Hundreds of physical therapists, physical therapy assistants, and PT students are expected to converge on Albany, NY today for Lobby Day. The therapists will be meeting with New York State lawmakers to discuss current legislation that would limit co-payments and out-of-pocket expenses for consumers of physical therapy.

Many insurance compaines designate physical therapists as "specialists," and therefore patients are required to pay a higher specialist co-pay. Higher co-pays and out-of-pocket expenses act as a barrier to physical therapy care. In some cases, patient's personal payments exceed the amount that is actually covered by the insurance company. That means that some patients pay 100% of the "co-pay" while the insurance company pays nothing for physical therapy services. The new law would limit the amount that a physical therapy patient would be required to pay thus allowing for greater access to physical therapy services.

To learn more about this year's Lobby Day, visit the New York Physical Therapy Assosciation website.

This morning a patient phoned my clinic and wanted to make an initial evaluation appointment right away. She said she had a total knee replacement about three weeks ago and was currently receiving physical therapy services at home. She had been progressing well, but her doctor wanted her to continue with physical therapy in an outpatient clinic to maximize range of motion (ROM) and strength in her knee so that she could walk better.

This particular patient lives about one block from a physical therapy clinic, but states that when she called to make her appointment there, they were unable to see her for eleven days. The patient knew that to maintain the positive gains that she had made thus far, she would need to be working in physical therapy sooner rather than later.

Luckily, I was able to see this particular patient today, and she had her initial evaluation and treatment done before lunch. She was set up with a home exercise program to keep working on her strength and ROM independently as well.

So how long should you wait to see your physical therapist? After a total knee replacement, it is important to gain maximum ROM and muscle activation and strength as soon as possible, so a waiting period of eleven days is a bit much. I know that some people have chronic conditions and may be able to wait a few weeks before starting therapy, but for the most part earlier rather than later access to care is best for most conditions.

If you need physical therapy, don't simply wait for the next available appointment time at a clinic, especially if it is more than a week away. Call around to a few different clinics near your home and ask how soon they can accomodate you. The sooner you get a plan in place and start working in physical therapy, the better off your outcomes are likely to be.

Today is National Bike to School Day, a day to ride your bicycle to school instead of taking the bus. If you are able, get out your bicycle and your child's bicycle, strap on your helmets, and get riding to school.

Why ride your bike instead of riding the bus or in a car? Bicycle riding is great exercise that helps keep the heart healthy and the legs strong. Plus, riding your bike is a better option for our environment than driving a car. It is also a great time to talk to your child about bicycle safety and the importance of wearing a helmet while bike riding to prevent head injuries.

If you have low back pain and sciatica, you may have tried many different treatments to find relief and to improve your ability to function. Your doctor may prescribe medication, physical therapy, or spinal decompression to attempt to treat your problem.

Epidural steroid injections are another common way to non-surgically treat the low back and leg pain associated with sciatica. The medicine is usually a steroid that is injected in your spine near the inflamed lumbar nerve. This steroid helps to decrease pain and swelling around the nerve root, and thus, offer relief from sciatica.

A study recently published in the Annals of Internal Medicine examined the effect of three different injections in the spine. The researchers randomized 85 patients with lumbar radiculopathy of less than 6 months duration into three groups. One group received injections of steroids, one group received etanercept (an arthritis medication with the trade name Enbrel), and the third group received normal saline injections. All participants received two injections spaced two weeks apart.

The main outcome measure in the study was leg pain one month after the second injection was administered.

The results indicate the there was more improvement in symptoms with the epidural steroids, but the improvement was not statistically significant when compared to etanercept or saline. That's right-your doctor could possibly inject salt water into your back to treat your lumbosacral radiculopathy, and this may help improve your pain level just as effectively as steroids. Of course, your doctor would never do such a thing, but the thought is pretty interesting.

Bottom line: for a specific group of patients, injection of steroids into the spine can help with the pain associated with sciatica. The trick is identifying those people, and identifying those patients who would not benefit from such a procedure.

What does help low back pain and sciatica? Most studies indicate that exercise and education are some the best and safest treatments for lumbosacral radiculopathy. Which exercises are best? A visit to your physical therapist can help find the right exercises for your specific condition.