Interesting Facts about Physical Therapy and Health

1-Direct access to physical therapy for neck and back pain can save you money

- Individuals with neck or back pain who see a physical therapist first before going to see a physician have on average $1,543 lower cost through the course of their care compared to those with a physician referral. 1

2-Sham (placebo) surgery may be just as beneficial as actual surgery

- A review of 6 previous research studies on sham surgery compared to actual surgery for many orthopedic conditions has shown that indivifrduals who had sham surgery had similar outcomes compared to those that had the actual surgery. 2

3-Only 44% of total knee replacements in the United States meet criteria to be performed

-In a study done on a group of individuals who received knee replacements, 34% were deemed to be inappropriate for a total knee replacement, 22% were inconclusive, and only 44% met criteria to actually be performed. Considering that more than $20 billion are spent each year on hip and knee replacements in the US it is possible that a great deal of money is spent on surgeries that really shouldn’t be performed. 3, 4

4-One in five individuals who get a spinal fusion require a second spinal fusion within 4 years.

- In a study of 433 individuals that had a lumbar spinal fusion about 20% of those individuals had to have a reoperation to their spine within 4 years. The most common reason for reoperation was pathology to an area adjacent to the initial surgery site. 5 This is especially concerning when considering the outcomes of lumbar fusion. In fact 55.8% of individuals that have a lumbar fusion report that they are no better or worse. 6

5-Meniscus repair surgery does not improve functional outcome compared to physical therapy

-A physical therapy protocol that focuses on knee range of motion, knee strength, and aerobic conditioning that consists of about 9 visits of therapy was just as effective as arthroscopic surgery of the meniscus according to patient reports at 6 months and 12 months. 7

6-Heavy load deadlifts can reduce low back pain

-The once prevailing belief that lifting heavy things was bad for your back can be put to rest. In a study of individuals with persistent (chronic) low back pain it was found that 12 weeks of progressively heavier deadlifting significantly reduces low back pain. Progressive deadlifting with training for proper form was just as effective as other physical therapy training for reducing low back pain. 8

7-When picking a running shoe comfort should be the most important factor

-When it comes to reducing injuries in runners with running shoes or inserts, it appears that the variable that is most important is that the runner select a shoe or an insert that they feel is the most comfortable. The decision on what kind of shoe should be decided by the runner, and not be swayed by fancy jargon used by a salesperson. 9

8- It is a myth that CrossFit is more dangerous than other sports such as running

-In a study from 2018 out of 1032 runners, 198 (19%) of them reported an injury, while out of 144 CrossFit athletes 12 (8%) of them reported injuries. Though the key to avoid injuries in any sport is proper training and skilled coaching. 10

9- Lumbar disc herniations will most commonly resolve on their own with no surgical intervention.

-A recent meta-analysis showed that 66.66% of lumbar herniations will spontaneously resolve with conservative care and no surgery. 11 The most unique aspect of spontaneous disc resorption is that it appears that the most severe cases of disc herniations are also the most likely to spontaneously resolve. 12

10- 50% of all non-contact ACL injuries can be prevented with proper training

-As little as 3 sessions of 20 minutes that includes strength and motor control training over 9 weeks can significantly reduce the risk of having an ACL injury by 50%. 13

11- Back braces and education about lifting techniques are not actually helpful at reducing low back pain

-A review from 2018 done on all past research found that back braces and instruction on lifting technique, regardless of whether or not it was 30 minutes or 4 hours, do not actually reduce the likelihood of someone getting back pain at work. In fact what was actually beneficial was performing exercise interventions such as back and abdominal strengthening, stretching, and cardiovascular fitness training 14

12-Breaks during work help prevent and reduce low back pain

-The best part is that they also do not impede on work production. It is definitely clear that active breaks from work are superior to passive breaks. 15 In this same vein a sit to stand desk can be helpful at reducing low back pain experienced at work. 16

13- Running does not actually increase the likelihood of an individual developing arthritis

-Despite what was once thought that arthritis develops related to overuse of joint; it actually appears that running does not increase the prevalence of arthritis. 17 In fact what we actually see is that recreational running is better for your knee cartilage than a sedentary lifestyle. 18 We see increases in arthritis in the hands linked to obesity which is indicative of the role that inflammation from fat tissue has in the development of arthritis in our bodies. Thus, exercise and maintaining a healthy lifestyle are ideal for reducing the likelihood of developing arthritis. 19

14- In order to improve endurance capacity athletes should include heavy and explosive resistance training to their training program.

-Many endurance athletes are still cautious of adopting heavy resistance training out of fear that it will impair their performance. Heavy lifting with fewer repetitions and sets in major lifts, both powerlifting and olympic lifts are helpful for endurance athletes as it improves neural recruitment of the muscles and decreases the oxygen demand to generate the same amount of force, thus improving running economy. 20

1- Denninger, T. R., Cook, C. E., Chapman, C. G., McHenry, T., & Thigpen, C. A. (2018). The Influence of Patient Choice of First Provider on Costs and Outcomes: Analysis From a Physical Therapy Patient Registry. Journal of Orthopaedic & Sports Physical Therapy, 48(2), 63-71.

2- Louw, A., Diener, I., Fernández-de-las-Peñas, C., & Puentedura, E. J. (2017). Sham surgery in orthopedics: A systematic review of the literature. Pain Medicine, 18(4), 736-750.

3- Lam, V., Teutsch, S., & Fielding, J. (2018). Hip and Knee Replacements: A Neglected Potential Savings Opportunity. JAMA, 319(10), 977-978.

4- Riddle, D. L., Jiranek, W. A., & Hayes, C. W. (2014). Use of a validated algorithm to judge the appropriateness of total knee arthroplasty in the United States: a multicenter longitudinal cohort study. Arthritis & Rheumatology, 66(8), 2134-2143.

5- Irmola, T. M., Häkkinen, A., Järvenpää, S., Marttinen, I., Vihtonen, K., & Neva, M. (2018). Reoperation rates following instrumented lumbar spine fusion. Spine, 43(4), 295-301.

6- Franklin, G. M., Haug, J., Heyer, N. J., McKeefrey, S. P., & Picciano, J. F. (1994). Outcome of lumbar fusion in Washington State workers' compensation. Spine, 19(17), 1897-903.

7- Katz, J. N., Brophy, R. H., Chaisson, C. E., De Chaves, L., Cole, B. J., Dahm, D. L., ... & Levy, B. A. (2013). Surgery versus physical therapy for a meniscal tear and osteoarthritis. New England Journal of Medicine, 368(18), 1675-1684.

8- Aasa, B., Berglund, L., Michaelson, P., & Aasa, U. (2015). Individualized low-load motor control exercises and education versus a high-load lifting exercise and education to improve activity, pain intensity, and physical performance in patients with low back pain: a randomized controlled trial. Journal of Orthopaedic & Sports Physical Therapy, 45(2), 77-85.

9- Nigg, B. M., Baltich, J., Hoerzer, S., & Enders, H. (2015). Running shoes and running injuries: mythbusting and a proposal for two new paradigms:‘preferred movement path’and ‘comfort filter’. Br J Sports Med, bjsports-2015.

10- Bueno, A. M., Pilgaard, M., Hulme, A., Forsberg, P., Ramskov, D., Damsted, C., & Nielsen, R. O. (2018). Injury prevalence across sports: a descriptive analysis on a representative sample of the Danish population. Injury Epidemiology, 5(1), 6.

11- Ming Zhong, M. D., & Liu, J. T. (2017). Incidence of spontaneous resorption of lumbar disc herniation: a meta-analysis. Pain Physician, 20, E45-E52.

12- Chiu, C. C., Chuang, T. Y., Chang, K. H., Wu, C. H., Lin, P. W., & Hsu, W. Y. (2015). The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical Rehabilitation, 29(2), 184-195.

13- Arundale, A. J., Bizzini, M., Giordano, A., Hewett, T. E., Logerstedt, D. S., Mandelbaum, B., ... & Beattie, P. (2018). Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy and the American Academy of Sports Physical Therapy. Journal of Orthopaedic & Sports Physical Therapy, 48(9), A1-A42.

14- Sowah, D., Boyko, R., Antle, D., Miller, L., Zakhary, M., & Straube, S. (2018). Occupational interventions for the prevention of back pain: Overview of systematic reviews. Journal of Safety Research, 66, 39-59.

15- Waongenngarm, P., Areerak, K., & Janwantanakul, P. (2018). The effects of breaks on low back pain, discomfort, and work productivity in office workers: A systematic review of randomized and non-randomized controlled trials. Applied Ergonomics, 68, 230-239.

16- Ognibene, G. T., Torres, W., von Eyben, R., & Horst, K. C. (2016). Impact of a sit-stand workstation on chronic low back pain: results of a randomized trial. Journal of Occupational and Environmental Medicine, 58(3), 287-293.

17- Lo, G. H., Driban, J. B., Kriska, A. M., McAlindon, T. E., Souza, R. B., Petersen, N. J., ... & Kent Kwoh, C. (2017). Is There an Association Between a History of Running and Symptomatic Knee Osteoarthritis? A Cross‐Sectional Study From the Osteoarthritis Initiative. Arthritis Care & Research, 69(2), 183-191.

18- Alentorn-Geli, E., Samuelsson, K., Musahl, V., Green, C. L., Bhandari, M., & Karlsson, J. (2017). The association of recreational and competitive running with hip and knee osteoarthritis: a systematic review and meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 47(6), 373-390.

19- How Fat Affects Arthritis. Retrieved from https://www.arthritis.org/living-with-arthritis/comorbidities/obesity-arthritis/fat-and-arthritis.php

20- Denadai, B. S., de Aguiar, R. A., de Lima, L. C. R., Greco, C. C., & Caputo, F. (2017). Explosive training and heavy weight training are effective for improving running economy in endurance athletes: a systematic review and meta-analysis. Sports Medicine, 47(3), 545-554.

Some Americans Pay More for Back Pain Relief, But Are They Really Getting Less?

Payless recently conducted a very telling social experiment. You probably heard about the shoe chain’s stunt in the news but just to recap quickly, “The Payless Experiment” tricked consumers into buying their typically budget-friendly shoes at sky-high markups. To carry out the clever ruse, the discount retailer invited style influencers to a (fake) launch party for a new high-end label in one of Los Angeles’ glitziest shopping areas. The attendees believed that they were buying fashionable, high-quality footwear and therefore didn’t object to the three-figure price tags.

Aside from being a brilliant marketing ploy for Payless, what lessons does “The Payless Experiment” have for our current healthcare system, and specifically for patients suffering from low back pain? The experiment is a commentary on perceived vs. real value but also how easily people can be swayed into believing that something is reliable as presented. Think about someone who has had weeks of pain and dysfunction stemming from low back pain: she wants to find a solution that will relieve her symptoms. If a physician presents surgery as the best option—and she’s assured that her pain will go away—then it’s going to sound appealing, right?

Today’s consumer has so many choices when shopping for just about anything from apparel to healthcare. But while it’s customary to shop for the best price for a goose down jacket (without sacrificing quality), shopping around for the best solution (and value) for our ailments is less typical. Doing our due diligence in healthcare may ultimately bring us back to the first proposed solution, but it also may introduce us to solutions that we didn’t know existed.

In the case of low back pain, one such under-heralded solution is physical therapy. Physical therapy, yoga and acupuncture are gaining in popularity as equally (or more) effective and less costly than surgical procedures, injections, MRIs and pain relievers—and for good reason.

Physical therapists are trained to restore and improve patients’ mobility, reduce soft tissue pain, improve function and build muscle strength. They not only develop custom strategies to treat persistent or recurrent low back pain, but educate patients on the prevention of future issues. Some preventive techniques include adopting and following a regular exercise program and learning to lift correctly by keeping the object close to the body.

As the holidays kick into high gear, you likely have a long list of gifts to buy. I’m willing to guess that you have a strategy in place for selecting appropriate gifts for each recipient.

As you match the right price point, size and color to each person on your list this holiday season, think about approaching your healthcare needs with the same level of scrutiny. After all, finding the right solution at the right price for our health needs contributes to improved long-term outcomes and better piece of mind.

Annual Physical Therapy Check-Up!

In my early 20’s, I lived in Argentina for 2 years. During that time it never occurred to me that I should be seeing a dentist on a regular basis. Growing up my mom would set up my regular dental exams, and I would show up to the dentist office every 6 months. However, after living in Argentina and then on my own through the early part of college, I had definitely fallen out of the habit of attending regular dental exams. I had 8 cavities filled over a 4 week period. Needless to say, I never missed another dental check-up!

The practice of meeting with a trained expert is important in order to learn what we should be doing to keep our bodies in optimal condition! For the most part it has become common practice to see the dentist every 6 months, and to have a physical with a doctor every year. However, most people are not going to see their physical therapist for annual or semi-annual check-ups.

It is often understated how important a physical therapist can be in finding deficiencies in movement, strength, cardiovascular capacity or range of motion that can become detrimental in the future. Physical therapists are experts in movement! That is what they are trained to be. Whether it be identifying compensations or overcoming current limitations, a physical therapist can play a valuable role in keeping you healthy and well.

This is a really common story that I hear in my practice, “Well, my shoulder pain started about 4 years ago while I was doing some over head activities, and I felt a pop in the shoulder. It has been hurting on and off since then. I haven’t done anything besides take advil every now and then, but now I can’t sleep on that side. So, I figured I should finally do something about it.”

I love seeing people with any number of problems going on. It is really fun to diagnose their situation and get them on a path to meet their goals. However, I think about those times when the patient spent nights where they maybe only slept 1-2 hours or days when they missed work all because of their aches and pains in the shoulder.

I think about how that situation would have been different had that person seen their physical therapist every year for a check-up. Maybe it is not something that the patient would go out of their way to seek care for initially, because it is not interfering too much in their life at the start. However, it could be something mentioned and evaluated in an annual check-up. Then that person could be helped to get on an exercise regimen that could help their shoulder or other condition before it evolves into something more complex. That is the value in checking in regularly with your physical therapist.

As the saying goes “An ounce of prevention is worth a pound of cure.” When it comes to my teeth I know better than to skip out on my regular teeth cleaning and exam. When it comes to my physical health I know better than to miss out on a chance to be screened, and make sure that I am on the right track to a healthy life.

In the state of Minnesota anyone can see a physical therapist directly without a physician referral. If you would like to schedule an annual check-up with a physical therapist, please click here.

Who Is Your Physical Therapist?