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Improving your bed & workstation setup can help reduce your neck pain
January 15, 2019

The neck has an incredibly important job to do. It supports the head and allows us to move it in a wide range of directions so that we can better navigate the world around us. But because of how frequently it’s used and its position in the body, the neck is also a very common location for pain, and sometimes all it takes is one bad night’s sleep to ruin your day.

In any given individual, there are many factors that may be responsible for the development of neck pain. What is most important to realize is that some of these factors are completely out of your control, while others can be modified and improved to reduce your chances of developing neck pain. For example, age-related changes to the structures of the upper spine will eventually occur in all individuals. Nothing can be done to stop these changes, and they may contribute to neck pain for some people.

But on the other hand, there are many changes that you can make to your life right now that can help prevent neck pain from occurring. Most of these modifications relate to avoiding postures and positions that might strain or otherwise aggravate the neck, particularly in bed and at workstations—the two places where we generally spend most of our time.

Bed setup

We spend roughly one-third of our lives sleeping, so the habits we develop in both our sleeping patterns and in how our beds are set up can have a major impact on the rest of the day. Sleeping in the wrong position or on a pillow that’s not supportive enough can both lead to neck pain either the next morning or gradually over time. To optimize your bed setup, we recommend the following tips:

  • Avoid sleeping on your stomach: the best sleeping position is on the back, followed by the side, while stomach sleeping turns the neck to the side and can lead to neck pain; sleeping positions are often established earlier in life and difficult to change, but trying to start a night’s sleep on the back will increase your chances of staying there
  • Use a pillow that’s right for you: make sure your pillow is of the appropriate firmness for your neck; different types of pillows are better for different individuals, but a good rule of thumb is to try to use a pillow that keeps your upper spine in neutral alignment, which means the natural curve of the neck is supported and maintained; feather and memory foam pillows may be helpful, while pillows that are too high or too stiff should be avoided
  • Get enough sleep every night: aim for the recommended 7-9 hours each night, as not getting enough sleep can actually lead to more pain

Workstation setup

    For many individuals, a great deal of time every day is also spent sitting at a desk and working on a computer. As with bed setups, the way in which a workstation is set up affects the neck and can play a part in the development of pain developing. To ensure that your workstation is not adding any strain to your neck, we recommend the following:

  • Make sure your computer is at eye level and not too close or far away from you; you shouldn’t have to crane your neck down or strain your eyes to look at it
  • When seated, the feet should be flat on the floor and the back of the chair should be in an upright position
  • Keep the keyboard directly in front of you, close by, and at a height so your shoulders are relaxed, elbows slightly bent, and wrist and hands straight
  • Consider using a document holder placed next to your computer to avoid constant neck movement when switching between the two

Other

  • Avoid neck strain when using your phone by raising it to eye level, taking frequent breaks, and minimizing phone time
  • Use a headset or headphones if you are on the phone frequently
  • Use a neck pillow for flights and long car rides
  • Regularly perform stretching and strengthening exercises for the neck to keep it flexible and strong

No matter your age, neck pain can be a nuisance
January 10, 2019

There’s a good reason that we often call things that bother us a “pain in the neck.” Neck pain is one of the most common health problems in the world, and it’s second only to back pain in terms of painful muscle and bone disorders. Statistics vary on just how prevalent neck pain is, but some figures estimate that as many as 80% of Americans experience it at least once each year. Depending on your age, there are different types of problems that can affect the neck, but the result is usually the same: neck pain and discomfort that gets in the way of normal movement.

The skeletal part of your neck is called the cervical spine, which is made up of seven bones (vertebrae). The vertebrae are referred to as C1-C7—the “C” stands for cervical—starting at the base of the skull (C1) and counting up towards the chest area (C7). Between each vertebra is an intervertebral disc, which cushions the bones and serves as a shock absorber. We use our cervical spine every time we nod, turn, or rotate our head in any direction, and this wide range of motion is one of the main reasons neck pain is so common.

For children and young adults, neck pain is far less common than it is later in life, but there are still plenty of issues that can occur. In this age group, most neck problems are due to strains and sprains of the muscles and ligaments in the neck. Here’s what usually happens:

  • Neck muscles and ligaments are flexible, but sometimes they can be pushed too far
  • This often occurs from holding bad postures—like staring down at a computer or cellphone—for extended periods of time, or sleeping on the neck wrong
  • Symptoms include pain and discomfort in the back, side, or front of the neck that limits movement and activity

As we get older, neck strains and sprains remain common, but a number of other neck-related conditions are also more likely to start developing. In the course of the normal aging process, several age-related changes begin to occur in certain parts of the cervical spine. What generally tends to happen is that the structures that make up the neck become weaker, the intervertebral discs lose some of their height, and the joints in the neck adapt to other changes in the body. Eventually, these changes make the structures of the neck slightly less effective, and as a result:

  • Osteoarthritis may develop, which occurs from losing some of the protective cartilage that surrounds the ends of bones
  • Spondylosis is another general term used to describe any pain related to age-related changes in the spine; this also becomes more common with aging
  • Problems with the intervertebral discs can lead to a herniated, or “slipped” disc, which may cause pain and other symptoms that radiate through the arms

These types of issues typically tend to develop between ages 40-60, but can be seen even earlier in certain individuals. Symptoms also range significantly, as some people experience regular pain and physical limitations, while others don’t notice any symptoms, even though these age-related changes are still occurring.

For adults over the age of 65, age-related changes continue to occur and may begin to become more advanced in some cases. This means that conditions like osteoarthritis and spondylosis are even more likely at this age, and they can be more severe for some individuals. Other conditions like spinal stenosis and osteoporosis also become more common in older age and add to the list of possible neck problems. Spinal stenosis is a narrowing of the spinal canal that puts pressure on the structures within it, while osteoporosis is a condition that causes bones to become weak and brittle. Other mobility limitations could make neck-related issues even more of an impairment for the elderly, but all of these problems are still treatable.

What’s important to understand is that while there is nothing that can be done to stop the aging process, there are countless changes you can make to your everyday life that can significantly reduce your chances of experiencing neck pain at any stage of life.

Supervised therapy is found to be effective for a wrist fracture
January 3, 2019

This type of fracture is especially common in older adults

The radius is the larger of the two bones of the forearm, and the end of this bone closest to the wrist is called the distal radius. A distal radius fracture is another term for a broken wrist, and it is one of the most common of all injuries. Fractures of the distal radius account for between 15-20% of all fractures, but they are especially common in individuals over the age of 60. In this age group, they are the second most common type of fracture behind hip fractures. Treatment for distal radius fractures typically consists of realigning the broken bone and then putting the patient in a wrist cast. Unfortunately, more than 50% of patients continue to have problems with their wrist after this procedure, which can lead to poor long-term outcomes. After the cast is removed, patients are usually instructed to follow a course of physical therapy. This can either be accomplished with a supervised program within a physical therapy clinic or with a home-exercise program designed by a physical therapist. Although both of these types of programs are commonly used, it’s not completely clear which is more effective. For this reason, a powerful study called a randomized-controlled trial (RCT) was conducted to compare a supervised physical therapy program to a home-exercise program for older adults with distal radius fractures.

Patients randomly assigned to one of two six-week treatments

Patients older than 60 who had been diagnosed with a distal radius fracture were invited to participate in the study. A total of 74 individuals were accepted and randomly assigned to one of two treatment groups: the supervised physical therapy group or the home-exercise group. All patients were treated with realignment and a cast for about 6.5 weeks and began their rehabilitation afterward. The supervised physical therapy consisted of hour-long sessions 2-3 times per week for a total of 12 sessions, and each session began with 15 minutes of wrist and hand exercises performed in a 93°F whirlpool bath. After this, the therapist performed a specific set of mobilizations of the wrist joint and then instructed patients to perform three other exercises designed to improve the flexibility of their wrist. For the home-exercise program, a physical therapist taught each patient how to properly perform a set of exercises at home during a 30-minute session. Their home-exercise program lasted 20-30 minutes and was to be performed twice a day for six weeks. It consisted of various stretching exercises and got progressively more difficult as time went on. All patients were evaluated before treatment began, immediately afterward and then after six months for wrist pain and function, as well as several other outcomes.

Patients in the supervised physical therapy group experience greater improvements

Results showed that overall, patients in both groups improved in all of the measurements taken. However, the participants who followed supervised physical therapy experienced significantly greater improvements in wrist function, as well as less pain and better wrist flexibility, compared to those who followed a home-exercise program. This was found to be the case immediately after treatment, as well as six months later. These findings suggest that a supervised physical therapy program will lead to better outcomes for individuals older than 60 with a distal radius fracture, but more research is needed to confirm this. In the meantime, patients who experience this injury should seek out the services of a physical therapist for appropriate treatment, since both forms of physical therapy were found to be beneficial for all patients in this study.

-As reported in the March ’17 issue of The Journal of Hand Therapy

Older adults with depression benefit significantly from exercise
December 27, 2018

Although research has been performed on the topic, several questions remain

Depression is common in older adults, with statistics showing that up to 9.3% of this population is affected by it. Dealing with depression later in life is often a significant burden, as it tends to result in increased health care costs, impairments in physical and mental functioning, and a higher risk for suicide and death. Antidepressants are the most common treatment for depression, with a class of drugs called selective serotonin reuptake inhibitors (SSRIs) typically offered as the first line option. Unfortunately, antidepressants are associated with a number of side effects in older adults, including falls, fractures, epilepsy, and heart-related problems. In addition, many individuals would prefer not to take medications for their condition, and this shows why alternative strategies are needed. Exercise has been suggested as a non-drug alternative treatment for older adults with depression, and several studies have evaluated its effects on this population. One large-scale review of these studies called a meta-analysis found that exercise provided a small-to-moderate effect on older patients, but there were several problems with this study, and many important questions remain. For this reason, researchers decided to conduct and updated meta-analysis to develop a clearer idea of how exercise affects older adults with depression and if it should be recommended.

Six medical databases searched for relevant studies

Investigators performed a search of six major medical databases for randomized-controlled trials (RCTs) that evaluated the impact of any type of exercise on adults over the age of 60. RCTs are high-quality studies in which groups of patients are randomly assigned to undergo different treatments, and they are considered the gold standard for determining if an intervention is indeed effective. This search led to eight RCTs being included in the meta-analysis, which contained data on 267 adults with depression. In these RCTs, 129 patients underwent an exercise program, while the other 138 did not participate in any exercises and served as controls for comparison. Once collected, these studies were reviewed and their findings were compared to one another with the goal of establishing a clear conclusion.

Researchers conclude that exercise should be considered a routine part of treatment for older adults with depression

The results of this meta-analysis showed that exercise had a large and significant antidepressant effect on older adults with depression. More specifically, researchers found these large and significant effects to be associated with exercise of moderate intensity—such as brisk walking—and in studies that used both aerobic exercise and strength training, and in both supervised and unsupervised formats. They also determined that some of the results published in the prior meta-analysis were underestimated due to bias, meaning that the actual effect of exercise was likely greater than the analysis suggested. With this in mind, researchers concluded that exercise should be advocated as a routine component of treatment for older adults with depression. One of the best ways to help older adults get involved in an exercise program is through physical therapy. Physical therapists are movement experts that work with patients on an individualized basis to provide a customized exercise program that considers their strengths and goals. Working one-on-one with a physical therapist can help depressed older adults become more active in their daily lives, leading to better overall health and reduced symptoms as a result.

-As reported in the July-Sept. ’16 issue of Revista Brasileira de Psiquiatria

If stress is weighing you down, exercise may be the answer
December 18, 2018

Stress is everywhere in today’s world

The world we live in today can seem like a breeding ground for stress. As a result, stress is an unavoidable part of life for a significant portion of the population. Recent statistics suggest that 70% of Americans experience some form of stress or anxiety every day, and most say that it interferes with their lives to at least a moderate degree. While daily stress generally comes and goes, about one in four individuals will go on to develop a mental health condition of some sort in their lifetime. Whether stress is an occasional inconvenience or an everyday impairment, most of us would probably agree that we could benefit from less in our lives. These days, there seems to be nearly as many apparent cures for stress as there are causes for it, and the effectiveness of each one varies significantly. But one of the most tried and true solutions to reduce stress is actually pretty simple: get more exercise.

Exercise benefits the body and brain in a number of ways

Getting regular aerobic exercise—which includes walking, running, and any other activity that increases your heart rate—will bring about a number of positive changes to your body, particularly to your metabolism and heart. It can also exhilarate and relax, and provide both stimulation and a calming effect by the same process. This calming effect is how exercise can manage stress and stress-related disorders like anxiety and depression as well. There are several explanations as to why exercise is responsible for these mental benefits, but it seems likely that the changes are related to both chemical and behavioral factors. On the chemical end, exercise has been found to reduce levels of the body’s stress hormones, such as adrenaline and cortisol. It also stimulates the production of endorphins, the body’s natural painkillers that are responsible for the “runner’s high” and feelings of relaxation many people experience after a hard workout. Behavioral factors have also been found to play a role in this process, as positive changes reinforce and encourage positive actions. What this means is that when you see improvements in your body—such as increased strength, better stamina, or a smaller waistline—it makes you feel better about yourself, which will all go on to reduce your stress levels as a result.

Take your pick from the many exercise options available

When done regularly, nearly any time of exercise will help bring about these positive physical and mental changes for you. Brisk walking and jogging are some of the most popular and easiest ways to get active and clear the mind, but others may prefer hiking, biking, swimming, yoga, high-intensity interval training, kayaking, or even rock climbing. It’s really up to you to find some type of exercise—or several—that work for you and do them on a regular basis. There is also a special sort of exercise known as autoregulation exercise that is specifically designed to replace the vicious cycle of stress with a cycle of relief. Several approaches may be used to accomplish this, such as deep breathing exercises, mental exercises like meditation, and progressive muscle relaxation, which focuses on loosening up tight and tense muscles throughout the body, one group at a time.

A physical therapist can help get you on your best foot forward

Current guidelines recommend getting about 150 minutes of moderate-intensity exercise (like brisk walking) or 75 minutes of vigorous-intensity exercise (like jogging) every week. If you are just starting to integrate exercise into your life or increasing the amount you already do, it may take time to reach these marks, so a gradual approach is always best. Seeing a physical therapist can also help you get to where you want to be. Physical therapists are movement experts that work with patients on a personalized basis to help them move better and more frequently. So if you’re trying to increase your weekly exercise, a physical therapist can provide you with recommendations on what types you should attempt, or they may find a specific exercise program based on your abilities and goals to help you succeed.

-Summarized from an article published in Harvard Health

More than 1/3 of older adults with frailty are also depressed
December 11, 2018

Difficult to evaluate this connection with the evidence available

Statistics suggest that about 10-20% of adults over the age of 65 are depressed. The number of older adults that are frail—which essentially means being weak and having a higher chance of getting injured—is also estimated to be similar. Both depression and frailty are associated with a number of negative effects in older age, such as a lower quality of life, increased use of health insurance and a higher chance of experiencing other health issues or dying. When both of these conditions are present at the same time, the effects can be even worse, with many of these individuals experiencing accelerated mental decline and disability. This shows why it’s important to understand the connection between depression and frailty, as it can help identify patients who are affected by either or both conditions, as well as to develop strategies to address them. Although there is some data available on this association, there are no large-scale studies that have focused on the two conditions exclusively. For this reason, a high-quality pair of studies called a systematic review and meta-analysis was conducted to determine how many older adults with frailty also have depression and vice versa.

Three major databases searched for relevant studies

To conduct the review, researchers performed a search of three major medical databases for studies that investigated depression and frailty in adults with an average age of 60 years and older. To be included, studies also had to utilize respectable criteria for defining both depression and frailty, and had to include a control group of patients who did not have these conditions for comparison purposes. This search led to 63 studies being screened and 24 of these meeting the necessary criteria for inclusion into the review. Once collected, the findings from these 24 studies were evaluated and compared to one another to determine how common frailty and depression were in older adults.

Exercise can be helpful for treating both frailty and depression

Results showed that there were 8,023 older adults that had frailty, and of these, 38.6% were also depressed. Similarly, 2,167 older adults were found to have depression, and 40.4% of them were also frail. Further analysis from five studies showed that when patients with depression were compared to individuals without depression, there was a significantly higher risk of also having frailty. Finally, the overall quality of the included studies was found to be good, which shows that these findings can be considered reliable. Taken together, this systematic review and meta-analysis show that a significant portion of older adults who are frail are also depressed, and vice versa. While this finding is alarming, the good news is this: treatment that targets either of these conditions can actually lead to improvements in both of them at the same time. Exercise, in particular, is an effective tool to manage both depression and frailty, as it leads to positive changes in both mental and physical health. This is one of the primary reasons physical therapy is highly recommended for older adults with any type of impairment, since it is based on helping individuals move better and more frequently. With this in mind, elderly individuals who are frail or depressed—or both—are strongly encouraged to seek out the services of a physical therapist. Doing so can result in lasting changes in both their physical and mental health, and in turn, improve their overall quality of life.

-As reported in the July ’17 issue of Ageing Research Reviews

Exercise found to decrease anxiety and other stress-related disorders
December 5, 2018

Updated analysis needed in light of new studies and flaws in prior research

Anxiety disorders are a group of mental health conditions that include generalized anxiety disorder, panic disorder, and phobias. Together with stress-related issues like post-traumatic stress disorder (PTSD), these conditions have all been found to have negative impact on patients’ lives, such as a reduced quality of life and increased risk for heart disease and early death. Targeted medications and a psychiatric intervention called cognitive behavioral therapy (CBT) are typically recommended as the primary treatments for patients with anxiety and stress disorders, but the outcomes are not always positive. About one-third of patients do not respond to medications or CBT, and these interventions are not available in certain parts of the world. Exercise is considered an alternative for the patients that are either unable or unwilling to try medications or CBT, but there has only been one high-quality study (meta-analysis) on the topic. At the time, this study concluded that there was not enough information to recommend exercise for anxiety disorders. Since then, however, additional research has been published, and researchers have pointed out certain flaws in the original meta-analysis. For this reason, an updated meta-analysis was conducted to evaluate the effects of exercise on symptoms in patients with anxiety or stress disorders.

Seven databases searched for relevant studies

The investigators performed a search of seven major medical databases for randomized-controlled trials (RCTs) that investigated the effectiveness of exercise in adults with an anxiety or stress-related disorder. RCTs evaluate specific interventions by randomly assigning patients to different groups, and they are considered the gold standard for determining if a treatment is beneficial. This search led to 62 studies being screened, and six RCTs fit the necessary criteria to be included in the meta-analysis. Once collected, the findings of these six RCTs were evaluated and compared to one another to assess the impact of exercise on patients.

Based on positive results, exercise should be considered a treatment option for anxiety

The six included RCTs contained data on 262 participants, with 132 undergoing an exercise treatment program and the other 130 serving as the control group, who did not undergo exercise and were used for comparison. Results showed that exercise significantly reduced symptoms of anxiety in these patients, who had a variety of disorders that included PTSD, generalized anxiety disorder, panic disorder, or social phobia. When compared to the control group, the effect size of exercise was found to be in the medium range.

Physical therapists can help promote exercise in patients with anxiety

These findings support the use of exercise for patients with anxiety or stress disorder, and the researchers suggested that it should therefore be considered a viable option for these patients. Physical therapists are movement specialists that promote and prescribe exercise for a wide variety of conditions. While they are often viewed as professionals that only treat physical problems, this study shows why they can also be utilized to help overcome mental health issues like anxiety. Patients with anxiety or stress-related disorders are therefore encouraged to seek out the services of a physical therapist for an exercise therapy program that can help them better manage their symptoms while also improving their health and fitness in the process.

-As reported in the March ’17 issue of Psychiatry Research

Older adults with knee arthritis benefit from a home-exercise program
November 27, 2018

Better treatments are needed to target this at-risk population

Knee osteoarthritis (OA) is a condition in which cartilage that normally protects the ends of bones in the knee joint gradually wears away over time, which leads to pain and disability. It is particularly common in older individuals and makes it challenging for them to perform many basic everyday tasks. This is why effective treatments and prevention methods are needed to target these patients and help them manage their condition, but there are currently no established interventions in place to accomplish this. Exercise therapy that focuses on improving the strength and flexibility of various muscles is one treatment that has been proven to be effective for knee OA patients, and it can be administered either at a physical therapy clinic or as part of a home-exercise program. Home-exercise programs are inexpensive and do not require special equipment, but some patients may have difficulty following exercises when not guided by a physical therapist. With this in mind, researchers decided to conduct a powerful study called a randomized-controlled trial (RCT) to determine how effective a home-exercise program was for older adults with knee OA and how closely they adhered to this program.

Patients are randomly assigned to one of two groups

Older adults with a history of knee pain in one or both knees were recruited for the study and screened to determine if they were eligible. This led to 52 individuals with knee OA being accepted and then randomly assigned to either the multiple exercise group or control group. All participants were taught a home-exercise program by a physical therapist and provided with an instructional booklet to help them better understand its components. Participants in the exercise group were instructed to perform three out of 10 possible exercises, all of which were strengthening or stretching exercises for muscles surrounding the thighs or hips. The specific exercises that were found to be appropriate for each patient in this group were based on an interview conducted by the physical therapist at the start of the trial. Participants in the control group were instructed to only follow one exercise, which was a chair-sitting strengthening exercise for the quadriceps muscles in the front of the thigh. All participants were instructed to perform three sets of 10 repetitions of each assigned exercise, five times per week for four weeks, and they were assessed before and after this intervention for various outcomes related to knee pain and function.

Home-exercise program leads to superior results, with most patients adhering to it

Results showed that participants in the home-exercise group experienced significant improvements in knee pain, stiffness and strength compared to the control group. Exercise group participants also reported superior scores in their ability to complete daily physical activities, social activities and general health conditions. In addition, it was found that 96.6% of participants in the home-exercise group and 100% of control group participants adhered to their assigned programs. Taken together, these findings suggest that a home-exercise program consisting of strengthening and stretching exercises for various hip and thigh muscles can lead to a number of benefits for older adults with knee OA. The individualized nature of these programs—since they selected exercises based on each patient’s abilities—may have also had a positive impact on these results and improved patients’ adherence. Based on these results, patients with knee OA are urged to see a physical therapist, who can provide either a home-based or supervised exercise program depending on which is more suitable for them. Visiting a physical therapy clinic this time of year is a particularly good idea for those who have already met their insurance deductible or out-of-pocket maximum for 2018, as their visits may be covered for the rest of the year.

-As reported in the August ’18 issue of Clinical Rheumatology

Low back pain patients who see PT first spend less
November 20, 2018

Patients with low back pain who see a physical therapist first spend less on care and have a lower risk of being prescribed opioids

Low back pain (LBP) is the most common painful condition in the U.S. Recent statistics have shown that about 25% of the population has reported being affected by LBP for at least one full day within the past three months, and LBP is therefore also listed as the number one contributor to years lived with a disability in the country. The guidelines for treating LBP not related to a more serious cause of pain is to at first take non-steroidal anti-inflammatory drugs (NSAIDs) while avoiding imaging tests like X-rays and MRIs. If patients do not improve, the next step is to undergo treatments like physical therapy and exercise therapy rather than being treated with prescription medications. But despite these guidelines, far too many patients are still being prescribed drugs like opioids and being sent to have advanced imaging tests for their LBP, while not nearly enough are taking advantage of services like physical therapy. Research has suggested that seeing a physical therapist early may reduce patients’ usage of healthcare services and costs by helping them to recover without dangerous or unnecessary interventions; however, there are no large-scale studies that have compared healthcare costs between patients seeing a physical therapist first compared to other health providers. Therefore, a review was conducted to investigate these values and determine what the advantages are of seeing a physical therapist first for LBP.

Data is collected on nearly 150,000 patients

To conduct the review, investigators searched a private health insurance database with claims-related information on 50 million individuals for patients who had a new diagnosis of LBP over a three-year span. Patients who had a prior history of LBP, back surgery or any other serious conditions were excluded. This search led to 148,866 patients fitting the necessary criteria and serving as the study sample. These patients were then categorized into three groups depending on their physical therapy (PT) access: 1) “PT First,” which means they saw a physical therapist before seeing any other medical professional, 2) “PT Later,” meaning they eventually visited a physical therapist at some point, but not initially, and 3) “No PT,” meaning they never visited a physical therapist. In some cases, groups 1 and 2 were placed together for statistical purposes. Researchers then analyzed data between these groups to gauge the effect of having physical therapy at any point for LBP.

PT First is associated with benefits across the board

Based on the data collected, it was found that the incidence rate of LBP was 82.7 for every 1,000 patients. Of the patients who had LBP, about 80% had no physical therapy, while 8.7% saw a physical therapist first and 11.5% saw a physical therapist later. For those in the PT Later group, the average amount of time they waited to do so was 38.3 days. When compared to one another, it was found that patients in the PT First group had significantly lower opioid prescription rates, advanced imaging tests and visits to the emergency department (ED) compared to those in the PT Later and No PT groups. When the PT First and PT Later groups were compared directly, these values were slightly lower but still significant in favor of PT First. In addition, overall healthcare costs were significantly lower for patients in the PT First group over the PT Later and No PT groups, which was based on outpatient, pharmacy and out-of-pocket costs. The PT Later group was generally found to have the highest rates and average costs across all categories.

Patients with LBP are strongly encouraged to see a physical therapist for treatment

These findings clearly show that seeing a physical therapist as the first line of treatment for LBP comes with several advantages over seeing one later or not at all. Patients who do so experience lower overall healthcare costs while also reducing their risk for being prescribed drugs like opioids, having unnecessary imaging tests or going to the ED. Therefore, individuals who are currently dealing with an episode of LBP are strongly encouraged to see a physical therapist if they have not already done so. Now is also a particularly good time to schedule an appointment, especially for those who have already met their deductible or out of pocket maximum for 2018. If this is the case, insurance might cover the physical therapy visits for the rest of the year before healthcare deductibles renew in January.

-As reported in the May ’18 issue of Health Services Research

Review shows exercise therapy one of the best shoulder treatments
November 13, 2018

Comprehensive study needed to pull together all research on the topic

Complaints related to shoulder pain are the third-most common after those of the back and neck. About 29 out of every 1,000 individuals will have an issue with shoulder pain each year, and it has the highest incidence in women and people between the ages of 45-64. About 36% of these individuals have a condition called shoulder impingement syndrome (SIS), which is a generic term for several shoulder disorders that all lead to pain, disability and a reduced quality of life. There are many conservative (non-surgical) treatments available for SIS and an abundance of research on their effectiveness, but there is yet to be a comprehensive overview that has pulled all of these studies together and compared them to one another. For this reason, a powerful pair of studies called a systematic review and meta-analysis was conducted to provide this needed overview on various conservative treatments for SIS.

Six databases searched for relevant studies

Investigators performed a search of six major medical databases for high-quality studies called randomized-controlled trials (RCTs) that evaluated the effectiveness of a conservative treatment for SIS. RCTs randomly assign participants to a treatment group and then compare them to one—or more—other groups to gauge how well an intervention works, and they are considered the gold standard of individual research studies. This search led to 324 RCTs being screened and 200 of these being accepted into the final analysis. Conservative treatments evaluated in these studies included exercise therapy, a form of hands-on therapy called manual therapy, steroid injections, taping and non-steroidal anti-inflammatory drugs (NSAIDs), among others. Once collected, the findings from these RCTs were compared to one another and the quality of each study was assessed to determine how reliable these findings actually were.

Despite low quality of evidence, exercise is still recommended for patients with SIS

On the whole, results were supportive of both exercise therapy and manual therapy for SIS patients. For pain alone, studies showed that manual therapy was superior to no treatment or a sham treatment, and that when combined with exercise, it was more effective than exercise alone. Manual therapy was also found to have immediate effects. Regarding pain and function, exercise therapy was found to be superior to no treatment, and specific exercises were found to be more effective than non-specific exercises. Finally, studies also showed that exercise therapy was superior to non-exercise modalities—like ultrasound and electrical stimulation—for improving flexibility. Unfortunately, the quality of the research was deemed very low, which was due to lack of consistency across studies and a high risk of bias. But in spite of this shortcoming, the researchers still concluded that exercise therapy should be recommended as the first line of treatment for SIS patients, and that adding manual therapy may lead to even better results. Individuals dealing with SIS symptoms are therefore encouraged to see a physical therapist for a comprehensive treatment program that is sure to include various exercises and manual therapy. Patients should also be aware that visiting a physical therapy clinic now can be especially advantageous if they already met their insurance deductible or out-of-pocket maximum for 2018, since these visits may be covered for the rest of the year.

-As reported in the September ’17 issue of the British Journal of Sports Medicine