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10/14/20: Managing Stress and Anxiety Virtual Session

On October 14th at 11AM, we welcome you to join a virtual session on managing and anxiety with Mark Karolkowski, OT. This session is available to the public.

This virtual event is sponsored by the International Association of Rehabilitation Professionals – Chesapeake, and the Maryland Joint Task Force for Injured Workers.

We’re excited for this event and hope you’ll join us!

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8/11/20: Desk Ergonomics & Stretches for Everyday Virtual Session

Join Matt Drzik of REHAB AT WORK Tuesday, August 11th, 2020 at 10 AM for a virtual session on Desk Ergonomics & Stretches to help you better transition to the Work From Home lifestyle. This event is hosted by REHAB AT WORK, Comp-X Medical Management, and Titan Investigative Alliance, LLC.

We hope you’ll join us for this virtual session, and we look forward to seeing you there!

When the session begins on 8/11/20 at 10 AM, please click here to join.

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Can A Bad Night’s Sleep Be Linked To High Blood Pressure?

Recent research shows that getting poor sleep can lead to a spikes in blood pressure. In our clinics, we routinely screen our patients for blood pressure, whether it’s for a physical or occupational therapy evaluation or an FCE or every day in a work hardening program. It’s quite alarming to see that a growing number of our patients are found either to have known hypertension for which they take medication or have no idea that they have hypertension only to be discovered by our screening. We have used patient education materials about the importance of getting proper sleep for years mainly to discuss how it can help manage the symptoms of chronic pain. Now we know that getting proper sleep may also help with the management of blood pressure.  In fact, researchers in this article suggest that there are probably a host of other health issues related to getting poor sleep. See the link below for a summary of their research findings, and get an answer to can a bad night’s sleep be linked to high blood pressure?

Sleepless Nights Linked to High Blood Pressure

Date:

June 4, 2019

Source:

University of Arizona

Summary:

A bad night’s sleep may result in a spike in blood pressure that night and the following day, according to new research led by the University of Arizona. The study, to be published in Psychosomatic Medicine, offers one possible explanation for why sleep problems have been shown to increase the risk of heart attack, stroke and even death from cardiovascular disease. 

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FULL STORY

A bad night’s sleep may result in a spike in blood pressure that night and the following day, according to new research led by the University of Arizona.

The study, to be published in the journal Psychosomatic Medicine, offers one possible explanation for why sleep problems have been shown to increase the risk of heart attack, stroke and even death from cardiovascular disease.

The link between poor sleep and cardiovascular health problems is increasingly well-established in scientific literature, but the reason for the relationship is less understood.

Researchers set out to learn more about the connection in a study of 300 men and women, ages 21 to 70, with no history of heart problems. Participants wore portable blood pressure cuffs for two consecutive days. The cuffs randomly took participants’ blood pressure during 45-minute intervals throughout each day and also overnight.

At night, participants wore actigraphy monitors — wristwatch-like devices that measure movement — to help determine their “sleep efficiency,” or the amount of time in bed spent sleeping soundly.

Overall, those who had lower sleep efficiency showed an increase in blood pressure during that restless night. They also had higher systolic blood pressure — the top number in a patient’s blood pressure reading — the next day.

More research is needed to understand why poor sleep raises blood pressure and what it could mean long-term for people with chronic sleep issues. Yet, these latest findings may be an important piece of the puzzle when it comes to understanding the pathway through which sleep impacts overall cardiovascular health.

“Blood pressure is one of the best predictors of cardiovascular health,” said lead study author Caroline Doyle, a graduate student in the UA Department of Psychology. “There is a lot of literature out there that shows sleep has some kind of impact on mortality and on cardiovascular disease, which is the No. 1 killer of people in the country. We wanted to see if we could try to get a piece of that story — how sleep might be impacting disease through blood pressure.”

The study reinforces just how important a good night’s sleep can be. It’s not just the amount of time you spend in bed, but the quality of sleep you’re getting, said study co-author John Ruiz, UA associate professor of psychology.

Improving sleep quality can start with making simple changes and being proactive, Ruiz said.

“Keep the phone in a different room,” he suggested. “If your bedroom window faces the east, pull the shades. For anything that’s going to cause you to waken, think ahead about what you can do to mitigate those effects.”

For those with chronic sleep troubles, Doyle advocates cognitive behavioral therapy for insomnia, or CBTI, which focuses on making behavioral changes to improve sleep health. CBTI is slowly gaining traction in the medical field and is recommended by both the American College of Physicians and the American Academy of Sleep Medicine as the first line of treatment for insomnia.

Doyle and Ruiz say they hope their findings — showing the impact even one fitful night’s rest can have on the body — will help illuminate just how critical sleep is for heart health.

“This study stands on the shoulders of a broad literature looking at sleep and cardiovascular health,” Doyle said. “This is one more study that shows something is going on with sleep and our heart health. Sleep is important, so whatever you can do to improve your sleep, it’s worth prioritizing.”

Story Source:

Materials provided by University of Arizona. Note: Content may be edited for style and length.

Journal Reference:

  • Caroline Y. Doyle, John M. Ruiz, Daniel J. Taylor, Joshua W. Smyth, Melissa Flores, Jessica Dietch, Chul Ahn, Matthew Allison, Timothy W. Smith, Bert N. Uchino. Associations Between Objective Sleep and Ambulatory Blood Pressure in a Community Sample. Psychosomatic Medicine, 2019; 1 DOI: 10.1097/PSY.0000000000000711 

REHAB AT WORK has clinics located across Maryland, Virginia, and the DC area. Contact us to learn about our physical therapy services, or refer a patient to our clinics.

Guy Seeley, PT

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Rehabilitation Management of Soft Tissue and Fracture After Trauma or Surgery: Principles for Improving Functional Outcomes

Phases of Soft Tissue Healing-Intervention 

Inflammatory Phase:  Immobilizing splint or sling may be used to protect tissue.  (2 days to 1 week)

Fibroblastic Phase:  Splint or device may be used to allow protected mobility.  This allows the healing tissue to strengthen while minimizing the negative effects of scar adhesion with the surrounding tissue. Passive Range of Motion is provided in the direction of the injury (Active concentric movement is minimized so as not to disrupt the repair).   Light resistance or dynamic pulleys may be used in the direction away from the injury.  This will allow eccentric recruitment of the injured tissue and helps improve the long term tensile strength of the repair.  Active assisted and place and hold exercise are graduated to active and resisted exercise by the end of the phase (up to 8 weeks post surgery). Pressure applications may help to control scar development.

Maturation Phase:  Healing tissue is strong; however, there may be hypertrophic scar due to tissue density (increased molecular bonds) and disorganized collagen fibers.  Splint or device may be used to provide low load stretch (static progressive splint or serial casting).  This would coincide with manual soft tissue and joint mobilization along with progressive strengthening and activity.

Note:  During the Fibroblastic phase, it is important to initiate controlled movement as soon as possible. Protocols are established for various injuries and surgical repairs.  Frequency of therapy will depend on the patient’s pain levels and/or ability to comply with a home exercise program to provide early gliding of the tissues. Frequency may also be governed by the size of the involved joints.

During the late Fibroblastic and Maturation Phase, therapy should be more frequent (depending on patient compliance) and it should be progressive.  The emphasis is on specific adaptation to imposed demand (SAID).  Respect should be given to pain so as not to disrupt the healing tissue or develop a secondary inflammatory response (which will perpetuate the scarring effect).  Anti-inflammatory medication and physical agents may be necessary to control inflammation.  Manual therapy is a very important intervention during this phase for soft tissue management and to reestablish joint balance and muscle length-tension. Again, care should be taken not to be too aggressive. The requirement for aggressive manual therapy should be minimized by the proper implementation of movement during the 2nd phase of healing. The patient’s compliance with a home exercise program for flexibility and gradual strengthening is very important.  Research indicates a direct correlation with low load total end-range time (TERT) and the effect of lengthening and modeling scar tissue.  

Phases of Fracture Healing

“Movers” versus “Resters” Fractures that are closed, relatively non-displaced and stable can be managed by protection without reduction or immobilization. Fractures that are non-displaced but are unstable or load bearing require immobilization such as a cast or fracture brace.  Open reduction is required when bone fragments cannot be approximated through closed reduction alone and internal fixation devices are then used.  

With immobilization by cast there is slight movement of the fracture sight and immature woven bone or external callous forms first as the bone consolidates and remodels.  When external callous forms first, more healing time may be required. A bone healing stimulator may be used.

With internal fixation, direct healing occurs and may be faster depending on the nature of the fracture and the number of fragments.  

Fracture Healing estimated time tables according to Apley and Solomon (1994)

Upper limb Lower limb

Callus visible: 2-3 weeks 2-3 weeks

Union: 4-6 weeks 8-12 weeks

Consolidation: 6-8 weeks 12-16 weeks

Immobilization or Early Mobilization Early mobilization treatment programs have specific focused protocols which govern timing type and quantity of desired movement. Advancement is determined by the stability of the fracture and radiographic indication of fracture healing.  Any immobilizing device should be monitored for signs of adverse response such as constriction of circulation or skin breakdown. Hinged splinting may be used to allow some restricted movement of a joint.  Care must be taken to preserve joint function above and below the fracture site. Co-contraction of the muscles isometrically across the fracture site is encouraged to facilitate circulation and bone healing.

Early Consolidation Therapy begins to focus on active use of the effected limb.  Active therapy may include specific resistance training as well as activities and tasks designed to remediate the muscles of the injured region.  There is continued focus on edema control and soft tissue management in the adjacent regions.  If there are changes in body posture or compensatory movement patterns these must be addressed.  Adherent or hypertrophic scar should be treated as previously described. Increased Muscular activity will help with edema control and the scar modeling.

The Final phase:  Once the orthopedic specialist gives clearance, Physical or Occupational Therapy should include activities to reintegrate the injured extremity to the body scheme and to condition the individual for specific ADL, IADL and vocational tasks. This allows intrinsic recovery of function and neurological relearning. Whole body exercise and activity should be incorporated to reverse any deconditioning that occurred during the convalescent period.  Sufficient data may be gleaned from the measurement of function and performance during this time in the program.  A Functional Capacity Evaluation may be necessary to determine job readiness and placement.  

Additional resource: Occupational Therapy for Physical Dysfunction 6th Edition 

If you need assistance with soft tissue rehabilitation management, contact the team at REHAB AT WORK today to schedule a consultation, or refer a patient for our services.

Richard Wilson, OTR

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Snow Shoveling: Does the Shovel Matter?

Here in the northeast the winter season brings new fashion trends, warmed beverages, ice skating, freezing temperatures, and ultimately snow. While all sorts of fun activities can come with snow (building snowmen, snow forts, sledding, etc.), it is inevitable that someone or something will need to shovel that snow off driveways, sidewalks, and streets. We often hear about how we should shovel snow, being mindful of our body mechanics and taking rest breaks throughout the process to protect our backs and joints, but is there anything else we can do (other than outsourcing the work J)? Our mechanics and pacing our activity are both vital to remaining unscathed when shoveling snow, but what if we went a step further and took a closer look at the equipment or tools we choose to use? Could the right equipment help us work smarter not harder?

Check out this article from Science Direct that explores these questions further.

If you’ve suffered an injury that needs to be rehabbed, contact the team at REHAB AT WORK to schedule a consultation.

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Carpal Tunnel Syndrome

Carpal tunnel syndrome is the result of median nerve compression in the carpal tunnel.  This is a relatively common nerve entrapment syndrome that can be associated with wrist pain and tingling, burning or numbness involving the palm side of the thumb, index, middle and half of the ring finger (see diagram above).  Carpal Tunnel symptoms can arise from highly repetitive use of the fingers. Typically, this results in tendonitis of the 9 tendons that pass through the carpal tunnel with the median nerve. This, in turn, can cause swelling and possible scar formation within the canal, compressing on the nerve.  The disease can also be the result of direct compression to the wrist and base of the hand or due to (repetitive) exertion of forces through the wrist and hand particularly from awkward wrist and hand postures. 

There have been limited studies to compare the work versus non work-related origins of the condition which may have had a negative effect on prevention efforts.  It is important to report symptoms and seek treatment early as this will increase the success of non-surgical intervention. Some businesses have access to an ergonomist or someone who may be able to customize your work station and recommend modifications to minimize physical stress factors. 

Your doctor may refer you to an occupational or physical therapist.  Your therapist should gather a detailed personal history including your vocational and avocational routines and interests.  It may become important to keep a diary of the activities that provoke your symptoms.  Anti-inflammatory drugs, ice or other physical agents may be used to calm down the physiological symptoms. Exercises for wrist/forearm, including wrist stretches, finger tendon glide and median nerve glide will help control progression of symptoms and can be incorporated into routine stretch breaks at work. Sometimes splints are used to rest the wrist (for nighttime use only).  The therapist can review work or leisure activity, assess risk factors and make recommendations for engineering modifications or personal protective equipment.  

Additional medical intervention may be deemed necessary (usually based on nerve study findings).  These interventions will be provided through a physician.   

If you suffer from carpal tunnel syndrome, it’s important to consult with professionals about further treatment. The team at REHAB AT WORK is here to help you through the steps of treatment if a physician determines that is the right path for you. Contact our team today to learn more.

Richard Wilson, OTR

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Is Your Smartphone a Pain in the Neck?

Smartphone technology continues to change the way we live our lives. We carry a device that allows us to communicate with friends and family around the world, receive up to the minute news, watch a movie while travelling, answer emails at 3 AM, as well as share our favorite Grumpy Cat memes! At times though, you can’t help but wonder if your smartphone is a pain in the neck?

All of this convenience takes its toll on our bodies. Just as the early 20th-century invention of the electric typewriter introduced us to carpal tunnel syndrome, and the late 20th-century release of the modern cell phone brought us BlackBerry thumb, daily use of cell phones, tablets, laptops, and computers are ushering in the era of new head, neck, shoulder, and back problems.    

In 2014, Kenneth Hansraj, MD, an orthopedic surgeon in New York, released the study “Assessment of Stresses in the Cervical Spine Caused by Posture and Position of the Head” in Surgical Technology International.  The study concluded that “the weight seen by the spine dramatically increases when flexing the head forward at varying degrees. An adult head weighs 10 to 12 pounds in the neutral position. As the head tilts forward the forces seen by the neck surges to 27 pounds at 15 degrees, 40 pounds at 30 degrees, 49 pounds at 45 degrees and 60 pounds at 60 degrees”.  

Lee, Kang, and Shin’s article “Head Flexion Angle While Using a Smartphone”, published in 2015 in the Journal of Ergonomics, found that “participants maintained head flexion of 33-45° from vertical when using the smartphone. The head flexion angle was significantly larger for text messaging than for the other tasks, and significantly larger while sitting than while standing”. This position results in neck and shoulder musculature sustaining a head weight equal to 40 to 49 lbs. 

Prolonged and repetitive use of this posture leads to changes in muscles of the neck, shoulder, and chest that are known as Forward Head Posture (FHP), or Upper Crossed Syndrome (UCS). First, the upper muscles at the back of the head and neck become extremely strained and overactive. When these muscles are overactive, the surrounding counter muscles are underused and become weak. Then, the muscles in the front of the chest become tight and shortened. The overactive muscles and underactive muscles can then overlap, causing an X shape to develop. In addition to face and neck pain, these issues can progress to include sleep apnea, teeth clenching, difficulty swallowing, changes in balance, and migraine headaches.

So, what can you do about this? Below are listed a few general tips to reduce or prevent the onset of FHP/Upper Cross Syndrome. 

  • Avoid using smartphones, tablets, or laptops for long duration tasks such as editing documents, researching topics, or watching movies.
  • Bring your device up to eye-level for use.
  • Change positions every 15-20 minutes to reduce muscle fatigue and stress.
  • Use hands-free voice activated speech options when texting or sending emails from your phone. 
  • Utilize proper ergonomic desktop computer set-up.  

Is your smartphone a pain in the neck? Personal consultation with a trained Physical Therapist will allow for a customized approach to address specific muscular, postural, and ergonomic concerns associated with your pain. Contact the team at REHAB AT WORK today to learn more, or refer a patient for our services.

-Karla Alberti, Physical Therapist, REHAB AT WORK

Studies Cited: