Human Performance and Rehabilitation Centers, Inc.

ASTYM for Improving Range of Motion in Breast Cancer Patients

One of the biggest challenges for breast cancer patients who have undergone breast surgery is the loss of range of motion due to the presence of scar tissue. Breast tissue is very delicate and scars to a higher degree than other areas of the body, so after a surgical procedure, such as a mastectomy or lumpectomy, the tissue can draw inward and harden, and limit flexibility. This often occurs along the incision and the drain sites. It can also occur in patients who have undergone radiation therapy.

As a result, many patients will find it difficult to raise the arm to perform simple tasks like showering, fastening a bra or reaching up into a cabinet. It’s important to seek out therapy after surgery to eliminate this build-up of scar tissue and to restore everyday function and mobility.

While manual therapy has long been used to address loss of range of motion, recent studies have shown ASTYM therapy — short for Augmented Soft Tissue Mobilization — to have very positive results in improving function and range of motion in breast cancer patients. ASTYM is a relatively new form of non-invasive soft tissue therapy used to effectively break down the scar tissue and trigger a reparative response. The process is simple but highly effective when administered correctly. Using a “scraping” motion, a certified clinician will gently run a small, smooth, hard plastic tool over the surface of the skin to find areas below the skin where scar tissue is present. This is done with the help of a lubricant to ease discomfort. These deliberative movements find and loosen scar tissue so that the body can reabsorb it. And, at the same time, it stimulates the production of new tissue. At the end of the therapy session, the clinician will also provide stretching and strengthening exercises to reinforce the work accomplished by the ASTYM stimulation.

Patients often feel increased range of motion and/or decreased tightness even after the first session of treatment. After a few sessions, significant flexibility can return as more scar tissue is reabsorbed and the body grows healthy new tissues.

For more information about ASTYM therapy for post-surgery breast cancer patients, please contact us at (706) 225-0380.

Laura Sherwood, PT, DPT, OCS is a licensed Physical Therapist at St. Francis Rehab Main Street Village in Columbus, GA. She is an APTA Board Certified Clinical Orthopedic Specialist (OCS) and an APTA Credentialed Clinical Instructor. Laura is certified in dry needling and ASTYM. Her special interests include orthopedic, neurological and lymphedema-related conditions.

How Speech Language Therapy Can Help After a Stroke

Speech therapy can make a big difference to those who have suffered strokes, but one of the most important things to remember is that treatment should be tailored to each patient’s specific needs and therapeutic goals. This is important because even people who have suffered strokes in the same part of the brain might exhibit different impacts. A licensed speech language pathologist (SLP) will create a therapy plan that gives a patient the best possible chance of achieving his or her specific goals, which will likely include improving speech and language capabilities as well as swallowing capacity. The therapy plan should also include at-home instructions for family members or caregivers to create continuity with what is accomplished in a therapy center.

To understand how speech therapy for stroke survivors works, it’s important to understand more about the common conditions these patients face.

Aphasia

The term aphasia refers to the impairment of language, including the ability to understand or produce speech. Severity of aphasia runs the gamut from anomia, or difficulty recalling specific words, to global aphasia, where a patient might be completely nonverbal and experience difficulty understanding what is said to them.

The speech language pathologist will create a treatment plan that helps a patient move from their current condition to working toward the specific functional improvement the patient and his or her family feel is important. Exercises may include impairment-based therapies, in which a clinician directly stimulates listening and speaking skills; or communication-based therapies where the therapist helps the patient compensate for language difficulty loss by helping him or her use other strategies or communication modes.

Dysphagia

Dysphagia refers to difficulty in swallowing, also a common problem for those who have suffered a stroke. A speech language pathologist will create a therapy plan for helping the patient restore as much of this important function as possible. This usually includes swallowing exercises, sometimes with resistance, that help strengthen muscles and re-teach swallowing skills. Patients also practice swallowing, possibly working up to sucking thick substances, like pudding, through a straw to strengthen neck and throat muscles. Regular repetition of swallowing exercises, both in the clinic and at home, is important in restoring function.

Dysarthria

Dysarthria is a condition in which speech is hard to understand or is slurred. The speech language pathologist will use repetitive exercises and other strategies to stimulate speech improvement.

Two Key Factors to Success

A couple of factors go a long way in how much success a stroke patient will have in speech therapy. One is attitude. It’s difficult to suffer a stroke and deal with its aftermath, but patients who adopt a positive, never-give-up attitude tend to see better results. Another factor is the willingness to practice at home. While onsite therapy with a speech language pathologist is key to making progress in improving impaired speech, language and swallowing, it’s crucial to repeat exercises at home with the help of caregivers. Continuity is key to seeing results.

 

Virginia “Ginnie” Byrd is a licensed Speech Language Pathologist based at HPRC’s St. Francis Rehabilitation Main Street Village Campus in Columbus, GA. Ginnie is certified through the American Speech-Language-Hearing Association (ASHA) and holds her Certificate of Clinical Competency (CCC). Speech, language, swallowing, cognition, and voice therapy are all part of her rehabilitation practice. 

 

How to Fall-Proof Your Home

Falling is one of the biggest health hazards faced by aging Americans. Every year in the U.S., more than 800,000 older adults are hospitalized for injuries resulting from falling, most notably, broken hips and head injuries, according to the Centers for Disease Control and Prevention. These injuries are costly, painful and sometimes require surgery. They can also mean lengthy periods of recovery that interrupt an otherwise robust life. The good news is that there are a lot of easy steps you can take to reduce the chances of a fall happening.

One of the simplest places to start is also the most common site for falls: inside the home. Fall-proofing your home, or the home of an aging loved one, means taking a close look at a variety of factors, from lifestyle to the physical environment to daily habits.

Tips to fall-proof your home

Wear proper footwear

Choose shoes or slippers with soles and backs. Avoid slides or flip-flops, which provide less stability and can slip out of place, causing you to trip.

Get your eyes checked

Not being able to see your surroundings clearly is a big factor in falling. Eye exams should be administered regularly for older adults to ensure eyeglass prescriptions are up to date and optical issues are addressed. Half of all adults will have cataracts, which cloud vision, by the time they are 80.

If you have a cane or walker, use it at all times

If you use an assistive device such as a cane or walker, be sure to use it correctly and at all times. Resist the temptation to prop it in the corner and go it alone. For additional advice, read our blog post about walking safely with a walking aid.

Don’t use furniture or walls as a walking aid

Using chairs, tables or the wall to assist you as you walk is not a good idea, as they can throw off your balance. If you find yourself reaching for help, it’s time to get a cane or walker.

Place frequently-used objects in accessible locations

Keep cell phones, reading materials, the remote control and other items you use often in easy reach on a table or in pouch that can be attached to a walker.

Don’t attempt to reach something high

It’s hard for some older adults to accept that they shouldn’t do some of the household tasks they’ve done historically, such as standing on furniture or a step ladder to reach something high. Wait for a friend or family member to help. Nothing is so important it should put you at risk for a fall.

Keep stairs and walkways clear of clutter

Older adults sometimes complain about the inability to walk around their home with ease because of clutter or unnecessary furniture. Be sure walkways are free and clear of any impediments. This is especially important for seniors with walkers.

Eliminate throw rugs and electrical cords that could cause tripping

Walk through the house carefully, and note any throw rugs or electrical cords that protrude. Throw rugs and area rugs can get caught under a walker, especially when their corners are bent. Tuck electrical cords neatly out of the way so they are not in walking paths.

Use nightlights or leave on lights at night
Falling often occurs when an older individual gets up during the night to go to the bathroom and can’t see in the dark. Be sure to leave on a nightlight or hall light to illuminate the path to the bathroom.

Place a non-slip mat in bathtub/shower

Slippery, wet surfaces are also culprits when it comes to falling. Place non-slip mats in the tub or shower, and cover the tile floor with a non-slip bathmat.

Install sturdy grab bars and railings

Grab bars are a great way to ensure seniors can get in and out of the shower without losing their balance. Sturdy railings should also be installed at front porch steps and other key transition points in a home. All interior and exterior staircase railings should be inspected for stability.

Make sure pets are not a hazard

Pets bring joy and provide companionship, but they can also be trip hazards when they jump up or walk in the way of an older adult. If a senior has a pet, be sure it’s well behaved. When a person at risk for falls visits someone who has pets, take steps to ensure pets are secured.

Brittany McLeod, PT, DPT, is a licensed Physical Therapist with a specialty in orthopedics on staff with HPRC St. Francis Main Campus since 2013. She received her Doctorate in Physical Therapy degree in 2012 at Upstate Medical University in New York and her BS degree in Health Science at SUNY Brockport New York in 2009. Brittany is a member of the American Physical Therapy Association, Orthopedic Section.

How To Walk Safely With A Walking Aid

At some point in your life, you could find yourself using a walking aid to support recovery from an injury or surgery, or simply to enhance your mobility. Walkers, crutches and canes are designed to meet different therapeutic needs, but they all have something important in common. They should be carefully fitted to your body. A walking aid that is correctly fitted and used properly is a game changer in helping you get around. On the other hand, one that is fitted or used improperly can slow your recovery and even introduce new stressors to the body.

Here are some tips that can help you achieve the best possible results with a walking aid.

Walkers

When it comes to walkers, one of the most important things to remember is that size really does matter. Walkers should be adjusted to your height to enable your posture to be as normal and erect as possible. The handles of the walker should be at the same level as your wrists when your arms are in a relaxed position. Individuals who are shorter than about 5’2” or taller than about 6’3” may need to special order a walker that will better accommodate them. Medical supply stores should help you fit your walker correctly.

The best way to use a walker is the same way you push a shopping cart. It should move with you fluidly. Don’t slide the walker to a new spot, pause, and then step to that spot. Instead, the walker should move forward at the same time that you’re stepping forward.

The rear feet of your walker can be outfitted with something to help it slide easier, such as plastic skis or tennis balls.

Canes

You may feel compelled to use that beautiful wooden cane you inherited from your grandfather, but there’s a slim chance it actually fits your frame. Today’s canes are adjustable. They can also come with a footed base to make retrieving them easier.

The top of the cane should be at the same height as your wrist when you’re standing with your arms relaxed. And while it may seem counterintuitive, the cane should be used on the opposite side of the body as the injured leg. To walk properly with a cane, advance the injured leg and the cane at the same time.

Crutches

When crutches are correctly fitted, the handle grips should be at the same height as your wrists when your arms are relaxed. Your arms should have a slight bend in the elbow as you walk with crutches; they should never be completely straight. You should also be able to place four fingers’ width between the armpit and the top of the crutch. Never rest your armpits on top of the crutches when walking or standing because it can pinch nerves in this part of your body.

For any walking aid, always consult with your health care provider or therapist about correct fitting and proper use. It can make a big difference in your recovery and overall health.

To learn about keeping your home a safe place to walk, read our blog post on How to Fall-Proof Your Home.

Karri Iten, PT, DPT, OCS, is a licensed physical therapist, a certified specialist in orthopedics and an APTA credentialed clinical instructor.  She has practiced at HPRC’s main location at St. Francis Hospital in Columbus, Georgia since 2016.

 

5 Easy Exercises to Relieve Basic Shoulder Pain

Shoulder aches and pains are a common complaint for adults, even for those who aren’t engaged in strenuous lifting or regular athletics. As your most mobile joint, the shoulder is made up of an intricate network of muscles, ligaments and tendons all working together to deliver both mobility and stability. Without the hard work of your shoulder, you wouldn’t be able to throw a frisbee to your dog, scratch your back, or reach for that item on the top of your closet.

That’s why it’s so frustrating when shoulder pain appears, sometimes out of nowhere. We don’t realize it, but pain in the shoulder often stems from our sedentary work life, when prolonged sitting behind a computer and craning our necks to talk on the phone places our shoulder muscles in unnatural positions for prolonged periods of time. Basic everyday activities such as yardwork and laundry can lead result in problems over time.

But there is good news. If your shoulder pain is minimal to moderate, and it hasn’t been going on for more than a few weeks, you have a good chance of improving it through the following gentle exercises. These exercises are quick and easy to perform, don’t require a clinician or special equipment, and they can be highly effective at reducing pain and tension in your shoulder muscles. Perform them a few times a day at work or home for about a month and it’s likely you’ll see improvement in your pain.

If the pain persists, then it’s time to see a physician, or go directly to a physical therapist (PT).  A PT can zero in on the exact area of your pain and develop a treatment plan for improvement. Remember, direct access laws enable you to schedule a visit with a PT without going to a physician first.

1. Shoulder pendulum

2. Shoulder blade pinch back

3. Hands slide on leg

4. Overhead stretch

5. Side-lying rotation

Bryce Gaunt, PT, SCS, is co-editor of and a primary contributor to the reference book A Systematic Approach to Shoulder Rehabilitation. He is a Fellow of the American Society of Shoulder and Elbow Therapists and became a Board Certified Clinical Specialist in Sports Physical Therapy (SCS) in 1998.

Feeling Better As We Age

It’s just the pits. As we age, things just start to ache more. And as they start to ache more, we become less active and our fitness levels can go down as a result.

We spoke with HPRC Therapist Karen Lynn about steps that we can take to increase our physical fitness and about the overall health benefits this can provide.  In addition to increasing your overall physical health, physical fitness can improve cognitive function.  It can help increase alertness, decrease depression and anxiety, improve sleep and slow the progression of dementia and Alzheimer’s.

Starting Out

Before anyone starts a new fitness program, see your doctor to make sure you choose the best program for what your body can execute effectively.  After you start the program, allow about four weeks for the exercise habit to kick in.  We’ve all done the start and stop and gotten so frustrated we want to throw in the towel. STICK WITH IT!

  • Start slowly, cut yourself a break in the beginning. You aren’t going to go from 0 to 60 in three days! Build up to more rigorous exercise as your fitness level starts to increase.
  • Mix it up! Include a variety of exercises that help with cardio, balance, flexibility and strength.
  • Lastly, always listen to your body. If something doesn’t feel right or you start to feel ill, call your doctor immediately.

Tips to Keep the Program Going

Often, exercise is just plain not fun.  Find something that is FUN for you. It’s possible…just think outside of the box a bit!

  • Make it fun – Choose something that you look forward to – even walking along a local trail is a great start. Find a ballroom dancing class to go to or an aquatics class if you love to be in the pool!
  • Make it social – Join a group of friends for a hike, bike ride or walk in addition to going out for dinner and drinks. It’s a lot more fun when you’re in it together!
  • Make it an adventure – Get out of the gym and explore a different environment. For example, instead of plain yoga or jogging try a yoga retreat or a bike ride along a trail.
  • Keep fueling your body with food – Exercise is going to become easier if you are fueling it with nutrient-dense food.

How Can We Encourage Our Parents?

Some of you reading this may have parents you want to encourage to start moving more.

As children, we want to see our parents live as long and as comfortable of a life as possible.   To encourage them to exercise, we can remind them that being strong, flexible and having good balance can help them remain independent at home longer.  Not having consistent physical activity can lead to falls, which can be very serious for the elderly.

Encourage them to use the buddy system and work out with friends.  If you live close by you could even work out with them.  Encourage your parents to state fitness goals such as playing in the yard with grandkids, walking a race with their daughter or being able to climb the stairs at home. We are happy to help you put a plan in place based on those goals.

How Can PT Help

Physical therapists are ‘movement experts’ in the health field.  A PT can offer guidance with increasing mobility, strength and independence through a program designed around a thorough physical exam.  The program will include considerations of health issues and concerns of the client and can safely get them on the road to being more healthy and happy.

As you can see, there are many ways older people can maintain or become physically fit.  They just need to have a plan, have some goals and an understanding of the importance this can have on their quality of life, now and in the future.

Improve Your Running Through Better Mechanics

Do you feel like you aren’t getting the best results from your morning run?  Maybe you are having a little nagging pain afterwards?  This could be due to poor running mechanics.  Not running properly can lead to a variety of overuse and chronic injuries – Achilles tendonitis, plantar fasciitis, stress fractures, hip and low back pain, etc.  It can also slow down your pace and make your run less efficient.

Most often, we see a patient and learn that they have inefficient running mechanics through treatment of an injury.  We will first treat the injury to get them back to running health and then we will evaluate further to get to the root of the problem. We observe a patient running both on and off a treadmill, slow their pace down to observe their running style, look for compensations and to assess joint movement. We also take a look at their footwear to make sure they are in the proper shoe for their foot type and running style.  This process incorporates everything from their head to their feet.

If there is an issue with your running mechanics, it’s important to focus on correcting it while you are running.  Focusing on the adjustment will improve your mechanics more quickly and will lead to less energy expenditure, less overall fatigue and most importantly less pain, resulting in a decreased chance of injury or reinjury.  Quite often, we have to spend time on running education to discuss running surfaces, road camber, speed and distance training plans, as well as establish frequency and intensity guidelines while making adjustments. Usually after a couple of weeks performing specific exercise techniques and focusing on the change in form, patients are able to report a positive difference in how they feel before and after a run.

Keep in mind, poor running mechanics don’t just show up in adults.  You can spot it in your children as well.   If your child complains of pain while running, anywhere in the body, it can be a sign they have poor mechanics, unless of course, they have pushed their limits in a race or speed workout.  Pain caused by running can present in places one might not expect such as the lower back, shoulders, feet and knees.  Observe their shoulders, hips and knees and also look at their feet.  Having high arches or flat feet can lead to injury in a runner, if not in the proper footwear.   If there is something that just looks a little off, it wouldn’t hurt to have a running assessment done to prevent injuries in your child.

Consider making an appointment to consult with one of our Sports Performance clinicians at our St. Francis Main Campus location in Columbus, GA or our MUV Fitness location in Columbia, SC.

Pregnant with Back Pain? Physical Therapy Can Help!

I recently had the opportunity to work with a woman in her 34th week of pregnancy, with a diagnosis of low back pain (LBP).   She was experiencing right sided buttock pain (pelvic girdle pain or PGP), with mild intermittent mid posterior thigh pain.  Her pain was made worse with attempting to stand on one leg as in dressing or washing her feet.   Her treatment included manual therapy, postural education and awareness to decrease the strain on her joints, and appropriate exercise.  As you can see in the photo to the right, with therapy she was able to adjust her posture so that she was carrying her baby instead of her baby carrying her.

When I encounter pregnant women with low back pain I expand my normal evaluation to focus on the unique physiological and musculoskeletal changes that occur during that exciting nine month period.   Pregnancy is a common time for back pain to begin, with over 50% of pregnant women reporting back and or pelvic girdle pain.   20-25% continue to experience LBP and PGP postpartum.  Think about the changes that occur in a woman’s body throughout pregnancy and it is no wonder women are three times more likely to develop low back pain than men. Physiological changes, alterations in hormone levels and necessary weight gain during pregnancy contribute to the increased postural demands on the musculoskeletal system.  How often do we gain an average 25 pounds in nine months? The growing baby places significant demands on the mothers’ core!

The mother’s spine adapts to the baby’s growth.  The natural spinal curvatures increase from the lumbar (low back) to the cervical (neck) spine.  The typical pregnancy sway back posture increases the load on the spinal joints.  The pelvis takes on an anteriorly rotated position, which places excessive stress on the SI joints, not to mention making it harder for the muscles around the joint to function accordingly and affects the stability of the pelvic ring.  Hence low back and pelvic girdle pain, (pain between the top of the pelvis and the fold of the buttock including the sacro- iliac joints and the joint of the anterior pelvis the pubic symphysis).  Hormonal changes produce laxity in the joints of the body, which is most recognized in the pelvis.  The joint at the front of the pelvis begins to widen in the 10th to 12th week, and averages a 6 millimeter separation which is considered normal.   The increase in laxity places a greater demand on the muscle system and it is theorized that it is the asymmetrical laxity and increased demand on the joints and muscle that lead to pregnancy related back pain.

Looking at the diagram above it is obvious that the abdominal muscles stretch in all pregnant women.   The rectus muscle, the most superficial of the abdominal group is stretched at its midline attachment to the underlying tissue called the linea alba. (Stay tuned for another blog about caring for abdominals before and after pregnancy)   Some women will have spontaneous return of their abdominal muscles postpartum and some will not. Weak and stretched abdominals limit the function of the core to assist in support of the spine.  Bending forward becomes impossible through the later stages of pregnancy, and alternative strategies for bending become the norm.

The bottom or basement of the pelvis is supported by 3 layers of very important pelvic floor muscle.  This group of muscles attaches from the pubic bone in the front to the tail bone in the back and along the sides of the pelvis.  These are muscles that we generally do not think about, but they are muscles that are under voluntary control. They function to support the contents of the pelvis, which in the last few months of pregnancy can be a considerable number of pounds.  PFM assist the back and pelvic joints with stability for increased loads, such as carrying and lifting.  They also function to keep us dry or continent, which is a demanding job considering the extra weight they are already supporting.  So, it is not uncommon for women to experience bladder leakage in the latter part of pregnancy.   Women with PGP are more susceptible to bladder leakage.  More argument to get help for your back pain!  No bladder leakage is ever considered normal !  The good news is, UI can be prevented with the use of Kegel exercises.

Since physical exam is the primary means of diagnosing back pain in pregnancy, a physical therapist with pregnancy postpartum specialization is one of the best options to help reduce or even eliminate your back or pelvic girdle pain, help you protect your abdominals, teach proper Kegel ex through pregnancy, and advise on regular exercise.  The mechanical dysfunctions of pregnancy related back pain  are helped by restoring and supporting  joint function, participating in regular and  appropriate  exercise (www.acog.org) and adapting posture and regular everyday day tasks to accommodate the growing baby.

Most patients believe that pain will be eliminated once they give birth but, up to 1/3 of women continue to experience pain 1 year or more after their pregnancy. Back pain during pregnancy does not have to be “normal”.   If you are experiencing back and or pelvic girdle pain with your pregnancy that is limiting your regular activities talk to your doctor, and request a visit to either one of our 2 women’s health physical therapists that specialize in pregnancy postpartum back and pelvic girdle  pain.

 

Learn more about the Women’s Health services offered by HPRC’s highly trained clinicians.

Managing Workplace Injuries

Following up on our previous blog post on Preventing Workplace Injuries, we also received some great tips from Birmingham clinician Morgan Jackson, PT, DPT on managing workplace injuries.

  1. Know Your Body: It’s important to monitor any aches and pains that begin to appear. The earlier you catch the injury the better – if injuries last more than 2-3 weeks, it’s time to see someone. Recovery can be much quicker, and you can avoid more serious issues that could require surgery and/or physical therapy.
  2. Know Your Symptoms: Dull aches that go away may be normal, but a persistent burning sensation or sharp pain may indicate that it’s time to see someone.
  3. Know Your Situation: If your activity level has changed, pains may be expected, but if your activity level hasn’t changed and you aren’t doing a new job with different movements – it may be time to see a therapist.

Most small strains or overuse injuries go away after two weeks, if the proper adjustments and rest are performed.  It’s important to see a doctor if the pain persists to avoid a more serious injury, for example, carpal tunnel syndrome, that could require surgery and/or physical therapy.

This is also an important time to talk to your employer’s HR team (or the person in charge of injury prevention, such as a safety manager) about your pain.  They can review the setup of your work area, chair and look at your posture to help you get into a more comfortable position.

Be sure to ask questions about the changes they suggest so you have a full understanding of the reasons for the changes.  And finally, if you don’t already have it, now would be a good time ask for any materials they have on injury prevention.

Preventing Workplace Injuries

We recently spoke with Birmingham clinician, Morgan Jackson, PT, DPT, about preventing workplace injuries. She shared great tips on how employees and employers can work together to prevent injuries and build a workplace where employees thrive.

Employees:

  1. Know your policies: Many workplaces have injury prevention plans in place. Reach out to the HR team or safety manager at your company to see if they have a program.  The tips they provide can be as simple as proper posture, setting up your chair properly and the correct placement of your monitor and keyboard.
  2. Take breaks: Take micro break every 20 minutes to stand up and stretch or move a bit. Then, most importantly, follow their guidelines and if you start to feel pain such as a sore back, wrist or shoulder ask them to come back for a tune-up.
  3. Escalate when appropriate: If pain persists more than 2-3 weeks, it may be time to see someone before it gets worse.

Employers:

  1. Have a policy and follow up: The most important thing the employer can do is have an injury prevention plan in place that can be tailored to each employee. But as important is the follow up and reinforcement.  Have a plan that starts on day one, but continues to educate and remind employees.
  2. Set up employee work stations: If in an office environment, help employees set up their work area in the proper way, including desk, chair, monitor, keyboard and mouse and explaining proper sitting posture to the employee.
  3. Don’t just tell the what, explain the why: Explain what things SHOULD feel like, but more importantly, explain why it’s important and what can happen if they don’t take direction properly.

 

In the event you are suffering from a workplace injury, learn some tips on how to manage the pain.