New York is a Direct Access state, which means that patients can go to a physical therapist without a Doctor's prescription.

Although many conditions, especially those that require a more in depth diagnostic workup, should be managed through a physician, there are a number of instances where seeing a physical therapist through direct access makes very good economic sense without compromising outcomes.

For more information about this study, visit:

 http://www.apta.org/PTinMotion/NewsNow/2011/10/14/DirectAccess/#.TrhAVfT_2XQ.email

Here’s a key excerpt from the NY Times blog post:

“But a major new review article, published last Friday in The Lancet, should revive and intensify the doubts about cortisone’s efficacy. The review examined the results of nearly four dozen randomized trials, which enrolled thousands of people with tendon injuries, particularly tennis elbow, but also shoulder and Achilles-tendon pain. The reviewers determined that, for most of those who suffered from tennis elbow, cortisone injections did, as promised, bring fast and significant pain relief, compared with doing nothing or following a regimen of physical therapy. The pain relief could last for weeks.

But when the patients were re-examined at 6 and 12 months, the results were substantially different. Over all, people who received cortisone shots had a much lower rate of full recovery than those who did nothing or who underwent physical therapy. They also had a 63 percent higher risk of relapse than people who adopted the time-honored wait-and-see approach. The evidence for cortisone as a treatment for other aching tendons, like sore shoulders and Achilles-tendon pain, was slight and conflicting, the review found. But in terms of tennis elbow, the shots seemed to actually be counterproductive.”

Read the complete article at this link: NTimes.com – Phys Ed: Do Cortisone Shots Actually Make Things Worse?

Take a look at the Move Forward ads below and let us know what you think.

Watch the videos here:

For more information about the APTA and their Move Forward campaign visit www.moveforwardpt.com. You can also stay on top of the latest physical therapy news and developments by following the Move Forward campaign on Facebook (www.facebook.com/Move4wardpt) and Twitter (www.twitter.com/moveforwardpt).

In 1999, we began with one small New York City office, and two employees.  Now we have twelve offices spanning the NYC metro area, with more than 45 physical therapists. 

Anniversaries are a time to look back – at the choices we’ve made and reflect on the good decisions and the mistakes.  It is also time to plan for the future.

If you look back to the beginning, why Recovery Physical Therapy even came into business, you’ll see the first good decision in a long line of great choices.  RPT started on the premise that this would be a company owned and managed by physical therapists.  Each Director has ownership in their facility which means that decisions are made from a clinical perspective and not by an accountant crunching numbers in a back office. 

Additionally, our President and CEO, practiced physical therapy in NYC for more than 20 years and understood that when patients are treated by licensed physical therapists patients heal faster with better overall outcomes.  He made the decision that licensed physical therapists would treat our patients.  Quality of care comes first. 

When I first came to work for RPT in 2003, our CFO took me on a tour of all six of our facilities.  As the day wore on, I started to panic, thinking I had made a big mistake. Each office was only treating a few patients at a time.  In my mind, clearly RPT was not doing well.  You see, I had previously worked at a competitor and physical therapists were constantly being pushed to see more patients in an hour, so I was used to offices loaded with patients. But not RPT.  It was quiet and calm in each office, one patient per physical therapist at a time.  It was just a different way of doing business.

We’ve also expanded with the same, “take our time” approach.   Each of our offices is strategically placed, based upon physician and patient feedback, as well as extensive research.  Instead of just blanketing the metro area with offices in order to “grow”, we’ve made decisions that make sense – such as, opening our Wall St office at 6 AM to accommodate our financial district patients to offering weekend hours at many of our “neighborhood” facilities.

Have there been missteps along the way?  Absolutely.  We’ve made some wrong hiring decisions, opened an office in an area that didn’t work out, and had to deal with our share of growing pains. Are their downsides to our philosophy?  In terms of volume, sure.  There are some insurance plans that we can’t participate with in-network simply because we can’t handle the number of patients that could potentially come our way. All in all though, the good far outweighs the bad.  We are blessed with a great leader, fabulous people, and loyal patients. 

Jim Cardone, our President and CEO, brings not only experience and expertise to the table; he has integrity and is an amazing leader.  He gives people what they need to succeed; he’s open to new ideas and supports our staff in all ways.

Our physical therapists are the best.  They are not only highly skilled practitioners, but they care about their patients’ recovery and treat them with highest level of attention. 

Our front desk staff greets our patients with a smile while untangling ever-changing insurance coverage and issues.  Kudos too, to our corporate staff who keep it all together behind the scenes.

Most of all, we are most grateful to all of our patients who have become like family to us.  We’ve watched many of you go on to achieve amazing things, like running a marathon after a debilitating injury or climbing to Mt Everest’s base camp.  Thank you for coming back again and again and for referring your friends and family to us. 

And to our physician partners, we look forward to continuing to provide the highest level of care that you’ve come to expect from us.  Thank you for believing in us.

 As we look ahead to the future, there will be bumps and bruises along the way but as long as we stay true to our core values, the future is limitless.

First, my recommendations are offered as a general scientific based suggestion to succeed as one training design may work for one runner, but may be a huge mistake for another.  We are all different.  Runners come in all shapes and sizes and our body mass, aerobic capacity, muscle strength, frequency of training availability, surfaces we run on, cross-training background, and general nutrition are all variables that will enable us to run with a smile, or make us vulnerable to ‘break down’, resulting in injury.  Many problems can be prevented if identified early and adjustments made.  Your program may only need to be tweaked and alternatively, it may need to be tailored a great deal.

Let’s start with rest, a subject one doesn’t think about when considering running 26.2 miles.  Admit it, runners are an obsessive group and you have to be somewhat to do this.  No one wants to stop running, but sometimes this is needed.  Do you run everyday, every other day, do slow long runs on weekends?  The thing to keep in mind is that your runs need to be of a specific intensity (speed), frequency, and duration to promote a physiological change. 

You may have started slow (hopefully approximately four month ago for your first marathon), but too tentatively.  Eventually, but gradually, you are going to have to get out and do some more ’substantial’ runs to build you aerobic capacity and anaerobic threshold.  It doesn’t mean you have to run a marathon distance before as I’ve met many runners who trained at distances no greater than 16 miles before their first marathon. (I did however have the experience of meeting an experienced runner in the starting line medical tent of a marathon who had run a marathon the day before.  He was attempting to run a marathon in every state in one year.  Surprisingly, he was complaining of shinsplints and it’s not something I would recommend.) 

It is possible to run without completing a 22 mile run before, but you need to set realistic goals and give yourself time to make these changes.  Sometimes, these shorter training runs may be beneficial as your body type may not allow you to complete the run without risk.  Make the changes in training first and give your body time to adapt.  This includes rest periods when you’re tired, ill, or are suffering from injuries.  Physiological changes actually occur during the rest periods and you need to give your body ample rest to promote this. 

Questions to ask yourself may be, “Am I so exhausted towards the end of a run that I am compensating or losing form?”  Are you developing pain or experiencing pain that is beyond the common muscle fatigue you get with running? This is different than being ‘stale’ or bored with the training, that can occur also.  You shouldn’t be doing only hills or interval runs and you may need to consult with a professional.  All marathons of notoriety offer links to groups or lectures way in advance that provide specific recommendations to help.  Some have groups that are charity based, but also train together, insuring consistency and will counsel you how to finish and enjoy the experience. 

Generally, you should be running about 40 miles per week about one month prior to the race.  You also need to taper this distance as you approach the last week.  Try running the last 10 miles of the course about two weeks before to familiarize you with it.  You can study the elevation on most websites to prepare for hills.  Along those lines, you can train on hills, but this should not be the only route you do.  Vary the pattern you run and avoid the pitch of a road.  Hard cement, the pitch of a road, and uneven surfaces can all lead to bio mechanical errors that may irritate structures in the legs.  Running just 1/2 mile on an irregular path can lead to tendinitis, strains, sprains, or poor form, leading up to stress reactions over time.  I will talk more in the future about specific problems you may encounter from dehydration to black toe-nails, Yucchh!   Have a good day and enjoy the nice weather.

 Types of Stretching

• Static (passive)
• Active Isolation (static)
• Active (dynamic)
• Contract – Relax (PNF)
• Strain – Counterstrain – Positional Release

 Static Stretching (Passive)
Static stretching is the most traditional way to stretch and remains a viable and popular option.  A muscle is put in a position of stretch over its entire length and held in its lengthened position (hence the name static) for a period of 30 seconds.  Research has demonstrated that the best results are achieved by repeating a static stretch four times.   Static stretches can be performed independently or with a partner.  There are a variety of positions in which muscles can be put on stretch, and some are more desirable than others.  For example, the hamstrings (in the back of the thigh) connect to the pelvis (at the ischial tuberosity – often referred to as the sit bone) and to the lower leg (just below both sides of the back of the knee).  The actions of the hamstring (when it contracts) are to extend the hip and flex (bend) the knee.  Therefore, to stretch the hamstring over its entire length, one must do the opposite – flex the hip and extend (straighten) the knee.  A good way to do this is to lie on your back and use your hands to draw your leg toward your chest, keeping the knee as straight as possible.  After you’ve taken up all the slack in the muscle and feel a stretch, hold the position for 30 seconds.  You will likely stretch a little further with each subsequent repetition.  

Not every passive stretch is a good one however.  Hamstring stretching positions that cause you to round your back as you lean forward go beyond the slack in the hamstring and stress the low back.  These are not advisable unless the forward bending comes exclusively from the hips and your back remains in a neutral position.  That also rules out hoisting your foot onto a very high surface and bending forward.  Try elevating your foot on a low stool instead (or sitting on the edge of a chair with your leg stretched in front of you) and bend forward from the hip with a straight back.  The result?  Less effort, better stretch, reduced potential for injury.

Studies have shown that a short-term effect of static stretching is the diminished force output of the stretched muscle.  This is one reason that some now eschew it as a warm-up prior to strenuous activity. 

Active Isolation Stretching – Static
Active Isolation stretching is exactly what its name implies – a muscle is stretched by actively contracting its opposing muscle.  Studies have demonstrated that the result of contracting one muscle (termed the agonist) is the relaxation of that muscle’s opposite, or antagonist.  Let’s use the hamstrings as an example once again.  Contracting your quadriceps (the muscle group in the front of the thigh whose action is to straighten your knee and assist in flexing your hip), will result in the relaxation of your hamstrings (in the back of your thigh).  Proponents of Active Isolation recommend holding the end position for only a few seconds.  Many athletes endorse this type of stretching and it has been shown to be very effective.

Active Stretching – Dynamic
Active Dynamic Stretching entails movements that put muscles on stretch.  Because they involve movement, these stretches are said to increase muscle temperature and prepare muscles for activity.  Dynamic stretches are also said to put joints through their full ranges of motion, though that is not likely because a joint can only be moved to its end range when the muscles crossing that joint are on slack (relaxed) rather than on stretch.   Examples of active/dynamic stretches include motions such as a lunge, which puts the hip flexors (in front of the hip/groin) on stretch, and the Inch Worm in which one creeps forward while maintaining a Downward Facing Dog yoga position (on the hands and feet with the butt high), which stretches the hamstrings.

If you like Active Dynamic Stretches I would not rely on them as the sole means of increasing your flexibility.  Because muscles are stretched in combination – for instance the calf along with the hamstring in the Inch Worm exercise – if one of those muscles is particularly tight, it will limit your ability to stretch the other.  Also, as with ballistic stretching, care must be taken to avoid setting off a stretch reflex due to the quick stretch that movement may elicit.

Contract – Relax (PNF)
PNF stands for Proprioceptive Neuromuscular Facilitation.  This is a broad classification that includes both strengthening and flexibility exercises.  PNF strengthening entails a variety of effective exercises that involve multiple muscle groups working in combination in functional cross-planar motions (working in diagonal patterns rather than strengthening individual muscles in isolation). 

PNF stretching is better known as Contract – Relax (C-R) and it has long been employed by physical therapists and athletic trainers to assist clients in developing increased flexibility.  Contract – Relax has both active and static components.  This type of stretching is based on research demonstrating that tension in a muscle is relaxed in the aftermath of contracting that same muscle.  This is quite different than the principle already described for active isolation stretching which shows that a muscle also relaxes with the contraction of its opposing muscle. 

C-R is most easily performed with a partner.  Using the hamstrings to illustrate once again: the hamstrings are held in a position of mild stretch (with the knee extended – straight – and the hip maintained in flexion) and are asked to contract gently.  This contraction is sub-maximal (only a mild force is exerted) and it is isometric (no movement is allowed).  This isometric hamstring contraction (to extend the hip) is held for several seconds, while the position of end range hip flexion with the knee straight is maintained with the aid of a partner.  Following the contraction there is a relax phase, during which the partner attempts to move the hip into greater flexion, thereby further stretching the hamstring.  The sequence is: contract (actively) – hold the contraction – relax/stretch (passively).  Several repetitions are performed with the ending position of each rep becoming the starting position of the next.  As a result, significant gains can be seen.

Strain – Counterstrain (Positional Release)
Another staple in physical therapy clinics, Strain – Counterstrain (S-CS) is a technique to release a muscle rather than stretch it, but the end result is more flexibility.  By passively maintaining a muscle in its fully contracted position for 90 seconds it has been shown that the muscle will relax, subsequently allowing it to stretch further.  Though often done with the assistance of a partner or health professional, Strain – Counterstrain positions can be maintained independently (as with holding the knees to the chest for the hip flexors) or with the help of pillows (as when releasing the hip abductors (outer thigh) in side-lying by elevating the upper thigh on pillows).  You may want to follow Strain – Counterstrain positioning with static stretching to capitalize on newly gained flexibility.

Conclusion
Just as we work to achieve balance in our lives, we also benefit from working toward a balance within our bodies.   Having normal flexibility is an important component of this balanced ideal and one that will help to prevent the stresses and strains that result in overuse injuries.