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[BACK PAIN] and when it’s appropriate for the patient to move forward or regress to another phase, is what makes a therapist competent. The main goal in the initial phase is to calm down inflammation of the tissue at fault as quickly as possible. The patient should not participate in any activities that would stretch the tissue more during this time. Activities that should be avoided include bending forward and twisting, walking, sitting for long periods of time, stooping, lifting heavy objects with or without rotation, and participating in static activities that require the ligament to hold the spinal column for long periods. Having the patient lie on their stomach or back and using modalities such as ice (inflammation) and electrical stimulation will help calm down the overstretched and inflamed tissue. The McKenzie Method and/or Williams flexion-based exercises can put the back in a position to not overstretch or compress inflamed tissue. Active rest, such as walking, can help put the low-back tissue on slack as the patient strides through the walking motion for posterior ligamentous dysfunction. Isometric back exercises and Kegel pelvic floor exercises for the pelvic/sacral region while lying in the prone or supine position are great for getting the muscles firing again without putting any major load on the surrounding inflamed tissue. During this phase, it’s important that the patient adheres to this program at home on a continual basis. Compliance is the key to managing symptoms to progress through the first phase. The next phase should be focused on strengthening the back via isometric exercises in a standing position. Performing rhythmic stabilization exercises for the back and pelvic musculature in a standing position can be done using a physioball or other devices. The third phase of lumbosacral rehabilitation involves active resistive exercises in single plane positions such as sidebending, rotation, extension and flexion. This can be done using exercise bands, a medicine ball or free weights. The purpose of the fourth phase is to mimic functional movements, and prepare the patient for return to normal work-related and recreational activities. We usually use exercise bands, medicine balls and/or free weights while incorporating chop, lift, push and pull exercises to mimic functional activities. It is also important to incorporate diagonal movements during this phase, as this is what’s most common in our daily lives. During patients’ physical therapy regimens, we often incorporate stability exercises using a body blade, rocker boards, physioball, the BOSU ball, and other devices that challenge their balance and put stress on their core region. The fifth and final phase is optional for those wanting to return to high-level recreational activities. This is the time to perform sport-specific exercises that produce the biggest load on the lumbosacral region. The Home Program Throughout the phases that involve resistance training, it is important that patients execute home programs appropriately. As you start to progress patients to more of a strengthening/stability regimen, do not get carried away with doing resistive exercises to the same region (lumbosacral) on a daily basis. Recovery throughout an aggressive training and rehabilitation regimen is nearly as important as the actual treatment itself. I usually require the patient to participate in a home program based on the amount of times he is being seen on a weekly basis in therapy. I back pain continued on page 46 1. Helps stretched ligaments heal faster. 2. Helps re-align and narrow pelvis after delivery. 3. Significant pain relief has been clinically confirmed. Sold Worldwide For Pregnancy and Back Pain PATIENTS WITH FORWARD HEAD POSTURE? ANTERIORLY WEIGHTED 1-5 POUNDS PATIENTS WITH CERVICAL IMMOBILITY? ONE POUND PROPORTIONALLY BALANCED CERVICAL EXERCISE TOOL • Improves neurological function Halo Products are Patented and Manufactured by White Sky, LLC Contact@HaloRejuvenator.com 888-884-4256(HALO) Like Us On Facebook & Receive Exclsuive Offers ADVANCE for Physical Therapy & Rehab Medicine 25
[INFECtIoN CoNtRol] soft-surface Contamination Within a week of being laundered, 92 percent of hospital privacy curtains studied were contaminated By Bill o’Neill what’s wrong with this picture: a nurse enters a hospital room, does a thorough handwashing, pulls back the privacy curtains and attends to a patient? The hard-to-spot flaw in this scenario is that the nurse’s conscientious efforts at hand hygiene are compromised by one simple, everyday act—touching the privacy curtains after washing her hands. According to a growing body of published, peer-reviewed evidence, those curtains may often harbor infectious microorganisms, such as MRSA and vancomycin-resistant Enterococcus (VRE)—and these opportunistic bacterial strains can hitch a ride on the hands of nurses. This unwitting transfer of pathogens could potentially increase the incidence of HAIs (healthcare-associated infections), 1 which currently afflict approximately one out of every 20 hospitalized patients and can lead to dire consequences. HAIs cause 100,000 deaths annually in the United States—more than deaths due to car crashes and HIV/ AIDS combined. 26 ADVANCE for Physical Therapy & Rehab Medicine The speed with which soft surfaces in the hospital environment can become contaminated was revealed in a recently reported study at the University of Iowa Hospitals in Iowa City. The results of the study were sobering: Within one week of being laundered, 92 percent of hospital privacy curtains studied were contaminated. 2 Those results echo findings from an earlier study conducted at the Cleveland VA Medical Center, which showed that 42 percent of hospital privacy curtains studied were contaminated with VRE, 22 percent with MRSA and 4 percent with Clostridium difficile. Meanwhile, a report from researchers at the Hospital of Saint Raphael in New Haven, CT, confirmed that when healthcare workers touch contaminated environmental surfaces, they are likely to transmit pathogens to patients. 3 Results from a recently released study presented at the 2011 annual meeting of the Infectious Disease Society of America have made an explicit link between a reduction in bioburden on hospital surfaces and reduced infection rates. 4 Research Implications While further research is needed, there are a number of implications for hospitals nationally. Since privacy curtains are one of the most commonly touched soft surfaces in the patient environment, hospital staff need to heighten their awareness about the possible pathogens hiding in these fabrics, and many healthcare workers may have to change longingrained habits. As the University of Iowa Hospital study suggests, staff should wash their hands after touching privacy curtains and before touching patients. Such a protocol can be time-consuming, however, at a time when hospital administrators and managers are already grappling with scheduling and staffing constraints. While healthcare facilities have long focused on disinfecting hard surfaces, such as bed rails, over-bed tables and door knobs, and sterilizing medical devices (catheters for example), they will face increasing pressures to address the condition of the entire patient environment. That means hospitals may need to expand their multi-layered attack on HAIs to fighting contamination on soft surfaces such as bedding and scrubs, as well as privacy curtains and other materials. The rapid rate at which soft surfaces can become contaminated in a hospital setting poses a challenge to conventional approaches to managing privacy curtains, including schedules for laundering and/or replacement. Some hospitals clean their curtains every few months, while others may only do so when they are obviously soiled; but all healthcare facilities will need to re-examine their approach to cleaning and maintaining these textiles. Strategic Considerations When it comes to reducing bioburden in the patient environment, there is, unfortunately, no “silver bullet.” Microbial contamination is endemic in the hospital setting, in spite of the Herculean efforts made by both clinicians and environmental services staff over the past several years. Consider the challenge: Whether colonized or infected, many patients bring pathogens with them when they enter the hospital. The ADVANCE
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Page 5 and 6: contents ADVANCE FoR PHYsICAl tHERA
Page 7 and 8: [MORe ARTiCleS] 9 Management Focus:
Page 9 and 10: [EDiToR’S ViEw] 8National Rehabil
Page 11 and 12: [MANAgEMENt FoCus] sticky notes wit
Page 13 and 14: [CoVER stoRY] ruNNiNg righT how To
Page 15 and 16: [CoVER stoRY] that patients adhere
Page 17 and 18: [Foot DRoP] Positive steps Understa
Page 19 and 20: [Foot DRoP] for strengthening or us
Page 21 and 22: [lAsER tHERAPY] laser and living ti
Page 23 and 24: [lAsER tHERAPY] Therapeutic Laser S
Page 25: [BACK PAIN] Pain Epidemic Physical
Page 29 and 30: [AquAtIC tHERAPY] Confidence gain W
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Page 33 and 34: [CoVER stoRY] running continued fro
Page 35 and 36: [CE DIRECTORY] • • Summer Webin
Page 37 and 38: Register Online at www.usa.edu or C
Page 39 and 40: [CE DIRECTORY] Attention Therapists
Page 41 and 42: [CE DIRECTORY] AUG. 12, 2012 NEWPOR
Page 43 and 44: [CE DIRECTORY] group discounts. Con
Page 45 and 46: [CE DIRECTORY] with disabilities. T
Page 47 and 48: [CE DIRECTORY] program producing LA
Page 49 and 50: EMPLOYMENT OPPORTUNITIES New York,
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