YouTube – EIM Elevator Pitch – BJ Lehecka 1st.wmv.

BJ from from Wichita State University won the top prize of $1000 in Evidence In Motion’s 30 Second Elevator Pitch 2008 Competition!

ALEXANDRIA, VA — A new review article published in the Journal of the American Academy of Orthopaedic Surgeons should help convince many patients with low back pain to consider physical therapy as a first line of treatment for their condition, according to the American Physical Therapy Association (APTA). The review, published in February 2009, recommends that in most cases of symptomatic lumbar degenerative disc disease, a common cause of low back pain (LBP), the most effective treatment is physical therapy combined with anti-inflammatory medications. Approximately 75 to 85 percent of adults will be affected by low back pain during their lifetimes.1

Symptomatic lumbar degenerative disc disease develops when a disc weakens (often due to repetitive strain), is injured, or deteriorates from aging. As a result, the disc is unable to hold the vertebrae as it should and the lack of stability can cause back pain.

The review details the different treatment methods for symptomatic lumbar degenerative disc disease, including physical therapy with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and concludes that, in most patients with low back pain, symptoms resolve without surgical intervention. The review also concludes that physical therapy and nonsteroidal anti-inflammatory drugs are the “cornerstones” of non-surgical treatment.

Physical therapist intervention includes strengthening of core muscle groups, including the abdominal wall and lumbar musculature, which can have positive effects in patients with this condition. According to APTA spokesperson Julie Fritz, PT, PhD, ATC, clinical outcomes research scientist at Salt Lake City’s Intermountain Healthcare and associate professor at the University of Utah, physical therapists have several treatment options that can help patients with LBP whether due to degenerative disc disease or a variety of other causes.

Exercise and manual therapy including spinal manipulation, have been shown to benefit many patients.2, 3. In addition, patient education to remain active and use appropriate body mechanics is beneficial. Physical therapists are trained to identify which of these treatment strategies will be most effective for an individual patient, which further improves the effectiveness of care.

In previous systematic reviews of the literature, it was found that exercise has been shown to improve function and decrease pain in adult patients with chronic LBP and that physical therapy was beneficial for the treatment of acute LBP.2, 3 In another systematic review, NSAIDs were found to provide LBP patients with short-term symptomatic relief.4

“Receiving care from a licensed physical therapist can further improve the odds that a patient can maintain their quality of life and avoid surgery,” said Fritz. In addition to building the core muscle groups, hands-on therapy to mobilize the spine has been shown to be particularly effective. 5, 6  “Spinal manipulation can be an important component of physical therapist treatment for low back pain. Supplementing exercise with spinal manipulation is also beneficial for many patients.”

Physical therapists can help patients develop a safe and effective exercise program that is tailored to an individual’s specific needs and goals. “Surgery should be the last option, but too often patients think of surgery as a cure all and are eager to embark on it,” said Luke Madigan, MD, an attending physician at Knoxville Orthopaedic Clinic, Knoxville, TN, and the lead author of the literature review.

Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility – in many cases without expensive surgery or the side effects of prescription medications. APTA represents more than 70,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Its purpose is to improve the health and quality of life of individuals through the advancement of physical therapist practice. In most states, patients can make an appointment directly with a physical therapist, without a physician referral. Learn more about conditions physical therapists can treat and find a physical therapist in your area at www.moveforwardpt.com.

1Andersson GB: Epidemiological features of chronic low back pain. Lancet 1999; 354:581-585.

2Hayden JA, van Tulder MW, Malmivaara A, Koes BW: Exercise therapy for the treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005;(3):CD000335.

3Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG: Spinal manipulative therapy for low back pain. Cochrane Database Syst Rev. 2004;(1):CD000447.

4vanTulder MW, Scholten RJ, Koes BW, Deyo RA: Nonsteroidal anti-inflammatory drugs for low back pain: a systematic review within the framework of the Cochrane collaboration back review group Cochrane review. Spine 2000:25:2501-2513.

5Childs JD, Fritz JM, Flynn TW, Irrgang JJ, Johnson KK, Maikowski GR, Delitto A: A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med. 2004; 141(12):920-928.

6Chou R, Huffman LH: Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline.; American Pain Society; American College of Physicians; Ann Intern Med. 2007; 147(7):492-504.

[Last updated: 02/23/09 | Contact: public-relations@apta.org]

As a matter of fact, a lot of patients who have had an injury still experience pain and stiffness with certain movements and activities even after completion of conventional physical therapy.   This limitation makes it difficult for patients to fully return to activities they were able to perform and enjoy before their injury.  The issue is that proper postural and movement patterns are not properly evaluated and addressed during the rehab phase, and this could be the final piece of the puzzle.  An important approach I would like to focus as an adjunct to other treatment interventions is PNF.

PNF stands for Proprioceptive Neuromuscular Facilitation. It originated in the late 40’s by Dr. Kabat and Maggie Knott to provide tools to help patients gain efficient motor function (Adler 1993).  A simpler translation of PNF is the use of sensory receptors in the skin to stimulate nerves and muscles, to allow for easier and more efficient movement patterns.  PNF is a specific treatment approach used to improve movement, coordination, stability, strength, endurance and overall function.  It can be used to treat any body part from the cervical spine to the foot.

Pain is an inhibitor of effective and coordinated muscle performance and it can be a sign of potential harm (Hislop 1960, Fisher 1967).  This is always addressed during every treatment session.  During a session, a patient assumes a position that allows for the most effective movement of a specific body part.  The therapist uses manual contact to initiate and facilitate a specific movement pattern. This treatment approach requires active patient participation and involvement making it functional.  It also allows for integrative manual therapy skills to be incorporated into the treatment session.  This approach requires one on one therapist attention since it is tapered to each individual patient.

After a couple of sessions, patients see a significant improvement with postural and movement patterns needed in everyday activities.  They also develop easier and less painful movement patterns, thus allowing them to return to activities they were doing before their injury pain free.  This makes PNF a highly cost effective and efficient tool in today’s medicine, where patients are looking for ways to decrease pain and improve function in fewer treatment sessions and with the best outcomes.

Reston, VA, January 26, 2009– Richard Deyo MD, the keynote speaker at the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) National Conference in October 2008, has again published data indicting the US approach to chronic back pain dramatically increases costs without improved outcomes. Deyo and colleagues reported in the January 2009 issue of the Journal of American Board of Family Practice the following staggering statistics:
·    A 629% increase in Medicare expenditures for epidural steroid injections;
·    A 423% increase in expenditures for opioids for back pain;
·    A 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries;
·    A 220% increase in spinal fusion surgery rates.
The incidence of chronic and acute Low Back Pain, as documented by office visits, has not changed during the last 12 years. The application of these technologies is not without consequences Deyo et al noted, ‘Innovation has often outpaced clinical science, leaving uncertainty about the efficacy and safety of many common treatments. Complications and even deaths related to pain management are increasing.’ Indeed, the reoperation rates for low back pain have increased, not improved. The authors conclude that the ‘Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain.’  They note that these approaches often are applying an acute care model to chronic pain and not acknowledging the current evidence that chronic pain requires a different approach and that there are ‘no magic bullets.’  In a “chronic care model” chronic back pain, like diabetes or asthma, ‘is a condition we can treat but rarely cure.’ Deyo et al suggest the solution that  ‘chronic back pain may benefit from sustained commitment from health care providers; involvement of patients as partners in their care; education in self-care strategies; coordination of care; and involvement of community resources to promote exercise, provide social support, and facilitate a return to work.’
Tim Flynn, PT, PhD, president of the AAOMPT states, ‘The manual physical therapist is the health care provider uniquely trained to manage individuals with chronic low back pain.  We utilize low risk, state-of-the-art care incorporating exercise, manual physical therapy, patient education and the application of the biopsychosocial model in managing this chronic condition. The Academy is dedicated to the application of current models for chronic pain management.’ The recent AAOMPT conference in Seattle focused on current theories and practice of chronic pain management with international experts on pain management.

Tallahassee, Florida, October 20, 2008 – Neck pain is one of the top 10 reasons for a patient to visit a doctor. The lead article in the most recent issue Spine reports on the results of a randomized clinical trial which demonstrated that patients who received manual physical therapy and exercise had twice the improvement in symptoms compared to the current guideline group. The subjects in the study experienced both short and long term improvements in their neck pain. The study compared the use of manual therapy and exercise compared to the current guidelines of advice, rest, and range of motion. The results of this study are comparable to those reported by Hoving et al in 2002, which also demonstrated that manual physical therapy and exercise resulted in excellent clinical results in the treatment of neck pain while also providing a significant cost savings compared to usual physician care (Kothals-de Bos et al 2003). Manual physical therapy includes the use of hands-on techniques including joint and soft-tissue mobilization, designed to restore motion and reduce pain. Hurwitz et al (2008) concluded in a systematic review on neck pain also in the journal Spine, “Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain.”

Tim Flynn, PT, PhD, president of the American Academy of Orthopaedic Manual Physical Therapy, expressed confidence that, “This study broadens the base and depth of evidence that manual physical therapy is the first line treatment for patients suffering from neck and arm pain.” He continued, “Year after year the physical therapy profession continues to produce high quality randomized, controlled trials that demonstrate conclusively that our profession provides better outcomes for less money, while also being substantially safer than other medical interventions. Wake up America, to a new day without pain.” If you have neck or back pain or the aches and pains of musculoskeletal problems contact your local physical therapist today.

Physical Therapy an Alternative to the High Risks of Methadone

Tallahassee, Florida, August 18, 2008 – A recent investigative report1 published in the New York Times highlights the alarming increase in methadone prescriptions for the treatment of chronic spinal pain.  The result has been a shocking increase in methadone related deaths.  Physical therapists can play a role in providing patients and physicians with an alternative to dangerous pain medications like oxycodone and methadone.

Methadone was once limited to use in addiction treatment centers to replace heroin, but today it is frequently given out by physicians to manage spine and joint pain.  The Drug Enforcement Administration noted that from 1998 to 2006, the number of methadone prescriptions increased by 700 percent.  “Many legitimate patients, following the direction of their doctor, have run into trouble with methadone, including death,” noted pain specialist Dr. Howard A. Heit from Georgetown University.  Florida alone, which keeps detailed data, listed methadone as a cause in 785 deaths in 2007, up from 367 in 2003.

“These are senseless deaths,” said Dr. Timothy Flynn of Regis University in Denver, CO, and President of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT).  “Patients should be aware that these medications are not the best option to reduce the symptoms of spinal pain. Research has shown that early movement and treatments like exercise and spinal manipulation offer strong benefits to spine pain and disability.”  “The medical management of spinal pain in this country is a failure,” continued Flynn, “we too often initiate prescription drug therapy before choosing safe and effective alternatives.”  Flynn suggests that patients seek out physical therapists as a first-line treatment for these conditions.

A February 2008 report published in the Journal of the American Medical Association reports that from 1997 to 2005, pharmaceutical expenditures for the management of low back pain increased by 171% while the rate of good outcomes fell.  “All the imaging we do, all the drug treatments, all the injections, all the operations have some benefit for some patients,” said Richard A. Deyo, a physician at Oregon Health & Science University in Portland and a coauthor of the report.  “But I think in each of those situations we’ve begun using those tests or treatments more widely than science would really support.”

For more on the benefits physical therapists can provide in the management of spinal pain, contact your nearest physical therapist or visit the American Academy of Orthopaedic Manual Physical Therapists website at www.aaompt.org.  AAOMPT represents physical therapists by promoting excellence in orthopaedic manual physical therapy practice, education and research.

Dr. Richard Deyo, MD, MPH will be the key note speaker at AAOMPT’s Annual Conference in Seattle this November.  The conference theme will focus on pain management and physical therapists’ role in this important area of care.

BENEFITS OF SPINAL SURGERY DISAPPEAR AFTER 6 MONTHS
Physical Therapy offers same outcomes for patients with sciatica 6 months after surgery!

Tallahassee, Florida, June 23, 2008 – A recent study published in the British Medical Journal1 reports that spinal surgery for patients with sciatica offers a short term benefit, but by 6 months that benefit disappears and no difference is seen between patients who had surgery and those receiving physical therapy.  The study suggests that the benefits of surgery are only short-term and conservative treatments such as physical therapy may offer the same outcome.
Sciatica often resolves quickly, but in some patients it persists.  Previous to this study, only limited evidence existed that could guide patients about when or if that resolution was going to occur.  In this study, patients had the option of opting for early surgery, or prolonged conservative management under the guidance of a physical therapist.  The surgical group showed improvement in symptoms for only a brief period following surgery.  But, by 6 months, and up to 2 years following surgery, the difference between the groups having surgery and those that didn’t disappeared.
“The significance of this study is that patients may be able to avoid surgery if they realized they can expect a similar improvement in symptoms if they use other ways to manage the pain for 6 months,” said Dr. Timothy Flynn of Regis University in Denver, CO, and President of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT).  “Patients should be aware that surgery is not the only option to reduce the symptoms of sciatica.”
The study’s authors conclude that since the early benefits of surgery are gone by 6 months, when deciding to have surgery for sciatica, well informed patients, and not physicians, should decide if and when they opt for surgery.
The results of this study, coupled with the findings of another study published earlier this year suggest expensive treatments for low back pain may not be the best approach.   Less expensive conservative options like physical therapy may be the preferred choice for patients with low back pain.
“The best course of treatment for low back pain is to make sure it is addressed early and does not progress to leg pain, or become a chronic condition,” continued Flynn.  “Research has shown that early movement and treatments like exercise and spinal manipulation offer strong benefits to this group of patients.”
These treatments include hands-on physical therapy to mobilize the spine and exercises designed to alleviate low back pain.  Flynn suggests that patients seek out physical therapists as a first-line treatment for these conditions.

Spinal Manipulation, Exercise and Advice Offer Patients an Effective Alternative for Back Pain

Tallahassee, Florida, Feb. 14, 2008 – Health care expenditures for patients with spinal conditions are rising without an associated increase in health status, according to a February, 2008 research report appearing in the Journal of the American Medical Association. The study suggests Americans may be wasting their money for treatments as the overall proportion of people with impaired function increased from 1997-2005, despite a 65% increase in expenditures to treat spine conditions. Physical therapists offering spinal manipulation, exercise, and advice can provide an effective alternative for patients with back and neck problems, often at a lower cost.

“I think the truth is we have perhaps oversold what we have to offer,” said Richard A. Deyo, a physician at Oregon Health & Science University in Portland and a coauthor of the report. “All the imaging we do, all the drug treatments, all the injections, all the operations have some benefit for some patients. But I think in each of those situations we’ve begun using those tests or treatments more widely than science would really support.”

What science does support is the effectiveness of physical therapy for affecting outcomes in patients with spinal conditions. “Research has consistently shown the value of particular physical therapy interventions for patients with back and neck problems,” said Dr. Timothy Flynn of Regis University in Denver, CO, and President of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT). “Specifically, spinal manipulation and exercise have repeatedly been shown to be effective in managing patients’ current pain and preventing future episodes.” Particularly discouraging in this recent report was an increase in pharmaceutical expenditures of 171% during the study period. This suggests that physicians are over-utilizing an ineffective treatment for spine pain. “You have drugs, you have surgery, or you have us,” explained Flynn. “The reality is that very few treatments have shown the ability to truly affect patients with spine conditions. Physical therapists can do just that.” These treatments include hands-on therapies to mobilize the spine and exercises designed to alleviate low back pain. Flynn suggests that patients should seek out physical therapists as a first-line treatment for these conditions. A separate study in 2006 demonstrated that patients with back pain were experiencing an increase in the rates of imaging and injections, meanwhile realizing a significant under-utilization of physical therapy.

For more on the benefits physical therapists can provide in the management of back and neck problems, contact your nearest physical therapist or visit the American Academy of Orthopaedic Manual Physical Therapists website at www.aaompt.org. AAOMPT represents physical therapists by promoting excellence in orthopaedic manual physical therapy practice, education and research.

PHILADELPHIA__The American College of Physicians and the American Pain Society recommend doctors prescribe physical therapy when managing patients with low back pain.

“There are many options for evaluation and treatment of low back pain,” said Amir Qaseem, MD, PhD, MHA, senior medical associate in the American College of Physicians Department of Clinical Programs and Quality of Care, and an author of the guidelines. “We wanted to review all the evidence and develop guidance for clinicians and to give our patients a realistic sense of what they can expect when they visit a clinician for low back pain.  In particular, clinicians should consider the addition of non-pharmacological therapies with proven benefits.”
“This recommendation comes as no surprise to physical therapists,” said Dr. Timothy Flynn from Regis University, Denver, and President of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT). “Research has consistently shown the value of particular physical therapy interventions for patients with low back pain.  Specifically, spinal manipulation and exercise have repeatedly been shown to be effective in managing patients’ current pain and preventing future episodes.  We are glad to see that the American College of Physicians and the American Pain Society recommend physical therapy as a safe and effective alternative to drugs for patients with back pain.”  Physical Therapists can help patients with low back pain by performing thorough examinations and designing an evidence-based treatment program to meet their particular needs.  These treatments can include hands-on therapies to mobilize the spine and exercises designed to alleviate low back pain.
For more on the benefits that physical therapists can provide in the management of low back pain, contact your nearest physical therapist or visit the American Academy of Manual Physical Therapists website at: http://www.aaompt.org.

Month-long Observation Focuses on the Importance of Physical Activity
for Adults and Children

ALEXANDRIA, VA, September 18, 2007 — For the nearly 100 million Americans who are overweight or obese, physical activity must be a crucial component to weight loss and better health, which is the focus of October’s National Physical Therapy Month, the American Physical Therapy Association (APTA) announced today.

According to a recent study conducted by the Trust for America’s Health, a research group that focuses on disease prevention, obesity rates continued their climb in 31 states last year. Health officials say the latest state rankings provide evidence that the nation has a public health crisis on its hands. Last year, The Centers for Disease Control and Prevention cited evidence that found that more than 22 percent of Americans did not engage in any physical activity in the previous month.

A lack of exercise is a major contributing factor to obesity rates. “People who are overweight or obese must follow an appropriate exercise program that includes aerobic conditioning and avoids exercise that can lead to injury,” notes Terry Michel, PT, DPT, DSc, CCS, a physical therapist at Boston’s Mass General Hospital. “Physical therapists will typically recommend a low-impact form of weight training, such as exercise bands that help avoid excessive joint stress, and modified yoga stretches and Tai Chi for promoting flexibility and relaxation,” she adds.

Physical therapists develop fitness plans for both adults and children that promote the ability to move, reduce pain, restore function, and prevent disability. For those who are overweight or obese, physical therapists balance the progression of the exercise prescription with the need for joint protection and safety during exercise.

“We are no longer looking at just adults who have diseases resulting from obesity,” says physical therapist Susan S Deusinger, PhD, professor and director of the Program in Physical Therapy at Washington University School of Medicine. “Rather, physical therapists need to regard obesity as a primary concern for intervention,” she adds. Previous research** conducted by Dr Deusinger confirmed recent rising health concerns on college campuses. Her study of 300 undergrads at Washington University in St Louis found that 70 percent of the students had gained an average of 9 pounds between their freshman and sophomore years, and most were still not meeting recommended guidelines for healthy eating and exercise behavior.

“To say the least, the results of this study are cause for concern,” notes Deusinger. “People are dying from the effects of obesity, and it’s not just our parents and grandparents anymore; it’s our friends, siblings, and colleagues. No one is immune from the dual epidemics of obesity and sedentary behaviour.”

Connie Cushing, PT, MS, a 17-year-veteran physical therapist at Children’s Hospital in Birmingham, Alabama, is a member of a practice team that focuses on overweight and obese children and teens at the Hospital’s Center for Weight Management. Along with a psychologist, physician, nurse practitioner and nutritionist, Cushing evaluates each child individually (both before they enter and leave the Center). As a result, Cushing can determine whether the patient is at risk for joint and musculoskeletal problems, as well as implement what the collective team learns regarding other commonly seen issues such as diabetes or asthma. “Patients often have multiple, pre-existing medical conditions that can affect their ability to exercise and what specific exercises they are capable of doing,” notes Cushing.

“For the younger children at the Center we recommend restricting television viewing and video game playing and encourage family games that can be played both indoors and outdoors at home,” says Cushing. “It becomes a bit more complicated with teens, as we need to factor in what their interests are, both in and out of school; if they work better in groups or individually; and if they prefer being outdoors or indoors. Based on their profile, we determine a list of goals and the best ways to achieve those goals. We’ve also found that having teens keep daily logs of their physical activity provides great incentive.” She adds, “The goal of the Center is not solely weight loss. Our ultimate goal is for these kids to make lifestyle changes. Yes, we want them to lose weight, but we also want them to eat better, sleep better, and to feel better physically and emotionally.”

Consumers can find information about the fight against obesity and about National Physical Therapy Month, whose theme is “Physical Therapy: The Science of Healing. The Art of Caring,” by visiting APTA’s Consumer Web page at www.apta.org/consumer.

Physical therapists are health care professionals who diagnose and treat individuals of all ages, from newborns to the elderly, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan of care using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. Physical therapists also work with individuals to prevent the loss of mobility by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

The American Physical Therapy Association (www.apta.org) is a national organization representing 70,000 physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can access “Find a PT” to find a physical therapist in their area, as well as physical therapy news and information at www.apta.org/consumer.
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** Racette SB, Deusinger SS, Strube MJ, Highstein GR, Deusinger RH. “Weight Changes, Exercise and Dietary Patterns During Freshman and Sophomore Years of College.” Journal of American College Health, vol. 53 (6); pp. 245-251, May/June 2005.