Wednesday, May 30, 2012

Tending to Bodies Near the Breaking Point

Here is an inspiring story in honor of Memorial Day and to all those who risk their lives every day to protect our freedom here at home....Physical Therapists making a difference in hostile territory....




Kuni Takahashi for The New York Times
Capt. Rachel Odom treated Staff Sgt. Dick Plank in Paktia Province, Afghanistan in April.

 
Kuni Takahashi for The New York Times
Captain Odom, left, rested in a helicopter after treating 13 soldiers.

Kuni Takahashi for The New York Times
Capt. Jamie Bell, second left, head of a center for concussion care, spoke with Staff Sgt. Joseph Marcinko, Sgt. Junior Daniel and Specialist Edward Herrera, patients.

Kuni Takahashi for The New York Times
Specialist Edward Herrera, 22, was treated at the concussion center in Khost, Afghanistan.

COMBAT OUTPOST RAHMAN KHEL, Afghanistan — Each week, Capt. Rachel Odom takes off in a helicopter to fly to yet another distant military outpost of this mountainous region of eastern Afghanistan to patch the troops in her care back together.

One recent morning, 13 soldiers came to visit her in the small wooden medical hut of a 100-man camp near the village of Rahman Khel, cradled by the snow-tipped mountains of Paktia Province near the Pakistani border. One after another, the soldiers told her of their twisted knees, back pains or shoulder strains — the increasingly familiar-sounding toll of a long war.

After multiple deployments in Iraq and Afghanistan, some of these soldiers’ bodies are nearing the breaking point. It is up to Captain Odom, 28, from Moselle, Miss. — the only physical therapist attached to the 3,500 men and women of the Fourth Brigade Combat Team of the 25th Infantry Division — to keep them together.

“These bodies get a beating,” she said as she spent the next 12 hours stretching out legs, lifting arms or standing on a box to lean over and pummel pulled back muscles, accompanied by sighs, groans, thanks and the occasional curse.

“They walk up and down mountains carrying a lot of gear, just a lot of weight, and that can result in daily aches and pains, and also injuries,” she said. “I am keeping them doing their job, living their lives with as little pain as possible.”

These soldiers are likely to be some of the last Americans to serve in Afghanistan, and as troops are beginning to withdraw ahead of the 2014 deadline, the war here can take on an end-of-the-race feel at times: the finish line is distant but finally in sight, and Captain Odom is working just to keep her charges running till they can reach it.

The action these days is rarely about face-to-face combat. Instead, it is an effort to keep up with an elusive enemy that slips from the looming mountains this time of year and moves invisibly from village to village through the woods and fields, heading west for the fighting season.

For the Army company based at this outpost, among the 19 on Captain Odom’s rounds, it involves long, bone-rattling journeys in armored vehicles protected against roadside bombs or suicide attacks. Or it is a five-hour slog encased in ever more elaborate body armor — designed to protect against a distant sniper shot or rocket. But it can add at least 35 pounds to a soldier’s load, even without his helmet, pistol, ammunition, water, medical kit and rifle.

“When you carry all this stuff and then go climb one of those mountains, it definitely takes a toll on your body,” said Sgt. James Daoust, a company medic.

Today’s protection is the I.O.T.V., or improvised outer tactical vest, a bulky affair that involves heavy ceramic block plates, side plates, deltoid protectors and groin guards. Some soldiers even have Kevlar underwear. (At higher altitudes, soldiers are allowed to wear a slimmed down I.O.T.V., called a platecarrier, but it is still heavy.) Around the bases in this region, sweating soldiers in shorts and sneakers run laps around the outer perimeter wearing the vests just to get used to them.

Captain Odom, who has broad rosy cheeks and a practical, considerate manner, represents a new kind of emphasis in the military on getting to these kind of injuries quickly, even mundane ones like twisted ankles or tweaked backs, before repeated strain can force soldiers out of the war altogether.

She was encouraged to go into the military by her uncle, a retired colonel, after she graduated from the University of Southern Mississippi. Now, she is five months from the end of her first tour of duty. She seems comfortable sprinting from a standing start in the darkness to board a waiting Black Hawk, or flying over the Afghan mountains in the moonlight, bound for yet another camp in her 19,000-square-mile territory, carrying her medical bag and an M4 carbine.

Among her patients this day, one said he felt as if the pain was crushing his back, which had hurt since Iraq. Another, First Lt. Jeffrey Russell, from Copperas Cove, Tex., said that when he jumped loaded with gear from the wall of an abandoned house during a patrol, his knee buckled.

“I don’t like being the platoon leader and having to sit back in the truck,” Lieutenant Russell said, “so I have come for a professional opinion.”

Captain Odom says Army Ranger units were the first to include physical therapists, rather than have them stay back at the hospital or in separate medical units. But now with their success, therapists have spread into mainstream combat units; Captain Odom is the first her brigade has had. “They are becoming more common,” she said.

One of the biggest challenges for the therapists is dealing with an injury that has become all too common in a war defined by the Taliban’s roadside bombs: blast concussions. Back at Captain Odom’s brigade base, Forward Operating Base Salerno, over the mountains amid the sweet-smelling eucalyptus trees of Khost Province, there is a special center to treat them.

The center is run by one of Captain Odom’s friends and colleagues, Capt. Jamie Bell, 32, from Lancaster, Calif., and has been open only for the past couple of years.

“A lot of the soldiers here have been deployed three, four, five times, so they are already coming with some PTSD, and then they get concussion,” said Captain Bell, referring to post-traumatic stress disorder. “They might get blown up three or four times in a month, and that’s when you might have a high risk of permanent damage. But if they have proper treatment and rest, they can be returned to duty without long-term effects.”

Inside the small concussion center, she gives soldiers who have been caught in blasts computer tests and games like Lego, Scrabble and Blokus to improve their memory, visual perception and sequencing skills. Three recovering soldiers were sitting on a black sofa and chair, silently watching “The Big Bang Theory” on television and looking tired and worse for wear.

One of them, Sgt. Junior Daniel, a tousle-haired 24-year-old from Mims, Fla., was on his third deployment. Two weeks earlier, while he was running from his armored truck toward a building occupied by insurgents in Gardez, his group came under gun and rocket fire. He said something “blew up close to my head.” He lost his hearing for a while, and still looked groggy.

One of the men with him in Gardez, Staff Sgt. Joseph Marcinko, 29, from Ohio, was also at the concussion center, with black bags under his eyes. He had stayed behind in the armored truck, but a rocket hit the door and knocked him unconscious for 10 seconds, he said.

The third soldier, Specialist Edward Herrera, 22, from Miami, on his first deployment, was a gunner in a truck when a truck in front was hit by a roadside bomb.

“I hit the turret with my head,” he said. “The driver slammed his brakes, and I hit my head on the turret again, and then I was being shaken awake.”

Sergeants Marcinko and Daniel insisted that they would be returning to work soon, and they did: about seven hours later, they were at the camp airport with rifles and packs, looking only a little more awake, trying to catch a night flight back to Gardez.

Wednesday, May 23, 2012

Workplace Wellness

Workplace Wellness

Working at a computer work station all day can take a toll on the body. Repetitive activities and lack of mobility can contribute to aches, pains, and eventual injuries.
Sitting at a desk while using the keyboard for hours on a day to day basis can result in poor circulation to joints and muscles, it can also create an imbalance in strength and flexibility of certain muscles, and muscle strain. These issues can be easily remedied by taking frequent short breaks, or "micro breaks," throughout your day.
  • Get out of your chair several times a day and move around—even for 30 seconds
  • Roll your shoulders backwards
  • Turn your head side to side
  • Stretch out your forearms and your legs
Additionally, specific guidelines for your work station can help maximize your comfort and safety.

Your chair should have the following:

  • Wheels (5 for better mobility)
  • The ability to twist freely on its base
  • Adjustable height
  • Adjustable arm rests that will allow you to sit close to your desk
  • Lumbar support
  • Seat base that adjusts to a comfortable angle and allows you to sit up straight

The position of the keyboard is critical:

  • The keyboard should be at a height that allows you to have your forearms slightly below a horizontal line—or your elbows at slightly more than a 90 degree angle.
  • You should be able to slide your knees under the keyboard tray or desk.
  • Avoid reaching for the keyboard by extending your arms or raising your shoulders.
  • Try to avoid having the keyboard on top of your desk. That is too high for almost everyone—unless you can raise your seat. The elbow angle is the best test of keyboard position.

The position of your computer monitor is important:

  • The monitor should be directly in front of you.
  • The top of the monitor should be at your eye level, and at a distance where you can see it clearly without squinting, or leaning forward or backward.
  • If you need glasses for reading, you may need to have a special pair for use at your computer to avoid tipping your head backward to see through bi-focals or other types of reading glasses.

How can a physical therapist help?

Many physical therapists are experts at modifying work stations to increase efficiency and prevent or relieve pain. Additionally, if you are experiencing pain that isn't relieved by modifications to your work station, you should see a physical therapist who can help develop a treatment plan to relieve your pain and improve your mobility.

See a Physical Therapist Demonstrate Exercises for the Workplace by clicking on the link below:

http://www.moveforwardpt.com/Resources/Detail.aspx?cid=60640713-eb92-4fca-81ee-7b371ef0c209

Thursday, May 17, 2012

Pelvic Pain

Physical Therapist's Guide to Pelvic Pain
Pelvic pain has many possible causes and a variety of symptoms that can make you feel uncomfortable and embarrassed. You're not alone—and your physical therapist can help.
What Is Pelvic Pain?
Pelvic pain is felt in the lower abdomen, pelvis, or perineum and is considered to be "chronic" when it lasts for more than 6 months.
Pelvic pain can be caused by:
o    Pregnancy and childbirth, when changing hormone levels can affect the muscles and cause the joints to become more "loose"
o    Pelvic joint problems
o    Muscle weakness or imbalance within the muscles of the pelvic floor, trunk, or pelvis
o    Lack of coordination in the muscles that control the bowel and bladder
o    Tender points in the muscles of the pelvic floor
o    Pressure on one or more nerves in the pelvis
o    Weakness in the muscles of the pelvis and pelvic floor
o    Scar tissue after abdominal or pelvic surgery, such as a C-section or episiotomy (incision), or as a result of a tear in the vaginal area
o    Disease
o    Pelvic organ prolapse, a shift in the position of the pelvic organs








Pelvic Floor - Female

 
How Does it Feel?
The pain in your lower abdomen and pelvis may vary; some people say that it feels like an aching pain; others say that it feels like a burning, sharp, or stabbing pain, or even pins and needles. In addition, you may have:
o    Pain in the hip or buttock
o    Pain in the tailbone or pubic bone
o    Inability to sit for normal periods of time
o    Pain in the joints of the pelvis
o    Pain with sexual intercourse
o    Tender points in the muscles of the abdomen
o    Reduced ability to move your hips or low back
o    Difficulty walking, sleeping, and doing physical activities
o    Urinary frequency, urgency, or incontinence
o    Painful bowel movements
o    Constipation or straining with bowel movements
With pelvic organ prolapse, there also might be a sensation of pelvic heaviness or a feeling like you're sitting on a ball, due to the pelvic organs bulging at the opening of the vagina.
 
How Is It Diagnosed?
Your physical therapist will perform an examination to identify the causes of your pelvic pain and any joint problems, muscle tightness or weakness, or pinched nerves. Your therapist also will determine whether you should be referred to a physician for additional tests.
 
How Can a Physical Therapist Help?
Based on the examination results, your therapist will select from treatments designed to reduce muscle tightness, improve your muscle strength, and improve how you use your muscles—which in turns helps reduce your pain and increase your ability to perform your roles in the home, in the community, and at work.
Strengthen Your Muscles and Make Them Work Better for You
Your physical therapist will:
o    Teach you how to do relaxation exercises.
o    Show you how to "find" the right muscles and use them correctly.
o    Use pelvic-floor exercises to help you strengthen your muscles so that they can properly support the pelvic organs. Pelvic-floor exercises include "kegels," in which you gently squeeze the sphincter muscles and squeeze the buttocks, thighs, and stomach muscles.
o    Instruct you in exercises to stretch and strengthen other important muscles and retrain them so that they work together normally.
Depending on your symptoms and level of discomfort, your physical therapist may decide to use biofeedback to make you aware of how your pelvic-floor muscles work and how you can control them better. Electrodes attached vaginally or rectally will provide measurements of muscle activity and display them on a monitor, and the therapist will work with you to help you understand and change those readings. The therapist also may use electrical stimulation to improve your awareness of your muscles and increase muscle strength. 
All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:
o    A physical therapist who completed a certification course in women's health physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
o    Get recommendations from family and friends or from other health care providers.
o    When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with pelvic pain.
o    During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
Further Reading
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of pelvic pain. The articles report recent research and give an overview of the standards of practice for treatment of TMD both in the United States and internationally. The article titles are linked either to a PubMed abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Fisher KA. Management of dyspareunia and associated levator ani muscle overactivity. Phys Ther. 2007;87:935-941. Free Article
Stuge B, Holm I, Vollestad N. To treat or not to treat postpartum pelvic girdle pain with stabilizing exercises? Man Ther. 2006;11:337-343. Article Summary on PubMed
Borello-France DF, Handa VL, Brown MB, et al. Pelvic-floor muscle function in women with pelvic organ prolapse. Phys Ther. 2007;87:399-407. Free Article
Depledge J, McNair PJ, Keal-Smith C, Williams M. Management of symphysis pubis dysfunction during pregnancy using exercise and pelvic support belts. Phys Ther. 2005;85:1290-1300. Free Article
Weiss JM. Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol. 2001;166:2226-2231. Article Summary on PubMed
 Acknowledgments: APTA's Secion on Women's Health; Kendra Harrington, PT, DPT, WCS
Click here to view original article from www.apta.org: http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=4c28867f-b11f-4148-a21c-f8b6c5ac7002

Tuesday, May 8, 2012

·         Physical Therapist's Guide to Wrist Fracture
A wrist fracture is a break in one of the bones near the wrist, most frequently the radius. Because of the high-risk sports that they play, wrist fractures often occur in children. Due to osteoporosis, wrist fractures also are very common in women after menopause.

What Is Wrist Fracture?
Wrist fracture can occur as a result of a trauma, such as a fall while you're playing sports or while you're just walking on a sidewalk. Fractures due to falls happen most often when people stretch the arm straight out to catch themselves as they fall. A strong enough force can cause a bone in the wrist or forearm to break.
There are 3 types of bone fractures:
o    Type I – a "nondisplaced" fracture, where the bone has a break but is still in normal position.
o    Type II - a fracture where a fragment of bone is shifted from its normal position.
o    Type III - the most serious type of fracture, because there are multiple breaks of the bone.
Type I and II fractures usually are treated without surgery, but type III fractures usually require surgery.

Wrist Fractures

 
How Does it Feel?
A fractured wrist is usually painful, tender, and swollen, and you may have difficulty moving your wrist or fingers.
 
How Is It Diagnosed?
An x-ray is the best way to diagnose a wrist fracture. If a physical therapist suspects that that you have a wrist fracture, the therapist may arrange for an x-ray and refer you to an appropriate physician. The physical therapist can check for damage to other joints and muscles and make sure that the nerves and blood vessels in your wrist, forearm, and hand have not been affected by the broken bone.
In most cases, people with fractures visit a physician with a specialty in managing bones and joints (orthopedist). Depending on the type of fracture, the physician might prescribe a cast or a sling, or, with severe fractures, surgery.
 
How Can a Physical Therapist Help?
While Your Wrist Is in a Cast or a Sling
While your bone heals, your arm will be in a cast or a sling to keep your arm still and promote healing. During that time, it will be important that your arm not get too stiff, weak, or swollen. Depending on the amount of activity that is allowed for your type of fracture, your physical therapist will prescribe exercises to keep your shoulder, elbow, and fingers moving while you are in the cast or sling.
So the rest of the body doesn't get out of shape, most people with wrist fracture will slowly return to exercising the other arm and the legs. Physical therapists can help you adapt your exercise program so that you can maintain your overall strength and fitness without interfering with the healing of your wrist.
When the Cast or Sling Is Removed
Your wrist will most likely be stiff, and your arm will be weak. Your physical therapist will examine your wrist and select treatments to improve its function.
Increase Your Strength and Your Ability to Move
Physical therapists prescribe several types of exercises during recovery from a wrist fracture. Early on, your therapist can help you begin to gently move your elbow, using "passive range-of-motion" exercises. As your arm gets stronger, you can exercise it yourself without weights ("active range of motion"). Once the bone is well healed, you can begin using weights or resistance bands. In addition to range-of-motion and strengthening exercises, the therapist can help you retrain your muscles to react quickly when you need to protect yourself from a fall.
Relieve Your Stiffness
Your physical therapist may use skilled hand movements called manual therapy to enable your joints and muscles to move more freely with less pain.
Get You Back to Your Daily Activities
Your physical therapist will help you remain independent by teaching you how to do your daily activities—such as dressing, working on a computer, and housekeeping—even while wearing a cast or a sling. Once you can move your arm freely without pain, the therapist may begin adding activities that you were doing before your injury, such as using your arm for dressing, grooming, and housekeeping. This program is based on the physical therapist's examination of your wrist, your goals, your level of physical activity and general health.
Prepare You for More Demanding Activities
Depending on the requirements of your job or the type of sports you play, you might need additional physical therapy that is tailored for these demands. A physical therapist can develop a specialized program for you.
Reduce Your Pain
To help control the pain and swelling in your arm, your physical therapist might use either warm or cold therapeutic treatments or electrical stimulation.
Everything that the physical therapist does will help you prevent long-term disability, including:
o    Returning the arm to a good level of fitness
o    Restoring full movement and strength in a safe manner while healing occurs
o    Assessing the fracture to make sure that you can return safely to previous home and work activities
o    Guiding you to a safe return to sports and other physical activities—a return too early after a fracture may increase the risk of another fracture
o    Recommending protective equipment, such as wrist guards, for use during sports
 
Can this Injury or Condition be Prevented?
Avoiding falls or other trauma is the best way to prevent fractures. Physical therapists are experts at determining your risk of fallin and can teach you how to do balance exercises and how to avoid falls.
 
Real Life Experiences
You're late for work, and there was a bad rainstorm last night. You take one step outside onto the sidewalk and slip. Your first instinct is to put your arm out to catch yourself from falling. As the heel of your hand hits the ground, you feel a sharp pain in the wrist.
What do you do next?
You hold the elbow securely against your body, stabilizing the wrist as much as possible to avoid further damage in case there is a broken bone. Then you go to your local family emergency medicine clinic or the emergency department of a local hospital, where an x-ray will be taken to rule in or rule out a fracture and to determine the fracture's severity.
The x-ray confirms that you have a "type II" fracture, where a fragment of bone is shifted from its normal position. Surgery is not needed. You begin to see your physical therapist, who treats you throughout the healing process and helps to restore full function to your wrist.
This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.
 
All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:
o    A physical therapist who is experienced in treating people with orthopedic problems. Some physical therapists have a practice with a orthopedic focus, and some even specialize in upper-body injuries.
o    A physical therapist who is a board-certified clinical specialist in the field of Hand Therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
o    Get recommendations from family and friends or from other health care providers.
o    When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with fractures.
o    During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

E. Anne Reicherter, PT, DPT, PhD, OCS, CHES