Common Misconceptions About Physical Therapy

Common Misconceptions About Physical Therapy

By: Brooke Smith, DPT

There are many common misconceptions about what physical therapy entails.  Let’s discuss a few common misconceptions and explain how physical therapy can help you get back to the activities you love, without pain!

Myth: Physical therapy is the same as receiving a massage

While physical therapy utilizes soft tissue mobilization similar to massage, the main difference is physical therapists are more target specific with their techniques.  With soft tissue mobilization, physical therapists look for muscles that are tender to the touch, which means the muscle is in some dysfunction.  Therefore, to decrease the tenderness, more pressure is applied to release muscle tension and decrease tenderness by releasing scar tissue and increasing blood flow to the area.  Soft tissue mobilization usually includes some discomfort.  These techniques are not used on every patient and are injury specific.

Myth: Physical therapy is only for athletes or people who had surgery

Physical therapy is useful in treating a large variety of pain and injuries from simple strains/sprains to post operative care.  We also treat a large range of the population from pediatric conditions to elderly with a wide range of activity levels.   Physical therapy can be helpful to people injured in car accidents, weekend warriors (recreational sport players), pregnant women, seniors, teens, elderly, post-operative, and job related injuries.  Physical therapists are also trained to detect symptoms that might require a referral to another health care professional to help treat any underlying issues that might be causing the symptoms.

Myth: Physical therapists will only use passive therapy and exercise for my problems

Some of the passive techniques people commonly think of are ice, heat, ultrasound, and electrical stimulation.  While these techniques are utilized, they are used in conjunction with manual techniques and specific exercises to help assist in the healing process.  Yes, physical therapy does include exercise, but we use specific exercises to strengthen and stabilize areas of weakness that might be the underlying cause of your symptoms. 

Myth: Physical therapy will be painful

It is possible to experience temporary soreness from manual techniques or exercises.  However, these effects should not last more than 24 hours and the end result is usually relief of your initial symptoms/pain.  Physical therapists use specific techniques and exercises to assist the body by aiding with the normal healing process and help it rebuild to function normally.  Physical therapy is safe and the soreness/discomfort will be minor and temporary with the goal of decreasing your symptoms.

I hope after reading this article you have a better understanding of physical therapy.  If pain is limiting your daily activities, please contact AZOPT at (623) 242-6908 to schedule your evaluation. 

Tips For Proper Work Station Ergonomics

Tips For Proper Work Station Ergonomics

By Doug Lehman, PT

If you have a job that requires primarily a seated position, poor posture can easily contribute to back, shoulder, and neck pain.  Spending lots of time on the computer in any setting can also be a problem if you are not using the correct posture. The good news is that there are a number of helpful tips that can improve your work station ergonomics and help decrease your symptoms of pain. 

Ergonomics are design factors, for the workplace, intended to maximize productivity by minimizing your fatigue and discomfort.  Some companies have an ergonomics department which will assess your work station and order any necessary equipment.  If your company does not have this department, here are some examples of what can be done to best prevent pain:

First of all, your feet should be flat on the floor.  If your chair needs to sit high to reach your work station, you still need somewhere to support your feet.  When buying a new stool is not an option, an old phone book usually works just as well.

Your hips and knees should rest at approximately a 90 degree angle.  As a general rule, your knees should be level with your hips, or slightly below, when seated.

Your elbows should be bent to 90 degrees when working on a keyboard.  You should not have to reach up or down to get to your keyboard.  Your shoulders should be relaxed and not elevated.  Your wrists should not be bent up or down while working.  A wrist support for the keyboard and mouse are useful.

Your chair should have good support for your low back, so be sure to use it!  Sitting on the front edge of the chair for an extended period of time does NOT allow for good back support.  If you do not have good support on your chair, a lumbar roll should be used.  A small pillow or rolled up towel can be just as effective as a professional lumbar roll. 

Remember to change positions often to allow your muscles to work and rest.  Changing positions allows for better posture and blood flow to your tissues.

And finally, your monitor should be at eye level.  An old phone book can again be used to help raise a monitor to the proper level.

With these tips, you are capable of completing an ergonomic assessment to your own work station.  Spending the time now can help reduce current pain or prevent future problems!  If you are experiencing back, shoulder, or neck pain, call us at 623-242-6908 to schedule an evaluation.

Incorporating Proper Body Mechanics

Incorporating Proper Body Mechanics

By Pamela Guevarra,PT, DPT

Often times, patients will ask me if the combination of physical therapy and exercise will be enough to heal their neck or back problems.  Don’t get me wrong, treatment by a physical therapist and a specialized home exercise program contribute heavily and play a significant role in achieving your treatment goals.  But is it enough?  Not entirely.  So then the question becomes, what more will help you achieve your goals and avoid future recurrences?  The answer is proper body mechanics.

Proper body mechanics are certain positions of everyday activities that keep your spine and body properly aligned.  This ultimately prevents symptoms like pain and stiffness in the spine. These positions are further recommended for people without back problems to help prevent stress on the spine, to help conserve energy, and keep you safe.

Our joints do not like staying in stretched positions for elongated periods of time.  For example, think about a time when you felt pain or discomfort in your neck after painting the ceiling.  Or a time when you awoke with stiffness in your neck or back after sleeping on your stomach with your head fully rotated to one position throughout the night.  Maybe your neck started getting tired after sitting at your computer with the neck and trunk flexed.  All of these examples, and others, will cause stress on your spine, which leads to pain and potentially degenerative joint disease.

So let’s talk about ways in which you can help achieve proper body mechanics in your everyday life.  There are sometimes multiple ways of doing certain activities.  Choose the best option for you.  If these options do not work with for you, consult your physical therapist for other options.

Sleeping.

Things to check:

·         Your bed should be firm and not sag.

·         Your pillow should not be too big that your head is bent forward or too small that your head is extended backward.  Thus, you head and neck should align with the spine.

·         While sleeping, the pillow should only support your head and neck and not your upper back.

·         Try to avoid sleeping on your stomach with your head fully rotated to one side.

·         Instead sleep on your side or back or ¾ stomach using a body pillow.

·         It may take some restless nights of sleep to get used to sleeping on your back or side.

Image Courtesy of WebMD

To sleep on your side:

·         Place 1 or 2 pillows between your legs in such a way that the top leg is supported to prevent it from pulling the spine in rotation; OR

·         Sleep on your side with a small rolled towel under the waist to prevent sagging of the spine on the waist area.

To sleep on your back

·         This is the safest method if you have night pain.

·         Place a pillow under your knees placing the low back in a neutral position; OR

·         Place a small rolled towel under your lower back helping it maintain its curve.

Sitting

Things to remember:

·         For long periods of sitting, try to stand up at least once an hour to relieve your spine.

·         Ensure that when seated, your hips are higher than your knees.

·         In most cars, the driver’s sit with their knees higher than the lower back, which causes a lot of stress on your spine, especially during long drives for people with neck or lower back problems. 

Here are some tips to assist your seated posture:

·         Fold a pillow lengthwise or roll a large towel and place it on the back half of the seat so when you sit on the chair, your hips are higher than your knees. This places your pelvis in a neutral position which in turn helps correct your posture.

·         If it is not possible to place a rolled towel or a folded pillow on the seat, sit astride a chair and place feet under the chair. An alternative if you need to study or have to work over a desk is to sit at the edge of the chair and then bend your knees and put your feet under the chair.

Standing

Things to remember:

·         Avoid standing in one position for a long time. It relieves the stress not only on your spine, but it also helps with the circulation on your legs.

Prolonged Standing

What to do:

·         For prolonged standing, place your foot up on a stool and alternate your legs if possible.

·         In front of your sink, you can open the bottom cabinet and place your foot in there.

Lifting and carrying

Things to remember:

·         Check the distance to transfer the object so you can plan accordingly.

·         Assess the weight of the object so you can decide if you need to use 1 or 2 arms/hands to lift an object or if you need assistance.

·       Remember to widen your base of support by separating your legs, making sure you bend at your hips, not your trunk.

·         Objects should be as close to your body as possible.

For Lifting Smaller Objects

There are two ways to lift an object:

·    When picking up small objects from the floor or lower areas, remember the golfer’s lift: place one foot in front of the other, while holding on to something for balance and support, and kick the back leg up while reaching.  This will keep the spine in a neutral position.

·         To pick up a heavy item, squat, placing yourself close to the item, keeping your back straight and lift with your legs.  Do not lift and twist your body in a bent position.  If possible, stagger your stance - positioning one foot in front of the other before you lift - so you can easily take your first step.

Household Chores

Vacuum and mopping

·         Walk with the vacuum or mop, keeping them close to your body to avoid reaching and protect your back.

Cleaning high areas

·         When cleaning something high like a tall window or trying to retrieve an item from a high shelf, avoid reaching up.  Find and use a step stool to raise yourself high and be safe.

Practice and repetition are keys to incorporating proper body mechanics into everyday home and work activities.  The mix of treatment by a physical therapist, a specialized home exercise program by your physical therapist, and proper body mechanics will help you achieve your goals in physical therapy.  While the treatment and exercises will work to improve your flexibility, range of motion and strength, proper body mechanics will make all of this easier. 

As always, consult a licensed physical therapist at AZOPT if you begin to have problems with your neck or back.  We will help you with the appropriate body mechanics that you will need in your everyday and work activities based on your specific condition.

Enjoy Halloween Candy with a Challenge

Enjoy Halloween Candy with a Challenge

By the Kids Place Pediatric Speech Therapists

What’s a parent to do when your child has a three-pound bag of candy after trick-or-treating?  While some families allow candy consumption in moderation, here are some other ideas for limiting your child’s candy intake:

1. Agree in advance on a set number of candies your child will be able to choose from their bag/bucket
2. For older children, agree on a percentage of their total number of candies
3. Agree on special activities/items for which your child may “trade-in” their candy (books, videos, games, etc.)
4. Use candy for arts and crafts

For the candies your children do eat, consider the following ideas to help develop speech and language skills:

1. Use words to describe the qualities of your candy (sweet, sour, crunchy, soft, sticky)
2. Have your child imitate oral-motor movements while enjoying their candy (For example, holding a lollipop, have your child protrude tongue forward then to the right/left to touch it. You can also practice holding the lollipop with lips only)
3. Encourage longer sentences by offering your child choices of candy that differ only by one quality (“Do you want the big square chocolate or the small square chocolate?”)
4. For nonverbal children, model signs for “eat,” “more” or “candy” and encourage imitation before reinforcing.
5. Have your child follow directions incorporating the candy (“First, get the red one, then, get the blue one”).

It is especially important to be aware of choking risks.  According to the Center for Disease Control and Prevention, 15% of choking episodes in children under 14 are caused by hard candy.  An additional 12.8% is caused by other candies.  This amounts to nearly 30% of choking incidents from candy.

Halloween foods that have the highest choking risk include:

• Gum
• Peanuts
• Hard candies
• Jelly beans
• Gum drops
• Gummy bears
• Licorice
• Fruit snacks
• Raisins
• Pumpkin seeds
• Popcorn 
• Caramel
• Candy corn
• Taffy
• Marshmallows

Lastly, be cautious of non-food items that have a high potential risk for choking.  Especially small toys or balls/marbles which a diameter of less than 1 and 1/3 inches.

This Halloween, allow your children to enjoy some of the candies from trick-or-treating, but challenge them to do more than just simply eating the candies! 

Happy Halloween!

The Halloween Conundrum – What to do with Extra Candy

The Halloween Conundrum – What to do with Extra Candy

By the Kids Place Pediatric Occupational Therapists

Many parents struggle with what to do with all the leftover candy their kids have from trick-or-treating.  Candy can be used in many fun activities that do not involve actually eating it, but rather promote the development of fine motor skills, visual processing skills, cognitive processing skills, and sensory development. 

First, try sorting the candy by color, size, shape, first letter of the name, the type of candy, or any other way you prefer.  To improve your child’s fine motor skills, encourage the kids to use only their index finger and thumb or only the index and middle finger with the thu

mb.  Sorting this way will help children develop isolated finger movements necessary while using writing utensils.  Also, by using the index and middle finger with the thumb, you are promoting the correct positioning your child should use writing with their pencil. 

Furthermore, you can have your children sort their candies using clothespins.  With the index finger and thumb, or index and middle fingers with their thumb, children can pinch the clothespin to grip and move the candies.  The resistance of the clothespin will help strengthen your kids’ fingers and improve their endurance during writing tasks.  Tweezers and chopsticks are other tools that encourage isolated finger movements.

Secondly, making crafts with candy can also be a fun way to use the extra.  You can draw pictures and have your kids glue candies on the lines.  You can also have your children draw their own picture and explain what each candy represents at the conclusion.  Candies, such as lifesavers, can be strung to make bracelets or necklaces.  This activity promotes bilateral integration, or using two hands together.  If a candy does not have a hole, your child can use a toothpick to push through the candy, also helping to strengthen the fingers. 

Additionally, candy can be used to create a gingerbread house.  You can either freeze the extra candy until it is closer to Christmas time, or make a Halloween/Fall themed house.  Using frosting as the glue, place the candies on graham cracker walls for decorations.

Extra candy can also be used for finger painting.  Place one color of hard-shelled candy (Skittles, M&M’s, etc.) in a class of water and watch the coating dissolve and become colored water.  Children can then dip their fingers in the water and “paint” paper towels.  For more concentrated colors, use just enough water to cover the candies.  

These crafts are fun for all ages, but they are especially beneficial if your child has difficulties with messy play (does not like to get food on their fingers, does not like to play in sand boxes, or does not like to play with finger paints, etc.).  Your child will most likely get frosting on themselves in small amounts while placing the candy, and will need to dip their fingers in water to get color on them.  These experiences will provide them with tactile input (or feeling it on their skin).  Working with small amounts of tactile input and increasing it over time can help your child become less hesitant towards messy play. 

We hope some of these suggestions will help your family enjoy Halloween candy in new ways that promote positive development in your child.

Happy Halloween!

Halloween Themed Outdoor Activities for Children

Halloween Themed Outdoor Activities for Children

By the Kids Place Pediatric Physical Therapists

As snow and cold weather sweeps through many parts of the country, this time of year is a perfect reminder to why we live in Arizona.  The beautiful weather outdoors plays host to many possibilities of games and activities.  In the spirit of Halloween, we want to introduce you to some themed games that are sure to be fun for your children, but also beneficial to their development.

Spider Web Maze

With a piece of chalk, draw a large spider web on the ground.  Using paper, plastic, or extra candy, place the “spiders” along the lines of the web.  Have your child walk the lines of the spider web, keeping both feet on the line, and count how many “spiders” they can grab in one minute without stepping off the lines.  This game is beneficial in that it improves coordination and balance.

Candy Grab

Dump a bucket of candy on the floor.  Using only their toes, see how quickly your child can pick up the candy and place it in a bucket.  This will work your child’s ankle strength and balance.

Candy Hopscotch

Draw hopscotch on the ground.  Throw the candy on the ground to skip that step.  All you will need is chalk and your Halloween candy.  This game will benefit your child’s jumping, coordination, and balance.

Spider Web Catch

This game can be enjoyed both indoors and outdoors.  Using painter’s tape, build a spider web in an open hallway or tree.  Crumble up some newspaper into various sized balls, and count how many your child can throw and stick in the spider web.  Throwing is a gross motor task that can be improved with items typically found in your house!

This Halloween, we are challenging families to use their candies in ways other than eating.  There are many additional games and activities that can be played for Halloween or any time of the year.  These ideas do not have to involve a lot of equipment or work.  The most important thing is to get up and play outdoors with your children.  Performing these activities with your children provides the proper foundation to encourage consistent exercise and activity!

We would like to hear from you.  What types of outdoor activities do you play with your children during Halloween?

Celebrate National Physical Therapy Month with Activity

Celebrate National Physical Therapy Month with Activity

By Erik Bassett, DPT
AZOPT Physical Therapist

This October, we celebrate National Physical Therapy Month (NPTM)!  NPTM is an awareness celebration held each October by the American Physical Therapy Association (APTA) to recognize the important roles physical therapists play in restoring and improving motion in people’s lives.  Nobody understands this more than the “Active Adult” community.  Also known as Baby Boomers, the active adult community is one of the largest and most powerful generations in the United States. They have redefined aging and are more educated, wealthy, and tech savvy than their parents or any generation preceding them.

However, a Harvard study has found that too many boomers are overweight or obese, increasing the risk for chronic health conditions such as heart disease, type 2 diabetes, and certain cancers.  Further, as we age we may lose flexibility, strength, and balance, which makes staying fit after 50 challenging for even the most determined baby boomers.

Working with a physical therapist can help boomers address these challenges, maintain fitness, and avoid injury – in many cases without expensive surgery or long-term use of prescription medications.  Physical therapy is no longer simply just about rehabilitation.  Physical therapists can help restore and improve motion to achieve long-term quality of life.  Physical therapists significantly improve mobility, and ability to perform daily activities. 

Physical activity may be the closest thing we have to the ‘fountain of youth.’  Yet it’s a fact of life that health and mobility concerns often arise as we grow older. The good news is that we can keep many of these concerns at bay through regular physical activity.

Being active plays a crucial role in improving and preserving health and quality of life.  Regular physical activity can improve bone density, posture, heart and lung function, muscle strength, joint function, sleep, and memory, among many other benefits.  By sticking with a physical activity plan, Baby Boomers can lower their risk of health conditions such as fractures, falls, depression, certain cancers, stroke, hypertension, heart disease, and diabetes.

As experts in restoring and improving motion in people’s lives, physical therapists define physical fitness as having good aerobic capacity, muscle strength and endurance, and flexibility. We encourage adults to get at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity, or an equivalent combination of the 2, each week. In addition, we recommend working all major muscle groups — arms, shoulders, chest, abdomen, hips, back, and legs at least 2 times per week and incorporate flexibility activities such as stretching, dancing, and yoga, into a physical activity regimen.

Physical therapists are uniquely qualified to help boomers stay fit and mobile.  To learn more about how we can help you at AZOPT, please call us at 623.242.6908 or email fitafter50@azopt.net.

The American Physical Therapy Association (APTA) is an individual membership professional organization representing more than 85,000 member physical therapists. APTA seeks to improve the health and quality of life of individuals in society by advancing physical therapist practice, education, and research, and by increasing the awareness and understanding of physical therapy's role in the nation's health care system.

Keeping Your Child Safe in their Car Seat

Keeping Your Child Safe in their Car Seat

By Josh MacDonald, OTR/L

Kids Place Clinic Director

Pediatric Occupational Therapist

At Kids Place, our therapists see a lot of children coming into the clinic in their infant carriers.  Unfortunately, too many of them are fastened into the car seat incorrectly.  While every car seat is different, there are a few standard rules about how to fasten them into infant carriers and forward facing seats.

First, the plastic retainer clip (the plastic clip across the chest) should be slid up to the level of the armpits.  This may seem high and appear to put pressure between the straps and the child's neck.  But, if the clip is not high enough, it will not hold the belt in place, and the child will slide between the straps and out of the seat in an accident.

Second, the seat belt should be tight enough that you cannot pinch any excess at their shoulder.  This is relatively snug.  When applied taught against the body, the seat belt assists in riding out the deceleration slowly.  If the strap is too loose, then the child will 'collide' with the seat belt in an accident, resulting in further injury.

Lastly, no additional pieces of aftermarket items should be added to the car seat.  These pieces are often not fire retardant, and could catch fire quickly.  Any padding on the seat belt strap to protect the neck will only create space between the child and the strap.  Remember, this needs to be a tight fit.  Space is bad.  Items hanging from the handle or on the seat of the vehicle will come loose in the accident and potentially strike the child.  These items are marketed well to convince us of their necessity or cuteness, but they are not crash tested and will be dangerous in an accident.

These are only a few of the rules and guidelines about car seats.  Your local fire department is able to assist you installing your car seat, and will teach you how to properly use the car seat.  This may seem like a hassle, but 90% of car seats are installed incorrectly and will not protect a child during an accident.  Make your child's safety a priority.

Celebrating Family Health and Fitness Day

Celebrating Family Health and Fitness Day

with advice from Josh McDonald, OTR/L, MS
and Mark Salandra, CSCS

Americans young and old have been gaining weight and slowing down. A report on physical activity and health from the U.S. Surgeon General’s office in the late 1990s found that “nearly half of young people aged 12-21 are not vigorously active on a regular basis” and that more than 60% of adults aren’t as active as they should be.

(A more recent study in 2010 didn’t show any improvement, finding that only 15% of high school students achieve the recommendations set by the CDC for physical activity.)

These findings led to the creation of Family Health and Fitness Day on September 28, a celebration marking its 17th year in 2013 that celebrates activity for the whole family.

Why is this something Americans should commemorate? “Staying healthy as a family provides motivation to all members, and it increases support for the members of the family that are not as motivated for physical activity,” says Mark Salandra, CSCS, the founder of StrengthCondition.com (one of Physiquality’s partner programs). He adds that daily physical activity should be as routine as brushing your teeth or any other healthy activity you do for your body every day.

Activity expert Josh McDonald reminds parents that every action is a lesson for children. “If we want our children to value healthy and active lifestyles, then we need to model those choices for them,” says Josh, an occupational therapist at Kid’s Place, a clinic for children run by Arizona Orthopedic Physical Therapy (a Physiquality network member with two locations in Arizona).

He encourages parents to make good choices for the entire family. By turning off the television and taking them out to play catch, by enrolling them in sports and camps, or by gathering everyone for a bike ride, parents are showing their children the value of health and wellness. As a parent, he notes, “When I initiate healthy decisions for myself, and I include my kids in those decisions, I establish lifelong patterns that they will carry with them into adulthood.”

The easiest way to be active with the family is to take a walk. The CDC recommends walking at least 10,000 steps a day, Mark notes. Why not strive for that goal with a daily walk after dinner? It’s a way to burn off some of the calories in your meal while continuing discussions started around the dinner table.

There are lots of ways to make healthy choices with your family, but Josh reminds parents that the responsibility for such healthy choices starts with them. “These decisions aren’t always easy,” he notes, “but the benefits are immense for both the parents and the children.”

What’s better For Pain - Heat or Cold?

What’s better For Pain - Heat or Cold?

By Doug Lehman, PT

Often times, patients will ask me if they should use heating pads or ice to treat pain.  My answer varies depending on the type of pain.  There are two basic types of pain that we treat: acute and chronic.  Acute pain is pain that occurred recently, usually within the past 24 or 48 hours.  Chronic pain is pain that extends beyond the expected period of healing.

Acute injuries are usually treated with cold therapy.  The general rule with cold therapy is if an area is red, swollen, or inflamed, or the injury just happened, we want to cool the area down and prevent further or reduce any inflammation.  Cold therapy will reduce swelling and pain by constricting blood vessels.  It will also limit any bleeding that may occur.  Cold therapy is generally used after exercise, again to cool the inflamed areas.  Cold should not be used to treat chronic injuries before exercise. 

Some choices for treatment can range from a bag of ice (or snow for cold weather climates), a gel cold pack purchased from a store, or a large bag of frozen peas (yes, this does work, just don't eat the peas!).  Cold treatment can be applied for 20 to 30 minutes before allowing your skin temperature to return to normal before reapplying the cold therapy.

Heat will generally be used for chronic injuries.  It can help sore, stiff, nagging muscles and joint pain.  Heat should not be used with acute injuries or any injury exhibiting signs of swelling or inflammation.  Heat can help relax tight muscles or muscle spasms. Heat used before exercise will increase the elasticity of joint connective tissues and stimulate blood flow. 

Choices for heat treatment include an electric heating pad, a microwavable hot pack, or uncooked rice in a tube sock heated in the microwave (yes, this works too!).  Heat should be used for 15 to 20 minutes at a time with enough layers between the heat source and skin to prevent burning. 

Heat or cold therapy works by stimulating your body's own healing force.  Many arthritis doctors recommend both heat and cold treatments to help reduce inflammation and ease the pain and stiffness that comes with arthritis. It may take a little "trial and error" to learn which therapy works best for your pain, but you can use this blog as a starting point.  For chronic pain, feel comfortable utilizing the method that works best for you.

Play-Doh®: Fun and Functional

Play-Doh®:  Fun and Functional

By Josh MacDonald, OTR/L

Occupational Therapist and Kids Place Clinic Director

Play-Doh® is a great tool for helping your child develop hand skills.  The texture and resistance are great for building up the muscles in the hands.  However, when it is time to pull out the tub of Play-Doh®, hold off on using all of the cool tools and gadgets. 

Hasbro has made some awesome and exciting accessories to go with the rainbow of colors for Play-Doh®.  Most of these tools do not promote the development of hand skills.  These tools and Play-Doh® factories rely on pushing or pulling levers and holding basic tool handles.  While playing with these items is not terrible for development, to make the most of this awesome Doh put the tools away and let the child’s hands work.

 

Learning how to keep a hand flat and active while rolling out a snake works different muscle groups than giving it a big squeeze to leave grip marks.  Rolling a ball between your palms requires more control than rolling it on the table, but both encourage exposure to different textures.  Pinching the Doh to squish small balls between the thumb and first finger builds up grip strength and thumb skill.  Small items can be hid forcing small finger movements to hunt for objects, and making flat pancakes takes more hand strength than banging with a hammer. 

The tools made for Play-Doh® are fun, but the creative, tactile and fine motor coordination benefits are so much greater when the child simply uses their own hands.  If your child insists on using the toys, try playing without them for 10 minutes, then allow the toys.  Even 10 minutes of direct hand play with Play-Doh® will improve overall hand strength and coordination.

Keeping Your Fluid Levels Up

Keeping Your Fluid Levels Up

By Ryann Roberts, DPT, CrossFit Level 1 Trainer

There’s nothing better than a cold glass of water after a workout, but don’t forget to fuel up on liquids before you hit the gym.  Athletes can lose a significant amount of fluid during physical activity; the more rigorous the routine, the more water they’ll need to replace – and who does not participate in rigorous exercise routines?

Approximately two-thirds of an average adult’s weight is made up of water.  Fluids are essential to proper body functioning, including temperature regulation, joint movement, and the transportation of oxygen throughout the body.  Dehydration, therefore, can elevate body temperatures, strain the cardiovascular system, and lead to heat injury.  Maintaining fluid levels is critical to any exercise routine.

The American College of Sports Medicine not only recommends adequate fluid replenishment, but also advises athletes to increase sodium intake after a strenuous workout.  While current medical advice calls for a reduced sodium diet, the temporary uptick in sodium is necessary to counteract the loss of electrolytes during physical exercise.

The next time you gear up for athletic activity, keep the following in mind:

Load up.  Drink 1 or 2 cups of water 30 minutes before starting exercise.

Maintain your levels.  Drink between ½ and 1 cup of water for every 15 minutes of exercise to replenish your fluids.

Weigh yourself.  Check your weight before and after exercise, and drink 2.5 cups of water for every pound lost during your workout.

Don’t rely on thirst. Water may be known as a “thirst quencher,” but if you’re thirsty, your body is already dehydrated.  Drink plenty of water after a workout, even if you’re not thirsty.  When your thirst is quenched, drink some more; you may not feel you need water, but your body does.

Use your body's natural indicators.  Urine can signal whether you’re adequately hydrated; look for a pale color, as opposed to a dark yellow, to know when your body has enough fluids.

Beware over-consumption.  While dehydration is a danger, drinking too much water can also pose a risk.  Athletes who consume excessive amounts of fluid can suffer from water intoxication, which occurs when sodium levels are depleted.  Be on the lookout for these symptoms: dizziness, nausea, apathy, confusion.

Eat your fluids.  Consider other forms of liquid refreshment to keep hydrated throughout the day.  Fruit, vegetables, and tea provide fluids and nutritional benefits.  But immediately after exercise, stick to water or electrolyte-enhanced fluids – they pack the best replenishing punch.

ACL Reconstruction: Allograft vs. Autograft

ACL Reconstruction:  Allograft vs. Autograft

By Erik Bassett, DPT

Recently, we posted a blog titled “Everyday People Rehabbing Major Knee Injuries with AZOPT.”  In this two part series, we focused on the rehab following a major tear in the ligaments of the knee.  In this scenario, AZOPT patient Josh had a surgical procedure known as an auto graft to repair the tears.  Many people wrote us wondering what exactly an autograft procedure is. 

First, just to refresh the memory, 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 tears occur approximately 200,000 times each year in America, of which nearly half require reconstruction.

There are two types of reconstructive surgeries to repair an ACL - allograft and autograft.  An allograft is a tendon used from something other than the individual patient, usually a cadaver.  An autograft is tendon used from the individual, usually the hamstring or patellar tendon.   What is the difference between the two types of reconstructive options, and is one better or worse than the other?  There are positives and negatives to each type of reconstructive surgery.

This year, The American Journal of Sports Medicine performed a meta-analysis, the best form of research, reviewing many articles on the subject written between 1999 and 2012[1].  According to the study, patients who received an autograft scored higher on a scale that rates common complaints of the knee.  Further, they report positive outcomes on a subjective report and positive results with a single leg hop test.  Comparatively, patients receiving an allograft report a positive return to pre-injury activity level along with a positive subjective report.  They also report positive results with a pivot shift and decreased anterior knee pain.  However, patients with an allograft procedure had a 3-fold increase in re-rupture rates compared to autografts.    

In March of 2011 I experienced a major ACL tear that required reconstruction.  I chose to have an allograft performed mainly due to the shortened length of recovery time.  With an allograft, there is a decreased recovery time due to smaller amounts of cutting other structures like the patellar and hamstring tendons.  While the recovery time is less with an allograft, after 12 months of rehabilitation both types of grafts result in equal knee range of motion, strength, and activity level if proper rehabilitation occurs.  To this day I am able to perform each and every activity the same as before my ACL reconstruction.  Occasionally, I experience only minimal pain after activity and mild aches during cooler weather. 

Rehabilitation is key to any ACL reconstruction.  Physical therapy is performed after an ACL reconstruction to enable the knee to recover in a timely manner.  Initial treatment following ACL reconstruction includes increasing range of motion both in flexion and extension, mild strengthening of knee and hip musculature, pain and swelling reduction using modalities, and soft tissue mobilization to increase tissue extensibility.   Crutches and a locked knee brace are typically used for the first 3 or 4 weeks.  As rehabilitation progresses, an increased amount of strengthening occurs.  It is important to strengthen the surrounding muscles to help support the ACL graft.

If you have ruptured your ACL and require a reconstruction, speak with your physician.  Generally, they will refer you to a surgeon for a consultation.  The surgeon will speak to you regarding the option for an allograft or an autograft.  Now that you know the difference between the two you can impress the surgeon with your knowledge.  Choose which type would be most beneficial for you in the long run.  When the operation is complete, call AZOPT to begin the rehabilitation process.  Good luck and happy recovery!

[1] American Journal of Sports Medicine. 2013 Apr 12. Bone-Patellar Tendon-Bone Autograft Versus Allograft in Outcomes of Anterior Cruciate Ligament Reconstruction: A Meta-analysis of 5182 Patients. Kraeutler MJ, Bravman JT, McCarty EC.

Premature Introduction of Solids to a Baby

Premature Introduction of Solids to a Baby
By Colleen Riordan, CCC-SLP
Speech and Feeding Therapist, Kids Place

First milestones for babies can be very exciting for a new parent.  First smiles, first words, and first steps are moments to be cherished.  But is there such a thing as pushing for these milestones to happen too early?  In the case of introducing solids to an infant, the answer is yes.  Although common advice is to begin introducing solids at 6 months of age, some health professionals are now giving the green light for solids at 4 months of age.  Recent polls have also revealed that some infants are receiving their first tastes of infant cereals and purees as young as 2 months.  Although it may be tempting to give your baby solids before 6 months of age, it is important to take into account your baby’s nutritional needs, gastrointestinal maturity, oral-motor development and a number of readiness cues.

Nutrition

Through the age of 6 months, breast milk or formula provides all of your baby’s nutritional needs.  In fact, many infants can thrive on breast milk or formula alone through 9 months of age.  Infant cereals and purees cannot provide the necessary calories, fat and nutrients for an infant’s developing body and mind.  Between the ages of 6 and 9 months, introduction of solids is for practice only; breast milk or formula is essential.  Some erroneously believe that infant cereal is necessary for iron supplementation. This is untrue.  Typically developing infants are born with iron stores to last them at least through the seventh month of life.  Another myth is that adding cereal to a bottle before 6 months of age will help a baby sleep through the night.  There are no studies to support this idea.  Adding cereal will change the nutrient content of the formula, and is linked to higher risk of obesity later in life.

Gastrointestinal Maturity

Before 6 months of age, infants have what is referred to as an “open gut”.  They are unable to filer out harmful substances and allergens.  Similarly, the intestinal tract is also unable to facilitate adequate absorption of nutrients in anything other than breast milk or formula, which contains enzymes to digest fats, proteins and starch.   By feeding a baby solids before his GI tract is mature, there is a higher risk of diabetes and food allergies.

Oral-motor Skills

Babies will exhibit a tongue thrust reflex which disappears between the ages of 4 and 6 months.  This reflex exists to protect an infant’s airway.  Before 6 months, infants will exhibit a sucking motion, a movement that is effective for anterior/posterior transit of liquids.  In order to deal with solids effectively, infants need to develop some tongue lateralization and rudimentary munching skills.  These skills are typically developed by 6 months.  Add to this the fact that most infants do not get their first teeth until after 6 months; this may be an evolutionary cue to us that infants are just not fully equipped to begin eating solids until after 6 months.

Reading the Cues

Many books will tell you that once a baby has doubled her birth weight, he is ready to begin solids.  Remember, that it is the combination of maturity of intestinal tract, nutritional needs, and oral motor skills that should be taken into account, instead of age or weight.   Conversely, if your baby is underweight at 4 or 6 months, the best nutrition is provided by breast milk or formula, and not solids.  Another cue parents should look for is the infant’s interest in the food that others are eating around her.  While this may be one readiness cue, it is also important to remember that infants are becoming great imitators at this age, mimicking your movements while eating.  This may be more of a social interaction than a cue that she really wants what’s on your plate!

Introduction of solids is one milestone that does not need to be forced. You will be eating with your baby in no time.  For now, enjoy the special moments breast or bottle feeding your infant, as they will go by quickly!