Return to Work Clinical Practice Guidelines

By: Dr. Laura Wenger, PT, OCS, FAAOMPT

In conducting evidence-based practice, there are three main things that physical therapists rely on to help make the best decisions for how to treat their patient: the patient’s preference, the experience of the practitioner, and the research that is available. Focusing on the research aspect, we rely heavily on high-quality peer-reviewed resources and journals to gather our information. This information gathering is a continual process that is going on behind-the-scenes when we are not working face to face with our patients. One such resource that we use is the Journal of Orthopaedic & Sports Physical Therapy (JOSPT), which provides us with monthly access to new research on a variety of topics within the orthopaedic and sports world of PT. This journal also publishes Clinical Practice Guidelines, which provide an evidence-based overview of specific topics.

Dr. Christine Richards, PT, OCS

Over the past few years, one of our very own PTs, Dr. Christine Richards, PT, OCS, has been working diligently with a group of PTs to author a Clinical Practice Guideline that was just published this summer in JOSPT, titled “Clinical Guidance to Optimize Work Participation after Injury or Illness: The Role of Physical Therapists.”(1) This guideline provides a summary of recommendations for best practice when it comes to physical therapists’ treatment of patients who have been involved in work-related injuries or illness, which is something we see often in the clinic. These recommendations covered all aspects of patient care, including timing and duration of care, evaluation, treatment involving multiple factors, ergonomic assessment and recommendations, and psychologically informed practice.(1) As with every patient that walks in our clinic, we want to use the most well-rounded approach to help workers either stay in their job or return to work after any illness or injury, and this guideline provides an excellent synopsis of the research on this topic over the past 20 years.(1) We are so proud of Christine for her hard work on this valuable project!

1. Daley D, Payne LP, Galper J, et al. Clinical Guidance to Optimize Work Participation after Injury or Illness: The Role of Physical Therapists. J Orthop Sports Phys Ther. 2021; 51(8):CPG1-CPG102. doi:10.2519/jospt.2021.0303.

Strength Training for Low Back Pain in Older Adults

By: Dr. Laura Wenger, PT, OCS, FAAOMPT

To follow up on my blog post from June regarding the importance of strength training, I’ve got another recent research review coming ‘atcha! A group of physical therapists in Spain performed a systematic review- a high quality approach to review multiple research studies- specifically looking at the effectiveness of resistance training programs to help treat older adults (60+) with chronic low back pain.1 Their search results yielded eight high quality research studies that were analyzed to describe the main characteristics of the strength programs used, so that us clinicians can glean the information in order to help us design more effective resistance exercise programs to help our patients over the age of 60 with low back pain that may be affecting their quality of life.1

Ellen taking her shot at perfecting bench press technique

 

Nathan laying down the knowledge on tips and tricks for the bench press

 

Me, working on perfecting my form with Nathan’s guidance

Ultimately, the researchers found that there were a variety of methods used in the strength programs across each of these research studies, but that they all had a positive impact on the patients’ pain, disability, and quality of life.1 The researchers also discuss the reasons why progressive strength programs work: by improving your brain’s ability to connect to the muscles in your body, bone mineral density, muscle function, physical strength, and functional capacity.1 Furthermore, research indicates that strength training programs also help older adults with chronic low back pain see improvements in coordination, balance, and flexibility.1

The three fundamental aspects of strength training programs that was found during this research review include:1

  • Global training of the whole body with emphasis on the large muscle groups
  • Using a traditional periodized program which utilizes the concept of alternating load plans in successive workouts (such as performing 8-10 rep maxes during one workout and 12-15 rep maxes on the next)
  • A gradual increase in volume and intensity initially and further increases in intensity later on in the program

Ultimately, this systematic review provided a big vote for the inclusion of resistance training to help with the treatment of chronic low back pain in adults aged 60 and over.1 A physical therapist will help not only create a program for you but more importantly guide you through proper technique and progression within the context of your individual body’s needs in order to move toward the end result of decreased pain, improved function, and improved quality of life. If you’ve been dealing with chronic back pain and are ready to do something about it, don’t hesitate to reach out to our clinic to schedule an initial evaluation so we can guide you through an individualized plan to help you achieve your goals.

1. Fritz N, Gene-Morales J, Saez-Berlanga A, et al. Resistance training for chronic low back pain in the elderly: a systematic review. J Human Sport and Exercise. 2021;16(3proc):S1492-S1506.

Strength Training in Physical Therapy

By: Dr. Laura Wenger, PT, OCS, FAAOMPT

With the addition of Dr. Nathan Dailey, PT, OCS, CSCS to our team last fall came his strong drive to utilize more strength training within our physical therapy treatment due to his specific background and knowledge as a Certified Strength and Conditioning Specialist. Lucky for Nathan (and all of us!), the remodel that was completed last year provided the perfect space to install a strength training area so that we can meet the needs of our patients. Since the installation of this equipment a few months ago, Nathan has been educating the rest of our team on technique and utilization of strength training within the context of physical therapy.

As it turns out in my investigations of literature, so many of the common issues we see can benefit from the addition of strength training in order to maximize rehabilitation effect. While we have always utilized strength training in other forms in our exercise prescription up to this point- using body weight, bands, and lighter weights- we are now able to further maximize these positive effects using the new strength equipment. For example, take a peek at this recent infographic from the British Journal of Sports Medicine outlining the research that supports strength training for improving running performance.

Infographic from British Journal of Sports Medicine

Regardless of the issue that’s bringing you to physical therapy, make sure to ask your physical therapist about how strength training can be an adjunct to your treatment in helping you move better, feel better, and be stronger and healthier in your life.

Resilience

By: Dr. Laura Wenger, PT, OCS, FAAOMPT

Resilience: The capacity to recover quickly from difficulties; toughness.

With the whirlwind of the past year during a worldwide pandemic, resilience is a word that comes to my mind often. I’ve witnessed resilience on so many levels in this past year: in our families, our community, our nation, the world, and within our clinic. The challenges of this past year have brought stress and difficulties to all of our lives, but our ability to maintain consistent relationships with our patients and help you all move better, feel better, and live better has been a bright light and source of inspiration to keep going strong.

Recently, our entire team had the opportunity to celebrate our resilience through the pandemic by participating in a guided three day mountain biking trip on the White Rim in Canyonlands National Park. Not only did we get to reflect on our ability to maintain and build our team in the past year, but we also had new opportunities to demonstrate our resilience through the activities of the trip itself. While some of us are seasoned mountain bikers, others of us are not, and there were good mental and physical challenges abound while navigating the gorgeous desert terrain. Whether it was staring up at the inclined road as it wound up from a low point, knowing we would need to make it to the top to eat our well-deserved lunch, or jumping over a two foot crack in the rim rock knowing that there was an 80 foot drop below, only to be able to stare in awe at the majestic view of the Green River bending and weaving through the canyon floor below us when you made it to the ledge, the challenges we faced led us to more strength and resolve knowing that we could do hard things and yet keep going to wherever we needed to next.

Looking up at the steep climb, knowing lunch is at the top!

The views making it worthwhile!

And, really, this is the greatest metaphor for physical therapy and life in general: facing challenges head on, whether they are mental or physical (or, more often than not, both), and doing what needs to be done to get to the next phase of the journey of recovery. The members of our team feel so lucky to be your guides along the way. Sometimes there is a delicious meal, or the comfort of camp, at the end of the challenge. Sometimes there is the excitement of meeting a milestone or goal that you have set for yourself. But, there is always power in the knowledge that you can do hard things, and that you have support along the way.

Integrating Pilates Exercises into Physical Therapy

By: Dr. Laura Wenger, PT, OCS, FAAOMPT

During this tumultuous past year, our clinic was fortunate enough to be able to go through with a planned remodel that included opening up our gym space (perfect timing in a world of physical distancing!) and updating our flooring. Along with updating our physical space, we have been able to update some of our equipment, as well! For those of you who have been patients of Tomsic PT in the past, you may have fond memories of the Shuttle machine. Now, in its place, we have a versatile clinical model of the Balanced Body Pilates Reformer, which has given us more ability to integrate Pilates exercises in our rehabilitation programs for many of our patients.

First, I’d like to explain a bit about what Pilates is. Names after its founder, Joseph Pilates, the exercise system created in the early 1900s is based on principles of core stability and strength through movement.(1) These exercises are performed on a spring-loaded machine, called a reformer, and there are also mat exercises that can be performed with no equipment necessary. Over the years, Pilates has evolved with many experts across the country teaching in Pilates studios, such as at one of the many esteemed studios that we have in our small town, as well as physical therapists and other health professionals integrating these exercises into the treatment of musculoskeletal problems from head to toe.

Christine teaching Jake the “Cleopatra” move for spine mobility
Nathan working on his spine mobility with guidance by Christine

We are lucky here to have the guidance of one of our PTs, Christine, to share her knowledge of a wide variety of reformer exercises that she has learned through her previous training. We were able to take some time in early January to have a few intensive skills sessions within our group to learn and practice these exercises. As we’ve been integrating various exercises on the reformer into our patient care, our patients have been seeing great results with more mobility, more strength, more function, and less pain. These results are in line with research articles that demonstrate the positive effect of using Pilates exercises as a rehabilitation tool for reducing pain and disability, such as the 2018 systematic review by Byrnes et al.(2)

Nathan cuing me on trunk stability during resisted arm exercises
Ellen giving Nathan feedback on his form during resisted leg exercises for core stability

We are excited to continue to learn more about the use of the reformer as an effective part of a rehabilitation program as we continue to explore its use on ourselves and our patients. If you are curious about how Pilates exercises can be integrated into physical therapy for a musculoskeletal injury or post-operative care, make sure to contact our office to discuss this with one of our therapists!

1. Balanced Body. Origins. https://www.pilates.com/pilates/origins. 2018. Accessed Feb 9, 2021.
2. Byrnes K, We PJ, Whillier S. Is Pilates an effective rehabilitation tool? A systematic review. J Bodywork & Movement Therapies. 2018;22(1):192-202.

Staff Spotlight: Dr. Nathan Dailey, PT, OCS, CSCS

We have another relatively new staff member that we would love to have you know better here at Tomsic PT! In October of 2020, we welcomed Dr. Nathan Dailey onto our staff just days after he finished his service with the US Army.

– How did you end up in Durango and where did you live previously?
My wife was fortunate enough to get a tenure-track professor position in Marketing at FLC early in FEB 2020 before this COVID craziness began. I was nearing the end of my contract w/ the Army and was excited to move out here with her and our 4-year-old son. My wife was coming from a professor position at the University of Texas at San Antonio (UTSA) and I was finishing an assignment at Fort Sill, OK (one of 4 basic training posts for the Army in the US). We are so happy to now call Durango home and to have our son grow up where there’s snow!

Nathan and his son at Mount Scott outside of Lawton, Oklahoma

– What do you love about working in Durango/at Tomsic?
One of the first things I noticed after only a few days of working here is how incredibly fit so many of the Durango residents are into their later years. So often we see the poor health outcomes associated with inactivity and Durango is an incredible little microcosm, a testament to how powerful remaining active is. I love treating patients who tell me that they ABSOLUTELY MUST return to skiing, hiking 14’ers, mountain biking and playing 2+ hour games of pickle ball.

Regarding the staff, I have been overjoyed to find that not one of them is unkind, mean-spirited or attempts to undermine me or the other members of the team; this was definitely not the case with some of my previous jobs and it makes going to work every day a pleasure.

– What are your special interests in PT and how do you incorporate them into your clinical time at Tomsic?
Anyone who talks to me for more than five seconds will realize that I am incredibly passionate about incorporating traditional elements of strength training into my clinical practice. I love not just incorporating the loaded movements themselves, but geeking out about such minutiae as load progression, volume manipulation and periodization. As most of the patients who come to see me have athletic goals (return to hiking every week for at least 9 miles per hike, be able to run across Zion National Monument in a single day, return to swing dancing), marrying these patients’ rehab w/ sport performance makes sense to me. This is something I did nearly every day while in the military and I am incredibly excited to bring this treatment style to the Durango community.

Nathan deadlifting 500lb at Fort Sill, Oklahoma in 2020

– What’s one fun fact about yourself that you’d like to share?
I am incredibly afraid of heights, but that didn’t stop me from jumping out of a perfectly good airplane (skydiving) in the spring of 2014 w/ my wife or sitting in the hurricane seat (near the window facing the wind) on several Black Hawk flights in Iraq. I continue to try to face my fears.

– Anything else that you’d like to highlight, feel free to share!
I am passionate about reducing the risk of injury to athletes (tactical or civilian) through careful manipulation of training load and slow introduction of resistance training. I have a white board and plenty of dry erase markers and am all too happy to share the insights I’ve learned!

Nathan, we are so happy to have you on our team!

Staff Spotlight: Dr. Christine Richards, PT, OCS

We here at Tomsic PT have had the pleasure of having Dr. Christine Richards, PT, OCS join our team in July of 2020. She brings with her a lot of knowledge, skill, and passion for seeing people get better and achieve their goals! See below to learn a bit more about Christine and why she is a great asset to our clinic:

– How did you end up in Durango and where did you live previously?
My husband Tom and I were living and working in Telluride for the past three years. Before that we had spent many years working seasonally, going between Alaska in the summers and various ski towns in the winters. Though some of the most beautiful places in the country, resort towns always left something lacking, and we were looking for a year-round community that was (relatively) affordable but still had a vibrant outdoorsy element to it. We visited Durango a number of times while living in Telluride, and we knew we would make the move someday. A job opening at Tomsic PT was just the right catalyst to do it!

Christine with her husband, Tom, and dog, Choyu, on some formations in the backcountry in Utah

– What do you love about working in Durango/at Tomsic?
I love Durango’s location, with close proximity to both the mountains and the desert, and plenty of ways to get out into quiet, expansive nature without going far. I enjoy the people I’ve met so far and look forward to getting involved in a variety of community activities once it’s safe to do so again. As for Tomsic PT, I feel very fortunate to be a part of this team. I love the collaborative nature of the group, with every person playing a vital and defined role in the workings of the clinic, and every opinion and person valued. The focus on education and growth is also a huge draw for me; the opportunity to be a mentor to physical therapy students, while at the same time receiving mentoring from experts in our field, is invaluable and a lot of fun!

– What are your special interests in PT and how do you incorporate them into your clinical time at Tomsic?
One of my primary interests in PT is manual therapy. I have a background of 10 years as a massage therapist before becoming a PT, and I have always felt an affinity for working with my hands through therapeutic touch. Furthermore, manual therapy in combination with exercise is consistently supported in our professional literature as producing good outcomes for various conditions in orthopedic physical therapy, and I am interested above all in producing good outcomes for my patients! I am actively pursuing further education in this area and the clinical reasoning directed toward its most effective use, and I utilize these techniques in the clinic whenever appropriate. My other special interests include chronic pain and pain neuroscience, reducing fall risk in seniors, yoga, and mindfulness.

– What’s one fun fact about yourself that you’d like to share?
Ever since childhood, I have been a singer, and that was my first profession. Massage therapy was just supposed to be a day job while I was trying to “make it”, but I’m glad life took me in a different direction! These days (or at least in non-COVID times), my husband and I enjoy singing in community choirs and for other small events. We look forward to getting involved in the music scene in Durango when it is safe to do so.

Christine on a ridge in Denali National Park, Alaska

We are so happy to have you here, Christine!

What We Learned During Our 14-Day Quarantine- Telehealth in PT

By: Dr. Laura Wenger, PT, OCS, FAAOMPT

Recently in November, our entire clinic staff voluntarily quarantined after we ultimately had three staff members test positive for COVID-19. This decision was made after extensive discussions with San Juan Basin Public Health staff and within our clinical staff, as we all felt that it was the right thing to do in order to best protect our patients and ourselves. While, thankfully, the majority of us continued to stay healthy while we were isolated in our homes (and the employees who were positive for COVID-19 all had full, swift recoveries) and no patients were found to have exposure from our staff cases, we were forced to pivot to utilizing telehealth for our current patients in order to keep them moving with their rehab. Although we have been providing telehealth visits since the beginning of this pandemic nine months ago, it was a big pivot for our clinicians to go from providing sporadic telehealth visits 1-2 times per week to providing multiple telehealth visits per day. 

With this swift change to telehealth came a quick adaptation to continuing to provide quality PT through a computer screen. While the manual therapy component of physical therapy can’t be performed through a screen, we continued to empower patients in self-mobilization techniques so that they could still benefit from the positive effects of imparting mobility on specific joints. The real winners of telehealth proved to be exercise and movement therapy, where we were able to continue our guided progression of movement and resistance training for each of our patients within the context of their injury. And, though I talk about these visits in past-tense, our work continues via telehealth as many of our patients decided to stay in that format because they still felt the positive effects of physical therapy from the convenience and safety of their homes. 

During our quarantine in November, I was providing telehealth from home with my assistant off-screen in the background!

To be completely honest, as a provider who is trained in manual therapy (i.e. a lot of “hands on” work), I was skeptical about my own ability to provide physical therapy through a computer screen at the same quality as an in-person visit. I’ve been pleasantly surprised, as have my colleagues, at our ability to continue to help our patients via telehealth at the same level of excellence that we strive to deliver each day in the clinic. 

We are again operating full-time in the clinic, with continued rigorous screening and mask policies for our patients and staff, as well as continued diligence in physical distancing within our clinic. That being said, we are also continuing to serve a portion of our current patients via telehealth as well as accepting new patients in the telehealth format so that we can ensure that our patients, both new and established, can work toward meeting their goals of moving better with less pain. If you are interested in how physical therapy can help you via telehealth during this time, please call us at (970) 259-0574 for more information and to set up an appointment with one of our specialized physical therapists! 

What is the NEUBIE?

For those of you who have been around in the clinic recently, you may have observed (or been part of yourself!) a treatment session where a patient is doing exercises and movements while hooked up to a machine via electrodes. Just this past March (right before the COVID-19 shelter-in-place requirements began), Ellen was able to go to Florida to be trained on a machine that uses a new version of an old technology, direct current electrical stimulation, called the NEUBIE. You may be wondering what NEUBIE stands for: Neuro Biological Electrical Stimulation. Ellen became intrigued in bringing this technology into our clinic after learning more about it at a national conference in January of this year.

The timing was not ideal, as Ellen could not have anticipated that there would be a dramatic drop in patients as folks stayed home in those initial months of the global pandemic. However, with the few patients that remained coming into the clinic in a safe manner for their high-priority rehabilitation (which consisted of a majority of people who had just had surgery before the shelter-in-place requirements began), Ellen and the other therapists began working with the NEUBIE machine and seeing the prospective benefit of this piece of equipment as an integral part of getting many of our patients to meet their goals. Once I returned back to the clinic in late April, I was also introduced to the NEUBIE machine and began learning about it’s practical uses.

Now, I’m not going to lie, I’m a bit of a skeptic by nature when it comes to “gadgets” that are supposed to enhance physical therapy. As a PT that has been trained in the specialty of manual therapy, I have a hard time thinking that our patients would need anything beyond my hands and my brain (to come up with beneficial exercises and activity progressions) to improve toward reaching their goals. However, although my uptake was slow in utilizing this technology within my patient care, I have been finding an outstanding benefit for many patients when I have used the NEUBIE machine to enhance their current exercise program. I’m not going to lie, I have been surprised to hear from many of our patients, especially those with chronic pain, how beneficial they have felt this addition to be by impacting their pain and quality of life in a positive way.

Though clinical research with this device is still in its infancy due to its relative novelty in use, we have seen many anecdotal cases of our patients in real-time benefit from the use of the NEUBIE as part of their rehab program. In order to understand a little more about how the the technology works to address the nervous system and aide in the brain to muscle connection that we often speak so fondly of when prescribing exercises, I think this video does the best job at explaining the basics:

As one of only three clinics in Colorado that have this technology available (with the other two located on the Front Range), we’d love to have you come in and learn more about how the NEUBIE can enhance your return to everything you love with better mobility, less pain, and improved quality. With an individualized approach to examination and coming up with a treatment plan and progression, we can discuss if the NEUBIE might be a good fit for your rehabilitation plan!

COVID-19 Recovery and Exercise

With the continuing threat of COVID-19 world-wide, it seems as if new information is coming out nearly daily. From trying to understand how the virus is transmitted to who is more susceptible to getting the virus and having serious health impacts from it (and everything in between), we are working our hardest to stay up-to-date with the latest information about COVID-19 and how it impacts ourselves, our patients, and the clinic. As we continue to remain open through the pandemic, we continue to use screening and cleaning techniques along with proper hygiene (friendly reminder- face masks required!) from our staff and within the patients as ways to stay safe and healthy during this time.

That being said, it is clear that this virus will be sticking around for a while and many questions will continue to arise as more people in our community are affected by COVID-19. In the physical therapy realm, one of the questions of interest to us is “when is it safe to start exercising again after recovering from COVID-19?”. This question was recently discussed in the open-access article “Exercise and Athletics in the COVID-19 Pandemic Era” on the American College of Cardiology’s website.(1)

COVID-19 Virus in Durango CO | Tomsic Physical Therapy

The article provides an interesting discussion, from the perspective of cardiologists, regarding COVID-19’s effects on the heart, the inflammatory-reducing effects of exercise, and what the recommendations are for returning to exercise and sport after recovering from COVID-19.(1) Knowing that, based on early data and observations, “COVID-19 infected patients with hypertension, diabetes, cerebrovascular or cardiovascular disease are more likely to require hospitalization, ICU level care, and die from the infection,” these pre-existing conditions must be taken into account when considering a return to exercise after being infected.(1) Ultimately, the current recommendations from the authors were as follows:

  • “… the recreational exerciser seeking to resume activity for general physical fitness after COVID-19 who experienced only mild to moderate symptoms, were not hospitalized, and had no concerning cardiac symptoms should be able to resume recreational exercise at moderate intensity once completely recovered.”(1)
  • “However, patients with pre-existing cardiac disease who are potentially at higher risk of complications with COVID-19 may require additional testing and risk assessment prior to return to regular exercise levels.”(1)
  • Based on two recently published statements quoted by the authors, it is suggested that athletes who tested positive for COVID-19 who were either asymptomatic or had mild symptoms and were not hospitalized take a rest period of 2 weeks from either the time of the positive test for asymptomatic individuals or from the time of symptom resolution for those people who had symptoms before considering return to exercise in a slow, progressive manner with guidance by their doctor.
  • Furthermore, for athletes who tested positive for COVID-19 who had significant symptoms and were hospitalized, a recovery period of at least two weeks after symptom resolution followed by further cardiac assessment and monitoring is recommended. Those with known myocardial injury need to wait 3-6 months before re-evaluation by a cardiologist before considering a return to exercise.

The authors of this article are quick to point out that this information is based on expert opinion, due to the fact that there are no higher level research studies performed on this topic because of the novelty of this virus. However, their concern for the impact of COVID-19 on the heart came through in their recommendations. Ultimately, if you have tested positive for COVID-19 (regardless of whether you were asymptomatic or had such significant symptoms that you were hospitalized), you should make sure to discuss how to safely return to exercise with your healthcare time. As information is quickly evolving, these recommendations may change as further research can be performed and observations are made, but the bottom line for now is that you should REST for at least a two week period regardless of how severely you felt impacted by the virus. Stay safe, stay healthy, wash your hands, and wear your mask!

  1. Emery MS, Phelan DMJ, Martinez MW. Exercise and Athletics in the COVID-19 Pandemic Era. https://www.acc.org/latest-in-cardiology/articles/2020/05/13/12/53/exercise-and-athletics-in-the-covid-19-pandemic-era.