Randy Step, from Running Fit, will be giving a talk at Probility’s State Street location on running outside during the winter. There will be great tips on how to dress, where to run, delicious treats and more.

Mark your Calenders! For January 12th, 6:00

Total knee replacements have been proven to be an effective long term intervention for the geriatric population; improving function and social interaction, and decreasing pain levels.

Signs you are ready for a need replacement include:

• Having consistent pain that also wakes you up at night.
• Having limitation in your daily activities due to increased pain levels
• Having limitations in your leisure activities due to increased pain levels
• You have tried other methods of treatment consistently for long periods of time including:
  • Injection(s): cortisone, Synvisc (1-3 injections dependent on the doctor or type of injection)
  • Physical Therapy involving hands on techniques to improve:
    • joint mobility
    • soft tissue (fascia, muscle, tendon, ligaments) mobility
    • exercise program to work on strength
    • flexibility
    • balance
    • walking tolerance
    • instructions in home exercise program
  • Activity modification including more rest breaks, water exercise, biking

Many factors need to be included when considering total knee replacement, including age, health and current bone density levels.

Relative and absolute contraindications to receive a total knee replacement:

• Active infection
• Significant knee hyperextension
• Severe obesity
• Arterial insufficiency
• Mental illness

What to expect following a total knee replacement.

• Typical hospital stay for 2-4 days
  • An assistive device such as a walker or cane may be needed for walking for a few weeks
  • Continuous passive motion device may be used
• After hospital there are three options
  • Home health care Physical therapy (1-2 weeks)
    • Typically involves a visit from a physical therapist 3 days a week
  • Inpatient rehabilitation at a hospital or nursing home
    • Typically involves 4-10 physical therapy sessions
  • Outpatient Physical therapy typically within 5-7 days following surgery
  • Last anywhere from 3-8 weeks

By Jessica Wyens, PT
References:

1. Dutton, Mark. Orthopaedic examination, evaluation, and intervention. New York: McGraw Hill Companies, 2008.
2. image: http://bit.ly/sD8ZEY

A hot topic related to football as of late has been concussions.  A concussion is a mild traumatic brain injury that occurs when the brain moves too much and hits the inside of the skull.¹  Events that can cause this can be a hard hit to the head or back, car accident, or a fall.²  Some people will lose consciousness and other will not.

Because a concussion can change the way your brain works, concussions can affect a person physically, emotionally, and cognitively.  Below is a list of common symptoms:

Physical symptoms may include:

• Headache
• Dizziness
• Difficulty with balance
• Nausea/vomiting
• Fatigue
• Difficulty with sleeping
• Double or blurred vision
• Sensitivity to light and sound

Cognitive symptoms may include:

• Difficulty with short-term or long-term memory
• Confusion
• Slowed “processing”
• “Fogginess”
• Difficulty with concentration

Emotional symptoms may include:

• Irritability
• Restlessness
• Anxiety
• Depression
• Mood swings
• Aggression
• Decreased tolerance of stress¹

Diagnosing a concussion can sometimes be difficult.  Tests like MRIs and CT scans will have results that are normal.  It is important to see a medical professional as soon as possible.  Your doctor can get you in touch with other health care professionals that can help treat your symptoms, like a neurologist or physical therapist.¹

It is also important not to resume activity too soon because post-concussion syndrome can occur.  Post-concussion syndrome is a condition where a combination of concussion symptoms last anywhere from weeks to up to a year or more after the initial concussion.³  The symptoms are similar to ones seen from a concussion.  Exerting yourself too soon, whether physically, like returning to physical activity, or cognitively, like returning to school or work, can delay the brain’s healing.¹  It is important to resume activities slowly when your symptoms subside and keep good communication with your doctor, physical therapist, and/or athletic trainer.  If you begin to increase your activity and your symptoms worsen, you have done too much and need to back off in order to give your brain sufficient time to heal.

How Physical Therapy Can Help

Physical therapy can help treat some of the symptoms of a concussion.  Headaches, one of the major symptoms of a concussion, can be complicated by neck or back injuries.  A physical therapist can evaluate your neck and back and work on any limitations they find, like poor joint mobility of the vertebra, tight and sore muscles, decreased flexibility of muscles, and weakness of muscles in the area.

Dizziness can also be treated by physical therapists.  Some physical therapists are specialized to treat the vestibular system, which includes the inner ear and helps keep your balance when you move your head and eyes.  These physical therapists can give you specific exercises to help decrease your dizziness and also improve your balance, which may also be affected.¹

It is important to know the symptoms of a concussion, especially if you or someone you know has been hit in an athletic event or in a car accident.  Being able to recognize the symptoms and getting to a doctor is the first step towards recovery.  Once a concussion is diagnosed, it is important to communicate with your health care providers when resuming activity in order to allow the brain to heal successfully.

by Lindsey Cook, Physical Therapist

Click on photo for image source

1. http://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=4f2ebb00-f1c0-4691-b2ab-742df8dffb99
2. http://www.mayoclinic.com/health/concussion/DS00320

http://www.mayoclinic.com/health/post-concussion-syndrome/DS01020

By Rebecca Peshkin

Soccer has been growing in popularity over the past 10-20 years in the United States.  I grew up playing soccer and as I become an adult, I would like to be able to continue to play for years to come.

Here in Ann Arbor there are some good opportunities to play for adults.  Because of both the weather being so cold for many months out of the year and the fact that there is limited day light to factor in to practice/ play time, indoor soccer is a really good alternative.  I like to play at  a complex on the West side of town, Wide World Sports Center http://www.wideworld-sports.com/home.php.  There are mens, womens, and co-ed teams for adults and each group / league has a range of playing experiences from beginners to advanced.

If you don’t mind driving, there are other facilities within a short distance, like:

High Velocity Sports in Canton- http://www.hvsports.com/

Total Sports Complex in Novi and Wixom- http://www.totalrollerhockey.com/

There are spring, summer, and fall outdoor leagues.  I’ve tried it playing through Ann Arbor Soccer Association http://www.aasaweb.org/ which was fun and organized or there are other leagues like Ann Arbor Premier Development League http://aapdl.com/ which is up and coming.  Wide World Sports Center also has an outdoor league.

I think soccer is a great way to exercise, push yourself, and a way to meet new people.  Check out some of these resources if you’ve never heard of them before!

Click on photo for image source.

What is it, and why is it important to you?

Direct access to Physical Therapy means that a person can refer themselves to a physical therapist and be treated by a physical therapist, without having to first go to a physician.  In Michigan patients can only be evaluated but can not receive treatment.  Being able to directly access a physical therapist can save you hundreds of dollars, time, and aggravation.  A survey by Mitchell and deLissovoy[1] found that insurance companies save an average of $1200 per patient.  When multiplied by the number of patients seeking therapy, this adds up an astronomical number of health care dollars wasted.

Is it safe to go to a physical therapist without seeing a doctor first?  The overwhelming answer is yes.  A study done in 2005 of 50,000 patients seen by physical therapists under direct access could not find one incidence of injury or adverse event or action against a physical therapist license.[2]  Forty-six states and the District of Colombia have passed some form of Direct Access for Physical Therapists.  Some of these states have had direct access for the past 30 years, and there is no increase in liability claims in those states.[3]

In many cases insurance companies will cover physical therapy without referral because they recognize that it saves them money.  However, Medicare does not currently reimburse for physical therapy services without a prescription from a doctor; despite the fact that other government agencies, such as the military, use direct access as a cost effective and patient beneficial model.

If you as a consumer would like to see your physical therapist directly, the most important thing you can do is to write or call to your senators and congressional members and tell them.

Michigan Government

Find your Senator:                   http://www.senate.michigan.gov/fysenator/fysenator.htm

Find your Congressman:          http://www.house.mi.gov/mhrpublic/

U.S. Government

Find your Senator:                   http://www.senate.gov/

Find your Congressman           http://www.house.gov/

How to Promote a Healthy Back at Work

By: Morgan Diver, PT, DPT

Low back pain is commonly caused by a person’s job.  It is reported that the jobs with the highest estimated incidence of low back pain “(over 10%) include mechanics and operators of heavy equipment; and people in construction.¹

Common causes of work-related low back pain:

• Force…lifting or moving heavy objects
• Repetition...repeating certain movements can lead to muscle fatigue or injury
• Poor posture…can also lead to muscle fatigue and injury
• Stress…can lead to muscle tension and tightness, which can contribute to or worsen back pain

How to prevent back pain at work:

• Include physical activity in your daily routine…maintain a healthy weight to minimizes stress on your back
• Eat healthy…we need calcium and vitamin D every day to help prevent osteoporosis, which is responsible for a lot of the bone fractures that lead to back pain
• Pay attention to your posture…
• If you stand for long periods at work, rest one foot on a stool or small box.
• Hold reading material at eye level
• When sitting, choose a chair that allows you to rest both feet flat on the floor while keeping your knees level or slightly below the level of your hips.
• Remove your wallet or cell phone from your back pocket when sitting.
• Minimize hazards… remove anything from your work space that might cause you to trip and fall
• Lift properly…
• Lift with your legs and tighten your core muscles
• Hold the object you are lifting close to your body
• If an object is too heavy to lift safely, find someone to help you
• Modify repetitive tasks…
• Use lifting devices or adjustable equipment to help you lift loads
• Try a headset if you are on the phone most of the day
• Limit the time you spend carrying heavy briefcases, purses and bags
• Frequently change your position….try taking a 30-second break every 15 minutes to stretch, move, or relax
• Manage stress… use positive coping mechanisms
• deep-breathing exercises
• exercise
• talking about your frustrations with a trusted friend

Physical Therapy for ACL Injuries

By Morgan Diver, PT, DPT

ACL is an abbreviation for the Anterior Crutiate Ligament. It is one of two ligaments that cross in the middle of the knee, connecting the femur (thighbone) to the tibia (shinbone).¹ Its role is to help stabilize the knee joint. An ACL injury refers to tearing of part or all of the ligament fibers.

Cause:

This injury most commonly occurs during sport or fitness activities that involve a sudden stop or change in direction¹ such as football, soccer, basketball, or skiing. Other causes include:

• pivoting with your foot firmly planted
• landing awkwardly from a jump
• a fall
• twisting or overextending the knee
• a car accident

How to know you might have torn your ACL:

• you hear or feel a “pop” in your knee when you are doing one of the above activities
• a large amount of swelling and/or bruising in the knee joint
• a feeling of instability or “giving way” in the knee
• limited knee movement
• pain in your knee when you place weight on your leg

Risk factors:

Women are at a greater risk then men due to:

• strength imbalance of the hamstrings (muscles in the back of the thigh) and quadriceps (muscles in the front of the thigh)
• structural body differences
• joint laxity / looseness
• hormonal influences
• smaller ACL size then men

Tests for diagnosis may include one or more of the following:

• X-ray – to rule out a possible fracture
• Magnetic resonance imaging (MRI) – to show the extent of injury
• Ultrasound – to check for injuries in the ligaments, tendons and muscles of the knee.

Treatment:

• rest, ice, compression, elevation (RICE) initially
• medication to decrease pain and swelling
• physical therapy to improve range of motion and strength along with decreasing pain
• surgical repair / replacement of the torn ligament
• bracing to improve stability of the knee

Prevention includes a proper training program:

• improve your overall conditioning
• strengthen your hamstrings (muscles in the back of the thigh)
• use proper technique for jumping/landing, cutting and change of direction

Sources:

1. http://www.mayoclinic.com/health/acl-injury/DS00898
2. http://www.webmd.com/a-to-z-guides/anterior-cruciate-ligament-acl-injuries-topic-overview

3. Dutton M. Orthopedic Examination, Evaluation, and Intervention.

2^nd ed. New York, NY: The McGraw-Hill Companies, Inc.; 2008:1012-13.

Exercise Guidelines during Pregnancy            

By Jessica Wyen

If you have been following a regular exercise program before pregnancy there is no reason why you shouldn’t be able to continue throughout your pregnancy.  Check with your health care provider before beginning a program or continuing.  Your health care provider can give you exercise guidelines based on your past medical history.  (Photo from www.bestpregnancytips.com.)

The American College of Obstetrics and Gynecology recommends greater than or equal to 30 min exercise per day most days of the week. ¹

General guidelines include:

• Avoiding holding your breath during activity
• Avoid fall risk activities such as: horseback riding or skiing
• Avoid contact sports such as: football, and basketball
• Avoid activities such as: jumping, hopping, skipping – though if you were a runner before, you can continue on a modified routine
• Avoid deep knee bends
• Avoid exercises in positions that make you uncomfortable such as laying on your back
• Avoid exercises in hot, humid weather
• Avoid allowing you heart rate to raise >140 beats per min
• Wear comfortable clothes and footwear while exercising
• Take multiple breaks
• Drink plenty of fluids
• Weight training is advisable to improve tone but avoid using weights that may strain your lower back
• Eat a healthy diet
• Never exercise to the point of exhaustion

Warning signs to stop exercising include:

• Chest pain
• Abdominal or pelvic pain
• Headaches
• Feeling fait or dizzy
• Vaginal bleeding
• Irregular or rapid heart rate
• Increased swelling in your legs
• Shortness of Breath

References:

1. http://women.webmd.com/exercise-during-pregnancy
2. http://www.americanpregnancy.org/pregnancyhealth/exerciseguidelines.html
3. http://www.acog.org/publications/patient_education/bp119.cfm

Ariel and Zoey and Eli, Too Proudly Present: A Premier with a Purpose This special premiere of Ariel & Zoey & Eli, Too will debut segments from Season 2 of their nationally-syndicated TV show and will include a performance by their band, Sugar Station! All proceeds benefit the University of Michigan Mott Children’s Hospital.

With the goal of empowering, educating and entertaining children primarily through music, Ariel & Zoey & Eli, Too debuted in September of 2010 and is now available in more than 90 million U.S. homes. The show features interviews with celebrities like Miranda Cosgrove and David Archuleta and accomplished public figures across many different sectors, educational segments and Sugar Station performances with the show’s varied musical guests, as well as the band’s own music videos. Planning the episodes’ content by using their own interests, observations and appetite for fun, Ariel, Zoey and Eli have created a show rich with musicality, humor, lessons and, most importantly, a lot of heart.

For Ticket Information Click Here

To learn more about this “Premier with a Purpose” click here.

As the summer gives way to the cooler temperatures of fall and people no longer want to sit on their decks, it’s a perfect opportunity to get outside and exercise in some of our local parks and view some fall color. Hiking is a wonderful way to get some fresh air, sunshine, and be rejuvenated. Talk about therapy! John Muir said, “In every walk with nature one receives far more than he seeks.” I think that you will find much more than you expected when walking in local nature areas. There are wonderful nature parks and preserves throughout Washtenaw County. Here’s an example of a places you may like to visit.  Other local parks can be found at www.a2gov.org

Dolph Park

Parking off of Wagner Road near Jackson Road.

It is a total of 57 acres, with walking trails with a variety of natural habitats.  A good place for family hikes, in an area that encompasses Ann Arbors only two natural lakes.

Nichols Arboretum

1610 Washington Heights, Ann Arbor

There are 3 entrances to this 123 acre park that has extensive walking trails. Prominent features are a peony collection, prairie landscape, and it’s trails along the Huron River. It has been called a living museum for the wide variety of trees and plants that it contains, some of which can not be found anywhere else in the area.

Matthaei Botanical Gardens

1800 N. Dixboro Rd., Ann Arbor Charter Township

This park has 300 acres that encompass formal gardens as well as natural areas and a discovery trail.  Some features of the formal gardens are a children’s garden, an English knot and herb garden, and a conservatory.

Pinckney State Recreation Area

8555 Silver Hill Rd., Pinckney, MI

www.michigan.gov/pinckney

At over 11,000 acres, it’s one of the largest parks in the area.  It has several hiking and biking trails as well as campsites.  A prominent feature of the park is the 40 mile long Potawatomi Trail, which could be a multiple day backpacking experience. For more information on each of the above parks, click on the park name to visit the webiste.

Article by: Dan Pasiak, Probility PT

Click on the photo for source