Mr. O’Brian founded this practice 23 years ago this month.  For such a small and committed group of individuals, Paul O’Brian, Ross Hutchinson, Rob Schultz and Cindy Keefover bring you passion, information, and unmatched skills when you need the most help from a physical therapy staff.  In addition, Caryn O’Brian and Anne Chiles offer another 30 years of experience working with insurance authorization and billing.  When you consider all this and the convenient location at 64th and Simms in Arvada, you should look no further for your Physical Therapy needs.  Call (303) 421-210 to schedule and appointment with Paul or Ross for you initial evaluation.

Celebrating Anniversaries is a post from: Physical Therapy Services in Arvada, Colorado ~ Accelerate Physical Therapy

One should consume 1/2 oz. of pure water per pound of your body weight daily (200 lbs= 100 oz. each day) and at a slow but steady sipping pace of about 3-5 oz per half hour for optimal liver and kidney clearance. Proper hydration is essential to your healing and your health each and every day.

People taking medications or even vitamins may have a unique need to add water to their diet. Exercise and forced-air heat like furnaces and car heaters dry you out as well. Many bottled drinks are in fact, less effective than plain old water. If your urine is yellow, or your feet are dry, add 2 glasses of water to your normal routine. Drink extra water on days you exercise, have massage, or require the heater in your house or car. Stop the pain. Don’t get dehydrated!

Eight a day

The body loses, on average, about two to three quarts of fluid daily through perspiration, exhaled moisture, and excretion. You must replace this fluid, hence the rule of thumb about consuming the equivalent of at least eight 8-ounce glasses of water daily. Some of the water you need comes from solid foods, especially fruits and vegetables. You get the balance from liquids you consume (juices, milk, soups), which are just as good as water.

Any change in diet, particularly an increase in protein or salt consumption. or an increase in exercise or outdoor temperature may raise your fluid needs. Certain drugs, notably diuretics, will increase water loss, as will alcohol or caffeine. Dehydration is a particular problem among the elderly, in part because the thirst mechanism becomes less efficient as we age.

Normally thirst is the best sign that you need more fluids. But if you’re exercising or working strenuously in the heat, you can lose a quart of water an hour. Don’t wait until you’re thirsty: drink before, during and after your workout.  If you fail to do this and need to replenish the water you’ve lost, weigh yourself after your workout, and drink a pint of fluid for each pound you’ve lost.

One glass of water shuts down midnight hunger pangs for almost 100% of the dieters studied in a University study.

Lack of water is the #1 trigger of daytime fatigue.

Preliminary research indicates that 8-10 glasses of water a day could significantly ease back and joint pain for up to 80% of sufferers.

A mere 2% drop in body water can trigger fuzzy short-term memory, trouble with basic math, and difficulty focusing on the computer screen or

Drinking 5 glasses of water daily decreases the risk of colon cancer by 45%, plus it can slash the risk of breast cancer by 79%, and one is 50% less likely to develop bladder cancer.

Are you drinking the amount of water you should every day?

Are you drinking enough water? is a post from: Physical Therapy Services in Arvada, Colorado ~ Accelerate Physical Therapy

Eccentric Exercise
Widely publicized in the early and mid 1970′s for its value in body building and fitness training, eccentric exercise has proven to be an effective component of the rehabilitation in tendinitis and epicondylitis conditions like tennis elbow.

Unloading Techniques
When exercise is applied while the effects of gravity are minimized, several conditions see benefits that otherwise might have been aggravated by exercise. The spine, shoulder and knee joints are commonly approached at Accelerate PT with exercise setups, which eliminate the use of secondary muscles that substitute for the weakened primary movers of the effected joints. A gradual progression in the loading of the joints facilitates progress in functional tasks including weight-bearing activities.

Aquatic Exercises
Another transitional form of exercise is submersion in water for both loading the muscles with resistance and/or to unload gravity from the body. Stimulation of proprioceptors and assisting the body to withstand longer duration exercise training are possible using public and private swimming pools and hot tubs.

Stretching Exercises
In addition to restoring range of motion for joint and muscle conditions, nerve tissue benefits from stretching techniques for the extremities and the trunk. Specific techniques carried out daily are important in the management of postoperative joint conditions and postural maladies including thoracic outlet and carpal tunnel syndromes.

EXERCISE HEALS is a post from: Physical Therapy Services in Arvada, Colorado ~ Accelerate Physical Therapy

Tendons and ligaments should be treated in the same manner by considering the mechanics of injury, adaptation to activity, and healing response during rehabilitation. Mechanical loading of a tendon/ligament can create injury with a single high load strain or repetitive loading or misuse injuries. The single high load strain can result in sprains, partial tears or ruptures which are more prevalent in ligaments, as muscle will rarely contract hard enough to tear a tendon. Achilles and patellar tendon ruptures are usually a result of muscle forces in combination with external forces. In repetitive strain situations the tissue injury begins with micro damage, which if created too quickly cannot be repaired fast enough. This results in pain, swelling and degradation of the tendon/ligaments mechanical properties. When this cycle continues, it can create a progressive degradation and make the tissue more susceptible to traumatic overload injuries. Tensile load is dictated by increased length of tissue stretched by percentage. A 1.5%-3.0% tensile load is common in normal activities, however without this stimulation the tissue will weaken, and with increasing the tensile load tendon strength will improve. Injury is created usually with over 10% tensile loads.

After a soft tissue injury the tendon/ligament will go through a typical soft tissue healing process. Inflammation 3-7 days, proliferation 2-3 weeks followed by remodeling after 2-3 weeks and up to more than one year, all in overlapping stages. Through the remodeling phase, the tissue fibers increase cross-links and align in the direction of tensile load. It is critical that the rehabilitation program provide adequate stress in a program of progressive loading that avoids inflammation. We must avoid over stress that can impede the healing process and cause scar tissue to form. The paradox of functional tissue training comes in balancing between sufficient loading to guide the healing process and overzealous loading that continues inflammation and tissue degradation. We minimize inflammation with early mobilization and PROM-AAROM program. This may be increased as the tissue progresses into the remodeling phase by progressive AROM, isometric and eccentric exercises followed by high repetition progressive exercises including CKC with proprioceptive and perturbation activities assisting in return to normal upper level activities.

Careful management of exercise type and intensity relative to the particular tendon or ligament injury, as well as awareness of the phase of recovery the tissue has reached is the key in progressing the patient. Optimal management will produce minimal pain and increased speed of healing, providing improved patient satisfaction.

About the Author:
Ross Hutchinson, PT, CSCS, has been actively involved in Colorado physical therapy since 1991.
You can contact Ross at his Arvada, Colorado office.

Functional Stress for Tensile Tissue is a post from: Physical Therapy Services in Arvada, Colorado ~ Accelerate Physical Therapy

All of the following describe generally accepted, well established and widely used physical therapy modalities and procedures provided at Accelerate Physical Therapy.  These procedures are used as primary or adjunctive techniques in soft tissue treatment for the progressive development of strength, mobility and to improve functional outcomes.

The primary use of thermal modalities is for pain, swelling and to improve the rate of healing soft tissue injuries.  Extended use is supported by consistently measured changes.  Certain diagnoses and post surgical conditions may require periods of treatment beyond the normal ranges of 3-6 weeks.

Additional use of procedures is occasionally necessary to help control swelling, pain or inflammation during the rehabilitation process.  They may be used intermittently as a therapist believes appropriate, or regularly if there is specific measured improvement during the treatment.

If you (the patient) are not responding within 3-4 weeks, alternative treatment, further diagnostic studies, or further consultations with your physician or another physical therapist should be pursued.

The Use of Modalities

Hot Packs
Reduce pain or raise the pain threshold before exercise, postural training and gait training
Reduce muscle spasm to promote increased movement
Increases circulation to aid healing

Cold Packs
Lowers body tissue temperature for reduction of inflammation
Lessens pain resulting from injury or exercise by increasing the pain threshold
Reduces swelling and hemorrhage.  Used in combination with compression and elevation
Lessens pain and inflammation from tendinitis and bursitis
Diminishes muscle spasm to promote stretching and decreases exercise induced muscle soreness
Increases circulation to aid healing

Paraffin Baths
A form of heat application that uses paraffin wax/mineral oil mixture applied safely at 126 degrees Fahrenheit.
Symptomatic resolution of pain
Elevates pain threshold
Prepares for exercise, mobilization of the distal extremities and gait training

Electrical Stimulation
Applies electrical current (AC or DC) over skin to muscles, joints or other soft tissue for the following reasons:
Relaxes muscle spasms (including TENS)
Reduces pain (including TENS)

Weight free exercise
Enhances recruitment by increased muscle fiber response
Promotes cell waste and bacteria removal for further healing
Enhances wound healing
Reduces inflammation/swelling/edema
Alleviates muscle spasm to promote increased movement
Stimulation of bone growth
Maintains muscle responses in spinal cord injuries
Facilitates muscle size and strength

Physical Therapy Procedures (Level One)

The level of complexity can characterize the following physical therapy procedures and the expertise required to perform the task.  These procedures involve training exercises or modalities requiring more specific skill than those characterized as modalities, but may be provided by assistants under the direct supervision of a licensed physical therapist.

Iontophoresis – The transfer of medication (including but not limited to steroidal anti-inflammatories and pain relievers) through the use of electric stimulation.  This procedures has the following results:
Pain reduction
Inflammation reduction
Reduction in swelling
Aids circulatory problems in the extremities
Decreases muscle spasms
Breaks down calcium deposits and softens scars

Ultrasound with or without Electric Stimulation is the use of sonic generators to deliver acoustic energy for thermal and/or non-thermal soft tissue treatment.  There may be a concurrent delivery of electrical energy.  Ultrasound can be used to obtain the following results:

Softening scar tissue and reduce pain associated with scar tissue and adhesions
To soften collagen fiber
Accelerate soft tissue healing process
Increase flexibility of muscles and tendons
Reduce muscle spasms and reduce pain associated with muscle spasms
Local heating

Phonophoresis – The application of ultrasound using a medicated lubricant that introduces molecules into the tissue similar to those used in iontophoresis.

Contrast Baths – Involves alternating immersion of the extremities; promotes circulation and has the following results:
Reduces swelling in the subacute stage of healing
Improves outlying circulation
Decreases joint pain and stiffness

Massage – Manual or mechanical manipulation of soft tissue to achieve:
Reduced swelling
Reduced muscle spasms
Improved outlying circulation
Increased muscle tone prior to exercise
Reduced adhesions
Increased muscle length

Gait Training – Crutch walking or walker instruction to a person with lower extremity injury or surgery
Promotes normal gait pattern with assistive device
Promotes safety in proper use of assistive device
Instructs in progressive use of more independent devices (platform walker, walker, crutches, an cane)
Instructs in gait on uneven surfaces and steps (with and without railings) to reduce risk of fall or loss of balance
Instruction in the use of equipment to limit weight bearing for the protection of a healing injury or surgery

Straight Plane Exercises with or without mechanical assistance or resistance has the following effects:
Improves strength and coordination
Reduces atrophy
Improves reaction, recruitment and endurance
Supervises safe progression of resistance
Teaches techniques which promote accelerated muscle development
Increases size and strength in musculotendinous tissue and tensile strength

Activities of Daily Living involves the instruction, active-assisted training and/or adaptation of activities for personal care or equipment for mobility and self-care.  This includes:
A person’s capacity in mobility and self-care to move from floor or sitting levels to standing, fluently and without pain.
Aids in sleeping without pain, grooming and self care including hygiene.

Functional Activities involve the instruction, active-assisted training and/or adaptation of activities or equipment and has the following results:
Improves a person’s capacity for homemaking, including meal preparation
Improves a person’s capacity form communication, utilizing equipment
Facilitates return to work at previous level of function in lifting, driving, climbing, pushing, pulling, etc.
Job site modification to decrease postural dysfunction/pain

Therapeutic Exercise with or without mechanical assist or resistance has the following indications:
Improve cardiovascular fitness
Reduces edema
Improves muscle strength and coordination
Improves connective tissue strength and integrity
Promotes circulation to enhance soft tissue healing/metabolism
Increases bone density
Increases endurance, reduces fatigue

Physical Therapy Procedures (Level Two)

A higher level of expertise is required to perform these complex tasks.  They may be administered only by a licensed physical therapist.

Neuromuscular Re-education The skilled application of exercise with manual, mechanical or electrical facilitation and through its use enhances motor response, strength and recruitment rate with independent control.

Neurodevelopmental Activities/Reflex and Sensory Integration/Proprioceptive Neuromuscular Facilitation (PNF) involves the skilled use of activities and exercises that promote neuromuscular responses through carefully timed proprioceptive stimuli to normal neurologically developed sequences.  It also improves neuromotor response and reduces risk of impromptu muscle failure.  It improves tolerance and enhances strength, normalizes movement patterns and improves cell waste and bacteria removal, and increases the muscular sense and perception of movement, stabilization and reaction time.  These techniques achieve sensitization, or if required, desensitization of joint movement.

Soft tissue mobilizations the skilled manual application of techniques designed to normalize movement patterns through the reduction of soft tissue pain and restrictions for the following reasons:

Muscle spasm around a joint
Trigger points
Adhesions
Neural compression

Joint Mobilization is the passive movement performed in such a manner (particularly in relation to the speed oft he movement) that it is, at all times, within the ability of the patient to prevent the movement if they so choose.  Skilled manual joint tissue stretching is used to improve, and as possible, normalize joint movement of the spine and extremities and is performed for the following reasons:

To improve joint play/mobility
Improve intrascapular arthrokinematics
Reduce pain associated with tissue impingement or friction

What is Physical Therapy … really? is a post from: Physical Therapy Services in Arvada, Colorado ~ Accelerate Physical Therapy

For Those Whose Back or Leg Hurts:

Ball Stretching

Ball Stretching – Rocking Technique

Bridging

Bridging with Ball Squeezes

Ball Stretching for Back and Radiating Leg Pain is a post from: Physical Therapy Services in Arvada, Colorado ~ Accelerate Physical Therapy

There has-been much research into bodyweight supported treadmill walking as an treatment.  A reasonable and similar alternative is aquatic therapy. The buoyant nature of water is similar to bodyweight supported treadmill therapy in that it reduces the amount of force transmitted through the joints of the lower body. When a person is standing in water, which is neck deep, 90% of their body weight is eliminated and at waist deep, 50% is eliminated.

Aquatic therapy encompasses any therapeutic activities, which occur in a pool. Often times these activities will include walking, balance exercises, stepping, etc. Using exercises such as these it is possible to target the hip and knee muscles which are often weak and in need of strengthening.

It is also possible to break functional activities into smaller parts and practice these with proper form in a non-painful environment thereby increasing the patient’s ability to perform the selected activity on dry land. By targeting these exercises to a patient’s specific needs and deficits in an environment of decreased weight bearing, we can make an impact on a patient’s functional ability.

Osteoarthritis? Exercise in Water! is a post from: Physical Therapy Services in Arvada, Colorado ~ Accelerate Physical Therapy

Mechanically adding height to the navicular bone at the medial arch changes the functional position of the foot, knee and hip, and dramatically prevents many common problems. Gradually, as the body adjusts to corrective changes, stresses change and any resultant pain subsides.  The problem will continue or return if left uncorrected.

Wear arch supports if you are standing, exercising, shopping, working and always at home.  A number of products are available in stores near you.  Go to our website for links to information about invaluable and inexpensive arch supports, which are available at a variety of stores near you.

Everyone should wear supplemental arch supports in their shoes, slippers, athletic footwear, training shoes and cleats.  Orthotics, or at least foam arch supports have been repeatedly effective in curing pain and dysfunction of foot, ankle, knee, hip and back.

Arch supports reduce the degree of:

• Flat feet or falling arches (pes planus)
• Foot pronation
• Ankle eversion
• Q angles at the knee (valgus)
• Uneven hips (pelvic obliquity)
• Lumbar scoliosis.

Mechanically adding height to the navicular bone at the medial arch changes the functional position of the foot, knee and hip, and dramatically reduces, and prevents most problems. Residual pain can take a few weeks to go away, but the problem will not get better if left uncorrected. Leg and back pain sufferers benefit from supplemental arch supports and orthotics. Even if you only stand all day, arch supports will control pain and manage many progressive problems that we commonly treat.

Wear Arch Supports! is a post from: Physical Therapy Services in Arvada, Colorado ~ Accelerate Physical Therapy

Acute and chronic conditions benefit from the weightless buoyancy, the graded resistance, and the hydrostatic pressure provided by the water. A weak and debilitated individual can use the water effectively for each stage of their recovery and the able, athletic individual with back pain, or a knee injury can withstand different levels of training in the same aquatic environment..

Pool therapy is not swimming – it is standing, walking, reaching, lifting, kicking, floating, running, jumping, treading, etc. It includes a variety of creative challenges, which are endless. The therapists at Accelerate Physical Therapy are ready for any challenge – using pool therapy provides us with one more creative tool to help our patients achieve their physical goals.

The buoyancy decreases the load on the joint structure, which eliminates pain, assists range of motion, and improves circulation. Thirty to ninety percent of body weight can be eliminated allowing early aerobic and resistive training for the athlete. Relieving weight through the spine offers significant pain relief for disc and radicular pathologies while allowing for functional gait, transfers, and resistive strength conditioning.

Arthritic conditions benefit from the reduced compressive forces while allowing for smooth synovial motion and muscle strengthening. Water provides an environment that reduces body weight by 90% when standing in shoulder depth water, thus decreasing musculoskeletal stress or impact on the body. What better way to encourage normal motion in a joint than by eliminating gravity?

Graded resistance is accomplished by varying speed of motion and surface area of the extremity. Upper extremity, lower extremity and trunk exercise performed at a slow speed is assisted while fast motion creates a resistive challenge. Use of water dumbbells, fins, and paddles increase muscle recruitment for higher level strengthening. Furthermore, motion in the water is highly functional as trunk and proximal stabilization musculature are recruited throughout movement in the pool. This challenge incorporates movement of the injured area of the body with the whole person-reinforcing normal motion and coordination. Throwing, pushing, pulling, lifting and reaching can be incorporated into the independent exercise program for return to sports or functional activity. When able, one may initiate high level activities early in the pool with faster return to activity. Further, the use of underwater exercise allows the muscles to be exercised in all directions. This is due to the fact that water resistance is 12 times greater than air resistance.

Confidence increases as the individuals we serve improve their level of control in the water. Soon the activity becomes easier and less challenging out of the water as strength gains continue.

Accelerate Physical Therapy offers one-on -one aquatic therapy treatment. Cost may be discounted by your insurance plan. Programs are tailored to the individual needs of the patient and the treatment diagnosis. Accelerate Physical Therapy. PC are Medicare B (outpatient) providers. If you are covered under Medicare B, we are paid 80% of Medicare’s fee schedule after your deductible is met. There is a limit of ~$,1900 benefits under Medicare B for all physical therapy provided to you everywhere in each calendar year. Medicare benefits are renewed every January. We are participating providers in nearly all insurance plans. We have only abstained from participation with group health insurance carriers who offer less than reasonable and customary reimbursement.

We teach aquatic exercise at the Wheat Ridge Recreational Center, 4005 Kipling St, Wheat Ridge, CO 80033, where the therapeutic pool is 88 degrees.

A cost effective community resource is the warm water therapy pool located at Margaret Walters Center features 92 degree water, pool depth of 0 to 4’6″, a walkway with rail, a hydraulic lift and easily accessible dressing rooms with lockers. Individuals and organizations may purchase swimming services from the DDRC Recreation Division. Please call Howard at (303) 431-0734. DDRC’s Walters Center offers Open Swim hours Tuesday through Friday mornings (8:30 – 9:30 AM), and afternoon Open Swim on Tuesday and Thursday (3:00 to 4:00 PM), and also Wednesdays (4:00 to 5:00 PM).

DDRC Recreation
Walters Center
12665 W. 52nd Ave.
Arvada, CO 80002
(303) 431-0734

Here is a list of some other sites to contact about warm water exercise opportunities:

Apex Center
13150 W 72nd Ave
Arvada, CO 80005
(303) 424-2739

Easter Seals Steve Vestal Center
5755 West Alameda Avenue
Lakewood, CO 80226
(303) 233-1666

Wheat Ridge Recreation Center
Therapeutic Pool (adjacent to the Hot Tubs)
4005 Kipling St
Wheat Ridge, CO 80033-4125
(303) 231-1300

YMCA of Arvada
6350 Eldridge St
Arvada, CO 80004
(303) 422-4977

We will update the list as we discover other options for you.

Where can you find warm water exercise? is a post from: Physical Therapy Services in Arvada, Colorado ~ Accelerate Physical Therapy

Accelerate PT on Facebook

Professional ice skater, Ryan Gutzmer, made an astounding recovery from a shoulder injury.  He sent us this link to witness his return to the big time.  Ryan was raised in Arvada, and now travels the world as an entertainer. 
Watch this:

World class skater finds us on Facebook! is a post from: Physical Therapy Services in Arvada, Colorado ~ Accelerate Physical Therapy