Treating Pain Takes Teamwork

By now, most people have heard that there is a healthcare crisis in our country related to the use and abuse of opioids. I just read an interesting fact that the Center for Disease Control (CDC) states that, “although sales of opioids have quadrupled in the United States, there has not been an overall change in the amount of pain that Americans report”.(1) Although there is certainly a time and place for opioid medication, the chronic overuse of opioid prescription medications can lead to other health issues, the worst of which being death related to abuse or dependence of the medication which is certainly getting the most press these days.

Because of this epidemic, the CDC and other health task forces are working to find alternatives to opioids for the treatment of chronic pain (pain lasting greater than 2-3 months). Of course, physical therapy is included in this list of alternatives, as our main job is helping people improve their quality of life and function while reducing pain. In the CDC’s main review and guidelines on the prescription of opioids, they highlight that physical therapy- specifically exercise therapy- is an effective tool for reducing pain and improving function in patients with low back pain, knee pain, hip pain, and fibromyalgia.(2) Furthermore, therapy that combines exercise with psychologically-informed approaches is even more effective in the treatment of chronic pain than one approach alone.(2) These approaches are integral in physical therapy training, and we are able to refer out to other psychological providers in our community if your specific treatment plan would benefit from this addition to maximize the benefits you can see.

With physical therapists that are specially trained to help you understand why you hurt and what you can do about it- including helping you find ways to minimize stress and make action plans for changing behaviors that may be feeding into your pain- you can see great benefit in your life when you team up with a physical therapist. All of our PTs at Tomsic Physical Therapy have been trained to help individuals in all walks of life to move better, feel better, and live better using the power of knowledge, exercise, and movement. If you have been dealing with pain and aren’t sure what to do about it beyond taking medication, don’t hesitate to contact us to set up an appointment for an initial evaluation to discover what physical therapy can do for your life.

1. American Physical Therapy Association. Physical Therapy vs Opioids: When to Choose Physical Therapy for Pain Management. https://www.moveforwardpt.com/Resources/Detail/physical-therapy-vs-opioids-when-to-choose-physica. Accessed August 10, 2018.

2. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49. DOI: https://dx.doi.org/10.15585/mmwr.rr6501e1

The “Fourth Trimester” and Physical Therapy

By: Dr. Laura Wenger, PT, OCS

The old adage, “Happy Mom equals Happy Baby”, is one stated often to new moms but, frankly, can be difficult to implement. With the physical and emotional changes that occur after giving birth, moms can often have a hard time being “happy” in their sleep-deprived, uncomfortable state that they often find themselves in after the blissful oxytocin hormones of birth wear off. Plus, now you’ve got a tiny human to learn how to care for which can provide its own emotions and anxieties and ultimately ends up putting the needs of the mom to maintain physical and mental wellness to the side for many women. These effects are all related to someone who had a healthy pregnancy and delivery, so they can often be compounded for women who had high-risk pregnancies, traumatic deliveries, or are dealing with clinical postpartum depression or anxiety. Recently, the American College of Obstetricians and Gynecologists released a Committee Opinion to stress the importance of caring for new mothers during the “Fourth Trimester” in the first few months after birth (you can find the press release with more information at https://www.acog.org/About-ACOG/News-Room/News-Releases/2016/Ob-Gyns-Stress-the-Importance-of-Postpartum-Care-The-Fourth-Trimester).

Laura getting back to physical activity with hiking during her “Fourth Trimester”

In this opinion statement, the group stresses the importance of coming up with a plan for postpartum care for the woman and her infant during pregnancy, with identification of the health care professionals to make up the woman’s postpartum health “team”. This team can include the obstetrician, pediatrician, nurses, mental health providers, the woman’s family and friends, community support groups, and… physical therapists! With one of the key aspects of fourth trimester care including facilitating the return to physical activity coupled with the fact that more than a third of women who have back pain during pregnancy continue to have back pain one year after giving birth, physical therapists are primed to play an integral role in getting women feeling better so that they can take care of not only themselves, but their families, in a more healthy and happy way.(1) I can speak from personal experience in that it’s easy for moms to just “deal with” aches and pains in their back, but there are actually simple exercises and muscle retraining exercises that can be done to address this prevalent condition. A skilled physical therapist can help you create an individualized exercise program that is easy to work into your busy days with baby to optimize how you feel. With physical therapy being one piece of the “Fourth Trimester” puzzle, don’t hesitate to contact us if you are planning for or are already in this stage, to learn how we can help you out during this very important time in your life. Also, don’t forget to plug into important resources such as https://www.postpartum.net for addressing mental health and wellness in the postpartum phase. For all you moms out there- remember that the best way to take care of others is to make sure you are taking care of yourself!

JOSPT Perspectives for Patients: Pregnancy and Low Back Pain- Physical Therapy Can Reduce Back And Pelvic Pain During and After Pregnancy. J Orthop Sports Phys Ther. 2014;44(7):474.

Welcome to Dr. Stacey Woodward

By: Dr. Laura Wenger, PT, OCS

Dr. Stacey Woodward, PT, CMPT joined our clinic in April 2018 and we have been so happy to have her join our team! I recently had the chance to ask her a few more questions about herself and find out more about her background and skills that she brings to Tomsic PT:

What brought you to Durango?
I grew up in the south/mid-west and wanted to settle down in city that let me enjoy all the outdoor activities I love as well as a good career. We (my fiancé and I) had some friend connections in Durango and decided to take the leap and move out west to find a home.

How long have you been a PT and what areas have you worked in?
I graduated from St. Louis University physical therapy school in 2010. I started out splitting a job in acute care and outpatient orthopedics prior to transitioning into a full time outpatient orthopedic clinic. While in St. Louis, I spent several months working at my company’s Endurance clinic treating runners. I practiced in home health for a year and a half when we moved to Durango before starting with Tomsic in April of 2018.

What do you feel you will bring to the practice?
I’ve completed advanced training in manual therapy as well as have a passion for treating athletes to get them back to the active lifestyle they love.

What do you hope to gain from working at Tomsic PT?
Tomsic has several well trained and talented clinicians and I hope to further my manual therapy skills from my co-workers.

When not at work, where are folks most likely to run into you around town?
I love the outdoors and enjoy Durango’s beauty by running or biking the trails. In the winter I’m on the mountain most weekends skiing. I spend my mornings before work at Crossfit to balance my outdoor activities with cross training to stay healthy and injury free. I also love a good meal and brew at some of my favorite restaurants/breweries; Animas Brewery, El Moro or Fired Up Pizza.

What is one fun fact about you that nobody would know?
I was born in Vancouver, Canada. My family moved the the states (Arkansas) when I was six years old. I’m a naturalized American citizen.

Stacey taking full advantage of all that our beautiful area has to offer!

Make sure to say “HI!” to Stacey when you see her in the clinic or around town!

The Benefits of Dry Needling

By: Dr. Laura Wenger, PT, OCS

It’s very likely that, if you’ve been to physical therapy recently (or know anybody who has), you have heard of dry needling. For those of you who don’t know, dry needling is defined as a “skilled intervention using a thin filiform needle to penetrate the skin that stimulates trigger points, muscles, and connective tissue for the management of musculoskeletal disorders.”(1) Though not necessary for treatment of every patient that walks through our door, dry needling is a tool that we may decide on using based on our professional judgement of your condition and how helpful we think it will be in getting you to feel better, faster. There are many factors that help us make these decisions, but more and more research is being published regarding dry needling in order to find out just how effective it can be in addition to other physical therapy treatments.

Jeff performing dry needling on an upper trapezius muscle

One recent study was published in February 2018 by many renowned physical therapy researchers.(2) These researchers decided to hone in on a problem that is near and dear to many people- subacromial pain syndrome, more commonly known as “shoulder impingement”. As this is a very common problem for people, studies are often undertaken to figure out how best to treat this problem as well as how to cut healthcare costs by offering the most efficient and effective treatments. Specifically, this study looked at patients that had at least three months of shoulder pain that was at least a 4/10 level of pain.(2) The patients either received treatment of exercise combined with dry needling or exercise alone, with the exercises targeting the key rotator cuff and shoulder blade muscles that help to improved shoulder function.(2) The treatments were once per week for a five-week period and the dry needling was only performed in the first two sessions for the group receiving that treatment.(2) What the researchers found was that the addition of two sessions of dry needling to a quality, supervised exercise program for the shoulder led to the patients utilizing significantly fewer health care resources than those who had exercise alone: they had less visits to additional providers and less use of additional treatments such as more PT.(2) On top of that, the dry needling plus exercise group had significantly less cost related to missing work as well as had better quality of life ratings than the exercise alone group.(2) All in all, the addition of dry needling to the physical-therapist directed exercise program was a real “win” for getting the patients better faster and spending less overall money in the process.

Currently, we have four physical therapists who are certified in dry needling. If you are a current or upcoming patient, make sure to ask your PT if dry needling might be a worthy addition to your treatment plan!

1. APTA. Description of Dry Needling in Clinical Practice: An Education Resource Paper. Alexandria, VA: APTA Public Policy, Practice, and Professional Affairs Unit; 2013.

2. Arias-Buria JL, Martin-Saborido C, Cleland J, Koppenhaver SL, Plaza-Manzano G, Fernandez-de-las-Penas C. Cost-effectiveness Evaluation of the Inclusion of Dry Needling into an Exercise Program for Subacromial Pain Syndrome: en e from a Randomized Clinical Trial. Pain Medicine. 2018;1-12. Doi:10.1093/pm/pny021

Helmets: They’re not just fashionable…

By: Dr. Laura Wenger, PT, OCS

We live in a world where there are a lot of different opinions and, luckily, we have the right to have our own opinions and are not silenced for doing so (thank you first amendment)! Even though opinions may spark debate and controversy, they also give us the opportunity to learn more about our fellow humans around us. One of the things that I love about working as a physical therapist is that we get to interact with so many different types of people, and I find that I always have something to learn from each patient I encounter.

If you happen to be in our main gym area during a busy time of day, it’s not rare to hear multiple conversations going on at once or, sometimes, one conversation happening amongst the entire group. One topic that interests me greatly, which seems to come naturally for a PT, is that of public health and safety. Within public safety, a topic that has come up often times during these “gym” conversations is that of wearing a bicycle helmet if you’re going to be hitting the road or trails on your bike! This is something that I have a strong opinion about and, lucky for me, the research does reinforce my position on the serious importance of wearing a helmet.

John, our lead tech, and Josh, our PT student, showing off their helmet style for their rides home on the river trail

I recently looked at a systematic review and meta-analysis (basically, a research study that looks at multiple studies to gather information) published in 2017 highlighting the importance of wearing your helmet.(1) After reviewing 43 studies looking at over 64,000 injured cyclists, the researchers found that the simple act of wearing a helmet was associated with reduced odds of head injury, facial injury, and especially serious or fatal head injury.(1) The fact that this analysis was able to look at so many people increases the significance of these findings. What it comes down to is that it is a no-brainer (pun intended!) to wear a helmet anytime you get on your bike. Even if you are a pro cyclist (hey, we are in Durango!), you can never predict when that strange thing will happen that can cause you to fall while riding your bike- the squirrel running right in front of you, the car backing out of the driveway, or the rock that sends your tire in the wrong direction to name a few scenarios. So, the next time you are going to venture out on two wheels- even for a quick ride down the street- don’t forget to strap on your helmet for one of the easiest things you can do to prevent injury!

OK, I’ll dismount my soapbox now…

1. Olivier J, Creighton P. Bicycle injuries and helmet use: a systematic review and meta-analysis. Int J Epidemiol. 2017;46(1):278-292.

Dance- It’s good for you!

By: Dr. Laura Wenger, PT, OCS

Aerobic exercise, one of the mainstays of living a healthy life, comes in many shapes and sizes. In Durango especially, many people think about aerobic exercise in the context of being outdoors in the beautiful mountains that surround us with activities such as jogging, hiking, skiing, snowboarding, snowshoeing, road biking, and mountain biking- all activities that I’ve discussed benefits of in previous blog posts. However, for some folks, the preferred method of getting their heart rate up and sweat coming down can happen indoors with such activities as dance!

Recently, I’ve taken up dancing as a weekly form of cardiovascular exercise (which, by the way, has been a blast!) and I found myself asking the question about how dance compares to other forms of exercise in terms of the cardiovascular benefits that it offers. Despite being fun and something that I enjoy doing, I wanted to see if I could still get all of the benefits of participating in regular aerobic exercise- namely reducing physical health risks that are often associated with a sedentary or inactive lifestyle- while dancing along to choreographed music with a group of lively ladies every Saturday morning.

Our tech, Nicole, during a dance performance

It turns out that researchers have asked the same question, seeing as dance is commonly rated as a highly enjoyable, versatile, and adaptable form of exercise.(1) Lucky for me, a recent systematic review that looked at 23 different studies found that dance of any genre is at least equally if not sometimes more effective than other types of structured exercise for improving health measures such as body composition, blood testing such as for cholesterol levels, and functional measures such as flexibility, balance, and strength.(1) The American College of Sports Medicine recommends 150 to 250 minutes per week of aerobic exercise, but it is nice to know that you can achieve that recommended amount of time through many means and still have a benefit in health and wellness.(1) Most importantly, I get to have fun while doing it! We hope that everyone in our community can find enjoyable ways to get in their aerobic exercise on a weekly basis in order to improve their physical and mental function.

1. Yan AF, Cobley S, et al. The Effectiveness of Dance Interventions on Physical Health Outcomes Compared to Other Forms of Physical Activity: A Systematic Review and Meta-Analysis. Sports Med. 2017. Https://doi.org/10.1007/s40279-017-0853-5.

Direct Access to Physical Therapy

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

A couple of months ago, a patient called to see if she could get her daughter in for an evaluation on short notice. Her daughter had twisted her knee on the stairs and she had swelling and knee pain that was concerning. This particular family has had experience with PT in the past for multiple acute and chronic musculoskeletal problems, so they have seen firsthand how PTs are helpful in assessing and treating bodies from head to toe, so they thought that it would be best to come straight in for an assessment to see what they should do. Luckily, we were able to get the patient in that day with a PT that she was familiar with for a timely assessment. After a thorough evaluation, the PT concluded that the patient likely had a mild sprain of her knee and with some easy exercises and RICE (rest, ice, compression, elevation) over the next couple of days, the patient would return back to normal function in her knee.

This is a great example of what is commonly referred to as “primary care physical therapy”, which is becoming more and more popular across the nation. In the past, patients have gone to their primary care physician for musculoskeletal injuries and, after a thorough assessment from their trusty doctors, they have usually been referred to PT to further assess and treat the problem. In more serious conditions, the patient gets referred to an orthopedic physician specialist if it seems pretty clear that the patient has a fracture or will require surgery due to a more significant nature of the injury, though this is a more rare situation. Historically, this has resulted in a lag time for initiating treatment, which can potentially lead to slower healing times along with more swelling, stiffness, and pain.

Nowadays, most* insurance companies do not require a physician referral to see a physical therapist, so the situation detailed in the example above is becoming more and more prominent. As the training of physical therapists has elevated to the doctorate level, PTs are specifically trained to assess patients as a direct access provider with the knowledge and skills to be able to treat and/or refer to a physician as needed based on each individual’s situation and injury. The best part is, regardless of the body part (or parts) injured, you can count on the PT for an honest, informed opinion on the best treatment plan to get you back to moving and feeling normally without having to spend a couple of days waiting for the process of multiple appointments and referrals to be completed. The faster you can get in to be assessed for a musculoskeletal injury, the more likely you are to begin to recover quickly versus waiting days (or, sometimes months) to get a professional evaluation performed. The next time you or a family member experiences pain or injury, make sure to call our office and we will get you in quickly to see one of our specialized physical therapists to get you back on the road to recovery as soon as possible!

Working hard to make folks feel and move better

*Please call our office to verify your insurance to see whether or not your policy requires a physician referral to PT

Recap of AAOMPT Conference

By: Dr. Laura Wenger, PT, OCS

One thing that we feel passionately about within our professional staff is a strong commitment to supporting our professional organizations, not only because they are our advocates for legislation that supports PT, but also because they provide great opportunities for education and growth within the profession of physical therapy. Ellen has been involved in one such organization, the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT), for over 20 years and she has instilled the importance of this involvement within all of us PTs here.

Recently, four of our therapists, including Ellen, were able to attend the yearly AAOMPT conference in Salt Lake City in October. Laura, Jeff, and Ted were excited to attend the conference for the first time, especially after hearing raving reviews about this conference from Ellen who has attended many conferences (including an international conference in 2016 in Scotland!) in years past. The conference offered up many benefits, including educational courses and discussions as well as the chance to network and connect with PTs from all over the nation whom are passionate about getting their patients better with manual therapy as a strong focus of their treatment.

Jeff, Ellen, Ted, and Laura enjoying filling their brains at the AAOMPT 2017 Conference!

We were able to learn about topics across the spectrum of treatment, such as preventative PT, the importance of strengthening the alliance with our patients, pain science, sleep hygiene and how it relates to pain, knee osteoarthritis, treatments for irritable nerves, and diagnosis as well as treatment for issues related to the upper ribs, shoulder and arm, core and trunk, and feet. Needless to say, our brains were very full after four days of learning from some of the best and brightest in our field, and we came back to the clinic ready to put some of our new thoughts and skills to use with our patients, present and future!

The Skinny on Climbing Injuries

By: Dr. Laura Wenger, PT, OCS

I recently got an email from a Durangoan that is living overseas to partake in amazing rock climbing adventures. She asked for some tips regarding keeping her shoulders strong and injury-free while climbing and was curious about what types of injuries climbers encountered the most. Climbing is a tough sport that requires a lot from our upper extremities and core, so making sure that you are adequately strong and progressively increasing your climbing is a must in order to prevent injury from overuse of a muscle that wasn’t ready for pushing (and pulling) that hard.

A study just came out this year regarding the results of a survey that assessed the types of upper extremity injuries that are sustained by rock climbers.1 Approximately 400 climbers of all types- including bouldering, trad, sport, ice, and indoor- responded, and the results of the study highlighted a few things from the sample of participants:1

  • 90% of the participants reported sustaining an upper extremity injury
  • The most common area injured was the fingers (41%) followed by the shoulder/arm (20%) and the elbow/forearm (19%).
  • As the level of experience increases- from beginners to professionals- the odds of finger injury also increases.
  • Females were significantly more likely to report a shoulder/upper arm injury than males- in fact, females were twice as likely to sustain an injury here versus their male counterparts
  • On that same note, females were significantly more likely to have surgery related to their shoulder/upper arm injury (21%) than males (11%)
That’s Nicole, one of our techs, way up there!

So, what’s the deal with the shoulder getting hurt with climbing? Shoulder injuries, such as impingement, rotator cuff strains, and sometimes subluxation/dislocation because of the range of motion required, occur commonly because of overuse injuries where somebody is a desk jockey during the week and then gets out and climbs hard all weekend. This “weekend-warrior” climbing can sometimes create excess stress and inflammation to the muscles and tendons surrounding the shoulder.

It is not always possible to completely avoid injury with rock climbing. But, if you are going to climb a lot, having a “regular” climbing program and not doing it so sporadically can set you up to not have these overuse-type injuries. Or, if you can’t get out and climb more often during the week because of work or life obligations, then doing some rotator cuff and shoulder strengthening every other day is a way to keep your shoulders conditions so that you can climb hard over the weekend with less risk for injury. If you need more tips or advice from a PT on how to prevent shoulder (or other upper extremity) injuries with climbing, or need to figure out what to do about an injury that you may already have, call us to schedule an appointment with one of our specialized physical therapists to get you back on the rock (or ice!) injury-free!

  1. Nelson CE, Rayan GM, Judd DI, Ding K, Stoner JA. Survey of Hand and Upper Extremity Injuries Among Rock Climbers. Hand. 2017;12:4):389=394.

The Therapeutic Alliance

By: Dr. Laura Wenger, PT, OCS

Sometimes, life doesn’t go how you’ve planned. We get it. A pain in your knee limits your summer hiking plans. A torn rotator cuff leads to a surgery and time off you haven’t planned for. Sometimes your aches and pains don’t necessarily limit your participation in an activity, but they don’t allow you to do things the way you would like to do them. Pain and discomfort come in all shapes and sizes. And not only that, but it happens to the best of us!

Take my case, for example. I was clicking along, training for a trail-running half marathon that is happening this October- the Durango Double that begins and finishes right behind our clinic that we love to sponsor and volunteer for! But, there were a few bumps and snafus that happened with my busy life schedule that happened to derail my training, which led me down a bumpy road to injuring myself due to poor training habits coupled with a pre-existing condition that I was not addressing the way I should have been. You may think, “But, you’re a PT- you should know better!!!” So, in the end, I’m taking a time-out from running to focus on my body in the way it needs to be focused on. What better way to do that then by surrounding myself with smart, caring and trustworthy PTs (AKA my colleagues here at Tomsic PT!) that can help guide me along my path to rehabilitation so that I can keep up in participation of trail-running endeavors for many years to come!

Sneaking in some exercises between patients

The neat thing about that concept is that there is research that has shown the powerful effect on the relationship between patients and physical therapists on treatment outcome in patients with low back pain.1 Sure, a well-trained PT is worth their weight in gold when they can recognize what is happening in your body that is contributing to your pain and, even more importantly, what needs to be done to help reduce your pain and discomfort in order to meet your goals. But, beyond having the ability to identify and treat your problems appropriately, the relationship- or therapeutic alliance- that is built between you and your PT may predict how much better you will get.1 Specifically, the therapeutic alliance depends on three things: (1) the therapist-patient agreement on goals, (2) the therapist-patient agreement on interventions (AKA treatment choices), and (3) the affective bond between patient and therapist, which refers to the trust and confidence that the treatments will bring the patient closer to their goals.1

Research has demonstrated that higher levels of therapeutic alliance were associated with greater improvements in perceived effect of treatment, function, and reductions in pain and disability.1 I just find it fascinating that the relationship we love building with our patients is not only fun in our small community, but it actually helps our patients get even better than they would have if we didn’t have a strong alliance built during our time together! Getting on the same page with your goals, the treatments we are offering, and how confident we are in how those treatments can improve your conditions is integral to having a successful rehabilitation of your problem. Even though this research focused specifically on low back pain, my hunch is that we can extrapolate this information to other areas of pain and discomfort as well. I feel fortunate that I am surrounded by empathetic and knowledgeable PTs to help guide me through my own issues, and I hope that each and every one of our patients realizes the importance in creating these relationships with each other!

 

  1. Ferreira PH, Ferreira ML, et al. The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain. Phys Ther. 2013; 93:470-478.