Text Neck: Real or Fake?

Do you check your phone often? Notice the burn in your neck or arm? Last year, I had a patient who had numbness down his left arm when he looked down at his phone or screen. Was this "text neck", the phenomenon of neck pain caused by frequent checking and texting from a mobile phone? Perhaps...it clearly was cervical radiculopathy, or a compressed/irritated nerve root in the neck. Fortunately my keen PT skills and few steroids later helped to get this patient back to work and pain-free neck movements. But it left me wondering -- did the phone lead to his issue?

A recent study done in Brazil puts into question whether "text neck" even exists. They took pictures of these kids as they looked at their phones, had experts analyze the pictures, and then cross-referenced the postures in the pictures with reported neck pain. This study did not show an association between text neck and neck pain in 18–21-year-old young adults. The findings challenge the belief that neck posture during mobile phone texting is associated to the growing prevalence of neck pain.

Obviously more goes into neck pain than simply posture: exercise status, nutritional care, psyche, medications, and more. Check out the article, pay attention to your posture (maybe), and contact us to learn more!

https://link.springer.com/article/10.1007/s00586-017-5444-5

Neck Pain at the Office

Anyone who has spent anytime writing a blog (like this one), paying bills online, or simply grinding away at their desk job at work knows neck pain. Neck pain strikes most Americans, second only after lower back pain. Among all occupations, office workers have the highest risk for neck pain. Nearly half of workers experience some type of neck pain each year!

What can you do prevent neck pain? In our Physical Therapy Journal (PTJ) this January, researchers offered some vital evidenced-based recommendations:

• Strengthening your neck and shoulder muscles if you have pain. A Doctor of Physical Therapy can easily guide you to the best specific exercises to meet your needs. So, if you have pain, skip the chiropractor or physician and directly seek out your PT!

• Perform routine physical activity and exercise like walking, cycling, and weight training. This can improve your muscle endurance, reduce sensitivity to pain, and boost your mood -- all of which may prevent neck pain.

• Preventing neck pain through ergonomic aids may offer only a small effect for generalized workers -- it may help those in pain, which again is something a physical therapist can help you with.

Neck pain has a significant cost and impact to work and our economy. Even if you are not employed, neck pain from office tasks can be burdensome and impact your activities of daily living. If this is you and you are in the Naples, Bonita Springs, or Marco area, use our Contact Us tag and set up a consultation today!

Does California Cause Cancer, or Just its Coffee?

A California judge recently ruled that some stores must label coffee as potential cancer-causing because it contains a compound known as acrylamide (https://www.yahoo.com/news/apnewsbreak-california-judge-coffee-needs-212748202.html). The unfortunate reality in this situation is that the defendants of the case, the coffee industry, did not have an opportunity to really express the potential health benefits of coffee. Research has shown that coffee is a strong antioxidant, reducing the risk of some neurological decline and Parkinson's, as well as promoting GI motility, which may reduce the risk of gut cancer. Large epidemiology studies show that coffee may even reduce the risk of death by roughly 6-15%, with consumption up to 6 cups per day. As such, does coffee really cause cancer from acrylamide?

Very unlikely. If there is any industry the California government and lawyers should be attacking it would be the potato chip and French fry manufacturers. Potato chips and french fries have the largest concentration of acrylamide (https://pubs.acs.org/doi/abs/10.1021/jf020889y#/doi/abs/10.1021/jf020889y). Analyzing a report from the FDA, it shows coffee to report ~90 parts per billion (PPB) on average in most coffees. Meanwhile potato chips and french fries stack in at ~300 to 400 PPB. Of course, the acrylamide level referenced in the court case may have been higher than 90 PPB, but shouldn't there be a sign warning for potential cancer on the package of your potato chips or menu for twisty fries? The big issue here is we're just discussing one compound, acrylamide. The cancer caused by alcohol and meat seemingly get a pass.There are countless carcinogens out in the world…should California have a sign posted on its borders as you enter: this state is known to cause cancer?

New Health Model for PTs: Wellness and Prevention

Insurance physical therapy at your hospital or local clinic is steeped in tradition: find the one problem, focus on it, and fix it. The services are reimbursed based on a fee-for-service model. The more care the more payment that is given, regardless of outcomes or future setbacks. Physical therapist's (PT) education skews also towards the model of problem-based learning, exam, and intervention. Lost in the mix of the insurance and educational maelstrom is the patient: what other issues are lurking, how do they address the "whole" patient and not just the one body part or pain, and how can they continue living healthy and happy?

Fortunately a new model of PT practice emerged. The Health-Focused Therapy Model (HFPTM) promotes PTs to recommend notions like smoking cessation, regular physical activity, and even nutrition, when/where appropriate. Researchers at the University of Alabama at Birmingham produced the new model which hopes to only enhance what PTs currently offer.

Your Doctors of Physical Therapy at Wells PT embrace, endorse, and put into practice the Health-Focused Therapy Model of care. From smoking cessation, exercise interventions, physical activity promotion, and nutritional counseling, Dr. Wells and Lauzon want the best for the whole YOU -- not just your knee or shoulder. Use the Contact tab on our webpage to set up your consultation today for the best Physical Therapy you've ever had.

Balance

Balance training is a useful intervention in rehabilitation of postural stability impairments as well as in training programs for performance enhancement. Active elderly people should be challenged with balance and proprioception exercises. One scientifically-based approach, the Sensorimotor Training, has shown great success. It can be characterized as a progressive balance training program using unstable surfaces such as foam pad, air disc, exercise ball which provide adequate challenges to the active senior. Proper balance training will enhance their postural stability and improve their activity level.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812830/

-Dr Lauzon

Low Back Pain: Exercise and the Mind

Lower back pain, even chronic lower back, responds positively to exercise, according to a recent large Cochrane review. For years we knew exercise, physical therapy (PT), and education could could help people recover from acute lower back pain. The effect on exercise on chronic lower back pain was questionable at best until this Cochrane review came out. Despite the positive news, many physical therapists still question what are the best exercises and what other factors are important to recovery.

A fantastic article published from a member of the Chartered Society Physiotherapy in the United Kingdom highlighted the importance of psychology with recovery of chronic lower back pain. The author sites:

• 69 per cent of participants believed they should take it easy

• 59 per cent believed any activity that caused pain should be avoided

• 53 per cent believed the risk of exercise outweighed the benefits

• 35 per cent believed that bed rest was the mainstay of therapy

• http://www.csp.org.uk/news/2018/01/30/ppa-study-day-beliefs-expectations-can-influence-effect-exercise-pain

Furthermore, he said that that negative language and beliefs about the body, such as describing it as ‘a broken machine’ or suffering from ‘wear and tear’, can affect the outcome of an intervention. 

It appears the beliefs and attitudes of a person can have a majority of impact on recovery from lower back pain. It is important to see the recovery from lower back pain as a team effort, with you, your PT, and often family helping you through recovery. Our expert staff have the skills to guide you through exercises and some psychologic tools to guide you through low back to full recovery. In rare cases we use a sports psychologist trained in cognitive behavioral therapy (CBT) to help even more. 

Call or mesaage us today for a consult in Naples, Bonita, or Marco Island.

New Year's

Many New Year's post go up a few days before and after the the big day. My team and I wanted to do something different and stand out. We are a week after New Year's, here are some pointers (or gentle reminders for some) to improve your health.

New Year Resolution by Dr. Anik Lauzon:

The new year is here! Another year to live, love and laugh has started. It’s also time to make lifestyle changes and take our health back on track.  Every year, we begin the new year with  good intentions thinking we will be committed to this new year’s resolution. In reality, most of us fail to be compliant with our new intentions, thus the year passes by and our resolutions are long gone. The “New Year Resolution” expression sometimes seems like a longtime goal that can’t be achievable.  We all hear that an active lifestyle and  healthy food are the most important elements for good health. Making continuous healthy choices can be challenging for some people even if they know all the benefits. What if instead of trying to focus on a year-long goal, we would decide to make changes the very first day of the year, the next day, and within the first week? Here are some examples of action you can take the very first day of the year:

-Take the stairs instead of the elevator

-Add vegetables to your meals and snacks

-Take a walk or play outside with your children instead of watching TV

-Place water in the fridge instead of soda or juice

-During week-end, prepare healthy meals for the week

-Include green, leafy vegetables in every meal

-Instead of sugary desserts, have fresh fruits

-Replace meat for grains and legumes a couple meals per week

Once we start changing one simple thing at a time, it does not feel overwhelming. Every healthy change we make will benefit our body and its function. We will no longer call it a “ New Year Resolution”, but instead a healthy lifestyle that can be maintained all year and all life long. Remember, every little change makes a difference!

Arthritis: Exercise and Food for Your Joints

More than 80% of older adults over the age of 65 have some form of osteoarthritis, also more commonly known as arthritis. In fact,  arthritis has more than doubled in the last 50 years! How did we get to this point? Is it just a matter of better Imaging or are we actually seeing a change within our bony structures? More importantly what can we do to prevent the continual growth of osteoarthritis within our population?

The answer lies within several studies that were published recently. Epidemiologists and researchers going back and measuring our skeletons of our ancestors have shown that physical exercise and activity have been a integral part of our lifestyle and bodies. With modern technology and changes to our lifestyle we have become less agrarian and less active. As a consequence our bones and bodies have changed. We have gained a little bit more weight, or joints have not gotten used to not being used, and we suffer from other ailments related to changes within our diet. In a study just this year in the Journal of American Medical Association shows that weight gain and lack of physical exercise is probably the biggest driver for inflammatory arthritis.

Studies show that the current American diet promotes inflammation and can actually worsen arthritis. Several studies show that those that are on a plant-based Mediterranean style diet have less inflammation and are less likely to have osteoarthritis. From excessive fat, excessive meat consumption, and pro-inflammatory processed foods help to drive arthritis.

Some of the best things that we can do for arthritis include exercise and lifestyle changes. The exercise that can offer the best benefit typically involves strengthening the muscles around the joint. For example for knee and hip arthritis, exercises that strengthen the upper thigh muscles and hip muscles has been shown to improve strength, function, and pain. Another component that can greatly help physical therapists and patients alike, is a drastic change in Foods consumed. Adopting a plant-based diet will likely offer the biggest anti-inflammatory benefit for those with arthritis. In addition a plant-based diet will confer benefits for the heart, blood sugars. Diabetes, body weight, and mental health.

So, as you're considering getting a steroid injection, surgery, or even a joint replacement, consider that exercise and diet probably have a bigger role in treating your arthritis than the traditional medical model. Because in the end, with the exception of joint replacement, there are no other truly evidence-based treatments for joint arthritis. Contact us today to schedule a consult for our physical therapist to evaluate you and provide you with a maintenance Physical Therapy Program specific to your arthritis needs.

Source: https://www.villages-news.com/osteoarthritis-doubled-past-50-years/

Gluten: Friend, Foe, or Just Food?

Unless you have been living under a rock the last 5 years, the gluten free movement has produced massive shifts in product lines, menus, and people. Gluten, a protein, found in wheat has been around for thousands of years. How did it go from an essential food, in some areas of the world, to a eschewed substance of inflammation and disease?

Let us start first with facts: gluten allergies occur in less than 1% of the population. Those allergic can have skin rashes, intense gut pain, diarrhea, weight loss, and malnutrition. A researcher studying children in Belgium after World War II saw these findings in young kids after their country went from near famine to feasting on poinds of bread. Shortly after, the substance gluten was isolated and taken out of their diets to improve the kids' symptoms: it worked and so started the investigations that lead to celiac disease.

Celiacs disease is an inflammatory bowel disease due to gluten. The gold standard diagnostic test is a gut biopsy. Celiacs disease is autoimmune in nature; the body attacks the gut as gluten passes through after consumption. Celiacs was well-known in Europe for decades, perhaps due to its identification in Belgium. In the United States, little was known about celiacs, let alone gluten, save for the last decade and a half. The question that remains with many: can you have gluten sensitivity and not an allergy?

Many doctors and researchers are binary regarding gluten's issues. Some strongly feel that gluten wrecks havoc on your gut, promotes inflammation, and can promote other diseases like obesity. Unfortunately, the studies for such notions are limited in scope, small in size, or flawed in their methods. In many studies, participants are given doses of isolated gluten to eat, which is unrealistic given we eat whole foods. As we eat whole wheat bread, for instance, any inflammation boosted by gluten is more than negated by the whole wheat's anti-inflammatory properties such as vitamins, fiber, and sterols. Moreover, several studies have highlighted how taking out a whole grain products, like wheat, can negatively impact your heart disease risk, gut, and blood profile. Gluten free (GF) options tend to be low in fiber, higher in sugar, and cost 3 times as much as regular products. As such, going GF may not be a best option for you. Regardless, people will still state they feel better without gluten, or at least moderated gluten consumption. This makes sense, as if you ate any food excessively you likely with see several side effects. Eat 2 bags of broccoli and you will likely have gas and bloating from the sulfur.

Why do TV doctors, oddball neurologists, some dieticianss, and even a few PTs recommend all their patients avoid gluten? Misinformation perhaps, or simply it is popular. Do the right the thing: ask questions, seek answers through testing and elimination dieting, and enjoy this great Freakanomics podcast: The Demonization of Gluten http://freakonomics.com/podcast/demonization-gluten/

Failed Back Surgery Syndrome (FBSS)

Chronic lower back pain is one of the leading causes of permanent disability. Often people with chronic low back pain will try multiple forms of treatment including Physical Therapy, medications, and injection therapy. Once they've exhausted all these efforts, many resort to surgery as the answer for their pain. Unfortunately only 35% of these cases are successful, particularly when Fusion is involved. As such, a group of pain management specialist recently have begun to use the diagnostic "label" of failed back surgery syndrome, or FBSS.

In the article below you can read how many pain specialists feel adding this additional "label" as a beneficial step. I would partially agree that the "label" is beneficial because some Physicians and surgeons are in denial that back surgery can fail. Some surgeons see patients with continued back pain after surgery as fakers or addicted to pain medicine. Physical therapists, as well as modern educated surgeons and Physicians, know that surgery is not always the answer for chronic lower back pain. Moreover, I strongly feel that simply adding a label is not enough.

As a physical therapist, I argue that simply adding a label may not be as beneficial as what occurs in the next steps after a patient is diagnosed or labeled. A large majority of patients with chronic lower back pain never seek psychological counseling. Emerging pain science Concepts are beginning to show that many of these patients with chronic lower back pain, as well as other forms of chronic pain, have larger issues at play. Many of these issues include anxiety, altered pain responses, depression, and chronic systemic inflammation from poor nutrition and lifestyle factors. Physical therapist are being armed with the knowledge of addressing some of these psychological Concepts through cognitive behavioral therapy (CBT) techniques, modern pain science techniques, as well as nutritional counseling.

Our team at Wells Physical Therapy embraces many of these Concepts and can help you or our friend through chronic pain. Contact us today for a consultation and enjoy the below article.

http://www.painmedicinenews.com/Primary-Care/Article/10-17/When-the-Last-Resort-Fails-Failed-Back-Surgery-Syndrome/44735

Arthritis, Athletes, and The Missing Piece

Arthritis: to play sports or not to play sports? The study below highlights the higher prevalence of hip and knee replacements due to osteoarthritis following professional rugby play. We know exercise and sport can help prevent arthritis but where is the line when a player pushes too much and compromises their joints? More research is needed to help support athletes through their life.

Also, I wonder how diet might impact these outcomes? We know trauma to the knee increases the odds of OA. But what about mitigating flare ups through food and improving strength with PT to prevent surgery? More studies needed...

https://m.medicalxpress.com/news/2017-09-highlights-high-prevalence-hip-knee.html

Nutrition and Physical Therapy: holistic and effective

Nutrition has long been a subject of much health discussions. Headlines are a buzz with the next diet fad or study linking food to causing or stopping chronic diseases. PTs help patients through these tough times of chronic disease and pain, only to miss the impact food has on patients.

Dr Wells will be rolling out a book for showing the connection between food and pain, arthritis, desurgical healing, and heart disease. A continuing education course is currently being developed to help PTs counsel patients and improve their lives.

Stay in the loop at: https://www.facebook.com/nutritionPT/

PRP or Dry Needling for Tendons?

PRP or dry needling? According to this recent pub PRP out-edged dry needling for chronic tendon issues, but not by much (statistical difference, likely not a clinical difference). Which do you choose?

https://www.ncbi.nlm.nih.gov/pubmed/27268111

Is there a magic amount of time to exercise for arthritis?

In a study of 1,600 adults with osteoarthritis (OA), researchers from Northwestern University found the right amount of time to exercise for sustaining function and keeping pain down. The study showed any activity or exercise is better than none; however, those who did at least 45 minutes of moderate activity (such as fast walking, moderate cycling) had the best functioing and pain scores after a 2 year follow up. Unfortunately only 10% of adults with OA meet the 45 minute goal, many due to the misinformed notion that pain means they are damaging their joints further (a concept debunked by modern pain science). So, get out and move or call your local PT today for a tune-up before you start!

Agility Ladders and Older Adults

Age has its impact on the human body. With minimal exercise, a poor Western Diet, and beliefs that age slows us down, we struggle to function as we age. One easy way to stay ahead of age-related changes is through an comprehensive exercise program designed by a physical therapist.

Balance drills, resistance training, and education is the mainstay for PT and aging adults. Despite these efforts we are still missing the mark amd adults continue to age and struggle with functioning. Study after study show we need to train power, especially functional power based movements. As such, I implement the use of an old sports training tool: the agility ladder.

The agility ladder pushes older adults to work on quick stepping, patterns, and change of direction. The ladder offers similar stepping that a person may have in a parking lot (stepping over curb quickly), a tight closet (side stepping), or walking through a crowd (weaving and shuffling). Assigning pattern helps with memory development and parallel processing. Enhance the parallel processing with upper extremity manipulation or verbal questions. 

Immediately, many physical therapist may be worried about "safety". For too long have we underdosed and not pushed our older adult clients. The Agility Ladder can easily be done with close one-on-one spotting and/or a gait belt. Ladder drills may be more time consuming and require closer supervision, which may be difficult in a very busy insurance based Physical Therapy practices. Regardless, I have seen the benefits outweigh the risks, and my clients have commented on how well they can move after using this intervention over many sessions. So, give it a try: go out and explorer agility ladders with your older adult clients!

Eat a Whole Food, Plant-Based Diet

Here's an amazing article highlighting the health benefits of eating only plants, mostly in their raw or whole form. Enjoy!

https://www.bustle.com/p/what-happens-to-your-body-when-you-stop-eating-meat-dairy-eggs-65718 

Back Pain, Manipulation, JAMA

According to a new, large systematic review done by the Journal of American Medicine (JAMA), spinal manipulation or mobilization significantly reduces pain and improves functioning for acute lower back pain. Nearly half of the Articles reviewed were published by physical therapists! 

Doctors of physical therapy are uniquely trained in spinal manipulation. Two weeks ago I had a unique case of a gentleman with lower back pain. He was in so much pain he was crippled forward over a Walker. After performing spinal manipulation, as well as therapeutic execrises, he no longer need of the Walker... after one treatment! 

Fast responses to treatment is it Priority for us. Call or message us today to schedule a consultation.

Article: https://www.ncbi.nlm.nih.gov/pubmed/28399251

Wells PT Presents at National Conference for PTs

Dr. Sean Wells presents at the 2017 NEXT Physical Therapy conference. His topic covered hip pain, differential diagnosis, and orthopedics. Enjoy the picture and we will share more informant from the conference soon!

Upcoming Book: Diet and PT

I have written on the positive effects of a plant based diet. Currently, I am working on my 2nd book , this one focused on nutrition and physical therapy. Diet is not just for trainers, weight loss experts, or people wanting to shed pounds. Diet is pivotal in tendon healing, recovery from stroke or spinal cord injury, and reducing inflammation.

Diet is also crucial for longevity. I have 2 second author publications on how reducing calories extends lifespan. Vegan and plant based diets have similarly show increasing lifespans and a reduction in life-ending diseases like cancer, heart disease, and stroke. How does a plant based diet do this? The evidence is still out but the preliminary results show it could be that plant based and some (non junk) vegan diets are low in omega 6 fats, animal fats, and animal antibiotics/hormones which stimulate inflammation. Others argue that plant based diets are chock full of anti oxidants (fruits) and prebiotics (vegetables), which help to reduce inflammation and boost the gut microbiome. The gut microbiome is tied to not only gut health but also mental health, endocrine and cardiac health, and the musculoskeletal system! 

Want to learn more? Stay tuned for my book coming out later this summer/early fall.

In the meantime, enjoy this article on red meat and its effects on your health:

https://mobile.nytimes.com/2017/05/15/well/eat/red-meat-increases-risk-of-dying-from-9-diseases.html?_r=0&referer=

Knee Arthritis - Pay for What Works

A recent study of nearly 86,000 subjects found the treatment for knee arthritis did not follow research supported clinical practice guidelines. The study showed physicians heavily used steroid and hyaluronic acid (HA) injections - 46% and 18% of the time - despite little evidence to support these interventions. More sadly physical therapy was used only13% of the time, despite PT being an evidenced based and cost effective treatment. 

The total cost for care for the subjects' knee OA was reflected by HA injections at 29.2%, which the American Academy of Orthopedic Surgeon's classifies this treatment as "strongly - cannot recommend". Meanwhile PT only reflected a total cost of roughly 10%.

PT is a cost effective treatment for knee pain. Call today for a consult!

Article: https://www.ncbi.nlm.nih.gov/pubmed/28209276