Category: Health Policy

I’m really enjoying the things I learn from Mike Leavitt’s blog.  He, of course, is the U.S. Secretary of Health and Human Services.  Mr. Leavitt connects Medicare spending to our overall national financial health:

"I would simply ask this question. If you were considering between an
investment in two organizations and one spent four percent on health
care with no future liability and the other spent 16 percent and had
trillions of dollars of unfunded obligations, which one would you be
most interested in?"

He tells us about Singapore, which spends only 4% of its GDP on healthcare.  They live longer.

ERIC

There is a 100 Push-up Challenge taking place over at the Get Fit Slowly blog community.  The participants of the challenge are using a protocol to slowly build their push-up fitness.  Push-ups are a difficult exercise, and many people have trouble doing them.  The military uses the push-up as a global strength measure due to its ability to predict success in military tasks.  But, push-ups can place the shoulders at risk, and may even rough up your back.  It’s worth asking a couple questions:  Are the fitness gains made doing push-ups worth these risks and, is there anything that can be done to improve the success of those undertaking the push-up challenge ?

What are you strengthening, really?

While it is intuitive that push-ups strengthen your arms, they do much more than
that!  Push-ups are often used in late stages of rehabilitation for the work they do strengthening the chest and shoulders, specifically the scapular stabilizing muscles.  Push-ups get a large amount of muscle activity in the upper trapezius muscle and the serratus anterior muscle.  Additionally, and most importantly, push-ups work your body’s core muscles around the spine.  As you do a push-up, gravity wants to make your back sag.  Keeping a nice, neutral spine requires a lot of abdominal muscle control, which can help to reduce low back pain.  This study suggests that a suspended push-up, where your hands are placed on a mobile surface like rings, provoke even more abdominal control, but also increase the load through the joints in your spine making this version of the push-up only good for healthy backs and strong cores.  A strong core, of course, is important for preventing low back pain.

Are push-ups a danger to the shoulders?

In short, YES!  Our arms are made for pushing, but in very specific positions.  As you get to the bottom of a push-up, the shoulder moves more towards extension.  When your arms are spread wide, this movement puts the shoulder in a precarious position.  The worst case is a risk of shoulder dislocation.  A less violent, yet more common occurrence is that the delicate tendons and joint capsule of the shoulder is over-stressed in this position, causing inflammation and pain.  You can minimize the risk to your shoulders by going slow, stopping when your upper arms parallel with your body (don’t let your elbows go past your torso, as in the picture above), and keeping your arms somewhat close to your body, but your hands neutral or turned outwards (turned in stresses your elbow).  If you keep good alignment and listen to your body over a dictated “preferred” form, push-ups can be good for your shoulders.

What to do on off days?

Since the 100 Push-up protocol calls for push-ups 3 days a week, that leaves 4 days to do something else.  While your muscles need time to recover, especially after a challenging task of push-ups, doing some simple cross-training can speed up both recovery and performance.  I would recommend aerobic exercise always, but also doing some non-arm-based core training on off-days.  Example:  crunches, swiss ball workouts, or hip and leg exercises like a leg press.  Keeping your body moving on recovery days is the concept behind “active recovery” which is the preferred method of rest when training.

Warning Signs?

Doing too many push-ups too quickly can get you into trouble.  The main spot of concern is the shoulders, of course.  It is important to differentiate muscle soreness from injury-related pain.  Injury pain is usually more focused in one spot and more intense.  Muscle soreness goes away after a day or so, but injury pain returns when the activity is performed again or does not go away.  If you’re doing the 100 Push-up Challenge and you feel some pain, please take a week off.  Yes, not just a day, a whole week!  In my clinical experience, it is much better to be conservative with inflamed shoulder structures than to challenge them.  It could be that the small, but honest break will enable you to keep pace overall.  Not taking that break can get you into some chronic pain trouble and doom your chances altogether. 

Good luck!

I recently was interviewed for a couple of related articles on yard work safety.  I also saw this NYT blog about lawn mower dangers and decided that was enough for me to link to some shameless(video too!) self-promotion.

Never mind the fact that the interviews I get as a physical therapist are only about lifting mechanics and gardening…that’s a whole different story!

And while we’re at it, who can forget the APTA’s Young at Heart campaign, which also includes tips on gardening safety.

Eric Robertson, PT, DPT
Board Certified Gardening Aficionado

A squeaky hip replacement, that is!  [Link, New York Times]

“It can interrupt sex when my wife starts laughing,” said one man, who
discussed the matter on the condition that he not be named.

Ceramic materials have some cool properties and have been heralded as the best option for joint replacement.  As a physical therapist, I argue that the best option for a hip replacement is avoiding one in the first place!  Hip manipulation and mobilization can help keep that hip moving nicely, and hip strengthening is a critical part of exercise as one ages. 

All that said, it is interesting to see this problem getting some big press.  You would be hard pressed to speak to a PT who has ever cared for hip replacement patients who hasn’t heard the squeaking.  They squeak.  Squeak = Friction.  Hmmm.

Click here for a very excellent YouTube video of a squeaking hip.

ERIC

The inherent conflict of interest that this man has in the issue of physical therapist direct access in Michigan should be enough to make him keep his mouth shut…or at least be excluded from an interview on the subject.

"It’s a safety question, according to state Sen. Tom George, a physician who heads the state’s health policy committee.

"What the law is, in Michigan, is to protect the consumer," George
said, "to make sure they’ve been properly diagnosed and examined by a
physician first."

A typical case for a physical therapist might involve shoulder pain,
he said. It could be a skeletomuscular problem, but it could be just a
symptom of a more serious problem.

"The leading cause of death in Michigan is heart disease," George
said. "Shoulder pain can be an indicator, so they should see a
physician first."

Yep, that’s right, it could be a heart attack, we’ve got to check everybody!  Are we to assume that Tom George thinks that a physical therapist cannot tell the difference between heart disease and shoulder pain?  Who voted this scoundrel in?

Who let’s him serve on a policy committee?  Time to rally the troops Michigan!

At least one group of surgeons is fighting to increase access to physical therapists.  The American Association of Oral and Maxillofacial Surgeons (AAOMS) has gotten a bill sponsored:  the "Medicare Oral Health Rehabilitative Enhancement Act of 2008" (H.R. 5590).

Currently, Medicare rules prohibit referrals to physical therapists from dentists.  It seems strange to me that Medicare would allow these fellows to operate on someone, without simultaneously providing them with the ability to rehabilitate their own patients.  I wonder which groups, if any, actually oppose this bill.

Oddly, I couldn’t find this bill on the APTA Legislative Action Center website.  But, you can always write your congressman and urge them to support the bill! 

ERIC

Two weeks ago, I sat in an audience listening to Mike Leavitt, the U.S. Secretary of Health and Human Services, as he suggested an upcoming report would reduce the time until the Medicare trust fund goes bankrupt.  But a report released this week left the 2019 estimated doomsday date unchanged.  I wonder why the disconnect?

Perhaps, Mr. Leavitt understands the absurdity of the following assumption:

"But the report, prepared by government actuaries and economists, said
these projections were unrealistic because they assumed that Medicare
payments to doctors would be cut by more than 10 percent in July and by
an additional 5 percent in January 2009 and in each of the next seven
years, for a cumulative reduction of about 40 percent." [via NYT]

By the way, I’m all about Mr. Leavitt’s Value-Driven Health Care Concept.

[Update: Mike Leavitt is a blogger!]

ERIC

My favorite morning news program mentioned today that American’s are spending a record level of their discretionary income on food, fuel, and medical bills.  The current economic woes coupled with the ever-rising health care costs remind me of Healthcare Analytics, the new corporation dedicated to developing the next vital sign:  Health Care Credit Scores.

Perhaps the most ominous quote from that article was by a south Florida hospital administrator who stated, "You want to concentrate on the ones that have the ability to pay."

Of course, she was referencing collection efforts, but I can’t help but wonder.  Perhaps we need a new model of delivery, not a better way to get payments.

ERIC