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

What's Your 401 (k) Health Portfolio?

We are constantly being warned about SAVING....saving for retirement, saving for an emergency, saving for unknown medical expenses. Most individuals over 30 are warned to start saving TODAY  to ensure a nest egg at 65, as social security may be non-existent at their retirement.

The size of your present investment will determine the quality of your retirement life!

Our previous blog talked about changes in healthcare and changes in the way we should look at health. This one is no different.

Lets look at health as an investment; the same way we look at stocks.

If you invest 30 minutes 3 times a week in exercise, research shows it's enough to ensure a healthy cardio vascular system. So let's name this investment "aerobic stock".

If you remove trans fats, fried foods, processed foods, fast foods from your diet and switch to home-cooked and healthy green meals; research shows it can reduce your risk of cholesterol, CVS disease, and high blood pressure. So let's name this investment "diet stock".

If you maintain a healthy lifestyle, don't smoke, don't consume excessive alcohol and get enough sleep, research shows you reduce your risk of liver, lung and heart disease. So let's name this investment "choice stock".

But have you ever thought about "MOVEMENT STOCK" ?

You may get to 65 with a strong heart, no cholesterol and no liver disease but they may seem quite useless if you cannot move!

No one is taking this "mobility stock" as a serious contender to their overall health portfolio.

Hence investment is low.

Here are some risk factors that are indicators of a poor mobility investment:

1. Can't cross legs to tie shoe laces (men) and (women) needing to sit down to strap shoes or put on stockings.

2. Neck and low back stiffness upon waking up or going to bed.

3. Headaches - not normal- even it triggered by stress.

4. Can't bend or stoop down to pick up things from floor or need help getting up from floor.

5. My favorite - POSTURE- your posture slouched, stiff or unaware is enough to breakdown the entire movement system.

While you may say I go to pilates, yoga, gym etc. therefore by default my investment is solid.Think Again! If you get a blood test every year even if you go the gym and eat healthy, why are you not assessing to see if your movement system is optimal or headed to breakdown?

Prior to private practice in NYC; I was a Physical Therapist to professional athletes world wide including tennis stars like Sharapova and the Williams sisters. The biggest reward was not having a million dollar athlete miss a match due to a movement breakdown. Preventing an injury is much better than rehab -- as it takes time away from life!

So I urge you big apple residents --- assess your movement stock by scheduling an appointment with a physical therapist- as living in the city is a professional sport!

Renuka Pinto, MPT, PGDR, CSCS, CES

Duffy & Bracken, Physical Therapy

-Serving Downtown NYC for over 24 Years!!

Physical Therapy for the 21st Century!

Physical Therapy never ceases to amaze me. I continue to be a huge advocate for the profession I fell in love with 34 years ago when I observed my first physical therapy session and the patient that was being treated told me that he had back pain for years and that PT cured him. I have heard that story so many times since then, from patients saying they thought they would be in pain the rest of their lives and that they should have come much sooner or that they were told that they would probably need surgery and now they no longer do. The pelvic work we do gives both men and women their life back, by strengthening the muscle to cure incontinence or stretching it to allow a normal sex life.

The future of Physical Therapy is not only to be able to get people out of pain or dysfunction sooner, reduce surgeries and medication use but also to prevent the ever growing need for joint replacements, assisted and nursing home living. This is not only the future of PT but it must be the future of the country. We cannot afford the ever-looming healthcare escalations.

We need to practice progressive and preventative medicine even if our archaic insurance companies and government haven't embraced it yet.

Physical Therapists have so much knowledge to share with you about your bodies and how to prevent future injuries and pain. It is crazy not to seek their help... I certainly do! I have been a physical therapist for 29 years and I know that when I have muscular skeletal pain or I'm having trouble with my sports performance and my instructor whether tennis, skiing, golf etc isn't completely solving the issue, I turn to our sports physical therapist to get the exercise or body correction needed to complete the task. An instructor can teach the correct technique but they don't change your body so you can perform the technique. That takes a physical therapist's knowledge.

This mindset of prevention and getting the help of physical therapists has and will keep me active. So far in my 50 years, I have climbed to Everest Base Camp, Kilimanjaro, the Inca Trail to Machu Picchu, the Milford Sound Trek, hiked many mountains, biked many hills and continue to jump on my wake board, surf board, snowboard or skis plus play competitive tennis and golf, all without incident, and my bucket list is still full. I plan on bucket listing into my 90's. What's on your bucket list and how can we help you continue to play the game of an active lifestyle.

I highly recommend it!

Ann Duffy, M.A., P.T.

Owner

A Note to Holiday Travelers from Duffy & Bracken Physical Therapy

It's that time of year again; where for two weeks straight we overindulge and uderperform. We become so busy with holidays parties, and spending time with family, that we neglect to take care of our physical well-being. For those who are traveling during the holidays, we inadvertently put our home exercise program on hold and make a resolution to begin again in the New Year. However, this does not have to be the case. There are simple steps we can take to ensure that we work those squats and bicep curls into our holiday plans.

DEPARTURE:

Just as we make a list of items we will be packing into suitcases and travel bags, we can also make a list of necessary and sufficient items we need for exercise.

1. Exercise Sheets: If you have been diligently keeping up with your exercise routine, you may not think this is necessary. However, it doesn't hurt to have them as a reference.

2. Therabands: Packing weights is not only impractical for many, but will definitely ensure that you have exceeded the baggage weight restrictions. Therabands are great substitutes for many strengthening exercises.

3. Tape: If taping is a regular part of your therapy, it may be a good idea to purchase a roll and learn how to do it yourself.

4. Sombra: If you have been introduced to it during treatment, this pain relieving gel will come in handy for those muscle and joint pains that are associated with long travel.

EN ROUTE:

Many of us have fallen in the trap of being completely immobile during long journeys.

Just remember to KEEP MOVING!

For long plane, train, or bus rides do your stretches often, or when you feel your body becoming stiff. Take a walk through the aisles and if this is not possible adjust your sitting position ever so often. For those with neck or back pain, talk to your therapist about purchasing neck or lumbar support rolls.

ARRIVAL:

Do your best to incorporate your exercise routine into your holiday plans. Find time in the morning or before you go to bed to do your exercises. Do your lunges or calf raises while brushing your teeth, or your single-handed tricep and bicep curls while drinking your coffee. Simple items around your hotel room can also be useful. For cold packs, freeze a bottle of water, or place ice cubes into a towel. For heating packs, dampen towels and warm in microwave (just for a few seconds). Taking a long cold or warm shower may also help.

From your departure to arrival time, there are many ways to ensure that your exercise routine is not placed on hold. Talk to your Duffy & Bracken therapist about tips and tricks that are specifically designed for your needs.

Keeping up with your routine ensures that you will have a HAPPY & PAIN FREE NEW YEAR!

 

Rhea Farquhar, PT Aide & GTS Trainer

PUMPING IRON: Female Edition

Once you enter a gym and have been there for more than a few minutes any gym member will notice something odd. A type of dividing line that separates where men and women workout. In the cardio section of a gym, I witness a mixture of both men and women working their calories off to increase performance, slim down, or just enjoy themselves. Sadly, similarities end there because once you migrate across the floor....pass the machines....into the darker section of the gym with barbells, dumbbells, plates, and squat racks...women disappear! WHY IS THAT?

As a Gravity Training System (GTS) trainer at Duffy & Bracken Physical Therapy and someone currently studying to become a Strength and Conditioning Professional, I help women learn about their weight lifting capabilities and it's benefits. The aim for most women is to develop a slimmer waist and toner body. Cardiovascular training will surely help lose weight, but what many women don't realize is that adding weight training will compound your weight loss efforts. That is because weight training adds muscle, which the body must maintain by burning calories and thus increasing your base metabolism. So in a sense, just having more muscle will make you a calorie burning machine just by standing around waiting for the train to come.

Ladies, let's have a heart-to-heart for a second. You're missing out on huge benefits that weight training provides that training with a treadmill and elliptical machine only simply does not. If you are looking for health benefits then look no further than that barbell. It is evident that weight training can increase bone health. So to protect those lovely bones there is no better preventive method than starting a weight-training regimen. Lastly, supplementing weight training with a cardiovascular program will better your performance than cardio training alone. Strengthening those bone, muscles, and ligaments will also help to prevent injury during your long runs. "But Jesse..." you might say..."I don't want to become like those bulky women I see on TV with a manly figure. I want to keep my physique and flexibility." Nothing to worry about, this will not happen unless that is your aim. I have never seen anyone 'accidentally' get a bulky figure.

So lets get to the good stuff....the exercise prescription. Firstly....squats, squats, and more squats. They are considered the King of all exercises for a reason. This multi-joint movement requires ankle, knees, and hip flexibility...strengthening all muscles from the abdominals down. Adding weights by holding dumbbells at shoulder height will stimulate the muscles and bones to grow strong. 3 sets of 10 will make sure those are achieved. Just remember to Watch Your Knees! Don't let them move too far over your toes or buckle inwards, to prevent unnecessary strain on your knees. I advise you to have a trained professional watch your form. Duffy & Bracken is a good source of those aforementioned trained professionals, ask us and we will help.

Next the upper body, women's upper body in relative comparison to men's are weaker so we need to get those guns pumped! Another amazing multi-joint exercise is the Military Press. (I like multi-joint exercises...more muscles demanded = more calories burned) In an upright-seated position grab a dumbbell of mild to moderate weight (5lbs is good for starters) and push overhead. This exercise is great in developing muscle and strength primarily in the shoulders and uses your biceps and triceps to help stabilize the weight. Start with a light weight and slowly progress to heavier until desired shoulder size, tone, and strength is achieved. Three sets of 10-15 repetitions is the ideal range for this exercise.

Supplementing these weight exercises into your cardio training will make sure you meet those cardiovascular goals and here at Duffy & Bracken we are all about making you reach your goals. I recommend coming in for a complimentary group Gravity Training Systems (GTS) workout, which will help develop muscle and trim waistlines. The GTS machine uses a combination of inclines and pulleys to safely and effectively workout nearly every muscle. After a few sessions with us you will feel more comfortable trekking into the weight section of your gym to begin reaping the benefits of pumping iron.

Jesse Barriuso, PT Aide & GTS Trainer

ARE YOU ENGAGED?

As one of the Gravity Training System (GTS) instructors at Duffy and Bracken Physical Therapy, one of the first questions I ask a client is whether there is a specific body part they would like to work on. One of the top answers is, "I want a flat tummy! Give me some abs". In response, I remind people abdominals already exist. They just need to be defined.

So how does one do that? First off, doing crunches all day will not work alone. Bulky abs under a layer of fat will be the end result. However, with a combination of aerobic exercises and resistance training, definition will become more evident. In addition, there stands one more element in regards to exercise that is a key component in getting maximum results during a workout; abdominal engagement.

Doubling as a physical therapy aide at the clinic, I find that patients have to learn how to properly engage their core. When the lower abdominals are incorrectly engaged during exercises that require flexion at the hip, it is common to compensate using another set of muscle called the hip flexor. The hip flexor is used to bring the thigh closer to the trunk and is primarily used during exercises such as running and leg lifts to stair climbing. So how do you distinguish between which ones you're using? It's not that you want to isolate the two completely, but you do want to focus on working the abdominals more with certain movements. The only way to do this is practice!

One way to practice is an exercise called transverse abdominis contraction (TAC) with marching. To do this, lie on your back and bend both knees. Keep feet about six inches apart with feet flat on the ground. Naturally, your lower back will have a slight curve away from the floor.

(Transverse Abdominis Contraction shown in the figure where dotted line is shown. Navel is drawn in towards spine and back is flattened)

The first step (TAC) is to engage your lower abs by tensing the muscle. Try drawing your lower abs towards your spine. You should be focusing on the muscles you feel engage when you cough or laugh. Do not hold your breath! This should make your lower back press towards the floor, providing a protective mechanism for your back. The next step is "marching". Slowly, lift one leg at a time bringing the knee towards your trunk, maintaining the 90-degree angle in the knee. Return leg to starting position and switch legs.

If performed correctly your back will stay pressed down and your lower abdominal should be overpowering your hip flexors. If the back begins to arch away from the floor, chances are your hip flexors are overpowering your abs. This can cause stress in the back.

Practicing transverse abdominis contrations can be done anytime. Sitting, standing, and walking are excellent opportunities to practice, as it will improve posture. To learn more about how to better engage your core during everyday activities or exercises, feel free to consult your physical therapist. Remember, the core is like the foundation of a building. The weaker or stronger the foundation, determines how well the building will stand.

Toupelle Goodman, PT Aide & GTS Trainer

Photo References:

Nicholas Institute of Sports Medicine and Athletic Trauma; http://www.nismat.org/ptcor/lbp

Jackie Brand Personal Trainer; http://www.jackiebrand.com/page46.php