How a Physical Therapist Can Help with Exercise

http://www.spine-health.com/

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Ten to twenty years ago a person experiencing back pain would most commonly be advised bed rest and immobilization of the back. Research within the past 10 years has shown that inactivity weakens the muscles that support the spine and, if continued too long, can prolong recovery or even make certain conditions worse.

Exercise, on the other hand, increases muscle flexibility and strengthand promotes healing by increasing blood flow to the injured site. Healthy muscles provide protection to bones and joints.

While back pain sufferers should always check with their doctor concerning the appropriate approach to treat their condition, many will be referred to a physical therapist. The role of the physical therapist in providing pain relief, rehabilitation and education is often critical to a successful recovery.

Top Three Reasons to See a Physical Therapist

1. To get relief from pain
2. To develop an individualized exercise program
3. To learn proper exercise technique and ways to give muscular protection to bone and joint structure

There are several mechanical methods and physical agents therapists use to relieve pain, such as applying ice/heat packs, ultrasound, and electrical muscle stimulation (see Passive physical therapy). In addition to exercise, some manual therapy techniques are massage and mobilization.

Pain is also relieved through active techniques and exercise therapy - exercises that stretch the sore muscles and increase their flexibility. Two common methods of exercise that provide pain relief include:

• The McKenzie approach to back exercises was developed specifically to centralize and relieve back related pain symptoms
• Dynamic lumbar stabilization exercises control pain by reducing motion at the injury location. This technique involves training muscles to automatically provide protective support during activity.

Individualized Exercise Program

Physical therapy involves evaluation of an individual's movement, physical capabilities, body type, and activity level in order to prescribe exercise and other physical means to help improve function. For certain conditions and diagnoses, a well-trained physical therapist will develop a customized exercise program based on research of the most effective spine exercises. The exercise program's pacing, specific exercises, and amount of practice with the physical therapist will vary depending on the condition and the individual's needs.

Developing the right exercise for the individual sometimes requires trial and error, reviewing the person’s response to the exercise, and adjusting the exercise accordingly.

Proper Exercise Technique

The proper exercise technique allows the patient to isolate the desired muscle/muscle group that increases the effectiveness of an exercise. A physical therapist will instruct a patient on the proper technique for performing each exercise in the individualized exercise program. Physical therapists strive to continually improve their exercise techniques, learning new ones as they come out, and scrutinizing new fads. The therapist will also cover posture and movement exercises, suggesting improvements for the patient that will provide added protection for the spine.

Pilates Exercise System to Promote Back Health

http://www.spine-health.com/

Fig 1a: Reformer: arms
(larger view)

Fig 1b: Reformer: legs
(larger view)

Fig 2a: Cadillac: leg springs
(larger view)

Fig 2b: Cadillac: roll back
(larger view)

Fig 3a: Wunda Chair: arms
(larger view)

Fig 3b: Wunda Chair: leg lunges
(larger view)

Fig 4a: Mat: stretch
(larger view)

Fig 4b: Mat: stretch
(larger view)

Fig 4c: Mat: leg circles
(larger view)

Pilates is an exercise program that focuses on the core postural muscles that help keep the body balanced and are essential to providing support for the spine. In particular, Pilates exercises teach awareness of neutral alignment of the spine and strengthening the deep postural muscles that support this alignment, which are important to help alleviate and prevent back pain.

The Pilates Exercise Program

Pilates is an exercise system named after its originator, Joseph Pilates. Mr. Pilates developed this system in the early 1900’s to improve his health and to support the health of fellow World War I internees. Later, he incorporated the resistance of springs into rehabilitation programs for hospitalized patients, and then translated the use of springs into machines and created the unique equipment now used in the exercise system.

Important principles of the Pilates exercise program include:

• Use of mental focus to improve movement efficiency and muscle control

• Awareness of neutral spine alignment, or proper posture, throughout the exercises
• Development of the deep muscles of the back and abdomen to support this posture
• Use of breath to promote mental focusing and centering
• Creating length, strength, and flexibility in muscles

Initially the Pilates exercise program was primarily used by professional dancers, who appreciated improved strength, balance and flexibility. In the 1980s Pilates was re-discovered and has now become a popular form of exercise for anyone interested in its health benefits.

The exercise system is usually taught in one of two formats:

• Using the unique Pilates equipment in private, or semi-private, sessions
• Group mat classes not using equipment

Pilates Equipment

The Pilates equipment uses the resistance of springs to create effort. The principle piece of equipment is called the Reformer and consists of a sliding platform anchored at one end of its frame with springs. The platform can be moved by either pulling on ropes or pushing off from a stationary bar. Thus, exercises include the challenge of moving the platform and maintaining balance on a moving surface (if sitting or standing). See figure 1a and figure 1b to view examples of some exercises done on the Reformer.

Another Pilates machine is called the Cadillac and consists of a padded platform with a cage-like frame above it. From this frame various bars or straps are attached by springs. See figure 2a and figure 2b to view photos of exercises done on the Cadillac.

A third piece of equipment, the Wunda Chair consists of a small bench-like platform with a bar attached with springs. Exercises are done by pushing on the bar while either sitting or standing on the bench, or standing or lying on the floor. See figure 3a and figure 3b for photos of chair exercises. Several other pieces of equipment unique to the Pilates system are likely to be encountered at Pilates studios.

Mat Exercises

Usually taught as part of a group class, mat exercises primarily focus on strengthening the muscles of the trunk and hip and increasing the flexibility of both the spine and hips. While the scope of the mat program is limited compared to the machines, there are many mat exercises that illustrate the Pilates principles. See figure 4a, figure 4b, and figure 4c for photos of some simple mat exercises.

Lately, Pilates has merged with other movement techniques, such as yoga, or use of an exercise ball. This promotes creative integration of the Pilates principles into a greater range of exercises in the mat class setting.

The important principles of Pilates are consistent with an exercise program that promotes back health. In particular, learning awareness of neutral alignment of the spine and strengthening the deep postural muscles that support this alignment are important skills for the back pain patient.

Patients with pain stemming from excessive movement and degeneration of the intervertebral discs and joints are particularly likely to benefit from a Pilates exercise program. In addition, postural asymmetries can be improved, thus decreasing wear and tear resulting from uneven stresses on the intervertebral joints and discs.

Pilates improves strength, flexibility, and suppleness of the muscles of the hip and shoulder girdle. Fluid and supported movement through these joints helps prevent unnecessary torque on the vertebral column.

The Pilates program also teaches awareness of movement habits that may stress the spine, and helps the patient change these habits to those that preserve neutral alignment. Awareness of excessive tension and the use of proper focus helps the patient use the body efficiently.

Pilates Considerations for Back Pain Patients

Before starting any new exercise system, it is always advisable to check with a physician or other healthcare provider. Before starting a Pilates exercise program, it is important to check that the potential instructor has received training in the Pilates exercise system, and that he or she understands any specific back problems. If a patient starts Pilates after physical therapy, the physical therapist should outline the exercise principles identified as particularly important for his or her rehabilitation.

Individuals with significant back problems may benefit from several one-on-one Pilates sessions with a qualified Pilates instructor. While more expensive than a group class or mat class, the time, money, and effort devoted to learning the exercises correctly can be well worth the investment, as exercises performed incorrectly can make a back problem worse. Initially, twice-a-week sessions tend to be helpful to learn the program more quickly. After that, weekly Pilates exercise sessions may be enough if the individual practices between sessions.

The principles of movement important for back health are taught in some of the simplest exercises of the Pilates system. One cannot underestimate the benefit of simple exercises that support the deep postural muscles of the trunk, awareness of neutral alignment, and supple use of the shoulders and hips. It is best to learn exercises that can be practiced at home between scheduled Pilates sessions.

Given its roots in ballet and dance, some of the movements in the Pilates system are very difficult and challenging. Many of the exercises should be avoided for individuals with significant back pain or degenerative disc disease. Remember, it is always advisable to first see a physician prior to starting any exercise program.

As a general rule, back patients should avoid exercises that push the spine into extremes of flexion or extension, or combine flexion with side bending or twisting the spine. These motions place excessive stress on the intervertebral discs. Also, it is important to avoid fatigue - either mental or physical - which is when proper form is lost and injuries more likely to occur.

Back Exercise
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The exercises in the Pilates system should be challenging (both mentally and physically) but not so difficult that they cause anyone to struggle. If an exercise causes pain - it is best to stop and tell the instructor. The exercise may be too difficult, or the person may need additional help to do it correctly.

Finally, it may take awhile for the full benefits of a Pilates exercise program to be realized. Just as problems that create most back pain problems happen gradually over time, learning to use one's muscles in a way that support - rather than stress - the spine takes time and commitment.

Video: Why is Exercise Important for Lower Back Pain?

Many people will experience some kind of lower back pain at some point in their lives. An ounce of prevention by doing a few simple exercises daily to keep the back nice and healthy will go a long way to alleviate lower back pain problems.Learn why exercise is so important for a pain-free, healthy back in this video.

Video presented by Grant Cooper, MD

Progression criteria during a muscle injury rehabilitation in football

Progression criteria during a muscle injury rehabilitation in football from FootballMedicine

http://footballmedicine.net/

MUSCLE INJURY REHABILITATION’S FLOW-CHART: FOOTBALL MEDICINE® 4X3X2 APPROACH

Does Exercise Change Your Brain?

Fonte: well.blogs.nytimes.com

By GRETCHEN REYNOLDS

 SEPTEMBER 2, 2015 September 2, 2015 5:45 am

Photo

Olga Kotelko holds more than 30 world records in her age category.Credit Patrik Giardino for The New York Times

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PHYS ED

Gretchen Reynolds on the science of fitness.

At the age of 93, Olga Kotelko — one of the most successful and acclaimed nonagenarian track-and-field athletes in history — traveled to the University of Illinois to let scientists study her brain.

Ms. Kotelko held a number of world records and had won hundreds of gold medals in masters events. But she was of particular interest to the scientific community because she hadn’t begun serious athletic training until age 77. So scanning her brain could potentially show scientists what late-life exercise might do for brains.

Ms. Kotelko died last year at the age of 95, but the results of that summer brain scan were published last month in Neurocase.

And indeed, Ms. Kotelko’s brain looked quite different from those of other volunteers aged 90-plus who participated in the study, the scans showed. The white matter of her brain — the cells that connect neurons and help to transmit messages from one part of the brain to another — showed fewer abnormalities than the brains of other people her age. And her hippocampus, a portion of the brain involved in memory, was larger than that of similarly aged volunteers (although it was somewhat shrunken in comparison to the brains of volunteers decades younger than her).

Over all, her brain seemed younger than her age.

But because the scientists didn’t have a scan showing Ms. Kotelko’s brain before she began training, it’s impossible to know whether becoming an athlete late in life improved her brain’s health or whether her naturally healthy brain allowed her to become a stellar masters athlete.

And that distinction matters. Before scientists can recommend exercise to forestall cognitive decline, they need to establish that exercise does in fact slow cognitive decline.

So far, much of the available evidence has been weak. Many epidemiological studies show that physically active older people perform better on cognitive tests than their sedentary counterparts. But those studies were associational and leave many questions unanswered.

A new experiment by the same group of researchers who scanned Ms. Kotelko’s brain, however, bolsters the idea that exercise makes a difference in aging brains.

In the study, published last month in PLOS One, Agnieszka Burzynska, now an assistant professor of human development at Colorado State University in Fort Collins, and colleagues at the Beckman Institute for Advanced Science and Technology at the University of Illinois in Urbana scanned the brains of older men and women, aged 60 and 80, using a technique that tracks oxygen delivery to cells to determine brain activity. The researchers also measured their volunteers’ aerobic capacity and asked them to wear an activity monitor for a week to determine how much and how intensely they moved each day.

Notably, the most physically active elderly volunteers, according to their activity tracker data, had better oxygenation and healthier patterns of brain activity than the more sedentary volunteers — especially in parts of the brain, including the hippocampus, that are known to be involved in improved memory and cognition, and in connecting different brain areas to one another. Earlier brain scan experiments by Dr. Burzynska and her colleagues had established that similar brain activity in elderly people is associated with higher scores on cognitive tests.

Interestingly, as Dr. Burzynska points out, none of these volunteers were athletes, as Ms. Kotelko was. In fact, none of them formally exercised at all. But those who walked, gardened and simply moved more each day had brains that appeared to be in better shape than those of the other volunteers.

Of course, while this research offers tantalizing clues as to why exercise may be good for the brain, the study, like Ms. Kotelko’s scan, cannot prove cause and effect.

So, fundamentally, we still do not know whether and how physical activity changes our minds — a confusion that most likely was intensified for many of us by the results of a well-publicized study published last month in JAMA. In it, researchers from the Wake Forest School of Medicine in Winston-Salem, N.C., and other universities asked sedentary, elderly men and women, between the ages of 70 and 89, to start walking and doing light resistance training while other volunteers joined a health education program to serve as a control group.

To measure whether exercise made a difference in brain health, all of the participants completed cognitive testing at the beginning and the end of the study.

On the surface, the results were discouraging. The scores for the people in the exercise group were unchanged after two years and about the same as the scores for the group that attended health classes, intimating that exercise had had no effect.

But look deeper and there is another, intriguing inference. The cognitive performance of the volunteers in both groups remained stable, instead of declining, as might have been expected at their ages. So it may be that exercise did keep the volunteers’ minds sharp — and so did getting out and attending classes and engaging socially with the world.

“There are so many things that may impact brain aging,” Dr. Burzynska said, “and so much that we don’t yet understand about the process.”

Scientists need to scan people’s brains before and after long-term exercise programs, she said, and parse how exercise affects the many different varieties of thinking. In the JAMA study, for instance, there were some small improvements among the oldest exercising volunteers in their working memory and attention, but not other cognitive skills.

But even in advance of more studies, it “seems very likely,” Dr. Burzynska said, that exercise enables our brains to age better, even if, like Ms. Kotelko, we get started a little later in life.

 

 00:51

Olga Koltelko in Action

Video

Olga Koltelko in Action

The master athlete has been shattering track-and-field records all over the world.

 By None None on Publish DateNovember 24, 2010.

Model hospital: working with lean healthcare in a bad economy

Fonte: http://planet-lean.com/model-hospital-working-with-lean-healthcare-in-a-bad-economy

      

By: Cristina Fontcuberta Adalid

Posted on 31 Mar 2014

CASE STUDY - In the past two years, the Consorci Sanitari del Garraf, a 433-bed public healthcare organization near Barcelona, experienced a lean turnaround. Basing her reflections on LGN's Lean Transformation Model, Cristina Fontcuberta Adalid of the Instituto Lean Management gives us an overview of the key building blocks of the transformation, of the approach followed from the very beginning, and of the results achieved up to now.

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Words: Cristina Fortcuberta Adalid, Instituto Lean Management

Corsorci Sanitari del Garraf has a long tradition of focus on patient care and of good working practices, and there is no doubt this pre-existing culture helped the organization to embrace lean thinking so successfully in the past couple of years.

In both 2012 and 2013, CSG made the Top 20 list of the best-managed hospitals in Spain, and in January it was awarded the Abedis Donabedian recognition for hospital quality excellence. Both are extremely sought-after accolades here in Spain. So how did the organization achieve such great results? To understand this, we can analyze CSG's journey using the Lean Transformation Model as a framework.

Scroll down and you will be able to see an A3 I drew - it will give you an overview of the transformation. Further below there are short explanations of each of the building blocks of a lean transformation as they took shape at Consorci Sanitari del Garraf.

But first, some background information:

Now that we have made introductions, let's get into the lean transformation. Here's my A3 of the Corsorci's transformation, looked at from the perspective of the Lean Transformation Model (each section is available in a larger format below).

- Situational Approach

• The problem CSG was trying to solve: In mid-2011, the organization had just finishedredesigning the map of its key processes. From that point onwards, it felt it needed to improve them on a daily basis and involve its professionals in process improvement. After reviewing different existing methodologies, it decided lean management was the best option. Why? Mainly, because of its "respect for people" philosophy.
• The challenge: lean was a completely unknown methodology at CSG. Those who had heard of it thought it was only applicable to car manufacturing. Initial resistance was evident.
• The opportunity: earlier in 2011, the CEO had attended a public workshop organized by ILM and was really enthusiastic about it. He was convinced lean could help his organization to improve the delivery of patient care and, at the same time, increase the engagement of professionals.

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- Basic thinking driving the transformation

The implementation of lean thinking at CSG is based on the following key aspects:

• Effective communication to achieve people involvement.
• Use of the scientific method and PDCA without losing momentum, in order to rapidly increase knowledge.
• Data-driven mindset: any action is based on data extracted from the gemba instead of guessing and perceptions.
• Time management: give people the time to adapt to new situations.

Here's what Lean Manager, Rosa Maria Simón, said: "One of the major objectives for CSG is to transform processes so that they can create value, provide high quality care and give optimal accessibility to our patients. Achieving this while in tough economic times is impossible without the participation of every person involved in the value chain. People are the number one source of value in our organization."

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- Capability development & the role of leadership

When you are deploying lean management techniques and principles, developing the capabilities of people is one of the things you can never go without. CSG was aware of this from the very beginning and knew that people development would contribute greatly to overcoming resistance.

• Training a group of people was one of the first things CSG did. Facilitators were asked to participate in a lean workshop that lasted several days. They are a group of 20 people from different management levels in the organization.

AN AREA FOR LEAN, THE ESPACIO LEAN

They didn’t necessary have to be the ones who would directly use lean tools, but those who would lead the entire project. After the workshop, the person responsible for training in the entire hospital became the main lean leader, and since then she has participated in every project and acted as a channel between professionals and the management team.

• Working on small, contained projects each time also helped people to rapidly implement improvements (this was “learning by doing”).

• After the implementation of the first three projects, a “lean diffusion” session was organized so that everyone interested (participation was not mandatory) could see with their eyes what was going on, the steps that were being followed and the results that were being achieved. The final goal of this session was keeping people informed.
• Aligned with this last point, a “lean diffusion” area was created. The A3s that were developed were hung to a wall in a busy location within the organization.

After a few months, staff behavior started to change as everyone began to understand what lean was about (and maybe, more importantly, what it wasn’t about). The picture on the left shows a page from the organization’s internal monthly magazine. In the article shown on the page, the Diagnosis Service team talks about their experience using lean principles and tools and share their point of view and how the changes directly affected them.

Over the entire course of the transformation, the active role of leadership has contributed to the achievement of good results. The project has been supported enthusiastically, down to the level of every decision and implementation of changes. On certain occasions, meetings on CSG’s lean work happened in the presence of some members of the management team.

The organization knows it has a long way to go in its lean implementation, but it’s also encouraged by the great start it experienced.

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- Process improvement

Process improvement at CSG follows the PDCA philosophy and is supported by the use of lean tools, such as A3s, value stream mapping, 5S, standardization or precedence diagrams.

The criteria used to select the first project (which had to be small, visible, easy to complete, assigned to a highly motivated team, etc.) were critical to its success, as it represented the early gains that gave the organization the traction it needed to expand the reach of its lean implementation.

The steps are the same in each project. Here they are:

• The PLAN phase consists, first of all, in starting the A3 of the project. The background and the available resources are written down, in the ‘Current Situation’ section. In order to fully describe and understand the situation and to detect opportunities for improvement, the team must go to the gemba. A value stream map is also included in the A3. Then, the overarching goal of the project is added to the A3, and the team starts to analyze each improvement opportunity and tries to reach its root cause. Once the analysis is complete, the team can start to think about countermeasures. 

• The DO phase consists in determining the actions that will lead the team to the future situation.

• The CHECK phase sees the monitoring of the indicators included in the A3. Generally, this happens several weeks after actions are implemented.

• The ACT or ADJUST phase entails the standardization or the adjustment (through a new PDCA cycle) of the actions, depending on the results achieved. 

The A3 is a tool that guides the development of the entire project.

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WANT TO READ MORE ABOUT LEAN AT CSG? CLICK HERE TO READ A STORY FROM THE SURGICAL THEATERS

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THE AUTHOR

 

Cristina Fontcuberta Adalid

Instituto Lean Management, Spain