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Peak Physical Therapy of Brooklyn
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Non-surgical treatment lead to similar outcomes for back pain: Interpretation of study's findings is misleading Low back pain is one of the most common painful conditions in the world. Although many individuals who experience low back pain will improve either with or without treatment, some go on to deal with long-term issues. Chronic low back pain (CLBP) is defined as any situation in which pain lasts for more than three months, and it is a major problem for physical therapists and other doctors. In general, it's recommended that non-surgical treatment that includes various types of exercises should be used first and that surgery should only be considered if these treatments are not available or don't lead to improvements. Lots of research has supported this type of approach, such as three recent high-quality studies that found no evidence that surgery was any better than non-surgical treatment after 11 years. Unfortunately, one recent study performed in Sweden tried to make the claim that surgery led to superior outcomes compared to non-surgical treatment; however, there were some issues with this analysis. Surgeons performed the study, who may have interpreted information in favor of surgery, even if it actually suggested otherwise. For this reason, a team put forth a commentary that explained the true nature of these findings to better guide patients and medical professionals. Large sample of patients randomly assigned to different treatments In the original study, patients with CLBP for at least two years were recruited to participate. This led to a sample of 294 individuals who were randomly assigned to either physical therapy or a surgical procedure called lumbar fusion. All patients were evaluated before these treatments and then monitored for between 9-22 years afterward for pain, disability, and other measures. According to the researchers who conducted the study, patients who had surgery reported better scores in most of the measurements taken, and they recommend that this surgical procedure is a valid treatment option for patients with CLBP. When looking into these results a bit more deeply, though, a different story emerges. Long-term results really show that there is no difference between treatments Researchers first pointed out that although patients were randomly assigned to have either surgery or physical therapy, they had a 3-to-1 chance of having surgery. This means that many more patients went on to have surgery versus physical therapy, and makes the results skewed in that direction. In addition to this, the patients that did receive physical therapy were not provided with quality treatments that were based on evidence, which is the norm for reputable physical therapists. Another major difficulty is the fact that although it's easy to track patients who move from non-surgical treatment to surgical treatment, this is very difficult for patients who do the opposite. Once again, this favors those who have surgery rather than physical therapy. Finally, the long-term results showed that while the surgical group of patients remained stable, the non-surgical group actually continued to improve after two years. Based on these important shortcomings, the original study was biased in its conclusion that surgery was superior to physical therapy. In actuality, it only performed better in certain measures, and non-surgical treatment actually had some advantages of its own. Therefore, the results from that study should be taken with caution, and patients should understand that what it truly shows is that surgery and non-surgical treatment like physical therapy lead to very similar results. The choice is theirs and should be made by evaluating the costs and long-term outcomes of both treatments. -As reported in the May '16 issue of The Spine Journal

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Recipe Wednesday - Good-For-You Cornbread: The day has finally come: Good-for-you cornbread! Click here for this awesome recipe!

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Motivational Monday: -Greg Anderson

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Specific exercises and hands-on therapy is helpful for ankle sprains: Many patients who experience one ankle sprain go on to have long-term issues Ankle sprains are the most common injury in athletes and those who are physically active. These injuries can occur anywhere in the ankle, but sprains to the outside of the ankle (lateral ankle sprains) are most typical and account for about 85% of sprains. In addition to the initial pain and disability that these injuries cause, up to 40% of patients who sprain their ankle once will go on to develop a condition called chronic ankle instability. Individuals with chronic ankle instability tend to experience continual pain and soreness, and a sensation that the ankle is "giving way." As a result, they are more likely to sprain their ankle again, which can lead to serious long-term issues. Two strategies used by physical therapists for treating these patients are manual therapy and exercise therapy. Manual therapy consists of different types of mobilizations being applied to the patient's ankle by the therapist, while exercise therapy involves various exercises designed to improve balance and increase strength. Both treatments have been found to lead to benefits, but it's not completely clear what effect they have when used together. Therefore, a randomized-controlled trial (RCT) was conducted to investigate the combination of these treatments for patients with chronic ankle instability. An RCT randomly places participants in different treatment groups to see which is more effective and is considered the most powerful type of individual study. Sample of patients randomly assigned to one of two groups Individuals who reported having recurring ankle sprains were recruited for the study and screened to determine if they were eligible. Out of 68 people screened, 56 fit the necessary criteria and were randomly assigned to one of two treatment groups. Both treatment groups 1 and 2 followed an exercise therapy treatment program that was given during two sessions per week for four weeks. Sessions consisted of six different exercises that were designed to increase strength and improve proprioception, which is the body's ability to sense its position in space during movements. These exercises were supervised by two physical therapists and progressed each week based on patients' abilities. In addition to exercise therapy, treatment group 2 also received manual therapy over the course of four weeks. This consisted of therapists performing a series of mobilizations of the ankle joint with the goal of improving patients' ankle mobility. Each technique lasted 20-30 seconds and was repeated 10 times each by the therapists. All patients were evaluated for pain, ankle stability, pain threshold, strength and flexibility before the study, immediately after treatment and then again one month later. Adding manual therapy leads to even greater outcomes Results showed that although both groups reported better overall scores in all the measurements taken, those in treatment group 2 experienced greater improvements than treatment group 1. This was based on lower levels of pain, better ankle stability and greater flexibility, pain threshold and strength in participants who had the treatment combination. These findings suggest that exercises for strength and proprioception can be very effective on their own for helping patients with chronic ankle instability, but adding manual therapy to the treatment program may likely lead to even greater outcomes for them. Therefore, patients with chronic ankle instability who continue to sprain their ankle should seek out physical therapy services to address their condition. By combining exercise therapy for strength and proprioception and manual therapy, physical therapists can produce noticeable improvements in these patients and help them to function better with a reduced risk for additional ankle sprains. -As reported in the August '16 issue of Manual Therapy

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Got back pain? Don't miss this: Got back pain? Don't miss this Here is our latest monthly video. http://bit.ly/2xVUUOs
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Recipe Wednesday - Grilled Romaine Lettuce With Caesar Dressing: Grilled salad?! We had to check this out! Click here for this cool recipe!

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Happy Physical Therapy Month!: Happy Physical Therapy Month to all of our patients! We love working with you and seeing you benefit from your progress -- keep up the good work!

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Seeing physical therapists early for neck pain is better than waiting: New strategies are needed to improve healthcare system Under the current system, the majority of healthcare in the U.S. is delivered in a fee for service, volume-based model. This means that healthcare providers like doctors have an incentive to handle a large number of patients since they will receive payment for their services regardless of each patient's outcome. Using this type of system is one of the main reasons that healthcare costs continue to increase in the country. Clearly, new strategies are needed to improve the system so that patients can receive the best and most appropriate care possible at a reasonable cost. One way to do this is by identifying treatments that are effective for the patient, priced reasonably and given at the appropriate time. The use of physical therapy early on is one treatment that is studied in this regard. The benefits of early treatment for neck pain have not been studied Recent studies have shown that early physical therapy for lower back pain is recommended to improve the outcomes of patients better than prescription medications and other treatments. It has also been found associated with less use of healthcare resources and lower costs overall. Neck pain is the second most common disorder that affects the body's movements behind lower back pain, and physical therapy is commonly used to treat it; however, the effects of early physical therapy for neck pain have not been studied. For this reason, a study was conducted that compared patients with neck pain who received physical therapy at an earlier date with those that waiting a period of time before beginning physical therapy. Information from a large database used to compare both patient groups A large database with detailed information about patients who received physical therapy for neck pain was used to conduct the comparison of early and delayed users. Patients were categorized as using early physical therapy if they reported their pain in less than four weeks, while those who waited longer than four weeks were classified as delaying physical therapy. A total of 1,531 patients were identified from the database and fit the necessary criteria. This included 451 patients who received early physical therapy and 1,080 who received delayed physical therapy. Early physical therapy leads to several benefits over delaying After comparing both groups of patients, it was found that those who received early physical therapy experienced better outcomes with less disability and pain than those who delayed it. This was found to be the case not only in their actual outcomes but in their value as well since patients got more out of each dollar they spent with early physical therapy over delayed physical therapy. Since patients improved more and required less treatment, there was also a benefit in cost for the physical therapists and insurance companies. Finally, the overall efficiency of treatment was found to be superior in the group that received early rather than delayed physical therapy. These findings clearly show that seeing a physical therapist for neck pain within four weeks will lead to much better outcomes than waiting longer to do so. More research is needed to confirm these findings and eventually make policy changes to reflect them, but in the meantime, patients who have neck pain are encouraged to see a physical therapist early instead of delaying treatment in order to experience the best possible benefits. -As reported in the July '16 issue of BMC Health Services Research

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