With October being PT month, let's improve an understanding of Comprehensive Therapy Services (or CTS') approach, so you can better understand the WHY behind what we do and help spread the CTS and PT's message of empowerment through movement and education. It is often thought that a PT either does exercise or massage. I too thought that this was what we did until delving deeper into my PT coursework. Learning about the cardiopulmonary system and how we treat congestive heart failure, chronic obstructive pulmonary disease, and cystic fibrosis was the first time I had heard about physical therapy interventions focusing on breathing, posture, and cardiac rehab. I learned about being a "neurol" PT who focuses on retraining the brain, motor function and pain with pathologies such as strokes, spinal cord injuries, cerebral palsy, Parkinson's, Multiple Sclerosis). Lastly , musculoskeletal class focusing familiar diagnoses such as hip impingements, meniscal and ligament tears, low back pain, etc. Provided novel ways for hands on techniques. Such techniques include massage but also joint mobilizations, craniosacral and visceral techniques, and exercise programming to help return patients/clients back to activities of daily living (ADLs), including sports.

During one of my first cardiopulmonary class' test, the teacher incorporated a patient who had heart surgery and a history of a musculoskeletal injury. Although I cannot recall the exact question, I do recall the speech that followed, and one that resonates with the philosophy of myself and the clinic, "You can look at the main diagnosis but our bodies are an integrated system and you cannot treat one system without addressing another." Thus, if you failed to remember this patient had a musculoskeletal issue, you might mistakenly perform a movement that could negatively affect the him or her. After this test, it became evident that as a PT you need to address each patient/client in a whole-body approach and not just the injury.

Thus, when you come to PT at Comprehensive Therapy Services, you are not a diagnosis walking in the door. You are a person whom we look at on an emotional and physical basis. Many of us PTs have had our own journey and can empathize with where you are at, and recognize sometimes the emotional challenges of an injury are as hard to overcomes as the physical ones. We also can appreciate the lifestyle changes encouraged are not meant to happen overnight and take time and patience, so give yourself permission to slowly integrate these changes.

The comprehensive approach involves assessing all the body systems to further appreciate how each system influences each other. Thus, the following are "big rocks" that are addressed with our clients, as they are large influencers to the multi systems approach:

1. Breathing: With the breath as a key to life, it can be as an instrument to help relax, as well as, activate muscular, nervous, cardiovascular, gastrointestinal (GI), and endocrine(hormonal) systems. With the diaphragm moving downward on the inhalation and upward on the exhalation, it assists in stretching and "turning on" the core (muscular system), as well as, intra-abdominal pressure regulation, which is important in bowel and bladder control, and GI function. Deep breathing has been shown to relax the nervous, as noted by decreased muscular tension and pain, decrease blood pressure and heart rate, as well as, assist in chemical and hormonal regulation. Although breathing is a subconsciously performed, learning to breathe more efficiently through the entire rib cage and how to vary the breath to effect some of the above functions is often one of the PT's goals. One of the first steps to improving the breath is to become aware of one's posture.

2. Posture: "Stand up straight!" "Sit up!" These phrases said so often, but what exactly do they mean and why does posture really matter? In this case, poor posture is considered slouching, tucking the tailbone under and rounding the back and allowing the head to draw forward. Poor posture can contribute to some of the following:

• Inability to breathe well, as the diaphragm is not able to move through its available range and the forward head can place the trachea in a disadvantageous position.


• Digestion as the stomach and intestines have greater pressure on them and the esophagus is no longer aligned, which can affect swallowing.


• Neck, upper, mid and low back pain due to the poor muscular alignment and additional stress to the spine.


• Shoulder and hip pain as these muscles are also placed in a poor alignment for optimal strength and power. This coupled with the joints no longer in an ideal position can lead to impingements, strains, arthritic changes, etc.


• Incontinence and/or pelvic pain as a tucked position will increase pressure to the abdominal contents and shortens the muscles in the pelvic contributing to tightness and weakness.

3. Movement: Movement is the truly one of the keys to health and vitality. Our society has normalized long bouts of sitting, and encouraged minimal exercise guidelines of 20 minutes as to not to overwhelm people and make movement attainable. The reality is long bouts of sitting, which is likely in poor position at times, will influence what was discussed in point #2. This does not mean you need to spend long hours exercising, rather just moving. Studies have shown puttering around has health benefits and is MOVEMENT. Movement influences all systems! Thus, PTs focus on how you are moving, how this may be influencing systems, and how can we improve and encourage more movement into your ADLs.

4. Hydration: With an average of 50-60% of the body made up of water, hydration is important. A recent study showed that 31.9% of college athletes start exercising in a dehydrated state. Another study showed 37% of admitted adults > 65 years were dehydrated. In other words, dehydration does not have an age bias, and can often be a driver to symptoms, such as poor memory, dizziness, incontinence, and weakness. In 2017, the Mayo clinic recommends 15.5 cups (3.7 liters) for men and 15.5 (2.7 liters) for women of fluids per day. Fluids can be tea, water, soups, smoothies, etc. Take an account of what you are consuming in your day and to assess if you are achieving the recommended amounts.

5. Diet: Although we are not nutritionists, as PTs we are conduits of information to help provide resources for you to improve nutrition and manage symptoms. There are multiple diet recommendations, and allow us to help you navigate resources in our community.

Our ultimate goal as PT is to assist you in becoming the best version of you!

Elizabeth Leeds, PT, DPT

Mindfulness - the art of paying attention on purpose, being present in the moment.

Any activity can be done with mindfulness - walking, cooking, breathing. There are many tools that can help you stay present in each unfolding moment such as body scan, guided meditations and mindfulness-based stress reduction (MBSR) techniques.

Mindfulness-based interventions have been shown to decrease stress, depression, anxiety, blood pressure and increase perceived health, quality of life, empathy and self-compassion (De boer, 2015)(Lawrence, 2013).

Stress plays a part in 60-80% of all primary care visits (Avey, 2003). Almost half (44%) of all Americans report elevated psychological stress in the last 5 years (APA, 2012).

In 2017, a team of Harvard researchers examined the effect of mind-body interventions on health care utilization (Stahl, 2017). Participants completed 8 weeks of yoga and meditation and within the next year participants used 43% fewer medical services. As a result, participants saved anywhere from $640-$25,500 per patient per year.

If you are anything like me, mindfulness is HARD. I am frequently found sitting in front of the TV, folding laundry and texting all at the same time.

Start small - choose one thing you will do mindfully in the next week. This could mean cooking without the TV or the podcast in the background or driving without any radio, phone call or audiobook. This could also mean adding 10-15 min of yoga or breathing into your daily routine.

You do not have to spend a great deal of time on this just commit to a few minutes each day and be consistent!

For FREE mindfulness resources, CLICK HERE »

References
Avey H, Matheny KB, Robbins A, Jacobson TA. Health care providers' training, perceptions, and practices regarding stress and health outcomes. J Natl Med Assoc. Sep; 2003 95(9):833, 836-845. [PubMed: 14527051]
American Psychological Association. Stress in America: Our Health at Risk, 2012. Washington, DC: American Psychological Association; 2012. Retrieved from: http://www.apa.org/news/press/releases/stress/2011/final-2011.pdf
De boer AH, Hoppentocht M. Comment on: inhaled antimicrobial therapy-Barriers to effective treatment, by J.Weers, Adv. Drug Deliv. Rev. (2014), http://dx.doi.org/ 10.1016/j.addr.2014.08.013. Adv Drug Deliv Rev. 2015;85:e1-2.
Lawrence M, Booth J, Mercer S, Crawford E. A systematic review of the benefits of mindfulness-based interventions following transient ischemic attack and stroke. Int J Stroke. 2013;8(6):465-74.
Nerurkar A, Bitton A, Davis RB, Phillips RS, Yeh G. When physicians counsel about stress: results of a national study. JAMA Intern Med. 2013;173(1):76-7.
Stahl JE, Dossett ML, Lajoie AS, et al. Correction: Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization. PLoS ONE. 2017;12(2):e0172874.

Rose Schlaff, PT, DPT

Hi. My name is Karianne Johansen and chewy candy is my kryptonite. I'm a Nutritional Therapy Practitioner and the founder of Inspira Wellness Collective-a group of individuals committed to empowering and inspiring others toward health and wellness on all levels and in all seasons of life.

Can you believe that it's already October? October seems to equal "sugar rush" regardless of who you ask. Every office seems to be teeming with candy corn, gummy candy, and all manner of chocolate. Don't even get me started on schools! There's no way to avoid it, so let's talk about it instead. Knowledge is power, right? Before we get to the healthier and less toxic versions, let's first talk facts. One of the primary culprits is High Fructose Corn Syrup (HFCS).

HFCS is not exactly our friend and here's why...

Four facts is probably enough for now! Instead, consider opting for candy that is sweetened with things like honey, maple syrup, brown rice syrup, raw cane sugar (it has all its vitamins and minerals intact still!), and sugar alternatives like erythritol, stevia, xylitol, etc. Check out brands like Yum Earth, Lily's Chocolate, or my personal favorite Torie & Howard. Their "Chewie Fruities" strongly resemble Starbusts, but in a Meyer lemon and raspberry flavor that is to die for!

Making healthy choices doesn't mean you need to go full-blown carrot sticks for Trick-or-Treating all the time. Candy will inevitably be eaten, but now you have some ideas for better options. Happy Halloween!