Get to know your PT: Julie Millar, PT, DPT

Therapydia Denver physical therapist Julie Millar

Therapydia Denver physical therapist Julie Millar takes some time to talk about building connections with her patients, how she spends her Saturday mornings and her favorite piece of wellness adive.

When did you know that you wanted to be a physical therapist?

I always had a love of science and health.  Most people don’t know that I had a previous career in laboratory science before becoming a PT. I would enjoy the “fact-finding” missions I had while doing research, but felt I was missing a piece of the human connection.  It wasn’t until I had a personal injury that I was exposed to my first PT.  Going through the rigor of rehabilitation and having the sense of achievement and teamwork was inspiring to then go through the training to be a PT.

What’s your favorite song to get you motivated?

Growing up in the 1980’s with the boom of dance videos, I can always go with a good Michael Jackson song.  I enjoy all kinds of music though, but if you put Michael Jackson’s “Thriller” on, I may just break out into the dance.

What is the biggest challenge involved in being a PT?

It used to be paperwork and working with insurance, however a little perspective has made me appreciate this process.  Now I see the biggest challenge is facilitating human behavior to maintain a person’s wellness after a course of treatment.  This is something I am passionate about and it is also why I teach Pilates to my patients in order to help people understand the need for continuum of care.  It has become mainstream in the world of dentistry to have routine preventative exams and cleanings. I think this should be something that we ALL in physical therapy need to embrace in the world of routine and preventative care for our neuromusculoskeletal systems.

How do you like to stay active?

I love to walk, hike, and do Pilates.  When I lived in England over the last few years, I got into Nordic walking, which is a really interesting and low-impact way to achieve fitness.  These are my main forms of exercise.

What surprised you the most about the physical therapist profession?

I never expected I would build such strong connections to my patients and clients.  Being a PT is one of the privileged health professions that one really gets to know the patients that we spend so much time with over a course of treatment.  It brings a smile to my face when I see people improve and start to feel better.

Are you currently pursuing any further education/certifications?

I am currently specializing in Pilates for rehabilitation and wellness.  There is no end to continuing education (which I love!), so I am always interested in more courses in furthering my knowledge of movement analysis, pelvic floor rehabilitation, Pilates, and anatomy.  I will also be advancing my skill level in trigger point dry needling over the course of the next year.

What’s your go-to breakfast?

A nice scramble of eggs with a little cheese and some leftover roasted cauliflower, avocado on the side, all doused in Cholula hot sauce…yum!

What do you wish everyone knew about physical therapy?

Most people don’t realize the level of education and skill PT’s have in our field.  PTs are the experts in the nervous system and musculoskeletal system as it pertains to movement.  Additionally, we are trained to know and understand medicine well enough in order to make sure you are with the best type of provider for your treatment.  What you learn from us will be valuable and relevant for the rest of your life.

What is the most important personality trait that a therapist must have?

The patience to LISTEN.  If I am not taking the time to listen to you, then it will be a fruitless effort.

What do you do to de-stress/unwind?

Breathe and go for walks.  Sometimes a nice bubble bath will do the trick.

Finish this sentence: On Saturday mornings, you can usually find me…drinking coffee, making a big breakfast, and slowly taking the time with my husband to get going for a lazy day.

What is your favorite piece of wellness advice to offer?

Try different things that may be outside the box for your particular style.  Do what you enjoy the most but also take some mental and physical breaks from your ritual routine every now and again to give your body a chance to learn something different.

Cervicogenic Dizziness – Could Your Dizziness be Coming From Your Neck?

By Nikki Bach SPT and Jessica Ford (Dietz) PT, DPT, NCS

Have you ever experienced dizziness that seems to be related to your neck? If so, you may be suffering from a condition known as “cervicogenic dizziness”. This blog will discuss the definition of cervicogenic dizziness, associated symptoms, how physical therapy can help, and expectations for recovery.

What is Cervicogenic Dizziness?

Dizziness is very complex and cervicogenic dizziness is just one type and/or reason to cause dizziness. Often patients characterize their dizziness as a feeling of imbalance, unsteadiness, or disorientation that occurs with neck symptoms. It is closely related to changes in the position of the neck or movement of the joints in the neck. Cervicogenic dizziness often, but not always, occurs as a result of trauma as one study showed a relation up to 75% of whiplash injuries. Cervicogenic dizziness can also be paired with other symptoms such as neck stiffness (loss of range of motion), neck pain, and/or tension headache.

The scientific reasoning behind cervicogenic dizziness is very interesting so it is worth discussing it a little bit! Currently the exact cause is still debated, but it is hypothesized that neck symptoms like pain or stiffness can cause dizziness due to incorrect sensory information being relayed from the neck to the brain about the head’s position in space. In order for the brain to process your balance and head position, it requires accurate information from different systems: visual (eyes), vestibular (inner ear), somatosensory (touch), and proprioception (mechanoreceptors, such as in the neck). The sensory mismatch theory states that with neck symptoms like pain or stiffness, the signals from the neck contradicts the other systems regarding the head’s position in space. This mismatch of information results in a feeling of imbalance, unsteadiness, and disorientation – i.e. dizziness.

Signs That Tour Dizziness Could be Cervicogenic Dizziness:

If you experience the following, you may be affected by cervicogenic dizziness:

  • Dizziness that seems to correlate with neck symptoms
  • Dizziness that began after or with neck trauma, such as whiplash injury
  • Dizziness that is worse with head movements
  • Dizziness after maintaining one head position for an extended time
  • Dizziness symptoms lasting minutes to hours
  • Dizziness associated with a tension headache

Cervicogenic dizziness is a less likely diagnosis if you experience any of the following symptoms:

  • Tinnitus (ringing in the ears)
  • Hearing loss
  • A feeling of “fullness” in the ear
  • Vertigo (true spinning sensation)
  • Falling or balance difficulties due to dizziness
    *** These types of dizziness are caused by other conditions and require further evaluation and assessment from PT or MD ***

How Can Physical Therapy Help?

Due to the close association between dizziness and neck symptoms with cervicogenic dizziness, many of the symptoms will improve with direct treatment to the neck. Your physical therapist can examine your cervical spine range of motion, joint mobility, and muscle balance to determine the particular cause of your cervicogenic dizziness. It is important to note that cervicogenic dizziness is not just related to neck pain/stiffness as cervical joint proprioception, cervical reflexes, as well as maladaptive balance sensory integration are also common deficits.

In general, your physical therapist will work with you to manage your symptoms and improve your quality of life. Your plan of care will most likely have a mix of standard cervical treatment as well as individualized, specific vestibular rehabilitation. Treating beyond just the neck pain and stiffness will even further reduce your dizziness to help you return to your favorite hobbies, work, and recreational activities so you can get back to doing what you love!

Expectations for recovery

The good news is that most cases of cervicogenic dizziness are significantly reduced with proper conservative treatment. One small-sample study found that 77% of their cervicogenic dizziness patient cases were resolved with physical therapy within 6 months, with 64% of these cases experiencing reduced or no dizziness after two years. You should realize that every patient is unique in their recovery so timelines may vary but usually improvements are seen within the first month!

If you believe you may be experiencing cervicogenic dizziness, you would benefit from making an appointment with a vestibular specialized physical therapist for an evaluation. While physical therapists are generally trained in treating the neck/spine, those who specialize in vestibular dysfunction are specially trained to treat, monitor, and appropriately progress every part of this condition.


References

Reiley, A.S., Vickory, F.M., Funderburg, S.E. et al. How to diagnose cervicogenic dizziness. Arch Physiother 7, 12 (2017).

Treleaven, J., LowChoy, N., Darnell, R., Panizza, B., Brown-Rothwell, D., & Jull, G. (2008). Comparison of sensorimotor disturbance between subjects with persistent whiplash-associated disorder and subjects with vestibular pathology associated with acoustic neuroma. Archives of Physical Medicine and Rehabilitation, 89(3), 522-530.

Brandt, T., & Bronstein, A. M. (2001). NOSOLOGICAL ENTITIES?: Cervical vertigo. Journal of neurology, neurosurgery and psychiatry, 71(1), 8‐12.

Eva-Maj Malmström, Mikael Karlberg, Agneta Melander, Måns Magnusson & Ulrich Moritz (2007) Cervicogenic dizziness – musculoskeletal findings before and after treatment and long-term outcome, Disability and Rehabilitation, 29:15, 1193-1205

Multiple Sclerosis and Exercise– How Much Exercise is Safe?

Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (i.e. the central nervous system). MS is a condition that causes the immune system to attack its protective sheath (called myelin) that surrounds every nerve. This protective sheath is very important when it comes to the health and efficiency of your nervous system as it is the communication between your brain and the rest of your body. MS can be a stable or progressive disease and can lead to permanent damage or deterioration of nerves.

Similar to my other blog posts, I like to emphasize that every neurologic condition is different for each individual. This is even more true for a condition such as MS! Multiple Sclerosis can present more as a brain injury, spinal cord injury, or a mixture of both depending on which part of nervous system is affected. Here are some common deficits that people with MS experience: numbness, weakness, changes in sensation, change in coordination or balance, vision problems, pain, dizziness, heat intolerance, and fatigue.

Fatigue is the most common symptom of MS, impacting 75-95% of patients. There is “neurologic fatigue” as well as “secondary fatigue”. Secondary fatigue is due to deconditioning and an overall a decrease in activity. Regular exercise is one of the main treatments to either improve and/or prevent this secondary fatigue. Heat intolerance is another very common symptom of MS. Exercise naturally increases your body temperature, however, with people with MS this can cause an increase in symptoms temporarily and leaves some people “scared” to exercise.

According to current research and clinical practice, exercise does not cause MS episodes or exacerbations. However, many report an increase in symptoms approximately 30 minutes after exercise. This change in symptoms is not permanent and is not causing any damage. The tough part is there are no recommendations for exercise for the MS population based on research. So, the following recommendations are just that – what I recommend based on my experience and knowledge of the diagnosis.

Benefits of Exercise With MS

One of the most important benefits of exercise is to reduce and prevent secondary deficits and fatigue! Sometimes these secondary deficits can be equally as debilitating and add to your MS symptoms. These are some of the benefits of regular, daily exercise for the MS population:

1) Improve cardiovascular fitness – prevent deconditioning and heart disease
2) Improve bowel and bladder function
3) Reduce secondary fatigue, as it adds to fatigue from MS
4) Prevention of bone density loss (osteopenia and osteoporosis)
5) Mood enhancement and decrease depression
6) Pain management – exercise releases endorphins in your body that reduces pain
7) Increase participation in social activities
8) Improvement in cognitive function
9) Weight management to maintain an ideal body weight for moving around

Exercise Recommendations

The following recommendations come from the American Heart Association. Again I want to emphasize that these are just recommendations, therefore, I often have many patients exercise more or less than these recommendations. It is strongly encouraged to consult your doctor and physical therapist before starting a regular exercise routine.

table of exercise recommendations for ms

In my practice of physical therapy, I often use the term “Rate of Perceived Exertion” or RPE to monitor the intensity of exercise. Therefore, you should feel like you are working “light to somewhat hard” when you complete any aerobic exercise. Exercising harder is not necessarily better for you! Later in this blog, we will go over more about what can be considered aerobic exercise as it is not just standard exercise.

borg's RPE scale

Types of Exercise

Give yourself credit for activities you do everyday that can be considered exercise! As well as remember, some may be able to perform lower or higher levels of intensity depending on their function and individual symptoms. Before you start or change your routine, I would challenge you to do the following:

  1. Have a mixture and variety of exercise. If you are able, try to mix up your routine to include at least two of the categories. That way you are continuing to challenge your body and you will see better results.
  2. Use the list below to help manage fatigue. You may want to prioritize, delegate, or pace/spread out certain activities that may be moderate-vigorous for you.

BLUE EXERCISES – light exercise (RPE 6-9)

  • Light household chores like dusting, making the bed, emptying the trash, etc.
  • Cooking simple meal in standing or complex meal in sitting
  • Relaxing Yoga
  • Tai Chi

GREEN EXERCISES – moderate exercise (RPE 10-13)

  • Gardening
  • Heavy household chores, like laundry, vacuuming, deep cleaning, putting away groceries, etc.
  • Strength training with light to moderate weights (<15#)
  • Aquatic Exercise
  • Walking Program – continuous >10min or faster speeds
  • Stairs when complete more than x1 flight
  • Pilates

YELLOW EXERCISES – vigorous exercise (RPE 14-17)

  • Biking with light to moderate resistance
  • Errands like grocery shopping
  • Yard work like raking leaves, push lawn mower, etc.
  • Dancing
  • Swimming
  • Jogging/Running 

Specific MS Considerations For Exercise

Here is some common evidence I provide my patients with MS to help improve tolerance to exercise as well as considerations for safety.

  • Stay hydrated!
  • Best to do exercises in AM when your body temperature is lowest and the environment around you is cooler
  • Wear light exercise clothes, recommend fabrics that wick moisture or are a lightweight material (not cotton clothes)
  • Don’t follow the “no pain-no gain” rule. You can over exercise as there is a neurologic fatigue factor which is not something to push through
  • Interval training (with rest breaks in between) is often more tolerable than continuous exercise
  • Perform both a warm-up and cool-down – approx. x5 minutes each at low effort
  • Cooling garments or fans for those who are heat sensitive with exercising (The National MS Society can help provide garments so visit the following website for more details https://www.nationalmssociety.org/Resources-Support/Find-Support)

8 Moves To Prevent Ski Injuries This Season

prevent ski injuries

Ski season is nearly here and it’s time to begin preparing for your first ride down the mountain. Making sure that your hip, knee, and core stabilizer muscles are strong and working well is a great way to aid in avoiding skiing injuries and ensuring a long and fun season.

Ski injury prevention starts with getting your quads and glutes into shape which will also help with your form and performance. Here are a few exercises to add to your training program to help prevent ski injuries-

Move 1: Sustained squat on bosu ball with side-to-side rocks

bosu ball squat

Place band around knees to improve lateral glute medius activation. Rock side-to-side sustaining a squat position.

Perform 3 sets for 1 minute each, 3 times a week. Progress holding medicine ball out in front of your body.

Move 2: Static skaters

Stand on one leg with a theraband around your ankles. Pull your opposite leg back at a 45 degree angle, keeping toes pointed forwards.
Make sure hips stay level and squeeze your glutes as you pull your leg out. You should be activating the stance leg glute as well to stabilize and will likely feel this leg working more during the exercise.

Perform 3 sets of 15 reps, 3 times a week. Progress ascend into a deeper squat on stance leg.

Move 3: Skater hops

Alternate hopping laterally. Descend into a controlled squat on weight bearing leg while reaching opposite arm towards floor and letting non stance leg bend behind your body.

Perform 3 sets of 15 reps, 3 times a week. Progress to landing on airex balance pad.

Move 4: Single leg squat

single leg squat

Begin with keeping weight in heel. Shift hips posteriorly, making sure your knee doesn’t travel too far forward. You can use a TRX band or a small board under your heel to increase range of motion.

Perform 3 sets of 15 reps, 3 times a week

Move 5: Paloff press single leg

Use a theraband anchored on a door or use a cable machine set up at shoulder height.
Obtain a single leg stance position on your outside leg farthest from anchor point.
Engage your core and glutes, ensuring to keep your pelvis level.
Hold your arms centered in front of you. Press out, up, down, and in, returning to starting position. Repeat.

Perform 3 sets of 10 reps, 3 times a week. Progress by standing on airex balance pad or unstable surface.

Move 6: Stir the pot

stir the pot

Begin in a plank position with elbows on a stability ball stacked beneath your shoulders.

While engaging your deep core muscles, move arms into small circles first clockwise and then counterclockwise.

Perform 2 sets of 10 in each direction, 3 times a week. Progress by increasing reps/time.

Move 7: Deadbug

Begin by lying on your back with a stability ball wedged between your arms and legs, with legs elevated into the air and knees bent at 90 degrees.

While opposite arm and leg squeeze into the airex pad, engage your deep core muscles and extended the other arm and leg out away from the ball.

Return to start position and switch to the other side.

Perform 3 sets of 10 reps, 3 times a week. Progress by taking away stability ball.

Move 8: Lunges with sliders

Begin with standing with one foot on the slider (May substitute Swiffer pad/paper plate).

Place your weight on the leg without the slider. Bending this knee, slide the other leg posteriorly into a squat position. Return to start position.

Perform 3 sets of 15 reps, 3 times a week. Progress holding weight at side or overhead.

Why Are These Moves Important To Do?

Adequate core, glute, and quad strength is very important to help ensure an injury free season.The sustained squat ski position demands a lot out of strength and endurance out of our legs. If glute weakness is present, it’s easy to allow our knees to fall medially towards each other. This throws off our hip, knee, and ankle mechanics leaving us prone to falls and injury. Having effective gluteal activation will allow you to maintain proper alignment through your joints allowing for pressure to be displaced equally and keeping you out of the “pizza” position to avoid possible injury.

A thorough glute program targets not only the glute maximus, but the glute medius as well. The above program is a great starting point to target the necessary muscles.

Now don’t be fooled into thinking only the legs need to be strong. Our cores have a big responsibility to drive our bodies into each and every turn and assisting to keep us upright. So give your core some love with our prescribed exercises above.

If you find you have questions about ski injury prevention, schedule an evaluation with one of our skilled physical therapists.

What You Should Know Before Returning To Running Postpartum

Running Postpartum

By Erin Mumby, PTA

There are multiple roadblocks mothers may encounter when returning to running postpartum. Prolapse, incontinence, diastasis recti, C-section symptoms, weakness and/or pain may be present and interfere with attempts to return to or beginning a running program. Seeking professional guidance from a pelvic floor specialized physical therapist for help returning to running post delivery can help reduce the impact of the above symptoms and get you back to running with confidence.

Before you run, you must walk (or rest!)

Mentally you may be ready to get back to your pre partum running routine, but your body may not be. Though you may feel like you are ready to return to running soon after delivery, the typical recommended return to running begins 3-6 months postpartum. However, you are encouraged to start off with gentle walks before you progress to running.

Be sure to check in with your doctor prior to returning to any physical activities.

Waiting the appropriate amount of time prior to attempting a return to high impact exercises is necessary for healing post-delivery especially when pelvic floor dysfunction symptoms are present including:

  • Urinary/fecal incontinence
  • Urinary/fecal urgency
  • Pelvic organ prolapse (typically accompanied by pressure/bulge in pelvic floor region)
  • Pain with intercourse
  • Diastasis Recti (separation of abdominal muscles)
  • Muscular pain

While on the topic of pelvic floor dysfunction, it is important to be aware of the potential risk factors and complications that may affect your return to running and can increase your present symptoms include:

  • Premature return to high impact exercises
  • Pre-existing conditions/complications
  • Breastfeeding
  • Obesity
  • Cesarean Section
  • Perineal scarring
  • Current pelvic floor dysfunction
  • Running with buggy/stroller (which alters normal running mechanics/form)
  • Level of fitness
  • Psychological status
  • Diastasis Recti
  • Sleep

If the above symptoms are present, you may need to wait a longer period of time before making a return to running. A visit with a physical therapist can give you helpful insight into your current situation and the best way to manage the symptoms you may be experiencing.  Your physical therapist can also recommend exercises you can perform that can help to prepare you for your return to running. 

Prior to beginning a running program, a new mom should be able to complete the following without pelvic floor symptoms including pain, urinary/fecal incontinence, or a feeling of heaviness:

  • Walking 30 min
  • Single leg balance 10 seconds
  • Single leg squat 10 reps each side
  • Jog on the spot 1 min
  • Forward bounds 10 reps
  • Hip in place 10 reps each leg
  • Single leg running man 10 reps each side

A Final Takeaway About Returning To Running Postpartum

It is recommended to have a thorough screening by a pelvic floor specialized physical therapist to ensure that you have adequate hip strength, core stabilization, and pelvic floor function. Your physical therapist will provide guidance for returning to running or other high impact sport/activities postpartum. Your physical therapist will also provide you a personalized program of specific exercises to ensure success with return to running postpartum, along with a structured plan for increasing distance and time.                                                                                                                                                                                                                                                                                 

The Effects Of A Stroke: Tonicity and Spasticity In The Extremities

The Effects of Stroke on Tonicity & Spasticity in the Extremities

Written by Jessica Dietz, PT, DPT, NCS

According to the American Heart Association, someone in the United States has a stroke every 40 seconds. The effects of stroke continues to be the leading cause of serious long-term disability in the United States. However, up to 80% of strokes can be prevented by lifestyle changes (especially exercise!) and management of atrial fibrillation, diabetes, high blood pressure and cholesterol.

There are two different types of stroke– ischemic and hemorrhagic.

Ischemic strokes: are the most common type of stroke and also the most preventable. Ischemic strokes occur due to disruption of blood flow to the brain, such as narrowing/blocked arteries or blood clots.
Hemorrhagic strokes: are less common and due to a blood vessel break or bleed in the brain like an aneurysm. For more information about types of strokes, visit the American Stroke Association.

Depending on the location, severity, and several other risk factors, every person with a stroke is different! There are many possible changes someone may experience as an effect of stroke such as:

  • Weakness
  • Difficulty speaking or swallowing,
  • Numbness
  • Altered cognition
  • Vision changes
  • Difficulties with balance

Only about 10% of patients experience a full recovery after having a stroke. That means almost 90% have some type of mild to severe impairment as an effect of a stroke that may continue to require rehabilitation or medical management.

One common as well as frustrating and potentially debilitating effect after a stroke is “TONE and/or SPASTICITY”. Throughout this blog, we will discuss more about tone/spasticity and its management and treatment.

What Is Tone/Spasticity?

Your doctors may have used the terms “tone” or “spasticity” to describe the stiffness in your extremities. Although tone and/or spasticity can be found in the neck and trunk it more commonly occurs in the extremities after a stroke. Often times these two terms are used interchangeable, however, they are different so it is important to know the difference as they are managed differently. To make it even more complicated, sometimes you can have both!

Everyone has some degree of TONE, which is the body’s underlying resting resistance to movement or stretch. Think, if you have low tone (i.e. hypotonicity) your limbs would be very easy to move almost like an overcooked noodle. More commonly, we see too much tone (i.e. hypertonicity) which causes a stiffness and resistance to movement.

SPASTICITY, however, is the body’s resistance to quick movements caused by a quick stretch to the muscle. For example, a quick stretch to your calf muscle when you are sitting can create clonus (which is a type of spasticity) that causes a fast beating motion of your leg. Spasticity is different than just muscle spasms as spasms often occur randomly and without a stretch of the muscle.

Why Does Tone/Spasticity Matter?

Normally with movement or stretch to the muscle, there would be a normal resistance in contrast to that movement or stretch. However, after a stroke there is often a loss of normal inhibition from the brain which can lead to over-excited neurons and nerve tracts. Hypertonicity and spasticity can further lead to postural changes, contractures (i.e. permanent loss of a joint’s range of motion), balance difficulties, and pain.
Here are two examples of condition presentations and how they impact function.

Example #1 – Hypertonicity in arm/hand
One of the most common presentations is hypertonicity in the affected arm and hand. This can cause the arm to remain stiff and difficult to move for getting dressed or performing other daily activities. Hypertonicity in the hand can cause the hand to remain in more of a clenched, fisted position which makes fine motor tasks difficult, such as grabbing a utensil to eat. This is also a common example of how an affected limb can be stiff (due to tone), weak, and potentially painful.

Example #2 – Spasticity in leg
Another presentation can be spasticity in the quadriceps muscle. The quad muscle is one of the most important muscles for standing and walking. If this muscle becomes spastic after a stroke it can lead to hyperextension of the knee or “stiff leg” when trying to take a step or go upstairs. This is a good example of also the phenomenon that spastic muscles are often WEAK muscles and sometimes you can use your spasticity for function. But if you take too much medication that decreases your spasticity you may find it more difficult to stand or walk.

How To Manage Tone/Spasticity?

Often the first treatment for both tone and spasticity include medication. Some common medications include: Baclofen (lioresal), Clonazepam (klonopin), Dantrolene (dantrium), Iazepam (valium), and Tizanidine (Zanaflex).

Other treatments for higher levels of tone/spasticity are botox injections, phenol/alcohol injections, and intrathecal baclofen pump. These medications should be managed and monitored by your doctor for the appropriate dose to minimize side effects of high doses.

Physical therapy and exercise provide conservative and non-medical management of either tone and/or spasticity. Physical therapy can help the most in the following ways:

Optimize the “window of opportunity” that exists with any of the above medications or injections that are used. For example, botox injections are most effective within 3-90 days after the procedure. This means we may have more range of motion, less resistance to movement, or less pain that our therapeutic interventions may be more effective.
Optimize function despite having tone or spasticity. Despite medication and other management, there usually is some level of abnormal tone or spasticity present which means you have to learn how to move and safely function with this new tone/spasticity. There are many “tricks of the trade” and techniques that a physical therapist can recommend to help maintain independence and function.
Skilled observer of function and movement. Often times, physical therapists and doctors work together in order to find the appropriate dosage of medication as well as muscle groups for injections that will allow someone to be the most mobile and independent.

Some other non-medical treatment ideas that can be performed in therapy include vibration, electrical stimulation (e-stim), taping, orthotics or bracing, and other adaptive devices.

The most successful treatment although continues to be specific stretching and strengthening, so see your local physical therapist for specific stretches and strengthening exercises to make it individualized to you!

How To Prevent A Stroke

We could not have a blog about stroke without highlighting the importance of stroke prevention! Once again, 80% of strokes can be prevented. Some of the most important prevention recommendations include some of the following:

  • Exercising/moving more
  • Eating healthy
  • Maintaining a healthy body weight
  • Quitting smoking
  • Decreasing alcohol consumption
  • Having regular doctor visits

To read more information about more prevention tips, visit the following websites:
National Stroke Association
American Stroke Association

Concussion Treatment: More Than Just Getting “Your Bell Rung”

concussion-management-treatment

According to the CDC, 2.87 million TBI-related emergency department (ED) visits, hospitalizations, and deaths occurred in the United States in 2014. Concussions are considered a type of mild Traumatic Brain Injury (TBI); while there is no structural damage, there is a temporary chemical imbalance/flux . The CDC further describes concussions as “any bump, blow, or jolt to the brain or body that causes the head and brain to move rapidly back and forth”. Common causes of concussions include the following: sports and recreation, falls especially with elderly population, car accidents, and military blasts/blunt trauma.

Breaking the Concussion Myth

The common misconception with concussions is that they are not a “big deal” and someone can return-to-game, work, or combat/service without taking the necessary steps to help relieve post-concussion symptoms. During the first 24 hours, it is most important to eliminate the potential risk of a second concussion. The brain is at a highly vulnerable for what we call “Second Impact Syndrome” which can cause further – and more[JD3]  severe – brain injury and potentially even life threatening. Multiple concussions can also cause more and more symptoms and prolong recovery.

Concussions are not just “your bell got rung”! We need to encourage athletes, military, and the community to listen to their bodies, and if they suspect a concussion speak up and take action. Managing your concussion symptoms may be able to return[JD4]  to activity sooner and drastically reduce their time needed to recover as well as reduce the likelihood of having chronic symptoms.

What to Do Immediately After a Concussion

Immediately after a concussion, your brain goes through a flux of chemical imbalances that are at its peak for the first 24 hours and can last up to 7-10 days post-concussion. During this time, someone may experience any of the following symptoms:

Physical/Postural Cognitive
Emotional Sleep
-Headache
-Nausea/vomiting
-Light sensitivity
-Eye problems
-Dizziness
-General unsteadiness
-Fatigue
-Feeling dazed
-Mentally “foggy”
-Feeling slowed down
-Answer questions slowly
-Difficulty concentrating
-Forgetful
-Repeats self
-Drop in academic performance
-Irritability
-Sad/Depressed
-Personality changes
-Anxiety
-More/less emotional
-Drowsy
-Sleeping more/less
-Difficulty falling asleep or staying asleep

 

With current research, complete mental and physical rest is recommended for the first 24-48 hours after a concussion. During this time, it is very important that an athlete not return to play until cleared by a medical provider! After 48 hours, someone can gradually re-engage back into their normal daily activities. It is recommended to schedule half days when returning to work or school as well as allowing breaks as needed throughout the day. In order to manage symptoms and avoid the snowball effect, use the “Rule of 3’s”. This means stopping any activity that is increasing symptoms >3 points from your “baseline” (on healthcare’s 0-10 scale).

When to Seek Further Concussion Treatment

Someone should seek emergency medical care if they suspect skull fractures, potential spinal cord injury, significant loss of consciousness, worsening mental status, seizures, or persistent vomiting. Even have a family member or friend help monitor things! Medical doctors should be the primary team member to manage and follow-up regarding “return to play”, “return to work”, and “return to learn/school” considerations.

Typically, we recommend pursuing Physical Therapy, specifically concussion-based rehabilitation, after  ~1 month of persistent symptoms. Physical Therapy can help with headache management, dizziness/unsteadiness, light/noise sensitivity, eye problems, visual over-stimulation, and coordination/processing speed. It is recommended to find a Physical Therapist in the area that is knowledgeable and has experience with concussion rehabilitation. These types of experienced therapists will be able to make an individualized concussion treatment plan that are specific and directed toward the patient’s goals. Post-concussion rehab can last anywhere from 1 month to > 6 months.

Other team members may include neuro-psychologists who perform neuro-cognitive screening and assessment, ophthalmologist for continued eye problems, speech therapy for continued cognitive deficits, athletic trainers to help assist return to play, and teachers/coaches/employers  to construct appropriately paced return to activity.

 

 

Get To Know Your Physical Therapist Assistant – Erin Mumby, PTA

Therapydia Denver physical therapist assistant Erin Mumby, PTA, takes some time to talk about her own experience with injury, why she loves Colorado, and her continuing education focus on pelvic floor for male and female patients.

When did you know that you wanted to be a physical therapist assistant?

I was always active and knew I wanted a profession which would nurture this part of me. I injured my knee and hip during varsity cross country and received PT which started me down this path.

What’s your favorite song to get you motivated?

Morning Sun. It’s very repetitive but I love it.

What is the biggest challenge involved in being a PTA?

Being a PTA has a few unique challenges. PTA’s have to be able to form their own personalized treatment style while at the same time, learn each PT’s treatment style to maintain congruency with pt treatment plans. We also face the issue of patients thinking we have no formal education. So patient education is important for us to gain trust.

How do you like to stay active?

I love the activities that Colorado has to offer. I rock climb, backpack, hike, and ski. I’d much rather be outside than in a gym.

What surprised you the most about the physical therapist profession?

The most surprising aspect of PT to me is the fact that I still run into people, physicians, surgeons who don’t utilize PT or are unsure of how we can help as a profession.

Are you currently pursuing any further education/Certifications?

I’ve spent my continuing education with pelvic floor focus for male and female patient’s along with becoming certified in the Selective Functional Movement Assessment and Functional Movement Screen. I am a certified clinical instructor. I am currently searching for a gait/running analysis course.

What’s your go-to breakfast?

Bagels, breakfast tacos, oat meal…I love breakfast!

What do you wish everyone knew about physical therapy? / What is the biggest misconception you hear from new patients?

I just wish the general pubic as a whole knew more about how PT can help so that people didn’t suffer with pain for so long prior to seeking treatment.

What is the most important personality trait that a therapist must have?

Simply just caring about the profession. This is what drives us to continue with our education and put in the effort to spend time researching to find more effective treatment plans.

What do you do to de-stress/unwind?

Working out and reading both help me to de-stress in the evenings.

Finish this sentence: On Saturday mornings, you can usually find me…in the mountains!

What is your favorite piece of wellness advice to offer?

I think the medical profession as a whole needs to give more focus on nutrition and how poor/good nutrition has affects on our system globally.

Get to Know Your PT: Aaron Page, Therapydia Denver Physical Therapist

Therapydia Denver physical therapist Aaron Page takes some time to talk smoothies, his recent move to Colorado, and what he wishes everyone knew about PT.

“The best workout plan is something that’s sustainable. In order to create lasting change, it needs to be approachable and repeatable.”

When did you know that you wanted to be a physical therapist?

Like a lot of physical therapists I know, I was an athlete growing up and had my fair share of injuries, so I was exposed to PT early and often. I got to know a great PT in my area when I was 15 or so, and he was a clear example of someone who cared about his patients and I wanted to be a practitioner like that. I guess I officially knew in undergrad when I decided to switch my major from Biology to Health and Human Sciences and move forward to grad school with being a PT as my goal.

What is the biggest challenge involved in being a PT?

The biggest challenge for a PT (besides the paperwork) is not falling into specific patterns of treatment. It’s easy to start going down similar paths of rehab with patients that may be exhibiting similar characteristics. The important thing to keep reminding yourself that each patient is unique and small nuances in care can make a big difference, so you need to be constantly reflecting on your choices and adapting to new information.

How do you like to stay active?

I recently moved to Colorado so anything I can do outdoors like hiking or biking has been great. I’m a fan of resistance training too and try to incorporate that into my treatment sessions, so I’m training in the gym as well to make sure I don’t ask my patients to do anything I can’t do.

What’s your favorite song to get you motivated?

It’s kind of obscure, but my go-to song for motivation is “Quiet Little Voices” by We Were Promised Jetpacks. I like songs that build throughout and this one does that really well. It’s super helpful on a run when the tempo picks up and the band gets louder as you go on.

What surprised you the most about the physical therapist profession?

Realistically I think what most surprised me was the difficulty of navigating the healthcare system. It seems like it should be something that works for you when you need it, but often times we’re faced with the challenge of trying to provide quality care within the confines of an insurance plan that makes it difficult for patients and practitioners to access all of the benefits they pay for each month with their premium. It seems crazy to me to have to justify care in certain situations that warrant it and still have hoops to jump through to make it happen.

Are you currently pursuing any further education/certifications?

I’m in the process of reviewing to get my CSCS (Certified Strength and Conditioning Specialist) and plan on getting my OCS (Orthopedics Certified Specialist) in the next few years. In the mean time I’m looking to take a course on Functional Range Conditioning to update on some movement systems.

What is the biggest misconception you hear from new patients?

The biggest misconception I get all the time is that PTs just do massage and stretching. Though those can be helpful in their own way and are sometimes incorporated in a treatment plan, physical therapy is much more than that. I wish everyone knew that PTs are movement experts and evaluating how your body moves and can (or cannot) control movement is a unique and challenging aspect for clinicians. I always try to emphasize that the more active a patient is in their treatment the better the outcomes.

What’s your go-to breakfast?

I’m usually trying to get something quick, so I’m a big smoothie guy. My go-to is usually spinach, almond butter, bananas, some sort of berry and almond milk. It’s either that or some Greek yogurt, raspberries and granola. I basically eat the same thing every morning haha.

What is the most important personality trait that a PT must have?

Most importantly, physical therapists have to be compassionate. Truly listening to your patient and finding a way to meet them where they are is crucial. If you don’t value your patient’s goals as your own, it can be tougher to get them there.

What do you do to de-stress/unwind?

I usually try to read. I bounce back and forth between fiction and non-fiction, but it’s easy for me to get caught up in what I’m reading and it helps to take my mind out of its normal space.

Finish this sentence: On Saturday mornings, you can usually find me…

On my way to find an egg-everything bagel and an iced coffee treat.

What is your favorite piece of wellness advice to offer?

The best workout plan is something that’s sustainable. Sometimes we ask our patients to do a lot in the name of rehab, but what we’re trying to instill more often than not is consistency. In order to create lasting change, it needs to be approachable and repeatable.

Click here to learn more about Aaron and the other physical therapists at Therapydia Denver.

Get to Know Your PT: Josh Hardy, Therapydia Denver Physical Therapist

Therapydia Denver physical therapist Josh Hardy takes some time to talk about his love of the mountains, staying active year-round, and how a high school basketball injury led to a career in PT.

“Find fun things to do that will keep you fit. You’ll never work out another day in your life.”

When did you know that you wanted to be a physical therapist?

When I was a junior in high school. I fractured my pelvis during a basketball game and ended up doing a fair amount of PT to get ready for track season. Spending time with my physical therapist got me interested in anatomy and biomechanics and I never looked back.

What is the biggest challenge involved in being a PT?

Honestly, the paperwork. It is tough to give your patients what they need and deserve in each visit while staying on top of your charts. In a busy week, you can easily end up doing 10-15 hours of paperwork on top of seeing 40 hours worth of patients.

How do you like to stay active?

In the summertime I love to hike, cycle, camp, and fly fish. In the wintertime I love to snowboard and snowshoe.

What’s your favorite song to get you motivated?

“17 Years” by Ratatat. It can get me excited to do anything from snowboarding to paperwork. That song just really gets me going.

What surprised you the most about the physical therapist profession?

How much health insurance influences care. In situations where a lot of rehab is needed (ACL reconstruction, rotator cuff repair, etc.), you really have to look at the patient’s insurance situation and strategize about how to ensure that they make a full recovery within the confines of their benefits.

Are you currently pursuing any further education/certifications?

Next on my continuing education list is definitely a shoulder course. Bigger picture, I’m always considering going back to get my PhD and someday contribute to the PT profession as an educator.

What do you wish everyone knew about physical therapy?

With most insurance plans you can come straight to physical therapy. If you have a musculoskeletal issue, you can often save yourself a copay and potential added costs of imaging by going to the practitioner that is ultimately going to get you healthy again (your PT).

What’s your go-to breakfast?

2 farm freshies sunny side up, 1 strip of bacon, wheat toast.

What is the most important personality trait that a PT must have?

You have to be outgoing and enjoy speaking with people. A big part of the job is having 15 to 20, 30-minute conversations per day.

What do you do to de-stress/unwind?

I like to get out of the city and up into the hills. It doesn’t really matter what I’m doing, I’m always happy if I’m in the mountains.

Finish this sentence: On Saturday mornings, you can usually find me…

Heading west on I-70

What is your favorite piece of wellness advice to offer?

Find fun things to do that will keep you fit. You’ll never “work out” another day in your life.

Click here to learn more about Josh and the other physical therapists at Therapydia Denver.