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It's that time of the year when many of us are thinking about New Year's resolutions. But when we do that, we are focusing on results and not what we should be focusing on, says Rory Vaden, self-discipline strategist and author of Take the Stairs: 7 Steps to Achieving True Success.

When we focus on results, we procrastinate, says Vaden, and "procrastination destroys our dreams more than any other controllable force." Maybe you dream of starting a business or traveling around the world or finally getting into better shape. Whatever your dream is, it can feel safer not to start a daunting task because when we don't start, we know we won't fail.

The irony about the fear of making mistakes is that mistakes can be our greatest teachers. "Successful people take action despite not knowing how it will turn out," says Vaden. The trick then is not to insist on stellar results, but on stellar effort. We should get in a habit of taking action - success is the result of our sum total of regular, small actions.

We can overcome procrastination by not saying, "I'm too busy" or "I don't have time." As soon as we say that we're too busy, we let ourselves off the hook. We stop thinking creatively about how to get other important tasks into our routine.

Also consider letting others know about our intentions - it's easier to let ourselves down than it is to let others down. Friends, family and colleagues can provide support and encouragement as we take actions to achieve our dreams and goals.

Let's journey together in 2014 and make it our goal to stay positive in our attitudes and make the most of every opportunity to be well and proactive about our health.

To Your Health,

Advance Physical Therapy, Inc.
 Physical Therapy 2014 - Preventive Medicine

When you have an ache in your back, or trouble getting your hand behind your back to tuck in your shirt, do you know your options? Yes, you can ignore it and hope it goes away! However, a more common option is to make an appointment to see your doctor. Meanwhile, depending on how long it takes to get in, your problem is not going away. After you see your doctor, you may need to wait longer to get in to see your physical therapist. Patients often wait two or more weeks before they finally begin physical therapy. But beginning this month, there is another option, thanks to a new law that allows Californians direct access to physical therapy services. You no longer need to see a physician first for a new problem that affects your movement.

This new legislation will not only speed up the healing process by treating problems earlier, but according to previously conducted studies in states that already have direct access laws in effect, the savings to insurance companies is substantial. Total claims for physician referral cases averaged $2,236 compared to $1,004 for direct access cases. (Mitchell J, de Lissovoy G. A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy. Phys Ther. 1997; 77:10-18.) 

As always, your physician and/or physician specialist (orthopedist, physiatrist, etc) will be important team members in your care. The new law provides that if your episode of care takes longer than 12 visits, or 45 days, your physician will be informed of your progress, and asked to advise us on your care. During your evaluation, or at any point before the 12th visit, we may also direct you to see your physician if there is a concern.

At Advance Physical Therapy, we are excited to have the opportunity to begin treatment early, since we know that problems resolve more quickly if they are identified and treated sooner. We see this as an opportunity to not only treat problems that are apparent because a pain is present, but also treat the problems "lurking under the surface" which have not become symptomatic yet. Some joints will never become symptomatic, but many will. The detection of abnormal movement patterns in small or large regions of the body can predispose a person to typical joint problems that occur frequently in the population. Physical therapists are the only healthcare professionals with the expertise in diagnosing movement dysfunction.

Direct access to physical therapy care is here. Let's partner together in being more proactive about disease and injury prevention.
Standing at Work Reduces Chronic Disease

People who decrease sitting time and increase physical activity have a lower risk of chronic disease, according to Kansas State University research. Even standing throughout the day -- instead of sitting for hours at a time -- can improve health and quality of life while reducing the risk for chronic diseases such as cardiovascular disease, diabetes, heart disease, stroke, breast cancer and colon cancer, among others. The researchers -- Sara Rosenkranz and Richard Rosenkranz, both assistant professors of human nutrition -- studied a sample of 194,545 men and women ages 45 to 106. The data was from the 45 and Up Study, which is a large Australian study of health and aging. "Not only do people need to be more physically active by walking or doing moderate-to-vigorous physical activity, but they should also be looking at ways to reduce their sitting time," Richard Rosenkranz said.

The twofold approach -- sitting less and moving more -- is key to improving health, the researchers said. People often spend the majority of the day being sedentary and might devote 30 to 60 minutes a day to exercise or physical activity, Sara Rosenkranz said. Taking breaks to stand up or move around can make a difference during long periods of sitting. Sitting for prolonged periods of time -- with little muscular contraction occurring -- shuts off a molecule called lipoprotein lipase, or LPL, Sara Rosenkranz said. Lipoprotein lipase helps to take in fat or triglycerides and use it for energy. "We're basically telling our bodies to shut down the processes that help to stimulate metabolism throughout the day and that is not good," Sara Rosenkranz said. "Just by breaking up your sedentary time, we can actually upregulate that process in the body."

In a previous study published in the International Journal of Behavioral Nutrition and Physical Activity, the researchers found that the more people sit, the greater their chances of obesity, diabetes, cardiovascular disease and overall mortality. For the more recent study, the researchers wanted to take a positive approach and see if increasing physical activity helped to increase health and quality of life. The researchers want to motivate people -- especially younger people -- to sit less and move more so they can age easier with less chronic disease. "There is only so far that messages about avoiding diseases can go, especially when talking about chronic disease because it is so far removed and in the future," Richard Rosenkranz said. "For young people, being motivated by avoiding diseases is probably not the most pressing matter in their lives. We wanted to look at excellent health and excellent quality of life as things to aspire to in health."

To help office workers and employees who often sit for long periods of time, the researchers suggest trying a sit/stand desk as way to decrease sedentary time and add physical activity into the day. A sit/stand desk or workstation can adjust up and down so employees can add more standing time to their days. There are even sit/stand desks for children to stand and do homework or projects.

The research appears in the journal BMC Public Health. Collaborators included Gregory Kolt of the School of Science and Health at the University of Western Sydney in Sydney, Australia, and Mitch Duncan of the Institute for Health and Social Science Research with the Centre for Physical Activity Studies at Central Queensland University in Rockhampton, Australia. While the researchers have used existing data for this latest study, the Rosenkranzes are now conducting experiments to manipulate sitting time in already active people. They want to understand how increased sitting time affects physiological risk factors such as blood pressure, body composition, triglyceride and cholesterol levels, inflammation and oxidative stress.
Overuse Injuries and Burn Out in Youth Sports

As emphasis on success in youth sports grows, overuse injuries and burnout in youth has become more common due to intense training, frequent competition and early single sport specializationGiven these concerns, the American Medical Society for Sports Medicine (AMSSM) has released a new clinical report that provides guidance to physicians and healthcare professionals who provide care for young athletes.

“Not only are overuse injuries in young athletes likely much more common than is realized, these injuries can require lengthy recovery periods, and in some cases, they can result in long-term health consequences,” says lead author John P. DiFiori, MD, Chief of Sports Medicine and Non-Operative Orthopaedics at UCLA, and AMSSM President.

For the 60 million US children and adolescents between 6-18 years who participate in some form of organized athletics, youth sports can be an enjoyable and beneficial experience, offering opportunities to increase self-esteem, peer socialization and general fitness. However, an emphasis on competition, collegiate scholarships and elite-level success has led to increased pressure to begin high-intensity training at young ages, often in only one sport. Consequently, overuse injuries and burnout are affecting many young athletes.

In light of these issues, the AMSSM convened an expert writing group of seven sports medicine physicians to review the latest data and provide recommendations for the sports medicine community.

The full report, entitled, Overuse Injuries and Burnout in Youth Sports: A Position Statement from the American Medical Society for Sports Medicine, was developed through a systematic literature search initially yielding nearly 1,000 articles, followed by author analysis. The findings reveal that the current literature, which reports overuse injuries comprise 50% of sports injuries, underestimates the burden of these injuries, since many do not result in time loss from sport.

In addition, this new report highlights several specific higher-risk overuse injuries that may result in prolonged recovery and have the potential to endanger future participation. Although infrequent, some may lead to long-term complications.

The paper also emphasizes that there are several unique risk factors for overuse injuries and burnout in children and adolescents. Social, emotional, cognitive and physical factors all play a role.

“Children grow and mature at different rates, making chronologic age a poor barometer for parents and coaches to set expectations and gauge progress,” said Dr. DiFiori, Head Team Physician at UCLA. “Understanding this can be critical to a child’s self-esteem and motivation to continue participating.”

Other notable findings and recommendations include:

● A history of prior injury is an established risk factor for overuse injuries that should be noted as part of each injury assessment, and pre-participation examination.
● Adolescent female athletes should be assessed for menstrual irregularity as a predisposing factor to bone stress injuries.
● Early sport specialization may not lead to long-term success, and may increase risk for overuse injury and burnout. With the possible exception of early entry sports such as gymnastics, figure skating and swimming/diving, sport diversification should be encouraged at younger ages.
● Limiting weekly and yearly participation time, limits on sport-specific repetitive movements (e.g. pitching limits), and scheduled rest periods are recommended
● Careful monitoring of training workload during the adolescent growth spurt is recommended, as injury risk seems to be greater during this phase.
● Pre-season conditioning programs and pre-practice neuromuscular training can reduce injury rates.

The extensive review provides a comprehensive analysis of overuse injuries and burnout in youth sports including these key aspects:
● Injury Prevalence
● Risk Factors
● Readiness for Sport Participation
● Sport Specialization
● High-Risk Overuse Injuries
● Prevention

The AMSSM hopes that this information can assist parents, coaches and healthcare professionals as they provide care for young athletes. The full statement is available at
If we can answer any questions or field any topics of interest regarding  physical therapy, health and wellness or about our programs, please contact us. We'd love to hear from you.
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