Shared Decision Making in Physical Therapy

Shared decision making between a patient and health care provider is linked with improved patient satisfaction, adherence to treatment, and health outcomes. Involving a patient in decision making may also reduce anxiety and improve confidence in any physical therapy treatment plan. Traditional models of health care use a provider focused approach which does not always incorporate patient values or preferences. Shared decision making enhances the patient-doctor relationship by allowing “2-way traffic” or a balancing of power between a patient & his or her health care provider.

Charles & Colleagues have defined five characteristics of shared decision making

  1. At least 2 parties are involved: patient & therapist
  2. Both parties take steps to participate in the process of treatment decision making
  3. Information sharing between parties is a prerequisite to sharing decisions
  4. Deliberation takes place by discussing the treatment preference of both parties
  5. A treatment decision is made & both participants agree on the decision

Research has shown that most patients seeking health care prefer to share decisions with their provider. Studies have investigated patient involvement in general medicine, cardiology, oncology, and mental health. But how about patients seeking care from a physical therapist?

Research Supporting Patient Involvement in Physical Therapy

A 2013 study by Dierckx & colleagues1 showed that more than two-thirds of patients seeking care from a physical therapist prefer to be involved in the treatment decision making process. The majority of patients either wanted to share their opinions or be actively involved in establishing the treatment plan. However, most alarming from this study, was the fact that in most cases physical therapists falsely perceived that their patient did not want to share decision making. Many physical therapists assumed patients preferred to be passive in the decision making process but this was not the case as most patients preferred to be more involved. This study shows that most decision making in physical therapy continues to be based on a paternalistic approach whereby therapists act in ways they consider is best for their patient but ignoring the benefits of involving the patient more.

Implications for Promoting Shared Decision Making

Promoting a balancing of power in the patient-therapist relationship results in greater patient control over their problem. The patient is no longer a passive recipient of treatment but instead becomes actively involved. When exercise therapy is the treatment, the responsibility of success or failure has to be shared between the patient and the therapist. The patient must do their part. Most patients want to share decisions with their physical therapist and most want to express their opinion before a treatment decision is made. Physical therapists that are blind to patient preferences contribute to a lack of patient involvement in their care and promote dependence on the physical therapist. A wiser approach should seek to actively engage more with patients to achieve the goal of shared decision making.  This will promote patient empowerment and control over their pain or problem. For any successful outcome to be achieved in physical therapy, patients must gain a sense of control without dependence on others. Shared decision making is one step towards this outcome.

Thanks for Reading!

Ernie

References

  1. Dierckx K, Deveugele M, Roosen P, Devisch I. Implementation of shared decision making in physical therapy: observed level of involvement and patient preference. Phys Ther. 2013;93(10):1321-1330.

Communication & the Patient-Therapist Relationship

The result of physical therapy treatment relies on the interplay between the technical ability, communication skills, and reflective capacity of the therapist to respond to the patient. In previous articles we discussed how a positive patient-therapist relationship is associated with improved satisfaction and treatment outcomes. Now we turn to which specific factors influence this relationship in an outpatient physical therapy setting.

A recent study by O’Keefe & colleagues investigated which factors influence patient-therapist interactions in outpatient physical therapy. From the research four key themes emerged:

  1. The interpersonal and communication skills of the physical therapist
  2. The practical skills of the physical therapist
  3. Providing individualized patient-centered care (individualizing treatment and considering patient opinions in the care plan)
  4. Organizational or environment factors (time with the therapist and flexibility with appointments)

The remainder of this article goes into more detail about the importance of the communication and practical skills of the physical therapist.

Interpersonal & Communication Skills

Factors related to communication which are associated with positive patient-therapist interactions include active listening, empathy, friendliness, confidence, and encouragement. Patients want to tell their story without being interrupted or rushed. When physical therapists listen to their patients they feel understood and valued which strengths the relationship. Patients want their physical therapist to empathize with what they are enduring and understand how this impacts their lives. Physical therapists that interact in a relaxed manner and incorporate humor develop a stronger bond with their patients. Therapists who offer emotional support and encouragement are more likely to motivate their patients to adhere to treatment recommendations. Finally, patients who feel confident in their therapist are more likely to trust and respect their opinions and recommendations. Physical therapists that possess and have mastered these interpersonal skills foster a positive patient-therapist relationship which leads to better results from care.

Practical Skills

Patient education and physical therapist expertise have been shown to be the two most important practical skills which lead to improved patient-therapist relationships. Interestingly, patient education is perceived as important only by patients, not by most physical therapists. This may be related to the notion that many physical therapists view themselves as “healers” who administer a treatment passively vs. the perspective as a “teacher” who teaches the patient how to actively manage their own problem. Patients prefer the latter where they are provided with a sense of control over their pain or problem. Patients also want clear explanations about their problem/diagnosis. They want to know how physical therapy can help and they want to know the rationale for employing specific exercises. Avoiding medical technical terminology is important. Patients often feel understand best through use of analogies and metaphors. Also patients believe it is important that their physical therapist possesses excellent technical ability & skills which is often exemplified through advanced training or degrees.

Conclusion

Patients and physical therapist believe a mix of interpersonal and practical skills are important factors which influence their working relationship. Research has shown that the strength of this relationship influences treatment satisfaction and outcome. Therefore, seeking out care from physical therapists that understand and possess these skills is recommended to anyone considering outpatient physical therapy as a treatment option.

Thank you for reading

Ernie

References

  1. O’Keeffe M, Cullinane P, Hurley J, et al. What Influences Patient-Therapist Interactions in Musculoskeletal Physical Therapy? Qualitative Systematic Review and Meta-Synthesis. Phys Ther. 2015;96(5):609-622.

Patient-Centered Communication

The therapeutic alliance refers to the collaboration between a patient and medical provider, their affective bond, and agreement on treatment goals. The therapeutic alliance was described in more detail in a previous article. As a matter of review, trust and empathy have also been closely linked with the therapeutic alliance. Research has shown that maximizing the therapeutic alliance can positively impact treatment results, health, and patient satisfaction. A strong therapeutic alliance results in improved patient adherence and overall engagement in their treatment. Thus, maximizing the therapeutic alliance is an important component of patient-centered health care.

Communication and Therapeutic Alliance

Effective communication between the patient and medical provider is arguably the most important factor associated with the therapeutic alliance and maximizing its impact on treatment outcomes. Three key communication factors are involved in the patient-therapist encounter. These are verbal factors, non-verbal factors, and interaction styles. Verbal factors pertain to such aspects as greetings and specific questioning during the medical interview. Non-verbal factors include facial expressions, gestures, and body orientation. Interaction styles refer to information giving, providing emotional support, and sharing responsibility in decision making with the patient.

Researchers from Australia investigated which communication factors was most closely associated with a strong therapeutic alliance. Compared to verbal and non-verbal factors, patient-centered interaction styles showed the strongest association with the therapeutic alliance. Specifically, interactions that promoted patient involvement, support, and engagement were strongest. Allowing patients to tell their story and attentively listening to patient concerns are important considerations during the patient-therapist interaction. Answering all patient questions in a comforting and caring manner facilitates and supports the therapist-patient relationship. Finally, the therapeutic alliance is strengthened when therapists ask questions with a focus on the patient’s emotional issues and when therapists show sensitivity towards these emotional concerns. Brushing over patient’s emotional cues during a medical interview is never a good idea.

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Patient-Centered Communication Enhances Treatment Effects

Medical providers who adopt communication styles which are comforting, caring, empathetic, and involve the patient will foster a positive therapeutic alliance. This promotes patient adherence and engagement allowing for the best possible treatment outcome for the patient. For patients receiving care in outpatient physical therapy clinics it is important to keep in mind that these non-specific factors will only enhance the effects of any specific treatments used, such as exercise or manual therapy. I believe that both specific and non-specific aspects of treatment need to be considered for patients to obtain the best possible outcome and reach their goals.

Thanks for reading!

Ernie

References

  1. Pinto RZ, Ferreira ML, Oliveira VC, et al. Patient-centered communication is associated with positive therapeutic alliance: a systematic review. J Physiother. 2012;58(2):77-87

Physical Therapist-Patient Relationship

The relationship, or alliance, between a patient and medical provider has been considered a critical factor in the success of any treatment plan. The therapeutic alliance refers to the sense of collaboration, warmth, trust, and support between a patient and their medical provider (physician, physical therapist, etc). There are three proposed components which contribute to the therapist-patient relationship. These components are therapist-patient agreement on goals, therapist-patient agreement on the treatment plan, and the affective bond between the patient & therapist.

The Therapeutic Alliance in Mental Health & General Medicine

A positive therapeutic alliance has been associated with positive mental health outcomes for depression, anxiety, mood, interpersonal problems, and overall psychological well being. Trust is an important factor in the patient-physician relationship. Research shows that a patient’s trust in his or her general practitioner is positively correlated with improved pain, general health, and quality of life. Trust forms the basis for self-efficacy which in turn leads to improved patient adherence and health outcomes. A positive therapeutic alliance has been associated with improved treatment outcome in psychotherapy and general medicine but what about physical therapy? Physical therapy involves a high level of patient-therapist interaction where patients often attend multiple clinic visits per week each lasting 30 to 60 minutes. Therefore, it is plausible that maximizing the therapeutic alliance can positively influence outcomes for patients attending outpatient physical therapy.

The Therapist-Patient Relationship in Physical Therapy

In 2010, Hall and colleagues reviewed the research investigating the influence of the therapeutic alliance on physical therapy outcomes. Not surprisingly, the researchers found the alliance between the physical therapist and patient has a positive effect on multiple domains of treatment outcome in physical therapy. In particular the alliance between the patient and therapist positively correlates with an improved ability to perform activities of daily living, reduced pain levels, improved physical functioning, decreased depression, improved overall health, and improved patient satisfaction.

In order to maximize the positive impact of the therapist-patient relationship a practitioner must measure and continually seek to improve their abilities in this domain. The Working Alliance Inventory is the most frequently cited method to measure this relationship or alliance. At our Barnegat and Manahawkin outpatient physical therapy clinics we have chosen to utilize the Consultation and Relational Empathy (CARE) Measure to track the strength of the relationships we develop with our patients. Our physical therapists collectively discuss and seek to improve skills in fostering the therapist-patient relationship. From the available research in this area, this only improves the overall outcome patients achieve at our clinics.

Thank you for reading!

Ernie

Patient Satisfaction with Outpatient Physical Therapy

Health care in the U.S. is shifting towards a value-based system where patient satisfaction plays a key role in the patient experience. Patient satisfaction is a reflection of the individuals overall experience with receiving a given treatment. It can be viewed from two perspectives: the quality of care and customer service. Individuals who are satisfied with the care they receive are more likely to be adherent to prescribed treatments, which is linked to improved outcomes and an overall higher quality of life.

What Determines Patient Satisfaction in Outpatient Physical Therapy?

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A 2011 article published in the Physical Therapy Journal asked and answered this question1. Overall a high percentage of patients (68% to 91%) reported being satisfied or completely satisfied with their experience in outpatient physical therapy. Three key dimensions of the patient experience were found to be associated with patient satisfaction. These dimensions are the interpersonal attributes of the physical therapist, the process of delivering care, and how the care was organized. The process of care includes such factors as continuity of care (discussed in a previous article), adequate follow-up, and involving the patient in decision making. The organization of care includes such factors as convenient hours, parking, cleanliness of the clinic, and the overall helpfulness of the staff. The remainder of this article will discuss the physical therapist attributes associated with patient satisfaction.

Physical Therapist Interpersonal Attributes: The Strongest Predictor of Patient Satisfaction

The attributes of the physical therapist have been shown to be highly associated with how satisfied patients are with outpatient physical therapy. Examples of such attributes include the physical therapist’s skills, knowledge, professionalism, and friendliness. Most patients expect these qualities in any health care provider and are sometimes erroneously thought to be universal across all providers. However with the shift of health care towards a value-based system and increasing specialization, advanced training and lifelong learning are becoming increasingly important. Today most expert physical therapists hold doctoral degrees, are board certified, and have completed advanced residency or fellowship programs in their area of specialization.

Knowledge and skills are only the tip of the iceberg when it comes to maximizing patient satisfaction. Effective communication skills are the most important attribute that a physical therapist can possess. Patients want their physical therapist to provide clear explanations about their condition. What is the diagnosis? Patients want their physical therapist to offer prognostic information. How much improvement can I expect and how long will it take? And patients want their physical therapist to explain their role in the treatment process. What can I do for myself to recover quickly? Finally, and perhaps the most important attribute any medical professional can possess is empathy. Patients want to feel they are being listened to and dealt with in a sympathetic and respectful manner. This is becoming increasingly less common as busy clinics render treatment by multiple providers. Therapist-Patient interactions may suffer and empathy is sacrificed in the process.

Conclusion

Multiple factors contribute to patient satisfaction with outpatient physical therapy. The interpersonal attributes of the physical therapist are by far the most important of these factors. Specifically, effective communication and empathy have been shown to be strongly associated with patient satisfaction. When deciding on a physical therapist, do some homework and be sure these attributes are present.

Thanks for reading!

Ernie

References:

  1. Hush J, Cameron K, Mackey M. Patient satisfaction with musculoskeletal physical therapy care: a systematic review. Phys Ther. 2011;91(1):25-36.

The Same Physical Therapist: Preserving Continuity

Longitudinal continuity refers to a patient seeing the same health care provider over time and developing a therapeutic relationship built upon trust. Research has shown that longitudinal continuity with the same primary care physician is associated with high satisfaction, trust, and adherence1. Later I will touch on similar research undertaken in outpatient physical therapy practices.

It is common for individuals who attend outpatient physical therapy to be seen by multiple physical therapists over the course of their treatment. BSR believes patients should be seen by one physical therapist over the course of their treatment. Patients at both our Barnegat and Manahawkin physical therapy clinics are managed by a single physical therapist. Our patients routinely cite this as one of the primary reasons they chose us. Unfortunately, the changing landscape of health care has forced many larger corporate owned or hospital based outpatient physical therapy clinics to adopt a different model. This conflicting model sacrifices the patient’s ability to be managed by a single therapist.

Why Sacrifice the Physical Therapist – Patient Relationship?

There are several possible reasons why an outpatient physical therapy practice would not seek to preserve longitudinal continuity. Administrative convenience, where the practice schedules patients with the earliest available physical therapist, often takes precedence over preserving the physical therapist – patient relationship. This is the result of a production model of healthcare where providers are viewed as interchangeable with emphasis placed on filling therapist’s schedules and maximizing productivity versus preserving longitudinal continuity. We view these as unacceptable reasons to schedule patients with multiple physical therapists. However, there are times when the complexity of the patient’s condition warrants additional consultation with a second physical therapist. Also, therapist vacations or illness may necessitate a small number of treatment visits with a covering physical therapist. This should be the exception not the norm at a physical therapy clinic.

The Benefits of Preserving Continuity

Now let’s turn to some of the research which supports an approach based on continuity. Beattie and colleagues2 investigated the association between longitudinal continuity (seeing the same physical therapist) and patient satisfaction. These researchers looked at more than 1,500 patient satisfaction surveys from six different private outpatient physical therapy clinics. Seventy percent of those completely satisfied with their experience were seen by a single physical therapist. Only thirty percent of those completely satisfied were seen by multiple physical therapists. Put another way, those who received outpatient physical therapy care from only one therapist were 3 times more likely to report complete satisfaction than those who received care from more than one therapist. Based on this research, clinics should make every effort to preserve longitudinal continuity as a means of improving the patient experience.

Our experience, the opinions of others (EIM Blog) and published research supports the idea that patients who attend outpatient physical therapy deserve the right to be seen by the same physical therapist. This maximizes the physical therapist – patient relationship which promotes trust, adherence, satisfaction, and the best possible outcome. When inquiring about outpatient physical therapy be sure to ask the facility if you will be seen by the same physical therapist every visit.

Thank you for reading!

Ernie

References:

  1. Baker R, Mainous AG III, Gary DP, et al. Exploration of the relationship between continuity, trust in regular doctors and patient satisfaction with consultations with family doctors. Scand J Prim Health Care. 2003;21:27–32.
  2. Beattie P, Dowda M, Turner C. Longitudinal continuity of care is associated with high patient satisfaction with physical therapy. Phys Ther. 2005;85(10):1046-1052.

Direct Access Physical Therapy: Q & A

Many healthcare consumers are unaware of the fact that they are free to access the services of a physical therapist without a physician referral. Every state allows for evaluation and some form of treatment without a physician referral. This has been the case in the state of New Jersey for almost 15 years, yet most of the patients that we work with in our Barnegat and Manahawkin physical therapy clinics are unaware of this. Most continue to believe that they must first visit another health care provider before seeking the services of a physical therapist. When we educate people about direct access we are greeted with a bit of surprise and many questions. Below are a few of the common questions we receive about Direct Access.

Direct Access saves time, saves money, and improves outcomes.

What are some of the advantages of accessing the services of a physical therapist first?

Directly accessing the services of a physical therapist saves time and money. Consumers are able to avoid wait times to see physicians and avoid delays in treatment while further testing might be pursued. Often these tests are not necessary and can potentially slow or negatively impact recovery (MRI for Low Back Pain>). A 2014 systematic review concluded that direct access controls health care costs and promotes high quality healthcare1. Compared to accessing physical therapy through a physician referral, those who directly accessed services were more satisfied with care, were prescribed fewer medications, underwent fewer diagnostic tests, and achieved better overall outcomes in fewer physical therapy treatment sessions. We have observed similar findings at both our Barnegat and Manahawkin physical therapy clinics. Patients who access our care directly achieve better overall outcomes in 20% fewer treatment sessions.

Are physical therapists qualified to deliver direct access services independent of physician referral?

Yes. Physical therapists are licensed healthcare professional who hold doctoral degrees. Physical therapists undergo extensive training in differential diagnosis and medical screening. This entails distinguishing non-serious musculoskeletal problems (low back pain, rotator cuff problems, meniscus tears, arthritis, etc) from more sinister potentially life threatening conditions (cardiac disorders, cancer, etc). Physical therapists at BSR Physical Therapy have also undergone more extensive residency, fellowship, and board certification training which focus further on these diagnostic skills. Physical therapists are not trained to make or confirm serious diagnoses but we are able to recognize when patients do not belong in our clinics and need an appropriate medical referral. We routinely refer patients to other medical specialists based on our physical exam or when the patient is not progressing towards their goals. Physical therapist’s clinical examination skills are on par with or better than most other healthcare professionals (Evidence here). How many other healthcare providers are going to spend one full hour actively listening to their patients in order to elicit all their concerns and then perform a comprehensive physical examination?

Will insurance companies cover direct access physical therapy services provided without a physician referral?

More and more health insurance companies are now covering physical therapy services without a physician referral. This is because of emerging research evidence showing cost savings with this approach2. At our clinics our front office professionals verify all health insurance benefits before starting treatment. In the majority of instances (>75% of cases) we are finding that a physician referral is not necessary to access and cover physical therapy care.

Approximately 10% to 20% of our patients access physical therapy care directly and this number is on the rise. Healthcare consumers are saving time, money, and achieving superior outcomes with greater convenience when directly accessing physical therapy. Health insurance companies are now recognizing these advantages as well. As health care reform continues to evolve, the health care consumer is becoming a more active participant in their own care. Direct access to physical therapy is here to stay and growing.

References:

  1. Ojha H a, Snyder RS, Davenport TE. Direct access compared with referred physical therapy episodes of care: a systematic review. Phys Ther. 2014;94(1):14-30.
  2. Pendergast J, Kliethermes S a, Freburger JK, Duffy P a. A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy. Health Serv Res. September 2011:1-22.

Neck Pain: Postural Correction Strategies

Retraining neutral sitting posture is an important factor in the recovery from of an episode of neck pain and also for preventing future episodes of neck pain. Sitting postural correction becomes especially important for those of us who spend a great deal of our time working at a computer or seated at a workstation of any kind. Most present day occupations and many leisure activities (involving the internet or a mobile device) place the neck and upper back in vulnerable positions stressing many anatomical structures of the cervical spine.

Frequent correction of neutral sitting posture serves two primary functions. First, it allows for regular reduction of adverse loads placed on the joints of the spine due to poor neck and upper back posture. Second it provides a training effect to the deep cervical stabilizing muscles during their functional postural supporting role. The aim of postural correction strategies is to change postural habits, not to strengthen weak muscles. Ultimately this should result in a comfortable low effort strategy which is easily assumed and maintained during prolonged sitting activities. Rigid high-effort correction of sitting posture should always be discouraged as this often results in increased muscle activity and pain.

Key Aspects of the Seating Surface

  • The feet should be flat on the floor
  • The thighs should be slightly inclined downward from horizontal (hips slightly higher than knees)
  • The buttocks should be completely supported by the seating surface
  • Go here for more tips on computer ergonomics

Sequence of Correcting Sitting Posture

  1. Gently roll the pelvis back and forth until sitting on the bony prominences deep within the buttock (ischial tuberosity). This will restore the natural curve (lordosis) in the small of the low back. This first step is the most important.
  2. Without arching or extending the spine, slightly lift the breast bone (sternum). Minimal correction should be needed here.
  3. Finally, slightly lift the back of the head towards the ceiling in order to achieve a neutral position of the eyes relative to the horizon. If steps one and two are performed correctly, minimal to no correction will be needed at the head and neck.

The neutral position should be comfortably maintained for ten seconds and repeated every 10 to 20 minutes during sitting. A timer is recommended to ensure adherence to the schedule. In between repetitions of the postural correction exercise a relaxed non-rigid posture should be assumed. We should not attempt to maintain “the perfect posture” during prolonged sitting. This is not recommended or realistic. Over the course of several days or a few weeks of practice, the neutral sitting posture will be more easily attained without conscious thought. Through self-awareness the body will learn this new strategy just like any other practiced skill ultimately leading to a healthy postural habit requiring little effort or conscious thought.

Now go ahead and try it….then re-read this blog post for reinforcement.

References

  1. Falla, D., O’Leary, S., Fagan, A., & Jull, G. (2007). Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting. Manual Therapy, 12(2), 139–43.
  2. Wegner, S., Jull, G., O’Leary, S., & Johnston, V. (2010). The effect of a scapular postural correction strategy on trapezius activity in patients with neck pain. Manual Therapy, 15(6), 562–6.

 

Low Back Pain: How Helpful is an MRI?

It’s not often that I am in agreement with health insurance companies but they seem to be getting one thing right as of late. We have noticed an increase in patient’s referred to our clinics for low back pain that have not undergone advanced diagnostic imaging techniques, such as MRI. It appears that large insurance companies are denying authorization for these MRI’s until the patient has undergone a course of physical therapy (more on the topic). Physical therapists are certainly on board with these decisions but some of our patients are often confused or annoyed by their insurance company dictating their care. So, should patients with an acute onset of low back pain undergo routine MRI or undergo a course of physical therapy first? Why not be safe and undergo the MRI first? How can a physical therapist offer treatment without knowing what the problem or diagnosis is?

Physical Therapy or MRI First?

A recent study published in the journal Health Services Research investigated this question. Researchers found that those patients seeking primary care services for low back pain and were referred for an early MRI underwent higher health care utilization at increased costs compared to those receiving early physical therapy. The additional cost of receiving the MRI first was nearly $5000 more than receiving early physical therapy. Earlier research studies show that consulting a physical therapist early results in decreased odds of undergoing diagnostic imaging (here) and decreased odds of undergoing future surgery for low back pain (here). Delaying physical therapy has also been associated with increased prescription opioid (narcotic pain medication) use and most of us are aware of how big of an epidemic this is becoming (more here).

Why Not Play it Safe and Undergo the MRI First?

A 2003 study in the Journal of the American Medical Association compared the use of early MRI vs. early x-ray for patients with a new episode of low back pain. One year later, pain levels and disability were no better in those undergoing the MRI. Of note, the group receiving the early MRI was more likely to undergo back surgery. This is not surprising given the high likelihood of pathological findings in asymptomatic subjects (no low back pain) who undergo advanced diagnostic imaging. A 2015 systematic review reported the prevalence of disc degeneration in asymptomatic individuals ranged from 37% of 20-year olds to 96% of 80-year olds. Similar rates were reported for asymptomatic disc bulges. If so many people without low back pain have these findings on MRI we cannot confidently conclude that these findings are the true cause of symptoms. Making erroneous assumptions based on MRI findings often leads to over treatment. The more testing and treatment a patient undergoes the more likely factors such as fear and anxiety come into play and these are the factors that have been associated with persistent or chronic low back pain.

Physical Therapy Treatment without Imaging

MRI or further medical work up is always indicated in situations where serious pathology is suspected or when response to initial treatment is poor. However, low back pain emanating from serious pathology has been estimated to occur in less than 2 percent of cases. Doctor’s of physical therapy are trained in screening for these signs and when there are any suspicions of non-musculoskeletal problems prompt referral is indicated. In most cases these problems are ruled out based on a detailed interview and medical history. Physical therapists then base their examination and treatment on the individual patient’s signs and symptoms; not based on a diagnosis or MRI scan. Physical therapists are concerned with how movement affects symptoms and how symptoms affect movement.

In most cases of low back pain delaying the MRI is the best approach.

Improving Running Mechanics to Avoid Overuse Injury

Spring is finally here and the nicer weather is nearly upon us. With longer and warmer days we are starting to see more and more folks outdoors exercising. Runners in particular tend to ramp up their training during this time in preparation for the spring and summer running season. One event we are looking forward to is the annual Get LBI Running 5k which is slated for Saturday May 16th.

In a given 12-month period 50% to 75% of runners sustain an injury. Due to the repetitive loading involved with running, even mild abnormal movement patterns can accumulate over time and result in overuse injuries. Some of the more common overuse injuries that runners sustain include patellofemoral pain, IT band syndrome, stress fractures, plantar fasciitis, compartment syndrome, and medial tibial stress syndrome (commonly called “shin splints”). Running mechanics play a significant role in running related injuries. Physical therapists are experts in examining and correcting abnormal movement patterns and this inlcudes running mechanics.

Research shows that training by qualified experts can improve running mechanics and potentially decrease the risk of injury. For example, runners undergoing cadence retraining showed improved running mechanics after 6 weeks of training. One case study, showed that step rate retraining combined with hip strengthening exercise resulted in improved running mechanics and reduced pain for a runner with iliotibial band syndrome. In controlled laboratory settings, computer and video analysis can show which features of running should be corrected. This could include excessive vertical oscillation, over-striding, excessive trunk lean, and excessive arm rotation. In clinical settings, real time feedback using a treadmill, mirror, and verbal cues by a physical therapist have been shown to improve running mechanics. One study showed that this type of running retraining also carried over to improved movement patterns with squatting and stair descent even though no additional movement-specific training was undertaken.

Runners with a history of overuse injuries and those currently experiencing pain may benefit from a running analysis by a physical therapist. Retraining running patterns does not require high tech equipment or multiple sessions with a physical therapist. Research shows that running mechanics can be improved with a treadmill, mirror, verbal cues from a physical therapist, and quite a bit of deliberate practice on the part of the runner.

Cheers!

Ernie