Posted on 10/12/2020
For the management of some types of pain, prescription opioids can certainly help. However, there is not enough evidence to support prolonged opioid use for chronic pain. We sat down with Katie McBee, P.T., DPT, OCS, M.S., CEAS II, PYT-C, regional director of our WorkStrategies Program, to ask her a few questions regarding opioid use, chronic pain and the benefits of physical therapy as a safe alternative to prescription medication.
1. In your opinion, what are the main reasons for the opioid epidemic in the United States?
There is no simple explanation as to what caused the opioid epidemic in the United States. Opiates are not a new drug and have been abused at other time periods in American history, but not nearly to the extent that is happening now. For example, with health care access issues due to COVID-19, opioid prescription rates are on the rise with death rates up 30% since the pandemic’s onset.
Initial research on opiate medications said they were effective and safe and addiction was rare when used for short-term pain.1 The development of FDA approved OxyContin in 1995 had labeling that stated iatrogenic addiction was “very rare,” and a widespread marketing campaign to physicians started to build medical providers’ confidence in prescribing these medications to decrease pain-related suffering.2 Add to that the 2001 standards implemented by the Joint Commission on Accreditation of Healthcare Organizations for organizations to improve their care of patients with pain medication and this is probably what catalyzed the beginning of our current opioid epidemic.
With medical providers focused on pain as a vital sign, pain quickly became the enemy and had to be eradicated to show successful management for many conditions with an increased focus on post-operative pain management. As drugs became more widely available, aggressively advertised and culturally acceptable, a three-fold increase in prescription rates for these medications ensued. With the increase in opioid prescription rates, death rates from side effects also increased by three-fold to more 16,000 in 2011.
2. What is the difference between chronic pain versus pain suffered as a result of an injury?
Pain is a mechanism designed to protect us from harm. Pain is not the enemy. A common misconception about pain is that it is not a simple cause/effect relationship. The amount of injury does not equal the amount of pain we experience. Pain is a complex process based on many areas of the nervous system and the brain communicating together to let us know what we need to prioritize and protect. The more threatening the brain perceives something, the more we potentially feel pain.
Acute pain or pain suffered immediately after an injury or surgery to the body’s tissues is a protection mechanism from the brain to remind you to protect the area so that no further harm is done. As the tissue heals and time passes, there is less threat of injury so the brain stops signaling, the pain eases and you slowly get back to normal activities.
In chronic pain, the tissues are not signaling danger to the brain as much as they are in acute pain. When the brain perceives threat for extended periods, it starts to change the nervous system to become a pain-producing machine. It creates new nerve junctions to make things hurt that wouldn’t normally hurt, like light touch on the skin. It can decrease the amount of pressure needed to create a pain signal. It creates more chemicals along the nervous system so it can create greater pain experiences with fewer stimuli. Research is still trying to figure out why some individuals have pain that goes away as the tissues heal and others have pain that persists despite the fact that the tissue has healed.
Individuals can be at risk of developing chronic or persistent pain for a number of reasons, including unhelpful coping strategies, stress, chronic illness and poor sleep habits. It appears the more emotional or physical stress going on at the time of the injury and/or during the healing process, the more at risk you can be of developing a persistent pain issue. A holistic approach to address some of these drivers of persistent pain is showing promise in being able to reduce the pain and get people with chronic pain back into their normal lives again.
3. Why is physical therapy important and what are some of the benefits to patients?
Physical therapy is an ideal treatment for many types of acute and chronic pain and should be a part of any single or multidisciplinary treatment plan for pain. The goal of physical therapy is to increase function and keep people in their meaningful life activities while they are healing. Physical therapists are trained to address many of the drivers of chronic pain and can perform testing and screening to see if your pain system is sensitized and adjust treatment to desensitize the pain system as well as address the functional limitations many people often experience when they are in pain.
Physical therapists have many tools they can use to decrease pain and desensitize the pain system. These tools include education on pain to discover what could be driving pain issues. Once the pain drivers are discovered, a physical therapist will develop a holistic plan to address these drivers, including increased activity, sleep hygiene, stress management skills and pacing techniques.
The best thing about physical therapy for pain is that the outcomes for some of the techniques are better than many medications and procedures available; plus, there are no negative side effects. If you or someone you know has an issue with pain, please request an appointment today to begin physical therapy treatment.
1. Porter J, Jick H. Addiction rare in patients treated with narcotics. N Engl J Med. 1980;302:123.
2. Van Zee A. The promotion and marketing of OxyContin: commercial triumph, public health tragedy. Am J Public Health. 20:99 (2):221-227.
Posted on 10/7/2020
Up until a few months ago, my life as a physical therapist was pretty normal. I went to work, did my job, helped my patients and team to the best of my ability and went back home. At the time I was working in a critical illness recovery hospital with some of the sickest patients in my geographic area, people recovering from major trauma and significant illnesses. I was part of a great team, but it was heavy work. I felt myself becoming burnt out and struggling to do my best work. I have done hospital-based and outpatient work throughout my career, so I began to think that a transfer to Select Medical’s Outpatient Division might be my next move.
Fast forward a few months and interviews later and I accepted a site supervisor position at an outpatient center. About a month into my new role, COVID-19 wreaks havoc on the world. It was a daily pivot in terms of center operations and managing a team during a global crisis. I was also in a really unique position because I had spent almost 10 years working in critical illness, learning about cardiopulmonary physical therapy, infectious diseases and protective equipment. I felt confident I could lead my team effectively with the best information I had. As we started to move through the pandemic, our greater area was looking for someone to help lead a developing COVID-19 recovery program and I felt uniquely qualified.
Select Medical’s clinical team had put together a top-notch Recovery and Reconditioning Program for those compromised by a variety of acute and chronic conditions, such as after-effects of the flu and cardiovascular disease. Developed in partnership with leading physicians, including physiatrists and infectious disease specialists, the program focuses on identifying key areas of deconditioning and weakness in patients. Select Medical’s licensed physical and occupational therapist are specially trained in the program, with each clinician having access to the most up-to-date COVID-19 information, best practices and safety precautions.
Physical, occupational and speech therapy is critical in helping COVID-19 survivors get back to their lives and jobs. This virus can be extremely debilitating on its own, and even worse when combined with the effects of limited mobility during hospitalizations, prolonged mechanical ventilation or additional medical complications. As physical rehabilitation professionals, we are uniquely qualified to work with these patients to:
- Increase mobility, balance and stability
- Decrease pain, soreness and general fatigue
- Improve range of motion and breathing capability
- Address cognitive impairments, dizziness and weakness
- Ensure a safe recovery to activities of daily living
Our clinical team believes firmly in safety first and have put out guidelines for monitoring patients to ensure we are exercising them hard enough to make progress, but not overstress their systems. We are also educating these survivors on how to monitor themselves during home exercises or simple household activities like cleaning and chores.
While this global pandemic has had a lot of challenges and negative aspects, when I really step back and look at the whole picture I am impressed with how we positioned ourselves. Every day, we are committed to putting patients first, keeping patients and clinicians safe and assisting those who have survived COVID-19 back to their highest quality of life. That’s something to be proud of, and we look forward to helping more and more heal through our Recovery and Reconditioning Program.
By: Erica R. Noel, P.T., MSPT. Erica is a physical therapist with Banner Physical Therapy in Phoenix, AZ. Banner and SSM Physical Therapy are part of the Select Medical Outpatient Division family of brands.
Posted on 10/2/2020
It's official, our favorite month of the year is here: National Physical Therapy Month. Please join us as we celebrate our amazing team members and the power of physical therapy throughout October. #NPTM2020 #ChoosePT #ThePowerOfPhysicalTherapy
Posted on 6/16/2020
Across the United States, thousands of people have been impacted by the coronavirus (COVID-19) pandemic. Many individuals are also compromised by a variety of acute and chronic conditions, such as emphysema, after effects of the flu and cardiovascular disease. As you or your loved ones recover from COVID-19 or other debilitating illnesses and conditions, you may be left with varying levels of deconditioning and weakness.
We understand this is a scary and challenging time. Our compassionate team of clinical experts can help you continue to heal through our Recovery and Reconditioning Program. Learn more.
Posted on 4/29/2020
We can help with your injury
If you have pain or an injury that isn't improving, our team at SSM Health Physical Therapy can get you on the road to recovery. Scheduling a complimentary consultation with our therapists is the first step to determining what's occurring and the right treatment for the cause of your pain or discomfort.
During your at-home consultation, our clinical team will get a thorough history of your pain or injury, including how long you've been dealing with it and what might have caused it. Our team will provide recommendations for treatment.
Depending on your injury and insurance coverage, you may be able to schedule therapy right away -- or we may recommend a follow up with your doctor for further evaluation.
Injuries aren't always scheduled, but relief can be. A complimentary consult is an easy way to start the healing process. To schedule, please contact our Central Scheduling office at 800-518-1626 or click here.
*Per federal guidelines, beneficiaries of federally funded plans are not eligible for complimentary injury screens.
Posted on 4/24/2020
At SSM Health Physical Therapy, there is nothing more important to us than your health and safety during this unprecedented time. The Department of Homeland Security and state governments have deemed physical therapy an essential component of health care during the coronavirus (COVID-19) pandemic; therefore, many of our centers remain open to serve those in need. We are taking extensive preventative measures, guided by the CDC, to protect our patients and employees who enter our centers.
We hope that by providing this information, you can make a clear decision to continue your plan of care with us during this time. The following protocols are now in place:
- Patient Screening: All center patients are screened at the time of their appointment confirmation phone call. For centers located in our inpatient rehabilitation hospitals, patients are screened prior to admission. This process includes taking patients’ temperatures. Patients presenting any level of symptoms do not receive therapy until they are cleared.
- Staff Screening: All employees are screened daily upon arrival at the center, including temperature monitoring. Those presenting any level of symptoms are removed from the center and undergo the required 14-day self-quarantine, not returning to the center until they are cleared.
- Masking: All therapists are universally masked and we are now requiring patients in our centers to be masked as well.
- TeleRehab: Offering TeleRehab to all patients who would prefer to be treated in the safety and comfort of their home.
- Hygiene Protocols: Continuous reinforcement with staff regarding hand washing. In addition, general environmental controls are in place, including deep cleaning of centers with EPA approved cleaners.
- Procurement Audit: Assessment of equipment and supplies to ensure centers are fully prepared to handle potential exposure to COVID-19.
- Employee Safety: Ongoing education and communication to all center employees.
That said, if you do not feel comfortable coming to a center for care during this time, we will gladly reschedule your appointment for a later date. In addition, many of our locations are now offering TeleRehab services so that you can easily connect with one of our licensed therapists through web-based technology that is HIPAA compliant. Learn more.
For patients coming to our centers for care, we ask that you please limit the number of people who accompany you to your appointments, unless they are necessary for transportation or assistance. If for any reason you are not feeling well, please contact the center and we will be happy to reschedule your appointment.
To help prevent the virus:
- Wash your hands often with soap and water for at least 20 seconds.
- Avoid close contact with people who are sick.
- Avoid touching your eyes, nose and mouth.
- Stay home when you are sick.
- Cover your cough or sneeze with a tissue and throw the tissue in the trash.
- Clean/disinfect frequently touched objects and surfaces.
Thank you for helping us ensure the safety of our patients and employees, as well as families of both.
Posted on 3/27/2020
SSM Health Physical Therapy now offers physical, occupational and speech therapy from the comfort and safety of your home through our Telerehab program.
If you're limited by travel, injury or a weakened immune system, we will virtually bring our services to you so you may heal, build strength and get back to the things you love.
What is Telerehab?
Telerehab lets you easily connect with one of our licensed therapists through web-based technology, all from the convenience of your home. Sessions are delivered one-on-one in real-time, and are private, secure and adhere to HIPAA requirements.
How does it work?
Telerehab sessions may be offered in place of or in addition to in person center sessions, dependent upon your condition and preference. All you need is a computer or device with a camera, microphone and internet access to begin.
- Simply click a link we'll send you - no downloads or accounts necessary!
- Just like the care you'd receive in our center, we'll cover:
- Pertinent paperwork
- Exercises, education and techniques to address your pain and impairments
- Instruction on how to best move forward with your therapy program
Our physical, occupational and speech therapists will work with you to make sure Telerehab is right for you. No prescription or physician referral is needed. Our goal is to help you feel better physically while making sure you're comfortable and an active partner throughout your treatment. For more information about Telerehab, call 866.33.REHAB.
Posted on 8/23/2017 by Colleen Boucher, P.T., DPT
Wearing proper clothing, getting the right amount of sleep and practicing proper stretching techniques are vital to an athlete’s success. But, just as is important is eating the right foods. A proper diet will allow athletes to remain active, maximize function and minimize risk for injury. Eating the right foods will also address factors that may limit performance such as fatigue, which can cause deterioration in skill or concentration during an event.
Using guidelines from the American College of Sports Medicine, we believe practicing these tips will help athletes remain active in their favorite sport. What and when you eat prior to physical activity makes a big difference in the way you perform and recover.
Eat three to four hours before your workout and make sure you’re eating food that not only contains adequate amounts of proteins and carbohydrates, but also provides sustainable energy, speeds recovery time and boosts performance. Early fatigue caused by malnutrition can result in improper mechanics, creating predisposition to injury.
Athletes should eat a diet that gets the bulk of its calories from carbohydrates, an athlete’s main fuel. Eating foods such as breads, cereals, pasta, fruit and vegetables will help to achieve maximum carbohydrate storage.
Re-fueling after exercise is just as important. Eating protein, carbohydrates and a small amount of fat after activity prevents the breakdown of muscles and can lead to better next-day performance. While protein doesn’t provide energy, it is needed to maintain muscles. Focus on incorporating foods with high-quality protein, such as fish, poultry, nuts, beans, eggs and milk.
Practicing proper hydration is equally important in reaching your optimal level of success. Athletes, especially those participating in high-intensity sports, should drink fluids early and often. An easy way to ensure you’re properly hydrated is focusing on the color of your urine. A pale yellow means you’re getting enough fluids, while a bright yellow or dark color means you need to drink more. We encourage athletes to:
Drink 17 to 20 ounces of water two to three hours prior practice.
Drink 7 to 10 ounces every 10 to 20 minutes during activity.
Drink 7 to 10 ounces of water after practice for every two pounds of body weight lost.
Drinking the right liquids is also a key factor in an athlete’s diet. Milk is preferred by many athletes as it provides a good balance of protein and carbohydrates. Sports drinks are great for replenishing electrolytes, which are lost when you sweat. If you’re losing a lot of fluid as you sweat, it’s a good idea to dilute sports drinks with equal amounts of water to ensure you’re getting the right balance of fluid and electrolytes. If possible, drink chilled fluids, which are more easily absorbed than room-temperature liquids and can help to cool your body.
Finally, avoid extreme diets as they increase the risk of micro-nutrient deficiencies. Vitamin and mineral supplements aren’t necessary if your diet includes a variety of nutrient-dense foods. Often, these supplements require supervision and monitoring for safety and effectiveness.
By: Colleen Boucher, P.T., DPT, center manager from NovaCare Rehabilitation’s Sicklerville, NJ center. Colleen has been a part of the NovaCare team since 2001 and enjoys treating all types of patients. She has a strong interest in vestibular rehabilitation and concussion management.