Medicare Insurance Update for 2018

As the New Year approaches, there are changes afoot for many insurance plans.  It is common for insurance plans to ‘roll over’ at the beginning of the calendar year.  This typically means that a new set of benefits is available to each plan holder.  It may also mean that there are updates to plan attributes such as deductibles, co-insurance, and pre-authorization requirements.  As a health-care consumer, it is important to know what to expect from your insurance coverage in the New Year.  It is Symmetry’s recommendation to take a look at the physical therapy benefits for your individual policy for 2018, so that you can make appropriate plans for how to most effectively utilize your benefits through the year.

The New Year will bring changes to all types of insurance plans.  Symmetry has been specifically following the development of changes pertaining to Medicare, which as a large federal policy will affect healthcare benefits for 55 million Americans.  We think it is important that our clients are aware of some important information with regard to Medicare coverage for physical therapy.  Below is a summary of what is currently occurring.

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Knee Osteoarthritis Twice as Common Today Compared to 75 Years Ago

According to a recently published study in PT in Motion News, knee osteoarthritis (OA) has more than doubled among Americans since 1940. The authors of the study say that this increase is NOT due to the trends of having longer lifespans or a higher prevalence of obesity. Instead, it is thought that the cause of increased knee OA is primarily due to inactivity!  Here are some of the details:

In this study, knee joints of 2,756 skeletons of varying age were divided into 3 groups, as below:

  • Between 6,000 and 300 BCE (“prehistoric”)
  • 1800s and early 1900s (“early industrial”)
  • Late 1900s through the early 2000s (“postindustrial”)

The findings of knee OA in postindustrial skeletons was about 16%, while the early industrial group prevalence has a 6% incidence rate, and prehistoric sample is 8%. To determine whether or not heavier body weights contributed to this difference, the results were controlled by grouping skeletons according to Body Mass Index.  Even when compared with skeletons of similar body mass, the prevalence of knee OA remained two times higher for the postindustrial group compared to the group of early industrial aged skeletons.   Similar results held true when comparing skeletons of different ages.

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Is Your Diet Contributing To Your Pain?

This guest post was written by Julia Lapo, a Doctoral of Physical Therapy student at Texas State in San Marcos, Texas.  Julia recently completed a clinical rotation at Symmetry.


Inflammation in the body is a common cause of joint pain and stiffness1.  Unfortunately, the process of aging is accompanied by changes that tend to exacerbate inflammatory processes.3 On a positive note, however, you may be surprised to learn that modifying your diet can help to alleviate some of the discomfort and stiffness associated with inflammation.1

So how does inflammation work? “Low-grade chronic inflammation is influenced by nutrients such as fatty acids, glucose, bioactive plant compounds, and vitamins and minerals.”2 These nutrients either increase or decrease the body’s inflammatory state.  This is why the inflammatory process is so intimately associated with nutrition and the metabolism of food.2 Understanding which foods fall within inflammatory or anti-inflammatory categories and modifying one’s diet to address inflammation is one way to impact complaints of pain.

This article explains that a healthy anti-inflammatory diet need not begin with a long list of restrictions, but rather can begin with gradual modifications intent on protecting cellular health by controlling systemic inflammation.2

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How a Physical Therapy Student Ended Up In Prison

As a dancer, tree climber, and lover of all things active, what originally drew me to physical therapy was the opportunity to use my love for movement to heal chronic pain. In physical therapy school, I committed myself to memorizing movement disorders, muscle attachments, nerve innervations and other meticulous details about the human body in an effort to understand what causes pain and how to fix it.

However, despite a rigorous academic course load, my curiosity about the nature of pain beyond its physical manifestations, as well as the potential for movement to facilitate the healing process was left unsatisfied by the sciences.

I recalled a woman I had met some time ago at a dance class. Her name was Ginger. She was sprite-like and magnetic with a mischievous, kind smile. She had made an announcement at the end of class, “We are looking for movement facilitators to teach incarcerated women how to share and move their stories through authentic movement. We will train you.”

Remembering this, I emailed her, feeling giddy and somewhat terrified. Perhaps this was what I was looking for.

The organization was called Truth Be Told. Founded in Austin in 2000, Truth Be Told’s mission is to promote self-discovery and community-building for incarcerated women through telling their stories of what brought them to prison. The point is not to rehash their crime, but rather to conduct a thoughtful exploration of the experiences and choices that were made every step of the way that led to imprisonment. The women who dare to embark on this journey can choose between three mediums of expression: speaking, writing, or movement.

Need I mention that one of the most terrifying parts is that facilitators are the first to share their stories?

Before long, I was in the middle of Travis County Judicial Department’s volunteer training, learning what to do in case of a hostage situation. (According to the handbook: “The County will NOT negotiate for your release”).  Shortly thereafter, I walked past the secure double doors into the Lockhart Correctional Facility as a facilitator-in-training for the first time.

Since my first time behind prison walls, I have had the honor of hearing over 20 stories and sharing my own twice, the first time as a facilitator-in-training and the second as a co-facilitator, working alongside Ginger.

A facilitator’s job is to create a space where women can feel safe to explore and share their truths. As a movement facilitator, I lead the class in a series of activities to develop body awareness and awaken the creative impulse in preparation for three minutes of “authentic movement” which will occur after the women share their stories. Authentic movement is a practice that allows the mover to explore spontaneous gestures, movements, and stillness – all while in the presence of a “witness.” I like to describe it as a process of unlearning how we were taught to move in order to access and embody subconscious messages from your body. Through the process, you learn to be fully present in the face of uncomfortable emotions arising in yourself and others.

What amazes me about the women I have encountered in prison is their ability to be vulnerable and to dig to the very depths of themselves despite the fear and discomfort of what may be uncovered. Likewise, I am constantly impressed by their ability to sit with the stories of others (some of which are dark, painful, or shame or guilt-provoking) with compassion and a lack of judgement. These are things I wish I saw more of in the free world.

Movement is so ubiquitous to our lives that it is sometimes easy to miss the impact it can have on our well-being. In addition to the physiological benefits of movements that we as physical therapists harness to help our patients, my experience with Truth Be Told has shown me how movement can help people to process trauma and difficult emotions. I have seen how three minutes of contemplative movement can transform a woman and help her to move forward in her healing journey.

My hope is to incorporate what I have learned in prison to help those recovering from chronic pain. Stay tuned!

Angel Young is currently a Doctoral of Physical Therapy student at Texas State University who recently completed a clinical rotation at Symmetry Physical Therapy. If you would like to learn more about Truth be Told, please check out their website here. They are always looking for volunteers, facilitators, and respectful witnesses to attend story gatherings and graduation ceremonies held in prison.

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How Much Should I Exercise?

If you have ever been to Physical Therapy, then you are probably aware that exercise activity and a prescription of “homework exercises” are typically going to be a component of your treatment.  Our bodies are designed to move, and when our movement becomes impaired through injury, bad habits, or inactivity, we typically begin to feel those effects through pain and lost abilities. Physical Therapists are movement experts, and are well trained at identifying and correcting the movement dysfunction that serves as the underlying cause of the problematic symptoms. This is one of the main reasons why Physical Therapists are such proponents of exercise and activity in general.  When done correctly, movement serves as the basis for ongoing health and wellness.

A common question that patients will ask when given a set of exercises to do at home is, “How often should I do them and for how long a period of time?”.  While the exact specifics of that answer will vary depending on the prescribed goal, the core answer will almost always be “Regularly”.  In the same way that other healthy habits  (getting quality sleep, showering, brushing your teeth, eating a healthy and well-rounded diet etc.), depend on consistency to accomplish long term maintenance, regular bouts of exercise/activity are essential for maintaining optimal body performance and functioning. We live in a world where technology has rapidly created an environment where both our work lives and entertainment options are becoming increasingly sedentary.  This has made establishing a regular routine of physical activity all the more important.

So, how do you establish a regular physical routine?

  1. Consult a Physical Therapist– Does pain prevent you from being as active as you want? Are you unsure about what activities might be appropriate for you?  Do you need help getting started on the right foot? These are all questions a Physical Therapist can help you to answer. A PT will also perform an assessment of your whole physical function and can then inform you of potential impairments and deficits that should be addressed, in order to help you to move at your best.
  2. Find Something You Enjoy– Does the thought of going to the gym regularly make you want to quit before you even start? Realizing that exercise can take on limitless forms and occur in many locales can be a very freeing concept to a large percentage of people who associate exercise with a gym.  Join a yoga or a dance class, take up hiking, biking or swimming, find a favorite exercise video that can be done at home, or join a recreational sports team.  There is an option for everyone out there.
  3. Make Long Term Goals– One of the consistent findings on assessment of the habits of successful people, is that these folks have the ability to establish long term goals and then work consistently toward achieving them. Do you want to drop some weight to fit into old clothes?  Be able to enjoy and participate in an event or activity for an upcoming vacation? Train to participate in a 5k or a marathon?  Make a goal, along with several short-term goal “checkpoints” and then track your progress as you enjoy the benefits of newfound healthy habits.
  4. Take Small Bites– Never underestimate the benefit of something done consistently for a short duration over a long period of time. A common barrier to physical activity is that there is not enough time in the schedule. There is always time to implement 5-10 minutes of activity into a day.   Park further away from your destination than usual  in order to squeeze in a few minutes of walking between errands.  Do standing squats or heel raises in place while waiting in line or watching your child’s sport activity.  Practice your 1-leg balance while brushing your teeth.  Go around the block with the dog.  Take the stairs to your next appointment.  You will be surprised how a 5-10 minute habit will both yield benefits as well as surprisingly grow into more activity over time.
  5. Participate With Friends– Not only does having an exercise buddy provide accountability for making sure you get your activity in, but being social while you move can make the process of getting fitter more enjoyable at the same time.

Ready to take on a new leave of physical fitness?  If you need help in getting started or want to make sure you are prepared to meet the goals you have set for yourself, give us a call! Symmetry Physical Therapy’s Physical Therapists would be glad to help you to be your best physical self.

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How to Stay Healthy and Fit During the Thanksgiving Holiday

Thanksgiving is a time of year in which it is easy to overeat and begin an unhealthy cycle that continues on through New Year’s Eve. Although eating plays a large part during the fall and winter holidays, this season doesn’t have to be a time to give up on healthy habits entirely.  Here are a couple of quick tips to stay fit and healthy over Thanksgiving while still eating some of the foods that you love.

Get Outside:  The weather is often wonderful in Austin at this time of year.  Since Thanksgiving dinner doesn’t take the entire day, this holiday is also a great time to get outside and go for a walk or a run with another family member or friend.  Or, challenge other members of the family to a game of freeze tag or flag football.  It will feel good to ‘earn’ the Thanksgiving meal.

Play a Game: Families often bond over meals during the holidays, but playing a game or doing another all-ages activity like a puzzle with a group is another great way of interacting before or after your Thanksgiving meal.

Eat in the Morning: People often skip breakfast on Thanksgiving Day in order to ‘save their appetite’ for dinner.  This isn’t the best idea for your health.  Avoiding food until the afternoon often leads to hunger and excess eating during the Thanksgiving meal.

Stay Hydrated: Drinking plenty of water is always important, and generally people do not do enough of it – particularly when the weather turns cooler.  Besides having a variety of negative health impacts, failing to drink enough water can spark hunger pangs. Try drinking several full glasses of water during the day on Thanksgiving so that your body does not mistake thirst for hunger.

Go Easy on Appetizers: It’s easy to get full on cheese and crackers or other savory and often fat-filled appetizers before dinner is even served. Make sure to save your appetite you’re your calorie consumption) for the big main meal!

Tips to Limit Overeating at Dinner:

  • Use a smaller plate: Research like this study shows that eating off of a smaller plate helps you to eat 22% fewer calories compared to using a larger plate.
  • Dim the lights: Studies like this one suggest that eating in softer light may lead to consuming less food.
  • Chew slowly: According to this study, fast eaters consumed 3 ounces of food per minute, while slow eaters only ate about 2 ounces per minute.
  • Beware of danger foods: Be careful of foods that may seem healthy, but actually aren’t. These can include green bean casserole, gratins, mashed potatoes, and cranberry sauce. That does not mean to stay away from them entirely, but just to eat everything in moderation
  • Skip seconds: Wait about 20 minutes after your first course before piling your plate with seconds… This is roughly the amount of time that it takes to feel full.  If after 20 minutes you are really still hungry, go for a second round of smaller portions.  If you are full, save the leftovers and look forward to another meal at a later time.

Don’t Deny Dessert: The holidays are a time for celebration.  Don’t feel that you have to restrict yourself entirely from certain foods.  Simply try to enjoy the sweeter items in moderation.

Thanksgiving is a time for family and good cheer.  Best wishes to you and your family from the Symmetry Physical Therapy team!


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Exercise is an Effective Treatment for Depression

Imagine going to the doctor with symptoms of depression and she hands you a new prescription: Do two sets of squats, 15 bicep curls, 10 laps around the track and call me in the morning. Though this is not (yet) an accurate picture, experts are starting to recognize that regular exercise is not only good for your mood, but may help combat depression, too.

According to the National Institutes of Health, in 2015 an estimated 16.1 million adults aged 18 or older in the United States had at least one major depressive episode within the past year. This number represented 6.7% of all U.S. adults.   The Center for Disease Control & Prevention states that 10.3 percent of physician office visits in the U.S. indicate depression on the medical record as one of the issues discussed during the encounter.  Sometimes life stressors can trigger depressive symptoms in individuals. Other medical conditions such as endocrine and reproductive system disorders are commonly associated with depressive symptoms.  Anxiety disorders and depression are also frequently interrelated.

The symptoms of major depressive disorder, the most common type of depression, range from an overwhelming feeling of sadness and loss of interest in most activities to altered sleep patterns and cognitive difficulties such as diminished ability to think, concentrate and make decisions.   Other symptoms that are associated with major depression include decrease or increase in appetite, constant fatigue, feelings of worthlessness or excessive and inappropriate guilt, and possibly recurrent thoughts of death and/or suicide. In a major depressive episode, symptoms persist for two weeks or longer and represent a significant change from previous functioning. Social, occupational, educational, and other important functioning are also impacted.  (Visit the Anxiety and Depression Association of America for more information on symptoms and how they often differ in people of varying age and gender.)

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World Diabetes Day is November 14th

World Diabetes Day – a day to raise awareness about diabetes – is coming up on November 14th.   Did you know that there are two types of diabetes? Type 1 Diabetes is an autoimmune condition. This means that the body’s immune system ‘turns on itself’, creating dysfunction.  In Type 1 Diabetes, a person’s immune system attacks beta cells in the pancreas, an organ which produces insulin. This means that the pancreas produces little, if any, insulin, which results in decreased ability for the body to deal with glucose in the blood stream.  Type 2 Diabetes is a chronic condition that results in part from abnormal insulin secretion, and in part due to insulin resistance, meaning that the body has difficulty using insulin appropriately.  (Type 2 Diabetes is the more common diagnosis, accounting for 90-95% of all diabetes cases.)  The issues associated with Type 2 Diabetes cause excess glucose to build up in the blood stream.  It is important to treat both Type 1 and Type 2 Diabetes appropriately.  If glucose is not managed appropriately in the body, problems such as heart disease, kidney disease, and nerve damage can occur.

Here are Some Common Symptoms of Diabetes

  • Frequent urination
  • Feeling thirsty
  • Feeling very hungry (even when eating normally)
  • Extreme fatigue
  • Blurry vision
  • Cuts/bruises that are slow to heal
  • Weight loss, even when eating more than usual (Type 1)
  • Tingling, pain, or numbness in hands/feet (Type 2)

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Is Chronic Pain All In Your Head?

A “Guest Post” by Angel Young, Student Physical Therapist

Since the 17th century, humans have understood pain to be a message from the body that something has been damaged or is not working as it should. We believe that there is a physical problem in the area where the pain is felt, and that the greater the pain, the more damage has been done. This makes sense because it is consistent with our experience of pain. If we bump our knee against the coffee table, we feel pain in our knee. If we bump our knee hard it hurts a lot, but if we bump it lightly, the pain is less. You may be surprised to learn that the latest research shows that pain is more far complicated than this.

Only in the last few decades has our understanding of pain evolved. While our traditional understanding of pain works well to explain acute (recent onset) pain, chronic (ongoing) pain can behave very differently. Thanks to the complexity and creativity of our brains, our nervous systems can exaggerate or distort pain signals, causing us to perceive that damage is occurring where it is not. Chronic pain can become its own animal, far removed from what is actually going on with our tissues. Our perception of pain may not be giving us accurate information about what is going on with our bodies. Pain may be felt in areas where there is no actual tissue damage.  For example, one feel pain with direct contact at the elbow, but the actual pain problem can be elsewhere – enmeshed in one’s central nervous system.

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Five Things Lily Learned During Manual Therapy Residency

After achieving a Doctorate in Physical Therapy (DPT) and becoming licensed to practice Physical Therapy, some therapists choose to continue their education through additional residencies, fellowships, and/or certifications. These post-graduate programs allow therapists to specialize in focused areas of physical therapy practice.  It can be very different to practice physical therapy in a clinic that treats muscular injuries as opposed to brain injuries, for example.  Or to work with the very old as opposed to the very young.  Therapists with a recognized specialty certification have demonstrated that they have an advanced skill set with regard to a particular patient type.  At Symmetry Physical Therapy, all of the therapists are specialists in Orthopedics, which means that they have advanced training and are recognized as experts in the treatment of the musculoskeletal system.  Even more specifically, each of the therapists at Symmetry holds advanced certification in Manual Therapy, which means that all have advanced skills in the hands-on aspects of Orthopedic Physical Therapy.

The program I chose for my initial post-graduate residency education is called the ‘Institute for Athlete Regeneration’(IAR).  After completing their program, I received a Certification of Sports and Orthopedic Manual Physical Therapy (CSOMPT).  Moving forward, I will continue through the IAR fellowship program, which will involve two additional years of advanced practice study.   During this journey, there are countless things that I have learned and will continue to learn that are invaluable to my day to day practice.  I thought that it might be interesting to share some of the them…

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