According to the CDC (Centers for Disease Control and Prevention), musculoskeletal disorders (MSDs) are defined as “ injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and disorders of the nerves, tendons, muscles and supporting structures of the upper and lower limbs, neck, and lower back that are caused, precipitated or exacerbated by sudden exertion or prolonged exposure to physical factors such as repetition, force, vibration, or awkward posture. ” What in the world does that mean and how does it apply to you?
In order to understand how MSDs apply to you, it is important to clarify the difference between acute musculoskeletal disorders and chronic musculoskeletal disorders.
1. Acute MSD: An injury caused by a traumatic mechanism that occurs at one specific point in time. An example of a traumatic mechanism of injury would be an auto accident, severe fall, or weight lifting accident. A traumatic mechanism of injury could result in broken bones, muscle strains, ligament tears, or even dislocations. A football player who sustained an ACL tear as a result of a hard tackle is a great example of an Acute MSD. 2% of MSDs that occur in the gym/sports are Acute.
2. Chronic MSD: An injury that occurs over a prolonged period of time as a result of poor body mechanics (how the body moves) and weakness. Chronic MSDs classified as that “annoying” neck , shoulder, back, hip, knee, and foot pain that tends to flare up at the most inopportune moments and makes it difficult to enjoy participating in physical activity. It is important to note that a Chronic MSD can eventually lead to an acute MSD because of your acquired weakness and poor body mechanics. An annoyingly painful shoulder can eventually turn into a shoulder injury that requires surgery if you are not careful. 98% of MSDs that occur in the gym/sports are Chronic. The good news…. it is the sneaky chronic MSDs that can be prevented!
The body is amazing at compensating for poor body mechanics, meaning that the body can withstand sitting with poor posture for a long time or lifting heavy objects the wrong way over and over again without getting hurt. Eventually, as you age, your body gets tired of compensating, and the bad habits that you were able to get away with when you were in your teens and early 20s come back to bite you in the behind. Your poor posture, weaknesses, and incorrect body mechanics will ultimately lead to that annoying chronic neck, shoulder, back, and knee pain. If you’re not careful, it may even lead to an acute injury requiring surgery.
However, the silver lining to this message is this. MDS, acute and chronic, can be prevented with the proper exercise prescription! By properly strengthening your upper body, core, and lower body, you will train your body to be strong and move the right way in all areas of your life. By preventing MSDs, you will continue to be able to participate in all the activities you love so much pain free!
Did you get injured working out but don’t know which health care provider to see? You’re not alone. With a wide variety of health care practitioners that are certified to treat muscular & skeletal (musculoskeletal) disorders, it can be quite confusing. Here, I hope to clarify the major differences in musculoskeletal clinicians, and the general progression of care/ referral process if you are injured.
Evaluates, diagnoses, and provides treatment to develop, maintain, and restore maximum movement and function throughout your life. Components of movement and function that are evaluated by a physical therapist include: strength, range of motion, flexibility, balance, posture, body mechanics, joint play, coordination, endurance and general mobility. Physical Therapists emphasize a treatment program that eventually transitions from manual treatment techniques & one-on-one strength training programs to an independent treatment program designed to prevent re-injury through exercise prescription and mobility training. You can see a Physical Therapist without a referral from your Doctor.
Common treatment techniques: manual joint mobilizations and/or manipulations, stretching, strengthening (creation of exercise program prescription), soft tissue mobilization, motor control retraining (brain to muscle connection).
Education: Doctor of Physical Therapy
Evaluates, diagnoses, and provides treatment to develop, maintain, and restore maximum movement and function throughout your life. Components of movement and function that are evaluated by a chiropractor include: range of motion, flexibility, posture, stability, joint play, and muscle tone. Chiropractors emphasize maintaining proper spinal alignment through regular routine skeletal adjustments. You can see a Chiropractor without a referral from your Doctor.
Common treatment technique: manual adjustment and/or manipulation, stretching, soft tissue mobilization
Education: Doctor of Chiropractic
Develops and implement fitness programs for clients who have no apparent physical limitations or who have received medical clearance to exercise. Personal trainers are not licensed to evaluate or diagnose a client with a musculoskeletal disorder.
Common treatment techniques: Developing exercise program for weight loss and/or to improve overall fitness
Education: The profession of personal training does not have an educational standard and is self-regulated. Trainers’ experiences may range from a master's degree in biomechanics with five years of experience working at an athletic setting or a weekend certification with no experience, however, ACE (American Council of Exercise) created a universal standard for personal trainer certifications.
Orthopedist (Orthopedic Physician, Orthopedic Surgeon)
A Medical Doctor that specializes in evaluating and diagnosing diseases and injuries pertaining to the musculoskeletal system. They handle everything from minor issues such as a sprained ankle to complex procedures and surgeries such as a hip replacement. Orthopedists refer to Physical Therapy (PT) first. If conservative treatment (PT) doesn't work, they look into surgical interventions. If surgery is performed, Orthopedists will refer a patient back to PT.
Most common treatment techniques: Medication prescription, referral to Physical Therapy, surgery (if conservative measures are ineffective)
Education: MD (Medical Doctor) or DO (Doctor of Osteopathic Medicine)
Physical Medicine and Rehabilitation (PM&R), also called Physiatry, is the branch of medicine emphasizing the prevention, diagnosis and treatment of musculoskeletal disorders that may produce temporary or permanent disability. They handle everything from minor issues such as an injured knee to Spinal Cord Injuries and Strokes.
Most common treatment approaches: Specialize in non- surgical treatment, medication prescription, use of “whole body approach” that goes beyond the resolution of symptoms to include prevention of recurrence including referrals to Physical Therapy or Chiropractors.
Education: MD (Medical Doctor) or DO (Doctor of Osteopathic Medicine)
Low Carbohydrate Diet (<150g/day)
The “low-carb” diet has been all the craze lately, but other than losing weight quickly, living a low carb lifestyle has a multitude of additional health benefits:
1. Reduces the amount of insulin in your body.
In the right proportions, insulin is a necessary hormone required for energy production. However, when excess insulin is released, it can have annoying (weight gain) as well as devastating effects on your body. Insulin is released in proportion to the amount of carbohydrates (not fat or protein) consumed by the body. Therefore, lowering your carb intake lowers the amount of insulin released.
What is Insulin? It is a hormone secreted by pancreas in response to elevated blood sugar levels. It transports the sugar in the bloodstream into your muscles where it is used for fuel. Sugar that is not used for fuel is stored in the liver, and if there is still excess sugar in the bloodstream, it is converted to triglycerides and stored as fat in the body.
Negative Effects of Insulin:
Fun Fact: The body does not NEED carbohydrates to function properly.
Bottom Line: Excess insulin prevents you from burning fat, increases hunger & cravings, and increases risk of chronic diseases such as heart disease and diabetes (just to name a few).
2. Improves Cognitive Health.
A spike in blood sugar level decreases the function of the hippocampus, the area of the brain associated with memory and learning. Keeping your blood sugar levels consistent (no spikes or lows) will help prevent lapses in memory, keep you focused, and allow you to keep on learning.
3. Reduces the amount of trans-fats, wheat, and fructose in your diet.
Trans-fats raises LDL (bad) cholesterol, lowers HDL (good) cholesterol, and increases your risk for type 2 diabetes.
Wheat is addictive and contains two metabolic nightmares: Gluten & amylopectin A. Amylopectin A is easily digestible, resulting in a spike in blood sugar. The spike in blood sugar results in a proportional spike in insulin released into the bloodstream (see negative effects above). Gluten, when broken down into amino acids (polypeptides) is able to pass the blood-brain-barrier (protective barrier of the brain). Once the amino acids pass through the barrier, they are able to attach to our morphine receptors. Gluten, is basically a narcotic. It is addictive, causes spikes in blood sugar, and is appetite stimulate.
Fructose (a specific type of sugar, high-fructose corn syrup is the most commonly known) is metabolized (broken down) by the body like fat. When consumed, the body immediately converts fructose into triglycerides (fat) which is deposited in the liver. When you consume fructose, you are literally eating fat. Excess amounts of fat in the liver can lead to damage over time.
4. Reduces cravings and keeps you fuller longer.
By going low carb you are removing the addicting properties of wheat and naturally begin to substitute food that high in protein and fiber for carbs. Foods that are higher in protein and fiber take longer to digest, preventing spikes in blood sugar, and keeping you fuller longer.
5. Prevents your body from becoming acidic (pH).
Naturally your body likes to remain neutral (think of the pH scale). Carbohydrates are very acidic. When the body becomes too acidic, minerals are pulled out of bones and tissues to compensate. Over time, the leaching of minerals may result in osteoporosis (weak bones) and sarcopenia (decreased muscle mass). Overly acidic tissues also cause inflammation, impair reactions in cells, and overtax the lymphatic system, impeding the body’s natural detoxification process. Also, having an acidic resting state makes it very difficult to lose weight.
How to maintain a neutral pH:
Ultimately living a low carb lifestyle, allows your body to reach a metabolic harmony. Living a low carb lifestyle helps you maintain a healthy weight, reduces your risk of chronic disease, and improves your energy levels as well as your memory and learning capability. What is there not to like?
Pair a low carb lifestyle with some High Intensity Interval Training (HIIT), and you have the perfect combination needed to kick those pesky blood pressure and cholesterol medications to the side.
Healthline put together a list of the top calorie counting apps for 2015. Check it out, and keep track of those carbs!
Citation: Bowden, PhD, CNS, J. (2013). Living low carb: Controlled-carbohydrate eating for long-term weight loss (Rev. ed.). New York, NY: Sterling.
-Lauren Jarmusz, sDPT
We already know that the physical therapy profession has many career avenues one can pursue: pediatrics, geriatrics, orthopedics, cardiopulm, neuro, women’s health, and sports. As a 3rd year DPT student quickly approaching graduation, I am excited to pursue the numerous options offered, but I also want more for our profession. What other career opportunities can a well-educated Doctor of Physical Therapy use his/her knowledge base for?
Within the past 20 years, the PT profession has undergone multiple changes in order to improve the both the practices and patient outcomes. No longer is a master’s degree sufficient for entry-level practice. The American Physical Therapy Association has mandated that all programs for physical therapy be at the doctoral level by 2020. Within the past year, the APTA has published a new Guide to PT Practice 3.0, and has outlined new roles and responsibilities for PTs to get involved with population health initiatives. With the push for healthy living and keeping active, who is more knowledgeable in this domain than physical therapists? No one.
What is even more interesting is that technology has started to grow alongside one of the foundational components of the PT practice-- the exercise treatment plan. Now, startups (like Constant Therapy) and researchers are using virtual or internet-based home exercise plans to assist with rehabilitation for patients who have sustained a stroke or TBI. Now, and in the near future, the typical orthopedic patient will jump on this technological bandwagon using internet-based or gaming based home exercise plans to assist in their rehabilitation (shameless plug). Some even say that technological advances will render the PT profession obsolete. I highly doubt that, but if you’re interested in technology, PT is a fun field to get involved in!
Another exciting change is the result of the push for easier access to effective primary and preventative care. For example, as we age our body naturally begins to lose strength, bone density, quick reaction motor fibers, and our blood pressure slowly begins to rise.
How does one combat these changes?
Which profession understands how normal and abnormal physiological processes affect strength and endurance?
In fact, the concept of PTs acting as musculoskeletal primary care providers has already been shown to be successful in movement-intensive and movement-crucial organizations like the United States military. In a study published in Military Medicine, data was collected on treatment approaches and outcomes among PTs and family practice physicians serving as the PCP for members of the military with musculoskeletal issues. The return-to-duty rate was 50% higher for patients whose PCP was a physical therapist. That being said, why are Primary Care Physicians not referring their patients to physical therapists as part as a normal check-up? This lack of interprofessional care can open up new career opportunities for PTs. Another startup, PhysioCare, is trying (alongside many, many PT professionals) to address this issue first-hand.
I challenge other DPT students, as well as new or progressive-minded physical therapists to invest in changing the stigma of physical therapy from a reactive, fee-for-service based profession (that is many times underutilized and misunderstood), to a highly respected, knowledgeable network of professionals known for its forward thinking, its progress-minded initiatives, acceptance and use of technology, and its role in proactive primary care and population health. We’ve worked hard to get our degree-- let’s use our talents and knowledge not only to improve physical therapy, but healthcare overall.
In today's entrepreneurial market, company giants such as Facebook, Skype, and Instagram choose to target generations Y and Z, in hopes to create a tech savvy customer base which will use these services throughout their lifetime. This is indeed sound logic, but are today's entrepreneurs neglecting a generation soon to be an extremely profitable investment?
The baby boomers are projected to climb from 41 million in 2011 to 71 million by 2029. With about 3 million baby boomers reaching retirement age every year for about the next 20yrs, one would think an intelligent decision would be to take advantage of these possible 60 million customers. Some companies are already ahead of the curve inventing and branding technologies. Here are a few examples of three innovative individuals and one large healthcare company who have already tapped into the baby boomer market.
Marjorie Skubic, director of the Center for Eldercare and Rehabilitation Technology at the University of Missouri, and her colleague, nursing professor Marilyn Rantz, have created an alert system using a combination of motion sensors, radar, and sensors that gather depth information to produce 3-D images of people used to detect falls.
Yuval Malinsky, CEO of Vigorous Mind, a web-based brain wellness & social networking platform for senior living, home care and hospitals, hopes to delay age related decline in cognitive function with the simple concept of regular mental exercise and physical activity. The Vigorous Mind program addresses the basic human desires of communication and socialization, independence, curiosity, and enjoyment. A personal dashboard is created for each individual containing sections to: plan and organize one's day, communicate with their friends and loved ones through email and/or skype, engage in brain stimulating exercises and games, and "reminisce and record their life story using our proprietary "Recollections" database of pictures from the 1920-1990s".
Even the government is recognizing the ever increasing medical needs of the rising baby-boomer population. Through the Affordable Care Act, Avera Health has received an $8.8 million grant from the federal government to use telemedicine in rural nursing homes. If Dr. Skubic and Rantz's and Yuval Malinsky's programs as well as technologies such as "Telemedicine" are successful, imagine having these devices placed in every nursing home in the country. It would become a national standard. Interested in tapping into this market?
Come get your feet wet at our Technology Application & Clinical Process Innovation in Senior Care meeting. See more information at http://www.healthinno.org/upcoming1.html. Listen to Yuval Malinsky, CEO of Vigorous Mind, Dr. Jatin Dave, Medical Director of Geriatrics at Tufts Health Plan, and Lorraine Pigeon, Director of Clinical Geriatrics and High Risk Populations, offer some insight into the profitable geriatric space and learn how they are changing the face of healthcare. Will you be next?