Knee Replacement Rest and Recovery

Knee replacement rest and recovery involves making sure you have set yourself up for success by not only having the right equipment available to help the rehabilitation process but, understanding that you need to have the ability to find time to rest and to make sure you allow sufficient time to stay off your knees or knee and give your body a rest.

For instance I advocate my patients to complete their knee replacement exercises approximately two times a day. If you truly do your exercises as instructed twice a day while putting a full effort into them that will get you the results you need to have a successful recovery. After your exercise routine, you want to immediately ice down your knee with a cold pack that fully encompasses your entire knee. I find that a majority of patients I treat really do not have an adequate ice pack to do the job. This is where they fall short in having the proper equipment to do the job.

I advise my patients to be sure that their affected leg is elevated for 20-30 minutes with the ice pack applied. Resting your knee replacement after exercise will be vitally important to avoid the unnecessary pain and swelling that will arise if you are not doing so. This is very important for the first two to three weeks out from surgery. As time goes on into week four and after, your ability to recover after exercise is not as acute.

You as a patient also want to strongly consider your activities in conjunction with the exercises you are completing to avoid added pain and swelling. All activity has a cumulative effect on your knee which will add up at the end of the day.

I will from time to time have patients that will call me regarding the excessive amount of pain that they are experiencing with their knee replacement.This can arise for several different reasons. Two of the more commons reasons I come across is either not taking their pain medication as prescribed and, staying up on their feet to long, in other words getting involved in doing activities around the house that should be left for someone else.

I have advised many patient to take the day off when they are experiencing chronic pain and excessive swelling. By taking the day off and allowing their knee to rest, they will find that they totally recover by the following day. Everyone learns sooner or later that their knee is much more temperamental than they realize and pushing their recovery to fast results in many a sleepless night.

Learn to complete your exercises twice a day once in the morning and again by no later than mid-afternoon. Ice down your knee after each rehabilitation session and elevate it as well, preferably higher than your heart to help with controlling edema.

When all else fails and you cannot get comfortable do nothing. Rest and relaxation for a day will not harm your rehab progress.

Tips for Starting a Physical Therapy Private Practice

It may have crossed your mind at one point or another that it's time to branch off and begin your own PT clinic. When first beginning this process, people will tell you that this will cost you thousands and thousands of dollars, but that doesn't have to be the case. Here are a few money-saving tactics you can implement into your physical therapy practice management and clinical operations from the start.

1. Necessary Equipment

When purchasing equipment, work toward being creatively efficient. Scour the web for PT blogs addressing the matter and price comparisons between companies. Most patients don't need to see the most high-tech, fancy or most expensive equipment - they just want what works. In fact, is likely that they won't have access to those machines at home, so training them on equipment they can actually use may be very beneficial. By simply doing your own form of physical therapy practice management research, you'll be able save a significant amount of money.

2. Clinic Office Size

Right now, you may think it's important to invest in a large space - mostly because you want your equipment to fit. However, you could cut costs by investing in a smaller office - thus saving even more on smaller machines that will fit nicely. Instead of paying for extra space you aren't using, fill the space accordingly. Then, if you need to expand once your business takes off, you can do so!

3. Beginner's Marketing

When you're just starting out, keep in mind that you just need the necessities: a business card and a letterhead. There's no magic spell you can use to conjure up new patients. What you can do is utilize your time wisely. Go out in the community and get to know people and tell them what you're all about. If you are even more technology driven, consider beginning your own website consisting of PT blogs that interested patients, personal trainers or physicians can visit for more information about who you are and what you plan to offer.

4. Physical Therapy Practice Management

There are methods you can utilize to get your business running in a more affordable way. One way, is choosing your billing option. You can outsource your billing to a medical billing company who will take somewhere between 5 and 12 percent. However, in the long run this may actually save you money, as you won't have to purchase expensive software or hire and train a new employee. If you'd rather invest in more tech-savvy software, try using Square. This piece of technology is quickly making its way into businesses everywhere. It costs about 2.75 percent.

When it comes to starting your own clinic, try these tips for saving as much as possible, and as you continue to grow and expand, you'll be able to make additions to your office, practice management and staff.

EMR: Will It Help or Hinder Your Medical Practice?

Making changes within your PT clinic may leave you feeling uneasy at first - especially if what you've been doing is working fine. Don't fix it if it isn't broken, right? Web-based practice management software may not be the best option for everyone, but many PT clinics have reaped its benefits. Let's take a look at a few advantages and unexpected costs of EMR software, as well as a few important questions to ask your provider before making the final purchase.


1. Lowers Cost

Initially, EMR software seems expensive. However, it saves more money over time. Because electronic or web-based practice management software not only leaves less room for error, but generally take less time to correct such errors, less time and resources are being wasted in the process.

2. Accessible

Because this software is online, it can be utilized anywhere that has Internet access. This means that house calls are not only more productive, but cut down on the time doing reports back at the office. For example, if your office invested in physical therapy note taking software, the notes that you take can automatically be aggregated within the online software, which means you can easily edit for mistakes on the spot, and there is no need to rewrite any patient information.

3. Easy Data Retrieval

Using web-based practice management software to store information means data can be aggregated in a way that retrieval is easy. With the proper filters added, physical therapists can get information based on a set of criteria. Also, if local pharmacies are a part of the system, doctors and physicians can prescribe medicine using the software instead of having to go through the pharmacist.

Unexpected Costs

Licensing: A software license could either be a one-time purchase or one that needs to be renewed on a monthly or yearly basis. Be sure to ask your provider!

Virus protection: Because you data will be kept completely online or through a software program, it's necessary to have virus protection and a backup file drive implemented for security reasons.

Storage: Most providers allow you to store data for free, up to a certain amount. After that point, many providers will begin charging, depending on how much data you need stored.

Audits: To be sure your practice management and physical therapy note-taking software could survive an audit, you'll need to get a screening from a consultant. This is a necessity so be sure to explore the cost before implementing EMR software,

EMR software may be the perfect solution to making your clinic more efficient, but before implementing any new changes, be sure to review the complete cost of the endeavor - as well as the potential pros and cons.

Occupational Health And What Companies Can Do

For many employers, the two health matters that cause the most difficulties in the working environment are: sickness absence and health issues caused by work. Occupational health is the practice of making sure that your employees remain in the best physical and mental health possible, during their time spent in the workplace.

It is best practice for all corporations to employ regular health assessments to ensure that employees are not suffering any unnecessary physical strain, or stress which may cause illness. Sickness and stress are two of the most costly reasons that employees have extended periods of time absent from work; there are many ways in which this can be combated.

Running health workshops is a good way to promote health and fitness in the workplace, or if possible providing corporate membership to a gym can encourage healthier staff. Stress management counseling can also be implemented, the relative cost of this compared with the cost of having one or two members of staff taking extended sick leave, is lower by comparison.

The rule that prevention is better than cure applies to occupational health, and although companies are obligated by law to provide resources to help employees avoid any of the illnesses caused by poor working conditions, it does help from a company prospective to be pro-active and ensure employees remain healthy and happy. The benefits of a company of taking good care of staff is that it has been reported that, the healthier and happier staff are better in their productivity, which is what every company should want.

Health and safety around the workplace should come down to common sense, but a lot of the time especially in larger companies, there can be dangers that may cause injury. The way to ensure staff safety is to have a member of staff, or many members of staff be tasked with keeping simple things in order in the workplace. This also gets the staff involved and makes them aware of the risks around the workplace.

There is a wide range of therapies available that will also help contribute such as acupuncture, physiotherapy, and even dieticians can all help in making sure that you do not end up with the costly problem of having staff on sick leave, costing you and the economy money. Check your local area to see what services can be brought in to practice. Therapy can be a reasonable price and if you have insurance you may be able to claim, and have it either completely paid for or have a contribution paid.

Top 4 Signs That You Need Orthopaedic Treatment for Your Injury

Many of us experience pain daily in our lives such as pain in our joints and back. We often simply accept it as part of aging and simply take painkillers or stop doing activities which we love. While it is a fact, we should not accept it without any professional medical help. Orthopaedic surgeons treat conditions relating to our musculoskeletal system which covers the bones, joints, ligaments, tendons and nerves. Depending on the severity of the injury, either surgical or non surgical means can be administered. Many people do not realise that they require the expertise of an orthopaedic surgeon and they are often referred to one by their general practitioner.

There are many reasons and causes for a patient to consult an orthopaedic doctor. Common reasons include:

1. Arthritis

2. Tumours

3. Broken bones

4. Joint replacement

5. Sports injuries

6. Spine injuries


Pain is the start of all problems and the same goes for orthopaedic problems. Patients often experience discomfort at different parts of their body such as their joints, rotator cuff, wrist or elbow. Even the slightest discomfort may indicate serious injuries. A locked finger could be due to trigger finger and pain after trauma could be due to torn ligaments or broken bones. Back pain could be due to herniated disc or a fractured vertebrae or even spine problems.


Swelling indicates an increase in body fluid or blood in that particular area and must not be taken lightly as it could be a sign of serious medical condition requiring surgery. When a patient experiences swelling in his joint, it could possibly indicate osteoarthritis.

Osteoarthritis is the most common joint disorder due to wear and tear on a joint over a prolonged period experienced by elderly patients and signs are swelling of the bones or joints.


Redness is caused by infection or injury and is often experienced with pain and swelling. Conditions such as tendonitis are often accompanied by redness. If a patient experiences pain and swelling with redness, it could mean a serious complication and an orthopaedic doctor is needed immediately. A decrease in range of motion for joints normally indicates musculoskeletal problems such as a torn ligament.

Visible injuries

Injuries such as sprain and dislocation are visible and they are musculoskeletal injuries which needs orthopaedic treatment. Deformity of the skeletal systems such as hammer toes and club foot will also require orthopaedic surgery to correct them.

What Does A Pediatric Physical Therapist Do?

A pediatric physical therapist is responsible for helping kids develop their motor skills so that these kids can work, play and act normally just as other kids do. The task of a pediatric physical therapist does not only involve in making sure that the child can balance and can use his body parts i.e. feet, legs and arms. They will assign specific activities or exercises to the child to help the child gain strength in his arms and legs. Even simple exercises like playing touch ball, baseball, crawling in and out of a tunnel and walking in a straight line can be very helpful to a child's physical development.

There will also be instances when a pediatric physical therapist will advice the patient's parents to modify the living area of the patient to avoid injury, accidents and the like. For example, if the house of the patient is a 2-storey and the bedroom of the child, who is unable to balance his body while walking, is in the top floor the doctor may advice the parents to transfer the child to a bedroom on the ground floor. There may also be adaptive equipments that would make the life of the child easier and his recovery faster.

The work of the therapist will usually start by examining the condition of the child. This includes checking the past medical history of the patient, running a battery of mental and physical tests as well as conducting an interview to the patient's pediatrician, parents and the child itself.

However, a Pediatric Physical Therapist will never be able to help a child's development if the parents or the child's guardian is not cooperative. The key to a child's fast development is the right set of physical exercises and the parents' guidance and participation. Every child needs their parents' approval and encouragement. This is even more important for children who have physical and mental disabilities.

The main job of a pediatric physical therapist is to ensure that the child's problems with movement and strength is addressed. Many people view this job as something very interesting, and indeed, it is! Imagine all the help you can extend to the little ones. It is not an easy job but the mere fact that you are able to help other kids is enough reason to work as a pediatric physical therapist. The salary of a therapist is also competitive and the chance of getting a promotion is also very high.

All Doctors of Physical Therapy in California

California State Universities are this year offering a Doctor of Physical Therapy program (DPT) as the Masters of Physical Therapy program (MPT) is fast becoming a thing of the past. This article will outline those universities making the switch and which State Universities in California now offer the DPT.

The DPT is progressively becoming the gold standard in physical therapy education across the United States. The DPT allows practitioners to become more recognised in the field of PT. This strengthens the case for physical therapists to become first contact practitioners across all states. Currently in the U.S. PTs work as first contact practitioners in 46 States and the District of Columbia, however there remain some stringent restrictions on physical therapy practice without the guidance of a doctor. To strengthen the case for physical therapists to become first contact practitioners, the American Physical Therapy Association has pushed for all PT programs to transition to Doctor of Physical Therapy (DPT) programs by 2020. This leaves little room for dispute that physical therapists are well qualified to be first contact practitioners.

There are currently 14 public and private universities offering a degree in PT in California. All private universities in California currently offer the DPT program, and it seems that finally the State Universities are following their example.

Commencing in 2012, all California State Universities (Northridge, Long Beach, Sacramento and San Francisco/Fresno) will offer DPT programs for physical therapy students. These programs offer more advanced clinical programs and clinical internships and allow the graduate to hold a doctorate degree on completion of the program. All California DPTs are accredited by CAPTE and all students can undertake the National Physical Therapy Exam on completion of their studies. Because they are state universities, the tuition fees are governed by the California State University Board of Trustees and are system wide. Tution fees for the DPT at any CSU in 2012 are $8074 per semester. Most DPT programs in California run for 8-9 semesters and offer 30-35 weeks of clinical internships within these semesters. The average number of students accepted into the DPT programs in California is 32 however there are usually many more applicants than this so study hard!!

For those who are completing a Masters Degree this year, California State Universities will offer a postprofessional transitional DPT to act as a bridging course and allow the graduate to hold a DPT upon completion. This postprofessional program usually involves 9-12months of further studies.

The path to becoming a physical therapist is a long and challenging one, however the DPT programs, now offered by California State Universities will ease the transition to practice and is the way of the future.

How to Avoid Knee Injuries

The knee supports the bulk of ones body weight is subject to the many physical stresses of everyday life. The knee is one of the most important joints of the body, and one of the most complexes. Because of this complexity, the knee is susceptible to many ailments. Among the most common are:

  • Arthritis caused by a deterioration of knee cartilage leading to wear and tear on the bones.
  • Ligament tears due to traumatic contact injuries or hyperextension that is stretching because of a sudden change of direct or pivoting.
  • The kneecap (patella) is connected to the tibia and femur by the patellar and quadriceps tendon. Overuse of the knee can cause tendonitis, an inflammation of the tissue.
  • Between the femur and tibia bones there is cartilage, known as the meniscus which keeps the bones from rubbing together. Repetitious movement or sudden turns of the knee can lead to meniscus tears, often in conjunction with other knee injuries.
  • Bursitis which refer an irritation of small fluid sacs which enclose the knee.
  • Dislocated kneecap while the patella slips to the outside of its usual alignment.
  • Hyperextension is used when the knee bends back away from the hinged lock position.

Fortunately many injuries can be avoided or tempered if one knows how to strap a knee.

Strapping a weak or injured knee provides support. A strong knee resists injury while an injured knee supported by sports tape will heal more quickly.

How to strap a knee

Knee taping techniques are designed to support the knee and to reduce stress on the knee during activity and they can be used for both to prevent knee injuries and for the treatment of existing injuries. Taping a knee is simple and, if done correctly, can be extremely effective.

You will need

  • 38mm rigid strapping tape
  • 75mm elastic adhesive bandage


The ideal angle for the knee when beginning strapping is 10ยบ. This can be achieved by placing a roll of tape under the heel of the knee to be taped, or by putting a folded towel under the thigh.

Begin with an anchor of 38mm rigid strapping tape around the lower thigh and the upper calf, taking care that they are not too tight as this can impede circulation. Subsequent straps will be attached to these anchors.

Next, make a cross on either side of the knee, starting from the mid-point of the shin and ending behind the thigh as well as starting behind the knee and ending at the midpoint of the thigh. The knee will be surrounded by a diamond shape. Support can be increased by repeating these steps several times.

Vertical straps from anchor to anchor on the inside of the knee add greater support.

Finally, using 75 mm adhesive bandage wrap the entire knee, making sure to cover the rigid tape completely.

Knowing how to strap a knee in the correct manner can provide support for weak knees, allow injured knees to recover faster and, generally, make getting about much easier.

Qualifications To Become A Physical Therapist

A physical therapist is a health care professional who diagnoses and treats individuals who have physical disabilities. Since physical therapy deals with the physique of the human body, a therapist must have an excellent sense of professionalism. Lack of proper training, knowledge and professionalism in this field may complicate the disabilities or ailments of the patient, thus making it hard to treat the patient.

For one to become a Physical Therapist, you should have an undergraduate degree in biology. Biology is simply the 'study of life'. As a Physical Therapist, your work is to deal with different people. Biology will help you understand the human body and the interconnections between the internal organs. This study will ultimately help one understand how the body works and functions. Therapeutic procedures are also vital in this medical field. These procedures are usually essential in evaluating the patients' progress as they continue with the therapy. The procedures include therapeutic massage and exercises.

Knowledge in human growth and development is also required for one to become an effective physical therapist. You need to understand that the human body develops with time. With this in mind, you should be aware of the reality that the way you deal with a child less than five years old differs from the way you treat an adult patient of over forty years of age. In physical therapy, some patients may need to be screened to determine their illness like born fractures.

To be able to operate the screening equipment and to analyze the results accurately, you need to obtain a course in medical screening and radiology. A degree in physics is necessary to help you understand the concepts of radiations, X-rays, and etc. A degree in counseling is also necessary. This will help you know how the brain controls the rest of the body organs. Sometimes, the patient may have recovered but the mind still has the feeling of being ill. In such a case, you may need to use your skills in counseling to help clear your patient's mind positively.

The way you deal with your patients and the language you use should not demoralize your client's status; a word of encouragement plays a better part in their healing process. Therefore, you need to study ethics and values to be able to understand your patients. Getting into this field would require a masters or doctorate in the physical therapist educational program. You also need to pass the national licensure examinations to receive a national license for operation as a legal and qualified therapist. Apart from the educational qualifications, you need to have the interest, patience, and ability to persevere all challenges in serving your patients.

Physical Therapy Job Outlook - Solid As a Rock

Are you considering a career in physical therapy but wondering about the job outlook once you get there? This article will outline why physical therapy is one of the fastest growing careers in America, and why it offers top job satisfaction and security.

The health care sector has been reported as one of the largest growing industries in America. This is largely due to an increasing ageing population and a concerning increasing rate of obesity, which will place increased pressure on services from all health care professionals. With the current trends we are seeing more and more people presenting to hospital and health care services. Their complaints are varied but a large percentage of them require input from a physical therapist. Due to our ageing population it is expected that orthopaedic presentations such as total knee and hip surgery, low back pain and shoulder pain will increase. Neurological problems such as stroke and Parkinson's disease may be also on the incline as well as more presentations for cardiopulmonary conditions such as COPD, heart disease and cancer. The more hospital admissions mean more work for physical therapists and other health professionals, which in turn drives the demand for health sector workers.

Even during a recession, the bureau of labor statistics indicate an expanding physical therapy workforce growing by 39% over the next 10 years, adding a further 75000+ jobs, to the current 200000 jobs, by 2020. It is partly due to this that Money Magazine on CNN Money, rated physical therapy as the second best job in fast growth fields in 2011.

To add to this, there is a shift towards direct access to physical therapy services for consumers. This means that patients do not require a doctor's referral to access physical therapy. Currently in the U.S. 46 States plus the District of Columbia offer direct access for patients. All physical therapists are highly qualified practitioners and are capable of performing appropriate assessment and management of patients. The American Physical Therapy Association hopes to change all physical therapy programs to Doctorates by 2020, leaving it difficult to dispute the competence of physical therapists as first contact practitioners. Considering the push for healthy lifestyles and more and more people taking control of their health, it makes sense to offer a physical therapy service without a referral from a doctor.

As well as job security, a positive work-life balance and job satisfaction are major factors when planning a career. A career in physical therapy is diverse, offers flexibility and is very rewarding. Physical therapists working full time usually work a 40hour week but this is quite flexible. Most therapists can choose to work weekends or evenings to earn extra money, or they might work part time. Other physical therapists might decide to work two part time jobs in two different areas for more of a challenge. It is because of this flexibility and diversity that Workforce Developments report that 78% of physical therapists are satisfied with their jobs, compared to the national average of just 47%.

So there you have it. The physical therapy job outlook looks very secure for the future, and offers a flexible and challenging career.

Health and Fitness: Physical Therapy Article Category

Avoiding a knee replacement is something that every individual with knee pain due to osteoarthritis tries to avoid or put off to the very end as a last resort. Depending on the amount of damage that osteoarthritis has caused inside thee knee compartment will determine how much time you have. You can buy some time and avoid surgery by following these three key ideas and putting them into action.

1. Ask Your Surgeon If You Are A Candidate For Viscosupplemntation.

You can check and discuss with your orthopedic surgeon if viscosupplementation injections will work in your case. The use of this procedure will depend on the amount of osteoarthritis you have in your knee and where it is located. This procedure helps replenish the natural lubrication you have and, helps to maintain the shock absorber qualities inside your knees. This can be discussed with your doctor to determine if the benefits outweigh the risks.

This procedure is given through a series of injections and you can feel either immediate results or may find some relief in a couple of weeks.

2. Lose Some Weight To Help Decrease Impact Forces In Your Knees.

The amount of weight you carry greatly impacts the health of your knees. As we age we tend to put on more weight if we do not make a conscious effort to exercise and eat right.

By carrying extra body weight you place a greater amount of force through your knees.

For every extra pound you carry over your ideal body weight, you add three pounds of added force to your knees when you walk and, ten pounds of added force when you run.

Ten extra pounds of body weight can add anywhere from thirty to sixty pounds of force through your knees.

Your diet and controlling your weight may be the most important thing you can do to maintain healthy knees and decrease the chances of developing osteoarthritis.

3. Keep Your Legs Strong With Resistance Training.

Maintaining strong knees involves keeping the surrounding muscles strong. The muscles involving your quadriceps, hamstrings, and calves when sufficiently strengthened allow them to absorb the impact of your daily activities such as walking and decrease the amount of stress that is placed through the knee joint itself.

Exercise activities such as bicycling and swimming also are highly recommended to build sufficient leg strength if you are unable to start a resistance training program.

Bicycling will build both quadriceps and hamstring strength and will help in developing your cardiovascular system which helps in delivering nutrients to your knees.

Swimming assists in taking stress off your joints and allows for more freedom of movement.

Avoiding a knee replacement through weight loss and exercise can be very successful if properly followed with discipline and determination. If you need viscosupplementation than it may be just a matter of time however before surgery will be required. it can buy you six months or more before replacement is required.

PT Schools - How To Choose The Right One

Choosing the right physical therapy (PT) school can be a very confusing decision. There are 210 accredited PT programs across America so how do you know which one is right for you? The following article will give you 10 things to think about to make it a bit clearer.

There are several different factors you need to consider when choosing the right PT school. Everyone is different and has different personalities and priorities so in the end it is where you think you would enjoy the experience the most. Some things to think about are as follows:

1. Accreditation?: Firstly you need to make sure the PT program you're looking at is accredited by CAPTE. If it's not then you will not be able to practise as a physical therapist and all your hard work will be for nothing.

2. What degree should you complete?: Currently there is a choice between a Master of Physical Therapy (MPT) and a Doctor of physical Therapy (DPT). The American Physical Therapy Association is pushing for all PT programs to be DPT by 2020 so it would make sense to enrol in a school that offered the doctorate program.

3. Is the PT school respected? There is no official Physical therapy school ranking and you won't be any less employable depending on which school you attend. If a school is respected however, you may benefit from better internship opportunities and more qualified teaching staff.

4. How much will it cost?: Obviously this is a major deciding factor in what PT school you attend. Don't think that the more it costs the better the program because it's not the case. Prices vary greatly between schools but you are looking anywhere between $25 000 and $50 000 a year. At the end of the day you have to pass the same NPTE as everyone else.

5. Physical therapy prerequisites?: Make sure you check with the PT school you intend on applying to that you have met all their prerequisites. They all differ so contact each school directly. If you haven't met the requirements you will not qualify for enrollment.

6. Where is the campus located?: This is important if you plan on moving away from home and study interstate. Studying interstate will increase the fees considerably more and many students become home sick and this can impact on your overall college experience. Also think about whether the location suits your life style.

7. What is the campus like?: Investigate campus facilities and extracurricular activities they offer that might interest you. It would be a good idea to visit the campus to get a better feel for its atmosphere.

8. What is the structure of the program like?: The curriculum and structure of all programs are different. Some spread out the clinical placements throughout the year and others do it all at the end of the course. This might cause you problems if you need to support a family for example. Smaller class sizes and a higher faculty to student ratio tends to be beneficial for improved learning.

9. What are the facilities like? - have a look at what extracurricular activities the university offers and what facilities are available. This will determine if it suits your lifestyle. More specific to your studies, new equipment and new facilities will put you in the best position to be at the forefront of the profession.

10. Course duration: generally the courses are all about the same in duration but some offer accelerated undergraduate programs.

So think carefully about your decision and just remember that you should choose a PT school that suits your lifestyle. University is not just about studying to get your qualification but creating one of the best experiences of your life.

Therapeutic Models for Pediatric Physical Therapy

When a child has a physical impairment, he/she often benefits from working with a skilled physical therapist in order to work towards attaining the skills that he/she lacks. Physical therapy can be practiced either in a medical clinic, in the child's home, or within the school system, and each relates to a different "model" of practice, with different goals and objectives.

The medical model of practice is what is typically thought of when one thinks of physical therapy. It can include going to an outpatient clinic where an array of different equipment can be utilized, including treadmills, weights, swings, ball pits, etc. The medical model can also be practiced in a child's home, if the child is homebound due to medical issues. The goals must be measurable and attainable, and therapists typically have to show progress towards these goals in order to be reimbursed by insurance companies. Often times, children with lifelong physical disabilities will have to take a break from therapy if they are not making progress towards the goals that have been established. This is known as an "episode of care", meaning that a child is not necessarily receiving services continually throughout his/her life.

Alternatively, by law, students are able to receive physical therapy services through their school system. These services would fall under the educational model of practice, and are part of a child's Individualized Educational Plan (IEP). This means that the physical therapist is a part of the special education team, which includes the student and the parents, that helps the student function within his or her "least restrictive environment", which is typically the school setting for school age children. Goals in the educational model will focus more on routines in the school day, adaptations for the classroom, and equipment needs. Services can be direct (working one on one with the student), which might resemble the medical model. However, services can also be indirect, integrated, or consultative, meaning that the therapist is working mainly with teachers, staff, and/or parents, providing ideas and training for how to manage the student's physical impairments so that he or she is still able to be functional in the classroom setting.

Before children are school aged, they can qualify for Early Intervention services. This is typically from birth through the age of three. Each state has different qualification standards, but typically a medical diagnosis that indicates need or low scores on a standardized test can qualify a child. Early Intervention services can be provided by the school district or the state, and the services are free to the family. Early Intervention services follow an Individualized Family Service Plan (IFSP), which is similar to an IEP in that it involves a whole team approach. The difference is that an IFSP is family focused and the least restrictive environment is typically in the child's home. Education and training of the parents and family is the main focus.

How To Use Ice Vs Heat For Pain Control

Everybody experiences pain at one time or another. Whether the pain is caused by a new injury or a nagging old one, the bottom line is we want to feel better and to get out of pain as quickly as possible. Thermal modalities (such as ice & heat) are time-tested solutions to getting rid of pain. But how do you know if you should be using ice or heat? I routinely get asked about which one is better to use - and when. Unfortunately, many people inadvertently create more problems for themselves by using the wrong thermal modality at the wrong time. The key to correctly choosing ice or heat depends on the situation.

Consider the following problems:

• You've got a nagging old football injury

• One day ago, you fell down a flight of stairs and injured your ribs and your right hip

• Two months ago you were in a car accident which left you with ongoing neck pain

• You twisted your ankle a week ago while skiing

• Your child got hit in the head by a baseball during a game

What do you do about these problems? How do you correctly select the right thermal modality (ice vs. heat)? Which one do you select, and how frequently do you apply the therapy?

The first thing you need to consider is how long ago the injury occurred. Recent injuries are ones which occurred within the past twenty-four to thirty-six hours. For recent (or acute) injuries, you want to use ice. The reason for this is because after a traumatic event, the body goes through a healing process involving a number of sequential phases. These are: (1) the inflammatory phase, (2) the proliferative phase and (3) the remodeling phase.

During the inflammatory phase, the capillary beds open up to allow more blood flow to the injured region. This is often accompanied by redness (rubor), an increase in temperature (calor), pain (dolor) and swelling (tumor). These events are important, not only to protect the injured area, but also to ensure proper healing takes place. However, while the inflammatory process is important, it is possible (and desirable) to accelerate the healing process without jeopardizing anything by altering the blood flow to the injury site. We have the ability to modulate this process by way of the careful application of ice. Ice is a natural anti-inflammatory. It reduces pain & swelling and without any adverse effects to the liver or kidneys (as what you may get by taking drugs). Ice works by closing capillary blood flow, reducing swelling and edema and numbing the affected region.

I use ice for fifteen minutes followed by a one hour interval before re-applying the ice again. Why take it off for an hour? You must allow the tissues to sufficiently warm up before using ice again so you don't get a frost bite or freezer burn (resulting in damage to the skin & connective tissue).

Once the inflammatory phase has completed, the body transitions to the proliferative phase. This is when the body starts to try to patch the injured area by laying down connective tissue and scar tissue. At this point, we want to encourage this process as much as possible by opening blood flow to the affected region. Heat facilitates the capillary bed perfusion. Heat also soothes and relaxes muscles, allows for fuller pain-free range of motion and additionally, it feels great. Heat is also appropriate for use during the remodeling phase (the final phase of tissue repair).

For older (chronic) problems, you will generally want to use heat as the preferred thermal modality. My rule of thumb when using heat is to apply it for approximately 15-20 minutes per session.

Another thing you can try for older chronic problems is to use ice-heat contrast. What is involved with contrast therapy is to use heat early on in the day (or before exercise). You would then use ice at the conclusion of exercise (or at the end of the day). Think about what you've always heard about exercise. You warm up before and cool down after. Using heat and ice facilitates this and gives you a more profound effect. Chiropractors, physical therapists and athletic trainers all use ice & heat to help their patients feel better, move better and heal faster. Using these modalities correctly will allow you to get out of pain and get back to doing your activities of daily living.

How to Avoid Ankle Injuries

If a horse breaks an ankle, the result is almost always a bolt to the head and the knacker's yard. For human beings, fortunately, the consequences of an ankle injury are much less extreme: a break is set, a sprain is strapped; some weeks on crutches, rest and rehabilitation, and we are as good as new. That is the upside. The downside is that if you are a professional athlete, or even a dedicated amateur, the time off the field or court or pitch can be disastrous. While your injury is mending, you cannot play, you cannot practice and you cannot train. Your fitness level drops, your skills suffer, and your muscles deteriorate.

It is, therefore, wonderful to know that if you learn how to strap an ankle before you are injured, you may avoid injury altogether.

Avoiding ankle injuries

Way back in 1946, an article was published in the Journal of the American Medical Association (JAMA) entitled a protective wrapping for the ankle. The author had figured out that ankles are the Achilles heel of all athletes, meaning that the ankle is very vulnerable. In fact ankle injuries are the most common sports-related injuries. This is particularly true in sports like basketball and netball which require a lot of running jumping and sharp changes of direction. Most ankle injuries are caused by landing badly after a jump, but twisting to change direction can also stress the ankle. However, the author of the article concluded, if ankles could be supported and reinforced with tape, many injuries could be avoided. The article outlined how to strap an ankle to prevent injury, and a small industry was born to manufacture and distribute sports tape.

How to strap an ankle with sports tape

Ankle injuries are most often caused by coming down, or landing, on the ankle at a bad angle. This can stretch and tear the ligaments and muscles. A well-supported ankle is less likely to "turn". A simple crepe bandage can greatly strengthen weak ankles, but professional athletes favour the much more complicated process of wrapping the ankle with sports tape.

How to strap an ankle the correct way is the subject of lengthy debate. There are many varieties of athletic or sports tapes. Some are rigid, some are flexible. Some are self-adhesive; others need a glue to keep them in place.

Whatever wrapping method you use, there are several common features of the process:

• Learn how to tear the tape: grasp it between forefinger and thumb, thumbs touching, and tear the tape by pulling in opposite directions.
• Avoid wrinkles while applying the sports tape as these can lead to discomfort and even blistering.
• Take care that the ankle is not so tightly wrapped that blood flow is constricted.
• Wax the lower leg before strapping. This avoids the pain of removing the tape (and hairs).

If you take the time and trouble to strap an ankle prior to practice or play, it is possible to greatly reduce the likelihood of sports injuries to these delicate parts of the body.

Is Carrying Your Baby on One Hip Leading You to Dementia As Well As Chronic Back Pain?

I am dedicating this article to all those wonderful, sleep-deprived, hardworking woman out there who have taken it upon themselves to increase the gene pool by having children. I am also in that ilk but the early memories of screaming, teething, snotty, teary bub's is buried deep in the back-waters of my mind (thank God!).

There is a plethora of ailments that I could address with mothers which include stress due to sleep deprivation, neck and shoulder pain from head positions during feeding, breast or bottle, makes no difference. I am however opting for the back conditions due to holding children on one hip.

The biomechanics of the hitched-hip syndrome that is adopted by most parents is an absolute nightmare. All you have to do is look at yourself in the mirror to see what is happening to the muscles of back, spine and hips to realise what toll our little darling's demands are creating. Now I'm not trying to tell you that you can't carry the fruit from your loins, but I urge you not to break into the bad habit of selecting just one side to carry on. What we do sets up a common pattern of shortening certain muscles, tendons and connective tissue and jamming up joints in the spine, hip, ribs and even as far reaching as the neck and knees.

There are several options you can employ to alleviate muscle imbalance not only of the pelvis but also to teach neural re-patterning. Let's try some fun things to change habits shall we? I want you to clean your teeth with the other hand go on try it for one week and see how it becomes slightly easier each time. What we are doing is setting up new neural pathways in the brain to ensure that the different set of muscle, tendon and joint sequences become "hard-wired". This is one of the many types of challenges we can do to stave off early dementure say some authorities and I believe them. The need to carry your child on a particular hip is only a habit and one that needs to be monitored. The elevated hip will lead to shortening of the muscles and tendons around the trunk on that side, tension up the outside of that leg which can cause knee problems. The change in pelvic positions will tighten the inner thigh muscles on one side which then can lead to rotations of the pelvis and lower back.

So now we need to look at the BIG picture in two fold, addressing back care with correct muscle and joint alignment. We are also encouraging new neural pathways in the brain, similar to the brain-training programs used by Occupational Therapists and Nintendo DS. This will keep you from feeling stiff and achy and further from wanting to roam the neighbourhood in your "nightie" wondering where the heck you are.

Please try to swap the baby from either hip for your brain wealth, musculoskeletal health and also the common patterns on body twists and neck turns that you place on your little one.

Know More About Types of Massage

If you are planning to distress yourself, why don't you try getting a massage? A massage is great way to releasing all that tension that has boiled up inside you. A massage uses a scientific method which it targets your pressure points and other superficial parts of your body to help produce a physical, emotional and therapeutic experience. Massages have different types and techniques. It would help that you get to know what these types of massages are and the benefits on offer before you decide to go to a massage clinic.

The Swedish massage or Western massage is the typical massage technique used in United States and in several locations in the Western world. This type of massage utilizes long strokes, friction and compression to re-energize the body with the stimulation of proper circulation of blood through your heart. This type of massage uses circular movements and combination of five strokes that focuses on the circulation of blood in the system. The Swedish massage should be the first option of any beginner patient who has never had a massage in his life because it provides the patient a great and relaxing experience since this massage is considered s the softest massage method.

The Shiatsu massage uses a Japanese system combining acupressure and traditional massage methods. The masseur applies pressure with the use of his fingers, thumb, palms, elbow, and even the knee to certain part of your body. You get to feel a sense of weightlessness and a great dose of pain and stress relief.

Acupressure has the same concept with Shiatsu massage. It uses finger and sometimes even toes to press pressure points on your body to stimulate the natural healing processes in your body. This massage technique presses the point commonly called meridians in Chinese medicine culture to release the muscular tension and help improve the flow of blood and life energy referred to as "qi" in the body to hasten the healing process. The only difference it has with acupuncture which it is commonly mistaken as is that it does not need any needles to stimulate the meridians. It only uses the hands and feet instead. Just like acupuncture, acupressure provides reduction in eye strain and neck pains. It would also get rid of headaches, backaches, tension, constipation, indigestion, ulcer pain, menstrual cramps and a whole lot more. Acupressure also helps release endorphins helping you with your sleep problems. Not only does acupressure alleviate the pain but it also helps in improving the organ functions.

Thai massage, commonly known as Yoga massage is massage technique that has been cultivated in Thailand for many centuries. The difference between Thai massage and acupressure is that Thai massage involves compressions and body stretches along with the pressing of pressure points. Thai massage mainly focuses on clearing energy blockages in the body and restoring balance and harmony. Yoga massages uses a firm mattress on the floor compared to using a table. Breathing techniques are also employed to the patients.

You can opt to choose any of these massage types which you think are favorable to you. Be reminded though that a massage is just a form of relaxation and not a treatment or cure for any ailment you may have. Ask your trusted osteopath about the real benefits of massage.

Hip Resurfacing and Physical Therapy Rehabilitation

Total hip replacement is one of the most common joint replacements surgeries performed. Due to society aging and the fact that many older adults are more active, hip osteoarthritis has become more prevalent. For more active individuals there is a type of procedure that is known as hip resurfacing that may be more appropriate.

In years past patients no matter what their age were given the only option of a total hip replacement. With a total hip replacement, your ability to participate in strenuous activities was taken away due to the high incidence of hip replacement failure. With a procedure known as hip resurfacing, you are able to get back to most of your prior activities without the fear of causing unnecessary prosthetic failure.

The advantages of a hip resurfacing procedure is the fact that there is less femoral bone removal.With less bone removal, the chances of dislocation are greatly reduced and, the ability of the orthopedic surgeon to go back in if needed to complete a total hip replacement at a later date is improved.

The majority of hip resurfacing procedures are done using a posterior approach much like a total hip replacement therefore, physical therapists will find similar post operative procedures and precautions to initially follow regarding rehabilitation.

There have not been an established therapeutic protocol to follow after surgery however many orthopedic surgeons may have designed one themselves for the rehabilitation staff to follow. For the most part once you begin receiving physical therapy you will be followed the same as if you had received a full hip replacement.

With this procedure being so new, most patients regarding physical therapy are followed on a case by case basis however.

Though with resurfacing the recovery may be a little faster, it is for the most part followed closely in initial recovery time like a total hip replacement.

Hip resurfacing patients may also experience slightly more pain after the procedure. The reason being that most patients that qualify for hip resurfacing are very active and, need continued education on not stressing the new implant too quickly after surgery which could affect the overall healing process.

Hip resurfacing seems to be a procedure that will only expand further due to the fact that younger more active adults are opting for the procedure that will not only allow them to resolve their hip pain but, also gives them back their freedom in regards to continued exercise and maintaining a high level of activity.

If you are interested into looking further into hip resurfacing, understand that the resurfacing success is closely related to the physicians experience with this procedure. Take the time to research the orthopedic surgeon and find out how proficient they are in this type of surgery.

No doubt more research will be needed in the areas of physical rehabilitation and what the long term affects of high physical participation is on hip resurfacing prosthetic components.

How To Help You Sleep After a Knee Replacement

Once your knee replacement is over and you leave the hospital everyone looks forward to getting home and relaxing. One of the biggest obstacles met by many will be the inability to sleep. Those first couple of weeks when you get home, trying to get a decent nights sleep can be difficult. There are several tips however that will help you sleep during those first two weeks you are home.

1. Take Your Medication As Prescribed. There are individuals I have come across during physical therapy that are trying to get of their pain medication too soon. In the hospital you are medicated differently than you will be at home. Your ability to handle the pain during the evening will not be as good as it was in the hospital. It is strongly recommended that you take your pain medication prior to going to sleep each night. Trying to stop the pain medication too soon will set you up for failure in controlling your pain. If you are having trouble with your pain medication and not handling it well, call your surgeon and get something else. This will be better than going without medication.

2. Use TV Or Radio To Help You Sleep. When getting ready to go to sleep you may want to consider having a TV or radio playing softly in the background. During the night the inability to handle the pain can be due to lack of external stimuli around you. During the day you will have the TV going or listening to the radio in the background. There will be cases where friends and family stop by as well. In these instances you have other things that you are engaged in. Your mind does not focus on the pain therefore you do not have the focus on your knee itself. Sleeping with soft music in the background can be comforting and help with pain relief.

3. Avoid Too Much Activity During The Day. There will be times when you may find yourself getting involved in activities that may be better left for someone else. The first several weeks are critical that you closely monitor your activity level. You generally will not suffer the consequences of overdoing some activity until later that night when you are trying to get some sleep. It is something that everyone will experience from time to time in the initial stages of your recovery.

If you find that you are awaken by your knee during the night, it is generally letting you know to move it. Either pumping your knee while lying down or getting up and walking a little will actually calm the knee down allowing you to fall back to sleep.

Getting a sound nights sleep will be challenging at first when you get home however in time as it heals you will be able to get back to your usual sleeping patterns within two to three weeks.

Three Myths About Knee Replacements

When it comes to the possibility of having to have your knee or knees replaced, there are myths that have been told by friends, family, and neighbors when it comes to knee replacement surgery. Though many of the same people who spread these myths may have good intentions, they just to not hold up in modern medicine today. There are many myths that have been carried over through the years however, I will cover the three I hear the most in my day-to-day activities in physical therapy.

  • The Knee Replacement Will Not Feel Natural. In the initial days after your surgery this may be the case however, in time as swelling is reduced, you are getting stronger and you are progressing with physical rehabilitation as a whole, you begin to feel as though the knee is more natural. Helping to give your new knee a more natural feeling is also affected by the superior surgical techniques and materials that are used today.

  • I am Too Young To Have Knee Surgery. Years ago patients that were in pain were advised to hold off on getting a knee replacement until they literally were in a wheelchair due to pain and the inability to walk. Today the age that someone having a knee replaced is younger than it once was. The need for a replacement has more to due with your level of pain than your age. I can assure you the older you are and the longer you postpone the knee replacement, the harder it is to rehabilitate. Many of those that have a knee replaced in their 50s and 60s indicate they should have had the surgery sooner.

  • You Should Wait As Long As Possible To Have The Surgery. Waiting until the very end to have your knee replaced is not a good idea. Living in the type of chronic pain with a knee that is bone on bone will also end up breaking down other areas of your body. For instance the lack of sleep at night due to a high level of knee pain can lead to insomnia and possibly depression. Waiting to the very end also can lead to back and, other joint pain due to the change in your walking mechanics. The high level of pain that you have to endure waiting to the very end before knee replacement surgery lowers your overall quality of life and, deconditions your entire body.

Having to have a knee replaced is of course a decision that takes some thought and planning. However, once you have the replacement you are able to live both pain-free and have a higher quality of life. Check with your orthopedic surgeon regarding any concerns you may have that will help you dispel some of the myths prevalent today.

Forest Hills Physical Therapy: Restoring Your Balance

Learning to live with Vertigo can be quite a challenge, but a physical therapist can make the process much easier for you. Before we go any further, though, we should point out that there are certain symptoms which, should they ever accompany your vertigo, would be reasons to seek out immediate medical attention. These symptoms include a change in alertness, difficulty speaking, and double vision. Vertigo itself is just the sensation of spinning, even when you're standing perfectly still. It does warrant medical attention, but alone, it does not constitute a dire emergency. It has multiple causes, and the vast majority of them involve the inner ear in one way or another.

Some people don't immediately think of physical therapy in conjunction with vertigo, but there is actually a lot that a physical therapist can do to help. For example, there are various head and neck movements which can get you moving again and help you keep your vertigo under control. Often, too, it's certain activities that trigger vertigo. If that's the case with you, then your therapist will really be of benefit. He or she can show you how to do those activities in different ways which will help you reduce your dizziness. If any of those activities also cause fatigue, then those will be given priority.

A large portion of a physical therapist's treatment of vertigo will consist of coaching you through various types of exercises. The particular exercises your therapist chooses will obviously depend on which specific symptoms you have. In general, these exercises have three overall goals. Clearly, one of those goals is to improve your balance. Another goal is to help your brain "correct" the differences between it and your inner ears. You will also be helped to improve your focus and vision. In addition to these exercises, your therapist will also suggest some that are intended simply to improve your overall health.

Some people don't realize this, but there are actually therapists with more specific specialties than simply physical therapy in general. If you suffer from vertigo, then you may want to look for a therapist who has completed a fellowship in neurological physical therapy. Such a therapist would be particularly well suited to addressing vertigo. Keep in mind, though, that all of them are qualified to treat people with dizziness. Thus, if you get a recommendation from a friend, family member, or your doctor, then it's definitely worth calling to set up an appointment.

If you or a loved one is suffering from Vertigo, Gait Impairment, or Balance issues, contact the physical therapists at Forest Hills Rehabilitation to see how we can help.