PHYSICAL THERAPY
“The more I practice, the luckier I get”-unknown.
This quote was first introduced to me by my father many years ago. My dad had responded to my jeering following a particularly lucky shot (in my personal opinion) that capped his victory in a game of HORSE. HORSE is a basketball game for those unfamiliar. What my father was playfully asserting here was one of the most important life lessons that I have ever learned: preparation is the key to success! What I would like to communicate today is a bit of a “How-to” guide for preparing for your best outcome with rehabilitation from outpatient physical therapy.
Preparing for the Initial Examination
Did Tom Brady just show up and dominate the NFL for the last 2 decades based on natural talent alone, or was it the countless hours of practice that helped him to become the best quarterback of all time? Brady fell to the 6th round of the NFL draft with 198 players selected before him due to a myriad of factors. He split time as a college quarterback (even as a senior), sported a less than stellar NFL scouting report and was buried deep on the Patriots depth chart before ultimately taking over for Drew Bledsoe midseason due to an injury. It was not sheer athletic prowess, but relentless preparation and determination was foundational to his success. Now obviously, we are not all professional athletes. We are a community of people with all sorts of different backgrounds and different values and that’s ok! It is our differences that make us stronger as a whole. I would suggest that all of us who are medically able, can find success in Physical Therapy with the right preparation and determination. I will begin with some key suggestions to achieving your best outcomes here in Physical Therapy, along with addressing a common questions regarding expectations. I will then describe what you might expect during your follow up visits along with some general health and wellness tidbits and accompanying CDC recommendations.
The Evaluation
***If you have trouble remembering what activities or movements seem to make you worse, consider typing it into a note file in your mobile phone!
2. Bring a list: Possible lists may include medications, past surgeries, MRI reports (if you have them) along with any questions you may have. For those of us with more complex medical histories, it would be helpful to any medical provider to have a thorough background from which to create the safest and most effective plan of care for you.
3. Is it going to hurt?: My patients know that I preach modification to avoid significant pain provocation. My very familiar refrain is “If it hurts to do 10 repetitions, we will do 8. If 3 sets is too much, we will stop at 2. If it hurts to raise your arm past shoulder height, we will avoid the range of movement overhead.” While some intermittent discomfort may be experienced, we avoid putting patients in a scenario where they might experience significant pain provocation. Initiating exercise may cause some delayed onset of muscle soreness one to two days following exercise. This is a normal response. Ultimately, your feedback will help guide us! We want everyone getting better. We don’t want anyone getting any worse.
4. Dress for success: It is cold in the northeast during the winter months! This much we all know. We physical therapists, like your medical doctor, will need to perform an examination on your injured body part(s). So if you have an injury to your knee, for example, please be sure to wear clothing that allows us to visualize your knees. A more thorough examination will lead to more efficient and individualized treatment for you!
5. Get ready to be active: As the name would suggest, physical therapy will very often rely on your physical participation. I will touch on this more in the next section. Additionally, please be sure to arrive in a timely fashion to get the most of your one-on-one time with your therapist!
Physical Therapy Treatment Visits
Physical therapy treatment will likely include several different types of interventions. We typically include activities such as manual therapy which includes soft tissue mobilization and mobilization of your joints. We use different “modalities” which may include use of technology such as an electrical stimulation or therapeutic ultrasound to help manage pain and encourage tissue healing. Foundational to many physical therapy plans of care is a physical component. This may include therapeutic exercises such as range of motion, stretching or strengthening activities. We may integrate some balance training or gait training should your plan of care necessitate. As you progress closer to your goals for returning to your usual function, dynamic activities to improve functional performance or therapeutic activity might also be utilized. We are also excited to offer dry needling at all ORI locations!
Ultimately, your best Physical Therapy outcome will depend on several factors! Here is a short list of several additional considerations that will help to set appropriate expectations for healing and foster your best outcome.
2. Nutrition: I am not a nutritionist or dietition, but I wanted to just include some interesting additional information that I thought was pertinent to health and wellness as well as an interesting study that I had reviewed relative to protein intake. Firstly, sedentary adult males need 2200-2400 calories/day while active men require 2800-3000 calories per day according to the FDA.gov. Younger, sedentary adult females require 1600-2000 calories (age dependent) while the recommendation for active adult females ranges from 2200-2400 calories.
Food Protein (grams) 3 ounces tuna, salmon, haddock, or trout 21 3 ounces cooked turkey or chicken 19 6 ounces plain Greek yogurt 17 ½ cup cottage cheese 14 ½ cup cooked beans 8 1 cup of milk 8 1 cup cooked pasta 8 ¼ cup or 1 ounce of nuts (all types) 7 1 egg 6 Source: USDA National Nutrient Database, 2015
Recommended Daily Allowance (RDA) for protein intake is .8grams/kg of body weight. This is a minimum nutritional requirement! Research on this topic is ongoing, but the American College of Sports Medicine (ACSM) states “To increase muscle mass in combination with physical activity, it is recommended that a person that lifts weights regularly or is training for a running or cycling event eat a range of 1.2-1.7 grams of protein per kilogram of body weight per day, or 0.5 to 0.8 grams per pound of body weight.” The 1.2 g/kg of body weight recommendation pertains to the endurance athlete while the 1.7 g/kg recommendation is for the strength training athlete. Interestingly, it was suggested by Tipton in Sports Medicine that “higher protein intakes (2-2.5 g/kg/day) seem to be warranted during periods of immobilization” (1). While a complete review of nutritional requirements and protein intake is well beyond the scope of this blog, I did just want to propose that nutrition is the fuel for your recovery! A diet of whole foods, including plenty of fruits and veggies, lean meats, grains (if desired) and healthy fats, while minimizing processed foods and refined sugars would help bolster the healing process.
It is my hope that I have provided our patients with a fairly thorough overview of the rehab process. It is important to be prepared and know what to expect out of not only the initial exam, but the treatment and the multitude of factors that may impact your recovery. Of course other dynamics such as our medical history (comorbidities), age and the extent of the tissue damage will also contribute to the end result. Healing and return to function is truly a multifactorial equation. Being injured involves loss of function and an inability to resume the activities that you love. We are here to tell you that we understand. We sympathize with you. Together, with hard work and determination, we can help to reduce your pain and facilitate the return to your ultimate functional goals. In closing, I would just like to express my gratitude by extending a sincere thank you to all of our patients for allowing us to participate in your care. We appreciate you! Be well.
(1). Sports Med. 2015; 45: 93-104 Published Online 2015 Nov 9
