Should I have an MRI first?

When most people have an injury, especially if it involves the neck or low back, they feel they need an MRI right away. Also, if a person is ordered to come to physical therapy after their injury without getting an MRI or some sort of advanced diagnostic testing they question why. These patients are usually fearful and hesitant to start physical therapy for fear that something is being missed about their condition and they might get worse or injure themselves more.

Many studies have have been done to show if there is any value of ordering an MRI or advanced diagnostic test following an injury. Unless it is a very serious injury there is very little correlation between positive findings and the relationship to level of pain.

Physical therapy is always the best conservative approach to any type of musculoskeletal injury. Early intervention is key to the overall healing process. Starting treatment early reduces the risk of the injury turning chronic. This can also help save you and your insurance company time and money. Unnecessary testing can get very expensive and this is what we are trying to avoid.

As physical therapists we are trained in detailed evaluations. I can guarantee that my evaluation will be more detailed than just about any health care professional that you will see. Education is a big part of what we do during our evaluation. We are able to find “red flags” and if something doesn’t add up we refer you out to another health care professional. There are clinical tests that we perform to determine what tissues are effected and if those are positive then we take the next step into treating them.

Advanced diagnostic testing is not necessary to have before starting physical therapy treatment. Sometimes, waiting to get a test before starting can delay the healing process of your injury. Physical therapists evaluate and treat a wide variety of injuries and can help with pain reduction and prevention of future injuries.

Is there a fountain of youth?


If you look all over the news especially on ESPN there is no way you are missing all the hype behind Tom Brady the quarterback of the New England Patriots. Now, let me preface that I am a huge Pittsburgh Steelers fan and it pains me to even talk about him. But it is really amazing what he has done for the length of time that he has done it. How has he been this good for so long? How is he getting ready for his 17th season in the NFL and 16th as a starter? Brady is 40 today August 3rd and in football years that is an eternity! The average NFL career is between 3-6 years depending on position and ability of play. Brady has broken records, won 5 Super Bowls, is a two-time NFL MVP and has the most wins as an NFL quarterback EVER! So how does he do it? How has he been able to keep up with all of these other younger more versatile quarterbacks? And how does it seem that he just has a knack to win the big game?

To be an NFL player you have to be special! You don’t just luckily get drafted and you don’t just get a starting job because you made the team. You have to work and work hard if you want to be successful in the league. There are many players that have gone past their years as a football player trying to get that one last season before leaving the game that they have loved to play for so long. Payton Manning comes to my mind right away. Even though he won a Super Bowl to end his career he was a shell of himself that year. His defense carried him most of the way and he did what he needed to do to win, even if it wasn’t pretty. Tom Brady has evolved as the exact opposite only getting better and more focused with age.

Let’s start with his diet and how he decides to fuel his body. It is no secret that he eats vegan most of the year. Now I’m not saying this is the option for ultimate health because there is no way that I could go without meat. But this is his secret to success. Diet plays a huge rule in your health and weight control. I have posted in older blog about the 80/20 rule that most should follow. 80% diet and 20% exercise. There is no need to kill yourself at the gym 6 days a week if you are not eating the right things to fuel your body. Next, his workout regimen is very strict requiring him to wake up very early each day because of his busy schedule as an NFL player. His workouts along with him being very conscious of his health play a huge rule in how he is able to keep going. He is a very focused individual and it shows through all that he does.

If you want to get serious about your health and the way that you feel I suggest you take a look at what this man has been able to accomplish. Tom Brady is an extreme case, but he is a perfect example of what hard work and dedication to your body and health can get you. Is 40 really the new 25? If so, Patriots fans would seem to think he might have at least 10 years left in the league! We all wonder how much longer he will be in the league for. The short answer, as long as his body will let him be. Truth is there is no telling how much longer he will play. He’s like the damn energizer bunny! All that I know is as a Steelers fan his retirement can’t come soon enough!

Things aren’t always impossible!

This past week was one of the best youth baseball experiences I have ever been a part of. Our 9 year old little league team went to the state playoff tournament. If you would have asked any one of us coaches at the beginning of the season how we expected to do I think we would have all said we probably wouldn’t make it past districts. Our team is made up of all 9 year olds and this was a 10 year old tournament. In youth baseball 1 year makes a huge difference. Some of these kids are a whole head taller and have at least 50-70 pounds on some of our kids. Our 10 year old team decided they did not want to be a part of this so we decided why not? If we go and get crushed at least they get the experience.

Districts were against a bigger North Allegheny team. It was a best of 3 series so we knew we would play at least 2 games. The first game was at our field. We came out and competed very well and won the game 9-2. We looked at each other and said we have a shot at this. 2 days later we won districts 16-15. That game was a lot closer but we battled back and won with a walk off hit! Now it seemed like we really had a shot!

A week or so later sectional playoffs started. This was a 4 team double elimination tournament. The first game was also against a much bigger team from Sharon, PA. This game was a very close game back and forth all game. Again, we ended it with a walk off win! It just kept getting more real! The goals we had set forth seemed attainable. Our second game was the next night against Carmichaels. We were down 4-0 after the first 2 innings, but that didn’t stop our boys! They came out on fire the next inning and continued that throughout the game. We ended up winning the game 7-4! It was awesome! We were in the winners bracket and had to be beaten twice now. 2 days later our boys didn’t disappoint. At this point we all believed we were going to win. We won 12-5 and won the PA section 2 championship! On to Morrisville, PA!

The experience all week in Morrisville, PA was awesome! Not only for us coaches but the kids had an absolute blast! From the banquet opening night, to opening ceremonies and the first game it was great. At this point the boys did feel some pressure and it was obvious from the first inning. We gave up 6 runs in the first inning and had to play catchup all game. We ended up losing 12-5 a very disappointing opening game and now we were in the losers bracket. We came back the next day ready to fight until the end and that is what these boys did. Coming back from being down 10-3 scoring 7 runs in one inning to tie the game. We just couldn’t hold them off for long. We ended up losing our second and last game and our run was over. It was sad to see these kids work so hard to come up short, but I was so proud of what they accomplished!

This entire season was very special and I am so glad that I got to be a part of it. Seeing how hard these boys worked to get where they did was awesome! They committed to a goal and they went for it without ever questioning themselves! They were never intimidated by any team that they faced and never let the spotlight get the best of them. I am so very proud of this team for never giving up.

When you have a goal that you want to attain ,whether it’s physical therapy related or not, you need to realize that things are not always impossible. It’s easy to look at something and say there is absolutely no way I can do that. It’s also very easy to not even try. We could have easily said lets just wait until next year and just enter in another tournament. But we decided to believe in our boys and just go for it and try. I am so glad that we did because they will never forget this, and neither will I!

Who doesn’t like a walk off?!?!

As long as I can remember I have always loved the Pittsburgh Pirates. I grew up in the 80’s and 90’s with the Killer B’s, Bonds, Bonilla, Bream and Bell! That was a great era of baseball to be a part of! The pirates were so competitive and seemed like they made the playoffs just about every year! Once free agency really took it’s tool on the Pirates they seemed to have nothing left but a farm system for the rest of the major leagues. Every year it seemed obvious, if a player started to do well it was certain they were getting traded by mid season. And every year that was the case. 20 years of losing was upon us! Do you even understand how long that is to suffer from losing? It hurts to even think about it. Even though it was rough I continued to watch my team get pummeled every year. I may have lost hope for about a year until they brought up Cutch! That was a great time because you knew he was something special! Even after they brought him up the losing continued up until 2012.

The Pirates actually had a great shot that year! They started out slow as usual, but at one point in the season they were 16 games over .500 with 7 walk off wins! They hadn’t had a winning season in 19 years and we were that far over! We were all going to win that year! And then the wheels fell off. They had a total collapse the last month and a half of the season and ended up in forth place in the N.L. Central with a record of 79-83 4 games under .500. Another losing season in the books!

2013 was a different story. They added some pieces that were going to prove to be key! Francisco Liriano and Russell Martin were added to help and boy did they ever. Again the pirates had 9 walk off wins that year! Liriano went 16-8 revitalizing his career and Martin ended up with 15 home runs! The key home run being in the wild card game when he belted a 2 run HR over the left field wall off of Johnny Cueto! It was still by far the best game I have ever seen. I was in my living room jumping up and down screaming! 20 years of losing can do that to a fan let alone a town! It was awesome! They lost in the divisional series against the Cardinals but it was still a great season. Their record was 94-68.

2014 started off just as strong in and out of first place of the division all year with the Cardinals. They ended up with with a record of 88-74 and made the wild card game for a second consecutive year. They had 10 walk off wins that year! They ended up losing to the Giants that day, but it was still a great season. Winning baseball was back in Pittsburgh!

2015 was even better then the year before. This time the national league central was stacked and between the Pirates, Cardinals and Cubs it was a battle all year. The pirates had 11 walk off wins that year and ended up with a record of 98-64! And they didn’t win the division! They made the wild card game for the 3rd consecutive year and lost to the Cubs. It was a very promising year!

2016 was very disappointing. They had just came off of a 98 win season and just didn’t look good. A lot of blown opportunities and they finished the season with only 4 walk off wins and a record of 78-83, another losing season! I personally was very upset and frustrated about it. How can you have a 98 win season and lose that many games the following year? Do walk off wins play a part in momentum?

As most of you know I help coach my sons travel baseball team. This past year has been a blast and I have enjoyed being a part of every moment. This year alone they have had 4 walk off wins that I can think of. One of them was just the other night in the sectional little league tournament. My son came up and hit a single into right center to win the game. It was great to be a part of! The next day those kids carried that momentum into another win and a birth into the championship! Last night we came in and totally dominated! A 12-5 win and a birth into the PA state little league championship! I am a big believer in momentum and feel that the experience these kids have will give them a huge advantage.

When I talk to my patients in my office about their success and failure I try and relate it to the walk off hit to win the game. If you have a great day or week or month of physical therapy you need to celebrate it! You need to use that as fire to build upon. Mindset alone can change what you believe and how you think. If your down it will show in your effort. If you use it to your advantage nothing can stop you!

So far this year the pirates are 48-48, 3 games out of first. They have had 7 walk off wins so far this year. One of them coming two nights ago. The momentum is starting to show because they have won 11 out of their last 13 games. Hopefully the walk off will hold true as to what type of season they will end up having.

Could bi-yearly follow ups with your physical therapist be the key to musculoskeletal health?

 

I had to go to the dentist the other day to get my teeth cleaned. Yes it was that time of year again, my 6 month check up and cleaning. As I was leaving the office I went to the front desk and scheduled my appointment for the next 6 months not even thinking about it. I said good bye to the office staff and went on to work. As I was driving to my office I started thinking about how natural it was for me to schedule a follow up visit with my dentist. It’s drilled into our brains that maintenance on our mouth and teeth will prevent us from having problems in the future. Catching things early can prevent pain, decrease cost of care and keep our mouths healthy overall. If we have an issue in the mean time we just give the dentist a call. Can this work with physical therapy?

 

As the day went on I thought about it more and more. What if I started to set up a follow up check up after discharge for all of my patients? Six week, Six month and one year is what went through my mind. This is what is done at your PCP, dentist, surgeon, dermatologist and many more health care professionals. I know first hand what happens when patients are discharged from PT. 95% of patients stop there home program the day after they are done. 6 months to a year goes by and all of a sudden they have a problem again. Who do you think they call? Not me! They call their PCP or their surgeon. That is what people think of when dealing with pain, strains, weakness, functional deficits. Finally patients will come back to me after going through the chain to be treated. Look at the time and money it takes for someone to get to me.

 

Now, what if I discharge someone and set up a 6 week follow up to see how they are doing? Add certain things as well as make sure they are continuing to improve. Just doing this would prevent them from having to spend insurance money to go to their PCP only to tell them to come to me. This would also help patients be held accountable to what they should be doing knowing that they will have to come to see me in 6 weeks. This can train patients to think about follow up appointments. This can help patients understand the importance of their health and know who they can come to for their musculoskeletal needs. We as physical therapists have to do a much better job of keeping in contact with their patients, making trusting relationships and making sure people are getting everything that they can out of us. We are such a valuable asset that most people don’t know how to use. Take advantage of it!

What can a good night sleep do for me?

A good night sleep makes you feel so good. The importance of a good nights sleep goes beyond feeling good the next morning or relieving exhaustion. Getting the right amount of sleep is a huge part of having a healthy lifestyle, and can benefit your mind, heart weight and more. So really what could an extra hour or two of sleep really do for you? If you are not getting the recommended 7-8 hours of sleep per night here are some reasons why you should consider going to bed an hour earlier tonight.

Improved health:

Getting a good nights rest is not going to cure you from disease or even make you immune. But many studies show there is a link between not getting enough sleep and health problems such as heart disease, diabetes, heart attacks and diabetes. These are usually after a longer period of time of not getting enough sleep. Shift work alone can cause interrupted sleep patterns causing you to lose sleep and in turn can cause health risks.

Less pain:

Getting the right amount of sleep helps you heal better and faster. Injuries take long enough to heal, why would you make it harder for your body to recover? I always tell my patients to try and find the most comfortable position to sleep in. If it’s in a recliner chair that’s fine. The more sleep you get the better you will heal and the less pain you will be in.

Better weight control:

Getting the right amount of sleep can help control your weight better than you think. If you wake up exhausted you are less likely to be physically active and go for that workout you planned on. You also might skip that healthy meal you wanted to make and grab a quick less healthy meal instead.

Lepton, the hormone that helps us feel full, is decreased in those that do not get enough sleep. So in turn those that do not get enough sleep tend to be more hungry than those that do.

Thinking more clear:

It’s a proven fact that if you get a good nights sleep you wake up refreshed and free of mind bogging information. Being rested clears the mind and helps with what you need to accomplish for the day. If you have that big test the next day, try to go to bed a bit earlier so that you can stay focused and rock it!

Reduces stress:

Sleep helps lower your blood pressure and stress hormones. Sleep helps encourage our bodies to relax. You know how it feels after a good nights sleep right? You wake up refreshed, in a good mood and ready to start your day. This is all due to decreased stress levels.

These are just a few reasons that an adequate amount of sleep can help your body and your mind. I encourage you to try and at least go to bed an hour earlier than normal each night this week. It will be difficult at first, but once you see the results you will see the benefits that it can have. Sleep should become a priority and can make a huge difference in the quality of life that you have.

Is physical therapy going to be painful?

Before I leave the room after all of my evaluations I always ask my patients if they have any questions. I also ask, if what I just explained to them makes sense? At least 50% of the time, if not more, I get “ is this going to hurt? It is a very good question considering the majority of people have no idea what to expect from physical therapy. When people are already in pain to start the last thing they want is to have more pain. Also, at this point, people can be fearful of movement. Therefore, it can become challenging trying to explain what to expect. Let’s talk about this question of pain and if it’s really something to expect when you go to PT.

I absolutely hate when people say that I love putting them in pain! I also get very upset when patients and PT’s alike will state PT stands for pain and torture. Or a PT is a physical terrorist. Really? Is that what most people think we are and do to people? Let’s get one thing straight. My job is to promote movement, function and mobility using your own body to heal itself. I am not here to try and put you in the most pain possible. I have no desire to try and increase your pain nor do I get excited when I do. This is a misconception that a lot of people have and it needs to stop.

Yes, there are times that you may have some discomfort from certain movements, activities and treatments. Take the shoulder for example. A patient that has RTC surgery is going to have pain during PT because you have to move the joint in order for you to gain motion. The shoulder is healing from surgery and that is another reason that it is going to be painful. Any time you have limited motion you are going to experience some sort of pain/discomfort because the joint is not moving properly. It’s not a sign for me to see how much pain I can put you in. It’s just a guarantee that you will be in some sort of discomfort because of the limited motion the joint has.

Will you experience some sort of pain during PT? Depending on what you are coming for the answer is yes. Other times PT can and should be very relaxing and calming. General soreness from activity and exercise is not what I consider pain. It’s just your bodies way of telling you to move your ass more often and you wont feel this way. If you are seeing someone that calls themselves a pain and torture expert or refers to themselves as s physical terrorist I suggest you find a different place to go.

When things get tough will you quit?


As most of you know that read my posts my son plays travel baseball and I’m a coach on the team. Lately it has taken over my life, and I’m okay with that because I enjoy it so much! But I keep finding different reasons to talk about it because these kids show me something different each week. As with all 9 year olds there is an up and down attitude about them each day, week and month. One day they look like super stars out there and nothing can stop them. The next day they look like they are back in T-ball again. This past weekend was one of those weekends where you wondered how they would respond after the events that took place.

We played in a tournament called the Battle of the Boarder in Youngstown Ohio. Leading up to the weekend we knew that competition was going to be very good. 2 teams in particular were going to be there. Beaver Valley Red and West Hills. The last time we played West hills they beat up on us pretty badly. By about 13 runs to be exact! It wasn’t pretty, but our kids had bounced back in the next tournament they played in to take 2nd place. We were in a different bracket then either team and were set to face 2 teams we had never played. The day before the tournament started one dropped out and our schedule changed. Now we were scheduled to play Beaver Valley. I was excited to see how our kids matched up against them since we had never played them before. Once the kids heard that was who they were playing that’s all they talked about. They obsessed about it actually! And it was not in a good way. The game started and we walked the first batter, not a good start! Nerves were probably going crazy for most, but we managed to get 2 outs and the score was only 1-0. Then all hell broke loose! We committed 6 errors giving up 12 runs in the first inning! After the first inning it was 12-0! How does this happen? Little things like catching the ball before trying to throw it. Balls going through their legs, and coming in on fly balls instead of stepping back first. All things our kids do very well most of the time. Their nerves got the best of them. Needless to say the game ended in 4 innings after losing 18-1. We lost the second game 12-6 against another team we had never played mostly due to mistakes and kids just not being in the game. It was tough to watch and hard to talk to the boys afterwards. Sunday would tell us what type of team we have and how they respond.

The next morning the kids warmed up and you could tell they were more lively and upbeat. They started out strong and lead most of the game until the bottom of the 5th giving up 2 runs to be down 5-4. The kids battled that last inning but couldn’t find a way to get another run. We lost that game, but showed great resilience and determination to come back after getting the crap beat out of us the day before. It was great to see how our boys responded.

I wanted to share this with you all because there are always going to be times in life and in physical therapy that you are going to want to quit. Things are just going to get too hard for you and giving up seems to be the easiest thing to do. I know because I have felt like quitting before. My first 2 weeks of PT school I almost quit! I felt that it was going to be too hard and too much for me to handle. I was sick of school at that point and now I was going to have to go for an additional 3 years! I went home that weekend and thought about it a lot. I kept telling myself I could go and get a job for a little while and figure it out. Then I realized that I committed to doing this and this was what I felt passionate about. I’m so glad that I decided to continue my journey. Just know that it’s normal to want to just give up when things are tough and not going your way. It’s the way you respond and show resilience that makes all the difference.

My experience with custom orthotics, and will they work for you?


A while back I wrote a blog about how even physical therapists need treatment sometimes. I went over my experiences with a foot problem that I developed over a few summers ago. I wanted to do a follow up post on my current situation and how it has taught me something that I teach my patients on a daily basis.

To summarize my experience I started to get some foot discomfort in the fall of 2015 after a long season of tournament baseball. I used to wear spikes when I coached because it made it easier to do things with the players. That Thanksgiving I played in a Turkey bowl and wore those same spikes and the next day I could barely walk. It took about 2-3 months of self treatment and taping methods to finally get some significant relief. It would still bother me from time to time, but I could deal with it. Well, summer came in 2016 and I decided to get a new pair of spikes thinking that it was just the brand the they were a few years old. At first it felt fine, but as the season wore on I could feel my foot slowly hurting again. I finally just started wearing regular running shoes and that seemed to help, but never completely. I finally bit the bullet and went to see a foot specialist. I was diagnosed with nothing more than over pronation of my forefoot and in turn my arch was collapsing causing significant pain. This is honestly nothing that I already didn’t know. I just wanted to make sure I didn’t have a stress fracture. To my relief I was recommended to get custom orthotics done so I obliged. I didn’t receive a call for a few months and by that time my pain was gone so I never called back.

Fast forward to April 2017 and baseball season had been in full swing since Thanksgiving indoors of course here in Western PA. We were just getting outside and I started wearing my spikes again…bad move. They hurt so bad that I decided to get some turf shoes most coaches wear. I also decided to call the foot specialist again to pick up my orthotics. I made an appointment and within 10 minutes of being there I was walking out with orthotics in my shoes. The initial feeling was a little different. I wasn’t sure what to think really. I just knew that I needed to give them a shot. I always tell my patients with any type of change in footwear whether it’s new shoes or orthotics do it in steps. So I wore them for an hour for the first week. Just one hour a day, then bumped it up to 3 hours and so on. I now wear them all day when I’m at work because I am on my feet most of the day. I have to say that since wearing them I have not experienced foot pain at all!! It’s amazing what a difference they do make and I’m very happy I made the decision to get them.

My advice to my patients with foot problems is always try orthotics, especially if they have a flat foot. I usually tell them to try an over the counter version to see. Some insurances don’t cover them and it can be expensive. So before they go full out I tell them to go the cheaper route first. Now that I have had such a positive experience with orthotics it will drive me to be more aware of patients that will benefit from this.

If you have any questions about your foot problem or any musculoskeletal issue that you may be experiencing please don’t hesitate to contact me! 

nicksivrichpt@gmail.com

Can wearing a back brace do more harm than good?


31 million Americans experience low back pain at any given time. It is the number one cause of disability worldwide. Also, low back pain is one of the most common reasons for someone to miss work and the second most common reason for someone to go to the doctors. Really? That many people have back pain? It is that common for them to go to their primary care doctor for it? Why are they not coming to physical therapy first? That’s a topic for another day, but seriously low back pain is a huge issue that a lot of us deal with on a daily basis. I see it first hand every day as I treat patients frequently with this problem. Some are strains, disc herniations, fusions, fractures and just general arthritis symptoms. It’s inevitable that I will get the question: “Do you think a back brace will help me?” “My friend’s brother has worn a brace for years and says he thinks I need one.” So I decided to share my opinions and some general facts about back braces to hopefully help you make that decision.

What is the back brace being used for? This should be the first question anyone should ask. The type of injury or problem that you are having will be a key factor whether you will benefit from a brace or not. When do you plan on wearing it? Is this something that you are planning on wearing all day? Do you want to use it while you are doing house work or working out at the gym? Are you planning on wearing it while you sit? These are some key questions that you need to focus on in order to see if this is right for you.

In my opinion, I never recommend for a patient to wear a back brace. This is usually what I tell them. I don’t recommend that you get a back brace. I feel you would not benefit from it and here is why. Your back is already vulnerable in the fact that you are injured and you are in pain. Your muscles are not working to their full potential and are weak. If you were to put a brace on, chances are that you would get some relief initially, but you would only be hurting yourself. Think about it this way, once you put that brace on your muscles are going to say to themselves, I don’t have to work as hard as I was before because I have this trusty brace doing most of the work. So as your muscles decide to take a nap they are also shrinking which is called atrophy. Now they are not as strong as they were before. After using this brace for the past several weeks you start to feel a bit better. You think, “Hey I feel pretty good let’s try going without the brace today.” Within 30 minutes you feel worse than you did before. And now you put the brace back on because that’s the only way it feels better. See, the brace is doing most if not all of the work for your core and those muscle decided that they wanted to be lazy and not work. Sure it helped take away your pain temporarily, but in turn it was hurting you in the long run.

Now, here is when I feel you can and should wear a brace.

When you are weight lifting or power lifting: weight lifters have been using belts and back braces for years. These are only used for a very short period of time and are taken off so your back is only being assisted for a short amount of time.

When your job requires you to lift a lot throughout the day: I see Home Depot workers wearing braces all the time. And as soon as they are done with the lift they take of the brace. This is fine because you are not allowing the brace to carry the load all day long.

Scoliosis: This type of brace is used to stop the progression of Idiopathic Scoliosis. This brace must be used in order to prevent the curvature from getting any worse.

It can be very confusing a to when you should or should not wear a back brace. I suggest that you take into account what you are trying to use it for and ask your Physical Therapist or other licensed health care provider. Braces can be a life saver, but they can also leave you worse than when you started.