Help Us End The Unfair Practice of "Specialty Copays"

A Bill (S.2319/A.1666) put forth by The New York Physical Therapy Association (NYPTA) is on the current NY State Assembly agenda and we need your help to get it passed. The unfair practice of so-called "specialty" copays is costing patients in dollars and forgone treatment, leaving New York State with a more costly and less effective health care system. 

Managed care companies continue to restrict access to physical therapy services by imposing "specialty" copayments of $40-$50. As the patient you maybe paying $50, while your insurance company is paying the physical therapist $5 or $10. Managed care health insurers have designated physical therapists as specialists for copayment purposes, allowing health plans to charge patients more per visit while maintaining reimbursement levels to physical therapists at 1980's levels, shifting more of the cost burden onto the backs of consumers and pushing PT's near bankruptcy.

These specialty copayments add up for New Yorkers, since physical therapy frequently requires multiple visits over an extended period of time as the practice of physical therapy works in conjunction with the healing process. In 10 visits the patient may pay ($50 X 10) $500 while the insurer pays ($5 X 10) $50. You have a COPAY and they have a Nopay.                                       
The bottom line is this: HIGH COPAYS HURT PATIENTS

The bill is currently in committee and we need your help to move it along. Please call your NYS Legislator and tell them to stop high copays for physical therapy care and to support S.2319/A.1666. This will help end the imposition of additional copays on New Yorkers for physical therapy services.
Sincerely,
Ann Duffy, MA., P.T.
Owner, Duffy and Bracken Physical Therapy


 Ways You Can Help!  

Talking Points for High Co-Pay Legislation - S.2319/A.166

Find your NYS Legislator

ELIMINATE WORKPLACE ACHES & PAINS!

Please allow me to introduce myself, my name is Julie and I recently joined Duffy and Bracken, PT. I practiced as a physical therapist for 7 years in Seattle Washington before moving to Downtown NYC. One of my specialties in Seattle was workplace modification and 5-hour return to work testing. These included activities such as touring a sawmill to adjust a workstation to accommodate an injured shoulder patient to modifying the internal organization of a police car to accommodate a low back patient. While the average New Yorker I currently treat is not in an industrial occupation, workspace modification is no less important. You spend 8-10+ hours a day at your desk and the more efficiently you set it up, the less stress you will experience on your neck, back and arms.

Here is a little test – can you sit with your back straight and feet flat on the floor for 5 minutes without fidgeting or adjusting and without an increase in pain? If you cannot then your core musculature does not possess the endurance for an 8 hour day in a chair.

Ergonomics strives to keep your joints in a neutral position to minimize the stresses on the muscles and ligaments. People come in different sizes so no two desks should look alike. Here are some suggestions for easy adjustments to your desk:

Adjustable Chair

When you are sitting your knees should be bent at a 90-degree angle with your feet resting on the floor. If you are petite and can lower your desk this is ideal but most desks do not have modifiable heights. If your feet do not touch the floor, bring the floor up to your feet with a footrest or even a small box.

The end of your seat should reach to four finger lengths to the back of your knee. Any farther forward can pinch nerves in your leg and make it uncomfortable to sit. Legroom under your desk should be at least 60 cm to allow for easy foot movement.

The backrest should be adjusted so that there is a convex surface supporting your low back. (If your chair does not have this I would suggest an adjustable lumbar support, which we stock here at Duffy and Bracken).

The arm rests should be positioned so that your elbows are slightly forward and bent at near a 90-degree angle.

With Foot Rest

 I am asked a lot about therapy balls as chairs. While I think this is good for watching TV, spending 8 hours a day on a therapy ball requires a lot of core endurance. If you would like to sit on a ball at work I recommend keeping a chair nearby for when your back becomes fatigued.

Keyboard

When you are typing your wrist should be supported and your elbows should be at a 90-degree angle. Because your arm rests should also support you at a 90-degree elbow angle it sometimes comes in direct conflict with your keyboard. I would suggest table length arm rests (they are shorter and allow you to push your chair up to the desk) on your chair or none at all if you are mostly on the computer or writing while at your desk.

Mouse

A traditional mouse used to control your cursor can add increased stress on your arm and shoulder because you have to elevate your arm for long periods of time. I recommend a trackball mouse. Your hand rests on the mouse and your thumb moves a roller ball that controls the cursor. They are inexpensive and your neck and shoulder will thank you.

Computer Screen

When you sit upright at your desk your eyes should be level with the top line of your screen. It is much easier for your eyes to track inferiorly without affecting your neck posture than it is for your eyes to track superiorly. If your computer screen is too high we tend to push our head forward and angle our head upwards, which tightens the back upper neck musculature. This is a good time to walk around your office and see your co-worker’s computer posture.

If you have a laptop it is harder to modify. I suggest putting it on a pedestal to raise the screen up and buying a wireless keyboard. 

 

Divide Your Desk Into Angles

Items that you use constantly should be within a radius of 50 cm – which means you do not have to reach far or rotate your body to grab them.  Items you use less can be a short reach away. 

Standing Desks

If you do a lot of reading you can make yourself a standing station at your desk. The optimal reading angle is with a 45-degree slanted desk and if you are writing the optimal angle for your elbows is with a 15-degree slanted desk. 

Unslanted Desk

 

Breaks

Most importantly you need to get up and walk around to give your body breaks from being in one position. Most people become so engrossed in what they are doing that they forget so I propose setting your cell phone to go off every 1-2 hours. A 5-minute walk around your office will help clear your head and give your muscles a chance to relax.

If you have any further questions about how to modify your workstation or you want a professional to assess your sitting ability, please do not hesitate to see me here at Duffy and Bracken, PT.

                                                                                                                                  

Julie Garner, DPT, COMT, CCI

julie@duffyandbracken.com

Strengthening Your Weak Link!

Kinesiology is the study of movement. It is what physical therapists are experts at. In kinesiology, a leg or an arm is often referred to as a "chain." The reason being is that a leg or an arm is comprised of parts with links, those links being joints. Muscles originate on a bone, cross a joint and anchor on another bone so it can stabilize and move a joint. So when we hear the expression, "a chain is only as strong as its weakest link," we could easily apply that idea to a human chain. That's a very important concept especially if you are an athlete. 

Aside from being a Physical Therapist, I have been an avid martial artist for a good 20 years. In that time I have suffered a nice bouquet of injuries; everything from a broken bone, to torn muscles in my mid back. After a four year hiatus, I recently joined a new martial arts school. I wanted to see how well prepared I was physically to go back into this very demanding activity so I had myself evaluated by Renuka Pinto (the supervising PT here at D and B) using the Functional Movement System (FMS). The FMS system, is a movement screen that is often used to assess an athletes' quality of movement by studying each kinetic chain. It can also be used on a non-athlete to evaluate how well they are functioning in their body in terms of movement. The individual scores are added together to create an overall final score. The FMS helps to identify not only the athletes limitations or weakness but also the compensations that cover up those weaknesses. The test takes about 20-30 minutes. It is broken up into subsections that look at very specific movement patterns. What's great about the FMS, is that not only does it identify these weaknesses, with each section, it will also give specific exercises to help improve the areas the athlete is weak in making it a very clear systematic approach.

By the end of the test, I had a good idea of where my weak links were. Renuka and her student (Karen), gave me exercises to improve my weakness and  enlightened me on my compensations. So not only will the FMS help refine whatever game you compete in, but more importantly, will help identify what injuries you are predisposed to. Whether you are a golfer that wants to improve that vital finite control in your swing, or you are an Ironman competitor that is looking to improve your endurance, the FMS will help you improve your practice and prevent injury so you can keep doing the game you love to do... So for all of you athletes out there that are preparing for an event or want to maximize your chances of preventing injuries I would highly recommend the FMS here at Duffy and Bracken. It is one of the many programs we offer to try to maximize how we can help you. If you are interested, ask anyone of us and we'd be happy to answer any questions. 

 

Happy Training!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Johann Howard, DPT, LMT

DIARY OF A PREGNANT THERAPIST!

For my last blog before going on maternity leave for the first time, I felt inspired to share some reflections related to my experience during pregnancy which has enhanced my insight as a physical therapist. This may peak the curiosity of others interested in the topic of pregnancy or even on the topic of creating new physical experiences.

As I have undergone childbirth preparation classes and read material on natural childbirth in hope of promoting a birth experience as normal/natural and, believe it or not, enjoyable as possible, it has been repeatedly pointed out that the prevalent portrayal of childbirth as a painful and dangerous experience has created a fear of this experience and belief that this description is inherently true. Thankfully, there is a widespread body of resources that helps to transform these beliefs into confidence in a woman's innate ability to birth. This makes a very simple point that fear of the birth process creates resistance to and intolerance of the physical experience of labor, and that by both understanding the physiology of normal uncomplicated labor and trusting the natural ability of mother and baby to safely complete the process, this fear can be eliminated, allowing an entirely different birth experience to unfold.

So though one of the hottest topics during pregnancy is the birth itself, there is a lot of "story" about what "happens to" a woman's body during pregnancy as well. A conversation develops about the potential dangers of childbirth as well as the potential for injury due to pregnancy. This includes not only impact on the mother's body during birth but during pregnancy and in life after pregnancy. What I found novel is that while it is well established that these unfortunate perceptions of childbirth are prevalent in modern civilized societies, so might our perceptions of the experience of carrying a child before and after birth be influenced by cultural expectations. What became tangible for me was that much like I wanted to undo my learned cultural beliefs about childbirth, I could change my perception of what my body was experiencing as pregnancy progressed. Though I felt that I possessed helpful knowledge that would enable me to care for myself and "prevent injury", I still needed to believe in nature's design just a little more.

To build upon this conversation, I would like to also point out that so far the conversation is talking about the mother as a pregnant individual, not a mother and child living, moving, birthing, and continuing to live together with ease, harmony and comfort, and actually establishing a relationship (though perhaps not with a lack of new sensation and experience for both parties).

Let me illustrate what these changes in perception boil down to for me. There were times I was distressed because of pain while walking. However, as the baby grew it dawned on me that I was already the mother of this baby.Then a bigger picture emerged illustrating that just walking down the street pregnant was at this stage already an activity in our parent-child relationship. I began to realize that it made sense that I could move in a natural way (though perhaps slower) with her (yes, it's a girl!), and not only feel less pain but feel happy in my new relationship. Sensations that I felt as physical stresses (abdominal muscle strain, pubic bone pressure when I walked or sacroiliac pressure with changing positions) began to be perceived differently- as evidence that my baby was resting on certain body parts of mine or guides for me to move with more mindfulness. Feeling “out of breath” and extra work in my legs going up stairs changed into “taking in more air” for the two of us.

Now am I saying that pain is all in the mind? No. Have I enjoyed the benefits of physical therapy to prevent, prepare and manage? Absolutely! Though attention to physical wellness continues to play an important role, what has also contributed to me feeling better and better while walking and moving are perceiving things in the following ways:

1. RELAXING and trusting that my body can "carry" my baby without additional effort or injury if I let it. In the early stages I noticed that as I walked there were times I tensed muscles around my waistline and in my hips, exerting effort to “carry the baby”.  When I realized I could relax all those muscles and move in a way that was harmonious with her, I soon saw that my body did not feel added stress. 

2. Building on the point about relaxing, being sure to BREATHE PROPERLY. Though the growing uterus takes up space near the diaphragm and ribcage, the diaphragm can still do its job. A breathing pattern which primarily originates in the diaphragm and is not restricted by tension in the shoulders, ribcage, abdomen or pelvis is an essential component of efficient posture. Being able to maintain efficient breathing is a good sign that you are feeling good!

3. TAKING TIME to move, whether it’s getting up, moving in bed, walking or squatting, not just because of being heavier or that it’s “harder”, but because “moving for two” may take that extra bit of mindfulness to negotiate how to move in a way that is kind to my body. I’m not saying that you couldn’t still run in the Olympics if you wanted to, but as for me, no more running for the bus!

As a PT, I have learned important lessons from experiences as the caretaker of my own human body which enhance how I help others help themselves. Whether you are carrying a baby in your womb, a child in your arms or even bags of things in a city schlep, I invite you to create a new language for what it is you are doing. Is there some way you could create more ease for your body, create more harmony between you and the person or things you are carrying, or learn to trust your body more? Time and time again it is a relief to find out that breathing easier and relaxing more creates more efficiency, comfort and pleasure in the body. If you are unsure of how to create ease in your body - pregnant or not - schedule an appointment with a physical therapist...we can help!

Sara Chan, PT, CFMT

Sugar Uncovered: Don't Make These Mistakes!

In the last few weeks there has been a lot of buzz around sugar because of the law that Mayor Bloomberg is trying to pass limiting the sale of large sized sugary drinks. As a health coach, I have had many people ask me about sugar and its effect on the body. The short answer is frequent consumption of sugar leads to weight gain, lethargy, and mood swings. Prolonged overconsumption can lead to obesity, diabetes and heart disease! How could such delicious treats cause so much harm?

The challenging part is that sugar has become part of our cultural DNA, which makes it almost impossible to avoid completely. Every holiday has its special sweet. When we mark significant life milestones - birthdays, graduations, weddings - cake takes center stage. Children do well on a test; we reward them with ice cream. When I walk around the streets of NYC, there are frozen yogurt shops and cupcake cafes popping up on every corner. We are surrounded by it!

But aforementioned sweets are not the only sugar culprits. The obvious treats are easy to spot and we can try to avoid them. But what happens when we THINK we are making a healthy decision BUT we are actually ingesting large amounts of sugar and don't even know it!

Don't be duped by these seemingly healthy but sugary favorites:

• Sauces/Glazes - Many times to get that perfect complement to your savory dish, chefs will add a sauce or a glaze. But beware, many glazes have added sugars. So that soy glazed salmon dish you love may look like the healthier choice but could have over20g of sugar...more than 1 chocolate glazed doughnut!
• Yogurt - This delicious snack can be very healthy but beware of yogurt with added fruit. Yoplait strawberry yogurt has 26g of sugar...as much as a Snicker's bar! If you are going to eat yogurt, eat the plain and add your own fruit for the touch of sweetness.
• Granola - Eaten by hippies for years...it must be healthy right? As it turns out, Kellogg's Original Granola has 17g of sugar...as much as 3 chocolate chip cookies!! If you are going to have granola, either make your own or be sure to check the labels for lower sugar options.
• Coffee/Iced Tea -I was floored when looking into coffee drinks and iced teas. I never thought twice about these, as they were obviously the healthier choice to the dreaded soda. Wrong!  A Starbucks Grande Cafe Mocha has 33g of sugar, which doesn't include any flavor shots, or sugar people add after they get it. If you are going to drink coffee or iced tea it's best to have it black/unsweetened.

Knowing a few of these sugary pitfalls will hopefully help you to make healthier, informed decisions. At 1 Healthy Life we know that it's easy to get off the healthy track and sometimes difficult to find your way back. That is why we work with people to help them take small steps(like cutting out sugary drinks) now that lead to BIG changes in your health later.

Working with a health coach will:

• Help you to truly identify realistic, attainable health goals
• Develop a customized plan that will step you toward your goal over a series of sessions
• Hold you accountable (in a loving way) to those goals week after week
• Identify if there are certain steps that are not working for you and help you to modify the plan so it works specifically for you. Not everyone is the same...therefore, no plan is going to be exactly the same

1 Healthy Life has partnered with Duffy & Bracken Physical Therapy to develop a program that is the one...two health punch combining wellness & exercise. In only 3 months you will have a Total Health Transformation! We will dive deep into eating right, reducing stress and improving your energy while Duffy & Bracken trainers will kick your butt on their Gravity Training System to improve your muscle tone, flexibility and overall physique.

You only get 1 life; why not make it your best life possible? And you can...with small steps and support along the way.

Schedule your 1 on 1 complimentary health breakthrough session today. What do you have to lose?

Mina Penna, Holistic Health Coach

Mina Penna is a Holistic Coach who works with clients to help them reduce stress, improve their energy, find more balance and lose weight. Mina was certified at the Institute of Integrative Nutrition and is a member of the American Association of Drugless Practitioners. Additionally, Mina is the Corporate Nutritionist for Sabra Dipping Co., LLC.

Cliffs Notes: Your Guide to Physical Therapy!

About a month ago, Duffy & Bracken owner, Ann Duffy wrote a passionate blog detailing both the role and the ability of physical therapists in providing preventative services and helping to curb ever-growing healthcare costs. A few weeks later, D & B director, Renuka Pinto, wrote an equally fervent blog highlighting how physical therapists can help individuals invest in their health with the same proactive, calculating approach they take to investing in their financial well-being. As luck would have it, these blogs were posted around the same time that a very poorly-informed segment aired on Dr. Oz, grossly misrepresenting what we as physical therapists actually know and do. (Disclaimer: if you are currently attending PT and receiving the type of care depicted in Dr. OZ's segment, please find a new physical therapist ASAP) To this end, I felt it only appropriate that I complete the D & B blog trifecta and devote this entry to summarizing the many skills that we as physical therapists possess, and reiterating how we can help you, the health care system, and the country as a whole .

Despite what Dr. Oz would have you believe, physical therapists are not merely the keepers of the machines, wielding ultrasound and electrical stimulation units against the dark forces of persistent low back pain, reinforced by our trusty sidekicks, the hot and cold packs; quite the contrary. Currently, to become a physical therapist, one must attend 3 years of graduate schooling, in addition to their undergraduate or post-baccalaureate. Pre-requisites for PT school are the same as those required for med school, generally with the addition of courses like exercise physiology and kinesiology in place of organic chemistry. Physical therapy graduate course work includes biomechanics, physiology, kinesiology, pharmacology, and radiology. PT students study pathology of not just the musculoskeletal system, but also pathologies of the neurological, cardiopulmonary, genitourinary, gastrointestinal, and integumentary systems. Following roughly 7 years of schooling, physical therapists currently graduate with their doctorate, and then enter the health care industry with an identity that is often time misunderstood, and a role that is severely underutilized by the general public.

Here are the cliffs notes as to what a physical therapist is, and what we actually do:

Physical Therapists are musculoskeletal specialists. With extensive coursework in anatomy and physiology, physical therapists possess the knowledge to both diagnose and treat nearly all musculoskeletal pathologies or refer patients to the appropriate practitioners if needed.

Physical Therapists are movement experts. With a strong foundation in biomechanics and kinesiology, physical therapists are trained to analyze everything from your gait to your golf swing. We can determine why your knee hurts when you go down the stairs, help you decrease your half marathon time, and tell you which shoes are best for your needs.

Physical Therapists take an active role in your recovery. Physical therapists use manual techniques such as joint and soft tissue mobilizations, taping in conjunction with therapeutic exercises to facilitate a return to full function. It is our hands, not the hot packs that will make you better.

Physical Therapists are easily accessible. Thanks to Direct Access, patients in New York can see a physical therapist (who has been practicing for at least 3 years) WITHOUT a referral from a physician. Patients are allowed to attend physical therapy for 10 sessions or 30 days before they are required to see their doctor and obtain a prescription.

Physical Therapists don't just cure pain, we can also prevent it. Physical therapists can predict your likelihood of injury by watching you perform simple functional movements. Additionally, patients are provided with home exercise programs and educational tools that allow them to prevent the reoccurrence of injuries and employ self-management strategies should symptoms return.

Physical Therapists help save you money. Although co-pays can be frustrating, attending physical therapy can help people get out of pain quicker, help people avoid invasive surgical procedures, and decrease the amount of medications that a patient needs to take. Six sessions with a $20-$35 co-pay and an adjustment to your workstation versus back surgery. I'll let you do the math.

If you're reading this blog, there's a good chance that you already know the benefits of attending physical therapy. However, I ask that you share this blog with your friends and family, and anyone who's complained to you about their stiff neck and their sore knee. For those of you who just had a mind-blowing experience, carry this knowledge with you and see a physical therapist the next time that ankle (or knee, shoulder, elbow, back, neck) starts acting up.

Carmen Shante Cofield, DPT, CSCS

Duffy & Bracken Physical Therapy

NO PAIN, NO GAIN!

My Duffy & Bracken Physical Therapy one year Anniversary is fast approaching. As the PR & Marketing Director, I wear multiple hats but one hat I didn't see coming was that of (wait for it) ....PATIENT. You see while finishing my Masters Degree, I worked from home for three years. As you can imagine, when I started commuting to Downtown NYC to work and began moving around more and more, I started feeling all sorts of aches and pains in my body. Even though I went to the gym when I could and got a work out in here or there....my mental activity certainly didn't make up for all my physical inactivity.

I figured how convenient for me....I work at a physical therapy clinic so I could just get a quick fix and be on my way. Boy was I wrong...TOTALLY wrong.

Many of you will want to argue with me that the 'No Pain, No Gain' philosophy is actually a myth and pain is not required to have a quality workout. Trust me I get! But I'm not here to argue that point....the truth is that Physical Therapy is unlike any other visit to your doctor's office. It most times will require more than just the quick fix even I expected. Like everyone else I was going to have to put in the work if I wanted to be pain free.

Here is what I learned while walking a mile in your shoes as a PT patient:

1. It may pain you to have manual therapy. Physical Therapy is not like getting a massage at your neighborhood spa. Manual therapy techniques are not as relaxing, it can even be uncomfortable, but trust your therapist to be your guide to long term freedom from pain.

2. It will pain you to do your exercises everyday. No one likes to do them but they are an integral part of your treatment plan....don't neglect them. And if you ever find yourself in pain again after being discharged, the first question you should ask yourself is ...have I been doing my home exercise program.... then make an appointment.

3. It will pain you to carve out a couple of hours a week for 4-6 weeks. Having been in your position, I definitely understand how difficult it can be to make time for treatment. We know your busy but don't be what I like to call a 'Repeat Offender'. Repeat offenders are patients who start feeling better in the middle of their treatment and decide that they don't need therapy anymore. They end up back in therapy because they didn't commit to the process. Would you tell your cardiologist that you don't need your heart medication anymore?

4. It may pain you to dip into your pockets for those co-pays at every visit. Yes, we know it adds up but we didn't make the rules we just enforce them. If you think about it...can we really place a price tag on being pain free and able to live your life to its fullest without physical limitations.

Anyone who has successfully completed their PT treatment plan will tell you that the benefits far out weigh the costs. When it comes to PT...No Pain, No Gain! So yes, it may be a pain in one way or another but most things worth doing are usually not easy. If you are currently in a PT treatment plan, commit to it and if your living in pain, you don't have to....make an appointment today!

Kieffer Pearce

PR & Marketing Director