In the News

The Park Record

Helping hands make you heal faster

Certified hand therapists open office in Basin.

By Andrew Kirk

Of the record staff

January 17-20, 2009

Margo Jones Brady and Kim Ross don’t believe you should stop having fun just because you are injured. The two are certified hand therapist with Hand and Orthopedic Rehabilitation Specialist that just opened a new office in Kimball Junction. Hand, wrist and elbow injuries can usually be protected by a splint made of thin thermoplastic material. The ones of wrists and hands fit inside a ski, biking or softball glove.

“Park City is a very active community. Patients with an injury want to know if there’s a way to still enjoy sports,” Explained Ross. The answer is yes. Hold a ski pole or hockey stick. Go cycling. Jones Brady said they don’t just want to get you back to work, they want to help you get back to doing what you enjoy.

Therapy aid Terri Bowers demonstrates how she can still hold a ski pole with a splint on protecting an injured thumb.

Patient Lisa Ruskin is an orthopedic physician herself and self described 56 year old “maniacal athlete.” “I’ve had a myriad of sports injuries and been to a lot of care centers. They’re the ultimate in personalized attention, accommodation schedule, making sure injuries heal as fast as possible and getting you back to best level of performance,” she said.

Ross and Jones-Brady are hand, wrist and elbow experts who come at their specialization from complementing, but different backgrounds. Ross started her career 17 years ago as an occupational therapist helping people with issues like carpal tunnel syndrome and other problems caused by poor ergonomics. Jones-Brady is a physical therapist and has been in orthopedics for 31 years. Her work with a hand-surgeon led to her career as a hand specialist.

She runs four offices west of the Wasatch Mountains, and the arrival of some skilled surgeons and other experts to Summit County prompted her to open a Kimball Junction office to serve the people here. “We specialize in the evolution of very specific conditions including swelling, scar tissue sensation, range of motion and wound care,” she said.

The proper management of problems can significantly improve the quality and rate of recovery. “It’s amazing to see how people get their range of motion back when they wouldn’t have otherwise,” said therapy aid Terri Bowers.

Suzanne Moore can attest to that. She shattered her elbow playing in summer. “Without their help, I wouldn’t be able to move my arm,” she said. The physical therapy is painful and difficult she said but regained her rang of motion is worth it. “They’re in a funny position. Therapy doesn’t always feel good, it hurts, but they do it in a nice way,” Moore said “They’re great.”

She also said the people at Hand and Orthopedic Rehabilitation Specialists taught her a lot about how the arms work and why she needed to do the exercise given her. Jones-Brady said proper education is necessary to make sure patient do the right stretching and exercises to speed their own recovery.

The Salt Lake Tribune

Severe vaginal tears common during birth in Utah

By Heather May

January 08, 2009

Almost 4,000 Utah women suffered severe vaginal tears last year while giving birth after their doctors used forceps or vacuum devices to deliver the baby.

That 14 percent injury rate, released by the Utah Department of Health Wednesday, is lower than expected compared to national figures. But the tears can cause long lasting problems, including painful sex and fecal incontinence.

“It’s hush, hush. Most people don’t talk about this,” said Ashley Nelson, a women’s health physical therapist in Salt Lake City.

She sees women seeking help to strengthen their pelvic floor muscles or who have irritated or damaged nerves because of scarring from tearing or subsequent care. Nationally, 9 percent of women report having fecal incontinence.

“A lot of times they may sew them up too tight [and women experience] pain [from] penetration. Or just the way they’ve been sewn back up — it’s irritated nerves and [they] constantly have pelvic pain,” she said.

While minor tearing during delivery is common, the health department report focused on third and fourth-degree lacerations, which extend from the vagina to the anus.

Using instruments increases the risk of severe tears. So does delivering large babies or having an episiotomy, a surgical cut between the vagina and anus. Doctors use instruments if the baby’s heart beat drops dangerously or if the mother is worn out from pushing.

Utah hospitals’ rate of vaginal tears range from 4.5 percent at Ogden Regional Medical Center to nearly 29 percent at Uintah Basin Medical Center in Roosevelt.

The University of Utah questioned its 23 percent rate, noting that the data is a year old. Newer data show its rates have dropped to about 15 percent.

Howard Sharp, the U.’s medical director of labor and delivery, said the U. was previously miscategorizing some tears. He said training also has helped. Besides learning how to use instruments, residents also are taught how to support the pelvic floor while using them.

“We have a hand supporting the perineum as the baby’s head comes out,” he said.

The report, “2007 Utah Hospital Comparison Report: Maternity and Newborns,” is mandated by the Legislature and available online at http://health.utah.gov/myhealthcare. It also includes information on what each hospital charges for maternity and newborn care.

Defying Gravity

Physical therapy that ‘unloads weight’ helps patients work out with minimal pain, exhaustion

By Lois M. Collins, Deseret News

Monday, March 28, 2005

Lorne Redmond, Natalie Williams and Jud Weiler have very different aches and pains. But they’ve all learned that on the road to recovery, gravity is not a friend.

Redmond’s pain stems from a disc ruptured more than a decade ago, followed by a period where he got somewhat better, then new damage from degeneration that left him with so much pain he was literally distraught.

Weiler has an autoimmune disorder related to multiple sclerosis. But instead of affecting his central nervous system, it has attacked his lower legs, leaving them weak and without feeling. That problem has been complicated by the fact that he needed a hip replacement and also developed stenosis in his lower back.

Click to view images.

Williams, a professional basketball player, hurt her knee for the umpteenth time while pushing off her right leg to do a layup.

Last week all three were undergoing physical therapy at Hand and Orthopedic Rehabilitation Specialists. But they were all using devices designed to minimize the effects of gravity by “unloading weight,” as rehab center co-owner Steve Crandall, a physical therapist board certified in orthopedics, put it.

All three work out regularly on an underwater treadmill made by a company called HydroWorx, where cameras capture their movements for analysis by a therapist. From various angles it’s possible to see how each one moves, whether certain muscles are favored and more. If there are gait problems, they can be corrected. But the water takes the weight away, allowing each of them to do more without significant pain, something that would be impossible on a normal treadmill, where the effects of gravity can amplify pain.

When more resistance is needed, Crandall or one of the other therapists simply turns up the water jets.

Athletic departments at schools like Brigham Young University and many sports teams also use underwater treadmills to aid recovery or simply to build strength. It’s a training tool that’s becoming increasingly popular with athletes.

The same principle is applied in a lower-tech way with water aerobics and therapy classes across the state. The Arthritis Foundation, for example, lists a half-dozen such classes on its Web site at any given time; senior centers note them as well. Many community pools also offer water aerobics classes or simply provide a venue where someone can go to work out in a buoyant, gravity-reduced setting.

Conquering gravity doesn’t just help people who have been injured, according to Dr. Junius Clawson, an orthopedic surgeon with the Intermountain Spine Institute at Cottonwood Hospital. It also makes the task of getting into shape doable for people who are overweight and weak because they’re not active.

You need to get strong enough to hold the weight you’re carrying, or you need to lose it,” Crandall said.

Folks who are overweight and out of shape also face complications related to weight and general health such as high blood pressure and diabetes. When they begin to get in shape in a low-impact environment that encourages rather than discourages the effort, they start losing weight and sometimes also don’t need to take as much medication, according to Clawson.

“Water is great, he said, for patients with spine injuries. “Most of the people are dealing with the musculoskeletal system, usually with a fracture that necessitates pool therapy. You can use muscles without putting stress into the fracture.”

Someone with a spine injury can work in the pool all day long and not hurt the back, Clawson said. And the strengthening can be done in any pool where there’s room to walk. It’s even better, though, with some extra resistance like that created by jets. And as the individual becomes stronger and able to do more, the resistance turns up the intensity of the workout.

At least once a day, Clawson said, he sends a patient to water therapy.

Water’s also king for some patients at Lake View Physical Therapy, the outpatient center at Lakeview Hospital, said Karl Ricks, a physical therapist.

They use the pool primarily for back injuries, surgeries or anything else where having the gravitational forces and weight on the back or limbs makes it too painful for exercise.

Water up to chest height, he noted, takes about 75 percent of someone’s weight off so that the pressure goes away and the individual moves around better. Ricks uses it with knee, hip and ankle therapy.

Water also helps muscle spasms relax, he said.

When someone hurts as much as he did, Redmond said, the natural inclination is to try to avoid moving at all. But that’s exactly the wrong thing to do. Walking in the pool causes no shooting pain, so he does much more. “It’s a starting point for therapy,” he said.

With the passage of time and consistent underwater workouts, he’s found he can also do more on dry land, he said.

When he went Christmas shopping with his sister, five to 10 minutes of wandering through the mall almost undid him, Redmond said. “I had to bend over, sit, hold onto something, pop medications.” Now, not quite three months later, he walks for an hour at a time and can even bear to sit for a while, as long as he has a decent chair.

He’s even using a normal treadmill a little bit.

Weiler walks with leg braces, except on the underwater treadmill. In the pool he can work out for a half-hour without pain, but when he walks across the parking lot, the pain returns in minutes. That’s the effect of gravity, Crandall said.

Besides the physical therapy, he does water aerobics three days at week at the Holladay Lions Club, strengthening his back muscles. In the water he’s learned to improve his balance while building his strength, he said. “I don’t hang on to things as

Williams works out in the water, too. But that’s not the only way she conquers gravity.

She works out regularly “in an unloaded environment while healing” so she doesn’t lose her quad strength. On a machine called a Newton (remember Isaac Newton and his apple experiment?), she can shed however many pounds her therapist decides through use of a hoist system that takes some of the weight. Wearing a special belt that hooks to the hoist, she walks or runs, pain free, several times a week.

Then she goes across the room to a special slant-board-type setup where the pull of gravity is mechanically adjusted to let her glide as she works her legs in bilateral squats. Finally, she hits an exercise machine called a TheraGym, which has a support bar that wraps around her back and under her arms, taking weight off as she jumps, climbs stairs, whatever. It’s a favorite with older patients recovering from injuries “who feel safe,” Williams said, because of the support.