In order to get ‘FIT’ you need to find the right FIT

 

Today I have the pleasure to introduce to my readers Next Phase Fitness.  I had the opportunity to participate in their Elevate 60 class which was taught by Doug Frantzen, co-owner and trainer.  The goal of Elevate 60 is to optimize loss of calories and build muscle for those of various fitness backgrounds.   A wide range of training routines and trainers are available to assure that your specific fitness goals are met. 

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The environment of the gym was warm and welcoming, not only by the staff but also by those who were taking part in the class.  The positive environment made me want to push harder during the class.

The heart rate monitored class motivated me to push to the next level and proved to be quite competitive for me.  I was making sure I was on par with Mr. Frantzen 🙂 (Dougs dad!).

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Heart Rate Monitor Screen

Next Phase Fitness is truly focused on the client.  They want to know who you are, what you do and what your goal is as far as exercise is concerned.  This new facility has the potential to grow and provide excellent service to all who participate in their classes.

So, let’s get to the reason why I am writing these blogs of gyms in the Loudoun area.  We are looking to FIT you with the RGHT fitness facility so that you can get ‘FIT.’

Next Phase Fitness is great for:

  1. Persons with an intermediate to advanced fitness background

  2. Persons who love group workouts and the camaraderie of those around them

  3. Persons who are interested in attending a fitness facility that does not have contracts

  4. Persons who hold a clean environment near and dear to their heart (like me)

  5. Persons who want to be pushed to the next level of fitness

  6. Persons that want to be in an workout environment where the instructors and owners are looking out for your well being. 

In an effort to enhance their knowledge on movement, Next Phase Fitness and Missing Link Physical Therapy will be collaborating to introduce a class for persons who are interested on learning the ‘Basic Movements Required for Exercise’.

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Left: Andre Heletsi (Owner Missing Link Physical Therapy) Right: Doug Frantzen (Co-Owner Next Phase Fitness)

Please provide comments about your experience at Next Phase Fitness. I am sure our readers would love to hear about it so they can make the right FIT in order to get ‘FIT’. 

If you have questions about Next Phase Fitness please contact them at: 

Next Phase Fitness, LLC 

21020 Sycolin Rd Suite 115

Ashburn, VA 20147

CustomerService@nextphasefit.com

703-858-4410

If you have questions for Missing Link Physical Therapy please contact us at: andre@missinglinkpt.com

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Why do I have a pain in my butt??!!

What do we treat the most at Missing Link Physical Therapy??!!!The pain in the butt!!! No, I don’t mean the client, but literally a pain in the butt sometimes referred to as sciatica or piriformis syndrome. Often individuals have difficulty standing, sitting, walking, running or going up stairs. This pain can be very debilitating and decrease function and quality of life. This blog is aimed to address ways to decrease pain and the necessary treatment required in order to regain your mobility and function.

Frequently when a sudden ache in the butt or leg occurs people always wonder, why? Individuals often don’t experience back pain and have not done anything differently to cause this pain. Well, the body is a great machine and was built to be resilient. Very often by the time you experience a particular pain the movement dysfunction has been present for years. It is like eating the wrong foods and years later you have hypertension and heart disease. In the majority of cases we can contribute the cause of the pain to a nerve irritation in the low back or peripheral muscles. For instance, with mild to moderate degrees of nerve irritation to the low back you can get this abnormal tightness and guarding of the hamstring, gluteal (butt) muscles, calf muscles and even heel pain or cramping of the bottom of the foot.

In order to start recovering from this state you need to remove the irritation to the spine. If the condition is acute this can be done by pharmacological means (please refer to your physician for the appropriate drug of choice). From a Physical Therapy disposition this can be done by avoiding certain postures; such as slouched positions, any activity that may place stretch on the hamstring (want to avoid stretching of the hamstring as it will cause stress on the nerve if there is nerve tension), reading in the bed with legs extended…Basically you want to avoid any position that will place stress on the nerve. Imagine a long string that is attached to your spine and extends all the way to your foot, every time you slouch or stretch the hamstring you irritate the nerve. The stretch may feel good initially but you will find that you may suffer a rebound effect of pain later in the day, with even more tightness in the particular muscle. Figure A shows an individual reaching into a box with a rounded back posture; this will increase tension in the back and also the nerve. Figure B shows an individual stretching the hamstring with a rounded back posture, at this time the nerve may be on maximal tension and irritation may be at its greatest. In Figure C the individual to the left is placing increased stress to the back and nerve, the individual to the right is exhibiting good technique with lifting by hinging from the waist and bending the knees.

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FigureA

hamstring stretch

Figure B

lifting

Figure C

After decreasing the nerve irritation it is now time to improve the muscle tension. This can be done by getting a deep tissue massage, foam rolling or trigger point dry needling (my recommended treatment of choice). You want to improve the muscle length of the gluteal muscles and back muscles. Figure D, E, F, H represent foam roll massages; these massages should be performed as tolerated, slowly kneading out the trigger points in the respective muscles. Figures G and I represent stretches that can be performed for approximately 45-60 seconds. Please refrain from doing exercises if pain is elicited.

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Figure D. Foam roll gluteals

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Figure E. Foam roll TFL

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Figure F. Foam roll low back. Be sure to keep back neutral or slightly flexed in order to avoid excessive stress on the low back.

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Figure G. Piriformis stertch

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Figure H. Foam roll quadrates lumborum (side of back).

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Figure I. Quadratus lumborum stretch (stretch to side of back)

Last step is to stabilize the spine by avoiding an anterior or posterior pelvic tilt. I recommend stabilization of the lumbar spine with the back in neutral.

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Figure J. The picture to the left represents an anterior pelvic tilt. The picture in the middle represents a neutral spine. The picture to the right represents a posterior pelvic tilt.

In this blog I have purposely avoided educating on abdominal stabilization as I believe that the exercise for stabilization should be monitored. The reason individuals have pain in the first place is because of a movement dysfunction, so I highly suggest getting assistance from a trained movement specialist (physical therapist, personal trainer, athletic trainer, pilates instructor, yoga instructor etc.). Pain does not just appear but is comes about due to increased stress being placed on a structure in the body over time. REPAIR THE MOVEMENT AND YOU IMPROVE THE PAIN.

Please take note that in order to have somewhat of a full recovery from this injury you must make sure that you are able to contract the deep abdominals appropriately and work on maintaining the contraction over time with your respective exercise/activity. With practice over time these muscles should contract involuntarily.

Over time if symptoms appear to be unrelenting and worsening we suggest getting further diagnostic testing to determine if there is structural damage such as a disc bulge/ herniation, degenerative changes in the spine, etc. Further medical treatment may be required in order to decrease symptoms prior to initiating an exercise program.

In our clinic we see many of these cases and have been very successful with treatment. We shall be delighted if you call us and schedule an appointment today. I am sure that you want to resolve the nagging pain in your ‘butt’.

You can Contact us at: Phone:703-858-5070, Email: office@missinglinkpt.com, website:www.missinglinkpt.com.

We are located at: 44933 George Washington Blvd Suite 165, Ashburn VA 20147

Clinical Assumptions versus Clinical Hypothesis

In today’s healthcare system it has become quite difficult to find an answer to your medical problems. This is partially due to the dwindling dollars provided to healthcare providers by third party payers. This decline in reimbursement is evident especially with regards to the provision of Physical Therapy services. Healthcare providers now create a Clinical Assumption versus a Clinical Hypothesis to solve your health care issues. I will be discussing scenarios based on Physical Therapy because that is my field of interest; however, the same thought process can be extended to other healthcare professions.

In an insurance based system, regular Physical Therapy treatment sessions are usually in thirty minute increments. In this thirty minute session the patient needs to update the therapist on his/her progress, the therapist needs to perform a set of tests and measures in order to guide the treatment and there maybe the need to perform a manual intervention followed by exercise.          Is twenty-five to thirty minutes enough time to perform all of these functions?  Just imagine you as the patient or even you as the therapist, it is an anxiety driven process. Before the therapist can complete the patient’s examination/treatment, the next patient is waiting and the therapist has to leave the first patient unattended to perform exercises with verbal instructions. What I have found to be the problem with this system is that it is all rushed and doesn’t leave enough time to understand your patient’s pain and movement dysfunction. The patient has been left alone to do their exercise??!! But the patient has a movement dysfunction!! I believe that the patient’s exercise must be monitored. I also believe that if the patient has dysfunction with his/her daily movement it will be carried over into the exercise resulting in a rebound effect with regard to any pain being experienced. Consequently, the patient’s goal has not been met.  The therapist doesn’t have enough time to figure out if the exercise is appropriate or not, assuming that if the exercise worked for patient A, with the same diagnosis that it will work for patient B. This is an assumption we cannot make as the exercise prescribed to patient B may actually exacerbate the injury. Patients should always feel as though their functional goals have been met every session. This can happen if the correct hypothesis was created. With improvement in the patient’s condition the hypothesis should continue to change.

Another example of a Clinical Assumption (true story): Patient goes to the doctor because of dizziness. The doctor asked a few questions and assessed her lungs, heart and ears. The patient was prescribed high dosed steroids diagnosing her with a vestibular neuritis. This was all of a 10 minute visit. What was the clinical hypothesis? Where is the differential diagnosis? Low and behold the diagnosis was wrong and steroids were not required. This is one of many errors made based on quick Clinical Assumptions. How much did the patients healthcare dollars pay for this?

My past and current experience reveals that in the Physical Therapy practice with an hour one-on-one session you are able to solidify a clinical hypothesis and treatment and patients, at the end of the session, feel as though their functional goals have been met. This is especially important for the more complicated treatments. For example, I have treated an ankle sprain in both the insurance based and fee for service settings; in the first setting it can take 2-4 sessions to reach meaningful outcomes and in the latter setting only 1-2 sessions. The difference is that I had more time to form an extensive clinical hypothesis to drive a meaningful treatment.

This blog is not to push everyone to go into a fee for service system but rather to push the healthcare system to increase reimbursements. With improved reimbursements we as Physical Therapist become more efficient and will reach functional outcomes sooner, in turn spending less resources and medical dollars.

We need a healthcare system that spends enough time to format the appropriate Clinical Hypothesis versus a Clinical Assumption.  We can spend less time with the Clinical Assumption but our outcomes suffer. On the other hand, we can spend more time with the patient and form the appropriate Clinical Hypothesis and improve the overall function and quality of life of the patient.

It is unfortunate that the healthcare system has become a business and has lost the personable nature of medical care. Your insurance card (some people think it is for free services) does not buy you better healthcare but rather places the patient in a system of inefficiency where executives of insurance companies and healthcare systems get paid 6 million dollars a year, and where the patients who have been paying their premiums for years cannot pay for their cancer treatments.

Just some food for thought. Your health is important and the best treatment should be available to all.

Are you at Risk for Injury In 2015??!!

Every New Year it is customary for us to make resolutions in order to improve some aspect of our life. Today it is my desire to address the physical resolutions such as losing weight, increasing activity level, participating in a new sport, resuming a sport and/or returning to sports after injury.

In 2015 Missing Link Physical Therapy (MLPT) wants to focus on injury prevention for persons in the community as a whole; from the professional athlete to the 80 year old who likes to participate in recreational activities. As Physical Therapists we have used the techniques of range of motion, strength and sports specific exercises to predict whether individuals are ready to return to their specific sporting activities. However, research reveals that these techniques are not 100% effective and some individuals develop new injuries or have a recurrence of the old injury.  Consequently, it is essential that we perform a Musculoskeletal Physical Assessment that will continue to assess range of motion and  strengthen in addition to the  performance of a Functional Movement Screen (FMS) and Y Balance Testing (YBT).

One might ask: Why is this Physical Assessment important? Research has shown that the right to left asymmetries can lead to abnormal stressors on the body resulting in injury over time. This evaluation enables us to assess asymmetries from right to left, assess the effects of past injuries on the body, and the effects injuries have contributed with regards to motor recruitment/proprioception. Think about the effects of an ankle or knee injury on your body. Wouldn’t it be great to have a test that reveals these imbalances and predicts risk for injuries?

The FMS and YBT are tests that show risk for injury. With regard to the YBT we can predict injuries based on gender, age and the specific sport undertaken by the individual. These tests give the clients an objective result on the risk for injury based on their specific sporting activity.  THIS ASSESSMENT IS PROVIDED AT MLPT.

In the New Year we encourage you to exercise!! Visit MLPT to have your Musculoskeletal Physical Assessment and we shall be happy to guide you towards increased activity/improved performance with decreased risk of injury.

Below are articles to substantiate the testing we are providing:

If you wish to schedule your Physical Assessment please call or email us at (703) 858- 5070; office@missinglinkpt.com

Overcoming the Challenge of Today’s Healthcare System

As a young Physical Therapist growing in experience and knowledge I question our effectiveness in the healthcare setting. I don’t mean to generalize everyone, but I think we have lost the love for people. We have lost the sympathy and empathy on which healthcare was built on. Because of financial restraints we have cut the time spent with patients. Along with the time lost we have lost the ability to perform personalized care. I am not an exception and have been guilty of this; and with the loss of personalized treatment I believe that outcomes are not optimized. Being a healthcare professional does not only mean giving the right drug or correct treatment. By building an intimate relationship with your patient, a relationship of trust can actually enhance the affect of the drug or treatment provided. Yes, there is no research to show this, but through my clinical experience I have seen first hand that a combination of the right treatment and good relationship have positive outcomes. Conversely, the right treatment with flawed patient interaction showed poor clinical outcomes.

I don’t believe that we are going to heal everyone, but I do believe that we can optimize the quality of life and function of individuals with more TIME. I believe that with more individual time we can change peoples lives and we can ‘LOVE’ them more. We can be better at achieving the functional goals of the patient instead of priortitizing our own clinical goals with the time we have. I believe that with more time there will be less money spent overall and better utilization of our patients’ healthcare dollars.

In my young Physical Therapy practice there is a common trend of people coming to therapy only once a week. This is because with a one hour treatment focused on individualized care we are able to achieve the goals of the patient in a timely manner. People are, over time, paying less and also spending less time away from their overall ‘dysfuntion’. Individuals are optimizing their function and becoming an active part of society.

Our chronic population needs more individualized time as we are not only dealing with the physical affects of pain, but also the psychosocial aspects. We need to continue to challenge insurance companies on reimbursement for our respective skill sets. We are worth more!! We need to get back to patient centered healthcare where outcomes, quality of life and function are our primary goal. This is my utopia because I see it is possible with what I do on a daily basis. Patients and clients will testify to my ‘crazy talk!!’ The missing link to healthcare is not necessarily the next super drug, surgical technique or diet but rather the intangibles that cost us nothing. It is the eye contact, smile, attention, hug, holding of a hand… the list goes on! I challenge all those who are in healthcare to try this and see what your outcomes are. See the reaction that is driven from it.

Let’s love each other and the healing will follow.

Welcome to the Missing Link!!!

What is Missing Link Physical Therapy (MLPT)?? (MLPT) is a fee for service Physical Therapy Clinic focused on improving the function of patients in a timely fashion. We provide Physical Therapy services on a one on one basis in a private treatment room setting. The time you spend at MLPT is all yours. We also provide massage and personal training services (with specialty in restoring movement and decreasing injury for those in the performing arts).

This is the place where ‘Mind, Body and Soul Connect,’ MLPT focuses not only on the individuals mechanical deficits but we also focus of the emotional and psychosocial reasons for an individuals pain as this can contribute to chronic pain. So how do we accomplish the ‘Mind’ and ‘Soul’ aspects of care? Well first we love on you!!! This is important because by caring and providing a loving environment we are able to calm that nervous system down thereby decreasing pain and also the anxiety driven by pain. We also collaborate with other health care professionals when we feel their services will be complimentary to ours such as Clinical Social Worker’s, Personal Trainers, Orthopedic surgeons and the list goes on.

We have created this blog to inform the community about their health care options and to let individuals understand that they don’t have to live in pain. During the course of a series of  blogs we will address common acute/chronic injuries we see and have been successful in treating. We will also share our philosophical views on healthcare and ways we can improve outcomes and not over utilize resources.

We hope you continue to follow us on the path of healthy living and a healthy lifestyle. COME JOIN US AND HEAL WITH US!!

www.missinglinkpt.com