What Is Wrong with Markelle Fultz?

Markelle Fultz and Thoracic Outlet Syndrome

Some Philly sports fans out there may have heard about Markelle Fultz’s new diagnosis of Thoracic Outlet Syndrome (TOS), which may be what is causing his shot to look awkward and unnatural. TOS is an injury in the area of the neck and shoulder that is classified as compression of nerves, arteries, and veins that travel through a small space called the thoracic outlet. At times one or all of these structures are being compressed. If the arteries or veins are obstructed than you can experience symptoms such as pain in the arm, numbness/tingling, discoloration, temperature changes, and a weakened pulse. When the nerves are affected symptoms involve muscle weakness, muscle wasting, numbness/tingling, and pain down the arm.

In Fultz’s case his nerves are being compressed, which makes it difficult for him to control the muscles needed to shoot a basketball due to the weakness and inability to coordinate the appropriate motions. The compression on these structures is caused by either tight muscles of the neck (scalenes) and/or the first rib or clavicle or also called collar bone. In rare cases an extra rib is present at birth, but this is not present in most of the population.

Fultz’s specialist has recommended physical therapy to help resolve this problem, which can help in a few different ways. One way is stretching of those particular neck muscles combined with soft tissue massage to increase flexibility and reduce the overall tension on the nuerovascular structures. A second way physical therapy can resolve TOS is by performing mobilizations of the first rib and clavicle to increase mobility and facilitate proper movement of the bones/joints, thereby relieving compression on the nerves or vascular structures. A third way physical therapy can help is by correcting poor posture which can be a contributing factor to the underlying issue. We can do this by educating patients on proper posture and certain stretching/strengthening techniques for affected muscles. Often times a combination of all three of these treatments techniques are used to help resolve the TOS. The report is that Fultz is going to be out 3-6 weeks while receiving physical therapy so that he can have sufficient time to address his specific deficits to reduce the compression on his nerves.

Mark Romano PT, DPT is the newest PTW Clinical Supervisor in  our Glenside location. To schedule an appointment or evaluation call Mark at (215) 887-2001 today!

National Physical Therapy Month

National PT month is over.

We set out to spread the message to drop the pills, consider alternatives to pain management.

Over the 31 days in October, we had over 25 videos posted of our staff dropping the pills, we had over 3300 views of our customers watching us drop the pills, and we personally delivered about 350 medicine bottles filled with M&M candies (to simulate you can't have just one, much like an opioid) to our local communities and Doctors offices to help spread the word.

We spread a loud message about the opioid crisis in America, such as:

The Centers for Disease Control and Prevention (CDC), the American College of Physicians, and the National Academies of Sciences, Engineering, and Medicine have issued guidelines and reports urging health care providers to pursue safe nondrug alternatives, including physical therapy, for most non–cancer-related pain treatment.

Physical therapists (PTs) treat pain through movement, hands-on care, and patient education—and by increasing physical activity you can also reduce your risk of other chronic diseases.

A recent study published in Health Services Research found that patients who saw a PT before trying other treatments for low back pain were 89% less likely to need an opioid prescription.

Statistics from the CDC, the Agency for Healthcare Research and Quality, and the United States (US) Department of Health and Human Services reveal the gravity of the problem.

1. In 2016, health care providers across the US wrote more than 214 million prescriptions for opioid pain medication—a rate of 66.5 prescriptions per 100 people.

2. As many as 1 in 5 people receive prescription opioids long-term for noncancer pain in primary care settings.

3. More than 11 million people abused prescription opioids in 2016.

4. Every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids.

5. More than 40% of all US opioid overdose deaths in 2016 involved a prescription opioid.

6. Drug overdoses claimed the lives of nearly 64,000 Americans in 2016. Nearly two-thirds of these deaths (66%) involved a prescription or illicit opioid.

7. The CDC estimates the total economic burden of prescription opioid misuse in the US is $78.5 billion a year, including the costs of health care, lost productivity, addiction treatment, and criminal justice involvement.

If you know someone in pain, encourage them to talk to their physician or PT about safe ways to manage pain.

The American Physical Therapy Association’s #ChoosePT campaign is raising awareness about the dangers of prescription opioids, and encourages consumers and prescribers to choose safer alternatives like physical therapy for most chronic pain management.


 If you have problems with pain, or know anyone in pain that could benefit from Physical Therapy to avoid use of medications and restore function, please give us a call! 




Bibliography
Centers for Disease Control and Prevention. US drug overdose deaths continue to rise; increase fueled by synthetic opioids. Updated March 29, 2018. Accessed July 26, 2018.
Centers for Disease Control and Prevention. Prescribing data. Updated August 30, 2017. Accessed July 26, 2018.
Centers for Disease Control and Prevention. Opioid basics. Updated August 27, 2017. Accessed July 26, 2018.
Centers for Disease Control and Prevention. Prescription opioid overdose data. Updated August 1, 2017. Accessed July 26, 2018.
Centers for Disease Control and Prevention. US prescribing rate maps.  Updated July 31, 2017. Accessed July 26, 2018.
U.S. Department of Health and Human Services, Office of the Surgeon General. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: US Department of Health and Human Services; 2016. Accessed July 26, 2018.
Florence CS, Zhou C, Luo F, Xu L. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care. 2016;54(10):901–906. Free Article


Robert Babb, PT, MBA, is owner and practicing Physical Therapist at the Physical Therapy & Wellness Institute located in Lansdale, Montgomeryville, Quakertown, West Norriton, Glenside, Harleysville, and Souderton, Hatfield, and Horsham, Pennsylvania. Rated the Best Physical Therapy for over 15 years, the hands on, one on one care at The Physical Therapy & Wellness Institute has offered pain relief and improved function to our suburban Philadelphia communities since 2002. For back pain, knee pain, jaw pain, joint pain, shoulder pain, and now help with our advanced specialists in urinary and bowel incontinence, we are open from 7 am to 8 pm most nights, and Saturdays!

Centers for Disease Control Recommends Physical Therapy

If you know someone in pain that affects their lifestyle, Physical Therapy can help.  

• The American Physical Therapy Association represents more than 100,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide.

• Physical therapists improve physical function and treat pain through movement, rather than just masking the sensation of pain.

•  Physical therapists can offer an alternative to opioids for long-term pain management and can provide services in conjunction with an opioid treatment plan, consistent with CDC guidelines.

Learn more about physical therapist treatment and APTA’s #ChoosePT public education campaign at MoveForwardPT.com/ChoosePT.


Robert Babb, PT, MBA, is owner and practicing Physical Therapist at the Physical Therapy & Wellness Institute located in Lansdale, Montgomeryville, Quakertown, West Norriton, Glenside, Harleysville, and Souderton, Hatfield, and Horsham, Pennsylvania. Rated the Best Physical Therapy for over 15 years, the hands on, one on one care at The Physical Therapy & Wellness Institute has offered pain relief and improved function to our suburban Philadelphia communities since 2002. For back pain, knee pain, jaw pain, joint pain, shoulder pain, and now help with our advanced specialists in urinary and bowel incontinence, we are open from 7 am to 8 pm most nights, and Saturdays!

Dump the Pills

In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to opioid pain relievers and healthcare providers began to prescribe them at greater rates.

Increased prescription of opioid medications led to widespread misuse of both prescription and non-prescription opioids before it became clear that these medications could indeed be highly addictive.

In 2017 HHS declared a public health emergency and announced a 5-Point Strategy To Combat the Opioid Crisis

 

Do Opioids help improve function?

“It’s not clear [in clinical trials] that opiates actually improve function in the long run,” she says. “In fact, there’s some evidence that people on chronic opiates lose function over the long run.” Loss of function is due in part to the side effects of these drugs, which include nausea, vomiting, and constipation. While they might ease pain, the side effects can keep a person from getting on with their life. What’s more, most people typically need to increase the dosage over time to keep getting the same level of pain relief”

https://www.webmd.com/special-reports/opioids-pain/20180314/opioid-alternatives

Crazy numbers:

• ·         Over a 200% increase in opioid overdoses since 2000
• ·         In 2015 alone, more than 30,000 people perished as the result of the overuse
• ·         Each day, more than 40 Americans die from prescription opioid overdoses
• ·         The amount of opioids prescribed and sold in the United States has quadrupled since 1999 with opioid-related deaths numbering more than 168,000
• ·         The Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey Reports suggest there was a 2.2-fold increase in overdose deaths from all drugs from 2002 to 2015, when more than 52,000 people died
• ·         From 1999 to 2016, more than 630,000 people have died from a drug overdose.
• ·         Around 66% of the more than 63,600 drug overdose deaths in 2016 involved an opioid.
• ·         In 2016, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was 5 times higher than in 1999.
• ·         On average, 115 Americans die every day from an opioid overdose

https://www.cdc.gov/drugoverdose/epidemic/index.html

One of several solutions to managing pain

Physical Therapy

Studies have shown there is evidence that Physical Therapy Is effective in treating pain and preventing chronic pain

For example:

·         Low back pain

o   A review of more than 60 randomized controlled trials evaluating exercise therapy for adults with low back pain found that such treatment can decrease pain, improve function, and help people return to work.39  The American College of Physicians states that “non-pharmacologic interventions are considered first-line options in patients with chronic low back pain because fewer harms are associated with these types of therapies than with pharmacologic options.”40

·         Before and after surgery

o   A review of 35 randomized controlled studies with a total of nearly 3,000 patients found that in patients undergoing total hip arthroplasty, preoperative exercise and education led to significant reductions in pain, shorter lengths of stay postoperatively, and improvements in function.41

·         Arthritis

o   Studies have shown that therapeutic exercise programs can reduce pain and improve physical function among individuals with hip and knee osteoarthritis.42,43

Chronic pain can be devastating. You don’t just want to survive, you want to thrive. A physical therapist can get you moving again, and moving = thriving

Get PT first before taking opioids.

Drop the Pills!