Author Archives: jonmill

Reopening Policy & Procedures

Virus Avoidance Workplace Policy and Procedures
Effective Date: 5-28-2020

Policy objective: to minimize the risk of exposure, illness or spread of viral infections among
staff and patients as well as preserving the essential functions of the clinic. This will be
accomplished through the following procedures:
Physical changes to the office include:
● Use of high efficiency air filters, increased outdoor air ratio, increased fan level to ensure
optimal air quality in the office.
● Screening area to be located outside of the office to ensure all who enter are safe and
have not knowingly engaged in exposure activity via temperature check and answering
specific questions around health and exposure. This form will be dated and initialled by
both the therapist and the patient.
● Provision of hand sanitizer, masks, touch free trash receptacles, tissues, hand washing
area and disposable towels for drying.
● Treatment areas located at least 10’ apart to ensure social distancing with separate
equipment and supplies that will not be shared between cleaning. Each area will” be
thoroughly cleaned between use.
● Barrier in front of Jaimes’ desk to eliminate droplet spread.
● Elimination of the waiting room option. If it is necessary that a parent join in a session
they will participate in the same screening process and accompany their child while
remaining in the treatment area.
Administrative Changes to DTS include:
● All paperwork to be completed online prior to first visit
● Copays to be done touch free
● Signage regarding our policy and requirement that all who enter wear a mask and
provision of PPE if required.
● All patients will wait in their cars until called/texted that their therapist is ready to meet
them outside of the office.
● Completion of question list and temperature checks to be done with your therapist before
entering the clinic.
● Any patient or staff member with a temperature above 99 degrees, apparent respiratory
symptoms or a positive answer to the screening questions will be asked to go home and
follow up with a medical professional if appropriate.
Cleaning Protocol within Clinic includes:
● All therapists and patients will wash hands or use hand sanitizer immediately upon
entering the clinic.
● Each work area will have its own supplies that will not be shared.
● Each work area and associated supplies will be thoroughly cleaned with a product
compliant with CDC guidelines between each patient.
● Staff and patients will wash hands during the session if needed and upon completion of
the treatment session.
● All commonly touched areas such as door handles, keyboards, faucet handles and
phones will be cleaned every hour.
During your Treatment Session you should expect:
● That both you and your therapist will be masked.
● To be asked not to touch anything between the entrance to our clinic and your treatment
space.
● To continue to receive high quality therapy services in a safe and protected manner.

Keeping Up-to-date and Informed 2019

Once again, Lu and Venetia attended the American Physical Therapy Associations Combined Sections Meeting, the biggest physical therapy conference in the country with more than 16,000 PT’s, PTA’s and PT students. This year, CSM was held in Washington, DC from January 23-26 and included presentations and workshops on the most current research and evidence-based treatment approaches on innumerable PT and health care topics. They started the week with a full day workshop on Kyphosis Management. Their focus on following days included workshops on:

The Pesky Patellofemoral Joint

The Young Athlete: PT Considerations

Exercise Intensity and Neurological Conditions such as Parkinsons Disease

Sports Medicine Secrets: Ankle and Foot Strength, Mobility and Coordination Deficits

Applying the Movement System to the Pediatric Patient

Just Screen It: Developmental Disability, Vestibular Deficit, or Both

They also participated in a step challenge, Walk4Wheels, with a goal of CSM participants walking 135,000,000 steps to ensure an APTA donation of $10,000 to fund adaptive wheelchairs for the Medstar National Rehabilitation Hospital’s Adaptive Sports Program. At the end of the week, the participating PT’s had achieved 133% of the goal with 180,175,214 steps!

Next year, off to Denver, Colorado for CSM 2020!

 

Scoliosis & The Schroth Method

What is scoliosis, how do I know if my child has it?

Scoliosis is a curvature of the spine which includes both a side bend to the right or left (also called lateral flexion) and twisting or rotation of the vertebrae. Usually there is one major curve, and a compensatory curve above or below that. The majority of cases of scoliosis are called idiopathic, meaning the cause is unknown. Visually, a person with scoliosis may look asymmetrical when standing, such that one hip may appear higher or more prominent, one shoulder blade may be higher or more prominent, the ribs on one side may be more prominent (also called a rib hump), and the shoulder and hip levels may not be level. These asymmetries may be more apparent when one bends forward as when touching your toes. The diagnosis of scoliosis is verified by an x-ray of the spine taken in a natural, standing position. Typically, patients are diagnosed in the early teen years, often at their annual physical. Since the curves continue to progress until skeletal maturity, early diagnosis and intervention is imperative.

What is the Schroth method?

The Schroth method was developed more than 80 years ago by Katharina Schroth, who had sciolosis herself. She developed a treatment method that was unique in term of the approach, the intensity and the success rate. Since scoliosis is a 3-dimensional deformity she developed her method to treat all 3 dimensions. Her method consists of a special series of exercises based upon active correction of the pelvis as the foundation of the spine, and subsequently performing trunk elongating exercises. This process also addresses de-rotation of the ribs and flattening of the rib hump. The main goal of rehabilitation is to prevent the curve’s progression and to improve the esthetical appearance of the body. Education regarding the purpose of the exercises and understanding of the given curve pattern is essential for success with the Schroth method.

What can I do as a parent?

Our goal with Schroth is to create a tailored exercise program which is challenging, yet easy to recall at home. As the program progresses, 40-60 minute of home practice is recommended at least 5 times a week. With time, clients will be able to perform corrections on their own and incorporate the new alignment into functional activities.

With all these things in mind, it’s safe to say that Schroth therapy can be little overwhelming during the first phase. Creating a supportive and motivating family environment is essential to enhance the success of the exercise program.

Is the Schroth method good for other postures as well?

Yes, it is! There are many exercises addressing other common problems of the spine besides scoliosis such as slouched posture, flat back, and Scheuermann disease (a kyphosis with wedged shaped vertebrae). A flat back or a rounded back will not progress to idiopathic scoliosis. These conditions tend to be less severe and more mobile, therefore easier to treat.

Is there an age limit to participate in the Schroth program?

Basically, there are no age limits for using this method, however, it is most effective during the growing phase of development. Bones in the growing period are less dense and more flexible making it possible to shape them. Schroth method utilizes specific muscle pull combined with special breathing techniques to mobilize the thorax into expanding or narrowing where needed. The earliest age to initiate the Schroth method is approximately at the age of 10 since an established body awareness should be present to start the active exercises. Before age 10, passive correction methods should be used to improve curvatures.

Scoliosis is a life-long condition however this doesn’t equal life-long therapy. Once the body and the brain are taught how to facilitate corrections, only regular yearly check-ups are required in addition to the home exercise program, which is gradually reduced to 3x per week or incorporated into other activities.

Once reaching adulthood, the focus is shifted to functional tasks along with a balanced amount of individualized, specific home exercises as well as sports and recreational activity. Schroth can also be initiated with adults at any age to provide education regarding each individual curve pattern and establish the specific exercise regime to prevent further progression of the curvature.

How much improvement is possible?

We do understand that clients and their parents wish for the greatest improvement in the shortest period of time. It is impossible to foresee the exact results with the therapy, however, it is proved that Schroth method could help to reduce the curvatures by an average of 10%. The results depend on the age, curve type, degree, severity and adherence to the personalized home exercise program. During Physical Therapy, we measure progression with a Scoliometer, an easy-to-use tool used to screen for changes. The more precise measurements are taken with X-ray and measured by Cobb-degree by the physician.

Is swimming helpful to prevent spinal deformities?

We are asked about swimming all the time! Swimming is good for spinal and peripheral joint mobilization, strengthening and endurance. However, with diagnosed scoliosis, a more tailored exercise program is required to prevent curve progression over time. Physical activities with a symmetrical, even load on the spine (running, biking, swimming) are recommended in addition to a personal home exercise program.

Is it possible to have scoliosis in adult life?

Adult scoliosis could be present due to many reasons:

  • Degenerative causes like osteoporosis with resultant spinal asymmetry
  • Secondary to Adolescent Idiopathic Scoliosis
  • Other orthopedic issues related to the spine

Schroth method could be an efficient treatment method to prevent further progression in these cases.

What does a treatment involve?

Each and every scoliosis is different in curve patterns, locations, severity and even compression types. As a result, treatments and exercises are different and individualized. Typically, manual techniques (joint and soft tissue mobilization, stretching) are combined with active Schroth exercises in each treatment session.

In the first few we put a great emphasis on rebuilding secondary spinal curves such as the lumbar arch or lordosis and the desired thoracic curve, since these curves are usually lost with scoliosis, and give the back a flattened appearance. Further sessions will incorporate more active corrections such as those pictured below which include breathing techniques as well as specific positions specific to each curve pattern.

 

For more information or to see if this technique is right for you, contact DTS where a Schroth certified therapist will be able to assist you.

Finding a Good Bike Fit for You

A proper bike fit will allow you to enjoy cycling while decreasing the chance of injury. The American Physical Therapy Association (APTA) makes the following recommendations for posture & fit:

Trunk Position & Shoulder Angle

  • For the recreational rider, trunk position should be 40-80° from horizontal and shoulder angle should be between 80-90°
  • For the road cyclist, trunk position should be between 30-40° and shoulder angle should be between 90-100°

Handlebars

Handlebar position will affect your hand, shoulder, neck and back comfort as well as overall handling.

  • For the recreational rider, the width should allow hands to be slightly wider than shoulders
  • For the road cyclist, hands should be approximately 2 cm wider than the shoulders

Knee to Pedal

The closer the angle is to 35°, the better the function and less stress on knee

  • For the recreational rider, the angle should be between 35-45°
  • For the road cyclist, the angle should be between 30-35°

Foot to Pedal

  • Position the ball of your foot over the pedal spindle for the best leverage, comfort & efficiency
  • A stiff soled shoe is best for comfort & performance

The Saddle

  • The saddle on your bike should be level – if the saddle tips downward, pressure will be placed on your hands & lower back
  • The saddle should also be a comfortable distance from the handlebars – too close, and extra weight will be placed on your mid-back and arms; too far away, and you may put extra strain on your lower back and neck

 

W Sitting & Why You Should Correct It

Many have heard the phrase “W sitting” and that it is “bad” for their child to sit this way. However, many are unaware of the reason that children are discouraged from sitting in this position.

First of all, what is W sitting?

W sitting is when a child is sitting on their bottom with both knees bent and their legs turned out away from their body. If you were to look at the child from above their head, his or her legs will be in the shape of the letter “W”.

Why is W sitting bad?

When a child “W” sits, it puts their hip joints into extreme internal rotation. This tightens the muscles on the inside and stretches the muscles on the outside of the hips.

Since everything is connected, what happens at the hips also affects the joints at the low back, knees and ankles.

  • This extreme rotation can cause a knock-kneed position and/or in-toeing of the feet.

The excessive stress and strain being placed on the hip and knee joint often result in increased risk of hip dislocation, long term leg pain and postural deformity.

The tightness in the hips also affects a child’s ability to sit erect in a chair or on the floor.

  • The legs are often wide apart and the heels lifted up to accommodate the tightness in the leg muscles, specifically the hamstrings. To accommodate the restricted hip movement the child tilts the pelvis backward and flexes the trunk.

W sitting makes it impossible for the child to shift their weight from one side of their body to the other, negatively impacting the strength of the outer hip muscles.

  • The ability to weight shift and build upon lateral hip musculature is especially important in standing and single limb balance and when developing the ability to run and jump.

W sitting does not allow the child to develop strong hip and trunk musculature.

  • In this position, the hip and trunk muscles are not challenged  and balance reactions are not incorporated.

Why do some kids sit like this?

It is the most stable way for children of all ages to sit because pelvis is relatively fixed and less muscle strength and control is needed to keep the trunk erect.

It has also been attributed to prolonged time spent in infant carrier devices.

  • i.e. swings, bouncy seats, car seats

Conclusion

Prolonged W sitting throughout childhood can lead to chronic hip and knee pain and a delayed development in gross motor skills such as coordination, balance and the ability to sit, walk and run with appropriate posture.

What can you do?

Make your child aware of this sitting position and remind he or she to avoid it.

Suggest other ways for your child to sit, such as:

  • long sitting, side sitting, crisscross sitting or sitting on a small bench

 

 

 

Running for a Cause.

This past Saturday, on September 16, 2017, some of our staff participated in Erika’s 5k Run. This is a local, annual event here in Merrimack that honors Erica Nicole Pombrio, and celebrate her life. Since 2010, the Erica Pombrio Foundation has brought Merrimack and surrounding communities together to honor and remember cancer survivors, co-survivors, and sadly those we have lost. These events continue to fulfill Erica’s wish to help those affected by cancer and let them know they are not alone in their fight! The proceeds from Erica’s Run and other fundraisers are donated directly to local families battling this disease. The foundation has raised over $120,000 in 7 years.

Please join us and help Erica’s friends and family fulfill a wish from Erica’s journal. If you would like to know more, participate, volunteer or donate, visit; www.ericasrun.com
Erikas Run Pic Collage
Pictured Left to Right: Jaime Bourgeois, Amanda Stuart, Lu Miller, Marie McGee, Diane Donahue

3 Times a Charm, a Personal Note.

Dear Family, Friends and Colleagues,

I would like to thank everyone who supported my ride in last years Pan Mass Challenge. Last year the riders in the Pan Mass Challenge raised over 50 million dollars to research and treat cancer through the Dana Farber Cancer Institute. I am very excited to be riding for the third time this August, although it will have a different feel without the whole of Team Emma.

Emma will be shining her light on us from above this year as this was her favorite event and I know she will be somehow present. I am even more committed to riding to do my part to raise money to treat Pediatric Low Grade Astrocytoma.

So on the first weekend in August, I will join 6,200 cyclists in the PMC ride, an annual bike-a-thon that raises money for research and care at Dana-Farber Cancer Institute (DFCI) in Boston.

And because every penny matters, 100 percent of your donation goes to DFCI, with our teams fundraising going directly to the Pediatric Low Grade Astrocytoma Program.

I’ve made a personal commitment to ride and raise $4000. I hope you can help me achieve this significant goal. Please donate to PMC ride by going to pmc.org

If you prefer to write a check, please make it out to the PMC, The Jimmy Fund or Dana-Farber Cancer Institute and mail it to me directly at:
Venetia Reilly, 40 Buttonwood Lane, Ipswich MA 09138.

Thank you for your anticipated support! UPDATE!! $200 away from GOAL!!

Children’s Higher Physical Activity Levels Associated with Decreased Depression

ChildrenPlayingOutside
Pediatrics published a meta-analysis on the association of children’s physical activity levels in childhood and adolescence with depression. Fifty studies (89,894 participants) were included from 2005-2015 that measured physical activity in childhood or adolescence and examined its association with depression. The results indicated that stronger effect sizes were seen in studies with:

  • Cross-sectional versus longitudinal designs
  • Using depression self-report versus interview
  • Using validated versus non-validated physical activity measures
  • Using measures of frequency and intensity of physical activity versus intensity alone

The researchers concluded that children’s higher physical activity levels are associated with decreased concurrent depressive symptoms although the association with future depressive symptoms is weak.

Reference: Korczak, D.J., Madigan, S., & Colasanto, M. (2017). Children’s Physical Activity and Depression: A Meta-analysis. Pediatrics, e20162266.

Your Therapy Source, Inc. Web Link: Children’s Higher Physical Activity Levels Associated with Decreased Depression

Permission granted by: Your Therapy Source, Inc. 4/2017

Keeping Up-to-date & Informed

Lu and Venetia attended the annual American Physical Therapy Association’s Combined Sections Meeting which was held in San Antonio, Texas, February 15-18. This national conference provides an opportunity for therapist to hear the most current, evidence based treatment strategies, testing tools and new to the market equipment relevant to our practice. Some of the top experts in their field were present and participated through many collaborative panels.
Lu and Venetia attended courses from many different sections to include Neurology, Pediatrics, Sports Medicine and Orthopedics. The following lectures were attended and all information will be shared with the staff through direct in-servicing and practice of new treatment techniques.

Promoting Motor Function in Children with Cerebral Palsy
Learning from Each Other: Sports and Neurology Sections Discuss Motor Learning
The ACL Injury from A to Z
Mechanical Lifts in Schools: Who? When? Why? What? Where?
Finding the Sweet Spot: Managing Load and Recovery Following Knee Joint Injury
More than a Diagnosis: A Clinician’s Guide to Managing the Injured Runner
Braking Bad: Eccentric Control from Talking to Walking
Hip Instability: Mechanism and Management of the Unstable Hip
Update on Minimalist Footwear
A New Etiology in Ankle Instability
Sports Medicine Secrets: Aberrant Spinal Movements in the Rotational Athlete
Update: The Pediatric and Adolescent Hip
Managing the Recreational Runner from Head to Toe
Update on Hamstring Strain: Mechanisms and Rehab

Lu and V CSM 2017

Jingle, Jingle, Jingle.

Jingle, Jingle, Jingle….no it’s not that time of year just yet but our staff was out this past Saturday participating in the Santa Fund Run.
The Santa Fund Run gathers generous donations from local residents to share with those less fortunate. All net proceeds from the race benefit the Santa Fund which is in its 55th year! Here’s to our wonderful reindeer, I mean staff; Leah Daigle (husband, Warren and son, Noah), Diane Donahue, Lu Miller and Venetia Reilly.

collage-2016-10-26-13_59_57

For more information or how you can donate please visit;
www.nashuatelegraph.com/santafund#SantaFundRun