Blog

By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults

I bet if I asked if you’ve ever heard of the term “Direct Access” you’d likely say no.  Even if you did,  you’d likely not know exactly what it meant.

Don’t feel bad – you’re not alone!

As a physical therapist with nearly 30 years of experience, I’ve personally witnessed many changes in laws governing the practice of outpatient physical therapy.  Some of these changes are state specific and some affect things on a more national level.  Many of these changes have profound implications relating to the quality and integrity of the profession while others impact consumers’ access to physical therapy care on an outpatient basis (i.e., when you go to an outpatient PT practice, either located within a hospital or, more commonly, when you go to an outpatient clinic at a separate physical location).

Some facilities are owned by the hospital system, while others are owned by physician groups or investors, and some are owned privately by independent physical therapists or groups of PT clinicians.  Direct access affects all of these.

For the longest time, you needed to be referred to a physical therapist by your doctor or dentist. Then that evolved to include nurse practitioners and physician assistants (i.e., “physician extenders”).  Some states limit whether chiropractors may directly refer their clients to a physical therapist (but they should have a conversation with them, if indicated, about how PT could help them and suggest they investigate on their own or via their primary care physician).

However, due to the importance of physical therapy as it relates to optimizing independence and recovering fully from an accident like a fall or sports related injury, or after a stroke or joint replacement, or from a newly diagnosed progressive condition like Parkinson’s Disease or an acute flare of Multiple Sclerosis, access to physical therapy has transformed from the referral only requirement to the Direct Access allowance.

DIRECT ACCESS to Physical Therapy is What’s Up!!!

By the way, physical therapy doesn’t always have to be “progress oriented” and another recent transformational change affecting physical therapy was a formal clarification during the Obama Administration specifying that PT is appropriate to manage chronic conditions that, in the absence of skilled PT services, would likely cause a progressive decline in functional independence or quality of life.  Thus, outpatient PT is very appropriate in cases involving chronic conditions when “progress” may be less likely.  Examples of this include weakness on one side of the body remaining after an older stroke or when battling progressive conditions like Ankylosing Spondylitis, Parkinson’s Disease or Multiple Sclerosis.

Here’s what you need to know about your rights to access outpatient physical therapy in South Carolina:

• South Carolina adopted Direct Access with special provisions in 1998. This means you do not need a referral to be evaluated by a PT or to start receiving treatment in PT;
• In the absence of a valid referral, your PT must refer you to a licensed medical doctor or dentist if providing PT services to you beyond 30 days after your initial evaluation;
• Your PT must refer you to a licensed medical doctor or dentist immediately if your condition is beyond the scope of Physical Therapy.

Every state has some form of direct access these days. 

• Some states are much more restricted than others, so if you’re reading this and are not from SC, you can find what your state allows by reviewing the American Physical Therapy Association’s (APTA) summary of direct access by state (Direct Access by State: found online (2/20/2018) at: https://www.apta.org/uploadedFiles/APTAorg/Advocacy/State/Issues/Direct_Access/DirectAccessbyState.pdf).

• Should you feel you might benefit from outpatient physical therapy care, you can still ask your doctor for a referral, but know that it’s not mandatory unless required by your insurance plan.  You can go to any outpatient PT that accepts Direct Access cases – it’s YOUR choice – so choose wisely and get started on the path to FEELING better, MOVING better and LIVING better!

Summerville Physical Therapy & Balance Rehabilitation for Adults

679 Orangeburg Road | Suite D | Summerville, SC 29483|  843-209-6375

By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults

How  Physical Therapy Can Help After a Stroke

Treatments for stroke depend on many factors, including what kind of stroke is involved and how long it lasted.  The sooner you can seek help after a stroke, the more likely you’ll have a better recovery.  Rehabilitative therapies, including physical, occupational and/or speech therapies, are critical after a stroke.

Physical, Occupational and Speech Therapies After Stroke are ESSENTIAL to Optimizing Outcomes

The goals of stroke rehabilitation are to help stroke survivors live as independently as possible while adjusting to new limitations.  Strokes can cause problems with movement, coordination and balance.  Paralysis or weakness is common after stroke — especially on one side of the body.  Physical therapy can help stroke survivors regain strength, coordination, balance, and control of their movements.

Things that were once easy to do, such as basic walking, sitting upright with adequate balance, or getting into/out of bed, may be extremely difficult or even impossible following a stroke.  Physical therapy can restore one’s capabilities in these areas and improve one’s overall capacity to remain independent or at least minimize the amount of caregiver assistance needed following a stroke.  To the latter end, PT also involves training caregivers on how best to care for an individual after a stroke.

If you’re ever in need of physical therapy after a stroke, your doctor should order physical therapy.  PT can occur in the hospital right after a stroke, at your home, in an outpatient setting, at an inpatient rehabilitation hospital, at a nursing home or at an assisted living facility.

Balance Training with PT in an Outpatient Setting

You can reduce your risk of having a stroke by staying active, maintaining a healthy diet and keeping your weight and blood pressure under control.  Talk to your doctor about other ways you can reduce your risk of having a stroke.

(Adapted from: “What Are the Different Types of Strokes?” found online at: https://www.healthline.com/health/stroke-types#Overview1; Dec. 21^st, 2017)

Frequent Asked Questions Regarding Strokes:

Q:  What is a stroke?

A:  A stroke is a medical emergency that happens when the blood flow to your brain is interrupted. Without blood, your brain cells start to die.  This can cause serious symptoms, lasting disability, and even death.  There are basically three main types of strokes, each type with their unique symptoms and, subsequently, unique treatments.  Physical Therapy is CRITICAL following a stroke regardless of the type.

Q:  What are the different types of strokes?

A:  There are three main types of stroke. The vast majority of strokes – about 87 percent of all strokes — are ischemic in nature.

• Transient ischemic attacks:  TIAs occur when a blood clot temporarily blocks blood flow to your brain.  The blood clot and TIA symptoms last for a short period of time and usually resolve completely within 48-72 hours.  Ischemic strokes occur when a blood clot keeps blood from flowing to your brain on a permanent basis.  The blood clot is often due to atherosclerosis, which is a buildup of fatty deposits on the inner lining of a blood vessel.  The deposits can break off and block blood flow in your brain — similar to what happens when you have a heart attack where a blood clot blocks blood flow to a portion of your heart.
• Ischemic stroke: An ischemic stroke occurs when a blood clot keeps blood from flowing to your brain.  The blood clot is often due to atherosclerosis, which is a buildup of fatty deposits on the inner lining of a blood vessel.  A portion of these fatty deposits can break off and block blood flow in your brain.  The concept is similar to that of a heart attack, where a blood clot blocks blood flow to a portion of your heart.
• Hemorrhagic strokes:  A hemorrhagic stroke results when a blood vessel in your brain ruptures or breaks, spilling blood into the surrounding tissues.  There are two types of hemorrhagic strokes: The first is an aneurysm, which causes a portion of a weakened blood vessel to balloon outward and sometimes rupture.  The other type is due to deformed blood vessels.  If a deformed vessel ruptures, it can cause a hemorrhagic stroke.

Q:  What are the symptoms of a stroke?

A:  The different stroke types cause similar symptoms because each affects blood flow in your brain.  The only way to determine what type of stroke you may be having is to seek medical attention.  A doctor will order imaging tests (e.g., CAT scans or MRIs) to view your brain.

The National Stroke Association recommends the acronym “FAST” to help identify the warning signs of a stroke:

Face: When you smile, does one side of your face droop or one eyelid stay partially closed?

Arms: When you raise both arms, does one arm fall/drift downward?

Speech: Is your speech slurred?  Are you having trouble talking?

Time: If you experience any of these symptoms, call 911 immediately.

Additional symptoms that don’t fit into the FAST model may include:

• sudden confusion, such as difficulty understanding what a person is saying;
• difficulty walking, sudden dizziness, or loss of coordination;
• sudden, severe headache that doesn’t have any other known cause;
• difficulty seeing in one or both eyes; and
• choking or coughing when swallowing foods or liquids

A TIA will cause these symptoms for only a short amount of time.  However, you shouldn’t ignore stroke symptoms, even if they go away quickly.

Q:  What other complications can a stroke cause?

A:  A stroke is a medical emergency for a reason — it can have life-threatening complications.  Examples of complications may include:

• Behavior changes:  Having a stroke can contribute to depression or anxiety.  You also may experience changes in your behavior, such as being more impulsive or more withdrawn from socializing with others.
• Speech difficulties:  A stroke can impact areas of your brain having to do with speech and swallowing.  As a result, you may have difficulty expressing yourself verbally as well as difficulty with reading, writing, or understanding other people when they’re speaking.

To read more:: https://www.healthline.com/health/stroke-types#Overview1;

By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults

The Importance of Flexibility to Proper Posture and Pain-Free Healthy Function

When my patients ask me what the most important contributors are to feeling good and moving well throughout Life, I always talk to them about proper posture and the importance of having good flexibility.  Flexibility in this respect refers to having your muscles and other soft tissues in our bodies at their intended, optimally healthy length.  In other words, we’re not too tight or too loose in our muscles.  Correct flexibility is, simply put, critical to so many things we need to do well in order to feel well.

For example, let’s say we’re tight in our hamstrings.  It follows, then, that we will most definitely have bad posture as it relates to the position and movement of our pelvis, hips and low back.  TRANSLATION:  Having tight hamstrings means unhealthy pulling on our pelvis so that we’re sitting too much toward or directly on our tailbones instead of sitting upright with good posture.  This in turn leads to a flattened low back curve (aka, a flattened lordosis), which in turn reduces our spinal mobility.  All of this together usually leads to chronic low back pain, reduced hip and trunk mobility, trigger points and other assorted muscular aches and pains, and maybe even skin breakdown on our tailbones (not fun at all and may even lead to a bad infection that knocks us down for good!)

So – even if you don’t read further, the take home message is this: Endeavor to improve your flexibility — you’ll feel better and live a healthier Life!

Staying active and stretching regularly help prevent a general loss of mobility.  Healthy mobility preserves independence as we age.  Our muscles need to be at their intended proper length in order to function at their best while providing the best possible joint support.  This helps reduce destructive forces on our joints, which preserves joint health further into life so that you’re less likely to need medical interventions such as steroid injections and corrective joint surgeries.  It also means that you’ll walk, run, play out in the yard with your kids, their kids and their kids’ kids, golf or play tennis, hike trails or climb mountains, or do whatever it is you love to do – LONGER and MORE COMFORTABLY as you get older!!!

You don’t need to take my word for it as a physical therapist with 30+ years in the clinic treating adults of all ages – but then again, maybe you should.  There is clear scientific evidence showing that we are a lot less likely to have an injury when we include flexibility training into our daily routines.  This is due to the fact that we can move more freely through a fuller range of motion at our joints.  However, an exception exists when we have excessive flexibility, which results in more instability at our joints.  This problem may increase the likelihood of injury.  So, when used appropriately, regular flexibility training allows us to become more “in tune” with our bodies, which facilitates better mental and physical health, injury prevention and recovery after an injury.

There are different ways to stretch and different schools of thought on the matter.  One source online that does a great job at describing these different ways, their pros and cons, and some other really important aspects of stretching can be found at the Human Kinetics webpage (found at: humankinetics.com).  There you’ll find information about technique, such as how intensely to stretch, how long to hold stretches and how often you should stretch, as well as what is meant by static versus dynamic stretching along with the pros and cons of each.

Physical Therapists Can Identify Flexibility Dysfunction & Help You Understand Your Signs & Symptoms

A good PT will help you right away with stretching exercises and sometimes strengthening exercises to complement your flexibility efforts.  You really can’t simply do an adjustment and correct poor flexibility or muscle imbalance, but sometimes these issues cause significant spinal malalignment.  Thus, PT and/or Chiropractic care can be helpful when you need a neck, back or other joint adjustment.

If you’re not sure whether your flexibility is good or bad, here is a great test you should do (YES — RIGHT NOW) to determine if you have proper and healthy hamstring length.  It’ll only take a few seconds:

1. Sit flat on either the floor or top of your bed mattress;
2. Be sure to sit on your “sit bones” (the bones you feel in the deep muscle of your buttocks.  You usually take note of these bones after sitting on a hard flat bench for too long);
3. Be sure to “sit tall” with your back totally vertical (i.e., like a Marine stands when at “Attention!”)  Suck in your gut and brace your abs to hold that tall sitting position;
4. Try to put both legs totally straight out in front of you (this is called the “Long Sitting” position), making sure your knees are completely straight and that your knees and toes are pointing “due North;”

***RESULTS & INTERPRETATION:  If (a) you CAN’T sit tall properly when you have your legs out in front of you in the proper long sitting position, or (b) you CAN sit tall but you CAN’T get your knees flat down and in proper long sitting position, then your hamstrings are almost definitely TOO SHORT.  If this is the case for you, you likely have been having low back pain and possibly have had some irritation of the skin over your tailbone at one time or another.  Both of these problems are easily corrected by some really good physical therapy where you’ll learn the extent to which you are limited and how to fix it so you feel better fast.  You’ll also be taught how to keep it from happening again.  You’ll end your PT feeling much better and knowing how to manage your flexibility independently.

Should you feel that you might need some expert help with your flexibility, consider calling us at Summerville PT & Balance at 843-209-6375 or just let your doctor know you’d like to be referred to Summerville PT & Balance for some help with your flexibility.   You’ll soon be experiencing a healthier, more active and pain-free Life!

(Adapted from, “The importance and purpose of flexibility” (Oct. 2017); found online at: http://www.humankinetics.com/excerpts/excerpts/the-importance-and-purpose-of-flexibility)

By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults

Simply Put: POOR POSTURE –> Dysfunction –> Pain

LOTS of “OUCHES” — 100% AVOIDABLE!

Q1: Do you have nagging pain in your low back?

Q2: Do you carry chronic tension in your shoulders?

A: If you have chronic discomfort in an area with no known injury, you may wonder why that is. The most likely answer is postural dysfunction (i.e., less than healthy posture, which misaligns the spine and causes muscles and joint forces to be something less healthy than intended).  This unhealthy support of the spine and the resulting abnormal movements and joint forces cause muscle imbalances that can’t support the spine and joints optimally, resulting in inflammation and pain that ultimately change the way we sit, lay, stand, move and most importantly – FEEL!

There are several very common postural stress patterns that physical therapists see in the clinic:
• posterior neck pain and stiffness;
• shoulder pain with restricted range of motion;
• a painful knot (called a trigger point) near the shoulder blade;
• low back ache; and
• hip tightness

“You Can’t Put a Bandage on Bad Posture!”

People typically describe these areas as tight and restricted, with nagging pain.  These patterns are quite frustrating, because they are stubborn and resistant to treatment such as application of heat, cold, electric stimulation, ultrasound, massage, traction and other treatments that provide temporary relief only.  This is because you can’t put a bandage on bad posture.  You must correct the postural issue(s) adequately to get the best and longest-lasting relief of your symptoms.

For example, when we have pain in our shoulders, we typically massage our shoulders.  When we have pain in our backs, we massage, twist and stretch out our backs.  Though massage and proper flexibility are important and offer some relief, collectively they do not fix the problem for good because they don’t address the problem comprehensively enough.

More often than not, the most common posture-related pain patterns are a result of tight flexor muscles (generally, those on the front of the body) and/or stretched and weak extensor muscles (those on the back of the body).

Looking at the figure above, we can see that the front of the body is collapsed and contracted, while the back is arched and stretched (I often refer to this as “lazy posture” as it does not require much work to hold this position).  We are essentially “hanging on our joints” instead of using the muscles correctly that support our joints.  Thus, we need to retrain your posture to “stack” the body the way it was meant to be stacked as the first step of correction (think of a tall house being built on it’s foundation.  If the foundation isn’t true, the house won’t be as well supported as it should and won’t stand up to stresses as well as it could, either).  This will allow us to focus on healthy, functional movement.  In doing so, you will have marked improvement in mitigating, if not preventing, your symptoms of chronic, nagging pain along with movement dysfunction.

Q3: How can Physical Therapy help me correct my bad posture?

A: Physical therapy is a great choice if you’re having chronic, nagging pain caused by bad posture. During an initial appointment, a good PT will obtain an understanding of the pain you are experiencing and evaluate your body’s posture and alignment to understand the source(s) of the pain.  You will be educated well about the issues causing you trouble so that you can understand the problem(s) adequately.  After all, a patient who understands their circumstances will always have the best chance of correcting them, and therefore will always have the best outcomes!

Based on the PT’s analysis, you’ll next be guided through a series of exercises designed specifically for your postural dysfunction.  The exercises are typically simple, gentle, and easy to do and focus on strength and flexibility.  Patients are expected to complete their exercises at home for best results, with further physical therapy guiding the way and tweaking or adding exercises in the most efficient manner so that you are not a lifelong patient.  In other words, a good PT helps you get to the root of the problem(s) and shows you how to fix them as quickly and as permanently as possible.

Most clients report seeing and feeling positive results after the first few treatment sessions. Typically, anywhere from four to twelve sessions are necessary for clients to maximize the postural changes, and you should expect to see your PT two to three times peer week for a two to four weeks.  It takes work on your part — it’s not a passive process.

Q4: My job requires me to sit a lot.  How can I fix my posture?

A: PTs frequently see tight muscles in the mid-back from too much sitting.  We sit at work, we sit in the car, and then we sit at home (many of us are far too sedentary).  So when a client comes in with knee pain, they may not expect their PT to focus on their posture.  However, your PT will explain that tightness and decreased motion in your mid-back contributes to a lack of motion in your pelvis.  The pelvis has muscles connected to the knee, and is thus contributing to the knee pain via restriction of normal mobility, abnormal joint forces in the knee, the inflammation that causes, and the pain that results.  The client is often amazed how their knee pain is relieved after doing the individually designed exercises that are focused on their upper body’s posture, not solely on the area that is painful.

If you have chronic, nagging pain, physical therapy is the best choice for helping you “get straight” in short order and for the long haul.  The experts at Summerville PT & Balance Rehab for Adults are well trained in identifying and fixing your posture-related pain and dysfunction and can get you back to feeling better quickly so you can enjoy greater Quality of Life!

Call Summerville Physical Therapy & Balance Rehabilitation for Adults to schedule your appointment today.

843-209-6375
SummervillePTandBalance.com
679 Orangeburg Road, Suite D
Summerville, SC 29483

(adapted from: “Poor posture = loss of function = pain.” Online (2014). Available at: http://redcloverclinic.com/2014/05/poor-posture-loss-of-function-pain/)

By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults

 Physical Therapy Can Help You with Balance Issues

Q:  What symptoms and risks are most commonly associated with “bad balance?”

A:  Good balance is often taken for granted.  Most people don’t find it difficult to walk across a gravel driveway, transition from walking on a sidewalk to grass, or get out of bed in the middle of the night without stumbling.  However, with impaired balance, such activities can be extremely challenging and sometimes dangerous.

Symptoms most commonly associated with “bad balance” can include weakness or unsteadiness, dizziness, vertigo (i.e., the feeling of spinning or that the things around you are spinning when they are not), hearing and vision problems, and difficulty with concentration and memory.  Of course, falling – or the fear of falling — is the most significant risk of having bad balance.

Falls can really cause big problems, from painful bumps, bruises and soreness to sprains that limit your function and take time to heal, to broken bones and even head and spinal cord injuries.  Falls can even lead to death.

Needless to say, preventing falls is a critical challenge we must address effectively to prevent or at least mitigate pain and suffering, reduced quality of life and the seriously high costs associated with medical care and rehabilitation after a fall.

 Q:  “How Can I Maintain Good Balance & Equilibrium?”

A:  Balance is the ability to maintain the body’s center of mass over its base of support.

Equilibrium is the feeling of steadiness, whether sitting or standing still, and especially during movement.

Properly functioning balance and equilibrium systems allow us to see clearly while moving, identify orientation with respect to gravity, determine direction and speed of movement, and make automatic postural adjustments to maintain posture and stability in various conditions and activities.

Good balance and equilibrium require adequate strength and coordination, as well as healthy sensory input from vision, proprioception (awareness of your position and level of effort), and the vestibular system (includes sense of motion, equilibrium and spatial orientation).

Healthy balance and equilibrium result when we’re properly integrating, managing and responding to all of that sensory and motor input.  Injury, disease, certain drugs, as well as the aging process, can affect one or more of these components and potentially turn one’s world “upside down.”

 Q:  “How Can Physical Therapy Help Me?”

A:  Managing balance and equilibrium dysfunction effectively requires a true Team approach.  This Team is comprised of various well educated and highly trained professionals, including experts in the fields of medicine (for example, your primary care physician, neurologist or ear, nose and throat (ENT) specialist), audiology and rehabilitation.  In close collaboration with other medical professionals, physical therapists are experts in evaluating and treating  vertigo, dizziness and all things contributing to balance disorders.  PTs work with you and your physician-led Team of experts to ensure an accurate diagnosis and effective treatment plan to get you back on track!

Physical therapy will get you feeling stronger, steadier, safer and back in control so that your risk of falling is minimized and you can enjoy improved mobility, independence and Quality of Life!

If you are experiencing problems with your balance, or sense of equilibrium, call the experts in evaluating and treating vertigo, dizziness and balance disorders.

Summerville PT & Balance offers specially trained therapists certified in vestibular rehabilitation.

Call Summerville Physical Therapy and Balance Rehabilitation for Adults and schedule your consultation today @ 843-209-6375.

Life is All about BALANCE!!!

[custom-facebook-feed]