Physical Therapy as the First Point of Care has Been Shown to Reduce Health Care Costs and Opioid Usage

A new study has shown that using physical therapy as the first point of care for patients with low back pain reduces overall health care costs and opioid usage.

According to the National Institutes of Health, 80% of adults experience low back pain at some point in their lifetime being the most common cause of job-related disability and a leading contributor to missed work days1. In addition to being a common ailment, low back pain is among the most common disorders associated with prescribed opioid use in primary care2. According to the new study, when patients turn to physical therapy as the first point of care, they enjoy the benefits of lower health care spending and opioid usage in relation to treating their back pain.

The study, published by Health Services Research, compared the differences in opioid prescription, health care utilization, and costs among patients with low back pain who saw a physical therapist at the first point of care, at any time during the episode, or not at all. The patients were between the ages of 18-64 years old with a new primary diagnosis of low back pain and were observed over a one year period.

The main findings of the report detailed that patients who saw a physical therapist at the first point of care had an 89.4% lower probability of having an opioid prescription, 27.9% lower probability of having any advanced imaging services, and 14.7% lower probability of ER visits, as well as significantly lower out-of-pocket costs compared to patients who saw a physical therapist late or not at all3.

The findings of this study emphasize the world of benefits physical therapy offers patients – most importantly – lasting relief from addressing musculoskeletal issues appropriately. Additionally, patients avoid opioid usage by getting to the root of the problem to provide real relief. Lastly, patients may face lower out-of-pocket costs and avoid undergoing costly diagnostic imaging procedures.

If you are suffering from a new diagnosis of low back pain or have been battling chronic low back pain, now is the time to realize the benefits of a comprehensive physical therapy program. Let Monmouth Pain and Rehabilitation be your first point of care for treating your low back pain. Together, we will help lower your overall health care costs by avoiding opioid prescriptions, advanced imaging services, and ER visits that may arise due to the development low back pain complications.

  1. Ashworth, J., Green, D. J., Dunn, K. M., & Jordan, K. P. (2013). Opioid use among low back pain patients in primary care: Is opioid prescription associated with disability at 6-month follow-up? Pain, 154(7), 1038–1044. http://doi.org/10.1016/j.pain.2013.03.011 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4250559/
  2. National Institutes of Health. (2017) Back Pain Fact Sheet. NINDS. NIH Publication No. 1505161. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet
  3. Frogner, B. K., Harwood, K., Andilla, C. H. A., Schwartz, M., & Pines, J. (2018) Physical Therapy As the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health Services Research https://doi.org/10.1111/1475-6773.12984

Most Common High School Sports Injuries and Steps for Prevention

High school sports play an important role in developing a healthy, active lifestyle for kids while also developing invaluable life skills such as goal setting, time management, leadership, cooperation, and social intelligence.

At the same time, youth athletes are prone to injuries just like their favorite pros. Youth athletes also face an increased risk of injury due to the fact that their bodies are still developing. It is key to find the optimal recovery options so that your kids can be back in action without missing too many games or practices – Monmouth Pain & Rehabilitation can make that possible!

Dr. R. Dawn Comstock conducted the National High School Sports-Related Injury Surveillance Study for the 2015 – 2016 academic year which monitored sports-related injuries among high school athletes, and identified the top five most common high school sports injuries:

  1. Head Injuries
  2. Ankle Strain/Sprain
  3. Knee Strain/Sprain
  4. Hip/Thigh/Upper Leg Strain/Sprain
  5. Hand/Wrist Injuries

Though a large portion of sports-related injuries did not require surgery, recurring injuries accounted for almost 10% of total injuries for the year. It is vital to understand that treating the symptoms of an injury does not always address the underlying cause of the problem. Pain medication can reduce inflammation and mask the pain giving the illusion that the injury has healed. Just because the pain subsided does not mean the injury has fully healed resulting in the increased risk of reinjuring the affected area.

Through effective injury management and preventative care, we can help keep kids active, healthy, and on the field! That is why it is important to understand the benefits that physical therapy, chiropractic, and acupuncture bring to the injury recovery and prevention process.

Benefits of Physical Therapy for High School Athletes

Physical therapy works to maximize movement during the recovery process, and seeks to avoid pain medication and surgery. This is achieved by assessing the extent of the injury, and creating a treatment program specific to the patient’s needs and capabilities. Physical therapy can be utilized not only after an injury has occurred, but at the first signs of tenderness and weakness. For instance, many times an athlete will perform through pain, further increasing their chance of injury. Consulting with a physical therapist at the first sign of pain will help to strengthen the affected area before the pain manifests into a debilitating injury.

Benefits of Chiropractic for High School Athletes

 Chiropractic care plays a key role in sports injury prevention and recovery. Training, practice, and competition take a toll on an athlete’s body, exposing them to increased stress that can result in chronic aches and pains which may lead to injury. Chiropractors correct spinal misalignments, fix asymmetries throughout the body, and increase range of motion by reducing the tension on muscles and tendons, which promotes faster healing and reduces the risk of injury. Chiropractic care is effective in injury prevention and can also benefit an athlete’s performance. Seeing a chiropractor without a preexisting injury is a proactive step in injury prevention.

Benefits of Acupuncture for High School Athletes

 Acupuncture produces improved energy and biochemical balance, which results in stimulating the body’s natural healing abilities and promoting physical and emotional well-being. Acupuncture is a common practice used by many professional athletes around the world. Studies show that acupuncture effectively treats sports injuries, while also improving the athlete’s performance and endurance. The growing popularity of acupuncture treatment raises awareness of how beneficial acupuncture is for injury prevention.

Monmouth Pain and Rehabilitation is Your Home Team!

 If you or your child have experienced a sports injury in the past, are currently facing a sports related injury, or want to take the proactive steps in strengthening and optimizing your body for peak performance, please feel free to take advantage of our free consultation (a $245 value) and contact us directly by calling 732-345-1377 or by emailing us using the Contact Form below. Monmouth Pain and Rehabilitation has three convenient locations in Monmouth and Ocean County: Shrewsbury, Wall, and Forked River. We look forward to helping with all your rehabilitation, physical therapy, and chiropractic needs!

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6 Treadmill Mistakes to Avoid

Most people have probably been on a treadmill at some point in their lives. It’s an incredibly useful exercise machine that is great for people of all fitness levels, whether you’re looking to have a reasonably paced walk, a steep uphill climb, or a more vigorous run or jog.

While using a treadmill can yield a number of health benefits, it is crucial to be sure you’re utilizing the machine safely and correctly. Make sure you don’t make these six mistakes when on the treadmill, to avoid injuries and ensure a beneficial workout.

1. Skipping a warm-up

Warming up gets your muscles ready to exercise, boosts blood flow, and increases oxygen supply, which improves performance. Taking your time before launching into a full-blown run can also help prevent injuries. Start at a comfortable speed to warm-up and gradually increase speed. If you are going to run, be sure to walk for a few minutes before and after running to give your muscles time to warm-up/cool-down.

2. Holding onto the bar

It may seem like a safe idea to hold onto the bar at the front of the treadmill when walking or running to avoid falling off the back of the machine. We will admit that it is helpful to hold on as you start the machine until you are comfortable enough to let go. Then, be sure to let your arms swing. Arm swing is a natural part of our gait and holding on while walking/running can inhibit this natural pattern.

3. Looking down

If you’re not quite comfortable on the treadmill, you may get the urge to look down at your feet, but try to avoid doing that. Posture is incredibly important when exercising, and looking down may actually cause you to lose balance. Try to remain as upright as you can, look forward, and don’t hunch over.

4. Staying at the front of the treadmill

Some people place themselves as close to the front of the treadmill as they can to prevent themselves from falling off the back. However, it’s important to center yourself and utilize the entire belt. This allows for a full stride and free upper body movement.

5. Not hydrating enough

Be sure to drink plenty of water before, during, and after your workout, especially if you’ll be running. Drink 16 oz 2 hours before your run, 5 oz every 15-20 minutes during, and another 16 oz after.

6. Sticking with the same old thing

Muscle repetition and overuse are major causes of injuries and machines like the treadmill are a huge factor in this. Running in one straight line, at the same incline and same pace through every run will likely lead to overuse and therefore injuries. The wisest choice would be to run outside to mix it up with turns and natural inclines. If you’ll be sticking with the treadmill, just change up your speed and use that incline function. It will give you a more complete and effective workout, and confuse your muscles in a good way.

If you’re interested in learning more about proper workouts, or you have experienced an injury from running, sports, or your daily activities, please give us a call at 732-345-1377. The team at Monmouth Pain & Rehabilitation is skilled in treating a wide range of injuries, as well as educating in injury prevention.

4 Surprising Ways Bicycling Can Improve Your Life

Written by Rob Burbella, MSPT

Bike Your Way to Better Health

So you’ve decided that now is the time to become healthier and physically fit. It’s a big decision, and it’s important to know your options in accomplishing your mission. One way is to bicycle. The positive effects of cycling are well established with studies that go back decades, and the benefits go beyond just “staying in shape”.

Improved Heart Health

According to Reuters Health in the journal Circulation, Anders Grontved, a researcher at the University of Southern Denmark in Odense studied the effects of bicycling for 45,000 Danish adults over 20 years. The study concluded that “biking either for recreation or as a way to commute is also great for heart health”.

Grontved discovered that bike riders had 11-18 % fewer heart attacks than those who did not ride a bike. Biking as little as an hour a week provided some protection against coronary artery disease. Cyclists who ride for an hour a day have an 18% lower risk of all-cause mortality than non-cyclists. For those who ride an hour and a half or more, the benefit increases to 28%, according to a 2000 study in the Journal of the American Medical Association. Luckily, the results suggest it’s never too late to start.

Higher Fitness Level = Lower Risk of Cancer

Riding your bike is a great way to get in shape and stay in shape. The benefits of physical fitness go beyond looking better and improving your fitness abilities. Another study published in the Journal of the American Medical Association recently looked at nearly 14,000 men and concluded that those with a higher fitness level as they approached middle age were at a lower risk for lung and colorectal cancer.

According to a study from Bristol University, exercise also helps to reduce your risk of colon cancer. Evidence from 35 of the 48 studies reviewed on bowel cancer proved that “regular exercise could cut the risk of developing the disease by 40-50%.” Lead researcher, Professor Ken Fox from the Department of Exercise and Health Sciences at the University of Bristol, says, “Physical activity is a crucial component of a healthy lifestyle and we have found a growing body of evidence that indicates its importance in keeping cancer at bay.”

Sleep Well

According to cyclingweekly.com, bike riding can help with insomnia. Researchers at the University of Georgia studied men and women ages 20 to 85 over a period of 35 years, and found that a drop in fitness of 2% for men and 4% for women resulted in sleep problems.

Dr. Rodney Dishman explained, “The steepest decline in cardiorespiratory fitness happens between ages 40 and 60. This is also when problems of sleep duration and quality are elevated.” Scientists suggested that the link between fitness and sleep could be due to exercise causing a reduction in anxiety, and thus improving the ability to sleep. Exercise also protects against weight gain, which is another cause of sleep dysfunction.

Furthermore, a study from Stanford University concluded that participants who normally had trouble sleeping could fall asleep in half their normal time after bicycling 20 to 30 minutes each day.

Boost Your Brain

According to virsilas.com, researchers from the University of Illinois found that “a five percent improvement in cardio-respiratory fitness from cycling led to an improvement of up to 15 percent in mental tests.” Bicycling can help the brain create new cells in the hippocampus, which is responsible for memory. “[Cycling] boosts blood flow and oxygen to the brain, which fires and regenerates receptors, explaining how exercise helps ward off Alzheimer’s,” says the study’s author, Professor Arthur Kramer.


As you can see, by starting or continuing with an exercise program like regular bicycling you will receive multiple benefits for your efforts. To quote the late great Freddie Mercury, “…get on your bikes and ride!”

If you’ve had some type of injury or pain and are unsure of your ability to bike, the physical therapy team at Monmouth Pain & Rehabilitation can help you discover exercises that suit you and your body. Call 732-345-1377 for more information.

Running Injuries: Etiology, Treatment, and Prevention

Written by: Marcia D’Argenio PT, DPT

Running is one of the world’s most popular forms of exercise. Upwards of 40 million people run regularly and more than 10 million people run at least 100 days per year in the US. Although running is an effective way to achieve many health benefits, it is associated with a high risk of injury.  Every year, up to 50% of all runners report an injury due to overuse. Read on for more information on how these injuries occur, as well as how to treat and prevent them from derailing you running goals.

Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFPS) is the irritation of the cartilage on the underside of the patella or kneecap. Risk factors include overpronation (excessive inward foot rolling) and weak muscles around the hips and knees. In order to decrease pain, taking extra rest days and reducing your mileage is necessary. Avoid running downhill, which can exacerbate pain. Biking, swimming, and the elliptical may speed up your recovery by strengthening the quads.

Stress Fractures

A stress fracture is a small crack in a bone that typically affects runners in the hip, shin and even the feet. It’s often due to repetitive motions such as running and jumping. The pain gets worse with activity and improves with rest. Rest is important, as continued stress on the bone can lead to more serious injury.

Cartilage Tears

If you experience a “clicking” or “catching” feeling and have intermittent pain from a recent hip twist or fall, you could have a cartilage tear. Tears in cartilage of the knee or hip are usually caused by trauma.  Stop running and see a sports medicine specialist if the joint has a pain, swelling, and a sudden decreased range of motion, all hallmark signs of a cartilage tear.

Iliotibial Band Syndrome

If you experience lateral knee or hip pain and most of your running is done on the road or track, your hip pain could be caused by Iliotibial Band Syndrome, which is irritation of the “ITB” that runs down the outside of the thigh from the hip to the shin. The ITB can be irritated by always running on the same side of the road or the same direction on the track, running too much too soon, tight hip or knee muscles, or wearing unsupportive shoes. Change your route or alternate directions on the track, stretch your hamstrings and ITB, and replace your shoes to treat and prevent progression of this all too common injury.

Prevent Injuries Before they Occur

So how can one prevent these common running injuries from sidelining them? Stretching plays a useful role in the management of common running injuries. In a study of 900 military recruits, those who stretched regularly experienced lower rates of low back and soft tissue pain.

As far as “warming up” is concerned, there is insufficient quality research to determine whether warming up reduces injury rates in runners.

Although debate continues regarding the role footwear plays in runners, it is important to wear a shoe best suited to the runner’s foot type in order to prevent injury. Common types of shoes are those with cushioning for runners with high arches, neutral shoes for those with an adequate arch, and shoes for those with a low arch (over-pronators) that are designed to minimize foot motion.

Additionally, optimal nutrition does enhance performance and recovery. It is important to consume adequate calories, carbohydrates, protein and healthy fats.

Lastly, runners should drink before, during, and after exercise as water loss of as little as 2 percent body mass can decrease performance. Weigh yourself before and after a run and drink 16 to 24 ounces of fluid for every pound lost during exercise.


Don’t let your injuries go without taking proper care of them. When in serious pain, it is important to see a professional. The Physical Therapy team at Monmouth Pain & Rehabilitation can work with you to get you back into your running routine if something is stopping you. Call 732-345-1377 or fill out the form on this page to make an appointment.

How to Prevent Ski Injuries

Written by: Michael Sabatino PT, DPT

It’s that time of the year again to dust off the skis and hit the slopes. In recent years, ACL injuries have become quite prevalent in Alpine skiing.

An injury to the ACL can result in an unstable knee, which may lead to expensive surgery. This can also cause a lengthy period of rehabilitation in order for the skier to resume an active lifestyle. The good news is that a little education can go a long way to minimize the risk involved, and you can be a weekend warrior without the hospital visit.

The anterior cruciate ligament (ACL) is the main ligament that connects your thigh to your shin bone and keeps your knee stable and shin in place. While there are three other ligaments that provide knee stability, the focus here is on the ACL due to its high prevalence of injury. According to (Majewski 2006), approximately 20,000 skiers become injured each year. There are various ways in which this injury can occur. The most predominant cause of this injury results from an innocuous, slow, and twisting fall backwards. The other most common way to injure the ACL is when a person falls while his or her foot is stuck in the ski and binding. This results in the skis becoming twisted which places adverse strain on the ACL.
Following a few simple suggestions can help you to avoid ACL injuries during ski season.  Ensure that you are physically ready for the slopes. As you begin to fatigue, follow proper technique and take breaks as needed. Avoid potentially dangerous situations altogether – there is nothing wrong with sticking to the nicely groomed trails and powder and steering clear of the obstacle park!

If a fall appears imminent, below are tips for a safe landing:

  • Keep your feet together
  • Do not straighten your knees during the fall
  • Try to land on your side; do not try to break the fall with your arms. If your skis are still moving, your knees are at risk.
  • Do not try to get up until you have completely stopped sliding. You can always get your equipment back afterwards.

Injuries on the slopes occasionally occur, but taking the necessary precautions will help prevent injuries and keep you healthy on the slopes all season long.

The physical therapists at Monmouth Pain and Rehabilitation in Shrewsbury and Wall Township are experienced in working with patients to prevent, treat and rehabilitate ACL injuries. To learn more about MPR’s comprehensive physical therapy treatment program call 732-345-1377 or fill out the form on this page.

Q & A with Dr. Nichole: Physical Therapy and Hockey

Dr. Nichole Chaviano graduated from the University of Delaware in 2010 with a BS in Exercise Science with a concentration in Physiology and a minor in Strength + Conditioning. While at UD, she had the opportunity to work with many Division 1 athletes as a Strength + Conditioning intern, not only in the weight room but also in a rehabilitation setting. She went on to attend Rutgers University, where she received her Doctorate of Physical Therapy degree in May 2015.

What are the most common hockey injuries you have seen?
Knee & Hip injuries- from ACL and other ligamentous injuries and injuries of the meniscus, as well as pulls, strains and tears of the groin and hamstrings to fractures of the lower leg.
Ankle & Foot injuries including ankle sprains, Achilles tendinitis and ruptures and blisters.
Shoulder, Head & Spine injuries including Concussions, whip lash, neck strains, Rotator cuff sprains/tears, shoulder dislocations & separations, disc herniations and fractures.

Do you have any tips for preventing Hockey Injuries?
Wear appropriate, fitted equipment. This may include helmets, pads, mouth guards, and fitted skates. In addition to appropriate equipment it is especially important for athletes to be physically prepared for sport, with sport specific strength and conditioning. Athletes should also participate in pre-testing for concussion management. In the event an athlete sustains a head injury having the pre-injury data helps to drive treatment and return to sport protocol more safely and quickly.

What should an athlete do if they are injured?
Depending on the extent of the injury the athlete should be cleared of any immediate risk of bleeding or fracture by MD. Once cleared they should see a Physical Therapist for treatment to safely and quickly return to the rink. At MPR this can include some of the latest technology including ImPact ™ Concussion testing, and Game Ready ™. All of our therapists create individualized treatment plans including the use of sport specific equipment including slide boards, airex and BOSU ™ balance training systems and Power Plates ™.

To learn more about the physical therapy program at Monmouth Pain and Rehabilitation call us at 732-345-1377 to schedule a free consultation ($245 value) at our Shrewsbury or Wall Township location.

How to stay in Motion while Sitting

Chair exercise is mainly geared for those who are at an increased risk of falling, have severe joint problems, or are wheelchair-bound. Exercise is important for people of all ages and fitness levels because it increases strength, flexibility and blood circulation while improving your mood! MPR Physical Therapy Assistant, Amy Ramos, demonstrates three full-body chair exercises that involve both the upper and lower body as well as core muscles.

Exercise 1:  Leg kick with twist – targets thighs and waist

Exercise 2:  Skater reach – targets core, waist, legs

Exercise 3: Seated running – targets core muscles, arms and legs

If you are trying to get back to a healthier version of yourself we are here to help. The physical therapists, chiropractors, acupuncturists, massage therapists and physicians at Monmouth Pain and Rehabilitation are experts in helping individuals throughout their lifelong journey of vibrant health. Contact us at 732-345-1377 or fill out the form on this page to learn how we can help you.

Learn how Posture can cause Headaches, Vision Issues & Pain!

Does your back ache throughout the day? Many people who spend their work day at a desk or behind the wheel of a vehicle accept back pain as part of their job description but it does not have to be.

Postural syndrome, also known as ‘Poor Posture Syndrome,’ results from the body being positioned with compromised posture for extended periods of time. If you sit in a slouched position your back is in the same position it would be in if you were to bend over and touch your toes. This is the ‘maximal bend’ of your back and places a considerable amount of pressure on the joints in your back.  This prolonged stretching on the back naturally causes aches and pain.

Postural Syndrome typically exhibits itself in pain and dull aches throughout the back, the area between the shoulder blades and the neck. Typically, the pain is the most severe while the body is in the anatomically incorrect posture while sitting, standing or lying. Over time, functioning with poor posture can also result in compromised neck strength, reduced range of motion, scar tissue and misaligned joints.

Fortunately, postural syndrome can be effectively treated with holistic therapies. Treatment goals typically focus on relieving pain, restoring balanced muscle strength, reestablishing full range of motion and establishing ergonomically correct posture. Monmouth Pain and Rehabilitation is a multi-disciplinary facility comprised of medical doctors, chiropractors, physical therapists, acupuncturists and massage therapists experienced in treating postural syndrome. If you think you might be suffering from postural syndrome contact Monmouth Pain and Rehabilitation today to eliminate aches and pains from your day to day. Call 732-345-1377 or visit www.MonmouthPain.com to schedule a free consultation ($245 value) in Shrewsbury and Wall Township, NJ.

What you need to know about Noisy Knees

Written by: Angie Mohamed, PTA

Noise from the knees, or crepitus, is a very common condition that many people experience. As we age, our knee joints experience some wear and tear. Cartilage and tissue that cover the bony areas of the knee may become uneven. Popping, cracking and clicking sounds can result from these areas rubbing against each other. As long as there is no pain when you hear the snap, crackle and pops – it is unlikely that you have a major problem in the knee joint.

Osteoarthritis Knee ( OA Knee ) ( Film x-ray both knee with arthHowever, If you start to have even minor knee pain, it could be the sign of a serious issue that can turn into major pain.

If there is knee pain or swelling along with noise from the knees, you may have structural damage or pathology. Potential issues could be meniscus tears, ligamentous injury, cartilage injury, dislocated knee cap, or osteoarthritis. The meniscus is a C shaped disc that cushions the knee joint and is a shock absorber. Meniscus tears are often caused by sudden twisting motion or from playing sports. Cartilage injury or wear can be due to a thinning or break down that causes your knee to respond with swelling or “catching” during motion.

Loose bodies in the knee (small pieces of cartilage or bone particles that become loose and float around within the knee joint) can also cause locking of the knee, a feeling that something is moving around in your knee and/or knee pain. Loose bodies should be removed to prevent further damage to cartilage by a minimally invasive surgical procedure.

If you are experiencing any of these symptoms or others, coming to our office for a consultation can help determine the cause of your noisy knees, address the issues and help prevent further damage. Call us today at 732-345-1377 or fill out the form on this page to schedule a free consultation ($245 value) and learn if Monmouth Pain and Rehabilitation’s Knee Pain Treatment program is right for you.

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