Creating Better Health
A monthly health article that spreads good news and ideas, to create and motivate a healthier lifetsyle.
Written by Russell Certo, PT OCS
By Russell A. Certo PT OCS - Founder of the MOG at Grand Island Physical Therapy - email@example.com
Eighty percent of Americans suffer from low back and neck pain at some point in their lives. Let that sink in. With such great odds that you - or someone close to you - will one day become a statistic, wouldn't it make sense to arm yourself with preventive strategies and knowledge?
Physical therapy is a good place to start. By performing a thorough evaluation, a physical therapist can identify the muscular, postural and skeletal limitations that could one day lead to an episode of back pain. As part of the assessment, the Physical Therapist will observe, as you perform a series of exercises and then gather an account of your daily activity level and environmental factors like operating machinery or working at a desk 40 hours a week. The PT will then use all of this knowledge to design a personalized exercise program and teach you a few strategies to prevent back pain.
* Use good body positioning at work, home and during recreational activities.
* Keep the load close to your body during lifting.
* Ask for help before lifting heavy objects.
* Maintain a regular physical fitness regimen - staying active can help to prevent injuries.
Lifestyle can play a big role in back pain. In fact, inactivity and incorrect body mechanics while participating in certain activities are two of the biggest contributors to back pain. In addition to the strategies listed above, it's also helpful to pay attention to little things throughout your day that could add up to bigger problems down the line.
Let's go back to that desk job for a minute: How often do you get up to walk, stretch and move throughout the day? A good rule of thumb is to stand up or move every 30 minutes. You may get bonus points with your boss, too, as your productivity soars due to the increased activity.
While low back pain rarely becomes serious or life-threatening, it can be quite painful and interfere with our daily lives. Working with a physical therapist can help patients identify the factors that might contribute to back pain and help to develop a prevention plan. But the healthcare professionals are also a great place to turn when you're seeking treatment for back pain or hoping to prevent a recurrence. With such good odds that you could one day become a low back pain statistic, why not do everything in your power today to change your trajectory? Seems like another good reason to find an activity (or better yet, two or three activities) that you enjoy, make it a regular part of your day and stick to it!
Walking is great, but your body needs more.The greatest long-term benefits of exercise stem from working your body into overload, meaning pushing strength, flexibility, and cardio conditioning to force your body to adapt to more stressful requirements. While there is research connecting some walking to basic heart health, walking alone does not stress your heart enough to create true cardiovascular improvement.
Try building in some intervals - short bursts of fast walking or jogging into your walks, and make time for strength training as well. If you're not a fan of running, try these:
TREADMILL. Regular walking won't burn more calories than running, but it can if you add an incline and some weights. Combining the cardiovascular fast walking with an incline helps strengthen your legs, while holding weights in your hands elevates your heart rate even more while building muscle in your upper body.
ROWING. One of the best "value" exercises - i.e. a high calorie burner - is rowing. It is a resistance exercise and you utilize your entire body if done properly, Three of the biggest muscles areas of your body are engaged including your back, legs, and shoulders. Up to nine muscle groups are used - your biceps, triceps, back, shoulders, lats, glutes, quads, hamstrings, and core! The higher the intensity of the workout, the more you burn.
SWIMMING. We're not talking a leisurely swim here, but if you choose the right stroke and maintain a high level of intensity, calories burned swimming can be more than running. Swimming not only involves your entire body but also puts less stress on your joints, With each stroke you must use your legs, arms, and core just to stay afloat. That is a great start to calorie burn because of muscle recruitment.
WEIGHT LIFTING. Strictly speaking, lifting weights for 30 minutes may not burn as many calories as running for 30 minutes during the workout period alone, but what lifting weights does do is burn more calories over the following days (and the longer term) due to the after effects of the workout. Weight training elevates the metabolism post workout for as long as 48 to 72 hours as the body recuperates from the workout.
As with any change in your lifestyle have a conversation with an expert. The MOG has Physical Therapists, Exercise Specialist and Primary Care Doctors who can help you.
Is Medical Fitness a Fad, Trend or Megatrend? - September 2018By Russell A. Certo PT OCS - Founder of the MOG at Grand Island Physical Therapy - firstname.lastname@example.org
Medical Fitness is a growing opportunity for the Physical Therapy Profession. In recent years many private practice companies have begun to offer fitness services that go beyond the typical "post rehab step down" programs often offered in a clinical setting. Many Physical Therapy Owners have explored how best to offer fitness services as an adjunct to their companies portfolio of services. These practices have gone beyond adding back schools, aquatic programs or industrial based care. They offer, among other things, pilates, yoga and circuit training in a fitness club atmosphere. These forward thinking practice owners have determined that the Physical Therapy Profession can deliver a more effective fitness service than what the current Fitness Industry provides. Additionally these Practice Owners believe that Physical Therapists have expertise and the skill sets to offer fitness programs to the medically compromised patient. These patients have not only rejected the fitness industry but for the most part have discarded the responsibility of exercise and its beneficial health effects. Physical Therapists have the opportunity to provide services and reach out to these medically compromised patients and offer services that will not only benefit these patients but should have a profound effect on the cost of health care. So the question that needs to be answered is whether or not medical fitness services are a fad, a trend, or a megatrend?
A fad is defined as, "a fashion that is taken up with great enthusiasm"; whereas, a trend is described as a, "general development or change in a situation or in the way that people are behaving". In the article, published in the Harvard Business Review (May 2010), The Sustainability Imperative: lessons for leaders from previous game changing megatrends, the authors David A. Lubin and Daniel Esty describe in detail the 4 stages of a Megatrend.
The four stages of a megatrend are; 1) reducing costs, risks, waste and delivering value 2) redesign selected products, processes and business functions to optimize performance 3) drive revenue growth through the integration of innovative approaches to their core business 4) differentiation of the value proposition through new business models. By researching the history of business, these authors were able to study companies that were able to provide sustainability during periods of major upheaval. They report that historical megatrends have been common in climates that have had major financial changes, shifts in social realities or when there is a conflict resulting in threats to resources.
Some of the examples these authors point to are the geopolitics of the Cold War driving innovation produced during the space race and the rapid development of microelectronics that drove the IT Megatrend. Another historical example was the quality movement adopted throughout business in the 1970's and 1980's. Ultimately the organizations and business leaders who recognized the changing environment and were able to move through the four stages of a megatrend, created greater value in their companies. In the end these leading organizations and leaders did old things in new ways, did new things in new ways, transformed their core business and created new business models that differentiated their company in the marketplace.
As an example let's explore the medical fitness concept with respect to the Private Practice that has adopted the concepts developed by the M.O.G., the Medically Oriented Gym. By first looking at doing old things in new ways, the M.O.G. facilities have taken their expertise as providers of rehabilitation and the based in service, these practices have brought successful clinic policies and procedures to the fitness industry. Instead of talking about health and worrying about selling memberships, the M.O.G. delivers fitness programs from the viewpoint of service. By delivering a service oriented product, measuring outcomes, collecting data and working with referring physicians and insurance companies, these practices are doing old things new ways.
Once the commitment was made to to deliver a better fitness product, the M.O.G. group had to develop new things in new ways. Programs were designed that would attract and retain the medically compromised patients who would be referred to them. Also the M.O.G. facilities had to provider programs that would allow the healthy motivated community member to become a club member in their facility.
Integrating the PT Clinic and the M.O.G. with all of the staff requirements created a totally different core business for the practicing physical therapist. In keeping with the American Physical Therapy Associations mission statement, the M.O.G. clinics were delivering physical therapy to the whole patient and caring for the entire health and well-being of the patient. It no longer became just about treating a total knee patient or a functioning Parkinson's patient. The core business has become much more holistic in its approach to caring for patients. All of this while remaining true to our roots and education as Physical Therapists. The adoption of this approach has successfully differentiated these PT Clinics from other rehabilitation services and has differentiated the fitness services provide at the M.O.G. from the traditional fitness club.
Finally, in keeping with the 4 stages of a Megatrend, the integration of the PT Clinic and the M.O.G. demanded a whole new business model. No longer could the business look at reimbursement rates, patient visits, visits per referral etc, it had to begin to develop outcome measures and data collection capabilities unheard of in the fitness industry and frankly not thought about in the rehabilitation world. Systems had to be designed to track each entity, the fitness service and the rehabilitation service. Also a system was required to account for the entirely new core business. Patients were no longer looked at as consumers for short periods of rehab time, but were potential customers for life using the services of this new business model as needed.
In this changing environment of health care delivery, it can be argued that the marketplace is ripe for a megatrend shift. Much of the policy makers are looking for innovative ways to reduce costs in health care.
Prevention & Treatment of Osteoarthritis - August 2018By Allison Biondolillo, PT, DPT - the MOG at Grand Island Physical Therapy
The onset of arthritis is related to a combination of modifiable and non-modifiable risk factors. Modifiable risk factors can include diet, exercise and tobacco use whereas non-modifiable risk factors include gender and family history. With such high incidence levels it is important to understand what you can do to decrease the risk or delay onset of arthritis or if already diagnosed what options there are for treatment.
Exercise has been proven to be one of the best non-drug treatments for osteoarthritis. Osteoarthritis occurs when the cartilage cushion that surrounds each of your joints wears down causing a "bone on bone" surface, lacking in joint congruency and shock absorption. When this occurs you often will feel pain, stiffness and experience some swelling. The phrase "motion is lotion" can be used to describe the effects of exercise on arthritic joints. When moving any particular joint through ranges of motion, often done during exercise; you are increasing joint lubrication and causing that bone on bone surface to move in an easier more fluid way.
But wouldn't exercise and repetitive stress on a joint cause increased arthritic pain and changes? That is one of the most common myths in the relationship between exercise and arthritis. When choosing an exercise program it is important to consider methods that promote low level aerobic exercise such as walking, biking or swimming, flexibility as well as a general strengthening program so muscles surrounding an arthritic joint can provide better stability.
Exercise has also been shown to offer great benefits when completed prior to having any joint replacement surgery. By improving mobility and strength before surgery can help ease the rehabilitation process afterwards. If you are unsure of where to begin be sure to ask your physical therapist or exercise professional for advice in selecting an appropriate exercise program for you.
The Importance of Proper Hydration - July 2018By Sue Attea PTA, NASM-CPT - the MOG at Grand Island Physical Therapy
Over half our bodies are made up of water and water is necessary to keep us running. The human brain is composed of 95%, lungs are 90%, blood is 83%, muscles are 76%, and bones are 22%. Whether you are drinking a bottle-full or eating water-filled food (ideally both), getting enough fluids in one way or another is essential for survival. So, how much water do we actually need? The amount of daily water needed varies from person to person and depends on a number of factors such as individual size, activity level, stress level, the climate or temperature, and our diet. Experts at the Mayo Clinic suggest dividing your body weight in half and using this number as the ounces of water you should consume. For example, if you weigh 150 pounds, you will need 75 ounces of water per day.
If you are exercising, flying, or out in the summer heat (yeah, it's finally here!), additional amounts of water are needed. How much water should you drink while exercising? There are no exact rules for how much water to drink while exercising, because everyone is different. The American Council on Exercise has suggested the following basic guidelines for drinking water before, during, and after exercise: * Drink 17-20 ounces of water 2-3 hours before you start exercising. * Drink 8 ounces of water 20-30 minutes before you start exercising or during your warm-up. * Drink 7-10 ounces of water every 10-20 minutes during exercise. * Drink 8 ounces of water no more than 30 minutes after you exercise.
What happens when you do not drink enough water? When your body doesn't have enough water, it becomes dehydrated and can't work properly. Dehydration happens when you lose more fluids than you drink and can vary from mild to severe. One of the best ways to recognize dehydration is the color of your urine. Ideally, light to clear urine indicates proper water intake. Dark yellow or amber-colored urine can be a sign of dehydration. Some common symptoms of dehydration include dry skin; low energy level; dizziness or lightheadedness; nausea or vomiting; muscle cramps; dry mouth; lack of sweating; hard, fast heartbeat.
Symptoms of severe dehydration can include mental confusion, weakness, and loss of consciousness. You should get emergency medical attention immediately if you have any of those symptoms. There are a number of ways to integrate more water into your lifestyle. Drink a glass first thing in the morning. Fill an easy-to-use water bottle and drink periodically over the course of the day. Try adding natural flavors like herbs or fresh fruits to make drinking less boring. You can even eat your water- - watermelon, zucchini, cucumber, grapefruit, strawberries, and lettuce are water rich foods. Whatever works for you, make drinking water a daily habit.
Sue can be contacted at email@example.com
Breathing During Exercise - June 2018By John Costa, PTA - the MOG at Grand Island Physical Therapy
During both cardiovascular exercise and resistance exercise, proper breathing is essential. A good breathing pattern ensures that working muscles continue to receive the oxygen they need for contraction. During low intensity cardiovascular exercise, breathing through your nose is the preferred method- warming and purifying the air as you inhale. When your intensity level increases to moderate or high intensity cardiovascular exercise, your body is telling you that it needs more oxygen and the preferred method of inhalation is through the mouth in order to take in more oxygen.
Breathing during resistance exercise is different; a simple way to remember to breathe properly is to "exhale on exertion" during resistance exercises. Exhaling on exertion helps with spinal stability and ultimately prevention of injuries. For example, if you are doing a push up, you would want to pace your breathing so when your chest is going to the floor, you would take a breath in and when your push up away from the floor you would then breathe out. During a squat you would inhale while squatting down and exhale on the way up. Isometric exercises are exercises where your muscles tense up but don't actually move (such as planks or wall sits). During these exercises there is no "exertion phase", therefore maintaining a consistent breathing pattern is important. Helpful tip: Count your breath while holding an exercise - that way you won't forget to breathe! Ensure avoiding holding your breathe during exercise: this could cause major spikes in your blood pressure.
Benefits of Regular Physical Activity and Exercise for Older Adults - May 2018By John Costa, PTA - the MOG at Grand Island Physical Therapy
The benefits of regular physical activity and exercise for older adults are listed below.
* Helps prevent weight gain. This one is a no brainer! Since a person's metabolism naturally slows with age, maintaining a healthy weight becomes more challenging. The more muscle mass a person has, the more calories your body will be able to burn at rest which can help prevent weight gain and chronic diseases.
* Helps maximize cardiovascular health. Regular exercise and physical activity can keep your heart stronger. A stronger heart can pump more blood without having to work as hard, and less force is put on your blood vessels. A stronger heart can help keep heart rate and blood pressure under control (and potentially get you to lower those meds)!
* Allows your body to be more resilient to breakdown. Strengthening your muscles, tendons, ligaments, and cartilage will help keep you stronger and your body less susceptible to injury.
* Improves pain tolerance and minimizes effects from arthritic changes. Physical activity and exercise provide an excellent drug free option to control chronic pain. Over 50 million adults are affected by arthritis (1) and regular exercise can help slow the progression of arthritis as well as control chronic pain caused by arthritis.
* Can help with balance and fall prevention. Exercise improves strength, flexibility and posture which are important for balance and coordination. It helps keep older adults independent and prevent falls.
John Costa, PTA can be reached at Physical Therapy at the MOG, 716-773-4323.
Parkinson's Disease - April 2018By Sue Attea PTA, NASM-CPT, Russ Certo PT OCS
Parkinson's disease (PD) is a progressive disorder of the nervous system that affects movement. It happens when there is a problem with certain nerve cells in the brain. Normally, these nerve cells make an important chemical called dopamine. Dopamine sends signals to the part of your brain that controls movement. It lets your muscles move smoothly and do what you want them to do. When you have PD, these nerve cells gradually break down or die resulting in low dopamine levels, so you have trouble moving the way you want. PD is progressive, which means it gets worse over time. Symptoms develop gradually and vary from one person to another.
What are the symptoms of Parkinson's disease?
* Tremor or shaking. Mainly at rest and described as "pill rolling" or back and forth rubbing of your thumb and forefinger.
* Stiff or rigid muscles. The stiff muscles can limit range of motion and cause pain.
* Slowed movement (bradykinesia). Steps may become shorter when you walk or you may find it difficult getting out of a chair.
* Impaired posture, balance, and gait.
* Loss of automatic movements. Decreased ability to perform blinking, smiling or swinging of arms when you walk.
* Speech changes. You may speak softly, quickly, slur, or hesitate before talking. Speech may become more monotone.
* Writing changes. It may become hard to write and writing may appear small.
Numerous studies within the past decade have shown the benefits of exercise through relatively short term follow-ups (six months to one year) for improving the above impairments Several studies that were based on highly structured programs have proven, exercise interventions delivered primarily by physical therapists, demonstrated improvement in physical function, balance, and gait.
Parkinson's disease does not have to be the debilitating process it is commonly thought to be. Exercise has been demonstrated as powerful "medicine" for Parkinson's patients and elicits a significant reduction in symptoms as reported by many patients. In collaboration with the University of New England, we have developed a comprehensive research study and exercise program targeting all levels of Parkinson's disease, from very high functioning to very low functioning individuals. The M.O.G. values individualization of exercise prescription while facilitating the social benefits of group exercise programming. Our highly educated team of interdisciplinary healthcare professionals creates an atmosphere equipped to adequately manage and control complex conditions.
Sue Attea, Physical Therapy assistant and exercise Specialist
Russ Certo, Founder of the MOG (medically oriented gym)
The MOG at Grand Island Physical Therapy
Burning fat... Itís more than just cardio! - March 2018By Sara Wilczek MPH
Usually when someone asks, "How do I gain muscle mass?" the answer is to lift weights. When the question "How do I lose fat?" is asked, most people will reply with cardio, but not just cardio can help lose weight and reduce fat, so can weight training. This is due to the calorie burn AFTER the workout is completed. Research shows that after a weight training workout, the metabolism (your bodies engine) can be boosted for up to 36 hours post-workout, meaning that rather than burning 60 calories an hour while laying on the couch, youíre burning 70. When you add up the extra calorie burn, it makes a difference.
To generate a high amount of post-calorie burn from cardiovascular exercise, you'd have to be doing it for a very long time, and typically individuals who are capable of doing such a thing don't need to be concerned with fat loss in the ?rst place (sprinting is a different story and will create effects with your metabolic rate closer to that of weight lifting).
The second factor to consider in the fat loss wars is long-term metabolic increases. While it's great to be burning more calories for 36 hours after the workout, that's not going to help you two weeks from now unless you are consistent with your exercise program (which you should be anyway, but that's not the point we're trying to make here). Weight training or resistance exercise will enable you to build up more lean muscle mass, which then serves as your calorie burning powerhouse in the body. When you calculate your basal metabolic rate, which is how many calories you would burn if you sat in bed all day and did absolutely nothing except breath, one of the factors that goes into this is your lean muscle mass. The more lean muscle mass, the higher your basal metabolic rate will be and therefore more calories burned.
To add to this point, it's critical that you are realistic with how much muscle mass you can build in each period of time. Naturally, males will be able to generate between 1-2 pounds of pure muscle mass in a given month and females will get about half that, around 1/2 -1 pound total. Over time though, with consistent efforts this will dramatically make you much more resistant to weight gain as you grow older. While the weight training session may not burn as many calories minute per minute as a cardio workout although that too can depend on how intense the resistance work or weight lifting is, the overall calorie burning benefits you receive from it typically outweigh that of cardio.
Sara Wilczek is the Director of the MOG at Grand Island Physical Therapy and can be reached at firstname.lastname@example.org
Chronic Disease and Cancer Care - February 2018By Russ Certo PT OCS
According to the Center for disease control (CDC), Chronic disease accounts for 80% of the total health care expenditures in the United States. The falls rate in individuals with diabetic neuropathies (numbness) is elevated by 1/3 compared to age matched controls. Individuals with diabetes and a history of receiving neurotoxic chemotherapy regimens fall 7 times more frequently.
Do you know that research supports early balance screening and intervention to reduce adverse effects in individuals with foot numbness (neuropathies) caused by diabetes or chemotherapy. The effects of chronic disease occur in the aggregate, meaning the checklist of adverse problems grows over time. People with chronic disease risk significant functional decline. Diabetes, obesity, high blood pressure, cardio pulmonary disease, cancer, depression, stress, arthritis, and dementia all respond positively to exercise and simple lifestyle changes.
For patients who receive some of the most common chemotherapy drugs, have a reduction in heart efficiency of 20% after just 6 treatments of chemo. After 10 years, 80% of patients receiving chemotherapy have decreased heart function. The good news is researchers from Duke University have demonstrated that patients with decreased heart function following chemotherapy can recover 50% of the dysfunction in 12 weeks if they begin a proper exercise program.
We all have good friends and family members that unfortunately have a chronic disease. Even in the younger population's chronic disease is becoming an epidemic. All of us have been touched by cancer, either ourselves or someone we love. It's overwhelming to be diagnosed and then suffer through the acute treatment required for cancer care. It's also easy to simply be grateful when you have been told you are in remission or have been cured and we all should be thankful. But now given a new lease on life we should all encourage our friends and family to adopt a healthy lifestyle to maximize the bodies function.
The last stage of cancer care should be to abolish the long term effects of the treatment and give our bodies and mind every opportunity to return to a pre diagnosis state. We should look in the mirror, examine our lifestyle and reach out to loved ones who suffer from chronic disease and others who have suffered the effects of cancer care and encourage them to commit to you, that you both will adopt a healthier lifestyle, together.
Russell Certo PT OCS, Founder
Physical Therapy at the MOG
Challenge Your Exercise Routine - January 2018By Russ Certo PT OCS
Researchers have demonstrated that total body exercise is better at reducing fat and increasing muscle strength. For many people, already excising, they generally do the same routine and the same set of exercises the same way with same weight and number of repetitions. The human body has a tremendous ability to adapt to exercise and if you donít challenge yourself to work harder or differently you will plateau and stop improving your health.
Constructing a full-body workout from the 4-minute technique is easy. Just pick one exercise per body part and do each for 4 minutes. If you rest 1-2 minutes between, say, nine exercises, you can easily get a great strengthening workout in barely 30 minutes Add your 20-25 minutes of aerobic exercise and you have an efficient and healthy routine in just 4 hours per week. This plan coupled with healthy nutrition choices will improve your overall wellbeing and improve your quality of life. Remember our goal, our theme throughout this series of educational articles is to live actively and independently for as long as possible.
Typically, we think of a given exercise in terms of sets and reps: 3 sets of 12 reps or 5 sets of 5 reps, for example. Our suggestion at the MOG is to change the way you exercise or make changes to the weights or movement performed and when participating in aerobic exercise we suggest throwing in a few higher intensity intervals (sprints) to your aerobic activities. One way to accomplish a challenging change is to participate in a circuit class or group class activity at least 1 time a week in addition to your regular schedule.
Another way to change your workout to boost your body's response is to follow the 4 minute workout developed by a Yale University researcher that he refers to as his 4-minute routine. The premise designed by Jim Stoppani, PHD is to squeeze as many reps as you can for a given exercise into a 4-minute block of time. You can do this for any muscle group, just pick one exercise and doing as many "reps" for 4 minutes, resting as needed.
First, weight selection is very important. If you go too heavy, your rep count in the 4 minutes will be too low to promote strengthening, and you'll end up fighting the exercise far too soon. If you go too light, you'll get a ton of reps, but probably won't stimulate much muscle growth. It is recommend that picking a weight that would normally have you reaching fatigue at 12-15 reps, you don't want to go much heavier than this with the 4-minute protocol. Once you have the exercise picked and you've loaded up the bar, machine, cable stack, or dumbbells with the appropriate weight, start the clock. In the span of exactly 4 minutes, you'll alternate between the exercise and resting to achieve as many reps as possible.
Be careful not to go to fatigue right out of the blocks, though. On the first set, do somewhere around 10 reps. Then, stop and rest for 15 seconds or so before you start the exercise again. You'll want to experiment with different rep-and-rest schemes over the 4 minutes, but the whole point is to find whatever strategy allows you to maximize the number of reps you do.
Ideally, you should complete around 36-45 reps in the 4 minutes to put you in the ideal muscle-building window or "sweet spot." If you're able to do more than 45 reps, you went too light and should use more weight next time. If you failed to hit 36, you went too heavy and should lighten the load next time.
If you frequently read our articles we have discussed our approach to exercise is functionally based. We have designed a Functional 5 plan that creates 5 movement patterns that we all use every day, and we use the patterns to strengthen these functionally associated muscle groups. Combining the Functional 5 plan and the 4 minute workout technique plus your aerobic activity of your choice, will challenge your body and continue to improve your health and lifestyle. Need Help? Contact me!
Russell Certo PT OCS, Founder
Physical Therapy at the MOG
Opiates; A Better Way - Non-opioid Pain Management - December 2017By Russ Certo PT OCS
The epidemic in opiod abuses and overdosing of pain killers is a contributing factor in our communities related to drug overdose deaths, especially in our youth and young adults. There are better ways to help people who must take pain killers to simply "get through a day" or those who have become drug addicted. Exercise and activity along with supervised drug management can be an effective approach. The following article provides a good overview.
The 2016 CDC guidelines on opioid prescribing encourage health professionals to find alternatives to opioids for managing their patients' chronic pain, including nonopioid drugs and nonpharmacologic options like physical therapy. Considering that 100 million Americans experience chronic pain, and 5 to 8 million take prescription opioids as treatment, there's plenty of room for pharmacists to partner with physical therapists to help patients manage chronic pain in ways that align with the guidelines.
Pharmacists are key partners in creating pain management plans, especially with respect to tapering off opioids, said Charles D. Ciccone, PT, PhD, FAPTA, professor in the department of physical therapy at Ithaca College School of Health Sciences and Human Performance in Ithaca, NY. "When a patient is on an opioid, there has to be a plan that it's not going to be taken indefinitely. As they participate in an effective physical therapy program, they can often begin to wean off pain medications," Ciccone said.
At Cleveland Clinic, patients on opioids usually start tapering off when they begin physical therapy, and they often have questions, said Elizabeth Casserly, PharmD, BCPS, pain management clinical specialist. "A lot of patients on opioids have a fear about going off them. We explain the tapering process, that it's very slow and we're here to support them. We talk about risk versus benefits, and about what it's doing to their endocrine systems and the rest of their bodies."
Casserly also makes a point of encouraging patients with their physical therapy, noting that pain management is a team effort. "While the taper can increase the pain a little bit at first, once patients get off the opioid they tend to feel better. We'll tell them the first treatments might be painful because they're using new muscles, but to stick with it and it will get better. We assure them that we're going to work at [pain management], but it takes their input, too."
According to Casserly, 90% of chronic pain patients at Cleveland Clinic's pain clinic are referred to physical therapy. "It's probably the first thing we do. A lot of the pain we see is skeletal muscle pain, and opioids don't work well on that," Casserly said. "For people who have been adjusting the way they walk because their back hurts, or protecting an arm because their shoulder hurts, what they really need is to strengthen the muscles [around the affected joints], and the way to do that is to get them up and moving."
Some patients who taper off opioids will still need nonopioid pain medication, and a pharmacist's expertise can help physicians and other prescribers determine which medications are appropriate, said Ciccone. He added that pharmacists can also explain adverse effects and how pain medications work with respect to physical therapy. "Pain medications will help the patient engage in physical therapy, but they will not mask pain to the point where patients work too hard and reinjure themselves during a physical therapy session," Ciccone said, adding that pharmacists can help alleviate any apprehension patients may feel about participating in rehabilitation while taking pain medications.
Casserly agrees and said it's part of her job to explain the limits of pain medication. "Any pain medication will only bring pain down 20% to 30%. That's why we need to use multiple modalities besides medications [to begin with]." Casserly encourages pharmacists to make the most out of collaborating with physical therapists in pain management. "Physical therapists' notes are often filled with great information about the patient, so use them. Physical therapists know how to treat people in pain and will figure out what exercises need to be done. They're the unsung heroes of the pain world."
Pharmacy Today a publication of the American Pharmacists Association
Russell Certo PT OCS, Founder
Physical Therapy at the MOG
Exercise and Balance - November 2017By Ashley Abramo MS, NASM-CPT
When we think about fitness programs muscle strength, flexibility, and heart health come to mind. These are all essential, but there is one very important piece of a fitness program that is often overlooked: balance.
Balance is the ability to maintain your center of gravity and overcome instability. Balance training is not just for those who experience balance issues or to prevent and reduce the occurrences of falls. Incorporating balance exercises into your current fitness routine is recommended for everyone from athletes, to those recovering from injury, to the elderly. Balance training will help you to improve your core strength, coordination, and postural alignment which, in turn, should result in fewer injuries and greater stability. Start out by adding 5 to 10 minutes of concentrated balance training into your workouts three times a week. In addition, you can alter some of the exercises that you are currently doing and challenge your balance.
Try these during your next workout:
Ashley Abramo is the Director of the MOG, a partner of TRILOGY, 1801 Grand Island Blvd.
The Importance of Flexibility - October 2017By Russ Certo PT OCS
It is important to include flexibility activities in your exercise routine. Flexibility allows for easier movements and efficient use of muscles and joints. Flexibility tends to deteriorate with age, mostly because of sedentary lifestyles or simply ignoring stretching on a daily basis.
Stretching increases blood flow through muscles and joints, while delivering essential nutrients to these tissues. Stretching also stimulates the lubricating fluids inside your joints. It improves joint "range of motion" making your movements easier and more efficient. Flexibility decreases stresses on joint, therefore reducing joint pain. Unfortunately, as we age the incidence of falling and sustaining injury increases dramatically. By having strong efficient and mobile joints you can potentially reduce the risk of falls and injuries.
There are things you can do to improve your flexibility; 1) Add stretching activities to your daily routine 2) try a MOGA, it does for your joints what a massage does for your muscles. Contact me for more information about a MOGA or an individual stretching program. Russ is the Founder and Director of the MOG, a partner of TRILOGY. 1801 Grand Island Blvd.
Balance and Falling - September 2017By Russ Certo PT OCS
Loss of balance and mobility are not inevitable as we grow older, but sudden falls in older individuals are a concern because the incidence of balance problems is known to increase significantly with age. The risk for serious injury increases as well. The good news is that many older individuals at risk for falls can be identified and helped.
So how do you know if you are at risk for falling? There are several known risk factors, both related to yourself (physical fitness/ailments, psychological and social factors) and your environment (the surfaces you walk on, obstacles, lighting, etc.), that can increase your susceptibility to falling. Some common indications include symptoms of dizziness or unsteadiness, taking one or more medications, a recent period of bed rest or inactivity, loss of strength or feeling in the legs or feet, or a loss of confidence in your ability to get around. However, there are many other subtle indicators that you or your physician may not even be aware that you have. To complicate the matter, falls are not typically the result of a single cause or risk factor. More often, they are the net result of a combination of factors.
Key physical factors
Balance problems and dizziness are obvious indicators that someone is at a higher risk for falling. It may not always be obvious that your balance is diminished, as unsteadiness may be caused by a number of smaller physical ailments that alone would not cause a person to fall. However, the combination of relatively minor problems can be a significant risk for falling.
Other key physical factors include reduced muscle strength in the legs and painful or unstable ankle, knee and hip joints, which can impact your ability to support yourself and quickly recover from sudden changes to the surface you are walking on. Limited range of motion and flexibility can make stepping over obstacles and walking on uneven or inclined surfaces more difficult. Arthritis can be an indicator of fall risk because it can result in poor range of motion, reduced muscle strength, and a loss of sensation at the affected joints. Poor vision and a history of ear infections or inner ear disorders are also risk factors. While having one or two of the above risk factors will not necessarily cause someone to fall, the likelihood of falling increases with the number of risk factors that are present.
What Can You Do
By remaining active in your daily life, you maintain your strength, flexibility and coordination, as well as your ability to keep your balance in a variety of conditions. If you notice that you are unable to confidently perform certain daily tasks, you should speak to a Professional. See Balance Self Test.
The "Blue Zone" Lifestyle - August 2017By Russ Certo PT OCS
Scientists have discovered several regions on earth where the people routinely live to be 100 yrs. old, rarely succumb to chronic disease and generally die peacefully in their sleep. These regions are referred to as "blue zones". The commonalities of these regions are; They donít smoke. Are active every day. Eat fruits, vegetables and grains. Put family first. Stay socially engaged. Simply put "blue zone" communities donít smoke, eat food close to nature, stay active and have positive meaningful social relationships. These are all components of a healthy lifestyle.
Most chronic diseases are not inevitable and are not unfortunate incidences like breast cancer or multiple sclerosis. 80% of chronic disease and its effects on health and the cost of healthcare is the result of poor choices by individuals. Unfortunately this idea is not new and has been in the public discourse for over 25 years, yet we continue to deteriorate as a society with respect to overall health.
It is as simple as turning knowledge into action. In past articles I have discussed making small changes, changes that you can succeed at and then build on with other small changes. In a lifestyle management process you can put all potential healthy changes into six categories;
If you and I were sitting down to discuss these things, I would ask you to identify one healthy choice you are willing to make and to strategize how together we can get that accomplished in your life. Do you take some kind of pain killer and want to stop? A lifestyle change can help you. Do you have too much stress? You can learn to manage that stress better. Do you want to exercise or eat better or learn how to make healthy choices? Just pick something and find experts to assist you. I never said it was easy, I simply say that with friends', family and support you can make a lifestyle change that is helpful and meaningful. After all isn't part of our deal in any relationship to be the best you that you can be? Then it's your responsibility to your spouse, your kids, your family and friends to be healthy, live long and actively.
Russ Certo is Founder of Trilogy a Lifestyle Management organization; email@example.com.
How Should We Really Be Assessing Overall Health? - July 2017By Russ Certo PT OCS
In the health field, Body Mass Index (BMI) is used as an indicator for body fat. This measure is adjusted for height, calculated as weight in kilograms divided by the square of height in meters. A fundamental issue with this calculation, and the correlations it is said to indicate, is that it measures excess weight rather than excess fat. The Department of Health and Human Services coins BMI as a surrogate measure of body fat, meaning, it is a measure that may correlate with other true clinical diagnoses, but it is not a guaranteed relationship.
BMI is used as a screening tool to assess body fat because it is inexpensive, noninvasive, and used universally by healthcare professionals. In addition, studies show a correlation to health risks associated with high BMI as predictive measure of morbidity (disease) and mortality (death). Although BMI measurements are easy to perform, they do have issues to consider. BMI does not account for confounding variables that influence body fat distribution such as, age, sex, ethnicity, and muscle mass. In addition, BMI does not have the capacity to distinguish between fat, muscle, and bone mass distribution. The shortcomings of BMI call for an assessment of our current evaluation methods, including new proposed protocols for evaluating the health of individuals.
BMI Classifications Then and Now
Over the past ten years a lot of research has gone into the evaluation of body composition to evaluate the overall health of individuals. This influx of research parallels the obesity epidemic that has been spreading through the United States over the past few decades. Research shows that excess fat increases risk for cardiovascular disease, stroke, and Type II Diabetes. BMI is a weak correlator to comorbidities and mortality rates because BMI is unable to consider family history, hypertension, coronary artery disease, and other metabolic conditions.
Since BMI is based off height and weight, it cannot stand as a strong indicator of fat distribution because a higher height to weight ratio may not be indicative of more fat tissue. For example, imagine an adult male with a height of 5' 10" and weight of 170 lbs, went in for his annual physical and his BMI was scaled in the normal range at 24.4. Over the next year, this man trains in heavy weight lifting, and puts on twenty pounds of solid muscle. The next year at his annual physical his new BMI is reported at 27.3, and he is now classified as overweight. It is inaccurate to distinguish this individual as unhealthy. This is one example of how BMI can be inaccurate for establishing an accurate perspective of overall health.
A psychologist at UCLA and her research team published a study last year that opposes all use of the BMI parameter in assessing overall health. The researchers studied the link between BMI and used health markers such as blood pressure, and glucose, cholesterol, and triglyceride levels. Data was used from the most recent National Health and Nutrition Examination Survey (NHANES). This analysis showed that 29% of individuals classified obese by BMI parameters, were metabolically healthy. This indicated 15% of Americans are wrongly classified as obese, as well as more than 30% of individuals within the normal BMI range were unhealthy based on the other indicators of health examined.
The M.O.G. (Medically Oriented Gym) is a fitness club established on the foundations of integrative and preventative healthcare, paired with a physical therapy practice to broaden the scope of expertise and services offered to those attempting to increase their quality of life through therapy, nutrition, fitness, and overall lifestyle management. The M.O.G. shares the same opinion as current research which shows that BMI alone is an ineffective indicator of obesity. The M.O.G. has developed a program to facilitate the long-disputed argument about how to assess the health of individuals through biomarkers and other parameters. Their evaluations are grounded in evidence based research and analyze one's overall fitness level and health. BMI is measured in addition to: body fat percentage, waist circumference, resting heart rate, resting blood pressure, resting oxygen saturation, and VO2 Max. Furthermore, internal health markers and functional tests aid in determine fitness level in addition to biomarkers indicative of health.
The M.O.G. Fitness Score scores four of the tests: BMI, Body Fat Percentage, Waist Circumference and a sub maximal VO2 level. The M.O.G. chose these four measures because there is ample research indicating normal ranges for age and gender, to normalize this scoring system across the board. This is to combat the incapability of BMI to sufficiently assess age and gender specific to body composition alone. The goal of the Fitness Score is to obtain normal range on all accounts for age and gender.
BMI is not a proper measure of overall health, especially when used as an isolated number. However, although other options exist, it persists as a primary diagnosing tool for overweight and obesity. Even great solutions, like the M.O.G. fitness score, are not available to everyone, and as of right now cannot be a universal option either. Due to its simplicity and surrogate correlations, clinicians and health care professionals will continue to use BMI to categorize American's into these fatness groups. Education needs to become more important to the providers taking these measurements and diagnosing individuals. The public needs to become aware of the downfalls of BMI, and the medical field's purpose for using it. If everyone can be on the same page about what BMI indicates, and what is involved in truly assessing oneís health, then perhaps our society can move together toward a less obese and healthy community that follows.
Spring Nutrition - Eating Natural vs. Processed Foods - May 2017By Ashley Abramo MS, NASM-CPT
Last month I started a conversation about general nutrition. This article is written by our Exercise Physiologist and Nutritionist, Ashley Abramo MS, NASM-CPT.
If you were to analyze your diet, could you separate foods into either whole, processed, or refined foods? Do you know the difference between these labels and the health benefits of adding more whole foods to your diet? A whole food is any food that hasn't been altered from its natural state and because of this it keeps all of its beneficial nutrients. They are natural or near natural. They contain the highest levels of vitamins, minerals, fiber, and other nutrients. These foods will also contain phytochemicals which boost the immune system and prevent cell damage.
Some of examples of whole foods include:
A processed food is a food that has been changed through some type of processing whether it's grinding, cooking, freezing, etc., but none of the nutrients have been removed. Be aware that not all processed food is harmful! Some examples of processed foods which are part of a healthy diet in moderate quantities are:
Processed foods that you may want to avoid are frozen meals (high sodium content), lunch meat, hot dogs and instant oatmeal (choose rolled or steel cut oats instead). A refined food, however, is any food that has been stripped of its nutritional content. An example of a refined food is white bread which is wheat that has been stripped of its bran and fiber. Other examples include: table sugar, cookies, crackers, macaroni, most packaged foods, oils found in fried foods, and chips.
Among the health benefits of eating more whole foods is better digestion (rich in fiber), better blood sugar, more energy, healthy weight maintenance, and the ability to easily decrease the amount of trans fat and saturated fat in the diet.
How can you add whole foods to your diet? Choose products with 100% whole grains whenever possible. Replace half the white flour called for in your baking recipes with whole-wheat flour. Also, use half the amount of sweetener when you can.
Make 1 Small Change this Week - April 2017By Russ Certo PT OCS
In my past couple of articles I made the case that being healthy is a lifestyle change that needs to occur gradually. Nobody will succeed if they attempt to completely overhaul their lifestyle. I know a few people that have been successful making changes that completely overhauled their eating habits, their activity level and in some instances financial and spiritual changes all at once. The common them for these few people was a major life event: a cancer diagnosis or a family member dying at a young age. Fortunately most of us do not experience those traumatic life affecting events.
So, if you are interested in improving your health, where do you start? The right answer is it does not matter, change your diet, become more active with activity that will improve your health, get more sleep, drink less alcohol or STOP smoking. Just pick one, any one. Over the course of the next few articles I will address each of these changes that you can make in a more specific manner. I will start with eating and nutrition.
About a year ago my wife and I decided to change our diet and do our best to remove sugar from our diet. After we did the necessary research we concluded the best thing to do was to remove added sugars and especially not consume the sugars that end in "ose", fructose and sucrose are two examples. Another interesting fact we learned about sugar was that cancer cells thrive on sugar molecules we ingest first, especially fructose. Our response to our research was to go into the pantry and look at all the stuff we had and remove anything that had these types of sugars. I was both amazed and surprised at how empty our pantry became. The amazing part of this was we thought we were pretty healthy decision makers when it came to food. We cooked our own meals from scratch generally, we made what we thought were healthy decisions, using things that had less than 5 ingredients and yet we stilled emptied the pantry.
I like candy, I grew up having dessert after a meal, my wife is a great baker and eliminating sugar took some discipline and vigilance. Our meals didn't change much, but some of the ingredients did. I gave up the 1 sugar in my coffee and began using a small amount of honey in my tea. The candy cravings stopped after about a month. I love chocolate and we found some dark chocolate that does not use sugar as its sweetener and yet still tasted good. After about two months, this new "diet" became habit and we have been able to stick to. Our weight dropped, our body fat decreased and things with sugar have become too sweet to eat and enjoy.
My suggestion to you for your diet is this; make small changes, don't make drastic changes that make you miserable. There are all kinds of diets out there, some are low in fat, some are low in carbs, some are all protein. They all claim to be the best way to lose weight. The common theme in most of these diets, especially the ones we see advertised on TV, is portion size. I donít suggest you become crazy like we did and eliminate sugar right away, but I do suggest starting with one small simple change this week.
Next week make another small change and the week after that, another. In a month you will start looking for bigger ways to make healthy changes in your nutrition and diet. Here is an example. Week 1 change the portion sizes of each meal and in between meals have 1 piece of fruit. Week 2 commit to making five meals at home using fresh ingredients and if you are not a great cook, follow a recipe and cook meals with your kids. Make the preparing of a meal an event with your kids! Week 3 begin to pay attention to food labels and try to only use food with 5 ingredients on the label. Again I suggest using the recipes found on the internet to make good stuff. Not everybody is a fan of yogurt, yet there are many ways to introduce yogurt using fresh fruit, a bit of honey and some granola. Once you have a system in place making healthy choices and creating great tasting home cooked meals is easy.
The diet and the nutrition we choose to have in our households influence the choices are kids make as they become adults. If you adopt a healthier lifestyle by making 1 small change each week, your family will notice and you will influence their view of health. The good news is you control what gets put into the pantry! You can be the example to your family whether you have young kids at home, are an empty nester or are lucky enough to have grandchildren hanging around. Remember the goal is to be more active, live healthier and longer independently. If you have any questions or comments for me I would be happy to hear from you at firstname.lastname@example.org.
Does WEIGHT Define Health?- March 2017By Russ Certo
A couple of weeks ago I had lunch with a very good and very smart friend of mine. In the conversation we inevitably ended up discussing our health, some of the issues now affecting us baby boomers and how we individually have changed our own habits. My friend said the best success in controlling weight was in just managing his diet and that exercise never was able to manage weight like a better diet did. Initially I will admit I was caught off guard and did not have an immediate response. Everything I know about health and fitness and exercise and aging was screaming inside my head to refute that weight is a measurement of health.
It took me a few minutes to gather my thoughts and once I did here is how I responded. Weight in and of itself is not a measurement of health and fitness levels. Your BMI number which is tracked as a measuring tool for wellness programs and by your Primary Care Physician, is also a misleading measurement with respect to health. Your BMI is a math equation that takes your height and your weight and determines a number. Ideal BMI is around 25, there is some differences between men and woman but for this article lets agree 25 is about what most consider normal BMI. The Center for Disease Control has decided that obesity begins at a BMI of 30 and then they have various degrees of obesity with morbid obesity being the most obese you can be. The point is weight and BMI in and of itself gives no indication of health. I could show you a 300 pound couch potato and then a 300 pound athlete with the same BMI.
The greatest predictor of early death is a low functioning cardiovascular system. If you do not exercise your heart muscle there is plenty of research that demonstrates you will be at a greater risk of early death. The good news in this research also states that even if you are defined as obese, using a BMI score, but you have good cardiovascular health you have less risk of early death. One of the measurements that can be performed to show the health of your heart and your body's ability to process oxygen is a VO2 test. It is easily done and takes about 8 minutes.
The third component of health and fitness especially for those who are starting to feel the effects of age is muscular resistance exercise. It is very important that everyone includes in their exercise program some form of resistance exercise to include all four extremities and your core muscles as well. As spring approaches its great that many people will start getting outside and begin walking again. Unfortunately, walking alone is not enough. To maximize the benefits of the time you are walking, find ways to add resistance exercise to the walk. Pulling on elastic exercise bands, stopping and doing some squatting exercise and lunges during the walk are beneficial exercise s to incorporate. Making your muscles stronger makes the muscle way more efficient in assisting your body metabolize calories and to process insulin which is key in all of us for maintaining our health. Having efficient muscles is especially important if you are diabetic or have recently been diagnosed as pre-diabetic.
Getting back to my friend, I agreed that the best way to control your weight is through diet but the best way to maximize your health and to remain independent in activity for as long as we can is to incorporate a good diet with a good cardiovascular exercise program and to include in your regimen some form of resistance exercise program. All of these things can be measured and re-measured to calculate your fitness level and the improvements you are making. Itís not essential but it is helpful and can be a motivator to continue your health journey.
Russell Certo PT OCS - The MOG at Grand Island Physical Therapy - email@example.com
Transform your life! Free Seminar seriesBy Russ Certo
Includes guest pass to the M.O.G.
March 8th - Getting started on your lifestyle transformation journey
March 15th - Knowing your numbers
March 22nd - Nutrition is key
March 29th - How to create change and make it last
-- Time: 6:00pm -- Reserve your spot today --
30 Minute presentation by Transformation Coaching Staff, followed by Q & A
For more information call 773-1600.
A HEALTHY LIFESTYLE, What's That? - February 2017By Russ Certo
Lifestyle changes are not easy to make.
There are so many things that could be changed, some harder than others. Look around, healthy living information is everywhere, TV commercials, magazines and internet ads. Everyone seems to be right and everyone seems to be a legitimate expert. So who do you believe and where do you start? I suggest you start with yourself and trust your gut. Starting with yourself simply means you start asking yourself questions, if you need to write these down so you can review them, you should. Start a simple review; when was the last time you had a yearly physical? When was the last time your doctor discussed your blood tests and other tests with you? When was the last time you exercised for 20 minutes or more? When you get hungry or are planning your meals for the day, are the choices you make the best choices available to you that day? When was the last time you made a commitment to set a healthy goal, works towards it and attain the goal? The answer to the trust question is simple, be honest in your answers and trust your "gut". Funny thing about deceiving and dishonesty is you can't fool yourself. None of the questions you are asking yourself are difficult. Just be honest and accept that's where you are today. Nothing you can do about past missed opportunities, however, you have supreme power over all future actions.
The next step in this process is to now set some simple goals. If you have not seen your doctor, make an appointment. When you sit with your doctor ask questions, don't leave without a total understanding of your current health status. Most good Primary Care Physicians will give you all the time you want if you are actively engaged in your healthcare. Second goal; if you are not exercising start with 20 minutes of some activity 3 times a week understanding that the current recommendation from the American Medical Association is 150 total minutes of activity a week. When it comes to your food intake there are as many strategies as there are food choices. I would again suggest trust your "gut". When making a food choice you know what is a better choice than another, fruit is better than candy, vegetables are better than salty snacks. Home cooking is generally better than eating out and the better foods have the shortest list of ingredients. In future articles we will present to you more specific detail. But to simply start making some healthy changes, set a simple goal 1-2 fruits a day, eat a breakfast without sugar, small changes are better than drastic changes.
What is LIFETSYLE CHANGE or Lifestyle Transformation?
It can be defined in many ways but again I will stick to the simplistic. A Lifestyle based in your health has a goal of a long independent life. This lifestyle change can be made at any age. There is plenty of data that demonstrates improved health markers and increased independence for elderly individuals despite having chronic debilitating disease. There are times experts should be sought out. Don't be fooled by "snake oil" peddlers who seem like experts, sound like experts but ultimately are just looking to separate you from your money. If it sounds too good it probably is.
One last thought. If you consider healthy lifestyle choices as a bank account and every time you make a good decision, fruit over candy, 20 minutes of activity, consider that a deposit into that account. The bigger the account grows the more you will have when you need to make a withdraw. A withdraw would be required when you catch a cold, get the flu, get in a car accident, have surgery, get cancer. The more your body can utilize the credits in your account the better chance you have given yourself to regain health and independence. Like any good retirement account, slow steady daily deposits will reap the greatest rewards.
Russell Certo - February 2017
The Creating Better Health column will appear every third Thursday of each month.
Lifelong Islander and Physical Therapist Russell Certo will be writing a monthly health article that will help you to a healthier lifestyle. The Director of MOG wrote: "Individual health is more than just a yearly physical and some cardiac exercise. Individual health is a lifestyle that includes your yearly physical and cardiac exercise but also includes, among other things, resistance exercise, proper nutrition, education, stress relief and even financial wellbeing. The simple goal of adopting a healthier lifestyle is a long active life and independent living. This lifestyle transformation series will address all things healthy in hopes of creating a change in the overall health of our community."
Certo recently announced that Grand Island Physical Therapy, the MOG and Primary Care are partnering with TRILOGY, an association of health and lifestyle professional service providers. The purpose of TRILOGY is to coordinate lifestyle transformation services and provide the community a staff of experts whose only goal is to intervene with the right professional with the right service at the right time. The services TRILOGY provides include; Primary Medical Care, Physical Therapy, Fitness and Exercise, Behavior Health, Corporate Employee Health and Wellness, Nutrition Counseling, Medical Specialties and Community Based Support Organizations.
"TRILOGY will provide us a coordinated way to keep our patients and members moving forward and making a lifestyle change that will give them a more productive and active lifeĒ stated Certo. This TRILOGY model of collaboration based on individual responsibility and choices has proven to improve health outcomes and lower the cost of individual healthcare. TRILOGY has one mission, to provide our communities an opportunity to live a long, healthy active life. For more information, access mytrilogy.org. Russell Certo is a Physical Therapist and is nationally recognized as an expert in rehabilitation and lifestyle management. He has been in practice on Grand Island since 1988.