly, you’ve got the potential to expand your body’s movement and function and to protect it against injury. You don’t have to imagine it in Columbia, where HPRC Physical Therapy has launched a new partnership with MÜV Fitness.

HPRC physical therapists experienced in sports medicine are accepting new patients at our recently open satellite location at MÜV Fitness on Forest Drive. HPRC Physical Therapy took this step in order to bring physical therapy services directly to active adults.

According to WebMD, adults can sustain a workout injury no matter how in shape they are, and the most common injuries include shoulder and knee strain, tendonitis, sprain, dislocation and shin splints. Working with a physical therapist can help ensure you’re exercising not just for general health, but for joint and musculoskeletal health as well. In fact, nothing is more important to keep you in the gym or on the trail long term. Guarding against injury is an important investment that will ultimately save you time, pain and money.

Do you need to see a doctor before visiting an HPRC physical therapist at MÜV? Absolutely not. Thanks to direct access (available to varying degrees in all 50 states), individuals can see an HPRC physical therapist at MÜV Fitness without having to get a doctor referral. So if you experience pain while working out, if you want a physical therapist to help you prepare for an athletic event or if you have existing aches and pains, you can access an onsite physical therapist at MÜV without hesitation. These services are available to both members and non-members of the gym.

The benefits of physical therapy don’t stop with the last session. You will take with you new knowledge on how to stretch properly, warm up, cool down and move your body correctly in any fitness setting.

Founded in Columbus, Georgia in 1955, HPRC has been providing physical therapy services to the Columbia community since 1988.

To make an appointment, please fill out the screening form at HPRC.net/forestdrive or call (803) 939-2213.

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Child’s Play: What you need to know about pediatric physical therapy

Lots of issues bring children to a pediatric physical therapist, from developmental delays to “head tilt” (torticollis) to a diagnosis of Cerebral Palsy or Down Syndrome. Pediatric physical therapists play a part in enabling children to live full lives by helping them build strength and balance. Here’s what parents and caregivers should look for in a productive pediatric physical therapy experience. [Read more]

The basic principles of physical therapy are applied consistently to people of all ages, but treating kids requires a special approach. To an adult, a PT might say, “give me 3 sets of 10 reps of this leg strengthening exercise,” but to a child, that doesn’t sound like much fun. Trained pediatric physical therapists know how to create an evidence-based plan of care that is both effective and engaging to a young person.

We begin by carefully evaluating our patients’ neuromuscular function, and we ask parents about how their child is getting along in his or her daily environments. Depending on the patient’s age, mobility and condition, we design a treatment plan that could include neuro-, ortho- aquatic or hippo therapy and other best practices.

On site, we use equipment and activities that look like fun, but that are actually proven strategies for achieving treatment goals. We might use therapy balls, platform swings, adaptive bikes, a jungle gym or a Wii. We might play basketball or kickball. We might place a child in front of a mirror and play tic-tac-toe with a dry erase marker as they balance on one foot. Each activity is an intervention proven to help pediatric strength, mobility and balance.

Sometimes children are scared and it’s hard to keep their attention. In such cases, we might invite a parent to act as lead therapist while we provide direction. Parents play a primary role in their child’s ongoing development, so this helps educate them as well.

In fact, a home therapy program is crucial to success. A good pediatric physical therapist will ask about a child’s living situation and daily routine and will adapt a treatment plan accordingly. A comprehensive plan of care will help pediatric patients improve their long term motor development, confidence and independence.

Think F.A.S.T! Warning Signs of a Stroke

Plain and simple, a stroke is an emergency. It’s important to recognize warning signs and know when to call for help. Surviving a stroke and minimizing its debilitating effects depends on how fast a patient receives treatment.

In recent decades, our society has become more aware of the warning signs of a heart attack, and this knowledge has saved lives. But we also need to know how to spot signs of a stroke, which we should think of as a “brain attack.”

Stroke is the No. 4 leading cause of death in the United States and a leading cause of severe long-term disability. The Centers for Disease Control and Prevention has labeled the majority of the southeastern U.S. states the Stroke Belt because of our higher rates of stroke incidence and mortality. Contributing factors include the region’s higher rates of uncontrolled blood pressure, smoking, diabetes, obesity, high fat diets and poor activity levels. Strokes affect African Americans at a higher rate than Caucasian.

If you or a loved one is having a stroke, acting F.A.S.T. is key. According to the American Stroke Association, patients who take a thrombolytic or clot-busting drug within the first three hours of their first symptom can reduce long-term disability from ischemic stroke, which accounts for about 87% of stroke cases.

To recognize the signs, think F.A.S.T.

F.A.S.T. stands for:

  • Face drooping. Sudden numbness or weakness of the face, especially on one side of the body, is a key sign that something is wrong.
  • Arm weakness. Sudden numbness or weakness of the arm or leg, especially on one side of the body, is also a sign.
  • Speech difficulty. Sudden confusion with speaking or understanding.
  • Time to call 9-1-1. Acting quickly has the potential to save lives and ensure a better recovery.

Symptoms can also include sudden trouble seeing or blurred vision in one or both eyes; trouble walking, dizziness or a loss of balance or coordination, or a sudden severe headache with no known cause. Any one of these can signal that is stroke is happening.

It’s important to try to document a patient’s last known well time so that first responders can pinpoint exactly when the stroke occurred. This critical piece of information will influence how the patient is treated and can greatly improve long-term outcomes.

Links

http://www.cdc.gov/dhdsp/maps/national_maps/stroke_all.htm

http://www.strokeassociation.org/STROKEORG/?gclid=CIj5l46M8c0CFQcMaQod5hUA3w

https://www.goredforwomen.org/about-heart-disease/symptoms_of_heart_disease_in_women/symptoms-of-a-stroke/

 

Good News: Bladder Leakage Improved by Strengthening Pelvic Floor

For many women, basic acts like sneezing, coughing and even laughing can trigger bladder leakage. It’s an embarrassing nuisance, but the good news is that physical therapy is an effective tool for eliminating and improving this condition.

About half of all women say they have experienced urine leakage at some point in their lives, and for some, it’s a daily event. The culprit is often weak muscles in the pelvic floor, or pelvic floor dysfunction (PFD). Certain acts like coughing, laughing bending or high impact exercise push on the bladder, but the pelvic muscles are not strong enough to push back and prevent leakage. This is called stress incontinence. Women of all ages experience this type of incontinence. We’re not talking about mental stress, but physical stress to the pelvic floor. That’s why women who have experienced pregnancy and delivery, or who may be carrying extra weight are at greater risk for experiencing this kind of bladder leakage. Athletes that engage in heavy impact exercise, running and jumping are also at risk. Older women may experience bladder leakage due to reduction in hormone levels and age-related muscular changes, but aging itself is not a cause of stress incontinence.

So, how can physical therapy help? The short version is we strengthen the pelvic floor muscles, a group of muscles that attach from the pubic bone in the front of the body to the tailbone behind. These muscles, resembling a hammock, are intricate and incredibly important, and it’s easy to take them for granted. Most of us have thought about toning our deltoids, glutes and quads, but have we considered strengthening our pelvic floor? We should.

A physical therapist who specializes in PFD will develop a targeted plan that will strengthen the pelvic floor and reduce and even eliminate bladder leakage. Such a plan goes beyond telling a woman to “just do Kegels,” the pelvic exercises developed by Dr. Arnold Kegel in 1948. Kegels are helpful, but they are not one size, fits all, since every woman is unique. Moreover, not all women understand how to perform this exercise correctly. About 51% cannot do a Kegel correctly with verbal instructions alone.

Kegels are just part of our approach. Physical therapists deliver a comprehensive program for strengthening the pelvic floor, followed up with customized at home exercises tailored to each patient’s therapy goals.

The National Association for Continence (NAFC) website reports it takes an average of seven years – seven! – before a woman will discuss bladder problems with her physician. Don’t wait. Physical therapy is a non-invasive, highly effective tool in resolving this issue.

Dry Needling: Let’s Get to the Point

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Therapy that includes the word “needle” is an attention-grabber, but for a growing number of patients, dry needling is a game changer for managing pain and increasing mobility.

We’ve seen great results using dry needling in a variety of patients, including a chronic migraine sufferer in her 50s who was able to stop taking the prescription drugs she’d relied on for years after just a few sessions. In another case, dry needling helped a high school soccer player hindered by severe hip and glute strain regain his performance and play without pain. We’ve also used the intervention in a breast cancer survivor in her 40s who was eager to regain arm movement after a double mastectomy and reconstructive surgery. Dry needling was an individual component of a complex therapy regimen, but a very important one. It helped our patient regain the ability to raise her arms above her shoulders and meet her goal of competing in a local charity dance event.

Because of its success rate and its ability to treat numerus pain-related conditions, dry needling has quickly become a popular therapy intervention across the country. Availability depends on state laws. HPRC was the first physical therapy provider in the region to offer dry needling several years ago, and we continue to be a leader in the field. Several of our PTs have become certified in this technique, completing 50 hours of additional training. Used in concert with manual therapies, this safe and effective practice is being used routinely across the U.S. to treat a range of common and unusual conditions.

How does dry needling work? What’s happening in terms of the body’s neuromuscular function is complex, but the short version is that small filament needles are carefully inserted into trigger points, areas we commonly refer to as “knots” in the muscle. They’re located below the skin’s surface within the muscle and connective tissue. Dry needling differs from acupuncture in that it’s based on medical principles supported by research, as opposed to an Eastern form of medicine that focuses on the body’s energy. Dry needling elicits a muscle twitch response that can be temporarily uncomfortable, but this is far outweighed by the benefits normally seen.

Before we begin dry needling, we locate trigger points through careful assessment and palpation. Trigger points occur when an overstressed muscle tries to heal itself, creating a ball of angry tissue that can trigger pain in other parts of the body. By inserting a needle into a trigger point, we force it to let go of that tension, effectively “resetting” the muscle and nerves and restoring their function. One of the most hopeful aspects of dry needling is that the targeted pain isn’t likely to return; there’s a good chance we’ve eliminated it long-term.

How to protect your child from an overuse injury

Bryce Gaunt, PT, SCS
Director of Physical Therapy
HRPC St. Francis Rehabilitation Center – Main Campus

Over the last 20 years, a growing number of children have become involved in youth sports. Keeping kids active is a positive trend, but in today’s hyper-competitive environment, it’s important to protect young athletes from overuse injuries.

An overuse injury results from excessive physical activity without adequate rest and recovery, and it occurs when the body’s workload is consistently greater than its level of fitness. Children who train and or compete intensely over time are more at risk for overuse injuries. This is especially true for the growing number of young athletes who play one sport year-round, what we call sports specialization.

We tend to think of kids as having unlimited flexibility and endurance, but they’re actually at higher risk for overuse injury because their bodies are still growing and developing and they’re doing so at constantly changing rates. Kids’ muscles, bones, joints and coordination are not yet mature, and they can’t handle the same kinds of trianing that a healthy adult might.

Consider the following:

• Overuse injuries account for half of all athletic injuries in children and teens.
• Young people are at nearly double the risk of injury when they participate in more hours of sports practice per week than their number of years in age, or where the ratio of organized sports to free play time is in excess of 2:1.
• Young people are more than eight times more likely to be injured if they train more than 16 hours per week.

There are many things we can do to safeguard against overuse injuries. Keep the following in mind:

• Appropriate training can decrease the likelihood of injury as much as 50%.
• Recovery is essential. Adequate rest and proper nutrition are key to helping a young body recover.
• Kids should participate in a wide variety of sports. This provides different stresses to the body, and improves athletic development through a wide range of movements.
• Training intensity should vary over the course of a year and include periods of high and low intensity.
• Proper stretching is key. Children tend to have excessively tight muscles due to their growing bones. A regular stretching regime can reduce injury risk.

Remember, the goal is to make sure that any kind of training is appropriate for a child’s fitness level and stage of growth and development. The workload must fit the body’s capacity to do the work.

Plantar Fasciitis:

Question:
My heel is very painful and my doctor told me I have plantar fasciitis, what does this mean and how can I treat it?

Answer:
The plantar fascia is a tight band of connective tissue that runs along the bottom of your foot attaching your heel to the ball of your foot. Plantar fasciitis is an injury or inflammation to this area, which typically results in heel pain. Patients with plantar fasciitis often report sharp stabbing heel pain which is worst with the first few steps in the morning or after prolonged sitting. The pain may also be more severe after you have been on your feet for a long time.

A physical therapist can evaluate your foot and develop a treatment plan to address your specific needs. The therapist will assess your range of motion, flexibility, strength, walking pattern, and balance. A treatment program of stretching, strengthening, modalities and manual therapy will likely help to relieve your pain and get you back to your desired activities.

Typically frequent stretching of the calf and/or foot is needed to help relieve pain and tension in the plantar fascia. A normal walking pattern is essential to avoid over-stressing other tissues throughout the body. Your doctor or physical therapist will likely recommend you wear supportive shoes as much as possible and may prescribe shoe inserts. Your physical therapist may need to help mobilize your soft tissue, and may use a variety of tools to accomplish this. Massage or tool assisted soft tissue mobilization to the bottom of your foot may be uncomfortable during the treatment, but you should feel better afterwards. You may need to temporarily decrease aggravating activities such as running while you heal. Taping techniques may be necessary to support your painful foot and supportive shoes are essential. Overall, while working with your physical therapist, you should experience a gradual decrease in the intensity and frequency of your pain.

Posture

We have probably all been told at some point in our lives, more often than not by mom or grandma, that we should fix our posture or stand up straight. Well grandma was on to something there! More often than not, while working with patients who are experiencing back, neck, or shoulder pain, I will identify one or more postural deviations which are likely contributing to their symptoms. Some of the most common postural deviations that I see on a regular basis include forward head, anterior pelvic tilt, and rounded shoulders.

Ideal posture gives our body a solid foundation from which to move. The spine is naturally made up of curves with the neck and the low back arching slightly and the mid back rounding slightly. Proper posture minimizes the strain on our muscles and joints and decreases the amount of work that our muscles need to do in order to fight gravity and keep us upright. In ideal standing posture from a side view our ears should line up with our shoulders, hips and knees and there should be a slight curve outward at the mid back and inward at the low back. In a sitting position, our bottoms should be near the back of the chair with our backs supported by the chair. The knees should be bent at approximately 90 degrees (meaning many of us need to adjust our chair height) and our shoulders and neck should be relaxed.

A postural deviation that is increasing in prevalence is forward head posture. This is what it’s called when our chins are sticking out and our ears line up in front of our shoulders. This commonly occurs with reading, computer work, television viewing, and texting. We have a tendency to bring the neck/chin forward in an attempt to get our eyes closer to whatever is holding our attention. Unfortunately, prolonged forward head posture can contribute to neck tension and soreness, headaches, and tingling in the arms. Cell phones tend to bring out the worst neck posture because we often bend our necks down at significant angles while also bringing the chin forward as we read, text or play games on the relatively small screen. The perceived weight of the head increases significantly the more we bend our heads forward. An exercise that you can do to correct forward head posture is cervical retraction with a chin tilt. To perform this exercise nod your chin down just a tiny bit then bring your neck straight back as you think about lifting the base of your skull as if it were being pulled by a string tied to the ceiling. Hold for a few seconds and then relax.

A second common postural deviation is excessive anterior pelvic tilt. This often occurs as a result of tight hip flexor muscles. As a culture, we spend more time sitting than what is ideal for our bodies. We often sit for extended periods for transportation, work, and recreation/relaxation. This can enable the muscles at the front of our hips to shorten and get tight, pulling our pelvis forward. When we stand with anterior tilt, we often increase the arch in our low back as a compensation to stay upright. This can put excessive strain on the low back over time. By pulling the hips forward and the pelvis into a neutral position the back can return to its natural position. An exercise to correct excessive anterior pelvic tilt is the posterior pelvic tilt. This can be performed in multiple positions. One way to do a posterior pelvic tilt is to start lying on your back with your knees bent and the bottoms of your feet flat on the floor. From this position gently press your low back down to the floor and use your abdominal muscles to gently rock your hips back or “tuck your tail”. Another exercise which may be necessary to correct excessive anterior pelvic tilt is to stretch the front of the hips or hip flexor muscles if they are tight.

The final postural deviation that I see very frequently is rounding of the shoulders. This often shows up as a combination of the shoulder blades being far apart and the arms being rotated in so that if a person is standing with their arms relaxed by their sides their palms would be facing behind them. It is also common for people with rounded shoulders to also have a greater than usual bend in the upper back. People with this posture commonly report neck or shoulder pain. This posture puts the body in a poor position for reaching or lifting overhead. Try rounding your shoulders and slumping your upper back, then try to raise your arms overhead from that position. Now try raising your arms while sitting up tall and gently pulling your shoulder blades back. Your arms should be much easier to raise from the second position. Not only is it harder to move your arms from the rounded position but this posture makes it easier for your rotator cuff tendons to be pinched. People with proper posture have the lowest incidence of rotator cuff tears. An exercise to correct this postural deviation is scapula or shoulder blade retractions. To do this exercise stand with your arms by your sides and gently pull your shoulder blades back and together with your thumbs facing out. Hold for a few seconds then relax. Be sure that your shoulders aren’t coming up toward your ears when you do this exercise.

In order to efficiently move our limbs, it is essential to have good posture. We can decrease the strain on our muscles and joints by making small adjustments in our static and dynamic positions. Proper alignment can be one step toward decreasing pain in the neck, back, or shoulder.

Functional Capacity Evaluations

Functional Capacity Evaluations (FCE) are full body assessments that are performed to determine an individual’s ability to safely return to work at pre-injury status or to determine if work modifications are necessary to allow the employee to safely resume their job. FCE’s are commonly used for:
– employees that have suffered musculoskeletal work related injuries and an evaluation is requested to determine their physical abilities in comparison to the demands of a target job
– establishing disability
– a generic test to assess an individual’s current physical ability when the job goal is unknown
A job description is requested and reviewed to assure all job demands are evaluated. The results of the FCE are then compared to the job description. If the client does not meet all the job demands, the evaluator will determine if the employee is a candidate for a work reconditioning program and recommendations will be made to the physician ordering the exam.
The length of the test and the number of days required to complete testing will vary depending on the injured body part. Hand, elbow, and shoulder exams are performed on one day and take approximately 4 hours to complete. Spine, hip, knee, foot, and ankle exams are performed over two separate days, taking approximately a total of 6-8 hours to complete. Clients are asked to dress in clothing and shoes that permit them to safely perform the presented tasks, and that information is provided prior to the day of testing.
The test may be executed by a physical therapist, occupational therapist, athletic trainer, or a kinesiologist. The test items are designed to determine cardiovascular fitness, lifting capabilities, strength, balance, and hand coordination. In order to perform the test, the individual must be medically stable and have met maximum medical improvement as determined by their physician.

The Things We Take for Granted

Dr. Oz brought women’s health into the limelight in April 2014 with an episode about Pelvic Floor Dysfunction (PFD). His segment introduced a very well-known pelvic floor physical therapist, Amy Stein MPT, from Manhattan. If you viewed or missed his segment you might be asking, “I need a physical therapist for my what?” Don’t fret, let me explain. The pelvic floor is a group of muscles, nerves, and soft tissue that attach from the pubic bone in the front of your body to the tailbone behind, similar to a hammock.

Physical therapists are well known and effective in treating all types of muscle problems. We treat muscle strain, spasm, weakness, and tightness. We treat muscles after injury and especially after surgery to regain their best function. Are you still asking, “Do I need a pelvic floor physical therapist?” The answer may very well be yes. The Massachusetts General Hospital website states one in three women will develop a pelvic disorder in her lifetime.

Physical therapists are teaming with doctors to effectively and conservatively treat many types of pelvic floor disorders.

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The muscles of the pelvic floor serve the important function of supporting the organs in the pelvis, and assist in stabilizing and supporting the spine. They also play a role in sexual function and pleasure, indeed important muscles! It is these muscles that help keep us dry or continent and must relax in order for us to empty the bladder or rectum, and stretch to deliver a baby. We take for granted that these muscles will function throughout our lifetime, but sometimes they just need help.

In May 2014, Moore Magazine had an article highlighting all the treatment options for one type of PFD, stress incontinence. A physical stress from above the bladder pushes down on the organs in the pelvis and the muscles just do not have enough oomph to push back. This is a muscle problem. The pelvic organs are not well supported due to muscle weakness. Does your bladder leak with sneezing, coughing, laughing or lifting things? Think again about that physical therapist.

In 1948 Dr. Arnold Kegel developed exercises for women to reduce bladder leakage, assist in vaginal laxity, and support mild pelvic organ prolapse. Pelvic floor muscles can be strengthened just like any other muscle with properly prescribed Kegel exercises. But, one size does not fit all! So, if you were ever told to practice Kegel exercises, you were on the beginning of the right path…possibly. I hear many women state, “Oh, I tried Kegel exercise and they didn’t work for me.” Unfortunately, up to 51% of women are not able to perform Kegel exercises through verbal instruction alone (Bump et all 1991). Properly prescribed, instructed (squeeze and lift) and practiced (repetitions determined by your ability to produce and hold a contraction) Kegel exercises do work. You don’t have to squeeze your thighs or hold your breath or clench your buttocks, but you do need to learn to isolate the hammock of muscles in your pelvic floor. You can learn to exercise these muscles with your regular gym workout, and no one will know the difference, except you. You will be more comfortable, dry and less anxious about finding a bathroom. Take a look at www.totalcontrolprogram.com or www.nafc.org for more info.

Kegel exercises are NOT all we do. Not all women or men need or should even try to do Kegel exercises. For various reasons, pelvic floor muscles can also become short and tight, and lose their ability to relax. Symptoms of tight muscles might be pelvic and low back pain, constipation, finding it hard to empty the bladder or bowel, or experiencing pain with intercourse. Physical therapy can help with that too. Manual techniques to soften and lengthen muscle tissue and reverse Kegel exercises help to restore function and reduce pain.

The muscles of the pelvic floor are especially vulnerable in women due to pregnancy and delivery, but are important in men’s health as well. Dysfunction has multiple causes and affects all ages. The National Association for Continence (NAFC) website reports it takes an average of 7 years before a woman will discuss her bladder problems with her physician. Ignorance is not bliss. Your doctor can guide your treatment. The GOOD news is pelvic floor dysfunction is treatable, and a physical therapist that specializes in the pelvic floor can offer conservative options.

In September 2014, The American College of Physicians released guidelines for non-surgical solutions for uncomplicated stress incontinence. These guidelines include pelvic floor muscle exercises, bladder training and weight loss as effective options, and recommended conservative options as a first choice of treatment.

A pelvic floor physical therapist specializes in understanding and treating the multiple problems of the pelvic floor muscles. We can help you find your muscles in your pelvis and learn to control them. We can help that got-to-go feeling with a bladder training program. A pelvic therapist will complete a comprehensive pelvic floor muscle exam, digitally examine the pelvic floor muscles, evaluate posture and examine the joints of the low back and pelvis and prescribe appropriate treatment options.

There is HELP and HOPE for your pelvic health problems! You will be grateful for those hidden muscles once they are no longer hiding from you!