Insurance coverage can be a tricky thing to navigate. Do you know what your individual deductible is? If so, do you know about your family deductible and coinsurance for a specialist visit? For most of us, myself included, the insurance specifications have become seriously complex. Many times I’ve intervened on behalf of patients that have met their wits-end while attempting to understand their chiropractic or physical therapy benefit coverage. In an attempt to simplify some of the frequently used insurance terminology, I put together this little cheat sheet to help in minimizing the frustration factor.
A coinsurance occurs when there is cost-sharing between the insurance company and the covered member/family. The insurance company may tell you that your responsibility is a 20% co-insurance and that they will cover the rest of the charges (remaining 80%). Quite often a coinsurance comes in to play after an individual or family deductible has been reached.
Example: Your opthamologist visit is $400 and Optima informs you that you have a 20% coinsurance after meeting your $200 deductible. Currently, you have met $0 of your deductible. Your responsibility would be: $200 of the deductible and then 20% of the remaining $200 specialist visit charge = $40.00. The total you can expect to pay for the visit is around $240.
A copay is a set fee that you are responsible for each time you visit a doctor. There are usually tiers or copays where a primary care doctor is typically less than the copay you may have for a specialist. Some plans have a copay due in addition to a co-insurance.
The set amount an individual or family must reach before transfering over to coinsurance coverage for medical services. Some plans have relatively low individual and family deductibles of $200 – $500 while other plans have larger $5000 – $9500 deductibles. Once you have met your deductible you may only be responsible for a fraction of the percentage of your medical care, referred to as a co-insurance.
Out of pocket maximum or stop loss
This is the absolute maximum a covered member or family will pay out of pocket for medical care including copays, deductibles and co-insurance for a defined period of coverage (usually a calendar or a contract year)
At the start of this holiday season, we’d like to give thanks for Balance(d). I named my practice Balanced because I believe in a measured approached to things – to the body, to patient care, and to life. It serves as a reminder to me as much as I hope it does for my patients. Last year I wrote about the importance of balance during the holidays, and you can read about it here. This year, I thought I’d share how I keep my balance during the holidays. Keeping your holidays stress free is great advice, but I want to talk a bit about how you actually do it.
For me, as an introvert, I’ve learned it is really important not to over schedule myself. If I do, it can really wear me out. So I keep track of my schedule in a calendar, and when I consider any invitation I look at the time slot and see what’s around it. If attending the event doesn’t leave me any recharge time, or there’s too much travel time, or if it means I’ll miss too much of my exercise plans, it’s likely a pass for me. Of course for those with children, schedules can be more complicated. You just have to keep your mind on the balance.
Another consideration around the holidays is food. I love food. You can often hear me talking about cooking, restaurants, and value-driven ingredients. To balance food around this time of year, I try to keep lunch light and very healthy – especially if I have plans for dinner or a party later. Then there are the oh-so-tempting sweets that pop up everywhere during the season. So, I eat a healthy snack before I head out since counting calories doesn’t work for me. When I am trying to relax and enjoy a party the last thing I want to think about is how healthy the food is I am eating. Filling up a little on healthier foods before I go can also help ease the guilt along with the managing how much I eat. I gain weight easily if I’m not careful, so I tend to stick with my plans.
I’m a big proponent of exercise, as many of my colleagues in the healthcare field are. If you’re trying to keep from gaining weight, or if you’re trying to lose weight during the holiday season, you’ve got to pay attention to your diet the most. However, exercising during the holidays will also help keep your weight in check as well as help to alleviate stress and keep you in a better mood overall. Of course, if you’re on a set plan for a competition, stick with your plan. If you’re like most people, you exercise more because you should and less because you love it – or perhaps you don’t exercise at all. Time is a big factor for those who don’t, but it doesn’t need to be all or nothing. The key thing is to keep your body moving. If during the holidays, you drop from four days a week to three, that’s a good trade-off. Another way to make the most of your time is to consider high-intensity interval training to make your exercise shorter but more intense. You’ll still build muscle, improve your cardiovascular function, and get all those wonderful stress relieving chemicals – going hard for 10-15 minutes can be as useful as an hour of moderate exercise on the bike or a long walk.
So, take these tips and find your balance this holiday season:
- Look at your calendar frequently and make sure you aren’t overloading yourself and the family
- Stick to a healthy breakfast and lunch and have a healthy snack so you don’t have to watch too much at a party
- Keep up with some amount of exercise, even if it’s less than you normally do
Sam Spillman, DC
The balance system is one of the most important systems the body uses. Throughout the day it helps us to drive a car without getting dizzy; slip on a slick surface without tearing ligaments; go up and down stairs without looking at every step; and walk down the sidewalk without tripping on uneven cracks. Balance is a complex masterpiece that can be honed to help every person function at their highest level. Have you ever wondered how gymnasts balance on the balance beam, or hockey players skate on ice while handling the puck, or how skiers tear manage to slalom downhill without falling? It all has to do with practice and creating a balance set to fit their unique sporting needs. There are three different balance systems that work together to create a wholly balanced world.
This is the feeling that we have in our feet, and is sometimes intertwined with proprioception. Somatosensation and proprioception are defined as how the sensors within the skin on our feet, joints, muscles and tendons sense where we are in space. These sensors constantly give feedback to different parts of the brain and brain-stem to correct movement, and ensure that the proper muscles are contracting to stabilize and move our body. This system can be disrupted by nerve damage (often called peripheral neuropathy), which often occurs with diabetes and some artery diseases. It can also be disrupted by pain, which is why anyone who has had an ankle sprain will tell you that they sprain the ankle over and over after the first injury. This is because the system is disrupted in the presence of pain so the ability of the ankle muscles to contract and prevent further sprains is impaired. When this system is disrupted due to lack of sensation or pain, the body relies on the other two systems below.
Simply put, vision gives us our picture of the world and integrates with the other systems to adjust muscle activity and movement to match what we see. We rely most of our vision during balance.
The vestibular system is an integral part to the balance system. It activates postural muscles throughout the day and also helps us move our eyes independent of head movement. This allows us to focus on one thing while there may be a lot of other things going on around us – think about reading a street sign while driving on the highway, for example. If both of your vestibular systems were non-functioning (you have two, one in each ear), the horizon would bounce up and down instead of being still when walking. Mismatches in information within this system is usually what causes motion sickness. The reason people get nauseous with motion sickness is that the brain has trouble with deciding which input to use – vestibular, somatosensory, or vision. Nausea is your brain’s way of saying: we need to sit down and take a break so I can figure this out. When this system is not functioning correctly, patients generally experience dizziness – defined as feeling off, light-headed, or spacey – and vertigo, which gives the sensation that the world is spinning around you. This system is most important for balance at night when vision can be eliminated.
Balance may not be as straightforward as it seems. It requires a lot of input and processing within our nervous system to work well. The good news is that our balance system can adapt to use one part of the system more than the other through training and practice. The bad news is that as we age, we generally lose sensation in our feet and vision leading to increased risks for falls.
We can help you find your balance before issues develop. Give us a call for your balance screening today!
Bryan Esherick, DPT
Inflammation can strike at any time. Anti-inflammatory drugs can be helpful, especially for new injuries and certain inflammatory-based pathologies. However, our bodies experience new episodes of inflammation (both beneficial and detrimental) all the time. So, using natural remedies is a safer way to decrease those frequent bouts of non-beneficial inflammation.
Here are a few natural remedies to try before you reach for a pill.
- Exercise: Even just 20 minutes of exercise can have anti-inflammatory effects on the body’s systems.
- Add powerful anti-inflammatory spices to meals: Give turmeric, cinnamon, and ginger a try. Turmeric can be sprinkled on variety of foods, cinnamon can be a great addition to your oatmeal or tea in the morning, and ginger brings a nice twist to a smoothie.
- Reduce red meat consumption: Recent studies show red meat can actually bring on inflammatory effects on the body. Chicken, salmon, and other foods high in Omega 3’s can be great options to prevent inflammation and get the protein you need.
- Eat more foods with anti-inflammatory properties: Fruits, vegetables, nuts, and legumes are your friends. Be sure to include multiple servings of these throughout the day to allow your body to be at its best.
Remember, your body is your greatest asset. Take good care of it, and it will take care of you for years to come!
Bryan Esherick PT, DPT
Treatments come in a variety of options. Opioids (oxycodone, hydrocodone, etc.) are often prescribed as treatment for an episode of pain patients are experiencing. If you haven’t been the recipient of these directly, there’s a good chance you know someone who has. They’ve been widely prescribed as they had always been considered both safe and effective. However, in the wake of an opioid epidemic, we want to remind our patients that there are safe and effective treatments that let you avoid the drugs – and without the side effects, That said, there are instances where these types of drugs are appropriate – post surgery or serious injury – and with proper management may be used safely. However, we want to use this platform to highlight our approach to more conservative treatments that can effectively alleviate pain.
As physical therapists, chiropractors, and massage therapists, we look to provide that first-line treatment for acute and chronic injuries alike – including: manual therapy; joint mobilizations; massage and soft tissue release; targeted therapeutic exercise; and health education. Let’s take a closer look at these distinct areas.
Joint Manipulation and Mobilization
Manipulation and mobilization are used throughout musculoskeletal health by chiropractors, physical therapists, and some osteopathic doctors. Despite popular belief, the aim of these treatments is not to put a bone back in place. Treatments like this work with the nervous system to affect pain (through release of endorphins), muscle tension (through reduction in pain and thus reduction in spasm), and proprioception (your brain’s sense of your joint position). In my opinion, 95% of cases require exercise to reinforce the effects of the manipulation. In other words, mobilization and manipulation gives your body a window to exercise with less pain so that you can correct the issue at fault and increase muscle tone. However, it does not correct the underlying cause of the pain independently. These are powerful pain relieving tools that can be employed to aid in your recovery from pain, especially in the spine.
Generally massage is thought of as a relaxation and stress reducing technique, but it can also be used as a powerful pain relieving and recovery tool. Therapeutic and sports massage are given in order to improve recovery through reduction in muscle tone and improvement in blood flow. Relaxation in muscle tone allows the muscle to receive the adequate nutrition is desperately needs to heal. Think of a muscle as a sponge; when it is squeezed out (overactive) it is not able to receive the water (blood) it needs to function. We see this happen often in cases of back pain associated with sustained postures, and receiving occasional massages would help alleviate this chronic paid in a more effective and cost-effective treatment. Massage also releases endorphins through a healing touch and targeted techniques, which helps to ease pain and creates a relaxing therapeutic environment for the body to heal. Your chiropractor or physical therapist may also use targeted soft tissue techniques to promote healing and pain reduction.
Therapeutic exercise is used widely by physical therapists and chiropractors as well. Movement encourages the body to release endorphins, reduce tissue tension through increased blood flow, promote healing through cellular processes, and prevent chronic pain from fear of movement. Exercise can be used as a means for tissue to adapt and heal to specific stresses it will encounter through daily activities. We use therapeutic exercise not only as a pain relieving mechanism, but also as a way to introduce stress to healing tissues in a controlled manner. If the tissue is not properly loaded over time, it can be substantially weaker than it was prior to the injury causing recurrent injuries. The best example of this phenomenon is chronic ankle sprains. Without proper rehabilitation, ankle sprains are likely to keep occurring as the body is unable to fully heal the tissue prior to sustaining a second, third, or fourth injury. Another common misconception is with arthritis. Many people stop moving because the arthritis is causing too much pain. On the contrary, our joints need to be loaded in order to provide nourishment to the joint surfaces. Without movement, joints can continue to degrade and become more painful. Remember, movement is your friend and is ultimately what will keep you feeling happy and healthy for years to come.
Education about a particular condition should not be taken for granted. It is the responsibility of your healthcare provider to educate you on your conditions, the treatment options, and expected recovery prognosis. Please don’t hesitate to ask your provider questions – fully understanding your condition is a key element to complete recovery. Education about pain can also be invaluable for the patient, which is why our office strives to provide pain education to help contextualize thoughts and beliefs about pain. Sometimes education is the stepping stone to preventing a patient from progressing to a chronic state of pain. For this reason, our office doesn’t just treat your condition, we help you understand it.
As you can see, there are many alternative treatment options for pain relief – and with far fewer side effects – than prescription drugs. It is important when seeking care for pain, that you explore all options landing on an course of treatment. Second opinions can often be helpful when you are unsure if a certain treatment is right for you. Trying a more conservative option first may save you time and dangerous side-effects from other riskier alternatives.
Our office uses all of the above techniques, and when necessary, uses other techniques including modalities and dry needling. Our goal is to provide our patients with the most comprehensive, evidence-based treatments to ensure the fastest and most complete recovery path from injury. We ensure that each patient is treated individually, as every patient has different needs from the healthcare system. Still have questions? Give us a call to learn more. We’d love to help you become the strongest version of your best self!
Bryan Esherick PT, DPT
Concussions. They can have lasting effects later in adulthood, so prompt treatment is essential to mitigate long-term effects. While the end of summer draws near, and fall sports get underway at the start of a new school year, it’s important for parents, trainers, and coaches to remain vigilant in watching for signs and symptoms of concussion in young athletes.
Here some tips to help you recognize concussions:
- Your child isn’t acting quite like themselves: Look for changes in your child’s usual mood, cognition, ability to pay attention, and energy level. When your child isn’t acting like he/she normally does following a game, it’s a safe bet they may have suffered a concussion.
- They sustained a jarring hit: Any hit, whether it is to the head or body, has the possibility of causing a concussion. Hits to the head are obviously related to concussions, but hits to the body can also cause concussions through whiplash-like mechanisms.
- Nausea or sensitivity to light or sound: These are some very common signs seen following a concussion.
- Dizziness while using their phone or watching TV: This can be caused by a sensory issue within the vestibular system. Also watch out for dizziness or imbalance while driving and walking in busy areas.
- IF YOU SUSPECT A CONCUSSION SEEK MEDICAL ADVICE: Waiting to seek medical advice can have an impact on the overall time it takes for your child to recover. Seeking medical advise as soon as you suspect your child may have a concussion is key.
One of the best things that you can do for your athlete as a parent or coach is to be sure that they have baseline testing consisting of physical, cognitive, and equilibrium tests prior to participation in practice and games. Should an injury occur, baseline testing allows the coach and trainer to know when it is safe to allow the athlete to return to sport after an injury has occurred. Also be sure that the testing for your athlete is comprehensive, and not performed only using the IMPACT computer-based test that doesn’t take into account the other functions of the body that may be impacted through concussion.
When seeking medical advice, remember that advice can come from a variety of medical practitioners including medical doctors, physical therapists, athletic trainers, etc. Medical examination usually consists of some tests and measures to determine the severity of the injury. Examination is necessary to rule out other serious pathologies, including a brain hemorrhage. Usual care for a concussion is a brief period of rest (1-3 days), followed by a graded return to sport and school, and then rest. Rest is essential for the brain to heal itself in the early stages, although activity should be resumed as quickly as possible while maintaining little to no symptoms. Physical therapists can help by determining a safe level of activity for the athlete and developing a sport specific training plan. Before your child returns to sport, ensure all testing compares to baseline, that physical activity has been progressed, and that your child is symptom-free with sport specific training.
By following these key steps after sustaining a concussion, your athlete can return to sport as quickly and safely as possible.
Note: This blog is not considered medical advice that should be used if you suspect a concussion in your child. If you believe your child may have suffered a concussion or would like to receive baseline testing, contact our clinic at 434-293-3800.
It has almost become cliché to say that runners should strength train. So then I ask are you a runner who is strength training consistently (2-3 times a week)? If the answer is “hmmm, no,” you might not fully understand all of the amazing benefits we get from strength training. Let me break it down for you.
Benefit #1: It Makes You Faster
Proper strength training has been shown to improve running economy, or the ability to run faster while using less energy. Let me put it this way, if you could run a 7-minute mile with the same amount of effort it takes you to run an 8-minute mile right now, you would take that deal right? Of course you would. Faster runners spend less time on the ground and produce more force when they strike the ground. You can improve your force production and ground contact time through various exercises, drills, speedwork and plyometrics that can actually train the neuromuscular system to fire faster. Make sure you are complementing your runs with all of this ancillary work. Take that deal!
Benefit #2: It Reduces Injury Risk
A strong body is crucial to tolerate the repetitive load of running. Many overuse injuries can be avoided with the addition of strength training and a variety of functional, rotational, and multi-directional movements to your regimen. I like to explain it this way: if you have an overuse injury like plantar fasciitis, you know the plantar is working too hard. Rest is an answer, sure. But come on, you and I both know you aren’t taking more than a day off without losing sanity! If you are able to strengthen the posterior chain (glutes, hamstrings, calves) to carry more of the load that your plantar is currently taking, you will reduce the use of your plantar and improve its function.
Benefit #3: It Enhances Recovery
This is probably my favorite fun fact that many runners don’t realize. When done correctly, lifting heavier loads produces a positive hormonal response that can rev-up the recovery process AND significantly reduce the risk of over-training. Lifting heavy will improve your overall strength, and metabolism; but what’s more I guarantee you will sleep really, really well at night.
All In All…
When done correctly and consistently, strength training and other ancillary work like drills and faster running can make you more efficient, reduce risk of injury, and enhance recovery. You will feel stronger on your runs and in races, and you will be able to tolerate higher training loads and have more energy.
Make strength training a priority and your body and mind will thank you!
Ann Dunn, M.S., CPT
BCPT Guest Blogger
Cardio. Personally, I am not the biggest fan of cardio workouts. The equipment at the gym is typically crowded, running isn’t comfortable to me, and it’s hard to find the time that fits into my schedule. But, I know it’s important for my health, so I’ve found ways to incorporate it. Enjoying your cardio workouts is half the battle in making the time to stay fit and healthy.
I love hockey. I play two to three times a week, and supplement my cardio workouts with the stationary bike. The bike is great for me – I can write notes, read articles, and it helps me unwind from a long day – all while getting my workout in. I also take the dogs for longer hikes when I have a little extra free time.
Cardio gets a bad rap for being repetitive, boring, and time consuming. But, cardio doesn’t only have to be a run on the treadmill, or spin on the bike, or an hour on the elliptical.
Find a physical activity you enjoy doing, and turn it into a hobby – outdoor activities are excellent for your lungs and your heart. Here are a few ideas for activities convenient for us here in the Central VA area:
- Hiking. There are lots of hiking trails here with various levels of difficulty. Get out there, and make your way the top for a great view of the blue ridge mountains.
- Kayaking. The Rivanna river offers a great opportunity for a workout with kayak or canoe on a warm summer day.
- Walking. The downtown mall right here in Charlottesville is a fantastic location for a brisk walk while you check out all of the sidewalk sales.
- Clubs. Find a sport club through the city website or Cville social. There are a variety of sports you can try, so find one you like and stick to it!
- Kids. They love to play, so join them outside and get active – you’ll be surprised at the workout you get just by joining your kids for play.
- Dog. Grab Fido and head out for a few spins around the block. The next time your dog stands by the door and stares at you to go out, get your running shoes and extend that walk. Don’t have a dog? Did you know, people who have them generally get about 30-minutes more exercise per day than those who don’t. So, maybe head to your local shelter and adopt one today!
The possibilities for a good cardio workout are endless.
All it takes is 30-minutes a day of moderate (50-60% of your max heart rate) activity to reap the benefits (improved immunity, healthier heart, healthier blood vessels, healthier lungs). So, find something you love and make the change to promote a longer, healthier life!
Bryan Esherick PT, DPT
Did you know heart disease and stroke cause 1 in 3 deaths among women each year – more than all cancers combined. The good news is that 80 percent of those deaths may be prevented. Your heart is the engine that keeps you going – supplying the ‘oil’ for your full body machine – so it’s important to take care of your heart.
February is heart health month, and we’re celebrating by sharing tips to help you keep your ticker ticking!
- Exercise daily. You should get 30-minutes of moderate exercise each day – and 1-hour per day for children. Moderate exercise includes things like a brisk walk, biking, weight lifting, or recreational sports. Exercise is important to keep your heart strong, much like you would for other muscles in your body. Check out our other recent blog posts about different types of aerobic exercises and heart rate zones.
- Eat Right. This may be the best, but also the hardest, thing to do to keep your heart healthy. Check the labels at your grocery store and choose foods high in fiber as well as vegetables – try to pass on foods high in fat, simple sugars, salt, and cholesterol. This will help ensure arteries stay open and your ticker stays healthy.
- Lessen the stress in your life. Stress can create a large burden on your heart by increasing blood pressure and releasing cortisol, and other stress chemicals. This can all have a negative effect on both the heart itself and the arteries it uses to transport blood. When you can’t eliminate the stress, try to manage it with a few breathing techniques; meditation; and even exercise! Find what works for you and try to work it into your daily routine.
- Stay positive with friends and family. Want to live a longer life? Positive relationships with those closest to you has been linked to be the #1 factor in living a longer life – ahead of quitting smoking and drinking; exercising; and eating right. As humans, we are meant to be social animals and look for opportunities to build relationships. So when you are done reading this, pick-up the phone and call a friend or family member and set up a time to get together and reconnect.
Some of the best indicators of a healthy cardiovascular system include a normal heart rate, low blood pressure, low cholesterol and A1c levels.
So, remember to take care of yourself, and keep your heart in check!
Bryan Esherick PT, DPT
Trying to focus on your health in 2018? According to research, almost 25% of people will abandon their New Year’s resolutions by the second week in January and almost 60% will quit before six months. Starting resolutions that are too vague, large, or unrealistic will only set you up for failure. If this has happened to you in the past, try setting up specific and actionable goals for yourself this New Year. For example, instead of saying “I want to get healthy in 2018”, break it down into smaller goals that you can attain by gradually changing some of your daily habits. Need some ideas?
We’ve rounded up a checklist to help create realistic, actionable, and attainable goals for a healthier lifestyle in 2018.
- Decrease processed sugar intake (cookies, cakes, candy, juices, jelly, etc). Women should aim to consume less than 25g per day and men should eat no more than 37g per day.
- Decrease refined carbohydrate intake (white flour, white pasta, white rice). Replace these unhealthy calories with whole grain bread, brown rice, and whole grain pasta.
- Decrease red meat and dairy intake. Replace red meat with fish, and substitute almond or soy milk for dairy products. To ensure adequate protein intake, be sure to eat plenty of beans, lentils, nuts, and seeds.
- Eat more fruits and veggies. It is recommended everyone strive for 9+ servings per day of nutrient-rich fruits and vegetables.
- Drink more water. Reduce or cut out carbonated, caffeinated, or calorie-containing beverages and replace them with water. Aim for 6-8 glasses per day.
- Prepare healthy meals ahead of time. Pick one morning or afternoon each week to shop for healthy foods, then prepare them in advance for more convenient meals and snacks throughout the week.
- Practice proper portion control. Protein portions should be the size of your palm. A portion of fat should be the size of your thumb. Fruit and vegetable servings should be the largest, and roughly the size of your hand. Eat slowly and only until you are satisfied, not stuffed.
- Include both aerobic and resistance-type exercises. Start slowly and gradually build some form of exercise into your daily regimen. Ultimately, shoot for 30 minutes each day at 4-6 days per week.
- Stretch more. Stretch your muscles daily, especially after exercising.
- Sit less. Sitting for prolonged periods of time is detrimental to your health. Move your body more each day, even if it means intentionally parking farther away at the grocery store or taking the stairs instead of the elevator.
- Stress less. Carve out daily time for yourself that allows you to relax and unwind. Plan ahead and stay organized to ward off additional stresses when life gets busy.
- Quit smoking. Consider using nicotine-replacement therapy and avoid triggers. Celebrate small successes along the way.
- Get more sleep. Aim for 7-9 hours every night. Sleep-proof your bedroom (get rid of lights, noise, and distractions) and create a bedtime ritual to help induce quality sleep. Avoid computer, tablet, or smartphone screen-time in the hours before bed.
- Improve Posture. Whether you’re sitting, standing, or sleeping, become more mindful in keeping your spine in its natural “S” curve. Imagine that you are being held up by a string attached to the top of your head.