TIPS FOR CAREGIVERS

For those of you who have loved ones living with or near you that you help on a daily basis, or for those of you who are medically trained caregivers, THIS IS FOR YOU. Caregivers have a significantly larger risk of injury that do most professions, and a larger incidence of stress-related medical complications, such as high blood pressure and cardiac dysrhythmias. We, here at Champion, understand the physical and emotional toll your job has on you - and we, with the help of the APTA, are here to help. Below is a link provided by the APTA to help people like you thrive in your career. 

http://www.moveforwardpt.com/PatientResources/VideoLibrary/detail/caregivers-caregiver-safety-tips 

Description: 

Lisa Leach, PT, DPT, demonstrates techniques to keep caregivers and those that they care for safe in a variety of environments.

For more information, please visit us at kcchampionperformance.com 

POSSIBLE CAUSES OF THAT PAIN IN YOUR BUM

Sciatica is one of the most common diagnoses that we see in physical therapy. But what exactly is sciatica and how do physical therapists treat this complex diagnosis? The simple answer is the treatment is all dictated by the source.

Generally, Sciatica is a term that is commonly used to describe pain, weakness, numbness, or tingling that radiates down the back of the leg. Typically, the symptoms follow the distribution of the sciatic nerve, but there can be some confusion as to the source of the pain especially when the patient’s symptoms are referred. Our job as PTs is to determine the source of the nerve irritation or referral origin and treat it accordingly. This is often accomplished with a thorough musculoskeletal exam and typically without the need for costly medical imaging. Alongside misalignment caused as a result from weak musculature of the hip, below are the most common causes of sciatica seen in PT and how we typically treat them.

1. Disc Herniation:

The most common source of sciatica is pressure on the sciatic nerve from a herniation or protrusion of a spinal disc. This pressure on the nerve can create an irritation and inflammatory response causing symptoms to radiate down the leg following the path of the nerve that is compressed.

What can physical therapy do to help patients with sciatica caused by a disc herniation?

• Studies have shown that patients respond well to repetitive lumbar range of motion in improving sciatica symptoms related to lumbar disc herniation. Typically the direction that most patients report relief of their symptoms is lumbar extension. However, a thorough physical therapy assessment will help decide a patient’s specific “directional preference”.
• Core stabilization exercises in conjunction with lumbar range of motion are also effective at reducing sciatica symptoms. PTs tend to focus on strengthening the transversus abdominis and gluteal muscles in both static and dynamic activities.
• Patient education is probably the most important component of the rehab of disc herniation. Patients are educated on proper sitting and standing postures as well as proper body mechanics with lifting activities to avoid causing further disc herniation.

2. Stenosis:

Narrowing of the space where the spinal cord or nerve roots exit the spinal canal is called stenosis. If the space is narrowed, that can create pressure on the cord or the nerves causing pain to radiate down the leg.

Stenosis is typically seen in a condition called degenerative disc disease. Our discs are located between the bony vertebrates and over time they can start to lose some of their height. This loss of height causes the narrowing of space seen in stenosis.

Another cause of stenosis is tiny little bone spurs called osteophytes that can form in the spinal cord or nerve root space.

What can physical therapy do to help patients with sciatica caused by stenosis?

• Our goal in PT is typically to help improve ROM in the lumbar spine to help open up the narrowed space. Patients with stenosis often respond well to lumbar flexion or bending exercises, which is in contrast to the lumbar extension exercises often seen in disc herniation. However, a thorough physical therapy exam will help determine the appropriate stretches/range of motion exercises.
• As with disc herniation, core stabilization and posture/movement retraining are important for patients with sciatica caused by stenosis.
• Functional dry needling (i.e. Trigger point dry needling) is also very effective for patients with lumbar stenosis. By using tiny, hair thin needles, we can quickly decrease the muscle tightness of spinal muscles, resulting in decreased compression of the lumbar vertebrae. We will discuss dry needling more in the last section.

3. Piriformis Syndrome:

Deep in your buttock/gluts is a muscle that runs diagonally from the outside of your hip to the lowest part of your spine. This muscle, called the piriformis, can get short and tight or even be in spasm. In 85% of the population, the sciatic nerve runs just beneath the piriformis and in the other 15% it runs through the muscle. The sciatic nerve can become compressed and irritated when the piriformis is taught or in spasm creating symptoms of sciatica down the back of the leg.

What can physical therapy do to help patients with sciatica caused by piriformis syndrome?

• Typically, a physical therapist will prescribe a thorough home exercise program that includes stretches for the piriformis, hamstrings, and glute muscles (see linked video for example of a piriformis stretch).
• Sciatic nerve glides/flossing can be effective at getting the sciatic nerve moving again if it is trapped by the piriformis, especially in conjunction with the stretches above (see linked video for example of a sciatic nerve glide).
• A common theme with all of the causes of sciatica is core stabilization. Core and glute strengthening exercises will help to reduce the demands put on the piriformis muscle with daily and recreational activities (see linked video for an example of a core exercise).
• Trigger point dry needling has also been found to be very effective at quickly reducing the tension of the piriformis.

UNDERSTANDING BALANCE

Balance is a complex process involving the reception and integration of sensory input and the planning and execution of movement. It’s the ability to control the center of gravity over the base of support in any given sensory environment. Reflexes are automatic responses by the peripheral or central nervous system to help support postural orientation and maintain balance; they occur rapidly enough to not be under volitional control.

Balance is a result of the interaction of three separate systems in the body:

• The Visual System, which helps us see things in the environment and orient us to the hazards and opportunities presented.
• The Vestibular System (the inner ear), which provides the brain with information about the position and motion of the head in relation to gravity.
• The Proprioceptors/ Somatosensory Receptors which are located in joints, ligaments, muscles, and the skin to provide information about joint angle, muscle length, and muscle tension all of which is gives information about the position of the limb in space.

The brain needs input from all three systems to distinguish motion of the self from motion of the environment. Any mismatch in these inputs can produce nausea, vomiting and dizziness. Some common examples that we all experience are

• The sense of perceived motion when sitting in a car at a stop light and the car next to you creeps forward, causing you to slam on your brakes
• When on a boat, proprioceptors perceive a rocking boat under your feet, but your eyes see a steady horizon.

More long-term complications with balance can make an affected person feel persistently unsteady or dizzy. In fact, as many as four out of ten Americans will at some point experience an episode of dizziness significant enough to send them to a doctor. These issues can be caused by improper function of the systems mentioned above, health conditions, or as a side effect from some medications. In severe forms, a balance disorder can intensely impact day-to-day activities resulting in an inability to function and cause psychological distress.

PRESSURE SORES

A pressure ulcer, sometimes called a "bed sore," is a skin injury that occurs in about 40,000 people every year. Usually, pressure sores happen when people are very ill for a long period of time and are not able to change their position in a bed or a chair. People who have conditions such as dementia and spend a lot of time in a bed or a chair might not even realize that they need to change their position.

What Is a Pressure Ulcer ("Bed Sore")?

Pressure ulcers are caused by forces that block the flow of blood to the skin:

• When too much pressure being exerted on the same area of the skin for too long, such as when someone lies in the same position all the time.
• When "shearing" forces cause the skin to bunch up in one area, such as when a person stays in a reclining position too long in either a bed or a chair.

Pressure ulcers can happen to:

• Newborns in incubators who are resting on lines or tubes.
• People with spinal cord injuries who have lost sensation and don't feel uncomfortable sitting in the same position day after day—and therefore don't realize that their skin is being affected.
• People who are bed bound and who are unable to change their position in bed.

Although pressure ulcers can develop anywhere on the body, they are more likely to occur on the buttocks of people who sit in a chair all day or in the heels, above the tailbone, and on the insides of the elbows of people who have to stay in bed all day.

Pressure ulcers can result from friction injuries to the skin when a person is being pulled across a surface, such as being pulled across a sheet when the bed is being made or being pulled out of a wheelchair.

Skin also can be injured by prolonged exposure to tape, urine, and feces, or it might be injured by tape removal. Although these injuries might look similar to a pressure ulcer, they often aren't. However, this kind of wound is more likely to become a pressure ulcer if the skin is exposed to too much or too little moisture, scrubbing, or temperatures that are too cool or too warm.

Signs and Symptoms

Many people with pressure ulcers don't know that they have one. Pressure ulcers might first be seen by a family member, a caregiver, or a physical therapist or other health care provider.

Pressure ulcers might be noticed when bathing or dressing someone who is at risk for developing them. A foul odor or the presence of yellow, brown, or gray mushy material on bedding or clothing might be noticed first and traced to an opening in the skin. Although pressure ulcers can be very painful, the person who has the ulcer might not notice any pain or might have pain but not be able to communicate it.

How Is It Diagnosed?

The physical therapist will conduct a full evaluation, including staging the pressure ulcer based on a system developed by the National Pressure Ulcer Advisory Panel (NPUAP):

• Stage I ulcer - persistent reddening of the skin due to staying in the same position for too long. In darker skin, the skin might look purple. The skin might feel warmer to the touch than the surrounding skin.
• Stage II ulcer - shallow wound that goes only partially into the skin, usually caused by friction.
• Stage III ulcer - a deeper wound that goes through all of the layers of the skin, including fatty tissue under the skin.
• Stage IV ulcer – a wound that goes deeper than just the skin, down into the muscle, tendon, ligament, or bone; it might even expose nerves and blood vessels.

These stages don't necessarily tell how severe a pressure ulcer is, and ulcers don't always progress from one stage to the next. What looks like a "simple" stage I ulcer might be a minor irritation of the skin—or might be hiding a large mass of injured tissue beneath.

If there are blood-filled blisters, or purple or maroon areas of what appears to be uninjured skin, that could mean the tissue beneath the uninjured-looking skin is dead. On the other hand, there might be extensive death of tissue such as muscle, but the skin might not look injured at all. This is why a large ulcer might seem to appear "out of nowhere" within a matter of a few days. Muscle and other tissue near bone may be damaged by pressure before the skin breaks down, revealing a large wound extending to the bone. Detailed examination by a physical therapist or other health care provider is needed.

Based on the examination, the physical therapist will decide whether any further testing or consultation with another health care provider is necessary. In some cases, surgery or the prescription of antibiotics by a physician may be necessary.

BIRTHDAY WISHES!

Happy Birthday to our very own Hope Hillyard, Owner and Head PT!

31 never looked so good :) AND Happy belated National Boss' Day! 

In all seriousness, we love and appreciate you more than you realize. Smoothie King gift cards and Skittles will never be enough to express our gratitude - working for you is a pleasure! 

Love, 

All your employees 

A FEW TIPS TO HELP RECOVERY AFTER BIRTH

Who didn't see this post coming, right? 

Besides, this blog, is for the most part, dedicated to orthopaedic injuries and surgeries, and our pelvic floor specialist, Molly, could use a shout out once in a while by means of a subject she frequents with her patients. 

1. Pads Only

No sexual activity, or use of tampons, is allowed for at least 6 weeks following vaginal delivery. This means you're only going to use pads to maintain that post-pregnancy, no-menstrual-cycle-for-nine-months flow. It doesn't hurt to double up, putting on pad in front of the other to help protect you from leakage, and increase the padding on those sensitive areas.

2. Padsicles

While you're at it, dipping your pads in aloe vera or witch hazel and freezing them make great little ice packs that are absorbent and relieving. If it sounds ridiculous, try sitting on wood or carpet and tell me it doesn't sound worth a try.

3. Sitz Baths

Whether you had an episiotomy or not, those stitches and swollen areas are going to need to be cleaned. Plus - the soak has been said to help reduce the pain.

4. Mesh Undies

Don't get me wrong - you can wear cotton. But not only is the mesh going to allow ample healing even with clothing on, but they're going to save you time, as well, since we know they're going to feel the wrath of the post-pregnancy menstrual cycle you're about to conquer. Everyone knows new moms are supposed to sleep when the baby sleeps, and trying to do laundry (with your cotton undies) is going to keep you from getting the rest you need to heal your entire body. Do yourself a favor! Snag some from the hospital and toss them when you're done. 

5. Don't Strain

Don't rush your trips to the bathroom. Not only are you going to have to find a position that's comfortable for you to use the restroom in, but give yourself time to do your business without rushing. Contracting/relaxing your pelvic floor muscles and abdominal muscles to hustle up urination, or to force your body to defecate quicker is going to agitate what's already sore. 

6. Wiping

You don't need a lesson on wiping, don't get me wrong. But make sure you're wiping front to back to avoid infection, and use medicated wipes for a little extra help. The last thing a new mom needs is some sort of infection in that same area. 

7.  Rest

Those muscles need time to heal. They've been stretched to or beyond their max, and they've had to work very hard to get that beautiful baby into your arms. Give your body time to relax, and after a couple of weeks, start doing pelvic floor strengthening exercises to help to make those muscles strong again. 

8. Some Symptoms Are Normal

Shakes, sweats, night-sweats, and chills are all normal. As your body readjusts to the hormonal imbalance you'll have following birth, your body will react in number of ways including internal temperature discrepancies. Don't fret - this'll go away in a couple of days. Should you have a fever, tell your physician and keep an eye on it. 

9. Epidural Symptoms

Don't be surprised if you have issues in the first 24 hours, especially the first couple hours, following birth from your epidural. It can sometimes take a little while for the effects to totally wear off - it's completely normal. Just be careful, and have someone near you at all times when you're getting up and walking around. 

10. EMOTIONS

Don't be surprised as your emotions fluctuate following birth. Postpartum hormonal imbalances are severe, and can lead to severe ups and downs as your body adjusts to not carrying a baby anymore. Be warned, many moms say their emotions went crazy as the milk started coming in. Again, as your body adapts, they should regulate steadily.