Think You Need a Prescription to See a Physical Therapist? Think Again!

Do you have an issue you’re putting off treating? An aching back/knee/hip etc. keeping you from doing your favorite activity? Want to begin training for that 5k or triathlon? Think you might be at risk for an injury? Did you know in most states in the US, you can be treated by a physical therapist without a referral from a physician? It’s called Direct Access, and many people don’t even know it exists even through its been around since the early 2000’s! So what is Direct Access and why should you care about it?

Direct access is a law enacted to allow patients to come directly to a physical therapist for evaluation and treatment. The laws differ state to state, but every one has some form of direct access. Click HERE to find your states regulations or call your licensed PT to find out more information. It saves patients time, money, and allows for faster implementation of a unique plan of care for the people we see. That means you can get better faster, and get back to your life sooner!

“But is my PT trained to handle direct referrals?” The answer is YES! We are trained to recognize “red flag” issues which are out of our scope of practice. In the event of these we are required by law to refer out to your physician for further evaluation. In addition, in NJ if we fail to see progress in a patient after 30 days of treatment, we are required by law to ask that you consult your physician.

“But will my insurance still cover it?” In most cases yes, but as with everything insurance related it’s best to find out your particular plans guidelines. Some insurances require a prescription (Medicare for example) for pre-approval for care and these will all be investigated prior to your first visit.

Direct Access has opened up the opportunity for PTs to treat sooner, and work on preventative care to decrease risk of injury. So if you’ve got an issue you’ve been putting off, want help training for your next big event, or just want peace of mind you aren’t at risk for a potentially devastating injury, come see us at Edge Physical Therapy and Sports Medicine and find out what we can do to keep you ahead of the competition!

 

Dr. Konstantinos Mavropoulos PT, DPT, TPI

Edge Physical Therapy and Sports Medicine 

 

The Top Reasons Why Your Hamstrings are Tight

You've likely been there one time or another, dealing with stiffness, pain, trouble walking, wondering what you can do to loosen up those pesky tight hamstrings. Fear not, as you are not alone in the struggle of hamstring tightness, and Edge Physical Therapy and Sports Medicine are here to help! So why are your hamstrings endlessly tight? Read on and find out why it occurs and what you can do to help.

The hamstrings are a powerful and large group of muscles, working during many of our daily activities. They run from the bottom of the pelvis and attach across the back of the knee, helping to both extend the hip and flex the knee joint. There are many reasons why hamstring “tightness” (you'll see why I use quotes) occurs but there are some simple things you can do to help alleviate the issue.

For some, true, decreased flexibility through the hamstrings is the culprit. However, this may not occur simply by not stretching enough, as improper positioning/tightness of your hip/back, occupational hazards (prolonged sitting/driving, prior injury, etc.), or muscle imbalance can all contribute to tightness. If you sit or drive a lot, your hips and knees are often in positions which shorten the hamstrings. Over time, this can lead to a chronic decrease in the muscle length.

An anteriorly tilted pelvis (forward rotation) of the hips is common in many and puts increased arching/stress on the lower back . As a protective mechanism, the hamstrings contract to try and reverse this, leading to over-activation and eventual restriction. Muscle imbalances such as weakness/tightness in the gluteals, abdominals, and hip flexors can all cause the hamstrings to be used in ways the body didn't intend.

For others, hamstring “tightness” may actually be tension of one or more of the many nerve chains which run down the legs, the largest being the Sciatic bundle. This neural tension can mask as tightness which won't improve just by stretching alone. You may feel intense pulling/burning, often near the back of the knee ( a common entrapment point) which doesn't alleviate with repeated stretching to the muscles.

Now that you know some reasons the hamstrings get tight, let's discuss some ways to help the problem! I'd be remised if I didn't first suggest seeking a skilled healthcare professional to properly evaluate the reason for your restrictions. Improper stretching/exercise can lead to further injury and more problems! Furthermore, you may be wasting your time stretching a muscle that isn't tight and I know your time is valuable!

For truly tight hamstrings, the answer is fairly easy, a good stretching program combined with changes to daily patterns such as more frequent positional changes can lead to improvements in flexibility. Stretching to the hip flexors, piriformis and hamstrings, combined with good core and gluteal strengthening can restore proper lower chain balance leading to less stress to the hamstrings themselves.

There are many ways to stretch, Static, Dynamic, and variations of Proprioceptive Neuromuscular Facilitation (PNF for short). Static stretching (toe touches or a long sitting hamstring stretch) should be completed at least 3 times a week. A study by Cipriani et al from the journal of strength and conditioning research, found that those stretching at least 6x/week total (daily or 3x/week) gained more flexibility than those who stretched less frequently.

Dynamic Stretching (leg swings, lunge stretch, single leg forward lean, etc) involves movement while you stretch which will warm the muscle up, and may improve flexibility over time. These are best done prior to activity as they won't compromise muscle power but will help guard against injury.

Finally, PNF stretching involves various techniques to elicit changes in the neuromuscular system such as a contract/relax or hold/relax technique. For the hold relax technique, place your heel on a step or chair and lean forward into a static hamstring stretch keeping the back and leg straight. After holding for 10-15 seconds, press your heel into the step or chair and hold for 5-6 seconds. Immediately after, move into a further stretch and you should feel you can move more comfortably. Complete 2-3 repetitions for added benefit.

For neural tension, there are a few ways we can glide or floss the nerves involved to relieve stress to the system. To stretch the Sciatic Nerve, lie on your back with your hips and knees bent to approximately 90 degrees. Place your hands behind your knee and slowly straighten towards the ceiling. Then pull your toes/foot up towards you and hold the position for a few seconds. Finally, return to the starting position and repeat 15-20 times. You can also do this exercise in a sitting position. Sit in a chair in a good upright position (No slouching!) with your feet on the ground. Straighten your knee and bring your toes up towards you, holding for a few seconds. Repeat 15-20 times. This is a great exercise to complete while at work as many of us can't find a place to lie down at our jobs.

Like anything dealing with the human body, the answer to hamstring tightness is multi-factorial. It doesn't have to hold you back and the above tips combined with proper analysis by a skilled professional can help! Come see the difference Edge PT can make and we'll help improve your flexibility, strength and performance to keep you ahead of the competition! Check out the video below to see how we at Edge treat hamstring tightness/neural tension! 

https://www.facebook.com/edgeparamusphysicaltherapybergen/videos/vb.424585941082087/603452646528748/?type=2&theater

Dr. Konstantinos Mavropoulos PT, DPT, TPI

Edge Physical Therapy and Sports Medicine