For a common hip condition, physical therapy and surgery lead to similar outcomes

All sports carry an inherent risk for injury based on the specific movements involved. Athletes that participate in sports with frequent leg extension and bending of the hips are at an increased risk for hip injuries, and issues like labral tears and hip impingement are becoming increasingly common in certain sporting populations.

The hip is a ball-and-socket joint in which the thighbone (femur) acts as the “ball” and a portion of the pelvis called the acetabulum is the “socket.” Both the femur and acetabulum are covered with smooth articular cartilage that protects bones and prevents them from rubbing against one another. Another specialized piece of cartilage called the labrum provides a suction seal and stabilizes the hip joint.

Hip impingement is a common condition in which excess bone that’s formed around the femur causes these two bones to rub against each other. Labral tears, which are also common, occur when the labrum is damaged from being pulled too far away from the acetabulum. These tears may result from a traumatic incident like a fall or an accident, but are most frequently overuse injuries caused by repetitive hip movement, particularly from sports like soccer, football, ice hockey, running, and golf.

Both conditions can lead to similar symptoms, which usually include pain in the hip or groin, stiffness, and a catching-like sensation in the hip. In many cases, labral tears don’t lead to signs or symptoms, but when they do, it can seriously interfere with your ability to function normally and participate in athletic activities.

Why we believe physical therapy is a better option than surgery

Injuries to the labrum can be treated conservatively (non-surgically), and we consider physical therapy to be the best solution available. A typical treatment program for one of these hip injuries will include the following:

• Recommendations for rest and limiting or temporarily stopping participation in sports
• A muscle-strengthening program that focuses on the muscles of the hip, core, and legs
• Manual (hands-on) therapy
• Movement re-education to help restore normal motion of the hip, back, and legs

The benefits of physical therapy for hip impingement have been highlighted in the medical literature, including one study published in 2018. In this trial, 80 patients with hip impingement were randomly assigned to undergo either surgery or three weeks of physical therapy, and were then followed up for two years. After this period, both groups experienced significant improvements, and “there was no significant difference between the groups at two years.”

These findings suggest that patients with hip impingement could expect to experience similar improvements, but it’s worth noting that surgery is associated with higher costs, a greater risk for complications, and often an extensive recovery period. Given these factors, we recommend that patients choose physical therapy because it’s a safer and less costly treatment option for their condition.

First, we’d like to take a minute to wish everyone a happy and blessed holiday season and thanks to all of our patient and community for the opportunity to serve you.  

Now, let’s talk about some of the major problems with our healthcare system…and Visalia and Hanford aren’t immune to this.

It’s a common talking point by now that the U.S. healthcare system is in need of repair, and one of the biggest issues is extremely high costs. In fact, we spend more on health care than any other nation in the world, with about 18% of our gross domestic product (GDP)—and approximately $10,000 per person—going directly to this system. But it’s also been found that significant portion of the money spent on health care is wasted, meaning that much can be saved if these areas are targeted.

Several studies have looked into these costs and how much can be considered “wasted spending,” but the most recent one was published in 2012. For this reason, researchers performed an updated review of the literature to estimate the levels of waste in the U.S. healthcare system, along with suggestions on how to reduce it.

Here’s What Some of the Research Says

To conduct the review, a search was performed for studies related to health care costs or savings over the past seven years. This process led to 71 estimates from 54 pieces of literature being included. Once collected, these documents were analyzed and calculations were executed to determine how much money was wasted on health care. Below are some of the key findings of the review:

• The estimated total cost of waste in the healthcare system was $760 billion to $935 billion
• Interventions to address this waste could potentially save $191 billion to $202 billion
• These estimates account for about 25% of the total health care expenditures in the U.S.

The potential sources of waste were grouped into six categories, and suggested interventions were given to address each one (“failure of care delivery,” “failure of care coordination,” “overtreatment or low-value care,” “pricing failure,” “fraud and abuse,” and “administrative complexity.” Three of these categories apply specifically to wasted costs that may occur when patients do not undergo physical therapy for a painful condition:

• Failure of care delivery: this is waste when the best types of practices to care for patients are not adopted or poorly executed
  • Example: an elderly patient could suffer a severe fall that could’ve been avoided if the patient was properly identified as at-risk and sent to a physical therapist to undergo a fall-prevention program
• Pricing failure: costs of services that are significantly higher in the U.S. than other countries—for various reasons—contribute to this this type of waste
  • Example: a patient with shoulder pain that sees a primary care doctor may be sent to have an expensive MRI or CT scan right away, whereas with a physical therapist, treatment would likely begin without these tests
• Overtreatment or low-value care: this type of waste results when patients receive treatments that are not considered effective according to research
  • Example: if a patient with low back pain visits a surgeon before seeing a physical therapist, surgery may be recommended to address their condition, even though research shows that it’s better to wait

The Healthcare System is More Patient-Centric than Ever – You Have Choices!

Patients have the power to lower their healthcare costs by educating themselves about their options.  By seeing a physical therapist first before any other medical professional, you can ensure that treatment will be started right away and most likely, you will be able to avoid unnecessary tests and treatments.  Click here to contact one of our offices.

SEEING A PHYSICAL THERAPIST FIRST FOR LOW BACK PAIN REDUCES THE CHANCES OF USING OPIOIDS

The opioid epidemic continues to ravage the U.S. In 2015, more than 12 million Americans reported long-term use or misuse of opioids, and there were over 42,000 deaths related to opioids in the following year. These statistics—which have largely been driven by an ongoing trend of over-prescribing pain medications—are just a brief glimpse into this multifaceted issue and the toll it’s been taking on the country.

Low back pain (LBP) is one of the most prevalent health conditions that American seek out medical care for, as up to 80% of the population will experience it at least once at some point in their lives. Several studies have shown that LBP is also among the most common conditions for which opioids are prescribed, and more than half of individuals who use opioid report a history of back pain.

This is all in spite of the fact that most guidelines recommend that opioids are not used for LBP unless other recommended treatments have failed and it’s likely that the expected benefits of opioids will outweigh the risks. Instead, these guidelines recommend that patients with LBP try other non-drug treatments first, which includes physical therapy, exercise, and other similar interventions.

Physical therapy is a movement-based strategy that addresses painful issues like LBP with a variety of exercises and techniques designed to alleviate symptoms and help patients move more easily. The primary advantage of physical therapy is that it identifies the root of the problem and helps patients learn to overcome it with specific movements, while pain medications like opioids are only intended to be a short-term solution that simulates pain relief. Physical therapy is also regarded as an extremely safe intervention with minimal to no risk for side effects.

Why physical therapy is recommended first, as outlined by a recent study

Patients with LBP have several options when it comes to deciding what type of medical professional to see for their condition, and it’s possible that who they see may affect the likelihood of receiving an opioid prescription in the future. With this in mind, a study was conducted to evaluate whether there is a connection between the medical professional these patients see and their eventual use of opioids. Below is a summary of the results:

• Over five years, there were 126,504 patient visits for LBP
  • More than half of patients (53%) initially saw a primary care doctor, while only 1.6% initially saw a physical therapis
• About 18% of patients received an opioid prescription within 3 days of the initial visit, 22% received one within 30 days, and 1.2% used them in the long term
• Patients who saw a chiropractor, acupuncturist, or physical therapist first all had significantly decreased odds of both early and long-term opioid use compared to those who saw a primary care doctor first
  • Patients who visited a physical therapist first had a 85% decreased chance of using opioids early after their visit compared to a primary care doctor

These findings show that it really does make a difference what type of medical professional you see first for LBP, and this applies to other conditions as well. Patients in pain are therefore encouraged to see a physical therapist before anyone else in order to begin an effective treatment plan that will lead to improvements while avoiding the risk of being prescribed opioids.

Before aggressive treatment with potentially harmful side effects, here’s why you should consider physical therapy

If you hurt yourself or start noticing any sort of pain, there are many decisions you’ll have to make next. Do you avoid physical activity or movements that might aggravate the pain? Do you put ice or heat on it, or take any medications to reduce your pain level? If the pain doesn’t improve after a certain period of time, do you see a professional for treatment? And if you do decide to see someone, who will it be?

It may be difficult to find the best answers to these questions, especially the last one about who to see first for  treatment. As a result, many people will end up scheduling an appointment with their primary care doctor, since it probably seems like the safest and most familiar choice when something is wrong. While primary care doctors are expected to always provide patients with the best possible treatments, it doesn’t guarantee you’ll receive treatment from a physical therapist.

Physical therapists are movement experts that are trained to optimize patients’ quality of life through carefully designed exercise and educational treatment programs. They treat a wide variety of injuries and conditions, but the most common symptom that they address is pain, and research consistently shows that physical therapy is effective for reducing it.

This is why most guidelines recommend that anyone in pain sees a physical therapist as a first-line treatment for their condition. Patients can either go straight to a physical therapist because of direct access—which allows anyone to at least have an initial consultation without a referral in all 50 states—or they can go their primary care doctor or some other medical professional and possibly get referred to therapy. Primary care doctors are strongly encouraged to direct patients with painful conditions involving the muscles and bones to physical therapy, but this does not always occur as it should.

Study highlights a major issue with the referral system for physical therapy

One of the many conditions that can benefit from physical therapy is knee osteoarthritis (OA), which has doubled in prevalence in recent years (at least 15 million Americans currently have it). As with other issues, many patients with knee OA visit their primary care doctor first, which may or may not lead to a physical therapy referral. To evaluate how many patients with knee OA are actually being referred and what other treatments patients receive, a study was conducted. Below are some highlights from its results:

• There were 2,297 visits with a primary care doctor, surgeon, or another specialist
• There was a significant decline in the number of referrals to physical therapy from orthopedic specialists over three years
• The number of primary care doctors that referred patients to physical therapy was low and did not change in any significant way over three years
• There was a non-significant increase in narcotics prescriptions and a significant increase in the number of non-steroidal anti-inflammatory drug prescriptions

This study shows that many doctors are not referring patients to physical therapy, and that the trend is actually going in the wrong direction, with an increase in pain medication prescriptions and a decrease in therapy referrals. That’s why the best way for patients in pain to avoid the risk of not getting referred is by taking matters into their own hands and accessing physical therapy directly.

Our ankles serve one of the most important roles of any of the body’s joints by supporting the weight of our entire body. With such a heavy task at hand, the ankles are also one of the most frequently injured regions, and ankle sprains are at the top of that list.

Ankle sprains result from the stretching or tearing of ligaments in the ankle and usually lead to some degree of pain, swelling, and tenderness. They are the most common injury in the athletic population, accounting for approximately 45% of all sports injuries. They are most frequently seen in basketball, football, and soccer, but can occur during any sport or activity when the ankle moves beyond its normal range of motion.

Ankle Sprains Usually Heal Quickly

Fortunately, the pain from ankle sprains will typically subside after 4-6 weeks if the patient follows the RICE protocol (Rest, Ice, Compression, and Elevation) and does not aggravate the injury further. But if the ankle sprain is not properly rehabilitated, it can lead to decreased range of motion of the ankle joint, particularly a loss of dorsiflexion motion (raising the foot upwards). This can lead to not only recurring ankle sprains, but excess stress on the knees, hips, and even the lower back, which may all be forced to overcompensate for the bad ankle in order to allow the body to move normally.

Physical Therapy Can Help in More Ways than One

For patients that do fail to recover properly from an ankle sprain and go on to experience additional sprains or other injuries, physical therapy can help prevent the problem from getting any worse with a targeted treatment program that typically includes:

• Stretching exercises to restore ankle movement
• Strengthening exercises to help patients regain strength and prevent long-term ankle disability
• Balance training to improve stability and help patients to learn to deal with any potential hazards
• Functional training, which consists of performing activities patients might have difficulty with like walking, running, or jumping

Prevention Should Be Part of Your Plan

But taking it a step further, physical therapy can also help individuals prevent a first ankle sprain from occurring altogether with a similar type of program designed specifically to prepare the ankle for increased stress loads. Athletes involved in some of the high-risk sports mentioned particularly stand to benefit from these types of program, which have been supported by research as effective for reducing the risk for ankle sprains. One study published in 2017 evaluated the effectiveness of proprioceptive exercises (which improve ones sense of where their body is in space) for preventing ankle sprains, and concluded:

Proprioceptive training programs were effective in reducing the incidence rates of ankle sprains in the athletic population, including those with and those without a history of ankle sprains

So if you’re concerned with your risk for ankle sprains and would like to reduce it, or if you’ve already suffered from a sprain and would like it to be your last, take action now by connecting with a physical therapist and addressing you risk head-on.

If you have neck pain that radiates into your shoulder and/or down your arm, you may have a herniated disc.  If so, then of course you’re likely to be looking for a specialist – one that provides herniated disc treatment in Visalia.

Successful Treatments for Cervical and Shoulder Pain – Physical Therapy Offers Relief

A common problem treated in Physical Therapy clinics is cervical pain combined with shoulder pain.  The patient may experience radiculopathy into either upper extremity, or pain radiating proximally into the suboccipital region or distally into the spine.  As with all effective treatment, addressing the cause of the problem leads to fast, effective relief for our patients.

A primary cause of cervical and shoulder pain is poor posture.  Many patients we treat work at a desk or computer terminal for eight or more hours a day, or 2,000 hours per year.  With time his or her posture will break down resulting in a forward head, rounded shoulders, and increased thoracic kyphosis.  If this process is not addressed, the patient may eventually experience degenerative cervical changes, cervical apophyseal disease, tightening of the anterior cervical musculature, rhomboid and upper trapezius muscle spasms and other permanent postural changes.

Poor Posture Causes Other Problems

Poor postural habits change the angle of the resting scapula on the thoracic cage.  This leads to impingement of the rotator cuff muscles (especially the supraspinatus) with shoulder elevation.

Try this yourself:

1. Sit with good posture. Shoulder blades are pulled back and down.  Low back is slightly arched into lordosis.  Eyes are looking forward and level.  Chin is up.  Raise your arms as high as you can.  This typically is close to 160 degrees or near vertical.
2. Now sit with poor posture typical of patients we see in our treatment or exam rooms. Slouch your low back.  Round your shoulders forward.  Let your chin and eyes drop forward.  Now try and raise your arms overhead.  Most people will experience a 60 degree decrease in range of motion or more.

Thoracic Outlet Syndrome is the peripheral entrapment of the brachial plexus producing symptoms often mistake for shoulder tendonitis, elbow tendonitis, nerve root pain or musculoskeletal pain of the neck and shoulder.

The Journal of Shoulder and Elbow Surgery (1995:4: 113-117) and JAMA (2004;196: 109-111) reported Thoracic Outlet Syndrome is suspected in cases of a patient history involving upper extremity heaviness or numbness with prolonged postures such as sitting and when laying on the involved side.