Pickleball has been reported as one of the fastest-growing sports among the adult population in recent years. Whether its popularity stems from the exercise it offers, its resemblance to tennis, or the camaraderie it fosters during matches, many enthusiasts find it addictive. As expected, with the game’s increasing popularity, there has been a rise in the number of injuries associated with pickleball.

Lower extremity injuries, such as muscle strains, ligament sprains, and fractures, were among the top reported injuries leading to emergency room visits.¹ Slips, trips, and falls are identified as the primary causes of these injuries. While we don’t intend for this information to discourage you from enjoying this endearing game, we strongly recommend taking an active approach to injury prevention by following our three suggestions.

Firstly, prioritize enhancing your balance. Incorporate activities like balancing on one foot for 30 seconds into your daily routine, such as during tooth brushing, dishwashing, or commercial breaks. Once you’ve mastered this, challenge yourself by passing a small, weighted object (only 2-5 pounds) between your hands in various positions. Increase the difficulty by performing these exercises on an unstable surface like a carpet, yoga mat, or pillow. The objective is to refine your balance and minimize the risk of injury, so ensure you’re close to a wall or sturdy object for support if needed.

Secondly, engage in cross-training. This entails exercising in ways beyond just playing pickleball to prevent muscle imbalances. Incorporate fundamental exercises such as squats, lunges, and core strengthening exercises into your routine. Strengthening your legs and core can offer better support for the dynamic movements in pickleball, reducing the risk of lower extremity injuries. Additionally, include flexibility exercises, such as pre- and post-play stretching, to enhance joint mobility and decrease the likelihood of strains or sprains.

Third, focus on proper footwear. Many slips, trips, and falls in pickleball can be attributed to inadequate footwear. Ensure that you wear supportive, non-slip shoes with good traction on the court. Make sure your shoes fit well and provide stability for lateral movements, as pickleball involves quick side-to-side actions that can strain your ankles and feet.

It’s important to listen to your body and not push yourself too hard, especially if you’re new to the sport or returning after a break. Start with a proper warm-up, including light cardiovascular activity and dynamic stretching, to prepare your muscles for the demands of the game.

If you experience any discomfort or pain, don’t ignore it. Addressing minor issues early on can prevent them from becoming more serious injuries. Consider consulting with us at Rye Physical Therapy for personalized advice and exercises tailored to your specific needs!

References:

1. Casals M, Jimenez S, Caparros T, Martínez-Gallego R, Baiget E. Scoping review and quality of studies on the epidemiology of pickleball injuries. Apunts Sports Medicine. 2023;58(217):100403. doi:10.1016/j.apunsm.2023.100403

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We are very excited to announce the opening of Rye Physical Therapy! For years, many of our Hampton Physcial Therapy Rye patients have asked us to bring our services closer to make their rehab care more convenient. So, when we saw the opportunity to open at this fabuous location, we knew it would be ideal!  We finally pulled the trigger and opened our doors on November 1^st at Airfield Place, 6 Airfield Dr Rye, NH – off Rt 1 (formally the Rye Airfield Skate Park). This beautiful facility has been completely renovated to include many Health oriented businesses.

Rye Physical Therapy will be run and operated by Hampton PT’s very own Shane Johnston. Shane and Kate Serodio are co-owners in this new venture.  Shane has been treating and healing patients for over 4 years at Hampton PT and is very excited for this amazing opportunity.  Shane will continue to provide the same great services we have here at Hampton PT such as Manual therapy, Dry Needling, Graston Technique®, Spinal Manipulations, Vestibular Rehab, post operative rehab, balance and fall prevention training and much more.

The family of businesses at AIRFIELD PLACE include; FlightHouse Gym – a full-service gym (formally MaxEdge Fitness), New England Pickleball, Rinse Recovery Spa, Flow House, The Hanger, as well as Engrain Café.  Within these businesses you will have access to Pickleball; Group Fitness classes, Pilates, yoga; an open Gym, Childcare services; and The Hangar is a coworking space.  Rinse Recovery will give you access to the most recent recovery technology available!  They will have a contrast room featuring a large traditional sauna, 3 infrared, and two Morozko Forge Cold Plunges to maximize the benefits of heat therapy, cold therapy, and contrast therapy.  This space will also have other recovery tools such Red Light therapy panels, Therabody Massagers, PEMF mats, etc.

We could not imagine a better location for Rye PT!

Stop by or give us call to schedule your Free Discovery Visit!

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Do you have pain in your shoulder and have no idea what could be causing it? Shoulder pain is actually one of the most common reasons people seek out physical therapy. Often times, the rotator cuff is the culprit. The rotator cuff is a group of four muscles: the infraspinatus, supraspinatus, subscapularis and teres minor. Together, these muscles provide stability for the shoulder joint as well as perform rotation of the shoulder. It is a very important muscle group that often wears down over time. The older we get, the more at risk we are for a rotator cuff tear whether it’s from overuse or a traumatic injury.

If you are diagnosed with a rotator cuff tear, physical therapy is typically the first line of treatment to work on improving the strength and stability of the shoulder complex. Often times, physical therapy is enough to regain normal function and allow for painless shoulder function. However, depending on the thickness of the tear and number of tendons involved, surgery may be needed. Maybe you’ve gotten to the point where you’ve tried PT and the next step is surgery. You’ve heard dozens of horror stories and are wondering what to expect… keep reading!

The surgical procedure to repair the rotator cuff is typically an arthroscopic surgery with very small incisions. The surgeon will insert an arthroscope, a small camera, which displays the picture onto a television screen and guides the surgeon through the repair. This is typically done as an outpatient procedure and is the least invasive surgical option. The complexity of the repair process will depend on whether the tear is a partial or full tear. If it is a partial tear, the area will be trimmed or smoothed, known as debridement. If it is a full thickness tear, the tendon will need to be reattached to the humeral head. The surgical incisions will be closed with stitches which will usually be removed around week two post-operative at your first follow up visit.

So you’ve gotten through the actual surgery, now what? You will typically be fitted to a sling and will go to your first physical therapy appointment two days post-operative. The sling is usually worn 24/7 for 4-6 weeks and provides protection for your arm while the tendons heal. During your first physical therapy visit, your therapist will remove the surgical dressing and evaluate the passive range of motion of your shoulder joint. Passive range of motion means your therapist will be moving your arm so your tendons and muscles are not contracting, potentially damaging the tendon repair. Each surgeon and protocol varies to some degree but the first few weeks of therapy will consist of your therapist stretching your shoulder passively.  The first few weeks of stretching are essential to restore the range of motion of your shoulder. One complication that can occur following surgery is adhesive capsulitis also known as frozen shoulder. This happens when the joint capsule “freezes” and tightens up, usually a result of your shoulder being immobilized in the sling all day. With adhesive capsulitis, restoring full range of motion can be very painful and take much longer. You might feel like you’re not doing much those first few weeks of therapy but being consistent with attendance and allowing your therapist to stretch the joint is essential to ensure full range of motion after surgery.

After the first few weeks of passive stretching, typically around week six, you can begin active range of motion and lifting weight equivalent to a coffee cup. Active range of motion means you are contracting your muscles to move your arm. You are no longer relying on your therapist to perform the motion. Your therapist will guide you through some gentle initial exercises and then begin to add in resistance for strengthening beginning around week 8-12. Together, you and your therapist will work to get you back to full strength and stability allowing your shoulder to withstand daily activities, work duties or athletics. The full rehab process can take 4-6 months or even longer so be patient with the process! Please don’t hesitate to reach out to us for any further questions or concerns regarding a rotator cuff repair.

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A great way to cool off and get some exercise this summer is to jump in a pool or lake. Swimming is a well-rounded workout with many great benefits including improving endurance, burning calories, and is a low impact workout which reduces stress and strain on our joints.  However, the shoulder is the joint that tends to take most of the load due to the repetitive overhead motion swimming requires, which can cause irritation and inflammation of the rotator cuff muscles causing the tissue to rub against bone. This is known as Shoulder Impingement.  This results in pain which can be experienced not only with activity but also at rest which may be confused with soreness.

Here are some symptoms to look out for:

• Shoulder stiffness
• Shoulder tenderness
• Weakness
• Decreased range of motion
• Pain when reaching above head
• Decreased activity tolerance

Stretching can be an effective tool to reduce the risk of injury and can be performed after your workout to ensure good mobility and recovery of the muscles used during swimming. The following stretches will focus on the lat muscles and pec muscles ,as well as improving mid back mobility to decrease excessive force on the shoulder and allow for proper alignment of the shoulder joint.

Here are a few stretches that you can try:

Doorway pec stretch

Stand in a doorway with one foot in front of the other. Place both arms on either side of the doorframe, with shoulders at 90 degrees.  Keep your chest up and lean forward until comfortable stretch is felt along the front of your chest. Hold for 20 seconds and perform 3 times.

Child’s pose

Begin on your hands and knees, slowly lower your buttocks towards your feet. And your chest toward the floor as you reach out to one the side. Hold 20 seconds and perform 3 times.  Repeat reaching out to the other side.

Thread the Needle

Begin on your hands and knees. Slide one arm along the floor and lower your shoulder towards the ground until you feel a comfortable stretch along your mid back.  Next bring that same arm back to center and reach up towards the ceiling looking at your hand.  Perform 10 reps. Repeat on other side.

Kneeling Thoracic Extension Stretch

Begin in a kneeling position in front of a table, bench or bed and place your elbows shoulder width apart onto the surface you are using. Begin to kneel back towards your heels until comfortable stretch is felt along your mid back. Hold 15 seconds and perform 4 times. You can hold onto a pole or stick if you are having difficulty maintaining the proper position.

If you are experiencing pain and/or are limited in tolerance to swimming, Contact Rye Physical Therapy and schedule an evaluation to see one of our physical therapists. We can help get you back in the pool!                                                                                                                              (top photo by freepik)

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BY Dylan Chisholm, PT, DPT, cert. DN, cert. VRS

Many people will attain medical professionals, including physical therapists, for spinal manipulations for their acute or chronic lower back, neck or mid back pain in hopes of alleviating their ongoing pain or related dysfunction. These manipulations, or “adjustments”, often produce loud, cracking noises that allow for the body’s natural receptors to reset, giving better alignment and thus assisting in reducing overall pain in the spine. However, many are unaware that physical therapists are also capable of manipulating, or “cracking”, various other joints of the body, including the hips, wrists, elbows, knees and ankles. This is known as extremity manipulations with the goal of reducing pain and allowing you to get back to doing the activities you love. The purpose of this blog is to educate you on various diagnosis and pain patterns that extremity manipulations can assist with along with various other physical therapy interventions.

One of the most common diagnoses that physical therapists see daily is osteoarthritis (OA), often in the hip, knee and ankle. Osteoarthritis is generally a degenerative process of the joint which can be very debilitating and painful for many patients. Hip OA will often clinically show as pain that can be along the front of the hip as well as into the groin. This pain is commonly seen due to extra compression into the hip that produces a “bone on bone” effect over time. The hip manipulation is a technique used to quickly decompress the joint and allow for fluids inside of the hip to better flow in and out of the joint, which provides nutrients and healing properties that can alleviate pain and make your walking tolerance better.

Knee OA can present as having increased stiffness and achiness into your knee especially with walking long distances, stairs and getting out of the car. The cartilage and menisci of your knee that provide a “cushion” for the knee bones over time will break down, causing the dreaded “bone on bone” and thus leading to increased pain and difficulty performing daily activities. Performing a quick knee manipulation can allow for the receptors of your knee to reset, which can assist in reducing pain and improve Range of Motion (ROM) and balance at the joint.

Many patients will at some point sprain their ankle, which can cause significant instability, swelling and pain at the ankle and can be a long-term problem if ankle sprains occur frequently over time. Due to progressive ankle OA, our calf muscles will also become tighter, which reduces the ability for us to pull our foot off the ground and clear the toes when we are walking, which can cause trips and falls. A manipulation of the ankle can help to reduce pain and improve the ability for the joints to move, which can help with walking and most daily activities.

Extremity manipulations are an important aspect of physical therapy treatment that is often overlooked but can be a game changer when it comes to reducing pain and improving function. This technique along with various other interventions that physical therapists perform, including soft tissue mobility, functional strengthening, dry needling, joint mobilizations and balance training can improve your quality of life and get you back to doing the things you love.

If you experience daily pain into your hips, knees and ankles and wish to get back to walking more with less pain, give Rye Physical Therapy a call and schedule with one of our highly skilled and trained physical therapists today!

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Proper posture is something most of us struggle with. For as long as I can remember, my mom used to frequently remind me to stand up straight with my shoulders back. As a kid I never understood the importance of good posture. However, maintaining good posture has a lot more benefits than just looking better! What exactly is posture? It’s our bodies alignment/positioning in relation to gravity. Gravity is constantly exerting force on our body regardless of what position we are in. Proper posture places the body in position so that no area is overstressed, decreasing susceptibility to pain and injury. It applies to standing, sitting and laying down. Good posture will place the body in a position in which our body weight is balanced throughout our spine and lower extremities, decreasing stress on muscles and ligaments.

Some of the benefits of good posture include improved breathing, decreased spine and shoulder pain and decreased headaches.

Breathing: When it comes to breathing, being in a forward slouched posture affects our lung’s ability to fully expand as the muscles in the front of the chest begin to shorten. Sitting up straight with the shoulders back can improve our bodies oxygen intake! Oxygen is very important in all cellular processes in our body and can help to improve energy and healing.

Back Pain: Back pain is another big culprit of poor posture. While maintaining good posture, our body should be in a neutral position so none of the muscles or ligaments are being overwork, shortened or excessively lengthening. The postural muscles should be in an optimal muscle position to work correctly, expending the least amount of energy. If we are constantly in a poor postural position, changes will occur to the spine and musculature overtime including changes to the blood vessels, nerves and ligaments. This will disrupt our body from performing with correct biomechanics increasing the chances of injury and spinal wear down over time.

Headaches: Most people with poor posture operate in a position in which the head sits forward. Your head is equivalent to the weight of a bowling ball so when the head is positioned forward, the muscles must work much harder to keep your head positioned on your spine! This increased stress placed on the muscles within the neck and upper back causes them to tighten. When the muscles tighten, headaches can occur.

Shoulder pain: It’s one of the most common things us PTs treat! Improving posture will decrease the risk of shoulder pain and dysfunction. Majority of people will allow their shoulders to roll forward which occurs most often in a seated position. This forward roll decreases the space within the shoulder joint. It also causes the front muscles to shorten while the back muscles will lengthen. Decreasing the space within the shoulder joint alters the shoulders normal biomechanics and can cause pinching of several soft tissue structures leading to pain and increased risk of injury.

So, what exactly does proper posture look like? When looking at yourself from the side, your body should follow your head. All your major weight bearing joints should be in line with your ear. Imagine a line going from your head to your feet. Your shoulders, hips, knees and middle of ankle should be right in line with the middle of your ear. You should also have a slight curve within your low back.

Maintaining good posture can be difficult to do and rather fatiguing. You might notice a burning sensation in your upper back after a while when you try to maintain correct posture. This is due to the fact the postural muscles are endurance muscles. Not only do they need to be strong, but they also need endurance to avoid resorting back to the rounded shoulder forward head positioning so many of us are susceptible to. In order to build endurance of the postural muscles, we should perform exercises at a lower weight with high repetition. This will allow those postural muscles to continue to contract over a longer period. Below are several exercises to get you started on improving your posture.

EXERCISES THAT HELP IMPROVE POSTURE:

Rows: While pulling back on the t-band, squeeze your shoulder blades together. Make sure you avoid your shoulders from elevating while you pull. You can perform this exercise with resistance bands or on a cable system. Remember to perform low weight and high resistance. Aim for 30 repetitions and when that becomes a piece of cake, increased the resistance or cable weight.

Prone scapular squeeze with extension: While laying on your stomach, squeeze your shoulder blades together and then elevate your arms a few inches off the table. Lower the arms followed by relaxing the shoulder blades. You can eventually add in dumbbells when you can fly through 30 reps with no fatigue.

Doorway stretch: This is a great exercise to perform to stretch out the anterior chest muscles which often become shortened. You will stand in the doorway with your shoulders and elbows up at 90 degrees. You will then step into the door until you feel a gentle stretch in the front of your chest. Hold each stretch for 30 seconds and perform 3-5 sets.

Bilateral external rotation: To perform, hold T-band in each hand with your palms facing each other and then slowly pull your hands apart. Keep your elbows at your side while you pull. Aim for 30 reps.

Physio Ball Y’s: To perform, lay across physio ball. You will then straighten out your arms and raise them up in line with your head and then lower them back down. Make sure you keep your head in a neutral position. You can add dumb bell weights to make this exercise more difficult when ready. Again, aim for 30 reps.

Give these exercises a try and if you feel you need further help or have any questions or concerns, please don’t hesitate to reach out to us here at Rye Physical Therapy!

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Dry Needling. It sounds scary and a little intimidating. You may have heard of it and are wondering what it all entails and if you would benefit from it. Dry needling (DN) is a treatment option a DN certified Physical Therapist can perform for a wide range of musculoskeletal disorders. Although it sounds similar to acupuncture, DN and acupuncture have very different training and theory behind them. While acupuncture follows certain meridians for needle placement, DN places small monofilament needles at the exact location of pain. DN can target trigger points within muscles, as well as tendons and bone, if necessary, to improve pain levels and get you back to what you love to do!

DN first came to be in the 1940s after the use of “wet” needling in which corticosteroids, analgesics or saline are injected into muscles and trigger points for pain relief. Several years later, a study was performed which showed no major differences between injecting a substance into painful areas compared to “dry” needling in which no substance is injected. Since then, numerous studies were performed supporting the use of dry needling for musculoskeletal pain. DN is a much safer treatment as it omits the use of medication for pain control.

The main goal of DN is to treat the muscle tissue by decreasing trigger points and reducing pain and inflammation. What exactly is a trigger point you ask? A trigger point is a tight band of muscle fibers that can restrict range of motion and create pain/tenderness. Trigger points cause prolonged or poor contraction of the muscle fibers. They are no longer getting proper blood supply which inhibits the muscle from receiving the oxygen and nutrients it needs to return to its normal state. Additionally, nerves surrounding the trigger point become more sensitized causing the area to feel more sore and painful. Utilizing DN to treat trigger points helps to de-activate the trigger point, releasing the taught fibers. This allows for improved blood flow and can flush out the area to reduce tension. DN needling is also very beneficial for areas of chronic inflammation such as arthritic joints and tendinitis. DN will stimulate blood flow and many cells crucial to the healing progress to start the healing cascade. DN is typically not a stand-alone treatment so it is important to work with your physical therapist to address your other impairments that may be contributing to your pain.

There are several other conditions the therapists at Rye Physical Therapy commonly treat with DN and have very good success, one being tendinopathies. Tendinopathy is the failed healing of a tendon, usually resulting in degeneration of collagen proteins. This condition presents with pain and a reduction in range of motion and flexibility. Tendinopathy typically results from overuse or sudden stress on a tendon. Several tendons susceptible to overuse include the achilles tendon, medial and lateral epicondyle tendons, rotator cuff tendons and the plantar fascia. The best type of DN to address tendinopathy associated pain is known as the pistoning technique. To perform this technique, the therapist will insert the needle and move the needle in an up and down motion, repeatedly hitting the targeted tissue. This will cause a disruption in the chronic degenerative process due to increased bleeding and production of cells necessary to promote healing. Other conditions we see major success with include headaches, rotator cuff pathologies and temporomandibular joint dysfunction. It can even be utilized to treat pain associated with osteoarthritis as certain chemical reactions occur during the needling process causing pain inhibition.

So, you’ve opted to try DN and are wondering exactly what to expect. If you are a new patient, your physical therapist will perform a detailed evaluation and identify your specific impairments. For the procedure, you will be placed in a comfortable position in which the therapist can easily access the location they will be dry needling. The area will be sterilized, and the therapist may palpate to feel for trigger points before carefully inserting the needles into the proper area. At times, the needles may be uncomfortable to insert but once in you shouldn’t continue to feel any lasting pain. Although it may sound even more intimidating, electrical stimulation will typically be hooked up to the needles. Once the electrical stimulation unit is on you will feel a comfortable pulsing sensation. The electrical stimulation is used to further promote increased blood flow and pain relief, enhancing the benefits of the needles. The whole procedure will last for about 10-30 minutes and the needles will then be removed. Immediately following, you may feel some generalized soreness to the area which typically resolves within 24 hours. It’s important to note not everyone is a candidate for DN. Those with needle phobias, metal allergies, clotting or bleeding disorders, pregnancy or lymphedema should avoid DN. DN is a great treatment option so if you would like to give it a try, please don’t hesitate to reach out to us here at Rye Physical Therapy!

Citations
Dry Needling Institute. (2018). Dry Needling for Craniofacial, Cervicothoracic and Upper Extremity Conditions. Montgomery, AL: Dr James Dunning.https://www.footdoctorscolorado.com/library/dry-needling-targeting-your-trigger-points.cfm

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A breakdown of a potential injury that can occur in your elbow that can easily become debilitating if not addressed early.

By Michael Brezak, PT, DPT

Winter may be finally coming to an end with the appearance of grass and increase in wet puddles in the road and yard. At least we all hope so, but this being New England how can anyone truly tell what the weather will do in an instant. One minute it is snowing in the morning, then sunny with clearing skies and warming sun. Yet as the snow starts to melt, we all experience the change of seasons. I personally call this mud season up here, but spring would also suffice. And with spring comes the term we have all come to love and hate, spring cleaning. Whether it is yard work or cleaning out items in the house/condo/apartment what have you, that tends to mean a lot of carrying, raking, or picking up heavy items to dispose of. This can bring on a whole mess of problems, but today I am going to delve into pain along the inner aspect of your elbow and help you better understand the cause, symptoms, and management of a debilitating injury that is oftentimes ignored.

Pain is something that at one point in our lives we have all experienced in one form or another. Oftentimes it is in or joints whether it is the knee, hip, or shoulder, but the elbow is also a joint that can be injured just as well. Excessive overloading usually with carrying based activities or repetitive use at our wrist with twisting/grasping motions can have an effect at the elbow. Largely this type of action can cause lateral epicondylitis or tennis elbow, but there is also medial epicondylitis or golfer’s elbow (golfer’s pay attention now). These two conditions are the result of overloading the tendons at the elbow of the muscles in the forearm through the aforementioned methods. A simple test is to place 1-2 fingers just below the joint line and ‘pluck’ or ‘strum’ your fingers back and forth across the tendon. If pain or discomfort ensues, well then you could be experiencing some joint tendonitis. Typically, this is reported as no pain or a dull ache throughout the day until on use it becomes a sharp/stabbing often causing a release while holding or carrying items.

“Typical symptoms are pain along the origin of the common flexor tendon with repetitive wrist flexion, pronation, and valgus stress. Patients may complain of night pain and pain at rest.” Christina Brady, MD and Anil Dutta, MD

So then what does treatment look like for someone who is experiencing this condition? Medical management is fairly straightforward upon completion of a medical history including a description of events or factors that tend to flare up or calm down the symptoms. Therapists at Rye Physical Therapy use techniques and manual therapy applications that are evidence based to achieve optimal results in the shortest amount of time. The therapists upon completion of a medical history will determine the best course of action for you whether it includes the newest ultrasound guided dry needling, instrument assisted soft tissue, or neural mobilization to facilitate tendon healing and decrease the inflammatory response. Ultimately with the mindset and goal to return you to your prior level of function. Still unsure? Rye Physical Therapy offers Free Discovery Visits in which a therapist will go over your symptoms and determine with you if physical therapy can be beneficial.

References:
Dutta, C. B. and A. (n.d.). Medial epicondylitis and medial elbow pain syndrome: Current treatment strategies. ClinMed International Library. Retrieved February 25, 2022, from https://clinmedjournals.org/articles/jmdt/journal-of-musculoskeletal-disorders-and-treatmentjmdt-2-014.php?jid=jmdt

Javed, M., Mustafa, S., Boyle, S., & Scott, F. (2015, November). Elbow pain: A guide to assessment and management in Primary Care. The British journal of general practice : the journal of the Royal College of General Practitioners. Retrieved February 25, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617264/

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By NICOLE CARVILLE, DPT – Rye Physical Therapy South

Spinal stenosis is an extremely common diagnosis that I see patients with daily as a Physical Therapist. Some patients present with x-ray or MRI findings diagnosing “lumbar spinal stenosis” at a certain spinal level. Other patients schedule a direct access appointment – if their insurance does not require a referral – and I am able to evaluate if they present with signs and symptoms consistent with spinal stenosis.

So, what is spinal stenosis?

By definition, it is caused by a narrowing of space around the spinal cord and is part of the natural aging process. It is often caused by degenerative osteoarthritis of the spine and is most frequently found at L4-L5, L5-S1 and L3-L4. It can be graded as mild, moderate or severe depending on the degree of narrowing. Other risk factors for stenosis include family history and genetics. It is most commonly reported by individuals over the age of 60 years old. However, it is important to remember that an image of your spine that shows stenosis does not mean that you will have pain from stenosis. Many patients have this diagnosis and have no pain for years, and others come to physical therapy with pain and we work hard to decrease and eliminate pain as much as possible.

What can spinal stenosis feel like?

The severity of symptoms that people experience depends on the degree of narrowing and the location which can lead to pressure on the spinal cord and nerve roots. Majority of patients who have lumbar spinal stenosis will feel pain in their lower back. However, some patients will also experience symptoms of pain, fatigue, weakness or numbness in the legs. These symptoms in the leg can also progress into something called claudication pain where there is a significant cramping sensation. This occurs when the nerves that exit from the lumbar spine and go down the legs have a lack of blood flow or have mechanical compression. Claudication pain is often associated with change in posture where bending forward from the back decreases pain and extending the back, standing and/or walking increases pain.

If spinal stenosis is degenerative, what can you do for me?

For patients that have spinal stenosis and are symptomatic, our treatment focuses on reducing pain as well as restoring function. This treatment includes manual hands-on treatment, exercise and modalities as needed. The exercises we do are flexion based, otherwise known as forward bending of the back. These exercises include range of motion, stretching and strengthening of the core and hips. In addition, we provide patient education with tips on sleeping position, activity modifications and what to avoid. The biggest emphasis is on avoiding spinal flexion, otherwise known as backwards bending. At Rye Physical Therapy we are also trained in Dry Needling techniques that many patients with stenosis find to be extremely beneficial for pain management. The goal of all our treatment interventions is to reduce irritation of both the spinal cord and nerves thereby reducing your symptoms.

What other treatment options are there?

In addition to physical therapy, patients can pursue medical interventions including oral medication and/or corticosteroid injections as well as surgical intervention if needed. Oftentimes, patients are managed with a multimodal approach where we combine multiple interventions.

Have you been diagnosed with lumbar stenosis? Or are you experiencing symptoms similar to the ones described above? Please give us a call at Rye Physical Therapy for an evaluation to discuss what you are experiencing and talk about how we can help you achieve your goals!

References:

https://www.ncbi.nlm.nih.gov/books/NBK430872/

https://www.welcomebackclinic.com/blog/Lumbar-Spinal-Stenosis-and-Neurogenic-Claudication.htm

https://pubmed.ncbi.nlm.nih.gov/34978252/

 

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by KATE SERODIO, DPT

It is that time of year again; time to pick your Health insurance plan! The question is, will you opt to stick with your Medicare and Medigap (supplemental Medicare plan that fills in the ‘gaps’) or change to a Medicare Advantage Plan.

The first thing you will want to ask yourself is:

– Do you want to be limited in which providers you can go to?
– Do you travel? Do you reside in another state for any length of time?
– Do you want to have to get a referral to see a provider?
– Do you want to pay a copay each visit or deal with high deductibles?

If you answered No to any of these questions, then a Medicare Advantage plan is most likely not a good fit for you! Recently, we have seen a big increase in the number of Medicare Advantage plans and I wanted to share a story that represents the Physical Therapy experience of many of our Medicare Advantage patients…

Last December, Jenny referred herself to Physical Therapy (PT) for her hip pain that was not getting better after a couple weeks of rest. She had already met her MC insurance deductible of $185 and had a supplemental insurance, which resulted in no cost for her to have PT. She had previously been to PT and was aware that she could come in without a doctor’s referral. She enjoyed the direct access as this saved her a trip from having to see her primary. We treated her for a couple weeks prior to the end of the year. Jenny returned after Jan 1^st for continuation of her PT. She presented her new Medicare advantage card thinking her benefit would be similar to her traditional Medicare plan. Unfortunately, Jenny’s new Medicare Advantage plan now required her to get a referral for therapy. She was frustrated with this change, as she had enjoyed the ability to book directly to PT and other specialists. Her frustration grew larger when she was told she now had a $40 copay for EACH visit! She quickly commented, this Medicare Advantage plan seems more like a disadvantage plan!

As the year of 2021 has continued, we have seen patients like Jenny again and again, making the same comment, “My Advantage Plan seems like a disadvantage from the traditional plan and supplemental plan I previously had”. As a physical therapist, I have been treating patients with Medicare for many years. For years, our patients came in and their plans were very straight forward and easily managed. Until recently, we had nearly a 100% of our patients with traditional MC plans along with supplemental plans. Suddenly, as of 2021 we had approximately 10% of patients change their plans to a Medicare Advantage Plan. We had several patients try to schedule visits directly with PT, however we had to refer them to see their PCP first. NH is a direct access state and you do not need a referral to go to PT, UNLESS your insurance requires it. MC traditional plans do not require this, however most Medicare Advantage plans do. We have also had several patients choosing to not have their PT due to the reoccurring copay costs, which can add up quickly. Unfortunately, this has resulted in many of our patients not getting the care they would have previously received with their traditional plan + supplemental.

Medicare Advantage plans are very similar to the plans that many people previously had when they were working. Medicare Advantage plans are offered by private insurance companies contracted with Medicare and provide at least the same level of coverage that Medicare Part A and Part B provide. Medicare Advantage enrollment is highly concentrated among a small number of firms.

• 44% United Healthcare and Humana
• 15% BCBS affiliates (including Anthem BCBS plans)
• 23% (CVS Health, Kaiser Permanente, Centene, and Cigna)

The Benefits of Medicare Advantage Plan:

– Medicare Advantage plans include everything that the original MC offers, with the exception of hospice care, and can offer additional benefits such as dental benefits, vision, and wellness programs. Some may cover prescription. Many enjoy a bundled plan.

– Medicare Advantage plans have lower premiums (However, Medicare Advantage plans often cover fewer expenses than Medigap — often resulting in more out-of-pocket expenses such as deductible, coinsurance and copays with office visits, Therapy services, lab work, surgery, and many others.

– Medicare Advantage plans have a maximum out-of-pocket limit or MOOP. In 2022, the mandatory MOOP for Medicare Advantage is $8,700, although you may find plans choose to set theirs much lower.

Benefits of Medicare Supplemental Plan ‘MEDIGAP’:

– Medigap covers you for any hospital or doctor in the US that accepts Medicare (the majority accept Medicare). 

– No need for prior authorization or a referral from a primary care doctor. Coverage includes the entire U.S., which may be important for those who travel frequently or spend part of the year in a different locale. This option is ideal for those who have particular physicians and hospitals they want to use.

– More security long term. When you first sign up for a Medicare Part A and Part B Medigap, insurance companies are obligated to accept you regardless of your current medical condition. However, if you have opted for a Medicare Advantage plan and then decide to return as your health declines you may not be able to find coverage or you may be charged significantly more due to your medical condition

The main downside of Medigap is that the premiums may be higher than those of Medicare Advantage. If you don’t mind the Medicare Advantage limitations of freedom and if you’re healthy and can predict that you’ll remain that way, then a MC advantage plan may be perfect for you. My primary concern as a provider is when I see people not getting the care they need because they’re worried about the added cost each time they require treatment. Therefore, when it comes to your health, my suggestion would be to have the plan that will add one less stress to your life when you really need it!

To speak with someone in more depth about these options, visit Medicare.gov

Don’t forget, the deadline to choose your plan is December 7^th so don’t delay!

Stay healthy and safe!

Kate

RESOURCES:

https://www.thestreet.com/personal-finance/insurance/health-insurance/medigap-vs-medicare-advantage

https://www.pmgmd.com/health-matters/medicare-facts/facts-about-medicare-advantage-plans/

https://www.investopedia.com/articles/personal-finance/010816/pitfalls-medicare-advantage-plans.asp

https://www.investopedia.com/articles/personal-finance/071014/medigap-vs-medicare-advantage-which-better.asp

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