Pain and pregnancy: How physical therapy helps
British Journal of Sports Medicine: Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline
What you need to know
We make a strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease, based on linked systematic reviews; further research is unlikely to alter this recommendation
This recommendation applies to patients with or without imaging evidence of osteoarthritis, mechanical symptoms, or sudden symptom onset
Healthcare administrators and funders may use the number of arthroscopies performed in patients with degenerative knee disease as an indicator of quality care.
Knee arthroscopy is the most common orthopaedic procedure in countries with available data
This Rapid Recommendation package was triggered by a randomised controlled trial published in The BMJ in June 2016 which found that, among patients with a degenerative medial meniscus tear, knee arthroscopy was no better than exercise therapy
What is the role of arthroscopic surgery in degenerative knee disease? An expert panel produced these recommendations based on a linked systematic review triggered by a randomised trial published in The BMJ in June 2016, which found that, among patients with a degenerative medial meniscus tear, knee arthroscopy was no better than exercise therapy. The panel make a strong recommendation against arthroscopy for degenerative knee disease.
Box 1 shows all of the articles and evidence linked in this Rapid Recommendation package. The infographic provides an overview of the absolute benefits and harms of arthroscopy in standard GRADE format. Table 1 below shows any evidence that has emerged since the publication of this article.
Box 1
Linked articles in this BMJ Rapid Recommendations cluster
Siemieniuk RAC, Harris IA, Agoritsas T, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ 2017;257:j1982. doi:10.1136/bmj.j1982
Summary of the results from the Rapid Recommendation process
Brignardello-Peterson R, Guyatt GH, Schandelmaier S, et al. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open 2017;7:e016114. doi:10.1136/bmjopen-2017-016114
Review of all available randomised trials that assessed the benefits of knee arthroscopy compared with non-operative care and observational studies that assessed risks
Devji T, Guyatt GH, Lytvyn L, et al. Application of minimal important differences in degenerative knee disease outcomes: a systematic review and case study to inform BMJ Rapid Recommendations. BMJ Open 2017;7:e015587. doi:10.1136/bmjopen-2016-015587
Review addressing what level of individual change on a given scale is important to patients (minimally important difference). The study informed sensitivity analyses for the review on net benefit, informed discussions on patient values and preferences, and was key to interpreting the magnitude of effect sizes and the strength of the recommendation
MAGICapp (www.magicapp.org)
Expanded version of the results with multilayered recommendations, evidence summaries, and decision aids for use on all devices
Table 1
New evidence which has emerged after initial publication
DateNew evidenceCitationFindingsImplications for recommendation(s)There are currently no updates to the article
Current practice
Approximately 25% of people older than 50 years experience knee pain from degenerative knee disease (box 2).1 2 Management options include watchful waiting, weight loss if overweight, a variety of interventions led by physical therapists, exercise, oral or topical pain medications such as non-steroidal anti-inflammatory drugs, intra-articular corticosteroid and other injections, arthroscopic knee surgery, and knee replacement or osteotomy. The preferred combination or sequence of these options is not clear and probably varies between patients.
Box 2
What is degenerative knee disease?
Degenerative knee disease is an inclusive term, which many consider synonymous with osteoarthritis. We use the term degenerative knee disease to explicitly include patients with knee pain, particularly if they are >35 years old, with or without:
Imaging evidence of osteoarthritis
Meniscus tears
Locking, clicking, or other mechanical symptoms except persistent objective locked knee
Acute or subacute onset of symptoms
Most people with degenerative arthritis have at least one of these characteristics.14 The term degenerative knee disease does not include patients having recent debut of their symptoms after a major knee trauma with acute onset of joint swelling (such as haemarthrosis)
Knee replacement is the only definitive therapy, but it is reserved for patients with severe disease after non-operative management has been unsuccessful.3 4 Some believe that arthroscopic debridement, including washout of intra-articular debris, with or without arthroscopic partial meniscectomy to remove damaged meniscus, may improve pain and function.
Current guidelines generally discourage arthroscopy for patients with clear radiographic evidence of osteoarthritis alone, but several support or do not make clear statements regarding arthroscopic surgery in other common groups of patients (table 2).
Table 2
Support from current guidance for arthroscopic surgery in patients with subgroups of degenerative knee disease
Lavage or debridementPartial meniscectomy for meniscal tearsPatients with radiographic osteoarthritisPatients without radiographic osteoarthritisPatients with mechanical symptomsPatients with evidence of osteoarthritisPatients without evidence of osteoarthritisAAOS24AgainstSupportiveSupportiveSupportiveSupportiveNICE25 26AgainstAgainstForNo commentNo commentBOA27*AgainstForForNo commentForAOA28*AgainstNo commentNo commentAgainstForOARSI29 30AgainstNo commentNo commentSupportiveNo comment
For= Explicit statement that arthroscopy should be performed in some patients.
Against= Explicit statement that arthroscopy should not be performed in some patients.
Supportive= Seemingly supportive of arthroscopy in some contexts.
*Official statement, not guidelines.
AAOS, American Academy of Orthopaedic Surgeons; AOA, Australian Orthopaedic Association; BOA, British Orthopaedic Association; ESSKSA, European Society for Sports Traumatology, Knee Surgery and Arthroscopy; NICE, National Institute of Health and Care Extdence; OARSI Osteoarthritis Research Society International.
Arthroscopic knee surgery for degenerative knee disease is the most common orthopaedic procedure in countries with available data5 and on a global scale is performed more than two million times each year (figure 1).6–9 Arthroscopic procedures for degenerative knee disease cost more than $3bn per year in the US alone.10 A high prevalence of features advocated to respond positively to arthroscopic surgery (such as meniscal tears, mechanical symptoms, and sudden symptom onset) as well as financial incentives may explain why arthroscopic knee surgery continues to be so common despite recommendations against its use for osteoarthritis. Further, patients may be frustrated with their symptoms, having tried several less invasive management strategies by the time that they see the surgeon, and in many cases this may come with an expectation for surgical management. Moreover, many patients experience important and marked improvements after arthroscopy, which may be erroneously attributed to the effects of the procedure itself instead of the natural course of the disease, co-interventions, or placebo effects.
Population adjusted trends in frequency of knee arthroscopy; percent. Arthroscopic knee surgery remains common despite accumulating evidence suggesting little benefit.
The evidence
The panel requested two systematic reviews to inform the recommendation.11 12
The systematic review on the net benefit of knee arthroscopy compared with non-operative care pools data from 13 randomised trials for benefit outcomes (1668 patients) and an additional 12 observational studies for complications (>1.8 million patients).12 Figure 2 gives an overview of the patients included, the study funding, and patient involvement in the design of the studies.
Characteristics of patients and trials included in systematic review of arthroscopic knee surgery.
Panel members identified three outcomespain, function, and quality of lifeas the most important for patients with degenerative knee disease who are considering surgery. Although the included studies reported these patient-important outcomes, it is difficult to know whether changes recorded on an instrument measuring subjective symptoms are important to those with symptomsfor example, a ch ange of three points might have completely different meanings in two different pain scales.
Therefore, a second team performed a linked systematic review addressing what level of individual change on a given scale is important to patients,11 a characteristic called the minimally important difference (MID).13 The study identified a range of credible MIDs for each key outcome; this range of MID estimates informed sensitivity analyses for the review on net benefit, informed discussions on the patient values and preferences, and was key to interpreting the magnitude of effect sizes as well as the strength of the recommendation.11
Understanding the recommendations
The infographic provides an overview of the benefits and harms of arthroscopy in standard GRADE format. Estimates of baseline risk for effects comes from the control arms of the trials; for complications, comparator risk was assumed to be nil.
The panel is confident that arthroscopic knee surgery does not, on average, result in an improvement in long term pain or function. Most patients will experience an important improvement in pain and function without arthroscopy. However, in <15% of participants, arthroscopic surgery resulted in a small or very small improvement in pain or function at 3 months after surgerythis benefit was not sustained at 1 year. In addition to the burden of undergoing knee arthroscopy (see practical issues below), there are rare but important harms, although the precision in these estimates is uncertain (low quality of evidence).
It is unlikely that new information will change interpretation of the key outcomes of pain, knee function, and quality of life (as implied by high to moderate quality of evidence).
The panel is confident that the randomised controlled trials included adequate representation from groups commonly cited to derive benefit from arthroscopic knee surgery for degenerative knee diseasenotably those with meniscal tears, no or minimal radiographic evidence of osteoarthritis, and those with sudden but non-traumatic symptom onset. Thus the recommendation applies to all or almost all patients with degenerative knee disease. Further, the evidence applies to patients with any severity of mechanical symptoms, with the only possible exception being those who are objectively unable to fully extend their knee (that is, a true locked knee). We did not consider young patients with sports related injuries or patients with major trauma in any age.
Trials that enrolled a majority of patients without radiographic osteoarthritis showed similar effect sizes to trials enrolling patients with radiographic evidence of osteoarthritis. Most of these trials exclusively included patients with meniscus tears. Meniscus tears are common, usually incidental findings, and unlikely to be the cause of knee pain, aching, or stiffness.14 Mechanical symptoms were also a prominent feature for most trial participants, and many had sudden or subacute onset of symptoms.15–18 Given that there is evidence of harm and no evidence of important lasting benefit in any subgroup, the panel believes that the burden of proof rests with those who suggest benefit for any other particular subgroup before arthroscopic surgery is routinely performed in any subgroup of patients.
Practical issues
It takes between two and 6 weeks to recover from arthroscopy, during which time patients may experience pain, swelling, and limited function.19 20 Most patients cannot bear full weight on the leg (that is, they may need crutches) in the first week after surgery, and driving or physical activity is limited during the recovery period.19 Figure 3 outlines the key practical issues for those considering arthroscopic knee surgery versus non-surgical management for degenerative knee disease.
Practical issues about use of arthroscopic knee surgery versus non-surgical management for degenerative knee disease.
Degenerative knee disease is a chronic condition in which symptoms fluctuate. On average, pain tends to improve over time after seeing a physician for pain,12 21 and delaying knee replacement is encouraged when possible.3
Values and preferences
Our strong recommendation against arthroscopy reflects a low value on a modest probability (<15%) of small or very small improvement in short term pain and function that does not persist to 1 year, and a higher value on avoiding the burden, postoperative limitations, and rare serious adverse effects associated with knee arthroscopy. The panel, including the patient participants, felt that almost all patients would share these values. The recommendation is not applicable to patients who do not share these values (that is, those who place a high value on a small, uncertain, and transient reduction in pain and function, and a low value on avoiding the burden and postoperative limitation associated with arthroscopy).
Costs and resources
The panel focused on the patient perspective rather than that of society when formulating the recommendation. However, implementation of this recommendation will almost certainly result in considerable cost savings for health funders. A rigorous economic analysis found that knee arthroscopy for degenerative knee disease is not close to cost effective by traditional standards, even in extreme scenarios that assume a benefit with arthroscopy.22 The panel made a strong recommendation against arthroscopy, which applies to almost all patients with degenerative knee disease, implying that non-use of knee arthroscopy can be used as a performance measure or tied to health funding.23
Future research
Key research questions to inform decision makers and future guidelines are:
Randomised trials—Does arthroscopic knee surgery benefit patients who are objectively unable to fully extend their knee or who have persistent, severe, and frequent mechanical symptoms?
Implementation studies—What are the most effective ways to reduce the overuse of arthroscopic surgery for degenerative knee disease?
Updates to this article
Table 1 shows evidence which has emerged since the publication of this article. As new evidence is published, a group will assess the new evidence and make a judgement on to what extent it is expected to alter the recommendation.
How patients were involved in the creation of this article
Three people with lived experience of osteoarthritis, one of whom had arthroscopic knee surgery, were full panel members. These panel members identified important outcomes and led the discussion on values and preferences. Pain was weighed as higher importance for most patients: for example, the patient panel members felt that a possible small benefit to function without a reduction in pain would be unimportant to almost all patients. Those with lived experience identified key practical issues including concerns with cost and accessibility for both arthroscopy and interventions provided by physiotherapists. The members participated in the teleconferences and email discussions and met all authorship criteria.
How the recommendation was created
A randomised controlled trial published in The BMJ in June 2016 found that, among patients with a degenerative medial meniscus tear, knee arthroscopy was no better than exercise therapy.32 This study adds to the body of evidence suggesting that the benefits of arthroscopy may not outweigh the burden and risks.33 34 The RapidRecs executive felt that the study, when considered in context of the full body of evidence, might change practice.35
Our international panel including orthopaedic surgeons, a rheumatologist, physiotherapists, a general practitioner, general internists, epidemiologists, methodologists, and people with lived experience of degenerative knee disease (including those who had undergone and those who had not undergone arthroscopy) met to discuss the evidence. No person had financial conflicts of interest; intellectual and professional conflicts were minimised and managed (see online appendix 1 on bmj.com).
The panel followed the BMJ Rapid Recommendations procedures for creating a trustworthy recommendation35 36 and used the GRADE approach to critically appraise the evidence and create recommendations (see online appendix 2).37 The panel considered the balance of benefits, harms, and burdens of the procedure, the quality of evidence for each outcome, typical and expected variations in patient values and preferences, and acceptability. Recommendations can be strong or weak, for or against a course of action.
Supplementary Appendix 1
bjsports-2017-j1982repsupp001.rtf
Education into practice
Project: how many arthroscopic procedures are scheduled in your organisation for degenerative knee disease?
Based on the information you have read in this article or in this package of Rapid Recommendation articles, is there anything which you might alter your practice?
To what extent might you use information in this article to alter the conversations you have with patients with degenerative knee disease, or those considering arthroscopic surgery?
Acknowledgments
We thank Alison Hoens for critical review of the recommendation and manuscript. We also thank Tahira Devji for expertly leading the systematic review of minimally important differences.
Footnotes
Disclaimer: This infographic is not a validated clinical decision aid. This information is provided without any representations, conditions or warranties that it is accurate or up to date. BMJ and its licensors assume no responsibility for any aspect of treatment administered with the aid of this information. Any reliance placed on this information is strictly at the user’s own risk. For the full disclaimer wording see BMJ’s terms and conditions.
Competing interests: All authors have completed the BMJ Rapid Recommendations interests disclosure form, and a detailed, contextualised description of all disclosures is reported in appendix 1. As with all BMJ Rapid Recommendations, the executive team and The BMJ judged that no panel member had any financial conflict of interest. Professional and academic interests are minimised as much as possible, while maintaining necessary expertise on the panel to make fully informed decisions.
Provenance and peer review: Not commissioned; externally peer reviewed.
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Lower Back Pain While Walking? Here's Why
5 Reasons Why Your Lower Back Hurts When You Walk
As a lower back pain (LBP) and spine care team of specialists, we have worked with thousands of people suffering with LBP. In addition, we have seen every possible intervention known to man. Through our experiences, we know factually that the number one difficulty when someone has back pain is walking. Why is LBP so prevalent with walking? We’re here to share with you why that is. Here are the 5 most common reasons why walking is so hard and painful when your back hurts.
Poor Hip Mobility. With every step we take our hip and pelvis move in three planes of motion. If we have any lack of motion in our hip it will cause the spine to move more than it is designed to move. Over time this increased motion (instability) can begin to create inflammation and compression of the nerves that exit the spine. This leads to sciatica and lower back pain.
Limited Foot and Ankle Mobility. When our foot hits the ground when we are walking, studies demonstrate that the body needs to absorb 2-3 times our body weight in forces. Those forces end up traveling up into the spine. If the foot is stiff and does not flatten when we walk like it is designed to do it will cause an increase in forces transmitted into the spine. The increased forces cause increased compression and can irritate the joints and nerves in the spine.
Decreased Hip Strength. It is very common to see people walking with a slight limp or lean to one side when the foot lands on the ground. This is an indicator that the lateral part of the hip is weak (gluteus medius). When this happens, the body compensates by leaning to that side. When the body leans to that side it causes compression of the nerves on the same side of the spine.
Stiff Ribs, Thorax and Upper Back. With every step we take we also have an arm swing in the opposite direction. This arm swing causes our upper back to rotate. If we have limited upper back rotation it will cause increased rotation in the lower back. This increased rotation can lead to increased compression and irritation to the joints and nerves in the spine.
Stenosis or Arthritis in the spine. Research indicates that if you are over 55 years old, have pain in your lower back while walking or standing and it goes away when you sit, there is a 97% chance you have arthritis in your spine. This arthritis predisposes you to have pain with walking in your spine.
If you address and resolve all of the things we have mentioned, then you can walk without pain even when you have stenosis or arthritis in the spine. Don’t let it be an excuse. Just know it is one of the 5 reasons why your back may hurt when you walk.
If you would like to learn more about Lower Back Pain and Sciatica and successful strategies to reduce pain and allow for pain free walking you should consider attending our lower back pain and sciatica workshops or you can click the link below to learn more about our specialty spline care: Mark Bengtson, Pinnacle PT
Lower Back Pain and Sciatica Treatment
https://pinnaclephysicaltherapy.org/become-a-patient
Are your shoes right for your feet?!! What should I look for in a good shoe?
Being able to move through our busy lives without pain is one of the most important prerequisites to the enjoyment of life - to have the freedom to do what brings us joy. The team at Pinnacle Physical Therapy has several of the most experienced and skilled physical therapists in the region. One of the most common recommendations from our team of experts emphasizes the importance of wearing good, supportive shoes that will provide guidance for optimal postural alignment, mobility and stability when we spend time on our feet (which is the majority of our day for most of us!).
How do you choose your footwear? What do you consider when buying shoes? Do your shoes provide protection for your feet, or are they mostly a fashion statement? Would you choose shoes that provide support for your legs, spine and body? If you are unlucky enough to have foot, knee, hip or spine pain, the shoes you choose for your feet will have a BIG impact on your pain levels and success with correcting these problems.
According to colleagues of ours at the Postural Restoration Institute, the type of shoe we wear can literally make or break our interaction with the ground and how we feel during our daily activities. Shoes vary dramatically in how they are made. Some are very thin and do not have much support. Some are overly stiff and do not allow us to feel the ground effectively. Shoes can be categorized like cars. Within the same name brand, the manufacturer can offer shoes of basic design to a more sophisticated design.
Everyone enjoys wearing fashionable shoes from time to time. However, the narrow toe boxes, high/narrow heels, poor arch supportive shoes can cause damage to our feet and transfer increased pressures to our knees, hips, low back and spine. According to Harvard Women's Health Watch Article in August 2013: "A 2012 study found that habitual high heel wearers have shorter strides, permanently flexed toes, and stunted calf muscles that leave them more prone to injury." When our feet hurt, we are less likely to be active or exercise to stay healthy.
Habitual wearing of poorly supported, narrow toed shoes can also lead to bunions (large painful bony bumps on the inside joint of our big toe), plantar fasciitis (painful stabbing in the heel and arch of the foot), ingrown toenails (toes being crowded by narrow shoes cause the nail to grow into the skin and can become infected and painful), corns (thickened skin from abnormal pressure), and hammertoes (toes that are pushed back and bend in the middle from overcrowding). When we choose a lower quality shoe, we lose control of our heel bones and inside arch of our foot. This problem allows our feet to roll too far inwardly or outwardly. Substitution in movement patterns when wearing improper shoes as we walk, exercise, work or play can lead to increased chance for injuries, pain development, fatigue or balance issues. When our feet lose their proper alignment, our knees, hips, low back, ribs, shoulders, neck and even our jaw has to adjust to compensate for the loss of coordinated balance being projected all the way up the line. On the other hand, wearing a good shoe can help to effectively impact your joints in a positive way to correct abnormal pain patterns or balance issues.
What does a good shoe feel and look like?
First, and foremost, your shoes should be comfortable right out of the box. No wearing in times should be necessary with quality, well fitting shoes. IN addition, an article in the Journal of the American Geriatrics Society supports the recommendation that wearing good athletic/running shoes can reduce your risk for falls. Whatever you choose, try to keep the heel low and solid. Look for soles that are not slick or smooth but have non slip qualities. Pinnacle Physical Therapy posts a recommended shoe list on our website, www.pinanclephysictherapy.org. This list is updated 1-2 times each year (see the link below). The shoe recommendations are based on the research done by the experts at the Postural Restoration Institute and the recommendations of the skilled team at Pinnacle Physical Therapy.
Choosing shoes is very personal and you can choose the style that fits you best. We do, however, recommend that you take the following into consideration when choosing a shoe:
A rigid, snug heel counter - the back of the shoe that wraps around the back of the heel. It shouldn’t bend when pinched or folded inward. The heel should be held snugly without slipping, giving the rest of our body guidance with each step.
A level heel at the back of the shoe that is of the same density of material on the inside and outside of the foot when viewed from the back.
A flexible forefoot that bends where the toes bend when a step is taken and not in the midfoot region.
A roomy toe box so the toes have plenty of room to spread out and wiggle.
A midfoot that doesn’t bend or twist excessively when pressure is applied, to protect and support the arch of your foot.
An arch on the inside of the shoe that can be “sensed” when walking and that supports the height of your arch so it does not collapse when walking. Most shoes do not have high enough arch support to fit the average arch. People with higher arches tend to suffer even more.
We encourage you to ask your physical therapist about which shoe is best for you. The skilled therapists at Pinnacle Physical Therapy will be happy to assist you or your family and friends to get into the best shoe for each person to maximize your comfort and control throughout your daily activities.
To read more or download a copy of the 2020 recommended shoe list click the following link:
Compression Therapy for Recovery
Recovery may be the biggest trend in fitness and sports performance. It’s not uncommon to experience muscle soreness or tension following intense training or the initiation of a new exercise regime.
Some soreness can be good, and even necessary, if you or your client have the goal of inducing muscle hypertrophy and increasing strength and performance.
But soreness that lingers can have a negative impact on subsequent workouts, games, and practices. Finding ways to promote recovery and minimize time spent in a phase of muscle deterioration is critical for high-level athletes, or anyone looking to optimize their performance and training.
One of the more popular methods of enhancing recovery is compression therapy.
In this article, we’re going to take a look at the efficacy of Normatec compression therapy, a fairly new phenomenon that many athletes and those in fitness are excited about as a means to achieving this goal.
How does Normatec Compression Therapy Work?
Normatec compression boots extend from the toes to the top of the femur and also have attachments for the hips or lower back. Each boot has five chambers that fill with air working in a distal to proximal sequence.
This setup is meant to assist the function and sequence with which our veins, musculature, and lymphatic system work. The goal is to clear deoxygenated blood and metabolic waste centrally to be filtered and re-oxygenated by the central organs.
Normatec does this by compressing different portions of the extremity in a sequential manner.
This is meant to create an environment favorable to a quicker recovery, as well as several proposed benefits:
Reduction in swelling
Improved tissue perfusion
Increase in total hemoglobin and oxygenated hemoglobin in muscle
Improved range of motion
Decrease in pain pressure threshold
Decreased muscle fatigue
Promotes relaxation
What Does the Research Say?
There seems to be enough evidence to support the theory that Normatec significantly helps reduce blood lactate levels following short bursts of high intensity exercise.
In a study of 21 D1 female athletes at Northeastern University, it was found that Normatec compression was comparable to forms of active recovery, and significantly more effective than passive recovery, in clearing blood lactate following a one-minute all-out sprint on a bicycle. In this study, passive recovery meant sitting stationary, while active recovery meant easy bike riding at 40% HRR.
Findings included:
Mean blood lactate pre-bike ride: 1.70 mM/L
Mean blood lactate immediately post bike ride: 9.94 mM/L
Post recovery blood lactate measurements
Passive recovery = 12.61 mM/L
Active Recovery = 7.49 mM/L
Normatec Recovery = 8.38 mM/L
Normatec and active recovery were effective in reducing blood lactate levels, while those who underwent passive recovery experienced a further increase in blood lactate levels.
I would be curious to see a fourth group where blood lactate measurements were taken in a group who partakes in a short 40% HRR bike ride followed by Normatec. I would guess that blood lactate levels would be even lower than active recovery or Normatec alone.
Nonetheless, this study strongly suggests that compression therapy is an appropriate means to help reduce blood lactate levels, and possibly help reduce fatigue and soreness, following a workout.
Further benefits on the cellular level include an increase in oxygenated and total hemoglobin levels following use of Normatec compression boots.
One study examined hemoglobin levels before and after the use of Normatec compression and they found a 42% increase in oxygenated hemoglobin and a 138% increase in total hemoglobin for the intervention group in comparison to the control group.
The authors of the study propose that this is primarily beneficial because Normatec helps to bring an influx of oxygen, nutrients, and proteins to the cells, which helps promote healing and recovery. This likely occurs due to compression causing the endothelial cells to stretch, which triggers a release of nitric oxide resulting in dilation of blood vessels.
In a different study, Weiner et al demonstrated a mean power frequency significantly higher under EMG analysis in the tibialis anterior following Normatec use in comparison to the contralateral leg acting as the control and not receiving Normatec. The power output of the tibialis anterior was compared to a pre-test measurement following fatigue of the dorsiflexors by maintaining suspension of a 10 kg weight around the foot. These same results were found regardless of which leg underwent compression as a form of recovery in follow-up trials.
The authors theorized that the improved performance was due to an increase in perfusion to local tissue following the use of Normatec. Regardless, this is evidence that Normatec can be a useful tool to help athletes maintain desired muscle function and prevent excessive fatigue following strenuous workouts.
Finally, two studies performed by Sands et al, demonstrated observable improvements in both increasing range of motion and decreasing pain pressure threshold following the use of Normatec.
In the first study, Dr. Sands and the authors explain that the US Olympic Training Center received Normatec compression boots as a donation. Interestingly, many of the athletes stated that they were experiencing noticeable, rapid increases in range of motion after sessions with Normatec.
From there, they decided to design a formal study with nine college-age female dancers who are accustomed to being in positions of extreme range of motion. The anecdotal claims were confirmed in the research results. The dancers gained notable increases in motion in the forward split position following the use of Normatec in comparison to the control.
The authors discuss how these findings likely are best explained by the result of neuroalteration, and not a change in muscle quality or muscle length. This is a good reminder that there are several ways to help athletes achieve increased mobility besides static and dynamic stretching and this can be especially helpful for athletes who need increased end range motion, such as gymnasts, dancers, or ice hockey goaltenders.
This study also suggests that Normatec can be a useful adjunct in a physical therapy clinic for clients who may struggle with movements like a hinge or squat due to decreased mobility. Starting a session with Normatec may be helpful to gain range and successfully move through these major movement patterns.
The second study by Sands demonstrated a decrease in muscle soreness, demonstrated by a decrease in pain pressure threshold, following the use of Normatec in comparison to pre-test measurements and the control. The authors discussed how early stages of edema after muscle microtrauma from exercise results in decreased tissue clearance due to the magnitude of extracellular fluid and the compromised status of the lymphatic vessels. The authors further theorized that compression therapy helps assist the vessels and lymphatic system clear out extracellular waste following exercise.
Summary
There seems to be enough research to suggest that Normatec is a legitimate adjunct to help athletes accelerate and enhance recovery in the days following a tough workout or strenuous activity.
Besides the metabolic and physiological benefits discussed, Normatec at its least is a helpful tool to help athletes relax and calm the nervous system or reduce muscular tone, which can lead to observable beneficial outcomes like increased range of motion and power output.
Article Source Here
Top 5 Healthy Life Hacks to Have an Awesome Morning
Getting your day started with coffee isn’t always enough. Sometimes, you need to give yourself an extra boost, espeically when you have little energy or trouble focusing. For an awesome start to your day, here are five tips to get you going right off the bat.
WAKE UP 5 MINUTES EARLY
What’s the power of five minutes? It can be more than you think. Spend this time doing simple breathing exercises or a quick meditation so you can get focused for the rest of the day. If that’s not your style, you can prepare a quick to-do list for your day ahead. Either way, it’s always nice to have a little extra time for yourself without losing too much sleep.
START WITH GREEN TEA, THEN COFFEE
A cup of coffee at 7 a.m can leave you burned out by 10 a.m. Try swapping it with green tea for a more gentle wake-up call. After that, you can brew your favorite coffee to keep you going strong. This practice also might help you consume less caffeine overall!
TAKE A QUICK MORNING WALK-& HAVE YOUR MEETINGS ON THE GO
Morning meetings can make us fall asleep…again! Don’t spend all of them sitting down if you don’t have to. Not only will morning walks help you wake up, but they can also add some extra physical activity to your day!
WRITE IN YOUR JOURNAL
Who says you have to journal at the end of the day when you’re tired and ready to sleep? You can journal in the morning about what happened yesterday and the things you’re looking forward to that day. Journaling can remind you of your daily goals and motivate you to stick to your commitments.
PACK YOUR LUNCH (OR SNACKS!)
Staying on track with your goals starts with having the energy to do them. Plan a healthy balance of fats, vegetables, carbohydrates, and proteins. This can be as simple as assembling dips, carrots, wraps, and salads each morning.
It’s time to try these tactics to jump-start your day!
Helping You Avoid Injuries This Winter
Another winter is setting in. With freezing temperatures already occurring, that only means one thing, we will be walking on ice for the next 4 months! How can you avoid a serious injury by way of a slip and fall, or what should you do if an unfortunate accident does occur?
Injuries related to slipping on the ice are one of the main causes of emergency room visits during the winter season. A person doesn’t always need to fall in order to sustain a serious injury either. When a person slips, they tense up their entire body, this can lead to knee injuries, muscle spasms, or more. Therefore, the first step is to avoid slipping and falling altogether. But How?
Preparation. Wearing appropriate shoes, ones with rubber soles and with a good tread will help. Additionally purchasing Yak Tracks, which can be found at most sporting good stores, will provide extra traction for safety. While a person might be completely prepared, they might get in a rush and forget to take these precautions. Take your time before you head out the door. Make sure your footwear is appropriate for walking on the ice.
What should you do if you do fall on the ice? If the injuries are serious seek emergency care. However, if the fall isn’t serious, you might experience pain and soreness in your knees, ankles, shoulders, wrists, back, or neck. If this happens to you this winter, a physical therapist can help. Contact a physical therapist for an evaluation of your injury and pain. Your pain will most likely not go away on its own so you should seek treatment. By not seeking appropriate care, you could continue to make the injury worse or you could fall again and this could be detrimental.
This winter Pinnacle Physical Therapy will be offering same day appointments. Call us at (208) 777-4242
The Benefits of Physical Therapy
Source: https://communitycare.com/News/Health-Blog-Article?URLName=The-Benefits-of-Physical-Therapy
When people think of physical therapy, or PT, they usually associate it with someone who was injured. For example, someone who was in a bad car accident or suffered from a stroke, might use physical therapy to help them recover. But physical therapy isn’t just for those who suffer from physical injuries. PT can be used by anyone looking to improve their mobility, manage pain and chronic conditions, recover from injury, and prevent future injury and chronic disease.
Physical therapy is performed by a physical therapist (PT), sometimes with the help of a physical therapist assistant (PTA). PTs and PTAs are experts in movement in the body who can improve a patient’s quality of life through exercise regimens, hands-on care, and education. They will assess your current ability and review your goals in order to create a treatment plan to meet your needs. PTs can be found in hospital or out-patient settings, health care practices (as is the case of CCP’s physical therapy services), fitness facilities, nursing homes, and so on. This makes it easy to access their services from almost anywhere. PTs and PTAs are able to work collaboratively with the rest of your health care team to ensure you are receiving the best care. Your primary care practitioner may refer you to a physical therapist for several different reasons.
Substitute for Surgery
One common reason someone may use physical therapy is to avoid surgery. Since surgery is oftentimes expensive and invasive, many patients would prefer to avoid it if possible. For example, if you were injured or are suffering from conditions like meniscal tears, spinal stenosis, and degenerative dish disease, physical therapy has actually been found to be as effective as surgery.
Pain Management
Physical therapy is also being used more and more in cases of pain management over prescribing opioids. This is because the CDC is encouraging health care practitioners to recommend safer alternatives for their patients. Opioids can cause depression, addiction, withdrawal symptoms, and, in some cases, overdose which can cause death. Physical therapy is one of the safer alternatives recommended by the CDC to help patients manage long-term pain since it may actually work better and has fewer risks and side effects.
Recovery and Injury Prevention
Physical therapy can also be recommended for those who are recovering from an injury and need to strengthen their movements. This can include anyone who has suffered from an accident or condition that has caused mobility issues that impact their daily lives. PT can also be used on a more long-term basis if a patient is considered to be at high risk of re-injuring themselves. People who play sports or have physically demanding jobs may be some of the patients who would utilize this service.
General Mobility Concerns
Patients who are older or who are suffering from health conditions that affect their daily movement can also benefit from seeing a physical therapist. Fall prevention is important as these falls can cause injury, loss of independence and, in extreme cases, even death. PTs can also help with general mobility concerns, especially when the mobility issues are affecting a patient’s quality of life.
If you suffer from mobility issues, you should have a conversation with your primary care practitioner to determine whether you could benefit from seeing a physical therapist. If you are in need of PT services, then consider using Community Care Physical Therapy. Our office gives patients an alternative to the hospitals and big rehabilitation centers and our physical therapists are known for their professionalism, expertise and personal attention to patients. We help patients make positive changes in their lifestyle and regain control over their bodies.
Community Care Physical Therapy has three convenient locations in Clifton Park, Delmar, and Latham. For more information, visit their website.
Sources
https://www.choosept.com/Benefits/Default.aspx
https://www.apta.org/nptm/
https://www.cdc.gov/drugoverdose/patients/options.html
https://www.cdc.gov/steadi/stories/routine.html
Why Should You Have Physical Therapy for Arthritis?
Physical therapy can help to alleviate pain, stiffness, soreness and other symptoms of osteoarthritis.
See Osteoarthritis Symptoms and Signs
If you’ve been diagnosed osteoarthritis in your knee, hip, shoulder, or other joint, you probably want to know how to relieve your joint pain and slow down the disease’s progression. Physical therapy can help you do both.
To achieve these goals, a physical therapist may employ a combination of strategies. A skilled physical therapist can teach you how to do the following:
Maintain or Increase Joint Range of Motion
Osteoarthritis can make a joint stiff. Physical therapy can improve your ability to bend and straighten a joint. Even incremental improvements in a joint’s range of motion can make a significant difference in joint function. For example, getting an arthritic knee to bend just 10 more may allow you to comfortably get in and out of low chairs.
Strengthen the Muscles that Support an Arthritic Joint
When osteoarthritis causes protective cartilage to wear away in a joint, there can be painful friction between the joint’s bones. You can decrease this friction by strengthening the surrounding muscles that support the joint. A skilled physical therapist can identify areas of impairments and teach you how to address these impairments with functional strengthening to help you improve strength and stability in your joints.
See Strength Training Can Crush Arthritis Pain
Improve Balance
Individuals with osteoarthritis often have impaired balance resulting from muscle weakness, decreased joint function, decreased mobility, and other factors. In addition to functional strengthening (mentioned above), skilled physical therapists may also incorporate balance components into your treatment plan that include changes in terrain/surface, walking distances, and elevation to simulate daily functional tasks in effort to improve balance and reduce your risk of falling.
See Walking: The Best Way to Start Getting Active with Arthritis
Adjust Posture
Good posture can take stress off arthritic joints. Your physical therapist can educate you about ways to adjust your posture and put less stress on joints as you sit, stand, and walk. This may include suggestions to modify your environment at home and work, and even in your car.
Simple changes, such as adjusting the position of your car seat, can put less stress on your arthritic joint(s) to make your daily routine easier.
Use Assistive Devices
Walkers, canes, crutches, splints, and shoe inserts may be recommended to help take pressure off certain arthritic joints depending on the severity of the condition.
Knowing when and how to use these assistive devices can help decrease risk for injury and/or further impairment. For example, a cane may not be needed around the house, but might be helpful when walking longer distances or doing errands. A skilled physical therapist can teach you how to properly fit and use certain assistive devices while also fostering an environment for you to work toward your functional independence.
While it is impossible to turn back the hands of time to eliminate the effects of osteoarthritis/degeneration, physical therapy is proven to be able to help individuals decrease their symptoms of pain and stiffness associated with osteoarthritis. In addition, physical therapy helps to slow down the degenerative process by improving the strength and stability in muscles that surround a given joint, thereby decreasing the wear and tear to your joints from activities of daily living.
Watch Video: Should I Exercise Through Joint Pain?
Physical therapy appointments are typically scheduled 1 to 3 times a week and for a few weeks or longer. After that, individuals can maintain their physical therapy programs on their own at home.
Learn more
Ways to Get Exercise When You Have Arthritis
When I'm in Pain, Should I Exercise or Rest?
Source: https://www.arthritis-health.com/blog/why-should-you-have-physical-therapy-arthritis
How Stress Can Lead To Injury & How You Can Stop It
While it’s intuitive that physical stressors can cause physical injuries, you might not know that mental and emotional stress can also lead to musculoskeletal injuries that require physical therapy. That’s right-a lack of sleep, a busy workweek, and other stressful life events can make you more prone to injury. Why is this, an how can you prevent the stresses of everyday life from causing you bodily harm?
When you experience stress, your body does a few things that naturally put you at an increased risk of injury. First, stress causes your nerves to function inefficiently. Second, stressful situations lead to higher levels of cortisol in the body, a hormone that inhibits muscle repair and immune system function. If you’re always dealing with stressful situations, then you’re constantly leaving your body open to physical injury.
You can prevent injuries ’ with all sorts of physical means, but if you fail to address your mental and emotional health, you’ll still be at a heightened risk. While you might not be able to prevent every stressful situation from ever happening, you can control how you react when one does occur.
A few simple things you can do to prevent mental stress are to get enough sleep, maintain a healthy diet, and drink plenty of water. If any of these basic stress inhibitors are absent from your daily routine, focus on incorporating them in to alleviate some of your stress. That said, practicing simple breathing exercises or another form of medication can also be helpful, especially if you’re looking for a physical way to mentally unwind after a stressful day.
While learning about how much stress hurts you can be even more stressful, you can find some peace knowing that with a few simple changes to your routine, you can prevent stress from causing physical injury.
Inspired by: eatingwell.com