Enfield Health & Wellness Center routinely mails newsletters to physicians to explain treatment options available through referral and to highlight the most current thinking in physical therapy. Here we have posted a few of these newsletters for your perusal. Contact us if you are a prescriber in or near Enfield, CT and would like to be added to our postal mail list.
Physical Therapy Comparable to Surgery for Meniscal Tearing with Osteoarthritis
In March, the New England Journal of Medicine published the first large, multicenter, randomized, controlled trial to examine the efficacy of arthroscopic partial meniscectomy plus physical therapy compared to physical therapy alone. Between the two experimental groups, improvements from baseline do not differ significantly. The authors suggest that their findings provide encouragement for offering non-operative strategies.
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Do Most PTs Treat Back Pain Incorrectly?
This article analyzes the performance of the physical therapists treating low back pain and concludes that 79% of patients receive sub-optimal physical therapy treatment. Physical therapy guidelines recommend an active approach for low back pain, from the acute phase forward.(2) There should be an emphasis on helping patients improve activity levels. Previous studies link an early, active approach to better outcomes with reduced costs.(3,4) The tens of thousands of billing records reviewed by Fritz and colleagues suggest that 79% of LBP patients receive primarily passive therapies from their physical therapists for the first two weeks of therapy.
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Low Back Pain & Timing of Referrals
Early PT Referrals Predict Improved Outcomes and Lower Costs
The consensus on when to refer to physical therapy for non-specific low back pain (LBP) is in a state of transition. A study published in Spine last December reviewed the medical records of 32,070 patients with a new, primary care LBP consultation.(1) They found that the median time from primary care consult to first physical therapy visit was 14 days, with 53% of physical therapy episodes starting within 14 days and 47% of episodes starting later. Those patients who started physical therapy earlier showed statistically significant patterns toward improved outcomes and lower costs.
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Majority of Guidelines Now Recommend Spinal Manipulation for Acute Low Back Pain
The new State of Oregon Evidence-Based Clinical Guidelines for the Evaluation and Management of Low Back Pain recommend spinal manipulation during the acute phase (<4 weeks). The recommendation comes with the highest level of recommendation achieved by any of the interventions listed - B. These new recommendations are a reversal of previous Oregon drafts that sent many patients to surgery without trying any form of physical therapy. Those lobbying for changes to previous versions argued that the analysis needs to look beyond short-term pain control to functional improvement and longer-term outcomes.
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OTC NSAIDs Increase Risk of Hearing Loss
Last October, the American Journal of Epidemiology published the first prospective study examin-ing the correlation between regular NSAID (nonsteroidal antiinflamatory drug) use and hearing loss in women.1 Multivariate-adjusted relative risk analysis demonstrates that regular ibuprofen and acetaminophen use increases the risk of hearing loss in women by 8% to 24% as the usage rates range from two doses per week to six or more doses per week. These results add to those of a previous study demonstrating that men regularly using ibuprofen, acetaminophen, or aspirin increase their risk of hearing loss up to 99%.2 Regular NSAID use appears to have a greater effect on the hearing of men than of women, but both men and women are at increased risk.
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Stop Swelling Before It Becomes Irreversible Lymphedema
Lymphedema is a painful, emotionally taxing condition suffered by more than half a million Americans.1 Irreversible lymphedema occurs when the lymphatic system is damaged to the extent that interstitial fluid production exceeds the lymphatic system’s capacity to filter and transport. In most cases of secondary lymphedema, surgery and/or radiation often did not cause all the damage necessary to create irreversible lymphedema. In many cases, these procedures only started the process. The subsequent swelling triggers an inflammation-like response that, when inadequately addressed, can permanently degrade the lymphatic system.
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Expert Recommendations for Treating Whiplash in the Acute Phase
More than 50% of patients injured in motor vehicle accidents receive whiplash diagnoses. Patients with acute neck pain develop chronic neck pain in 15% to 40% of cases. Can pearls of wisdom from high quality research help America do better with this troubling diagnosis?
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Is Physical Therapy Cost-Effective in Whiplash Treatment?
Inasmuch as patients with acute whiplash develop chronic neck pain in 15% to 40% of cases, prescribing every measure shown to improve whiplash outcomes may be justifiable. Indeed, multiple studies have demonstrated various physical therapy interventions to be effective at improving pain ratings, recovery speed, and ability, compared to usual care. However, this does not answer the more difficult question of cost-effectiveness. Is it better in terms of societal costs for patients to heal at their own pace with medications and advice?
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Improvement for All Types of Vestibular Disorders
The Vestibular Disorders Association reports that more than 12 million Americans suffer from a dizziness or balance problem that significantly interferes with their lives and that 40% of the population over the age of 40 will experience a dizziness disorder in their lifetime. Patients typically bring these complaints to their family practitioners or to the emergency department. If not successfully treated, the occasional disequilibrium can lead to fall injuries, auto accidents, work accidents, and fear of performing normal activities of daily living. When designing a treatment plan for patients with any type of vestibular disorder (peripheral or central), you can in-clude certified vestibular rehabilitation at Enfield Health & Well-ness Center.
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Addressing Fibrosis to Improve Tendinopathies
Histopathologic studies have long established inappropriate fibrosis and scarring, that lacks the parallel, longitudinal structure of a normal tendon, as consistent elements in various tendinopathies. One of the specialized approaches available at Enfield Health & Wellness Center improves physical therapy results by specifically addressing the fibrosis and scarring usually associated with tendinopathies. The Graston Technique is an instrument-assisted, soft tissue mobilization technique utilizing ergonomically designed stainless steel instruments to detect and break down scar tissue and fascial restrictions.
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The Efficacy of Corticosteroid Injections for Tendinopathy
The Lancet: A Systematic Review of Randomized Controlled Trials
In a systematic review published recently by the Lancet, Coombes et al. consistently found that peritendinous corticosteroid injections are sometimes effective in the short-term for tendinopathy but usually worsen out-comes past 13 weeks compared to other treatments.
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When Recommending Specific Exercises
Professional Contact Improves Outcomes
In many cases, Enfield Health & Wellness Center will assert that a small number of visits to our practice will improve outcomes compared to teaching a patient an exercise regimen once or twice and sending him/her home. For the most part, this is accomplished through verification of correct performance, professional input on progression of intensity, and individualized manual therapy. Interestingly, Gail Deyle, DPT, tested this hypothesis in a randomized, controlled trial.
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Introducing Mulligan Concept - A New, Progressive Manual Therapy Approach Available
at Enfield Health & Wellness Center
The physical therapists of Enfield Health & Wellness Center practice a relatively new manual therapy so effective that authors describing its physiology have referred to its results as the “Pain Release Phenomenon.” First described in the literature by Brian Mulligan in 1992,1 an admirable body of re-search now attests to its effectiveness.2-15 The Mulligan Tech-nique, sometimes titled Mobilization With Movement, deliv-ers immediate relief and recovery from local musculoskeletal pathology of mechanical origin.
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What McKenzie Method Means to Doctors and Patients
Faster Results - Lower Costs
Worldwide, the McKenzie Method® has consistently grown in recognition and has established itself as a scien-tifically proven foundation in spine care. Over the past two decades, literally hundreds of research papers sup-porting the use of the McKenzie Method have appeared in numerous peer review journals. Journals such as Spine, the Journal of Neurology, JMPT, Physiotherapy, and the New England Journal of Medicine have all fea-tured research demonstrating the faster results and low-er costs of the McKenzie Method.
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Low Back Pain and Faster Return to Work
A randomized, controlled trial published recently in Spine demonstrates that prompt intervention including manipulation, an individualized exercise program, and guided exercises produces faster and more cost effective results than “normal medical care” in cases of acute and sub-acute simple low back pain (LBP). Participants in the guided exercise group spent 35% less time off work (an average of 7 days) and showed significantly better results on pain assessments and health status assessments at one month and two months. Even though patients in Group 2 received injections and physical therapy and returned to work better prepared for the rigors of their jobs, participants in Group 2 reduced overall costs by $367 to $850 per patient.
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A Different and More Serious Complaint:
Occupational Low Back Pain
Occupational low back pain (OLBP) is a different and more serious condition than non-occupational low back pain (LBP). OLBP ranks as a leading cause of workplace disability, representing at least one fourth of all costs due to work-related conditions. studies specifically measuring return to work after four weeks of normal medical care have found full return to work rates of 28% to 58%, calling into question the assertion that most “recover” in four to six weeks with minimal intervention. There is strong evidence that if a person misses four to twelve weeks of work, he or she will have up to a 40% chance of missing work for the ensuing year.
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Back Pain Patients Managed Passively Experience 280% Higher Recurrence
-The Role of the Multifidus in Chronocity -
It is commonly held that low back pain (LBP) resolves spontaneously in the majority of cases, but the passive treatment this statement would suggest results in 280% higher recurrence or greater. In a randomized, controlled trial published in Spine, Julie Hides, PhD, and colleagues demonstrated with unusual specificity that LBP cases that would commonly be labeled as “resolved” have in fact not resolved.
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Success With the Most Common Form of Vertigo in Two Treatments
The Vestibular Disorders Association estimates that 42% of the adult population reports episodes of dizziness or vertigo to their physicians and that in 85% of those cases, vestibular dysfunction causes the patient’s problems. Left unaddressed, the occassional dizziness or dysequilibrium can lead to injury falls, auto accidents, work accidents, or fear of performing normal activities of daily living.
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Delivering Long-Term Relief for Chronic Headaches
Every year, 17% of women and 14% of men present themselves to a healthcare practitioner looking for relief from headaches.1 Practitioners seeking to offer maximum, long-term relief to their patients can include headache treatment at Enfield Health & Wellness Center as part of their management strategy. Enfield Health & Wellness offers headache assessment and management that provides expert care for orthopedic factors contributing to many recurring headache and migraine situations.
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Non-Specific Low Back Pain - Not Specific Enough
Classification Improves PT Results
Authors have suggested that, while this broad category may be useful in medical practice, it can be deleterious to clinical research, clinical guidelines, and, resultantly, physical therapy practice. The assessment-based therapy treatment plan, delivered promptly after injury, produces results superior to strictly interpreted AHCPR “evidence-based guidelines.”
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Is Back Pain an Injury?
What is the More Cost Effective Model?
In this article, we explore a promising alternative to the misguided acute vs. chronic model and explain why most cases of low back pain should not be treated as an injury. Low back pain (LBP) ranks as a leading cause of disability among Connecticut’s adults. Despite increased attention to the problem over the past three decades, annual healthcare costs related to LBP continue to rise at rates exceeding inflation. Research has shown some cost-effective approaches for prevention of low back pain and LBP disability, and these approaches are available to you through Enfield Health & Wellness Center.
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