California Needs Your Help!

As a continuation of the last blog I want to discuss an important issue that is being heard in the Senate Appropriations Committee right now!  Supporting this bill will help change the way the public receives health care services to the “new approach” (discussed last week) where the person with musculoskeletal pain can visit their physical therapist before seeing their primary care physician.  This would allow for immediate treatment if it is appropriate, effectively decreasing the amount of time you are in pain. The physical therapist would refer you to a primary care physician if your physical therapist thinks it’s warranted.  You get referred to a specialist for further testing only if necessary. 

“SB 924 will allow consumers to be directly treated by physical therapists just as in many other states.”¹

“SB 924 will streamline health care delivery, increase consumer choice and reduce costs for consumers.”¹

“SB 924 will allow patients to go directly to physical therapist, avoid extra co-pays and if appropriate for physical therapist services, begin treatment immediately.”¹

“Currently, 36 states allow patients to directly access physical therapist treatment (17 with unlimited direct access and 19 with some restrictions) and they have been doing so safely for an average of 25 years. In 36 other states, Medicare pays for the direct treatment by physical therapists before a formal diagnosis is determined by a physician.”¹ 

THIS IS NOT THE CASE IN CALIFORNIA! 

In California Medicare recipients are denied their equal right to direct access to the same physical therapy services afforded to patients in those 36 other states.

“Lastly, physical therapy education and training justifies clarification and recognition by the legislature that the profession is qualified to treat patients' impairments and movement dysfunctions without a formal diagnosis of a disease.”¹

Please call or write the members of the Senate Appropriations committee and  show your SUPPORT for SB 924.

Senate Appropriations Committee:

Kehoe (Chair, D) - (916) 651-4039, fax (916) 327-2188 - Click Here for Support Letter Template
 

Walters (Vice-Chair, R) - (916) 651-4033, fax (916) 445-9754 - Click Here for Support Letter Template
 

Alquist (D) - (916) 651-4013, fax (916) 324-0283 - Click Here for Support Letter Template
 

Emmerson (R) - (916) 651-4037,  fax (916) 327-2187 - Click Here for Support Letter Template
 

Lieu (D) - (916) 651-4028, fax (916) 323-6056 - Click Here for Support Letter Template
 

Pravley (D) - (916) 651-4023, fax (916) 324-4823 - Click Here for Support Letter Template
 

Price (D) - (916) 651-4026, fax (916) 445-8899 - Click Here for Support Letter Template
 

Runner (R) - (916) 651-4017, fax (916) 445-4662 - Click Here for Support Letter Template
 

Steinberg (D) - (916) 651-4006, fax (916) 323-2263 - Click Here for Support Letter Template

Click here to view a copy of SB 924

Click here to view the Legislative Action Center

All references are from the California Physical Therapy Association (CPTA) and California PT Notes

There Is A Fork In The Road: Which Way Will You Go?

Let me start off my asking you a question.  Would you rather have back pain for 20 days or 50 days?  This may sound like a pretty simple question but our current health care system may push you towards the 50 days of pain rather than the shorter time frame.  I will separate these two groups into the “old approach” of thinking of treatment for musculoskeletal pain vs. the “new approach” to treat these symptoms.  The reason these words are in quotation marks is because the old approach is still very prominent in our health care system and very few partake in the new approach, especially here in California where direct access to a physical therapist is not allowed.

The old approach consists of you getting some sort of musculoskeletal pain.  You may not be able to get in to see a physician for up to 1 month.  You finally get to see the general physician and they send you to a specialist for the body region where you are having pain.  That specialist may send you for diagnostic testing such as X-Rays, or a MRI.  After this you follow up with the primary physician, the specialist or both.  At this time the decision for you to see a physical therapist is made.

In the new approach you meet with your physical therapist first, maybe also seeing your primary physician if your physical therapist thinks it’s warranted.  You get immediate treatment if it is appropriate and get referred to a specialist for further testing only if necessary.  

So why has the system not changed?  Why does physical therapy direct access get denied every time it goes through congress?  It is because the American Medical Association (AMA) has too much to lose in order to change to a new patient-centered system.  Physicians can lose out on “initial visits, follow-up visits, diagnostic testing, drug prescriptions... all of those equate to profit”¹

If you like the idea of the new system you can write your local assembly member or donate to CAL-PT-PAC which is the only political action committee in California representing the profession of Physical Therapy.  You can donate HERE

Reference: http://blog.myphysicaltherapyspace.com/2012/01/the-back-pain-story.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+EvidenceInMotion+%28Evidence+In+Motion%29

That MRI May Harm You!

Magnetic Resonance Imaging (MRI) is thought of as the gold standard diagnostic tool for finding abnormalities of the bones, muscles and ligaments of the body.  But there are many reasons you should be wary of the results of your MRI in the future.

A New York Times article by Gina Kolata in October 2011 commentated on a study where the authors took 31 professional baseball pitchers who were both injury and pain free and gave them a MRI.  The results found abnormal shoulder cartilage in 90% of the athletes and abnormal rotator cuff tendons in 87% of the athletes.  Let me reiterate that these were athletes that did not complain of any previous injury or past or current pain in their shoulder.  Dr. James Andrews, a top sports orthopedic surgeon put it perfectly.  “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an MRI.”

In that same month a Journal, Health Services Research, came out with a study titled “The Relationship between Low Back Magnetic Resonance Imaging, Surgery, and Spending: Impact of Physician Self-Referral Status”  The objective of the study was to examine the relationship between use of MRI and receipt of surgery for patients with low back pain.  Many results came of this study but the most ground breaking was that among patients receiving orthopedic surgery, the likelihood of having spinal surgery increased by 34% if the orthopedic surgeons owned the MRI machine.   The moral of the story may be to ask your doctor if he or she owns the MRI equipment or benefits financially from you getting the MRI before consenting to imaging.  

In November of 2011 an article by Tim Flynn et. al was published in the Journal of Orthopeadic and Sports Physical Therapy (JOSPT).  This article, “Appropriate Use of Diagnostic Imaging in Low Back Pain: A Reminder that Unnecessary Imaging May Do as Much Harm as Good,” described an MRI as only a picture of a single moment in time.  This picture, let us say of a disc lesion, gives us no compelling evidence that the patient will have prolonged course of impairment or disability.  In simple terms, the MRI has no way of looking at function.

Below are two MRI images.  The first image (A) shows a small disc bulge in the bottom 1-2 joints.  The second image (B) shows disc bulges at multiple levels of the spine with compression of the spinal cord and nerves that innervate the leg.

 

 B - Multi Level Disc Bulges

A - 1-2 Disc Bulges

Now that you have seen those pictures, I’ll briefly tell you their story.  Image “A” belongs to a 32 year old man with a small disc bulge on MRI and this small bulge has lead to severe back and leg pain which is debilitating.  This patient has missed work for multiple months out of the year secondarily to pain.  Image “B” shows a spine with severe degeneration and multiple disc bulges.  This is an image of a 62 year old.  This man has no pain and regularly hikes all around the world as a hobby.  

"A"

"B"

Once again we can see that the MRI does not tell the whole story.  Do not let that next MRI harm you!

References:

          1.  http://blog.myphysicaltherapyspace.com/2011/11/education-to-avoid-harm.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+EvidenceInMotion+%28Evidence+In+Motion%29

          2.   J Orthop Sports Phys Ther 2011;41(11):838-846, Epub 3 June 2011. doi:10.2519/jospt.2011.3618

What is My BMI?

When I ask my patients or clients what their height is, I get a quick response.  When I ask them their weight I get a hesitated response but I do get a number.  When I ask these same people what their body mass index (BMI) is I get blank stares of uncertainty.   BMI is a good and reliable screening instrument of body fat for people.  A reliable tool is one that actually measures what it is meant to measure.  BMI is calculated by comparing weight and height. 

To calculate your BMI you will need your weight in kilograms and your height in meters.  The equation is as follows:

BMI = weight (kg) / (height (m))²

I’ll give you a second to calculate that …

….

….

Ok, BMI ranges fall into these categories:

·         18.49 or less = underweight

·         18.5 to 24.99 = normal weight

·         25 to 29.99 = overweight

·         30 to 39.99 = obese

·         40 and higher = morbidly obese

Some disparities need to be noted.  “At the same BMI, women tend to have more body fat than men. At the same BMI, older people tend to have more body fat than younger adults.  Highly trained athletes may have a high BMI from increased muscularity rather than increased body fatness.”¹ 

These numbers can serve as a good guideline for your overall health.  Those who have higher BMIs or are overweight are at higher risk for many health problems involving the joints, lungs, and heart.  If you found your BMI to be higher than you expected you should talk to your physician about a diet and exercise plan.  Exercise, such as the group fitness classes at Hayashida and Associates, has proven to lower BMI while improving overall health.  Do I smell a New Year’s Resolution?

1. Anthem Healthy Solutions - 2011 - Issue 01

Get Smart by Exercising!

That title can be a little misleading.  You would be smart to exercise more as this would help you stay healthy and physically fit.  But a new study shows that you can strengthen your brain with physical exercise.  Researchers at the University of South Carolina conducted a study where they analyzed cellular activity of the brain of two populations (of mice), those who ran on a treadmill and those who just sat around their cages.

We already know that exercise can help remodel muscles in our body.  Part of this remodeling includes the synthesis of Mitochondria in the cell.  This part of the cell floats around and acts as an energy powerhouse to the cell.  This in turn makes our muscles stronger and healthier.  The researchers wanted to see if the same changes occurred in the brain.

The group of exercising mice not only performed better on a “run to exhaustion test” on a treadmill but upon studying cells in the brain showed an increase in the amount of Mitochondria.  This is a very important finding.  “There is evidence…that mitochondrial deficiencies in the brain may play a role in the development of neurodegenerative diseases, including Alzheimer’s and Parkinson’s diseases.”¹ 

So get out there and revitalize your exercise program or begin an exercise program if you have not already started.  The physical exercise can potentially sharpen your thinking, reduce mental tiredness, and decrease your chances of developing life changing diseases such as Alzheimer’s and Parkinson’s disease.

The smartest thing you could do is begin an exercise program at Hayashida and Associates Physical Therapy Inc.  Contact Training@HayashidaPT.com for more info..

Ref: http://well.blogs.nytimes.com/2011/09/28/how-exercise-can-strengthen-the-brain/#?wtoeid=growl1_r1_v3

My Neck Hurts… So Why is My Physical Therapist Treating My Back?

Many people will have neck pain at one point in their life.  It is estimated that up to 50% of all Americans will suffer from neck pain each year.  It is only second to low back pain on the list of disabling musculoskeletal disorders.  Some neck pain is caused by injury such as falls or whiplash injuries but the majority of pain in the region is caused by gradual stresses, such as poor posture, abnormal lifting patterns or awkward sleeping positions.  It is common practice in physical therapy for mobilizations or manipulations to be used to decrease spine pain and restore normal movement patterns.  Many people that I talk to are uncomfortable having their necks manipulated or “popped.”  Luckily for those who are against mobilizations/manipulations of the neck a recent study in the Journal of Orthopedic and Sports Physical Therapy(JOSPT) shows that mobilizations of the upper back may ease or eliminate neck pain.

This study was actually a review of many past studies in the area.  This type of study is held in high regard because many different factors are considered and only high quality studies are compiled for results.  The researchers looked into studies where patients received upper back mobilizations/manipulations and were then compared to patients who received other forms of physical therapy.  The researchers found that mobilizations/manipulations of the upper back “as part of the treatment resulted in less pain, increased neck motion, and improved function.”¹

Patients in my clinic who prefer not to have mobilizations/manipulations of the neck can receive these same treatments to the back in order to decrease their neck pain while increasing their function.  Mobilizations and/or manipulations to the upper back are very safe and may help you feel better faster.  Your Physical Therapist can help determine if you are a good candidate for this type of treatment.  This evidence only further validates the treatment choices already in place at Hayashida and Associates Physical Therapy where upper back mobilizations/manipulations have been used often to treat patients with neck pain.

 J Orthop Sports Phys Ther 2011;41(9):643. doi:10.2519/jospt.2011.0506

How Am I Supposed to Workout When I Am So Busy?

Everyone seems to get all excited about getting their beach bodies in prime condition once the warm weather of the spring rolls around.  But during the fall and winter time many people complain that they do not have enough time between work, school, fall cleaning, holidays, along with many other daily activities.  I know it is difficult as even I am constantly battling getting to the gym or doing a short run after work.  We are often tired, can think of a million things we need to do around the house and most of all we would like to just relax.  Below are a couple ideas to get you motivated, if your physical and mental health as well as weight control are not big enough motivators.

WORKOUT WITH OTHER PEOPLE – This is a great way to keep on track.  In the digital age you can even set up workout plans with your friends or family across the country with Facebook or E-mail.  In this fashion you can post your daily workouts, goals, and progress towards those goals.  If you do not post your workouts or do not meet your goals, everyone will see.  This is a great motivator.  Of course you can also go the conventional way and join group fitness classes such as the ones at Hayashida and Associates where everyone will know when you are missing.

PUT YOUR WORKOUTS ON YOUR CALENDAR – Often if you schedule it on your calendar you will see it and this can motivate you to follow through.  This will also make sure that you do not schedule other activities during this time.  Most calendars on computers or phones nowadays will pop up reminders which will jog your memory (no pun intended) that you need to get working out.

FIND A FORM OF EXERCISE THAT YOU ENJOY – This might be the most important aspect of this whole blog entry.  If you choose to run because it is the easiest thing to do and the most accessible but you hate every moment of it, you are less likely to do that activity.  If you enjoy watching TV or listening to a podcast make sure to incorporate that into your fitness routine.

For those of you who dread your workout each day hopefully these simple ideas make you look forward to your next workout so that you can stick to a schedule, meet your fitness and health goals, and maybe even catch up on your favorite TV show while you do it.  If you need a kick start, come to a FREE fitness class here at Hayashida and Associates Physical Therapy to see how fun exercise can be.

Reference: http://lifehacker.com/5854874/how-can-i-fit-a-workout-into-my-daily-routine