Healthy Tips and Tricks to Keep You on TOPS in 2017

With the beginning of a new year upon us, we all have one thing on our mind: WEIGHT LOSS. This is the time of the year when the gyms are packed and everyone is trying to find the next best weight loss scheme to help shed those extra holiday pounds. We have put together a few suggestions to help everyone stay on TOPS of their goals in 2017!

  1. Get Moving! – This is seemingly a no brainer, but we often forget that moving our body does not require a gym membership or several hours of our day. We can all add in extra cardio throughout the busy day by opting to take the stairs at work, to walk for 10-20 minutes during our lunch break, or to mix in some squats, lunges, or stretching every 1-2 hours at our desk or on our way to a meeting. Exercise is exercise regardless of whether it is performed in one chunk of time or if it is conducted in short bouts throughout the day, so stay consistent with working movement in some capacity or another into your regular day and you will notice an improvement in your mood, your productivity at work, and your waistline.
  2. Meal Preparation – As the old saying goes, you cannot out train a bad diet. We all try to find a quick fix to help stimulate weight loss, but instead of spending money on buying various weight loss products you should invest your time in good old fashion meal prepping at home. Plan on using one afternoon to shop and prep every meal for the week, which usually saves you time and money if you stick to eating your scheduled meals. By cooking meats in bulk and portioning vegetables, fruits, and healthy carbohydrates, you will be more apt to stick to the diet and less likely to overindulge. If you find yourself in a time crunch and you need a quick fix to avoid those ‘hanger’ pains, look for snacks that are high in protein with minimal ingredients. A good rule of thumb to follow is to opt for food choices with 5 ingredients or less (all of which you can pronounce), and be sure to look for snacks with no added sugars and no artificial colors or dyes.
  3. Relax – With the holiday hangover from all the hustle and bustle, it is important to remember to take some time for yourself and RELAX! All the stress from shopping, cooking, and hosting can really bog you down, so make sure you are allotting 7-8 hours per night for restful sleep. Not only is sleep important for mental clarity and total body rejuvenation, but it is also vital for hormone synthesis and hormonal balance. If you cannot find time to squeeze in 7-8 hours of sleep, make sure you are taking short bouts of time throughout the day to focus on performing mindful, diaphragmatic breaths to decrease your heart rate and return your body to homeostasis. Try it out: sit still and bring your attention to your breath. Deeply inhale through your nose for a count of 5 seconds, hold your breath for 3 seconds, and slowly exhale through your mouth for a count of 7 seconds. You should be able to perform approximately 3 diaphragmatic breaths per minute, and after 1-2 minutes you should notice a decrease in your resting heart rate.

For more tips and tricks on staying motivated and rejuvenated in 2017, come in and see us at T.O.P.S.!

FOOT STRENGTHING FOR RUNNING

Running season in Arizona is upon on us with training for the P.F. Chang’s marathon. With the increased training and mileage comes potential for foot pain/injuries. During the running gait each foot must be able to stabilize and provide dynamic stability individually. Therefore, it is important to perform supplementary single leg stance loading in all three planes of motion. The three planes of motion are the sagittal plane (forward and backward movement), frontal plane (side to side movement), and transverse plane (rotational movement).

We have come up with four different exercises to perform 2-3 x per week to supplement your running that will encompass all three planes of motion:

  1. Nose to Wall: Stand on one leg with other leg in the air out front. Shift your body weight forward to the point where you almost feel your heel come off the ground on your stance leg and then shift your body weight back. Try to avoid the woodpecker type motion. Repeat for 3 sets of 10-12 reps alternating legs.
  2. Lateral bandwalk: Put a band around both ankles and start with your knees and hips slightly bent. Keep your feet pointed straight forward the entire time take 12 steps sideways. Stay facing the same direction and take 12 steps back, repeat the movement 2 more times down and back.
  3. Posterior medial step down: Stand on one leg with most of your weight on the heel, but still keeping big toe in contact with step. Sit back like performing a single leg squat focusing on more of a hip bend as opposed to a knee bend. Pay attention to your knee on the side you are loading to ensure that it is stable, not diving in too much and touch the floor with your opposite heel. Return to a fully extended position with the knee and hip completely straight focusing on squeezing your glutes and quads at the top.
  4. Doorway touches: Stand and balance on one leg with a soft slightly bent knee and touch the Left doorjam with Right hand and Right doorjam with Left hand. Perform this alternately for 10 on each side for 20 total touches. Repeat this for 3 sets.

This group of exercises can be best performed prior to running as a movement prep to engage your foot intrinsics and to get the posterior chain acitvated.

If there are any activities you are having difficulty with come in and see us at TOPS Physical Therapy and Osteopractics.

LET’S TALK FOOT PAIN AND SHOES!

Ever have foot pain or discomfort and cannot find the right shoe for your foot? Feel like all of the cool name brand shoes just don’t quite cut it? If so, there have been many patients who have the solution to your problem! There are a variety of shoes that help to minimize many of the “foot-pain” issues. These include a wider toe box, zero-drop sole, and flexible sole. What do these things mean??

Toe box: the area where the toes reside. In general, the widest part of the shoe should be at the end of the shoe and not at the ball of the foot.

Zero-drop sole: The sole of the shoe does not have a build-up or larger heel as compared to the toe of the shoe. In many traditional shoes, the heel has a larger sole, which can sometimes be the cause of foot pain. This also contributes to a tighter calf muscle, which when wearing sandals, as we often do in Arizona, would cause increased pain. **Warning: if you are have not transitioned to a zero-drop sole yet, please talk to us or a trained professional prior to quickly transitioning out of an elevated heel. This will prevent pain from starting!

Flexible sole: The bottom of the shoe should not be rigid when bending the toe towards the heel, which allows for a more natural motion of your foot. There should also not be a crease that occurs in the toe box when bending the toe towards the heel. This also goes for orthotics that are placed in the shoe. If you experience increased toe pain after inserting orthotics, please inform the medical professional who suggested them, or bring them in and let us check them out!

There are a couple of brands that have withstood test of time: Altra and Lems. These two have been created for the active person while allowing the foot to remain in a natural, relaxed position across every terrain!

If you have any further questions or are curious if you could benefit from these shoes, please contact us and we will help you figure out what is best for you! Happy Shoe Shopping 🙂

Is Pain Hindering Your Holidays? Get On TOPS Of It!

Turkey stuffing, grocery stores, Christmas shopping, home decorating… Annnnddddd, great weather in Phoenix!  This is the time of year when we start to get back out and run, hike, bike, etc. At T.O.P.S., we believe that getting out and moving is essential to your physical and mental health. We also understand that you may have aches and pains that arise after hibernating all summer! Not only does this affect you physically, but it’ll take a toll on your mental well-being as well.

Don’t let that happen!

Especially as the holidays are approaching, there are meals to be cooked, lines to stand in, and family fun to be had. Aches and pains should not be on the forefront of your mind, or limiting your desire to do any of these activities!

Plus, your deductible is most likely already met! We have direct access, meaning you don’t even have to see a doctor before coming… you can come straight in and we will check you out, and get you started, on your FIRST appointment. We have an Osteopractor on site, which means you can get all of your dry needling, joint manipulations, or physical therapy done in one location.

Not to mention, once your physical pain is minimized, your mental clarity will improve, providing for shopping stamina, great gift ideas for those hard to shop for, and delicious meals!

As Saint Augustine said, “The greatest evil is physical pain.”

So, We invite you in, to come check out what we can do for you during these hectic holiday times, and get you running, hiking, or biking your way into 2017!!!

Ten Things You Didn’t Know About PT

  1. The National Physical Therapy Month is each October, celebrating and recognizing the work that physical therapists do to improve the health and restore the motion of our nation’s citizens.
  2. Physical therapists do not only perform their work in clinics or private practices. They can work in other settings such as hospitals, schools, and even nursing homes.
  3. There are over 200,000 physical therapists in the United States. (via www.apta.org)
  4. Your physical therapist can treat you for vertigo. (via moveforwardpt.com)
  5. Yes, physical therapy can be as (or more!) effective than surgery to address a variety of conditions.
  6. Physical therapists formed their first professional association in 1921, known as the American Women’s Physical Therapeutic Association. (via www.apta.org)
  7. What is a classic piece of equipment that your parent’s may have in their basement that is also widely used in physical therapy and rehab center across the US? The NordicTrack Classic Pro Skier. (via guidedoc.com)
  8. The ‘massaging’ of a muscle by a physical therapist will not be like the soothing massage you would expect at a spa.
  9. There are different types of physical therapy, which are: orthopedic, post-operative, cardiovascular, neurologic rehabilitation, or pulmonary rehab.
  10. Yes, many physical therapists hold advanced degrees!

The American Academy of Manipulative Therapy: Fellowship in Orthopaedic Manual Physical Therapy

President Obama signed the Patient Protection and Affordable Care Act (ACA) into law on March 23, 2010. The ACA represents the most significant transformation of the American health care system since the Medicare legislation of 1965.1 It has been suggested that the Congressional Budget Office (CBO) and the Obama administration have used creative accounting to arrive at an alleged deficit reduction following implementation of the ACA;1 furthermore, according to several recent economic health policy analyses,1-5 if the employer mandates, individual mandates, Medicare cuts, state health insurance exchanges, and Medicaid expansion are each fully implemented, there will likely be a significant increase in deficits rather than a reduction.1 Additionally, it is accepted that the ACA will provide greater demand for mid-level primary care clinicians such as nurse practitioners, physician assistants, or even physical therapists; however the extent to which the ACA will impact these professions within the U.S. health care workforce has received little attention.6

The 2014 Medicaid expansion was the single biggest budgetary increase in the Medicaid system since its inception in 1965. Moreover, the impact that the ACA will have on access to care, in part will largely depend on whether the newly eligible individuals choose to participate in the Medicaid enrollment process.4 The subsidies provided by the ACA are available to those purchasing health insurance through state-based exchanges that have incomes up to 400% of the poverty level ($93,700 for a family of four in 2014). At 138% of the poverty level, an individual is responsible for the cost of health insurance up to a level of 2% of their income; however, for incomes above this level, the maximum percentage of income that an individual should pay increases in increments to 9.5% of income at 400% of poverty level. This all costs money of course. For 2011 to 2013, US health spending grew on average at 4.0% with a historical rate of 3.8%; however, since the implementation of the ACA in 2014, health spending growth is expected to accelerate to 7.4% as both the state-based health insurance subsidies and Medicaid expansion are fully implemented. Thus, the healthcare share of the gross domestic product (GDP) is projected to rise from 17.9% in 2010 to 19.6% by 2021.2,3 Comparatively, the UK, Canada and Germany have been able to maintain health care spending levels between 8.2% and 9.8% of GDP for several decades.7-10

As the U.S. healthcare system continues to expand and rapidly evolve as a result of the implementation of the many aspects of ACA, so must physical therapists if they truly want to become the first choice providers for Americans with neuromusculoskeletal disorders. The profession has historically prided itself on its ability to improve pain, disability and general health with exercise. However, in the past decade, Physician-Owned Physical Therapy Services (POPTS) and/or “contract-management” PT operations have reached new heights. Furthermore, as a result of the implementation of the provisions in the ACA, and in many larger metropolitan markets, “big” healthcare, hospital and network mergers have effectively turned off the tap for referrals from medical physicians to independently owned physical therapy clinics. It has become much more difficult for the independent, private practice physical therapist to make a living over the past decade. Additionally, with DPT student loan levels at record highs and the aforementioned changes in healthcare, it is difficult to fathom how the new crop of physical therapists will be able to afford to open up their own clinics and become their own bosses—as we believe it should be for a growing, not diminishing, portion of a doctoring profession.

As U.S. healthcare moves towards a pay-for-performance, or outcome-based system, physical therapists will need to recognize that they need to be more than exercise specialists. Yes, exercise is medicine, but many professions (e.g. athletic trainers, personal trainers, chiropractors, massage therapists, osteopaths, medical physicians, oriental medical doctors, podiatrists, and even surgeons) prescribe or utilize exercise in the management of their patients—exercise is a shared procedure among many professions and no single profession can lay exclusive claim on such. We are not the only profession that claims to be movement specialists; furthermore to date, the majority of the American public may not even recognize us as the primary authorities on exercise or movement. Interestingly and contrary to the belief held by many physical therapists for two decades, it is now clear from the literature that the transverse abdominus is not the only muscle authorized by God to “stabilize” the spine;11-14 that is, for low back or neck pain, specific or core stabilization exercises targeting the deep neck flexors or the transverse abdominus are no better than general exercise.11-14

In short, skyrocketing health care costs (partly due to the implementation of the ACA) combined with dwindling reimbursement rates have left patients, referral sources and insurance companies demanding better patient outcomes in less time. We believe the need for advanced training in Orthopaedic Manual Physical Therapy has never been more crucial for the successful operation of your own fully independent, outpatient physical therapy clinic that isn’t at the mercy of “big” healthcare or overly dependent on referrals from medical physicians.

As three relatively new private practice owners in outpatient orthopaedic physical therapy, we investigated a number of APTA-accredited Fellowship programs that would allow us to gain the skills necessary to help grow our new practices. While we found a number of quality programs throughout the United States, the American Academy of Manipulative Physical Therapy (AAMT) Fellowship in Orthopedic Manual Physical Therapy appeared to be more focused than other programs on the actual psychomotor development of advanced procedural skills in spinal manipulation and dry needling, along with a focus on exploring the scientific evidence underpinning such. The 12-month, accelerated AAMT Fellowship does not require relocation and this was advantageous for us in order to continue working in each of our respective practices. Moreover, the evidence-based curriculum was both comprehensive and directly applicable to the management of patients with neuromusculoskeletal conditions. In particular, the training we received in non-thrust mobilization, high-velocity low-amplitude thrust manipulation of the spine and the extremities, tool-assisted therapy, dry needling, manual techniques related to vestibular disorders, and differential diagnosis appears to have facilitated a dramatic expansion in our referrals and patient population, as we are now able to treat a greater number and variety of patient diagnoses in less time. Within just three months of entering the AAMT Fellowship program, each of our clinics went from standard or general physical therapy providers (seeing predominantly post-op patients) to specialty clinics with the ability to diagnose and treat much more complex patients, including: cervicogenic headaches, migraine, tension type headaches, post-partum pelvic pain, plantar fasciitis, second and third rib syndrome, cervicothoracic myofascial pain syndrome, and a variety of maxillofacial pain syndromes.

The American Academy of Manipulative Therapy Fellowship in Orthopaedic Manual Physical Therapy is accredited by the American Physical Therapy Association (APTA) as a post-professional fellowship program for physical therapists in Orthopaedic Manual Physical Therapy. Therefore, after graduation from the 12-month AAMT Fellowship program, we will be awarded the FAAOMPT credential (i.e. become Fellows of the American Academy of Orthopaedic Manual Physical Therapists) via AAOMPT, the official Member Organization of IFOMPT (International Federation of Orthopaedic Manual Physical Therapists). In addition, we also earned the Certification in Spinal Manipulative Therapy (Cert. SMT), the Certification in Dry Needling (Cert. DN), and the Diploma in Osteopractic while completing the AAMT Fellowship curriculum. We believe this has been paramount in our ability to effectively market our services directly to the consumer (i.e., potential patients) and to specialist physicians (headache neurologists, gynecologists, maxillofacial surgeons, physiatrists, podiatrists, dentists etc.) as these specialty certifications demonstrate the ability to provide treatment and/or diagnoses that are above and beyond what a “general” physical therapist has been educated and trained to do.

The AAMT Fellowship curriculum is particularly strong in clinical research. In addition to an online journal club whereby we continuously appraise the latest literature on manual therapy, exercise, dry needling and Western acupuncture, we receive intensive training in research design, research methodology, biostatistics, grant writing, emerging technologies in physical therapy research, and the biopsychosocial and pharmaceutical aspects of pain management. We were blown away by the lectures provided by Dr. Stacy Fritz, the head of the University of South Carolina Doctor of Physical Therapy Program. Moreover, the hands-on instruction with fMRI, non-invasive brain stimulation, gait-rite technology and diagnostic ultrasound more than surpassed our expectations. We particularly enjoyed the advanced musculoskeletal imaging course with Dr. Paul Beattie and the applied musculoskeletal anatomy course (with real cadavers!) at the third week-intensive in Columbia, SC.

Nevertheless, regardless of the didactic coursework and all of the scientific literature that we have critically appraised over the past year in the AAMT Fellowship, evidence-based medicine is not restricted to randomized controlled trials, systematic reviews and meta-analyses.15 In the seminal article “Evidence-based medicine: what it is and what it isn’t”, Sackett et al15 stated, “Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient.” In short, the technical skill and mastery that we have each gained during the AAMT Fellowship, specifically in the sub-specialty areas of spinal manipulation and dry needling, and the practical clinical training (both diagnostic and management based) has allowed us to work from a platform that rests on all three pillars of evidence-based practice.

We believe the curriculum, hands-on training, and osteopractic approach to patient care offered through the AAMT Fellowship program is second to none. Dr. Dunning has truly created a team of faculty members that are both academic and clinical experts. For example, each AAMT faculty member is adept at manipulating or adjusting the upper cervical spine16,17 and masterful in the use of the 9-point semi-standardized dry needling protocol for the management of knee osteoarthritis18-34—thus, you can learn by seeing as well as by doing. With over 140 applicants to the AAMT Fellowship program within its first two years of existence, Dr. Dunning has also been able to handpick the most qualified and well-suited fellows-in-training. We have particularly enjoyed the camaraderie with exceptionally talented physical therapists throughout the United States. It has been a privilege to be a part of such a fine group of individuals that have the ability to move the profession forward. We are thankful for the friendship and professional connections that we have made through the AAMT Fellowship program.

As Albert Einstein once said, “Education is what remains after one has forgotten what one has learned in school.” For those of you considering an APTA-accredited post-professional fellowship program in Orthopaedic Manual Physical Therapy, we believe the 12-month, accelerated AAMT Fellowship is your best option!

AUTHORS

  1. Casey Bush, PT, MSc, Cert. DN, Cert. SMT, Dip. Osteopractic
    Owner & Physical Therapist, Body, Heart & Spine, Jonesboro, AR
    Fellow in Training, AAMT Fellowship in Orthopaedic Manual Physical Therapy
  2. Dr. Amy Brannon, PT, DPT, Cert. DN, Cert. SMT, Dip. Osteopractic
    Owner & Physical Therapist, T.O.P.S. Physical Therapy, Phoenix, AZ
    Fellow in Training, AAMT Fellowship in Orthopaedic Manual Physical Therapy
  3. Todd Koos, PT, Cert. MDT, Cert. DN, Cert. SMT, M.Div., Dip. Osteopractic
    Owner & Physical Therapist, Physical Therapy Center, Monroe / Waxhaw, NC
    Fellow in Training, AAMT Fellowship in Orthopaedic Manual Physical Therapy

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  2. Sjaastad O. The International Headache Society. A new multi-disciplinary forum. Cephalalgia. Mar 1983;3(1):10.
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  4. Sjaastad O, Saunte C. Unilaterality of headache. Hauge’s studies revisited. Cephalalgia. Dec 1983;3(4):201-205.
  5. Price CC, Eibner C. For states that opt out of Medicaid expansion: 3.6 million fewer insured and $8.4 billion less in federal payments. Health Aff (Millwood). Jun 2013;32(6):1030-1036.
  6. Cleland JA, Glynn P, Whitman JM, Eberhart SL, MacDonald C, Childs JD. Short-term effects of thrust versus nonthrust mobilization/manipulation directed at the thoracic spine in patients with neck pain: a randomized clinical trial. Phys Ther. Apr 2007;87(4):431-440.
  7. Pfaffenrath V, Dandekar R, Mayer ET, Hermann G, Pollmann W. Cervicogenic headache: results of computer-based measurements of cervical spine mobility in 15 patients. Cephalalgia. Mar 1988;8(1):45-48.
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  9. Sillevis R. The use of dry needling in combination with manual therapy techniques for a patient with cervicogenic headache: a case report. Journal of Physiotherapy. 2011;3:9-18.
  10. Roland M, Rosen R. English NHS embarks on controversial and risky market-style reforms in health care. N Engl J Med. Apr 7 2011;364(14):1360-1366.
  11. Lederman E. The myth of core stability. Journal of Bodywork and Movement Therapies. 2010;14:84-98.
  12. MacDonald DA, Moseley GL, Hodges PW. The lumbar multifidus: does the evidence support clinical beliefs? Man Ther. 2006;11(4):254-263.
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Kangan Water

Kangen is Japanese for "return to the origin" of healthy living water found in places like Lourdes, France; Nordenau, Germany; Tlacote, Mexico Delhi, India and other natural and healthy spring waters around the planet. That is what Kangen Water® does - return the body back to its original "alkaline" state. Kangan Water® produces a strong negative Oxidation Reduction Potentional (ORP). The stronger the negative value of ORP (measured in milliVolts) the better the water is in reducing oxidation, which is the cause of the aging process.

Alkaline drinking water is water that has a greater number of oxygen ions, increasing its pH. Drinking it can increase stamina, reduce aging, and prevent cancer, among other benefits, because the higher number of hydroxyl ions in Kangen water helps to neutralize the acidic hydrogen ions. Kangan Water not only eliminates the cause of aging, it has plenty of other health benefits, as well.

What liquids do you consume? Are they contributing to sickness and disease or health and vitality? ‪#‎alkaline‬ ‪#‎Kangen‬ ‪#‎health‬

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