Tag Archives: physical therapy

Conservative Care for Shoulders

By Mary O’Donoghue, Chief Clinical and Product Officer, MedRisk


Mary O’Donoghue, Chief Clinical and Product Officer, MedRiskShoulder pain is one the most common musculoskeletal problems in workers’ compensation, second only to low back pain. In fact, it is even more prevalent in some industries. Like low back pain, shoulder pain has been shown to respond well to conservative care, especially physically therapy.

Strenuous work, including heavy lifting over a long period of time, carrying, pulling, or pushing can cause shoulder pain and problems. The type of repetitive overhead arm motion that warehouse workers, flight attendants and construction workers perform also contributes to shoulder issues.

Symptoms include pain at rest and when lifting and lowering the arm or with specific movements. Some patients feel weakness when lifting or rotating the shoulder or experience a crackling sensation when moving the shoulder in certain positions. Limited range of motion and/or pain associated with internal and external rotation and forward flexion can indicate a partial thickness tear of the rotator cuff. Another symptom is painful abduction, which is the movement away from the median plane of the body. Full-thickness tears are indicated by weakness of external rotation and abduction.

Until recently, surgery was the common approach to rotator cuff tears and similar shoulder injuries. Now, guided by research, clinicians are adopting more conservative methods. This usually involves a combination of physical therapy and temporarily modifying activity, such as avoiding heavy lifting or sustained overhead use of the arms.


Spinal Manipulation Can Alleviate Back Pain, Study Concludes

illustraion of x-ray style view of lower back pain

A study suggests spinal manipulation can reduce lower back pain for some people.

One of the most common reasons people go to the doctor is lower back pain, and one of the most common reasons doctors prescribe powerful, addictive narcotics is lower back pain.

Now, research published Tuesday in the Journal of the American Medical Association offers the latest evidence that spinal manipulation can offer a modestly effective alternative.

Researchers analyzed 26 studies involving more than 1,700 patients with lower back pain. The analysis found spinal manipulation can reduce lower back pain as measured by patients on a pain scale — like this one — from zero to 10.

Spinal manipulation, which is typically done by chiropractors, physical therapists, osteopaths, massage therapists and some other health providers, involves applying pressure and moving joints in the spine.

Patients undergoing spinal manipulation experienced a decline of 1 point in their pain rating, says Dr. Paul Shekelle, an internist with the West Los Angeles Veterans Affairs Medical Center and the Rand Corp. who headed the study.

“So if it had been a 7 it would be a 6, or if it had been a 5 it would be a 4,” Shekelle says. That’s about the same amount of pain relief as from NSAIDs, over-the-counter nonsteroidal anti-inflammatory medication, such as ibuprofen.

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Study Says PT as Effective as Surgery for CTS


EDITORS NOTE:  Fortunately for our patients, we have one the finest Physical Therapists in the Santa Maria Valley, Ed Donahue!

info graphic of how to avoid carpal tunnel computer workSacramento, CA – Physical therapy is as effective as surgery in treating carpal tunnel syndrome, according to a new study published in the Journal of Orthopaedic & Sports Physical Therapy® (JOSPT®).

Researchers in Spain and the United States report that one year following treatment, patients with carpal tunnel syndrome who received physical therapy achieved results comparable to outcomes for patients who had surgery for this condition. Further, physical therapy patients saw faster improvements at the one-month mark than did patients treated surgically.

Carpal tunnel syndrome causes pain, numbness, and weakness in the wrist and hand. Nearly half of all work-related injuries are linked to this syndrome, which can result from repetitive movements. Although surgery may be considered when the symptoms are severe, more than a third of patients do not return to work within eight weeks after an operation for carpal tunnel syndrome.

The study demonstrates that physical therapy – and particularly a combination of manual therapy of the neck and median nerve and stretching exercises – may be preferable to surgery, certainly as a starting point for treatment.

“Conservative treatment may be an intervention option for patients with carpal tunnel syndrome as a first line of management prior to or instead of surgery,” says lead author César Fernández de las Peñas, PT, PhD, DMSc, with the Department of Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine at Universidad Rey Juan Carlos, Alcorcón, Spain.


Return-to-Work Programs


The only place success comes before work is in the dictionary” –
Vince Lombardi

At the 2015 WCI Conference this session addressed the issues faced from employees returning to work and to create a successful return-to-work program. .
benefits of return to work programs graphic
The speakers included Margaret Spence, President/CEO, Douglas Claims & Risk Consultants, Inc, and Rose Royo, Supervisor, Workers Compensation, Miami Dade County Public Schools.

Key idea to remember, work smarter not harder. Main focus when creating a return to work program is the employee. The injured worker is an employee not a claimant. Imperative to make sure the employee knows they are vital to you and that you are not just treating them as a claim. The employment situation creates the workers’ compensation situation. It is essential to have a happy medium when working with an employee and the return to work program. The goal is to keep the employee working you do not want to get wrapped up in everything else.

When you create a return to work program, it is helpful follow these guidelines:

• Create an injury management team-this starts with the highest employee in your organization

• Understand the organization’s why- injured employee should be at the center of the focus

• Define the process-make sure there are steps the employee needs to take in order to get back to work

• Embrace your purpose and value-Remember your employee is most important

• Make the business care-costs money to bring new employees into the company, focus on getting the injured worker back to work

• Find ways to engage-this program should be a collaborative effort between several departments

• Create an integrated disability team- build proactive policies

As an employer you cannot be afraid to ask the employees what can we do for you in order to get you back to your job and work at 100%. The saying goes a “happy worker is a happy worker!”

Return to work programs are not something you create in a year and never look at the program again.


Differences between Occupational Therapy and Physical Therapy

OT_vs_PTPeople often ask “what is the difference between occupational therapy and physical therapy?” Both professions are health care related, both have many similarities like assisting patients in regaining the ability to perform everyday functions, and many times the 2 will collaborate while providing care for patients.

However, each profession has a different focus. The occupational therapist is trained to modifying the physical environment as well as training the person to use assistive equipment to increase independence. They focus to help their patients engage in meaningful activities of daily living (ADLs). The physical therapist is trained to identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention, and rehabilitation. They focus on the physical, psychological, emotional, and social well-being.

As an example: an occupational therapist is often involved in educating people on how to prevent and avoid injuries, as well as educating people about the healing process. Physical therapists in turn often help people improve their ability to do their daily activities through education and training. While there is this crossover between professions both play very important roles and are more specialized in their areas of expertise. In many situations, both types of health-care professional are involved in injury recovery.

Physical and occupational therapy is a booming field in the healthcare industry. Both professions require special certification and a post-bachelor’s degree to practice. According to the U.S. Bureau of Labor Statistics, the number of OTs in the work force is expected to increase by 26 percent between 2008 and 2018, and the number of PTs is expected to increase by 30 percent.

Check out the following video explaining some of the differences between occupational and physical therapist:

[embedplusvideo height=”388″ width=”640″ standard=”http://www.youtube.com/v/sX9MV9_aT1Q?fs=1″ vars=”ytid=sX9MV9_aT1Q&width=640&height=388&start=&stop=&rs=w&hd=0&autoplay=0&react=1&chapters=&notes=” id=”ep3287″ /]

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How to Get Medicare-Covered Health Services at Home

David Sayen is Medicare’s regional administrator for California, Arizona, Nevada, Hawaii, and the Pacific Trust Territories.
David Sayen is Medicare’s regional administrator for California, Arizona, Nevada, Hawaii, and the Pacific Trust Territories.

Medicare covers a variety of health care services that can be provided in the comfort and privacy of the individual’s home. These include intermittent skilled nursing care, physical therapy, speech-language pathology services, and occupational therapy.

Such services used to be available only at a hospital or doctor’s office. But they’re just as effective, more convenient, and usually less expensive when you get them in the home.

Those who get Medicare benefits through a Medicare Advantage health plan (instead of Original Medicare) should check with the plan for details about how it provides Medicare-covered home health benefits.

To be eligible for home health services, an individual must be under a doctor’s care and receive the services under a plan of care established and reviewed regularly by a physician. The doctor also needs to certify that you need one or more home health services.

In addition, the recipient must be homebound and have a doctor’s certification to that effect. (Being homebound means leaving the home isn’t recommended because of the patient’s condition, or the condition keeps the patient from leaving without using a wheelchair or walker, or getting help from another person.) Also, the patient must get their services from a home health agency that is Medicare-approved.

If the patient meets the criteria, Medicare pays for covered home health services for as long as they are eligible and their doctor certifies that the services are needed.

Skilled nursing services are covered when they’re given on a part-time or intermittent basis. In order for Medicare to cover such care, it must be necessary and ordered by the patient’s doctor for their specific condition. The patient must not need full-time nursing care.

Skilled nursing services are provided either by a registered nurse or a licensed practical nurse under an RN’s supervision. Nurses provide direct care and teach the patient and their caregivers about the care required. Examples of skilled nursing care include: giving IV drugs, shots, or tube feedings; changing dressings; and teaching about prescription drugs or diabetes care. Any service that could be done safely by a non-medical person (or by the individual patient) without the supervision of a nurse isn’t skilled nursing care.

Physical therapy, occupational therapy, and speech-language pathology services have to be specific, safe, and effective treatments for the patient’s condition.

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Heat Illness Training is Front Burner in CA

A heat index chart

Heat Illness Prevention in Agriculture Gets Focus in California

Cal/OSHA, the Nisei Farmers League, and 23 other agricultural organizations are teaming up for this years “Heat Illness Prevention in Agriculture” training events.
The free sessions began recently in Fresno, Calif., and will continue throughout the spring and summer at locations across the state. The goal is to reduce heat- related fatalities and gain a greater level of compliance in the agriculture community through training programs for growers, farm labor contractors, and supervisors.
The training will provide information about employers responsibilities under Californias Heat Illness Prevention Standard and will explain changes made to the regulation last August that are now in effect.
Cal/OSHA said its outreach, education, and enforcement have led to a measurable increase in the number of employers who are complying with the regulations, up from 35 percent in 2006, to 76 percent in 2010. As a result, heat- related deaths have declined from 12 in 2005 to two last year.
John Duncan, director of the Department of Industrial Relations, which oversees Cal/OSHA, said the heat illness prevention outreach effort is one of the most successful safety education efforts in Cal/OSHAs history.
It is clear that our heat illness training and enforcement efforts are saving lives and resulting in increased compliance among employers,” Duncan said. “Our efforts thus far have laid the groundwork to carry this training initiative forward and to expand this type of collaboration into other industries. These efforts will continue until we reach everyone who works out in the fields, on construction sites, anywhere out in the elements.”
Cal/OSHA and its partners in agriculture conducted more than two dozen heat illness prevention training seminars in California last year. Some 1,600 agriculture employers and supervisors attended the training events that are held in both English and Spanish. Those employers passed the information on to an estimated 400,000 workers.
Every year since we have been offering this training, we find more farm supervisors and labor contractors complying with heat illness regulations. More employers are giving the provision to workers of water, shade, and training the full attention it needs,” said Cal/OSHA Chief Len Welsh. “There is no doubt this outreach effort is having a positive impact, but we still have work to do in order to reach our goal of making worker safety and health have the prominence in workplace culture that we all want to see.”
In 2005, California became the first state to develop a safety and health regulation to protect workers from heat illness.

OSHA Seeks Employer Input On Adding ‘Ergonomics’ Column To Injury/Illness Logs

man in the ultimate ergonomic computer chair
Can I get one of these at Office Max?

Washington, DC (CompNewsNetwork) – The Occupational Safety and Health Administration (OSHA) is seeking input from the business community on its proposal to add a column for work-related musculoskeletal disorders (MSD) on employer injury and illness logs, known as the form 300 log.OSHA is holding three teleconferences in partnership with the U.S. Small Business Administration’s Office of Advocacy to gather small business input on the proposal.

The proposal would require employers already mandated to keep injury and illness records to add the step of checking a column when recording work-related musculoskeletal disorders, also commonly known as ergonomic injuries.

Interested businesses that wish to participate in one of the teleconferences should contact Regina Powers at powers.regina@dol.gov by April 4 and indicate the teleconference in which they wish to participate.

Proposed Rule

The proposed rule covers only MSDs that employers already are required to record under the longstanding OSHA rule on recordkeeping.

Before 2001, OSHA’s injury and illness logs contained a column for repetitive trauma disorders that included hearing loss and many kinds of MSDs. In 2001, OSHA proposed separating hearing loss and MSDs into two columns, but the MSD column was deleted in 2003 before the provision went into effect. OSHA’s proposal would restore the MSD column to the Form 300.

Virtual Health Care May Be Better Than In-Office Visits

Doctor's hand reaching out of computer holding a stethoscopeA five-year study of HIV patients found a telehealth system, including a virtual pharmacy and community forums, to be as effective as in-office visits to the doctor. The study could mean increased virtual health care and cheaper medical costs around the world, especially for high-maintenance chronic illnesses such as HIV.

From autonomous robotic surgeries to advanced computerized diagnoses, many recent technological breakthroughs have benefited the medical industry and the patients it serves. Now, results from a five-year study have revealed an exciting conclusion: Virtual check-ups can be just as effective as, if not more than, in-office visits to the doctor.

In the study, a group of Barcelona-based physicians successfully treated 200 HIV patients via an online home care system called “Virtual Hospital.” The technology covers all aspects of managing the health of chronic HIV-infected patients, who require frequent and careful care. This month, PLoS One published the results, which found telehealth to be as effective as in-office visits.

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Patients and Clinicians Must Share Healthcare Decisions, Say Experts

Clinicians have an ethical imperative to share important decisions with patients, and patients have a right to be equal participants in their care, say a group of experts.

doctor with mother and young son
So draw me a picture

In December 2010, 58 people from 18 countries attended a Salzburg Global Seminar to consider the role patients can and should play in healthcare decisions. Today, they publish a statement urging patients and clinicians “to work together to be co-producers of health.”

It comes as the government in England finalises plans to give people more say and more choice over their care than ever before.

The experts argue that much of the care patients receive is based on the ability and readiness of individual clinicians to provide it, rather than on widely agreed standards of best practice or patients’ preferences for treatment.

Results from the 2010 Cancer Patient Experience Survey seem to support this view. It found significant variations in the choice and information patients are given, and their involvement in decisions about treatment.

The experts also say that clinicians are often slow to recognise the extent to which patients’ wish to be involved in understanding their health problems, in knowing the options available to them, and in making decisions that take account of their personal preferences.

As such they call on clinicians to stimulate a two-way flow of information with patients, to provide accurate information about treatment, to tailor information to individual patient needs and allow them sufficient time to consider their options. In turn, they urge patients to ask questions and speak up about their concerns, to recognise that they have a right to be equal participants in their care, and to seek and use high-quality health information.

They also call on policymakers to adopt policies that encourage shared decision making and to support the development of skills and tools for shared decision making.

One of the signatories, Professor Glyn Elwyn from Cardiff University, says that despite considerable interest in shared decision making, and clear evidence of benefit, implementation within the NHS “has proved difficult and slow.”

Angela Coulter from the Foundation for Informed Medical Decision Making agrees and points to recent evidence showing that most patients want choice, but that many clinicians remain ambivalent or antagonistic to the idea. She believes the government’s new commitment to shared decision making presents a challenge to entrenched attitudes and the need for big change in practice styles.

Story Source: The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by BMJ-British Medical Journal, via EurekAlert!, a service of AAAS.