American Physical Therapy Association
Report Outcomes of Treating Common Back Conditions
Surgically Versus Nonsurgically
with sciatica who undergo early microdiskectomy surgery
report faster recovery and improvement in leg pain
than patients who receive prolonged conservative treatment.
However, 1 year later, both groups of patients reported
similar recovery results.
Versus Prolonged Conservative Treatment for Sciatica,"
published in the May 31 issue of New England Journal
of Medicine (NEIM), compared early microdiskectomy
surgery with a strategy of prolonged conservative
treatment with eventual surgery if needed. Patients
who has early surgery reported faster recovery and
more rapid improvement in leg pain. After 1 year,
the outcomes in the two groups were similar, and 95%
of the patients in both groups reported recovery.
study in NEIM compared surgical treatment with
nonsurgical treatment, including physical therapy,
of spondylolisthesis. Because of extensive patient
crossover, the data were essentially nonrandomized,
and as-treated analyses were performed. During 2 years
of follow-up, patients treated surgically had greater
improvement in pain and function than those treated
nonsurgically. Patients treated nonsurgically showed
moderate improvement over time.
In an accompanying
NEIM editorial, "Back Surgery -- Who Needs
It?", Richard A. Deyo, MD, MPH, says, "The
consensus seems to be that patients who were excluded
from these trials because of major motor deficits
need surgery, as do some with major spine trauma.
For these patients, surgery may preserve life or function.
Absent major neurologic deficits, patients with herniated
disks, degenerative spondyloisthesis, or spinal stenosis
do not need surgery, but the appropriate surgical
procedures may provide valuable pain relief. In such
situations, decisions should be made jointly by well-informed
patients and their physicians."
York Obtains Direct Access
July, New York became the 43rd state to pass direct
access legislation. The Consumer Access to Physical
Therapy bill eliminates, under certain conditions,
the physician referral requirement for patients who
need physical therapy services. The bill passed the
legislature with bipartisan support and becomes effective
the new law, patients can directly access the services
of a licensed physical therapist for 10 visits or
30 days, whichever comes first.
therapists have been working with the state legislature
to achieve direct access for patients for nearly 25
years," said James Dunleavy, PT, MS, president
of the New York Physical Therapy Association in a
news release. "This bill is a thoughtful piece
of legislation with patient safety taking the highest
have the freedom to choose your own physical therapist.
As of December 2006, residents in New York can go
directly to a physical therapist without a physician's
in mind that your insurance policy may require a visit
to the primary care physician first or limit your
access to only preferred providers.
physician may refer you for physical therapy that
is to be provided in his or her office or to a facility
in which he or she has a financial interest. If either
situation is the case, insist that your physical therapy
be provided by a licensed physical therapist.
A recent major study by the Health Care Financing
Administration showed that patients who received an
appropriate amount of physical therapy experienced
better outcomes than did those whose access to treatment
was restricted by third-party payer restraints.
Shaughnessy, Schlenker, and Hittle, Home Health
Care Outcomes Under Capitated and Fee-For Service
Payment, Health Care Financing Review, Fall
Direct access to physical therapy results in lower
patient costs. In most states, patients may obtain
physical therapy directly from a licensed physical
therapist. Direct access saves money for both consumers
and insurers; maintains a high quality of care; encourages
preventive health care; reduces the need for long-term
care; does not promote overutilization; and makes
physical therapy services more accessible to more
Mitchel J. de Lissovay G, A Comparison of Resource
Use and Cost in Direct Access Versus Physican Referral
Episodes of Physical Therapy, Physical Therapy,
Physical therapy is cost effective. Early physical
therapy intervention prevents more costly treatment
later. Hospital lengths of stay involving head injuries,
strokes, and orthopedic disorders are reduced by early
Cope D, Hall K, Head Injury Rehabilitation: Benefit
of Early Intervention, Archives of Physical Medicine
and Rehabilitation, 1982
Hayes S. Carroll S, Early Intervention Care in the
Acute Stroke Patient, Archives of Physical Medicine
and Rehabilitation, 1986
Linton SJ, Hellsing A, Anderson D, A Controlled Study
of the Effects of an Early Intervention on Acute Musculosketetal
Pain Problems, Pain, 1993
therapists treat the consequences of disease or injury
by addressing impairments, functional limitations,
and/or disabilities in patients. Some of the more
common conditions treated by physical therapists are:
conditions, such as back and neck pain and osteoporosis.
and soft-tissue injuries, such as fractures
and dislocations and pre- and post-surgical conditions.
conditions, such as stroke, traumatic brain
injury, Parkinson's disease, cerebal palsy, and
tissue conditions, such as burns, ulcers, and
conditions, including osteoarthritis and rheumatoid
and circulatory conditions, such as congestive
heart failure and emphysema.
injuries, such as carpal tunnel syndrome.
injuries, such as overuse injuries and trauma
in recreational and professional athletes.
Therapy Professionals, P.C. strives to utilize the
best evidence-based assessments and treatments in
our practice. We continue to improve our treatment
outcomes by reviewing the latest literature for recent
advances, and attending continuing education seminars.
We find that sharing our clinical experience amongst
our staff, and with our referral sources helps to
improve all lines of communication. With this in mind,
we would like to highlight our treatment techniques
for plantar fasciitis and heal pain.
with plantar fasciitis require proper education on
the nature and progression of recovery of this condition,
as well as many key principles including: acute care
management, proper footwear and support, controlling
aggravating factors, along with proper exercise and
weight loss. Unless patients are made aware of what
activities worsen their condition, and they consciously
reduce these activities, their condition is unlikely
to improve regardless of what treatment is provided.
new and chronic conditions can have daily acute episodes
of symptoms that require principles of acute care
management. These include "relative" rest
by reducing the amount of time standing and walking,
as well as pacing their activity with times of nonweightbearing.
Patients may benefit from use of cryotherapy in the
form of ice or ice massage, contrast baths, and whirlpool.
If edema present, compressive wraps or stockings may
be helpful. Many patients need instruction in general
footwear. Supportive shoes, or various inexpensive
arch supports or orthotics are often important to
control excessive pronation or over-stretching of
the plantar fascia. Prolonged walking and standing,
as well as standing without a show should be avoided.
We educate our patients regarding supportive shoes
with a solid heel counter and proper fit. They need
to avoid standing barefoot, and we suggest at least
a supportive sandal or slip-on style shoe at home.
case management involves clinical care, as well as
patient education to help control aggravating factors
that may perpetuate their condition. Most patients
realize that being overweight can contribute to their
symptoms, however they generally choose an exercise
such as walking, that involves increased weightbearing
and subsequently provokes their symptoms. They need
to be educated to choose exercises that involve less
weightbearing such as walking in water or other water
based exercises, cycling, or mat activities. The intensity,
duration, and frequency of their exercise should be
closely monitored in order to establish a pain free
starting point and logical progression. Specific manual
therapy techniques, along with these exercises help
in the recovery process. Physical therapy modalities
including Iontophoresis (Dexamethasone or acetic acid),
ultrasound/phonophoresis, soft tissue mobilization
with deep friction massage, and electrical stimulation
all provide therapeutic effects. External arch taping
techniques, along with nonweightbearing, specific
static stretching exercises may be necessary in chronic
fasciitis can be very challenging to manage, and it
is encouraging that we can demonstrate improved outcomes
with appropriate interventions. We appreciate your
confidence and referrals, and as always, please feel
free to contact our office regarding any questions,
concerns, or comments that you may have.
Therapy Proves Highly Beneficial
study published in the December issue of Physical
Therapy (the journal of the American Physical Therapy
Association) has found that although both clinic-based
and home-based physical-therapy programs proved to
be beneficial for osteoarthritis of the knee, clinic-based
treatment programs, including manual therapy applied
by physical therapists (PTs) combined with PT-supervised
exercise, had better overall results.
The study, conducted by Gail
D. Deyle, PT, DPT, at Brooke Army Medical Center in
Form Sam Houston, Texas, and colleagues, consisted
of 134 patients with osteoarthritis of the knee. The
patients were randomly assigned to either a clinic-based
treatment group or a home-based exercise group. Patients
in the clinic-based treatment group received supervised
exercise, individualized manual therapy, and a home-exercise
program over a 4-week period. Patients in the home-based
exercise group received the same home-exercise program
over the same period, reinforced at 2 weeks with a
Although both groups showed
significant improvement, the clinic-based treatment
group had a 52% improvement rate compared with 26%
from the home-based exercise group. The average distance
walked in 6 minutes improved about 10% in both groups.
After 4 weeks, patients in both groups participated
in identical home-exercise programs, with no clinical
treatment intervention. At 1 year, both groups remained
improved. However, the patients in the clinic-based
treatment group were less likely to take medications
for their arthritis.
The study investigators concluded
that adding clinical physical therapy visits for manual
therapy and supervised exercise provides greater symptom
relief for patients with osteoarthritis of the knee.
therapists strongly support the conclusion from the
1996 Surgeon General's Report that Americans can substantially
improve their health and quality of life by including
moderate-intensity physical activity for at least
30 minutes or more every day. Physical therapists
treat over one million people each day who have cardiovascular
disease and musculoskeletal conditions. Interventions
involving exercise training and lifestyle changes
are used by physical therapists to reduce the severity
of the effects of cardiovascular disease and to prevent
Lakeville, NY 14480
at New York Fitness
3163 State St. (Rt. 5)
Caledonia, NY 14423
at St. Pat's Club
66 Stanley St.
Mt. Morris, NY 14510