My Face Mask Routine During COVID-19
This is my new morning ritual during the COVID-19 pandemic — I drive to my office (I am still considered essential) and park (street parking has been wonderfully available). I don my well-worn surgical mask and walk into WWSPT where I undergo symptom screening and a temperature check. Then, I promptly wash my hands and get my computer ready for my patients for the day. All-day long I wear the mask and wash my hands frequently, all this I to prevent the spread of any infection.
Likewise, when I go to the grocery store and the hardware store, I sport my mask. If I jog or walk, I have it with me, just in case I encounter others on the empty routes I usually choose. I cannot, however, exercise for long within its confines, so when outside for a walk I don’t wear my mask but have it with me. Overall, it is a small inconvenience.
A brief evidence review for the use of face masks while in public provides some useful insights as well as underscores the limits of our knowledge.[1] Despite the high frequency of respiratory virus infection across humankind and the low cost of masks, there is a dearth of good studies on face mask use (this is in some ways a commentary on our collective priorities). From five systematic reviews that have been published and two pre-print systematic reviews, one can glean the following:
- There is an abundance of poor-quality studies
- Masks may be superior to no masks in the general public during an influenza epidemic
- Masks were worn less than 50% of the time by people assigned to wear masks
- There is some efficacy if worn by symptomatic individuals
- There is a need for high-quality randomized controlled trials
Justifications for not wearing a mask in public include the limited assessments of effectiveness, the likelihood that they are not worn properly or consistently, the possibility that wearers may feel protected and avoid other public health interventions, and the need to reserve masks for healthcare workers. I wear my mask to protect my self and my patients so I can feel that I can safely provide physical therapy care. I believe it is a simple but again sometimes inconvenient this I can do.
In this review, the authors invoke the precautionary principle in approaching an issue of potential harm when scientific knowledge is lacking. In other words, when it comes to using a simple and cheap intervention that may be effective, they suggest wearing a face mask in public.
Given the thinness of the evidence and my penchant for an evidenced-based approach, why have I adopted a new ritual? I think that there are actually three reasons. First, I do so out of respect for, and in solidarity with my front-line colleagues who depend on PPE for their safety and that of their families. Second, when out and about in my small town, I see myself as a role model for good social behavior. Finally, like the authors, I believe in the precautionary principle when it comes to this strange and frightening virus. What do I have to lose?
Wendy Webb Schoenewald. PT, OCS
Mothers Are Strong
I’ve been thinking about pregnancy lately. Maybe it’s because Mother’s Day was last month, my amazing wife gave birth to our son this past February, and I have a few friends and relatives who just had kids or are currently pregnant. I have not had any direct, personal experience of pregnancy or birth and so I don’t consider myself an expert by any means. But I do have experience as a husband, father, and physical therapist helping people deal with pain during and after pregnancy. As any mother knows, pregnancy, birth, and motherhood do not come without some degree of challenge and pain. Thankfully, there are ways of coping with and many times improving these pains through physical therapy.
The human body is amazingly adaptable to be able to grow, carry, and deliver a baby. Many changes occur during pregnancy, birth, and then after. The added weight to the belly changes a woman’s center of mass and may pull differently on her low back and hips. Swelling in hands can cause conditions such as carpal tunnel syndrome. Near the end of the first trimester, the hormone aptly named “relaxin” starts circulating making ligaments slightly looser, in preparation for ligaments and joints in the pelvis to stretch slightly during labor. This is thought to contribute to various joint pains.
When my wife was pregnant with our first child, she had pain in her low back and deep in the back of her hip which made walking painful. Thankfully, a specific manual technique that I had just learned in PT school at that time was super effective and took away her pain with walking entirely!
I do want to be clear that in the short term just after delivery and after clearance from a medical provider, it is most appropriate for women to see a women’s health specialist include pelvic floor rehabilitation, regardless of the type of delivery or complications. At WWSPT, we often see women (and spouses!) who have developed pain related to lifestyle changes and weakness after pregnancy and birth which we can address whether you are 6 months or 16 years out.
Some mothers have pain during pregnancy or after giving birth which never fully resolves on its own. I treated one mother for knee pain who told me that her “whole left side felt off” ever since she had her son 2 years before. We discussed when she experienced her pain and it appeared that her pain was exacerbated by repetitive bending to pick up her son and possibly related to always carrying him on one side of her body. She used to exercise, but naturally, since giving birth she had been sitting more and bending over more frequently. She was referred to me for knee pain because her knee felt weak and painful with these bending motions, but a thorough movement examination revealed that her pain was actually coming primarily from her lower back. She responded well to specific exercises for her lumbar spine and we also worked on proper bending and lifting form, especially the use of a hip hinge, in conjunction with strengthening her legs and core so that she could lift and carry her two years old son without any pain. Anyone who has lifted a pudgy two-year-old out of a crib knows that this movement takes some strength!
There is one condition where some of the abdominal muscles (your “abs”) separate a little bit from the expanding belly. This is called “diastasis recti abdominis” and it affects around 60% of women after birth (an example of one study here)[1]. This condition can coincide with pelvic or low back problems or maybe more of aesthetic concern for some women. The recovery from a C-section may also affect the strength of the core muscles. I have heard a few mothers who I have treated for low back pain tell me that they aren’t allowed to do core exercise because they had diastasis recti or a C-section. I would like to dispel this myth. While there may be short term precautions to take as you recover, core exercise is actually what is needed to improve the strength of the 4 layers of core muscles you have. A physical therapist can help you safely exercise these muscles and progressively strengthen them without injuring yourself.
What about partners? I have treated fathers who, despite not physically carrying their child for 9 months or actually giving birth, happened to put on a lot of weight and become less physically active once they had kids. This is completely understandable. Suddenly, your sleeping and eating schedules change and you are busy learning how to keep your children alive and well. I often hear mothers and spouses say that they “used to exercise but haven’t really exercised since having kids” and I can personally relate to this. Often, a lack of exercise is part of the problem, and finding specific exercises to address strength and mobility issues is part of the solution.
Pain during or after pregnancy is common and there is something that can be done about it. Just as the body adapts for pregnancy and the demands of labor and subsequently taking care of a child, the body can make changes so that you can do more and avoid being in pain. Whether you are dealing with hip or back pain during pregnancy or just trying to pick up your son without knee pain, there is a lot a physical therapist can do to help you move better with less pain.
[1] Sperstad JB, Tennfjord MK, Hilde G, et alDiastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors, and report of lumbopelvic pain British Journal of Sports Medicine 2016;50:1092-1096.
When’s the right time to see a PT?
Time to see a Physical Therapist, PT?
By Dr. Greg Synnestvedt PT DPT
Have you ever had physical therapy? Some people picture typical physical therapy as the rehabilitative process that a person goes through after joint replacement surgery. While this is one important time to participate in therapy, most people in a physical therapy clinic are coming for very common pains. The most common areas people seek PT for are 1) low back pain 2) shoulder pain and 3) knee pain. There are also people who are not in any pain at all (lucky them!) but want to improve their balance, walking, mobility, or ability to do daily tasks.
When is the right time to see a physical therapist? If you are trying other treatments for an ache or pain, it is worth seeing a physical therapist to get their opinion before going to other specialists. A recent study found that seeing a physical therapist first for low back pain reduced the overall healthcare costs and also reduced the chances of opioid prescription down the road. Whoever you see first in the healthcare system has a large impact on your path through the system—this is not the way it should be, but this is how it is. You can see a physical therapist with a direct access license for 30 days before requiring a referral from your physician, and this could give you enough time to see that you will be okay without an injection, procedure, or expensive MRI right off the bat. If your physical therapist thinks that your situation requires your physician’s attention, they will refer you to the physician for consultation.
A similar study to the one mentioned above found that early physical therapy for people with neck pain reduced the rate of imaging, opioid prescriptions, and overall costs. Early was defined as people who saw a physical therapist within 3 months. If you have an issue for more than a few weeks that isn’t getting better, it could be useful to consider trying PT.
As patients, we usually seek the “silver bullet” treatment, though this rarely exists. Ture healing and improving are nearly always processes involving time and effort. Take, for example, knee pain from arthritis, which is a very common problem. The clinical practice guidelines put out by the Academy of Orthopedic Surgeons recommends physical therapy as a primary treatment for knee arthritis, with strong evidence. Despite this recommendation, non-recommended treatments such as hyaluronic acid injections, corticosteroid injections, and opioids remain among the most commonly utilized treatments for patients in the year leading up to joint replacement (Bedard et al., 2017). This study estimated a 45% healthcare savings if only the recommended treatments were used. This is not to say that injection is never useful, but that it is worth trying physical therapy.
As a patient, you are your best advocate. If you have a joint or muscle pain or difficulty moving, ask your doctor for a referral to physical therapy and see what PT can do for you.
Bedard, Nicholas A., et al. “The AAHKS Clinical Research Award: what are the costs of knee osteoarthritis in the year prior to total knee arthroplasty?.” The Journal of arthroplasty32.9 (2017): S8-S10.
1: Frogner BK, Harwood K, Andrilla CHA, Schwartz M, Pines JM. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health Serv Res. 2018 Dec;53(6):4629-4646. DOI: 10.1111/1475-6773.12984.
Epub 2018 May 23. PubMed PMID: 29790166; PubMed Central PMCID: PMC6232429.
Horn, Maggie E., and Julie M. Fritz. “Timing of physical therapy consultation on 1-year healthcare utilization and costs in patients seeking care for neck pain: a retrospective cohort.” BMC health services research 18.1 (2018): 887.
Study: Seeing a PT First for LBP Lowers Overall Costs, Reduces Chances of Later Opioid Prescription
https://www.apta.org/PTinMotion/News/2018/05/24/PTFirstForLBP/
Study: Early Physical Therapy for Neck Pain Associated With Lower Imaging Rates, Opioid Prescriptions, and Overall Cost
https://www.apta.org/PTinMotion/News/2018/12/04/EarlyPTNeckPain/
How much does exercise help a body?
Let’s count the ways the body benefits with exercise:
Before starting an exercise program, especially if you have been sedentary, (a couch potato), consult a doctor to make sure you do not have any underlying conditions that could be a problem. Once you have been cleared, commit to an exercise program, start slow and gradually increase intensity. Make exercise a priority, maybe get a buddy to make it more enjoyable as well as accountable, then pick the days and times you will exercise and stick to it for life. I personally prefer to work out first thing in the morning, then there are no excuses. Workout/exercise three to five times a week, by six weeks, you should notice a positive difference in how you feel. At first you may experience some soreness, but all that means is you are working your body in ways it is not used to, which is great!
The benefits of exercise include but are not limited to the following: Improved sleep, improved gastrointestinal motility, improved brain function, more energy, stronger heart and lungs, stronger bones and muscles, improved posture, better balance, improved mental state, etc. The list goes on and on. Pick an activity you like and stick to it, or mix it up, just do something!
Some examples of great exercise include walking, swimming, dancing, biking, yoga, weight lifting, circuit training, Tai Chi, martial arts, boxing, gardening, hiking, etc. Again, the list is endless. The best exercise/activity for your body is the one you will do. – commit to doing. The body was meant to move, so move it. Right now there are more opportunities to exercise for people of all ages, so take advantage of them. Groups are great because they add a social component, which adds to the fun and accountability. The better shape you are in prior to an injury or illness, the better you are able to deal with and/or recover from it. George Bernard Shaw once said: ”We don’t stop playing when we grow old, we grow old, when we stop playing.”
A physical therapist can help you get moving again, especially if you have any problems with your balance, joints, muscles, or endurance, that keep you from participating in various activities with confidence. So, the best exercise/activity is the one you will do. The body was meant to move, so move it.
As always, check with your doctor first, then get moving, and get more out of life!
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