Peer Review Feedback | Ultrasound | Flexibility (Anatomy)

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Ross Owens Malcolm Campbell English 1103 8 November 2012 Journey Through the Benefits and Works of Physical Therapy

Physical therapy is one of the fastest growing jobs in the United States today due to the aging baby boomers. The goal of treatment is to help people “restore [their] activity, strength and motion following an injury or surgery.”(Cluett) These are not the only reasons I became interested in physical therapy. As I grew, I began to have shoulder pain due to acute scoliosis and weak stabilizer muscles connected to my shoulder blade. I went to a physical therapist to get the pain under control. After this firsthand experience with the occupation, I became interested. Soon I began to seriously consider physical therapy as my career choice. This assignment has given me the perfect opportunity to delve deeper into the career field that will become my future. I will now take you with me on this journey to discover the treatments used in physical therapy and how they work. Physical therapy is a fairly broad field. There are physical therapists that work in retirement homes, focus on sports injuries, and focus on surgery recovery. Even though some are more specialized, all therapists start to help their patients in the same way. First they must “identify deficiencies in the biomechanics of the body.” (Cluett) By identifying these deficiencies, the main area of focus can be determined along with the best method of treatment. Some treatments are more routine than others such as treatments that are recommended after surgery. These are more routine because the same procedures usually require the same treatment

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after the surgery but some people don’t recover from operations as quickly as others. This means that physical therapists need to be “knowledgeable about [the] body's limitations after surgery and can help ensure a successful outcome.”(Cluett) If a therapist sets up a regimen of exercises that is too strenuous, then there is a risk that damage will occur that will reverse the surgery. When someone needs physical therapy that has not had surgery, recommending exercises is a little bit more difficult. When someone comes in complaining about pain, like in my case, the therapist looks at the type of pain, the location of pain, patient history, activity level, and a few other things to figure out what is wrong. After that, the patient is guided through a series of treatments. I was given a series of strengthening exercises and stretches to do. These were the best things for me to do because I needed to strengthen the stabilizer muscles, muscles that hold things in place, and relieve tension in my back. Stretching and strengthening aren’t the only treatments used to help patients. Dynamic exercises, ice application, heat application, therapeutic ultrasound, and electrical stimulation are also used for various problems. Stretching is among a therapist’s most useful tools. By stretching you are applying stress to specific muscles and tendons. When you stretch over a period of time, your body reacts by increasing the length of muscle and tendons. This increased length increases flexibility and range of motion. Flexibility allows you to get into positions more comfortably. Flexibility also increases you muscle’s efficiency so it boosts your endurance slightly. Stretching also increases blood flow to muscles.(Inverarity) This increased circulation also enhances efficiency by getting rid of waste from muscle cells, carbon dioxide and lactic acid, faster. The increased circulation also decreases recovery time for muscle injuries. This is quite useful for most injuries therapists see. The next benefit is good posture. Inverarity says that good posture “can minimize discomfort and keep aches and pains at a minimum.” The discomfort that comes from bad posture is caused

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by overworking muscles that don’t work as hard when your posture is good. If you take that and turn it around, you will realize that good posture lets those muscles relax so that they don’t cause pain or discomfort. Aside from the physical effects of stretching, there is also a mental benefit. Stretching has been found to relieve stress by loosening tight muscles accompanied with stress. (Inverarity) The direct benefits of stretching are great but stretching also enhances coordination and balance. This leaves you less prone to future injury, especially in the later years of life. (Inverarity) All of these benefits are somewhat familiar to me but I had no idea that I was missing on them. I was missing out because stretching is almost useless if you don’t warm up your muscles beforehand. (Inverarity) With these benefits in mind, I have come to believe that stretching is one of the most important things to do to stay healthy and injury free. Sadly, it is often overlooked or not taken as seriously as it should be. After your therapist has finished their evaluation, they may determine that you need to undergo strength training. This training may target specific muscles that are not used enough as it was in my case. During these exercises, core strengthening and dynamic exercise are also incorporated because of their many benefits. Core strengthening improves balance, increases stability, and decreases risk of injury.(Komaroff) Core strengthening is not easy because of how many muscles make up the core and because most people don’t have a strong core. The core muscles are made up of all four abdominal muscles and many of the muscles in your back. All these muscles can generate a lot of power as well because they are found so close to your center of gravity. The movements start at the core and work their way up or down so most movements involve using your core. Core strength may improve power but it also improves posture and back health. Further research on good posture told me that it allows one to breathe more deeply. (Komaroff) Strength training is very useful for relieving pain and recovering from surgery but

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core strengthening’s benefits are often a bonus when you are done with your therapy. Another bonus that comes from the exercises comes from using dynamic exercise. Dynamic exercise is multiplanar so it focuses on balance. Therapists work on balance by getting you to work on the muscles that need attention while doing something that involves balance. That could be lifting a weight while one of your feet is on a partially deflated ball or jumping on a piece of specialized equipment. Dynamic exercise also has benefits such as more balance and decreased risk of injury.(Babiarz) I had my fair share of core strengthening and dynamic exercise when I was in physical therapy. I had to do back exercises and do another exercise that involves putting my feet on the ground and my chest on a ball while I lifted weights with my arms; it’s harder than it sounds. Dynamic exercise and core strengthening intertwine because having a strong core makes balancing easier so patients get a double dose of core strengthening. With the benefits from these added exercises, patients are less likely to need to go back to a physical therapist. That may not be good for business, but the therapists want to help their patients so they are willing to do that. Ice and heat application are often some of the first treatments used after an injury has occurred. This is very familiar to me because I live an active lifestyle. There have been few weeks when I’m not sore from exercise or bruised so I know how to deal with it. People often make the mistake of applying heat to sore or bruised areas because it relieves tension and makes the area feel better. This does nothing for muscle recovery in the first few days and it actually makes bruises bigger. If you want to get rid of soreness and bruises quickly, then ice application is the way to go. The affected area should be iced around two times a day but not for too long because that creates a chance for nerve damage or frostbite. When ice is applied, blood vessels constrict, inflammation goes down, and cell metabolism slows down. That is why ice is good for treating bruises. Bruises are cause by blood cells that leave blood vessel due to damage caused

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by some sort of trauma. These blood cells become visible if they are in the skin or shallow enough to be seen. When ice causes the blood vessels to constrict, fewer blood cells are let out because of the decreases blood flow. This prevents the bruise from getting as big as it would have without ice. Applying ice for muscle soreness is also useful. The ice stops inflammation so that there is more normal blood flow than there would have been if inflammation was allowed to continue. This more normal blood flow is good for bruises and muscle soreness because it removes waste, lactic acid for muscles and dead blood cells for bruises, and brings in nutrients so the cells can heal. Applying heat after forty eight hours increases the blood circulation and it relaxes muscles to relieve pain. Medicines can also be recommended to reduce inflammation and increase circulation. These medicines include acetaminophen, ibuprofen, naproxen, and aspirin. Therapists will often combine stretching, ice, heat, and medicine to obtain optimal results. It is not a miracle cure but it will decrease healing time dramatically. Ice and heat application are often the first thing a therapist will recommend because it shortens recovery time. Ultrasound therapy may be another option for pain in muscles, tendons, joints, ligaments, and other soft tissues.(Sears) We cannot hear ultrasound but that does not means that it has only one frequency and strength. Diagnostic ultrasound and therapeutic ultrasound have different uses because of the frequency and strength they use. The sound used for diagnostic ultrasound is a higher frequency but it is not as strong. This means that if we could hear ultrasound, the sound of a diagnostic ultrasound would be higher pitched but not as loud as therapeutic ultrasound. As you might have figured out, getting the right strength and frequency for the intended use is important. Ultrasound has also been used to break apart kidney stones so if someone attempted to use the same settings for diagnostics or therapy then serious damage would most likely occur. There is no need to worry about that because doctors and therapists know what settings the machines

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should be on. Within therapeutic ultrasound, there is a small range of frequencies and strengths that are used for therapy. Ultrasound causes deep tissue heating at one end of the frequency and cavitation, expanding and contracting of air bubbles in and around your tissues, at the other. The therapist will decide which point in the frequency range would be most beneficial to you. The deep tissue heating has the same effects as heat application that was discussed earlier but it gets deeper and can be confined to a more specific area. The heating happens because ultrasound causes the cells to move and it creates friction. Cavitation is achieved when ultrasound puts the air bubbles under pressure and the lets off with each pulse of sound. This has been theorized to speed up cellular processes. There is some controversy about whether ultrasound is an effective means of treatment. There have been many studies done about ultrasound that have supported and not supported it. A study about Achilles tendon pain has shown that there is “no difference in outcome measurements between heavy eccentric loading and ultrasound. Participants in this study were given proven pain relieving exercises to do every day and the other group was given ultrasound therapy to do twice a week. After 12 weeks, both the treatments were just as effective. (ST Donell) This study shows that it is possible to cure without exercises if it is needed. This is advantageous for those who are physically unable to do the required exercises. Unfortunately, the patients that do ultrasound will miss out on the benefits of core strengthening because they aren’t doing exercises. There is another method of healing that therapist use that doesn’t involve much effort from the patient. Electrical stimulation is that other method for treating pain. The machine that is used for electrical stimulation is called a TENS unit, transcutaneous electrical nerve stimulation. It is a small box that runs on batteries or plugs into a wall. It has wires that come out and the wires have sticky electrodes that attach to you. Based on my personal experience, using a TENS unit is

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a weird experience. Your muscles have small contractions when electricity is passed through them and sometimes you can see them. At one point during my experience it felt like my skin was literally crawling off of me; it was like it was a bug and it just decided it was going to leave. Even though it is weird to use, TENS units have been shown to do some good. TENS units have been thought to work in two different ways. In low a frequency, they stimulate the production of endorphins, a hormone that the body uses natural pain killers. In high a frequency, nerves are stimulated and it blocks the pain because the nerves that are trying to send pain signals to the brain are blocked out by the nerves sending impulses caused by the electrical current.(Macnair) Based on personal experience, I believe that TENS units increase blood flow in the area because the muscle fibers are contracting and I have already discussed how blood flow is important when the body is trying to heal. Physical therapists will probably tell their patient to get a TENS unit if they think that the patient will benefit from it. They will show the patient how to use it and what frequency they should have it set on. After instruction from the therapist, the patients can treat themselves from home. They may need to come back to do some exercises, but the patient can use the TENS unit at home. The TENS unit may be enough but if it is not then therapist have other options. That’s the great thing about physical therapy; there are always multiple options that can be combined to achieve the best result. As this journey comes to an end, I have come to realize that I have learned a wealth of information about physical therapy and the techniques that they use. I think the most important thing I noticed was that most of the treatments increased blood circulation in the afflicted areas so that the area could heal faster. I also became aware of how fascinated I am by the human body and physical therapy. I think anyone else would have fallen asleep while reading any of the articles that I read through. I, on the other hand, found them intriguing and I wanted to read more

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even though the articles would sometimes drift into an area that I was not writing about. It feels comforting knowing that I have chosen a career path that I am so captured by and knowing that the job opportunities are only going to increase for the next decade and maybe more. I often wondered during my research, “what would happen if physical therapy didn’t exist?” What do you think?

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Works Cited Babiarz, Shawn. “Exercise in Physical Therapy: Tools to incorporate multiplanar balance exercises into a practice.” Physical Therapy Products Sep/Oct 2012, Vol. 23 Issue 7. SPORTDiscus. Web. 1 November 2012. Cluett, Jonathan. “Physical Therapy.” About.com Orthopedics. InterActiveCorp. 8 January 2012. Web. 12 October 2012. ST Donell, et al. "Eccentric Calf Muscle Training Compared With Therapeutic Ultrasound For Chronic Achilles Tendon Pain--A Pilot Study." Manual Therapy 13.6 (2008): 484-491. CINAHL Plus with Full Text. Web. 7 Nov. 2012. Inverarity, Laura. “Stretching 101.” About.com Physical Therapy. InterActiveCorp. 8 November 2007. Web. 12 October 2012. Komaroff, Anthony, ed. “The real-world benefits of strengthening your core.” Harvard Health Publications. Harvard Medical School. 24 January 2012. Web. 12 October 2012. Macnair, Trisha. “Transcutaneous electrical nerve stimulation (TENS).” BBC Health.BBC. June 2009. Web. 15 October 2012. Sears, Brett. “Therapeutic Ultrasound in Physical Therapy.” About.com Physical Therapy. InterActiveCorp. 4 April 2012. Web. 13 October 2012.

Paragraph 1: -Connected well with audience because of the personal experience -Set up exactly what should be revealed in the text (benefits of physical therapy) -Clearly identifies what exactly physical therapy is Paragraph 2: -Still staying connected through experience -Walking through the step by step functions of physical therapist

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Paragraph 3: -Intro into stretching(what is involved) -Very short sentence structure, a tad choppy through beginning. Elaborate and elongate -Listed both physical and mental benefits (broadens readers understanding) - "All of these benefits are somewhat familiar to me but I had no idea that I was missing on them" Got lost a tad bit, but the next sentence clarified. Clean up a little of the wording. Paragraph 4: -"Core strengthening is not easy because of how many muscles make up the core

and because most people don’t have a strong core." (perception, research?) - Provides specific examples Paragraph 5: Eliminates misconceptions - The affected area should be iced around two times a day but not for too long because that creates a chance for nerve damage or frostbite. (EFFECTED) Paragraph 6: - Ultrasound has also been used to break apart kidney stones so if someone attempted to use the same settings for diagnostics or therapy then serious damage would most likely occur. (slight run on) - “no difference in----where does the quotation end? Paragraph 7: - It has wires that come out and the wires have sticky electrodes that attach to you.-touch up a little bit. - At one point during my experience it felt like my skin was literally crawling off of me; (comma after "experience" -" it was like it was a bug and it just decided it was going to leave." (redundant) - felt like the last paragraphs dropped off from the standards of the previous ones

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To start off I found this very interesting just because I am thinking about being a physical therapist myself. I like in your intro paragraph you bring up a personal experience which allows the reader to get to know the author a little bit more. Usually in a title the most important, or the one talked about most comes first, but in this case, it isn't. Through the paper, the works, or physical therapy was focused on a whole lot more than the benefits. Speaking of benefits, when I think about benefits of physical therapy, the thing that comes to mind is physically. But I like how you state mental benefits as well. One thing I must comment on is when you were speaking about cavitations, I wasn't 100 percent sure as to what it was. So explain that a little bit more. Overall, you have really good ideas, I think that you have to articulate them a little bit better in order to have a paper that progressively gets better.

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