Do you often wake up feeling stiff and sore in the morning? Do you have trouble getting out of bed or walking into the kitchen to get your breakfast? This is commonly known as morning stiffness that is caused by worn joints, muscle tightness, or arthritis. We feel this tightness in our bodies more frequently in the morning due to the hours of inactivity while sleeping. The area of stiffness varies by person, but most say in the morning is when it feels the worst. Research shows pain will subside about an hour after waking or soon after moving.

To help ease morning stiffness, keep these tips in mind…

• Medication: Keep pain-relieving or anti-inflammatory medications by your bedside and take them 30 minutes prior to getting up.
• Arm & Leg Circles: Moving arms and legs gently in a circular motion while lying in bed can help relax muscles and get the blood circulating.
• Stretching: While still lying in bed, incorporate stretches that target the stiffest areas of your body including the back, hips, knees, and shoulders.
• Heat: Before or after stretching apply a heating pad or take a hot bath to help loosen tight muscles and make it easier to get moving.
• Joint Cream: Putting joint cream on specific areas of tightness can provide short-term relief and make it easier to move and stretch.
• Herbs and Supplements: Herbal treatments like fish oil, evening primrose, borage, or black currant oils may ease joint stiffness and inflammation from arthritis.

If morning stiffness affects your ability to safely get out of bed or is keeping you from enjoying activities, talk with your doctor about the benefits of physical and occupational therapy.

How Can Physical & Occupational Therapy Help?

After a thorough evaluation, therapy may recommend different sleep positions and exercises to improve flexibility, strength, and range of motion. Additional specialized treatments may include hot and cold therapy, therapeutic massage, and the use of pain-reducing technology such as electrical stimulation and ultrasound therapy.

Why is hand and grip strength so important? Having a strong grip makes it easier to perform normal daily tasks like holding a coffee cup, carrying grocery bags, or brushing your teeth. Research has shown that a person’s grip strength can be an indicator for overall muscle strength, upper limb function, bone mineral density, increased fractures and falls, and overall quality of life.

It’s common as we age to see a decrease in grip strength due to natural age-related loss of strength and muscle mass. Additionally, other causes may include scar tissue, carpal tunnel, arthritis, and nerve or tendon damage. As a result, a person may experience trouble holding and opening items and other activities they enjoy.

Now that we recognize why grip strength is so important, below are exercises that can help to improve your overall hand and grip strength.

• Improve Crush Grip (ability to squeeze something between your fingers and palms) with hand strengthening equipment like stress balls, therapy putty, and hand exercisers.
• Improve Finger Strength & Dexterity with a finger-walking exercise. Put your hand on a table, palm facing down. Slowly lift each finger moving toward the thumb.
• Improve Support Grip (ability to hold on to an object) with farmer carries. Hold a weight or bag and walk with it across the length of the room, then turn around and walk back.
• Improve Pinch Grip (the grip strength between the tips of your four fingers and thumb) by pinching clothespins or using tweezers to manipulate small objects.
• Improve Hand Range of Motion with finger stretches. Put your palm down on the table, straighten your fingers, hold the stretch for 30-60 seconds, and release.

Physical & Occupational Therapy Can Help! If you are having difficulty with hand strength or pain due to weakness, injury, or illness, you may find that performing a simple task is troublesome. Physical therapists recommend exercises to improve range of motion, build strength, and regain function. Occupational therapists offer strategies to overcome challenges so you can fully participate in daily and leisurely activities.

Talk with your doctor about a prescription for outpatient therapy.

On December 2nd, the release of the CY 2021 Medicare Physician Fee Schedule Final Rule confirmed that we would face a huge overall 9% cut in our Med B Therapy CPT code reimbursement beginning January 1, 2021. I talked to many of you as we shook our heads and shared our mutual concern about such a large cut. The impact on our senior care providers and specifically, our rural locations would be devastating.  It was clear that the outpouring of advocacy efforts in response to the fee schedule proposed rule were being ignored. During a pandemic, that has overwhelmingly impacted our geriatric population, our critical rehabilitation services were gravely at risk of not being accessible due to such significant reimbursement cuts.

Thankfully, our industry has once again proved to be irrepressible! Our associations, industry leaders, and stakeholders nationwide persevered by rallying together to fight for our rehab services to be regarded as essential and to reduce the financial impact that was imminent in the final rule. We at HTS, as an active member of NASL (National Association for Support of Long-Term Care), urged all of our therapy team members to fervently become part of the advocacy for our patients and our profession. Proudly, countless HTS employees reached out to our federal legislators to provide the necessary details of how this cut in reimbursement would affect our most vulnerable population during the PHE.

The outcry from stakeholders commanding legislative action to protect rehabilitative services paid off.  In late December, Congress passed the Consolidated Appropriations Act of 2021 (H.R. 133).  This provided a partial fix for the looming therapy cuts.
The overall impact to the Medicare B Therapy CPT codes was significantly diminished as a result of the provisions of this Act. Now, instead of an estimated overall 9% cut, therapy codes’ reimbursement will be reduced by approximately 3.5% (depending on the code). While this is still a financial hit in the midst of a pandemic, the ability for operators to compensate and adapt to lower reimbursement is more fathomable than the original 9% reduction. This partial fix is made possible by the following measures:

• The bill delays the implementation of the new add-on fee schedule complexity code (G2211) for three years.
• The bill infuses $3 billion into the 2021 fee schedule for one year only which adds 3.75% of payment for all codes.
• The bill delays the 2% Medicare sequester cuts for three months.
• The bill continues the current Alternative Payment Model thresholds for two additional years
• The bill extends the work 1.0 geographic index floor which increases payments for the work component of the physician fee schedule payments through December 31, 2023 for geographical areas that labor cost is lower than the national average.

Here is an example of commonly used therapy CPT codes illustrating the impact of the Consolidated Appropriations Act of 2021 (H.R. 133) for both the 9% and 3.5% reductions.

As shown in this example, providers and therapy companies alike will be challenged to offset the reduction in reimbursement. This offset may additionally be exaggerated by the overall increased costs associated with the pandemic. The need for PPE, COVID testing for employees, as well as reduced efficiencies due to isolation and other restrictions, will continue through the coming months as we continue to power through the most difficult challenge in our industry.

HTS will continue to stay steadfast during this time and true to our mission of providing “a hope and a future” (Jeremiah 29:11) to maintain the best quality of life for those we serve. Please contact me with questions, and we will continue to keep you updated on any changes on this topic and many others in the future.

 

Cassie Murray, OTR, MBA, QCP
Chief Operating & Clinical Officer

 

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References:
https://rules.house.gov/sites/democrats.rules.house.gov/files/BILLS-116HR133SA-RCP-116-68.pdf
https://waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/Overall%20Summary%20Joint%20Committees%20Final%2012.21.pdf