The shoulder is one of the most used and mobile joints in the body, which is why it can be so difficult when you are experiencing pain or an injury in that area. A complex ball and socket joint, essentially, the shoulder is made of the humerus (arm bone), the scapula (shoulder blade), and clavicle (collarbone). Due in large part to how much we use our shoulders, this joint is incredibly susceptible to injury. There are many different types of shoulder pain and injuries, but two of the most common causes of pain are overuse and poor posture. In today’s society many people spend the entire day typing on a computer, hunched over and full of concentration. We often don’t realize just how hard this is on our bodies overall, especially our shoulders.
There are many different symptoms and types of shoulder pain that people can experience – including an aching, burning pain right between the shoulder and the neck. Others complain of a sharp pain at the tip of the shoulder when reaching their arms overhead. Regardless of the type of pain, it is a good idea to take action as soon as possible. The longer you ignore it and don’t seek treatment, the worse it will get.
When it comes to shoulder pain or injuries, there are numerous different treatment options, from surgery and medication to physical therapy. In recent years alternative forms of medicine have become more widely used to treat a host of injuries and ailments, including shoulder injuries. In order to better understand how you may benefit from physical therapy for your shoulder injury, we thought it would be helpful to go over some of the most common shoulder problems people experience. If you are living with any of the following, we encourage you to consult a Grand Prairie physical therapist to see if this is a viable option for you.
Some Common Shoulder Injuries and Problems
Some of the most common shoulder problems and injuries that can be treated with physical therapy include:
Why pay cash or out of pocket from insurance for Physical Therapy? Every year more and more of our patients are paying cash out of their own pockets for our physical therapy services. Like most health care providers, we bill insurance companies as a service of convenience for our patients. In recent years, deductibles have climbed to $5000 or more, copays have become higher, and scrutiny by insurance companies over what is covered has increased. We are now at a point where many of our patients/clients have lower out-of-pocket expenses if they simply pay for our services without going through their insurance carrier.
Government regulators allow us to provide discounts if sessions are paid for by the patient on the day of service, with further discounts if they pay for multiple sessions. We can afford to offer these discounts because we significantly reduce our administrative expense if we are not billing your insurance company and then waiting for 30-90 days or more to get paid (unfortunately that is not unusual). As the patient you have less cost, however your payment to us does not apply to your deductible. If you have a flex spending account or health savings account, your payments to us may be reimbursed.
Often spending two to three sessions focusing on your issue is very productive and can actually save you time and money in the long run. This is especially true if you have a high deductible plan.
Some physical therapy practitioners and clinics will accept a “fee for service” reimbursement or “capitation”. In the last few years insurance companies have cut back on physical therapy insurance reimbursement 30-50%. Physical Therapy clinics that accept a capitated rate may have to reduce time spent directly with a Physical Therapist. Often a co-pay of $30.00-$40.00 is required for a 30 minute treatment. That combined with meeting your deductible, and now you are paying more for PT, than if you paid cash.
If you have a high deductible plan, $2000.00 or greater, you are essentially paying out of pocket. Why not make the choice where you want to go? NOT where your insurance or your health network dictates?
With overuse of opioids for the treatment of chronic pain becoming a national public health epidemic, the Centers for Disease Control and Prevention (CDC) released guidelines that recommend nondrug approaches such as physical therapy over long-term or high-dosage use of addictive prescription painkillers.
"Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain," the guidelines state ("CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016" - March 15, 2016). "Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate."
While there are certain conditions - including cancer treatment, palliative care, and end-of-life care - where opioid prescription for chronic pain may be appropriate, the CDC cited numerous cases where opioid use could be significantly reduced or avoided altogether.
"The contextual evidence review found that many nonpharmacologic therapies, including physical therapy, weight loss for knee osteoarthritis, psychological therapies such as CBT (cognitive behavioral therapy), and certain interventional procedures can ameliorate chronic pain," the guidelines state. "There is high-quality evidence that exercise therapy (a prominent modality in physical therapy) for hip or knee osteoarthritis reduces pain and improves function immediately after treatment and that the improvements are sustained for at least 2-6 months. Previous guidelines have strongly recommended aerobic, aquatic, and/or resistance exercises for patients with osteoarthritis of the knee or hip. Exercise therapy also can help reduce pain and improve function in low back pain and can improve global well-being and physical function in fibromyalgia."
Physical therapists partner with patients, their families, and other health care professionals to manage pain, often reducing or eliminating the need for opioids. Research has shown that a simple education session with a physical therapist can lead to improved function, range of motion, and decreased pain.
Before you agree to a prescription for opioids, ask if physical therapy might be right for you.
Working With Combat AthletesSports that involve fighting are among the most challenging and stressful—not to mention dangerous—competitions.Combat athletes compete in many different sports. While some—such as wrestling, boxing, and karate—have been practiced for hundreds or even thousands of years, others, such as mixed martial arts (MMA) and Brazilian jiu jitsu (BJJ), are new to the scene. (The term "combat sports" describes a competition whose essence consists of direct combat between 2 competing athletes.
Similar to athletes in other pro sports—as well as to tactical athletes, including military personnel, police, and firefighters—combat sports athletes' continued employment relies on their physical performance and, ideally, avoiding injury. However, the physical demands of combat sports mean that injuries occur more frequently than in other sports. In MMA, for example, a number of studies have found an injury rate of 24-29 per 100 fight participations.
Both women and men compete in combat athletics. Women compete in judo in the Olympics as well as at other levels; MMA fighter Ronda Rousey was an Olympic judo bronze medalist before transitioning to MMA, where she won the UFC (Ultimate Fighting Championship) women's bantamweight championship. Holly Holm was a professional boxer and kickboxer before defeating Rousey to win the UFC bantamweight championship. Amanda Nunes, the current MMA bantamweight champion, started training in karate at age 7 and pursued training in boxing at the age of 16. She holds a black belt in BJJ and a brown belt in judo. In fact, many women combat athletes have practiced multiple martial arts.
Physical therapists work with these athletes focus on minimizing injuries, addressing those that do occur, and extending the careers of the athletes.
We analyze technique and identify the sources of the movement problem from the individual, then complete manual therapy, stretches, strengthening, and neuromuscular reeducation, and build back up into reintegrating appropriate movement into the specific problem area to maximize performance.
While conditions and injuries for combat sports athletes can vary, the most common injuries are rib injuries, thoracic restrictions, lower back pain, knee pain (frequently meniscal or at the iliotibial band or medial region), hip impingement and pain, ankle sprains, elbow hyperextension (often among "newbies" to their sport, she says), postconcussion headaches, and chronic whiplash.
We can also see a lot of shoulder impingement syndrome (SIS), which frequently occurs because the athletes have been taught to protect their chin while throwing jabs by "putting on a hoodie"—bringing their shoulders up and forward, as if shrugging into a jacket.
Many of these patients stay in 'fight stance,' continuing to cover their chin as they go to their [daytime or salaried] jobs, and the anterior tipping of the scapula will frequently, over time, cause partial supraspinatus tears if not addressed, For these patients, my first goal is to fully normalize thoracic mobility, costal mobility, and cervical mobility through manual interventions. Ribs 1-4 are very frequently restricted in these patients. Soft tissue work and stretching instruction usually is needed."
It's also important to assess lumbar and hip mobility and lumbopelvic stability, as many of these patients are using their upper body to power their punches instead of rotating through their hips and pelvic girdle, and incorporating their whole body in delivering the strike.
Regarding chronic injuries, Lou sees a lot of low back and shoulder pain. Each fighter is different, but a large contributing factor I've seen is from the fighter's posture—rounded shoulders, pitched forward—compounded by the dominant patterns in specific types of combat sports such as wrestling, judo, and jiu jitsu.
In the realm of MMA, the most common injury location is the head and face—predominately the nose, eyes, and jaw regions. This is followed by the lower extremities and then upper extremities.
The upper and lower extremities tend to follow distal to proximal locations with regard to higher injury rate,The hand typically suffers a higher injury rate, followed by the elbow and then the shoulder. The lower extremity follows the same pattern, with the toes having the highest injury rate, followed by the ankle and then the knee. The research shows this across multiple studies.
Combat Sports & Terminology in BriefHere are brief summaries of some of the sports and terms mentioned in this blog .
Boxing, both amateur and professional, involves attack and defense with the fists. Boxers wear padded gloves and generally observe the code set forth in the Marquess of Queensberry rules. Matched in weight and ability, boxing contestants try to land blows while attempting to avoid the blows of the opponent. A boxer wins a match either by outscoring the opponent—points can be tallied in several ways—or by rendering the opponent incapable of continuing the match. Bouts range from 3 to 12 rounds, with each round normally lasting 3 minutes.1
Brazilian Jiu-Jitsu (BJJ) is a martial art and combat sport that teaches a smaller person how to defend himself or herself against a larger adversary by using leverage and proper technique. The Gracie family, founders of BJJ, modified judo and traditional Japanese jujutsu to create the art. It contains stand-up maneuvers but is most known for its ground-fighting techniques. Gaining superior positioning—so one can apply the style's numerous chokes, holds, locks, and joint manipulations to an opponent—is the key in BJJ.2 Fights may be won by submission or by points awarded by the referee.
Chokes are submission moves that apply pressure to the neck, cutting off blood to the brain. A player who does not "tap," or submit, will lose consciousness.3
Joint Locks are moves that apply pressure to a joint and push it in an "unnatural" direction (ie, locking an arm and forcing an elbow backward). This restricts an opponent's movement and/or causes him or her to submit due to pain and/or potential for a hyperextension injury or broken bone.
Jujutsu is a Japanese martial art and method of close combat for defeating an armed and armored opponent while using no weapon or only a short weapon. Because striking an armored opponent proved ineffective, practitioners learned that the most efficient methods for neutralizing an enemy took the forms of pins, joint locks, and throws. These techniques were developed around the principle of using an attacker's energy against him or her, rather than directly opposing it.4
Karate developed out of martial arts forms practiced on Okinawa, an island now part of Japan. The word karate is Japanese for "open hand" (kara means open and te means hand). Te signifies that the main weapon is the body. Instead of an arsenal of swords or guns, the "karateka" cultivates a personal arsenal of punches, kicks, and deflection techniques. Kara relates to the psychology of karate. Karatekas are open to the world around them, making them better equipped to handle any attack.5 Historically, and in some modern styles, grappling, throws, joint locks, restraints, and vital-point strikes also are taught.
Krav Maga is a tactical mixed-martial art/combative and self-defense system that combines boxing, judo, jujitsu, and aikido. It was developed for the Israel Defense Forces and Israeli security forces. The primary goal, to neutralize a threat as quickly as possible, governs all the other principles of Krav Maga. It consists of strikes, holds, and blocks. The fighter looks to combine an offensive movement with every defensive movement.6
MMA (Mixed Martial Arts) is a full-contact sport that allows a variety of fighting styles to be used (including martial and non-martial arts techniques). Striking and grappling techniques, either standing or on the ground, are permitted. The early years of the sport saw a wide variety of traditional styles, but it is now common for fighters to train in multiple styles, creating a more balanced skill set.7 A competitor may win by submitting his or her opponent (forcing the opponent to concede the match), knocking out the opponent, prompting a referee stoppage (technical knockout), accumulating the most points from the judges, or causing an injury that results in a doctor's stoppage.
Muay Thai or Thai boxing is the Thai national sport. In Muay Thai, competitors fight standing as in Western boxing, but elbows, knees, and kicks strikes are allowed, with the only protection being the gloves. An important part of this fighting style is the clinch (standing wrestle).
Seniors wrestle with a variety of medical issues that can make it more difficult to stay steady on their feet. Each year, more than one-third of people age 65 or older fall. Of those who fall, up to 30 percent suffer moderate to severe injuries, such as hip fractures, and increase their risk of early death, according to the CDC. Falls and related injuries can seriously impact a senior’s life, limiting certain activities or even making it impossible to live independently.
Balance exercises are crucial to help prevent falls by improving a person’s ability to control their body. Frequently doing a few simple, at-home exercises will help seniors enhance their coordination and decrease the risk of falling.
One great thing about exercises to improve balance is that they can be done as often as you wish, anytime, anywhere. Before you begin, make sure you have a sturdy chair, person, railing or countertop nearby to hold on to if you feel unsteady. It’s also a good idea to talk to your doctor about any exercise-related concerns. Don’t engage in anything that feels overly uncomfortable.
Here are four balance exercises for older adults:
1. Stand on one foot. We’ll start off simple. Find a sturdy chair to stand behind and hold on to for balance. Lift one foot up and hold it for 10 seconds. Repeat this 10 to 15 times, then switch and do the same thing with the other leg. It may be easier to stand on one leg than the other – this is totally normal. Once you perfect this move, try reaching your raised foot as far as you can out to the front.
2. Walk heel to toe. Start by putting one heel in front of the toes of your other foot. You want your feet to touch. If they can’t touch, get them as close as you comfortably can. Choose a spot in front of you to focus on. Start walking, putting one heel in front of the toes on your other foot. Walk 20 steps like this, staring at your spot for balance.
3. Rock from side to side. For this exercise, begin by placing your feet hip width apart, pressing into the ground with the same force in each foot. Slowly transfer your weight to one side, lifting the opposite foot. Hold it up for for 20-30 seconds. Transfer the weight back into both feet and repeat on the other side. Repeat this process five times on both legs.
4. Balance walk. Pretend you’re a tightrope walker in the circus. Raise your arms out to your sides, parallel to the floor. Choose a spot ahead to focus on and walk towards. Start walking in a straight line. As you walk, lift your back leg up and hold it for a few seconds. Repeat this while alternating legs, walking 20 steps.
As your balance gets better, you can modify these exercises to make them more difficult. To challenge yourself, try holding onto the chair with only one hand. With time, try holding on with only one finger and, finally, with no hands. Once you’re steady on your feet, try doing the exercise with your eyes closed.
As you age, it’s important that you are able to balance well. Steady balance is essential to avoiding dangerous falls. Start small, doing a few repetitions of these exercises every couple days, gradually allowing your coordination to get better. Staying active will help keep you or your senior loved one’s body and mind healthy and happy.
Start using these balance exercises for fall prevention today.
Questions? Feel free to call us at 858-792-1124 or email us at firstname.lastname@example.org today
If arthritis is limiting your activities, a physical therapist can help.
A physical therapist (PT) can help you get moving safely and effectively. Physical therapists are licensed professionals with graduate degrees and clinical experience who examine, diagnose and treat or help prevent conditions that limit the body's ability to move and function in daily life, according to the American Physical Therapy Association (APTA).
Physical therapy focuses on the body’s ability to engage in movement. Movement can be anything from getting in and out of chairs to climbing stairs, walking in your neighborhood, playing a sport or doing recreational activities.
Goals of physical therapy in arthritis include improving the mobility and restoring the use of affected joints, increasing strength to support the joints, and maintaining fitness and the ability to perform daily activities.
What Can a Physical Therapist Do for You?
Develop an individualized plan of exercises to improve flexibility, strength, coordination and balance to achieve optimal physical function.
The goal of a physical therapy session is to teach you how to do things in your treatment plan – such as performing certain exercises, or how to best use hot/cold compresses – for yourself. The visits are often short and focus on identifying problems with your physical function and giving strategies for care that you can do at home.
The key to a successful outcome is learning the exercises from a physical therapist and practicing them at home over the long term. Improvement is gradual – the body gets stronger and more adept slowly over time – so consistent practice is essential.
When visiting the PT, think clearly about what your complaint is and what you would like to be able to do after physical therapy. Your goal can be getting in and out of your car without pain, raising up on your toes or raising your arms to reach items in your kitchen cabinets, taking a walk or performing your job without pain in the hips, knees and feet. Your PT can then work with you to develop a plan that is right for you to achieve your goals.
Preoperative Physical Therapy Results in 'Significant' Reduction in Postoperative Care Use for Patients Undergoing Hip or Knee Replacement
A new study has found that as few as 1 to 2 sessions of preoperative physical therapy can reduce postoperative care use by 29% for patients undergoing total hip or knee replacement, adding up to health care cost savings of more than $1,000 per individual.
Researchers in Ohio reviewed 4,733 Medicare cases involving total hip or knee replacement from a combination of 169 rural and urban hospitals with wide geographic distribution, and found that 79.7% percent of patients who did not receive preoperative physical therapy required postacute care services. That rate dropped to 54.2% for patients who received even a small number of physical therapy sessions before surgery. The study was e-published ahead of print in the Journal of Bone and Joint Surgery (abstract only available for free).
After adjusting for demographic variables and comorbidities, the study's authors estimated a 29% reduction in postoperative care use among the preoperative physical therapy group, which translated into adjusted cost reductions of $1,215 "driven largely by reduced payments for skilled nursing facility and home health agency care."
Patients with at least 1 billed encounter using CPT codes designating physical therapy evaluation or self-care/home management training were included in the preoperative group, providing they had received the service within 30 days of their surgeries.
Researchers believe that the benefit of preoperative physical therapy was derived mostly from the way it prepared patients for postoperative rehabilitation. In most instances studied, they write, preoperative physical therapy was limited to 1 or 2 sessions, which "suggests that the value of preoperative physical therapy was primarily due to patient training on postoperative assistive walking devices, planning for recovery, and managing patient expectations, and not from multiple intensive training sessions to develop strength and range of motion."
"Our study demonstrates a significant reduction in postacute care use associated with the use of physical therapy during the preoperative period for total joint replacement surgery," authors write, adding that in settings where replacement surgery has been recommended by an orthopedic surgeon, "physical therapy appears to provide value within the structure of a standardized preoperative joint replacement education and planning program in which physical therapists may play an important role."
While researchers acknowledge that more work needs to be done to pinpoint the best way to balance resource allocation between pre- and postoperative activities, they cite the current study's findings as a good first step in refining new models of care.
"As payments in health care move from a fee-for-service basis to more global payments that require some risk sharing by providers," authors write, "the ability to manage populations across the continuum to high-quality outcomes at low cost will be imperative."
It’s important to maintain exercise, especially as you age. As physical therapists, you may be seeing more active seniors looking to stay fit after injuries or orthopedic surgery.
But active seniors who are keen on keeping their bodies fit may be signing up for gym classes or doing routines that are no longer safe. Think of all those Zumba classes or senior weight training classes. Who knows if the instructors are aware of their medical conditions and past injuries.
This can lead to serious complications and even new injuries that can derail a fitness program.
Since active seniors have different exercise needs than a younger population, it might be difficult to determine what kind of program would best serve them. Can they be well-managed by a personal trainer? Or are they better off with a physical therapist? Both are needed, It’s just that they both have different roles.
The Role Of Personal Training
Personal training is a structured workout program that allows clients to exercise on a regular basis under supervision to maximize results.
The Role Of Physical Therapy
Our Physical therapists rehabilitate and educate patients who are hurt and return them to their regular routine, skillfully providing treatment plan designed to correct dysfunctional movement and return Seniors to their previous level of function, inclusive of a daily workout routine to maintain the progress they made during therapy.
Issues With Pain And Mobility
Seniors who struggle with pain, balance, and coordination, and who need rehabilitation are best suited for physical therapy.
Personal trainers are trained to help patients improve their fitness level, not heal injuries or deal with pathology. The danger in relying solely on a personal trainer is if they push a patient too far beyond their limits, there is a risk for injury. There should be a team approach, and we seeing a physical therapist when there’s an existing condition that makes exercise hard. Some preexisting conditions that need to be taken into consideration, extremity asymmetry, gout, or swelling in their knees or other joints that limits normal range of motion. This can also apply to seniors with neurological disorders like Parkinson’s.
It’s A Team Effort
Personal trainers are no replacement for physical therapists and vice versa. However, both have important roles to play in maintaining health as people age.To decide if a patient needs a personal trainer or physical therapist, take into account their fitness level, their health (if their bones or muscles are injured), and their goals (fitness or rehabilitation).When you have an injury, it's always best to see a physical therapist first. Your physical therapist will devise a treatment plan, which may include working with a qualified personal trainer or clinical exercise specialist.
There are many veins and nerves in our anatomy and many times they get affected and cause the pain. There is one major nerve called sciatic nerve that is made with tiny roots of nerves that comes from lower back area of spine. When this nerve is compressed a medical issue arises that is called sciatica. Today the majority of the people are aware of this condition and also the treatments because it is common to get affected by this condition. Physical therapy is the most remedy to relieve the apian in the patients. There are many physiotherapists who can help you out.
Physical therapy for sciatica
It is very simple to get this treatment, but it is also important that you consult a professional sciatic nerve therapist for this condition. It is important to consult one first. Professionals are going to educate the patients, which is another important thing. After that they are trained with the accurate moments. The sciatica physical therapy includes forces, manipulation of frequency like things and all this is done by the therapists in the right way. This therapy has become very popular among the patients because the oxygen amount in the blood is also increased. This increase in the blood circulation and relieves the pains to a great extend. In case patients are suffering from oxygen deprived sciatica, then this is the best for them.
More to learn
Physical therapy as you know is the best treatment to ease the sciatic nerve pain. Experts are going to tell you about several; treatment plans, exercise, stretches that these treatments are very effective and takes less time to heal the patient. Today we all are living busy lives and it s hard to get out time for regular therapy appointments. It is also going to be tiresome and exhausting. The patient must be commitment to them and follow the program step by step to get the results.
There are top notch benefits of the physical therapy and you are going to learn various types of exercises and stretches on the daily basis. You will have to follow them step by step. Therapist is having lots of experiences and they can understand your needs the better. They can eliminate pain as much as they can. If you need to heal faster than overall outcomes are going to depend upon you totally. There are doctors and therapists both available and he choice is going to depend all upon you, which you are going to choose. You must prepare a goal sheet and this is going to keep you busy and motivated.
It is possible to get rid of the sciatica and get rid of the pain. You will be able to do all the things which you love to-do. You are going to be back on your feet and will run all over. You just have to make sure that you are choosing the right therapist for your condition to get the treatment and heal faster and in the more effective way.
Many patients arrive at their first physical therapy appointment expecting to receive hot packs, ultrasound and instructions on how to complete a series of exercises. These modalities are warranted in many instances and most therapists would agree that exercise is needed to help restore muscle imbalances. However, many therapists now approach the restoration of function from a different perspective. These therapists are interested in why a muscle isn't functioning properly and view back exercise not as the driving mode of recovery but as a complement to manual therapy. They may, for instance, look to restore proper sacroiliac or lumbar joint function to treat piriformis syndrome rather then directly manipulate the piriformis muscle through exercise.
Manual physical therapy is a specialized form of physical therapy delivered with the hands as opposed to a device or machine. In manual therapy, practitioners use their hands to put pressure on muscle tissue and manipulate joints in an attempt to decrease back pain caused by muscle spasm, muscle tension, and joint dysfunction.
Manual Physical Therapy is Less Established for Back Pain Management
While all physical therapists have the option to use manual therapy in their practices, many don't spend the time or the resources to become efficient in this area of practice. Patients should be aware that it is a lesser known physical therapy technique among physicians and may not be as commonly prescribed. Also, many of the conditions that practitioners treat with manual therapy are not demonstrated with imaging or lab tests but rather during motion testing and treatment, and therefore insurance company reimbursement may be limited.
While patients may be referred for physical therapy treatment by their primary care doctor, an orthopedic surgeon, or other doctor involved in their back care, most states have direct access laws permitting patients to seek help for low back pain from a licensed physical therapist without having to seek a written referral.
Manual therapy can be helpful for the treatment of joints that lack adequate
mobility and range of motion in certain musculo-skeletal conditions. This
limitation can cause discomfort, pain, and an alteration in function, posture,
and movement. Manual physical therapy involves restoring mobility to stiff joints and reducing muscle tension in order to return the patient to more natural movement without pain. Thus, manual physical therapy may provide back pain relief both for patients with chronic back pain involving joint problems, such as sacroiliac joint dysfunction, and acute back pain from soft tissue injuries such as a back muscle strain or a pulled back ligament. Although extensive clinical studies have yet to be performed on all areas of manual therapy, limited clinical data and patient reports support the assertion that manual physical therapy can be effective in relieving back pain for certain patients.
As a group, manual physical therapy techniques are aimed at relaxing tense back muscles and restricted joints in order to decrease back pain and increase flexibility. In general, manual physical therapy techniques employ the following types of movement:
Kenneth Mauck, MPT, MS Lead Physical Therapist