Living Well May 2015

May/June 2015 ~ living well

sports medicine MAY / JUNE 2015 A Publication of the

sports physicals keep you safe

play it safe with concussions

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living well ~ May/June 2015

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here are many things to love about Montana.

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May/June 2015 ~ living well

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living well ~ May/June 2015

A publication of the

missoulian.com

People in Missoula and western Montana want to feel good, look good and live well. Available at more than 150 newsstand locations throughout the area, Western Montana Living Well is well suited to more than 30,000 readers monthly who want health tips on fitness, nutrition, family, financial advice, wellness, therapy and beauty.

publisher Mark Heintzelman graphic design Krista Ness Ray Lombardi

advertising sales Rachel Crisp Philips 406-523-5223 contributors Daniel Brown Donna Kay Jennings Shawn Lake Joy McKay Jessie Patterson Mike Tran

The opinions, beliefs and viewpoints expressed by the various authors and forum participants in this publication do not necessarily reflect the opinions, beliefs and viewpoints of the Missoulian or Lee Enterprises. The author of each article published in this publication owns his or her own words.

No part of the publication may be reprinted without permission. ©2015 Lee Enterprises, all rights reserved. Printed in the USA.

Get back in the swing of things.

If your muscles and joints aren’t up to par, our primary care providers and physical therapists are experts at getting you back on course.

Western Montana Clinic Lean on us for all your healthcare needs.

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May/June 2015 ~ living well

May/June 2015 VOL. 29 proper footwear

in this issue sports medicine

pg. 8

rest and recovery pg. 12

young athletes pg. 16

physical therapy pg. 25

concussions pg. 20

tommy john pg. 28

chronic pain pg. 32

over 60 pg. 34

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living well ~ May/June 2015

The facts about overtraining

By Donna Kay Jennings, APRN-PMH, PsDC

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f you wish to develop the body you dream of, you must avoid overtraining at all costs. To make this crystal clear, I’ll stress that overtraining is the act of working a muscle or group of muscles beyond what is needed to induce a maximum stimulus for growth.

That means you should focus only on performing a quality set or sets of exercises rather than increasing the number of sets. For the doubters and non-believer, I’ll now go into detail as to why overtraining is a problem. It’s all about stress and the hormone cortisol.

Cortisol is an important hormone in the body. It is secreted by the adrenal glands and involved in the functions and more: • Proper glucose metabolism • Regulation of blood pressure • Insulin release for blood sugar maintenance • Immune function • Inflammatory response

A high level of physical or mental stress causes fat, protein and carbohydrates, along with epinephrine and a number of other endocrine hormones, to be rapidly mobilized in order for you to take quick action against the stressor (the well-known – fight or flight response to stress.) During this mobilization, cortisol and adrenaline increase while DHEA (Dehydro-epiandrosterone) and testosterone decrease.

Normally, cortisol is present in the body at higher levels in the morning and at its lowest level at night. The fight

or flight response to stress isn’t the only reason cortisol is secreted into the bloodstream. It is also responsible for several other stress-related changes in the body.

Small increases of cortisol have some positive effects in the body: • A quick burst of energy for survival purposes • Heightened memory function • A burst of increased immunity • Lower sensitivity to pain • The maintenance of homeostasis in the body Homeostasis: is the body’s natural tendency to maintain, or attempt to maintain, an internal stability or balance. The organ systems of the body do this by coordinating biological responses that automatically compensate for environmental changes.

While cortisol is an important and helpful part of the body’s response to stress, it’s also important for the body to activate its relaxation response following a stressful event.

This allows the body’s function to return to normal.

Unfortunately, in our current high stress culture, the body’s stress response ramps up so often that it doesn’t have a chance to return to normal. Moreover, you should know that high-intensity exercise and prolonged exercise, both, increase cortisol levels. This means that overtraining creates a chronic stress in the body along with high, prolonged levels of cortisol!

Cortisol levels remain elevated for about 2 hours following an exercise session, since exercise is a stressor.

May/June 2015 ~ living well

Therefore, prolonged exercise sessions or repeated sessions without appropriate rest between the session’s results in chronic, elevated cortisol. Additionally, poor diet, inadequate supplementation and lack of rest, in general also play key roles in cortisol secretion. A chronically elevated cortisol level causes your body to enter a state of constant muscle breakdown and suppressed immune function, increasing your risk of illness and injury while cannibalizing muscle tissue.

That’s right. Chronically high cortisol levels shrink muscle tissue. Because of this, we’ve learned that minimizing cortisol levels is ideal for an athlete if he or she wishes to achieve tissue growth and positive adaptations to exercise training.

Another negative outcome of too much cortisol is increased abdominal fat. Aside from appearance frustrations, increased abdominal fast is associated with a greater number of health problems than fat deposited in other areas of the body. This happens because abdominal fat can secrete dangerous hormones. Some of the health problems associated with excess stomach fat are heart attacks, strokes and a poor cholesterol profile that can lead to other health problems.

Still other negative effects of too much cortisol are: • Reduction in athletic performance because of fatigue and inflammation • Reduction in ligament health • Poorer sleep quality • Mood swings • Reduced sex drive • Decreased bone density • Slowed wound healing • Impaired cognitive performance • Suppressed thyroid function • Imbalanced cognitive performance • Suppressed thyroid function • Imbalanced blood sugar such as hyperglycemia • Higher blood pressure • Lowered immunity and other inflammatory responses in the body Cortisol secretion varies among individuals. People are biologically wired to react differently to stress. One person may secrete higher levels of cortisol than another in the same situation. Studies have also shown that people who secrete higher levels of cortisol in response to stress also tend to eat more than people who secrete less cortisol.

They also eat food higher in carbohydrates. If you’re more sensitive to stress, it’s especially important for you to learn stress management techniques, as well, as adopting a lowstress lifestyle to the degree possible.

sense for someone interested in wellness!

A more scientific approach is to have your hormones test with a saliva test. A suppressed hormone system maybe a sure sign of decreased exercise capacity and overtraining.

There is also strong evidence that an athlete who exercises in a carbohydrate-depleted state experiences greater increases in cortisol. Decreased frequency of menstrual periods in women (amenorrhea) has been linked to insufficient energy availability. That, in turn, triggers a stress-hormone response and suppresses estrogen and progesterone.

How can I modulate cortisol?

You can modulate your cortisol production through rest, nutrition, and supplementation. First, since repeated bouts of exercise cause chronic, elevated cortisol, it is crucial to get plenty of rest between workouts. You get your best results, by far, with a day or two of rest between workouts.

Bottom line: Once you’ve completed the number of sets, you need to discontinue exercising that particular muscle group for the remainder of the session. If press ahead with additional sets, it means either you did not fatigue yourself with the required number of sets, or you’re simply choosing to ignore this rule-at your peril. Then cortisol becomes your enemy instead of your friend.

Come visit us at New Health/Aleph P.C. for your saliva test kit today, no appointment needed.

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Mood swings, lack of motivation to train, loss of muscle, and loss of appetite are all symptoms of an elevated cortisol level. Sound familiar? That’s right: It’s the overtraining syndrome! If you are not taking steps to modulate your cortisol, you are breaking down your muscle, storing fat, and getting sick, none of which make

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living well ~ May/June 2015

May/June 2015 ~ living well

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Proper footwear

Shoes can prevent, manage arthritis

By Mike Tran

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oints are formed in a very specific fashion to allow the ends of bones to move fluidly upon their adjacent surfaces. When something effects or modifies how bones interact with each other at a joint in the body, arthritis is the result. The problem with arthritis is that by the time you notice something is wrong, the process is often times quite progressed.

That is because the cartilage that lines the surface of the bones that are articulating lack pain receptors, so by the time pain is felt, the protective cartilage that helps joints move smoothly is worn down and irritation has occurred to surrounding tissues and/or bone.

The shoes you wear can either perpetuate or diminish the effects of arthritis throughout your lower body and in many cases your

upper body as well.

Even if you’re not a runner or walk substantial distances, you are probably on your feet much of the day, and the type of shoe you wear may have a significant effect on not only your feet but a rippling effect up through your knees, hips, and even eventually through your spine as well. Imagine how many steps you take every day and then multiply that by a life time. That is a lot of steps, and each step can be considered a drop in a very large bucket over time slowly increasing the amount of damage at a joint or joints over time.

Your feet perform two major functions during walking or running. First, your foot provides a pliable cushion to absorb the impact from your body and contour to the

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living well ~ May/June 2015

adjacent surface you are walking or running on. Second, your foot provides a rigid structure to propel your body forward through space. The ability of your feet to perform these functions is directly related to the structure and function of your arch. Your feet can generally be classified in one of three categories of arches: high arch (pes cavus), neutral arch, and low arch (pes planus). The type of shoes you wear should be dictated by the type of arch you have.

In addition to the type of arch you have, another factor that influences the kind of support you need is whether your arch is rigid or flexible. You can find machines at grocery stores that do a great job of showing you what type of arch you have in terms of high, neutral, or low, but cannot determine whether your arch is rigid

or flexible. This information may be most important when selecting a shoe. A rigid arch may indicate the need for a stiff, less flexible, arch support while a more flexible arch may indicate a more cushioned arch support.

Another factor that influences your feet is body weight. Increases in body weight places an equivalent increase in stress through your arch. The more weight your arch has to support, the more likely it is to give under your body weight. This can lead to a progression in “flat-footedness” or result in a new case of flat feet.

There are a number of subsequent malalignments that may occur when a person’s arch flattens out. The most common is the creation of a valgus deformity at the knee,

Podiatrists, orthotists, and physical therapists are all professionals that can help determine the best shoes for you or whether a more custom orthotic may be most appropriate.

a deformity in which the angles at your knees point inwards toward each other; also known as “knockkneed.” Not only does this result in increased likelihood of developing or progressing arthritis at your knees but also muscle imbalances and weakness in the hips which may also perpetuate arthritic conditions at the hips which in turn may be translated up through the spine.

This phenomenon is also why I only recommend very few individuals to wear any of the new “bare-foot” style running shoes that have become so popular recently.

Because of their lack of any sort of arch support these shoes are appropriate for only a very select number of people. In any case, proper foot wear in addition to weight loss can help curb the problem.

Podiatrists, orthotists, and physical therapists are all professionals that can help determine the best shoes for you or whether a more custom orthotic may be most appropriate. Podiatrists are medical physicians with specific foot, ankle, and lower extremity training.

Orthotists are specialists trained in determining need for, design, and the fitting of orthotics. In addition to assessing feet, physical therapists can also help correct muscle imbalances and instruct in proper body mechanics. Experienced employees at specialty foot wear shops can also be excellent resources.

Mike Tran is a physical therapist in the Rehabilitation Institute of Montana at Community Medical Center.

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Rest & recovery

May/June 2015 ~ living well

By Joy McKay, PT

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Prevent sports injuries with a proper training program

n order to have optimal benefit physiologically and psychologically in any training program, it is essential to be adequately prepared for participation. Physical conditioning prior to participation and gradual introduction of an activity can help alleviate potential for injury. Important components of physical training include sufficient muscular strength and power, balance, cardiovascular endurance and flexibility.

Upon embarking in a sport specific training regime, one of the most important and often overlooked principles is adequate rest and recovery from training sessions. Proper recovery and rest maximize the physical benefit from training sessions. Recovery and rest will enhance your ability to continue in a training program and ultimately enhance performance.

Recovery and rest are essential to be built into any training program or prolonged activity that is moderate to intense in demand. Anytime we put our bodies through physical stress or a hard training episode, the physical benefits from that demand come from the body’s adaptation to the exercise stress. This occurs after the training session when the body has a chance to recover and rest. The cells, tissues and muscle will repair during this time and then rebuild. Active recovery is the time frame immediately following a training session and lasting for the next few days. Directly following a training session a proper cool down of continuous lower intensity exercise is performed. The active recovery continues over the next few days where lower intensity training sessions continue prior to the next

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intense episode. If you turn around and do too intensive of a subsequent session without proper recovery, then your system can begin to experience depletion of muscle energy storage (glycogen), micro trauma and cellular/tissue breakdown.

Rest is taking 1-2 days either completely activity free or participating in a low intensity activity that does not duplicate your sport or activity. If rest days are not routinely incorporated into the training regimen, then the body does not get adequate recovery, which can lead to overtraining syndrome, or worse, a physical injury. This can include feeling fatigued, loss of enthusiasm for the sport

or activity, decreased performance and difficulty sleeping.

The importance of getting adequate sleep at night as part of the recovery is also of vital importance. Consistent poor sleep has been linked in studies to subtle changes in hormone levels, decreased muscle recovery and glycogen synthesis, decreased aerobic endurance and increased perceived difficulty of exercise.

The current recommendation when participating in a year round sport or repetitive intense activity is that every 3- 4 months there should be 1-2 week period of rest that can include active recovery performing a lower intensity program that is not duplication of the sport or activity.

May/June 2015 ~ living well

If rest days are not routinely incorporated into the training regimen, then the body does not get adequate recovery, which can lead to overtraining syndrome, or worse, a physical injury.

If you have already experienced an injury or are having pain with exercise currently, rest and recovery are necessary. How much rest and what type of recovery you will need can be determined by a medical professional.

This is where an individualized program that might include evaluation for imbalances, cross training or use of physical agents to enhance healing might be prescribed.

Proper recovery and rest are often overlooked and often not properly utilized. Yet they are critical for optimal physical training benefits, improved performance, avoidance of injury or overtraining and ultimately in allowing longevity of participation.

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living well ~ May/June 2015

Sports physicals help keep

young athletes safe

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By Shawn Lake f your child is in school sports, you’re probably familiar with balancing the delight of watching your young athlete play and the worry about kids getting hurt. And rightly so — sports-related injuries and illnesses can put kids out of the game, and sometimes cause long-term problems.

Schools are stepping up with new policies that help protect kids. However, keeping school athletes safe starts even before the first practice, with the sports physical. A thorough sports exam can uncover issues that may make your child vulnerable to a sports injury or to becoming ill while playing.

May/June 2015 ~ living well

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Most such problems can be treated, and the young athlete can still play sports. The key is to make an appointment and have the physical done by your primary care provider. These more extensive exams go beyond the brief screenings offered by many schools and can catch problems they miss.

At your child’s sports physical, the physician will ask about his or her medical history. For example, a previous injury or condition such as asthma or allergies can mean your child should take specific precautions during practice and play. The doctor may also ask about your child’s diet, medications, and/or use of dietary supplements.

Your child’s doctor will also perform a physical exam, focusing on the demands of the particular sport. The exam may involve checking:

• Height and weight • Blood pressure and pulse • Vision • Heart, lungs and abdomen • Ears, nose and throat • Muscle strength and flexibility • Joints and posture Be sure to let the doctor know about any concerns you may have.

For example, has your child lost or gained weight recently? Has he or she ever felt dizzy or had trouble breathing during a game or practice? Has anyone in your family ever fainted or become ill during exercise? These clues can help the doctor zero in on potential problems.

In some rare cases, an undiagnosed heart defect can cause sudden death when the person is doing strenuous exercise. If you have a family history of certain heart conditions, your doctor may recommend a simple screening test such as an electrocardiogram or echocardiogram.

Not all heart conditions rule out sports, and with their doctor’s approval, some kids can still participate. But as with any health condition, it’s essential to know all you can. Your child’s sports physical can give you the information you need for safe play.

If you don’t have a primary care physician, you can find a family doctor, internal medicine doctor or pediatrician at the Community Physician’s Group—go to http://www. communitymed.org.

“ The key is to make an appointment and have

the physical done by your primary care provider.

“

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living well ~ May/June 2015

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Left untreated, these symptoms may worsen. Get screened and see if you are a candidate for treatment.

VeinMo

May/June 2015 ~ living well

ontana.com • Call 406-541-3200

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living well ~ May/June 2015

Play it safe with

concussions

By Shawn Lake

May/June 2015 ~ living well

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ack in the day, the thing to do after getting a bump in the head was to get right back in the game. The thinking was that if athletes weren’t knocked out, or even if they were, as soon as they could stand up again they were good to go.

That thinking was very wrong. Doctors now understand that even small bumps to the head can cause concussion. Concussion is a brain injury, and if it’s ignored it can cause lasting problems — especially in children and adolescents.

Kids are more susceptible to the effects of concussion because their brains are still developing. In sports, concussion can happen from things like running into another player, falling or hitting a gym wall or goal post.

Concussions also occur on the playground, the classroom or even in your own back yard.

That’s because anything that causes the head to move rapidly back and forth—even if it doesn’t strike an object — can injure the brain. So a jolt that results in a whiplash-type movement can result in concussion.

Are you off balance?

Have you fallen?

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Call 406.543.7860 Today! concussions • balance • sports injuries • dizziness

Missoula • elementpt.com balanceexpertsmt.com • 406.543.7860

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Loss of consciousness is the most obvious sign of concussion. But according to the Centers for Disease Control and Prevention, other signs and symptoms can show up right away or days later. Watch for: • Headache • Confusion • Trouble with memory or paying attention • Dizziness or balance problems • Feeling groggy or sluggish

• Feeling irritable or depressed • Nausea or vomiting • Sensitivity to light or noise • Double or blurry vision • Trouble sleeping

May/June 2015 ~ living well

After a concussion, the brain needs rest to heal.

In fact, re-injuring the brain while it’s still healing can cause long-term, life-changing problems.

The American College of Emergency Physicians, along with the CDC and other agencies, recommend these steps to rest and heal the brain: • See a doctor. Kids with signs or symptoms of concussion should be examined by a physician.

• Don’t tough it out. Stay out of the game until all symptoms are gone and a doctor has okayed it. Never go back in the same day.

• Avoid activities that could jostle the brain.

• Take a break from mental activities too.

Studying, playing video games and even watching TV can strain your brain.

The best way to deal with concussion is to avoid them. Kids and adults should always wear helmets for contact sports and other activities like biking, snowboarding and skiing. It’s also important to follow safety rules and practice good sportsmanship. And always puts kids in the right car seat when you drive— you can find age and size guidelines for car seats from the American Academy of Pediatrics (www.aap.org.)

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Catalyst Physical Therapy is proud to welcome Angela Saporita, DPT, OCS, FMS

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atalyst Physical Therapy is proud and excited to announce the newest addition to our team, Dr. Angela Saporita.

Angela earned her Doctorate of Physical Therapy in 2011 at the University of Missouri. She gained clinical experience working in Texas, Missouri, Utah, and Washington. Angela moved to Hamilton in 2011 and has enjoyed working with Bitterroot Valley residents over the last four years.

Here is what one patient had to say: “After my first visit with Angie, that night the nerve pain, the numbness, and the tingling in my left arm and hand was gone. It was the first time since my car accident (over a year ago) that I didn’t have that horrible pain in my arm! For all the exercises and physical therapy I’ve done, nothing ever eliminated that nerve pain until I saw Angie. She brought back a joy to my life because I was able to do more every day. Otherwise I was sitting with a hot or cold pack on the couch because my pain was so severe.” -Tammy B. In 2014, Angela achieved national recognition by becoming board certified as an Orthopedic Clinical Specialist (OCS) by the American Physical Therapy Association. This certification demonstrates an advanced level of knowledge, experience, and skill in orthopedics. Only 4% of physical therapists nationwide have earned this accreditation.

Angela has completed advanced training in functional dry needling through Kinetacore. She is a certified expert in the Functional Movement Screen (FMS) and will be continuing to provide complimentary consults and movement screens to the public. She has been a member of the American Physical Therapy Association since 2008.

Angela enjoys exploring the Bitterroot Mountains with her husband, Dan, and spends her free time fly-fishing, playing soccer, snowboarding, and participating in yoga and archery.

Angela shares Catalyst’s commitment to patient-focused, one-on-one care for each entire session with a physical therapist. We are proud to be the only multi-therapist private practice clinic in the Hamilton area that does not employ aides, trainers or technicians.

You will always have your physical therapist’s full attention for your entire visit at every visit.

Catalyst’s guarantee: You pay for physical therapy, you get a physical therapist all the time, every time!

Catalyst Physical Therapy Preventing Tomorrow’s Injuries Today Why YOU Should Call TODAY! • You want to experience pain relief.

• You want improved strength and flexibility.

• You want to be involved in the activities you love with less pain.

• You want to improve your balance and walking ability.

• You want to improve your overall game.

• You want to get back to what you enjoy most in life.

If you can relate to any of the above, then don’t wait

CALL TODAY!

363-2494

117 N. 4th St., Ste A2, Hamilton

Feel the difference.

to Glacier National Park

Yellowstone National Park

From the Crown of the Continent to Old Faithful’s doorstep. Join us on a journey from Yellowstone to Glacier and back again this summer in our May/June 2015 issue.

Subscribe today at MontanaMagazine.com/subscribe or call 1-888-666-8624

The many facets of

physical therapy

By Jessie Patterson, SPT

May/June 2015 ~ living well

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id you know that physical therapists can treat dizziness, headaches, and incontinence?

Physical therapy (PT) is generally thought of as recovery from a surgery or injury from an athletic event or fall. However, there are many different settings and specialty areas of PT, many of which are often not known by the general public. In this article, you will find a brief overview of the wide variety of expertise held by physical therapists.

Practice Settings Orthopedic The most commonly known area of physical therapy is the Orthopedic realm, where PTs manage pain associated with musculoskeletal conditions, generally in an outpatient clinic setting. It encompasses a wide array of dysfunction of joints or muscles, including ligamentous sprains, muscle strains, fractures, headaches, whiplash, and rehabilitation after surgery. There are many approaches and specialty areas of Orthopedic physical therapy, including sports injury rehabilitation and manual therapy. Manual therapists focus on the use of their hands as their primary tools to perform treatments such as joint mobilization or manipulation to promote ideal joint movement and soft tissue mobilization to release tension in muscle or surrounding tissue.

Acute Care/Inpatient Rehabilitation Physical therapists who practice in acute care or inpatient rehabilitation settings treat patients who have been admitted to the hospital for a wide variety of reasons.

They focus on preparing the patient to return home safely and work on areas such as getting in and out of bed independently and walking endurance. Inpatient rehabilitation facilities are generally for patients that would benefit from a longer duration of more intensive therapy after an acute hospital stay. Physical therapists usually work alongside occupational and speech therapists.

These settings are generally for patients that have endured more intensive accidents, surgeries, or illnesses.

Home Health Some physical therapists assist the patient with therapy in the patient’s home. This generally occurs if a patient is able to return home after a stay at a hospital, but still requires PT services to increase function, mobility, and safety before returning to functional community activities.

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Skilled Nursing Facility If a patient is not able to safely return home, they may be treated by PT in a Skilled Nursing Facility (SNF). This can be short-term or long-term, based on the patient’s needs and insurance requirements. Similar to hospital-based care, the PTs in this setting often focus on independence and safety with functional activities, such as walking, transfers, and bed mobility. Physical therapists also focus on strength, endurance, and other specific goals when patients reside in the SNF for extended time periods.

AREAS OF FOCUS Neurology Physical therapists are trained to treat patients with neurological conditions including, but not limited to: stroke (CVA), concussion, traumatic brain injury (TBI), spinal cord injury (SCI), Parkinson’s disease (PD), multiple sclerosis (MS), cerebral palsy (CP), and muscular dystrophy (MD). Testing and treatment for patients post-concussion is a growing area in PT due to the high risk involved for patients who return to work or play too soon after injury. A wide variety of treatment approaches are used for neurological rehabilitation, based on the condition and how far out they are from diagnosis, as well as the individual’s abilities and goals. Some treatments are focused on recovery of the patient’s nervous system, while some are focused on compensating for lost function with other methods and adaptive equipment. These treatments can be performed in any setting discussed above and at any point in a patient’s recovery or progression of the condition.

Balance/Dizziness/Vestibular Although difficulty with balance can occur at any age, recent studies have shown that 75% of people over 70 years old have “abnormal balance” (source: APTA).

Imbalance is a widespread problem that can lead to falls and/or other musculoskeletal problems. We use three systems to maintain balance: 1) somatosensory system (the senses in our legs); 2) visual system; and 3) vestibular system (the inner ear). All three of these systems need to be working adequately for us to maintain our balance during daily activities. We can train the somatosensory and visual systems by performing certain balance exercises that bias each. Dysfunction of the vestibular system, the inner ear, can cause dizziness or vertigo in addition to imbalance. Training of this system is important and

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involves specialized testing to determine which areas are not functioning adequately and exercises to improve those areas. One vestibular condition is called Benign Paroxysmal Positional Vertigo (BPPV), where otoconia, tiny crystals of calcium carbonate, become dislodged and move into areas of the inner ear they shouldn’t be in, causing vertigo. Treatments include maneuvers of the body and head that move these crystals back to the appropriate areas.

Cardiovascular/Pulmonary

Each year, 25% of deaths in America are caused by heart disease, making it the leading cause of death (source: moveforwardpt.com). PTs who specialize in cardiopulmonary rehabilitation focus on health of a patient’s heart, lungs, and blood vessels. They treat patients with risk factors of heart or lung disease or those who have been diagnosed with heart or lung dysfunctions, such as those with history of heart attack, cardiac bypass, valve replacement, congestive heart failure, chronic

May/June 2015 ~ living well

obstructive pulmonary disease (COPD), emphysema, and asthma. PTs monitor patient’s vital signs to ensure they are stable enough to begin and continue exercise focused on aerobic endurance, strength, and education.

Cardiopulmonary rehabilitation can be based in the hospital or in an outpatient clinic setting.

Women’s Health

Physical therapists who specialize in women’s health can often effectively treat areas such as pelvic pain and incontinence. These conditions are often caused by increased tension, decreased tension, or inability to properly use the pelvic floor muscles, all of which can be treated with a variety of PT methods. Men who have prostate enlargement and difficulty voiding can also benefit from many of these pelvic floor exercises. PTs can also help women who are pregnant or post-partum to decrease pain associated with the changes in their body due to pregnancy. These changes include increased hormone levels in their body, which can cause joint laxity, and increased and unequal distribution of weight on the body, which can cause pain in the low back and other areas.

A PT can help with this through postural training, strength training, and release of muscle tension that are safe for both mother and baby.

Oncology

preparation for on-land exercise.

Hand Rehabilitation

The hand is a highly complex area of the body that is used for a wide variety of everyday tasks. Physical therapists that specialize in hand rehabilitation focus on decreased pain, improved joint mobility, and increased strength to promote increased dexterity and ability to perform daily tasks required for a patient’s occupation and/or household tasks.

This is in no way an all-encompassing list of the areas of practice for physical therapists. There are other specialty areas such as dry needling, wound care, prosthetic training, orthotic fabrication and fitting, and occupational health areas. However, this article provides an overview of some of the areas of PT that are not as commonly known.

The overall goal of physical therapy is to “help people of all ages and abilities reduce pain and improve and restore mobility to achieve long-term quality of life” (source: moveforwardpt.com). Please see the resources below to read more about all areas of physical therapy.

Element Physical Therapy has experienced physical therapists that specialize in vestibular disorders, including imbalance and dizziness, and all Orthopedic conditions.

We have specialized equipment, such as the NeuroCom SMART EquiTest®, and video oculography goggles for more specific testing and training of the vestibular system.

Physical therapists can perform treatments to reduce some of the effects of treatment for patients with cancer.

They can perform lymphedema treatment for patients after lymph node removal and soft tissue mobilization after surgical procedures to increase mobility of scars and other tissue. They can also assist in pain management and creation of an individualized exercise program to assist with overall mental status and improvement of quality of life to maximize the body’s ability to fight the disease.

Our unique packaging system offers the comfort and

Pediatrics

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PT’s can treat children throughout their lifespan for a wide variety of conditions, from children who have physical developmental delays and neurological conditions to accidents/injuries. The can fit a child for wheelchairs and other adaptive equipment to modify the child’s environment to promote inclusion in school and community environments. PTs can help encourage proper posture and movement, as well as provide education for parents and caregivers that will help set the child up for long-term success.

Aquatic

Aquatic physical therapy provides a way for patients to undergo cardiovascular exercise, strengthening, and stretching in a low-impact environment. This is beneficial for those who have joint pain associated with obesity or arthritis because it reduces the stress on those joints while still obtaining benefits. It can be used to promote good posture and body awareness for weight loss and

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living well ~ May/June 2015

Is baseball battling a

Tommy John epidemic?

By Daniel Brown, San Jose Mercury News

J

oe DeMers was just 10 years old when he started using the most powerful word in a young pitcher’s vocabulary — no.

No, he wouldn’t pitch on short rest. No, he wouldn’t go beyond his pitch count. No, he wouldn’t play for multiple teams.

Now a high school senior, DeMers has a fastball in the mid-90s, a scholarship commitment to Washington and first-round buzz in advance of the Major League Baseball draft.

Is he glad he took the prudent route?

Yes. “I’ve pretty much gone my whole career without injuries,” said DeMers, a student at College Park High in Pleasant Hill, Calif.

DeMers is among the lucky ones to emerge unscathed from the increasingly demanding world of youth baseball.

The landscape is so dotted with red flags that two governing bodies, Major League Baseball and USA Baseball, teamed up to create new guidelines to help young arms stay in tact.

The creation of Pitchsmart.org comes at a time when

major league elbows are wearing out at record rates, with Tommy John surgeries nearly doubling over the past three seasons. This spring had hardly gotten underway before top pitchers Yu Darvish of the Rangers and Zack Wheeler of the Mets had to make the Tommy John decision.

“There is a real sense of urgency to understand the entire TJ surgery now,” said Stan Conte, the Dodgers’ vice president of medical services and a member of the Pitchsmart.org advisory board.

The surgery

In July, the American Sports Medicine Institute went so far as to describe it as an epidemic. In a position statement that seemed aimed squarely at youth league coaches, the institute wrote: “In many cases, the injury leading to Tommy John surgery … began while they were adolescent amateurs.”

From 2000-2011, there were an average of 15.4 Tommy John surgeries per year in the majors. But over the past three years, the average has almost doubled to 28.3.

Perversely, though, the upward trend leads not to fear

May/June 2015 ~ living well

but acceptance in some cases. It’s as if reconstructing a damaged ulnar collateral ligament is as inevitable as rotating the tires.

Fueled by the misperception that most pitchers come back throwing harder — “an urban myth,” one major league trainer called it — some teenage prospects are electing for Tommy John surgeries, even though they don’t need it.

The trend amazes early pioneers such as Tom Candiotti, who was the second player — and the first not named Tommy John — to reach the majors after undergoing Dr. Frank Jobe’s revolutionary procedure. Candiotti had the elbow ligament surgery in 1981, seven years after John made history, but only after Jobe made sure it was worth his while.

“He said, ‘You need to tell me: Are you a prospect?’ ” Candiotti recalled.

Jobe, who died March 6, 2014, at age 88, pioneered the operation in 1974, when he transplanted an unneeded tendon from John’s right wrist into his left elbow. John pitched on that elbow until he was 46, winning 164 games post-surgery.

John once told the Orange County Register: “I think there should be a medical wing in the Hall of Fame, starting with him.”

Candiotti later became the first patient to square off against the man himself, starting opposite John on Aug. 25, 1983 in what was billed as “the battle of the reconstructed arms.” Candiotti delivered a complete game 7-0 victory and arrived at the ballpark the next day to find John waiting for him in the dugout.

“He sat down and we talked about my surgery, his surgery and what it felt like to get better,” Candiotti, now 57, recalled. “He was the most gracious man in the world. He said, ‘You’re not done yet. You’ve still got a long way to go.’ ” Back then, they were the only two men on an unpopulated island — like Neil Armstrong talking to Buzz Aldrin about what it’s like to walk on the moon.

Now, the Tommy John community is a burgeoning metropolis, and the population is trending younger.

In 2000, Dr. James Andrews and colleague Glenn Fleisig reported performing Tommy John surgery on 17 youth and high school players, making up 18 percent of all elbow reconstructions they did that year. In 2010, the last time Andrews and Flesig collected data in a similar fashion, there were 41 surgeries on kids making up 31 percent of the procedures. And Andrews told USA Today Sports this past summer that the stats were getting worse.

“The largest number of all those different groups, believe it or not, is high school kids,” he told the paper.

“They outnumber the professionals. There was a tenfold increase in Tommy John at the high school/youth level in my practice since 2000. I’m doing way more of these procedures than I want to.”

Little Leaugers

Little League Baseball has established pitch limits (backed by Pitchsmart.org) that vary depending on age.

At ages 7 to 8, a player tops out at 50 pitches, for example,

29

while ages 17 to 18 can go as many as 105.

But a survey led by Dr. Joseph J. Fazalare confirmed what parents know: Some coaches lie. In that 2012 study, only 73 percent of coaches reported that they followed the pitching rules, and only half (53 percent) felt that other coaches generally followed the rules.

In the South Bay alone, there are plenty of examples of fudging the workload. Cases include a 12-year-old throwing 110 pitches over five innings this year; a 10-yearold pitcher throwing an estimated 130 pitches in a no-hitter in 2012; a 10-year-old in 2014 throwing three days in a row and totaling 156 pitches.

Ross Nakaji, a specialist at Los Gatos Orthopedic Sports Therapy, can gauge the trend just by walking around his office. His older patients have asked him, in essence: What are all these little kids doing here?

The results

Tommy John success stories are helping fuel the heat.

New York Mets ace Matt Harvey appears to be the latest back on the fast track, hitting 99 mph this spring in his first game since Aug. 24, 2013. “Things felt so good that the fact that I did have surgery is completely out of my mind,” he said.

Harvey would follow in the recovery footsteps of pitchers such as John Smoltz, a patient in 2000 who will be inducted into the Hall of Fame this summer; Chris Carpenter, who finished second in Cy Young Award balloting two years after elbow surgery; Stephen Strasburg, who led the National League in strikeouts last year after undergoing the operation in 2011.

But it’s not always such a smooth ride, according to a study by Eric C. Makhni, published last spring in the American Journal of Sports Medicine. Of the 147 major league pitchers examined in that study, 80 percent returned to pitch in at least one game. But only 67 percent of established pitchers returned to the same level of competition postoperatively, and 57 percent returned to the disabled list because of injuries to the throwing arm.

Candiotti counts himself among the lucky ones. After his pioneering Tommy John surgery, he had to reinvent himself as a knuckleball pitcher, but he lasted 16 years in the major leagues.

After all of them, he got a Christmas card from Jobe.

Candiotti recalled with a laugh that the cards were always addressed the same way: “To my prospect.”

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living well ~ May/June 2015

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living well ~ May/June 2015

invisible battle managing your chronic pain

W

By Brandpoint hen struggling with chronic pain, many often feel their concerns fall on deaf ears.

Without physical symptoms, friends, family and sometimes even physicians may fail to empathize with the debilitating effects of the condition. Just because chronic pain lacks physical manifestations, it doesn’t mean the battle is without casualties; sleep loss, decreased productivity and strained relationships are just a few of the things that may result from chronic pain conditions.

There are an estimated 100 million Americans living with chronic pain, according to the American Academy of Pain Medicine. Many of those sufferers are dealing with conditions like osteoarthritis, sciatica, fibromyalgia, and diabetic peripheral neuropathy, among others. While each individual experiences pain differently, there are some effective pain management techniques, including prescription medication, which can provide potential options to try before costly surgeries or potentially addictive narcotic pain therapy. Talk to your doctor to find out if these tips can help supplement your chronic pain regimen.

1.

Be active – It can be difficult to think about getting out and exercising when you’re struggling with chronic pain, but light exercise can actually help soothe the discomfort from certain conditions. Look for low-impact physical activities like yoga, walking or aquatic exercise to get you started on a manageable exercise routine.

2.

Eat healthy foods – Establishing a well-balanced relationship with food can help to maintain a healthy weight, and it can also provide the energy and nutrition needed to maintain an active lifestyle. Certain foods, like cherries, ginger and hot peppers have ingredients that may help to reduce pain.

3. Advanced technology options – New technology is

bringing more options to chronic pain sufferers. Quell, a slim, lightweight wearable device that wraps around the calf, provides 100 percent drug-free pain therapy through non-invasive nerve stimulation technology. People with existing, implanted devices that utilize electrical stimulation - such as a pacemaker, defibrillator or

4. Get a good night’s sleep – Two-thirds of people

suffering from chronic pain report they don’t get quality sleep at night, according to the National Sleep Foundation.

Creating a good sleep environment is the first step toward improving your sleep - consider experimenting with blackout shades or white noise machines. Devices that track sleep can also be beneficial to help you analyze your sleep activity, the capability to monitor your pain therapy and sleep activity via your smartphone.

5. Try acupuncture and massage – Many have

experienced pain relief through age-old traditions like acupuncture and massage. Acupuncture is believed to work by increasing endorphins and blood flow throughout the body, helping to reduce pain. Therapeutic massage is another potential pain-relief option for many sufferers of chronic pain, as the masseuse will encourage muscles to loosen, releasing pain and tension as well.

There are many conditions that cause chronic pain and each individual experiences pain differently. As such, there are many medication options available to help treat different kinds of chronic pain. Talk to your doctor to discuss how lifestyle adjustments and non-medication options can fit into your pain management plan and help you reclaim your life.

Over 60 and Happy May/June 2015 ~ living well

33

Balancing independence and support

systems as a senior

A

By Goodman Group

s a senior care provider for more than ten years, I have noticed with admiration the great determination that our seniors have to maintain their independence. As all of us age, this long habit of independence can grow even stronger. In some senses, this is healthy and can help a person thrive and adapt to changes. In other cases, this can lead to isolation, a sense of helplessness, and sometimes even ill health.

While we who work in senior care strive to preserve the independence of seniors and encourage that spirit, we also work very hard at creating support systems, resources, and information banks for the population that we love. The Missoula area has a wealth of such supports and opportunities to learn about the challenges that come with aging. It is very important to be aware of what your community offers and to feel confidant taking advantage of their services. It’s an excellent way to educate yourself, make friends, and optimize your overall well-being.

Most cities or counties have an area aging office that provides counselling on Medicare, Medicaid, prescription plans, and help at home. The Missoula Aging Services office also provides classes for caregivers, opportunities to volunteer, meal programs, and information on senior living options. It is a good idea to know how to get in contact with your local aging services office, even if you feel you won’t need it. The Missoula Aging Services Office is located at 337 Stephens Avenue.

Another great resource for seniors is your local senior center. Most senior centers have a very active membership with a wide range of ages and host a variety of social events. Our Missoula Senior Center provides wonderful opportunities to make friends and volunteer.

It offers classes on everything from yoga to painting.

The Senior Center also partners with other entities to provide blood pressure clinics, classes, and health fairs.

Joining your local senior center is one of the healthiest choices you can make. The Missoula Senior Center is

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living well ~ May/June 2015

located at 705 South Higgins.

In Missoula, there is also a new hotline for seniors or families of seniors who are facing hard decisions and aren’t sure how to start conversation with loved ones. This new service seeks to help seniors explore their options, figure out what is right for them, either now or in the future, and share that information with their families.

Seniors can even request that someone be present to help them talk to their families. The hotline number is 406396-2479.

Some communities are fortunate enough to have collaborative associations that bring together senior service providers. Missoula’s collaborative group is Senior Options and Services. This group is comprised of home health providers, disability centers, medical equipment suppliers, therapist, pharmacists, assisted living and skilled nursing communities, and various financial, insurance, and planning advisors. SOS also welcomes alternative health providers, art therapists, and other business owners interested in serving seniors.

SOS sponsors free lectures to the community twice a year on topics that senior have requested. Their next lecture will be held at the Missoula Federal Credit Union on May 21, from 6:00 p.m. to 8:00 p.m. The lecture topic will be “Understanding Risk Factors for Alzheimer’s Disease,” presented by Dr. Rob Velin, PhD, Neuropsychologist.

Senior Options and Services can be contacted through their website http://missoulasos.org/ One of the increasing concerns of seniors is the growth of dementia and Alzheimer’s. Knowledge is a great way to ease fear if a senior is not directly affected by dementia, and support is a great way to ease burdens if you are. Most communities have support groups, education resources, and care solutions for those facing dementia or caring for someone who is facing it. Missoula offers seniors education on dementia and caregiving at Missoula Aging Services.

Several long term care and assisted living facilities offer

memory care on a permanent or respite basis. At least three support groups for caregivers meet in Missoula. One meets every forth Monday of the month at the Missoula Senior Center at 6:30. One meets every second Monday of the month at noon at Summit Independent Living. One meets every Wednesday at noon at The Village Senior residence.

Missoula is also privileged to host The Walk to End Alzheimer’s annually. This is a chance for everyone to play a part in the fight against a disease that has touched nearly all of us. The walk chairs would welcome senior volunteers who want to learn more, volunteer, or just come and walk.

To find out more, you can talk to Sarah Bass at The Village Senior Residence or Denise Sherman at Case Management Caregiving. Involvement in such events is a great way for seniors to stay in touch with the latest information, make connections with peers, and give back to the community.

Volunteer opportunities are another resource that seniors can overlook. Volunteer work broadens horizons and restores youth and energy. The Senior Center, Missoula Aging Services, and Saint Patrick’s Hospital have volunteer programs that offer seniors a chance to use their skills and wisdom in ways that can make a difference in their lives and the lives of those they are serving. And volunteer work is good for everyone! It would be an excellent chance to teach a grandchild about service.

In Missoula, most of our senior providers are more than willing to set aside time to talk to anyone who has questions. If you aren’t sure where to start, Aging Services, any assisted living community, or a skilled nursing social worker would be equipped to answer questions and steer you in the right direction.

Seniors are a cherished part of any community. We applaud the independent spirit that seniors sport, and at the same time, are ready to supplement that independence with support. Knowledge is important. The more you learn, the better you feel about your decisions and we are here to serve.

May/June 2015 ~ living well

Living excellence every day.

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living well ~ May/June 2015

Competitor Daredevil Riding partner Teacher

Conqueror

I ride hard. Occasionally, I land hard.

It’s good to know Community is here.

Big risks can lead to big injuries. For injuries that require immediate care, our emergency department physicians and highly trained staff are prepared to give fast, expert treatment to get you back on the trail as quickly as possible. From minor injuries, to sudden illness, to life-saving trauma care, we’re committed to giving our patients the highest quality, family-friendly care available, in a timely manner.

If it’s emergency care, of course it’s Community.

Visit communitymed.org/emergency Community Medical Center is an independent, local non-profit hospital.

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