New PTOSI therapist at our Plymouth clinic:  Jillene Chitulangoma, DPT now treats patients at our Plymouth and Roseville locations.

Tanya Bourdage, MPT joined PTOSI and our Minneapolis staff 3/17/08! Tanya brings 11 years of physical therapy experience.

New PTOSI location:  Ryan Torgrude, DPT, OCS, MTC, CSCS is the Clinic Director at our new Coon Rapids clinic.

American Heart Association Prescribes Physical Therapy First

DALLAS__The American Heart Association recommends doctors change their approach to prescribing pain relievers for patients with or at risk for heart disease. In a scientific statement published Feb. 27, 2007 in Circulation: Journal of the American Heart Association, the heart specialists instead prescribe physical therapy first.

“We believe that some physicians have been prescribing the new COX-2 inhibitors as the first line of treatment. We are turning that around and saying that, for chronic pain in patients with known heart disease or who are at risk for heart disease, these drugs should be the last line of treatment,” said Elliott M. Antman, M.D., FAHA, lead author of the American Heart Association scientific statement and professor of medicine at Harvard Medical School and Brigham and Women’s Hospital.

“We advise physicians to start with non-pharmacologic treatments such as physical therapy and exercise, weight loss to reduce stress on joints, and heat or cold therapy. If the non-pharmacologic approach does not provide enough pain relief or control of symptoms, we recommend a stepped-care approach when it comes to prescribing drugs.”

“This recommendation comes as no surprise to physical therapists,” said Liz Schorn from Physical Therapy Orthopaedic Specialists, Inc. (PTOSI) in Minneapolis and Fellow of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT). “Research has repeatedly shown the value of early physical therapy for patients with musculoskeletal conditions. We are glad to see that the AHA’s recommendations of physical therapy as a safe and effective alternative to drugs are consistent with these findings. It only makes sense to see your physical therapist before trying drugs and surgery.”

To read the AHAs scientific statement online, go to: http://www.americanheart.org/presenter.jhtml?identifier=3045689. For more on the benefits of physical therapy, contact PTOSI or visit the American Academy of Manual Physical Therapists website at: http://www.aaompt.org.


STUDY SHOWS SPINAL FUSION SURGERY FAILS ONE IN FIVE TIMES!

Spine fusion (surgery) is commonly viewed as a stabilizing treatment that may reduce the need for additional surgery. However, according to a recent study published in the medical journal, Spine, “the indications for fusion surgery in degenerative spine disorders remain controversial, and the effects of fusion on reoperation rates are unclear.”

The study, is titled “Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures”. According to the authors, BI Martin and associates from the Department of Medicine, University of Washington, Seattle, WA, the objective of the study was to “determine the cumulative incidence of reoperation following lumbar surgery for degenerative disease and, for specific diagnoses, to compare the frequency of reoperation following fusion with that following decompression alone.”

The study found a rate of nearly 20% reoperation following the first spinal surgery. “In other words,” said Don Darling of Physical Therapy Orthopaedic Specialists, Inc. (PTOSI) in Minneapolis and Fellow of the American Academy of Orthopedic Manual Physical Therapists (AAOMPT), “one in five people who have their spines fused in surgery, must suffer through additional surgery because it failed the first time. That's an alarming rate. In the vast majority of cases, patients would have benefited from physical therapy first.”

The conclusion from this study is clear, according to the AAOMPT: Patients should be informed that the likelihood of re-operation following a lumbar spine operation is substantial. The group suggests considering alternatives to lumbar surgery proposed by the Association of Ethical Spine Surgeons, who understand that lumbar surgery rates in the U.S. are preposterously over-utilized. The number one alternative to lumbar surgery, according to the surgeons themselves, is to first visit a physical therapist.

“That is the mantra of AAOMPT”, noted Darling, “Go see your physical therapist first. We will not prescribe drugs or perform invasive procedures that may well cause more harm than good. We can alleviate the pain in your back, and show you how to prevent it from reoccurring.”

For more information about the benefits of physical therapy and how it can help you alleviate back pain, eliminate your use of prescription drugs, and prevent costly and painful surgery, go to: http://www.aaompt.org, or contact PTOSI.


Rake Appeal
Why Race?
On the legions of untalented athletes who enter competitive events.
by Sarah Barker, photos courtesy of Jeff Frey and Associates Photography, Inc.

(Grandma's Marathon) - July 2006

When we were all younger and firmer, my husband was a competitive runner and our daughters were Dad groupies. Upon returning from the crusades, battle scarred and sweaty, the girls would surround him, hopping around with Barbies in their fists and shrieking, “Did you win Dad, did you win?” The situation was such that sometimes he could truthfully say yes and a cheer went up, yeah, and all was happiness. But sometimes when he was being silly and honest, he said, “No, I was tenth.” Not only was he tenth, he was colder than yesterday’s starlet. The daughters were of the Linda Evangelista don’t-get-out-of-bed-for-less-than-ten-thousand-dollars school of thought.

Why race if you weren’t going to win?
Of course that’s immature thinking. Judging from the streams of competitors transitioning from swim to bike to run in the Lifetime Fitness Triathlon later this month, not to mention the ten thousand runners who’ll be making their way down Summit Avenue in the Twin Cities Marathon in October, there must be lots of reasons to race that don’t include a prize worth $500,000. The Road Running Information Center reports that while numbers of participants in marathons have steadily climbed in each of the past ten years, median finishing times are significantly slower—from 3:54 to 4:23 for men and from 4:15 to 4:51 for women. This suggests the athletes swelling the ranks are definitely not racing to win.

Missy Fee, thirty-eight, race director for the Heart of the Lakes Triathlon in Annandale, first became involved in the event as a competitor in the early 1990s. There were perhaps one hundred other racers that year, including her husband who signed up on race day. This year, the short course reached its five-hundred-entrant limit in just two days, four months prior to race day. Between short and long courses and relay teams, the Heart of the Lakes Triathlon drew one thousand entrants who each paid sixty dollars to participate. “It’s hard to say what’s motivating people to enter triathlons,” she said. “I can only speak for myself. I was a competitive athlete in high school and college, and I had run several marathons. This is a local event, and when I saw what the distances were, I thought, I can do that.”

Suzannah Mork, a doctoral candidate in the school of kinesiology at the University of Minnesota, has interviewed twenty ironman-distance triathletes and discovered several characteristics unique to participants of this extreme event that comprises a 2.4-mile swim, a 112-mile bike, and a 26.2-mile run. “In most events, racers compete against each other. Ironmans are so challenging that there is a strong sense of cooperation and camaraderie among racers, and every finisher really is a winner.” The triathletes she interviewed listed many reasons for racing, among them, curiosity, motivation to exercise, an enormous sense of accomplishment, and even social opportunities. “There’s a lot of time to talk on a fifty-mile bike ride. Triathletes appreciate the chance to meet and socialize with other like-minded people. They commented, ‘We used to meet for coffee. Now we meet for a run.’ ”

Overwhelmingly, the reason proffered for racing is to challenge oneself, to discover something about oneself by finding limits and then pushing beyond, to see what’s on the other side. So says Jan Kahring, age fifty-three of Maple Grove, who, when interviewed, was in the thick of training for Grandma’s Marathon, her first. “I like to push myself but I need a race to motivate me to get out and do the training.” She recalled a cold, rainy weekend when she did an eighteen-mile run—something that would not have occurred had she not been training.

Any intuition that training more often and more intensively increases one’s susceptibility to injury was debunked by Liz Schorn, a physical therapist in Minneapolis. “I think people who race are more attuned to proper training techniques, hydration, diet, and stretching and therefore are less likely to get injured,” she said. “Racers are also more likely to have invested in better-quality gear which helps prevent injury. The noncompetitive athlete may take a more casual view of these factors and, even though they are logging fewer miles, may be just as likely to sustain injury.” She notes that while participation in races has increased over the past ten years, the number and types of injuries she sees has remained steady.

Of course, race participants don’t sign waivers of responsibility for nothing. Two entrants died during the 2006 Los Angeles Marathon, and a third was hospitalized. Race officials ran out of water during last year’s Life Time Fitness Triathlon, held in ninety-degree heat. At least three competitors ended up in Hennepin County Medical Center’s intensive care unit. This year both the Mad City Marathon in Madison, Wisconsin, and the Med City Marathon in Rochester took place over the unseasonably hot Memorial Day weekend; both events were called off after five and three hours, respectively. In Madison, some five hundred runners who were still on the course were encouraged to accept a ride to the finish area or to walk the remaining miles at their own risk.

“I don’t really get it,” says Diane Wiese-Bjornstal, an associate professor of kinesiology at the University of Minnesota, speaking of the flood of people entering races these days. “Racing does motivate people to be active, and as a kinesiologist, this is important to me. But my cynical side has observed that races serve as a notch on the belt, an observable accomplishment that seems increasingly important in our society,” she said. Beyond health, Wiese-Bjornstal suspects that at least part of the motivation for neo-racers is our society’s obsession with the tangible evidence of success; acquiring a souvenir race T-shirt serves as a marker of success, much like driving a Hummer or buying a mini-mansion. Anyone can jog or go for a swim or a bike ride, Wiese-Bjornstal points out, but “racing has become increasingly attractive in part because it raises the status of the participant. The intrinsic value of physical activity has shifted to extrinsic—‘Look, I completed a triathlon’ rather than ‘I am a disciplined person’ or ‘I love being outside on my bike.’ ”

Many of the registrants filling triathlons and marathons are young professionals trying to make their mark on the world. Wiese-Bjornstal observed that this generation was one of the first to have had a highly scheduled childhood, with organized sports starting as early as three years old. If a child enjoys whacking around a can with a stick, the inclination for many parents is to channel that activity into a peewee hockey program, where he quickly learns there is more glory in competing than there is in merely whacking around a can with a stick. It’s not surprising that children who grew up connecting physical activity with competition and external rewards would, as adults, choose to race, Wiese-Bjornstal explained.

“That may be true,” said Charlie Peterson, a runner and triathlete from St. Paul. “I saw a lot of people wearing their T-shirts and finisher’s medals around after the Boston Marathon. The T-shirt is really important to some people.” Although a young professional himself, Peterson says his motivations for racing involve travel and socializing. “It’s a fun thing to do with friends and a great way to see another city.”

The opportunities to socialize and belong to a community played an important role in Janet Robertz’s decision to race. The forty-four-year-old Bloomington resident had been running every day for seven years before she ever entered a race. Even though she was the first woman finisher in that event, she was sorry she’d entered. “It was a horrible experience—stressful, competitive, crowded, and I felt just terrible. This was the exact opposite of everything running had been for me. After that first race, I wanted no part of it.”

But being both intrinsically motivated and talented as a runner, Robertz eventually transitioned from being vehemently noncompetitive to becoming one of the country’s top masters (age forty and older) runners. “I still love running by myself on trails through the woods, but racing has opened a whole world to me. I’ve gotten to travel and I’ve met the most wonderful people. It’s been fantastic. Back before I was racing, I knew nothing of the running community. I thought I was kind of weird. A few years ago, I was at the Avon marathon and my sister said, ‘Oh my gosh, all these people look just like you.’ It’s true. They’re my people.”


OMM and Sports Injuries, Summer 1998
www.com.msu.edu/communique/Summer98/SportsOMM.html

Osteopathic Manipulative Medicine Proves Excellent Treatment for Athletes
by Dawn Wondero

When an athlete has recurring knee pain while running, what should a physician check first - her knee, or something else?

"I looked toward her feet," said Sarah Strong, a certified athletic trainer with MSU Sports Medicine.

If you are an osteopathic physician working with athletes, you too might have answered, "feet first." Ms. Strong, who will become an MSUCOM student this fall, has spent a lot of time working with MSUCOM physicians, and has learned the first steps in thinking like a DO.

"An injury here may affect a body part in a different place," she said. "With this patient, it ended up that the alignment of her entire lower body was off. We could tell something was wrong by watching her walk."

For athletes, their physician's ability to detect and treat structural problems can mean the difference between a most valuable player trophy, spending all season sitting the bench because of an injury, or even the end of an athletic career.

"Structural integrity and function are a requisite for athletics," said Lynn Brumm, DO, a team consultant for the MSU Department of Intercollegiate Athletics. Brumm, who is professor emeritus for MSUCOM's Department of Family and Community Medicine, explained that an athlete's musculoskeletal system experiences much pressure during training and competition.

"The extreme physical activity in sports means structural integrity and function are constantly stressed, compromised, altered or restricted. This can cause a number of problems, including discomfort and interference with the normal physical behaviors and activities required in athletics," he said.

Larry Nassar, DO, ATC, national team physician for USA Gymnastics and a team physician for MSU Intercollegiate Athletics, realizes the potential of osteopathic manipulative treatment when this kind of stress has caused problems. Also a certified athletic trainer, Dr. Nassar, an assistant professor in the MSUCOM Department of Family and Community Medicine, chose the osteopathic profession because he believed having manual medicine skills would make him a better provider. Like Dr. Brumm, Dr. Nassar now uses these manipulation skills to treat the injuries and illnesses of a wide range of athletes.

"Basically OMT allows athletes to recover quickly from injuries because it helps with the healing process. It reduces swelling, allows for greater lymphatic drainage and circulation, decreases pain and increases range of motion," said Dr. Nassar, MSUCOM Class of '93. He also said he uses manual medicine on athletes to help drain sinuses, resolve constipation and relieve upper respiratory congestion.

"When it comes to manual medicine, it is important that the medical provider know and understand a great variety of techniques," Dr. Nassar said. "Then the techniques can be better customized for the nature of the injury and the specific athlete, therefore giving the care provider a greater advantage. This gives us the 'art' in medicine," he added.

Although he agrees that understanding and utilizing many methods are important, Dr. Brumm believes certain types of OMM, such as muscle energy and articulatory techniques, can be applied very quickly, decrease athletes' down time and help them get back on the field, floor mat or court more quickly than other methods.

"In athletics, you're trying to return a particular athlete to performance in sports immediately," Dr. Brumm said. "These kinds of treatments will do this, where some of the other methods take longer to bring the athlete back to full status."

Dr. Brumm also urges osteopathic physicians to look at newer methods of manipulation, which can help athletes with long standing and more complicated structural problems.

"A major advance in the care of complicated structural dysfunction is the understanding of muscle imbalance and muscle firing patterns, first researched and developed by Janda and Lewit of Czechoslovakia, and clinically coordinated and developed as a specific exercise treatment of somatic dysfunction and its cause by Mark R. Bookhout, MS, PT," Dr. Brumm said. "The application of this modality has produced recovery for athletes whose careers were otherwise in jeopardy. In my opinion the osteopathic profession would be well advised to actively utilize this modality," he added. Whichever method is used, both Drs. Brumm and Nassar said OMM allows them to treat their athletic patients more fully than if they did not have these skills.

"Being trained in OMM allows me to provide care during a competition and during practice," Dr. Nassar said. "I use OMM sometimes between events to help athletes reduce muscle spasms, to increase the range of motion and to decrease pain. I've also used it on the field during football games."

Another osteopathic physician who recognizes the benefits of a holistic approach is John Finley, DO, team physician for the Detroit Red Wings. Although Dr. Finley said he only occasionally uses OMM on his athletes during their high-contact games, he does take care of their structural and other injuries afterward.

"As an osteopathic physician, I am able to look after all the various medical needs which are frequently related to the musculoskeletal system," said Dr. Finley, a MSUCOM clinical professor. "With the concept of holistic medicine, osteopathic medicine is being recognized as an all-inclusive profession-being able to take care of all of the athletes' problems."

Dr. Nassar agreed. "Manual medicine gives you an extra tool to work with that, if you do not have the ability, you couldn't give that care to your athlete. You would have to refer the athlete to a physical therapist or an athletic trainer," he added. "On the road with the gymnastics team, I spend 90 percent of my time doing OMM. It's one of the main tools that keeps these kids going."


Kempainen overcomes bad stomach in marathon.(SPORTS)

From: Star Tribune (Minneapolis, MN) | Date: February 18, 1996 | Author: Zavoral, Nolan

***** Published 02/20/96: This article incorrectly identified the occupation of physical therapist Liz Schorn, who works with Minnesota athletes. *****

Bob Kempainen didn't have the stomach to run 26.2 miles here Saturday, but he sure had the heart.

Nauseous and vomiting over the last 2 miles, the University of Minnesota medical student from Minneapolis held on to win the U.S. men's Olympic marathon trials in a course-record 2 hours, 12 minutes and 45 seconds. Kempainen, who was seeded third, collected $100,000, the richest payoff in marathon history, and earned his second Olympic marathon berth.

Today, the enduring picture from the race over the hilly Charlotte course will not be that of the second and third-place finishers - Mark Coogan of Boulder, Colo., and Keith Brantly of Ft. Lauderdale, Fla. - shaking hands over the last mile, acknowledging they had made the team.

It will be of Kempainen who, after crossing the finish line, bent over with his hands on his knees and retched for a sixth and final time.

"But the bottom line is I made the team," said Kempainen, still looking ashen 2 hours after the race.

Coogan finished more than 100 meters behind Kempainen in 2:13: 05, ahead of Brantly's 2:13:22. Steve Plasencia, former Gophers runner now living in Eugene, Ore., who made two Olympic teams at 10,000 meters, missed making his third by finishing fourth in 2:14: 20.

Kempainen, 29, winning his first marathon in seven tries, received high marks from competitors for his pluck. At least once, he wobbled during his vomiting episodes, but kept on and actually seemed to lengthen his lead.

"He's the toughest human being on the face of the earth," Brantly said. "If that'd been me, I'd have been stopping and crying."

Ed Eyestone of Layton, Utah, who finished 15th in a vain attempt to make his third straight Olympic team, echoed Brantly - to a point.

"That's gutsy," Eyestone said of Kempainen. "What some people will do for $100,000 [the amount awarded to the winner]."

Kempainen - sponsored by Nike and with healthy six-figure earnings from his six-year marathoning career - said the money will go directly into the bank. The American record-holder in the marathon (2:08:47) seemed less certain about what had caused his problems. He pointed to his diluted energy drink he said he wasn't tolerating well, and he alluded to the gene pool.

"I think I inherited my dad's gastrointestinal system," said Kempainen, who began experiencing problems as a junior high school runner. "He's got a weird stomach, too."

Kempainen's stomach started getting weird on mile 24, which he nevertheless ran in 4:42 to extend his lead to 30 meters over Coogan and Brantly.

"I got my water bottle and I realized I wasn't feeling good," he said. "It was a sign of the future. To stop was out of the question. But I started to feel queasy.

"Next thing I know, I've got a little gap, and then I got an upset tummy."

Other favorites had problems as well on a cool, sunny day, with temperatures hovering around freezing. Second-seeded Arturo Barrios of Boulder dropped out with a torn calf muscle, and 1993 World Marathon champion Mark Plaatjes of Boulder left with assorted injuries.

Kempainen, who led lead-pack surges at miles 12 and 18 to overhaul unheralded early leader Paul Zimmerman of Beaverton, Ore., blasted through the hills of the 25th mile in 5:05. Arms stroking smoothly and strongly, the 1990 National Cross-Country champion continued to conquer hills and never was threatened.

Except by himself.

"But between my hurlings, I felt pretty good," he said. "I focused on staying relaxed. When I started to grind, I started feeling bad again.

"My legs felt good enough, but I was worried about inhaling and coughing."

Kempainen's physical problems didn't end with the race. At the post-race news conference, Kempainen, wincing, stood up from behind the dais he shared with his new Olympic teammates and tried to walk off leg cramps. Liz Schorn, an exercise physiologist from Minneapolis who works with Kempainen and other top Minnesota athletes, immediately went to his aid.

Kempainen, 17th at the 1992 Olympics, said he will spend seven weeks finishing medical school and then begin training for the Aug. 4 Olympic marathon in Atlanta. He said his preparation wouldn't change much from his marathon training in general.

"I think I put in a pretty solid race in Barcelona," he said. "I don't think I have to reinvent the wheel."

COPYRIGHT 1996 Star Tribune Co.