The Neck is Part of the Core - Chin Tuck Exercises

How do we strengthen our neck? In High Intensity Interval Training (HIIT) workouts, it's not uncommon to hear people say that their neck fatigues before anything else when they are working on core strengthening. They are limited by neck pain when doing V-ups, sit-ups, bicycles, etc.

Research has shown that the way we strengthen our core is from the inside out. Meaning, we have to address the deepest layer of muscles that stabilize the spine before we ask the bigger muscle groups to start working on movement. In my last post, I made an argument that the core includes the neck, shoulder, abdomen, and hip stabilizers. For the neck, the deep neck flexor muscles as a group should be addressed with core strengthening. The neck is very similar to the low back. Think of the low back and how the abdominals are in the front of the trunk and work to bend the spine and/or keep it stable. Now, looking at the neck, it has the same directional curve and the deep neck flexors are positioned in front to draw the chin down or keep the spine supported. Essentially, the deep neck flexors are the "abdominals" of the neck, stabilizing it prior to and during movement.

The chin tuck is a simple exercise that draws attention to the deep neck flexors. As you can see in the video, I am gently tilting my chin down as if I am making a double chin. Ideally, one would perform a chin tuck and then hold the position for up to 10 seconds for 10 repetitions every hour through the day. Note that I am not jamming my chin down but simply nodding. This puts the neck in an optimal position for the deep neck flexors to protect and support the spine as one progresses into crunches, sit-ups , V-ups, and more challenging exercises. Several peer reviewed studies have shown significant improvement in neck pain and neck strength when subjects performed chin tucks frequently through the day. If you are unable to lay down through the day, you may also perform this exercise in a sitting position. Remember again that it is a simple chin tuck taking the head back over the shoulders, not looking down and flexing your neck. If you feel like you are hardly doing anything, you are likely doing it right. The movement is subtle but important for proper head and neck positioning.

 Meredith L. Bremner, PT, DPT, Cert. DN

Doctor of Physical Therapy

Rocky Mountain Spine and Sport, LLC

For further information on neck pain and strengthening, visit our website and schedule to see a skilled physical therapist. www.rmsspt.com

5 Ways to Improve Your Overall Fitness

   

1.    Get up and get going … no matter what the exercise is, just start somewhere. "Motion is lotion" and the body was designed to move. Our joints, ligaments, muscles, and connective tissue are all at their optimal function when challenged on a daily basis. For some, this may be through high intensity interval training (HIIT) workouts and for others this might be walking 30 minutes. Just start somewhere!
 
2.    Work on your core regularly. We used to think that the core was limited to the abdominal muscles, but it pertains to the axial skeleton which includes the neck, shoulders, back, abdominals and hips. There are key exercises for each region that should be in your routine to maintain a strong foundation on which you can move. Stay tuned on our website to see an example exercise for each region.
 
3.    Vary your training and goals - Our bodies respond to change. This means that if we are doing the same exercises over and over with the same amount of load, our bodies won't respond. If you would like to get stronger or more fit, consider changing the type of exercise or vary your weight and intensity. Sometimes this can best be done through the year with the changes in season. In the summer, take the opportunity to get outside with the nice weather and take a break from lifting in the gym. You will notice a change with more cardio and your muscles and joints may thank you for the much needed break.
 
4.    Find a training buddy … Research has shown that people do much better with exercise in a social setting provided there are common goals. Find someone who will keep you honest and even push you a bit. This can really help you with your consistency and improve your overall fitness.
 
5.   See your local Physical Therapist for a precise exercise program and recommendations tailored to your body's unique needs. A Physical Therapist is trained in the evaluation and examination of human movement and function and can identify movements that will help you reach your goals.

See rmsspt.com for locations and our staff bios. 

Meredith L. Bremner, PT, DPT, Cert DN

Doctor of Physical Therapy

Rocky Mountain Spine and Sport, LLC

Finding a Quality Physical Therapist: How Do Americans Evaluate Quality

I recently read a report based on a survey, conducted by the Associated Press-NORC Center for Public Affairs Research, that Americans do not think that information about the quality of health care providers is easy to come by, and they lack trust in information sources that tend to produce such indicators. It also revealed that when it comes to what being a quality health care provider means, there is a disconnect between how experts and consumers define it. The survey found that most Americans focus on the doctor-patient relationship and interactions in the doctor's office, with fewer thinking about the effectiveness of treatments or their own health outcomes. Further, individuals report that they value provider quality over cost and are willing to pay more for higher-quality doctors, but when asked directly in the survey, few report having done so.

http://www.apnorc.org/PDFs/Finding%20Quality%20Doctors/Finding%20Quality%20Doctors%20Research%20Highlights.pdf

 "When Americans are asked to volunteer what they think is the most important factor that makes a high-quality doctor, responses vary widely but mostly focus on doctor-patient relationships and personality (59 percent), rather than on the delivery of care or the patient's own health outcomes (29 percent). Most frequently, Americans say that a quality doctor listens, is attentive, or shows interest in them (18 percent). Other top responses focus on doctor-patient interactions and their traits, including that the doctor has a caring attitude (8 percent), good bedside manner (8 percent), various other positive personality traits (7 percent), and time spent with patients (5 percent). Relating to the delivery of care or patients' own health outcomes, 11 percent values most a doctor's ability t accurately diagnose and fix their health problem, and percent mention a knowledgeable doctor".

So this got me thinking, would the same survey given to Americans who have had #physicaltherapy have the same findings. I tend to think that it would, however I also think that the number for patients/clients who relate positive outcomes to quality #pt would be higher than with physicians.

Patient's come to physical therapy expecting pain relief and functional improvement, however the power of listening, being attentive and showing interest in a patient both personally and clinically is very powerful. Over the years I have had many patients who have failed physical therapy due to more severe underlying pathology, had surgery, and then returned rather happily to PT with me. I attribute this to a strong trusting relationship that was built during our treatment sessions which happen through active attentive listening and a caring attitude.

Physical therapists' have the opportunity and advantage as compared to other health care professionals when it comes to building a trusting relationship. First of all, we typically spend at least 30 minutes with our patients giving us plenty of time to first listen and then counsel and treat. Secondly, we have more frequent follow up visits to implement our plan of care. Unfortunately insurance and reimbursement constraints have led to the practice of "volume scheduling" leaving less time for attentive listening.

Every human being wants to feel important and heard, especially when dealing with a health issue. #Physicaltherapists are by training, as are physicians, good listener's, however projecting a caring attitude and good bedside manners are traits that generally cannot be taught, they are innate.

Eric W. Krell, PT, DPT, BScPT, MTC
Co-owner Rocky Mountain Spine and Sport, LLC
follow @EKrellDPT

The Benefits of Physical Therapy

"I have often said, and I see it becoming more true with each passing year especially now with the increase of life expectancy and the desire on the part of many to stay engaged during those years, that while medicine and surgery may save lives, no profession speaks to the quality of those lives better than does physical therapy."

                                                                                                                                             

- Stanley V. Paris PT, PhD, FAPTA

                                                                                              (Mildred Elson Award, Acceptance

Speech, Amsterdam, 2011)

Many people do not know all of the ways that physical therapy can help them, if you find that you cannot do certain things because of pain, then it might be time to talk to your doctor or call Rocky Mountain Spine and Sport to see if physical therapy can help you.

There are certain signs that you may benefit from physical therapy. These signs can include:

• Inability to stand or sit comfortably for long periods of time

• Back, neck or joint pain

• Limited movement at any joint or in your neck/back

• Difficulty getting in and out of bed

• Trouble sleeping

• Inability to walk for at least 20 minutes

• Trouble with balance or unsteadiness

• Unable to enjoy leisure or recreational activities

• Unable to interact with children or grandchildren

• Limited ability to exercise

• Unable to work

• Difficulty going up and down steps or curbs

• Regular headaches

• Pain with chewing, or a painful clicking in your jaw

If you find yourself in pain or discomfort from the most basic daily activity, alleviating this could be found in physical therapy treatment. Physical therapy doesn't involve medication and it doesn't mask the pain or discomfort. Physical therapy is intended to resolve the issue. To get you back to normal and allow you to enjoy the things you love to do.

The key benefits of physical therapy are to evaluate physical problems, increase and maintain muscle strength and endurance, restore and increase joint range of motion, increase coordination, decrease pain, decrease muscle spasms, decrease swelling and inflammation of joints, promote healing of soft tissue injuries, correct walking problems, educate patients and family, decrease stress and many more too numerous to mention.

The American Physical Therapy Association (APTA) has defined physical therapy as a clinical approach utilizing skilled, specific hands-on techniques, including but not limited to the manipulation/mobilization, used to diagnose and treat soft tissues and joint structures for the purpose of modulating pain and improving function.

At Rocky Mountain Spine and Sport Physical Therapy it is our goal to get every one of our patients back to work.... play.... life!  We have highly trained physical therapists at five convenient locations ready to help you. There is no need to wait any longer, physical therapy can help you regain full use of your body and put you on the road to recovery. Call one of our locations today to get started.

Eric Krell  - PT, DPT, BScPT, MTC

Follow @EKrellDPT

Six Things to Know Before Choosing a Physical Therapist

So your Doctor says you need physical therapy or, as in many states with direct access, YOU decide you want to see a Physical Therapist (PT).  How do you go about choosing the right PT and PT establishment?

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Many people don’t realize that they have a choice when it comes to where they attend physical therapy. Yes, your Doctor may have recommended a place to you who could be great and truly based on a history of proven outcomes, OR it could be because they have a financial interest in where you receive PT.  This is an entirely different subject.  Just be aware that this arrangement is out there.

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You are the director of your own healthcare, and it’s important to make an informed choice. Consider the following six criteria that can make all the difference in your care and more importantly your outcomes.

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1.      Credentials: Not all Physical Therapists are created equal.  Yes, we all have the same underlying core education, however post-graduate experience and continuing education is key to you getting the care you need.  Credentials are an indication of advanced or specialty training that can mean you will feel better and move better, faster. Look for a therapist who has experience treating your specific condition and pursues advanced training, such as orthopaedics or manual therapy. Here are some credentials to look for: MTC, COMT, OCS

2.      Customized: Every patient is unique with their own health history, physical challenges and diagnosis. Ask about the plan of care that will be created specifically for you to reach your goals. Your plan of care should be tailored to your needs and be dynamic in that as you progress, so does your plan of care.

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3.      Convenience: Studies show you are more likely to complete your plan of care when the clinic is convenient to your home or place of employment, so set yourself up for success. Completing the plan of care is a very important step towards recovery as studies have shown that those who do complete their plan are seven times more likely to return to work, use less healthcare benefits and are seven times less likely to have additional surgeries.

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4.      Compliance: Your health insurance may require a referral as part of your insurance plan.  As of 2013 there are 46 States that have some form of Direct Access to PT, which in its purest form means you do not need a referral to see a PT.  Colorado happens to be one of those states. You may check with your insurance company and ask about referrals, copays and coinsurance or simply contact one of our locations and we will contact them for you.  Compliance with State and Federal insurance regulations is very important.

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5.      Confidence: Recommendations from patients who had a great experience can help you make your decision with confidence. Ask the therapist for testimonials or search out comments on their social media page or website.

6.      Personality: This is a big one!  Personalities matter.  I believe this criterion is probably the most important. If all of the above 5 factors are good initially but there is a core personality difference between you and your PT, the overall FIT will not be good and soon confidence and compliance will decay and once this happens who cares how convenient, customized and credentialed the PT is.  It is human nature, sometimes we just don’t click.  Do not settle.  This does not mean you have to leave the PT establishment.  You don’t have to give up the convenience and compliance.  Simply request to see someone else.  We’re all adults and your PT should be understanding and helpful.  One key to a great PT is that they understand their limitations and seek to get you to the right person.

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I hope this has been helpful.  Before you make your first appointment call the office you are considering or, even better, stop by, ask questions and request to meet briefly with one of the PT’s.  Rocky Mountain Spine and Sport is here to serve your specific rehabilitation needs.  We invite you to stop in, see one our clinics, walk around and meet a PT.

Eric Krell  - PT, DPT, BScPT, MTC
Follow @EKrellDPT

Community Involvement

Rocky Mountain Spine and Sport is committed to the Colorado communities in which we provide Manual Orthopedic Physical Therapy.  Since opening our first outpatient clinic in Lone Tree, Rocky Mountain Spine and Sport has made a priority of giving back. ​
How can an outpatient orthopedic physical therapy company give back, you might ask?  There are many ways.  We have given free educational seminars on topics ranging from managing osteoporosis through exercise, managing low back and neck pain pre and post-operatively as well as sports injury rehabilitation and preventive exercise training.

You may also see the Rocky Mountain Spine and Sport tent at many local 5 and 10k fun runs.  We have also teamed up with Boulder Running Company and had some of our experienced Manual Physical Therapist’s give talks on running injury and prevention.
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Since 2009 Rocky Mountain Spine and Sport has held a food drive at each clinic location.  We have collected almost 1000 pounds of food each year which is donated to the Elbert/Douglas County Task Force.
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Please contact us if you would be interested in having one of our Physical Therapists from any of our Denver locations present on a topic of interest to your company or staff.  We are here to serve.

Eric Krell  - PT, DPT, BScPT, MTC
Follow @EKrellDPT

Physician Owned Physical Therapy Practices: The Dollars Behind Your Referral; That Nobody Talks About

I’m a Physical Therapist (PT) first, but LOVE entrepreneurship and the thrill of taking a business concept and turning it into a thriving reality.  I’m all about free enterprise but as a co-founder and co-owner of a growing independently, PT owned practice I am finding it hard to accept the slowly growing trend of physician owned physical therapy clinics.

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I have been practicing physical therapy since 1995.  Back then the payment system was a “fee for service” system.  Basically, whatever you billed you received payment at 100%.  Then Healthcare Management Organizations (HMO’s) steam rolled the fee for service system significantly managing care and reorganizing the payment structure.  Thankfully this has toned down a bit since the early 2000’s and we are seeing less HMO management, but unfortunately ever decreasing reimbursement continues.  With the decreasing reimbursement and the need to pay overhead some PT clinics and physician’s office have had to increase volume to meet their financial needs.  I get it.  We have to be lean and mean but without sacrificing quality of care!  However, the means at which some will go to, to pay bills and maybe line their wallets is beginning to bother me.

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Most state regulatory agencies do allow for physicians to own a PT practice even though the state PT practice acts and our national association have some language against physician owned practices or POPTS (physician owned physical therapy services).  In Colorado, there are a handful of POPTS clinics in town all of which are orthopedic surgeon owned.  Without directly calling them out by name I can tell you this, they typically schedule PT patient’s/clients every 15 minutes and are often supervising 2 to 4 patients at one time.  Now that is some volume.  But what about the quality of care; the one-on-one, hands-on treatment that most post-surgical patient’s and in my opinion most patient’s require?  You can answer that one for yourself.  I get more complaints from patients that have been to one of those clinics about the lack of personal care and the feeling of being run thru a mill then I get from patients that came from private PT owned clinics.

On the clinical side, every time I see a post-operative patient that has left PT due to poor progress and more specifically adhesions (usually in the knee or shoulder) they were attending PT at a POPTS clinic or a strictly managed care/insurer like Kaiser.  Adhesion happens, but most of the time it is due to poorly managed post-operative care in PT as long as there were no major complicating factors like infection and/or an unusually long period of immobilization.

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The monetary benefit behind your referral is obvious.  There are people that do very well in these clinics however there is a misunderstanding that the care is better because it is connected with the surgeon’s office and since the surgeon sent me there I better do what they say.  Not necessarily true.  I recently learned of an arrangement with two Colorado orthopedic surgery clinics and a PT clinic where the Surgeons get a significant percentage of the billings from the PT services provided at the clinic on patient’s they refer.  My understanding is the physician’s office will bill for the PT services done offsite in a clinic that structurally, based on state documents, they really don’t own.  It sounds kind of dirty doesn’t it?

Wouldn’t you want to first go to a clinic that your surgeon recommends because they give outstanding service and have excellent published outcomes and secondly to a place that is convenient to your work or home so that attendance in the early phase of rehab is easy?  All PT clinics and PT’s are not created equal regardless of what they say on their web site.  I wish that wasn’t the case but it’s a fact of life as with most professions.

Rocky Mountain Spine and Sport does not and will not in any way participate in the devaluing of our profession or sell-out to a Physician group for referrals as this only hurts our practice and in my opinion leads to poor care.  We can also back up our statements of quality care with outcome studies.  Ask for it, we’ll provide it.

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So may you, the potential client/patient, ask questions about your referral and why you are being sent to a specific PT clinic.  May you also do your homework and ask questions regarding your care at the PT clinic before you sign up.

Eric Krell  - PT, DPT, BScPT, MTC
Follow @EKrellDPT