Posted on 12/15/2020

Recently while watching a NFL football game, I came across a commercial with former professional football player John Elway. Mr. Elway was talking about a hand issue he was having called Dupuytren’s contracture, and he explained that there is now a non-surgical treatment option for this condition.

As a certified hand therapist for almost 17 years now, I am very familiar with Dupuytren’s contracture. However, to see this hand issue brought to life via a TV commercial definitely caught my attention as it isn’t often discussed. In the commercial, Mr. Elway talks about having difficulty with common, everyday tasks and shows a picture of the contraction in the palm of his hand.

So, you may ask, “What is this condition?”

Imagine having a finger, or fingers, bent into the palm and being unable to open the hand up fully. This would affect your ability to lay your hand flat on a tabletop, place your hand into a glove or shake hands. In the case of Mr. Elway, he could not grip or throw a football correctly, an activity that he had done for 16 years as a football player. It even affected his golf game.

There is no known cause of how Dupuytren’s develops. It has been thought of as a condition that people who have origins in northern European countries can contract. It is often called “The Viking’s Disease.” It is most commonly found in men of 50-60 years of age, but women can also be impacted. It affects three percent of the U.S. population.

Dupuytren's symptoms can take a long time to develop. Mr. Elway mentions in the commercial that he was diagnosed 15 year ago. Signs of Dupuytren’s includes:

• A hard lump in your palm
• Inability to place your hand flat on a surface such as a tabletop or counter
• Scar-like bands that form in the palm
• Fingers bent into the palm with the inability to open/extend your finger fully
• Hand pain (although this is less common)

Our hands contain a tough, fibrous layer of tissue called palmar fascia which gives us a protective layer between our skin and tendons. It also gives our palms firmness. In Dupuytren’s, the fascia can thicken and contract. The most common, visible sign of Dupuytren’s are the hard lumps and bands which are known as nodules and cords. The combination of nodules, cords and the contracting palmar fascia can make your fingers bend in toward your palm.

I often see patients with Dupuytren’s contracture after they have had some sort of procedure or surgery done to their hand. Many have come to me after they have been diagnosed and treated by a hand surgeon. There are two popular techniques to manage Dupuytren’s contracture, as there is no cure:

• Surgery, where a hand surgeon opens up the skin and removes all the excess tissue. 
• An injection to the fibrous cords, which will break them down.

Typically after either surgery or the injection, therapy by a certified hand therapist is indicated. There are many ways that a certified hand therapist can help patients with Dupuytren’s contracture.

Therapy after surgery or injection would first consist of an extension orthosis, commonly known as a splint. An orthosis is custom-made for each patient using a piece of thermoplastic material and Velcro strapping. This would help the finger or fingers stay straight. A patient can wear this full-time or just at night, depending on what their surgeon indicates.

Range of motion exercises are given to help regain full mobility of the hand and fingers. A patient’s wound would be addressed if they have had surgery to watch for infection and manage scar tissue. Lastly, a patient’s strength would be addressed. The end goal for our patients is that they will have functional capability of their hands and are able to perform all the activities of daily living that they choose to do in their lives.

Please contact your local outpatient center to schedule an appointment with a certified hand therapist to discuss the various options for Dupuytren’s contracture and determine if therapy may be beneficial for you.

By: Kelly Lee O’Connor, M.S., OTR/L, CHT. Kelly is an occupational therapist/certified hand therapist for NovaCare Rehabilitation in Horsham, PA. Images supplied by Linda Lamaute, M.S., OTR/L, CHT.

NovaCare and Saco Bay are part of the Select Medical Outpatient Division family of brands

Posted on 12/1/2020

In today’s “new normal,” day-to-day life, personal health and wellness is at the forefront of all of our minds. We are protecting ourselves, cleaning more often and trying our best to live fit and healthy lives. One of the most important factors in determining our long-term health and wellness is the food that we put into our body. Especially during this time of year, when sweets and rich foods are easily in reach, it’s more important than ever to make sure our diet is full of nourishing foods to fuel our immune system and fight off illness.

While a healthy, balanced and colorful diet is extremely important, there are a few key vitamins and minerals that help build our immunity more than others. They all act on different parts of our body’s reaction to illness, allowing the body to fight longer and harder against these intruders. These particular vitamins, and some of their function in the immune system, include:

• Vitamin C – Protects your cells against free radicals, and absorb/store iron
• Vitamin B6 – Makes antibodies to fight disease
• Vitamin E  – Defends your cells against free radicals

Luckily for us, these vitamins are found in many of the foods that we eat on a daily basis. Some common foods that contain these nutrients include:

• Vitamin C – Oranges, strawberries, bell peppers, spinach, broccoli, and kale.
• Vitamin B6 – Tuna, salmon, chicken, chickpeas, bananas
• Vitamin E – Vegetable oil, peanuts, sunflower seeds, almonds, spinach, broccoli

The above is by no means an all-inclusive, but definitely a good starting point to begin making changes to help strengthen your immune system. Although these vitamins can easily be found in the health and wellness aisle at your local grocery store or pharmacy, it is not the best way for our body to absorb and take in these nutrients. Including foods that contain high amounts of each of these vitamins into our diet is a much easier, and healthier, way to get our body’s fill.

Another important aspect of strengthening our immune systems that comes in handy during the current times is daily physical activity. This could include walking, running, hiking, yoga and strength training. Any time you are getting your heart rate up and blood pumping, you are stimulating your body to build stronger muscles, flushing out the lungs and heart as well as boosting your immune system. Exercise helps recruit specific cells that find pathogens and wipes them out, as well as increases the amount of these cells that flow through the body on a regular basis.

If you have questions, a nagging injury that is limiting your ability to perform daily tasks or are unsure about the right path to take for your personal wellness journey, please reach out to your health care provider to discuss the best plan for you.

By: Erica R. Konopka, P.T., DPT. Erica is a physical therapist and multi-site center manager for Select Physical Therapy in North Carolina. 

Saco Bay is part of the Select Medical Outpatient Division family of brands.

Posted on 11/10/2020

Did you know that exercise is one of the most under-utilized tools for managing many aspects of your health? It is well known that exercise can help with weight loss by boosting your metabolism and burning calories, but there are so many more benefits, especially as we age.

Individuals naturally lose bone density and muscle mass as they age. Studies show that after the age of 50, bone breakdown occurs more than bone strength. Women particularly see an acceleration in bone loss around menopause, which puts them at a higher risk for osteoporosis. While there are supplements to help with this, regular weight-bearing exercise reduces the risk for osteoporosis.

At age 30, we naturally begin to lose muscle mass; physically inactive individuals can lose between three-to-five percent muscle mass each decade after 30. These factors lead to an increase in frailty, which in turn increases the likelihood of falls and fractures. The good news is that you can offset these problematic changes by sticking to a regular exercise program.
Here are some other great and important benefits of regular exercise:

• Exercise helps to reduce the risk of chronic disease. According to The National Institute of Health, lack of regular exercise is the primary cause of chronic disease in the United States. Getting into a fitness routine can increase insulin sensitivity, which in decreases blood sugar, blood pressure, fat levels in blood and cholesterol. It also improves cardiovascular health.
• Do you have a high stress job? Do you easily allow anxiety to interfere with life? Regular exercise can help with that. Exercise triggers your brain to release endorphins in your body which are mood enhancers and natural pain killers. They create a feeling of well-being. Along with being a mood enhancer, exercise also helps to increase energy levels. Exercise has been shown to begin to help elevate moods in as little as 10 minutes into the activity.
• Improving brain health and memory. Exercise increases your heart rate, blood flow and oxygen to your brain. According to a study by the Proceedings of the National Academy of Sciences of the United States of America, regular aerobic exercise increases the size of the hippocampus, the part of your brain that is involved in verbal memory and learning. Exercise also stimulates the release of growth factors chemicals in the brain that affect brain cell health, the growth of new blood vessels in the brain and even the survival of brain cells. Reduce your risk factors by beginning an exercise program today.

You don’t need to exercise for hours at a time to see results in your general well-being. By setting aside 30 to 45 minutes most days of the week for moderate physical activity (brisk walking, swimming, strength training), you can reap the rewards of enhanced health and wellness.

Now that you are aware of all of the great benefits from regular exercise, why not jump in? You don’t have to be a seasoned athlete to exercise. If you are nervous about beginning a program, a physical therapist is a great resource to help design a safe and effective program for you. Physical therapists are movement specialists who are more than qualified to set up an appropriate program to fit your needs.

In most states, you can choose to see a physical therapist without a referral from a physician. If you do need a referral, most primary care doctors will gladly provide you with a prescription for physical therapy so that you can begin your journey to a better, healthier you.

Make time for your wellness before you are forced to make time for your illness. Your physical therapist can help.

By: Colony A. Hopkins, P.T., DPT, COMT, AIB - VR/CON. Colony is a physical therapist with NovaCare Rehabilitation in Uniontown, Pennsylvania.

Saco Bay and NovaCare are part of the Select Medical Outpatient Division family of brands. 

Posted on 10/21/2020

As recently as five years ago, if you had Googled ‘esports athletes,’ you may very well have come across many sarcastic comments about how they aren’t real athletes. In 2020, you will find items about their tremendous hand-eye coordination, work ethic and the degree to which they work to hone their craft.

You’ll also find the following: esports are growing at a tremendous rate, for both participants and in terms of viewership. Nearly 100 million people watched the League of Legends World Championships in 2018. There are more than 1.2 billion players of esports worldwide. It is expected that there will be $1.1 billion dollars of revenue generated by worldwide esports in 2020.

Much like their colleagues in traditional sports, esports athletes place a demand on their bodies that can sometimes be detrimental to their physical health. Unlike traditional athletes, these negative effects rarely start with one-time injuries and are not often obvious. I have had the privilege to work as a physical therapist with the Harrisburg University Storm esports program and have seen problems ranging from carpal tunnel syndrome, to tennis elbow (lateral epicondylitis), to nerve entrapments and neck and upper back pain.

For the gamers at Harrisburg U, we take a comprehensive approach. They often train many hours a day, so things like load management, which is often discussed in regard to the National Basketball Association and National Football League, is a very real thing that our physical therapists advise for gamers. The gamers at Harrisburg U workout with a personal trainer multiple times every week. We help coordinate with their personal trainer what they should be doing with upper extremities during these sessions so they aren’t overloading muscles in the arms and hands.

As with many problems that physical therapists address, a problem in one area can be rooted elsewhere, such that an unnoticed postural problem an lead to pain in the wrist or hand. Positioning is very important for gamers and maintaining proper posture is key, so targeted exercises for their postural muscles are a must. Sometimes correcting this can be the difference to the pain in their hands. Basic sports medicine principles like stretching, warming up and using ice after practice and competition are also vital.

Esports is a burgeoning field both as a profession and as an avocation. Much like their counterparts in traditional sports, they place high demand on key muscle groups and face the risk of injury or pain. This is true for professional and collegiate players and weekend warriors. Just as we do with any athletes, physical therapists play an important role in prevention, management and recovery from injury for the esports athlete.

By: Bryan Hoyt, MSPT, CEAS. Bryan is a physical therapist and regional director of operations for Select Physical Therapy in central Pennsylvania. 

Posted on 10/12/2020

For the management of some types of pain, prescription opioids can certainly help. However, there is not enough evidence to support prolonged opioid use for chronic pain. We sat down with Katie McBee, P.T., DPT, OCS, M.S., CEAS II, PYT-C, regional director of our WorkStrategies Program, to ask her a few questions regarding opioid use, chronic pain and the benefits of physical therapy as a safe alternative to prescription medication. 

1. In your opinion, what are the main reasons for the opioid epidemic in the United States?

There is no simple explanation as to what caused the opioid epidemic in the United States. Opiates are not a new drug and have been abused at other time periods in American history, but not nearly to the extent that is happening now. For example, with health care access issues due to COVID-19, opioid prescription rates are on the rise with death rates up 30% since the pandemic’s onset.

Initial research on opiate medications said they were effective and safe and addiction was rare when used for short-term pain.¹ The development of FDA approved OxyContin in 1995 had labeling that stated iatrogenic addiction was “very rare,” and a widespread marketing campaign to physicians started to build medical providers’ confidence in prescribing these medications to decrease pain-related suffering.² Add to that the 2001 standards implemented by the Joint Commission on Accreditation of Healthcare Organizations for organizations to improve their care of patients with pain medication and this is probably what catalyzed the beginning of our current opioid epidemic.  

With medical providers focused on pain as a vital sign, pain quickly became the enemy and had to be eradicated to show successful management for many conditions with an increased focus on post-operative pain management. As drugs became more widely available, aggressively advertised and culturally acceptable, a three-fold increase in prescription rates for these medications ensued. With the increase in opioid prescription rates, death rates from side effects also increased by three-fold to more 16,000 in 2011. 

2. What is the difference between chronic pain versus pain suffered as a result of an injury? 

Pain is a mechanism designed to protect us from harm. Pain is not the enemy. A common misconception about pain is that it is not a simple cause/effect relationship. The amount of injury does not equal the amount of pain we experience. Pain is a complex process based on many areas of the nervous system and the brain communicating together to let us know what we need to prioritize and protect. The more threatening the brain perceives something, the more we potentially feel pain. 

Acute pain or pain suffered immediately after an injury or surgery to the body’s tissues is a protection mechanism from the brain to remind you to protect the area so that no further harm is done. As the tissue heals and time passes, there is less threat of injury so the brain stops signaling, the pain eases and you slowly get back to normal activities. 

In chronic pain, the tissues are not signaling danger to the brain as much as they are in acute pain. When the brain perceives threat for extended periods, it starts to change the nervous system to become a pain-producing machine. It creates new nerve junctions to make things hurt that wouldn’t normally hurt, like light touch on the skin. It can decrease the amount of pressure needed to create a pain signal. It creates more chemicals along the nervous system so it can create greater pain experiences with fewer stimuli. Research is still trying to figure out why some individuals have pain that goes away as the tissues heal and others have pain that persists despite the fact that the tissue has healed.

Individuals can be at risk of developing chronic or persistent pain for a number of reasons, including unhelpful coping strategies, stress, chronic illness and poor sleep habits. It appears the more emotional or physical stress going on at the time of the injury and/or during the healing process, the more at risk you can be of developing a persistent pain issue. A holistic approach to address some of these drivers of persistent pain is showing promise in being able to reduce the pain and get people with chronic pain back into their normal lives again.

3. Why is physical therapy important and what are some of the benefits to patients? 

Physical therapy is an ideal treatment for many types of acute and chronic pain and should be a part of any single or multidisciplinary treatment plan for pain. The goal of physical therapy is to increase function and keep people in their meaningful life activities while they are healing. Physical therapists are trained to address many of the drivers of chronic pain and can perform testing and screening to see if your pain system is sensitized and adjust treatment to desensitize the pain system as well as address the functional limitations many people often experience when they are in pain.  

Physical therapists have many tools they can use to decrease pain and desensitize the pain system. These tools include education on pain to discover what could be driving pain issues. Once the pain drivers are discovered, a physical therapist will develop a holistic plan to address these drivers, including increased activity, sleep hygiene, stress management skills and pacing techniques. 

The best thing about physical therapy for pain is that the outcomes for some of the techniques are better than many medications and procedures available; plus, there are no negative side effects. If you or someone you know has an issue with pain, please request an appointment today to begin physical therapy treatment. 
References

1. Porter J, Jick H.  Addiction rare in patients treated with narcotics. N Engl J Med. 1980;302:123.
2. Van Zee A. The promotion and marketing of OxyContin: commercial triumph, public health tragedy. Am J Public Health. 20:99 (2):221-227.

Posted on 10/7/2020

Up until a few months ago, my life as a physical therapist was pretty normal. I went to work, did my job, helped my patients and team to the best of my ability and went back home. At the time I was working in a critical illness recovery hospital with some of the sickest patients in my geographic area, people recovering from major trauma and significant illnesses. I was part of a great team, but it was heavy work. I felt myself becoming burnt out and struggling to do my best work. I have done hospital-based and outpatient work throughout my career, so I began to think that a transfer to Select Medical’s Outpatient Division might be my next move.

Fast forward a few months and interviews later and I accepted a site supervisor position at an outpatient center. About a month into my new role, COVID-19 wreaks havoc on the world. It was a daily pivot in terms of center operations and managing a team during a global crisis. I was also in a really unique position because I had spent almost 10 years working in critical illness, learning about cardiopulmonary physical therapy, infectious diseases and protective equipment. I felt confident I could lead my team effectively with the best information I had. As we started to move through the pandemic, our greater area was looking for someone to help lead a developing COVID-19 recovery program and I felt uniquely qualified.

Select Medical’s clinical team had put together a top-notch Recovery and Reconditioning Program for those compromised by a variety of acute and chronic conditions, such as after-effects of the flu and cardiovascular disease. Developed in partnership with leading physicians, including physiatrists and infectious disease specialists, the program focuses on identifying key areas of deconditioning and weakness in patients. Select Medical’s licensed physical and occupational therapist are specially trained in the program, with each clinician having access to the most up-to-date COVID-19 information, best practices and safety precautions.

Physical, occupational and speech therapy is critical in helping COVID-19 survivors get back to their lives and jobs. This virus can be extremely debilitating on its own, and even worse when combined with the effects of limited mobility during hospitalizations, prolonged mechanical ventilation or additional medical complications. As physical rehabilitation professionals, we are uniquely qualified to work with these patients to:

• Increase mobility, balance and stability
• Decrease pain, soreness and general fatigue
• Improve range of motion and breathing capability
• Address cognitive impairments, dizziness and weakness
• Ensure a safe recovery to activities of daily living  

Our clinical team believes firmly in safety first and have put out guidelines for monitoring patients to ensure we are exercising them hard enough to make progress, but not overstress their systems. We are also educating these survivors on how to monitor themselves during home exercises or simple household activities like cleaning and chores.

While this global pandemic has had a lot of challenges and negative aspects, when I really step back and look at the whole picture I am impressed with how we positioned ourselves. Every day, we are committed to putting patients first, keeping patients and clinicians safe and assisting those who have survived COVID-19 back to their highest quality of life. That’s something to be proud of, and we look forward to helping more and more heal through our Recovery and Reconditioning Program.

To learn more about our program or to schedule an appointment today, please click here.

By: Erica R. Noel, P.T., MSPT. Erica is a physical therapist with Banner Physical Therapy in Phoenix, AZ. Banner and NovaCare are part of the Select Medical Outpatient Division family of brands.

Posted on 10/2/2020

It's official, our favorite month of the year is here: National Physical Therapy Month. Please join us as we celebrate our amazing team members and the power of physical therapy throughout October. #NPTM2020 #ChoosePT #ThePowerOfPhysicalTherapy

View our National Physical Therapy Month video

At Saco Bay, there is nothing more important to us than your health and safety during this unprecedented time. The Department of Homeland Security and state governments have deemed physical therapy an essential component of health care during the coronavirus (COVID-19) pandemic; therefore, many of our centers remain open to serve those in need. We are taking extensive preventative measures, guided by the CDC, to protect our patients and employees who enter our centers.

We hope that by providing this information, you can make a clear decision to continue your plan of care with us during this time. The following protocols are now in place:

• Patient screening: All patients will be screened upon arrival of their appointment time to make sure they are not exhibiting symptoms. If a patient is presenting with COVID-19 symptoms, they will be advised to return home and contact their physician.
• Staff screening: All employees will be screened for COVID-19 daily. Those presenting any level of symptoms will return home and follow up with their physician before returning to work.
• Health hygiene protocols: Ongoing reinforcement to all staff regarding hand washing and other preventative measures for equipment and supplies are in place and being reinforced.
• Masking: In an effort to keep our patients and staff safe, anyone entering our center is required to wear a mask. If you have a medical condition or other restriction which prevents you from wearing a mask, please speak with the center manager. Your inability to wear a mask may limit our ability to accommodate you.

That said, if you do not feel comfortable coming to a center for care during this time, we will gladly reschedule your appointment for a later date. In addition, many of our locations are now offering telerehab services so that you can easily connect with one of our licensed therapists through web-based technology that is HIPAA compliant. Learn more.

For patients coming to our centers for care, we ask that you please limit the number of people who accompany you to your appointments, unless they are necessary for transportation or assistance. If for any reason you are not feeling well, please contact the center and we will be happy to reschedule your appointment.

To help prevent the virus:

• Wash your hands often with soap and water for at least 20 seconds.
• Avoid close contact with people who are sick.
• Avoid touching your eyes, nose and mouth.
• Stay home when you are sick.
• Cover your cough or sneeze with a tissue and throw the tissue in the trash.
• Clean/disinfect frequently touched objects and surfaces.

Thank you for helping us ensure the safety of our patients and employees, as well as families of both.

 

Posted on 3/27/2020

Saco Bay Orthopaedic & Sports Physical Therapy now offers physical, occupational and speech therapy from the comfort and safety of your home through our telerehab program.

If you're limited by travel, injury or a weakened immune system, we will virtually bring our services to you so you may heal, build strength and get back to the things you love.

What is telerehab?

Telerehab lets you easily connect with one of our licensed therapists through web-based technology, all from the convenience of your home. Sessions are delivered one-on-one in real-time, and are private, secure and adhere to HIPAA requirements.

How does it work?

Telerehab sessions may be offered in place of or in addition to in person center sessions, dependent upon your condition and preference. All you need is a computer or device with a camera, microphone and internet access to begin.

• Simply click a link we'll send you - no downloads or accounts necessary!
• Just like the care you'd receive in our center, we'll cover:
  • Pertinent paperwork
  • Exercises, education and techniques to address your pain and impairments
  • Instruction on how to best move forward with your therapy program

Our physical, occupational and speech therapists will work with you to make sure telerehab is right for you. No prescription or physician referral is needed. Our goal is to help you feel better physically while making sure you're comfortable and an active partner throughout your treatment. Request an appointment today.