An Easy Way to Increase Your Plant Intake!

Hey there! Welcome to 2020! This post was inspired by a video I watched this morning, done by a friend and colleague, Eric, with the Institute of Clinical Excellence. The link can be found here. Basically, Eric was talking about an easy way to increase your plant intake by making smoothie, which is awesome! And exactly I what I do. It is honestly the only way I am able to meet the recommended 5-9 servings of fruits/vegetables per day. And believe it or not I’m not a big salad guy, so this is actually the only way I eat leafy greens.

For me personally, I drink two smoothies a day, and the later of the two has been the same for roughly 15 years.

Mid-morning snack

• 1 cup fat-free milk

• 1 banana

• 2 Tablespoons creamy peanut butter

• 1 cup fresh spinach

• 1/3 cup dry oatmeal

• 1 Tablespoon ground flaxseed

Post-workout

• 1 cup fat-free milk

• 1 banana

• 2 Tablespoons creamy peanut butter

• 1 apple (usually red delicious)

• 1/2 cup frozen blueberries

• 1 Tablespoon ground flaxseed

*Warning* Both of these smoothies are intended to be high in calories and protein, so make adjustments where necessary.

So if my math is correct, that covers around 4 1/2 servings, roughly half of my intended goal. All I need is some veggies added to lunch and dinner and I’m on target.

Couple tips:

• I always use frozen fruit instead of ice, doesn’t water it down.

• Feel free to substitute milk for an alternative.

• I make both of them at the same time since the ingredients are already out.

• If using oatmeal, I make it the day before for improved texture. Makes it thicker, like cake batter, which I love. Otherwise its gritty and like chalk. Also the reason my above recipe has no ice or frozen fruit.

I hope this year includes adding more plants to your day!

Until next time,

Fuel Physio Team

Increased Walking Time Found to Lower Risk of Low Back Pain

Hey There! Today’s post will look at reducing your risk of Low Back Pain (LBP), one of the most common conditions worldwide. Some researchers have found the average lifetime prevalence of LBP to be upwards of 38.9% and “most prevalent among females and persons ages 40–80 years” (1). While other researchers report that upwards of 80% of Americans will “experience at least one episode of back pain during a lifetime" (2).

Nonetheless, the prevalence is high, while the cost and burden is also significant. However, results of a recent study have found an association between walking and LBP. Researchers discovered that in a general population over 50 years old, “walking for more than 3 days per week for over 30 min at a time was negatively associated with LBP” and “similarly, walking for more than 5 days per week for over 1 h at a time was [also] negatively associated with LBP” (3).

it is also important to note that low back pain and pain in general is multifactorial and the sensation of pain extends far greater than an actual physical injury. Factors such as stress, anxiety, fear, poor sleep habits, and physical inactivity can all contribute to the presence of pain. Now if you find that walking doesn’t help, don’t worry, other forms of physical activity or exercise should still be your first line of defense. Most episodes of acute LBP have actually been found to resolve on there own, just keep moving and don’t limit your activity.

Though, if you still find your LBP has not resolved, seeing a Physical Therapist FIRST has proven time and time again to be the most appropriate path of care. Findings from a most recent study found “that seeing a PT First for a LBP episode significantly lowered the probability of having an opioid prescription, advanced imaging service, and ED visits compared to patients that did not” (4), which are similar in findings to many other studies (5,6).

Until next time,

Fuel Physio Team

1. Hoy, D., Bain, C., Williams, G., et al. (2012). A systematic review of the global prevalence of low back pain. Arthritis & Rheumatism, 64(6), 2028-2037.

2. Rubin, D. I. (2007). Epidemiology and risk factors for spine pain. Neurologic clinics, 25(2), 353-371.

3. Park, S. M., Kim, G. U., Kim, H. J., et al. (2018). Walking more than 90 minutes/week was associated with a lower risk of self-reported low back pain in persons over 50 years of age: A cross-sectional study using the Korean National Health and Nutrition Examination Surveys. The Spine Journal.

4. Frogner, B. K., Harwood, K., Andrilla, C. H. A., et al. (2018). Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health services research.

5. Childs, J. D., J. M. Fritz, S. S. Wu, T. W. Flynn, R. S. Wainner, E. K. Robertson, F. S. Kim, and S. Z. George. 2015. “Implications of Early and Guideline Adherent Physical Therapy for Low Back Pain on Utilization and Costs.” BMC Health Ser- vices Research 15: 150–160.

6. Fritz, J. M., G. P. Brennan, and S. J. Hunter. 2015. “Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges.” Health Services Research 50 (6): 1927–1940.

Reducing Risk of Gestational Diabetes

Hey There! Today we want to talk about Reducing Risk of Gestational Diabetes, which can certainly be multifactorial; however, our focus will be on nutrition and consuming the most appropriate eating pattern. And in case you haven’t seen us use the term “eating pattern” before, it essentially means what you consistently eat over time.

Gestational Diabetes, a form of diabetes during pregnancy, has found to be one of the most common conditions to occur during pregnancy, affecting upwards of 1 in 7 births. Those who are diagnosed with are at a higher risk of developing Type 2 Diabetes down the road, while the child is also found to be at higher risk of Type 2 Diabetes and obesity. Also know that development of gestational diabetes may go undetected with little or no symptoms, which is why most physicians will test for around 24-28 weeks.

So what can you eat to help control blood sugars? Researchers of a recent systematic review and meta-analysis, looking at randomized controlled trials of dietary modification for gestational diabetes management, found no strong pull towards a particular type of pattern. Such as low-glycemic index, low carbohydrate, energy restriction, fat modification, or following the DASH. However, evidence does still support that low glycemic index patterns have a large decrease in fasting and post-meal glucose values. Evidence also shows that following a DASH pattern has favorable outcomes for glucose values, HbA1c levels, and infant birth weights.

The general recommendation is higher nutrient-rich foods. While keeping in mind the saying “eating for two” is not the best to go by. In the first 3 months of pregnancy you should only see a minimal gain in weight, 1-4 pounds, and than 2-4 pounds/month until delivery. Every mother is expected to gain weight during pregnancy, even if overweight or obese, so be sure to talk with health care provider on how much weight gain is appropriate.

If you’re at a higher risk of developing gestational diabetes (being overweight or obese, physically inactive, or with a history of previous gestational diabetes) or have been newly diagnosed with gestational diabetes, please be sure to work closely with your healthcare provider and utilize the services of a Registered Dietitian Nutritionist, if possible; they can help educate and personalize a healthier eating pattern.

Now of course in addition to a healthier pattern, consistent physical activity is important for reducing risk of gestational diabetes. For the most part, still shooting for those same physical activity recommendations if you weren’t pregnant. Pregnancy should not mean permanent bedrest, unless medically advised to do so. Please be sure to chat with your healthcare provider or physical therapist about possible activity modifications.

Until next time,

Fuel Physio Team

References:

Yamamoto, J. M., Kellett, J. E., Balsells, M., et al. (2018). Gestational diabetes mellitus and diet: a systematic review and meta-analysis of randomized controlled trials examining the impact of modified dietary interventions on maternal glucose control and neonatal birth weight. Diabetes Care, 41(7), 1346-1361.

https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/gestational

We ALL Need a Good Night's SLEEP

Hey there! Today we want to share some fresh evidence on sleep and some potential outcomes of your children not getting enough sleep. And I say children because the population of this study was specific to those aged 8-17 years old. But know that sleep is an important factor for all ages.

Though these researchers found that children with insufficient sleep, around 7 hours/night, were more likely to have poorer lifestyle characteristics when compared to children and adolescents with sufficient sleep, around 9 to 10 hours, respectively. The difference in lifestyle characteristics were found to be unhealthier dietary habits, increased screen time, and being classified as overweight/obese. The study also mentions the possible improvement in sleep sufficiency with improving aerobic fitness.

Now you may be thinking, 7 hours is pretty good. However, the recommendation for children and adolescents is much higher than that of adults. In a census statement from The American Academy of Sleep Medicine, the organization recommends within a 24 hour period children aged 3-5 should sleep 10-13 hours (including naps), children aged 6-12 should sleep 9-12, and adolescents/teens aged 13-18 should sleep 8-10 hours. The organization also reports that “sleeping fewer than the number of recommended hours is associated with attention, behavior, and learning problems. Insufficient sleep also increases the risk of accidents, injuries, hypertension, obesity, diabetes, and depression.”

If you’re looking for ways to improve you or your child’s sleep habits, as well as other information related to sleep, check out the National Sleep Foundation and Tuck.

Until next time,

Fuel Physio Team

Updated 2018 Physical Activity Guidelines

Hey there! We’ve got some big news to share this week! The federal guidelines for physical activity recommendations have just been updated for the first time in 10 years! But guess what, not much as changed. The foundation of the recommendations still suggest a minimum of 150 minutes of moderate-intensity physical activity and muscle-strengthening activities two or more days a week.

However, the new guidelines have a few new emphasizing points and key guidelines for specific populations, such as specifics to preschool-aged kids, older adults, and adults with disabilities. For example:

“Preschool-aged children (3 through 5 years) should be physically active throughout the day to enhance growth and development. Adult caregivers of preschool-aged children should encourage active play that includes a variety of activity types.”

“Children and adolescents aged 6 through 17 years should do 60 minutes (1 hour) or more of moderate-to-vigorous physical activity daily.”

For adults, “additional health benefits are gained by doing physical activity beyond the equivalent of 300 minutes (5 hours) of moderate-intensity physical activity a week.”

“As part of their weekly physical activity, older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities.”

“When adults with chronic conditions or disabilities are not able to meet the above key guidelines, they should engage in regular physical activity according to their abilities and should avoid inactivity.”

In addition, there are recommendations for “Safe Physical Activity,” including:

“Increase physical activity gradually over time to meet key guidelines or health goals. Inactive people should “start low and go slow” by starting with lower-intensity activities and gradually increasing how often and how long activities are done.”

“Protect themselves by using appropriate gear and sports equipment, choosing safe environments, following rules and policies, and making sensible choices about when, where, and how to be active.”

“Be under the care of a health care practitioner if they have chronic conditions or symptoms. People with chronic conditions and symptoms can consult a health care professional or physical activity specialist about the types and amounts of activity appropriate for them.”

The guidelines also do a great job at highlighting the many known health benefits of physical activity. The list is pretty extensive, so be sure to check out the guidelines in its entirety. But it includes health benefits for which there is fairly new evidence for, such as “improved bone health and weight status for children aged 3 through 5 years,” “brain health benefits, including improved cognitive function, reduced anxiety and depression risk, and improved sleep and quality of life,” and “for people with various chronic medical conditions, reduced risk of all-cause and disease-specific mortality, improved function, and improved quality of life.”

The real take home message is that we need to move more, move often, and that all movement counts. Also remember that your physical activity minutes do not need to be completed consecutively, but can be added up over time!

Until next time,

Fuel Physio Team

Physical Activity Guidelines & Walking Pace

Hey there! And welcome to a long overdue blog post from the Fuel Physio Team. We'll be honest in saying that most of our efforts in writing have gone towards Wellfie Wednesday Tips. If you haven't seen those or know what they are, check them out!

Lets talk physical activity guidelines and how the aerobic component can be obtained with just simply walking throughout the week. No gym equipment necessary! So the recommended amount for sustained health benefits are as follows, and these can be found in greater detail here. 

• 150 minutes a week of moderate-intensity aerobic physical activity
• 75 minutes a week of vigorous-intensity aerobic physical activity
• The guidelines also emphasize muscle-strengthening activities of moderate or high intensity, involving all major muscle groups, for 2 or more days a week

Now that we know our recommended time to reap all the amazing benefits of physical activity, how can we achieve the recommended intensity? Well, lets look at moderate-intensity. The guidelines do actually mention "brisk walking" as an example. But exactly is "brisk walking?" There was an article published earlier this year in the British Journal of Sports Medicine that looked at just that. They determined that an absolute threshold of moderate-intensity occurs with a walking pace or cadence of >100 steps/min. However, know that even at a slower cadence, health benefits can still be had.

This link from the CDC provides other examples of obtaining moderate or vigorous intensities. Including mention of the "talk test." Where during an activity if you unable to speak a few words without pausing for a breath, your activity is most likely of vigorous-intensity.

Until next time,

Fuel Physio Team

Not One Profession Can Do It Alone. Team Approach for Prevention.

Hey, folks!

     Welcome back to a traditional blog post! It has been some time since I posted one of these. Most of my writing lately has been dedicated to our Wellness Wednesday tips and #WellfieWednesday initiative. This is a topic that has undoubtedly been touched on a number of times, but I felt it necessary to bring it up again. 

     We cannot do it alone. We cannot change population health with the unique skill set of a physical therapist or any single healthcare professional for that matter. We need a more collaborative team approach when it comes to preventing chronic disease. If you’re a PT trying to offer preventative wellness services but have no RDN (registered dietitian nutritionist) on speed dial, or vice versa, you’re doing it wrong; you’re not offering your patient or client a well-rounded approach to their care.

     Physical therapists may have the skills to help prevent, from the standpoint of exercise benefits and quality movement, but lack extensive dietary knowledge and the ability to offer nutritional counseling. Dietitians possess the nutritional component to educate healthy eating but lack the skills of promoting appropriate movement patterns and exercise prescription. Hell, even I, the one trying to juggle both of these amazingly beneficial professions, will not have everything needed to prevent. No one person has it all unless of course, you have MD, PT, OT, RDN, PhD, etc. after your name. And if that is the case, props to you, please share how you keep up with all those licenses and what your con-ed looks like. 

     We need a preventative model with multiple disciplines on board, making an array of services available to an individual if they need them. Now remember every person lives in a world of different circumstances. One person may be eating healthy but not moving enough, while another is getting adequate exercise but eats like crap, and a third requiring extensive behavioral change due to struggles with both. Specialties specialize for a reason, so take advantage. Now I’m not saying everyone needs a team of six to prevent the onset of diabetes or cardiovascular disease, but they should have the option if their health disparities call for it. 

     However, on the flip side. If education was done right and done early, we wouldn’t need a huge team of people trying to play catch up. And that is where change needs to occur. Just something else to chew on and indeed requires a post in itself. 

Thanks for reading and enjoy your week!

-    Dr. Patrick Berner, PT, DPT

FreeTheYoke Starts Today!!

     Happy Saturday! I hope you’ve had a wonder week! And for those of you who work a schedule similar to mine, make this week your best yet! Today’s post is about FreeTheYoke. Certainly check out the website by clicking the link here, but I’ll do my best to give a quick summary of what this is.

     FreeTheYoke is a movement aimed at creating awareness for the chronic diseases that burden our population. Basically letting people know you don’t have to live that way. And with some education and behavioral lifestyle changes, you can reduce your odds of having poor health outcomes. Simply by being physical activity, eating right, not smoking, and getting enough sleep. May sound like a lot, but there are healthcare professionals that can help. They’re called Physical Therapists!

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     FreeTheYoke is shedding light on the fact that physical therapists can be active participants in helping prevent illness and death that result from lifestyle-related chronic diseases. So how are they trying to let the public know that a physical therapist can help? Attempting to break a world-record for the longest bike relay, going from PT clinic to PT clinic, from San Francisco, CA to Manasquan, New Jersey. What this does is allow physical therapists to portray their healthy habits and be a model for other individuals.

     So how can you take part? RIDE! You can check out the course by clicking here. And don’t worry, if you’re not near any check points you can join in on the virtual ride. Simply log your hours by clicking here. Doesn’t matter if you’re commuting to work or on a spin-bike at the gym, join in on the fun! Most importantly, SHARE your ride! Whether it’s Twitter, Facebook, or Instagram, use #FreeTheYoke so your accomplishments can be shared with everyone taking part.

     If you have any questions or want more information, reach out to @FreeTheYoke or @mikeeisenhart on Twitter.

Thanks for reading!

Dr. Patrick Berner, PT, DPT

Everyone Deserves General Nutritional Information.

     Hey, Everyone! So just to give a little update on myself, since this past month or so has been pretty hectic. Once we got back from Europe, we took a cross country road trip, but what I should really say is that we moved across the country. Started my first travel PT assignment this week in Reno, NV in a skilled nursing facility and so far it has been great! So enough about me and onto the topic of choice this week, nutritional education. This post is intended for clinicians, but also the consumer (patient or client).

     Getting straight to point with this one, I find that many physical therapists and some other healthcare providers don’t always take the time to educate their patients/clients on the importance of nutrition and the huge role it plays in recovery, as well as the normal day to day function of the human body. Everyone deserves to know this information, and just because you as a clinician may not have a strong background in it, doesn’t mean your patient shouldn’t be informed.

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     I’m not talking counting calories, perfecting the grams of protein, and all that kind of detailed counseling that should be left to a dietitian. I’m talking about discussing general nutritional information, such as the importance of calcium for your elderly patient (really all ages), adequate protein for recovery following surgery or injury, reducing saturated fats for someone with high cholesterol, and healthy weight gain for a client that is pregnant. The list can go on and it ends up including every single person you as a healthcare provider come in contact with. And as for the consumer reading this, there is always some aspect of what you eat that can be improved.

     Now let’s say you don’t know those general nutritional needs, don’t be afraid to admit it and do the right thing, refer them to a registered dietitian nutritionist. The Academy of Nutrition and Dietetics has a great resource on their website that allows you to find an RDN in your area. Click here for the link. And I’m advising the use of an RDN because they are licensed and hold the highest qualification to provide nutritional education and counseling.

     So whether you are a practicing clinician or a patient, seek out nutritional information, incorporate that knowledge with exercise and safe movement, and live a more preventative lifestyle.

Thanks for reading!

- Dr. Patrick Berner, PT, DPT

Population Health and Being a Lifestyle Physical Therapist

     Hey there! Today I am going to touch on a topic, though a huge passion of mine is somewhat difficult to explain to people, even to those within the healthcare field. And that is population health and being a lifestyle physical therapist. 

     This past week, I was fortunate enough to spend four high-quality days with Mike Eisenhart and his team at Pro-Activity and Base Camp 31 and witness all the many things that they do. I'll tell you right now that traditional physical therapy is about 20% of their operations, so if you're stuck in the mindset of that's only what a physical therapist does, this post may not be for you. However, my hope is that this will be an eye-opener for you if so. 

     As some of you may know, Pro-Activity operates under five key elements consisting of Move, Fuel, Recover, Endure, and Connect. All of which are beautifully integrated into several different models or programs, as you may wish to call them. There's the average Joe looking to live a healthy life, your teenage athlete looking to improve performance, your individual struggling with metabolic conditions, and lastly the blue collar employee that doesn't know you're there to improve his/her quality of life. 

     None of these approaches have a single focus. They're not geared towards preventing only musculoskeletal injury. And you know why? Because as a physical therapist you can do more than strengthen some quads, perform a manipulation, and walk your patient down the hall. You have the skill set to change lives. You have the power to reinvent the way someone lives and the ability to facilitate a much higher quality of life for them, their family, and their friends. 

     As a physical therapist, I strive to make a difference, to change lives, and to help the population as a whole. This approach isn’t something easy, nor enjoyable at times, but if you’re a physical therapist because you genuinely want to help people, you would love being a lifestyle physical therapist. You shouldn’t be solely focused on correcting a dysfunction or biomechanical impairment; you should be treating the person as a whole. And as a whole, that individual deserves education beyond movement patterns and exercise prescription; they deserve an approach that sets them up for life. 

     Now is the opportunity to change not only the profession but also the lives of the people you encounter. Population health is possible and as a physical therapist, you should be striving to provide more. And if for whatever reason you feel ill-prepared on a topic, please know that referring to another healthcare provider is not a sign of weakness, but a sign of excellent patient/ client care. 

     If you're someone who wants to change and improve the population's health and well-being, please reach out! Mike can be contacted on Twitter @mikeeisenhart or at meisenhart@pro-activity.com

- Dr. Patrick Berner, PT, DPT

Inspiration and Thanks

Hey there!

     I want to start off by saying thank you to everyone that has supported our video, either by simply watching it or sharing. It makes me proud to be a part of a profession that can truly speak volumes. I want to give special thanks to Dr. Chaconas, who has supported me in all my efforts throughout my time at the University of St. Augustine and with the inspiration to make our video. I want to thank Sean, "the GetPT1st guy," as he was called for a tiny bit for helping us promote the video. I want to thank our amazing actors and actresses, Dr. Todd Bourgeois, Dr. Kerri Waegelein, Dr. Holli Flippo, Gretchen Davis, Erin Marsh, and Jules. And lastly, I want to thank Franchot at That Moment Productions for his awesome cinematography and making one hell of a video. 

     As day four rolls around, we sit at around a quarter of a million views with a reach of about a million people. By the way if you haven't seen or shared our video, go to my homepage or check it out here. I am in awe to say the least, Dr. Chaconas and I never expected these outcomes from such small fundraising efforts. With that said, our video was not tremendously expensive to produce, though we did work with a great cinematographer who I'm pretty sure cut us a deal. Thanks Franchot! 

     My biggest hope is that this sparks a fire within physical therapists around the world, whether you are a lone therapist or a part of a larger organization. Our profession has a lot to offer and unfortunately it is something that the general public doesn't know. We need to work harder at spreading the word and that starts with individual efforts. But yes, our organizations on the state and national level could do a better job at promoting the tools and skills of a physical therapists. And from what I have been seeing, many state chapters are changing their thoughts on how marketing the public actually works. 

     Thank you!!

- Dr. Patrick Berner, DPT

Links:

Dr. Chaconas

GetPT1st

Franchot

Research Day Presentation - Spring 16'

     Hey, everyone! This post contains video from a platform presentation I gave on Research Day - Spring 16' at the University of St. Augustine for Health Sciences, St. Augustine, FL campus. The presentation was on a patient case report that used a health promotion and prevention model for a patient with osteoporosis. The presentation has an emphasis on physical therapists appropriately implementing nutritional education into practice. 

- Dr. Berner, DPT, CEAS

Research Day Presentation - Spring 16' from Patrick Berner on Vimeo.

Start Your Healthy Life, But Do It Right

     Hey, everyone! Today I’m talking about starting on your path to a healthier lifestyle. Now I’m not talking about ditching everything unhealthy all at once because frankly that won’t work. Change takes time, so take it slow and enjoy the ride. There is no such thing as an overnight transformation, no pill that will cure all your problems, and no magic potion to change you from Professor Klump to Buddy Love. If you want change that lasts a lifetime, do it right. Here are a few steps to help you out. 

Find Motivation
     Find a reason to change within yourself because no one likes being told what to do. Do you want to be healthier? Do you want to live longer and have some fun with the grandkids? Do you want to travel more and take full advantage of all that life has to offer? Once you have that inner drive, you’re ready.

Determine What To Change First
     Do you want to tackle your diet, your level of fitness, the amount of stress you have, or do you need to quit smoking? I wouldn’t try and do all of these at once. Pick the thing you think you’re ready for and go with that. As you get further in your lifestyle changes, you can be working on multiple aspects of a healthy life. In determining what’s first, you can go for easy, the biggest impact, or what will keep you motivated. I suggest going with what continues to motivate you from within.

Start Small
     Like I said, I’m not talking about ridding all the bad habits you may all have at once. Just pick one thing to start with. Park farther away and increase the amount of walking in your day. Find a new fruit or vegetable you like. Cut down the amount of soda you may drink. Drink more water. Cook with less salt. Decrease the number of times you eat out. Take a walk around the block while you talk on the phone. The possibilities are endless. 

Gradually Add
     Once you have successfully made that first small change, add on another one. Remember keep them small. Just because you started eating apples doesn’t mean you’ll now go to the gym every day and never drink soda. Try for a new change every week or every two weeks. It’s gradual, it’s a slow process, but your body needs time to adapt to accept these changes. 

Take Pride In Your Success
     Be excited about the changes you have made, no matter how small you may think they are. A successful transformation isn’t going from where you are currently to having the body of a supermodel. Other things can be used to show improvements, such as improved blood pressure, glucose readings, and cholesterol levels. Those things show how your body has changed internally, how more efficiently your engine is now running. But the most important sign of success is how you feel, whether you now feel healthier or feel the power you have in changing your life for the better. 

     Welcome to a healthier lifestyle! And if you’re ever having trouble in making a lifestyle change, seek out a physical therapist or registered dietitian, they make great life coaches and will help get you to where you want to be. 

Thanks for reading!

- Patrick Berner, SPT, CEAS

Two Weeks of Ergonomic Fun! Few Key Points

     Hey, everyone. This is going to be hopefully a real informal post about my ergonomic experiences the past two weeks. So lets dive right in. Last week I took the CEAS I: Ergonomics Assessment Certification Workshop to get my CEAS (Certified Ergonomics Assessment Specialist) credentials, which was followed up by attending the 16th Annual Applied Ergonomics Conference these past few days. So to say the least, I learned about ergonomics and then truly learned about ergonomics. I want to share mainly a few of the things that popped out these past two weeks.

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     One of the main reasons I love the concept of ergonomics is because it revolves around preventing injury. It’s about making a work environment that fits the employee while reducing their fatigue, stress, and risk of injury. The most important thing to remember is that we are all of different shapes and sizes, so a one size fits all workplace design does not work. Ergonomic setup needs to be individualized, and that doesn’t mean using a tool or buying a chair that’s labeled “ergonomic.” The practice of ergonomics is very detailed and after the things I saw this week, it is highly engineering oriented. But we as physical therapists can surely be a part of it. 

Sitting vs. Standing

     So there has been a lot of talk recently about the benefits of standing instead of sitting all day. Well, I’m sorry to tell you that there is not any strong research to support this, and none of the professional ergonomists are recommending to stand all day long. But what they do recommend is being ACTIVE during your workday and taking “ergo breaks.” 

     During one of the conference sessions, John Kerst shared “5 Ways to Make Your Desk Job Less Sedentary.”

• Alternative Workstation (Sit to stand or lean to stand)
• Coffee & Water Cup Size (Decreasing coffee size or increasing water, more bathroom trips)
• Try Walking Meetings (Said to increase brain activity)
• Integrate Technology Assist (Step counter, Fitbit, alarms to get up)
• Vary Your Posture
  • 20 minutes of leaning/sitting
  • 8 minutes of active standing (weight shifting)
  • 2 minutes of walking around)
• Education (Increase knowledge deficits on posture and physical fitness)

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“Ergo breaks” can consist of getting up and moving around, as well as targeted stretches depending on your occupation. 

Work in the Perfect Zone!

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     Another speaker, Ben Zavitz, gave 10 “Everyday Ergonomic Solutions.”

1. Get things off the floor
2. Raise the employee
3. Use a wheel or roller
4. Lighten the load (material substitution or weight distribution)
5. Use mechanical assistance/ leverage
6. Tilt the workstation
7. Extend the tool
8. Use ergonomically engineered tools (it’s the features, not the name)
9. Daily oiling and preventative maintenance
10. Design hands-free options

     Education needs to be blended, especially when training for operations and safety. Kent Hatcher’s presentation, “Utilizing Blended Learning to Provide Effective Ergonomics Training,” pointed out the deficits in training an employee exclusively by computer-based technology or classroom setting. Practice makes perfect. He shared the 70:20:10 rule from the Center for Creative Leadership. Learning is 70% hands-on problem solving, 20% feedback and networking, and 10% classroom/ coursework.

     Every session that I attended and every speaker that I listen to had one thing in common, and that was addressing the issue early will yield the greatest outcomes. If a job looks like it may be harmful, puts an employee in an awkward position, or requires continuous repetition, make adjustments before an injury occurs.

    There was also a big focus on wellness and the implementation of various types of programs within companies around the world. Being an area that I wish to practice in, there will be many future posts regarding this topic. I hope you found some of this information interesting. All the credit goes to the presenters of the 16th Annual Applied Ergonomics Conference and CEAS instructors. 

Thanks for reading!

- Patrick Berner, SPT, CEAS

It’s Time for a Credentials Check! PT/DPT vs CPT and RDN vs Nutritionist

Hey there! So this blog post kind of grew off of a tweet I made yesterday,

“If we tryin to ‪#prevent, why are the 2 powerhouse professions of ‪#Move & ‪#Fuel not collaboratin? ‪#NNMchat ‪#GetPT1st ‪#PT ‪#RDNday ‪#FreeTheYoke”

     I’m talking about the professions of Physical Therapy and Dietetics, which truly are powerful professions that unfortunately go unrecognized for all they can do. With chronic lifestyle diseases continuing to rise, why are we not collaborating? Why are we not giving patients or clients the best of both worlds? Diet and exercise have been proven over and over again to help prevent disease and improve the quality of life, yet I rarely see a PT and an RD working together or even know what the other has to offer. The typical response being that a PT helps the elderly woman walk down the hall while the RD is making their meals. This just isn’t the case. The amount of education, training, and quality control that goes behind earning these credentials is extensive.

     To really highlight how extensive their training is, I’m going to compare them to the public’s immediate response when asked, “who do you go to for help with diet and exercise?” Well a personal trainer or nutritionist, duh! And I want to say that I’m not putting these professions down because there are certified personal trainers (CPT) who do a tremendous job. However, from a consumer’s perspective, I would want an individual that comes highly qualified. I’m going to keep these comparisons brief enough to make my point; otherwise, this post could get more complicated than it needs to be.

Physical Therapist (PT) - All new PTs are now required to hold a Doctor of Physical Therapy (DPT)

Requirements (1):

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• Complete a 4-year bachelor’s degree
  • The major of the degree doesn’t matter as long as requirements are met for PT school application, appropriate courses in anatomy, chemistry, physics, etc.
• Complete a Doctor of Physical Therapy degree from an accredited CAPTE (Commission on Accreditation in Physical Therapy Education) program, typically 3 years to complete
  • “curriculum may include, but are not limited to, biology/anatomy, cellular histology, physiology, exercise physiology, biomechanics, kinesiology, neuroscience, pharmacology, pathology, behavioral sciences, communication, ethics/values, management sciences, finance, sociology, clinical reasoning, evidence-based practice, cardiovascular and pulmonary, endocrine and metabolic, and musculoskeletal.”(1)
  • Along with roughly 1,200 hours of clinical experience
• Pass a national examination, which is given by The Federation of State Boards of Physical Therapy (FSBPT), to become board certified
• Become licensed in the state of practice
• Practice under a code of ethics, set forth by the American Physical Therapy Association (APTA)
• Complete approximately 30 hours of continuing education every 2 years, depending upon the state
• Can hold certification in specialized areas, such as orthopedics, neuro, sports, pediatrics, etc.

Certified Personal Trainer (CPT)

Using the National Strength and Conditioning Association’s (NSCA) certification requirements (2):

• 18 years old
• High school diploma
• CPR/AED Certified
• Possibly a background in exercise science 
• Pass a written examination
  • Focused on fitness assessment, program planning, exercise, and safety

Registered Dietitian (RD) or Registered Dietitian-Nutritionist (RDN)

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Requirements (3):

• Complete a 4-year bachelor’s degree in dietetics from a program that is accredited by ACEND (Accreditation Council for Education in Nutrition and Dietetics), which is a part of the Academy of Nutrition and Dietetics (AND)
  • The degree is heavily geared towards food science, biochemistry, medical nutrition therapy, food management, and much more
• Complete an ACEND accredited dietetic internship, roughly 1200 hours, distributed among healthcare facilities, community health, and foodservice distribution
• Pass a national examination, which is given by the Commission on Dietetics Registration (CDR)
• Become licensed in their state of practice
• Practice under a code of ethics, set forth by AND and CDR
• 75 hours continuing professional education (CPE) every 5 years
• Can hold certifications in specialized areas such as geriatrics, sports, diabetes, renal disease, cancer, etc.
• Most states nationwide require an RD credential, along with state licensure, to perform nutritional counseling and prescribe diets. 
  • Check out this Link for more information

Nutritionist

Requirements:

• Having a passion for nutrition.
• There is no legal protection over this term, as there is with RD and RDN.
• This individual could potentially have a degree in food science or nutrition.
• Not much else to say about this one.

     As you can see, these two professions are truly powerful in the field of human movement and nutrition, providing the keys to preventative healthcare. Both of these professions go to extreme measures to ensure highest quality of care and competency. These credentialed individuals have thousands of hours of education and training under their belt with the ability to do more than walk someone down the hall and cook up some food. So I ask you again, why are these professions not collaborating to provide the best approach to a preventative lifestyle?

Thanks for reading.

- Patrick Berner, SPT

(Soon to be DPT graduate with a degree in dietetics ready to make a change!)

References:

1.  Clark M. Physical therapist (PT) education overview. American Physical Therapy Association. http://www.apta.org/PTEducation/Overview/. Accessed March 10, 2016.

2.  National Strength and Conditioning Association. CPT certification - certified personal trainer - personal trainer certification. https://www.nsca.com/Certification/CPT/. Accessed March 10, 2016.

3. Academy of Nutrition and Dietetics. What is a registered Dietitian Nutritionist? http://www.eatrightpro.org/resources/about-us/what-is-an-rdn-and-dtr/what-is-a-registered-dietitian-nutritionist. Accessed March 10, 2016.

Toast to a Nice Cold Glass of Plain Water & Ditch the Soft Drinks!

     Hey everyone! I'd like to start off by acknowledging that March is National Nutrition Month! It is an annual campaign put on by the Academy of Nutrition and Dietetics in an effort to advocate healthy eating. Check out their site for more information and some great dietary tips. EatRight.org 

     Lets get to talking about water. A recent study published in the Journal of Human Nutrition & Dietetics looked at the nation's consumption of plain water and overall caloric intake. The survey obtained results from 18,311 adults over the age of 18 from 2005 to 2015. Researchers found that increasing plain water consumption by one to three cups a day could decrease caloric intake per day by 68 to 205 calories, as well as decrease sodium intake per day by 78 to 235 grams.(1) 

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     Personally, I enjoy the taste of plain water, but others may want some flavor. My advice is to ditch the soft drinks and flavor up the natural way. There are lots of different ways to make plain water taste delicious without adding TABLESPOONS of sugar. A 12oz can of coke has roughly 2 1/2 Tablespoons of sugar. (2) That's a lot of added calories in your day, especially if you're having more than one.

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     Flavor your water the natural way! Easily done by using various fruits and natural sweeteners. Check out a few links here to some recipes. Have fun with it and come up with your own.

Buzzfeed List of 14 Recipes

Combo of Lemon/Lime, Orange, & Berries

Pomegranate, Ginger, & Lime

     If you're looking to cut calories, start small by changing what you drink on a daily basis. Thanks!

- Patrick Berner, SPT

1. An R, McCaffrey J. Plain water consumption in relation to energy intake and diet quality among US adults, 2005-2012. Journal Of Human Nutrition And Dietetics: The Official Journal Of The British Dietetic Association. February 22, 2016.

2. Us C. How much sugar is in Coca‑Cola? http://www.coca-cola.co.uk/faq/ingredients/how-much-sugar-is-in-coca-cola/. Accessed March 3, 2016.

Preventative Programs Help Reduce ACL Injury

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     Injury to the anterior cruciate ligament of the knee is a very common occurrence, especially for younger adolescent females. The majority of injuries occur during sports that require running, jumping, and cutting. They occur at an estimated annual rate of 250,000, with females being 2-8 times more likely than males.(1) Females are said to have increased risk due to anatomical and hormonal differences.(2)

     The results of a meta-analysis and a systematic review, high-quality research, conclude that preventative programs are beneficial for the reduction of ACL injury. The meta-analysis found that when these programs included neuromuscular and proprioceptive training, ACL injuries were reduced by 50.7%.(1) This type of training involves increasing the awareness one has over their extremities. The systematic review concluded that preventative programs were successful when they included strength training with plyometric, balance and proprioception, and education on proper body mechanics.(2)

     The components of these preventative programs are well within the scope of practice of a physical therapist. In addition to that stated above, programs should include specific training that may be required for a particular sport, such as increased plyometrics for sports with increased jumping. Seek a licensed physical therapist for the development of an ACL preventative program.

-Patrick Berner, SPT

References:

1. Donnell-Fink L, Klara K, Losina E, et al. Effectiveness of Knee Injury and Anterior Cruciate Ligament Tear Prevention Programs: A Meta-Analysis. Plos ONE. December 4, 2015;10(12).

2. Michaelidis M, Koumantakis G. Effects of knee injury primary prevention programs on anterior cruciate ligament injury rates in female athletes in different sports: A systematic review. Physical Therapy In Sport. August 2014;15(3):200-210. 

Every Healthy Pregnancy Should Include Visiting a Physical Therapist

     As awareness continues to build on the benefits of seeing a physical therapist for low back pain, it should not be forgotten that physical therapists can help with numerous other conditions. One of those conditions being a very natural phenomenon, pregnancy. Even with pregnancy rates on a decline, the latest study shows “98.7 per 1,000 women aged 15-44” are becoming pregnant(1). That remains to be a large number of women that may experience the following symptoms during or after their pregnancy(2): 

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•    Low back pain
•    Pelvic girdle pain
•    Weight gain
•    Gestational diabetes
•    Urinary incontinence (uncontrolled bladder)
•    Preeclampsia
•    Leg Edema (swelling)
•    Deep vein thrombosis (blood clots)
•    Depression
•    Morning sickness
•    Fatigue
•    .... The list goes on

     The purpose of physical therapy intervention is to prevent or reduce the occurrence of these symptoms. A systematic review performed by Kampen et al. found physical therapy intervention to be effective in the treatment and prevention of pregnancy symptoms(2). The results indicated that the skills of a physical therapist can accurately address the following(2):

• low back/ pelvic girdle pain
• weight gain beyond recommendations
• urinary incontinence 

     These symptoms can be addressed with targeted exercises, such as Kegels for urinary incontinence. The guidance of a physical therapist should be sought to ensure proper performance of these particular activities and receive adequate education about safe movements. 

     Also, don’t forget that nutritional intake is crucial during pregnancy, for both mother and child. Seek the help of a registered dietitian for nutritional meal planning. 

- Patrick Berner, SPT

1. Fox M. U.S. Pregnancy rate hits record low, data shows. NBC NEWS. December 11, 2015. http://www.nbcnews.com/health/womens-health/u-s-pregnancy-rate-hits-record-low-data-shows-n478381. Accessed February 4, 2016.

2. Van Kampen M, Devoogdt N, De Groef A, Gielen A, Geraerts I. The efficacy of physiotherapy for the prevention and treatment of prenatal symptoms: a systematic review. International Urogynecology Journal. 2015;(11):1575. 

Say No to Drug Therapy for Chronic Pain. Choose a Physical Therapist.

     The incidence of chronic pain is on a steady rise and chronic low back pain is one of the most common contributing conditions. Studies suggest the “the global number of individuals with low back pain is likely to increase substantially over the coming decades.”(1) The World Health Organization lists low back pain as one of the most debilitating conditions worldwide, but “the causes of lower back pain are rarely addressed.”(2)

     The prescribing of opioids has long been the approach to dealing with chronic pain, and studies show that “more than half of regular opioid users report [having] back pain.”(3) The prevalence of opioid use has increased so much over the years that the Centers for Disease Control and Prevention released a document intended for those medical doctors prescribing medication for chronic pain. This document is titled the CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016.

     The CDC states, that “in 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every adult in the United States to have a bottle of pills.”(4) The CDC also states, that “the overall prevalence of common, predominantly musculoskeletal pain conditions that can be chronic (e.g., arthritis, rheumatism, chronic back or neck problems, and frequent severe headaches) was estimated at 43% among adults in the United States.”(4) These are musculoskeletal conditions that physical therapists have expert knowledge of.

     The CDC guidelines endorse conservative management, stating that "based on contextual evidence, many nonpharmacologic therapies, including physical therapy… can ameliorate chronic pain.”(4) Numerous studies support the use of physical therapy for chronic low back pain and this may include the use of specifically targeted exercises, lumbar stabilization programs, physical therapy mobilizations, and many other treatment options.(5,6) A good physical therapist will aim to treat the underlying causes of pain or help put together a maintenance program, because yes some conditions may require life-long management.

     Also important to note that yes some musculoskeletal conditions may require medication intervention, but conservative treatment by a qualified physical therapist should be sought first.

- Patrick Berner, SPT

References:

1. Hoy D, Bain C, Buchbinder R, et al. A systematic review of the global prevalence of low back pain. Arthritis & Rheumatism. June 2012;64(6):2028-2037.

2. 6.24 low back pain, World Health Organization. 6. Priority diseases and reasons for inclusion. http://www.who.int/medicines/areas/priority_medicines/Ch6_24LBP.pdf. Accessed January 23, 2016.

3. Deyo R, Von Korff M, Duhrkoop D. Opioids for low back pain. BMJ (Clinical Research Ed). January 5, 2015;350: g6380.

4. Dowell D, Haegerich T, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. Atlanta, GA: CDC; 2016.

5. Specific rehabilitation exercise for the treatment of patients with chronic low back pain. Journal Of Physical Therapy Science. August 2015;27(8):2413-2417.

6. The effect of lumbar stabilization exercises and thoracic mobilization and exercises on chronic low back pain patients. Journal Of Physical Therapy Science. December 2015;27(12):3843-3846.

Save Our Children. The Decline of Physical Education.

     Today I wanted to share briefly some information I became aware of two weeks ago. I had a very informative meeting with an elementary school physical education teacher. I was shocked by what I had learned, and I am sure you will be too. I will not mention the school, nor the parish or county because I assure you that this is a national issue.

     Now I ask you to think, how much time during a week do children receive physical education? I initially thought they got approximately 30 minutes a day. You would think that is a fair amount of time, close to what I received growing up. I then thought okay maybe only three times a week. Again, I was wrong. Children at this particular school receive 35 minutes of physical education ONCE a WEEK. I was outraged to say the least. And a majority of this time is spent moving the children from a classroom setting to the field and back.

     Furthermore, I learned that children's grades in physical education are now solely based on objective testing and not physical achievements. The Presidential Physical Fitness Award, a program many of us undoubtedly participated in while going through elementary school, is no longer being used. The computer tests now used prompts students to answer such questions as the correct sequence of a hop or skip; however, this does not test their coordination of the activity.

     There needs to be a drastic increase in the amount of time children are receiving physical education. Children need to be educated how to properly use and maintain their body in order to live a long and healthy life; increasing the time spent on other subjects does not help a child who already lives a sedentary lifestyle. Yes, all education is important, but physical activity has proven to enhance the function of mind and body. If you are a parent or guardian and not demanding more time for physical education, you are adding to the current decline in our children's physical activity.

     It is time to speak out and make an actual change!

- Patrick Berner, SPT