Physical Therapist, Physical Therapy and Physiotherapy
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I am excited today to share my experience providing physiotherapy services using Healthfx Physiotherapy’s virtual Conferencing platform . As a physiotherapist, this innovative video conference technology allows us to assess and treat individuals from a distance and here is why I am so excited about this opportunity as a growing necessity.
First of all Tele-health Physical therapy is 100% accepted by our licensing body meaning that we are performing all of the requirements that Physical Therapists do which is to conduct an assessment, provide a diagnosis and physiotherapy treatment. I am personally excited about this for our clients because I know it works. There are so many musculoskeletal problems that I have treated successfully over the years using virtual care as the head physiotherapist with Canada basketball, especially leading up to the 2012 and 2016 Olympic Games. During this 8 year period, we successfully treated conditions such as acute back pain, neck pain, knee sprains , hip injuries, and conditions such as rotator cuff tears, plantar fascitis, tendonitis and many other strains and strains. Providing physiotherapy to these olympic athletes was a fabulous experience for me in developing the skills I needed to support them this way.
Now in the social distancing world, being able to provide services remotely has become an absolute necessity. Without a shadow of a doubt, providing my services virtually has been one of the most memorable and rewarding experiences of my 30-year career as a physiotherapist. It’s fun, its efficient but most importantly it is an safe and effective treatment option.
I’d like to describe my experience with providing physiotherapy services at a distance through the lens of one patient.
Let’s call her “Clare.” She is a Chiropractor herself and the first time I connected with Clare, was during the fall just before COVID-19. She had a knee accident with a tear to the ACL ligament and was slotted to have surgery with the Toronto Raptors Orthopedic Surgeon Dr. Paul Marks and her elective surgery was cancelled. We lined up a remote Physical Therapy Session to set up a strengthening program for her to do in her home and she expressed how helpful the session was. At the beginning of our first session, she could see me through her computer sitting in my office and I had access to all of my equpment so that I could demonstrate the exercises to her and modify them accourding to her specific enviornment. Her family were also involved in holding her device and supporting her as we carried out the treatment session.
After she updated me on the previous two weeks, we went through all of the administrative formalities, including informed consent and making sure Claire agreed to being evaluated through Virtual Care. Ahead of our first meeting, Claire had received and filled out the online intake form with her past history details and we reviewed this history just as we would in person. I had actually reviewed these forms and knew a lot about her condition and health history before we even got started, which helped Claire warm up and feel more comfortable with receiving services through Virtual Care.
Claire, who was working as a Chiropractor, gladly discussed with me her condition starting from the date of her injury. As she talked about her job, it was clear we had one thing in common: we both believed we were providing important services to our patients during these challenging times. This session felt like connecting as we would on facebook though we were conducting a consultation meeting virtually.
Chaire told me that until she is able to reschedule her knee surgery, she hopes to be able to develop more leg strength and stay as fit as possible to prepre for this surgery. I explained that we were going to start the examination, so Claire went to a private area of the house where she would be actually performing the exercise program that were to develop. I knew at that point that Claire was comfortable and motivated to carryout the assessment portion and treatment portion of the Virtual Physiotherapy assessment. We were on our way!
At this point, Claire and I stood up, slightly adjusted our camera angles and proceeded with the assessment, which felt the same as it would have in person.
This is what happened next - a virtual physical examination including:After going through a series of movements, asking more questions and performing some specific tests, Claire and I agreed that her injury had stiffened up her knee and we needed to address her stiffness as well as her weakness. As we discussed the nature of her injury, what to expect in terms of recovery and what she could do to assist with her recovery, including specific exercises I wanted her to do, Claire seemed grateful and appreciative.
Together, we also took some time to review what her return to work process would look like after she had her ACL surgery and how I would be communicating with her surgeon and personal trainer if she needed this help and as we navigate this process, all of which could be done virtually!
Incidentally, Claire also explained to me that a she was concerned that she may not be able to do some of the activites that she was use to doing after surgery so we talked about the research around risk and certain activites. By talking through it, we were able educate her that her conerns were not necessary as she will be able to do what she loves to do very well and with minimal risk. Mission accomplished, Claire was excited about her future and getting started on a more progressive program!
Claire and I have had a couple of follow-up sessions since. We are continuing to progress her exercise program as her subjective and objective examination findings continue to improve. Moreover, Virtual Care allows me to do cool things like sharing my computer screen with Claire during our sessions to show her clips of animated exercise and written descriptions of the type of injury she had.
Claire is still waiting for her surgery but back working full hours and providing much needed support to her patients. Overall, our experience working together using Virtual Care has been incredibly positive.
For more information about Virtual Care, check out our website or call us at (416) 960-4689
It's hard getting physically fit. Most individuals benefit from having a supportive environment, like these great athletes, members of the 2016 olympic team, photographed with feet in ice buckets and recovery drinks in hand. I love that they are smiling while obviously their feet are freezing. In writing about fitness, this example of individuals that are so committed and devoted to their sport, we can see how their goals drive there training however they also understand the importance of routine. The lessons to be learned apply to those who what to improve general health, the benefits of these routines for every day people.
I wanted to start my blog with a comprehensive resource to answer the bigger question, what is physical fitness and the importance of including each of the components necessary as well as how to start and progress your fitness level to a healthy state. For those of you who want to go little further than a healthy level of fitness, these steps are also included. Healthfx Physiotherapy understands what inactivity can do and the steps required for you to reach a physical healthy state again.
Physical Fitness is the health and care of our bodies through physical activity. From a health perspective, the components of fitness are:
Although each of these components are movement related traits or capacity they are generally independent of the others. The underlying concept here is that a better status in each of these components is associated with a lower risk for development of disease or functional disability. Without getting too technical, the skill-related components of fitness are:
These components are more genetically dependent than the health-related components and play a role in some occupations but are mainly of interest in the athletic populations with the exception of balance, having a significant role for everyone and to prepare for aging and reduce the risk of falls once you reach those higher risk years.
The fundamental goal of a physical fitness program is to bring about a change in personal health and fitness behaviour, which includes, at a minimum, habitual physical activity. This regular physical activity should result in long-term exercise compliance and attainment of individual fitness goals and objectives.
The basic objectives of a exercise program are:
To gain health benefits and prevent inactivity disorders or to seek to attain greater health benefits and higher levels of fitness beyond basic health and this can be done by engaging in physical activity of more vigorous intensity or of great volume (longer duration and greater frequency). Daily physical activity is essential to improve health and quality of life, and maintain functional capacity. Health benefits are proportional to both the volume and intensity of activity, thus, even increase adds some benefit.
To meet either of the above objectives one must execute a balanced exercise program. The American College of Sports Medicine and American Heart Association and centers for disease control and prevention recommend the following. Aerobic fitness is the ability to perform large muscle, dynamic, moderate-to-high intensity exercise for prolonged periods of time. What that means is that to perform such exercise depends on the state of the respiratory, cardiovascular, and skeletal muscle systems. More simply stated, your level of aerobic fitness determines how long and how hard you can exercise.
Involves activity utilizing a large portion of total muscle mass, maximizes large muscles (eg, muscles around thigh and hip), involves dynamic, rhythmic muscle contractions and minimizes static contractions and use of small muscles. The activity should be continuous such as cross-country nordic skiing, running, cycling, swimming, skating, rowing, walking, aerobic dance, indoor aerobic exercises machines, and some sports if continuous in nature such as soccer, basketball and court sports.
Frequency, duration, and intensity. Accomplish moderately intense aerobic activity 30 minutes a day, five days a week or vigorously intense aerobic activity 20 minutes to 25 minutes a day, 3 days a week and muscle fitness exercise, or an equivalent combination of moderately and vigorously intense aerobic activity.
If you are looking for a more extensive health and fitness benefit, accomplish moderately intense aerobic activity 300 minutes (5 hours) a week, or accomplish vigorously intense aerobic activity 150 minutes a week, or an equivalent combination of moderately and vigorously intense aerobic activity.
Generally, the minimal levels of exercise volume and intensity above are necessary to maintain health and fitness, while the higher levels are necessary to improve health and fitness.
Moderately intense aerobic activity equates to continuous exercise that raises heart and respiratory rates, initiates sweating (varies with client), and permits conversation; vigorously intense aerobic activity elicits higher physiological responses and permits light or broken conversation. Exercise intensity may be measures objectively via Heart Rate (HR) calculations.
Calculate maximum HR. For ages less than 40 years subtract again years from 220; Max HR = 220-age. For ages equal to and greater than 40 years multiply age in years by 0.7, then subtract product from 208. Max HR = 208-0.7age for those aged 40 years and above.
Measure resting HR for 3-4 days soon after walking for 60 seconds, while in the same body position and take the average of these measures.
HR Range = Maximal HR - Resting HR.
For example, a 30 year old with a resting HR of 70 beats/min calculates maximal HR as 220-30=190 beats/min and HR range as 190-70 =120.
Therefore, this individual should keep exercise HR above 130 beats/min, but below 172 beats/min, targeting 160 beats/min for at lease 20 minutes to 25 minutes 3 days/week. Unfit individuals should start at the lower end of the HR range. As fitness levels increase, the resting HR will decrease, therefor increase the intensity percentage from low (50%) towards optimal (75%). Also, base fitness personnel can help fine tune these calculations taking into account medications, risk of injury, and individual preferences and objectives. See your doctor for advise.
Patience sand perseverance are critical to maintain an active lifestyle and effective exercise program because many will start a physical activity program, but within the first two or three weeks of starting, quit and return to an inactive lifestyle. One must maintain regular activity for at least three or four weeks before tangible and lasting health improvements, including body fat loss, will occur. To help ensure that increases in frequency, duration, and especially intensity of activity occur in a gradual fashion, the following stage of progression are helpful to avoid injury, illness and potential discouragement.
Include low level aerobic activities and light muscular endurance exercises for minimal muscle soreness or discomfort. Do not be aggressive in this stage. Set individual goals which are achievable and realistic; include a system of personal rewards. Majority of failures occur in this page - persevere to experience benefits.
Progress more rapidly here at a higher intensity, steadily increase duration to 45 minutes of continuous exercise. increase frequency as adaptation to exercise permits.
After six months of regular activity, focus on maintenance. Review goals ensuring that long-term focus is on a lifestyle approach to activity, remembering that considerable heath benefits come from regular participation in moderate exercise.
A linked term for muscular strength, the maximum force generated by a specific muscle or muscle group, and muscular endurance, the ability of a muscle group to execute repeated contractions over a period of sufficient time duration to cause muscular fatigue. A balanced physical activity program should address the five health-related components of physical fitness, with primary emphasis on aerobic fitness, but muscular fitness is also important as inclusion of muscular fitness exercise, and provides several benefits.
Benefits of Muscular Fitness Exercise – General Guidance.
The maximum ability to move a joint freely, without pain, through a range of motion. Flexibility tends to decrease with age, primarily due to the decrease in activity associated with age. Although flexibility is not assessed during the AF Fitness Assessment, no single test can be generalized to evaluate total body flexibility, it is important to health and functional living and should be part of a well-balanced physical activity routine.
Despite the popular perception that stretching prior to exercise enhances performance and prevents injury, little scientific evidence exists to support such long-held beliefs. Rather, engage in a gradual, activity-specific warm-up that includes the movement patterns of planned activity, e.g., if running for the workout then warm-up with brisk walking, jogging, and dynamic movements or drills such as leg swings and knee raises. To help maintain flexibility one should stretch after a workout when muscles, tendons, ligaments and connective tissue are warmer (above normal body temperature).
Although frequently ignored, these activities before and after an exercise session are important. Warm-up should be conducted as above (activity specific movements and dynamic drills) and always precede physical activity to increase body temperature and blood flow and to guard against muscle, tendon and ligament strains and tears. Cool-down, as important as the warm-up, is a gradual reduction in activity to prevent blood pooling, hasten recovery and avoid injury.
These are terms recently combined with flexibility in this final health-related component to designate a broader term that encompasses the role of stability and mobility in posture, occupational functional movement, and daily functional living. Stability deals with maintaining non-movement functional positions, including postural stability. Stability ranges from shoulder to ankle with shoulder, core and hip stability as primary. Mobility, similar to stability, is stable, controlled, functional movement through an active range of motion in the various planes of motion.
The salient phases of a recommended general workout session address the above components in the following order:
Body temperature increases via activity specific warm-up such as dynamic activity drills.
Aerobic activity such as crosscountry skiing, running, cycling, swimming, skating, rowing, walking, aerobic dance, indoor aerobic exercise machines (e.g., cycle ergometer, elliptical, rower, versa climber, stair), and some sports if they are continuous in nature.
Resistance training such as calisthenics, weight/object training (e.g., machines, free weights, medicine balls, kettle bells, bands, cables, ropes), plyometrics, and field exercises. Movement Patterns – run, bend, twist, squat, pull, push. Body Regions – core, lower, whole body, upper. Stability and Mobility/Functional Movement.
Combined aerobic and muscular fitness actions, e.g., rotations, or running between muscle fitness stations.
Occupational or sport specific skill development/practice as desired.
(Cool-Down). Activity specific cool-down. Flexibility training
Healthfx Physiotherapy can help point you in the right direction but ultimately it will be your efforts to stick to a plan. If you have injuries or pain that get in the way, we can help you.
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