Can Exercise Save You from Breast Cancer?

By Kateri Kane PT, DPT

Many people in this country have either known an immediate relative or a friend who has battled breast cancer.  This particular cancer is the most common cancer diagnosis in women and the second leading cause of cancer death following lung cancer.  Risk factors include:

Key Risk Factors

Additional Risk Factors

Gender (female)

History of benign breast disease

Age 60 or older

Ethnicity (whites: increased incidence; blacks: more deaths)

Age at first menstruation (increase risk if <12 years old), especially when combined with late menopause (>55 years)

Late menopause (>50 years)

Nulliparity, infertility; 1st child born after age 30

Diethylstilbestrol exposure

Age at first live birth (increased risk if >35 years)

Alcohol (?2 drinks/day of beer, wine, hard liquor)

2 or more first degree relatives (mother, sisters, or daughters) with breast or ovarian cancer

Postmenopausal weight gain (20-30 lb. or more since age 18); obesity

Male relative with breast cancer

High doses of chest radiation before age 30 (e.g. Hodgkin’s disease)

Number of previous breast biopsies (whether positive or negative)

Environmental exposures (under investigation)

High-fat diet

As least 1 biopsy with atypical (ductal or lobular) hyperplasia or radial stars

Long term use of first-generation oral contraceptives before 1975 (high does e.g. EstrAval) or recent (last 5 years) combined hormone replacement therapy

Previous personal history of breast cancer

High bone density (postmenopausal women); circulating estrogen promotes bone formation

To check out your risk, click here.

Several of these risk factors are modifiable, meaning that your lifestyle can affect your level of risk for getting breast cancer.  Many studies have been performed particularly on the effects of weight gain as a risk factor.  The American Cancer Society found that 20-30 pounds of weight gain after the age of 18 produces a 40% greater likelihood of developing breast cancer than for women who either gain only 5 pounds or have been overweight since childhood.  So what can you do to reduce your risk?  45-60 minutes of moderate-to-vigorous activity 5+ days per week is recommended.  For those of you who don’t think you have time to exercise 5 days a week, activity does not just mean exercising on the elliptical at your local gym.  Moderate to heavy yard work or house work could also be classified under this description.  The key term here is ACTIVITY.

But what if you already have breast cancer? Is exercise still recommended?  The answer is yes!  A meta-analysis, one of the most highly reliable forms of research, was performed on the effects of exercise on breast cancer patients and survivors.  This study found that women with breast cancer who participated in exercise had significant improvements in quality of life as well as physical functioning, peak oxygen consumption, and reduced symptoms of fatigue.

The take home message here is that exercise is good for both preventing breast cancer and for managing your condition if you already have it.  Different levels of activity may be recommended depending on your stage of cancer, so if you are unsure at what level of intensity you should be exercising, contact a health care professional for guidance.


Goodman & Fuller’s Pathology: Implications for the Physical Therapist

Canadian Medical Journal

Journal of the National Cancer Institute

What Exactly Is Direct Access?

By Kateri Kane, PT, DPT

October is Physical Therapy Month, so we thought we would use this opportunity to provide some good information you might not know about the field of physical therapy.  Have you ever heard the terminology direct access in relation to physical therapy?  If not, here’s the run down.  Direct access is an individual’s freedom to acquire physical therapy treatment WITHOUT a referral from a physician.  Say for example, you twisted your ankle or started having back pain and needed physical therapy to recover.  Through direct access you are able to bypass going to a doctor’s appointment in order to get a referral for PT.

Direct access not only saves you the hassle of visiting your doctor, it can also save you money.  According to a study by Jean M. Mitchell and Gregory de Lissovoy, when comparing physician referral episodes of physical therapy. Direct Access episodes, total paid claims were 2.2 times higher for physician referral episodes.  Direct access episodes also encompassed fewer visits and thus less cost in this study. Even though your insurance may cover the majority of your physician and PT visit costs, you still have to pay your copay every visit.  These costs can add up, especially as the rates of copays increase; so the idea that you MAY have fewer PT visits and no doctor visit to pay for could be financially helpful.

Unfortunately, not EVERY state has direct access, but the majority of states do.  According to the APTA, 47 states and the District of Columbia have direct access.  Michigan, Indiana, and Oklahoma are the only states that DO NOT.  Michigan and Oklahoma allow for a PT evaluation but no treatment without a referral, while Indiana does not allow for either of these without a referral.  Despite the fact that a majority of states have direct access, each state has different rules and possible restrictions that can be viewed here.

So how exactly does direct access work?  In Pennsylvania, you are permitted to see a physical therapist that has a Direct Access certification for up to 30 days without a prescription from a physician.  If you require treatment for longer than this amount of time, then your physician will need to be contacted and sign off on a plan of care to continue with treatment.  If a therapist determines that you need further testing or that you are not an appropriate candidate for PT at the time of evaluation, he/she will refer you to your physician or a specialist.

Even though state law may allow you to see a PT through direct access, your insurance may not pay for it.  Medicare in particular allows for an initial evaluation through direct access, but will not cover any treatment without a referral from a physician.  It is important for you to be familiar with your insurance plan in order to know what is covered.  If you are unsure of your plan benefits, you may want to ask the physical therapist’s office to check into your coverage before you begin therapy.

We hope this information helps give you a better idea of what PT benefits are out there for you.  Once again if you have any comments, questions, or suggestions for future topics let us know.  Thank you and stay active.



APTA Overview

APTA Direct Access

APTA Direct Access by State


Backpacks Can REALLY Be a Pain in the Neck

By Kateri Kane, PT, DPT

Most kids just want to fit in with the crowd and keep up with whatever is in style. Middle school and high school can especially be tough both socially and academically. So much is expected from both peers and adults. So what does this have to do with backpacks? Well, believe it or not, I was a student once. Every day I witnessed how kids were wearing their backpacks. Typically, they were slung on one shoulder with loose straps and a ridiculous amount of books in them. If I wanted to fit in, I knew that I had to do the same. Had I known then what I know now, I never would have worn my bag the way I did.

What are the risks of improperly wearing a backpack? Neck, back, and shoulder pain can all result from excessive backpack weight as well as carrying the bag on one shoulder or with the straps too loose. 

No, structural scoliosis does not occur from wearing your backpack on one shoulder, but functional scoliosis is a possibility. Functional scoliosis is not a permanent change in the joint structures; instead, it is caused by muscle shortening due to prolonged time periods in an abnormal position (being side bent in this case). Even though structural scoliosis may not be caused by backpacks, if your child has already been diagnosed with structural scoliosis, it can be aggravated by a heavy backpack that is held incorrectly.

The long term effects of carrying a backpack improperly may include: excessive compression on the spine resulting in dysfunction at the joints, hip and knee pain from the impact of walking while carrying an increased weight, and the formation of poor postural habits. Postural habits can be especially difficult to break and will worsen back problems as children grow older.

What is the proper way to wear a backpack? According to the American Physical Therapy Association (APTA) and the American Academy of Orthopedic Surgeons (AAOS), backpacks should be worn as follows:

  • Always use both shoulder straps
  • Tighten the straps so that the bag rests over the strongest mid-back muscles
  • Pack lightly(no greater than 15% of body weight)
  • Organize your backpack(heaviest items closest to your body)
  • Remove unnecessary items
  • Lift your bag properly (use your legs, not your back)
  • Build muscle strength

As a parent, you may have to take action. Back in high school, I didn’t have time to go to my locker and switch books between certain classes. I ended up carrying almost all of my books with me, which was a huge strain on my neck and back. If your child ends up in a similar situation, you may have to talk to the school about lightening the load, increasing the opportunity for students to stop at their lockers, or even having a set of classroom books so that the students don’t have to carry as much. The APTA created a video which is a good summary of everything listed here.

Share this material with your kids.  Keep them informed so that they can be the ones to set a trend that will help their bodies in the future, annot harm them. HAPPY BACKPACK AWARENESS DAY! Feel free to leave any comments or suggestions. Our next entry will discuss your ability to have direct access to physical therapy.Thank you and stay active.


Move Forward PT

Ortho Info

Tucson Weekly


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  Disclaimer:  The information in this medical library is intended for informational and educational purposes only and in no way should be taken to be the provision or practice of physical therapy, medical, or professional healthcare advice or services. The information should not be considered complete or exhaustive and should not be used for diagnostic or treatment purposes without first consulting with your physical therapist, physician or other healthcare provider. The owners of this website accept no responsibility for the misuse of information contained within this website.