Physical Therapy First Lowers Cost

     In honor of PT Day on Capital Hill, I wanted to briefly share the results of two recent research studies. The first focuses on the cost in regards to new onset of low back pain and whether patients first utilized physical therapy or advanced imaging. The second looks at physical therapy vs. surgery for lumbar spinal stenosis.

     As evidenced by this research study, utilizing physical therapy first is the most efficient and effective way to manage a musculoskeletal condition. Unlike a physical therapist, medical doctors to do receive the extensive knowledge and training in how the human body moves. 

View fullsize

Diagram to help depict the path a patient can take. I do not have the research for the numbers provided here.

View fullsize

                            Click image to enlarge the abstract.

     As evidenced by this research study, a conservative management approach was just as successful as surgery. There is a time and place for surgical procedures; however, a vast majority can be prevented with physical therapy. 

                              Image Location

View fullsize

                              Click image to enlarge the abstract.

     The bottom line is that physical therapists are the musculoskeletal experts and deal with conditions of movement, involving muscles, tendons, ligaments, bones, etc. Physical therapy has shown to significantly decrease healthcare cost, which is a massive problem in our country. The profession should have direct access nationwide and the research evidence is vast to support this. For those of you who do not know, direct access is when a patient can see a physical therapist first without needing a doctor’s referral. Physical therapists are trained to recognize conditions outside their scope of practice and when to refer to a medical doctor.

     Check out this link to see where your state stands on direct access. Direct Access Summary by State.

      Regardless of your state’s direct access laws, remember that you have the right to choose your physical therapist.

 - Patrick Berner, SPT

Your Body Needs Sun, But Does Not Need Skin Cancer

     With summer approaching, I wanted to briefly touch on sun exposure and skin cancer. For this blog, I have embedded video and direct links that can explain this information more clearly. CancerResearchUK.org does a tremendous job at educating on this subject and also on various other cancers. 

So is there a safer time to go outdoors?     YES                                                                                                  

     One of the most interesting tips I found through their website is the use of the shadow rule. The shadow rule, also known as Holloway's rule, indicates that the sun's rays are strongest when your body's shadow is shorter than your own height. This typically puts the strongest sun rays between the hours of 10am and 3pm. 

Safely Enjoy the Sun

• Take advantage of the shade
• Cover up
• Minimize exposure during strong sun rays
• USE SUNSCREEN - at least SPF 15

Why Your Body Needs Sunlight

• Vitamin D production
• itamin D is needed for Calcium absorption 
• Calcium is a very important mineral needed for maintaining bone health, nerve transmission, muscle contraction, and deserves its own blog post.

     Monitor Yourself!

     Skin cancer is preventable and can be successfully treated with early intervention. Utilize the ABCDE's of identifying skin cancer, specifically malignant melanoma.

- Patrick Berner, SPT

Cancer Research UK. Sun, UV and cancer. Cancer Research UK. http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/sun-uv-and-cancer. Updated March 24 2015. Accessed May 10 2015. 

Melanoma Research Foundation. The ABCDEs of Melanoma. Melanoma Research Foundation. http://www.melanoma.org/understand-melanoma/diagnosing-melanoma/detection-screening/abcdes-melanoma. Updated 2015. Accessed May 10 2015.

PT Clarification Order: Physical Therapists Do More Than Treat Injuries

     I felt this topic needed to be addressed after a conversation I had with an old friend of mine, who worked as an ATC (athletic trainer) for an NFL team. We talked about how he chose his career path and what other professions he had thought about going into. He told me that he chose not to go down the PT path because he didn’t want to treat old people his whole life. I was outraged that another healthcare professional had no idea what physical therapists have to offer.

      After this encounter and many others of similar outcome, I was reassured that there is a general misunderstanding about the physical therapy profession. We do more than treat old people and individuals with an injury. I chose to share with you the practice act of South Carolina, primarily because I appreciate the accuracy of the statue’s wording. However, you can find the reference to prevention within PT practice act’s across the country.

 “ "The practice of physical therapy" means the evaluation and treatment of human beings to detect, assess, prevent, correct, alleviate, and limit physical disability, bodily malfunction, and pain from injury, disease, and any other bodily or mental condition…” (South Carolina Physical Therapy Practice Act, 2014). 

S.C. PT Practice Act     Louisiana PT Practice Act     Florida PT Practice Act

      Physical therapists have the skill set to be a part of the fight against preventative disease and promote a healthy lifestyle for the entire population. There are PTs working for companies nationwide that conduct functional capacity evaluations and pre-employment screenings in order to identify individuals prone to an injury. Those at risk are rehabbed or undergo work hardening in order to prevent any serious injury. PTs can also be found promoting wellness and increasing quality of life within the school system and community programs.

      The point is that physical therapy deals with preserving the human body, not just repairing it.

 - Patrick Berner, SPT

Key Items I Look For: Nutrition Facts Label

      Before the end of National Nutrition Month, I wanted to post a topic that I hope you find helpful while choosing foods to purchase. For starters, purchasing fresh fruits and vegetables, lean meats, and seafood is the way to go. I believe these foods, those without labels, to be the healthiest choice. In order to monitor their nutrient content, refer to Supertracker or SELFNutritionData and enter the item to receive its’ facts. 

1.     Calories and Serving Size

• I always start with a calorie amount in mind and choose an item within that range.
• Watch out for the serving size. Companies have become clever in identifying their foods as low calorie, but the serving size is far too small. For example, you decide to buy some low calorie crackers, but the serving size is only 5 crackers.

2.     Fats

• High fat items do not need to be completely avoided until you know the type of fat.
• Limit saturated fat and avoid trans fat.
• Unsaturated fats (poly and mono) are a healthy choice.

3.     Carbs

• I do not follow the latest fad that limits carbohydrate intake; your body needs this energy source.
• A product that is whole grain, high in dietary fiber, and high in carbohydrates resembles a good choice.
• A product where the grams of sugar are almost identical to the grams of carbohydrate should be avoided. 

4.     Protein

•  This part relies on your personal intake and whether or not you have reached your protein needs elsewhere.
• The recommended intake is 0.8g per kg of body weight; however, specific populations require more.

5.     Ingredients

• These are listed in order of quantity.
• A product with an ingredient list that runs along the entire packaging is an item I avoid. This indicates an overwhelming amount of unnatural substances.
• As of now, I avoid high fructose corn syrup and aspartame. Some current research states consumption of these to be safe; however, I am not entirely convinced.

Seek the help of a registered dietitian for individual nutrient requirements.

- Patrick Berner, SPT

Choose the Correct Motivational Path for a Successful Rehab

      Various approaches to therapy will come and go, but the need for motivation will always remain. Patients or clients need incentive in order to achieve their goals, whether these goals are their own, their families’, or the clinician. From a clinician’s point of view, goals need to be created that will help their patient’s attain the highest quality of life. So what is the #1 question all patients should be asked?

 What do you enjoy doing and what physical requirements does your body need to have?  

      Once you have this information, you can create an individualized plan to help them reach their goals. But how will you motivate them? This is when you need to find out what pushes your patient to do well and what kind of reinforcements they prefer. Aside from your patient’s health status, choosing the best motivational approach is what indicates the need for personalized therapy.

      Some patients may only require general reinforcement as motivation, such as:

·      verbal praise

·      healthy treats or sweet treats

·      small rewards for reaching milestones or completing goals

·      quantitative data for those patients that prefer to see their numeric values change

      However, I believe the biggest motivator to be visual change. Is your patient able to actually see progress towards doing what they enjoy? Whether it is performing your therapy session in front of a mirror, keeping photographic record, or video recording them, this approach allows patients to see the improvements being made and spark the desire to continue on. Clinicians should consider this motivational approach because most patients will respond positively towards their visual transformation.

       Find what motivates your patient, client, or anyone for that matter and utilize that approach.

-Patrick Berner, SPT

Make Your Workouts Fun!

      The beauty about exercising is that you can literally do it anywhere and I mean anywhere! Lacking a gym membership is not an excuse. You can burn calories inside your own home or even outdoors, which is the greatest place to stay fit!

      Last year my girlfriend and I traveled to California, where we biked the Golden Gate Bridge. The ride was an 8-mile trail full of views that certainly counted as a workout. Biking outdoors is an excellent way to stay in shape, but I wouldn’t advise jumping into a long ride without first building up your exercise tolerance.

      In 2013, during a trip to Colorado, I spent time hiking St. Mary's Glacier, located west of Denver, and skiing in Breckenridge. My body was certainly not prepared for the change in elevation, but I enjoyed the challenge. 

      Being fortunate enough to live in Florida, I have many different opportunities to exercise outdoors. However, remember every region of the country has something unique. My two favorite recreational activities here are playing beach volleyball and kayaking the intercostal waters. Great thing about kayaking is that you only need a body of water, which can be found virtually anywhere. 

      If you happen to be stuck indoors, you may have to be a little creative. The purchase of resistance band and a pull up bar can go a long way, but remember there is always the traditional push up and air squat. P90X and Insanity have become popular workout DVD's and may be worth a try, although I have not personally done either one. Keep in mind though, if you have not exercised before, do not immediately start these programs. 

      My point is that you can burn calories doing something that you love. You can walk, run, skate, dance, shoot some hoops, throw a ball, and the list goes on. But as with beginning any new activity, seek the advise of a licensed medical professional. 

- Patrick Berner, SPT 

My Post-Workout Smoothie, Why Are You Supplementing?

     Over the past 7 or 8 years I have been drinking the same smoothie after my workouts, well roughly the same with minor changes here and there. I also like to occasionally have a nice filling meal after the gym, but smoothies are quick and easy.

• 1 cup 1% milk
• 1 medium sized banana
• 1 medium sized apple (red delicious packs the most punch)
• 1/2 cup low-fat vanilla yogurt 
• 2 tablespoons peanut butter (Creamy Jif)
• 1/2 cup frozen blueberries (eliminates the need for ice)

     Using the USDA's SuperTracker, I was able to get the complete nutrient content of my smoothie. 

• 611 Calories
• 24g Protein
• 91g Carbohydrate
  • 68g Sugar (Natural Fruit Sugars)
  • 10g Fiber
• 21g Fat 
  • 14g Unsaturated Fat (Poly/Mono)
• Great source of Calcium, Potassium, Copper, Magnesium, Phosphorus, Zinc, and a majority of B vitamins.  
• And not to mention all the beneficial antioxidants and phytochemicals found in these fruits. 

     During my undergraduate studies, I did a literature review on nutrient needs post-exercise and concluded that only 20g of protein is necessary for muscle building. Also, any carbohydrates consumed are for glycogen storage and the energy source for future workouts. So why is there so much protein supplement use, when a smoothie like this can adequately meet your body's needs? Yes, supplementation is necessary for some, but not when your body can efficiently obtain enough nutrients from food.   

     I strongly encourage using the free USDA tool in order to get an idea of your entire nutritional intake. 

     I also wanted to share my breakfast smoothie, which I started making last year in an effort to save some time in the morning and it has worked out well thus far. 

• 1 cup 1% milk
• 1 medium sized banana
• 2 tablespoons peanut butter (Creamy Jif)
• 1/2 raw spinach
• 2 tablespoons milled flaxseed
• 1 packet of cooked instant oatmeal
• 1/2 cup frozen blueberries (eliminates the need for ice)

• 636 Calories 
• 25g Protein
• 80g Carbohydrates
  • 37g Sugar
  • 15g Fiber
• 29g Fat
  • 21 g Unsaturated Fat (Poly/Mono) 
  • Flaxseed is an excellent source of Omega-3
• Great source of Calcium, Potassium, Copper, Iron, Magnesium, Phosphorus, Zinc, Folate, Vitamins A, K, and all of the B's. 

- Patrick Berner, SPT

Enter your email address:

Delivered by FeedBurner

Advanced Technology for Paraplegics

     Today I sat in on a great presentation given by Innovative Neurotronics' national representative. He presented on several of their advanced technology products; however, one in particular stood out, the ReWalk. The technology, which was recently approved by the FDA, is simply amazing. Specially suited for paraplegics, the technology is available for spinal cord injury patients with injury at T3 or below. Upper extremity strength and coordination is necessary in order to operate the machinery. 

     The ReWalk is intended to enhance the quality of life for patients that were previously wheelchair bound. This technology is not intended to replace conventional physical rehabilitation. These patients still require the skills of an expert physical therapist. In fact, for these patients to even fully utilize this technology, extensive therapy must take place to address the patient's strength, coordination, and balance. This type of technology is just the beginning of much more to come and further advancements will continue to increase quality of life for the disabled population. 

- Patrick Berner, SPT

Enter your email address:

Delivered by FeedBurner

Patient Involvement During Clinical Decision-Making

      A research article I presented last year inspired this short blog. The study looked into patient collaboration during decision-making and whether or not patients wanted to be involved. The results indicated that a majority of patients preferred to be a part of making decisions for their intervention. However, the therapists in the study did not utilize this approach. I have included a link to the article if you wish to check it out.

       I believe a current misconception about therapy is that the therapist should be in total control of the intervention. This misconception occurs among all healthcare professions, not just physical therapy. A patient’s preferences or ideas should always be utilized in determining their care, but within reason of course. A skilled professional should know a patient’s limits. This approach is a great way to boost motivation and prevent noncompliance. Quality care needs to be a top priority among all professions and what better way to do that than giving patients what they want. 

       As for those of you reading who are in the patient’s shoes, don’t be shy. Speak up about things you would like to see done in your therapy session or treatment plan. Being involved will certainly improve your end result.

- Patrick Berner, SPT

Click here for the article.

5 Steps To An Easy Grocery List

     Today I want to share with you my method of grocery shopping that I’ve used for years. I find it to be a good way to reduce the hassle and stress of figuring out what to eat for dinner on a daily basis. As said in Hamlet, “There’s a method in his madness,” so if this doesn’t entirely make sense I apologize. However, I hope some of these tips can make your shopping experience a little easier. 

1.     Plan Ahead

     Shop for a week’s worth of food, but honestly you could do more. It’s a good idea to have a designated shopping day in mind, I prefer Saturday. Start by writing out the days you’re purchasing food for. 

 2.  Know Your Basic Go To Items

      This includes a list of things I buy every time I go to the store. Such as what I eat for breakfast, what I use to make smoothies, and what I have for lunch. 

3.     Improvise and Be Creative

      This step involves taking a quick scan of whatever you have available in the refrigerator or pantry. Start thinking of meals you can already cook or could cook with some extra ingredients. 

                                            My Go To Items

4.    Fill in the Major Food Groups

       My dinner always consist of a meat or protein source, a carbohydrate, and a vegetable. Utilizing what you have, start filling in the blanks for each day and create your meals. Add what you don’t have to your list.

                                       Items I Already Had

                                           Finalized Meals

5.     Utilize the Freezer

      Freezers are good at storing frozen meats, fruits, and veggies better than bulky cardboard boxes of processed food. If there’s a sale, stock up and freeze the extras, which can cut your future grocery list.

Please share your thoughts or any other helpful tips! 

- Patrick Berner, SPT

                  Ready to Hit the Store!

Enter your email address:

Delivered by FeedBurner

Educate Yourself Before Trying Something (Runner Edition)

     I recently volunteered at marathon here in Florida, where I was a part of the medical team in the orthopedic tent. We were located at the finish line and available for runners that displayed signs of needing assistance or whom voluntary sought help. Keeping with my prevention approach, I wanted to mention just a few things that could have been prevented with just a few simple tips.

       A majority of runners I saw presented with signs of dehydration and muscle cramps, blisters, and possible stress fractures. There were however a couple runners we saw that fell during the race and displayed signs of arm fractures, but that’s a different story. Runners that were far worse, with signs of hypothermia or other conditions, were cared for elsewhere in the medical tent. 

     Simple Tips to Prevent 

  ·   Adequate Hydration

Before, during, and after a long run make sure to drink water and something that has electrolytes, like Gatorade or Powerade. It is important to replenish electrolytes lost through sweat to avoid muscle cramping. Rule of thumb is to drink 16oz for every pound of body weight lost, which relies on you weighing yourself before and after. However, to steer clear of all the math, just drink a couple glasses and have a banana.

·   Recognize Overuse

Your body has just ran over 26 miles and soreness is bound to happen. Don’t be surprised if you feel like you have been hit by a bus, your muscles and tendons have most likely fatigued and been overworked. Utilize available ice to decrease soreness and possible inflammation, but keep your application time to 10-20 minutes.

·   Do Not Stop Moving & Know How to Self-Stretch

After such a long race your body has been built up with lactate acid. Continue to walk around  after, while pretending to do some bicep curls, to help circulation and prevent some muscle soreness. Stretching is another way to help increase circulation. I have a few favorite lower extremity stretches, but I’m saving that for a future post. 

·    Inspect Your Shoes

Looking at the bottom of your shoe reveals a lot, especially for a physical therapist. Repetitive wear on one particular side can indicate a biomechanic issue or an improperly fit shoe. Shoes that don’t fit well can lead to stress fractures if you have constantly been putting pressure on one spot. They can also create an environment for forming a blister. If your shoes don’t protect against blisters, look into padding sensitive areas and ensuring you have good socks.

·    Do Not Run in New Shoes

If you find the need to purchase new shoes, do it far beforehand. This allows time for you to slowly break them in during training. Most of us wouldn’t buy a new car and drive it across country without getting to know all the features or how it handles. Don’t put your feet and lower extremities through that pain.

Based on what I saw, many runners need to be educated. They should know what to expect and how their bodies will react, only then can they decide if they are truly injured. Remember to always utilize available medical staff and volunteers to rule out serious injury. 

- Patrick Berner, SPT

Enter your email address:

Delivered by FeedBurner

Estimated Annual Total Cost of the Top 6 Preventative Conditions

     I want to start off my blogging experience by addressing the annual cost of just six of the most preventable conditions. Evidence exists that lifestyle modification can reduce the incidence of these illnesses, which in turn can decrease their cost. This topic may only be of interest to those that care for understanding the economic burden, though these numbers are large enough to catch the attention of anyone.

     The estimated figures used for these conditions were found through various research articles or public announcements and their references have been provided. They include direct healthcare cost and indirect cost from loss of productivity, which resulted from the illness. I utilized the Bureau of Labor Statistics CPI Inflation Calculator (1) to account for inflation and bring these values to the equivalent of the 2014 US dollar. 

     Combined cost of only these six conditions gives a total annual price tag of over $1 trillion. Yes, some of these conditions may have some overlap, such as obesity and diabetes; however, this overall estimate excludes various other preventable costs. Including, but not limited to, worksite injury, osteoarthritis, and joint replacements.

     These figures should highlight the importance of incorporating a preventative lifestyle in order to reduce the financial burden. A number of things need to occur in order for change to happen. Individuals need to be educated more on the importance of nutrition, physical activity, balance, coordination, and proper body mechanics. Insurance companies need to expand reimbursements for preventative treatments, especially for programs that can be run by licensed physical therapists. But most importantly, individuals need to realize that insurance will not always pay for necessary professional care. 

- Patrick Berner, SPT

1. Bureau of Labor Statistics. CPI Inflation Calculator. Databases, Tables & Calculators by Subject. http://www.bls.gov/data/inflation_calculator.htm. Published January 16, 2015. Accessed January 28, 2015.

2.  American Heart Association. Heart Disease and Stroke Statistics—2014 Update. AHA Statistical Update. http://circ.ahajournals.org/content/early/ 2013/12/18/01.cir.0000441139.02102.80.full.pdf. Accessed January 27, 2015.

3. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36(4):1033-46.

4. National Cancer Institute. Cancer Prevalence and Cost of Care Projections. http://costprojections.cancer.gov/. Published January 2011. Accessed January 27, 2015.

5. Tucker DMD, Palmer AJ, Valentine WJ, Roze S, Ray JA. Counting the costs of overweight and obesity: Modeling clinical and cost outcomes. Curr Med Res Opin. 2006;22(3):575-86.

6. Davis JC, Robertson MC, Ashe MC, Liu-ambrose T, Khan KM, Marra CA. International comparison of cost of falls in older adults living in the community: A systematic review. Osteoporosis Int. 2010;21(8):1295-306.

7. Crow WT, Willis DR. Estimating Cost of Care for Patients With Acute Low Back Pain: A Retrospective Review of Patient Records. J Am Osteopath Assoc. 2009;109(4):229-233.