Human Performance and Rehabilitation Centers, Inc.

PT First: You can see a physical therapist without a doctor referral

Physical therapists are experts in movement, trained to eliminate pain through non-invasive, evidenced-based clinical approaches. For the growing number of Americans suffering from situational or chronic pain, the fastest road to recovery may be to see a physical therapist directly. All states offer some degree of direct access, meaning you don’t need a referral from your doctor to make an appointment. [read more]

Having direct access to a physical therapist is a game changer for many patients. It’s a trend that first began in 1957 but really caught fire around the late nineties. The level of direct access depends on state law, but it generally allows patients a greater degree of control in addressing injury recovery or pain. This streamlined experience is truly a progressive approach to health care. It can cut out wait time, unnecessary testing and long-term pain medication.

When a physical therapist sees any patient, he or she begins by performing a methodical one-on-one clinical evaluation. We listen carefully to our patient’s description of symptoms. We observe and measure their mobility and record their neuromuscular function. We diagnose the site of the pain as well as its underlying source.

Once we complete an evaluation of patients who come to us without a referral, one of three things will occur.

  1. Treatment begins immediately. We determine that physical therapy will achieve the desired results, and we proceed right away with a tailored treatment plan. The patient is instantly on the road to recovery without having to wait for further x-rays or MRIs.
  2. We refer the patient to a physician. If, after our clinical assessment, we determine the patient’s issue is not related to neuromuscular or musculoskeletal function, we recommend the patient see a doctor.
  3. We treat and refer. In some cases, we treat the patient using physical therapy techniques, and we also recommend they see their doctor to address an ancillary issue that is also present.

Physicians and hospitals will continue to be an important partner to physical therapists, but many patients can achieve their therapy and pain management goals far faster and cheaper by taking advantage of direct access and seeing their physical therapist first for aches, pains, injuries and other neuromuscular and musculoskeletal dysfunctions.

View American Physical Therapy Association Direct Access by State

 

Author:

Dr. Chris Wilson, PT, DPT, CHES
Director, Physical Therapy
HPRC, Mount Pleasant, South Carolina

Shoulder pain: Addressing rotator cuff issues early pays off

The shoulder is a key player in everyday life. When it’s not functioning properly you can feel pain while carrying out basic functions, including putting on a jacket, or reaching into the back seat of the car. These are hallmark signs of a rotator cuff issue. Untreated, this condition can become a much bigger problem.

The rotator cuff is the group of muscles and tendons that hold the shoulder joint in place and allow the arm and shoulder to move. Age, injury and overuse are all causes for rotator cuff disease. The muscles or tendons can become inflamed, frayed or torn resulting in pain and limited mobility and strength. If this sounds familiar, it’s important to be evaluated by your doctor early. Physical therapy is an effective way to improve low grade rotator cuff injury and avoid surgery.

When a patient comes in with a low-grade rotator cuff injury, we begin by using manual evaluation techniques on the shoulder joint to discover the level of strength and flexibility. There are four main muscles in the rotator cuff that act as a cohesive unit. When one is injured, others get out of balance. A patient has probably developed a habit of avoiding certain movements without even realizing it, while overcompensating with other muscles. Part of our strategy is to find out where these imbalances are so we can rebuild strength and flexibility in muscles experiencing pain or weakness.

Once we determine this, we can begin appropriate stretching and strengthening exercises. We also develop a tailored home program so that a patient can continue therapy daily. Multiple studies have shown that a quality home program is a big factor in helping patients achieve good results.

We educate patients thoroughly about the frequency and duration of the home exercises we want them to accomplish. We send home diagrams with written instructions and we can email videos of exercises to reinforce what we’ve done in the clinic. Usually, patients with low-grade rotator cuff injury see results in four to six weeks.

 

 

Untying the knot: Myofascial trigger point therapy an effective tool for resolving tension

We’ve all felt them — those tight spots in the neck, shoulders and back that make you feel sore and stiff. You might call them knots, but they’re referred to as myofascial trigger points, and they require a specific type of physical therapy. Performed correctly, myofascial trigger point therapy can help inactivate the trigger point, relax the hardened bands of muscle tissue, and restore strength and flexibility.

Normal muscle contractions operate through a series of events involving nerve conduction and the sliding of protein filaments (myosin and actin) that contract the muscle cells and change the length and shape of the muscle cells. The message to contract a muscle is relayed from the brain to the spinal cord and then out into the muscle cells. The muscle cell is composed of many fibers, fibrils and filaments. Trigger points form when the protein filaments are unable to slide past each other and allow the muscle to return to its normal resting length. These hardened bands can compress the underlying tissue, blood vessels and nerves, leading to pain, weakness, and stiffness

The weakness results because the muscle fibers are already too busy being knotted up they cannot overlap any further to generate more power.  A therapist with good palpation skills will palpate the body in search of the trigger point, based on the client’s complaints of pain reported in the initial exam. The tissue will feel like a hardened knot (rock) or taut band(rope). The spot will be painful on compression and can cause referred pain, or pain that shows up in the body in a distant location.

Trigger points are brought on by a number of factors. While they can be caused by injury or trauma, most often, they build gradually over time.

Culprits include:

  • Static postures, such as sitting behind a desk all day
  • Repetitive motion, including working behind a computer or on an assembly line
  • High velocity movements associated with sports like swimming, golf, tennis or baseball
  • Muscle overload or strain resulting from lifting something too heavy or an abrupt increase in exercise
  • “Weekend Warrior” activities or extreme exercise on weekends
  • Past sports injuries

A physical therapist trained in myofascial trigger point therapy will palpate the muscle until he or she locates the tight muscular band. The therapist should also use the location of the referred pain to help trace the origin, since the body contains a network of established referred pain patterns. Then, using a variety of manual therapy techniques, the therapist will help each trigger point release its contracted state. Dry needling (link to HPRC blog) may also be used to release the taut bands.

The length of time it takes to ease a trigger point depends on a number of factors. The therapist will address any factors (mechanical, medical, psychological) that led to the pain initially or are continuing to make the trigger points worse during the course of rehabilitation. Patients can continue the work we accomplish in therapy sessions through at home exercises, including applying pressure with tennis or racquet balls or Foam Rollers, and frequent stretching of the affected muscles following pressure release work.  Trigger points can be successfully resolved with adequate Myofascial release, proper stretching, muscular retraining and activity modification. It is wise to seek out a physical therapist who specializes in manual therapy, specifically Myofascial Release and/or dry needling techniques to help untie those knots.trigger-point-culprits

My aching back: Using physical therapy to address low back

If you’ve experienced low back pain, you’re not alone. According to the National Institute of Neurological Disorders and Strokes, about 80% of American adults – both men and women – will experience low back pain at some point in their lives. For many patients, physical therapy is an effective tool in improving low back pain and restoring strength and function.

The low back, or lumbar region, is an incredibly important part of the body. Comprised of five vertebrae, the low back supports the weight of the upper body as we go about our daily lives. Multiple components have to work together for the low back to function properly. Soft cushions or discs between the vertebrae act like shock absorbers as we walk, lift, run and jump. Ligaments hold the vertebrae in place. Tendons attach the muscles to the spinal column. Finally, dozens of pairs of nerves are embedded in the spinal cord. Each of these parts works in tandem, so when something is compromised, we feel pain.

No two patients experiencing lower back pain are the built exactly the same, which is why a physical therapy setting can be so effective in addressing a patient’s issues and body mechanics. Our goal is to restore normal physiological motion in the low back through tested hands-on therapy technques that zero in on each joint. In many cases, this mechanical approach is a much more effective – and certainly less invasive – than surgery.

Some of the patients we see experience pain due to spinal stenosis, or the narrowing of spaces in the spine. This is usually caused by age, normal wear-and-tear or arthritis. As joints harder and narrow over time, they can encroach on the nerves that are rooted there. When that happens, the nerves become compressed. We use techniques including traction modalities, manual therapy, joint manipulations and extension exercises both in the clinic and at home.  These therapies help give the nerves more room to function and can help reduce pain in our patients.

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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.