By: Jeffrey Yaskin, PT, MPT, MTC, CSCS

Do you know how to squat? Squatting is an activity that we should be performing many times throughout the day, hopefully, without even thinking about it nor realizing we are doing it. We don’t think much about walking from one spot to another and nor should we think much about squatting from a standing position down to the ground. Squatting is very healthy for the musculoskeletal system and as well as for the gastrointestinal system. It is also a very functional movement. Somewhere along the line, unfortunately, some people have come to the conclusion that squatting is bad for you. In this first of a 3 part series on squatting, we will touch on the functional aspects of squatting.

A child naturally squats to interact with objects on the floor. If you have children aged 1 to 5 and they are playing with items on the floor they simply squat down and “sit” in the squatting position with no issue until they are ready to stand. What you do not see is a child that age bending over to reach the same object on the floor. “The squat position is typically acquired after 10-12 months of development”(1). Squatting is more stable than standing which is why children adopt it earlier than standing. “ Standing in free space is not typically achieved until a child reaches 12-14 months of development”(2). Why squat over bend? Squatting is more stable and places less stress on your joints. Bending over in a standing position is less stable and places much more stress on your lower back. Interestingly, at this young age no one tells nor teaches the young child to perform this activity, it is innate. We all squatted this way and it begs us to question, why did we stop as we became older.

Were you glued to the TV watching the Olympics this summer? I believe it was during the wee hours of the night that the Olympic Lifting portion was telecast. With the explosion of Crossfit as an exercise philosophy, Olympic Lifting has become mainstream. The two lifts are the clean and jerk and the snatch. Both start in a deep squat position with the bar on the ground. Lift the bar with an upright trunk to the chest and stabilize yourself in another deep squat with the bar resting on your shoulders. In the clean and jerk, the second squat you have the bar resting on your shoulders and then you stand up pressing the bar overhead. “The clean tells you a lot about an athlete”(3). In the snatch, the second squat you have landed with the bar pressed overhead and then you stand up with the bar pressed overhead. “Nothing will tell you more about an athlete’s range of motion and understanding of the midline stabilization and torque principles than the snatch”(4). Both lifts are extremely technical and require copious amounts of time training to fully master. Any Olympic Lifting coach worth their mettle will agree that both of these lifts begin and end with a perfect squat.

If you have ever been to a train station in one of the older and smaller Italian towns and have to use the restroom you were probably met with a hole in the ground. What am I supposed to do with that? Squat! That’s right squat down and do your business. Prior to the invention of the toilet we defecated as humans by deep squatting. “Squatting has been the natural defecation position for humans since time immemorial “(6). If you have ever been exercising outside and had to move your bowels you simply squatted down and no problem. “There is a muscle that encircles the gut like a lasso when we are sitting or standing, and it pulls the gut in one direction, creating a kink in the tube “(7). “Squatting leads to a nice straight intestinal tract, allowing for a direct, easy exit “(8). I know many of us are dog owners and how does your dog poop? Sitting? No they squat down! “Hemorrhoids, digestive diseases like diverticulitis and even constipation are common only in countries where people generally sit on some kind of chair to pass their stool.”(9) So for the health of your bowels add more squatting to your daily routine.

Properly functioning pelvic floor muscles are synonymous with deep squatting and are necessary for pelvic stability and proper bowel and bladder health. “Once below a parallel squat, a quad dominant individual will not be able to maintain balance. This person will fall backward, unable to release tension in the quadriceps to allow the glutes, pelvic floor and core musculature to take over and stabilize” (10). A stable squat involves proper balance of the quads, glutes, pelvic floor and core muscles. The pelvic floor muscles become eccentrically lengthened during a deep squat. Squatting increases the size of the pelvic outlet by 1-2 cm vs standing position. “By forcing the upper leg bones (femur) to act like levers on your pelvic bones, you can widen your pelvis opening by 20-30 percent” (11). Squatting with knees pushed out wide increases tension in the hip adductor muscles pulling on the pubic bones and opening the pelvic canal. The levator Ani muscles (pelvic floor muscles) counter the pull from the adductor muscles. This helps keep them healthy and functioning properly. Properly squatting deep throughout the day helps to keep the pelvic floor muscles functional.

One way to assess your squat and muscle balance is Durango is a through a Functional Movement Screen(FMS). This is a seven-part screen for people without pain who want their basic movement ability profiled. This movement screen was created in 1998 and currently is standard practice in assessing Special Forces Operators, NFL-NBA-NHL-MLB players and Olympic athletes. Guess what movement is the first tested in the FMS? The Overhead Squat. Watching a person squat with their arms in an overhead position is very telling about that person’s movement health and efficiency. “Extremity mobility, postural control, pelvic and core stability are well represented in the deep squat movement pattern. The deep squat is a move that challenges total body mechanics and neuromuscular control when performed properly” (5). Are you starting to understand how important the simple squat is in our daily lives? We are certified in assessing the FMS and would be happy to screen you as part of our free injury screen program.

Thus far we have discussed many reasons to squat daily. Its functional and it helps to maintain the health of the viscera, hips,and pelvic floor musculature. In the second and third parts of this squat analysis we will closely look at what is considered a proper way to squat and the many faults related to squatting poorly.

References:

(1), (2): Kobesova, A, Safarove, M. and Kolar, P. Dynamic neuromuscular stabilization: Exercise in the developmental positions to achieve spinal stability and functional joint centration. In: Hutson, M. and Ward, A (Eds.), Oxford Textbook of Musculoskeletal Medicine. Oxford University Press: 66-83, 2015.

(3), (4): Starrett, Dr. K. Becoming a Supple Leopard: The ultimate guide to resolving pain, preventing injury, and optimizing athletic performance. Victory Belt Publishing: 183, 195, 2013.

(5), (10): Cook, G. Movement: Functional movement Systems. On Target Publications: 90, 196, 2010.

(6), (7), (8), (9): Enders, G. Gut: The Inside Story of Our Body’s Most Underrated Organ. Greystone books: 17, 18, 2015.

(11): Russell, J.G.B., “Moulding of the Pelvic Outlet”,J. Obstet. Gynaec. Brit. Cwlth, Sept. 1969, Vol. 76, pp. 817-820.

There has been a phrase circulating in the media over the past few years that can be quite alarming for the average American who finds themselves sitting for most of the day for work, hobbies, or simply by choice: “Sitting is the new smoking”. Now, I don’t even have to get into how bad smoking has been proven to be for our health and the good news is that many people in our society agree with that and have taken measures to remove smoking from their lives. However, sitting is a common theme during our day-to-day activities in our country, so much so that “data from adults in high-income countries suggest the majority of time awake is spent being sedentary”.¹

What are the implications associated with sitting that give it such a bad rep? Some of the highlights of the negative effects related to a lack of physical activity include increased risk of type 2 diabetes, cardiovascular disease, stroke, some cancers, and even premature mortality.¹ Needless to say, all of those negative effects are things that we do not want in our lives. However, because of the nature of much of our work, many of us are relegated to sit at a desk for eight hours a day, five days a week. So, what, if anything, can we do to counter the negative effects of our required sitting?

A group of researchers recently sought out to find the answer to that exact question. They analyzed 16 high-quality studies with data from over one million people. I’ll repeat that last part – they had date from over one million people, meaning that the researchers had a lot of data to base their results off of! What they found was that those people who were more physically active, getting in at least 60-75 minutes per day of moderate intensity physical activity, seemed to have no increased risk of mortality even if they did have to sit for more than eight hours per day.¹ That gives hope to those of us who are required to sit for that extended period of time due to our jobs, hobbies, etc. that, by making sure we get the right amount of activity into our day, we can come out in the end with no higher risk of mortality related to all that sitting.¹ Other factors to take into consideration are how to decrease your total amount of sitting time to less than four hours per day, as those folks tend to have lower risk of mortality associated with sitting.¹ Is there any way you can get a standing desk or, even better yet, a treadmill walking desk to use at your day job? Can you fit in the 60-75 minutes of moderate physical activity into your lunch break, by doing such activities as taking a brisk walk?

Just remember, you’re not “doomed” if you have to sit for roughly eight hours (or more) a day. However, you have to be active in order to counteract the negative effects of the time you spend sitting! If you need help with figuring out more ways to work activity into your lifestyle and especially to prevent injury while doing so, schedule an appointment soon with one of our specialized physical therapists to find out your options.

1. Ekelund U, Steene-Jahannessen J, Brown WJ, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonized meta-analysis of data from more than 1 million men and women. The Lancet. Avail online 28 July 2016. https://dx.doi.org/10.1016/S0140-6736(16)30370-1.

One of the fun things that we get to involve ourselves in within the community is participating in health fairs. Over the past year, representatives for Tomsic PT have made their way to various health fairs, such as in local companies like StoneAge and La Plata Electric Association as well as the La Plata County Health Fair for county employees. One of our favorite things to do at health fairs, besides meet you all and teach you about various benefits of physical therapy, is the Functional Movement Screen^TM. This is especially the case in regards to our PT, Jeff Yaskin, PT, MPT, MTC, CSCS as he achieved his certification in the Functional Movement Screen^TM in 2011.

Some of you may be wondering, “Great, but what is the Functional Movement Screen^TM (FMS^TM) ???”. The idea behind the FMS^TM is that it can be used as “a screening test [used] to identify specific movement dysfunctions that may be related to musculoskeletal injury risk.”¹ The screen looks at seven movement tests that are meant to assess overall body mobility, stability, coordination, and postural control, with a score associated with each test.¹ After each test is performed and graded, the scores are added together to come up with a final score that may be used as an indicator of injury risk.¹ Of note, the test is meant to be used on an uninjured person, as the presence of pain on any test requires an automatic score of zero with further assessment recommended.¹ That’s why we think this is a great screening tool to use at health fairs since we do end up speaking with a large amount of folks who aren’t yet injured and wonder how physical therapy can be beneficial for them.

There is a lot of research out there regarding the FMS^TM, but a recent study sought to find out whether or not the performance of just one of the seven tests that makes up the screening could be used to predict performance on the entire FMS^TM.¹ The reasoning behind this study was so that the researchers could attempt to identify one of the tests as a “red flag” tool to be used quickly and easily to fast-track the need for further assessment regarding heightened risk of injury.¹ The researchers found that there may be a meaningful relationship between the performance of the deep squat test (see the picture below) with the overall FMS^TM score in the sense that better scores on the deep squat were related to better FMS^TM performance overall.¹ They also found that the converse would be true in that the odds of scoring poorly on the FMS (indicating potentially higher risk of injury) were 3.56 time greater for the individuals who scored poorly on the deep squat test.¹

You may notice that most of our PTs already use the deep squat test during our evaluations of various lower extremity and spine problems, and this research backs up the fact that our assessment of this may be helping us build a better idea of what an individual’s risk for injury or overall functional movement (or dysfunctional movement) is like.¹ To learn more about the FMS^TM and how it may help us identify your risk for injury (or how to guide our treatment if you are already injured), give us a call to schedule an appointment with any of our qualified PTs.

1. Clifton DR, Grooms DR, Onate JA. Overhead Deep Squat Performance Predicts Functional Movement ScreenTM Score. Intl J Sports Phys Ther. 2015;10(5):622-627.

Running season is upon us! We here at Tomsic PT are keeping up with the latest races more in the form of sponsorship these days. We had the privilege of sponsoring the Narrow Gauge 10 Mile race over Memorial Day Weekend and had a blast answering questions, stretching out, and taping runners following the race. We were also excited to see our former co-owner, Dave Rakita, running this race for the 39th time! Now, if that isn’t inspirational, I don’t know what is. We are looking forward to the continued running season and our upcoming sponsorship of the Durango Double Trail and Road Half Marathons on October 8th and 9th. If you are running or spectating, make sure you keep an eye out for our booth as we will be setting up shop right behind our clinic on the river trail.

Running season is exciting but, unfortunately for some, picking up the pace of mileage and speed comes with aches and pains. Research has estimated that 20 to 80% of runners get injured each year, which is a large amount of people when you consider that over 15 million people are running each year in the US.¹ As physical therapists, we get really excited about watching people move, and I especially love to do treadmill running analysis. Because of the large amount of runners that are injured each year, we undoubtedly see many folks in the clinic who benefit from running assessments. Oftentimes, we will suggest that people alter the way that their foot strikes the floor with each stride as a way to decrease biomechanical stresses placed on their ankles, knees, hips, and spine. A recent study sought to find out whether or not retraining footstrike patterns actually does reduce knee pain, improves biomechanical measures, and/or influences the risk of ankle injuries.¹

The researchers completed training subjects for eight sessions over two weeks with a focus on switching their footstrike pattern from a rearfoot strike, where the heel hits first, to a forefoot strike, where the mid-foot hits first.¹ They compared the group of trained subjects to another group of runners who received no training, but continued their running program.¹ The researchers found a number of positive effects in the training group, including:

• Significantly reduced knee pain¹
• Improved biomechanics at the knee with reduced collapsing inward of the knee¹
• Improved ankle range of motion consistent with the forefoot strike pattern¹

What’s great about this study is that the effects of the training not only were noticeable directly after the two-weeks training period but also further out at a one-month follow-up.¹ What that tell us is that, when we re-train a person on the treadmill to alter their footstrike patterns, the effects can continue well beyond our treatment which is the ultimate goal of teaching the body new and more effective ways to move. If you are a runner and are experiencing an injury or looking for ways to prevent injury, call us to schedule an evaluative appointment for a running analysis with one of our specialized physical therapists.

1. Roper JL, Harding EM, Doerfler D, Dexter JG, Kravitz L, Dufek JS, Mermier CM. The effects of gait retraining in runners with patellofemoral pain: A randomized trial. Clinical Biomechanics. 2016(35):14-22.

Hiking is a favorite pastime for folks of all ages here in Durango. Whether it’s a quick and steep in-town hike or a long and likely more-steep hike in the vast San Juan and La Plata ranges surrounding us, you are likely to stumble upon other hikers on the trails enjoying the beautiful vistas, heart-pumping ascents, and quad-burning descents. This is especially true in the mid-summer months when the wild flowers are in full effect and the increase in altitude can offer a reprieve from the higher temperatures in town.

In late April of this year, I had the pleasure of attending a three day course in Denver dubbed “Manipalooza”. This course was put on by a PT educational group called Evidence in Motion, which is led by many important names in physical therapy research including Dr. Tim Flynn, Dr. Julie Whitman, and Dr. John Childs. Despite the name, the conference was not all about manipulations, which is a technique that physical therapists use to provide a high-velocity low-amplitude thrust during joint mobilization. The course also included speakers who addressed the group regarding interesting and relevant information, such as pain science and concussion diagnosis and treatment. One of the speakers that interested me the most was Dr. Larry Benz, DPT, OCS, MBA, MAPP, as he spoke about a term that is very important in the field of physical therapy: empathy.

Let’s first take a look at the definition of empathy in a medical context. As described by Hojat et al.,

“[We] define empathy in the context of medical education and patient care as a predominantly cognitive (as opposed to affective or emotional) attribute that involves an understanding (as opposed to feeling) of patients’ experiences, concerns, and perspectives combined with a capacity to communicate this understanding. An intention to help by preventing and alleviating pain and suffering is a characteristic of empathy expressed in the context of patient care.”¹

One of the things that Dr. Benz touched on during his lecture was the difference between empathy and sympathy. It would be one thing for us, as physical therapists, to be sympathetic toward your pain and elude that. However, being empathetic to your pain and trying to understand your experience and perspective allows us to further help to come up with solutions to your problem, whether it be chronic pain or an acute injury.

A strong sense of empathy, I believe, one of the things that sets physical therapists apart from other healthcare professionals. And, not only do I believe this, but patients do, too. A recent study sought to examine the meaning of caring from the perspectives of patients undergoing physical therapy.² The results of this pilot study indicated that physical therapists have “embraced caring as a core value in clinical practice that reflects a deep commitment to patient-centered care.”² Some of the main examples that the study found regarding patient perceptions of their physical therapists included such statements as, “[my therapist] seems to take an interest in patients beyond just the medical stuff,” and “I think [physical therapists are] pretty good about explaining ‘hey this is what’s going on with this and this is what you’re probably going to experience’”.² These examples of valuing the patient as an individual and providing reciprocal and ongoing communication are excellent examples of caring, which is very much a part of being an empathetic healthcare provider.²

As healthcare providers, we strive to be empathetic so that we can understand the needs of each patient as an individual. Come and learn what makes physical therapy the optimal solution for healing with an empathetic provider at Tomsic Physical Therapy by scheduling an appointment with one of our specialized therapists today.

1. Hojat M, Vergare MJ, Maxwell K, et al. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med. 2009;84(9):1182-1191.
2. Greenfield B, Keough E, Linn S, et al. The Meaning of Caring from the Perspectives of Patients Undergoing Physical Therapy: A Pilot Study. J Allied Health. 2010;39(2):e-43-47.

Here are some quick facts that Dr. Kotlyar from the Telluride Medical Center found:

• In 2013, 8.5 million Americans participated in mountain biking.¹ The popularity of the sport has been steadily increasing and has become increasingly popular with the development of lift-accessed terrain so that ski resorts can find purpose during the summer months.¹ As we know in Durango, you don’t need a lift to access great trails, but many folks find appeal in skipping the grueling uphill that some trails require.
• When comparing biking injuries, about 70% of the injuries are related to mountain biking where the other 30% are related to road cycling.¹ Dr. Kotlyar’s study only looked specifically at injuries that went through the Telluride Medical Center Emergency Department, which turned out to be 304 biking-related injuries over the period of three years.¹
• Injuries to the thoracic, or chest, region happen more regularly during mountain biking.¹ Also, trail injuries happened to be more common in males and older riders also happened to be the ones suffering more injuries to the thoracic region.¹
• Head injuries occur more often during road riding.¹ In addition to that, injuries that occurred while road cycling were more likely to require transfer to a higher level of care than injuries sustained on trail.¹
• 70% of the injuries reported occurred in males.¹ This is consistent with the report that there is a 71 to 86% male predominance in bicycle-related sports.¹
• The most common biking-related injuries are lacerations, abrasions, and contusions (64%), with arm, wrist, or hand fractures making up the remaining majority (26%).¹ The good thing there is that the more severe injuries, such as head, thoracic, or abdominal injuries, are less common.¹

Biking, in both mountain and road forms, is a very popular sport in Durango and a common recreational activity that our patients want to be able to get back to. Along with the common lacerations, abrasions, and contusions that were seen in the Emergency Department at Telluride Medical Center during this study, we also tend to see a lot of the musculoskeletal aches and pains that come along with road or trail crashes. As your orthopaedic specialists in Durango, we would love to help you get back in the saddle. Call us to schedule your appointment today!

1. Kotlyar S. Cycling Injuries in Southwest Colorado: A Comparison of Road vs Trail Riding Injury Patterns. Wilderness & Environmental Medicine. 2016. 1-5.

In April, Janet Wells, PT, MSPT and I had the pleasure of presenting a free, informational talk regarding some common aches and pains related to pregnancy such as low back pain and pelvic floor dysfunction. The purpose of this talk was to inform the public that, despite people thinking that these common issues are “normal”, they are not necessarily supposed to occur and there are things that you can do about them! Here is a brief summary of the presentation so that folks can understand a little bit more about these common pregnancy-related issues.

• 24 to 90% of pregnant women report low back and/or pelvic girdle pain.^1,2 That’s a very wide range, and there are a couple of things to consider when looking at those percentages. The definition of pregnancy-related low back is so varied which is likely one reason why the percentage is so broad. Also, there are probably many women out there who are not actually reporting the fact that they have pain to their providers, so this may skew the percentage as well.
• 5 to 37% of women report low back and/or pelvic girdle pain for months following delivery.^1,2 That means that the pain doesn’t end once the baby comes out. Also, in some cases, women don’t experience any discomfort during pregnancy and then will begin to experience it once the baby is born. There are many reasons that this may happen, but one thing to remember is that the body is trying to return back to its “normal” positioning after stretching out for many months and, on top of that, there is the new demand of holding an infant nearly 24/7. Postural weakness may be to blame for many of the issues that happen in the post-partum stage.
• Low back pain and pelvic pain in pregnancy contribute to: difficulties in performing functional activities of daily living, increased sick leave, and sleep disturbance.^1,2 Some people feel they can just “tough it out” when it comes to these issues despite the difficulties that they create in their life.
• Many women do not report their low back or pelvic pain during pregnancy to providers or seek treatment despite significant consequences!^1,2 This is unfortunate, because there are many things that can be done regarding low back and/or pelvic pain during pregnancy, especially when looking at different physical therapy treatments. It is important for pregnant and post-partum women to make sure that they don’t just try to “live with it” when they are experiencing these types of pains and aches so that they do not get to the point where their function and quality of life are affected negatively after a temporary issue becomes chronic.

Janet and I are excited that we will continue to be able to use this presentation to teach women about their bodies and some of the resources that they can turn to in our community regarding their low back pain and pelvic floor dysfunction both during and after pregnancy. For those pregnant or recently pregnant women out there: please don’t shy away from finding help from a qualified professional in order to come up with a strategy for decreasing your pain and dysfunction. Call us today to set up an evaluation appointment if you are experiencing any pregnancy-related issues.

1. Van Benten E, Pool J, Mens J, Pool-Goudzwaard A. Recommendations for Physical Therapists on the Treatment of Lumbopelvic Pain During Pregnancy: A Systematic Review. J Orthop Sports Phys Ther. 2014. 44;464-A15.
2. Ferreira CWS, Alburquerque-Sendin F. Effectiveness of physical therapy for pregnancy-related low back and/or pelvic pain after delivery: A systematic review. Physiotherapy Theory and Practice. 2013. 29(6);419-431.

We are thrilled to introduce our new member of the Tomsic PT family, Jeff Yaskin. He recently made the trek out to Durango from South Florida, and I had the chance to find out more about what brings him to the Four Corners region and what experiences he brings to our clinic.

Why did you choose moving to Durango?
My family and I decided to move to Durango, from south Florida, for the beautiful change in topography, cold weather, warm people and unique experiences this town offers. My wife has an aunt, uncle and cousins that live here and we have been vacationing here since 2008 so we were familiar with the area. We are looking forward to great adventures here and a wonderful place to raise our two young daughters.

What experiences do you bring to Tomsic Physical Therapy?
I have a strong manual therapy background having studied Mulligan, Ola Grimsby and, ultimately, passing certification in manual therapy under Dr. Stanley Paris at the University of St. Augustine. I have also been certified in the functional movement screen (FMS) and a certified strength and conditioning coach (CSCS). These certifications have educated me as the optimal exercise prescription whether you are a physical therapy patient or an elite athlete.

What special strengths do you bring?
During my physical therapy career I was fortunate enough to work alongside a neurosurgeon who routinely referred cervical and lumbar fusion and artificial disc replacement patients to my clinic. I I have an affinity for working on surgical and non-surgical cervical and lumbar cases.

What is the FMS?
The FMS is for individuals who do not currently have musculoskeletal pain but will be scored solely on how they move. The screen is a great precursor for athletes about ready to start the sports season or an individual who is starting a new exercise program. Simply because you do not have pain does not equate to moving well. Moving well is a prerequisite to injury reduction, optimizing performance and helping
you achieve your goals. I received FMS certification in January 2011.

What is the CSCS?
Certification as a strength and conditioning coach stipulates that you have been educated to train a wide age spectrum of clients in multiple environments safely. The certification denotes education into training clients for endurance, strength training and plyometrics.

Energy systems of the body as well as diet and nutrition are emphasized as well throughout the learning process. In 2015 all NCAA division I strength and conditioning coaches were required to hold the CSCS designation. I received CSCS certification in December 2013.

What are your continuing education goals?
My goals for continuing education are to enhance my manual skills and to initiate coursework in board certification in orthopedics.

Where can you be found in Durango when you are not in the clinic?
Typically you will find me at a local park– lifting weights, sprinting or jumping. I also enjoy volunteering at athletic events around town or at my daughters elementary school.

We are all excited to have Jeff join our team so that we can continue to learn from each others specialties to help patients get better faster. With the addition of Jeff, we will also be starting Saturday morning clinic hours beginning on April 16th. Call us now to schedule an initial evaluation with Jeff, as his schedule is filling up quickly!

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.