Crash Course: Physical Therapy after a Motor Vehicle Accident

SONY DSC

Statistically speaking, every person traveling in a motorized vehicle will be in an accident at one point in their lifetime. On average, there are more than 6 million car accidents on the roads annually (1). According to the 2015 census, there are approximately 2.4 million people in the Portland region (2). That is a lot of impending injury! Post-accident care for non-fatal crash injuries can range from a same day ER visit to a primary care physician visit a week later with medications, Xrays or MRIs frequently prescribed. This initial medical care to rule out red flags is important especially considering advanced age, high speed collision, paresthesias or numbness/tingling, and if mobility is extensively limited. Though, this is often the end point of treatment for most individuals and they are left to guide their own care. Typically, massage and chiropractic treatment is the duo of care accessed, yet more and more people are realizing that there is something missing in their recovery and that is the restoration and rehabilitation of functional strength that was lost after the accident. Without functional strength retraining under the guidance and expertise of a physical therapist, healing can be severely delayed and result in, among other issues, loss of job attendance and revenue. In 2010, motor vehicle crashes in the United States equated to almost $1 trillion in productivity loss (3). Yet, a lot of physicians do not prescribe physical therapy, especially for the “minor injuries” with little to no pain at all.

depositphotos_36839587_originalSay what?

You might be surprised to have just read that I suggested physical therapy for “no pain at all” after a motor vehicle accident. Pain is a peculiar thing. Initial pain from an injury can be present or not depending on inflammatory processes ignited, pain processing per individual, and sometimes severity of injury. I am eluding to the idea that the absence of pain does not equate to non-injury. There is research that demonstrates decline in muscle activity post MVA resulting in diminished muscle bulk over time and this almost always leads to significant dysfunction and pain down the road with additional loss of productivity at work, participation in recreational activities, and altered daily lifestyle. In the neck, for example, post MVA MRI assessments of injury to the cervical spine in relatively “injury-free” individuals revealed swelling in the major deep cervical flexor muscle (4). Swelling within a muscle renders it dysfunctional and muscles so close to the spine have basically ZERO leverage to be able to just “come back on their own” with daily movement and typical exercise approach. The longus colli muscle is responsible for supporting the neck the way the abdominal core supports the trunk. It provides crucial stability for the cervical spine to disallow shearing forces with the day to day insults, let alone more aggressive endeavors in recreation like running, soccer, crossfit, and yoga, to name a few.

 

086-cartoon-businessman-shoulder-debt-boxBaby Bye, Bye, Bye.

Without proper rehabilitation of these deep neck flexors and core musculature, they will remain inhibited and atrophy as a result. Say goodbye to these deep, small, essential muscles and prepare to welcome the beast that is pain. Or…. seek the care that you need. An orthopedic physical therapist is trained to screen for red flags that would prevent one from being able to participate in a rehab program at that current time and help get you the right care. They will examine the pathoanatomical causes of symptoms and are uniquely trained to tease out the impairments and dysfunctions from the crypt! The sooner one seeks treatment, the less underlying dysfunctions that set in and cultivate. This equates to less down time from life, less $USD spent on playing catch up in care, and happier, pain-free people in the long run. If you have or know someone who has had a motor vehicle accident, we at Therapydia would be happy to help with an assessment and treatment as needed. Give us a call or email us to get started.

 

 

 

 

  1. http://www.lawcore.com/car-accident/statistics.html
  2. http://www.oregonmetro.gov/news/portland-region-nears-24-million-residents-growing-41000-last-year
  1. http://www.rmiia.org/auto/traffic_safety/Cost_of_crashes.asp
  2. Deepak Takhtani, Eduardo Scortegagna, Oguz Cataltepe and Sathish Dundamadappa. MRI Findings of Injury to the Longus Colli Muscle in Patients With Neck Trauma. Neuroradiology/Head and Neck Imaging, August 2016, Volume 207, Number 2.

Toilet Ergonomics: Posture Matters In Places Other Than The Office

Squatty Potty

 

Written by Dr. Emily Melzer, DPT

For centuries, humans have squatted to defecate, but due to 19th century advancements of the sewer system and sanitation, the porcelain throne we sit on today was born. However, in that moment of history, society was unaware of the dysfunction they were setting us all up for.

Real Potty Talk

The dysfunctions I am alluding to are hemorrhoids, constipation and diverticulitis. Not to mention increasing our risk of syncope (fainting), deep vein thrombosis and stroke. You may wonder why simply sitting to defecate would put you at risk for these complications. As you hear quite regularly in regards to the office, there is a certain posture to help you work most efficiently, that is commonly referred to as ergonomics. Ergonomics are important in places other than the office, for instance in your bathroom. Research has sought out and proved the most efficient, effective and proper way to defecate.

And that position is, drum roll…SQUATTING.

The reason squatting is effective when defecating is due to the function of the puborectalis muscle. The puborectalis is responsible for keeping your rectum closed off, increasing the angle between the colon and rectum. Research demonstrates that the angle decreases when obtaining a full squat to defecate, easing the release of contents. This body mechanism reduces the need to strain, in turn eliminating the risk of hemorrhoids, syncope and stroke. It also better allows the release of all content, decreasing the risk of constipation.

Improve Your Toilet Ergonomics

Eliminating the toilet all together seems like a drastic, and let’s face it, unrealistic goal for the United States, but simply adding a small stool underneath our toilet, is a feasible change you can make today. One research study looked at defection while seated, seated with knees raised 60 degrees and a full active squat to 60 degrees. While the full active squat demonstrated the least angle and the quickest time for release of content, the passive squat achieved by placing a stool under the feet was a close second.

I personally have a Squatty Potty in my home, and I can provide consumer feedback of the improvement in efficiency, effectiveness and overall improved bowel health with the addition of this product into my life. I will never be without a squatty potty under the porcelain throne in my home. I may even consider purchasing the travel version (that’s right, there is an inflatable squatty potty!).

Give us a call today and we would love to help you with your mobility and strength to help in this everyday daily activity!

1. Dov S. Comparison of Straining During Defecation in Three Positions – Results and Implications for Human Health. Digestive Diseases and Sciences. 2003; 48: 1201-1205.
2. Sakakibara R, Tsunoyama K, Hosoi H, et al. Influence of Body Position on Defecation in Humans. LUTS, 2010; 2: 16-21.

Are you contracted with my insurance company?

health insurance policy and piggy bank

 

Are you contracted with my insurance company?

This is a question we get all too often.  It is often thought that if a physical therapy clinic you want to go to is not in-network with your insurance, you cannot use your insurance to receive care there. In actuality, most insurance plans have out-of-network reimbursement. While the details of deductible and coinsurance may be different, you can still come to our clinic and receive the therapy you deserve.

The most important point is that you can still come see us!

Why go out-of-network?

To be in-network, it means the physical therapy clinic has a signed contract with a health insurance company. The downfall of this contract is that it allows the insurance company to dictate the kind of therapy you receive. And the truth is, not all therapy is created equal. At Therapydia, we customize your treatment, we individualize programs, we work one-on-one with you. At Therapydia our therapists keep up to date with the latest techniques and strategies to deliver the most effective treatments, techniques and strategies. 

Our 45-60 minute one-on-one treatments with a doctor of physical therapy will often expedite your treatment as it allows us to address multiple components of your body mechanics and movement. We do not follow standard guidelines; we use our solid platform of education, clinical experience and learned skills from continuing education to provide therapy appropriate for you and you specifically.

Receive the care you deserve

Man stretching a woman's arm in a room

Receiving therapy using out-of-network coverage at Therapydia Portland will get you a higher quality of care as we dictate how your treatment is given, not your insurance company.  We will form a caring relationship and will be available to encourage you and offer support through your recovery. Your PT will be available to you via PT Anywhere, our exclusive online patient portal, to answer any questions and/or concerns in order to keep your rehabilitation on track.

While out-of-network benefits vary, we have discovered that out-of-network reimbursement is often comparable to in-network coverage. Please feel free to contact us so we can help you learn more about your physical therapy benefits; we will gladly call your insurance to verify your coverage and provide you with the information we receive.  We look forward to helping you on your path to recovery!

 

Cool Down For What?

young business man use fans to cool down

Cool Down For What? 
Don’t leave your exercise routine hangin’!

Cooling Down – the most underrated and ill performed part of a work out. Most don’t consider it a necessity let alone even part of a work out. In reality, it is equally as crucial as the warm up and main event. A patient at Therapydia Portland had a revelation when we were wrapping up our session last week and felt armed with new knowledge of what a real cool down entailed. He inspired this blog.

For those that include a cool down in their exercise or sport repertoire, congratulations, but you’re not off the hook yet. I’ll bet the majority take the last 5 minutes of their run, for example, and slow it down a bit and call it a cool down. This should be considered maybe a start to the cool down process but let us dissect the pieces of a proper cool down and then package it up in a savory morsel for you to enjoy, reflect upon, and crave.

Step One: Ramping Down Your Heart Rate for Homeostasis.

Depending on the intensity of the exercise, this could take a few to several minutes. You can use the latest technology to monitor your heart rate or the good old-fashioned two-finger pulse check on the carotid artery along the side of the neck (press gently). Reduce the intensity of movement or exercise and monitor your pulse for baseline rate. Normal baseline heart rate will fall between 60 and 100 beats per minute. Practice taking your heart rate often when at rest to determine your average resting rate and aim for this at cool down.

Step Two: Soft Tissue Restoration.

After exercise, your muscles and fascia (connective tissue, see previous blog on Graston Technique® for loads of info on fascia) have taken a toll and need some attention in order to restore flexibility and proper length tension relationships to be ready to perform for you again in exercise or general daily life tasks. All the contraction-relaxation of muscle during exercise builds tension in the muscle and its surrounding fascia (excellent! this is part of what nourishes muscle). If muscle and fascia are allowed to remain constricted, they will not be able to perform at 100% capacity for you in other tasks, which reduces your performance potential. This cyclic malpractice can also amount to injury in a short period of time. Bad news!

The soft tissue restoration routine should include self-massage and stretching. I am a huge advocate for the foam roller! It is a beautiful piece of equipment – cheap and effective – and it should be in every person’s house. My green dude is a staple in my living room and he keeps the side of my couch company when I’m away. If shoulder injury or stability is an issue and you cannot perform self-massage by supporting yourself over a foam roller, you can easily convert this method to handheld roller and apply the same principles. Rolling your body over the foam roller (most of the body is accessible for this technique) in multiple angles will, in a sense, “iron” out the “wrinkles” in the fascia and muscle. Points of significant restriction will be very tender and you want to be sure not to hold your breath or tense up over these spots. If too painful, work adjacent to these areas first and use limbs not currently being massaged to support yourself to take a little more weight of your body off of the foam roller.

Stretching is last and this is a great time to perform static stretching; whereas dynamic stretching (stretching through movement) is awesome for a warm up to prep the tissue to accept increased loads. Static stretching is holding a stretch posture for an increased length of time. The traditional hamstring stretch and runner’s calf stretch are examples.

Simply put, the recipe for a cool down is 1 part heart rate resolve, 1 part foam rolling, 1 part static stretching. We at Therapydia Portland want to be your go-to resource for specific routines that complement your fitness style. We know there are many ways to stretch and foam roll, which can be daunting to sift through all the information on the web. Schedule an appointment with us at your convenience and let us guide you to keep you healthy and injury free.

WELCOME!

Welcome

We are so thankful for the support that we have received in the past 6 months! Health care providers, community members and their family and friends have come to receive our quality care.  The testimonials, verbal support and feedback have been amazing and we are so thankful for the kind words.  Word of mouth has really spread what we are doing in our clinic and for our community.  With the increased awareness of our services our clinic is definitely growing!  In the past 2 months we have added Abbie and Nikki joining our office as support staff and we couldn’t continue to provide quality service without them supporting our clinical growth.   Their hard work and contributions drive our quality of care and we are so lucky to have them on our team.  In addition to adding support staff we are very excited to bring on another health care provider Sabrina Seraj-Villaneuva starting in June.  Sabrina and Jason have known each other for the past 12 years starting back to grad school days back at USC.  They are looking forward to working together and continuing to provide quality care for all of the Therapydia patients.  Sabrina has lived in the Portland area for the past 2 years splitting her time working at OHSU and Therapeutic Associates in Clackamas.  For more information about our staff please check out our team page where you can click on everyone’s bios.  Once again thank you for all the support and we look forward to continuing the quality care we provide at Therapydia Portland.

 

Get a Proper Bike Fit to Cycle with Confidence

Get a Proper Bike Fit to Cycle with Confidence

Bike to work

Bike to work

 

Did you know Bike To Work Day is happening next Thursday? Whether this is your first biking or your hundredth, a proper bike fit assessment can help you prevent injury and improve performance. No more neck pain, lower back aches and hand numbness. Learn about the benefits of a bike fit and top things to look for when optimizing your bike to meet your biomechanics.

Benefits of a Proper Bike Fitting

  • Lower back pain and knee pain are the most prevalent injuries with cycling. A comprehensive bike fitting will take into account your individual biomechanics to prevent injury and aid you inreaching your peak performance.
  • Prevent Injury by establishing neutral positions that reduce stress on your body. This is especially important if you have recurring injuries.
  • Improve performance by finding comfortable positioning that will allow you to exercise more effectively and build strength.
  • Master your technique by making sure all of your body is working in sync for a more seamless ride.
  • Experience a more enjoyable ride because you will have peace of mind, you will be comfortable and will start feeling improvements, which will help motivate you.
Image take from http://www.jimlangley.net/wrench/bicycleparts

Image take from http://www.jimlangley.net/wrench/bicycleparts

Mechanics of a Bike Fitting

Even with small changes in your bike fit, you can expect exponential changes biomechanically. There are multiple parts of a bike fit and depending on your pre-existing areas of pain, you can ask your physical therapist to hone in on those areas. Below are common pointers we give to cyclists of all levels who are looking to improve their cycling posture. Before making multiple changes, please talk to a professional to get their insight on how to better optimize your bike fit.

  • Bend your elbows. Having bent elbows will help absorb shock through your upper extremities and reduce stress on your cervical spine.
  • Maintain a neutral spine. This helps keep you from hyperextending your neck by trying to maintain an upward glaze. Without proper trunk alignment or thoracic spine extension riders often experience hyperextension injuries in the head and neck region from trying to maintain an upward gaze without proper upper back mobility.
  • Find your handlebar sweetspot. Poor handlebar positioning may cause stress on your spine as you try to sustain a proper position. It may also result in hand pain or numbness due to your grip.
    To keep a neutral pelvic alignment, don’t tilt your saddle downward. A downward tilted saddle may put unnecessary stress on your wrists. It may also impact your erector spinae, multifidus, obliques and quadratus lumborum if your muscles have poor endurance.
  • Find your saddle sweetspot. Oftentimes riders change the angle of the saddle for comfort rather than actually assessing if you have the right saddle fit for your body type. Before changing the position of your saddle we recommend finding the right saddle fit first. When you ride your knees constantly maintain a semi-flexed or mid-range contraction, which can put stress on your hamstrings. When a saddle is placed too high often times this places the pelvis in a posterior tilt creating a biomechanical shortening of the hamstrings. This can lead to muscle strains or even numbness and tingling in your legs during long rides.
  • Wear padded gloves and proper shoes. During long rides you may grip more tightly or apply more pressure with your feet while pedaling. Wearing the proper gear is just as important as your position on your bike to reduce stress and let you enjoy your ride.

Get a Bike Fit Today From Your Physical Therapist
Physical therapists are biomechanical experts and look at your movement from a holistic view. They will be able to analyze your bike fit and how you fit on your bike keeping in consideration any previous or recurring injuries you may have to get the most out of each ride. Our physical therapists will work with you one-on-one to make adjustments as needed to improve and build strength.

Supporting local Community

Attention local community members! Keep an eye out for our new ad in the local Laurelhurst newsletters… we are excited to provide quality care to the community and we have been receiving great feedback about our services.  Check out our testimonials on our site or see what people are saying on our Google plus page!Portland Physical Therapy: Laurelhurst, Kerns

Telemedicine: Case Study

Therapydia TelemedicineWhat is Telemedicine?

With the advancement of technology coupled with the limitations that physical therapy health care providers are encountering via insurance limitations telemedicine allows patients immediate access, near and far, to get specific health care advice, prescriptions of movement and consultations which could prevent unnecessary diagnostic tests and measures.

As our health care world continues to change I am excited to be part of the Telemedicine movement.

In the past month we had a patient encounter that we felt we important to share for a couple reasons:

  • This case specifically highlights the difficulties that normal people go through when dealing with our current medical model and all the practitioners one may encounter.
  • It also highlights how when patient cases are dealt with properly someone can get more effective treatment regardless of whether someone is local or thousands of miles away.
  • With proper resources and communication people can receive physical therapy via telemedicine and it can be very effective

To protect the patient’s confidentiality names have been omitted, substituted with initials.  DW has agreed for me to post this case and she hopes that it will provide some insight to our Telemedicine process and how it has helped her.

A few weeks ago I received a Facebook message from an old college friend asking if I knew anything about a “rare” diagnosis named “idiopathic lumbosacral radiculoplexus neuropathy”.  Turns out his mother, who lives on the other side of the country, had been diagnosed with this over a year ago and was frustrated with her progressive worsening.  I told him that I had seen thousands of patients with idiopathic back pain that also had some sort of radicular symptoms down the extremities.  In layman terms idiopathic means unknown cause, lumbosacral defines the lower back and pelvic tailbone region, radiculoplexus neuropathy basically is an irritation or inflammation of the nerve bundles that exit from the spine.  It is important to note my friend’s mother, until acquiring this diagnosis was a normal active nurse and after dealing with this diagnosis she had now lost the ability to walk independently or perform many of her prior activities of daily living. I received multiple emails from the son and daughter of the patient, which gave me some insight on the patient’s medical history and timeline of diagnostic tests.  Now through these emails I had found out that over the past year DW had been to multiple doctors, multiple specialists, undergone 7 MRIs, 2 X-rays, formal physical therapy and various prescription medications to help her symptoms without any definitive plan or answers to why she had acquired this “idiopathic diagnosis” or more importantly what to do from today moving forward.

After reviewing the medical notes I set up our first Telemedicine appointment, which was just like any normal evaluation we perform here in our clinic.  Per the patient’s request DW had her daughter present on the video conference as to be an assistant just in case DW would need help with any mobility testing and/or we had technologic difficulties. Normal subjective examination was performed, objective testing, and special tests in order to determine an action plan.  In the hour appointment we spoke of DW’s diagnosis, and I came up with a physical therapy assessment of her orthopedic limitations and her functional impairments.  In addition I gave her some mobility exercises to start on that day that she could perform independently and some exercises that her daughter would assist with.

It is important to note here that in just this first appointment DW and her daughter mentioned that they received more from me in the initial evaluation that they had in the past 6 months. How does this happen?! How can one person see that many doctors, specialists and participate in formal physical therapy without some sort of education, evaluation and proper action plan to address this patient’s needs and goals.

Our next appointment was 1 week later however I told DW and her daughter that we were always available via phone, email, or Facebook messenger if they needed to contact us prior to our next appointment.

The next appointment we learned and witnessed some pretty amazing things. She had gained more mobility in her leg than she had in previous months.  She also mentioned feeling more sensation in her leg something that had been absent for quite some time.  Her mobility was starting to return but her strength and endurance for maintaining these new positions was very poor.  At this appointment she was given a progression from her day one exercises and we planned on meeting in another week.  The next goal would be to stand and be able to shift her weight from one leg to the other.

Next appointment was two weeks later and once again more good news. DW was bearing more weight through her legs with less assistance with her arms on the assistive walker she had been using to stand.  Even better news was that DW felt her muscles in her legs working, something she hadn’t felt in months.  Her ability to transfer from chair to wheelchair, wheelchair to bed, bed to sitting and sitting to standing all improved.  Her strength and endurance were slowly improving but more importantly DW had new hope.  She was seeing progress herself.

Now DW and her daughter were given more exercises to perform daily and DW was instructed that returning to a local physical therapist was the next recommended intervention.  Going to a local physical therapist that understood DW’s needs, goals and progression was crucial to her continued recovery.  In order to assure DW’s transition our office called local physical therapists near to DW, explained to the therapists what we had accomplished in just a few visits & recommended our physical therapy assessment and plan of action and collaborated with DW what she would have to do moving forward from here on out.

I’m happy to say that DW had her first physical therapy appointment this week and I received some good feedback from her regarding her first visit.  I plan to follow up with a video conference in the beginning of next year to see how far she has come with her functional mobility and if she is closer to her goal of being able to walk again…

Tips to stay healthy during the holiday season…

Be active, happy and healthy

As the weather is changing and the end of the year quickly approaches there are many of us that are experiencing the holiday work parties, the friendsgiving gatherings, and the eventual holiday hustle to travel, eat, drink and be merry.

With all these increases in tasks and relative decreases in time to complete the parties, shopping and last minute meetings stress is bound to increase.  Statistically the last quarter of the year is when hospitals see a large increase in admissions.  This has been attributed to heart attacks, strokes, and car accidents mostly stress related.  Managing stress through proper planning can prevent these health issues and potential accidents.

Thankfully we only have a few weeks left of 2014 to get through this stressful quarter however here are some gems from the Center of Disease Control and Prevention to use while we close out this year.

Wash your hands to avoid getting a cold of flu

If you haven’t done so already, consider getting a flu shot

Balance your day with work, home, play and rest

Plan properly for those holiday travels

If you are more musically inclined here is The CDC Holiday song on the 12 ways to Health.

Another component to be mindful of is Vitamin D intake.  Living in Oregon most physicians recommend taking Vitamin D supplement due to the lack of Sunshine that the population receives.  In the past 10 years technologic advances have pushed people to spend more time indoors on computers, watching television or spending time on our tablets.  During the winter as temperatures drop and holiday season demands increase people spend less time outside, therefore Vitamin D intake is sparse. This leads to increased reports of depression possibly due to seasonal affect disorder and/or people who may not have friends or family to celebrate the holidays.  This article highlights some good information regarding Vitamin D, SAD and depression.

Lessons to be learned, plan ahead this holiday season, aim to properly balance work, home, play and rest, and get outside and enjoy being active!

Stay Tuned…

Happy New YearsStay Tuned…Over the last few weeks of 2014 we will be giving gifts of knowledge in regards to health, wellness and pain free functional mobility, we hope that these gifts not only provide components of education but also inspire you to make positive changes towards a better 2015 version of you.  Happy Holidays Everyone!