Take Charge of Your Health! How to Advocate for Yourself.

StethoscopeKaitlyn Parrotte, PT, DPT

Board-Certified Clinical Specialist in Orthopaedic Physical Therapy (OCS)

Certified Functional Manual Therapist (CFMT)

The new year is in full swing, and many of us have set goals to help start things off with renewed energy. One area in which, many people make goals in is health. While some folks vow to go to the gym regularly, or eat healthily, many other individuals commit to having medical check-ups, or taking care of a long-festering issue, such as a painful knee or abdominal pain. No matter what type of healthcare provider you are visiting, it is imperative that you come prepared to make sure you are getting all the facts, and are able to advocate for yourself to ensure you are receiving the best treatment for you.

Come with a Plan

One way you can advocate for yourself is to come prepared to a medical consultation by bringing a list of questions and subjective information with you. Be prepared to discuss what is bringing you to see that health care provider. What symptoms you might be experiencing? When these symptoms began? What makes you feel better and worse? How your symptoms make you feel limited in your daily life, and what you are hoping to get out of seeing that practitioner (i.e. a referral to a specialist, pain relief, etc.,.)? Many questions can arise during a medical examination, so don’t be afraid to ask for clarification, and make sure you understand the information you have been given. Research has shown, that individuals who ask specific questions about their health, may receive more comprehensive care. For example, in a 2015 article from the Journal of Family Medicine and Community Health, researchers found that when older patients were more proactive with communication to their doctors, primary care physicians were more likely to recommend both cancer screening and cancer prevention to their patients.1

On Second Opinions

When you receive a medical result, do not be afraid to get a second opinion. People seek out second opinions for various reasons: to get reassurance on a treatment protocol, to confirm the findings of a particular healthcare provider, to verify the reputation of a given institution, and even due to patient dissatisfaction in the communication or relationship with a practitioner.2-3 Whatever your reason, know that it is your right to have a second opinion to ensure you are getting the best possible care. Some research has found that second opinions have changed the diagnosis and/or course of treatment. In two studies that look at different patient populations with cancer, they found that in cases where a specialized practitioner was consulted, the accuracy of initial staging for a diagnosis increased, treatment and management of the condition was affected in about 20% of cases, and unnecessary surgeries were prevented in about 7% of cases.4-5 Thus, getting a second opinion can be very beneficial to you. Whether it changes the course of a treatment, or simply reinforces what you have already been told, seeking a second opinion can help you make educated decisions regarding your care.

Consider Both Risks and Benefits

If you are given a diagnosis and are informed of your treatment options, make sure to ask about, and consider, the risk-benefit analysis for each. The “risk-benefit analysis” is defined as “the consideration of whether a medical or surgical procedure, particularly a radical approach, is worth the risk to the patient as compared with possible benefits if the procedure is successful.”6 What this means is, it is important to weigh any treatment’s potential outcome on your quality of life, as well as your values and goals, when determining what route of care you’d like to embark on. If the risks outweigh the benefits for you personally, then it may not be a treatment worth trying. However, that is a very specific and personal decision, that must occur between you and those close to you, under the guidance of your health care provider.

Prevent Illness Before it Happens

While it is very important to be well-informed and prepared for a visit so you can better advocate for yourself, taking steps to prevent illness or injury in the first place, is crucial to promote overall well-being. Two major changes you can make in enhancing your health are diet and exercise. According to the Dietary Guidelines for Americans, 2015-2020, 117 million individuals, which is about half of all American adults, “have one or more preventable chronic diseases,”7 which include cardiovascular disease, high blood pressure, type 2 diabetes, some cancers (i.e. colorectal and postmenopausal breast cancer), and poor bone health. Theses chronic diseases are related to poor quality eating habits and physical inactivity. Furthermore, more than two-thirds of adults, and nearly one-third of children, are overweight or obese, which is associated with increased health risks and higher healthcare costs.7 Key recommendations for a “healthy eating pattern” include: eating a variety of vegetables, fruits, grains, proteins, and oils, as well as fat-free or low-fat dairy, while limiting saturated fats, trans fats, added sugars, and sodium.7 Research has found that most Americans do not eat enough fruits and vegetables. However, those that do tend to eat more fruit at breakfast and in snacks throughout the day, while more vegetables are consumed at lunch and dinner.8 This is something that can be added to your routine easily to ensure you are consuming a balanced diet.

As previously mentioned, physical inactivity can contribute to poor health; however, engaging in regular physical activity helps improve your overall health and fitness, and reduces your risk for many chronic diseases. According to the 2008 Physical Activity Guidelines for Americans, adults aged 18-64 need at least 2 hours and 30 minutes of moderate-intensity aerobic activity (i.e. brisk walking), and at least 2 days of muscle strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, arms). The same recommendations are given to older adults over the age the 65 years.9 That may sound like a lot of time that you don’t have; however, the CDC reports that engaging in aerobic exercise for even 10 minutes at a time can be beneficial.9 So get on your walking shoes and start power-walking to your appointments, or to the breakroom at work!

Ok. That was a lot of information, so here is a recap:

  1. Being well-informed and prepared with questions for medical consultations allows you to better advocate for yourself, and may help you to receive more comprehensive care.
  2. Seeking a second opinion, especially when considering a major medical procedure, is something that is your right as a consumer, and can impact your diagnosis and/or course of treatment.
  3. Considering the risk-benefit of any medical or surgical intervention is important to ensure that a given treatment is appropriate for your quality of life, values, and goals.
  4. While being educated and engaged when dealing with a medical concern is important, helping to prevent illness or injury through diet and exercise are critical for maintaining a healthy life.

If you are saying to yourself, “this is too overwhelming; there is no way I can do this!”, then I will leave you with a quote from Audrey Hepburn: “Nothing is impossible. The word itself says I’m possible!” You have the information; now it is time to get out there and start leading a healthy life, so the energy and inspiration of the new year keep ringing all year long!

Sources:

  1. Kahana E, Lee JE, Kahana B, Langendoerfer KB, Marshall GL. 2015. Patient planning and initiative enhances physician recommendations for cancer screening and prevention. J Fam Med Community Health, 2(9), pii 1066.
  2. Mordechai O, Tamir S, Weyl-Ben-Arush M.2015. Seeking a second opinion in pediatric oncology. Pediatr Hematol Oncol; 32 (4): 284-9.
  3. van Dalen I, Groothoff J, Stewart R, Spreeuwenberg P, Groenewegen P, van Horn J. 2001. Motives for seeking a second opinion in orthopaedic surgery. J Health Serv Res Policy, 6 (4): 195-201.
  4. Sawan P, Rebeiz K, Schoder H, Battevi C, Moskowitz A, Ulaner GA, Dunphy GA, Mannelli L. 2017. Specialized second-opinion radiology review of PET/CT examinations for patients with diffuse large B-cell lymphoma impacts patient care and management. Medicine, 96 (51), doi: 10.1097/MD.0000000000009411.
  5. Lakhman Y, D’Anastasi M, Micco M, et al. 2016. Second-opinion interpretations of gynecologic oncologic MRI examinations by sub-specialized radiologists influence patient care. Eur Radiol;26:2089–98.
  6. “The Free Dictionary by Farlex – Medical Dictionary.” https://medical-dictionary.the freedictionary.com/risk-benefit+analysis.
  7. U.S. Department of Agriculture & U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2015-2020. Washington, DC: U.S. Government Printing Office; 2015.
  8. Moore LV, Hammer HC, Kim SA, et al. 2016. Common ways Americans are incorporating fruits and vegetables into their diet: intake patterns by meal, source and form, National Health and Nutrition Examination Survey 2007-2010. Public Health Nutr; 19 (14): 2535-9.
  9. “Physical Activity Basics.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 4 June 2015, http://www.cdc.gov/physicalactivity/basics /index.htm.

Preparing for the Marathon with Physical Therapy at Beyond Basics!

JHO-Muscogee Moms Contest-Blog

Fiona McMahon, DPT

Hi all! If you have been following our blog, you should be aware that Beyond Basics Physical Therapy and I are teaming up to raise money the Tisch Multiple Sclerosis Research Center of New York with Team Tisch MS. I’m hoping to raise $3,000 dollars to support multiple sclerosis research.  We have currently raised approximately $1,500!. Please support us and click HERE to donate. What puts the fun in this fundraiser ( sorry, not sorry about the pun) is that we get to get donations through running the New York Marathon, which I will be running in November.

I have run 4 marathons before including New York, and even though my timed goals were not lofty ( I really only cared about dragging my body from A to B 26.2 miles later), I relied on PT every single time, to keep my body whole and prevent me from sustaining race ending injuries. This year is no different and this week I will be having my first appointment with Jessica Babich, at Beyond Basics.

 

Why go to Physical Therapy if you are not injured?

No matter how you cut it, physical therapy is an investment. Based on your insurance, co-pays can vary to very little to more expensive, and no matter how much you are paying, the time it takes to go to physical therapy and diligently do your exercises is a finite resource. So why add more tasks to an already arduous training schedule? For me, the answer is easy, I want my body to not only run a faster marathon this fall, but I want to do so in a health way to protect my joints, ligaments and muscles, so I can not only continue to run, hike, ski, and play outside, but also so I can continue working without pain.

But aren’t you a PT, can’t you just PT yourself?

One of the most powerful and surprising lessons I’ve learned through being a physical therapist is, it is really hard to be objective about your own body. Physical therapists are trained to see large scale impairments like weak hip strength, which I know for a fact is something I need to work on, but also small scale impairments in movement, like slightly more pronation on the right foot than the left, those are things another practitioner needs to observe from the outside to diagnose and treat. Having an objective movement analyst ( aka a physical therapist), can help you see weaknesses, and alignment issues that even the most expert observer may miss on themselves. Long story short, you don’t know what you don’t know.

Why someplace like Beyond Basics Physical Therapy

I work at Beyond Basics, so full disclosure, it is the most convenient place I could go. That being said, it is also the best place I could go. Physical therapy clinics come in “flavors” and for someone hoping to truly optimize their performance, Beyond Basics Physical therapy and clinics with the same “flavor” are where to go. What makes Beyond Basics physical therapy so special is the hour one-on-one treatment they offer. This allows us to address all three pillars of movement, efficiently, effectively, and completely. The three pillars are mechanical, ( tightness, or lack thereof, of muscles, joints, fascia and ligaments as well as bony alignment), strength (how strong is a particular muscle and is it strong enough to do it’s job), and finally neuromuscular control, ( do your muscles do the right thing at the right time, this is really important to stabilize the joints of the leg and back, and is often overlooked in some busier physical therapy practice). Other physical therapy practices have a slightly different flavor. They may have a one physical therapist treating 4 patients and hour. Even if time is divided up perfectly equitably between patients, this allows the therapist of only 15 minutes on hands-on treatment to correct mechanical and neuromuscular issues, therefore leaving 75% of the time doing exercises with other patients. That flavor of physical therapy can work for some people, especially those who like to socialize with other patients during treatment, but for me, marathon training is too hard to only get 15 minutes of hands on time and spend 45 minutes doing exercises in a crowded gym. I feel that I am perfectly capable of doing my assigned exercises regularly as part of my home program. I would much prefer to work with a therapist who can tailor my treatment to suit my needs, not one who has to juggle the time constraints of treating multiple patients at once.

How are you preparing for PT?

Beyond Basics Physical Therapy is based out of New York. Like most states in the USA, New York has direct access, so I don’t need to have a prescription to come in. I will be bringing a few things to my appointment that I think are essential: health history, attire, and attitude.

Health History: Health history is a big one. In physical therapy a complete health history includes your current medications, and medical conditions, past injuries ( this is really important, and things like an ankle sprain a few years ago can clue us in on a lot ), and other factors like stress, amount of sleep you typically get, how much you work out and what you do, and diet.

Attire: Another important and sometimes overlooked item on the list. Your physical therapist will have to examine different areas on your body, as well as have access to treat those areas. Loose fitting shorts and an athletic top are a good bet. Even if you are going to physical therapy, for a condition like pelvic floor dysfunction, your therapist may ask you to do exercises, so it wise to bring workout clothes to your appointment. If you are a runner, bring in your shoes. The wear pattern on used pair of running shoes can provide heaps of valuable information.

Attitude: This is super important. Physical therapy is a partnership between you and your physical therapist. For me I already, foresee finding time to do the exercises that Jessica will prescribe to be a challenge. But the fact is, home exercise is part of the deal, and I won’t get nearly as much benefit from physical therapy alone, versus physical therapy with home exercise. Like I said before marathon training is simply too hard to just go through the motions at physical therapy.

 

What are your goals and what do you expect to gain from physical therapy?

Like I said before, I want to stay as healthy for as long as possible, but I would be lying if I said my primary goal wasn’t to increase my time. I want to put my money where my mouth is and put all my old times out in the open. So you can know where I am starting from and where I hope to go.

Here are my past times:

Mount Desert Island 2010: total time 3h 56 minutes 18 second: 9 min per mile pace

Mount Desert Island 2011: total time 4h 05 minutes 21 second: 9 min 22 seconds per mile pace

Sugarloaf 2011: total time 3h 52 minutes 25 second: 8 min 51 seconds per mile pace

New York City 2013: total time 4h 0 minutes 47 second: 9 min 11 seconds per mile pace

Here’s my dream goal for this race:

3 hours and 45 minute at 8: 35 pace.

As you can see, it’s 7 whole minutes faster than my fastest race over 7 years ago . To get there, I can’t get injured and I certainly can’t waste any precious energy during the race running inefficiently. I know that Beyond Basics will give me the best chance to meet my goals.

If you are looking to increase your performance in your sport of choice come see us to make sure you are getting the most power out of your serve, swing, or stride. Click here to access our home page and make an appointment today.

Continue to follow us here, on Instagram, and on Facebook to see my progress in physical therapy as well as my progress towards my goal of raising $3,000 dollars for MS research. If you care to donate please click here to donate to this worthy cause

BBPT Health Tips: Let’s Roll!

Fiona McMahon DPT,

Foam rolling. I certainly have a love hate relationship with my foam roller. My IT bands (the tissue on the side of your leg) hate it, but I love how it keeps my knees and joints happy. Foam rolling is a method to release knots in muscle and improve the mobility of tight muscles and joints. If you are a gym rat, runner, or athlete of any kind, consider giving foam rolling a try. In a review published in the International Journal of Sports Physical Therapy in 2015, foam rolling was shown to reduces delayed onset muscle soreness (DOMS), and temporarily increase range of motion.

First of choose your weapon…. I mean roller.

 

White roller: Great for starters: gentle, but can deform over time because it is softer.

white-foam-roller

foamroller6x36fsBlack roller: This roller is not for the faint of heart, it’s the toughest one of the bunch. It’s not a great place to start, nor is it good if you bruise easily, but for the foam roller aficionados out there, it is really great for a tight IT band and hamstring.

 

 

21nc-kpj2l-_sy300_Grey roller: This is a nice in between roller for those of us who need a little more than the white roller, but aren’t quite ready for the black one. It is actually a composite of both rollers.

 

 

 

Artisanal Foam Roller: This one retails for about 120$ on Amazon and is good if you are super fancy. I haven’t tried it because I’m not very fancy.13187983_252069785150011_953005372_n

 

The Stick and other hand rollers:

 

48d2a548-59cd-437f-b9a1-7a145ae1e592This one is good for those who travel often, because it occupies relatively low amounts of space in carry-on luggage. It is also great for people with tight inner thighs and tightness closer to the pelvic bone, which can be difficult to get to using regular foam rollers. Retail names include: “The stick”, “the tiger tail”, and others.

Other Rollers:

There are other rollers that come in a variety of fun colors and designs. These rollers are less standardized so you may want to experiment if you feel like opting for one of the less classic varieties.

 

Now that you’ve picked your roller, let’s get rolling!

When foam rolling, you can adjust the weight you place on the roller by reducing the amount of support you give yourself. The more of your body weight you put on the foam roller, the more intense it will be.  If you find a particularly tender part oscillate your body on that spot to facilitate release. In addition, you can flex and straighten the area that you are working on to help with additional lengthening of the tissue.   Attempt 10-15 passes for each body part to help improve your function and tissue mobility.

 

ITB band rollingitb
Quad rolling

quads

 

Hamstring rolling

hams

 

Back rolling

rolling-back

 

Adductor rolling with stick

the-stick

 

Sources:
Cheatham S, Kobler M, Cain M, et al. The effect of self-myofascial release using foam roller or roller massager on joint range of motion, muscle recovery, and performance: a systematic review. Int J Sports Phys Ther. 2015 Nov;10(6):827-38

BBPT Health Tips: Quadriceps Stretch

Quadriceps Stretch

 

Hello folks! Beyond Basics Physical Therapy’s latest health tip is the quadriceps stretch!

IMG_3827
Victoria LaManna, DPT, PT, CLT at Beyond Basics

Muscles involved: The quadriceps. The quadriceps are a muscle group that has four separate muscle heads, (quads (four), ceps (heads), get it?). If you walk, you put these guys to work everyday. They work to extend (straighten) the knee and one of the heads, (the rectus femoris) works to flex (bend) the hip.

Stretch Type: Static: Best if performed after workouts on warm muscles. Exercise caution if stretching cold (unwarmed up) muscle.

Caution: This stretch is not advisable for those with balance issues

As always: No stretch should ever be painful. If a stretch is painful, stop and consult your physical therapist for modification.

Directions:  Standing with support in front of you if you need support. Bend your knee and hold your leg at the ankle. Be careful not to abduct your leg (or let your knee move laterally away from the body).   Hold this pose for 30 seconds to a minute on each leg and repeat.

Learn more about Victoria here!

Welcome to Beyond Basics Physical Therapy’s monthly “Tip from your Physical Therapist!”

Fiona McMahon, DPT

We are rolling out a new tip monthly to help you increase your fitness and general health. Today we will be going over a stretch. Before we get started, let’s go over some basics.

The most common question I get asked when I give people a stretch to do is, “ should I do this stretch before or after I work out?” My answer usually is, whenever you are most likely to remember to do it. The best stretch or exercise is one you actually do”. I then go on to explain that you get a little more bang for your buck if you do it after exercise. In a Cochrane review, researchers show that stretching before exercise typically reduces delayed onset muscle soreness (DOMS) by ½ point on a 100 point scale and stretching afterwards reduced muscle soreness by 1 point on a 100 point scale.

Reading that last paragraph, you probably thought, “small potatoes, Fiona, 1 point is not worth disrupting my routine for”. But stretching has many other benefits. The Mayo Clinic Reports that regular stretching has been shown to improve athletic performance, improve blood flow to the muscle, and reduce risk of injuries. Do I have your attention yet?

Let’s introduce July’s stretch:

Adductor Stretch

Adductor Stretch- melissa Stendahl
Staff Physical Therapist, Melissa Stendahl demonstrates

Muscles involved: The adductors, or inner thigh muscles. These muscles primarily serve the function to bring your legs together and are commonly involved in “groin tears”

Stretch Type: Static: Best if performed after workouts on warm muscles. Exercise caution if stretching cold ( unwarmed up) muscle.

As always: No stretch should ever be painful. If a stretch is painful, stop and consult your physical therapist for modification.

Directions: Hold this pose for 30 seconds to a minute; repeat. You may increase the intensity of this stretch, by hinging at the hips and bringing your torso forward over your legs. Remember, to keep your back straight and that this should be a gentle stretch and should not be painful.

Learn more about Melissa Stendahl here!

Sources:

 

Herbert R, de Noronha M, Kamper S. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Review.  2011.
Mayo Clinic Staff. Stretching: Focus on Flexibility. Mayo Clinic. 2014. http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/stretching/art-20047931?pg=1. [Accessed: July 23,2016} 

Happy Marathon Training Season! Preserve your Performance with Beyond Basics Physical Therapy!

Fiona's Marathon photo

Fiona McMahon, DPT

Marathon training season is just around the corner! If you are competing in the New York Marathon, it’s about time to lace up those sneakers and set off on your 18 or 20-week training plan. As an experienced marathon runner, I know personally the frustration and anxiety that can accompany being sidelined from the action. Prior to my days as a PT, I accumulated ankle injuries, knee injuries (both of my knees), and hip injuries while training for various races. These injuries were so upsetting, I had given up my weekends with my friends to wake up for 20 mile long runs on Sunday, I had gone through more sneakers than I care to think about, and coughed up $300 a race in entry fees. Total bummer.
At the time of my first marathon, I was not a physical therapist; rather I was working in a genetics lab in Maine. I was fortunate to have two physical therapists that worked for my company help me when my knee became so painful I could not stand to work at my lab bench, let alone run 26.2 miles. Through weeks of work, they returned me to my old self and I successfully completed my first marathon in Mount Desert Island, Maine. Since that time, I have run 4 marathons and sought the help of physical therapists to help stave off injuries and allow me to train at my top capacity as I push closer towards a Boston Marathon qualification time.
Physical therapy helped me gain a critical awareness of my deficits as a runner. I found out I had a weak butt, tight iliotibial bands, and hamstrings. Who knew?! There is a lot as runners that we tend to overlook in terms of physical fitness. Many of us believe that putting in the mileage alone will prepare our bodies to endure the stress of months of training on hard pavement. It won’t. We need a strong core and hip stabilizers to reduce the impact on our joints. We need long and strong muscles to help generate enough force to efficiently move your body the length of the race. If you are only thinking cardio with marathon training, chances are good you are missing something that could help your overall time and health.
If you are starting out on your first 26.2 mile journey (or any athletic journey), or completing your 30th, don’t ignore your body’s signals that there might be an injury that needs attention. Treating an injury early with good physical therapy treatment is often much easier than treating one later on. Early treatment also minimizes disruption to your original training plan.
At Beyond Basics Physical Therapy, we go beyond what is offered in many physical therapy clinics. Our clinicians are orthopedic experts and spend an hour with their patients in one-on-one treatments, creating specialized plans to keep you in tip-top shape and return you to training faster. We are trained to look at the athlete holistically to determine the specific cause of a patient’s injury/deficit rather than a cookbook “one size fits all approach).
As clinicians, our goal is not only to heal our patients but to empower them to know more about their own bodies and to be able to take control of preventing future injuries. We take pride in our specialized home exercise plans, which a runner or any athlete for that matter, can take with them for the rest of his or her athletic career. I encourage you as a runner, to check us out and learn more about your running needs.