- Your Bridge to Health -

Patients receiving expensive and risky treatment for knee surgery
April 12, 2018

Knee condition is one of the leading causes of disability in the country

Osteoarthritis is a painful condition that develops when cartilage breaks down over the course of time. This is why it’s often called “wear and tear” arthritis. Osteoarthritis can occur in any joint in the body, but the hips and knees are affected most frequently. Knee osteoarthritis is a very common condition that affects more than 10% of the adult population, and it’s considered a leading cause of disability in the U.S. Conservative (non-surgical) treatment that includes physical therapy is typically recommended as the first line of treatment for knee osteoarthritis, but surgery may be necessary for patients that fail to improve. Total knee replacement is the most common surgical procedure used to treat these patients, and it often leads to successful outcomes with less pain and better knee function afterward. Before getting to the point when surgery is needed, knee osteoarthritis patients may undergo a variety of different treatments. There is a set of treatment guidelines from the American Academy of Orthopaedic Surgeons (AAOS) that all doctors should be following when making these decisions, but many doctors continue to prescribe treatments that are not recommended. To get a better idea of what types of treatments doctors are prescribing knee osteoarthritis patients before surgery and how much it’s costing, a study was conducted.

Large database examined for patterns in treatment recommendations

A large database used for recording information on patients who had a total knee replacement surgery served as the main source of data for the study. Researchers identified 86,081 patients who fit the necessary criteria for the study and examined the treatments that they received prior to having surgery. Based on the guidelines for treating knee osteoarthritis, they chose to analyze the use of eight treatments, which included physical therapy, braces, injections and both over the counter and prescription pain medications, including opioids.

None of the top three treatments used are supported as effective

Results showed that in the year prior to having knee replacement surgery, most patients (66%) received at least one of the analyzed treatments for their knee osteoarthritis, which cost an average of $506 per patient. The three most commonly used treatments were corticosteroid injections, hyaluronic injections, and opioids. For the injections, one of two different chemicals—either a corticosteroid or hyaluronic acid—is injected directly into the knee to reduce pain. In total, these three treatments accounted for about 43% of the costs associated with managing knee osteoarthritis; however, none of them are recommended by the guidelines as effective interventions for this condition. In addition, the hyaluronic injections were responsible for approximately 30% of patients’ costs, even though the guidelines strongly recommend against using them. This shows that many patients with knee osteoarthritis are being given treatments that are not recommended, which could cost them more and do not even lead to successful outcomes. Patients dealing with knee osteoarthritis should, therefore, seek out only treatments that follow the AAOS guidelines, which will help them experience the best possible outcomes and avoid surgery unless it is completely necessary.

-As reported in the January ’17 issue of The Journal of Arthroplasty

Physical therapy found to be more effective for carpal tunnel
April 10, 2018

Debate still exists on which treatment is better

Carpal tunnel syndrome (CTS) is a condition that causes numbness, tingling and weakness in the hand due to too much pressure on a particular nerve in the wrist. Between 6-12% of the population deals with the symptoms of CTS on a regular basis, which causes many individuals to miss work as a result. Treatment for CTS can be either surgical or conservative (non-surgical), and there is still a fair amount of debate on which treatment is more beneficial. Although surgery has been found to lead to better long-term results in some studies, it’s also been shown that 33% of individuals who have surgery do not return to work two months later. In addition, physical therapy is commonly used as a conservative treatment for CTS, but there is not a great deal of evidence to support it. For these reasons, a powerful study called a randomized-controlled trial (RCT) was conducted to compare the effectiveness of surgery to a hands-on form of physical therapy called manual therapy for patients with CTS.

Patients randomly assigned to one of two treatment groups

Individuals diagnosed with CTS were invited to participate in the study, and a total of 95 fit the necessary criteria. These participants were then randomly assigned to one of two groups: the manual therapy group or the surgery group. Patients in the manual therapy group attended three 30-minute treatment sessions over three weeks to address their condition. The manual therapy consisted of the physical therapist performing a series of movements and maneuvers with their hands to the wrist and other areas of the body that may have affected nerves in the wrist. This included the hand, biceps, pectoral and shoulder muscles. The final session focused exclusively on education, and participants were instructed to perform certain exercises twice a day for one month. Patients in the surgery group were treated with a surgical procedure called endoscopic decompression and release of the carpal tunnel and then attended the same education session as the manual therapy group afterward. All participants were evaluated before treatment, and then again three, six, nine and 12 months later for pressure pain threshold—the minimum force applied that causes pain—and several other outcomes.

Manual therapy leads to greater improvements than surgery

After one year, results showed that patients in both groups experienced improvements from their treatments. In particular, these patients reported less intense pain and less sensitivity to pain at both six and 12 months after treatment. The manual therapy group, however, showed even greater improvements than the surgery group in their pain intensity at three months and their pressure pain threshold at three, six and nine months. These findings suggest that surgery and manual therapy seem to be beneficial to a similar degree for patients with CTS, but manual therapy may be slightly more effective. In addition, manual therapy comes with far fewer risks and is significantly less expensive than surgery. For these reasons, manual therapy could be considered a preferable treatment option for CTS, but each patient should make their decision individually after carefully weighing the pros and cons of each approach.

-As reported in the March ’17 issue of the European Journal of Pain

Surgery and therapy lead to very similar outcomes for hip conditions
April 6, 2018

Studies directly comparing these two treatments are lacking

Femoroacetabular impingement syndrome (FAIS), also known as hip impingement, is a condition in which extra bone grows along one or both bones of the hip joint. This causes the bones to rub against each other during movement and results in painful symptoms in the hip and groin area. Conservative (non-surgical) interventions like physical therapy may be recommended as the first line of treatment for FAIS, but some patients have hip surgery either right away or after conservative methods don’t lead to improvements. The rate of hip surgery has been growing at a rapid rate in recent years, and it is now considered the standard treatment for FAIS in the U.S.; however, high-quality evidence is actually lacking on the best treatment for this condition. No studies have directly compared surgery and physical therapy for patients with FAIS, and a better understanding of the long-term effect of these interventions is needed. Therefore, a powerful study called a randomized-controlled trial (RCT) was conducted that compared the outcomes of physical therapy to surgery for FAIS patients in the long term.

80 patients randomly assigned to one of two treatment groups

Individuals seeking care for FAIS were invited to participate in the RCT and screened to determine if they were eligible. This process led to 80 patients being accepted and then randomly assigned to either the physical therapy or surgery group. Patients in the physical therapy group attended two 45-minute treatment sessions per week for six weeks, for 12 sessions total. Treatment was based on each patient’s specific impairments and consisted of a variety of stretching and therapeutic exercises for the hip and lower back. These patients were also instructed to follow a home-exercise program. Surgery was performed within four months, and was followed by a physical therapy program. All patients were assessed at the start of the study and then six months, one year and two years later for a number of outcomes related to hip pain and function.

Despite its popularity, surgery does not lead to better outcomes than physical therapy

Over the course of two years, the results primarily showed that physical therapy and surgery led to very similar outcomes for patients. In particular, there were no significant differences between the surgery and physical therapy groups in overall hip function at any of the time points of six months, one year and two years. In addition, the physical therapy group actually reported significantly better scores than the surgery group in their ability to perform daily activities at the one- and two-year follow-ups. The surgery group also had higher rates of complications from their treatment, as well as hip arthritis, compared to the physical therapy group.

These findings suggest that patients with FAIS can experience similar benefits with both surgery and physical therapy. Despite its popularity, surgery may not be the best option for all of these patients, especially because physical therapy is less expensive and comes with far fewer risks. So if you’re dealing with hip pain that may be due to FAIS or a similar condition, it may be best to try physical therapy as your first course of treatment. Physical therapy can be helpful for many patients, but if it doesn’t help you experience significant improvements over time, then you may want to consider surgery.

– As reported in the February ’18 issue of The American Journal of Sports Medicine

Prevention program reduces ankle sprains in the athletic population
March 30, 2018

Experiencing one ankle sprain increases the risk for additional sprains in the future

Ankle sprains are the most common injuries that occur in the athletic population, and the risk for these injuries is particularly high in individuals that participate in sports with lots of jumping, changing direction and/or pivoting. After an athlete experiences an ankle sprain, several structures in the ankle become weakened, which increases the risk for another ankle sprain in the future. For this reason, some individuals who sprain their ankle once go on to deal with repeated ankle sprains and long-term problems that can seriously interfere with their participation in sports. One way to address this is by reducing the risk for ankle sprains in the first place with certain preventive strategies, such as proprioceptive training. Proprioception allows one to know where their body is in space, and it allows us to take in sensory input from the outside world and integrate it into a particular movement. A prime example of proprioceptive training for the ankle is balance exercise, which can enhance the body’s ability to adapt to a changing environment and protect it from injury. To develop a better idea of how effective this type of training could be, researchers conducted a review on all available literature on the topic.

Four databases searched for relevant studies

Investigators performed a search of four major medical databases for studies on the topic. In particular, they were looking for powerful studied called randomized-controlled trials (RCTs) that evaluated the protective effect of proprioceptive training for preventing ankle sprains in active individuals. This search led to a total of seven RCTs being included into the review, and these studies contained data on 3,726 participants. Once the studies were collected, investigators reviewed their findings and compared them to one another to determine if the programs actually reduced the risk for ankle sprains.

Proprioceptive training found to be effective for reducing patients’ risk for ankle sprains

The results of this review generally showed that the proprioceptive training was in fact effective for reducing the risk for ankle sprains in active individuals. In particular, they found that individuals who completed the training had a 35% reduction in the risk of ankle sprain compared to those who did not. In addition, it was determined that if 17 patients underwent the training, at least one ankle sprain would be prevented. Another analysis found that participants with a history of ankle sprains who completed the training had a 36% reduction in risk for future ankle sprains. These findings show that a proprioceptive training program may be a beneficial method for reducing ankle sprains in athletes, regardless of their history of ankle sprains. Additional research is now needed to further investigate these programs to determine which exercises are best and how long they should last, but patients should still view this as a smart strategy to reduce their risk for an ankle sprain. Those who are interested in keeping their ankles protected should also consider seeing a physical therapist to receive an appropriate treatment program.

– As reported in the November ’17 issue of the Journal of Athletic Training

Surgery and physical therapy lead to similar result for carpal tunnel
March 29, 2018

Patients are advised to have surgery if condition is severe or other treatment fails

Carpal tunnel syndrome (CTS) is a painful condition affecting the hands that is particularly common in the workplace. The prevalence of CTS is approximately 6-12% in the general population, but it accounts for nearly 50% of all work-related injuries. CTS is the result of a pinched nerve in the wrist, and patients who develop it usually experience numbness, tingling and weakness in their affected hand. Treatment for CTS can be either surgical or non-surgical (conservative) depending on the patient’s condition. Conservative treatment is typically recommended at first, but if symptoms are severe or the patient fails to improve after attempting this treatment, surgery may be recommended. Physical therapy is commonly used to treat patients with CTS and often consists of a number of different interventions, including manual therapy, in which the therapist performs various mobilizations and manipulations with their hands. Studies comparing the benefits of surgery and physical therapy have produced mixed results, and it’s not completely clear which is the better choice for patients. Therefore, a powerful study called a randomized-controlled trial was conducted to determine whether manual therapy or surgery was more effective for treating patients with CTS.

140 patients randomly assigned to one of two groups

Individuals diagnosed with CTS were invited to participate in the study and screened to determine if they were eligible. Of the 140 patients screened, 94 fit the necessary criteria and were randomly assigned to one of two groups: the manual therapy group or the surgery group. Patients in the manual therapy group received one 30-minute treatment session per week over three weeks, for three sessions total. These treatment sessions consisted of various manual therapies that targeted the elbow, forearm, wrist, fingers and shoulder, as well as the neck, which is commonly impaired in patients with CTS. At the final session, patients were educated on how to perform the exercises at home and told to perform them if their symptoms got worse. Participants in the surgery group underwent surgery based on a decision made between them and the surgeon, and then received the same educational session on exercises as the manual therapy group after the procedure. All patients were evaluated before the treatments and then again one, three, six and 12 months later for a number of different outcomes, including overall symptoms and function.

Manual therapy leads to greater improvements at first, but results are similar in long term

Results showed that after one month, patients in the manual therapy group experienced significantly greater improvements in function, the seriousness of their symptoms and pinch grip strength than those in the surgery group. After six and 12 months, the two groups reported similar scores in most outcomes measured. Nonetheless, these findings are supportive of manual therapy, since they suggest that patients can expect to have better short-term outcomes with manual therapy compared to surgery. This can be particularly important for office workers, who will be able to return to work and perform their necessary duties quicker after undergoing manual therapy. It’s also important to point out that manual therapy is significantly less expensive and comes with far fewer risks than surgery, which makes it the more attractive option of the two considering both led to very similar results. For these reasons, patients with CTS should continue to try physical therapy—especially manual therapy—as the first line of treatment for their condition before considering surgery, since it leads to superior short-term and similar long-term outcomes.

-As reported in the March ’17 issue of JOSPT

Sleep, a healthy diet & strength training reduces risks for injury
March 23, 2018

Several important factors can influence injury risk throughout development

Childhood and early adolescence are crucial times of rapid change and development. When these young individuals establish healthy habits in nutrition and physical activity early in life, it increases the chances of them maintaining these behaviors later on and developing optimal physical literacy. Physical literacy is the ability, confidence and desire to be physically active for life, and it’s considered essential for lifelong health and fitness. In addition, keeping healthy habits and strong health literacy will reduce the risk for injuries in this younger population, which means more time being able to stay active and less on the sidelines. For this reason, researchers are now becoming more interested in what factors can improve physical literacy and reduce injury risk in children and adolescents, and two recent studies investigated this topic from different angles.

Questionnaires and a study review are used to investigate the topic

In the first study, a web-based questionnaire was emailed to 340 athletes at 15 high schools during the autumn and spring semesters. The questionnaire contained background questions regarding variables like age, gender and sports participation, followed by more detailed questions about sleep, nutrition, stress, self-esteem and injuries. The results from these questionnaires were then analyzed in an attempt to make conclusions on which of these behaviors were associated with a reduced injury risk.

In the other study, researchers performed a search of two medical databases for studies on physical literacy in young athletes and the role of resistance training in preventing injuries. Resistance training is essentially any type of physical exercise in which some type of resistance-such as dumbbells, elastic bands or bodyweight-are used to build muscle strength. The findings from each of these studies were then reviewed and compared to determine if resistance training was effective for reducing the risk for injuries in younger athletes.

Both studies show that there are several important habits that can reduce injury risk

Results of the first study revealed several important observations about young athletes. Most significant was the fact that the recommended intake of fruits was not met by 20% of young athletes, intake of vegetables not met by 39% of athletes and fish in 43% of athletes. The recommended amount of sleep was also not obtained by 19% of these athletes during the autumn semester. Further analysis of these findings showed that athletes who slept more than eight hours on weekday nights and achieved the recommended nutrition intake during the autumn semester reduced their odds of sustaining a new injury during the spring semester.

In the other study, resistance training was found to be effective for reducing the risk for injury by up to 68%. Resistance training was also associated with improved sports performance and health measures, and helped young athletes develop better physical literacy. Based on the findings of these two studies, it appears that the most effective ways to reduce the risk for injury in children and adolescents are by getting enough sleep, maintaining a healthy diet and participating in resistance training. Parents, coaches and athletic trainers should therefore urge young athletes to adopt these types of behaviors, and physical therapists can also play a major role by teaching them resistance training exercises that will build muscle and regulate injury risk in this vulnerable population.

– As reported in the November ’17 issue of the Scandinavian Journal of Medicine & Science in Sports and the September/October ’17 issue of Sports Health

Painful exercise intensity is not beneficial for tennis elbow
March 22, 2018

The immediate effects of exercise on pain are not clearly understood

Lateral epicondylalgia, which is commonly referred to as tennis elbow, is a painful condition that affects about 1-3% of the general population. Tennis elbow is the result of inflammation of tendons at the elbow that travels to the wrist, and it develops from overuse in sports and other activities. Individuals who play tennis and other racquet sports are at the greatest risk for tennis elbow, but it can also develop in anyone else that performs activities requiring the use of the elbow and wrist on a regular basis. Patients with tennis elbow typically experience pain on the outside of their elbow that becomes worse with certain movement and gripping motions, and exercise is considered an important part of treatment to address these symptoms. Although the benefits of exercise for treating tennis elbow have been well established, its immediate effects on patients’ perception of pain are not known. Therefore, a study was conducted to determine how patients’ perception of pain is affected by certain exercises, which can help physical therapists better cater exercises specifically to each patient.

Three measures used to evaluate patients’ pain

Patients with tennis elbow for at least six weeks were invited to participate in the study and screened to determine if they were eligible. This led to a total of 24 individuals with an average age of 52 years being accepted. The experiment was conducted by having each participant perform two different exercises for the wrist and measuring their pain levels before and afterward. Each wrist exercise was performed 10 times and held for 15 seconds each with a 15-second rest, and patients also completed a control condition to compare to the exercises in which they remained seated with the arm resting. Participants were evaluated with the following three pain measurements before, immediately after and 30 minutes after each exercise: pain intensity, pressure pain threshold (the minimum force applied that leads to pain) and pain-free grip force (the amount of force a patient can generate to the onset of pain).

Exercises performed above patients’ pain threshold increase pain intensity

The results of these measurements showed when the patients performed the exercises at 20% above their pressure pain threshold, it increased the intensity of their pain immediately after the exercise. When the same exercise was performed at 20% below their pain threshold, though, it did not have the same effect. This pain intensity was also found to remain significantly higher 30 minutes after performing the exercise above their pain threshold. Finally, the patients with greater pain and disability or fear of movement unsurprisingly reported greater pain intensity during these exercises as well. These findings show that certain exercises performed beyond a patient’s pain threshold can cause pain that lasts for at least 30 minutes afterward and that it may be worse in those that already have higher pain and disability levels. Although further research is necessary, this study may help to better shape exercise programs for patients with tennis elbow, as physical therapists can take account of their pain threshold and cater their exercises accordingly. Doing so will help to improve treatment for this condition while avoiding any unnecessary pain for patients.

-As reported in the December ’16 issue of The Clinical Journal of Pain

Personalized program decreases risk for another hamstring injury
March 16, 2018

About one-third of patients will get injured again within a few weeks of returning

Strains of the hamstrings, which are a group of three muscles located in the back of the thigh, are the most common injuries that occur in soccer players. Making matters even worse is the fact that after experiencing a first hamstring strain, about one-third of players will go on to have another hamstring injury within a few weeks of returning to play. This high rate of re-injury may be either due to players not taking enough time to completely heal before returning or because their rehabilitation program was not sufficient. It is therefore important to ensure that the rehab programs used are as effective as possible for reducing the risk for future hamstring strains. One possible way to accomplish this is to use a treatment algorithm consisting of an ordered sequence of steps, where each step depends on the success of the previous step and is based on how each patient responds. With this in mind, a powerful study called a randomized-controlled trial (RCT) was conducted to evaluate the effect of this algorithm on the risk of hamstring strains in soccer players.

A total of 48 soccer players complete the study

Soccer players in Spain who had recently experienced a hamstring strain were invited to participate, and a total of 48 individuals were accepted and completed the RCT. These individuals were then randomly assigned to either the rehabilitation algorithm (RA) group or the rehabilitation protocol (RP) group and began treatment five days after their injury. Both rehab programs were performed and controlled by a physical therapist, but they were each structured in different ways. Patients in the RP group completed a program that consisted of hamstring exercises plus a general rehab and progressive running program, which was completed on a daily basis. After each participant was pain-free, they performed a test to determine if they were eligible to return to soccer, and if they failed, the rehab program was extended. The RA group followed a rehab program based on an algorithm, which only allowed patients to proceed to the next step if certain criteria were met. There were two parts of this program, with the first consisting of exercises designed to correct different risk factors related to hamstring injuries. The second part consisted of sprint training, strength training and manual therapy, and running sessions were also performed throughout. All participants were monitored for six months and any additional injuries they experienced were recorded.

Patients who follow the treatment algorithm experienced fewer injuries

Results showed that over six months, the soccer players in the RA group experienced substantially fewer hamstring strain injuries than those in the RP group, especially in the early period when most of these injuries occur. In addition, the amount of time needed to return to sports was slightly shorter in the RP group, but the RA group experienced more substantial improvements of their performance in a sprint test. These findings suggest that an algorithm for rehabilitating hamstring strain injuries may be the better strategy for reducing the risk for future injuries while also improving players’ performance. Individuals who are dealing with a hamstring strain should therefore consider seeing a physical therapist and following a similar rehab program to increase their chances of returning to sports appropriately with a lower risk for future hamstring injury.

– As reported in the July ’17 issue of Medicine and Science in Sports and Exercise

Older adults with headaches benefit from physical therapy treatment
March 15, 2018

Neck pain associated with headaches is more common in older age

Headaches can be a problem for just about anyone, but they affect people of different ages in unique ways. Secondary headaches, which are headaches influenced by other areas of the body—like the neck—and associated neck pain become more common with older age. For older adults, secondary headaches—in which the cause of the pain is from something other than the headache itself—and associated neck pain both become more common as the person ages. Many of these older adults with headaches and neck pain also experience neck dysfunction, which can be very bothersome and prevent them from functioning normally. It’s also possible that this neck pain and dysfunction might actually be the source of these headaches, which highlights why it’s so important to address these issues. There are many treatments available for headaches and associated neck pain and dysfunction, but it’s not completely clear which is most effective for older adults. Physical therapy is generally considered a safe and effective treatment option, but more research is needed to study how far its benefits go. Therefore, a powerful study called a randomized-controlled trial (RCT) was conducted to evaluate the effectiveness of physical therapy for older adults with headaches and associated neck pain and dysfunction. RCTs randomly place participants in different treatment groups and are highly regarded as idealized study designs.

65 patients between ages 50-75 complete the study

Adults between the ages of 50-75 years old with recurrent headaches and associated neck pain and dysfunction were invited to participate in the RCT. A total of 65 fit the necessary criteria for the study and were randomly assigned to one of two treatment groups: the physical therapy group and usual care group. Participants in the physical therapy group attended 14 individual treatment sessions over 10 weeks, each of which lasted for 45 minutes. These sessions included a combination of hands-on treatments performed by the physical therapist and a variety of exercises that targeted the muscles in and around the neck. Participants in this group were also instructed to perform their exercises once daily without aggravating pain and to keep an exercise and headache diary to monitor their condition. Individuals in the usual care group were asked to continue with their medication and pursue any other treatments for their condition, so long as it did not include physical therapy. All participants were evaluated before treatment began and then again 11 weeks, six months and nine months later for headache frequency and several other outcomes.

Participants who receive physical therapy improve in multiple areas

On the whole, results showed that participants who received physical therapy improved more significantly than those who underwent usual care. In particular, the frequency of their headaches was significantly reduced after 11 weeks and remained at this level up to nine months later. In addition, participants in the physical therapy group reported more significant reductions in headache intensity and duration, as well as neck pain and disability, than the usual care group up to the nine-month follow-up. Finally, this group even reported improvements in their quality of life, flexibility, and perception of the treatment’s benefit, and used fewer medications than the usual care group. These findings show that 10 weeks of physical therapy are capable of leading to several benefits in older adults dealing with headaches and associated neck pain and dysfunction. Since physical therapy is a safe intervention that leads to very few side effects, older individuals with this condition should strongly consider seeking out the services of a physical therapist to address their condition and reap the benefits of a proven treatment.

-As reported in the January ’17 issue of The Spine Journal

Most patients with common foot injury don’t seek out physical therapy
March 13, 2018

Approximately 10% of population will experience the injury at some point in their lives

Plantar fasciitis is a very common foot injury, as about one million individuals will seek out treatment for it each year and roughly 10% of the general population will experience it at least once in their lives. The injury involves the plantar fascia, which is a strong piece of tissue that normally absorbs shock and supports the arch of the foot. Patients with plantar fasciitis typically experience a stabbing pain in the bottom of the foot near the heel, which is usually the worst with the first few steps after awakening. Recommended treatments for plantar fasciitis include a variety of stretching and strengthening exercises, bracing and a hands-on therapy called manual therapy, which is usually administered by a physical therapist. There is strong evidence showing that physical therapy-based treatments like manual therapy and exercises are effective for this injury, but it’s not completely clear if patients are actually taking advantage and seeking out this type of care. For this reason, a study was conducted to investigate how many patients with plantar fasciitis are referred to physical therapy and what types of treatment those who are referred receive.

Patient record database serves as primary source of information

A patient record database, which contained information on patients diagnosed with plantar fasciitis and their associated health care visits, was used for the study to evaluate trends regarding physical therapy. This database provided details on 819,963 patients diagnosed with plantar fasciitis, who were billed for a total of 5,739,737 visits to a medical professional over four years. Additional data on these patients was then analyzed to determine what proportion sought out physical therapy services.

More efforts are needed to educate patients on benefits of physical therapy

Of the more than 800,000 patients in the database, only 7.1% were actually evaluated by a physical therapist within 30 days of their diagnosis. A total of 78% of the entire group of patients were between the ages of 30-59 years old, with women being 50% more likely to seek out treatment for their condition, and 85% of patients were evaluated in a private or hospital-based outpatient clinic. Of the patients evaluated by a physical therapist, 87% received manual therapy and 89.5% received supervised rehabilitation as part of their treatment program. Patients who were treated with manual therapy were found to have shorter lengths of care and paid less overall for their care than those who did not. These findings show that although physical therapy is strongly supported by evidence as a beneficial treatment for plantar fasciitis the vast majority of patients with the injury do not seek out this type of care. There are several possible explanations for this, including lack of education, financial concerns and poor geographic location, all of which can limit access to physical therapy. This highlights the need for patients to better understand why physical therapy is such a suitable intervention for plantar fasciitis, and should serve as encouragement to seek out these services if dealing with this condition. Doing so can put patients on the fastest road to recovery and save them money in the process.

-As reported in the February ’17 issue of JOSPT