Aquacare Rehabilitation Services, Inc. is pleased to announce the opening of its newest location in Salisbury, MD. The Physical Therapy & Injury Center of Aquacare, located at 659 South Salisbury Boulevard. “We made the decision to open this location in response to the needs of the community for a urgent care physical therapy center that specializes in early intervention following injuries. If physical therapy is initiated early in the healing process, the desired result can be a faster return to work and sports related activities,” says Jennifer O’Neill, regional clinical director for Aquacare.
In addition to traditional physical therapy, this location will specialize in providing treatment for spinal injuries, sprains/strains, auto and work-related accidents and sports injuries and acute/chronic pain management. This location will also specialize in hand/upper extremity rehabilitation and wound care, specialties of Juanita Milbourne PT, a physical therapist with 20 years of experience. Other specialties offered at this location will be women’s health programs including lymphedema and a breast cancer recovery program. The Physical Therapy and Injury Center of Aquacare guarantees that evaluations can be scheduled within 24 hours if needed. Offering convenient early morning and evening hours, this location will also offer same day scheduling. Aquacare provides the best possible therapeutic treatment choosing from a full range of treatment approaches. For more information on Aquacare’s Physical Therapy & Injury Center call 410-677-0700.
What
is TMD? And, Do You Have It? Have you ever had pain in your jaw or cheek? Does your
jaw click or pop when you open or close your mouth?
Do you suffer from neck pain or headaches? Perhaps your
dentist or physician has told you that you have TMD. Temporomandibular Disorders (TMD) is not just one condition,
but rather a group of disorders involving the temporomandibular
joints (jaw joints) and the muscles of mastication (chewing
muscles). Although we really do not know how many people
actually suffer from TMD, it appears that more women
are affected than men. Approximately, 40-75% of individuals
not seeking treatment have at least one sign of TMD
and 33% have at least one symptom of TMD. This means
that between 9-17 million individuals may indeed benefit
from treatment of TMD. What is the Temporomandibular Joint (TMJ)? The temporomandibular
joint connects the lower jaw, otherwise known as the
mandible, to the temporal bone at the side of your head.
You can feel the joint on each side of your head if
you place your fingers just in front of your ears and
open your mouth. These joints are flexible and allow
the jaw to move smoothly up and down and side to side;
thus, enabling us to talk, yawn and chew. There are
muscles attached to and surrounding the jaw joints,
which control the position and movement of the jaw. With mouth opening, the rounded ends of the lower jaw,
known as the condyles, glide along the joint socket
of the temporal bone. When we close our mouths, the
condyles then slide back to their original resting position.
There is a soft disc that lies between the condyle and
the temporal bone to keep the motion smooth and absorb
shock from chewing and other joint movements. So, what causes TMD? Severe injury to the jaw or temporomandibular
joint, such as a heavy blow, a fall or impact from a
car accident can damage the joint, fracture the jaw
or contuse the chewing muscles. This damage can alter
the smooth motion of the jaw and cause pain or locking.
Arthritis in the temporomandibular joint may also result
from injury. However, other causes of TMD are far less clear. One
theory suggests that structural malalignment between
the mandible and the skull (bad bite) can trigger TMD.
Some experts propose that physical or mental stress
may cause or aggravate TMD. Another theory suggests
a link between neck pain and TMD since neck pain is
associated with TMD 70% of the time. No scientific evidence
exists to link gum chewing with clicking sounds in the
jaw joints, or that jaw clicking leads to TMD. In fact,
joint noises or clicking of the jaw is quite common
in the general population. If no other symptoms are
present, then jaw clicking usually does not require
treatment. Diagnosing TMD can be confusing because the exact causes
and symptoms of TMD are not exactly clear. Currently,
there is no standardized test to correctly identify
TMD. About 90% of the time, the patient’s chief
complaint or description of symptoms, in conjunction
with a basic physical examination of the face and jaw
can provide useful information to diagnose these disorders.
The examination typically includes palpating or feeling
the jaw joints and chewing muscles for pain or tenderness;
listening for clicking, popping or other joint noises
during jaw movement; and examining for limited motion
of the jaw while opening and closing the mouth. The primary symptoms of TMD include the following:
1. pain or discomfort located in the area of the temporomandibular
joint (TMJ) and masticatory muscles or facial region,
2. joint noises (clicking or popping of the jaw) during
jaw movement, 3. limitation or difficulty in jaw movement.
Other symptoms may include neck and shoulder pain, headaches,
difficulty or pain with chewing, talking or yawning
and clenching or grinding the teeth. In addition, symptoms
such as earaches, dizziness or hearing problems may
sometimes be related to TMD. Please keep in mind that
occasional discomfort in the TMJ or chewing muscles
is fairly common and is normally not a cause for concern. How is TMD treated? The guidelines for treating TMD
recommend a non-invasive, cost-effective, conservative
and reversible approach. Conservative treatments do
not invade the tissues of the face or jaw joints, and
reversible treatments do not cause permanent or irreversible
changes in the structure or position of the jaw or teeth.
Physical therapy can offer a conservative and reversible
approach to treating Temporomandibular Disorders. Physical
therapists can educate patients to control bad habits
such as nail biting, thumb sucking or ice chewing; instruct
patients in resting position of the jaw; awareness training;
educate patients regarding relaxation strategies or
stress reduction techniques such as diaphragmatic breathing
and imagery; diet modification; posture education; and
avoiding extreme jaw movements. Furthermore, modalities such as heat, ice, ultrasound,
phonophoresis/iontophoresis or electrical stimulation
can be effective in reducing pain, tightness and inflammation
in the jaw joints and chewing muscles. Soft tissue mobilization
or massage to the masticatory muscles (chewing muscles)
and neck muscles can be effective in reducing pain and
tightness in these muscles and improve jaw and neck
mobility. Mandibular stretching, manual mobilization
of the TMJ and home exercises to improve jaw movements
may also be incorporated in the treatment of TMD disorders. Juanita Milbourne, PT received her Bachelor’s of Science in Physical Education & Health from Morgan State University and also a Bachelor’s of Science Physical Therapy from the University of Maryland Eastern Shore. Juanita has over 18 years of experience as a physical therapist and offers a TMD program at Aquacare’s Physical Therapy and Injury Center in Salisbury. Juanita is currently accepting new patients. For more information, call 410-677-0700.
The
Role of Exercise in Preventing and Managing Diabetes
Diabetes Mellitus (DM), or “the sugar”
as it’s often called, is becoming a nationwide
epidemic. Consider these statistics…17 million
people or 6.2% of the population, have diabetes. 5.9
million of those people are undiagnosed. Nearly 20.1%
of people 65 years or older have diabetes. About 2700
people are diagnosed with diabetes every day. The current
economic cost is estimated to be 98 billion dollars.
In general, Diabetes is classified into 3 categories.
Type 1, historically called juvenile onset or insulin
dependent diabetes, includes 5-10% of those diagnosed
with diabetes. With type 1, your body stops making insulin
or makes very little. Insulin allows the glucose in
the blood to get into the cells. The cells need the
glucose to burn for energy. With Type 2, aka adult onset
diabetes, the body doesn’t make enough insulin,
cannot use it right or both. 90-95% of those diagnosed
with diabetes have type 2. Gestational diabetes is a
form of diabetes that develops during pregnancy and
occurs with 7% of all pregnancies in the U.S. It does
resolve after the pregnancy but the person is at a higher
risk for developing diabetes later in lift. Genetics,
a history of gestational diabetes, a large amount of
abdominal fat, age and race are predisposing factors
to developing reduced insulin sensitivity and, subsequently,
diabetes.
With this latest epidemic, health care providers are
finding that Type 2 diabetes is no longer an adult onset
disease. 8-45% of children newly diagnosed with Diabetes
have Type 2. The complications of diabetes are numerous. Those with
diabetes are at 2-4 times higher risk of developing
heart disease and having a stroke. High blood pressure
affects 73% of individuals with DM. There are 12,000
to 24,000 cases of blindness each year associated with
DM. 43% of kidney failure cases are related to Diabetes.
More than 60% of all lower extremity amputations are
related to DM.
The question at hand with this epidemic is how to best
control it. Certainly eating right and taking medication
quickly come to mind as options. There is, however,
another way to control, prevent and even reduce the
effects of diabetes…. EXERCISE!!
As long ago as 600 BC exercise was prescribed for treatment
of diabetes by Indian physician Sushruta, known as “
the father of surgery”. In the 18th century exercise
was widely recommended by physicians. In the 1920’s,
Elliott Joslin identified exercise, with proper eating
and insulin administration as 1 of 3 components of good
therapy for diabetes. Today, exercise is recognized
as an established principle of diabetic treatment.
What does exercise do for diabetes? When one starts
to exercise, the muscles require more fuel. This fuel
is provided by burning glucose. This leads to decreased
levels of blood glucose. Exercise also improves the
body’s ability to use glucose. This then decreases
the amount of insulin needed by the body. Exercise has
been found to reverse the resistance to insulin that
occurs with aging, obesity, increased body fat and physical
inactivity. Insulin is a major anabolic, or building,
hormone that inhibits protein breakdown. Protein is
a major component of muscles and regular exercise thus
helps one to maintain muscle mass and his functional
strength needed to complete daily tasks. With cardiac
problems, exercise decreases risk of heart disease which
is the leading cause of death for individuals with diabetes.
It can also decrease levels of LDL’s (bad cholesterol)
and increase HDL’s ( good cholesterol). Exercise
has been shown to reduce blood pressure. Finally, exercise,
along with proper eating, can allow one to control Type
2 diabetes without medication. “The journey of a thousand leagues starts from
where your feet stand” . Starting your exercise
program will be a journey and involves taking simple
steps each and every day.
Getting started is usually the hardest step. It is strongly
recommended that you consult your physician prior to
starting an exercise program, who may want to run some
tests to see how your heart, blood vessels, eyes, feet
and nerves are doing. Your diabetic care provider can advise you on how to adjust your diabetes care plan
for exercise.
Next, you need to determine the right exercises that
fit your health condition. Things to consider are other
medical conditions, current fitness level, available
fitness/exercise centers or one may consider consulting
a fitness professional for guidance/motivation. Types
of exercises to include in your program are aerobic
or cardiovascular exercises (i.e. walking, biking, swimming)
and strength training. Strength training exercises may
be high tech, using home or gym equipment or low tech,
hand held weights, stretch bands or simply moving your
arm or legs against gravity. Strengthening exercises
help improve muscular strength and endurance, enhance
flexibility and body composition and decrease risk factors
for heart problems.
As you progress, do so slowly but steadily. Learn ways
to pace yourself, how to measure your heart rate and
what your range should be. You may need to start at
5 minutes but can increase 1 minute per day or 5 minutes
per week.
Key elements to your exercise program are warming up,
stretching and cooling down. Warm up can be as simple
as marching in place and helps prepare your body for
exercise. Recommended time is 5-10 minutes. Stretching can occur after warm up, during your cool
down or at both times. Stretching helps improve and
maintain flexibility, prevent injury to muscles during
exercise, helps improve circulation in the arms and
legs and helps prevent cramping.
Be sure to drink plenty of fluid before and after exercise.
17 ounces of fluid 2 hours prior to exercise and drinking
during the exercise activities is recommended. Water
is the best choice but if you’re exercising for
a longer period of time you may want to choose a drink
that contains carbohydrates.
As you begin exercising regularly, you will need to
be sure you have proper shoes. Sensation changes are
very common and often undiagnosed with diabetes. Our
feet change as we get older, so have your foot size
measured. You might find your feet are not the size
you thought they were. Choose socks that are smooth
and fit snugly to avoid bunching in your shoes. Always
examine your feet after exercise and get new shoes regularly,
every 9-12 months at a minimum, more frequently as your
exercise increases.
Now that you are starting to exercise, it is extremely
important to monitor how you are feeling during exercise
as well as your blood glucose levels. ADA safe range
is 100-250 mg/dL for exercise. For both Type 1 and 2,
blood glucose should be monitored before and after exercise
to learn your body’s response to the exercise.
For type 1, if your level is <100 before exercise,
eat a carbohydrate snack beforehand. If level is 100-150,
be prepared to snack while exercising. For type 2, limit
snacking before exercise. Do not exercise if your blood
glucose levels are not regulated. For type 1, if blood
glucose is>250 with ketones in the urine, do not
exercise. With type 2, if level is >400 , do not
exercise. The blood glucose testing with exercise is
especially important when starting an exercise program
or a new activity. The information from the testing
will allow you to better predict how exercise will affect
your blood glucose levels.
The most common problem for type 1 diabetics associated
with exercise is low blood sugar or hypoglycemia. It
can occur during or up to 48 hours after exercise. Symptoms
include shakiness, anxiety, dizziness, fatigue, blurred
vision, difficulty focusing or concentrating and loss
of consciousness. This does not typically occur with
type 2 diabetes regulated with diet and exercise.
To sum it up, exercise has a long history of use as
a tool to effectively manage diabetes. Exercise needs
to become a regular part of your life, much like brushing
your teeth. Make it fun by finding an exercise partner,
your spouse, friend or neighbor to walk with. Read the
paper or watch TV while you ride the stationary
bike or walk on a treadmill. Take the dog out for a
walk; it’ll do you both good.
Why exercise? Why not! Compare the time spent a week
managing your diabetes to a few hours per week of exercise.
With a minimal time investment, you can reap major physical
and emotional benefits, not to mention regaining power
of your life by tightening the control you have over
diabetes. “Small Steps, Big Rewards” is
the name of a recent exercise campaign noted in the
December issue of Diabetes Care. Getting started and
taking that first small step will be the hardest part
of your journey but, once taken, the rewards will come. Reference sources: Ginger Schirmer, Ph. D., R.D., www.diabetes.org,
ADA
Jill Elliott, PT of Aquacare Rehabilitation, located
in Lewes, DE. She recently attended a course entitled
“ Diabetes: A National Epidemic”. Aquacare
is pleased to announce a new Diabetes Physical Therapy
Program, The Role of Exercise in Preventing and Managing
Diabetes. This program is designed to help those diagnosed
with diabetes or with insulin resistance (Pre-Diabetes)
learn how to use and incorporate exercise into their life.
It is offered in the Salisbury (410-548-7600), Easton
(410-770-9720) and Lewes (302-945-0200) offices.
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