Your Health

Physical Therapy and Your Body

• Throwers Ten Injury Prevention program for throwers (pdf)
• Throwing Interval Program (word doc)
• Tennis Elbow Stretches and Exercises (word doc)
• Knee Injury Prevention Strategies for Female Athletes  Guide from Neurologic and Orthopedic Hospital of Chicago
  
• Guide to Shoulder Pain and Treatment (Cleveland Clinic)  
• New 2008  Physical Activity Guidelines for Americans: http://health.gov/paguidelines/
   
• Take the Presidents Challenge Adult Fitness Test to see how you rate!
  

• New (April 08): Revised position statement by the American Academy of Pediatrics: Strength Training by Children and Adolescents (posted 4.17.08)

Brochures provided by the American Physical Therapy Association

Brochures provided by the American College of Sports Medicine

Selecting & Effectively Using a Treadmill	Selecting & Effectively Using an Ellipitcal Trainer	Selecting & Effectively Using a Stationary Bike
Selecting & Effectively Using a Rowing Machine	Selecting & Effectively Using a Stepper/Stair Climber	Selecting & Effectively Using a Personal Trainer

Many patients may benefit more from non-invasive treatments:

ROSEMONT, Ill., Feb. 2 /PRNewswire-USNewswire/ -- The simplest method for treating low back pain may actually be the best method. A literature study published in the February 2009 issue of The Journal of the American Academy of Orthopaedic Surgeons (http://www.jaaos.org/) finds that in most cases of symptomatic lumbar degenerative disk disease, a common cause of low back pain, the most effective treatment is simply a combination of physical therapy and anti-inflammatory medication.
Symptomatic lumbar degenerative disc disease occurs when a disc weakens, often due to the effects of aging, repetitive strain or injury to the disc space. The result is that the disc cannot hold the vertebrae as well as it used to, and that lack of stability can cause low back pain. In some cases, the pain is great enough that the patient may seek treatment from an orthopaedic surgeon. These treatments can include a range of noninvasive and invasive/surgical options.
According to the review findings:

1. 90 percent of patients with low back pain will see their symptoms fade on their own within three months.

2. Most of those patients will recover within six weeks.

Therefore, the researchers determined that, barring an emergency, the initial treatment of all patients with low back pain should be noninvasive.

"Recently, disc replacement surgery has been proposed as a cure or treatment for symptomatic lumbar disc disease," says Luke Madigan, M.D., an attending physician at Knoxville Orthopaedic Clinic, Knoxville, TN, and the lead author of the review. "But the FDA studies on lumbar disc replacement have only so far shown equivalence to fusion for discogenic disease. Long-term outcomes are still to be published and caution should be exercised with their use." Madigan also notes that in the past, surgical fusion was used to treat this condition, and the success rate was 50-60 percent.

Meanwhile, noninvasive treatments have brought about greater success by helping patients strengthen the injured area and prevent further strain:

1. Physical therapy that focuses on strengthening core muscle groups in the abdominal area and the lower back has demonstrated positive effects in patients with disc-related pain.

2. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen have been found effective for short-term relief of low back pain, and no NSAID was found to be any more effective than the others.

3. Educating patients on better body mechanics -- for example, lifting with the legs instead of the back -- is found to lessen the strain that is placed on the lumbar region.

4. Another recent literature review advocated mobilization or activity in the treatment of low back pain as opposed to bed rest, and exercise has been shown to improve function and decrease pain in adult patients with chronic low back pain.

5. Braces have not been found to be effective in treating low back pain, although whether patients actually wear the brace in the prescribed manner may be a factor.

Invasive treatment should only be explored if these and other noninvasive treatments have not been effective.

"Surgery should be the last option, but too often patients think of surgery as a cure all and are eager to embark on it," Madigan says. "Also, surgeons should pay close attention to the list of contraindications, and recommend surgery only for those patients who are truly likely to benefit from it."

IS YOUR CHILD'S BACKPACK MAKING THE GRADE?

Source: www.apta.org

Physical Therapists Offer Tips to Lighten the Load on Children's Backs

ALEXANDRIA, VA, July 25, 2005. While backpacks are one of the most convenient ways to carry books and school supplies, an overloaded and/or improperly worn backpack gets a failing grade, according to the American Physical Therapy Association (APTA). Physical therapists can assist students in making changes while carrying school items.

"Wearing backpacks improperly or ones that are too heavy put children at increased risk for spinal injury," says Mary Ann Wilmarth, PT, DPT, MS, OCS, director of the transitional doctor of physical therapy degree at Northeastern University in Boston.

Wilmarth, an APTA member, conducted a study at a private, pre-kindergarten through 9th grade school in Andover, Massachusetts, and found that postural changes, particularly excessive forward head posture, are magnified when the backpack weighs more than 15% of the student's bodyweight. The postural imbalances appeared to be most significant with prepubescent female students.

"Back pain is already the most common ailment among working Americans adults. If we don't correct the backpack issues that are causing children back pain, the issue will become magnified in years to come," Wilmarth said.

According to Wilmarth, injury can occur when a child, in trying to adapt to a heavy load, uses faulty postures such as arching the back, bending forward, or leaning to one side. These postural adaptations can cause improper spinal alignment, which hampers functioning of the disks that provide shock absorption. A backpack load that is too heavy also causes muscles and soft tissues to work harder, leading to strain and fatigue. This leaves the neck, shoulders, and back more vulnerable to injury.

Another study conducted by Wilmarth found that college-aged students also were affected by disproportionate weight and improper use of backpacks, although not as significantly as with the younger students.

Wilmarth recommends following these tips for safe backpack use:

• Wear both straps. Use of one strap causes one side of the body to bear the weight of the backpack. This can be true even with one-strap backpacks that cross the body. By wearing two shoulder straps, the weight of the backpack is better distributed, and a well-aligned symmetrical posture is promoted.
• Remove and put on backpacks carefully. Keep the trunk of your body stable and avoid excessive twisting.
• Wear the backpack over the strongest mid-back muscles. Pay close attention to the way the backpack is positioned on the back. It should rest evenly in the middle of the back. Shoulder straps should be adjusted to allow the child to put on and take off the backpack without difficulty and permit free movement of the arms. Straps should not be too loose, and the backpack should not extend below the low back.
• Lighten the load. Keep the load at 10-15% or less of the student's bodyweight. Carry only those items that are required for the day. Each night remove articles that can be left at home. Organize the contents of the backpack by placing the heaviest items closest to the back to reduce kinetic forces that cause postural malalignment and overwork muscles. Use CDs instead of full textbooks whenever possible; some students even have two sets of books so as not to have to carry the heavy books to and from school.

When selecting a new backpack, Wilmarth recommends choosing ergonomically designed features that enhance safety and comfort:

• A padded back to reduce pressure on the back, shoulders, and underarm regions, and enhance comfort'
• Hip and chest belts to transfer some of the backpack weight from the back and shoulders to the hips and torso;
• Multiple compartments to better distribute the weight in the backpack, keep items secure, and ease access to the contents; and
• Reflective material to enhance visibility of the child to drivers at night.

Wilmarth found that backpacks with wheels are a good option for younger students who did not change classes or go up and down stairs frequently, but there are precautions to use with those as well. Be sure that the extended handle is long enough so that the child is not forced to twist and bend, and that the wheels are sufficiently large so that the backpack doesn't shake or topple. Older students found traditional backpacks to be better due to the frequent walking between classes and also when going to and from school.

Parents and children can avoid injury by recognizing the following warning signs that the backpack is too heavy:

• Change in posture when wearing the backpack;
• Struggling when putting on or taking off the backpack;
• Pain when wearing the backpack;
• Tingling or numbness in arms and legs, mostly arms; or
• Red marks on the shoulders.

Click here to see images depicting the correct way to wear a backpack. The site also offers consumers brochures, such as "Taking Care of Your Back" and/or "Scoliosis," and news releases, as well as "Find a PT," a national database of physical therapist members of APTA.

The American Physical Therapy Association is a national professional organization representing more than 66,000 members. Its goal is to foster advancements in physical therapy practice, research, and education.

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Tips from The American Academy of Orthopaedic Surgeons

According to the American Academy of Orthopaedic Surgeons, snow shoveling and snow blowing can increase injuries to the back, shoulders and wrists. The improper use of equipment combined with performing unfamiliar exercises increases the likelihood of injuries form shoveling or snow bower use. The American Academy of Orthopaedic Surgeons offers the following safety tips for shoveling and snow blower use:

• Check with your doctor. Because this activity places high stress on the heart, you should always speak with your physician before shoveling or snow blowing. If you have a medical condition or do not exercise regularly, consider hiring someone to remove the snow.
• Dress appropriately. Light, layered, water-repellent clothing provides both ventilation and insulation. It is also important to wear the appropriate head coverings, as well as mittens or gloves and thick, warm socks.
• Pace yourself. Snow shoveling and blowing are aerobic activities, comparable to weightlifting. Take frequent breaks and replenish fluids to prevent dehydration. If you experience chest pain, shortness of breath or other signs of a heart attack, seek emergency care, such as by calling 9-1-1.
• Warm-up your muscles. Shoveling can be a vigorous activity. Before you begin this physical workout, warm-up your muscles for 10 minutes with light exercise.
• Never stick your hands in the snow blower. If snow becomes too impacted, stop the engine and wait more than five seconds. Use a solid object to clear wet snow or debris from the chute. Beware of the recoil of the motor and blades after the machine has been turned off.
• Clear snow early and often. Begin when a light covering of snow is on the ground to avoid shoveling packed, heavy snow.
• Use a shovel that is comfortable for your height and strength. Do not use a shovel that is too heavy or too long. Space your hands on the tool grip to increase your leverage.
• Push the snow instead of lifting it, but if you must lift, do it properly. Squat with your legs apart, knees bent and back straight.
• Lift with your legs, without bending at the waist. Scoop small amounts of snow into the shovel and walk to where you want to dump it. Holding a shovelful of snow with your arms outstretched puts too much weight on your spine. Never remove deep snow all at once; do it piecemeal.
• Do not throw the snow over your shoulder or to the side. This requires a twisting motion that stresses your back.
• See what you are shoveling/snow blowing. Do not let a hat or scarf block your vision. Watch for ice patches and uneven surfaces.
• Avoid falls by wearing shoes or boots that have slip-resistant soles.
• Do not leave the snow blower unattended when it is running. Shut off the engine if you must walk away from the machine.
• Watch the snow blower cord. If you are operating an electric snow blower, be aware of where the power cord is at all times.
• Add fuel before starting the snow blower. Never add fuel when the engine is running or hot. Do not operate the machine in an enclosed area.
• Read the instruction manual. Prior to using a snow blower, read the instruction manual for specific safety hazards, unfamiliar features, and whenever attempting to repair or maintain the snow blower.