Tuesday, February 26, 2013

Reducing Your Risk For Type 2 Diabetes



Reducing Your Risk For Type 2 Diabetes

As our waistlines expand (the number of obese Americans has now reached more than 35%), many people are facing a higher risk of such diseases as heart disease, stroke and cancer, as well as type 2 diabetes. With the CDC reporting that more than 25 million Americans are now diabetic, and that the risk for developing diabetes is expanding across all ethnicities and age groups, it is imperative that more of us consider how to reduce our chances of developing type 2 diabetes because of obesity.

Although there is a genetic predisposition to the disease, its leading causes are often poor lifestyle choices: lack of exercise and an unhealthy diet, which can lead to being obese. Even if you have hereditary risk factors for developing type 2 diabetes, the American Diabetes Association lists several ways to reduce your chances of becoming diabetic.

Increase your physical activity.
Physical activity is imperative for your health. It keeps your heart and lungs strong, reduces stress (and weight) and improves your mood. It also reduces many of the risk factors associated with type 2 diabetes, like being overweight and having high blood pressure. If you’re trying to increase your activity levels, the ADA notes there are several things that you can do.

Move around more throughout the day. Little things can go a long way. Take the stairs instead of the elevator. Park at the far end of the lot when you run errands or go to the office. Use your break to walk a lap or two around your office building. Essentially, try to sit less; recent studies show that too much sitting can double your risk for type 2 diabetes.
Aerobic exercise. While this can be achieved by taking an aerobics or cardio class at the gym, just taking a brisk walk or bike ride can do the trick.

Strength training. Strength or resistance training has also been shown to help reduce blood glucose levels; some studies have shown that it’s even more effective than aerobic exercise. That said, many experts advise using a combination of aerobic exercise and strength training to improve health and reduce your risk of diabetes.

Flexibility and stretching. Keeping your muscles loose and flexible reduces your chance of injury, whether you’re exercising or simply moving around the house. If committing to classes like yoga or Pilates is too much, think about adding in a short stretching program before heading out for a walk.

Maintain a healthy weight.
Being overweight increases your chances of developing type 2 diabetes. If you make changes to your diet and physical activity, you may see your weight go down (and even 10-15 pounds can make a big difference in your risk). If you don’t see such positive changes, or you’re concerned that the loss isn’t enough, talk to your doctor and your physical therapist about what else you can do, and what a reasonable weight goal would be for you.

Eat healthier.
The ADA says that “eating well to maintain a healthy weight is one of the most important things you can do to lower your risk for type 2 diabetes and heart disease.” Here are some of their experts’ tips on how to improve your eating habits.

Plan smart. Make out your shopping list before going to the grocery store; it’s much easier to use willpower to avoid buying unhealthy food than it is to not eat it once it’s in the house. When thinking about what to buy, consider lean meats and fresh fruit and vegetables. If you’re not sure how much you should plan per person in your home, use the tools available at the Choose My Plate website created by the USDA. And be sure to add healthy snacks like fruit or nuts to your list; those in-between munchies (like potato chips or candy bars) can often ruin a good diet at regular meals.

Shop smart. Stock your larder with healthy basics like brown rice and whole-grain pasta, and when you run out of them, add them to your grocery list. At the store, avoid those aisles with the high-sugar, low-nutrition foods like candy and cookies in order to avoid their temptation. And try to shop when you’re not hungry; we’ve all gone to the store when we’re ravenous and ended up with things we didn’t need in the cart. (This is also why they recommend sticking to your grocery list.)

Eat smart. If you’ve bought canned vegetables, rinse them with water before cooking to reduce their sodium content. Start meals off with a salad or vegetable soup to increase your veggie intake and reduce your appetite for the (higher calorie) main course. And when you’re eating out, try to pick grilled meats rather than fried, and skip the fries for steamed vegetables.

Know your blood glucose level.
Increased blood glucose is a key indicator of type 2 diabetes. Here’s how the ADA explains its importance:

When you eat, your body breaks food down into glucose (sugar) and sends it into the bloodstream. Insulin, a hormone made by the pancreas, helps move the glucose from the blood into the cells to be used for energy. Your body usually makes just the right amount of insulin to match the food you eat.

When the cells no longer respond well to insulin, they are “insulin resistant” and glucose can’t get into the cells. So the cells don’t get the fuel they need, and glucose builds up in the blood stream. This is called high blood glucose. Untreated, high blood glucose causes problems such as nerve damage, kidney or eye problems, heart disease, and stroke.

Talk to your doctor about your glucose levels and whether they point to a risk of pre-diabetes or type 2 diabetes.

Know your cholesterol number.
Having high cholesterol can increase your chances of both type 2 diabetes and heart disease, and both can be life-threatening. If it is high, you may be able to lower it simply by eating a low-fat diet and monounsaturated fats, like olive or canola oil; others may need help with medication. Speak to your doctor about what cholesterol range is right for you, and how best to achieve it.

Know your blood pressure.
High blood pressure puts stress on your heart and on your entire body, and is another risk factor for type 2 diabetes. While increasing physical activity can help to lower it, speak to your doctor about your blood pressure and what you can do to maintain a healthy level.


The simple take-away? Eat healthy. Exercise more. It can be daunting to start new habits, but they will definitely increase your health. Look through the American Diabetes Association’s site for more tips on how to improve your habits and decrease your chances for type 2 diabetes.

Wednesday, February 20, 2013

Couch Potato Children – Tips to Get Them to be Physically and Mentally Active


Couch Potato Children – Tips to Get Them to be Physically and Mentally Active
By: Bobbi Michels, PT, Kid’s Place

It’s a Saturday morning, and already we can hear the kids:

“Mom, it’s my turn to play on the computer!”

           “Can I watch T.V?”

                     “No, I want to play an X-box game!”

Oh boy! How many of you hear the same from your children?

Staying active with older children is a challenging, but vital tool to maintaining a healthy lifestyle, not to mention fun! The question is - how I can stay active and avoid another electronic, couch-potato filled weekend?

First, let’s discuss the negative impact of a couch-potato filled weekend.

According to the Arizona Department of Health Services, “the lifestyle changes that accompany the current advances in technology have equated to more screen time, less physical activity and more fast food1.” The unfortunate reality of this situation is that diabetes is on the rise. In the last ten years, the number of adults diagnosed with Type 2 diabetes has more than doubled. The report goes on to explain “diabetes is inextricably tied to obesity and inactivity and this ongoing problem is becoming a public health crisis of epidemic proportion. Nearly 1.2 million people in Arizona are obese, 477,649 more people than 10 years ago. Arizona is tenth in the nation for obesity.”

So back to the question – “how I can stay active and avoid another electronic, couch-potato filled weekend?” The answer: fun, fitness activities that challenge our children physically and mentally.

There are three basic elements to fitness: endurance, strength and flexibility. It is important to incorporate these into your activities. Currently the Center for Disease Control (CDC) recommends 60 minutes per day of exercise for school aged children.

Here are several great reasons to encourage children to exercise:
  1. Children who exercise have leaner body composition, less fat and are less prone to becoming overweight or obese. Those who are already overweight can lose those excess pounds through exercise3.
  2. Exercise increases bone density, which keeps bones strong and resilient.
  3. Children who exercise regularly are less likely to develop diseases or chronic illness such as diabetes, allergies, heart and respiratory issues. 
  4. Exercise is also linked to a decrease in mental issues like depression, anxiety, and attention deficit disorders.
  5. Exercise will improve blood flow, aiding in overall growth and oxygenation of muscles.
  6. Exercise stimulates new neuron growth in the brain resulting in increased cognition, focus and rapid reaction times.
  7. Children who exercise often sleep better, enabling them to handle daily challenges that come their way.
Thankfully, Arizona offers several indoor and outdoor activities that will challenge our children’s physical and mental abilities. So go crazy! Try new things like hiking, horseback riding, or a fitness class. Play traditional games like volleyball, basketball, flag football and soccer. Expand the “fun” in exercising trying activities like paintball, Frisbee golf, and trampoline jumping. Or just hit a bucket of golf balls at your local driving range. Rock climbing gyms where everyone can participate can encourage a little fun family competition. In the summer enjoy a cool trip to Polar Ice for open skating. You will be glad to get back outside to the heat!
 
As a family, we have enjoyed many outings to encourage our children to get up and moving while building special family memories. Most recently, we completed the IMS Arizona Marathon 5k. Below are some more ideas of places you can take your children to encourage fitness and activity. These are just some examples. I’d love to hear some of your ideas. Leave me a comment below and tell us where you go or want to go to get your kids outside and moving.
  • Hit a bucket of golf balls at Valley Golf Center
    • (623) 935-9351
    • 12247 West Indian School Road, Avondale
  • Go on a  Arizona Horseriding Adventures or Old West Party Adventure
    • (623) 640-3814
    • 14629 W. Peoria Avenue, Waddell
  • Explore the desert on horseback with  White Tanks Riding Stables
    • (623) 935-7455 - 20300 W Olive Ave, Litchfield Park, AZ
    • (623) 640-3814 - 14629 W Peoria Ave, Waddell, AZ
  • Roller around at Skate Zone
    • (623)925-0179
    • 13550 W. Van Buren Street, Goodyear
  • Everybody loves to bowl - Brunswick Tri City Bowl
    • (623) 932-3388
    • 1425 N Central Ave, Avondale
  • Try some intense fitness at CrossFit Fury
    • (623) 932-4338
    • 540 N Bullard Ave #15, Goodyear
  • Kids versus adults at Tempe Paintball
    • (480) 966-1900
    • 1401 S. McClintock Dr.,
Tempe
  • Bounce around at  Jump Street
    • (602) 889-0081
    • 5665 West Bell Road
, Glendale
  • Climb together at  Phoenix Rock Gym
    • (480) 921-8322
    • 1353 E. University Dr., Tempe
  • Another kids versus adults, without the paint - Stratum Laser Tag
    • (480) 545-5500
    • 1455 S. Stapley Drive, # 11, 
Mesa
  • Cool down indoors at Polar Ice Peoria
    • (623) 486-0386
    • 15829 N 83rd Ave, Peoria
  • Skate, bike, play basketball, or walk around at Dust Devil Park
    • 107th & Camelback
What are you waiting for? Get up and go have major fun exercising and staying healthy as a family!!

  1. Arizona - Number (in Thousands) of Adults(aged 18 years or older) with Diagnosed Diabetes, By Age, 1994 - 2010 http://apps.nccd.cdc.gov/DDTSTRS/Index.aspx?stateId=4&state=Arizona&cat=prevalence&Data=data&view=TOPA&trend=prevalence&id=1

Wednesday, February 13, 2013

Everyday People: Rehabbing Major Knee Injuries with AZOPT

Everyday People: Rehabbing Major Knee Injuries with AZOPT

Minnesota Vikings running back Adrian Peterson. Chicago Bulls point guard Derrick Rose. Washington Redskins quarterback RG3. Most recently, snowboarder Lindsey Vonn. What do these professional athletes have in common? They have all had surgery to repair a torn ACL. If you are a sports fan, you will read about an athlete tearing their ACL almost too frequently. Not to downplay this horrific injury, but ACL injuries have become so commonplace, that we expect an athlete to recover quickly from ACL surgery, and in some cases, perform even better. Just look at what Adrian Peterson accomplished this season in Minnesota, winning the NFL’s MVP award. Athletes are privy to top doctors, top physical therapists, and top rehabilitation equipment, right?
 
But what happens when a young, otherwise healthy, person tears his ACL? Can they expect the same doctors, same level of physical therapy, and ultimately, the same return to normal activity? To answer these questions, we will examine Arizona Orthopedic Physical Therapy’s patient Josh H., who is in the mist of rehabbing his left knee after surgery from suffering a grade 3 tear of his ACL and MCL, along with torn meniscus and bone bruising.
 
On November 7, 2012, Josh was enjoying a Judo class with his son. While practicing with another adult, their legs became entangled, and the sparring partner fell onto Josh’s fully extended left knee. It was one of those fluke injuries that could happen during any activity. Josh knew it was bad right away. He heard a loud, audible snap that sounded like celery when you break it in half. His leg felt like a peg, there was total instability. Josh immediately called his primary care physician, who referred him to an orthopedic surgeon. There, Josh was given a physical exam and an MRI, which revealed the tears.
 
A ligament is a tough band of fibrous tissue connecting two bones. The ACL (anterior cruciate ligament) and PCL (posterior cruciate ligament) are inside the knee joint connecting the femur (thigh bone) to the tibia (large bone of the lower leg). The ACL and PCL form an “X” inside the knee that stabilizes the knee against front-to-back and back-to-front forces.
 
ACL injuries are sprains, in which the ligament is torn or stretched beyond its normal range. Almost always, when the ACL is torn, it’s due to a sudden stop, twist, pivot or change in direction at the knee joint (like a running back, point guard, or skier), extreme hypertension of the knee (like Josh’s injury or a gymnast landing a vault), or through direct contact to the outside of the knee or lower leg. A grade III ACL injury is the most severe form of injury in which the ACL is completely torn through and the knee feels very unstable.
 
According to Health A-Z, a Harvard Health Publication, “most ACL injuries are severe Grade IIIs, with only 10% to 28% being either Grade I or Grade II. Currently, between 100,000 and 250,000 ACL injuries occur each year in the United States, affecting approximately one out of every 3,000 Americans. Although most of these injuries are related to athletic activities, especially contact sports, about 75% occur without any direct contact with another player.”
 
Prior to this injury, Josh was a generally active person. As a 35 year old, Josh participated in CrossFit 3 or 4 times per week, and also enjoyed Judo, bike riding, and golf. He had intended to participate in the Toughmudder run this February. This father of 3 was not prepared for the substantial change in lifestyle caused by this injury – not being able to carry his kids or even tie his shoes. Initially, Josh felt a sense of loss from doing the activities he once enjoyed, but his faith (Josh is a Pastor) guided him through this difficult period.
 
Immediately following the injury, Josh was placed on crutches and told to rest and heal, allowing the swelling to go down in the knee. This is common practice in Grade III tears known as RICE - Rest the joint, Ice to reduce swelling, Compress the swelling with an elastic bandage, and Elevate the injured area. Josh followed this regimen through the month of November.
 
Once the swelling and pain subsided, Josh began seeing AZOPT’s Ryann Roberts, DPT, on December 5, 2012. Throughout the next few weeks, Josh and Ryann worked on basic strength, flexibility, and range of motion. Physical therapy consisted of range of motion stretching, hamstring stretching, quadriceps strengthening, balance training and knee stability training – all with the purpose of preparing for surgery and the rehabilitation that will follow. In three weeks, Josh met all of his pre-surgery goals.
 
Post Surgical Photograph of Josh's Knee
The next step in Josh’s recovery was surgery. On January 14, 2013, Josh underwent a surgical procedure known as auto graft to repair the torn ACL. Dr. Douglas Hartzler performed the surgery, in which he uses a section of tendon taken from Josh’s hamstring to replace the torn ACL. Dr. Hartzler also shaved down the torn meniscus. The MCL healed on its own during Josh’s pre-surgical physical therapy. Currently, almost all knee reconstructions are done using arthroscopic surgery, which uses smaller incisions and causes less scarring than traditional open surgery of the past that left large scars.
 
As Josh said, “after surgery is when the real work comes in play.”
 
Two weeks after surgery, January 23, Josh was back at AZOPT with Ryann to begin the long and tedious process of rehabbing the knee allowing Josh to get back to regular life and exercise, but more importantly, reducing the risk of reinjuring the knee or injuring the other knee. At the time, Josh was icing the knee and resting. Dr. Hartsler had given the green light for easy isometric exercises with the goal of returning to light jogging in three weeks.
 
To track progress, Ryann recording these initial measurements:
 
Active Knee Flexion – 85° (normal is 120-125°)
 
Passive Knee Flexion – 98° (normal is 130-135°)
 
Passive Knee Extension: -6° from full extension

Inability to maintain full knee extension during straight leg raise
Girth measurements (circumference of knee):
  • Mid patellar - R: 39.1 cm L: 44 cm

  • 5 cm below patella - R: 35.7 cm L: 40.8 cm

  • 5 cm above patella - R: 44.9 cm L: 46 cm
 
In his first physical therapy session with Ryann after surgery, Josh received manual therapy on a table to increase his range of motion. The plan was to begin no resistance bike pedaling at the next session if his range of motion allowed. Josh was instructed to continue using ice at home and to elevate his leg for several hours each day.
 
In the short term, 2 to 6 weeks, Josh will look to improve his range of motion to within normal limits. The goal over the next 12 weeks is for Josh to be able to walk with some light jogging while reducing the swelling by 90% and returning to light fitness activity. At physical therapy, Ryann will supervise therapeutic exercises geared to correct specific strength deficits. Ryann will also administer manual therapy including joint mobilizations and soft tissue treatments. Josh will have physical therapy two or three times each week for the next 12 weeks.
 
Josh has reasonable expectations for his recovery. He understands that each individual is on a continuum and heals differently. While there is not a general timeline for recovery, Josh fully expects to get back into all the activities he loves – CrossFit, bike riding, golf, etc. – except Judo. Josh is finished with Judo. When asked what kind of advice he would give someone in his situation, Josh said “be pragmatic. It may take a while to rehab – a month, 8 weeks, sometimes longer – to significantly heal, so be patient. And remember, suffering is good for us, it perfects our character, teaches us how to be useful and content, and helps us remember to be thankful for what we do have.”
 
We will check back on Josh in March to report his progress. In the meantime, let us know what questions you have about your injuries or rehab process. The team at AZOPT is available to answer your general or specific questions. You can ask your questions in the comments section below, or live tweet with a therapist @AZOPTTherapy.

Wednesday, February 6, 2013

Concerned about Your Child’s Handwriting? Try These Helpful Tips



Concerned about Your Child’s Handwriting?  Try These Helpful Tips
By: Josh MacDonald, OTR/L


www.SharonsCreativeCorner.com
Increasing expectations in pre-school and kindergarten can mean children are learning to write much earlier than before.  This has the potential to create multiple issues with your child’s handwriting.  Gripping the pencil tightly, wrapping the thumb completely around the pencil, the hand becoming tired out easily, or letters appearing choppy without any smooth lines can all indicate your child has fine-motor coordination delay or weakness.

'Fine motor' refers to the development of small muscle movements of the hands which develop as your child's whole body gains mobility, stability, cognitive, and emotional/social development.   Unfortunately, the hands of 3 to 5 year old kids are often not developed enough to manage the accurate fine motor requirements of handwriting without specific warm-up and training.  The in-hand manipulation skills required to make the small, smooth circles and straight lines are often more challenging than many kids are ready for at this stage.  Nevertheless, schools have increased writing in the curriculum resulting in many kids who are struggling to keep pace.

There are solutions that can be effective for many of these kids.  If the challenges are minimal and the child is motivated, some of the following suggestions may bridge the gap and improve their performance:

Play with Play-Doh!
    Improving overall hand strength, including the smaller muscles in the hand, will help prevent fatigue and increase muscular endurance.  Have your child play with Play-Doh or 3 to 4 containers of silly putty at the same time.  Making large and small balls, rolling out snakes, and using tools to ‘work’ the Play-Doh will all help strengthen the hands.
Count Your Pennies
    Coordination of the fingers plays a big part in handwriting.  The ability to manipulate objects with coordination and accuracy will greatly improve the accuracy of letter formation.  Try playing with pennies and nickels, picking them up from the table and transferring them from the palm to the finger within the hand.  Using a small coin bank with a slim slot will encourage the use of finger tips for accuracy of placement.
Arts and Crafts
    Cutting small items, beading or working to glue small items will all help to develop awareness and coordination of the hands and fingers.  Whether it is cutting out shapes from paper plates, or coloring in small spaces, craft time is a great way to help kids with hand skills.
Tools Make a Difference
    Minor equipment changes can also help with handwriting.  Using crayons broken into 3 smaller pieces or very small pencils prevents ‘over gripping,’ and will encourage use of fingertips and result in more accuracy.  You can also try one of the many different pencil grips available on the market.  There is no one magical grip that works for everyone.  Try several of them and stick with one of it makes a noticeable difference.  You don’t want your child becoming dependent on this grip, so limit it to either only homework time, or only school time.
Each of these is offered as suggestions and may not, independently solve the problem.  Your child may need more involved help.  If this is the case, occupational therapy may be necessary.

If you are concerned with the overall development of your child, contact Kid’s Place for a Complimentary Developmental Assessment.  Our complimentary developmental assessment is a 15 - 30 minute exam performed by a licensed physical, occupational, or speech therapist to assess developmental concerns with respect to gross motor, fine motor, or speech.  Based on these results, our therapists will make recommendations for your next steps, which may include following up with a medical doctor.  Additionally, you may be shown simple exercises for the home to improve physical development.  

To schedule a Complimentary Injury and Performance Screen or for more information, simply call (623) 229-7808.  Appointments are required.