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Exercise & therapy help with pain and improve hip arthritis: Updated review is needed to determine if treatments should be used Hip osteoarthritis is a condition in which cartilage that surrounds and protects the hip joint gradually wears away. This causes bones to rub against one another and leads to pain and disability in patients with the condition. When it comes to non-surgical (conservative) treatment for hip osteoarthritis, exercise therapy and manual therapy are often recommended first. Exercise therapy includes aerobic exercise and a number of other different exercises designed to improve strength and range of motion, or flexibility of the hip. Manual therapy is a hands-on treatment performed by physical therapists that consists of various mobilizations and manipulations to the joint. Its goal is to improve the mobility of the hip and the surrounding area, which can reduce pain and improve physical function. Although there are studies that support exercise therapy as an effective treatment for hip osteoarthritis, there is little research on the effectiveness of manual therapy for this condition, either when used alone or when combined with exercise therapy. For this reason, a powerful study called a systematic review was conducted, which gathered all the relevant studies on exercise therapy and manual therapy for hip osteoarthritis. This was followed by a meta-analysis, which analyzes each of the studies found in the systematic review with the goal of identifying important trends. Seven studies are accepted for the review To find data for the review, 10 major medical databases were searched for studies on the use of exercise therapy, manual therapy or both for hip osteoarthritis. Of the 372 studies that were screened, a total of seven met the necessary criteria and were included in the review. These studies contained information on 886 patients, and they investigated the effects of the treatments on pain, physical function and quality of life. Physical therapists delivered the treatments in all studies except for one, and the nature and frequency of these treatments varied in each of the included studies. Once collected, all studies were then analyzed to determine which of these treatments was most effective for hip osteoarthritis. Both therapies are effective on their own, but not in combination Results from the meta-analysis revealed that both exercise therapy and manual therapy are effective for reducing pain and improving physical function in patients with hip osteoarthritis. There was also low-quality evidence that combining exercise therapy and manual therapy can lead to benefits as well, but these benefits were only found to last for a short amount of time. The reason for this may be that patients who had both treatments did not spend as much time on each therapy than those who received only one. Nonetheless, this systematic review and meta-analysis show that both exercise therapy and manual therapy can be helpful for treating hip osteoarthritis. Therefore, patients with this condition should strongly consider seeing a physical therapist for a treatment program that consists of these therapies in order to alleviate their pain and improve their physical function. -As reported in the December '15 issue of Clinical Rehabilitation

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5 Things You Need to Know About Whiplash Injuries: 5 Things You Need to Know About Whiplash Injuries Here is our latest monthly video. http://bit.ly/2rjUFpD
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Seeing a PT may lead to lower costs and less medical treatment: Spinal disorders are very common and expensive Musculoskeletal disorders are injuries or pain in structures like ligaments, joints, and tendons throughout the body. They are one of the biggest health care problems affecting middle-aged Americans because they are extremely prevalent and expensive to treat. Of all musculoskeletal disorders, spinal disorders like low back pain account for the majority of costs and disabilities that people experience. This is mainly due to an increase in imaging studies like MRIs and CT scans, steroid injections, and spinal surgeries. As a result, there is a need for a better approach to reduce costs and improve the outcomes for patients. Doctors may not refer patients to physical therapy for up to six weeks Physical therapy is commonly prescribed as an effective treatment for patients with spinal disorders and other musculoskeletal disorders. The timing of when a patient is referred to physical therapy, and when it begins, can have a significant effect on the results they experience and the costs of treatment. Currently, guidelines recommend that doctors should delay referring patients with back pain to physical therapy for up to six weeks. Despite this, some studies suggest that starting physical therapy earlier-within 1-4 weeks-could lead to better outcomes and reduce the risk for developing long-lasting (chronic) pain and disability. Since these two approaches conflict with each other, more research is needed to determine how long a patient should wait before seeing a physical therapist. Therefore, a systematic review was conducted, which is a high-quality, comprehensive review on all the available studies on the timing of physical therapy for musculoskeletal disorders. A total of 14 studies are used for the review Researchers conducting the review searched through four major medical databases for studies that were relevant to the topic. In order to be selected for the systematic review, each study had to include data on physical therapy used for a musculoskeletal disorder, with one group using physical therapy early and the other using it later. A total of 3,135 studies were screened, and 14 of these fit the necessary criteria and were used for the review. These studies ranged in size and in quality, with the smallest study including 280 participants and the largest including 431,195 participants. The findings of all of these studies were then analyzed with the goal of determining if it was more beneficial to begin physical therapy earlier. Some patients may benefit from seeing a physical therapist early Although the review was supposed to cover a number of different musculoskeletal disorders, all the studies that were selected focused on spinal pain. Overall, there was evidence that starting physical therapy early (within four weeks) was associated with lower costs for the patient when compared to delaying treatment. This was likely due to the fact that fewer tests and interventions- like injections and surgery-were used when patients began treatment sooner. Those types of interventions may be recommended when patients hold off on treatment and see a doctor before a physical therapist. Unfortunately, the quality of the studies used in this systematic review was not very high, and additional studies are needed to investigate this topic in greater detail. Nonetheless, this review suggests that there is no risk of starting physical therapy within four weeks after low back pain is first noticed, and it may actually save patients money. Patients with low back pain and other spinal disorders should therefore consider seeing a physical therapist sooner rather than later for their condition. -As reported in the February '16 issue of the Journal of Orthopaedic & Sports Physical Therapy

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Happy Memorial Day!: Our clinic wishes you and your family a happy Memorial Day! We thank all those who have fought for our country.

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Hands-on therapy combined with exercise has benefits for neck pain: Exercise is considered an important part of treatment When there is no specific cause that leads to the development of neck pain, it's referred to as nonspecific. Nonspecific neck pain is a very common condition that affects between 30-50% of the general population. This type of pain usually has a negative effect on daily life and can cause patients to seek out treatments that may become expensive over time. It is therefore important that the treatment these patients receive is effective and improves their physical functioning and quality of life. Exercise is one intervention that is strongly supported by research and considered an important part of any rehabilitation program. In particular, exercises that strengthen, or stabilize certain parts of the spine can be helpful for neck pain. In addition, a hands-on form of therapy called manual therapy may also be useful for reducing pain and increasing flexibility and function. Manual therapy includes two different approaches called manipulation and mobilization, and research has shown that these therapies can improve neck pain. On the other hand, there is a lack of studies that have looked into the combination of manual therapy and stabilization exercises for nonspecific neck pain. For this reason, a study called a randomized-controlled trial (RCT) was conducted. An RCT is a powerful, high-quality study that randomly assigns patients to different treatment groups in order to determine which of these treatments is more effective for neck pain. Over 100 patients accepted and completed the study Patients diagnosed with nonspecific neck pain for at least three months were recruited and screened to determine if they were eligible for this RCT. Out of the 116 patients assessed, 102 fit the necessary criteria and completed the study. Each patient was randomly assigned to one of two groups: the stabilization exercises only group or the manual therapy with stabilization exercises group. Patients in the stabilization exercises only group went through a program of three exercise sessions per week for four weeks. Each session lasted one hour and consisted of exercises that were intended to strengthen and stabilize the muscles surrounding the neck and shoulder blades. Before each session, the physical therapist would also provide education on how to achieve and maintain proper posture to reduce strain on the neck. Patients in the other group received the same treatments, as well as a series of mobilizations to the neck and shoulder blade region. These applications lasted for 15-20 minutes and were also performed three times a week for four weeks. All patients were evaluated for disability, neck pain intensity, quality of life and neck range of motion, or flexibility, before and immediately after the treatments. Combining the two treatments leads to the greatest benefits After four weeks, it was found that stabilization exercises and manual therapy led to greater improvements in disability, pain intensity at night, neck range of motion and quality of life than stabilization exercises only. This shows that while stabilization exercises may be beneficial on their own, combining them with manual therapy appears to lead to even better results. Since this RCT only evaluated these patients before the treatments and after they concluded four weeks later, it's difficult to determine if these treatments will also lead to long-term benefits. Additional studies are needed to investigate this matter in greater detail. Nonetheless, this RCT supports the use of stabilization exercises and manual therapy for treating nonspecific neck pain, and patients with this condition are encouraged to seek out physical therapy that can deliver these effective treatments in order to help them improve. -As reported in the February '16 issue of the Journal of Orthopaedic & Sports Physical Therapy

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Physical therapy more effective than advice for low back pain: Advanced treatments are needed since condition is complex Low back pain (LBP) is one of the most common medical conditions in the general population, and it serves as a major cause for disability in people who suffer from it. LBP is also extremely expensive, and most of the costs associated with it are due to injuries that last longer than six weeks, which can prevent patients from going to work normally. Unfortunately, up to 71% of people who experience LBP once will still have symptoms one year later. This shows just how important it is to create treatments that are effective for people after experiencing the first signs of LBP. Advice on how to avoid pain in daily life is considered an important part of treatment for these patients, but more is needed. LBP is a complex disorder that can occur from many different causes, and more advanced treatments are therefore necessary. Physical therapy that is personalized, or individualized to each patient, is one such treatment that may be effective for LBP. Individualized physical therapy takes into account various factors that may be responsible for the patient's pain, and then addresses these factors with specific treatments to help the patient improve. Though there have been studies on individualized physical therapy, no high-quality studies have evaluated it combined with advice for LBP. Therefore, a randomized-controlled trial (RCT) was conducted on individualized physical therapy in addition to advice for LBP patients. RCTs are the most powerful type of individual study that can be performed. Participants are randomly divided into two treatment groups Volunteers who had LBP for at least six weeks but no more than six months were evaluated to determine if they were eligible for the RCT. Out of the 2,038 volunteers who were evaluated, 300 fit the criteria and were accepted. These 300 participants were randomly assigned to one of two groups: the individualized physical therapy with advice group or the advice-only group. Participants in the first group attended 10 sessions that lasted for 30 minutes over 10 weeks of treatment. Each patient in this group was then given a specific, individualized treatment program based on their condition. Though each program was different, they all consisted of various exercises to address the patient's pain and problems functioning normally. Participants in the advice-only group attended two 30-minute sessions in which a physical therapist explained the nature of their pain, reassured them that they would improve, and gave them advice on how to remain active without making their pain worse. Participants in the first group also received very similar advice on their condition. All patients were assessed using questionnaires on their pain and activity levels before treatment and then again five, 10, 26 and 52 weeks later. Combination of two treatments better than advice alone At the end of 52 weeks, results from the RCT showed that both groups actually improved over time according to the questionnaires. The individualized physical therapy with advice group, however, experienced greater improvements overall. The combination group showed significantly higher activity levels at 10, 26 and 52 weeks, as well as significantly less pain at 5, 10 and 26 weeks. These findings show that while both treatments were effective for patients with LBP, combining individualized physical therapy with advice is even more helpful for patients. Most importantly, this shows that the improvements patients make after 10 weeks of treatment can last for up to one year. It appears that patients with LBP will, therefore, benefit from individualized physical therapy that addresses their problem on personal basis along with advice that can help guide patients further and encourage them along the way. -As reported in the October '15 issue of the British Journal of Sports Medicine

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Physical therapy before ACL surgery leads to better outcomes: Surgery is the main treatment for these types of injuries Injuries to the knee account for almost 45% of all sports-related injuries, and the anterior cruciate ligament (ACL) is the most commonly damaged structure of the knee. ACL injuries lead to pain, muscle weakness, instability of the joint and poor quality of life, and they can be a major burden on those who experience them. The main treatment for ACL injuries is a surgical procedure called ACL reconstruction, and every year over 200,000 surgeries are performed. These surgeries amount to costing more than $3 billion annually. Physical therapy often used to increase strength and function Prior to surgery, many patients are prescribed a course of physical therapy - pre-operative physical therapy - to prepare the knee. Pre-operative physical therapy is designed to increase muscle strength and function, and reduce further damage of the knee joint, with the overall goal of shortening the time of recovery. Although this form of physical therapy is commonly used, there is a lack of research to fully support its effectiveness for these patients. For this reason, a large-scale study called a systematic review was conducted on the topic. This systematic review compiled all the available research on pre-operative physical therapy for patients having ACL reconstruction with the aim of establishing a clear consensus on what type of effects this treatment had on patients. Researchers only accept high-quality studies on the topic To perform the review, researchers searched through four major medical databases for appropriate studies on the topic. They only accepted studies called randomized-controlled trials (RCTs) that included patients suffering from ACL injuries treated with pre-operative physical therapy. An RCT is a high-quality individual study - as opposed to systematic reviews, which are collections of studies - that randomly assigns patients to different groups for treatment and then evaluates which one experiences better results. This search led to 500 RCTs being identified, but only eight of them fit the necessary criteria and were accepted to the systematic review. These eight studies contained data on 451 patients, with ages ranging from 15-57. All eight RCTs were reviewed in detail and then assessed for quality. Pre-operative physical therapy may be valuable to patients having surgery The RCTs included in the systematic review presented a range of pre-operative physical therapy approaches used, with different lengths, frequencies and the actual content of treatment. Despite this range, the review found that these treatments improved overall outcomes for patients with ACL injuries. This was mainly based on the fact that pre-operative physical therapy led to significant improvements in patients' muscle strength and knee-related function. These findings show that having a course of physical therapy prior to surgery for an ACL injury may be of value to these patients and lead to a better overall recovery. Patients preparing for ACL reconstruction should, therefore, ask their doctor or surgeon about pre-operative physical therapy if the treatment is not already offered. -As reported in the February '16 issue of Clinical Rehabilitation

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Happy Cinco De Mayo!: Our clinic wishes you a fantastic Cinco De Mayo!

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New CDC guidelines to help doctors prescribe opioids more safely: Prescription rates have been increasing recently Opioids are natural or synthetic chemicals that are used to reduce pain, and some of the most common opioids include hydrocodone (Vicodin), oxycodone (OxyContin), methadone and fentanyl. Today, they are commonly prescribed for many painful conditions, and the number of opioid prescriptions has been increasing to the point that rates have now quadrupled since 1999. Although opioids are supported by evidence to be effective for alleviating pain and improving function in the short term, it's not clear if they are also beneficial in the long term for pain lasting more than three months (chronic pain.) In addition, using opioids for any amount of time comes with serious risks, including addiction and overdose. In 2013, approximately 1.9 million people abused or were dependent on prescription opioid pain medication, and between 1999-2014, more than 165,000 people died from an overdose related to opioids. Many doctors find managing chronic pain to be challenging Many primary care doctors report that they face challenges when it comes to managing patients with chronic pain. Some doctors claim that managing these patients is stressful, and they are concerned with properly prescribing opioids, as well as the fear that patients may misuse these prescriptions or become addicted. In general, most doctors believe that opioid pain medication can be effective for controlling pain, but addiction is a common problem for patients that take them for too long. They also agree that opioids are generally over-prescribed and that more efforts are needed to regulate this. All of this information highlights the need for more guidance to help doctors manage these patients. With this in mind, The Centers for Disease Control and Prevention (CDC) created an updated set of guidelines for doctors prescribing opioids to treat patients with chronic pain. Older study is updated and supplemented with a newer study In order to create these guidelines, the CDC updated a 2014 study called a systematic review that investigated the effectiveness and risks of opioids. A systematic review is a powerful, high-quality study that collects and evaluates all available research on a topic - such as opioid prescriptions - to find common themes and hopefully reach a conclusion. Researchers also conducted another review on the benefits, harms, values, preferences and costs associated with opioids. They were interested in questions related to when opioids should be initially prescribed or continued for chronic pain, which opioids are the safest to prescribe, and how to monitor patients for potential harms. The findings from both of these reviews were combined, and a set of guidelines for prescribing opioids was established. Recommendations encourage prescribing other drugs first and starting with low dosages Based on the information reviewed, the researchers put forth a set of 12 recommendations for doctors prescribing opioids. The most important of these include the following: * Use non-opioid drugs and other treatments first before opioids; doctors should only consider prescribing opioids if the benefits outweigh the risks, and if prescribed, should be combined with other non-opioid and other treatments like physical therapy * Before starting opioids, doctors should establish treatment goals with their patients, discuss the risks and benefits, and consider how the use of opioids will stop if the benefits of using the drugs don't outweigh the risks * When opioids are used, doctors should prescribe the lowest effective dosage and only immediate-release opioids instead of extended-release or long-acting opioids * Doctors should evaluate the benefits and harms of continued opioid use with their patients every three months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages * For patients with opioid use disorder, doctors should offer or arrange assistance, such as medication-assisted treatment As a patient, it's important to be aware of these guidelines so that you know your condition is being properly managed. When making any treatment decision, your doctor should always discuss the available treatment options and carefully explain the risks and benefits associated with each one. This is necessary to make informed decisions and avoid any unnecessary treatments like opioid prescriptions that may be dangerous. Patients should also be aware that many chronic painful conditions can be effectively treated with physical therapy, which is capable of leading to significant improvements without the need for pain medications. -As reported in the February '16 issue of Recommendations and Reports

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Patients found to move better after performing certain exercises: Even though surgery is commonly used for injury, it often leads to poor results Hip fractures are one of the most common and severe types of injury in older people. In most cases, older individuals that fracture their hip are treated with surgery; however, the recovery after surgery is actually quite poor. In fact, only 30% of these patients regain the same level of physical function as before the fracture. Many of them also experience an impaired ability to stay mobile (impaired mobility) and lose their physical independence, which means they may require long-term personal care. After surgery, many patients follow a course of rehabilitation. This type of treatment aims to improve mobility, maximize physical function and prevent or reverse the loss of one's physical condition. One type of rehabilitation is structured exercise, which is designed to improve healing from the fracture and improve strength and coordination. Though supervised exercises are used to treat patients recovering from a fractured hip, it is not clearly known if they actually improve the overall mobility of these patients. Based on this, a powerful study called a systematic review was conducted, which was used to gather all the relevant studies on supervised exercise for hip fracture patients. It was followed by a meta-analysis, which analyzed each of the studies found in the systematic review and sought to make conclusions based on them. Four medical databases are searched to find appropriate studies To conduct the systematic review, four major medical databases were searched for studies on structured exercise for hip fractures. Only studies called randomized-controlled trials (RCTs) were accepted, which are considered the most powerful type of individual study. They involve randomly assigning a group of patients to smaller groups in order to determine which is more effective for treating a condition or injury. This search led to a total of 19 RCTs that were deemed acceptable and included in the systematic review. These 19 RCTs were further evaluated to determine if they could be closely compared, and 13 of them were accepted for the meta-analysis. Researchers of the meta-analysis were most interested in the primary outcome, which was overall mobility: the ability to walk, move around and change, or maintain, body position. They also looked into a number of secondary outcomes, which included measures like balance, physical performance and quality of life. All studies accepted to the meta-analysis were then analyzed in detail. Structured exercise leads to improvements in mobility after hip fracture Results from the meta-analysis showed that structured exercise does indeed lead to significant improvements in overall mobility after a hip fracture. In particular, programs that took place in settings other than hospitals were found to lead to even greater effects than those performed in hospitals. This was also found to be the case with programs that included what's called progressive resistance training. This form of training uses weights and other forms of resistance like elastic bands to build strength in the hip, and the load grows progressively heavier as the patient builds strength. These outcomes suggest that structured exercise - especially when it involves progressive resistance training and is performed outside of a hospital - can help patients with a hip fracture by improving their overall mobility. Based on this, carefully-guided exercise that fulfills these criteria may be very useful for these patients and get them back to their levels of physical functioning quicker after surgery, though more research is needed to confirm this. -As reported in the March '16 issue of the British Journal of Sports Medicine
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