Our family often chooses vacations based on outdoor activities. We are travel junkies and adventure is our main goal. Until our trip to Washington, UT for the Ironman 70.3 St. George, I had never considered how difficult it must be for physically challenged individuals and their families to plan a vacation that would be accessible for all involved.
Southwest for the ability to choose your seat ahead of time (important – because on our flight out here with another airline, they sat our 6 year old alone and our 3 year old alone in the back of the plane, away from us. What?!)
Virgin Atlantic – Accommodations for those with visual, mental, and hearing impairments, as well as wheelchair accessible bathrooms! (if you’ve ever seen a regular airline bathroom, they’re toddler-size at best).
We have 58 National Parks in the United States. Overall, the system has taken a pledge over the last several years to make each park accessible to all types of disabilities. Because each park has it’s own inner workings, you must choose your park of interest to see the accessible options. From a few minutes of clicking, it seems not all National Parks are created equal. To be fair, the overall goals of most National Parks are to preserve the natural beauty of the environment, so the hesitation to disrupt the habitat is understandable.
All national parks are listed here by state. Since we are spending most of our time at Zion, here is what I’ve highlighted:
Zion boasts several accessible options, including the visitor centers, museum, restrooms, shuttle busses, picnic areas, and Zion lodge. Several campsites are reserved for those with disabilities. Several paved trails await, including the Pa’rus Trail and Riverside Walk, which are wheelchair accessible, albeit with assistance. We also “hiked” the Lower Emerald Pool trail, which was paved and perfect for our kids! Service animals are permitted on-leash.
One of my passions is fitness, and it’s how I met my husband (Fire Up Chips). That has definitely rubbed off on our children, who participate in everything from gymnastics to running to drumming to swimming. And as much joy as I get out of watching them participate on the weekends, I feel guilty every second I’m at work, giving everything I have to help other children to have the opportunity to do the same.
Guys, I didn’t realize how many adaptive sports are in each state. I’m super excited. This is NOT a comprehensive list, because, I only had approximately 74 hours to dedicate to this post!
But seriously. Adaptive surfing in Hawaii? Check. Adaptive skiing and rock climbing in Colorado? Check. Scuba Diving? Duh. Whether you live in the area, or are looking for opportunities during your summer vacation, check out all the amazing inclusive activities for each state, adapted for all levels of ability.
I missed something? Comment below if you’ve got some more to add!
This is a common question in the clinic, on the internet, and in mom groups everywhere. Will my child benefit from Chiropractic Care? I always hesitate because I don’t want to come across as one-sided on the war between physical therapists and chiropractors. I want cohesion in the medical field. We need inter-professional, mutual respect in order to provide the best care possible to our patients. But, we also have a responsibility to provide transparency for our growing body of patients and clients that are (rightfully so) demanding a better patient care experience and making more informed decisions for themselves and their families. So, as with any medical service or treatment, I do extensive research (insert Hermoine Granger scuttling off to the library here), from reputable sources, regarding the benefits versus the risks.
D.D. Palmer, the founder of chiropractic care, declared that 95% of all disease was due to displaced vertebrae, and the other 5% due to other bone displacements (Leboeuf-Yde 2019). Soon after its inception, a divide arose between evidence-based practicioners and the traditional vitalists.
As the world continues to shift towards an evidence-based society, the field of chiropractic continues to lack any such credible evidence as other professions have produced in the terms of high-quality, randomized, well-designed intervention studies. This is where the divide in the profession is most evident. The traditionalists – those who follow the orginal way of thinking – not only confuse the general population to the overall beliefs and practices surrounding the profession, but they have been known to actively block the establishment of University-Based education in chiropractic, which would then be subject to the rules and regulations of most other medical professions. The evidence-based new order of Chiropractic aims to bring the profession up to par with other medical fields by integrating both theory and science to best treat their patient population.
Do I sense a shift?
Various chiropractic associations have started to take measures to distance themselves from the traditional approach and enter the realm of evidence-based decision-making. Recently, the American Chiropractic Association produced a document to educate physicians and patients on the guidelines suggested to be the latest evidence in guiding chiropractice care. These include not obtaining spinal imaging without the presence of red flags, repeated x-rays to monitor progress, avoiding passive or palliative modalities for low back pain disorders, avoidance of long-term pain management without outside referral to a mental health professional (there is a close relationship between chronic pain and depression/anxiety), and avoidance of use of lumbar supports and braces for long-term treatment or prevention of low back pain. Numerous systematic reviews have found no value for use of these treatments in this context.
This tactic changes the focus from the chiropractor, to where the focus of any legitimate healthcare profession should be, on the patient. The end result should, hopefully, be a general shift towards a more modern approach and away from old traditions. -Leboeuf-Yde et al.
Chiropractic for Infants and Children
Photo Credit: Google
The American Chiropractic Association Consensus is a document written as a guideline to practice within their scope to treat children, but it lacks clear and concise protocols in which to use with this population. Chiropractors are (hopefully) not cracking a baby’s joints like they would an adult’s. They are providing more of a mobilizing force that gently move the bones “back into place.”
Why all the “quotations?” The chiropractic subluxation theory has long since been debunked when it relates to the misalignment of the vertebrae.
A similar review written by Thistle in 2017 outlines responsibilities already commonplace in the medical profession, like using evidence to guide clinical desicion-making, referral with presence of red flags, and age-appropriate anatomical and physiological considerations in regards to manual therapy application. It concluded that clinical judgements in pediatric patients should be based on basic principles of evidence-based practice. Co-management with other health care providers is appropriate when the child is not showing clinically significant improvements after an initial trial of chiropractic care [read: if the kid isn’t better in one visit, refer them on to a specialist that can better treat the child. A huge concern regarding Chiropractic care is the possibility of withholding or delaying necessary medical care to those who truly need it.]
Out of 1,200 Canadian Chiropractors that responded to a survey, almost all had treated pediatrics (<18 years of age) but only 45% had formal training in pediatrics after school. (Verhoef 1999)
One study found that Chiropractic care for children is often inconsistent with the recommended medical guidelines. (Lee 2000)
One survey found only 40% of all Chiropractic visits in Canada were for musculoskeletal conditions. 24% were for prevention, which accounts for a large portion of visits in children younger than four (Verhoef 1999)
Evidence in Adults
Koes et al found, in a review of randomized control trials (the highest level of evidence) that there was insufficient evidence that Chiropractic was effective in treating chronic or acute low back pain
Systematic reviews suggest some short-term relief from cervical manipulation in sub-acute or chronic neck pain (Hurvitz et al 1996, Coulter et al 1996), but none compared manipulative treatment to other established treatments.
No effectiveness has been shown in treating migraine headaches (Kapral 2001)
Evidence in Children
No studies have been done on back pain in children
No effectiveness shown to treat asthma in children (Balon)
No effectiveness for Colic (Olafsdottir 2001)
Substantial gaps in the evidence for the effectiveness of chiropractic care in children (Thistle 2017)
No specific recommendations were provided on age-appropriate treatment dosage, frequency or duration (Thistle 2017)
Limited support found in higher-quality studies for asthma, colic, bed-wetting, or respiratory disease.
“There is not yet sufficient research evidence related specifically to children to definitively identify indications for spinal manipulation within the chiropractic scope of practice” – Best Practices Recommendations for Chiropractic Care for Infants, Children and Adolescents
My Personal Beefs
Anecdotal Evidence is All You Need: As a Doctor of Physical Therapy, we are paid based on outcomes. We’re held to the highest standard by insurance companies and referring physicians alike. We must consistently produce high-level evidence supporting our methods, continue honing our craft with approved continuing education courses each year to maintain our licenses, and most of all, rehabilitate our patients as quickly and efficiently as possible with as little waste as we can manage. So, why, do Chiropractors get a free pass to treat with whatever methods they deem fit without having to prove a lick of it to a single soul?
Supporters will tell you than anecdotal evidence is all you need. Well, if a person even thinks they may get better, they have a 30% chance of getting better. That’s science. Google the placebo effect. When I walk into a Chiropractic office, and, before I even get to talk to the Doctor, I have to watch a video on all the patients that “don’t have to come every week for the rest of my life, I want to,” you bet my mind will already be made up that “oh, this must work!” So, most of us are required to show effectiveness above and beyond this mark to substantiate our hypotheses in the literature.
Did you know that ice packs, heat packs, massage, and manipulation are all passive, meaning you as the patient don’t do any of the work? Sounds wonderful, right? Actually, studies show the more active you are in your own care, the more effective it will be at managing symptoms and chronic pain (Cosio).
Appeal to Fear:
Smoking causes cancer. Fact. Drunk driving causes fatal car crashes. Fact. Your infant needs an adjustment because his birth was traumatic and his spine is subluxed, which will lead to illness and suffering. Wait…..what?
Fear tactics ignite the flight or fight response inside us. A Doctor is telling your your child needs this, or else…So you do it once, keep doing it, for the health and wellness of your child. It’s a questionable tactic in proven facts let alone unsubstantiated claims (Simpson) by professionals that directly benefit from your worst fears.
So, now what?
Now, don’t get me wrong. I like to feel good like the next person. A little targeted spinal manipulation can be good for the soul. It Feel free to keep on cracking those solid, structured adult skeletons to your heart’s content. But, realize that there is no proven benefit from manipulation for acute or chronic neck and back pain in adults when compared with other treatments like massage or physical therapy treatments.
Until the profession, as a whole, can come together and:
Provide some high-quality studies showing safety and effectiveness of specific treatment protocols that are proven to improve to specific problems in specific populations
Stop preying on the fear of the public with threats and misguided promises of miraculous healing (or publicly denounce those who do)
Demonstrate a positive inter-professional relationships by both recognizing when a medical issue is out of their scope of practice and begin making referrals to the correct professionals in a timely manner in the best interest of the patient
I cannot, in good faith, recommend this practice to anyone. Making informed decisions is kind of my goal with this whole thing, and I’ll probably get some flack for telling it like it is. But, when it comes to risking it all when your child is concerned, I’ll take all the hits if it makes you think twice about taking them in for their weekly “therapy.” Kids are my passion and I’ll take this one for the team.
Glossary Anecdotal: Not necessarily true or reliable, because it is based on personal accounts rather than facts or research Placebo Effect: A beneficial effect produced by a placebo treatment, which cannot be attributed to the placebo itself, but to the patient’s belief in that treatment. Red Flags: A term used by doctors, referring to signs and symptoms found during an evaluation, to indicate the possibility of a more sinister underlying problem. Passive/Palliative Modalities: Interventions applied to a patient with no active participation from the patient, including heat, cold, e-stim and ultrasound. These modalities have been found to increase patient inactivity, prolong recovery, and increase health care costs and are not skilled care. Systematic Review: The highest level of evidence available. It is a single research study that compiles all the evidence on a certain topic in one place to summarize best practices.
Should kids run? That’s the burning question in minds of parents and medical professionals. While there will be minimal scientific evidence to prove or disprove a hypothesis related to dosage that will ultimately lead to injuries (yes, please sign my kid up to run until his bone breaks along his growth plate…) there are some conclusions on the matter.
I love to run (my 18 year-old self who hated to run campus because I just wanted to work on ball skills would be in disbelief). My husband runs and completed his first full Ironman last Spring in Texas (proud Ironwife moment).
Now, I will preface this by saying my kids are the epitomy of free-range. My son and daughter beg to be outdoors. What’s my secret? I have no clue, they have literally been running circles around me for the past 6 years. But I do know they love to be active. They are more attentive, more well-behaved, more intentional after a good day at the park or bike ride down the road. I’m the mom that lets them run 100 yards ahead of me at the zoo. Open the back door and make sure they tell me if they’ll be outside our yard. As long as they’re safe, I’m fine with not helicoptering over their every move. How else will they learn? Plus, how else will I get the dishes done and dinner made? But, I digress.
So my kids constantly ask “when can WE run with you guys???
Key words above, highlighted, bolded, underlined. No matter what activity it is, please let it be on your kids’ terms. Kids are overtrained by well-meaning coaches and parents. They’re resilient and won’t tell you up front and honestly about pain and symptoms (and sometimes they’re even too young to articulate their feelings) until it’s too late. Kids just want to please you, and if they think they’ll let you down, or get in trouble, by being open and honest about injury, then they’ll push through it instead of seeking the help and guidance they need to regain their health.
Children’s bodies are ill-adapted for sport-specific training, in the traditional sense. They lack the adult hormones, bone structure, and body type to develop muscle hyptertophy linked to improved strength and performance. They can, however, adapt their cardiopulmonary fitness easily at this stage in life, just as any adult can.
I am a huge proponent of physical activity. Hiking? Yes. Dance? Yes. TaeKwonDo? Absolutely. If it gets your kids UP and ACTIVE? Get it. Parkour? Heck, it’s basically the love child of gymnastics and skateboarding. Love it. Just stay off the roof, please. Our society has become so unfit that children are presenting with adult diseases like diabetes, back pain, and even carpal tunnel syndrome. In other cultures, it’s the norm to walk/run/hike/gather miles per day. So whatever it takes to get the kids up and out of the house, I say go for it! This can also avoid the problem of specialization early in life. The more sport-specific you are early in childhood, the more prone you are to both injury and burnout. Experts suggest specialization should not occur until late adolescence, or late high school years. So diversity is key here. After you train for that 5k, start up soccer. When that’s done, swimming. And so on.
So, how can I get my kid started? Slowly. They are still prone to overuse injuries if progressed too quickly or don’t rest as they should between runs. Kids are more likely to get injured while growing, and often hit plateus of progression parallel to a growth spurt. Growing pains are caused by the bones growing faster than the muscles, leading to cramping and increased fatigue. Not only is this painful for some children, it causes increased weakness in almost all children. So, don’t push harder during these times, take it easy while your muscles catch up with the rest of the growing skeleton!
So, what do YOU think? This PT and her kids say yay!
Wide feet, narrow feet, small feet, big feet – the main challenge is finding shoes that will fit perfectly sort-of-okay over these extra-wide contraptions. I’ve compiled a list of size ranges and recommendations below that seem to fit well for the families I interact with. I, in no way, shape or form, was paid for this article. I wish.
What I like about these:
They come in adult sizes! Because kids grow up! (WHAT?!)
They’re “cool” (I’m pretty sure I’m past the age where I can be relied upon to categorize this information, but word on the street).
They come in every color imaginable.
The zipper Velcros over the top and secures the shoe shut, but also works as a nifty zipper pull which is easier to grasp than most zipper pulls. (yay independence!)
Now, I’ll tell you how excited I was when I first saw these come out. They’re amazing, zipping the entire way and pretty easy for kids to be independent. I will have to convey my disappointment, that although they are on the “affordable” side of adaptive clothing, they don’t seem to stand up to time very well. I’ll recommend these for those non-ambulatory kids and those who do most of their exercise in standers or with assistance. But kids dragging their feet everywhere (independently or otherwise) will be replacing these shoes often. [Insert sad trombone here.]
So, I’m super bummed because Converse used to carry these adorable hatch-back style of Velcro shoes that completely opened in the back and allowed you to slide your foot right in. I’m not seeing them anymore on their website. Maybe you can still find those in the outlets. They’re best for the skinny-minny feet!
If I’m not mistaken, these shoes were originally made, years ago, for adaptive purposes. Now they’ve grown by leaps and bounds, because, well, they’re awesome.
What I like about them:
They’re machine-washable. Yup. Just throw them in, let them air-dry. Voila.
They’ve got reinforced toes for all those children (ahem, Isabel) who drag.their.feet.
You can buy ($5) extra-long, interchangeable, Velcro straps to accommodate for the extra width of the braces. (Can I get an Amen?!)
The entire top opens up to allow you to slip the foot right in.
One word: BOOTS!! I personally live in Michigan. Where we are in Winter Hell for approximately 982734 months out of the year. Where there are millions upon millions of snow boots on every shelf starting July 5th. Plae’s boots zip all.the.way.down.
They run on the narrow side, but I say give them a shot due to their flexible material.
Have you been to Target lately? No? You’re lying. Go into the sock section, there are bins and bins of kid’s knee-high socks with unicorns, astronauts, and Harry Potter to name a few. Check some out here, but go in-store for the most selection! (They’ve also got Caroline Carts at all stores, so it should be a bit easier to go in)!
Questions? Comments? Did I miss your favorites? As always, feel free to start the conversation!
Hi! I’m Sarah. I’ve been a Pediatric PT since 2011. I have my Doctorate of Physical Therapy from The Medical University of South Carolina. I’m currently working on my PhD in Pediatric Physical Therapy at The University of Michigan – Flint in Pediatric Physical Therapy. I’m interested in teaching, education and research to make the world a better place – one physical therapist at a time! I also think an educated parent is an empowered parent. You are your child’s main advocate, and I strive to give you the knowledge and reasoning that translates to better decision making for your family. Thanks for having me!