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 October Is National Physical Therapy Month
October 2019        Issue # 104 
Choose Physical Therapy First
Physical therapists (PTs) are movement experts who aim to optimize mobility and manage pain to improve quality of life. PTs' prescriptions of exercise and patient education can be helpful in a variety of ways to anyone of any ability in all life stages. Here are four reasons to choose PT:

Decrease Falls Risk: For Americans over the age of 65, the rate of death related to falls increased by 31% between 2007 to 2016. This year alone, one third of adults from this population will fall. These spills may lead to only minor scrapes and bruises, but are also responsible for 95% of hip fractures. Experts believe these numbers are steadily rising due to the increase in size of the aging population, longer life expectancies, and increased prevalence of disease processes that can lead to deconditioning such as heart disease, stroke, or cancer. However, the good news is researchers have shown adults can proactively prevent falls with the help of physical therapy by improving strength and balance.

Avoid Surgery: Why get surgery if you don't need it? Before undergoing invasive procedures, try physical therapy first! Studies have reported that PT results in equivalent gains in functional improvement and patient satisfaction when compared to many common orthopedic surgeries. A few conditions physical therapy can successfully manage include meniscus tears, knee osteoarthritis, spinal stenosis, degenerative disk disease, and even some rotator cuff tears.

Decreased Head Injuries: As the devastating effects of head injuries among professional athletes continue to rise, new information has also revealed the risk for children ages three to 17. The Center for Disease Control and Prevention (CDC) reports about 7% of children in this age group have experienced a head injury and the percentage of incidence significantly increases with age. These concussions can leave lasting effects on brain tissue and function, causing physical, cognitive, and behavioral symptoms, both short- and long-term. However, research suggests that early return (within one week) to physical activity can decrease the chances of persistent post-concussive symptoms (PPCS) such as headaches, balance issues, memory problems, fatigue, and visual impairments.

Avoid Opioids: In some situations, opioids may be an appropriate part of medical treatment. But more than 60% of Americans who have died from opioid overdoses have also been sufferers of chronic pain. The CDC is urging healthcare providers to seek alternative treatments like PT for pain management. Recent studies have reported that opioids may not be any more effective than non-steroidal anti-inflammatory drugs (NSAIDS) for chronic pain, and are largely ineffective in treatment or management of low back pain. A survey of 6,300 adults found that 78% of participants prefer non drug-related treatment and 41% found PT to be the most effective.

If you or your doctor feel physical therapy would be a good fit for you, head on over to our website to schedule an appointment today!
Physical Therapists' Beliefs Can Negatively Affect Patient Outcomes
Kinesiophobia as described in physical therapy literature is "the excessive, irrational, and debilitating fear of physical movement and activity resulting from a feeling of vulnerability to painful injury or reinjury." As PTs have been at the forefront of orthopedic injury management, it is important to consider what messages are conveyed to our patients. Traditionally, many PTs have used a biomedical approach, where pain is attributed to structural or mechanical deficits. However, newer research is shedding light on the key role that healthcare professionals' attitudes and beliefs can play on patients' health and outcomes. 

Our beliefs are a cognitive process related to our perceptions of how we think things are. It is possible that a physical therapist with kinesiophobic beliefs can transfer these feelings and behaviors to patients, both verbally and nonverbally. This is widely seen in the treatment of low back pain. Many PTs continue to recommend avoidance of daily activity such as bending, lifting, and twisting even though current research continues to show these movements are non-threatening and healthy for our spine. In fact, PTs who advocate kinesiophobic beliefs tend to provide more biomedical education to patients and fewer work and activity recommendations, which is contrary to the current treatment guidelines for low back pain as established by the American Physical Therapy Association. When examined further, a 2015 study published in Physical Therapy Journal found that these beliefs can affect healthy and pain-free individuals alike. 256 participants where administered a lifting-capacity test instructed by a physical therapist. Participants whose test was performed by a physical therapist with kinesiophobic beliefs were found to lift on average 8.0 kg (about 17.5 pounds) less than their peers whose exam was performed by a therapist without these beliefs. 

At Blue Hills Sports and Spine Rehabilitation about half of our patient census comes to us for low back pain. With the use of a biopsychosocial approach, we evaluate patients for fear avoidance and movement beliefs on their initial visit and aim to educate patients about the resilience of the human body. Further, we discuss the benefits of an active lifestyle in which many patients are excited and relieved, to transition back into recreational activities they felt would be detrimental to their symptoms. To get a sense of our active approach to spine rehab, check out this Low Back Strengthening program via our exercise portal, or print a PDF version for the gym.
Keep Stride this Hockey Season
October also means the return of the Bruins for hockey season. Groin strains are a common musculoskeletal injury sustained by hockey players and account for about 10-20% of their injuries. A large study reviewing National Hockey League teams found that the rate of these strains are increasing, with the most occurring during pre-season training, and 90% being non-contact related.

The groin consists of six adductor muscles of the hip. Their primary function is to swing the leg across your body or, when in stance, to stabilize the leg and pelvis during movement. Adductor strains can result in missed playing time for a variety of sports, but particularly in sports that put a large demand on these muscles. During a skater's powerful stride, the hip extensors and abductors are the primary movers to push the player along the ice, while the hip flexors and adductors are responsible for stabilizing and decelerating the stride. A 2001 study published in the American Journal of Sports Medicine found that pre-season hip adductor strength was 18% lower in NHL players who sustained a groin strain, compared to their non-injured teammates. They also had a lower adductor-to-abductor strength ratio on the injured side. This suggests that a strength imbalance between the propulsion muscles (abductors) and deceleration muscles (adductors) may be a main mechanism of injury. 

By addressing these muscular imbalances of the hip, we can lower the risk of groin-related injuries. In fact, NHL players who practiced in the off season, as well as rookies, were found less likely to be affected. For those already injured, an eight- to twelve-week progressive strengthening program that includes adduction and abduction strengthening, abdominal strengthening, balance training, and skating movements on a slide board has been shown to be effective for treatment. Check out our Preseason Hockey Program through our exercise portal or use the PDF version to get started today. 
Curated and Edited by: Andrew DeStefano, PT (Boston Office)
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