FAQ
FAQ

Questions about FYZICAL Franklin and Its Staff

Is Fyzical Franklin connected with any particular hospital or physician?

No. Fyzical Therapy and Balance Centers of Franklin is a private physical therapy clinic with no outside investors. Although we accept referrals from a variety of medical doctors and other healthcare facilities, none of them profit from their referral of patients to us. There is no conflict of interest.

What do all those initials mean… DPT, MPT, ECS?

DPT indicates that your physical therapist has a Doctorate Degree in Physical Therapy. This is the highest level of education in the field of Physical Therapy. MPT indicates that your therapist has a Masters Degree in Physical Therapy. Additionally, some therapists have additional certifications or credentials. Our director, Dr. Matt Hornsby, is one of 8 Physical Therapists in North Carolina to have earned National Board Certification in Clinical Electrophysiology (ECS).

What type of physical therapy do you provide at FYZICAL Franklin?

We specialize in Vestibular Rehabilitation, Balance training, Outpatient Orthopedic Physical Therapy and Electrodiagnostic Testing (EMG/NCV). This includes physical therapy for pre-and post-surgical orthopedic injuries, Geriatric Rehabilitation including balance training, Sports Injury Rehabilitation, and Back Rehabilitation for acute as well as chronic back conditions.

Questions about becoming/being a patient at FYZICAL Franklin

Do I need a referral from a physician to have physical therapy?
Generally, no. Under the North Carolina Practice Act, Physical Therapists have the prerogative to treat patients without a referral and most insurance companies will reimburse for physical therapy without a referral. However, a few insurance companies do require a physician referral for payment. For example, most Blue Cross and Blue Shield plans do not require a physician referral, but at present Medicare does. Our office staff will be glad to check that for you if that is a concern.

What should I wear for my appointments?
Loose fitting clothes (ex. sweats, T-shirts) and comfortable walking or athletic type shoes are generally best. Because you may be involved in a variety of activities… on the equipment, stretching on the mat tables, etc., we ask that you be modest in your choice of clothing.

How long will each appointment last?
Your first appointment is usually a little longer than subsequent ones because it includes a thorough initial examination. This is very important as it helps set the course for your program. The first appointment generally lasts 1½ to 2 hours. Subsequent appointments usually last 1 to 1 ½ hours.

How long will I have to have therapy?
This varies from individual to individual. You will receive a thorough examination at your first appointment and an individualized program will be set up to specifically address your particular needs. At that point, your therapist will be able to discuss treatment goals and the expected duration of your program.

Will you be in contact with my physician about my progress?
Yes. Your referring physician will be kept informed of your progress. Please let us know ahead of time when you have follow-up appointments with your physician so we can prepare a written or dictated progress report for each return visit.

I am from out-of-state and my physician there has referred me for Physical Therapy. Will you see me?
Yes… As long as the referral is from a medical doctor(physician) and we can verify that he/she is requesting us to Evaluate and Treat as Appropriate (we do not accept “prescriptions” for care).

What about bad weather?
In case of dangerous weather… snow, ice… please listen to the local radio stations for a closing/delayed opening notice or call the office before you come in.

For your safety, and the safety of our staff, we usually do not open when severe weather makes driving conditions hazardous. When in doubt, call.

Where do I park?
We have ample parking in our upper and lower paved lots. During extremely busy times, we ask that those patients who are physically able, consider using the lower lot if possible. That will leave the closer spots available for patients who have greater difficulty… ex. those recovering from hip, ankle, leg injuries; the elderly, etc. Should you ever arrive, needing a close-to-the-door spot and all the upper level spots are full, please feel free to come inside and let the office staff know that you need assistance. We will be glad to have someone come and park your car for you.

Can my family/friend/spouse/children come back and be with me during my therapy?
For safety, confidentiality, efficiency, and liability purposes, we must ask that family members remain in the waiting area and refrain from entering patient treatment areas of the clinic, unless requested to do so for educational purposes.
Also, as our primary attention must be directed towards serving our patients, unless your children are able to sit quietly in the waiting area unsupervised, we must ask that you make other arrangements for them.

What if I can’t make it to an appointment?
Please call and let us know if you cannot make one of your appointments. Please be aware, however, that we do require that patients maintain consistent attendance. More than 3 absences, for whatever reason, may result in your being discharged from our clinic. We cannot help you get well unless you’re here; and we must reserve time slots for patients who are committed to participating actively in their rehabilitation.

Financial Questions

Will you file my insurance for me?
Yes. We do this as a courtesy, at no charge to you. If Medicare is your primary insurance, we will also file your secondary insurance for you, if you have one.

Does Medicare pay for Physical Therapy? Are there any limits?
Yes. Medicare will pay but has a yearly limit for physical therapy treatments. However, a patient may qualify for an exemption from that limit if it is documented that their condition requires continued care. In our experience, Medicare has been generous in extending care for beneficiaries when needed. Your physical therapist will decide if you qualify for extended care.

How can I know if my Insurance will pay for Physical Therapy and if there are any limits?
As a courtesy to you, our office staff will call your insurance carrier prior to your initial examination to verify your benefits. At that time, any limitations will be documented and our office staff will assist you in monitoring them.

Also, if you have any questions as to whether or not we are in your particular Provider Network, just call. Currently we are a Participating Provider for (have a contract with) Blue Cross and Blue Shield NC, Tricare, Crescent, Medcost, Medicare, and Medicaid (under 21 yrs. old).

Do I have to pay my bill at each visit?
As a courtesy to you, our office staff will call your insurance carrier prior to your initial examination to verify your benefits. Your copay, or portion of the charges are due at the time services are rendered. We accept cash, checks, credit cards (Mastercard, Visa, & Discover), and debit cards.

If you are involved in a litigation case such as a lawsuit or automobile accident in which case payment is not expected until sometime in the future, we do require at least partial payments at each visit.

Ask A Physical Therapist

Physical Therapy As A Career:

Q: I am considering a career in Physical Therapy. Generally speaking, what are the requirements and where are schools located?

Because of the growth in specialization in the field, virtually all Physical Therapy programs are now either 2 or 3 year Masters degree programs, which require 4 years of undergraduate work prior to application. Typically people first receive their undergraduate degree in a related field (for example, Biology,) then make application to a Physical Therapy Masters Program. North Carolina is fortunate to have a number of good programs.... Duke, UNC, East Carolina and close to home at Western Carolina University. Competition is usually tough, with many applicants for a limited number of positions. Generally, students who are accepted have a combination of excellent grades/admission test scores and solid work or volunteer experience in the field. Best of luck, it's a great field to be in.

Osteoporosis / Osteoarthritis:

Q: Are Elliptical Trainers appropriate for those of us who suffer with osteoarthritis of the hip? I wonder about the repetitive motion and the fact that, unlike a treadmill or an old fashioned walk, the feet stay planted in the same position.

Exercise equipment that lessens joint impact stress, like the stair climber, exercise bike and elliptical trainer, should be a better choice for your osteoarthritic hip than activities that cause high impact stress (running, jump rope, etc.). The elliptical trainer should produce less impact stress to your hip than even exercise walking, motion, done repetitively, of an OA joint is not in itself harmful and can actually be beneficial. Moderate to high impact repetitive motion of a weight bearing joint with OA can further compromise the joint.

Without knowing the severity of your help OA, alternating walking with the elliptical trainer 5 days per week may provide just the right mix of impact (weight bearing) activities. I recommend that you talk with your local physical therapist, one that specializes in orthopedic rehabilitation, about a hip rehabilitation program specific to your needs.

Q: Are Elliptical Trainers appropriate for those of us who suffer with osteoarthritis of the hip? I wonder about the repetitive motion and the fact that, unlike a treadmill or an old fashioned walk, the feet stay planted in the same position.

Exercise equipment that lessens joint impact stress, like the stair climber, exercise bike and elliptical trainer, should be a better choice for your osteoarthritic hip than activities that cause high impact stress (running, jump rope, etc.). The elliptical trainer should produce less impact stress to your hip than even exercise walking, motion, done repetitively, of an OA joint is not in itself harmful and can actually be beneficial. Moderate to high impact repetitive motion of a weight bearing joint with OA can further compromise the joint.

Without knowing the severity of your help OA, alternating walking with the elliptical trainer 5 days per week may provide just the right mix of impact (weight bearing) activities. I recommend that you talk with your local physical therapist, one that specializes in orthopedic rehabilitation, about a hip rehabilitation program specific to your needs.

Q: Why is physical activity important for women with osteoporosis?

Exercise and physical activity help to fortify women against fracture and injury. By increasing muscular support of weakened bones and keeping joints and muscles flexible, exercise can help women become less vulnerable to injury. Also, exercises that increase muscular support of the bones are important because they improve flexibility and balance, helping to prevent falls and strains. Finally, regular physical exercise is crucial to prevent further bone loss. As with all new exercise programs, however, a person needs to begin slowly and get assistance when appropriate. A physical therapist can help design a program suited to your individual needs.

Q: I have worn cartilage (arthiritis) in my hip and it has been suggested that I stop running and type up cycling or swimming instead. I hate to give up the benefits of running. What do you think?

Running is a great sport and great exercise, but it doesn't do much for arthritis, especially if you run on hard surfaces. That's why non-weight-bearing activities like cycling and swimming are often suggested. Also, walking on "soft" surfaces such as a trail or a rubberized track are often encouraged. You see, when you run, the pounding on your hip can actually accelerate your arthritis. Hopefully by switching to activities that still give you a good cardiovascular work-out, but decrease pressure on your joint, you will preserve the working life of your hip.

Q: I have worn cartilage (arthiritis) in my hip and it has been suggested that I stop running and type up cycling or swimming instead. I hate to give up the benefits of running. What do you think?

Running is a great sport and great exercise, but it doesn't do much for arthritis, especially if you run on hard surfaces. That's why non-weight-bearing activities like cycling and swimming are often suggested. Also, walking on "soft" surfaces such as a trail or a rubberized track are often encouraged. You see, when you run, the pounding on your hip can actually accelerate your arthritis. Hopefully by switching to activities that still give you a good cardiovascular work-out, but decrease pressure on your joint, you will preserve the working life of your hip.

Back Injuries:

Q: I'm over 50 with a bad back and my doctor says to give up running altogether. One of the key things that help keep me motivated in maintaining fitness is anticipation of summer and completing two or three short-distance triathlons which include a 5k run. I use an elliptical trainer throughout the year but am concerned that I can't use that exclusively to train and will eventually have to do some sort of training runs in preparation. I wonder if a couple of 30 minute slow jogs a couple of weeks before the event or maybe just one long on a week would get me ready and minimize further injury. Any suggestions about how to minimize exacerbating back problems and still complete the run?

I will answer your question in general terms as I do not know your medical history, have not examined you and do not have information regarding any diagnostic studies that were done. Given that preface, here are a few comments that may be beneficial to someone that has a back problem that enjoys running as a part of their fitness routine.

1. Find an experienced physical therapist in private practice that specializes in back injury rehabilitation, especially in the athletically active individual. Back rehabilitation should include appropriate exercises (flexibility, strength, and endurance), body mechanics training and nutritional information including weight loss to an ideal body weight (IBW).
2. Use only quality shoes that are extra-cushioned for training.
3. Train only on flat surfaces without side slope.
4. Use a treadmill for the majority of training. Treadmills have a great degree of "give" than most surfaces (i.e. road, dirt tracks, etc.). Landice and Cybex make excellent treadmills. Be prepared to pay about $2,000, but the treadmill with be worth the investment. The concept of specificity of exercises is important. In short, specificity of exercise means training by a method that is similar to the event that you will be completing in. The treadmill would meet that criterion.
5. Cross training may also be beneficial. Training runs on flat surfaces with highly cushioned shoes or better yet, on the treadmill 3 days per week alternating with the elliptical trainer or other exercises the other other days is suggested.
6. Finally, as one gets older, the lack of flexibility and back mobility seem to be the primary culprits that lead to a significant amount of back pain and thus functional limitation. Therefore, flexibility training (with special focus on hamstrings, quadriceps, heed cords, etc.) as prescribed by an experienced physical therapist specializing in back injuries should be most helpful when done pre and post-exercise/training.

Q: I have heard that it's bad to sleep on your stomach if you have back problems. Is there a "best" way to sleep?

Sleeping on your stomach is not necessarily bad. In fact, there is no one best position, but here are a few things to consider. Sleep on a mattress that is firm, but not extremely hard. Sleeping on a sagging mattress can put the back in an unbalanced stressful position and lead to problems. Move around; avoid sleeping in just one position. Finally, when getting out of bed, roll to one side and sit up sideways, using your arms to help.

Q: In your experience, what is the most common cause of back injuries or problems?

With few exceptions, most back disorders are the accumulation of months or even years of poor posture, faulty body mechanics, stressful living and working habits, loss of flexibility and a general lack of physical fitness. In fact, by middle age, almost everyone has felt some form of back pain. Further, statistics show that a person who had had a backache is ten times more likely to have another one. That's why for most people, the key for managing back problems is a treatment program that includes a healthy dose of general fitness conditioning as well as a practical, effective education program to prevent re-injury.

Q: What is the best sleeping position if you have a bad back?

It's hard to say which one sleeping position is best for any individual... your back will probably let you know which ones don't work. In fact, moving around while you sleep is probably best. Sleeping in any one position for too long (especially if you sleep more than 7-9 hours) is not good. Also it is important to avoid sagging mattresses as they can put your back in an unbalanced, stressful position. In general,

1) Look for a mattress that is firm but not hard,

2) Sleep in a bed large enough to allow freedom of movement, and change positions frequently,

3) when getting out of bed, roll to one side and sit up sideways, using your arms to help.

Q: It seems that every spring, I hear of someone hurting their back while playing golf. What is the connection?

Golf is a great sport and there is no inherent connection between it and back injuries. Like all active sports, however, a lack of proper conditioning and pre-game stretching can result in injury. Recreational golfers often don't consider golf a true sport and underestimate the importance of proper conditioning. Also, they often neglect to warm-up and stretch properly before playing. Most golfers begin with a couple of bad, full-body rotations and practice swings and then they're off. As a result, most injuries occur on holes 1 through 4 (because of a lack of proper warm-up) and on holes 15 through 18 (from fatigue.... a lack of physical conditioning). In short, a program of regular exercise between games and a good, 20-minute stretching program prior to each game can go a long way in preventing injury.

Stretching:

Q: Why is stretching so important for an exercise program?

The plain truth is that without flexibility, you are probably not achieving your full exercise potential and you are an injury waiting to happen. You see, tight muscles simply cannot go through their full range of motion. In fact, lack of flexibility is probably the biggest cause of Achilles tendonitis and is a major factor in shin splints, two injuries common to runners. When you stretch, move slowly and gradually into each position and hold for several seconds before relaxing. Repeat each stretch 6-8 times. Never bounce to force your muscles into a stretch and never stretch a muscle to the point of pain. Pain indicates that you are stretching too hard or that some injury needs attention.

Q: I have a limited amount of time to stretch and warm-up before I exercise in the morning. Is it really worth getting up extra early for?

Absolutely. When you first get up in the morning, your muscles are tight. In fact, at that time, your muscles are generally about 10% shorter than their normal resting lengths. As you move around, they stretch to their normal lengths. When you start to exercise, your muscles stretch even more, up to about 10% longer than their normal resting length.... that's a total percent change of 20%.

Basic physics tells us that muscles work more efficiently when they are longer; meaning they can exert more force with less effort. Longer muscles are also much less prone to injury. So the extra time spent warming up your muscles before a training run or race is worth the effort in improved efficiency and decreased likelihood of getting injured.

Q: I hear a lot about how athletes need to stretch their muscles before a workout. Is there any need for the average adult to have a stretching program?

Without regular stretching, the average adult's flexibility declines by roughly 5% every ten years. Eventually, this can make even everyday tasks difficult. Also, increasing stiffness can increase your susceptibility to injury and cause a variety of aches and pains. This is particularly true for senior citizens. The good news is that it is never too late to start. Regular stretching, as little as ten minutes a day, can increase flexibility and get you moving more easily and efficiently.

Running / Fitness Walking

Q: I started a running program last spring but am concerned aobut being able to keep it up during the winter. Any suggestions?

I answered a question previously about dressing appropriately for colder weather and certainly that is important. Additionally, here are some other suggestions:

1) If possible, try to exercise at midday if you can as this is the warmest part of the day.

2) If you live in a windy area, plan your running route so that you head into the wind on your way out and have it to your back when you return. This will help you avoid being over-chilled at the same time you're beginning to tire.

3) Give yourself time to acclimate to the cold. As winter goes on, your body becomes accustomed to colder temperatures and will retain heat more effectively.

4) Finally, get back inside after you finish running. Cold air surrounding a still-sweaty, non-exercising body will bring down you body temperature fast.

Q: I have recently begun doing some long-distance running, but have had problems with leg cramps toward the end of a couple of races. Any suggestions?

Since they come on late in a race, the most likely causes are fatigue and/or dehydration. A sports drink before and during a race is often recommended to counteract this. Also, a lack of adequate stretching is another possible reason for cramping. During a typical 12-16 mile run, your feet hit the ground (and your calf muscles shorten/contract) thousands of times. Consequently, stretching before and after your runs is very important. A good exercise to both stretch and strengthen your calf muscle is to stand with the ball of one foot on the edge of a step while you hold onto the railing. Alternately raise and drop the heel several times as far as it will go, then switch feet.

Q: My child does a lot of distance running and therefore burns a lot of calories. What are the general recommendations for a good performance diet for runners?

Liz Applegate, Ph.D. (Runners World) suggests that the optimal training diet should get around 60% of its calories from carbohydrates, 25% from fats, and 15% from protein. This gives plenty of carbohydrates for replenishing spent glycogen stores, and protein for restoring hard-working muscles.

Q: Does running increase a person's chances for premature development of osteoarthritis?

Some of the factors known to affect the degeneration of cartilage in the joints are: increasing age, body build, injury, infection, obesity and metabolic disorders. Although research continues, studies have shown that running or jogging as an isolated activity, does not in itself cause osteoarthritis. For example, one study compared a group of runners who ran 25 miles per week with a group of non-runners. There was no difference in cartilage thickness, spur formation or joint stability. Because joints are designed for motion and shock absorption, running on appropriate surfaces appears to be safe. Of course, research has focused on runners with non-injured joints. Those who have had joint injuries, or have any of the other risk factors mentioned previously should consult a professional before beginning a jogging or running program.

Q: How long should a good pair of running/exercise shoes last? How can you tell when you need new ones?

It all depends on how you use your shoes and how well you take care of them. A couple of easy things you can do to increase their life is to always let them air dry rather than putting them in the clothes dryer; and to store them in a dry place, out of direct sunlight. As time passes, check your shoes periodically. Here are some things to look for that may indicate it's time for a new pair:

1) lugs or treads on the sole pattern begin wearing out.. a sole that is worn out can cause pressure spots on the foot and alter your footstrike,

2) the midsole (the area between the outsole and the shoe's "upper") feels brittle and compressed,

3) when set on a flat surface, the shoe appears to tile inward or outward. Remember, your shoes are meant to cushion and protect your foot, not just cover it. They are an important first line of defense against exercise-related injuries.

Q: Is there any "quick check" you can do in the store to make sure new athletic shoes fit correctly?

When buying sport or athletic shoes, try the "pinch test". If you can pinch some of the shoe's top material, from the area between the laces and the side, there's probably enough space between your foot and the side of the shoe. You're wise to be careful when investing in pricey athletic shoes. Poorly fitting shoes are a major source of foot problems.

Q: Now that the weather is really turning colder, do you have any suggestions for how to dress to walk/job in these times of variable weather?

In colder weather, it is important to layer your clothing. Here's a good tip for deciding how much to put on: If you're warm as you head out the door, you're probably overdressed. You should feel a little chilly at first but fairly comfortable after 2-5 minutes of exercise.

Also, when layering, the fabrics closest to your skin should draw sweat away from your body, so choose polypropylene or acrylic blends. On very cold days, don't forget a hat — you lose a lot of body heat through your head if you don't — and keep your hands, feet and face protected.

Q: My wife recently started a walking program and has progressed to a fairly long course. Aside from watching for cars, what are some good safety suggestions?

Walking is excellent exercise and your wife is to be congratulated. Here are a few tips to keep in mind when it comes to safety:

1) Tell someone when you will be out walking and when you expect to return. Carry some identification and a quarter for a phone call.

2) Don't expect drivers to watch out for you. When crossing an intersection, establish eye contact with drivers before proceeding.

3) Dress correctly. If it's dark, wear white or, better yet, reflective clothing.

4) Don't wear headphones. They tune you out from your surroundings and make you vulnerable to all sorts of hazards — cars, bikes, dogs, etc.

5) Be careful of walking in remote areas alone. (Hmmm.. If you take up walking too, then your wife won't have to worry about that last one. Just a thought.)

Q: What kinds of surfaces are the best for running or walking?

The best surfaces are firm but not too hard and relatively flat and smooth. Generally roads make fine running surfaces (traffic allowing) but keep in mind that they are generally sloped so that water will run off the center of the road. When running against traffic, this slant can cause your right foot to pronate (roll inward) and your left foot to supinate (roll outward) so choose the flattest route possible. Sidewalks are not the best because the concrete is significantly harder than asphalt and they are not continuous- you have to jump on and off at corners. Also, many are cracked and uneven. Running tracks are often a good option if you use the outside lanes and change direction often to compensate for the persistent curved path.

Q: I started a walking program last fall, but these bouts of cold weather are taking away my enthusiasm. Any suggestions for staying true to my commitment while I wait for spring?

Of course, if you can afford them, treadmills are nice in winter, but even without one, you don't necessarily have to give up your walking, just consider some modifications. Dress in layers so that you can stay comfortable as you get warmed up. Ear muffs or a hat and gloves are helpful too. Remember to wear bright colors if you will be caught by the earlier nightfall. If your regular walking shoes are chilling your toes, consider some of the new, light-weight hikers. Cut higher, they keep out the slush while providing more warmth, comfort and traction. Also, remember to keep a sharp eye out for slippery or icy spots. You may have to slow down a little from your usual pace. Some days you may have to skip entirely when conditions are too bad, but don't get discouraged. When spring finally does come around again, you'll be way ahead of the fair-weather walkers.

For The Weekend Athlete:

Q: Which is better for minor muscle aches and injuries, ice packs or those sports creams you can buy over-the-counter?

The heating effect caused by most sports balms is usually caused by menthol compounds. Menthol increases blood flow to the skin but it does not penetrate any deeper and thus does not actually help in healing muscles. Ice, on the other hand, is the best agent available to reduce swelling after an injury, and swelling often can cause more harm than the initial injury itself. So while it may not feel as good to apply, ice is the best choice for minor muscle aches and strains.

Q: Is it helpful to eat during a long bicycle ride?

Yes. Consuming carbohydrates before and during a ride of 1.5 hours or more helps a cyclist finish stronger and recover quicker. Carbohydrates are the food most readily broken down into glycogen, the primary fuel for muscles. For very long rides, or for riders who seldom stop to eat, liquid carbohydrate drinks may be better because they provide a rapid burst of energy. The complex carbohydrates found in granola bars, bananas, and other fruits release energy more gradually and are best eaten off the bike, during rest stops. As Fred Brouns, an exercise physiologist with the Tour de France, points out, "Good cyclists are also good eaters."

Q: In general, how many days a week should a person exercise? To be serious about it, do I have to workout 7 days a week?

Most of the current literature suggests exercising a minimum of 3 days per week, with 4-5 days a week being preferred. Remember, E is for exercise, not exhaustion. For most people, 7 days a week is just too much, because it doesn't allow the body time to heal and refuel. Pushing too hard can leave you feeling chronically fatigued, as well as put you at risk for injury. Remember, the best fitness program is one that you can stick with.

Q: With my job and family responsibilities, I don't have big chunks of time to use for exercise. Is it worth it to run/exercise for just short amounts of time?

Yes, especially if you can grab a couple of exercise times a day. You can't go wrong, no matter how little time you have to exercise. You can boost your overall fitness with only 10 or 20 minutes of running a day.... lowering your heart rate, increasing your breathing capacity and increasing your endurance. For example, for a quick 10 minute run, start by jogging easily for a minute, then steadily increase your speed until you are doing your maximum by eight minutes. Then ease off for the last minute, ending with walking. Give it a try.

Q: Why does exercise always seem to be recommended in programs to prevent heart disease? Isn't watching your diet enough?

Researchers at the US Centers for Disease Control have recently stated that physical inactivity is the one single factor that puts the greatest number of Americans at risk for developing heart disease. In fact, a sedentary person is almost twice as likely to develop Coronary Heart Disease (CHD) as an active one. The evidence indicates that encouraging programs that increase the levels of physical activity in the population at large may be the most effective way of lowering the overall incidence of heart disease in this country.

Q: Is it better to drink fluids before or after a workout in the summer time?

The answer is "all of the above".... be sure to drink before, during and after exercise. Exercising in the heat can cause dehydration, which may lead to fainting, heat exhaustion or even heat stroke. In fact, it is best to drink more than just what you need to satisfy your thirst, especially if you are older. Older bodies don't always reliably signal the body's true need for fluids. So drink up!

Specific Injuries:

Q: My husband, a 52 year old male, had an MRI done. It has come back as saying "he a complete full thickness tear of the suprasinatus and subscapularis tendon and medial dislocation of the long head of the bicepts tendon. Can you please explain to me what exactly this means and how serious is it? They also say that he has to have surgery. How long does this usually take to heal?

The "rotator cuff" is a group of four muscles vital for function of the shoulder joint. The superspinatus and subscapularis muscles are two of the four muscles. A tear can be caused primarily from trauma (falling on the shoulder, etc.) or can be degenerative (wear and tear). Medial dislocation of the long biceps tendon is common in degenerative rotator cuff tears with disruption of the subscapularis tendon. Full thickness means complete tear through the entire tendon.
Considering the age of your husband, sugery is typical to reduce pain and preserve function. However, surgery is not required, especially in the very elderly, but long term pain and functional limitations can result from not having the procedure done. Rehabilitation is vital after surgery. Typically rehabilitation will start 3-5 days after surgery and last for about 10-12 weeks.

Q: I have suffered for two years with this pain in my neck and shoulder (fibromyalgia) and been to every kind of doctor and still no results. Help.

Fibromyalgia can be treated successfully but requires focused, determined, patient participation. Fibromyalgia is often associated with emotional anxiety or depressive states. Periods of inactivity and depressive emotions appear most common in patients I've treated with fibromyalgia. A person with a diagnosis of fibromyalgia must exercise appropriately on a daily basis and often receive psychological counseling to assist in resolving the emotional difficulties. Exercise may initially seem to make you worse, but with perseverance, in 6 to 8 weeks, exercise should become quite tolerable and is ultimately the key to managing fibromyalgia.

Therefore, fibromyalgia appears best treated by a multifaceted approach with exercise, counseling, and especially in acute phases, possibly pain management.

Q: What rehabilitative techniques are necessary for torn rotator cuffs? When is surgery necessary and when is it avoidable?

Typically, in degenerative rotator cuff tears, shoulder range of motion is abnormal and muscles are weak. A muscle strength imbalance often exists. Additionally, there are postural concerns that need to be addressed. Therefore, normalization of range of motion and strength are necessary as well as improvement of posture. Above-the-head and heavy lifting activities are to be avoided.

Treating rotator cuff injuries is not simplistic. There are chapters in books and whole books themselves written on rotator cuff injuries for both post surgical and nonsurgical rehabilitation techniques. Based on my experience of 15 years and my supervision of probably 2000-3000 rotator cuff injuries, success in non-surgical rehabilitation is 60-80%. Of course, age, severity of rotator cuff tear, current physical status, etc. are all factors that affect overall outcomes. Typically, patients choose surgery based primarily on pain. Secondarily, surgery is chosen due to loss of function. Elderly patients more often choose not to pursue surgery as compared to younger, athletic populations. I certainly recommend conversing with your orthopedic doctor about surgical and nonsurgical alternatives.

Q: What are possible injuries to the rotator cuff?

Rotator cuff injuries are typically either traumatic or degenerative. Acute traumatic injuries may include falls, throwing, automobile accidents, etc., and comprise only 5-8% of all rotator cuff problems. Degenerative rotator cuff problems comprise >90% of all cases. Degenerative problems are common in the elderly population. Above-the-head work, and repetitive heavy lifting can lead to degeneration of the shoulder joint. Typical progression of the degeneration includes tendinitis, bursitis, impingement, and then ultimately a tear. Of the four muscles that are part of the rotator cuff, >90% of all degenerative injuries involve the suprasinatus muscle tendon. Tears can range from minimal partial tears to full-thickness or complete tears.

Q: What is Achilles Tendonitis?

Basically, this is an inflammation of the Achilles tendon (the large tendon connecting the two major calf muscles- the gastrocnemius and the soleus- to the back of the heel bone). Under too much stress, the tendon tightens and is forced to work too hard. It becomes inflamed (tendonitis) and over time, can produce a covering of scar tissue. If it continues to be stressed, it can tear or rupture. Excessive hill running or speedwork, both of which stress the Achilles tendon, can cause this to develop. The best prevention plan includes a good stretching program and wearing good shoes when you exercise.

Q: On injuries such as sprains, when should you use heat and when should you use ice?

That's a common question, but an important one.... certainly worth answering again. Never use heat on a new injury — it keeps the broken blood vessels open, causing more bleeding and swelling. Instead, use ice for the first 48 hours, applying it for 20-30 minutes, several times a day. This will slow the bleeding and swelling. Then, after the broken blood vessels have started to heal, you can apply heat to bring healing nutrients to the area.

Q: What are shin splints?

Shin splints is a term that is used to describe pain in the lower leg that occurs during exercise, often on the inside border of the (tibia) shin bone. It has many causes and can affect athletes at all fitness levels. >Beginning runners can develop the problem as they are not accustomed to the activity, and seasoned athletes can develop it if they change running surfaces or shoes. As such, treatment must be individualized, but an important component of rehab for most all cases is a good stretching program, before and after exercising. Also a program of exercises to progressively strengthen the muscles is usually recommended.

Ergonomics, Job Site Related:

Q: I have to stand for long periods in my job. Do you have any suggestions to help keep my back from getting tired and sore?

Sure. Here are a few things to try. Put one foot up (like on a ledge or step) and change positions often when standing for long periods of time. Use a cushioned mat if possible. Don't stand with your knees locked and avoid high-heeled, hard heeled or platform shoes. Try to position your work so that you avoid bending at the waist or neck for long periods. Many back disorders are the accumulation of months or even years of poor posture, faulty body mechanics, and stressful living and working habits. That's why for most people, the key to preventing back problems is a program that includes a healthy dose of general fitness conditioning as well as a practical, effective education program.

Q: I spend most of my day sitting at a desk. Often my neck and back are sore at the end of the day. Any suggestions?

Proper sitting posture is one of the best things you can do to prevent back and neck problems. Use a chair that supports your back in a slightly arched position; place a small pillow at your lower back if necessary. Be sure your chair is low enough so that you can place both of your feet on the floor, but no lower. Sit close to your work. Avoid leaning forward and downward for long periods of time; instead try elevating or moving your work surface around to avoid this. Finally, try to incorporate short, mini-breaks so that you avoid sitting for long periods of time without getting up.

Q: I spend a lot of time working at my desk, many hours using a computer. Which would be more beneficial, a couple of long breaks during the day or several shorter ones?

Research has shown that workers who take "micro-breaks" (taking 3-5 minutes each hour) can help prevent injury and actually raise productivity over workers who follow a more traditional schedule. Taking numerous short breaks lets your body recover from work easier than one long break. It only takes a few minutes to go through a quick stretching and exercising program that can improve your flexibility and circulation, and take stress off your lower back. Exercises don't have to be elaborate. For computer users, suggested exercises usually include shoulder shrugs, hand and wrist stretches and neck range-of-motion exercises. Of course, the best program is one tailored for your specific activities.

Q: I have been hearing about repetitive trauma and cumulative trauma at work. What exactly do these terms mean?

First you should know that Repetitive Trauma, Cumulative Trauma, and Over-Use Injuries are all one and the same condition. Basically there are two types of "Repetitive Trauma" injuries. The first type is an injury to the nerve, the best known being Carpal Tunnel Syndrome. The second is an injury to the muscles and/or tendons, the most common being

It has been shown that the tendency for this type of injury is directly related to posture, amount of force required to perform the task, and the amount of repetition involved. Preventing these injuries involves looking at one's activities and minimizing these contributing factors.

Q: My wife and I are putting on an addition to our home and want to plan it carefully. What is the best height for a work surface such as a counter?

The right work height depends on the task you are doing. For most regular work around the home, you should try to position your hands at about elbow height. For precision, your hands should be 4-6 inches above elbow height. For heavier or more forceful work, or work which requires downward pressure, your hands should be 4-6 inches below elbow height.

This is an important, but often overlooked aspect of design. The correct work height will make your task easier and lessen your risk of injury.

Submit A Question

If you would like to submit a question to our Q and A page, just click here. While specific questions regarding individual conditions/diagnoses cannot be addressed, questions of a general nature on topics such as strains, sprains, exercise, fitness, ergonomics, training, back safety, repetitive trauma, osteoporosis and other geriatric issues, injury prevention, and other general physical therapy topics are welcomed.

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Leader in the health and wellness space, providing private practices with business systems, operational support, clinical education, and proprietary technology and protocols. FYZICAL® is actively changing the healthcare landscape by providing patients with wellness programs and clinical care in: Fall Prevention, Orthopedic and Vestibular Rehabilitation

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