A Time for Change: Stage 2 – Contemplation

After reading our last two blogs you are now ready to start giving some thought to changing your behavior.  In this next stage, contemplation, you start to think “maybe I should go to a physical therapist for my back pain” or “I should start working out so I can become healthier.”    Although you are beginning to have these feelings your plans remain distant and indefinite.  “When you talk about the possibility of change, there is always a ‘but’”¹  You have a good reason to make a change in your life but there is always an excuse to follow such as you don’t have enough time or it may cost you some extra money that you weren’t planning on spending.

In this stage you go back and forth from wanting to change and wanting things to stay the way they are.  Many people get stuck here for weeks, months, or even years.  These are the people that every January 1^st, make the same New Year’s resolution but never even begin to make the change.  It’s on your mind but you can’t get out of the rut and just make the right decision.  It is best to stop thinking about all the obstacles to change and focus more on the problems that you truly want to change.

“Give your Mind a Nudge – Every time you catch yourself making a ‘but’ statement, push yourself to examine it more closely.  In the example where you’re ‘too busy’ to exercise, you might ask yourself: ‘If I don’t have a 30-minute block of time for exercise, do I have three 10-minute ones?’ or “If I like to watch TV in the evening, could I do it while walking on a treadmill?’”¹

Track Your Problems and Progress – Make a daily journal and keep track of every time you are in pain or every time you think about being unfit.  Did you try to put on a pair of pants and they don’t fit the way they used to? Write it down!  You will be able to look back at this journal and find patterns.  Maybe you notice that you are more bloated after eating certain foods - Change your diet!  Maybe you find that you have more pain after being inactive and sitting for long periods of time – Go see a physical therapist! Do you become aware of gained body weight or lost muscle mass – Begin an exercise program at Hayashida & Associates Physical Therapy.

Stay Tuned: In next week’s blog we actually start to make the changes that we have been talking about this past month.  We will then follow up on the hardest stage of them all, maintaining the change in your life over the long haul.

http://www.arthritisselfmanagement.com/newsletter/12-15-2011/time-for-a-change/?page=all

Image: https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtP0yOF389uMz7UgpVnvlTELvd1lQJkOUUKdFxvlnGurzHb3ZfSrccNQF8iopKftr3m5lYRgu199RDmAhzVRFaX61t_BHCQLSNUBteM0AX7xXhcILGpeR6WUdNXgfvhJ5U3ah5UKU3xSk/s1600/but.jpg

A Time For Change: Stage 1 – Precontemplation

Changing our lives is not easy and as discussed in our last blog post there are five distinct stages that we must go through in order to achieve this change.  These changes can be as little as drinking one less cup of coffee each day or as big as entering a workout regimen in order to prepare for an Ironman.  Stage 1, precontemplation, is where almost 50% of the public is currently situated and getting past this stage can be very difficult.

This stage is marked by you not even thinking about change.  Your physical therapist, physician, spouse, family member, or friend may be urging you to make a change, whether it is working out more or eating better, for example.  During precontemplation you hold onto the belief that nothing needs to change and you think that things are fine the way they are.  You read a blog article or see a billboard explaining how much changing your health matters but you ignore it.  You sit there and say to yourself, “I am healthy; I am in good physical shape.”1  In your mind you are immune to any health problems that your peers or physical therapist is trying to explain to you.  If you have found yourself constantly dismissing the advice of others you may be stuck in this phase; here are some ways to move on to the next stage.

Weigh Your Options – In this stage “people tend to focus on the downside of adopting a healthy new behavior while ignoring the upside.”¹  Get past this by making a pro and con list.  Take out a piece of paper.  No, I mean right now, take out a piece of paper and write five to ten pros of changing to a new healthy behavior. On the other side write five to ten cons for changing.  Look at the two columns. “Is there a stronger case for or against making a change?”¹

Find a “Change Partner” – It is hard to take nutrition advice from someone who is extremely overweight.  Find someone who has made a change in their life that is somewhat similar to the change that you want to make.  If you have a physical therapist, friend, coworker or anyone else who wants to change or has changed their behaviors, start a conversation with them.

Just talking about your issue will catapult you into the next stage, Contemplation.  So start today.  Don’t worry about changing your unhealthy behavior now, just start to think about it and the consequences if you don’t change. Keep coming back as we will continue to talk about the next four steps, what they entail, what needs to be overcome and how to move to the next stage.

http://www.arthritisselfmanagement.com/newsletter/12-15-2011/time-for-a-change/?page=all

Image: http://www.integrityfirstreverse.com/pros_cons_files/stacks_image_51_1.png

A Time For Change: INTRODUCTION

Many people in America need to change in some way or another.  Americans have become unfit, unhealthy, overweight, have high stress levels, and deal with pain and disability on a daily basis.  We all could use a little help with changing our daily routine, our diets, and our other health habits to live healthier and more comfortable lives.  Everyone out there has some room for improvement.  The new year always comes with its ‘resolutions’ but the majority of people do not hang on to these for the long haul; this is part of the reason we need to have new resolutions each and every year.  “If you try to make a change but fail to stick with it, you may feel as if there is something wrong with you and your determination”¹  But there isn’t!

Almost everyone has trouble keeping the change in their life.  “Otherwise we would be a nation of calm thin, salad eaters.”¹  We need to understand that making change is an ongoing process.  In the late 1970’s a psychology professor found that in order to completely change, especially lifestyle changes, we need to go through five distinct stages.  Precontemplation, contemplation, preparation, action, and maintenance.

"Precontemplation is the stage at which you don’t intend to change a particular behavior in the foreseeable future. In the contemplation stage, you first start considering change, but you are still undecided about when to undertake it. That’s followed by the preparation stage, during which you make firm plans to change your behavior soon. Next is the action stage, when you actually begin exercising, dieting, or adopting some other healthy behavior. Finally, you reach the maintenance stage, by which time you have kept up the new behavior for several months. At this point, you are working to make your new habits permanent and trying not to backslide."¹

Does your physical therapist keep telling you that you need to correct your posture?  Does your physician tell you that you need to change your diet in order to decrease you blood pressure or control your diabetes?  Have you been thinking about losing weight?  Are you having a hard time joining or going to the gym?  If so, you are ready for change.  Let's do it!

Over the next couple blog posts we will talk about each of these steps, what they entail, what needs to be overcome and how to move to the next stage. 

1.  http://www.arthritisselfmanagement.com/newsletter/12-15-2011/time-for-a-change/

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