This month, the Center for Disease Control (CDC) released their latest recommendation for use of opioids, commonly known as prescription pain medications, based on an extensive review of research and current practice in the United States. The recommendation is a very powerful one that any prescribing medical doctor, physician assistant, or nurse practitioner in the United States will be likely paying a lot of attention to when helping to treat patients with chronic pain. Physical therapists, alike, are turning their attention to this recommendation due to the fact that we often see many patients with chronic pain that are using these medications. Although this recommendation was geared to the medical community, it is very important as a patient to understand the position of the CDC in order to help with your condition and decisions on whether or not to take prescription opioids.

I want to include this statement from the CDC guidelines and then break it down so we can better understand what it means. “Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate.”¹

Nonpharmacologic therapy: This includes such things as physical therapy, behavioral therapy, and weight loss.¹

Nonopioid pharmacalogic therapy: tylenol, NSAIDs (such as ibuprofen and naprosyn), and other prescription and over the counter medication that does not include opioids.¹

Using the definitions above, the main point of the above CDC statement is that physical therapy and other nonopioid therapies are recommended above using opioid drugs. The only time that opioids may be useful are if the benefits may outweigh the risks to the patient, such as overdose with potential death, tolerance and loss of effectiveness.¹ The risks are even higher for people with sleep apnea, liver disease, mental health conditions, alcohol or drug dependency disorders, or pregnant women.¹ Due to the fact that research has repeatedly shown that physical therapy can significantly help with hip and knee osteoarthrtis pain, low back pain, fibromyalgia, and other chronic pain conditions, the CDC is strongly advising that patients are given the option of exercise-based physical therapy first before being prescribed opioids to manage their pain.1 The last sentence of the statement above reinforces the use of physical therapy alongside the use of prescription pain medication if they must be used, due to the positive effects of physical therapy treatment shown in research.¹

So, what’s the take home message? If you are experiencing pain and are having a discussion with your prescribing practitioner regarding pain medication, make sure that they have read and understand the recent CDC recommendations. If they don’t bring up physical therapy, be an advocate for yourself and ask if they think it would be helpful in your situation, because the research points to the answer being “yes!”.¹ If you are currently taking opioid medication, please talk to you prescribing practitioner about strategies for managing your medication use. Make sure that you call us to schedule an appointment to speak with a physical therapist regarding your chronic pain.

1. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65:1–49. DOI: https://dx.doi.org/10.15585/mmwr.rr6501e1.

There is a new word that we are seeing more and more on a doctor’s prescriptions when patients come in for their first evaluation with us: prehabilitation. Basically, people are being advised to begin physical therapy before their impending surgeries in an effort to make sure that the patient is as prepared as possible before going under the knife. This preparedness involves knowing what their post-operative precautions will be, getting their range of motion and strength as good as possible before the surgery, and being more psychologically prepared for how they might feel after surgery. Recent studies have shown that the effects of prehabilitation are not only going to decrease medical costs by up to 29% following a surgery, but that they are also going to increase the patient’s quality of life.^1,2

One of the few things that we dislike as a physical therapists is seeing people in excruciating pain after they have undergone surgery, especially if they weren’t expecting that amount of discomfort. Being able to educate our patients about expectations after surgery well before they head into the operating room not only makes our jobs easier in the long run, but also helps to mentally prepare our patients for what they might feel so that they are not in shock during the week or two after surgery when they resume PT. As we often have to tell patients, surgery is “trauma” for the body, although the outcome is usually better than their pre-surgery level and well-worth it. Unfortunately, however, it is rarely a quick fix and being prepared for the recovery process is integral to feeling as good as possible afterward. We have seen the positive effects of prehabilitation first-hand with our patients and it is exciting to know that there is continuing evidence to support it for cost-saving and, more importantly, patient recovery and satisfaction.^1,2

Coming in to see a specialized physical therapist for prehabilitation before surgery does not always require a physician referral, so don’t hesitate to call us to find out what your pre-operative visit would require and schedule an evaluation appointment.

There is good news out of the United Kingdom for all of those walkers and fitness enthusiasts out there! A recent 10-year study that looked at 324 healthy female twins from the UK found a positive link between higher fitness, specifically of the legs, and a decreased rate of aging in the brain.¹

The researchers were looking specifically at something called leg explosive power, or LEP, to measure the fitness levels of the participants legs.¹ For those readers out there who aren’t physics nerds like me, power takes two measurements into account: force, how much a person can push, and velocity, how fast a person can push. To measure cognitive ability, the researchers put the participants through standardized thinking, learning, and memory tests.¹ Also, there were twenty pairs of twins that underwent magnetic resonance imaging (MRIs) so that the researchers could actually see their brains and look at different areas of the brain for signs of aging.¹

A special thing to note about this study is the benefit of using twins, which meant that the researchers could control for genetic factors and early development factors that may confound cognitive function later in life.¹ Most research studies do not have this benefit, which makes the results of this study more powerful.

The researchers basically found that, of the twin pairs studied, the twin that had more leg power at the start of the study maintained their cognition better and had fewer brain changes that displayed aging on an MRI after 10 years.¹ This study suggests that treatment biased toward improving leg power may be beneficial for your brain health.¹ So, the next time you are sweating and wondering why we are making you focus so much on your form during your squats, remind yourself that you are attempting to keep your brain healthy and strong! If you have any questions regarding this research or you want to speak to a physical therapist about a safe way to improve your leg power, call us to schedule an appointment with one of our specialized PTs today.

1. Steves CJ, Mehta MM, Jackson SHD, Spector TD. Kicking Back Cognitive Ageing: Leg Power Predicts Cognitive Ageing after Ten Years in Older Female Twins. Gerontology Online Publication DOI: 10.1159/000441029. 2015: 1-12.

Did you know that seeing a physical therapist first, before any other healthcare provider, to treat your low back pain can actually save you money over the course of a year?^1,2 One of the professors from my Doctorate of Physical Therapy alma mater, Dr. Julie Fritz, PT, PhD, FAPTA, has recently spearheaded a piece of research that advocates for seeing a physical therapist in regards to low back pain. She and two other researchers focused their efforts on looking at privately insured individuals that had low back pain and, more specifically, how the effect of the first-seen provider for their problem affected the healthcare costs and procedures over the following year.^1,2 They studied the insurance claims of approximately 750 patients who sought out medical care from a whole host of providers for their low back pain, such as primary care providers, chiropractors, an emergency department, physiatrists, other specialists such as rheumatologists, and physical therapists.^1,2 As you can tell by that list of various providers, there are many different routes that are taken to get appropriate healthcare if you are having an episode of low back pain, and many people are often confused as to whom would be the best person to see first in this case. The researchers hoped to gain information from this study in order to help guide and streamline the process of what provider to see first when you have low back pain in order to get better faster by way of having less procedures and spending less money overall.^1,2

The results of the study showed that seeing a physical therapist first paid off in the long run.^1,2 The patients who accessed physical therapy directly in the case of their low back pain ended up having fewer x-rays and MRIs, fewer emergency room visits, fewer spinal injections, and fewer surgeries compared to those patients who sought care from a different provider initially.^1,2 When looking at overall costs over a year associated with treating low back pain, patients who consulted a PT first had the second lowest costs, only just behind those patients who consulted a chiropractor for their initial care.^1,2 Overall, the costs for the year were significantly lower than those of patients who ended up seeing a physiatrist first.^1,2 This isn’t to say that it wouldn’t be helpful at all to see a physiatrist or other specialist when dealing with low back pain, but if you see a physical therapist first they will be more likely to help conservatively via evidenced-based care and manual treatment, and will be able to send you in the direction of a specialist if warranted. This is especially important to know and get the word out about, considering that in this study only 6.4% of the patients studied were those who went directly to a physical therapist to start improving their low back pain.^1,2

So, what’s the take home message here? If you have low back pain, it will save you more money and you will undergo fewer procedures, such as imaging and injections, if you go directly to a physical therapist for treatment versus another provider.^1,2

For your physical therapy needs regarding low back pain or any other pain you may be dealing with, call us today to schedule an initial evaluation with a physical therapist. Not sure if you will benefit from PT? You can also call to schedule a free, 15-minute injury screen to learn more about your options.

1. American Physical Therapy Association. Study: Seeing a PT First for LBP Decreases 1-Year Utilization Rates Among Privately Insured. PT in Motion. https://www.apta.org/PTinMotion/News/2015/10/13/LBPPTFirst/ . October 13, 2015. Accessed November 1, 2015.
2. Fritz, JM. Kim J. Dorius J. Importance of the type of provider seen to begin health care for a new episode low back pain: associations with future utilizations and costs. J Eval Clin Pract. 2015 Sept 29.

Walking is one of the easiest and most accessible fitness activities that you can do. For people who have joint pain, general weakness, or other issues, walking is also oftentimes one of the more tolerable fitness activities. Well, there is good news for all you walkers out there! A recent research group out of Ohio State University has found that simply varying your walking speed is a surefire way to make sure you are getting an increased calorie burn.¹ More specifically, the researchers found that “changing your pace could burn up to 20 percent more calories than maintaining a steady stride.”¹ This easy adjustment to your walking program is especially important if walking is your main form of activity and, even more so if you are using it to help with weight loss or maintenance.

The main idea behind the results of this study is that you are affecting your energy systems to burn more calories when you are stopping and starting, or varying your speed, as we more naturally tend to do on a daily basis when going about our daily activities.¹ It is assumed that your legs and body have to work harder when having to adapt to various speeds.¹ So, if you are looking for a way to get more out of your walking program, see if you can think about varying the speed and movements that you use during your recommended 30 minutes of exercise per day in order to increase the amount of calories burned.¹

To learn more about this, please call us to schedule an initial evaluation with one of our specialized physical therapists. Also, if you are unsure if physical therapy would be beneficial to you, please call us to schedule a free 15-minute injury screening to learn more about your condition and what you would benefit from.

1. Dallas M. For a Better Calorie Burn, Adjust Your Speed While Walking. Medline Plus. 13 Oct 2015. Available at https://www.nlm.nih.gov/medlineplus/news/fullstory_155127.html. Accessed 24 Oct 2015.

If you are anything like me, you have a favorite pair of running shoes that you throw on before heading out the door to go on a run. Personally, I have a pair of shoes that I stick with year after year because I have found that they work best for my body and my feet after some trial and error with other brands and styles. Shoes are a big deal for most runners, and there is often a lot of debate on which shoe is the best, depending on your foot posture and running style. Regardless of which type of shoe you tend to use, another question up for debate is whether or not you should be using multiple pairs of shoes that you alternate between for runs and whether or not that decreases your risk of injury as a runner. A recent research group in Europe performed a study to attempt to answer that question.¹

It has been shown that overuse injuries are the most common type of injury sustained in runners and that anywhere from 27-70% of runners, both recreational and competitive, may sustain an overuse injury over the period of one year.¹ I see more and more patients, especially in the super active town of Durango, come in with various leg, pelvis, or low back injuries that are aggravated by or were initially caused by running. The group of researchers in Luxembourg hypothesized that, because various previous studies have shown the effects of footwear on running patterns, a regular change in the pair of shoes that you use may cause variation in the stresses placed on your body, thus decreasing overuse injuries.¹ They also hypothesized that runners who actively participated in other sports would be less likely to sustain injuries due to the fact that they were varying the stresses placed on their body.¹

In order to help determine whether or not their hypotheses were correct, the group kept track of approximately 260 amateur runners over the course of 22 weeks.¹ The runners were asked to report their training activity, the types of shoes that they wore, and whether or not they sustained any injuries.¹ A runner was considered a “multiple shoe user” in this study if they reported a minimum of two different pairs of shoes that they alternated at least two times over the 22 weeks that they were reporting their information.¹ A little over half of the total runners in this study ended up being multiple shoe users.¹ What the researchers found in the long run was that the runners who alternated between multiple pairs of shoes during their training period ended up having a 39% lower risk of injuring themselves as compared to those who used the same pair of shoes for the entire 22 weeks.¹ This was just one study and more research would be warranted to explore this further in the future. However, it is information that would make me consider having another pair of running shoes actively ready to swap out with my normal shoes in order to potentially vary the stresses on my body and lower my risk of injury. If you want to pick a PT’s brain about this further and learn more about how to fine-tune your training and body in order to prevent running injuries, contact our clinic to schedule and evaluation today.

1. Malisoux L, Ramesh J, Mann R, Seil R, Urhausen A, Theisen D. Can parallel use of different running shoes decrease running-related injury risk? Scand J Med Sci Sports. 2015;25:110-115.

With recent efforts to curb childhood obesity, organized school sports have quickly become a popular way to encourage children to be more fit. Each year in the United States, over 38 million children participate in sports.¹ Unfortunately, about one-third of these children will sustain an injury that is serious enough to sideline them from practice or games.¹ One of the biggest questions in the world of physical therapy centers around how we can help children prevent these injuries. This is with the intention of encouraging children to continue enjoying their time participating in sports; not only to improve their fitness levels, but also to build their engagement with others in their community and facilitate learning through the problem-solving that sports participation often requires.

The organization Safe Kids Worldwide performed a comprehensive survey of children, coaches, and parents to learn more about the current culture of children’s sports injuries.² In this survey of 1,000 athletes, 1,005 coaches, and 1,000 parents, they found that 1 in 4 athletes and coaches were not actively doing anything to prevent injuries.² This is alarming, considering that being proactive is key when it comes to preventing sports injuries.²

If you are a parent, a coach, or an athlete that has a few minutes to spare, the survey can be accessed here.² Knowledge is power when it comes to learning how to prevent sports-related injuries in children. As physical therapists, we do our best to acknowledge preventative measures when we see patients before their injury occurs, although we unfortunately don’t often get the chance to see them until it’s too late. Don’t hesitate to reach out to a physical therapist preventatively to learn more about conditioning, strength, and flexibility programs to move one step in the right direction toward thwarting any injury that will keep you or a child you know on the sidelines.

1. Safe Kids Worldwide. We Work to Prevent Sports Injuries. 2015. Available at https://www.safekids.org/we-work-prevent-sports-injuries, Accessed August 12 2015.
2. Safe Kids Worldwide. Changing the Culture of Youth Sports. 2015. Available at https://www.safekids.org/sites/default/files/documents/ResearchReports/skw_sports_study_2014_8-11-14.pdf, Accessed August 12, 2015.

As important as it is to get outside and exercise on a regular basis, this can prove challenging in the heat of the summer; especially if you are unable to get out in the early morning or late evenings when the temperatures are cooler. There has been a lot of buzz in recent years about sodium supplementation and its effects on replacing minerals lost in sweat during workouts, but one topic that has been less clear is how sodium supplementation affects thermoregulation. ¹ Thermoregulation is your body’s ability to maintain its core internal temperature.² When exercising in hotter weather, not only does your body have to work harder to keep up with the activity level that you are participating in, but it has to work hard to regulate your body temperature so that you don’t overheat. Sweating is one of our body’s natural processes to help with regulating our temperature during exercise.¹

A recent study sought to further investigate the effects of sodium supplementation on thermoregulation in trained endurance athletes.¹ During each hour of exercise, endurance athletes typically sweat 1 to 1.5 liters of fluid, of which an average of 0.8 grams per liter is sodium.¹ Some past studies have shown conflicting results as to whether or not pre-exercise sodium supplementation affected the rate of sweat loss or rise of core body temperature, so the authors of this study decided to take a new twist to determine how during-exercise supplementation affected these body processes.¹ Specifically, the researchers hypothesized that the sodium supplementation would decrease the rate of sweat loss leading to adverse effects of increased perceived heat stress and increased time to exhaustion.¹

In this smaller study, 11 endurance runners and cyclists put each athlete through two tests: One where they were given a placebo tablet to use during exercise, and the other where they were given a sodium supplementation capsule.¹ These capsules, given to the athletes immediately prior to and at intervals throughout their workout, contained an amount intended to replace about half of the sodium lost during an average two-hour workout.¹ The athletes were also give a certain amount of water to ingest during the workout to ensure that they stayed adequately hydrated.¹ Before, during and after two hours of their respective exercise, the runners and cyclists were put through a series of tests in order to study their sweat rate, heart rate changes, thermal sensation (how warm they felt), perceived exertion (how hard they felt they were working), and their time to exhaustion with a time-trial test at the end of 2 hours of sustained exercise.¹

And what did these researchers find? Sweat rate, skin temperature, thermal sensation, rate of perceived exertion, heart rate, and time to exhaustion were no different between the placebo and sodium capsule trials.¹ Although this was a smaller study consisting of only 11 athletes and more research in this subject is warranted, the results of this study suggest that there may not be any clear benefit to loading up on sodium supplements during your summer activities in order to regulate your body temperature more effectively.¹ However, what is clear is that regardless of your favorite summer activities, proper hydration plays an important role in thermoregulation.¹ So don’t forget your water when you are out playing and enjoying these hot days!

1. Earhart EL, Weiss EP, Rahman R, Kelly PV. Effects of Oral Sodium Supplementation on Indices of Thermoregulation in Trained, Endurance Athletes. Journal of Sports Science and Medicine. 2015;14: 172-178
2. Holland, K. Thermoregulation. Healthline. 4 June 2013. Available at https://www.healthline.com/health/thermoregulation#Overview1, Accessed 17 July 2015.

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The public website for the American Physical Therapy Association, MoveForwardPT.com, recently published an article that is important for anybody with lumbar spinal stenosis to pay attention to.1 The article highlights a recently published randomized control trial (the gold standard of clinical trials) that compared function in patients two years after being randomized to either surgery or physical therapy treatment for their lumbar spinal stenosis related back pain.1,2 This study found significant results that are of benefit for anybody considering decompression surgery for their low back.

Lumbar spinal stenosis (LSS) is a condition in which the space where the nerves exit the spine becomes smaller, usually due to boney growths and other degenerative changes.2 The participants in the study, who had all been diagnosed with LSS and were aged 50 or older, were randomized to either undergo surgery or participate in 12 physical therapy visits at the frequency of twice per week for six weeks.2 After two years, the patients followed up with a survey regarding their overall function, and no significant difference was found between the two groups.2

This information is important because when one is deciding between surgery and physical therapy to deal with back pain due to LSS, surgery is proven to be more risky and costly.2 If there is equal success in functional improvements achieved by attending a regimen of physical therapy, the choice is obvious.1,2 If you have recently been diagnosed with spinal stenosis and want to find out more about how physical therapy can help improve your function, contact us to set up an appointment today.

1. Physical Therapy Equal to Surgery for Spinal Stenosis. Move Forward PT. May 2015. Available at: https://www.moveforwardpt.com/DidYouKnow/Detail.aspx?cid=457c02af-e7ca-4515-9d98-d51c9a5805d1#.VVyeDkYrYxd. Accessed May 20 2015.
2. Delitto A, Piva SR, Moore CG, et al. Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial.

Our Rakita Tomsic team was well-represented at the 12 Hours of Mesa Verde team race on May 9th. Our team included one of our rehab techs John, Ellen, and even Dave Rakita, who made an appearance out of retirement. Keep in mind this is despite the fact that the race only lasted about two hours due to inclement weather conditions! With the mud flowing and snow flying, Dave was the only one who managed to get a full lap in at the race before it was cancelled due to the weather and increasingly poor trail conditions. Poor Dave’s bike took the brunt of the ride with quite a bit of mud caked in by the end of the lap.

Unfortunately, this was just not the year for this bike race, with the wet spring that we have been experiencing! Hopefully the weather will hold out next year for this fun team race so that the Rakita Tomsic Physical Therapy team can fully participate. Until next year, 12 Hours of Mesa Verde!