Two very common scenarios are seen every day at Gold Medal Physical Therapy and other clinics across America:

You bend over one day to tie your shoes before work and feel a jolt shoot from your back all the way down your right leg.
You recently retired and want to take control of your back or neck pain that you have been dealing with for decades so that you can enjoy time with your grandchildren or traveling the world.

When this happens, it is common for people to seek out an MRI to try to determine what is truly going on.

After an MRI, you receive a report detailing the findings. The report will include many words such as degenerative, desiccation, osteophyte, bone spur, spondylosis, herniation, or bulge.

So would mine, and I am completely pain-free!

A 2014 study by Brinjiikji et al. reviewed MRIs of over 3,000 people grouped by decade from people in their 20s to people in their 80s. Everyone in the study had no history of back pain and had full pain-free function.

Thirty percent of participants in their 20s had lumbar (low back) disc bulges and seventy-three percent of participants in their 70s had lumbar disc bulges – without even knowing!

A similar 2015 study by Nakashima et al. showed that eighty-seven percent of the over 1,100 study participants had a disc bulge in the cervical spine (neck) without any pain, history of pain, or other symptoms.

Just because there are findings on an MRI report does not mean that your pain will be forever, unchangeable, or that you will require surgery to fix it. Every day in our clinics we help people regain function, decrease pain, and avoid surgery.

Often, findings on an MRI report can be viewed as simply a natural process of life, just as one’s hair turning gray. We observe what is on the report, but then treat the deficits we can change as physical therapists: muscular weakness, flexibility, mobility, etc.

There are times when an MRI report or a patient’s current symptoms and presentation will mean they need further medical intervention such as consultation with an orthopedic surgeon or neurosurgeon. We as physical therapists are well versed in noticing the signs and symptoms of a patient that needs to seek out further consultation, and we will refer out for anything that we believe will not respond to conservative care or is an emergency.

What is Vertigo?

There are several types of vertigo that can be treated in physical therapy. The most common type of vertigo is known as benign paroxysmal positional vertigo commonly referred to as BPPV. BPPV is twice as common in women than men and also more common in individuals greater than 60 years old. This type of vertigo is due to crystals known as otoconia in the inner ear that become dislodged and are now free floating in the semicircular canals in the inner ear. These crystals are gravity sensitive and there is a feedback loop that works with the vestibular nerve to send signals for posture, balance, eye and head position. When there is dysfunction present patients often report dizziness and nausea, and present with nystagmus which is involuntary eye movements.

How can Physical Therapy help?

Physical therapy uses head movement techniques known as the modified Epley maneuver and the barbeque roll maneuver to help the crystals move back to their original resting position. This decreases the dizziness and nausea that are often the main symptoms of BPPV. Symptoms can resolve quickly within the first few treatment sessions. Exercises are then implemented to improve the vestibular system to prevent reoccurrence. These exercises include balance, eye and head movements, and also strengthening of the head, neck, and shoulder for improved proprioception and optimal positioning of the head and neck.

What can I do for prevention? 

There has been some recent research to figure out some of the causes of BPPV. Some research suggests a link with BPPV diagnosis and low vitamin D and calcium levels. Vitamin D helps with the absorption of calcium and phosphorus from the food you eat. The otoconia are calcium crystals and with low calcium the crystals become less dense and easier to become dislodged. There is also a link between BPPV and osteoporosis for the same reasons for low vitamins D and calcium. It is theorized that BPPV is more common in the older population due to nerve atrophy and the loss of the nerve cells and the nerves pass the messages along more slowly. No matter the cause, BPPV is treatable and responds very well to physical therapy and often patients find that they are able to return to their previous level of function.

Call us today to see if you could benefit from physical therapy.

Insurance – oh what horrifying word. The truth is insurance can be scary if you do not know what it is exactly you are reading. It sounds like a bunch of mumbo jumbo. Deductible, co-insurance, co-pay, in-network, out of network, and let’s not forget to mention all the little codes they put on your Explanation of Benefits and expect you to know what they mean by them. Sure they give you explanations of everything but if you truly do not understand the wording you will be confused.

Does anyone ever really understand the language of insurance companies? The answer is no. No one really truly understands their insurance benefits and knows exactly what their insurance company is talking about when it comes to your benefits and when they send your explanation of benefits. Well that’s what we are here for!

When you go see your physician and they prescribe you physical therapy, I bet a thought you might have is – does my insurance cover it? Yes, 90% of insurance plans cover physical therapy. There is that small 10% of plans that do not cover it.

While your insurance may cover it there may be an out of pocket cost to you! So how do we determine what your out of pocket cost will be? Normally, we will verify eligibility online or with a phone call. When we verify your insurance we obtain your benefits for physical therapy – we will find out if you have a deductible and if it applies to physical therapy, if you have a copay or if you have a co-insurance, how many visits you are allowed, if you need a script or referral from a visit.

What does deductible, co-pay, co-insurance and out of pocket mean?

Deductible

What is a deductible? A deductible is a specified amount of money that the insured must pay before an insurance company will pay a claim: You will be responsible for your entire deductible before your insurance will pay for anything.

Co-pay 

Do I have a copay? A copay is a fixed amount you pay for a health care service, usually when you receive the service. The amount can vary by the type of service. How it works: Your plan determines what your copay is for different types of services, and when you have one.

Co-insurance 

What does coinsurance mean? Coinsurance is the percentage of costs you pay after you’ve met your deductible. You will never have a copay and a coinsurance. There may be these slight procedures that require a copay and coinsurance but that is very rare.

Out of Pocket 

The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits. The out-of-pocket limit doesn’t include: monthly premiums.

If you have any further questions or would like to set up an appointment please feel free to reach out to one of our Patient Care Coordinators at either office or request an appointment above.

One of the major challenges that many people have had to deal with since 2020 is working from home. Whether it was having to create a make-shift desk and workspace in a pinch, or if you already had a home office set up, many Americans have had to face these challenges.

Here we will briefly discuss some modifications that you can make in the home to help with your seated posture, and ultimately reduce the risk of postural related pains.

What Chair should I use?

A chair that is adjustable will be your best bet. As easy (and cheaper $$) as it is to use a dining room table chair, this may be a major culprit to your posture. Ideally, a chair that has adjustable height setting is key, which will allow you to sit comfortably with a few easy steps:

– Feet flat on the floor
– Hips and Knees at 90* angles
– Wrists straight with the elbows rested at an angle




What kind of table should I use?

As long as you have an adjustable chair, and your table height allows you to be seated comfortably and correctly, then any table will do fine. Just remember:
– Wrists slightly below your elbows
– Keep your arms close to your sides
– Keep you monitor at arms length away
– The top of your monitor should be at your eye height

What happens if I sit in bad posture for too long?

One of the most common issues that can develop is what is called Upper Crossed Syndrome (UCS). UCS will present with a forward head, rounding of the thoracic (upper back) spine, shoulders up and forward. This can lead to decreased mobility in the upper back, tightness in the pec muscles (Chest) , the Upper Trapezius (Neck) and your sub occipitals (Attaching to your skull).

Is Upper Crossed Syndrome bad?

If left uncorrected it can lead to aches and pains as well as longer term postural issues. However, there are a few things that can be done to prevent the occurrence.
– Change the way that you are sitting
– Stretch the muscles that are tight
– Strengthen the muscles that are weak

What exercises are best for me to start NOW?

– Seated Thoracic Extensions with a Foam Roller
– Is Ys and Ts with a Foam roller
– Upper trapezius and Levator scapulae stretches
– Pec stretches
– Theraband Rows
– Theraband Pulldowns

Examples for some of these exercises can be found in the home exercise tab at the top right hand side of the page.

Disclaimer: As always, these are examples of exercises/ stretches that your physical therapist can discuss/ provide to you. If you attempt any of these exercises and develop additional pains, please contact your M.D or seek counsel from a Physical Therapist. Thank you.

Pre-operative Physical Therapy, also known as ‘Prehabilitation’, has shown to have positive outcomes on the recovery process of postoperative rehabilitation for individuals undergoing orthopedic surgery. Undergoing surgery with a poor preoperative functional status can increase the chance of complications postoperatively.

Here are some common questions asked about pre-habilitation, also known as prehab:

What can I expect from my prehab care?

Your therapist and clinical team will prescribe you targeted exercises to improve your overall strength and range of motion (ROM). The more ROM and strength you have prior to surgery, the easier it will be to reach these milestones after. Nutrition is vital before and after surgery. Your Doctor may recommend you meet with a nutritionist. This will ensure that you have a balanced diet needed for recovery.

Surgery is not only taxing on the body, but also on the mind. Working with a Physical Therapist who has helped individuals like yourself, may give you a better understanding of what to expect during the recovery process. You may be discouraged at first, feeling as though you are not progressing as quickly as you’d like. This is okay, recognizing that everyone progresses at different rates is part of the healing process.

Rehab is hard and should be challenging.  Prehab with a Physical Therapist will help to place you in the right mind set to succeed.  Exercise is going to be crucial in your recovery.  Learning discipline and holding yourself accountable will help you recover more quickly.

Which population will find prehab most effective?

Typically, we have found that the elderly population benefits the most from Pre-hab. However, all ages typically do well and we have found that individuals who have sustained ACL tears do particularly well with prehab therapy.

What are the benefits of prehab?

Range of motion and strength appear to improve/ progress faster in individuals who utilize prehab as opposed to those who do not. Patients report reduced post surgical pain levels after working in a course of rehab prior to surgery. Your Physical Therapist can give you an accurate idea of what you need to do for a quicker recovery. Most importantly, having therapy prior to surgery helps you, the patient, set expectations following your procedure.

How long should I undergo prehab?

This will be up to your Surgeon and Physical Therapist. It will likely depend on the severity of the injury and what goals you would like to accomplish prior to your procedure.

I once had a patient, an older patient. She grew up on a farm. Her dad worked hard and would occasionally suffer from heel pain. For treatment he would lie on the trailer bed and have his wife hit his heel repeatedly with a mallet until the pain was gone. For all of you anchorman fans out there, in the words of Brian Fantana, “They have done studies, 60 % of the time, this works every time”. This sounds barbaric, I know, but it was a different time and medicine back then isn’t what it is now. Over the next few paragraphs, I’ll talk about what plantar fasciitis is, how someone can develop plantar fasciitis, as well as what we do in PT to treat this and how you can treat it yourself at home.

What is it?

Plantar fasciitis in its simplest terms is an inflammation of the connective tissue (fascia) along the bottom of your foot and heel. Typically it occurs as a result of overuse and poor biomechanics (things don’t move like they should) of the foot and ankle. Pain can be present in multiple areas along the base of the foot, but more often than not it occurs around the outside edges of the heel. Some people present with pain that is worse in the morning and gets better with weight bearing throughout the day, others experience discomfort as the day goes on and feel relief with rest. Typically the pain will improve within a year, but working with your Doctor and Physical Therapist, we can help make improvements within a shortened timeline.

How does someone get plantar fasciitis?

Typically, this will occur in individuals who spend a fair amount of time on their feet or if there is a sudden change in activity level within a course of a week, month or days. A person with plantar fasciitis will most likely have limited dorsiflexion, an ability to pull your toe up, as well as abnormalities within the arch of their feet. At the core of the problem, plantar fasciitis is an overuse injury, so you need to be consistent with your rest cycles if you are just beginning or have already established an exercise program.

How can Physical Therapy help?

At Gold Medal Physical Therapy, we use a combination of manual therapy techniques (massage, stretching, joint mobilization), corrective exercise and self management techniques to help reduce pain and improve function. It is recommended that you get fit for an appropriate pair of shoes, as proper footwear can help to decrease symptoms. Talking to your podiatrist or orthopaedic MD, they can help fit you for a night splint that can additionally help reduce your pain in the morning and throughout the day. It is recommended that you use Ice to help manage the inflammation, either through a direct cold compress or utilizing a frozen water bottle along the bottom of your foot.


Exercises to perform at home.

Standing calf stretch : Bent and Straight Knee

Plantar Roll out (golf ball or frozen water bottle)



Arch Raises (starting position)


Arch Raises (ending position)

Please consult your Doctor or Physical Therapy team prior to attempting any of these exercises. We sincerely hope this post helped to expand your understanding of plantar fasciitis and what you can do on your own to treat and manage your symptoms.

5 Tips to Reduce the Likelihood of Headache

Headaches can be quite a nuisance, especially when they escalate to painful migraines that practically incapacitate
you. Whether it’s from overexerting yourself during exercise or having high stress levels, it can be tempting to
eliminate it with the aid of an over-the-counter pill, such as ibuprofen or paracetamol. However, you might not always
have these pills on hand, which is where these other ways to avoid and alleviate headaches can come in handy!

1. Hot and Cold Applications

IMAGE CREDIT: Unsplash
Applying cold or hot packs to your head can help reduce the pain, especially for muscle tension headaches. Cold
packs can be applied for 10 minutes at a time before taking a break, while warm compresses are best placed on the
back of your neck and forehead for relief.

2. Hydrate

Have you ever wondered why your headache is so pronounced after having a few drinks the night before? This is an
example of a dehydration headache, which Medical News Today describes as something that can happen even
without consuming alcohol. Getting a glass of water or a hydrating beverage filled with electrolytes will help bring your
headache down in no time.
It’s also best to avoid headache-inducing beverages. Aside from alcohol, caffeinated drinks are also to blame for
headaches, especially if you have too much coffee, energy drinks, or soda. Try asking for a half-decaffeinated
beverage the next time you’re at a coffee shop. Be conscious of your alcohol intake as well, especially with drinks like
whiskey and red wine.

3. Proper Neck Posture

IMAGE CREDIT: Pain Free Working
Poor posture can cause aches and pains all over the body, including your head. Every inch that your neck bends
forward past its normal curve places a significantly greater amount of pressure on your muscles, contributing to
headaches. Unfortunately, slouching is very common these days, especially with remote work and the absence of
proper office equipment like office chairs and desks with appropriate heights
Those working from home can benefit from investing in an ergonomic chair, but be careful not to purchase just any
office chair. An ergonomically designed one should have a good seat height range, a seat pan with a waterfall edge,
and adjustments for backrests, armrests, and headrests. Chairs with adjustable neck lengths for customized support
cradle your head and prevent it from tilting too close to the computer screen, thereby eliminating the development of
headaches due to poor posture.

4. Reduce Stress Levels

IMAGE CREDIT: Pexels
While it seems like stress can’t be avoided these days, learning how to manage it is one of the best ways to curb
persistent headaches. These headaches are usually some of the most painful, escalating into migraines as the day
progresses. To address this, be more deliberate about removing stressors from your environment and practice deep
breathing or meditation techniques. Doing this removes the tension in your head and body, resulting in less head
pain.

5. Quality Sleep

IMAGE CREDIT: Pexels
A study from Biomed Central has found that sleep deprivation is linked to a loss of ion homeostasis in the brain,
contributing to migraines. Aside from getting a full eight to ten hours of sleep every night, improving the quality of your
sleep is also crucial. Having a relaxing routine to wind down before bed and sticking to your bedtime may seem
insignificant, but they contribute a lot to how well you sleep and reduce the likelihood of your headaches.


Headaches are never fun, whether it’s the low, persistent drum you feel or a sharp pain behind the eyes. Fortunately,
they typically don’t last long. Using these 5 tips and our webinar on headaches can help you get rid of them even
more quickly. So before you reach for that Tylenol, consider grabbing a glass of water first and mind your posture!

Written by Tracy Osborn for goldmedalpt.com